3 - (SYM 105) an Arts-literacy Intervention for Adolescent Depression and Anxiety Symptoms: Outcomes of a Randomised Controlled Trial of Pre-texts with Kenyan Adolescents

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. We conducted a universal RCT (Randomized Controlled Trial). Students from Kenyan high schools (N=235, ages 13-to-19, 5319% female) were randomized to either Pre-Texts or a study skills control intervention. Pre-Texts consists of art-making exercises that interpret a literary text, followed by collective reflection on the process of interpretation through artmaking. Participants met daily for a week in groups of 6-12 youths for one-hour sessions. Groups were facilitated by high school graduates trained as lay-providers. Pre-Texts produced a greater reduction in depression (d = ·53, 95% CI (Confidence Interval) [·22, ·84]) and anxiety symptoms (d = ·57, 95% CI [·26, ·87]) from baseline to 1-month follow-up compared to the control group. Among participants with moderate-to-severe depression and anxiety symptoms, Pre-Texts reduced depression symptoms (d = ·76, 95% CI [·27, 1·26]) but not anxiety symptoms (d = - ·14, 95% CI [- ·64, ·35]). 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 and extended follow-ups will help assess the strength and sustainability of these effects.