Background
mental illness, death, anxiety, traumas, PTSD, depression, disability
SEQUELAE, NAIROBI
Gender-based violence (GBV) and mental health conditions are distinct but intertwined global challenges [Adolescence is a critical time for prevention of both GBV and mental illness. Although sequelae can manifest later in life, the World Health Organization (WHO) estimates that half of all mental illnesses begin by age 14 and three-quarters by age 20. Neuropsychiatric conditions are the leading cause of disability, and suicide is the second-leading cause of death, among 15–29 year-olds globally [In Nairobi, Kenya, adolescents living in informal urban settlements are exposed to high rates of poverty, violence, and other traumas, yet little is known about the impact of this environment on mental health. Rates of GBV in these settlements are high: for example, depending on age, between 8–25% of female adolescents living in the informal settlements experience sexual assault each year [In this study, we both consider mental health overall in this population and in response to an empowerment self-defense (ESD) program. ESD programs, which teach skills like awareness, verbal confrontations, and physical self-defense, have been shown to reduce annual incidence of sexual assault [As discussed above, informal settlements have high prevalence of sexual violence, which has been demonstrated to negatively affect mental health, and the global burden of poor adolescent mental health is enormous and poorly characterized. Therefore, we sought to understand the potential benefits of an ESD intervention on adolescent girl’s mental health, as well as describe overall adolescent mental health, in these under-studied communities.The primary aims of the current study were the following: (1) estimate the prevalence of depression, anxiety, and PTSD among adolescents living in the informal settlements of Nairobi, both overall and stratified by sex; (2) stratify prevalence of mental health conditions by history of sexual violence; (3) explore the potential average treatment effect of the empowerment intervention on mental health (i.e., the population level effect of the intervention on all participants); and (4) investigate possible sources of heterogeneity in those treatment effects.