Prevalence of Adolescent Depressive Symptoms and Anxiety: Sex and Race as Associated Factors in a Cross-Sectional Study

Adolescent mental health remains a pressing public health priority in Malaysia, particularly during early secondary school entry when depressive symptoms and anxiety often emerge. This cross-sectional study evaluated the prevalence of depressive symptoms and anxiety and their associated sociodemographic factors among 1,371 13-year-old secondary school students in Sarawak. Depressive symptoms were screened using the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R), and anxiety were assessed using the Spence Children’s Anxiety Scale (SCAS). Multiple logistic regression was used to evaluate sociodemographic factors associated with depressive and anxiety. The overall prevalence of depressive symptoms was 22.8% (CESD-R total score: Mean19.61, SD 9.19), while the prevalence of anxiety was 54.6% (SCAS total score: Mean 39.67, SD 16.84). Female adolescents exhibited significantly higher adjusted odds of reporting depressive symptoms ( AOR = 3.14 , 95 %   CI   [ 2.34 , 4.21 ] , p < . 001 ) and anxiety ( AOR = 2.44 , 95 %   CI   [ 1.95 , 3.06 ] , p < . 001 ) compared to males. Regarding racial background (‘Other races’ reference group), Chinese ethnicity was associated with significantly lower adjusted odds of both depressive symptoms ( AOR = 0.42 , 95 %   CI   [ 0.27 , 0.65 ] , p < . 001 ) and anxiety (AOR=0.35,95% CI [0.24,0.54], p<.001). Iban ethnicity showed lower adjusted odds for depressive symptoms ( AOR = 0.59 , 95 %   CI   [ 0.41 , 0.86 ] , p = . 006 ), whereas Malay ethnicity was associated with lower adjusted odds for anxiety ( AOR = 0.65 , 95 %   CI   [ 0.44 , 0.94 ] , p = . 021 ). Household income was not significantly associated with either outcome. The high symptom prevalence highlights an urgent need for age-appropriate, culturally sensitive, and gender-responsive school-based mental health interventions.