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Puberty- and Menstruation-Related Stressors Are Associated with Depression, Anxiety, and Reproductive Tract Infection Symptoms Among Adolescent Girls in Tanzania

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Abstract

Background

Puberty and menstruation are significant stressors for adolescent girls and young women in low-resource settings in sub-Saharan Africa. However, little is known about the impact of these stressors on girls’ mental health and reproductive health.

Methods

In 2018, a cross-sectional self-report survey was conducted with 581 adolescent girls and young women between 13 to 21 years old who had reached menarche and were attending secondary school in Moshi, Tanzania. Structural equation modeling was used to examine the relationships of puberty-related stressors and menstruation-related stressors (menstrual deficits, movement/activity difficulties, and menstrual symptoms) to depression, anxiety, and the likelihood of reporting reproductive tract infection (RTI) symptoms.

Results

Puberty-specific stressors, menstrual symptoms, and menstrual deficits were associated with depression and anxiety. Movement/activity difficulties were associated with anxiety. Increases in menstrual symptoms, menstrual deficits, puberty stressors, and depression were associated with an increased likelihood of reporting a lifetime RTI. However, the relationship of puberty stressors and depression with RTIs was no longer significant in two of three models after correcting for Type I error.

Conclusions

Overall, puberty- and menstruation-related stressors were associated with mental health and symptoms of reproductive tract infections. This suggests there is an important relationship between stressors specific to adolescent girls and young women during puberty, mental health, and reproductive health. There is a need for adolescent-tailored interventions to reduce the negative impact of stressors among girls transitioning through puberty in sub-Saharan Africa.

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Fig. 1
Fig. 2
Fig. 3

taken from the model controlling for menstrual deficits and activity/movement difficulties. Variables are held constant at the mean and school was set to the reference school. SD = standard deviation

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Acknowledgements

Internal funding at Duke University was provided by the Duke Global Health Institute, the Charles Lafitte Foundation Program for Research in Psychology, The Graduate School, and the Center for International and Global Studies. We thank the Kilimanjaro Christian Medical College, Femme International, Neema Macha, Mage Mark, Jennifer Rubli, Jessica Coleman, Olivia Hunt, Emily Mawyer, and Elizabeth Knippler for their contributions.

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  1. Department of Psychology and Neuroscience, Duke Global Health Institute, Duke University, 417 Chapel Drive, Durham, NC, 27708, USA

    Emily M. Cherenack & Kathleen J. Sikkema

  2. Department of Sociomedical Sciences, Columbia University, 722 W 168th Street, New York, NY, 10032, USA

    Kathleen J. Sikkema

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Correspondence to Emily M. Cherenack.

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Cherenack, E.M., Sikkema, K.J. Puberty- and Menstruation-Related Stressors Are Associated with Depression, Anxiety, and Reproductive Tract Infection Symptoms Among Adolescent Girls in Tanzania. Int.J. Behav. Med. 29, 160–174 (2022). https://doi.org/10.1007/s12529-021-10005-1

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