Adolescent Mental Health in Kenya: Where is the Data?

January 23, 2019

The mental health needs of children and adolescents in low and middle-income countries (LMICs) have been neglected, leading to a serious mental health gap. The mental health care needs of young people are not acknowledged, and when they are, there are insufficient numbers of professionals trained to provide such care. The World Health Organization reports that mental health problems affect 10–20% of children and adolescents worldwide. They also estimate that half of all mental illness begins by age 14, though most cases go undetected and untreated. Depression, anxiety, conduct disorders, and attention-deficit/hyperactivity disorder (ADHD) are the leading causes of health-related disability in this age group. Left unaddressed, the problems continue into adulthood, affecting one’s relationships, work, and overall quality of life.

Compounding the problem is that there are large gaps in data on the burden of mental disorders in low- and middle-income countries such as Kenya which deprives countries of critical information required to plan and deliver effective interventions. Little data is available on the burden of mental illness in Kenya, and whatever little that is available is not disaggregated by age. As a result, it is only possible to roughly estimate the scale of the problem based on data from small-scale studies and the developed world – far from ideal for context-specific planning and budgeting. Kenya, as in many other countries in sub-Saharan Africa, has struggled to collect civil registration and vital statistics, including the cause of death data. As a result, accurate causes of death are not always captured in Kenya’s official statistics. When it is, suicide deaths are likely to be under-reported, in part because attempting suicide is illegal in Kenya and the stigma associated with suicide. The Kenya National Bureau of Statistics reports 421 deaths from suicide in 2018. Though it is very dicey to draw conclusions from international comparisons, a recent analysis shows that actual suicide deaths in South Africa, with one of sub-Saharan Africa’s strongest national statistical offices, could be more than 12 times the official numbers due to under-reporting or misreporting deaths in cases of suicide.

Aside from the lack of evidence on the true burden, we don’t know enough how to identify young people at risk of mental health disorders, and what factors help to protect them.  Additionally, learning more about the availability and use of mental health services could inform the developing and establishing effective models for delivering services to this age group.

We know from experiences in other countries that gathering data on mental health is often challenging. Mental illnesses are often under-diagnosed because symptoms are either not recognized or are wrongly attributed to spiritual or behavioral issues. Fear of stigma and/or abuse from their families may also prevent young people from reporting. Fears of legal culpability may also hinder self-reports of suicide attempts.

Knowledge of the prevalence of child and adolescent mental health problems is a first step in determining the magnitude of the problem in Kenya. The identification of risk and protective factors affecting child and adolescent mental health will inform the design of interventions that can reduce the burden of these disorders. That is why the African Population and Health Research Center (APHRC) is collaborating with the University of Queensland (Australia) and Johns Hopkins University (USA) to conduct a nationwide study on adolescent mental health in Kenya to address the dearth of evidence on the prevalence of adolescent mental disorders in the country. The survey on mental disorders in adolescents will provide national and county governments and other stakeholders with important information needed for prioritizing and planning services to address the burden of mental disorders in Kenya.

This year, APHRC starts the Kenya National Adolescent Mental Health Survey (K-NAMHS), a three-year study funded by a sub-grant from the University of Queensland, with a grant from Pivotal Ventures. We expect to determine the prevalence of mental health conditions among adolescents aged 10-17 years. Mental health conditions of interest include major depressive disorder (MDD), generalized anxiety disorder (GAD), attention-deficit/ hyperactivity disorder (ADHD), social phobia, and conduct disorder (CD). By identifying risks and protective factors for adolescent mental disorders, we hope to build the evidence base for health priority settings.

Ultimately, it is hoped that this new evidence on the burden of adolescent mental health will lead to improved ability to design and implement effective and age-appropriate mental health services in Kenya that will improve the quality of life of young people in the country. This study also comes at an opportune time, following the launch of the Kenya Mental Health Policy 2015-2030 which seeks to destigmatize, decriminalize and deinstitutionalize mental health concerns.  As such, we hope the findings of the study will be easier to adapt and operationalize into programs for child and adolescent mental health.