A Mindfulness-Based Intervention for Reducing Adolescent Depression and Anxiety Symptoms: A Study Protocol for a Pilot Randomized Controlled Trial in Kenya

Background: Depressive and anxiety symptoms significantly impact the well-being of African youth. This problem is compounded by limited access to appropriate mental health care services and societal stigma. In addressing this issue in Kenya, we employed the network approach to psychopathology to identity the most significant symptoms of depression and anxiety. These network analyses revealed self-blame and depressed mood in the depression network, as well as too much worry and uncontrollable worry in the anxiety network. Consequently, we identified mindfulness-based interventions, particularly the Learning to Breathe (L2B) program, as effective tools to mitigate these influential symptoms and potentially reduce the prevalence of overall depressive and anxiety symptoms. We adapted and modified the L2B program into the Shamiri Mindfulness Intervention, tailored for the Kenyan context. This pilot aims to assess the impact of the Shamiri Mindfulness Intervention on participants' mindfulness, depressive symptoms, and anxiety symptoms.

Methods: We propose a randomized waitlist-controlled study to pilot the Shamiri Mindfulness Intervention among Kenyan Secondary School students. The intervention will consist of lessons, activities, and discussions aimed at enhancing participants' understanding and practice of mindfulness, specifically focusing on their thoughts, emotions, and behaviors. The pilot will involve four 1-hour sessions conducted weekly, with groups of 10-12 students led by local lay-providers trained by our team and supervised by clinical psychologists. Data will be collected at baseline, midpoint, endpoint, and one-month follow-up from all participants. Upon completion of data collection, participants in the waitlist condition will receive the Shamiri Mindfulness Intervention.

Discussion: Positive findings from this study can serve as an impetus for conducting additional trials of school-based and lay-provider delivered mindfulness-based interventions in other African and low-to-middle-income settings. By further exploring these interventions, we can adapt and refine them to offer a valuable tool for enhancing youth mental health. This approach presents a low-cost, effective, and culturally appropriate alternative to traditional Western psychotherapy. The potential impact extends beyond the current study, as it contributes to the growing body of evidence supporting the implementation of mindfulness-based interventions in diverse contexts, ultimately benefiting young individuals facing mental health challenges worldwide.