Browsing by Author "Davies Simukoko"

Background Depression and anxiety are leading causes of disability globally, yet national epidemiological evidence from Zambia remains scarce. This study estimated the prevalence of depression and/or anxiety among Zambian adults, identified individual and community-level factors associated with these conditions, and quantified the contribution of community-level clustering to outcome variation. Methods We conducted a secondary cross-sectional analysis of the 2024 Zambia Demographic and Health Survey (ZDHS), which included 26,536 adults aged 15–59 years. Probable depression was defined as a PHQ-9 score ≥ 10 and probable anxiety as a GAD-7 score ≥ 6; a binary composite outcome was positive if either threshold was met. Bivariate associations were tested using Rao–Scott adjusted chi-square tests. Two-level random-intercept multilevel logistic regression models were fitted with survey clusters as the grouping factor, and results are reported as adjusted odds ratios (AORs) with 95% confidence intervals. Results The overall prevalence of depression and/or anxiety was 8.2% (95% CI: 7.8–8.6%), rising with age from 4.2% (15–19 years) to 11.5% (40–44 years). Prevalence was notably higher among daily alcohol consumers (35.5%), women who experienced sexual violence (16.7% vs. 8.2%; p < 0.001), and those widowed, divorced, or separated (12.5%), with provincial prevalence ranging from 3.3% (North-Western) to 14.4% (Copperbelt). In the full multilevel model, daily alcohol consumption (AOR: 3.74, 95% CI: 2.25–6.21), HIV-positive status (AOR: 1.71, 95% CI: 1.30–2.26), and older age (AOR 40–44: 2.56, 95% CI: 1.99–3.28) were the strongest risk factors, while female sex (AOR: 0.70) and being married (AOR: 0.85) were protective. The ICC of 0.116 (MOR: 1.87) indicated meaningful community-level clustering that remained largely unexplained after full adjustment (ICC: 0.113; LRT χ²=247.64, p < 0.001). Conclusion Approximately one in twelve Zambian adults experiences depression and/or anxiety, with burden concentrated among older adults, people living with HIV, heavy alcohol users, survivors of sexual violence, and those who have experienced marital dissolution. Substantial and largely unexplained community-level clustering points to structural and contextual determinants beyond individual risk factors. These findings support integrating mental health screening into HIV care and chronic disease platforms, prioritising task-sharing models to expand coverage, and directing resources toward high-burden provinces.