Discussion

This study provides the first nationally representative description of probable mental health conditions among persons aged 10 years and older in Uganda using data from the 2024 National Population and Housing Census. At the national level, approximately one in eight persons (12%) experienced probable general psychological distress corresponding to nearly four million people. Among specific probable mental health conditions, probable depressive disorder was the most prevalent (7.8%), followed by probable bipolar condition (4.4%) and probable anxiety condition (3.8%). Probable psychosis affected about 1.9%, while probable suicidality was reported by 272,271 individuals (0.9%).

The observed prevalence of probable general psychological distress (3,773,915 (12.0%) and specific conditions such as depression, anxiety and bipolar disorder is broadly consistent with evidence from other low- and middle-income countries, where common mental health conditions are widely reported in the general population (Kaggwa et al., Reference Kaggwa, Harms and Mamun2022; Opio et al., Reference Opio, Munn and Aromataris2022; Kalungi et al., Reference Kalungi, Kinyanda, Akena, Gelaye, Ssembajjwe, Mpango, Ongaria, Mugisha, Makanga, Kakande, Kimono, Amanyire, Kirumira, Lewis, McIntosh, Kuchenbaecker, Nyirenda, Kaleebu and Fatumo2025).

This level of population exposure indicates that mental health problems are not confined to small or clinically visible groups but represent a broad public health concern with potential implications for daily functioning, social participation, quality of life and economic productivity (Michon et al., Reference Michon, ten Have, Kroon, van Weeghel, de Graaf and Schene2008; Singh et al., Reference Singh, Bassi, Junnarkar and Negri2015; Immurana et al., Reference Immurana, Abdullahi, Kisseih, Azuug, Mohammed, Kofi Boachie, Kizhakkekara, Doegah and Dalaba2024). Similar population-level burdens of psychological distress and common mental disorders have been documented across sub-Saharan Africa and East Africa, where community-based studies and national surveys consistently report high prevalence of depressive and anxiety-related symptoms in the general population (Greene et al., Reference Greene, Yangchen, Lehner, Sullivan, Pato, McIntosh, Walters, Gouveia, Msefula, Fumo, Sheikh, Stockton, Wainberg and Weissman2021; Jörns-Presentati et al., Reference Jörns-Presentati, Napp, Dessauvagie, Stein, Jonker, Breet, Charles, Swart, Lahti, Suliman, Jansen, van den Heuvel, Seedat and Groen2021; Gbadamosi et al., Reference Gbadamosi, Henneh, Aluko, Yawson, Fokoua, Koomson, Torbi, Olorunnado, Lewu, Yusha’u, Keji-Taofik, Biney and Tagoe2022). In Uganda, previous national estimates have suggested that up to 14 million people may be living with a mental health condition, based largely on extrapolations from smaller studies and service utilisation data rather than nationally representative population measurement (Kaggwa et al., Reference Kaggwa, Harms and Mamun2022; Opio et al., Reference Opio, Munn and Aromataris2022).

While these earlier estimates are not directly comparable to the census-based findings presented here due to differences in age coverage, definitions and measurement approaches – they nevertheless suggest that mental health challenges are present at a notable level in the population. The present findings, based on nationally representative census data among persons aged 10 years and above and derived from standardised symptom indicators, extend this evidence by providing population-level estimates of probable mental health conditions in Uganda.

Beyond general psychological distress, the prevalence of specific probable mental health conditions observed in the census is broadly consistent with patterns reported in prior community-based and facility-based studies in Uganda (Kaggwa et al., Reference Kaggwa, Harms and Mamun2022; Opio et al., Reference Opio, Munn and Aromataris2022; Mugisha et al., Reference Mugisha, Ward, Kinyanda, Kwiringira, Kiwuwa, Symon, Van Damme and Vancampfort2025; Ziegel et al., Reference Ziegel, da Silva, Bulamba, Daama, Kigozi, Miller, Kigozi, Kyasanku, Mugamba, Hammarberg, Ekström, Nalugoda and Hollander2025). Studies conducted in different regions of the country have documented high levels of psychotic features, suicidality and symptoms of bipolar mental health conditions among adolescents and adults, often exceeding estimates from high-income settings, although such studies have typically been geographically limited and methodologically heterogeneous(Rukundo et al., Reference Rukundo, Mishara and Kinyanda2016; Mwesiga et al., Reference Mwesiga, Nakasujja, Nakku, Nanyonga, Gumikiriza, Bangirana, Akena and Musisi2020; Ainamani et al., Reference Ainamani, Mbwayo, Mathai, Karlsson, Rukundo and Hall2025a). The relatively lower prevalence of probable psychosis and suicidality observed in the census mirrors findings from community surveys in Uganda and the wider East African region, where severe mental health conditions are less common at the population level but associated with substantial morbidity, mortality and social exclusion (Bentall et al., Reference Bentall, Teuton and Dowrick2007; Lundberg et al., Reference Lundberg, Cantor-Graae, Rukundo, Ashaba and Östergren2009; Mwesiga et al., Reference Mwesiga, Nakasujja, Nakku, Nanyonga, Gumikiriza, Bangirana, Akena and Musisi2020; Bahati, Ainamani, et al., Reference Bahati, Ainamani, Ashaba, Rukundo and Sigmund2022; Bonnell et al., Reference Bonnell, Clifton, Rose, Waddell and Littenberg2022). Taken together, these findings highlight the value of including mental health modules in national censuses and support the inclusion of expanded and standardised mental health measures in future population-based assessments to improve comparability and inform targeted interventions.

Our synthesis of census data indicates consistent gender differences across all assessed probable mental health conditions, with higher prevalence reported among females than males. This pattern was observed for probable general psychological distress, as well as for all specific conditions assessed, including probable depression, anxiety, bipolar disorder, psychosis and suicidality, although the magnitude of differences varied by condition.

The higher prevalence of psychological distress and common mental health mentions among females is consistent with findings from population-based studies across Uganda, East Africa and sub-Saharan Africa, where women tend to report higher levels of mental health-related symptoms than men (Mugisha et al., Reference Mugisha, Ward, Kinyanda, Kwiringira, Kiwuwa, Symon, Van Damme and Vancampfort2025; Ziegel et al., Reference Ziegel, da Silva, Bulamba, Daama, Kigozi, Miller, Kigozi, Kyasanku, Mugamba, Hammarberg, Ekström, Nalugoda and Hollander2025). For example, evidence from Uganda indicates notable gender differences in the presentation of psychotic conditions. A 1-year prevalence study among first-treatment-contact patients at the National Psychiatric Referral and Teaching Hospital found that women exhibited more pronounced psychotic features compared to men (Bentall et al., Reference Bentall, Teuton and Dowrick2007; Mwesiga et al., Reference Mwesiga, Nakasujja, Nakku, Nanyonga, Gumikiriza, Bangirana, Akena and Musisi2020; Ceasar Kimera et al., Reference Ceasar Kimera, Mpungu Nakimuli, Kampikaho Turiho, Levin, Kaddumukasa, Sajatovic, Katabira and Kaddumukasa2024). Similarly, prior evidence shows that women experience a disproportionate burden of common mental conditions, particularly depression and anxiety, which are closely linked to social and structural determinants of health (Lund et al., Reference Lund, Brooke-Sumner, Baingana, Baron, Breuer, Chandra, Haushofer, Herrman, Jordans, Kieling, Medina-Mora, Morgan, Omigbodun, Tol, Patel and Saxena2018; Ainamani et al., Reference Ainamani, Weierstall-Pust, Bahati, Otwine, Tumwesigire and Rukundo2022; Cheng et al., Reference Cheng, Zhao, Xu, Wang, Zhu, Yang, Zou, Li, Liu, Ye, Shi, Wang, Song and Wang2025).

In the Ugandan context, several factors may contribute to these observed gender differences. Women and girls are more likely to experience caregiving burdens, economic insecurity, gender-based violence, sexual violence and constrained access to education and employment opportunities, all of which are established risk factors for psychological distress (Altemus et al., Reference Altemus, Sarvaiya and Neill Epperson2014; Kaggwa et al., Reference Kaggwa, Namatanzi, Kule, Nkola, Najjuka, Al Mamun, Hosen, Mamun and Ashaba2021; Ainamani et al., Reference Ainamani, Weierstall-Pust, Bahati, Otwine, Tumwesigire and Rukundo2022). Biological and social vulnerabilities associated with gender may accumulate across the life course, potentially increasing exposure to chronic stress and mental health challenges (Altemus et al., Reference Altemus, Sarvaiya and Neill Epperson2014). At the same time, gender norms may influence help-seeking behaviour and symptom reporting, with men potentially underreport psychological distress due to stigma and expectations around masculinity, a pattern observed in other African settings and across the globe (Kobusingye et al., Reference Kobusingye, Morris-Howe and DeDiego2025; Burns et al., Reference Burns, Olive, Turner, Rice, Wrobel, Montgomery-Farrer, Norton, Seidler and Hayley2026). Importantly, although gender differences were modest in absolute terms, their consistency across all assessed mental health outcomes highlights the need for gender-responsive mental health approaches (Kobusingye et al., Reference Kobusingye, Morris-Howe and DeDiego2025). Integrating mental health services into platforms that routinely engage women, such as primary healthcare, maternal and reproductive health services and community-based programmes, may help address women’s disproportionate exposure to psychosocial stressors. At the same time, strategies to improve mental health awareness and help-seeking among men are also needed to ensure equitable access to care.

Our synthesis of census data indicates consistently higher prevalence of probable mental health conditions among rural residents compared with urban residents across all assessed outcomes, highlighting place of residence as a key dimension of mental health inequality in Uganda. These findings are consistent with the community studies in Uganda that have previously found higher levels of psychological distress in rural settings than urban communities (Opio et al., Reference Opio, Munn and Aromataris2022; Seruwagi et al., Reference Seruwagi, Nakidde, Lugada, Ssematiko, Ddamulira, Masaba, Luswata, Ochen, Okot, Muhangi and Lawoko2022). Higher levels of psychological distress in rural areas may reflect the cumulative effects of structural and environmental stressors that disproportionately affect rural populations, including poverty, limited access to services and environmental vulnerability (Ndyanabangi et al., Reference Ndyanabangi, Basangwa, Lutakome and Mubiru2004; Kigozi et al., Reference Kigozi, Ssebunnya, Kizza, Cooper and Ndyanabangi2010).

In Uganda, rural communities are more likely to experience chronic poverty, food insecurity, livelihood instability and exposure to climate-related shocks such as droughts and flooding (Lawrance et al., Reference Lawrance, Thompson, Newberry Le Vay, Page and Jennings2022; Mokhwelepa and Sumbane, Reference Mokhwelepa and Sumbane2025). These stressors have been consistently linked to elevated risk of common mental health disorders in low- and middle-income countries, particularly in predominantly agrarian settings (Atwoli et al., Reference Atwoli, Muhia and Merali2022; Mahmood et al., Reference Mahmood, Clery, Yang, Cao and Dykxhoorn2025).

Limited access to health and social services in rural areas may further exacerbate mental health conditions (Kigozi et al., Reference Kigozi, Ssebunnya, Kizza, Cooper and Ndyanabangi2010). For example, mental health services in Uganda remain heavily concentrated in urban centres, and rural populations often face long travel distances, shortages of trained personnel and limited availability of psychosocial support (Kigozi et al., Reference Kigozi, Ssebunnya, Kizza, Cooper and Ndyanabangi2010; Dwanyen et al., Reference Dwanyen, Luberenga, Asiimwe, Galukande, Blow and Kasujja2024).

Conversely, although urban residents may experience distinct stressors, they may benefit from greater access to healthcare facilities, educational opportunities, employment and social services, which can mitigate some mental health risks (Kigozi et al., Reference Kigozi, Ssebunnya, Kizza, Cooper and Ndyanabangi2010; Katayama et al., Reference Katayama, Woldesenbet, Munir, Bryan, Carpenter and Pawlik2023). The observed urban–rural disparities underscore the importance of strengthening mental health integration within primary healthcare in rural areas, including task-sharing approaches, community-based psychosocial support and improved referral systems.

Our findings indicate pronounced sub-regional variation in probable general psychological distress across Uganda, suggesting that the mental health conditions are unevenly distributed geographically. Higher prevalence was observed in sub-regions such as Teso, Bukedi, Bugisu and Busoga, whereas comparatively lower prevalence was recorded in Ankole and Buganda. These patterns highlight the importance of regional context in shaping population mental health outcomes.

Several of the high-burden sub-regions identified are located in eastern and parts of northern Uganda, areas that have historically experienced economic marginalisation, livelihood insecurity and repeated environmental shocks (Kabunga et al., Reference Kabunga, Okalo, Nalwoga and Apili2022; Batte et al., Reference Batte, Apio, Semulimi, Nuwasiima, Kasoma, Mwesigwa, Twinamasiko, Siddharthan, Mukisa, Mukunya, Abaatyo and Nalugya2024; Kazibwe, Reference Kazibwe2025). These areas are increasingly exposed to climate-related shocks and mobility pressures, which may compound existing social and economic stressors and may contribute to elevated psychological distress (International Organization for Migration, 2023). Evidence from sub-Saharan Africa consistently demonstrates strong associations between socio-economic adversity and common mental health conditions, particularly in agrarian and climate-vulnerable settings (Atwoli et al., Reference Atwoli, Muhia and Merali2022; Mahmood et al., Reference Mahmood, Clery, Yang, Cao and Dykxhoorn2025). By contrast, sub-regions such as Buganda and Ankole, which exhibited lower prevalence of probable psychological distress, generally benefit from relatively better infrastructure, economic opportunities and access to health and social services. The lower prevalence observed in these regions may be associated with greater availability of education, employment and healthcare services, which could help reduce chronic stressors and improve access to support. However, these geographic differences should be interpreted with caution, as they may be influenced by reporting practices, cultural variation in the expression of distress or unmeasured contextual factors. In addition, the observed patterns may be subject to ecological fallacy, whereby associations observed at the group level may not reflect individual-level relationships.

Taken together, these regional imbalances underscore the importance of geographically targeted mental health strategies rather than uniform national approaches. Population-level evidence from the census provides a critical foundation for identifying high-burden sub-regions and prioritising resource allocation. Strengthening community-based psychosocial support, integrating mental health into primary healthcare and expanding outreach services in high-prevalence regions may be particularly important for reducing regional mental health inequalities. These implications align with global mental health recommendations that emphasise context-specific, equity-oriented approaches to mental health system strengthening in low- and middle-income countries.