Cumulative adverse childhood experiences and their association with depression and anxiety: a cross-sectional study of youth living in informal urban settings in Kenya.

Adverse childhood experiences (ACEs), such as abuse, neglect, and household dysfunction, are linked to adverse mental health outcomes, particularly among adolescents and young adults living in informal urban settlements, where poverty, unemployment, and exposure to violence exacerbate early life adversity. Despite this, research on ACEs and mental health in these contexts remains limited, especially among youth living in informal urban settlements in Nairobi, Kenya. Between September and December 2024, we conducted a community-based study involving 94 youth aged 15 - 24 years living in two informal settlements in Nairobi. Participants were recruited through peer-driven sampling if they had used alcohol or drugs in the past 30 days prior to the study. Data were collected using tablet-based surveys administered in English or Swahili on mental health outcomes of depression (using PHQ - 9), anxiety (assessed by GAD - 7), stress (assessed by stress scale), and ACEs (evaluated by the ACEs scale). We conducted generalized linear models to examine the relationship between ACEs (0 - 2 vs. 3+ experiences) and mental health outcomes. The median age was 21. Most participants were male (54%) and reported three or more ACEs (56%). Even though depression and anxiety scores were low, youth with 3+ ACEs had significantly higher depression and anxiety scores than those with fewer ACEs, but no significant association with stress symptoms was observed. There is a need for early identification of ACEs and the integration of psychosocial support into community-based youth services to prevent the long-term effects of childhood adversity.