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Introduction: Mental health issues are increasing among college students facing a myriad of stressors. Most mental disorders (75%) have their onset in late adolescence and early adulthood (up to 25 years). While biological explanations account for 40% of mental illness, environmental risks including adverse childhood experiences (ACEs), acute and chronic stressors account for 40% of mental illness.
Objective: To determine prevalence of depression and correlation with ACEs, recent experiences and current stressors and barriers to treatment seeking among first year students in 3 Kenyan universities.
Methods: Cross-sectional study using data from World Mental Health International College Student (WMH-ICS) survey initiative.
Results: Of 334 respondents 18-28 years; 181 were males. 19.5% had a depressive episode with 65% having age of onset between 15-18 years. Prevalence of depression was 14% (females-20.0%, males-8.8%). 44% had experienced 1-3 ACEs while 11.3% had 4+. Most common ACEs were: parental divorce/separation/never married (29%), death of either/both parents (17%), parent having serious alcohol/drug problem (15%), verbal abuse (14.9%), emotional abuse (11%), and parental mental illness (10.6%). Those with 4+ ACEs had 3.65 higher odds of depression (p=0.011). A single increase in number of ACEs experienced conferred 1.18 increased odds of depression (p=0.029). Most common recent experiences in last 12 months were: breakups (33.8%), death of close friend/family (30.4%), and serious betrayal by close person (27.9%). 4+ recent experiences conferred 8.08 higher odds of depression (p=0.02). A single increase in number of recent events led to 1.34 increased odds of depression (p=0.001). Most common current stressors in last 30 days were finances (24.6%), stress about overall life (18.4%) and love life (18%). Those with 1-3 current stressors had 6.2 higher odds of depression while those with 4+ stressors had 10.9 (p<0.001). A unit increase in current stressors led to 1.6 increased odds of depression (p<0.001). Despite high confidence in the effectiveness of treatment (74%), students reported several barriers to help-seeking. The most common barriers were a preference for self-management (71%), uncertainty about where or from whom to seek help (66%), concerns regarding treatment costs (48%), and embarrassment about seeking care (45%).
Conclusion: Depression among Kenyan university students is strongly associated with cumulative psychosocial adversity and ongoing stressors. Current stressors had strongest association compared to recent experiences or adverse childhood events. Findings support trauma-informed student mental health services. Strengthening resilience and addressing barriers to help-seeking is essential.