Background

Mental health problems among youth in low-resource countries are compounded by the limitations of societal stigma and the inaccessibility of traditional treatments. Therefore, there is a need to develop scalable, accessible, and stigma-free mental health interventions. We developed and tested Pre-Texts, an arts-literacy intervention that targets adolescent depression and anxiety in Kenya.

Method

This was a universal RCT where high school students (N=235, ages 13-to-19, 53.19% female) were randomized to either Pre-Texts or a study skills control intervention. Pre-Texts consists of art-making exercises that interpret a literary text, like those required in school. Moments of creative expression are followed by collective reflection on the process of interpretation through art-making. Participants met daily for a week in groups of 6-12 youths (average size = 8) for one-hour sessions. Groups were facilitated by high school graduates (ages 18 - 22) trained as lay-providers. The groups met concurrently as after-school activities.

Results

Compared to the control, participants in Pre-Texts reported a greater reduction in depression (d = .53, 95% CI [.22, .84]) and anxiety symptoms from baseline to 1-month follow - up (d = .57, 95% CI [.26, .87]). When we looked at a subset of youths with moderate-to-severe depression and anxiety symptoms, Pre-Texts produced a greater reduction in depression symptoms (d = .76, 95% C [.27, .1.26]) than in anxiety symptoms (d = -.14, 95% CI [-.64, .35]).

Conclusion

This report suggests that an arts-literacy intervention with challenging school material in a group setting, implemented as an afterschool program, can reduce depression and anxiety symptoms in adolescents in Sub-Saharan Africa. Replication trials with larger sample sizes and extended follow-ups will help test the strength and sustainability of these effects.

Keywords: adolescents, depression, anxiety, Pre-Texts, Sub-Saharan Africa, interventions, school-based texts, global mental health, arts