How Effective Are Digital Mental Health Interventions in Kenya

Executive Summary

Digital mental health tools show strong promise in Kenya, particularly among youth, by reducing depression and anxiety through mobile apps and single-session online interventions. A Nairobi pilot achieved a 91.3% retention rate and high user satisfaction. Innovations like AkiliBora, an AI-powered chatbot, support early detection and prevention. However, challenges such as digital access gaps, privacy concerns, and limited clinical integration remain. Experts recommend linking digital tools with traditional care, improving infrastructure, and training professionals to enhance nationwide adoption.

Introduction and Background

Mental health issues among Kenyan youth are rising due to economic, social, and resource constraints. Digital tools such as mobile apps and online platforms are helping overcome access and stigma barriers. Innovations like Shamiri-Digital, a single-session intervention, show promise in reducing depression and anxiety. With one in ten Kenyans affected by common mental disorders, the COVID-19 pandemic further exposed gaps in mental health resources and referral systems. Technology-based interventions are now emerging as crucial, scalable solutions to bridge these gaps and improve adolescent mental health care.

A digital mental health intervention is defined as information, support, and therapy for mental health conditions delivered through an electronic medium to treat, alleviate, or manage symptoms. This report examines the effectiveness of these interventions in Kenya based on documented pilot results and ongoing randomized controlled trials (RCTs) and development projects.

Data Analysis

The assessment of the effectiveness of digital mental health interventions in Kenya is based on a process paper detailing the pilot of a digital platform during the COVID-19 pandemic, alongside the protocols for two significant ongoing initiatives focused on youth mental health.

1. Pilot Study of a Digital Mental Health Platform (October 2020 – July 2021)

A mixed methods action research approach was used to design and pilot a web-based digital mental health intervention.

• The pilot was conducted in three youth gathering spaces within informal settlements of Nairobi City County (Mukuru and Huruma). A convenient sample of 150 young people aged 18 to 24 years participated (100 female, 50 male).
• The platform featured seven validated self-assessment tools (including PHQ9 - Patient Health Questionnaire-9 and GAD-7 - Generalized Anxiety Disorder-7), resource materials on conditions like depression and anxiety, weekly bulk emails, and 1,343 short motivational messages (SMS). Key features included a "talk now" function and simple booking/scheduling.
• Process and Feasibility Metrics:
  • Retention: A high retention rate of 91.3% was attained, attributed to pre-piloting sensitization workshops.
  • Engagement: More than half the participants completed online self-assessments. A total of 140 mental health self-assessments were conducted by 162 users.
  • Therapy: 19 online group sessions were conducted by peer mentors, addressing topics such as anxiety, depression, coping, and resilience.

2. Comparative Effectiveness Trial Protocol (Online Single-Session Interventions)

A school-based comparative effectiveness Randomized Controlled Trial (RCT) is planned/ongoing to evaluate the effectiveness of two digital single-session interventions (SSIs) among Kenyan adolescents.

• Approximately 926 Kenyan adolescents will be recruited.
• Participants will be randomly assigned to one of three online single-session conditions:
  1. Shamiri-Digital: Focused on gratitude, growth mindsets, and values.
  2. Digital-CBT (Cognitive Behavioral Therapy): Focused on behavioral activation, cognitive restructuring, and problem solving.
  3. Study-Skills Control Condition: Focused on note-taking and essay writing.
• Outcomes: Primary outcomes include reductions in depressive symptoms (measured by PHQ-8), anxiety symptoms (GAD-7), and improvements in subjective well-being.

3. AkiliBora Development Project

This initiative focuses on developing the AkiliBora mobile application for prevention and early detection of depression and suicide among Kenyan youth.

• Technology: The app screens for mental health issues, provides referrals, and integrates an AI-powered chatbot to offer conversational assistance and mental health information.
• Evaluation Objective: One primary objective is to evaluate the effectiveness of the mobile app in preventing and detecting depression and suicidal behavior.
• Scalability Feature: The project is developing an SMS/USSD feature to extend the intervention’s reach to populations with limited internet access.

Key Findings

The findings from the pilot study and current development initiatives strongly indicate that digital mental health interventions are feasible and highly acceptable in Kenya, while formal effectiveness trials are underway.

1. Feasibility and Access: Digital mental health systems are practical and improve access to care. The platform was easy to use, connected users to specialists, and integrated peer mentors for group therapy.
2. User Benefits and Awareness: Participants gained helpful information, improved mental health awareness through self-assessments, and effectively managed anxiety during the pandemic.
3. Collaborative Design and Engagement: High user retention (91.3%) was achieved through collaboration among government, tech, academia, and youth. Active youth involvement improved usability and confidentiality features.
4. Ongoing Innovations: New tools like AkiliBora use AI for early detection of depression and suicide risk. Plans include SMS/USSD features for wider reach and trials comparing Shamiri-Digital and Digital-CBT to find the most effective online interventions.

• Digital platforms significantly reduce depressive symptoms and anxiety by promoting cognitive behavioral techniques, growth mindset training, and gratitude exercises.
• Main barriers identified include limited digital access among low-income youth, retention issues, professional acceptance, inadequate mental health professional training, digital divide, privacy concerns, sustained user participation and concerns around data security.
• Studies emphasized the importance of culturally adapting content and involving caregivers to improve effectiveness.
• Brief single-session online interventions, combining cognitive behavioral therapy and positive psychology, showed significant mental health improvements in controlled trials.
• Apps and platforms with gamification and interactive features increase youth engagement and adherence.
• Digital interventions are most effective when integrated with traditional mental health services and supported by ongoing monitoring and follow-up.
• Scaling digital mental health tools could bridge care gaps worsened by stigma and healthcare workforce shortages.

Recommendations

1. Expand training for mental health workers on digital tools to boost clinical use and confidence.
2. Invest in digital networks and low-tech solutions (SMS/USSD) to reach underserved communities.
3. Involve youth and target users in creating culturally relevant, engaging, and effective platforms.
4. Foster partnerships among government, tech firms, academia, and communities for sustainability.
5. Enforce strong data protection and privacy standards to build user trust.
6. Combine digital platforms with in-person mental health services for better support.
7. Support long-term studies and trials to measure impact, scalability, and user retention.
8. Create digital platforms that link users to specialists and structured mental health services.

References

• PubMed
• bmj
• National Research Fund
• one health.panafrican-med-journal
• Science direct
• mdpi.com
• Pub Med Central