For many years, psychiatrists have tried to understand factors involved in response to medications or psychotherapies, in order to personalize their treatment choices. There is now a broad and growing interest in the idea that we can develop models to personalize treatment decisions using new statistical approaches from the field of machine learning and applying them to larger volumes of data. In this pursuit, there has been a paradigm shift away from experimental studies to confirm or refute specific hypotheses towards a focus on the overall explanatory power of a predictive model when tested on new, unseen datasets. In this paper, we review key studies using machine learning to predict treatment outcomes in psychiatry, ranging from medications and psychotherapies to digital interventions and neurobiological treatments. Next, we focus on some new sources of data that are being used for the development of predictive models based on machine learning, such as electronic health records, smartphone and social media data, and on the potential utility of data from genetics, electrophysiology, neuroimaging and cognitive testing. Finally, we discuss how far the field has come towards implementing prediction tools in real‐world clinical practice. Relatively few retrospective studies to‐date include appropriate external validation procedures, and there are even fewer prospective studies testing the clinical feasibility and effectiveness of predictive models. Applications of machine learning in psychiatry face some of the same ethical challenges posed by these techniques in other areas of medicine or computer science, which we discuss here. In short, machine learning is a nascent but important approach to improve the effectiveness of mental health care, and several prospective clinical studies suggest that it may be working already.

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This study was funded by grants from the Harvard University Center for African Studies, the Harvard College Research Program, and the Harvard University Weatherhead Center for International Affairs. The authors are grateful to the principals and school administrators of the five schools that we worked with in Kenya. In particular, we are grateful to Mr. Jarius Akweya for his support.

Study activities were funded by Shamiri Institute. Ethics approval was granted by the Maseno University Ethics Review Committee (MUERC). We are grateful to Mr. Dennis Mureithi, the Dean of Studies at the school we worked in in Nairobi, Kenya.

Smartphone applications for the treatment of depression and anxiety have acquired millions of users, yet little is known about whether they include evidence-based therapeutic content. We examined the extent to which popular mental health applications (MH apps) for depression and anxiety contain treatment elements found in empirically supported psychotherapy protocols (i.e., "common elements"). Of the 27 MH apps reviewed, 23 included at least one common element, with a median of three elements. Psychoeducation (in 52% of apps), relaxation (44%), meditation (41%), mindfulness (37%), and assessment (37%) were the most frequent elements, whereas several elements (e.g., problem solving) were not found in any apps. We also identified gaps between app content and empirically supported treatments. Cognitive restructuring was more common in depression protocols than in depression apps (75% of protocols vs. 31% of apps), as was problem solving (34% vs. 0%). For anxiety, exposure (85%, 12%), cognitive restructuring (60%, 12%), and problem solving (25%, 0%) were more common in protocols than apps. Overall, our findings highlight empirically supported treatment elements that are poorly represented in current MH apps. The absence of several core treatment elements underscores the need for future research, including randomized trials testing the effectiveness of popular MH apps.

IMPORTANCE Low-cost interventions for adolescent depression and anxiety are needed in low-resource countries such as those in Sub-Saharan Africa.OBJECTIVE To assess whether Shamiri, a 4-week layperson-delivered group intervention that teaches growth mindset, gratitude, and value affirmation, can alleviate depression and anxiety symptoms in symptomatic Kenyan adolescents. DESIGN, SETTING, AND PARTICIPANTSThis school-based randomized clinical trial included outcomes assessed at baseline, posttreatment, and 2-week and 7-month follow-up from 4 secondary schools in Nairobi and Kiambu County, Kenya. Adolescents aged 13 to 18 years with elevated symptoms on standardized depression or anxiety measures were eligible. Intent-to-treat analyses were used to analyze effects. Recruitment took place in June 2019; follow-up data were collected in August 2019 and February 2020.INTERVENTION Adolescents were randomized to the Shamiri intervention or to a study skills control. All adolescents in both conditions met in groups (mean group size, 9) for 60 minutes per week for 4 weeks. MAIN OUTCOMES AND MEASURES Primary outcomes were depression (Patient HealthQuestionnaire-8 item) and anxiety (Generalized Anxiety Disorder-7 item) symptoms. Analyses of imputed data were hypothesized to reveal significant reductions in depression and anxiety symptoms for adolescents assigned to Shamiri compared with those in the study skills group. RESULTSOf 413 adolescents, 205 (49.6%) were randomized to Shamiri and 208 (50.4%) to study skills. The mean (SD) age was 15.5 (1.2) years, and 268 (65.21%) were female. A total of 307 youths completed the 4-week intervention. Both Shamiri and study skills were rated highly useful (4.8/5.0) and reduced symptoms of depression and anxiety, but analyses with imputed data revealed that youths receiving Shamiri showed greater reductions in depressive symptoms at posttreatment (Cohen d = 0.35 [95% CI, 0.09-0.60]), 2-week follow-up (Cohen d = 0.28 [95% CI, 0.04-0.54]), and 7-month follow-up (Cohen d = 0.45 [95% CI, 0.19-0.71]) and greater reductions in anxiety symptoms at posttreatment (Cohen d = 0.37 [95% CI, 0.11-0.63]), 2-week follow-up (Cohen d = 0.26 [95% CI, −0.01 to 0.53]), and 7-month follow-up (Cohen d = 0.44 [95% CI, 0.18-0.71]).CONCLUSIONS AND RELEVANCE Both the Shamiri intervention and a study skills control group reduced depression and anxiety symptoms; the low-cost Shamiri intervention had a greater effect, with effects lasting at least 7 months. If attrition is reduced and the clinical significance of outcome differences is established, this kind of intervention may prove useful in other global settings where there are limited resources, mental illness stigma, or a shortage of professionals and limited access to mental health care.

Objectives: Depression and anxiety are leading causes of youth disability worldwide, yet our understanding of these conditions in Sub-Saharan African (SSA) youths is limited. Research has been sparse in SSA, and prevalence rates and correlates of these conditions remain scarcely investigated. To help address these gaps, this cross-sectional study assessed the prevalence of adolescent depression and anxiety symptoms in a community sample of high school students in Kenya. We also examined associations between those symptoms and psychosocial and sociodemographic factors. Methods: We administered self-report measures of depression and anxiety symptoms, social support, gratitude, growth mindsets, and life satisfaction to 658 students (51.37% female) aged 13 – 19.Results: Only the measures of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Screen-7), and social support (Multidimensional Scale for Perceived Social Support Scale) showed adequate internal consistency (Cronbach alpha > 0.70) in the study sample. Findings with these measures among 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.Conclusions: This study highlights the high prevalence of adolescent internalizing symptoms in Kenyan high school students, identifies important correlates of these symptoms, and illustrates the need for culturally appropriate assessment tools.

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