Adolescent depression and anxiety—which are linked with many negative life outcomes—are prevalent around the world, particularly in low-income countries such as those in Sub Saharan Africa (SSA). We used network analysis to examine the topology, stability, and centrality of depression and anxiety symptoms. We analyzed data from a large community sample (N = 2,192) of Kenyan adolescents aged 13-18, using the Patient Health Questionnaire and the Generalized Anxiety Disorder Screener. We identified the central symptoms of the depression and anxiety symptom networks, and we compared the structure and connectivity of these networks between low-symptom and elevated-symptom sub-samples. Our findings indicate the most central depression symptoms were “self-blame” and “depressed mood”, while the strongest depression symptom associations were “self-blame” ––“depressed mood” and “trouble concentrating” ––“little interest/pleasure”. Similarly, the most central anxiety symptoms were “too much worry” and “uncontrollable worry”, while strongest anxiety symptom associations were “too much worry” ––“uncontrollable worry” and “trouble relaxing” ––“restlessness”. We found a statistical difference in the network structure between low-symptom and elevated-symptom adolescents. The low-symptom sample had higher network connectivity scores for both depression (global strength difference = 0.30; low-symptom = 0.49; high-symptom = 0.19; p = .003) and anxiety symptoms (global strength difference = 1.04; low-symptom = 1.57; high-symptom = 0.53; p < .001). This is the first report that uses network analysis techniques to identify central symptoms of adolescent depression and anxiety in SSA. Our findings illustrate how network analysis may inform understanding of psychopathology within cultures and suggest promising treatment targets.

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<0.001; RMSEA=0.05; CFI=0.96; TLI=0.95) and GAD-7 (2=88.19; p<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.

Internalizing symptoms are common and debilitating among adolescents. Network analysis, which models associations among psychopathology, risk factors, and protective factors, may help clarify relationships between social support and internalizing symptoms, including within understudied cultural groups. We performed network analyses of 1) depressive and anxiety symptoms, 2) social support, and 3) all three measures among 658 Kenyan adolescents. In the internalizing symptoms network, worry, nervousness, and feeling down exhibited the highest expected influence. In the social support network, friends showed the greatest expected influence. In the full network, social support from family, friends, and significant others were all negatively associated with internalizing symptoms, and feeling down was a particularly important bridge node between internalizing symptoms and social support. Our findings suggest that feeling down is closely linked to social support in this sample of Kenyan adolescents. The study illustrates the potential of network analysis to aid understanding of psychopathology cross-culturally.

-Adolescent mental health problems—which are associated with many negative life outcomes—are prevalent in low-income regions such as those in Sub Saharan Africa (SSA) yet many youths suffering from these problems never get treatment.-Existing treatments are inaccessible to SSA youths because they are long, costly, and require expert delivery in a setting where incomes are low, and a paucity of caregivers exist and where social stigma limits help-seeking.-Most of the efforts to develop interventions for youth mental have been led by researchers from Western high-income countries and can be criticized as socio-culturally inappropriate and costly. -To guide intervention development efforts, we propose a four-step approach that encourages researchers to develop mental health interventions that are simple, stigma-free, scalable and school-based. Through this four-step approach, researchers can expand mental healthcare access in SSA by developing interventions that circumvent existing barriers.

Objective: Loneliness is associated with negative mental health outcomes and is particularly common among adolescents. Yet, little is known about the dynamics of adolescent loneliness in non-Western, low-income nations. Accordingly, we estimated the severity of loneliness in a sample of Kenyan adolescents and used mixed-effects regression modelling to determine the socio-cultural factors associated with loneliness. We also used network analysis to examine the associations between loneliness, depression, and anxiety at the symptom-level. Method: We analyzed data from a large sample (N = 2,192) of school-attending Kenyan adolescents aged 1219 (58.3% Female, 41.7% Male). Standardized measures of loneliness (ULS-8), depression (PHQ-8), and anxiety (GAD-7) were used. Results: Our mixed-effects model revealed that female and lower-income adolescents felt lonelier. The perception of feeling alone emerged as the aspect of loneliness most strongly linked to depression and anxiety symptoms. Conclusions: Our findings establish an estimate of loneliness levels in Kenyan adolescents, and reveal sociocultural factors associated with loneliness. We found that perceptions of isolation more strongly linked loneliness to psychopathology than did objective measures of isolation or preferences for social contact. Finally, we identify specific aspects of loneliness that could prove to be treatment targets for youth psychopathology; however, further research is needed. Limitations, future directions, and clinical implications are discussed.

Background: Individual symptoms of mood disorders have been shown to have unique associations with other symptoms. However, little is known about which symptoms are most strongly associated with a) other internalizing symptoms and b) “positive” indicators of mental health, such as happiness. Methods: To better understand these relationships, we applied network analyses in a sample of Indian adolescents (Study 1; n=1,080) and replicated these analyses in a pre-registered study with Kenyan adolescents (Study 2; n=2,176). Participants from both samples completed the same measures of depressive symptoms, anxiety symptoms, and happiness. Results: We found that internalizing symptoms formed a separate cluster from the happiness items. Worrying, feeling nervous, feeling sad, and feeling like a failure had the strongest associations with other symptoms. Feeling sad and feeling like a failure had the strongest (negative) associations with happiness items. Main findings were consistent across the two samples, suggesting a cross-culturally robust pattern. Limitations: We used cross-sectional data, and we administered scales assessing a limited subset of symptoms and happiness items. Conclusions: Overall, our findings support the idea that certain internalizing symptoms are more strongly associated with happiness. These findings contribute to a body of literature emphasizing the advantages of symptom-level analyses and the importance of paying attention to individual internalizing symptoms. We discuss how efforts to understand associations between individual symptoms and “positive” mental health indicators, like happiness, could have theoretical and practical implications for clinical psychological science.