Pregnancy and early motherhood can be challenging under any circumstances for adolescents. However, in Kenya the challenges are huge. Many pregnant and parenting adolescents face stigma, interrupted education, financial hardship, strained family relationships and limited social support.
The challenges can increase their risk of depression and other common mental health problems during a critical stage of life.
Access to mental health care for this group remains limited. In Kenya 15% of girls aged 15 to 19 have been pregnant and the national adolescent birth rate is 73 per 1,000 girls. Mental health specialists are scarce and services are concentrated in urban areas.
Mental health support is rarely integrated into routine maternal and adolescent health care. Consequently many young mothers who could benefit from support never receive it. Similar challenges are seen across many African countries.
We are mental health researchers and clinicians who have spent more than a decade working with adolescents, young mothers, health workers and policymakers to improve access to mental health care in Kenya.
In a recent paper we set out the findings of a trial that tested the effectiveness of group interpersonal psychotherapy for depression management in Kenya among 122 perinatal (pregnant or parenting) adolescents.
Adolescents who received the full programme saw average depression scores fall from 12.4 at the start of the study to 2.2 after treatment, a reduction of about 83% in symptoms
Group interpersonal psychotherapy is an intervention conducted in primary care settings in groups. It helps people understand how their emotional well-being is influenced by relationships, social support, communication and major life changes.
The trial ran full and mini interventions. The full intervention involved eight sessions; the mini version had four. The study applied a collaborative care approach within the World Health Organisation (WHO) mental health gap action programme framework for training a nonspecialist workforce, where trained nurses screened participants and supervised group sessions delivered by community health promoters collaboratively with psychologists. Participants included perinatal adolescents, aged 13 to 18 years, in their first to second trimester of pregnancy.
Our findings show the interventions reduced depressive symptoms. In the case of full treatment, results were evident within one week after the intervention. Substantial improvement occurred within the first four sessions for both arms.
The findings also underscore that psychological care can be delivered effectively through primary health-care services, even in settings where specialist mental health professionals are limited. Adolescents who participated experienced greater improvements in depressive symptoms and daily functioning than those receiving standard care.
It shows mental health care does not have to depend solely on psychiatrists or psychologists to achieve results.
Our research
Our study enrolled 122 pregnant adolescents aged 13 to 18 years receiving care in two maternal and child health clinics in Nairobi. Participants were randomly assigned to receive either standard care, four sessions of group interpersonal psychotherapy, or the full eight sessions programme.
The intervention focused on helping participants strengthen relationships, improve communication, build social support and manage difficult life transitions.
Trained lay providers facilitated the group sessions under supervision from clinical psychologists and nurses who had received training through the WHO mental health gap action programme.
What we found
The results were striking. Adolescents who received the full programme saw average depression scores fall from 12.4 at the start of the study to 2.2 after treatment, a reduction of about 83% in symptoms.
Those who received the shorter version improved from 11.6 to 3.9, a 66% reduction.
Adolescents receiving standard care improved from 11.0 to 7.9, a reduction of about 28%.
Young mothers who participated in the group therapy programmes experienced two to three times greater improvements in depression symptoms than those receiving standard care alone.
Why the findings matter for Kenya
Kenya has about 150 psychiatrists serving a population of more than 50-million people. The Kenya Psychiatric Association has around 163 psychiatrists in its records and reports most of the professionals work in urban areas.
The shortage of specialist providers remains one of the biggest barriers to improving mental health care in Kenya. Traditional one-to-one therapy models require highly trained professionals who are in short supply.
Our findings suggest another path forward. Group interpersonal psychotherapy allows a pair of trained facilitators to support several adolescents at the same time. It can be delivered by non-specialist providers working in existing community and primary health-care systems. It can also be integrated into maternal and child health services.
Moving from evidence to action will require integrating mental health into the services pregnant and parenting adolescents already use
The group format also offers advantages beyond the therapy itself. Young mothers often experience isolation and feel nobody understands their circumstances. Group sessions create opportunities for peer support, shared learning and connection with others facing similar challenges. These social connections may be part of the therapeutic benefit.
Kenya aims to provide mental health care within maternal and child health services, and our findings offer evidence this is possible.
Moving from evidence to action
The next step is ensuring such support becomes routinely available.
By building on existing health platforms rather than creating separate systems, Kenya has an opportunity to narrow the mental health treatment gap and improve outcomes for young mothers and their children. Our study shows this can be done at scale by allowing non-specialists to share the tasks.
Other countries face similar workforce shortages and treatment gaps. The study therefore offers guidance for their policymakers and practitioners seeking practical, affordable and sustainable approaches.
Moving from evidence to action will require integrating mental health into the services pregnant and parenting adolescents already use.
This approach aligns with national efforts to strengthen primary health care. By integrating routine depression screening, evidence-based group interventions and appropriate referral mechanisms into maternal health services, Kenya can scale up its efforts.
For pregnant and parenting adolescents, this is more than a health intervention. It is an investment in education, family wellbeing, child development and future opportunity.
- Manasi Kumar: professor, department of population health & institute for excellence in health equity, New York University Grossman School of Medicine, New York University.
- Anne Obondo: associate professor, department of psychiatry, University of Nairobi.
- Caleb Othieno: professor, department of psychiatry, Maseno University.
- Obadia Yator: research fellow, University of Nairobi.
- Dr Carol Ngunu, Shillah Mwaniga, Joseph Kathono, Vincent Nyongesa and Darius Nyamai contributed to the research on which this article is based.
