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.

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.

Several reports have suggested an increased prevalence of osteopenia and osteoporosis in HIV-infected individuals. Vitamin D deficiency may be a risk factor for osteoporosis and bone fractures. We aimed to determine the prevalence of vitamin D insufficiency in an outpatient HIV clinic in Boston. We collected serum levels of 25-OH vitamin D and evaluated calcium and vitamin D intake in adult HIV-positive outpatients during the winter and spring of 2005. Fifty-seven subjects were enrolled. The prevalence of moderate (< or = 20 and>10 ng/ml) and severe (< or =10 ng/ml) 25-OH vitamin D deficiency was 36.8% and 10.5%, respectively. Lower vitamin D intake was significantly associated with severe 25-OH vitamin D deficiency (p=0.01). Lactose intolerance tended to be associated with severe vitamin D deficiency (p=0.08). Antiretroviral use and low daily calcium intake were significantly associated with elevated parathyroid hormone levels (p=0.01 and 0.03, respectively). Vitamin D deficiency was frequent in ambulatory HIV-positive patients. HIV-infected individuals living in areas with low exposure to ultraviolet light during winter may benefit from vitamin D supplementation.

Background 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). Methods Four hundred twenty Kenyan adolescents (ages 13–18) with clinically elevated depression and/or anxiety symptoms will be randomized to either the 4-week Shamiri group intervention or a group study-skills control intervention of equal duration and dosage. Participating adolescents will meet in groups of 8–15, led by a high-school graduate trained to deliver Shamiri as a lay-provider. Adolescents will self-report primary outcome measures (depression—measured by the PHQ-8, and anxiety symptoms—measured by the GAD-7) and secondary outcome measures (perceived social support, perceived academic control, self-reported optimism and happiness, loneliness, and academic grades) at the 2-week intervention midpoint, 4-week post-intervention endpoint, and 2-week post-intervention follow-up. We predict that adolescents in the Shamiri group, when compared to the study-skills control group, will show greater improvements in primary outcomes and secondary outcomes. Discussion Results may suggest that a brief, lay-provider delivered, school-based intervention may reduce depression and anxiety symptoms, improving academic outcomes and other psychosocial outcomes in adolescents with clinically-elevated symptoms in sub-Saharan Africa. Trial registration Pan African Clinical Trials Registry PACTR201906525818462. Registered on 12 June 2019.

Background Loneliness, a transdiagnostic feature of psychopathology, is an experience of perceived isolation only weakly linked to the amount of time spent alone. Although traditional loneliness interventions aim to increase social contact, targeting maladaptive cognition about time alone may be an effective way to reduce loneliness. We investigated whether a brief reappraisal manipulation enables individuals to experience their time alone more positively. We also tested the impact of trait loneliness, compulsive social media use, and trait reappraisal on experiences of time alone. Methods College students and community members (N = 220) were randomly assigned to read a passage about the benefits of solitude (n = 74), the true prevalence of loneliness (n = 72), or a control topic (n = 74). Participants then sat alone for 10 min. Results Across conditions, positive and negative mood significantly decreased after sitting alone. Participants who read about the benefits of solitude experienced a smaller reduction in positive mood than those in the control condition. Participants who less frequently used reappraisal in their everyday lives benefited most from the manipulation. Conclusions Our results provide preliminary evidence that reappraising time alone as solitude may boost resilience to the decrements in positive mood associated with time alone. Limitations, clinical implications, and directions for future research are discussed.

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Background: We assessed the psychometric properties of standard Western-derived instruments, the prevalence of depression and anxiety symptoms and their associations with sociodemographic and psychosocial variables in a large sample of Kenyan adolescents. Methods: We administered self-report measures of depression (PHQ-8) and anxiety (GAD-7) symptoms, social support, gratitude, happiness, optimism and perceived control to 2,192 Kenyan youths (57.57% female) aged 12-19.Results: 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 the PHQ-8 and GAD-7, a subsequent CFA conducted on the basis of the 1-factor model on another sub-sample (N = 1096) yielded good goodness of fit for the PHQ-8 (2=76.73; p&lt;0.001; RMSEA=0.05; CFI=0.96; TLI=0.95) and GAD-7 (2=88.19; p&lt;0.001; RMSEA=0.07; CFI=0.97; TLI=0.95). Some 28.06% of participants met the clinical cut-off for depressive symptoms and 30.38% for anxiety symptoms. Social support, gratitude, happiness, optimism, and perceived control were negatively associated with symptoms. Older and female adolescents reported higher symptoms, while adolescents with three or more siblings reported lower symptoms. Limitations: Cross-sectional data no not allow us to investigate the onset, maintenance, and course of depressive and anxiety symptoms and our large sample was not randomly sampled.Conclusions: The western-derived PHQ and GAD met conventional psychometric standards with adolescents in sub-Saharan Africa; depression and anxiety symptoms showed relatively high prevalence and significant associations with important psychosocial and sociodemographic factors.

Background: Disentangling the impact of social media use on well-being is a priority for psychological research. Numerous studies suggest that active social media use (ASMU) enhances well-being, whereas passive social media use (PSMU) undermines it. However, such research has conducted group-level analyses, potentially obscuring individual differences. We examined person-centered relationships between SMU and depression symptoms by using a publicly available experience sampling dataset (Aalbers et al., 2019). Methods: Dutch undergraduate students (N = 125) reported PSMU, ASMU, and depression symptoms 7 times daily for 14 days. We (a) visualized interindividual variability in temporal associations between social media use and individual depression symptoms, (b) compared the aggregate network model to idiographic models, and (c) determined the distribution of person-specific temporal associations. Results: Overall, we found that associations between social media use and depression symptoms differed substantially from individual to individual in both strength and kind. In addition, PSMU and ASMU were very weakly to weakly associated with depression symptoms for most individuals. Conclusions: Studying idiographic relationships between social media use and depression may help us (1) determine which individuals are most at risk of experiencing elevated depression symptoms after using social media and (2) personalize therapeutic treatments to alleviate symptoms.