Body image, associated stigma as a determinant of depression, anxiety, and stress among adolescents in Salem, Tamil Nadu: a cross-sectional study

Body image shaming is a growing public health concern affecting adolescent mental health. Adolescents face increasing pressure from peers, families, and the media regarding their appearance. Negative comments about appearance have been associated with depression, anxiety, and stress during this critical developmental stage. To explore the association between body image shaming and depression, anxiety, and stress among adolescents in Salem, Tamil Nadu. A cross-sectional study was conducted among 310 adolescents aged 10–19 years, selected through multistage random sampling in Salem. Data were collected using a structured questionnaire including socio-demographics, the Body Image Shaming Scale (BISS-20), and the Depression, Anxiety, and Stress Scale (DASS-21). Inferential statistics included chi-square tests to examine associations between categorical variables and binary logistic regression analyses adjusted for gender, BMI category, residence, and education level to assess the independent association between body image shaming and depression, anxiety, and stress. High levels of body image shaming were reported by 46.8% of the participants. Mild depression (19.7%), extremely severe anxiety (22.6%), and moderate stress (19.7%) were observed. There was a significant association between body image shaming and depression (χ²=13.5; p = 0.009), anxiety (χ²=41.2; p < 0.001), and stress (χ²=36.78; p < 0.001). BMI was significantly associated with stress ( p < 0.02). Body image shaming is prevalent among adolescents and is strongly associated with adverse mental health outcomes. Awareness campaigns should target both adolescents who experience shaming and those who engage in it, promoting empathy, body positivity, and supportive peer interactions. Targeted interventions, such as awareness campaigns, peer support groups, counselling services, and school-based programs, are essential to address this issue and promote adolescent well-being.