Prevalence and risk factors of depression, anxiety, and stress among secondary school students in Abha city, Saudi Arabia.

BACKGROUND: Adolescence is a vulnerable developmental stage associated with an increased risk of depression, anxiety, and stress, which can adversely affect academic performance and quality of life. Despite growing concern about adolescent mental health in Saudi Arabia, evidence among secondary school students remains limited. This study assessed the prevalence and severity of depression, anxiety, and stress among secondary school students in Abha City and identified associated sociodemographic and family-related factors. METHODS: A cross-sectional analytical study was conducted among 400 male and female secondary school students from governmental schools in Abha City, Saudi Arabia, between October and December 2025. Participants were selected using multistage stratified random sampling. Data were collected using a structured questionnaire and the validated Arabic version of the Depression, Anxiety, and Stress Scale (DASS-42). Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were performed using R version 4.4.3, with statistical significance set at p < 0.05. RESULTS: The prevalence of depression, anxiety, and stress was 39.0%, 53.5%, and 38.3%, respectively. Moderate-to-severe symptoms were observed in a substantial proportion of students. Female students had significantly higher rates of all three outcomes (p < 0.001). Multivariable logistic regression identified female sex and smoking as independent predictors of depression, anxiety, and stress. Chronic disease and a positive family history of psychiatric disorders were independently associated with depression and stress, whereas increasing family size was associated with lower odds of stress. Maternal employment was independently associated with anxiety, whereas parents not living together were independently associated with depression. CONCLUSION: Secondary school students in Abha City experience a high burden of depression, anxiety, and stress, with anxiety being the most prevalent condition. Female sex, smoking, chronic disease, family history of psychiatric disorders, family size, maternal employment, and parental marital status were independently associated with psychological distress. These findings support routine school-based mental health screening, early identification of high-risk students, and targeted psychological support and health promotion programs.