Our present understanding of depression relies on a Western nosology that might not be generalizable across diverse cultures around the world. As a consequence, current clinical research and practice may not capture culturally salient features of depression. Expanded cross-cultural research that uses ethnographic methods and indigenous instruments may yield information of clinical utility to enhance culturally sensitive research and practice. In this mixed methods study, we used ethno-semantic interview procedures based on the DSM-5’s cultural formulation process to elicit a broad range of depression features reported by the Luo people of Western Kenya. We identified how the Luo conceptualize depression, including idioms of depressive distress, moods associated with persistent negative affect, and other features including context, stressors and support systems. This information informed the co-development of a Luo Depression Questionnaire (LDQ-17). We used the LDQ-17 in a cross-sectional community survey (N=116) to investigate its association with a standard Western instrument (Patient Health Questionnaire-9; PHQ-9). Factor analysis revealed a 1-factor model for the PHQ-9 but not the LDQ-17 for which exploratory factor analysis suggested a 3-factor model including cognitive, affective, and physical symptoms. Psychological, environmental/social, and even supernatural causes of these symptoms were identified, as were support systems. Finally, visualizations through multidimensional scaling approaches showed some overlap between the LDQ-17 and the PHQ-9, but the indigenous LDQ-17 identified salient features the Luo associated with depression that the PHQ-9 missed. Our findings illustrate how simple ethnographic procedures may guide development of indigenous instruments to complement current standardized instruments, potentially enhancing cultural relevance.

Adolescent depression and anxiety—which are linked with many negative life outcomes—are prevalent around the world, particularly in low-income countries such as those in Sub Saharan Africa (SSA). We used network analysis to examine the topology, stability, and centrality of depression and anxiety symptoms. We analyzed data from a large community sample (N = 2,192) of Kenyan adolescents aged 13-18, using the Patient Health Questionnaire and the Generalized Anxiety Disorder Screener. We identified the central symptoms of the depression and anxiety symptom networks, and we compared the structure and connectivity of these networks between low-symptom and elevated-symptom sub-samples. Our findings indicate the most central depression symptoms were “self-blame” and “depressed mood”, while the strongest depression symptom associations were “self-blame” ––“depressed mood” and “trouble concentrating” ––“little interest/pleasure”. Similarly, the most central anxiety symptoms were “too much worry” and “uncontrollable worry”, while strongest anxiety symptom associations were “too much worry” ––“uncontrollable worry” and “trouble relaxing” ––“restlessness”. We found a statistical difference in the network structure between low-symptom and elevated-symptom adolescents. The low-symptom sample had higher network connectivity scores for both depression (global strength difference = 0.30; low-symptom = 0.49; high-symptom = 0.19; p = .003) and anxiety symptoms (global strength difference = 1.04; low-symptom = 1.57; high-symptom = 0.53; p < .001). This is the first report that uses network analysis techniques to identify central symptoms of adolescent depression and anxiety in SSA. Our findings illustrate how network analysis may inform understanding of psychopathology within cultures and suggest promising treatment targets.

Objective: Training lay-providers to deliver mental health interventions is both effective and cost-effective. However, more research is needed to document training and supervision procedures and to collect lay-providers’ feedback. We analyzed the acceptability of a 10-hour lay-provider training and supervision delivered primarily by undergraduates. We also tested lay-provider fidelity and quality. Methods: This study documents training and supervision from an RCT of the Shamiri intervention, a 4-session, school-based intervention which significantly reduced symptoms of anxiety and depression in Kenyan adolescents. We delivered a 10-hour training to 13 lay providers (M(SD)age=21.00(1.95), %female=61.54). We also hosted 30-minute supervision meetings twice weekly. Independent raters coded session recordings for fidelity and quality. We also collected quantitative and qualitative feedback from lay-providers. Results: Reliability and mean ratings for all six of our fidelity and quality measures (delivering required content, adhering to specified details, thoroughness, skillfulness, clarity, and purity) were very good to excellent. Lay-provider quantitative ratings of training were also overwhelmingly positive, with an overall satisfaction rating of 6.46/7.00. We identified central qualitative themes in lay provider comments: Generally, comments about training style, content, and personal interactions were overwhelmingly positive, and many lay-providers reported personal growth. Comments about timing and location were mixed. Conclusions: This study provides preliminary evidence that a very brief training delivered primarily by undergraduates can teach high-school-graduate lay-providers to deliver effective mental health interventions. Additionally, we discuss lessons-learned and implications for future research, including the importance of considering local context when planning and of continuously collecting and addressing lay-provider feedback.

Children and adolescents in non-western settings and low-resource environments may experience distinctive problems and psychiatric symptoms. Researchers and policymakers often aim to understand those problems and symptoms using standardized nomothetic assessment tools. These tools tend to be validated on western samples and may “miss” problems that are prevalent and important in non-western cultures. Brief, low-cost, idiographic assessment tools may help identify these concerns, usefully complementing traditional measurements. To examine this idea, we applied the Top Problems Assessment (Weisz et al., 2011) and two standardized measures of depression and anxiety to 100 adolescents from Kibera, a resource-poor urban settlement in Kenya. Data were collected from early June to July of 2018. The Top Problems Assessment asked students to identify their three most important problems. We then a) applied thematic analysis (Braun & Clark, 2006) to identify the most frequently reported types of problems and b) analyzed the depressive and anxiety symptoms most frequently endorsed on the standardized measures. Standardized assessment revealed that worrying and difficulty concentrating were the most commonly reported symptoms. On the Top Problems Assessment, 61% of the sample reported a social problem, 38% a cognitive problem, and 35% an economic problem. By contrast, emotional and behavioral problems assessed via the standardized measures were reported as top problems by only 17% of the sample. The Top Problems Assessment yielded specific problems faced by Kenyan youth that may not have emerged through a routine assessment using standardized measures. Our findings are the first to demonstrate that the Top Problems Assessment can be used to identify locally relevant concerns that may be missed by commonly used standardized measures. Overall, our findings suggest that idiographic assessments like the Top Problems Assessment can produce culturally relevant information and usefully complement standardized measurement tools.

{Background: Adolescent depression and anxiety symptoms are prevalent in Sub-Saharan African countries, yet treatment options are scarce, and stigma limits help-seeking. Brief, computerized single-session interventions (SSIs) that contain empirically supported stigma-free elements can potentially expand access to treatment. We developed and evaluated such an intervention for Kenyan adolescents. Method: High school students (N = 103, age 13 to 18) were randomized to a digital SSI Shamiri-Digital (Shamiri means “thrive” in Kiswahili) or a study-skills control intervention. Shamiri-Digital consisted of reading and writing activities about three concepts: growth mindset, gratitude, and value affirmations. Both Shamiri-Digital and the study-skills control condition were delivered electronically in schools. Results: Compared to the control, Shamiri-Digital produced greater reduction in adolescent depression symptoms in both the full sample (p = 0.031

Objectives

Depression and anxiety are leading causes of youth disability worldwide, yet our understanding of these conditions in Sub-Saharan African (SSA) youths is limited. Research has been sparse in SSA, and prevalence rates and correlates of these conditions remain scarcely investigated. To help address these gaps, this cross-sectional study assessed the prevalence of adolescent depression and anxiety symptoms in a community sample of high school students in Kenya. We also examined associations between those symptoms and psychosocial and sociodemographic factors.

Methods

We administered self-report measures of depression and anxiety symptoms, social support, gratitude, growth mindsets, and life satisfaction to 658 students (51.37% female) aged 13–19.

Results

Only the measures of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Screen-7), and social support (Multidimensional Scale for Perceived Social Support Scale) showed adequate internal consistency (Cronbach alpha > 0.70) in the study sample. Findings with these measures among Kenyan youths showed high levels of depression symptoms (45.90% above clinical cutoff) and anxiety symptoms (37.99% above clinical cutoff). Older adolescents reported higher depression and anxiety symptoms, as well as lower social support than younger adolescents. Females reported more anxiety than males, and members of minority tribes reported more anxiety than members of majority tribes.

Conclusions

This study highlights the high prevalence of adolescent internalizing symptoms in Kenyan high school students, identifies important correlates of these symptoms, and illustrates the need for culturally appropriate assessment tools.