Mental Health Problems Among Indonesian Adolescents: Findings of a Cross-Sectional Study Utilising Validated Scales and Innovative Sampling Methods

Purpose: This study aimed to estimate the prevalence of mental health problems and identify potential risk and protective exposures for adolescents in Indonesia. Methods: An innovative sampling approach was applied to simultaneously recruit school- and community-based adolescents aged 16–18 years old from Jakarta (urban megacity) and South Sulawesi (remote province). We used multistage cluster sampling for in-school (N = 1,337) and respondent driven sampling for out-of-school (N = 824) adolescents. Mental health was measured using two validated scales: Kessler-10 and Center for Epidemiologic Studies Depression Scale-Revised . Psychiatric interviews were conducted in a subsample (N = 196) of students from Jakarta to validate the self-report scales. Results: The estimated population prevalence of psychological distress and depression were 24.3% (95% CI = 21.5–27.2) and 12.6% (10.5–14.4) for in-school and 23.7% (20.7–26.7) and 23.5% (20.4–26.5) for out-of-school adolescents, respectively. In participants who completed a psychiatric interview, common psychiatric morbidities were social anxiety, depression, and suicidality. Compared to in-school females, male in-school adolescents reported a lower prevalence of psychological distress (16.9% (13.1–20.7) vs. 30.4% (26.4–34.4)) and depression (10.1% (7.2–13.1) vs. 14.6 (11.4–17.8)). By contrast, for out-of-school adolescents, males reported a higher prevalence of psychological distress (25.2% (21.6–28.9) vs. 20.2% (15.1–25.3)) and depression (26.3% (22.5–30.1) vs. 16.9% (11.8–21.9)). In-school adolescents who did not seek healthcare despite a perceived need were more likely to report psychological distress and depression. Discussion: Adolescent mental health problems are highly prevalent in Indonesia, with substantial variation by gender, geography, and school enrolment. This study and its approach to sampling and measurement may serve as a model to improving mental health surveillance across other settings.