Mental health and gender-based violence: An exploration of depression, PTSD, and anxiety among adolescents in Kenyan informal settlements participating in an empowerment intervention

Rina Friedberg; Michael Baiocchi; Evan Rosenman; Mary Amuyunzu-Nyamongo; Gavin Nyairo; Clea Sarnquist

doi:10.1371/journal.pone.0281800

Mental health and gender-based violence: An exploration of depression, PTSD, and anxiety among adolescents in Kenyan informal settlements participating in an empowerment intervention

PLoS One. 2023 Mar 29;18(3):e0281800. doi: 10.1371/journal.pone.0281800. eCollection 2023.

Authors

Rina Friedberg¹, Michael Baiocchi^{2

3}, Evan Rosenman⁴, Mary Amuyunzu-Nyamongo⁵, Gavin Nyairo⁵, Clea Sarnquist⁶

Affiliations

¹ LinkedIn, Data Science and Applied Research (all work completed while at Department of Statistics, Stanford University), Stanford, CA, United States of America.
² Stanford Prevention Research Center, Stanford, CA, United States of America.
³ Department of Statistics, Stanford University, Stanford, CA, United States of America.
⁴ Harvard Data Science Initiative, Cambridge, MA, United States of America.
⁵ African Institute for Health and Development, Nairobi, Kenya.
⁶ Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America.

Abstract

Objective: This study examines the prevalence of depression, anxiety, and post-traumatic stress disorder (PTSD) among adolescents attending schools in several informal settlements of Nairobi, Kenya. Primary aims were estimating prevalence of these mental health conditions, understanding their relationship to gender-based violence (GBV), and assessing changes in response to an empowerment intervention.

Methods: Mental health measures were added to the final data collection point of a two-year randomized controlled trial (RCT) evaluating an empowerment self-defense intervention. Statistical models evaluated how past sexual violence, access to money to pay for a needed hospital visit, alcohol use, and self-efficacy affect both mental health outcomes as well as how the intervention affected female students' mental health.

Findings: Population prevalence of mental health conditions for combined male and female adolescents was estimated as: PTSD 12.2% (95% confidence interval 10.5-15.4), depression 9.2% (95% confidence interval 6.6-10.1) and anxiety 17.6% (95% confidence interval 11.2% - 18.7%). Female students who reported rape before and during the study-period reported significantly higher incidence of all mental health outcomes than the study population. No significant differences in outcomes were found between female students in the intervention and standard-of-care (SOC) groups. Prior rape and low ability to pay for a needed hospital visit were associated with higher prevalence of mental health conditions. The female students whose log-PTSD scores were most lowered by the intervention (effects between -0.23 and -0.07) were characterized by high ability to pay for a hospital visit, low agreement with gender normative statements, larger homes, and lower academic self-efficacy.

Conclusion: These data illustrate a need for research and interventions related to (1) mental health conditions among the young urban poor in low-income settings, and (2) sexual violence as a driver of poor mental health, leading to a myriad of negative long-term outcomes.

Copyright: © 2023 Friedberg et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Anxiety / epidemiology
Depression / epidemiology
Female
Gender-Based Violence*
Humans
Kenya / epidemiology
Male
Mental Health
Stress Disorders, Post-Traumatic* / psychology

Grants and funding

This study was funded by South African Medical Research Council through the What Works to Prevent Violence Innovation Grant (#52069); by the Department of Defense, Air Force Office of Scientific Research, National Defense Science and Engineering Graduate (NDSEG) Fellowship, 32 CFR 168a; and by the Marjorie Lozoff Fund, Michelle R. Clayman Institute for Gender Research, Stanford University. LinkedIn Corp provided support in the form of salary for RF. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The specific roles of these authors are articulated in the ‘author contributions’ section.