Adverse Childhood Experiences (ACEs) and Mental Health Challenges Among Kenyan Youth Living in Informal Settings

Background:

Adverse childhood experiences (ACEs), including abuse, neglect, and household dysfunction, have a range of adverse mental health outcomes, particularly in adolescence and young adulthood in urban informal settlements. These youth face intersecting stressors of poverty, unemployment, and daily exposure to community violence, which collectively may intensify the mental health consequences of early life adversity. Yet mental health research focusing on this group remains sparse, especially for youth residing in Nairobi’s urban informal settings, where structural inequities and limited access to supportive services exacerbate the burden of ACEs and mental health distress. There is limited evidence on how ACEs may shape youth mental health difficulties, particularly in informal settings. To fill this gap, this study examined the association between adverse childhood experiences and mental health outcomes among youth aged 15–24 years living in two informal settlements in Nairobi, Kenya.

Methods:

We used cross-sectional data from a pilot longitudinal mixed-methods study collected between September and December 2024 in two informal settlements in Nairobi, Kenya. The sample includes 94 youth aged 15–24 recruited through peer-driven sampling. Youths were eligible if they had used alcohol or other drugs in the past 30 days and lived in the study areas; those with severe mental health or substance use disorders requiring inpatient care were excluded. Trained research assistants, fluent in English and Swahili, administered 30-minute tablet-based surveys in participants' preferred language. Participants completed screening measures for mental health outcomes, including the 9-item Patient Health Questionnaire (PHQ-9), the 10-item stress survey, the 7-item General Anxiety Disorder Scale (GAD-7), and the 10-item Adverse Childhood Experiences Scales (ACEs). Informed consent was obtained from all participants and guardians of minors (below 18 years). To examine the association between ACE levels (0-2, 3+) and mental health outcomes, we estimated generalized linear models with a Gaussian distribution and identity link for stress and Gamma distributions and identity links for depression and anxiety.

Findings:

Most participants were female (54%) and had experienced 3+ ACEs (56%) with a median age of 21. Older participants, females, and those with 3+ ACEs had higher mean or median stress, depression, and anxiety scores compared to their counterparts. Participants with greater secondary education reported increased stress symptoms but lower depression and anxiety than those with secondary education or less. Participants who reported 3 or more ACEs reported significantly greater symptoms of depression (β=3.18, 95% CI: 0.88, 5.48, p<.01) and anxiety (β=2.76, 95% CI: 0.90, 4.62, p<.01) compared to those who reported 0-2 ACEs. We did not find a significant association between ACEs level and stress symptoms.

Conclusion:

These findings highlight the urgent need for trauma-informed mental health interventions that specifically target youth with histories of adversity. Prevention strategies should prioritize the early identification of ACEs and integrate psychosocial support into youth programs within informal settlements. Given the high prevalence of ACEs and limited access to mental health care in these settings, community-based approaches that combine prevention, screening, and targeted support can play a critical role in mitigating the long-term impact of childhood adversity.