Background:
Measuring mental health across different cultures can be difficult. Tools developed in Western countries may not capture the types of stress or emotional distress that matter most in other cultural settings. This study explored whether a Kenyan-made mental health tool can add valuable information when used alongside common Western tools to understand mental health among Kenyan adolescents.
Methods:
We studied 2,906 adolescents from 40 secondary schools in Kenya (average age 16 years; 57% girls). We compared the Ndetei-Othieno-Kathuku (NOK) Scale—developed in Kenya—with two widely used Western tools: the PHQ-8 (for depression) and the GAD-7 (for anxiety). We tested how reliable and valid the NOK tool is, how it overlaps with or differs from Western tools, and what score should be considered “clinically elevated” for Kenyan youth. We also looked at whether age, gender, academic confidence, family structure, and experiences such as parental loss were linked to higher symptom levels.
Results:
The NOK tool showed mixed reliability acceptable for anxiety but weaker for depression—and its structure differed from Western tools. We identified cutoff scores of 3.5 for NOK-Depression and 6.5 for NOK-Anxiety, with moderate accuracy in identifying elevated symptoms. The NOK tool reported higher rates of depression (46%) and anxiety (32%) than the PHQ-8 and GAD-7 (27% and 22% respectively). The two types of tools grouped separately in our analyses, and network analysis showed that NOK items were more strongly connected to other symptoms, suggesting they may capture more culturally relevant experiences. Elevated symptoms were more likely among older adolescents, girls, those with lower academic confidence, those not living with both parents, and those who had lost a parent.
Implications:
Using both local and Western mental health tools together provides a fuller picture of adolescent mental health in Kenya. This combined approach helps capture culturally specific experiences of distress while still allowing comparisons across countries. It supports more accurate, culturally responsive mental health assessment for young people.
