Assessing Psychosocial Health Risk of Adolescents in a Family Medicine Clinic: A HEADSSSS‑Based Cross‑Sectional Study at a Southern Nigerian Teaching Hospital

Technical Summary: Assessing Psychosocial Health Risk of Adolescents in a Family Medicine Clinic

Problem Statement
Adolescence (ages 10–19) is a critical developmental stage characterized by heightened vulnerability to mental health challenges and risk behaviors, yet these issues frequently go unreported during routine primary care visits. While the HEADSSS framework (Home, Education/Employment, Activities, Drugs, Sexuality, Suicide/Depression, Safety) is an internationally recognized tool for integrated psychosocial screening, its application in sub-Saharan Africa is scarcely documented. Furthermore, no primary-care study in Nigeria has previously adapted this framework to include a "Spirituality" domain to reflect local sociocultural contexts. Consequently, there is a lack of epidemiological data regarding the prevalence and distribution of psychosocial risks among adolescents in Nigerian primary care settings, leading to missed opportunities for early detection and intervention.

Methodology

• Study Design and Setting: A cross-sectional study was conducted between May and June 2026 at the Family Medicine Clinic of the University of Benin Teaching Hospital (UBTH) in Benin City, Nigeria.
• Participants: The study targeted adolescents aged 10–19 years. A systematic random sampling technique was employed to select 385 participants; 381 completed questionnaires were analyzed (99.0% response rate). Eligibility required the ability to communicate verbally or in writing and provide informed consent (or parental consent/assent for minors).
• Instrument: Researchers utilized an adapted HEADSSSS framework. The standard domains were expanded to include Spirituality, creating an 8-domain assessment. Items were rated on a five-point Likert scale (Strongly Disagree to Strongly Agree). Scores were summed to generate subscale scores (ranging 3–15) and an overall risk index.
  • Risk Classification: Scores >10 indicated low risk; 5–10 indicated moderate risk; <5 indicated high risk.
  • Reliability: Internal consistency for the sample yielded a Cronbach's alpha of 0.826 overall. The Spirituality subscale was 0.886, though the Depression/Suicidality and Alcohol/Drug subscales scored below 0.60. The authors note that HEADSSSS is primarily a clinical interview guide rather than a standardized psychometric questionnaire.
• Data Analysis: Data were analyzed using SPSS version 21.0. Descriptive statistics were used for prevalence, while Chi-square and Fisher's Exact tests examined associations between psychosocial risks and socio-demographic variables (age, sex, education, living arrangement, income).

Key Results

• Prevalence: A total of 76.6% (n=292) of adolescents screened exhibited at least one psychosocial health risk. The majority (76.3%) were classified as "moderate risk," with only one participant (0.3%) classified as "high risk."
• Domain-Specific Risks:
  • Drug/Alcohol Use: The most prevalent risk domain, affecting 46.2% (n=176) of participants.
  • Sexuality: The second most common risk, with 36.7% (n=140) categorized as engaging in risky sexual practices.
  • Depression/Suicidality: 10.2% (n=39) were identified as vulnerable.
  • Other Domains: Low activity levels (8.7%), poor educational motivation (4.5%), negative spiritual influence (3.9%), and feeling unsafe (3.4%) were also observed.
• Associations with Socio-Demographics:
  • Education: Significantly associated with both drug/alcohol risk ($\chi^2 = 9.449, p=0.008$) and risky sexual practices ($\chi^2 = 18.384, p<0.001$). Secondary school students showed the highest proportions of risk.
  • Living Arrangement & Income: Significantly associated with depression/suicidality risk. Adolescents living with guardians and those with no personal income were at higher risk ($p=0.024$ and $p=0.037$, respectively).
  • Non-Significant Factors: No statistically significant associations were found between specific risks and age, sex, or ethnicity.

Key Contributions and Claims of Significance
The paper positions its contributions within the context of bridging gaps in adolescent health research in Nigeria and sub-Saharan Africa:

1. Feasibility of Integrated Screening: The study demonstrates that the HEADSSSS framework is feasible for use in a routine primary care setting in Nigeria, providing a holistic profile of adolescent vulnerabilities beyond single-domain assessments.
2. Contextual Adaptation: By adding the Spirituality domain, the study addresses the need to adapt global screening tools to local sociocultural realities, a step not previously taken in Nigerian primary care studies.
3. Data on Social Determinants: The research moves beyond descriptive prevalence to link psychosocial risks with specific social determinants (education, living arrangement, income), highlighting how family and socioeconomic structures directly shape adolescent wellbeing.
4. Clinical Utility vs. Research Limitations: The authors modestly claim that while the tool is effective for guiding clinical conversations and identifying high-risk groups, its lack of standardized psychometric properties (particularly in the drug/alcohol and depression domains) limits its comparability across studies. They emphasize that the tool is best suited for clinical screening rather than producing standardized epidemiological data.

Conclusion
The study concludes that three out of four adolescents in this primary care setting present with psychosocial risks, primarily related to substance use, sexual health, and mental health. The findings underscore the necessity for adolescent-friendly services in primary care that focus on substance use prevention, sexual health education, and mental health support. The authors call for future research to validate the HEADSSSS framework specifically within the Nigerian population and to adapt its domains further to cultural contexts, while noting that longitudinal designs are needed to establish causality.