The Social Patterning of Adolescent Depression: A Multi-Group Path Analysis of Social Stress, Support, and Context in Addis Ababa, Ethiopia

Abstract

BACKGROUND: Early adolescence (ages 10–14) is a period of heightened vulnerability to depressive symptoms. While adolescent depression is socially patterned, evidence from low‑ and middle‑income countries, especially for early adolescents, remains limited. METHODS: This quantitative phase identified tendencies linking social stressors to depressive symptoms as part of a broader explanatory mixed‑methods study integrating Pearlin’s Stress Process Theory with Archer’s Morphogenetic Approach under a critical realist meta‑theory. Data were collected from 830 adolescents in a highly deprived area of Addis Ababa using validated measures of social stressors, social support, and depressive symptoms. Structural equation modeling examined context–mechanism–outcome tendencies. RESULTS: 77.7% screened positive for risk of depressive symptoms. Neighborhood disorder showed the strongest total association with depressive symptoms (β = 0.506), operating through both direct and support‑mediated pathways. Family and school stressors displayed distinct direct and indirect associations. Multi‑group analysis showed these tendencies varied significantly by gender, family structure, and socioeconomic position. CONCLUSIONS: The findings identify key socially patterned tendencies linking stressors and depressive outcomes and provide a structured basis for the qualitative phase, which will investigate the underlying social processes and forms of reflexive response.