Stratified and geographic patterns of depression and anxiety in Mozambican women: Mental health policy implications

Abstract

Objective To identify the risk factors of depression and anxiety among ever-married Mozambican women, including rural–urban, internet-use, and province- wide geographic inequalities, and to inform mental health policy. Methodology This study used cross-sectional design and 13,183 ever-married women aged 15−49 years from the nationally representative Mozambique Demographic and Health Survey (MDHS) 2022−2023. The outcome variables were assessed using the Patients Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7), with score (>=10) indicating depression and anxiety respectively. Survey-weighted multivariate logistic regression models were used to determine factors associated with anxiety and depression, and results were presented as adjusted odds ratios (aORs) with corresponding 95% confidence intervals (95% CIs). Findings Among all women, 11% reported anxiety symptoms, and 10% reported depressive symptoms. Women aged 35–39 years associated the highest odds of anxiety (aOR = 2.06, 95% CI: 1.48–2.87) and depression (aOR = 1.49, 95% CI: 1.07–2.08). Additionally, women aged 45–49 years showed the second-highest odds of anxiety (aOR = 1.58, 95% CI: 1.12–2.23), while the second-highest odds of depressive symptoms were also observed among women aged 45–49 years (aOR = 1.32, 95% CI: 0.92–1.89), compared with women aged 15–19 years. Age at first sex (<18 years) was significantly associated with anxiety (aOR = 1.66, 95% CI: 1.25–2.19) and depression (aOR = 1.60, 95% CI: 1.17–2.18) compared to aged ≥18 years. Women participation in decision making autonomy significantly associated with lower odds of anxiety (aOR = 0.67, 95% CI: 0.54–0.83) and depression (aOR = 0.65, 95% CI: 0.53–0.81). Household asset ownership of (aOR = 0.76, 95% CI: 0.62–0.92), and improved sanitation facilities associated with lower odds for anxiety (aOR = 0.76, 95% CI: 0.60–0.98) only. While, improved household materials (aOR = 1.37, 95% CI: 1.07–1.76) and internet use (aOR = 1.46, 95% CI: 1.07–1.99) were associated with higher anxiety. Geographically, women Cabo Delgado and Zambézia, Nampula consistently associated with higher odds while Gaza associated with lower odds of both anxiety and depression compared to Maputo City respectively. Conclusions Targeted mental health symptoms interventions should prioritize aged 35–49 years and high burden provinces such as Nampula strengthening women’s decision-making autonomy. Integrating routine mental health symptoms screening into reproductive and women’s health services may help decrease anxiety and depression among Mozambican women.