Changes in depression, anxiety, and post-traumatic stress symptoms among children and adolescents exposed to adverse childhood experiences following participation in the PROACT intervention in Nairobi, Kenya.

Introduction: Globally, children and adolescents exposed to Adverse Childhood Experiences (ACEs) face an increased risk of developing mental health disorders. The prevalence of these mental disorders is further amplified by the lack of access to specialised mental health treatment especially in low resource settings. There is an urgent need for scalable mental health interventions that can effectively address the needs of these vulnerable populations. Non-specialist-delivered interventions, such as PROACT (Psychoeducation, Relaxation, Problem-solving, Activation, and Cognitive Coping Therapy), represent a promising scalable approach that could help bridge the existing mental health treatment gap in low-resource settings. Objectives: This study aimed to assess changes in depression, anxiety, and post-traumatic stress symptoms among children and adolescents exposed to adverse childhood experiences following participation in the PROACT intervention delivered by trained social workers in Nairobi, Kenya. Methodology: Mixed-methods pre-post study design was employed. Twenty purposively selected sites across Nairobi County each contributed one social worker (N = 20), who received training to deliver the intervention. A total of 40 children participated and received 4-6 PROACT sessions. Quantitative data were analysed using STATA version 17. Paired t-tests were used to compare baseline and endline scores, while mixed-effects linear regression models with participant ID as a random effect were fitted to estimate changes in outcomes over time and account for repeated measures. Statistically significant improvements were observed across all mental health outcomes. Mean anxiety scores decreased from 6.2 at baseline to 2.7 at endline (mean difference: -3.5; 95% CI: -4.7 to -2.2; p < 0.001), while mean depression scores decreased from 6.4 to 2.9 (mean difference: -3.6; 95% CI: -4.9 to -2.3; p < 0.001). Mean PTSD scores decreased from 16.7 (95% CI: 12.8-20.5) at baseline to 7.3 (95% CI: 4.4-10.1) at endline (mean difference: -9.4; 95% CI: -14.6 to -9.3; p < 0.001). Mixed-effects linear regression analyses corroborated these findings, demonstrating significant reductions in PTSD (β = -9.44), anxiety (β = -3.48), and depression (β = -3.59) symptoms (all p < 0.001). Conclusion: The PROACT intervention was feasible and acceptable when delivered by social workers in Nairobi primary healthcare facilities and was associated with improvements in mental health outcomes among children and adolescents. These findings highlight the potential of task-sharing approaches to expand access to mental healthcare in low- and middle-income countries (LMICs) and warrant further evaluation in controlled studies.