Abstract
This study assessed the psychometric properties of standard Western-derived instruments, the prevalence of depression and anxiety symptoms, and their associations with sociodemographic and wellbeing variables in a large sample of Kenyan adolescents. Self-report measures of depression (PHQ-8) and anxiety (GAD-7) symptoms, social support, gratitude, happiness, optimism, and perceived control were administered to 2,192 Kenyan youths (57.57% female) aged 12–19. Both the PHQ-8 (α = 0.78) and GAD-7 (α = 0.82) showed adequate internal consistency. EFA with a sub-sample (N = 1096) yielded a 1-factor structure for both PHQ-8 and GAD-7, a subsequent CFA conducted on the basis of a 1-factor model on another sub-sample (N = 1096) yielded good and moderate goodness of fit, respectively, for the PHQ-8 (χ2 = 76.73; p < 0.001; RMSEA = 0.05; CFI = 0.96; TLI = 0.95) and the GAD-7 (χ2 = 88.19; p < 0.001; RMSEA = 0.07; CFI = 0.97; TLI = 0.95). Some 28.06% and 30.38% of participants met the clinical cut-off for depressive and anxiety symptoms, respectively. Social support, gratitude, happiness, and perceived control were negatively associated with both depression and anxiety symptoms. Older adolescents reported higher symptoms while adolescents with more siblings reported lower symptoms. The western-derived PHQ and GAD met conventional psychometric standards with adolescents in Kenya; depression and anxiety symptoms showed relatively high prevalence and significant associations with important psychosocial and sociodemographic factors.
Similar content being viewed by others
References
Abbo, C., Kinyanda, E., Kizza, R. B., Levin, J., Ndyanabangi, S., & Stein, D. J. (2013). Prevalence, comorbidity and predictors of anxiety disorders in children and adolescents in rural north-eastern Uganda. Child and Adolescent Psychiatry and Mental Health, 7(1), 21. https://doi.org/10.1186/1753-2000-7-21
Adewuya, A. O., Coker, O. A., Atilola, O., Ola, B. A., Zachariah, M. P., Adewumi, T. … Idris, O. (2018). Gender difference in the point prevalence, symptoms, comorbidity, and correlates of depression: Findings from the Lagos State Mental Health Survey (LSMHS), Nigeria. Archives of Women’s Mental Health, 21(6), 591–599. https://doi.org/10.1007/s00737-018-0839-9
Adlina, S., Suthahar, A., Ramli, M., Edariah, A., Soe, S. A., Mohd, A. F. … Karuthan, C. (2007). Pilot study on depression among secondary school students in Selangor. The Medical Journal of Malaysia, 62(3), 218
Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40(1), 57–87. https://doi.org/10.1111/1469-7610.00424
Antaramian, S. P., Huebner, E. S., Hills, K. J., & Valois, R. F. (2010). A dual-factor model of mental health: Toward a more comprehensive understanding of youth functioning. American Journal of Orthopsychiatry, 80(4), 462–472. https://doi.org/10.1111/j.1939-0025.2010.01049.x
Anum, A., Adjorlolo, S., & Kugbey, N. (2019). Depressive symptomatology in adolescents in Ghana: Examination of psychometric properties of the Patient Health Questionnaire-9. Journal of Affective Disorders, 256, 213–218. https://doi.org/10.1016/j.jad.2019.06.007
Avenevoli, S., Stolar, M., Li, J., Dierker, L., & Ries Merikangas, K. (2001). Comorbidity of depression in children and adolescents: Models and evidence from a prospective high-risk family study. Biological Psychiatry, 49(12), 1071–1081. https://doi.org/10.1016/S0006-3223(01)01142-8
Axelson, D. A., & Birmaher, B. (2001). Relation between anxiety and depressive disorders in childhood and adolescence. Depression and Anxiety, 14(2), 67–78. https://doi.org/10.1002/da.1048
Balázs, J., Miklósi, M., Keresztény, Á., Hoven, C. W., Carli, V., Wasserman, C. … Wasserman, D. (2013). Adolescent subthreshold-depression and anxiety: Psychopathology, functional impairment and increased suicide risk: Adolescent subthreshold-depression and anxiety. Journal of Child Psychology and Psychiatry, 54(6), 670–677. https://doi.org/10.1111/jcpp.12016
Bartels, M., Cacioppo, J. T., van Beijsterveldt, T. C. E. M., & Boomsma, D. I. (2013). Exploring the Association Between Well-Being and Psychopathology in Adolescents. Behavior Genetics, 43(3), 177–190. https://doi.org/10.1007/s10519-013-9589-7
Bass, J. K., Bolton, P. A., & Murray, L. K. (2007). Do not forget culture when studying mental health. The Lancet, 370(9591), 918–919. https://doi.org/10.1016/S0140-6736(07)61426-3
Bentler, P. M., & Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88(3), 588–606. https://doi.org/10.1037/0033-2909.88.3.588
Bertha, E. A., & Balázs, J. (2013). Subthreshold depression in adolescence: A systematic review. European Child & Adolescent Psychiatry, 22(10), 589–603. https://doi.org/10.1007/s00787-013-0411-0
Borsboom, D. (2017). A network theory of mental disorders. World Psychiatry, 16(1), 5–13. https://doi.org/10.1002/wps.20375
Brady, E. U., & Kendall, P. C. (1992). Comorbidity of anxiety and depression in children and adolescents. Psychological Bulletin, 111(2), 244–255. https://doi.org/10.1037/0033-2909.111.2.244
van Buuren, S., & Groothuis-Oudshoorn, K. (2011). mice: Multivariate Imputation by Chained Equations in R. Journal of Statistical Software, 45(1), 1–67. https://doi.org/10.18637/jss.v045.i03
Caddick, H., Horne, B., Mackenzie, J., & Tilley, H. (2016). Investing in mental health in low-income countries (ODI Insights). Overseas Development Institute. https://www.odi.org/sites/odi.org.uk/files/resource-documents/11184.pdf
Campbell, S., & Osborn, T. L. (2021). Adolescent Psychopathology and Psychological Wellbeing: A Network Analysis Approach. Bmc Psychiatry. https://doi.org/10.1186/s12888-021-03331-x
Collins, P. Y., Patel, V., Joestl, S. S., March, D., Insel, T. R., Daar, A. S. … Walport, M. (2011). Grand challenges in global mental health. Nature, 475, 27
Cummings, C. M., Caporino, N. E., & Kendall, P. C. (2014). Comorbidity of anxiety and depression in children and adolescents: 20 years after. Psychological Bulletin, 140(3), 816
Diener, E. (1984). Subjective well-being. Psychological Bulletin, 95(3), 542–575. https://doi.org/10.1037/0033-2909.95.3.542
Dumont, I. P., & Olson, A. L. (2012). Primary Care, Depression, and Anxiety: Exploring Somatic and Emotional Predictors of Mental Health Status in Adolescents. The Journal of the American Board of Family Medicine, 25(3), 291–299. https://doi.org/10.3122/jabfm.2012.03.110056
Essau, C. A. (2003). Comorbidity of anxiety disorders in adolescents. Depression and Anxiety, 18(1), 1–6. https://doi.org/10.1002/da.10107
Fatiregun, A. A., & Kumapayi, T. E. (2014). Prevalence and correlates of depressive symptoms among in-school adolescents in a rural district in southwest Nigeria. Journal of Adolescence, 37(2), 197–203. https://doi.org/10.1016/j.adolescence.2013.12.003
Fried, E. I., van Borkulo, C. D., Cramer, A. O. J., Boschloo, L., Schoevers, R. A., & Borsboom, D. (2017). Mental disorders as networks of problems: A review of recent insights. Social Psychiatry and Psychiatric Epidemiology, 52(1), 1–10. https://doi.org/10.1007/s00127-016-1319-z
Gleser, L. J. (1966). A note on the sphericity test. The Annals of Mathematical Statistics, 37(2), 464–467
Grant, K. E., Lyons, A. L., Finkelstein, J. A. S., Conway, K. M., Reynolds, L. K., O’Koon, J. H. … Hicks, K. J. (2004). Gender Differences in Rates of Depressive Symptoms Among Low-Income, Urban, African American Youth: A Test of Two Mediational Hypotheses. Journal of Youth and Adolescence, 33(6), 523–533. https://doi.org/10.1023/B:JOYO.0000048066.90949.be
Greenspoon, P. J., & Saklofske, D. H. (2001). Toward an Integration of Subjective Well-Being and Psychopathology. Social Indicators Research, 54(1), 81–108. https://doi.org/10.1023/A:1007219227883
Haroz, E. E., Ritchey, M., Bass, J. K., Kohrt, B. A., Augustinavicius, J., Michalopoulos, L. … Bolton, P. (2017). How is depression experienced around the world? A systematic review of qualitative literature. Social Science & Medicine, 183, 151–162. https://doi.org/10.1016/j.socscimed.2016.12.030
Hill, B. D. (2011). The sequential Kaiser-Meyer-Olkin procedure as an alternative for determining the number of factors in common-factor analysis: A Monte Carlo simulation. Oklahoma State University
Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55
Joseph, S., & Wood, A. (2010). Assessment of positive functioning in clinical psychology: Theoretical and practical issues. Clinical Psychology Review, 30(7), 830–838. https://doi.org/10.1016/j.cpr.2010.01.002
Kaiser, H. F. (1970). A second generation little jiffy. Psychometrika, 35(4), 401–415
Kern, M. L., Benson, L., Steinberg, E. A., & Steinberg, L. (2016). The EPOCH Measure of Adolescent Well-Being. Psychological Assessment, 28(5), 586–597. https://doi.org/10.1037/pas0000201
Khasakhala, L., Ndetei, D., Mutiso, V., Mbwayo, A., & Mathai, M. (2012). The prevalence of depressive symptoms among adolescents in Nairobi public secondary schools: Association with perceived maladaptive parental behaviour. African Journal of Psychiatry, 15(2), 106–113. https://doi.org/10.4314/ajpsy.v15i2.14
Kilburn, K., Thirumurthy, H., Halpern, C. T., Pettifor, A., & Handa, S. (2016). Effects of a Large-Scale Unconditional Cash Transfer Program on Mental Health Outcomes of Young People in Kenya. Journal of Adolescent Health, 58(2), 223–229. https://doi.org/10.1016/j.jadohealth.2015.09.023
King, N. J., & Bernstein, G. A. (2001). School Refusal in Children and Adolescents: A Review of the Past 10 Years. Journal of the American Academy of Child & Adolescent Psychiatry, 40(2), 197–205. https://doi.org/10.1097/00004583-200102000-00014
Kirmayer, L. J., Gomez-Carrillo, A., & Veissière, S. (2017). Culture and depression in global mental health: An ecosocial approach to the phenomenology of psychiatric disorders. Social Science & Medicine, 183, 163–168. https://doi.org/10.1016/j.socscimed.2017.04.034
Kleinman, A. (2004). Culture and Depression. New England Journal of Medicine, 351(10), 951–953. https://doi.org/10.1056/NEJMp048078
Kleinman, A., & Good, B. J. (1985). Culture and depression: Studies in the anthropology and cross-cultural psychiatry of affect and disorder (16 vol.). Univ of California Press
Knafl, G. J., Dixon, J. K., O’Malley, J. P., Grey, M., Deatrick, J. A., Gallo, A. M., & Knafl, K. A. (2009). Analysis of Cross-Sectional Univariate Measurements for Family Dyads Using Linear Mixed Modeling. Journal of Family Nursing, 15(2), 130–151. https://doi.org/10.1177/1074840709331641
Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A New Depression Diagnostic and Severity Measure. Psychiatric Annals, 32(9), 509–515. https://doi.org/10.3928/0048-5713-20020901-06
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Kroenke, K., Strine, T. W., Spitzer, R. L., Williams, J. B. W., Berry, J. T., & Mokdad, A. H. (2009). The PHQ-8 as a measure of current depression in the general population. Journal of Affective Disorders, 114(1–3), 163–173. https://doi.org/10.1016/j.jad.2008.06.026
Lewis-Fernández, R., Aggarwal, N. K., Bäärnhielm, S., Rohlof, H., Kirmayer, L. J., Weiss, M. G. … Lu, F. (2014). Culture and Psychiatric Evaluation: Operationalizing Cultural Formulation for DSM-5. Psychiatry: Interpersonal and Biological Processes, 77(2), 130–154. https://doi.org/10.1521/psyc.2014.77.2.130
Lewis-Fernández, R., & Díaz, N. (2002). The Cultural Formulation: A Method for Assessing Cultural Factors Affecting the Clinical Encounter. Psychiatric Quarterly, 73(4), 271–295. https://doi.org/10.1023/A:1020412000183
Lewis-Fernández, R., & Krishan Aggarwal, N. (2013). Culture and Psychiatric Diagnosis. In R. D. Alarcón (Ed.), Advances in Psychosomatic Medicine (Vol. 33, pp. 15–30). S. KARGER AG. https://doi.org/10.1159/000348725
Liu, X., Peng, C., Yu, Y., Yang, M., Qing, Z., Qiu, X., & Yang, X. (2020). Association between sub-types of sibling bullying and mental health distress among Chinese children and adolescents. Frontiers in Psychiatry, 11, 368
Magai, D. N., Malik, J. A., & Koot, H. M. (2018). Emotional and Behavioral Problems in Children and Adolescents in Central Kenya. Child Psychiatry & Human Development, 49(4), 659–671. https://doi.org/10.1007/s10578-018-0783-y
Manson, S. M., Shore, J. H., & Bloom, J. D. (1985). The depressive experience in American Indian communities: A challenge for psychiatric theory and diagnosis.Culture and Depression,331–368
Masuyama, A., Shinkawa, H., & Kubo, T. (2020). Validation and Psychometric Properties of the Japanese Version of the Fear of COVID-19 Scale Among Adolescents. International Journal of Mental Health and Addiction. https://doi.org/10.1007/s11469-020-00368-z
McCullough, M. E., Emmons, R. A., & Tsang, J. A. (2002). The grateful disposition: A conceptual and empirical topography. Journal of Personality and Social Psychology, 82(1), 112–127. https://doi.org/10.1037/0022-3514.82.1.112
McElroy, E., Fearon, P., Belsky, J., Fonagy, P., & Patalay, P. (2018). Networks of Depression and Anxiety Symptoms Across Development. Journal of the American Academy of Child & Adolescent Psychiatry, 57(12), 964–973. https://doi.org/10.1016/j.jaac.2018.05.027
McGuinness Teena, M., Dyer Janyce, G., & Wade Ellin, H. (2012). Gender Differences in Adolescent Depression. Journal of Psychosocial Nursing and Mental Health Services, 50(12), 17–20. https://doi.org/10.3928/02793695-20121107-04
Ministry of Education, S. and T (2014). Basic education statistical booklet
Ministry of Education, Science, and Technology (2015). Ministry of Education, Science and Technology National Education Sector Plan (Basic Education Programme Rationale and Approach). Republic of Kenya. https://www.education.go.ke/index.php/downloads/category/17-policy-documents?download=82:natio
Mitchell, S., & Abbott, S. (1987). Gender and symptoms of depression and anxiety among Kikuyu secondary school students in Kenya. Social Science & Medicine, 24(4), 303–316. https://doi.org/10.1016/0277-9536(87)90149-3
Ndetei, D. M., Khasakhala, L., Nyabola, L., Ongecha-Owuor, F., Seedat, S., Mutiso, V. … Odhiambo, G. (2008). The prevalence of anxiety and depression symptoms and syndromes in Kenyan children and adolescents. Journal of Child & Adolescent Mental Health, 20(1), 33–51. https://doi.org/10.2989/JCAMH.2008.20.1.6.491
Ndetei, D. M., Mutiso, V., Maraj, A., Anderson, K. K., Musyimi, C., & McKenzie, K. (2016). Stigmatizing attitudes toward mental illness among primary school children in Kenya. Social Psychiatry and Psychiatric Epidemiology, 51(1), 73–80. https://doi.org/10.1007/s00127-015-1090-6
Nunnally, J. (1978). Psychometric theory (2nd edit.) mcgraw-hill. Hillsdale, NJ, 416
Osborn, T. L., Kleinman, A., & Weisz, J. R. (2021). Complementing standard Western measures of depression with locally co-developed instruments: A cross-cultural study on the experience of depression among the Luo in Kenya. Transcultural Psychiatry, 13634615211000556. https://doi.org/10.1177/13634615211000555
Osborn, T. L., Rodriguez, M., Wasil, A. R., Venturo-Conerly, K. E., Gan, J., Alemu, R. G. … Weisz, J. R. (2020). Single-session digital intervention for adolescent depression, anxiety, and well-being: Outcomes of a randomized controlled trial with Kenyan adolescents. Journal of Consulting and Clinical Psychology, 88(7), 657–668. https://doi.org/10.1037/ccp0000505
Osborn, T. L., Venturo-Conerly, K. E., Arango, G., Roe, S., Rodriguez, E., Alemu, M. … Weisz, J. R. (2021). Effect of Shamiri Layperson-Provided Intervention vs Study Skills Control Intervention for Depression and Anxiety Symptoms in Adolescents in Kenya: A Randomized Clinical Trial. JAMA Psychiatry. https://doi.org/10.1001/jamapsychiatry.2021.1129
Osborn, T. L., Venturo-Conerly, K. E., Wasil, A. R., Schleider, J. L., & Weisz, J. R. (2020). Depression and Anxiety Symptoms, Social Support, and Demographic Factors Among Kenyan High School Students. Journal of Child and Family Studies, 29(5), 1432–1443. https://doi.org/10.1007/s10826-019-01646-8
Osborn, T. L., Wasil, A. R., Venturo-Conerly, K. E., Schleider, J. L., & Weisz, J. R. (2020). Group Intervention for Adolescent Anxiety and Depression: Outcomes of a Randomized Trial with Adolescents in Kenya. Behavior Therapy, 51(4), 601–615. https://doi.org/10.1016/j.beth.2019.09.005
Othieno, C. J., Okoth, R. O., Peltzer, K., Pengpid, S., & Malla, L. O. (2014). Depression among university students in Kenya: Prevalence and sociodemographic correlates. Journal of Affective Disorders, 165, 120–125. https://doi.org/10.1016/j.jad.2014.04.070
Patel, V., Flisher, A. J., Hetrick, S., & McGorry, P. (2007). Mental health of young people: A global public-health challenge. The Lancet, 369(9569), 1302–1313. https://doi.org/10.1016/S0140-6736(07)60368-7
Rosseel, Y. (2012). Lavaan: An R package for structural equation modeling and more. Version 0.5–12 (BETA). Journal of Statistical Software, 48(2), 1–36
Saluja, G., Iachan, R., Scheidt, P. C., Overpeck, M. D., Sun, W., & Giedd, J. N. (2004). Prevalence of and Risk Factors for Depressive Symptoms Among Young Adolescents. Archives of Pediatrics & Adolescent Medicine, 158(8), 760–765. https://doi.org/10.1001/archpedi.158.8.760
Seligman, M. (2018). PERMA and the building blocks of well-being. The Journal of Positive Psychology, 13(4), 333–335. https://doi.org/10.1080/17439760.2018.1437466
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Löwe, B. (2006). A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092. https://doi.org/10.1001/archinte.166.10.1092
United Nations Children’s Fund. (2016). The state of the world’s children 2016: A fair chance for every child. United Nations Children’s Fund
Vigo, D., Thornicroft, G., & Atun, R. (2016). Estimating the true global burden of mental illness. The Lancet Psychiatry, 3(2), 171–178
Weisz, J. R., Sigman, M., Weiss, B., & Mosk, J. (1993). Parent reports of behavioral and emotional problems among children in Kenya, Thailand, and the United States. Child Development, 64(1), 98–109
Weisz, J. R., Southam-Gerow, M. A., & McCarty, C. A. (2001). Control-related beliefs and depressive symptoms in clinic-referred children and adolscents: Developmental differences and model specificity. Journal of Abnormal Psychology, 110(1), 97
Weisz, J. R., Suwanlert, S., Chaiyasit, W., Weiss, B., Walter, B. R., & Anderson, W. W. (1988). Thai and American perspectives on over- and undercontrolled child behavior problems: Exploring the threshold model among parents, teachers, and psychologists. Journal of Consulting and Clinical Psychology, 56(4), 601–609. https://doi.org/10.1037/0022-006X.56.4.601
Williams, B., Onsman, A., & Brown, T. (2010). Exploratory factor analysis: A five-step guide for novices. Australasian Journal of Paramedicine, 8(3), https://doi.org/10.33151/ajp.8.3.93
Winefield, H. R., Gill, T. K., Taylor, A. W., & Pilkington, R. M. (2012). Psychological well-being and psychological distress: Is it necessary to measure both? Psychology of Well-Being: Theory Research and Practice, 2(1), 3. https://doi.org/10.1186/2211-1522-2-3
World Health Organization. (2019). GHO | By category | Human resources—Data by country. WHO. https://apps.who.int/gho/data/node.main.MHHR?lang=en World Health Organization
Yara, P. O., & Wanjohi, C. (2011). Performance Determinants of Kenya Certificate of Secondary Education (KCSE) in Mathematics of Secondary Schools in Nyamaiya Division, Kenya. Asian Social Science, 7(2), p107. https://doi.org/10.5539/ass.v7n2p107
Yorbik, O., Birmaher, B., Axelson, D., Williamson, D. E., & Ryan, N. D. (2004). Clinical Characteristics of Depressive Symptoms in Children and Adolescents With Major Depressive Disorder. The Journal of Clinical Psychiatry, 65(12), 0–0
Zeng, G., Peng, K., & Hu, C. P. (2019). The Network Structure of Adolescent Well-Being Traits: Results From a Large-Scale Chinese Sample. Frontiers in Psychology, 10, 2783. https://doi.org/10.3389/fpsyg.2019.02783
Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Osborn, T.L., Venturo-Conerly, K.E., Gan, J.Y. et al. Depression and anxiety symptoms amongst kenyan adolescents: Psychometric Properties, Prevalence Rates and Associations with Psychosocial Wellbeing and Sociodemographic factors. Res Child Adolesc Psychopathol 50, 1471–1485 (2022). https://doi.org/10.1007/s10802-022-00940-2
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10802-022-00940-2