Impact of the DREAMS interventions on Common mental disorders among adolescent girls and young women: Causal analysis of a prospective cohort in two Kenyan settings

Common mental disorders (CMD) are increasing globally among young people. The DREAMS (Determined-Resilient-Empowered-AIDS-free-Mentored-Safe) multi-component intervention package, delivered during 2016–2023, aims to reduce HIV incidence among adolescent girls and young women (AGYW). We hypothesised that social, health and economic benefits of DREAMS would reduce CMD, though this was not the program’s goal. In each of two Kenyan settings (Gem and Nairobi) a randomly selected cohort of around 1000 AGYW aged 13–22 years was enrolled during 2017–2018 and followed up during 2019–2022. CMD was measured using the Shona-Symptom-Questionnaire; a score of ≥7 was classified as `experiencing CMD’. We used inverse-probability-of-treatment-weighting to control for confounding and compared 3 groups of AGYW: those invited to DREAMS by 2018 (early invitees), during 2020–2022 (later invitees), or not invited to DREAMS (non-invitees). In 2022, the proportion experiencing CMD was 45% (463/1023) in Gem, and 46% (410/889) in Nairobi. In Gem, the estimated proportions with CMD were 49%, 45%, and 38% for the counterfactual scenarios in which all AGYW were early invitees, all were later invitees, or all were non-invitees, respectively. There was evidence of an increase in CMD prevalence when comparing early invitees with non-invitees (11%; 95% CI:2%,21%). In Nairobi, the estimated proportions with CMD were 46%, 55%, and 32% for the scenarios in which all were early invitees, all were later invitees, or all were non-invitees, respectively. There was evidence of an increase in CMD prevalence when comparing early invitees to non-invitees (14.4; 95% CI:2.1%, 26.4%) and when comparing later invitees to non-invitees (23.3%; 95% CI:5.8%,41.2%). CMD was common among AGYW in both settings. The higher CMD prevalence among DREAMS invitees compared with non-invitees might be due to increased recognition of, and willingness to disclose, symptoms of mental ill-health. Specific interventions to address CMD among AGYW should be incorporated within health and HIV prevention programmes.