The Structure of Psychopathology Among Young Adults in Kenya, Namibia, and South Africa

The generalizability of psychopathology constructs across human populations is often assumed, but most evidence comes from Western contexts. The ‘Majority World’ (Africa, Asia, Latin America, the Middle East) is underrepresented in psychopathology research. Current efforts to reorganize mental disorder classifications provide an opportunity to better integrate evidence from these undersampled contexts. This study tested how the hierarchical structure of psychopathology replicates and deviates among a community sample of young adults in Kenya, Namibia, and South Africa. Using confirmatory and exploratory models, we investigated the structure and measurement invariance of common mental health symptoms. Our results provide limited support for the Internalizing and Externalizing distinction across these contexts. In the confirmatory models, the two spectra were nearly perfectly correlated. Exploratory models similarly indicated a single higher-order General Distress spectrum across countries. At a lower-order level, three dimensions consistently emerged across countries: Disinhibited Negative Affect, Dysregulated Sleep and Stress, and Harmful Substance Use. Attention-deficit/hyperactivity and anger symptoms showed substantial variation in loading patterns, suggesting cultural differences in symptom expression. Exploratory analyses revealed considerable variability in symptom structures across the three African countries, likely reflecting demographic, cultural, and semantic influences. This variability was further underscored by exploratory models, which identified low-loading and varying symptoms that confirmatory approaches often fail to detect. These results show how universal and culture-specific aspects shape psychopathology, and emphasize the need for data from diverse global samples to better understand these differences. We advocate for a more inclusive, culturally-sensitive approach to investigating mental health globally.