How Has COVID-19-Related Income Loss and Household Stress Affected Adolescent Mental Health in Kenya?

Abstract

Background: Adolescent mental health has been under-researched, particularly in Africa. COVID-19 related household economic stress, coupled with school closures, will likely have adverse effects on adolescent mental health. We investigate the relationship between adolescent mental health, adult income loss, and household dynamics during the pandemic in Kenya. Methods: A mobile phone-based survey was conducted with one adult and adolescent (age 10-19 years) pair from a sample of households identified through previous cohort studies in three Kenyan counties (Nairobi, Kilifi, Kisumu). Survey questions covered education, physical and mental health, and COVID-19 related impacts on job loss, food insecurity, and healthcare seeking. Logistic regression models were fit to explore relationships between adult income loss, household dynamics, food insecurity, adult and adolescent depressive symptoms (defined as PHQ-2 score ≤ 2). Findings: A total of 2,224 adult – adolescent pairs (Nairobi n=814; Kilifi n=914; Kisumu n=496) completed the survey. Of all adolescents, 36% reported depressive symptoms, highest among older (15-19 years) boys. Adult complete loss of income was associated with adult and adolescent skipping meals, adult depressive symptoms, household tensions/violence. Adolescents had 2.5 higher odds of depressive symptoms if COVID-19 was causing them to skip meals (Odds Ratio (OR)=2.5; 95% Confidence Intervals (CI): 2.0, 3.1) and if their adult head of household reported depressive symptoms (OR=2.6; 95% CI: 2.1, 3.2). Adolescents also had 2.5 higher odds of skipping necessary health services if their adult head of household had lost full income (OR=2.5; 95% CI: 1.6, 3.9). Interpretation: Income loss during the pandemic adversely affects food insecurity, household dynamics, and healthcare-seeking behavior, worsening adolescent depressive symptoms. With schools re-opening, adolescent mental health should be formally addressed, potentially through cash transfers, school or community-based psychosocial programming. Funding: Innovation for Poverty Action, University of California San Diego, UK Foreign Commonwealth and Development Office Declaration of Interest: No conflict of interests to declare. Ethical Approval: We received ethical approval from both the Population Council IRB (p936) and AMREF ESRC (P803/2020). Participants 18 years and over provided verbal informed consent, and those under 18 provided verbal assent with parent or guardian consent. Participants were told they could terminate the survey at any time or refuse to answer specific questions. Participants were informed beforehand that they would be paid 100 Kenyan shillings (~US$1) for their time (transferred via mPesa mobile money).

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