Discussion
depression, PTSD, anxiety, adolescence
NAIROBI
Mental health conditions among socioeconomically disadvantaged adolescents, particularly those in low-income settings, are critically understudied. A major contribution of our work is a set of estimates for the prevalence of moderate to severe PTSD (12.2%), depression (9.2%) and anxiety (17.6%) among male and female class eight students attending schools in informal settlements of Nairobi, Kenya.The literature offers some insights into semi-comparable populations. For example, our study found a substantially higher rate of PTSD relative to a reported rate (6.6%) for children aged 3–19 in rural Uganda [In this sample, depression varied notably by gender, with female adolescents reporting significantly higher prevalence, at 10.4%, than male adolescent, at 5.9%. This finding is consistent with many other studies reporting higher depression rates among women and adolescent girls globally [We also found that experiencing rape within the last two years was a strong predictor of scoring poorly on all PTSD, depression, and anxiety scales. This relationship held regardless of being in the intervention or control group of the larger study. It is also consistent with prior research that has established that experiencing rape during adolescence is correlated with depression, anxiety, and PTSD [We found that reporting prior rape at baseline was especially detrimental to the mental health of these young adolescents. Specifically, our generalized linear model associated prior rape at baseline with significantly increased rates of PTSD, depression, and anxiety. That model also suggested that the ability to pay for a needed hospital visit for a family member was a significantly protective factor for PTSD and depression. These results indicate that students with more favorable baseline conditions, both in terms of rape experiences and economically, are less likely to report mental health conditions. It also illustrates a dire need for mental health services that are accessible to the most vulnerable populations who may be most at risk for mental health conditions.Ability to pay for a needed hospital visit for a family member also showed up as a factor associated with individuals who had the largest mental health improvements over the duration of the study. This group also had significantly less agreement with negative gender-normative statements as well as significantly lower academic self-efficacy; the latter merits future exploration. Combining these results with the generalized linear mixed model that showed that ability to pay for a needed hospital visit was also protective for mental health conditions, there is a cohesive story, consistent with other literature, about how individuals who start off in more stable positions are more likely to remain in stable positions.Finally, we compared differences between the cohorts of female adolescents who received the empowerment intervention versus the SOC, but found no statistically significant differences in mental health outcomes. As the empowerment intervention was designed for GBV reduction, not targeted to mental health outcomes, this is expected. Nonetheless, since poorer mental health and experiences of violence are often correlated, it may be worth including mental health measures in GBV evaluations, and consider combined interventions that might be able to address both of these intertwined issues concurrently [