A Composite Indicator of Anxiety and Depression Signs in Children and Adolescents of Low- and Middle-Income Countries: a Subjective-Objective Multidimensional Approach

Abstract Although mental health is critical at all stages of life, childhood and adolescence are especially sensitive periods, as psychological difficulties during these phases are shaped by multifaceted social, economic, and environmental factors and may lead to long-term biopsychosocial consequences. Understanding these determinants is complex because they involve interrelated sub-indicators. To address this challenge, this study developed composite indicators representing the susceptibility to anxiety and depression among children and adolescents in LMICs, using a subjective–objective optimization approach informed by expert opinion. By integrating specialist knowledge with data-driven weighting, the proposed method strikes a balance between conceptual relevance and empirical consistency. Results indicate that functional difficulties in self-care, mobility, concentration, memory, and parental involvement affect both anxiety and depression. Depression is more associated with child labor, discipline, adaptability, and GDP, whereas anxiety relates more to communication, social interaction, and neighborhood safety. The proposed composite indicators provide a scalable, interpretable tool to identify priority regions, guide targeted interventions, and support evidence-based mental health policies for children and adolescents in LMICs.