Peer-reviewed article

Mental distress among adolescent girls and young women in Southern Africa: a multi-country analysis of child marriage and intimate partner violence

Ololade Julius Baruwa, Elona Toska, Boladé Hamed Banougnin, Rachel E Yates, Lorraine Sherr et al. · 17 Apr 2025

Abstract

Background Marriage is a significant life milestone, shaping family formation and psychological well-being. This study investigates the associations between marriage, marital timing – including child marriage – and mental distress among adolescent girls and young women (AGYW) in four southern African countries.Methods We analyzed data from 13–24-year-old AGYW collected in nationally representative Violence Against Children Surveys (VACS): Lesotho (2018), Mozambique (2019), Namibia (2019), and Zimbabwe (2017). Past-month mental distress was measured using the Kessler Psychological Distress Scale-6 (K6), operationalized as moderate-to-severe (K6 ≥ 5) and severe mental distress (K6 ≥ 13). Marriage was computed as a binary variable of ever-married among 13–17-year-olds. Marital timing among 18–24-year-olds was categorised as: never married, married before age 18 (child marriage), or married at age 18 or older. Multivariable logistic regression models estimated the odds of mental distress associated with (i) having ever married among 13–17-year-old AGYW and (ii) marital timing among 18–24-year-old AGYW, accounting for covariates: school enrollment, household poverty, urban residence, age, and country. We investigated whether past-year IPV moderated the association between marriage/marital timing and mental distress.Results Among 13–17-year-old AGYW, marriage was associated with severe mental distress (adjusted odds ratio [aOR] = 8.85, 95% CI: 2.86–27.39; p < 0.001) but not with moderate-to-severe mental distress. Among 18–24-year-old AGYW, child marriage was associated with severe mental distress (aOR = 3.30, 95% CI: 1.11–9.82; p = 0.032) but not with moderate-to-severe mental distress. Past-year IPV was associated with moderate-to-severe mental distress in both age groups and severe mental distress among 18–24-year-olds. Among AGYW aged 13–17 years, IPV moderated the relationship between marriage and severe mental distress (p < 0.001). Among 18–24-year-olds, AGYW who experienced both IPV and child marriage had the highest probability of severe mental distress (20%).Conclusion Mental health support for AGYW should include IPV prevention and post-violence care to address the unique stressors faced by both married and unmarried AGYW.