We adapted Project Thrive! into a single-session program. We tested with 103 Kenyan youths in 2019. Thrive! Online significantly reduced depressive symptoms with effects exceeding those of standard face-to-face psychotherapy. Thrive! Online teaches growth mindset, gratitude, and value affirmations. In 2021, Thrive! Online will be accessible to >200,000 Kenyan kids through our partner Zeraki. We are excited to offer a web-version of Thrive! Online free and accessible to anyone.Access Thrive! Online
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Developing low-cost, socio-culturally appropriate, and scalable interventions for youth depression and anxiety symptoms in low-income regions such as countries in sub-Saharan Africa is a global mental health priority. We developed and intend to evaluate one such intervention for adolescent depression and anxiety in Kenya. The intervention, named Shamiri (a Swahili word for “thrive”), draws upon evidence-based components of brief interventions that involve nonclinical principles rather than treatment of psychopathology (e.g., growth mindset, gratitude, and virtues).
Common mental health disorders, like depression and anxiety, account for 45% of the global disease burden on youths aged 15–29. This challenge is particularly significant in low and middle-income countries (LMICs) where risk factors such as poverty, limited treatment options and stigma restrict access to care and exacerbate the burden and magnify the impact of mental disorders. Given these barriers, there is an urgent need for research dedicated to expanding mental healthcare for young people in LMICs.
This paper reports the encouraging findings of our digital single-session intervention targeting adolescent depression and anxiety. High school students (N=103, age 13–18) were randomized to a digital SSI Shamiri-Digital (Shamiri means “thrive” in Kiswahili)or a study-skills control intervention. Compared to the control, Shamiri-Digital produced a greater reduction in adolescent depressive symptoms in both the full sample (p .028, d 0.50) and a subsample of youths with moderate to severe depression symptoms (p .010, d 0.83) from baseline to2-week follow-up. The effects exceed the mean effects reported in meta-analyses of full-length, face-to-face psychotherapy for youth depression
This paper reports the encouraging findings from our pilot trial of the group-based intervention with 51 high-symptom youths in an urban slum in Kenya. Compared to the control, our intervention produced greater reductions in adolescent depression symptoms (p=.038;d=.32) and anxiety symptoms (p=.039; d=.54) from baseline to 4-week follow-up, and greater improvements in academic performance (p=.034; d=.32) from the school term before versus after the intervention. There were no effects on overall social support or perceived control, but the Shamiri group showed larger increases in perceived social support from friends (p=.028, d=.71).
Here we report findings on the general prevalence of mental health problems in a community sample. Our findings suggest that 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.
Our research informs our attempts to shape policy. See some of our white papers and policy briefs below
To guide intervention development efforts, we propose a four-step approach that encourages researchers to develop mental health interventions that are simple, stigma-free, scalable and school-based. Through this four-step approach, researchers can expand mental healthcare access in SSA by developing interventions that circumvent existing barriers.
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.
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 aged13-18, 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”.
Standardized assessment tools developed in Western contexts may systematically miss certain 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. In this study, we examined the utility of open-ended assessment as a method to identify culturally relevant concerns and to classify the most common problems experienced by low-income Kenyan youth. We administered the Top Problems Assessment and two standardized measures of depression and anxiety to 100 adolescents from Kibera, a resource poor urban settlement in Kenya. The Top Problems Assessment asked students to identify their three most important problems. We then a) applied thematic analysis 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 assessments revealed that worrying and difficulty concentrating were the most commonly reported symptoms. On the TopProblems Assessment, 61% of the sample reported a social problem, 38% an academic 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 extent to which psychological wellbeing may play a preventive and therapeutic role in the development and maintenance of adolescent emotional disorders depends, in part, on the nature of the overlap between these two constructs. We used network analysis to examine the relationship between adolescent psychopathology (measured by depression and anxiety symptoms) and psychological wellbeing (measured by happiness, optimism, social support, perceived control, and gratitude). This was a cross-sectional study with a in a large community sample of Kenyan adolescents (N = 2,192, ages 13-to-18). Network analyses was conducted to examine the topology, stability, centrality, and bridge nodes of a network of psychopathology and psychological wellbeing measures.Two distinct community clusters emerged, one for psychopathology nodes and another for wellbeing nodes, suggesting that these are two distinct but connected concepts. Central and bridge nodes of the wellbeing and psychopathology network are identified. The most central nodes in the network were general gratefulness and worry; the strongest negative edges between psychopathology and psychological wellbeing were depressed mood—I love life and irritability—I am a joyful person; the main bridge nodes were optimistic about future and special person around for me
Internalizing symptoms are common and debilitating among adolescents. Network analysis, which models associations among psychopathology, risk factors, and protective factors, may help clarify relationships between social support and internalizing symptoms, including within understudied cultural groups. We performed network analyses of 1) depressive and anxiety symptoms, 2) social support, and 3) all three measures among 658 Kenyan adolescents. In the internalizing symptoms network, worry, nervousness, and feeling down exhibited the highest expected influence. In the social support network, friends showed the greatest expected influence. In the full network, social support from family, friends, and significant others were all negatively associated with internalizing symptoms, and feeling down was a particularly important bridge node between internalizing symptoms and social support. Our findings suggest that feeling down is closely linked to social support in this sample of Kenyan adolescents.
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.