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Randomized Controlled Trial
. 2023 Mar 29;18(3):e0281800.
doi: 10.1371/journal.pone.0281800. eCollection 2023.

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  1 , Michael Baiocchi  2   3 , Evan Rosenman  4 , Mary Amuyunzu-Nyamongo  5 , Gavin Nyairo  5 , Clea Sarnquist  6
Affiliations
Randomized Controlled Trial

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 et al. PLoS One. .

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.

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Conflict of interest statement

The authors have read the journal’s policy and have the following competing interests: RF is a paid employee of LinkedIn Corp. This does not alter our adherence to PLOS ONE policies on sharing data and materials. There are no patents, products in development or marketed products associated with this research to declare. The other authors do not have any competing interests.

Figures

Fig 1
Fig 1. CONSORT flow diagram.
Flowchart showing participants and schools from baseline to endline.
Fig 2
Fig 2. Prevalence of mental health conditions.
Forest plots of prevalence estimates for moderate-to-severe PTSD, depression, and anxiety.
Fig 3
Fig 3. Conditional average treatment effects.
CATE estimates, shown as a histogram (left) and varying with covariate values (right).
See this image and copyright information in PMC

References

    1. Golding JM. Intimate Partner Violence as a Risk Factor for Mental Disorders: A Meta-Analysis. J Fam Violence. 1999. Jun 1;14(2):99–132.
    1. Pico-Alfonso MA, Garcia-Linares MI, Celda-Navarro N, Blasco-Ros C, Echeburúa E, Martinez M. The Impact of Physical, Psychological, and Sexual Intimate Male Partner Violence on Women’s Mental Health: Depressive Symptoms, Posttraumatic Stress Disorder, State Anxiety, and Suicide. J Womens Health. 2006. Jun 1;15(5):599–611. doi: 10.1089/jwh.2006.15.599 - DOI - PubMed
    1. Ullman SE, Filipas HH, Townsend SM, Starzynski LL. Psychosocial correlates of PTSD symptom severity in sexual assault survivors. J Trauma Stress. 2007. Oct 1;20(5):821–31. doi: 10.1002/jts.20290 - DOI - PubMed
    1. Choudhary E, Smith M, Bossarte RM. Depression, Anxiety, and Symptom Profiles Among Female and Male Victims of Sexual Violence. Am J Mens Health. 2011. Nov 21;6(1):28–36. doi: 10.1177/1557988311414045 - DOI - PubMed
    1. Johnson K, Scott J, Rughita B, Kisielewski M, Asher J, Ong R, et al. Association of Sexual Violence and Human Rights Violations With Physical and Mental Health in Territories of the Eastern Democratic Republic of the Congo. JAMA. 2010. Aug 4;304(5):553–62. doi: 10.1001/jama.2010.1086 - DOI - PubMed

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