This study used nationally representative data to identify risk and protective factors for depression and anxiety among ever-married Mozambican women aged 15–49 years and to describe rural–urban, internet-use, and province-level geographic inequalities relevant to mental health policy.
The analysis used a cross-sectional design drawing on 13,183 ever-married women from the Mozambique Demographic and Health Survey (MDHS) 2022–2023. Mental health outcomes were measured using the Patients Health Questionnaire-9 (PHQ-9) for depressive symptoms and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms. A score of ≥10 on each instrument was used to indicate presence of depressive or anxiety symptoms.
Survey-weighted multivariable logistic regression models were fitted to examine associations between sociodemographic, reproductive, household, and environmental covariates and the two outcomes. Results are presented as adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs). The study used stepwise variable selection and considered stratified analyses by place of residence and internet access. All analyses were based on de-identified public DHS data.
Among the sampled women, 11% reported anxiety symptoms and 10% reported depressive symptoms as defined by GAD-7 and PHQ-9 cutoffs, respectively.
Age patterns: Women aged 35–39 years had the highest adjusted odds of anxiety (aOR = 2.06, 95% CI: 1.48–2.87) and the highest odds of depressive symptoms (aOR = 1.49, 95% CI: 1.07–2.08) compared with women aged 15–19 years. Women aged 45–49 years also showed elevated odds for anxiety (aOR = 1.58, 95% CI: 1.12–2.23) and were the second-highest group for depressive symptoms.
Reproductive history: Early sexual debut (age at first sex <18 years) was associated with higher odds of anxiety (aOR = 1.66, 95% CI: 1.25–2.19) and depression (aOR = 1.60, 95% CI: 1.17–2.18) compared with debut at age ≥18 years.
Household and environmental factors: Household asset ownership was associated with lower odds of anxiety (aOR = 0.76, 95% CI: 0.62–0.92). Improved sanitation facilities were also associated with lower odds for anxiety (aOR = 0.76, 95% CI: 0.60–0.98). Conversely, improved household materials (aOR = 1.37, 95% CI: 1.07–1.76) and internet use (aOR = 1.46, 95% CI: 1.07–1.99) were associated with higher odds of anxiety.
Decision-making: Women’s participation in decision making—identified as decision-making autonomy—was associated with significantly lower odds of anxiety (aOR = 0.67, 95% CI: 0.54–0.83) and depression (aOR = 0.65, 95% CI: 0.53–0.81).
Geographic differences: Province-level analysis indicated consistent patterns where Cabo Delgado, Zambézia, and Nampula were associated with higher odds of both anxiety and depression relative to Maputo City, while Gaza was associated with lower odds for both outcomes.
The study describes province-level heterogeneity in symptom burden. High-burden provinces identified—Cabo Delgado, Zambézia, and Nampula—consistently showed elevated adjusted odds for both anxiety and depression compared with the reference (Maputo City). Gaza consistently showed lower odds. The analysis also examined stratified disparities by place of residence (rural versus urban) and by internet access, aiming to capture context-specific patterns of social connectivity, information access, and health care availability.
Risk factors identified in multivariable models include:
Protective factors identified include:
These associations were derived from survey-weighted multivariable logistic regression and reported as adjusted odds ratios with 95% confidence intervals.
Based on the findings, the author recommends targeted interventions that prioritize women aged 35–49 years and provinces with higher symptom burdens such as Nampula, Zambézia, and Cabo Delgado. Strengthening women’s decision-making autonomy is highlighted as a potentially protective strategy. The study also supports integrating routine mental health symptom screening into reproductive and women’s health services to improve detection and referral for anxiety and depression among reproductive-aged women.
The paper positions these recommendations within the context of limited mental health resources in low- and middle-income settings and suggests that nationally representative evidence can inform resource allocation and tailored interventions.
Strengths: The analysis used a large, nationally representative MDHS sample and standardized measurement tools (PHQ-9 and GAD-7) with a defined cutoff (≥10). The analytic approach included survey weighting, multivariable adjustment, stratified analyses, and an effort to select confounders systematically.
Limitations: As a cross-sectional analysis, causality cannot be inferred. The report does not provide longitudinal follow-up. Details beyond those reported in the manuscript about model selection criteria, potential residual confounding, or the role of unmeasured variables are not expanded here; any additional methodological specifics should be consulted in the original article.
Data access: The underlying de-identified data are publicly available through the Demographic and Health Surveys (DHS) Program; researchers must register with DHS to request access to the Mozambique 2022–2023 dataset.
The author reported no specific funding for this work and declared no competing interests.