Christine Wasanga - Academia.edu (original) (raw)

Papers by Christine Wasanga

Background Developing low-cost, socio-culturally appropriate, and scalable interventions for yout... more 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 Kenyan adolescents (ages 13-18) with clinically elevated depression and/or anxiety symptoms will be randomized to either the four-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, improve academic outcomes and other psychosocial outcomes in adolescents with clinically-elevated symptoms in Sub-Saharan Africa.

BMC Health Services Research, Aug 4, 2023

Background Low-and middle-income countries (LMICs) have the highest socioeconomic burden of menta... more Background Low-and middle-income countries (LMICs) have the highest socioeconomic burden of mental health disorders, yet the fewest resources for treatment. Recently, many intervention strategies, including the use of brief, scalable interventions, have emerged as ways of reducing the mental health treatment gap in LMICs. But how do decision makers prioritize and optimize the allocation of limited resources? One approach is through the evaluation of delivery costs alongside intervention effectiveness of various types of interventions. Here, we evaluate the costeffectiveness of Shamiri, a group-and school-based intervention for adolescent depression and anxiety that is delivered by lay providers and that teaches growth mindset, gratitude, and value affirmation. Methods We estimated the cost-effectiveness of Shamiri using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines for economic evaluations. Changes in depression and anxiety were estimated using the Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder questionnaire (GAD-7) at treatment termination and 7-month follow-up using two definitions of treatment benefit. Cost-effectiveness metrics included effectiveness-cost ratios and cost per number needed to treat. Results Base case cost assumptions estimated that delivering Shamiri cost 15.17(in2021U.S.dollars)perstudent.Asensitivityanalysis,whichvariedcostandclinicalchangedefinitions,estimateditcostbetween15.17 (in 2021 U.S. dollars) per student. A sensitivity analysis, which varied cost and clinical change definitions, estimated it cost between 15.17(in2021U.S.dollars)perstudent.Asensitivityanalysis,whichvariedcostandclinicalchangedefinitions,estimateditcostbetween48.28 and $172.72 to help 1 student in Shamiri, relative to the control, achieve reliable and clinically significant change in depression and anxiety by 7-month follow-up. Conclusions Shamiri appears to be a low-cost intervention that can produce clinically meaningful reductions in depression and anxiety. Lay providers can deliver effective treatment for a fraction of the training time that is required to become a licensed mental health provider (10 days vs. multiple years), which is a strength from an economic perspective. Additionally, Shamiri produced reliable and clinically significant reductions in depression and anxiety after only four weekly sessions instead of the traditional 12-16 weekly sessions necessary for goldstandard cognitive behavioral therapy. The school setting, group format, and economic context of a LMIC influenced

Background: Developing low-cost, socio-culturally appropriate, and scalable interventions for you... more 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 highschool 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 postintervention 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.

Frontiers in Public Health, Feb 13, 2023

The violent colonial history of psychiatry in Africa prevents individuals from helpseeking. Becau... more The violent colonial history of psychiatry in Africa prevents individuals from helpseeking. Because of this history, mental health care is now stigmatized, and clinical research, practice, and policy fail to capture the salient features of distress across African communities. If we are to transform mental health care for all, we must adopt decolonizing frameworks to ensure mental health research, practice, and policy are enacted in a manner that is ethical, democratic, critical, and serves the needs of local communities. Here, we present that the network approach to psychopathology as an invaluable tool in achieving this purpose. The network approach recognizes mental health disorders not as discrete entities, but rather as dynamic networks that are made of psychiatric symptoms (called nodes) and the relationships between these symptoms (called edges). This approach can pave a path to decolonizing mental health care by alleviating stigma, allowing context-based understanding of mental health and mental health problems, opening new avenues for (low-cost) mental health care and empowering local researchers to pioneer context-based knowledge production and treatment.

Developing Country Studies, 2017

In Kenya recent community studies indicate (nacada,2012) indicate significant alcohol consumption... more In Kenya recent community studies indicate (nacada,2012) indicate significant alcohol consumption resulting in many deaths. Despite prevalence of alcohol abuse, few studies have been done on the challenges of alcohol abuse and its effect on the non-drinking spouse. Most past studies on effect on alcohol abuse on spousal relationship have focused on the role of spouse on facilitating or curtailing alcohol abuse of their spouses. The purpose of this study was to investigate the challenges of alcohol abuse and its effect in the marital relationship. The study was carried out in Ainamoi Division, Kericho County. To realize the purpose of the study a descriptive survey design was used and data was collected through questionnaires, interviews and focused group discussion. The target populations were people whose spouses' abuse alcohol and were selected using stratified and snowballing sampling procedures. The division was stratified into urban and rural so as to ensure comprehensive coverage of the area. Snowballing sampling was used to identify participants who led the researchers to others. A sample population of 144 respondents was used. Descriptive statistics was used to analyze quantitative data with the help of the Statistical Packages for Social Science (SPSS). The qualitative data was summarized into themes in line with the study objectives and thematic analysis done. The research found out that alcohol abuse causes many challenges for example it causes failure in communication, financial problems, resentments, domestic violence among others which affect the spousal relationship. The research recommends that there is need to sensitize non-drinking spouses on the psychosocial challenges of alcohol abuse on the spousal relationship. There is also need for establishment of counseling centers in more places in order the address the alcohol problem. This would assist non-alcoholic spouses to cope with alcohol abuse in a more effective way.

Frontiers in Psychiatry, Nov 17, 2022

Globally, over , people die by suicide every year. For every one completed suicide, more attempts... more Globally, over , people die by suicide every year. For every one completed suicide, more attempts have been made. As previous attempts are one of the strongest predictors of future suicide, help-seeking in moments of crisis, particularly after an attempt, may have important implications for suicide prevention. Unfortunately, the criminalization of suicide in several countries hinders help-seeking, increases the stigmatization of those who attempt suicide and obstructs the accurate tracking of suicides. Here, we highlight the negative e ects of suicide criminalization and discuss evidence-based strategies for suicide prevention such as means restriction, improved mental health literacy and access to psychosocial support, and responsible media coverage of suicides.

Introduction: Low levels of mental health literacy amongst parents can have negative effects on y... more Introduction: Low levels of mental health literacy amongst parents can have negative effects on youth mental wellbeing and help-seeking behaviors. Here, we explored the impact of a brief psychoeducational workshop on improving parent mental health literacy and family relationships in Kibera, a low-resource high-risk setting in Nairobi, Kenya. Methods: The workshop was designed to address this issue, and it was delivered by trained facilitators to small groups of parents (N=72). Data was collected at baseline, post-workshop, two-week follow-up, and one-month follow-up. Results: Statistical and thematic analysis of the data revealed significant improvements in parent mental health literacy scores and family relationships, indicating the acceptability and effectiveness of this workshop. Discussion: The findings suggest that brief, group-based psychoeducational workshops can be effective in improving parent mental health literacy and family relationships, thereby addressing challenges faced by parents and youth in the Kenyan context. Future studies are needed to conclusively determine if such workshops can improve participants' own mental health or their perception of child behavior.

Background: Research dedicated to youth mental health problems in low-resource countries is an ur... more Background: Research dedicated to youth mental health problems in low-resource countries is an urgent and critical global health priority. Prior to COVID-19, only a handful of studies had estimated the prevalence rates of youth depression and anxiety and identified the associations between these problems with socio-demographic and psychosocial variables. As COVID-19 has emerged as a stressor for youth mental health, new studies on youth mental health during and post COVID-19 may yield important research, policy, and practice implications. Here, we assessed the prevalence of depression and anxiety symptoms and their associations with psychosocial and sociodemographic variables in a large sample of school-going youths in Kenya. Method: Measures of depression (PHQ-8) and anxiety (GAD-7), social support, perseverance, optimism, perceived control, connectedness, happiness, purpose in life, and gratitude were administered to 1,498 Kenyan adolescents (55.47% male) aged 13-to-21 years (M age = 16.33) in mid-2021 when schools reopened after the COVID-19 school closures. Results: Some 42.46% and 37.56% youths met the clinical cutoff for elevated depression and anxiety symptoms, respectively. Adolescents whose academic performance was not satisfactory endorsed higher depressive and anxiety symptoms. Female adolescents and those who lived with a single parent endorsed higher depressive and anxiety symptoms, respectively. Subjective wellbeing and perceived control were negatively associated with depressive symptoms. Conclusion: The prevalence of depression and anxiety symptoms among Kenyan adolescents has remained steady when compared to pre-pandemic studies. However, symptoms were high when compared to those of adolescents in other countries during COVID-19. This study also identified potential important risk and protective factors.

Trials, May 25, 2022

Background: Adolescents in low-and middle-income countries in need of mental health care often do... more Background: Adolescents in low-and middle-income countries in need of mental health care often do not receive it due to stigma, cost, and lack of mental health professionals. Culturally appropriate, brief, and low-cost interventions delivered by lay-providers can help overcome these barriers and appear effective at reducing symptoms of depression and anxiety until several months post-intervention. However, little is known about whether these interventions may have long-term effects on health, mental health, social, or academic outcomes. Methods: Three previous randomized controlled trials of the Shamiri intervention, a 4-week, group-delivered, layprovider-led intervention, have been conducted in Kenyan high schools. Shamiri teaches positively focused intervention elements (i.e., growth mindset and strategies for growth, gratitude, and value affirmation) to target symptoms of depression and anxiety and to improve academic performance and social relationships, by fostering character strengths. In this long-term follow-up study, we will test whether these mental health, academic, social, and characterstrength outcomes, along with related health outcomes (e.g., sleep quality, heart-rate variability and activity level measured via wearables, HIV risk behaviors, alcohol and substance use), differ between the intervention and control group at 3-4-year follow-up. For primary analyses (N anticipated = 432), youths who participated in the three previous trials will be contacted again to assess whether outcomes at 3-4-year-follow-up differ for those in the Shamiri Intervention group compared to those in the study-skills active control group. Multi-level models will be used to model trajectories over time of primary outcomes and secondary outcomes that were collected in previous trials. For outcomes only collected at 3-4-year follow-up, tests of location difference (e.g., t-tests) will be used to assess group differences in metric outcomes and difference tests (e.g., odds ratios) will be used to assess differences in categorical outcomes. Finally, standardized effect sizes will be used to compare groups on all measures. Discussion: This follow-up study of participants from three randomized controlled trials of the Shamiri intervention will provide evidence bearing on the long-term and health and mental health effects of brief, lay-provider-delivered character strength interventions for youth in low-and middle-income countries.

Globally there is ample evidence that human conflicts are common worldwide and human beings who h... more Globally there is ample evidence that human conflicts are common worldwide and human beings who have been subjected to traumatic events associated with ww; conflicts and collective violence experience serious psycho-social consequences. One such conflict was tlul()()7 Post Flection Violence (PEV) that res lilted in death, displacement. immense losses and traumatic events that caused serious psychological distress. This study was designed to ..:.\/;!ore the psycho-social challenges facing the Internally Displaced People (lOPs) in Maai-Maluu camp in the R iji Valley, Kenya. Specifically. the study sought to establish the levels oj depression among the lOP s and the psychosocial challenges that they were experiencing. The target population comprised of 277 adult male and female lOPs in Maai Mahiu camp. Respondent driven sampling strategy (ROS) was used to identify a sample size of 1401DPs. To assess the levels of depression among the lOP s, Beck s Depression Inventory (BDI) was administered. Focus group discussions were used to obtain information 011 the psychosocial challenges thev were experiencing. Findings indicated that the levels of depression were quite high: 82% of the respondents were depressed: 4 I % were severelv depressed. 30% were moderately depressed while 11% had mild depression. 111 addition to being depressed, the lOP :\. were also experiencing other psychological distresses such as few; despair; lack of sleep and isolation. Other identified challenges were lack of basic needs and social amenities. It was recommended that the lOP s be resettled as soon as possible to resume a semblance of normal life and psvrhological interventions he mounted to help those undergoing depression and other pSI 'CIwlogical disorders.

Research Square (Research Square), Sep 4, 2020

BMC Health Services Research

Background Low- and middle-income countries (LMICs) have the highest socio-economic burden of men... more Background Low- and middle-income countries (LMICs) have the highest socio-economic burden of mental health disorders, yet the fewest resources for treatment. Recently, many intervention strategies, including the use of brief, scalable interventions, have emerged as ways of reducing the mental health treatment gap in LMICs. But how do decision makers prioritize and optimize the allocation of limited resources? One approach is through the evaluation of delivery costs alongside intervention effectiveness of various types of interventions. Here, we evaluate the cost-effectiveness of Shamiri, a group– and school–based intervention for adolescent depression and anxiety that is delivered by lay providers and that teaches growth mindset, gratitude, and value affirmation. Methods We estimated the cost-effectiveness of Shamiri using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines for economic evaluations. Changes in depression and anxiety were estimated us...

Background: Depressive and anxiety symptoms significantly impact the well-being of African youth.... more Background: Depressive and anxiety symptoms significantly impact the well-being of African youth. This problem is compounded by limited access to appropriate mental health care services and societal stigma. In addressing this issue in Kenya, we employed the network approach to psychopathology to identity the most significant symptoms of depression and anxiety. These network analyses revealed self-blame and depressed mood in the depression network, as well as too much worry and uncontrollable worry in the anxiety network. Consequently, we identified mindfulness-based interventions, particularly the Learning to Breathe (L2B) program, as effective tools to mitigate these influential symptoms and potentially reduce the prevalence of overall depressive and anxiety symptoms. We adapted and modified the L2B program into the Shamiri Mindfulness Intervention, tailored for the Kenyan context. This pilot aims to assess the impact of the Shamiri Mindfulness Intervention on participants' min...

Background: Adolescents in the juvenile justice system are vulnerable to mental health problems, ... more Background: Adolescents in the juvenile justice system are vulnerable to mental health problems, a challenge that is exacerbated by the rehabilitation methods used in these settings. There is a need to understand adolescent mental health in juvenile detention settings with an emphasis on possible interventions that can improve adolescent mental health while incarcerated. This scoping review aims to identify mental health interventions in the juvenile justice system. Methods: We conducted a scoping review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist used to guide reporting. A search was conducted on the PsycINFO and Google scholar databases for original research articles published between 1990 and 2021. Results: Our search generated 3575 studies; 3506 were excluded after screening. Sixty-nine articles met the inclusion criteria after the first screening. A second review narrowed this to 23 studies. T...

The problem of delinquency in adolescence is a worldwide social phenomenon. Of most concern is th... more The problem of delinquency in adolescence is a worldwide social phenomenon. Of most concern is the impact of delinquency on the adolescence, theirfamilies, and the society at large, and the relationship between delinquency and adult crime. It has been argued that delinquency leads to adult crime and therefore a life long career. There is need therefore to deal with adolescence delinquency to curb the trend ofadolescents maturing to adulthood with criminal behaviors. The government of Kenya has established rehabilitation schools with the aim of correcting and reforming the delinquent adolescents into adjusted productive citizens. The rehabilitation schools have programs designed to meet this objective. This paper aimed at assessing thefactors related to the effectiveness of rehabilitation schools with particular attention to parents' involvement and adolescents perception towards rehabilitation schools and recommend measures that can increase their effectiveness. This is against ...

The purpose of the study was to establish the role and practice of cognitive restructuring in man... more The purpose of the study was to establish the role and practice of cognitive restructuring in managing psychological well-being of secondary school teachers. Methodology: A desktop review research design was applied. The researcher used Google Scholar to track out the essential readings and scholarly publications that would form the basis of their investigation. In order to satisfy the requirements for inclusion, only papers that were published within the prior ten years were considered. Findings: The findings of the study showed that cognitive restructuring has a favorable and significant impact on the psychological well-being of instructors. Unique Contribution to Theory, Policy and Practice: The research found that encouraging psychologists and guidance counselors to employ cognitive restructuring and assertive therapy was one of the most effective ways to reduce depressed tendencies. In addition, reducing levels of stress and burnout as a result of the increased pressure from test-based accountability procedures in teachers should be a primary goal of programs designed to address the psychological health of secondary school instructors.

Background Developing low-cost, socio-culturally appropriate, and scalable interventions for yout... more 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 Kenyan adolescents (ages 13-18) with clinically elevated depression and/or anxiety symptoms will be randomized to either the four-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, improve academic outcomes and other psychosocial outcomes in adolescents with clinically-elevated symptoms in Sub-Saharan Africa.

BMC Health Services Research, Aug 4, 2023

Background Low-and middle-income countries (LMICs) have the highest socioeconomic burden of menta... more Background Low-and middle-income countries (LMICs) have the highest socioeconomic burden of mental health disorders, yet the fewest resources for treatment. Recently, many intervention strategies, including the use of brief, scalable interventions, have emerged as ways of reducing the mental health treatment gap in LMICs. But how do decision makers prioritize and optimize the allocation of limited resources? One approach is through the evaluation of delivery costs alongside intervention effectiveness of various types of interventions. Here, we evaluate the costeffectiveness of Shamiri, a group-and school-based intervention for adolescent depression and anxiety that is delivered by lay providers and that teaches growth mindset, gratitude, and value affirmation. Methods We estimated the cost-effectiveness of Shamiri using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines for economic evaluations. Changes in depression and anxiety were estimated using the Patient Health Questionnaire (PHQ-8) and Generalized Anxiety Disorder questionnaire (GAD-7) at treatment termination and 7-month follow-up using two definitions of treatment benefit. Cost-effectiveness metrics included effectiveness-cost ratios and cost per number needed to treat. Results Base case cost assumptions estimated that delivering Shamiri cost 15.17(in2021U.S.dollars)perstudent.Asensitivityanalysis,whichvariedcostandclinicalchangedefinitions,estimateditcostbetween15.17 (in 2021 U.S. dollars) per student. A sensitivity analysis, which varied cost and clinical change definitions, estimated it cost between 15.17(in2021U.S.dollars)perstudent.Asensitivityanalysis,whichvariedcostandclinicalchangedefinitions,estimateditcostbetween48.28 and $172.72 to help 1 student in Shamiri, relative to the control, achieve reliable and clinically significant change in depression and anxiety by 7-month follow-up. Conclusions Shamiri appears to be a low-cost intervention that can produce clinically meaningful reductions in depression and anxiety. Lay providers can deliver effective treatment for a fraction of the training time that is required to become a licensed mental health provider (10 days vs. multiple years), which is a strength from an economic perspective. Additionally, Shamiri produced reliable and clinically significant reductions in depression and anxiety after only four weekly sessions instead of the traditional 12-16 weekly sessions necessary for goldstandard cognitive behavioral therapy. The school setting, group format, and economic context of a LMIC influenced

Background: Developing low-cost, socio-culturally appropriate, and scalable interventions for you... more 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 highschool 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 postintervention 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.

Frontiers in Public Health, Feb 13, 2023

The violent colonial history of psychiatry in Africa prevents individuals from helpseeking. Becau... more The violent colonial history of psychiatry in Africa prevents individuals from helpseeking. Because of this history, mental health care is now stigmatized, and clinical research, practice, and policy fail to capture the salient features of distress across African communities. If we are to transform mental health care for all, we must adopt decolonizing frameworks to ensure mental health research, practice, and policy are enacted in a manner that is ethical, democratic, critical, and serves the needs of local communities. Here, we present that the network approach to psychopathology as an invaluable tool in achieving this purpose. The network approach recognizes mental health disorders not as discrete entities, but rather as dynamic networks that are made of psychiatric symptoms (called nodes) and the relationships between these symptoms (called edges). This approach can pave a path to decolonizing mental health care by alleviating stigma, allowing context-based understanding of mental health and mental health problems, opening new avenues for (low-cost) mental health care and empowering local researchers to pioneer context-based knowledge production and treatment.

Developing Country Studies, 2017

In Kenya recent community studies indicate (nacada,2012) indicate significant alcohol consumption... more In Kenya recent community studies indicate (nacada,2012) indicate significant alcohol consumption resulting in many deaths. Despite prevalence of alcohol abuse, few studies have been done on the challenges of alcohol abuse and its effect on the non-drinking spouse. Most past studies on effect on alcohol abuse on spousal relationship have focused on the role of spouse on facilitating or curtailing alcohol abuse of their spouses. The purpose of this study was to investigate the challenges of alcohol abuse and its effect in the marital relationship. The study was carried out in Ainamoi Division, Kericho County. To realize the purpose of the study a descriptive survey design was used and data was collected through questionnaires, interviews and focused group discussion. The target populations were people whose spouses' abuse alcohol and were selected using stratified and snowballing sampling procedures. The division was stratified into urban and rural so as to ensure comprehensive coverage of the area. Snowballing sampling was used to identify participants who led the researchers to others. A sample population of 144 respondents was used. Descriptive statistics was used to analyze quantitative data with the help of the Statistical Packages for Social Science (SPSS). The qualitative data was summarized into themes in line with the study objectives and thematic analysis done. The research found out that alcohol abuse causes many challenges for example it causes failure in communication, financial problems, resentments, domestic violence among others which affect the spousal relationship. The research recommends that there is need to sensitize non-drinking spouses on the psychosocial challenges of alcohol abuse on the spousal relationship. There is also need for establishment of counseling centers in more places in order the address the alcohol problem. This would assist non-alcoholic spouses to cope with alcohol abuse in a more effective way.

Frontiers in Psychiatry, Nov 17, 2022

Globally, over , people die by suicide every year. For every one completed suicide, more attempts... more Globally, over , people die by suicide every year. For every one completed suicide, more attempts have been made. As previous attempts are one of the strongest predictors of future suicide, help-seeking in moments of crisis, particularly after an attempt, may have important implications for suicide prevention. Unfortunately, the criminalization of suicide in several countries hinders help-seeking, increases the stigmatization of those who attempt suicide and obstructs the accurate tracking of suicides. Here, we highlight the negative e ects of suicide criminalization and discuss evidence-based strategies for suicide prevention such as means restriction, improved mental health literacy and access to psychosocial support, and responsible media coverage of suicides.

Introduction: Low levels of mental health literacy amongst parents can have negative effects on y... more Introduction: Low levels of mental health literacy amongst parents can have negative effects on youth mental wellbeing and help-seeking behaviors. Here, we explored the impact of a brief psychoeducational workshop on improving parent mental health literacy and family relationships in Kibera, a low-resource high-risk setting in Nairobi, Kenya. Methods: The workshop was designed to address this issue, and it was delivered by trained facilitators to small groups of parents (N=72). Data was collected at baseline, post-workshop, two-week follow-up, and one-month follow-up. Results: Statistical and thematic analysis of the data revealed significant improvements in parent mental health literacy scores and family relationships, indicating the acceptability and effectiveness of this workshop. Discussion: The findings suggest that brief, group-based psychoeducational workshops can be effective in improving parent mental health literacy and family relationships, thereby addressing challenges faced by parents and youth in the Kenyan context. Future studies are needed to conclusively determine if such workshops can improve participants' own mental health or their perception of child behavior.

Background: Research dedicated to youth mental health problems in low-resource countries is an ur... more Background: Research dedicated to youth mental health problems in low-resource countries is an urgent and critical global health priority. Prior to COVID-19, only a handful of studies had estimated the prevalence rates of youth depression and anxiety and identified the associations between these problems with socio-demographic and psychosocial variables. As COVID-19 has emerged as a stressor for youth mental health, new studies on youth mental health during and post COVID-19 may yield important research, policy, and practice implications. Here, we assessed the prevalence of depression and anxiety symptoms and their associations with psychosocial and sociodemographic variables in a large sample of school-going youths in Kenya. Method: Measures of depression (PHQ-8) and anxiety (GAD-7), social support, perseverance, optimism, perceived control, connectedness, happiness, purpose in life, and gratitude were administered to 1,498 Kenyan adolescents (55.47% male) aged 13-to-21 years (M age = 16.33) in mid-2021 when schools reopened after the COVID-19 school closures. Results: Some 42.46% and 37.56% youths met the clinical cutoff for elevated depression and anxiety symptoms, respectively. Adolescents whose academic performance was not satisfactory endorsed higher depressive and anxiety symptoms. Female adolescents and those who lived with a single parent endorsed higher depressive and anxiety symptoms, respectively. Subjective wellbeing and perceived control were negatively associated with depressive symptoms. Conclusion: The prevalence of depression and anxiety symptoms among Kenyan adolescents has remained steady when compared to pre-pandemic studies. However, symptoms were high when compared to those of adolescents in other countries during COVID-19. This study also identified potential important risk and protective factors.

Trials, May 25, 2022

Background: Adolescents in low-and middle-income countries in need of mental health care often do... more Background: Adolescents in low-and middle-income countries in need of mental health care often do not receive it due to stigma, cost, and lack of mental health professionals. Culturally appropriate, brief, and low-cost interventions delivered by lay-providers can help overcome these barriers and appear effective at reducing symptoms of depression and anxiety until several months post-intervention. However, little is known about whether these interventions may have long-term effects on health, mental health, social, or academic outcomes. Methods: Three previous randomized controlled trials of the Shamiri intervention, a 4-week, group-delivered, layprovider-led intervention, have been conducted in Kenyan high schools. Shamiri teaches positively focused intervention elements (i.e., growth mindset and strategies for growth, gratitude, and value affirmation) to target symptoms of depression and anxiety and to improve academic performance and social relationships, by fostering character strengths. In this long-term follow-up study, we will test whether these mental health, academic, social, and characterstrength outcomes, along with related health outcomes (e.g., sleep quality, heart-rate variability and activity level measured via wearables, HIV risk behaviors, alcohol and substance use), differ between the intervention and control group at 3-4-year follow-up. For primary analyses (N anticipated = 432), youths who participated in the three previous trials will be contacted again to assess whether outcomes at 3-4-year-follow-up differ for those in the Shamiri Intervention group compared to those in the study-skills active control group. Multi-level models will be used to model trajectories over time of primary outcomes and secondary outcomes that were collected in previous trials. For outcomes only collected at 3-4-year follow-up, tests of location difference (e.g., t-tests) will be used to assess group differences in metric outcomes and difference tests (e.g., odds ratios) will be used to assess differences in categorical outcomes. Finally, standardized effect sizes will be used to compare groups on all measures. Discussion: This follow-up study of participants from three randomized controlled trials of the Shamiri intervention will provide evidence bearing on the long-term and health and mental health effects of brief, lay-provider-delivered character strength interventions for youth in low-and middle-income countries.

Globally there is ample evidence that human conflicts are common worldwide and human beings who h... more Globally there is ample evidence that human conflicts are common worldwide and human beings who have been subjected to traumatic events associated with ww; conflicts and collective violence experience serious psycho-social consequences. One such conflict was tlul()()7 Post Flection Violence (PEV) that res lilted in death, displacement. immense losses and traumatic events that caused serious psychological distress. This study was designed to ..:.\/;!ore the psycho-social challenges facing the Internally Displaced People (lOPs) in Maai-Maluu camp in the R iji Valley, Kenya. Specifically. the study sought to establish the levels oj depression among the lOP s and the psychosocial challenges that they were experiencing. The target population comprised of 277 adult male and female lOPs in Maai Mahiu camp. Respondent driven sampling strategy (ROS) was used to identify a sample size of 1401DPs. To assess the levels of depression among the lOP s, Beck s Depression Inventory (BDI) was administered. Focus group discussions were used to obtain information 011 the psychosocial challenges thev were experiencing. Findings indicated that the levels of depression were quite high: 82% of the respondents were depressed: 4 I % were severelv depressed. 30% were moderately depressed while 11% had mild depression. 111 addition to being depressed, the lOP :\. were also experiencing other psychological distresses such as few; despair; lack of sleep and isolation. Other identified challenges were lack of basic needs and social amenities. It was recommended that the lOP s be resettled as soon as possible to resume a semblance of normal life and psvrhological interventions he mounted to help those undergoing depression and other pSI 'CIwlogical disorders.

Research Square (Research Square), Sep 4, 2020

BMC Health Services Research

Background Low- and middle-income countries (LMICs) have the highest socio-economic burden of men... more Background Low- and middle-income countries (LMICs) have the highest socio-economic burden of mental health disorders, yet the fewest resources for treatment. Recently, many intervention strategies, including the use of brief, scalable interventions, have emerged as ways of reducing the mental health treatment gap in LMICs. But how do decision makers prioritize and optimize the allocation of limited resources? One approach is through the evaluation of delivery costs alongside intervention effectiveness of various types of interventions. Here, we evaluate the cost-effectiveness of Shamiri, a group– and school–based intervention for adolescent depression and anxiety that is delivered by lay providers and that teaches growth mindset, gratitude, and value affirmation. Methods We estimated the cost-effectiveness of Shamiri using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guidelines for economic evaluations. Changes in depression and anxiety were estimated us...

Background: Depressive and anxiety symptoms significantly impact the well-being of African youth.... more Background: Depressive and anxiety symptoms significantly impact the well-being of African youth. This problem is compounded by limited access to appropriate mental health care services and societal stigma. In addressing this issue in Kenya, we employed the network approach to psychopathology to identity the most significant symptoms of depression and anxiety. These network analyses revealed self-blame and depressed mood in the depression network, as well as too much worry and uncontrollable worry in the anxiety network. Consequently, we identified mindfulness-based interventions, particularly the Learning to Breathe (L2B) program, as effective tools to mitigate these influential symptoms and potentially reduce the prevalence of overall depressive and anxiety symptoms. We adapted and modified the L2B program into the Shamiri Mindfulness Intervention, tailored for the Kenyan context. This pilot aims to assess the impact of the Shamiri Mindfulness Intervention on participants' min...

Background: Adolescents in the juvenile justice system are vulnerable to mental health problems, ... more Background: Adolescents in the juvenile justice system are vulnerable to mental health problems, a challenge that is exacerbated by the rehabilitation methods used in these settings. There is a need to understand adolescent mental health in juvenile detention settings with an emphasis on possible interventions that can improve adolescent mental health while incarcerated. This scoping review aims to identify mental health interventions in the juvenile justice system. Methods: We conducted a scoping review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist used to guide reporting. A search was conducted on the PsycINFO and Google scholar databases for original research articles published between 1990 and 2021. Results: Our search generated 3575 studies; 3506 were excluded after screening. Sixty-nine articles met the inclusion criteria after the first screening. A second review narrowed this to 23 studies. T...

The problem of delinquency in adolescence is a worldwide social phenomenon. Of most concern is th... more The problem of delinquency in adolescence is a worldwide social phenomenon. Of most concern is the impact of delinquency on the adolescence, theirfamilies, and the society at large, and the relationship between delinquency and adult crime. It has been argued that delinquency leads to adult crime and therefore a life long career. There is need therefore to deal with adolescence delinquency to curb the trend ofadolescents maturing to adulthood with criminal behaviors. The government of Kenya has established rehabilitation schools with the aim of correcting and reforming the delinquent adolescents into adjusted productive citizens. The rehabilitation schools have programs designed to meet this objective. This paper aimed at assessing thefactors related to the effectiveness of rehabilitation schools with particular attention to parents' involvement and adolescents perception towards rehabilitation schools and recommend measures that can increase their effectiveness. This is against ...

The purpose of the study was to establish the role and practice of cognitive restructuring in man... more The purpose of the study was to establish the role and practice of cognitive restructuring in managing psychological well-being of secondary school teachers. Methodology: A desktop review research design was applied. The researcher used Google Scholar to track out the essential readings and scholarly publications that would form the basis of their investigation. In order to satisfy the requirements for inclusion, only papers that were published within the prior ten years were considered. Findings: The findings of the study showed that cognitive restructuring has a favorable and significant impact on the psychological well-being of instructors. Unique Contribution to Theory, Policy and Practice: The research found that encouraging psychologists and guidance counselors to employ cognitive restructuring and assertive therapy was one of the most effective ways to reduce depressed tendencies. In addition, reducing levels of stress and burnout as a result of the increased pressure from test-based accountability procedures in teachers should be a primary goal of programs designed to address the psychological health of secondary school instructors.