Extreme weather exposure, resource insecurity, and associations with mental health outcomes among Kenyan adolescent girls and young women: longitudinal findings

ABSTRACT Extreme weather events (EWEs), including floods, heatwaves, and drought, increasingly undermine access to essential resources such as food, water, and sanitation, potentially worsening mental health outcomes. These links are understudied among youth in climate-affected settings. We examined experiences of traumatic EWE exposure, resource insecurity, and mental health among a prospective cohort of 597 adolescent girls and young women (AGYW) aged 16-24 in Nairobi and Kisumu, Kenya followed at three six-monthly visits (April-June 2024, October-November 2024, March-April 2025). At each visit, participants were classified into lower, moderate, or higher resource insecurity using a longitudinal three-state hidden Markov model. We fit log-linear generalised estimating equations to estimate risk ratios (RR) linking traumatic EWE exposure to resource insecurity, and resource insecurity to problematic substance use, and linear models to estimate mean differences (MD) in depressive and anxiety symptoms. We adjusted for baseline and time-varying confounders using inverse probability of treatment weights. At baseline, 21% of participants reported six or more EWEs in the past year. Two-thirds experienced moderate resource insecurity and 14% higher insecurity – a proportion that remained fairly stable over follow-up. More traumatic EWE exposure was associated with increased risk of moderate or higher insecurity (adjusted RR=1.12, 95% confidence interval [CI]=1.10-1.14). Higher insecurity was associated with more severe depressive (adjusted MD=10.15, 8.60-11.369) and anxiety (adjusted MD=2.39, 2.00-2.78) symptoms, and with problematic substance use (adjusted RR=5.77, 2.61-12.76), with evidence of dose-response relationships. 3Climate adaptation strategies should integrate tailored resource and mental health support for AGYW.