According to the World Health Organization (WHO), depression is the leading cause of disability, with an estimated 264 million people affected globally (1). It is the third most common cause of years lived with disability (YLDs) in the general population (2). Anxiety is an ongoing feeling of worry or apprehension that is inappropriate given the circumstances of one’s life. It can be expressed in different ways, such as uncontrollable worry, intense fear, phobias, and panic attacks (3). In 2017, 260 million people globally were affected by anxiety disorder (4).

The latest figures show that the number of conflict-affected people reached more than 100 million, which is an increase due to recent global events (5). According to the United Nations High Commissioner for Refugees (UNHCR) reports, by the end of 2021, 27.1 million refugees were in refugee camps, 83% were hosted in low- and middle-income countries, and one-fifth of all refugees worldwide are hosted in Africa, predominantly in three countries: Uganda, Sudan, and Ethiopia (6). During the conflict between Sudan and South Sudan in 2013, nearly 400,000 people died, 4 million people were displaced (2 million within Sudan) and another 2.5 million were refugees in neighboring countries like Ethiopia (7).

Nearly all individuals affected by these emergencies will experience psychological distress. An estimated 35 million (42%) of the 82.4 million displaced and stateless people globally experience mental disorders such as depression and anxiety (8). Refugees and internally displaced people had a reported prevalence of post-traumatic stress disorder, depression, and nonspecific anxiety disorders that varied widely from 3% to 88%, 5% to 80%, and 20.3% to 81%, respectively (9). A meta-analysis of studies on long-term mental health with a total of 16,010 war-affected refugees showed that the prevalence of depression was at 2.3–80%, of PTSD at 4.4–86%, and of anxiety disorder at 20.3–88% (10). Recent research found that among 43% of Syrian refugees living in 10 countries, 40% had depression and 26% had anxiety (11). In Africa, the prevalence of depression was 49.9%, 32%, 48.1%, 37.8%, and 45% in southern Sudan, Rwandan refugees in Uganda, and Somali refugees, in Maiayni camp and Dabat town, Ethiopia, respectively (12–15), while the prevalence of anxiety was 49.4% in South Africa (16), 73% in Uganda (17), and 33.6% in Ethiopia (15).

The greater susceptibility of migrants to depression has been connected to both pre-migration events, like exposure to war trauma (18), and post-migration adverse circumstances that refugees frequently encounter in a new country, such as persecution, violence and human right violations (19) and also being separated from family, having trouble with the asylum procedure or even being detained, being unemployed, and having problems assimilating, losing relatives, sexual and physical assault, and lack of food or shelter (20). Moreover, they are underprivileged and vulnerable groups, whose vulnerability is due to the fact that they lack the same legal protections as citizens, making them vulnerable to abuse, hostility from the community, and economic disadvantage, all of which are risk factors for psychological distress (21). Delayed access to mental health care after resettlement increases the risk of depression more than fourfold in traumatized refugees exposed to adverse life experiences compared to the general population (22).

Even though the majority of refugees live in low-income countries, research on refugee mental health is overwhelmingly limited to those who reside in western countries (23). Currently, there is a scarcity of information on the prevalence of depression, anxiety, and their associated factors in the Bambasi refugee’s camp. To address this critical information gap, our study aims to assess the prevalence and its associated factors of depression and anxiety among Sudanese refugees residing in Bambasi Camp, northwest Ethiopia.

This study contributes to the field of existing evidence on mental health issues among refugees, particularly in Ethiopia, and gives insight into the mental health needs of this vulnerable population. It can also inform policymakers and aid organizations about the development of policies and programs that address the mental health needs of refugees and provide the necessary support. Moreover, the study has practical implications for mental health professionals, counselors, social workers, and aid workers working with refugees by identifying those associated factors and providing targeted interventions that address the specific mental health needs.

The main aim of this study is to assess the prevalence and associated factors of depressive and anxiety symptoms among Sudanese refugees at Bambasi Camp. Our analysis found that the prevalence of depressive and anxiety symptoms in the Bambasi Camp was 46.2% (95% CI: 41–51%) and 39.6% (95% CI: 34.2–41.2), respectively.

The magnitude of depressive symptoms in our finding is in line with previous studies done in Uganda at 46.2% (32), southern Juba at 49.9% (12), Syrian refugees in Greece at 44% (33), Karenina refugees living in the Thai–Burma border at 41.8% (34), and USA at 47.7% (35). However, it was higher in comparison to the previous studies done on Somali and Eritrean refugees in Ethiopia at 38.3% and 37.8%, respectively (14, 36), northern Uganda at 15.2% (37), Somali refugees in Kenya at 40.8% (29), Istanbul at 34.7% (38), Germany at 39.8% (39), and Burmese refugees in Australia at 36% (40). The possible explanation could be the ongoing feeling of insecurity in their home country (Sudan), and the sensitivity of the tool differences may be the reason for the discrepancy—for instance, in a study among Eritrean and Somali refugees’ camps in Ethiopia that used PHQ 9, we used HSCL-25. In addition, refugees in low-income countries have increased odds of depression due to multiple reasons (41). Conversely, the prevalence of depressive symptoms in the current study is lower than in a study conducted among African refugees in South Africa at 54.6% (16), Syrian refugees residing in Iraq at 59.4% (42), Cambodian refugees in the USA at 80% (43), Canada at 51.7% (44), and Bangladesh at 51.6% (45). The possible explanation might be due to the use of different tools in Afghanistan and USA; both used DASS-21 and Composite International Diagnostics Interview, respectively. Furthermore, sampling procedures, study design, cultural differences among refugees, and the use of a large sample size may amplify the prevalence.

The prevalence of anxiety symptoms in our study revealed 39.6% (95% CI: 34.2–41.2), which is in line with research done in Istanbul at 36.1% (38), USA at 40.3% (35), and Karenni refugees in Thai–Burmese at 41% (34). However, the current prevalence study was higher than the study conducted in Germany from Arabic-speaking refugees at 26.8% (46), Syrian refugees in Germany at 13.5% (47), and Australia at 20% (40). The possible explanation for this may be separation anxiety, the type of stress experienced during the post-migration period, and also the added load of resettlement procedures in a new country (48). In addition, the use of a 3-year follow-up study design in Germany, the use of the DASS 21 tool, and a smaller sample size (n = 148) in Australia may be the possible explanations. Conversely, the prevalence of anxiety in the current study is lower than in a study done in Bangladesh at 70% (45), Afghanistan at 72.2% (49), South Africa at 49.4% (16), and Uganda at 73% (17). This variation across these settings could be due to various reasons, such as the use of different tools, cultural differences in illness narratives, sampling techniques, and types of trauma experienced (50).

In our study, being female was associated with depressive symptoms. The finding shows that female participants have 2.6 times more chances of experiencing depressive symptoms than male participants. This finding is consistent with other studies done in Tigray (14), Somalia refugees in Ethiopia (36), Somalia refugees in Kenya (29), Greece (33), Ukrainian refugees in Greece (51), Syrian refugees residing in the Kurdistan region of Iraq (42), and Yazidis refugees in Turkey (52). However, in contrast to this, research done in Uganda shows that female participants are equally affected as men (32), and among Rohingya refugees in Bangladesh, Ethiopian refugees in Toronto, and the conflict-affected population in Somalia, women were less likely to get depression than men (41, 45, 53), respectively. The possible reason for this discrepancy might be that, in the war zone, women faced gender-specific risks as potential victims of rape, sexual abuse, targeted killing, widowhood of deceased soldiers, and pregnancy-related complications due to poor antenatal and postnatal healthcare (54). Additionally, despite the complexity of the sex difference in depression, recent evidence suggests that biological factors, particularly decreases in estrogen during menses, lactation, and menopause, may contribute to the increased prevalence of depression in women (3). On the contrary, testosterone conversion in male patients’ brain via aromatase, presence of androgen receptors in hippocampal neurons, non-recycling nature of testosterone in male patients, and presence of sexually dimorphic brain nuclei in male patients convey special protection for depression among male (55).

Our finding reveals that participants who have no job in the camp are significantly associated with depressive symptoms. Several factors contribute to this association. This study is supported by a study conducted on Eritrean refugees in Tigray (14), Afghanistan post-war (49), Somalia (53), and Rohingya refugees in Bangladesh (45). The possible explanation for these might be that unemployment can lead to feelings of hopelessness, loss of purpose, and reduced self-esteem and can also hinder the refugees’ ability to meet their basic needs and engage in meaningful activities. This leads to social isolation, dependency on aid, and limited opportunity for personal growth and development, which can contribute to feelings of worthlessness and depression (10).

In addition, staying 11 and more years in the refugee camp was a significant predictor of depressive symptoms. This is supported by a study conducted on Eritrean refugees in Tigray (14), Moria refugee camp in Greece (56), and in Canada (57). The possible reason for this might be the limited opportunities for education, employment, and mental health services in the camp, and integration in camp settings can exacerbate feelings of frustration, stagnation, and dependency (56). Over time, the initial support from fellow refugees or external aid organizations may decline, leaving long-term refugees more vulnerable to feelings of loneliness, uncertainty for the future, and disconnection from their homeland and cultural roots (58).

In this study, participants who had poor social support were more likely to increase the odds of getting depressive symptoms than those who had good social support. Our study is in line with the studies done in Tigray, Bangladish, Turkey, and Sudan. The possible reason might be poor social support among refugees, which can contribute to depression through mechanisms such as social isolation, limited access to resources, and recovery from trauma and stress (41).

Being female was another significant predictor for anxiety symptoms. This finding is consistent with studies done in Istanbul (38), Norway (59), and Bangladesh (45). The possible explanation may be that women in refugee camps often have a higher risk of gender-based violence, including sexual assault, domestic violence, and exploitation (60). Moreover, female patients may experience limited access to healthcare services, including mental health support, due to overcrowding and a lack of privacy and confidentiality in seeking healthcare services, which increases the level of stress and anxiety among women (61).

Additionally, our analysis showed that age above 45 was associated with anxiety symptoms, in line with a study conducted in Thailand (62), and Australia (63). The reason might be that refugees over 45 experience unique stressors related to their age, for example, declining physical health, reduced social support networks, acculturation, loss of social roles, and integration into the host society as well as an increased feeling of anxiety and worry about their health (64).

This study is not without limitations. The following are potential limitations: Due to the nature of sensitivity and recall bias, there may be underreporting of traumatic event items. HSCL-25 is a screening tool rather than a diagnostic tool, so the endpoint of depressive and anxiety symptoms might not be certain. Additionally, using self-report data, cross-sectional study design, limited socioeconomic data, and language and cultural barriers.

This study revealed that nearly half and more than one in three of the participants had depressive and anxiety symptoms, respectively. Being female heightened the risk of experiencing depressive and anxiety symptoms. This study recommends routine screening for depression and anxiety in the refugee camp setting. Additionally, community support networks including the host community can be fostered by organizing support groups and peer counseling programs that promote social cohesion and resilience, moreover facilitating conditions for the inclusion with the Ethiopian host society, and involving them in socio-economic participation or sustaining a meaningful resolution to the conflict in Sudan would facilitate the return of refugees back to their homes, support the healing process, and re-build their lives as recommended.