Abstract
Mental disorders are the leading global cause of health burden among adolescents. However, prevalence data for mental disorders among adolescents in low-income and middle-income countries are scarce with often limited generalisability. This study aimed to generate nationally representative prevalence estimates for mental disorders in adolescents in Kenya, Indonesia, and Viet Nam.
Methods
As part of the National Adolescent Mental Health Surveys (NAMHS), a multinational cross-sectional study, nationally representative household surveys were conducted in Kenya, Indonesia, and Viet Nam between March and December, 2021. Adolescents aged 10–17 years and their primary caregiver were interviewed from households selected randomly according to sampling frames specifically designed to elicit nationally representative results. Six mental disorders (social phobia, generalised anxiety disorder, major depressive disorder, post-traumatic stress disorder, conduct disorder, and attention-deficit hyperactivity disorder) were assessed with the Diagnostic Interview Schedule for Children, Version 5. Suicidal behaviours and self-harm in the past 12 months were also assessed. Prevalence in the past 12 months and past 4 weeks was calculated for each mental disorder and collectively for any mental disorder (ie, of the six mental disorders assessed). Prevalence of suicidal behaviours (ie, ideation, planning, and attempt) and self-harm in the past 12 months was calculated, along with adjusted odds ratios (aORs) to show the association with prevalence of any mental disorder in the past 12 months. Inverse probability weighting was applied to generate national estimates with corresponding 95% CIs.
Findings
Final samples consisted of 5155 households (ie, adolescent and primary caregiver pairs) from Kenya, 5664 households from Indonesia, and 5996 households from Viet Nam. In Kenya, 2416 (46·9%) adolescents were male and 2739 (53·1%) were female; in Indonesia, 2803 (49·5%) adolescents were male and 2861 (50·5%) were female; and in Viet Nam, 3151 (52·5%) were male and 2845 (47·4%) were female. Prevalence of any mental disorder in the past 12 months was 12·1% (95% CI 10·9–13·5) in Kenya, 5·5% (4·3–6·9) in Indonesia, and 3·3% (2·7–4·1) in Viet Nam. Prevalence in the past 4 weeks was 9·4% (8·3–10·6) in Kenya, 4·4% (3·4–5·6) in Indonesia, and 2·7% (2·2–3·3) in Viet Nam. The prevalence of suicidal behaviours in the past 12 months was low in all three countries, with suicide ideation ranging from 1·4% in Indonesia (1·0–2·0) and Viet Nam (1·0–1·9) to 4·6% (3·9–5·3) in Kenya, suicide planning ranging from 0·4% in Indonesia (0·3–0·8) and Viet Nam (0·2–0·6) to 2·4% (1·9–2·9) in Kenya, and suicide attempts ranging from 0·2% in Indonesia (0·1–0·4) and Viet Nam (0·1–0·3) to 1·0% (0·7–1·4) in Kenya. The prevalence of self-harm in the past 12 months was also low in all three countries, ranging from 0·9% (0·6–1·3) in Indonesia to 1·2% (0·9–1·7) in Kenya. However, the prevalence of suicidal behaviours and self-harm in the past 12 months was significantly higher among those with any mental disorder in the past 12 months than those without (eg, aORs for suicidal ideation ranged from 7·1 [3·1–15·9] in Indonesia to 14·7 [7·5–28·6] in Viet Nam).
Interpretation
NAMHS provides the first national adolescent mental disorders prevalence estimates for Kenya, Indonesia, and Viet Nam. These data can inform mental health and broader health policies in low-income and middle-income countries.
Funding
The University of Queensland in America (TUQIA) through support from Pivotal Ventures, a Melinda French Gates company.
Previous article in issue
| Original language | English |
|---|---|
| Pages (from-to) | 1671-1680 |
| Number of pages | 10 |
| Journal | The Lancet |
| Volume | 403 |
| Issue number | 10437 |
| Early online date | 5 Apr 2024 |
| DOIs | |
| Publication status | Published - 3 May 2024 |
Funding
For K-NAMHS, we thank Nelson Mbaya of APHRC, Kenya, and Vivian Nyakangi (previously of APHRC) for their contributions to both NAMHS and K-NAMHS. We also thank Damazo Kadengye (APHRC) for his assistance with the calculation of the K-NAMHS sample size. We thank Boniface Chitayi (Kenya Psychiatric Association), Lawrence Nderi, and Nabila Amin for their contributions to the planning and implementation of K-NAMHS. In addition, we thank Simon Njuguna and Peris Wambui of the Ministry of Health (MoH) in Kenya for their support. We also thank James Kinyanjui and Zachary Ochola (Kenya National Bureau of Statistics) for their assistance and support in relation to K-NAMHS. For I-NAMHS, we recognise and thank Mustikaningtyas, Heru Subekti, Dita Azka Nadhira, Ajrina Rarasrum, Akto Adhi Kuntoro, and Anggriyani Wahyu Pinandari of the I-NAMHS team from Universitas Gadjah Mada (UGM) for their efforts and contributions. We also recognise and thank our collaborators from Hasanuddin University (Makassar, Indonesia), Ansariadi and Indra Dwinata, and from Universitas Sumatera Utara (Medan, Indonesia), Zulfendri and Kintoko Rochadi. We also thank Diana Setiyawati (Faculty of Psychology, UGM) for her support throughout the development and implementation of I-NAMHS. For V-NAMHS, we thank Dang Nguyen Anh (IOS, VASS), Nguyen Dinh Chung (Social And Environmental Statistics Department, General Statistics Office, Viet Nam), Nguyen Doan Tu (General Office of Population and Family Planning [GOPFP], MoH, Viet Nam), Pham Vu Hoang (GOPFP), Tran Thi Mai Oanh (Health Strategy and Policy Institute [HSPI], MoH, Viet Nam), and Hoang Thi Phuong (HSPI) for their contributions to V-NAMHS. For NAMHS more broadly, we thank Mark Emerson (Johns Hopkins Bloomberg School of Public Health, MD, USA) for his work in programming the survey instrument across all three countries. We thank Susan Sawyer (University of Melbourne, Murdoch Children's Research Institute [MCRI], and Royal Children's Hospital, VIC, Australia) and the late George Patton (University of Melbourne, MCRI) for championing the issue of adolescent mental health and whose evidence-based advocacy led to the investment that eventually became NAMHS. We thank the interviewers and field staff in each country, whose dedication and perseverance during an exceptionally challenging period for data collection made NAMHS possible. Finally, we sincerely thank the adolescents and their primary caregivers who participated in the surveys in each country. NAMHS was funded by The University of Queensland in America (TUQIA; Washington, DC, USA) through support from Pivotal Ventures, a Melinda French Gates company. The funding for NAMHS was administered by the University of Queensland, which, in turn, provided funding to the APHRC for K-NAMHS, to UGM for I-NAMHS, to IOS, VASS for V-NAMHS, and to the Johns Hopkins Bloomberg School of Public Health as a collaborating partner on NAMHS.
| Funders | Funder number |
|---|---|
| Murdoch Children's Research Institute | |
| Pivotal Ventures | |
| Damazo Kadengye | |
| James Kinyanjui and Zachary Ochola | |
| University of Queensland in America | |
| University of Melbourne | |
| Kenya Psychiatric Association | |
| NSW Ministry of Health | |
| Universitas Gadjah Mada | |
| Royal Children's Hospital | |
| University of Queensland | |
| Melinda French Gates company | |
| Vivian Nyakangi | |
| Universitas Hasanuddin | |
| African Population and Health Research Center | |
| TUQIA | |
| Universitas Sumatera Utara | |
| Boniface Chitayi | |
| General Office of Population and Family Planning | |
| Susan Sawyer |