Abstract
Background
Depression is one of the most common mental disorders among adolescents, negatively affecting their well-being and imposing a substantial economic burden on society. Understanding its prevalence and associated factors is crucial for effective prevention and intervention strategies.
Methods
This was a cross-sectional, quantitative study conducted nationwide in Cape Verde during October and November 2023. A structured sample of 782 adolescents (52.7% male), aged 15–19, was randomly selected from households and interviewed using the Mini International Neuropsychiatric Interview (MINI 5.0). Key validated instruments - including the MINI, BDI-II, DASS-21, BAI, BHS, BSS, MSPSS, SCS-SF and ASSIST - were employed for diagnostic and symptom assessment. Those diagnosed with depressive disorders completed additional self-assessment questionnaires. Data was analyzed using appropriate statistical tests to assess associations and significance levels (p < 0.05).
Results
The overall prevalence of depressive disorders was 11%, significantly higher in females (p < 0.05). No significant variation was observed across municipalities (p = 0.287), except for the major depressive episodes with melancholic features, which were more prevalent in Santa Catarina and Praia, followed by S. Vicente and S. Felipe [χ²(20, N = 105) = 36.844; p < 0.001]. Depressive symptoms were significantly associated with female sex, low family income, anxiety, stress, hopelessness, impaired social and romantic relationships, and elevated suicide risk (p < 0.05). However, no significant associations were found with current generalized anxiety disorder or alcohol abuse and other psychoactive substance use (p > 0.05). Self-compassion and perceived social support emerged as protective factors against depression (p < 0.05).
Conclusions
This study presents the first nationally representative data on adolescent depression in Cape Verde. The findings indicate a high prevalence (11%) of depressive disorders among adolescents aged 15–19, with considerable functional impairment and increased suicide risk. Key associated factors include being female, low household income, psychological distress (anxiety, stress, hopelessness), and difficulties in interpersonal relationships. Conversely, self-compassion and social support serve as important protective factors. Addressing gender disparities and reinforcing mental health interventions - especially for girls and adolescents from low-income families - is essential to reducing the burden of adolescent depression in Cape Verde.
Clinical trial number
Not applicable.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12888-026-07829-0.
Keywords: Adolescents, Prevalence, Depression, Associated factors, Protective factors, Functional impairment
Background
Adolescence, the developmental stage between childhood and adulthood, is recognized as a critical period characterized by rapid physical, cognitive, emotional, and social development [1, 2]. The World Health Organization defines adolescence as ages 12–19 years [3]. This stage is also associated with the emergence of mental disorders [4].
Mental health is a key determinant of individual quality of life and societal well-being. Mental disorders represent a significant global public health challenge, affecting all age groups [5]. In 2019, approximately 293 million individuals aged 5–24 years experienced at least one mental disorder, with substance use disorders affecting 1.22% of this population. Among adolescents aged 15–19 years, the prevalence of mental disorders was estimated at 13.96% (95% UI: 12.36–15.78), with notable age and sex variations [6].
Early-onset mental disorders significantly increase the risk of persistent psychiatric morbidity in adulthood [7].
Depression ranks among the top causes of global morbidity and disability [8]. In this study, the term “depression” is used in two distinct but complementary ways. “Depressive disorders” refer to clinically diagnosed conditions based on DSM-5 and ICD-11 criteria, assessed via the Mini-International Neuropsychiatric Interview (MINI), whereas “depressive symptoms” denote the severity of self-reported symptomatology measured using the Beck Depression Inventory-II (BDI-II). Depression manifests as pervasive sadness, anhedonia, social withdrawal, impaired academic performance, and reduced self-esteem [9], and is a principal contributor to illness and disability among adolescents [2]. Exposure to adverse life events, such as trauma or significant loss, increases vulnerability to depressive disorders [10]. The COVID-19 pandemic has further exacerbated adolescent mental health challenges, increasing risks for suicide, substance misuse, and psychiatric conditions [11]. Globally, approximately one in seven adolescents aged 10–19 years experience mental health conditions, predominantly anxiety, depression, and behavioral disorders, with regional and socioeconomic disparities influencing prevalence [1, 12–14]. Sub-Saharan Africa exhibits higher rates, with estimates of 26.9% affected and nearly 30% among trauma-exposed subpopulations [15].
Associated factors include female sex, low socioeconomic status, comorbid anxiety, stress, hopelessness, substance use, and elevated suicide risk [11]. Anxiety disorders frequently co-occur with depression, with social anxiety being a strong predictor mediated by social comparison and social support [16]. Hopelessness - defined as the pervasive belief that circumstances cannot improve - is a key symptom linked to depressive disorders and suicidality [17–20]. Substance use, particularly alcohol and other psychoactive drugs, often co-occurs with depression, exacerbating clinical severity and complicating treatment [21–27].
Protective factors such as perceived social support and self-compassion mitigate depressive symptoms and enhance resilience [28–37]. Given the significant impact of depression on adolescent development and lifelong health trajectories, rigorous research is essential to inform public health policies and preventive interventions in this population [38].
To date, no national studies have comprehensively examined depression among adolescents in Cape Verde. Limited epidemiological data and challenges in mental health service delivery have hindered identification and management of depressive disorders in this population. This study therefore provides crucial evidence to inform health policy, guide preventive strategies, and support the development of adolescent mental health services in Cape Verde. These findings will contribute to evidence-based planning, resource allocation, and the design of culturally appropriate interventions.
Methods
Study design
This study employed a cross-sectional, observational, and quantitative design.
Data collection
Data were collected across the national territory of Cape Verde, comprising 9 islands and 22 municipalities, during October and November 2023. Data collection teams included Clinical Psychologists and Nurses with prior experience and specific training for this project.
Given the number of instruments administered, potential participant fatigue was considered. To minimize this risk, trained interviewers conducted assessments in private settings, followed a structured administration order, allowed short breaks when necessary, and monitored participant engagement throughout the data collection process.
Data collectors - inter-rater reliabilitylimitat
Inter-rater reliability was assessed during training using simulated interviews, yielding satisfactory agreement (κ = 0.82).
Language and cultural adaptation
All instruments were administered in Portuguese or Cape Verdean Creole. For instruments not originally available in Cape Verdean Portuguese or Creole, a standardized translation and cultural adaptation process was followed. This process included forward translation by bilingual mental health professionals, back-translation into the original language by an independent translator, and reconciliation by an expert panel to ensure semantic, conceptual, and cultural equivalence.
Pilot testing was conducted with a small group of adolescents to assess comprehension, clarity, and cultural relevance of items. Minor linguistic adjustments were made where necessary, without altering the original meaning of the items. No changes were made to the structure, scoring, or diagnostic algorithms of the instruments.
Participants
The sample comprised 782 adolescents aged 15 to 19 years, representing the national adolescent population of Cape Verde. Sampling was stratified by island, municipality, sex, and age group, based on disaggregated data from the 2021 Census provided by the National Statistics Institute [39], with a 95% confidence interval. The sample distribution reflected the national demographic characteristics.
Eligibility criteria
Participants were eligible if they had resided in Cape Verde for at least six months, were aged between 15 and 19 years, and did not present any pathology, mental disorder, or intellectual developmental delay that could impair their ability to respond to the questionnaire.
This study focused on older adolescents (15–19 years) to (i) ensure adequate cognitive ability to complete the structured diagnostic interview (MINI) and several self-report instruments; and (ii) align with national policy interests targeting late-adolescent mental health in Cape Verde.
Exclusion criteria
Excluded were individuals who were non-residents or had resided in Cape Verde for less than six months, those younger than 15 years, or those with physical or mental conditions potentially compromising response quality.
Measures
Sociodemographic data including gender, age, educational level, marital status, employment status and income, religion, and history of physical illness were collected using a background questionnaire. History of physical illness was recorded but not included in the analyses presented in this manuscript.
Mini-international neuropsychiatric interview (MINI 7.0.2)
The Mini-International Neuropsychiatric Interview (MINI) version 7.0.2 was used to establish diagnoses of depressive disorders, generalized anxiety disorder, and disorders related to alcohol and other psychoactive substances [40, 41]. The MINI is a brief, structured diagnostic interview designed for use in clinical and research settings by trained interviewers and is fully compatible with DSM-5 and ICD-11 diagnostic criteria.
The interview consists of standardized diagnostic modules with dichotomous (yes/no) responses following algorithm-based decision rules. Diagnoses are generated based on the presence or absence of symptom criteria within each module. Interviewers received standardized training (approximately 1–3 h), in accordance with MINI administration guidelines.
Within the depressive disorders module, diagnoses were further stratified into current versus recurrent episodes and by the presence of melancholic features, as defined by the MINI diagnostic algorithms. These subtypes were included due to their clinical relevance in characterizing disorder severity and chronicity. As a diagnostic interview, internal consistency coefficients (e.g., Cronbach’s α) are not applicable; however, the MINI demonstrates strong validity and reliability across diverse populations, including Portuguese-speaking samples.
Beck depression inventory-II (BDI-II)
Depressive symptom severity was assessed using the Beck Depression Inventory-II (BDI-II), a 21-item self-report questionnaire widely used in adolescent populations [42]. Each item is scored on a 4-point Likert scale ranging from 0 to 3, yielding a total score between 0 and 63.
Severity levels were classified as minimal (0–13), mild [14–19], moderate [20–28], and severe (≥ 29), in accordance with the original manual. The BDI-II has been previously validated in Portuguese-speaking populations and demonstrates strong psychometric properties. In the current study, the BDI-II showed excellent internal consistency (Cronbach’s α = 0.90).
Depression anxiety stress scales – 21 items (DASS-21)
Psychological distress related to depression, anxiety, and stress was assessed using the Depression Anxiety Stress Scales-21 (DASS-21) [43], a 21-item self-report instrument comprising three 7-item subscales. Items are rated on a 4-point Likert scale (0–3).
Subscale scores were summed and multiplied by two to allow comparability with the full 42-item version, as recommended by the instrument developers. Although the DASS-21 was originally validated for individuals aged ≥ 17 years, all participants including those aged 15–16 years completed the instrument. This approach is supported by prior regional studies and psychometric evidence indicating adequate reliability and validity among Portuguese-speaking adolescents from age 15 [44]. In the present sample, internal consistency was high across subscales (Depression α = 0.86; Anxiety α = 0.82; Stress α = 0.88).
Beck anxiety inventory (BAI)
Anxiety symptom severity was measured using the Beck Anxiety Inventory (BAI) [45], a 21-item self-report questionnaire assessing common somatic and cognitive symptoms of anxiety experienced during the past week. Items are rated on a 4-point Likert scale (0–3), with higher scores indicating greater symptom severity.
Severity categories followed standard cut-off scores (minimal, mild, moderate, and severe). The BAI has been widely validated in adolescent and Portuguese-speaking populations. In this study, the BAI demonstrated excellent internal consistency (Cronbach’s α = 0.91).
Beck hopelessness scale (BHS)
Hopelessness was assessed using the Beck Hopelessness Scale (BHS) [46], a 20-item self-report instrument measuring negative expectations about the future, motivation, and outlook. Items are answered in a true/false format, with higher scores reflecting greater levels of hopelessness.
The BHS has demonstrated adequate psychometric performance in adolescent samples. In the present study, the scale showed good internal consistency (Cronbach’s α = 0.82).
Beck scale for suicide ideation (BSS)
Suicidal ideation was assessed using the Beck Scale for Suicide Ideation (BSS) [47], a 21-item instrument designed to evaluate the presence and severity of suicidal thoughts. Items are rated on a 3-point scale (0–2).
In this study, the BSS was used both as a screening tool and to assess severity. For regression analyses, suicidal ideation was dichotomized (presence vs. absence). The BSS demonstrated excellent internal consistency in the current sample (Cronbach’s α = 0.89).
Multidimensional scale of perceived social support (MSPSS)
Perceived social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS) [48], a 12-item self-report instrument assessing support from family, friends, and significant others. Items are rated on a 7-point Likert scale, with higher scores indicating greater perceived support.
The MSPSS has been validated in adolescent and Portuguese-speaking populations. In the present study, internal consistency was high across subscales (Family α = 0.88; Friends α = 0.85; Significant Others α = 0.87).
Self-compassion scale – short form (SCS-SF)
Self-compassion was assessed using the Self-Compassion Scale – Short Form (SCS-SF) [49], a 12-item self-report measure evaluating compassionate versus self-critical responses to personal difficulties. Items are rated on a 5-point Likert scale.
Higher scores reflect greater self-compassion. The SCS-SF has demonstrated good psychometric properties in adolescent samples. In this study, internal consistency was satisfactory (Cronbach’s α = 0.83).
Alcohol, smoking and substance involvement screening test (ASSIST)
Substance use-related health risks were assessed using the World Health Organization’s Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) [50]. The ASSIST evaluates frequency of use and related problems across multiple substance categories.
Risk levels were classified according to WHO scoring guidelines. In this study, moderate-risk scores were operationalized as indicative of substance abuse, while high-risk scores were classified as substance dependence. These thresholds were used to derive categorical variables for alcohol abuse/dependence and other substance abuse/dependence. As a categorical screening tool, internal consistency coefficients are not applicable.
Sheehan disability scale (SDS)
Functional impairment was assessed using the Sheehan Disability Scale (SDS) [51], a brief self-report measure evaluating impairment across three domains: work/school, social life, and family life. Each domain is rated on a 10-point visual analog scale, with higher scores indicating greater functional impairment.
The SDS has been widely used in mental health research and demonstrated adequate reliability in adolescent populations. In the present study, internal consistency was acceptable (Cronbach’s α = 0.78).
Psychometric summary
All instruments demonstrated adequate to excellent internal consistency in the present sample, with Cronbach’s alpha values ranging from 0.78 to 0.92. All tools have been previously validated for the Cape Verdean population and demonstrated strong psychometric properties, particularly internal consistency and factorial validity. A detailed summary of the psychometric characteristics of all instruments, including number of items, response scales, applied cut-off scores, and internal consistency coefficients, is provided in Annex 1.
Data analysis
Data were analyzed using IBM SPSS Statistics version 26, with a 95% confidence interval. Descriptive statistics included absolute and relative frequencies to characterize the sample and depression prevalence. Independent t-tests compared mean ages between sexes, with homoscedasticity checked via Levene’s test.
Associations between categorical variables were examined using chi-square tests, including tests of independence for sociodemographic characteristics and depressive symptoms. For some analyses, depressive symptoms were dichotomized from an ordinal scale.
Suicide risk associated with depression was estimated using odds ratios and logistic regression models to assess moderation effects.
Proportions of missing data were calculated for all variables. Missing values were minimal and handled using pairwise deletion where appropriate. The extent of missing data for each variable is reported in the relevant tables.
Ethics
The study received approval from the National Health Research Ethics Committee (CNEPS, Order No. 69/2022) and the National Data Protection Commission (CNPD, Authorization No. 300/2022/CNPD). Procedures complied with the Declaration of Helsinki guidelines.
In accordance with Cape Verdean legal and ethical standards, adolescents aged 16 years or older are considered legally autonomous for decisions regarding research participation. Therefore, participants aged 16 years or older provided their own written informed consent. For adolescents aged 15 years, written assent was obtained from the participant, alongside written informed consent from a parent or legal guardian.
Permission to use all psychometric instruments was obtained from the respective authors or copyright holders. All instruments have prior validation in Cape Verdean or Lusophone populations, and their internal consistency for the present sample is summarised in Annex 1.
Data collection was conducted individually in private settings by trained data collectors to ensure confidentiality and minimise response bias. Participants were informed that they could withdraw from the study at any time without consequence. Any adolescent exhibiting acute distress or reporting suicidal ideation during assessment was immediately referred to local mental health services according to a predefined safety protocol.
Signed documents were stored securely at the National Institute of Public Health (INSP) and will be destroyed after publication.
The authors declare no conflicts of interest.
Results
Sample characteristics
The study sample comprised 782 adolescents from the general population of Cape Verde, including 52.7% males and 47.3% females (Annex 2).
Age
Participants ranged in age from 15 to 19 years, with a mean age of 17.0 years (SD = 1.404). No significant age differences were observed between sexes [t(774) = 0.183, p > 0.05]. Homogeneity of variances was confirmed via Levene’s test (p > 0.05).
Marital status
Most participants identified as single (97.2%), with a minority reporting marital status as married (2.8%). A statistically significant difference in marital status distribution was observed between sexes [χ²(1, N = 775) = 7.199, p < 0.05].
Education
Regarding educational attainment, 0.4% of participants were illiterate, 11.6% had completed basic education, 84.4% secondary education, and 3.6% were enrolled in higher education. Significant sex-based differences in educational level were identified [χ²(2, N = 776) = 12.837, p < 0.05].
Occupation
The majority of respondents were students (88.5%), followed by those employed in personal services and sales (3.0%) and domestic work (2.6%). Significant differences in occupational categories between sexes were observed, based on the chi-square test with Monte Carlo simulation [χ²(11, N = 732) = 30.668, p < 0.001].
Professional status
Concerning professional status, 5.9% reported current employment, 83.8% identified as students, 8.2% were unemployed, and 2.1% did not respond. Significant sex differences in professional status were found [χ²(4, N = 773) = 11.224, p < 0.05].
Family income
Approximately half of the participants (49%) disclosed family income data, whereas 42.4% declined and 8.6% were missing responses. Among respondents, 25.3% reported a family income below 16,000 CVE (basic income threshold). Notably, disclosure of income is culturally sensitive in Cape Verdean contexts, often resulting in nonresponse. Significant sex differences in reported family income were detected [χ²(8, N = 709) = 17.718, p < 0.05].
Religion
The majority (72.1%) identified as Catholic, 14.9% followed other religious affiliations, and 13.0% reported no religious affiliation. No significant differences were observed between sexes regarding religious identification [χ²(2, N = 659) = 0.199, p > 0.05]. Additionally, 53.7% reported active religious practice.
Nationality
Nearly all participants (99.4%) were Cape Verdean nationals, with no significant sex differences observed [χ²(1, N = 771) = 0.113, p > 0.05].
Current medical conditions
Overall, 9.3% of respondents reported having at least one medical condition, including hypertension (14.4%), visual impairments (9.3%), diabetes (8.2%), and asthma (8.2%) (Annex 2). No significant sex differences in medical condition prevalence were found [χ²(1, N = 754) = 1.251, p > 0.05].
Diagnostic criteria, prevalence and symptom severity of depression assessed with the MINI and BDI-II
Among the 782 participants, depressive disorders were identified through the MINI, with 11.0% meeting criteria for a current major depressive episode, 8.1% for recurrent major depressive episodes, and 6.3% for episodes with melancholic features. Within the subgroup presenting a current major depressive episode, 7.0% exhibited a single disorder subtype − 4.7% met criteria for a single major depressive episode, 2.2% for recurrent episodes, and 0.1% for melancholic features - whereas 4.0% experienced recurrent major depressive episodes with melancholic features (Table 1).
Table 1.
Distribution of depression diagnoses and symptom severity in the sample
| Category | n | % |
|---|---|---|
| Clinical Diagnoses (MINI) | ||
| Current Major Depressive Episode | 37 | 4.7 |
| Recurrent Major Depressive Episode | 17 | 2.2 |
| Major Depressive Episode with Melancholic Features | 1 | 0.1 |
| Recurrent Major Depressive Episode with Melancholic Features | 31 | 4.0 |
| Total (Diagnoses) | 86 | 11.0 |
| Depressive Symptom Severity (Inventory) | ||
| Minimal (0–13) | 55 | 46.2 |
| Mild (14–19) | 19 | 16.0 |
| Moderate (20–28) | 28 | 23.5 |
| Severe (29–63) | 17 | 14.3 |
| Total (Symptom Severity) | 119 | 100 |
Depressive symptom severity was subsequently assessed among participants diagnosed with at least one depressive disorder, anxiety disorder, or alcohol-related disorder during the MINI interview (n = 163; 20.8%) using the Beck Depression Inventory - II (BDI-II). Based on BDI-II classifications, 46.2% reported minimal symptoms, 16.0% mild symptoms, 23.5% moderate symptoms, and 14.3% severe symptoms, reflecting a heterogeneous distribution of symptom severity within this clinical subgroup (Table 1).
The observed frequencies of current major depressive episode [χ²(1, N = 776) = 35.281; p < 0.001], recurrent major depressive episode [χ²(1, N = 761) = 21.012; p < 0.001], major depressive episode with melancholic features [χ²(1, N = 103) = 5.307; p < 0.05], and current recurrent major depressive episode with melancholic features [χ²(1, N = 776) = 9.373; p < 0.05] were significantly higher among females.
No statistically significant differences were found in the prevalence of current major depressive episodes [χ²(20, N = 782) = 25.287; p > 0.05] or recurrent major depressive episodes [χ²(20, N = 767) = 18.425; p > 0.05] across municipalities.
Conversely, significant differences were observed across municipalities regarding current major depressive episodes with melancholic features [χ²(20, N = 105) = 36.844; p < 0.001]. The highest prevalence was recorded in Santa Catarina (14.3%) and Praia (14.3%), followed by São Vicente (12.2%) and São Felipe (12.2%) (Table 2).
Table 2.
Major depressive episode (MINI) by sex, and municipality
| Variables | Current Major Depressive Episode | Recurrent Major Depressive Episode | Major Depressive Episode with Melancholic Features | Recurrent Major Depressive Episode with Melancholic Features | |
|---|---|---|---|---|---|
| n (%) | n (%) | n (%) | n (%) | ||
| Sex | |||||
| Men | 19 (22.4) | 15 (24.6) | 12 (24.5) | 8 (25.8) | |
| Women | 66 (77.6) | 46 (75.4) | 37 (75.5) | 23 (74.2) | |
| χ2 | 35.281** | 21.012** | 5.307* | 9.373* | |
| Municipality | |||||
| Ribeira Grande | 2 (2.3) | 1 (1.6) | 0 (0.0) | 0 (0.0) | |
| Paul | 0 (0.0) | 0 (0.0) | -- | 0 (0.0) | |
| Porto Novo | 1 (1.2) | 2(3.2) | 2 (4.1) | 1 (3.2) | |
| S. Vicente | 14 (16.3) | 8 (12.9) | 6 (12.2) | 3 (9.7) | |
| Ribeira Brava | -- | -- | -- | -- | |
| Tarrafal de S. Nicolau | 2 (2.3) | 0 (0.0) | 1 (2) | 0 (0.0) | |
| Sal | 8 (9.3) | 4 (6.5) | 3 (6.1) | 3 (9.7) | |
| Boavista | 4 (4.7) | 4 (6.5) | 3 (6.1) | 2 (6.5) | |
| Maio | 1 (1.2) | 1 (1.6) | 1 (2) | 1 (3.2) | |
| Tarrafal | 2 (2.3) | 3 (4.8) | 3 (6.1) | 2 (6.5) | |
| Santa Catarina | 10 (11.6) | 7 (11.3) | 7 (14.3) | 2 (6.5) | |
| Santa Cruz | 5 (5.8) | 2 (3.2) | 3 (6.1) | 1 (3.2) | |
| Praia | 16 (18.6) | 15 (24.2) | 7 (14.3) | 7 (22.6) | |
| S. Domingos | 3 (3.5) | 4 (6.5) | 3 (6.1) | 1 (3.2) | |
| S. Miguel | 2 (2.3) | 1 (1.6) | 0 (0.0) | 0 (0.0) | |
| S. Salvador do Mundo | 1 (1.2) | 1 (1.6) | 0 (0.0) | 0 (0.0) | |
| S. Lourenço dos Órgãos | 1 (1.2) | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
| Ribeira Grande de Santiago | 0 (0.0) | 1 (1.6) | -- | 0 (0.0) | |
| Mosteiro | 3 (3.5) | 2 (3.2) | 2 (4.1) | 2 (6.5) | |
| S. Felipe | 8 (9.3) | 4 (6.5) | 6 (12.2) | 4(12.9) | |
| Santa Catarina do Fogo | 1 (1.2) | 1 (1.6) | 1 (2) | 1 (3.2) | |
| Brava | 2 (2.3) | 1 (1.6) | 1 (2) | 1 (3.2) | |
| χ2 | 25.287a | 18.425a | 36.844a** | 24.819a | |
**p < 0.001, statistically significant at the 1% level
aBased on 10,000 sample tables with seed 2000000 (Monte Carlo experiment)
No significant differences were detected across municipalities for current recurrent major depressive episodes with melancholic features [χ²(20, N = 782) = 24.819; p > 0.05].
Subtypes (current, recurrent, melancholic features) are reported as they follow MINI diagnostic modules and allow characterization of chronicity and severity.
Levels of depressive symptoms by sex and municipality
No significant differences were observed in the levels of depressive symptoms between genders [χ²(3, N = 450) = 6.001; p > 0.05], nor across municipalities of residence [χ²(21, N = 119) = 56.025; p > 0.05] (Annex 3).
Association between depression and sociodemographic variables
Significant associations were found between depressive symptoms and both gender (p < 0.001) and family income (p < 0.05) (Table 3). Female participants exhibited higher levels of depressive symptoms [χ²(1, N = 116) = 5.302; p < 0.05]. Additionally, participants reporting a family income at or below 15,000$00 (the national minimum wage in 2023) or declining to disclose income showed elevated depressive symptoms [χ²(6, N = 112) = 13.376; p < 0.05].
Table 3.
Association between depression and sociodemographic variables
| Variables | Without depression | With depression | χ2 | p |
|---|---|---|---|---|
| Sex | 0.021 | |||
| Male | 25 (46.3%) | 16 (25.8%) | 5.302 | |
| Female | 29 (53.7%) | 46 (74.2%) | ||
| Age range | ||||
| 15 | 9 (16.4%) | 7 (10.9%) | 3.120 | 0.538 |
| 16 | 4 (7.3%) | 8 (12.5%) | ||
| 17 | 10 (18.2%) | 16 (25%) | ||
| 18 | 20 (36.4%) | 17 (26.6%) | ||
| 19 | 12 (21.8%) | 16 (25) | ||
| Marital Status | ||||
| Not in a relationship | 54 (98.2%) | 59 (92.2%) | 2.220 | 0.215 |
| In a relationship | 1 (1.8%) | 5 (7.8%) | ||
| Education | ||||
| Elementary or lower | 8 (14.5%) | 8 (12.5%) | 1.495 | 0.552a |
| Secundary/Middle School | 46 (83.6%) | 52 (81.3%) | ||
| University | 1 (1.8%) | 4 (6.3%) | ||
| Religion | ||||
| Catholic | 30 (68.2%) | 38 (74.5%) | 0.830 | 0.660 |
| Other | 7 (15.9%) | 5 (9.8%) | ||
| None | 7 (15.9%) | 8 (15.7%) | ||
| Eployment Status | ||||
| Unemployed | 12 (22.2%) | 13 (20.3%) | 0.271 | 0.902a |
| Employed or self-employed | 3 (5.6%) | 5 (7.8%) | ||
| Student or in an unpaid internship/apprenticeship | 39 (72.2%) | 46 (71.9%) | ||
| Household Income | ||||
| ≤ 15,000 | 18 (34.6%) | 16 (26.7%) | 13,376 | 0.021a |
| 16,000–25,000 | 4 (7.7%) | 9 (15%) | ||
| 26,000–45,000 | 10 (19.2%) | 5 (8.3%) | ||
| 46,000–65,000 | 6 (11.5%) | 1 (1.7%) | ||
| 66,000–100,000 | 0 (0.0%) | 2 (3.3%) | ||
| > 100,000 | 0 (0.0%) | 1 (1.7%) | ||
| Don´t want to answer | 14 (26.9%) | 26 43.3%) |
aBased on 10,000 sample tables with seed 2,000,000 (Monte Carlo experiment) The correlation is significant at the 0.05 level (2-tailed)
Relationship between depression, anxiety, hopelessness, and substance abuse
No statistically significant associations were found between depression and current generalized anxiety, alcohol abuse or dependence, or the abuse and dependence on other psychoactive substances (p > 0.05) as assessed by the MINI (Table 4). These findings were corroborated by self-report questionnaire results.
Table 4.
Association between Depression, Anxiety, and substance abuse
| Variáveis | Without depression | With depression |
χ2 | p | |
|---|---|---|---|---|---|
| Current generalized anxiety disorder | |||||
| Yes | 0 (0.0%) | 2 (10%) | 0.967 | 1 | |
| No | 9 (100%) | 18 (90%) | |||
| Current alcohol dependence | |||||
| Yes | 46 (83.6%) | 48 (76.2%) | 1.005 | 0.365 | |
| No | 9 (14.6%) | 15 (23.8%) | |||
| Current alcohol abuse | |||||
| Yes | 38 (90.5%) | 51 (92.7%) | 0.159 | 0.724 | |
| No | 4 (9.5%) | 4 (7.3%) | |||
| Current substance(s) dependence | |||||
| Yes | 3 (42.9%) | 4 (40%) | 0.014 | 1 | |
| No | 4 (57.1%) | 6 (60%) | |||
| Current substance abuse(s) | |||||
| Yes | 2 (28.6%) | 2 (22.2%) | 0.085 | 1 | |
| No | 5 (71.4%) | 7 (77.8%) | |||
The correlation is significant at the 0.05 level (2-tailed)
Association between depressive symptom, anxiety, stress, hopelessness, and functional impairments
Increasing depressive symptom severity (BDI-II scores) correlated positively with anxiety levels measured by the Beck Anxiety Inventory (BAI; r = 0.495; p < 0.01) and the Depression Anxiety Stress Scales (DASS-21; r = 0.274; p < 0.01), stress (r = 0.365; p < 0.01), hopelessness (r = 0.495; p < 0.01), and functional impairments in social (living with friends; r = 0.340; p < 0.01) and romantic relationships (having a boyfriend/partner; r = 0.242; p < 0.05) (Annex 4).
Protective factors against depression
Depression was significantly negatively correlated with self-compassion (r = -0.474; p < 0.01) and perceived social support from family (r = -0.345; p < 0.01), friends (r = -0.335; p < 0.01), and significant others (r = -0.201; p < 0.05). Higher levels of self-compassion and perceived social support were associated with lower depressive symptomatology (Annex 5).
Depressive symptoms and suicide risk
All adolescents diagnosed with depression were found to be at risk of suicide, with 53.5% classified as high risk, 7.0% moderate risk, and 39.5% low risk. Although 58.1% of depressed female participants were at high suicide risk, no significant sex differences were observed in suicide risk classification [χ²(2, N = 42) = 1.538; p > 0.05] (Table 5). The mean suicide risk score among depressed participants was 9.9 (SD = 11.746) according to the MINI, positioning them at the threshold for high risk. The Beck Scale for Suicide Ideation (BSS) mean score was 11.9 (SD = 6.4).
Table 5.
Prevalence of suicide risk in the group of individuals with depression
| Suicide risk | Total n (%) |
Sex | χ2 | p | |
|---|---|---|---|---|---|
| Male n (%) |
Female n (%) |
||||
| Low (1–5) | 17 (39.5) | 6 (54.5) | 11 (35.5) | 1.538a | 0.484 |
| Moderate (6–9) | 3 (7) | 1 (9.1) | 2 (6.5) | ||
| High (≥ 10) | 23 (53.5) | 4 (36.4) | 18 (58.1) | ||
| Total | 43 (100) | 11 (100) | 31 (100) | ||
aBased on 10,000 sample tables with seed 2,000,000 (Monte Carlo experiment)
The correlation is significant at the 0.05 level (2-tailed)
Estimation of suicide risk associated with depression
Individuals with depression had 1.2 times greater odds of being at risk of suicide compared to those without or with minimal depressive symptoms (Odds Ratio = 1.2). The estimated prevalence of suicide risk among Cape Verdean adolescents with depression was 59.4% (Table 6).
Table 6.
Suicide risk by depression status: observed and expected counts with residuals
| Residues and Cell Countsa.b | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Suicide risk | Observed | Expected | Residues | Standardized residuals | Adjusted residuals | Deviation | |||
| Counts | % | Counts | % | ||||||
| Low points | Without depression | 9 | 14.1% | 8.531 | 13.3% | 0.469 | 0.160 | 0.254 | 0.159 |
|
With depression |
17 | 26.6% | 17.469 | 27.3% | -0.469 | -0.112 | -0.254 | -0.113 | |
| Moderate to high | Without depression | 12 | 18.8% | 12.469 | 19.5% | -0.469 | -0.133 | -0.254 | -0.134 |
|
With depression |
26 | 40.6% | 25.531 | 39.9% | 0.469 | 0.093 | 0.254 | 0.092 | |
aModel: Poisson
bDesign: Intercept + Dichotomous Suicide Risk + Dichotomous Depression
Model validation
Model fit was confirmed by testing the null hypothesis of independence between variables [χ² [1] = 0.065; p > 0.05], indicating no significant interactions (Table 7). The odds of not being at suicide risk relative to being at risk in the general adolescent population was 0.685 (p < 0.05), signifying differential likelihoods of depression presence in this population.
Table 7.
Model validation
| Goodness-of-fit tests a.b | ||||||
| Test | Value | df | Sig. | |||
| Likelihood ratio | 0.064 | 1 | 0.800 | |||
| Pearson´s Chi-square | 0.065 | 1 | 0.799 | |||
| Parameter Estimates b.c | ||||||
| Predictor | Estimate | SE | Z | p | Confidence Interval 95% | |
|
Lower bound |
Upper bound | |||||
| Intercept | 3.240 | 0.184 | 17.585 | 0.000 | 2.879 | 3.601 |
| [SuicideRisks_Dichotomous = 1] | -0.379 | 0.255 | -1.491 | 0.136 | -0.878 | 0.119 |
| [SuicideRisks_Dichotomous = 2] | 0a | |||||
| [Dichotomous_Depression =. 00] | -0.717 | 0.266 | -2.692 | 0.007 | -1.238 | -0.195 |
| [Dichotomous_depression = 1.00] | 0a | |||||
a. This parameter is set to zero because it is redundant
b. Model: Poisson
c. Design: Intercept + Dichotomous Suicide Risk + Dichotomous Depression
d. Intercept: Log-odds of the reference category when all predictor variables are in the reference category
e. Predictor = 0a/1a: Reference category used as baseline
f. Estimate: Logistic coefficient (log-odds)
g. SE: Standard error of the coefficient
h. Z and p: Significance tests of the coefficient
i. 95% CI: 95% confidence interval for the coefficient
Discussion
This study provides the first population-representative data on adolescent depression in Cape Verde, detailing prevalence, risk and protective factors, and associations with suicide risk and substance use. The prevalence of depressive disorders observed in this study was lower than the global estimate of 13.96% among adolescents. Several factors may contribute to this difference. Cultural aspects, including tendencies toward emotional restraint and stigma surrounding mental illness, may influence the expression and reporting of depressive symptoms. Methodological differences, such as the use of structured diagnostic interviews (MINI) and a probabilistic sampling frame, may yield more conservative prevalence estimates compared to studies relying solely on symptom scales. Contextual factors specific to Cape Verdean adolescents, such as strong family and community support networks and resilience-promoting environments, may further reduce observed prevalence. These findings underscore the importance of considering cultural and contextual factors when interpreting prevalence data and highlight the need for locally tailored mental health research and interventions.
Female gender and low family income were significantly associated with higher depressive symptomatology, consistent with international evidence positioning gender and socioeconomic inequality as robust determinants of adolescent mental health [15, 52–57]. Although BDI-II scores did not differ significantly by gender, females presented higher MINI-based prevalence of depressive disorders and greater symptom severity, reinforcing known sex disparities in internalizing disorders. Income at or below the national minimum wage - and non-disclosure, which may reflect economic insecurity - was associated with elevated depressive symptoms, corroborating research linking socioeconomic disadvantage with depression [58, 59].
Depression prevalence across municipalities was largely similar, with the exception of major depressive episodes with melancholic features, which were more frequent in Santa Catarina and Praia. This partial geographic variation contrasts with findings from larger countries, where regional disparities are more pronounced [15]. Cape Verde’s small geographic size, population mobility between municipalities, and relatively homogeneous access to basic services may contribute to the limited spatial differentiation observed.
Consistent with the literature, depression showed strong positive correlations with hopelessness, anxiety, and suicide risk. The robust association with hopelessness aligns with its recognized role as a proximal predictor of suicidality among adolescents [16, 18, 60, 61]. While the MINI did not identify a significant association between depression and generalized anxiety disorder, self-report measures revealed a clear relationship, reflecting the frequent co-occurrence of depressive and anxiety symptoms documented globally [17, 19, 20].
Depression substantially increased suicide risk in this population: 59.4% of adolescents with depression also presented suicide risk. This prevalence underscores an urgent need for early detection and targeted intervention. The absence of sex differences in suicide risk contrasts with findings from other settings [62, 63], suggesting that sociocultural factors in Cape Verde may attenuate the typical gender gap.
No significant association was found between depression and alcohol or other psychoactive substance use/dependence. Several hypotheses may explain this pattern.
First, underreporting of substance use due to social desirability bias is plausible in this age group. Second, the relatively low prevalence of heavy alcohol or drug use among adolescents aged 15–19 years in Cape Verde may reduce the likelihood of detecting statistically significant associations. Third, although exceptional cases of alcohol use initiation in childhood exist, alcohol consumption typically begins during adolescence; therefore, related disorders tend to emerge later in life. Fourth, the considerable length of the questionnaire may have affected response quality on the final scale (ASSIST). Finally, statistical power may have been insufficient to detect effects, particularly for less prevalent substances. This divergence from the international literature - where substance use is a well-established correlate of adolescent depression [24, 64, 65] - highlights the importance of context-specific research.
Self-compassion and perceived social support emerged as important protective factors, consistent with global evidence showing their buffering roles against depressive symptoms and psychological distress [28, 30, 32, 34–36, 66–68]. Depressive symptoms were also associated with impairments in social and romantic functioning, pointing to the need for comprehensive psychosocial and relational interventions.
Together, these findings highlight the critical importance of systematic screening, accurate diagnosis, and evidence-based treatment for depressive disorders among Cape Verdean adolescents. Strengthening these clinical and public health capacities is essential to reduce morbidity, prevent suicide, and mitigate the broader societal burden of adolescent depression.
Limitations
The findings of this study should be interpreted in light of several limitations. First, the cross-sectional design precludes causal inference, limiting the interpretation of the results to observed associations. Second, the focus on adolescents aged 15–19 years may limit the generalizability of the findings to younger adolescents aged 10–14 years. Finally, the exclusion of adolescents with severe cognitive or psychiatric conditions that could impair comprehension of the questionnaires may have resulted in an underestimation of the true prevalence of depression. These limitations should be considered when interpreting the study findings.
Conclusion
This study provides the first nationally representative evidence on adolescent depression in Cape Verde, revealing a concerning mental health burden within this population. The findings highlight the broader societal and public health implications of depression, particularly its impact on adolescents’ social functioning, emotional wellbeing, and vulnerability to suicide risk. These results underscore the urgent need to prioritize adolescent mental health as a national public health agenda.
From a policy and service-delivery perspective, the findings point to clear priorities for action. Strengthening early identification of depressive symptoms, expanding youth-friendly mental health services, and integrating mental health promotion within schools and community structures are essential steps. Special attention should be directed toward girls and adolescents from low-income households, who face disproportionate vulnerability. Protective factors such as self-compassion and social support also have practical relevance, suggesting that interventions enhancing emotion regulation, resilience, and supportive relationships may yield meaningful benefits.
The high prevalence of suicide risk among adolescents with depression further emphasizes the need for targeted prevention strategies, routine risk assessment, and accessible crisis-response mechanisms. Building capacity within the mental health workforce and improving intersectoral collaboration - particularly between health, education, and social protection sectors - could play a pivotal role in reducing the burden of adolescent depression.
Future research should expand to include younger adolescents (10–14 years), adopt longitudinal approaches to examine developmental trajectories and causal mechanisms, and evaluate culturally adapted preventive and therapeutic interventions. Such evidence will be crucial for informing sustainable and contextually relevant mental health policies in Cape Verde.
Implications for research and public health
This study underscores the urgent need to strengthen adolescent mental health infrastructures in Cape Verde. Based on our findings, several concrete actions are recommended. First, the development of population-based surveillance systems dedicated to monitoring adolescent mental health would allow systematic tracking of depressive symptoms, associated risk factors, and service utilization across municipalities. Second, school-based early detection and psychosocial screening programmes should be prioritized, embedding mental health assessment within existing school health services to identify at-risk students early and reduce progression to severe depressive episodes. Third, integration of mental health services into primary care settings, through trained general practitioners and mental health nurses, could facilitate timely intervention and reduce barriers to treatment. Fourth, culturally adapted community-based prevention programmes should be expanded to promote mental health literacy, reduce stigma, and strengthen protective factors such as social support and self-compassion, in collaboration with educators, public health professionals, and local organizations. From a research perspective, larger longitudinal and mixed-methods studies are needed to clarify causal pathways, assess societal burden, and evaluate effectiveness and cost-efficiency of interventions, informing national guidelines and scalable prevention models. These measures collectively aim to improve early detection, care pathways, and outcomes for adolescents experiencing depression in Cape Verde.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
The authors thank all adolescents and their families who participated in the study, as well as the local health and education authorities who supported the data collection. Special thanks to the interviewers and field supervisors for their commitment and professionalism.
Abbreviations
- NIMH
National Institute of Mental Health
- NSDUH
National Survey on Drug Use and Health
- INE
National Statistics Institute
- M.I.N.I.
International Neuropsychiatry Interview
- BDI
II-Beck Depression Inventory 2
- DASS
21-Depression Anxiety Stress Scales-21
- BAI
Beck Anxiety Disorder
- BHS
Beck Hopelessness Scale
- BSS
Beck Scale for Suicide Ideation
- MSPSS
Multidimensional Scale of Perceived Social Support
- SCS-SF
Self-Compassion Scale-Short Form
- ASSIST
Alcohol, Smoking and Substance Involvement Screening Test
- SDS
Sheehan Disability Scale
Author contributions
E. D.-L. Conceptualization, Project administration, Supervision, Investigation, Funding acquisition, Data curation, Formal analysis, Validation. Writing – original draft, Writing – review & editing. A. L. L. R. Investigation, Writing – review & editing. J. J. X. S. Data curation, Formal analysis, Validation. M. L. L. M. Funding acquisition, review & editing.
Funding
Data collection from this research was funded by UNICEF and the National Institute of Public Health of Cape Verde. The authors’ participation was completely free
Data availability
Data related to this study is available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
This study was approved by the National Committee of Ethics for Health Research of Cape Verde (Portuguese acronym of CNEPS) (CNEPS, Order No. 69/2022) and the National Data Protection Commission (CNPD, Authorization No. 300/2022/CNPD). Written informed consent was obtained from all participants and their legal guardians prior to participation, in accordance with ethical standards and the Declaration of Helsinki.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Supplementary Materials
Data Availability Statement
Data related to this study is available from the corresponding author upon reasonable request.