Self-report of mental health distress among pregnant and parenting adolescents during the COVID-19 pandemic in Malawi

Objective: Few studies have examined the effects of the COVID-19 pandemic on mental health among young people in sub-Saharan Africa and particularly pregnant and parenting adolescents exposed to multiple stressors. Our study addresses this gap by examining self-report of mental health challenges among pregnant and parenting adolescent girls during the pandemic. Methods: : We undertook a cross-sectional survey involving 666 girls aged 13-19 in Blantyre district, southern Malawi, between March and May 2021. We recruited eligible respondents from households in 66 randomly selected rural (26) and urban (40) enumeration areas. Mental distress was assessed using nine symptoms including worry, restlessness, fear, anxiety, sadness, loneliness, frustration, fear, stress, and boredom. Girls were asked whether they experienced more of these symptoms after the start of the COVID-19 pandemic. Any girl experiencing one of these symptoms was considered to have experienced mental distress. Bivariate and multivariable regression models were used to examine correlates of mental distress. Findings: Girls’ median age was 18 years with a range of 13-19 years. Most girls (68.3%) reported having experienced somewhat more or much more mental distress, with 17.6% indicating all nine symptoms. In the adjusted model, pregnant and parenting girls aged 19 were more likely to report having experienced more mental distress (OR=1.79; 95% CI 1.15 – 2.77) during the pandemic compared to those aged 13-17 years. Similarly, girls who had ever worked had a higher likelihood of experiencing more mental distress (AOR:1.65; 95% CI 1.12 – 2.41) than before the pandemic. On the contrary, perceived neighborhood safety was protective against mental distress (OR=0.81 95% CI 0.69 – 0.95 p<0.01). Conclusion: Pregnant and parenting adolescent girls' mental health was adversely affected by the COVID-19 pandemic, thereby exacerbating their vulnerabilities and increasing risk of poor mental health. Our findings could inform interventions targeting adolescents’ mental health during pandemics.