Abstract
<title>Abstract</title> <p> <bold>Background</bold> Adolescence is a critical developmental period with heightened vulnerability to mental health disorders, yet evidence on modifiable determinants, particularly integrated 24-hour movement behaviours, remains scarce in sub-Saharan Africa. This study examined the associations between adherence to the 24-hour movement guidelines and depressed feelings and suicidal attempt among school-going adolescents in Sekondi-Takoradi, Ghana. <bold>Methods:</bold> We conducted a secondary analysis of the 2022 subnational Ghana Global School-based Student Health Survey (GSHS) involving 3,577 adolescents (12–17 years). The 24-hour movement guidelines were classified according to the World Health Organization and Canadian 24-hour movement guidelines. Depressed feelings and suicidal attempt were assessed using GSHS questions. Survey-weighted prevalence estimates were calculated. Multivariable logistic regression models controlling for covariates were used to estimate the odds of depressed feelings and suicidal attempt. <bold>Results</bold> The weighted prevalence of depressed feelings and suicidal attempt was 16.1% and 26.4%, respectively. Only 2.5% met all three movement guidelines while 22.1% met none. Meeting two guidelines was associated with lower odds of depressed feelings (aOR = 0.58, 95% <italic>CI</italic> : 0.48–0.70). Conversely, meeting two (aOR = 0.67, 95% <italic>CI</italic> : 0.56–0.80) and all three (aOR = 0.55, 95% <italic>CI</italic> : 0.32–0.97) movement guidelines were associated with lower odds of suicidal attempt, with a significant linear trend (p = 0.0137). <bold>Conclusion</bold> Although adherence to integrated movement guidelines is low among Ghanaian adolescents, meeting any two or all three guidelines was associated with positive mental health. Public health programs should consider promoting 24-hour movement behaviors. Longitudinal studies are needed to establish causal relationships. </p>