An arts-literacy intervention for adolescent depression and anxiety symptoms: outcomes of a randomised controlled trial of Pre-Texts with Kenyan adolescents

Tom L Osborn; David M Ndetei; Pier Luigi Sacco; Victoria Mutiso; Doris Sommer

doi:10.1016/j.eclinm.2023.102288

An arts-literacy intervention for adolescent depression and anxiety symptoms: outcomes of a randomised controlled trial of Pre-Texts with Kenyan adolescents

EClinicalMedicine. 2023 Nov 15:66:102288. doi: 10.1016/j.eclinm.2023.102288. eCollection 2023 Dec.

Authors

Tom L Osborn¹, David M Ndetei^{2

3

4}, Pier Luigi Sacco^{5

6}, Victoria Mutiso^{2

4}, Doris Sommer^{7

8

9}

Affiliations

¹ Shamiri Institute, Nairobi, Kenya.
² Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
³ Department of Psychiatry, University of Nairobi, Kenya.
⁴ World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya.
⁵ DiSFiPEQ, University of Chieti-Pescara, Italy.
⁶ metaLAB (at) Harvard, Cambridge, MA, USA.
⁷ Department of Romance Languages and Literatures, Harvard University, Cambridge, MA, USA.
⁸ Department of African and African American Studies, Harvard University, Cambridge, MA, USA.
⁹ Cultural Agents, Inc., Boston, MA, USA.

Abstract

Background: Mental health problems are prevalent among youth in low-resource countries and are further compounded by stigma and limited access to traditional treatments. The need for scalable, accessible, and stigma-free mental health interventions is urgent. We developed and tested Pre-Texts, an arts-literacy intervention that targets adolescent depression and anxiety, in Kenya.

Methods: We conducted a universal RCT (Randomized Controlled Trial). Students from Kenyan high schools (N = 235, ages 13-19, 53.19% female) were randomized to either Pre-Texts or a study skills control intervention. Pre-Texts involves the use of a text-such an excerpt from a novel, a physics lesson, or a technical manual-to inspire art-making that is followed by collective reflection on the process of interpretation through artmaking. Participants met daily for a week in groups of 6-12 youths for 1-h sessions. Groups were facilitated by high school graduates trained as lay-providers. This study was pre-registered at the Pan African Clinical Trials Registry (PACTR; registration number: PACTR202111497122432). The trial took place between August 11th 2021 and December 18th 2021.

Findings: Pre-Texts produced a greater reduction in depression (d = 0.52, 95% CI [0.19, 0.84]) and anxiety (d = 0.51, 95% CI [0.20, 0.81]) symptoms from baseline to 1-month follow-up compared to the control group. Similarly, in a sub-sample of participants with elevated depression and anxiety symptoms, Pre-Texts produced a greater reduction in depression (d = 1.10, 95% CI [0.46, 1.75]) and anxiety (d = 0.54, 95% CI [-0.07, 1.45]) symptoms.

Interpretation: Our findings suggest that a brief arts-literacy intervention with challenging school material in a group setting, implemented as an afterschool program, can reduce depression and anxiety symptoms in adolescents in Sub-Saharan Africa. Future replication trials with larger sample sizes with extended follow-ups will help assess the strength and sustainability of these effects.

Funding: The study was funded by grants from the Mind, Brain, and Behaviour (MBB) Initiative at Harvard University and the Center for African Studies at Harvard University.

Keywords: Adolescents; Anxiety; Arts; Depression; Global mental health; Interventions; Pre-Texts; School-based texts; Sub-Saharan Africa.