Association between depression severity and self-medication practices among urban college-going adolescents in Bangladesh

Background Self-medication is a common concern among adolescents in low- and middle-income countries, and depression may contribute to it through impaired self-care, reliance on medicines to relieve distress, and limited access to mental-health care. This study assessed the association between depression severity and self-medication among urban college-going adolescents in Bangladesh. Methods This cross-sectional study included 450 students aged 16–19 years from two urban colleges in Dhaka, recruited by convenience sampling. Depression severity was assessed with the Bangla-validated PHQ-9, and self-medication was defined as medication use without a prescription over the preceding two months. Associations were examined using chi-square tests and multivariable logistic regression (adjusted odds ratios [AORs] with 95% confidence intervals [CIs]). Results Overall, 170 of 450 adolescents (37.8%) reported self-medication. Self-medication was more common at higher depression severity, rising from 22.0% among adolescents without depression to over 50% among those with moderately severe or severe depression ( p < 0.001). After adjustment, the odds of self-medication were about 2-fold higher with mild or moderate depression, 4-fold higher with moderately severe, and 3-fold higher with severe depression (all p < 0.05), and about 51% lower among female adolescents (AOR = 0.49, 95% CI: 0.31–0.79). Unadjusted associations with unsafe medication practices attenuated after adjustment. Conclusions Higher depression severity was associated with self-medication among urban college-going adolescents. School- and college-based mental-health screening and referral, pharmacist-led counseling, and stricter enforcement of prescription-only dispensing may help reduce inappropriate self-medication. Because self-medication was assessed as a general medication-use behavior, without information on the specific medicines used, their regulatory classification, or the indication for their use, this association is not evidence of depression-related self-medication. Longitudinal studies are needed to clarify the direction of this association.