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 WHO also estimates that half of all mental illness begins by the age of 14, affect 10–20% children and adolescents worldwide. Most of these 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, leading to high role impairment that affects the quality of life the individuals lead.
Compounding the problem is that there are large gaps in data on the burden (prevalence) of mental disorders in low- and middle-income countries such as Kenya, thereby depriving countries of critical information required to plan and deliver effective interventions. Little information is available on the burden of mental illness in Kenya, and whatever is available is not disaggregated by age. As a result, it is only possible to roughly estimate the scale of the problem based on small-scale studies and data from the developed world, a situation that is 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 data on cause of death. As a result, any cause of death is not always captured in Kenya’s official records. 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 (KNBS) reports 421 deaths from suicide in its 2018 report. 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.
Gathering data on mental health may be challenging. On the one hand, mental health problems are mostly under-reported across all countries and particularly in lower income countries where there is less attention for mental health problems.
Symptoms of mental illnesses are often under-diagnosed because they are not recognized or are wrongly attributed to spiritual or behavioral issues. Fear of stigma and/or abuse stemming from acknowledging symptoms of mental illness may also prevent young people from reporting. Gathering data on people younger than 18 years always has ethical considerations including the need for parental consent. However, seeking parental consent can make young people vulnerable to stigma from their own families unless carefully implemented. Fears of legal culpability may also hinder self-reports of suicide attempts.
Knowledge of the prevalence of child and adolescent mental health problems is the 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. To this end, 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 of services to address the burden of mental disorders in Kenya.
The Kenya National Adolescent Mental Health Survey (K-NAMHS) is a three-year study funded by a grant from Pivotal Ventures through a sub-grant from the University of Queensland. The objectives of the survey are:
- To determine the prevalence of mental health conditions among adolescents age 10-17 years. Mental health conditions of interest include major depressive disorders (MDD), generalized anxiety disorder (GAD), attention-deficit/ hyperactivity disorder (ADHD), social phobia, and conduct disorder (CD).
- To identify risk and protective factors for adolescent mental disorders.
- To provide an evidence base for health priority setting.
- The inclusion of data into the Global Burden of Disease analysis/estimates.
The study which will be conducted between 2019 and 2021 will test the reliability and validity of an updated lay-interviewer administered tool (DISC-5) in screening for mental health conditions in children and adolescents in Kenya. It will provide prevalence data on adolescent mental health disorders and identifies risk and protective factors for AMH.
Ultimately, it is hoped that this new data/evidence on the burden of child and adolescent mental health will lead to improved ability to design and implement effective and age-appropriate mental health services in Kenya that will improve their quality of life of young people in the country. This study also comes at the right time following the launch of the Kenya Mental Health Policy 2015-2030 which seeks to destigmatize, decriminalize and deinstitutionalize mental health concerns while ‘giving them high priority owing to the impact they have on a patient’s life as well as the socioeconomic development of the nation’. As such, we hope the findings of the study will be easier to adopt and operationalize into programs for child and adolescent mental health.