Akinkunle, O, Stefan J, Ndetei D, Musau A, Mutiso V, Mudenge C, Ngirababyeyi A, Gasovia A, Mamah D.  2016.   A comparative study of psychotic and effective symptoms in Rwandan and Kenyan students.
Musyimi, CW, Mutiso VN, Haji ZR, Nandoya ES, Ndetei DM.  2016.  Mobile Based mhGAP-IG Depression Screening in Kenya., 2016 Nov 30. Community mental health journal. AbstractWebsite

We aimed to determine the prevalence and determinants of depression using mobile based mental health Global Action Programme Intervention guide (mhGAP-IG) in remote health care settings where most priority mental health problems are managed by non-mental health specialists and evaluate the feasibility of the application. Adult patients were recruited from four rural public health facilities in Kenya using systematic random sampling and screened for depression. There were no missing items since the application prevented saving of data unless all the items were answered. The prevalence of depression was 25% with suicidal behavior being the most significant comorbid problem. Older age, personal and a family history of a mental disorder were significantly correlated with depression. Exploring the use of health-related mobile applications in identification of priority mental health problems is useful notably in low-resource settings; and also forms a basis for prevention of mental disorders and intervention at acute stages.

Recorla, LA, Achenbach TM, Ivanova MY, Turner LV, Althoff RR, Arnadottir HA, Au A, Belina M, Caldas J, Chen Y-C, Csemy L, da Rocha MM, Decoster J, Fontaine JR, Funabiki Y, Guomundsson HS, Harder VS, Sebre S, Silvares E, Simulioniene R, Sokoli E, Vazquez N, Kim YA, Leung P, Ndetei DM, Maras JS, Marcovic J, Oh KJ, Samaniego VC, Zasepa E.  2016.  Problems and adaptive functioning reported by adults in 17 societies . International perspectives in physiology research practice. 5(2):91-109.
Nyundo, AA, Ndetei DM, Othieno CJ, Mathai AM.  2016.  The performance of International HIV dementia Scale (IHDS) versus Mini Mental Status Examition Scale (MMSE) in assessment of HIV-associated Neurocognitive Disorders (HAND) among HIV-Infected Tanzanian adults: a Case-Control Study. AbstractWebsite

vailability of HAART has improved the outcome of HIV-associated neurocognitive disorders (HAND) though the prevalence is still high. Routine screening for HAND may offer room for early detection and prompt management that may improve overall outcome.


To compare the performance of International HIV dementia scale (IHDS) and Mini Mental Status Examination (MMSE) Scale in assessing HIV-associated neurocognitive disorders.


This was a case- control study involving 351 HIV-cases and 150 HIV-negative controls. International HIV dementia scale and Mini Mental Status Examination scale were used to screen for neurocognitive deficits.


For cases, 91(25.9%) were males and 260(74.1%) were females while for 150 controls, 38(25.3%) were males and 112 (74.7%) were females. Under IHDS score 240(68.4%) of cases had HAND compared to 10(2.8%) when MMSE was used. The mean scores under MMSE for cases was 29±1.7 compared to 29.3± 1.2 for controls (p = 1.00). The mean IHDS scores for cases was 9.35 ± 1.89 compared to 10.35±0.89 (p < 0.0001) for controls.


Our findings suggests that IHDS has better sensitivity in detecting cases of HAND and perform better in identifying HIV/AIDS cases that requires further cognitive evaluation on comprehensive neuropsychological batteries.

Nyundo, AA, Ndetei DM, Othieno CJ, Mathai AM.  2016.  Neurocognitive correlates of the use of combined Antiretroviral Therapy among HIV-infected adults attending care and treatment center at Muhimbili National Hospital, Dar es Salaam, Tanzania: An analytical crosssectional study. Tanzania Medical Journal. AbstractWebsite

The discovery of the highly active antiretroviral therapy has improved the life span of people living with HIV/AIDS (PLWHA) to almost that of the general population. This, however, has been coupled with increased incidences of HIVassociated dementia, especially mild cognitive impairment. Combined antiretroviral therapy (cART) has been observed to improve neurocognitive functions but the ART regimen that is best suited for improvement of neurocognitive functions is still largely unknown. This study was aimed at determining how neurocognitive deficits in patients on cART were related to ART regimen.

Nyavanga, EJ, Chebet IM, Barasa M, Ndetei DM.  2016.  Effectiveness of Psychoeducation on Improving Opinions About Mental Illness Among Primary School Teacher Trainees in Kenya. Science Journal of Public Health . 4(6):422-429. AbstractWebsite

Opinions about mental illness have been found to be negative among college students and the general population. Studies have indicated that improving literacy levels would improve opinions and lead to individuals to seek help and family to provide the needed support. This study aimed to determine the effectiveness of psycho-education on the opinions about mental illness among public primary teacher trainees in Kenya. Convenience sampling was used to identify four public teacher colleges out of the twenty. Self-administered demographic questionnaire and opinions about mental illness scale were presented to the participants to collect data in four evaluations for the experimental group and three for the control group. The ethical protocol was followed from getting authority to informed consent from the participants. Out of the 2925 questionnaires presented, 2775 were returned fully filled, a return rate of 94.34%. Summative scores improved among the experimental group in the second, and third assessments, but this reduced to almost the original measure in the fourth assessment. This study found that psycho-education of mental illness is effective in improving negative opinions about mental illness among these participants and this study recommended mental health studies is included in the teachers’ curriculum.

Ndetei, DM, Mutiso V, Musyimi C, Mokaya AG, Anderson KK, McKenzie K, Musau A.  2016.  The prevalence of mental disorders among upper primary school children in Kenya., 2016 Jan. Social psychiatry and psychiatric epidemiology. 51(1):63-71. AbstractWebsite

The aim of this study was to estimate the prevalence and correlates of mental disorders among upper primary school children in grades five through seven in Kenya.

Ndetei, DM, Mutiso V, Maraj A, Anderson KK, Musyimi C, McKenzie K.  2016.  Stigmatizing attitudes toward mental illness among primary school children in Kenya., 2016 Jan. Social psychiatry and psychiatric epidemiology. 51(1):73-80. AbstractWebsite

Literature describing stigmatizing attitudes towards people with mental illness by children in the developing world is lacking. Children's mental health issues in the Kenyan context are especially pertinent due to the increased likelihood of exposure to risk factors and the high prevalence of mental disorders. The objective of the current study was to examine socio-demographic factors associated with the endorsement of stigmatizing attitudes towards people with mental illness among Kenyan school children.

Mutiso, VN, Musyimi CW, Tele A, Ndetei DM.  2016.  Epidemiological patterns and correlates of mental disorders among orphans and vulnerable children under institutional care., 2016 Nov 03. Social psychiatry and psychiatric epidemiology. AbstractWebsite

The objective of the study was to estimate the prevalence, comorbidity and socio-demographic correlates of common mental disorders among orphan and vulnerable children (OVCs) in residential care.

Musyimi, CW, Mutiso VN, Nandoya ES, Ndetei DM.  2016.  Forming a joint dialogue among faith healers, traditional healers and formal health workers in mental health in a Kenyan setting: towards common grounds., 2016 Jan 07. Journal of ethnobiology and ethnomedicine. 12:4. AbstractWebsite

Qualitative evidence on dialogue formation and collaboration is very scanty in Kenya. This study thus aimed at the formation of dialogue and establishment of collaboration among the informal (faith and traditional healers) and formal health workers (clinicians) in enhancing community-based mental health in rural Kenya.

Mokaya, AG, Mutiso V, Musau A, Tele A, Kombe Y, Ng'ang'a Z, Frank E, Ndetei DM, Clair V.  2016.  Substance Use among a Sample of Healthcare Workers in Kenya: A Cross-Sectional Study., 2016 Sep-Oct. Journal of psychoactive drugs. 48(4):310-9. AbstractWebsite

This study describes reported substance use among Kenyan healthcare workers (HCWs), as it has implications for HCWs' health, productivity, and their ability and likelihood to intervene on substance use. The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) was administered to a convenience sample of HCWs (n = 206) in 15 health facilities. Reported lifetime use was 35.8% for alcohol, 23.5% for tobacco, 9.3% for cannabis, 9.3% for sedatives, 8.8% for cocaine, 6.4% for amphetamine-like stimulants, 5.4% for hallucinogens, 3.4% for inhalants, and 3.9% for opioids. Tobacco and alcohol were also the two most commonly used substances in the previous three months. Male gender and other substance use were key predictors of both lifetime and previous three months' use rates. HCWs' substance use rates appear generally higher than those seen in the general population in Kenya, though lower than those reported among many HCWs globally. This pattern of use has implications for both HCWs and their clients.

Mendenhall, E, Isaiah G, Nelson B, Musau A, Koon AD, Smith L, Mutiso V, Ndetei D.  2016.  Nurses' perceptions of mental healthcare in primary-care settings in Kenya., 2016 Jul 12. Global public health. :1-14. AbstractWebsite

Kenya maintains an extraordinary treatment gap for mental health services because the need for and availability of mental health services are extraordinarily misaligned. One way to narrow the treatment gap is task-sharing, where specialists rationally distribute tasks across the health system, with many responsibilities falling upon frontline health workers, including nurses. Yet, little is known about how nurses perceive task-sharing mental health services. This article investigates nurses' perceptions of mental healthcare delivery within primary-care settings in Kenya. We conducted a cross-sectional study of 60 nurses from a public urban (n = 20), private urban (n = 20), and public rural (n = 20) hospitals. Nurses participated in a one-hour interview about their perceptions of mental healthcare delivery. Nurses viewed mental health services as a priority and believed integrating it into a basic package of primary care would protect it from competing health priorities, financial barriers, stigma, and social problems. Many nurses believed that integrating mental healthcare into primary care was acceptable and feasible, but low levels of knowledge of healthcare providers, especially in rural areas, and few specialists, would be barriers. These data underscore the need for task-sharing mental health services into existing primary healthcare in Kenya.

Mamah, D, Musau A, Mutiso VN, Owoso A, Abdallah AB, Cottler LB, Striley CW, Walker EF, Ndetei DM.  2016.  Characterizing psychosis risk traits in Africa: A longitudinal study of Kenyan adolescents., 2016 Oct. Schizophrenia research. 176(2-3):340-8. AbstractWebsite

The schizophrenia prodrome has not been extensively studied in Africa. Identification of prodromal behavioral symptoms holds promise for early intervention and prevention of disorder onset. Our goal was to investigate schizophrenia risk traits in Kenyan adolescents and identify predictors of psychosis progression. 135 high-risk (HR) and 142 low-risk (LR) adolescents were identified from among secondary school students in Machakos, Kenya, using the structured interview of psychosis-risk syndromes (SIPS) and the Washington early recognition center affectivity and psychosis (WERCAP) screen. Clinical characteristics were compared across groups, and participants followed longitudinally over 0-, 4-, 7-, 14- and 20-months. Potential predictors of psychosis conversion and severity change were studied using multiple regression analyses. More psychiatric comorbidities and increased psychosocial stress were observed in HR compared to LR participants. HR participants also had worse attention and better abstraction. The psychosis conversion rate was 3.8%, with only disorganized communication severity at baseline predicting conversion (p=0.007). Decreasing psychotic symptom severity over the study period was observed in both HR and LR participants. ADHD, bipolar disorder, and major depression diagnoses, as well as poor occupational functioning and avolition were factors relating to lesser improvement in psychosis severity. Our results indicate that psychopathology and disability occur at relatively high rates in Kenyan HR adolescents. Few psychosis conversions may reflect an inadequate time to conversion, warranting longer follow-up studies to clarify risk predictors. Identifying disorganized communication and other risk factors could be useful for developing preventive strategies for HR youth in Kenya.

Clair, V, Mutiso V, Musau A, Frank E, Ndetei D.  2016.  Online learning improves substance use care in Kenya: Randomized control trial results and implications. Annals of Global Health. 82(3):320-321. AbstractWebsite

Alcohol use is the 5th most important risk factor driving the global burden of diseases. WHO identifies a lack of health worker training as one of the main barriers to providing cost-effective brief interventions for alcohol use disorder. This study assesses the impact of online training, using the model, on the delivery of the WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and its linked brief intervention (BI).

Bhui, KS, Fiorillo A, Stein D, Okasha T, Ndetei D, Lam L, Chaturvedi S, Maj M.  2016.  Improving education, policy and research in mental health worldwide: the role of the WPA Collaborating Centres. World Psychiatry. Website
Aggarwal, NK, Lam P, Castillo EG, Weiss MG, Diaz E, Alarcón RD, van Dijk R, Rohlof H, Ndetei DM, Scalco M, Aguilar-Gaxiola S, Bassiri K, Deshpande S, Groen S, Jadhav S, Kirmayer LJ, Paralikar V, Westermeyer J, Santos F, Vega-Dienstmaier J, Anez L, Boiler M, Nicasio AV, Lewis-Fernández R.  2016.  How Do Clinicians Prefer Cultural Competence Training? Findings from the DSM-5 Cultural Formulation Interview Field Trial., 2016 Aug Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry. 40(4):584-91. Abstract

This study's objective is to analyze training methods clinicians reported as most and least helpful during the DSM-5 Cultural Formulation Interview field trial, reasons why, and associations between demographic characteristics and method preferences.


Daar, AS, Jacobs M, Ndetei D.  2014.  Declaration on mental health in Africa: moving to implementation. Global Health Action. 7 AbstractWebsite

rgent action is needed to address mental health issues globally. In Africa, where mental health disorders account for a huge burden of disease and disability, and where in general less than 1% of the already small health budgets are spent on these disorders, the need for action is acute and urgent. Members of the World Health Organization, including African countries, have adopted a Comprehensive Mental Health Action Plan. Africa now has an historic opportunity to improve the mental health and wellbeing of its citizens, beginning with provision of basic mental health services and development of national mental health strategic plans (roadmaps). There is need to integrate mental health into primary health care and address stigma and violations of human rights. We advocate for inclusion of mental health into the post-2015 Sustainable Development Goals, and for the convening of a special UN General Assembly High Level Meeting on Mental Health within three years.

Keywords: Africa; mental health; WHO action plan; roadmap; basic services; policy; implementation; stigma; human rights; post-2015 Agenda; UN General Assembly

Responsible Editor: Peter Byass, Umeå University, Sweden.

Widmann, M, Warsame AH, Mikulica J, Johannes von Beust, Ndetei D.  2014.  Khat use, PTSD and psychotic symptoms among Somali refugees in Nairobi: a pilot study. Frontiers in public health. 2:71. AbstractWebsite

n East-African and Arab countries, khat leaves are traditionally chewed in social settings. They contain the amphetamine-like alkaloid cathinone. Especially among Somali refugees, khat use has been associated with psychiatric symptoms. We assessed khat-use pat-terns and psychiatric symptoms among male Somali refugees living in a disadvantaged urban settlement area in Kenya, a large group that has not yet received scientific atten- tion. We wanted to explore consume patterns and study the associations between khat use, traumatic experiences, and psychotic symptoms. Using privileged access sampling, we recruited 33 healthy male khat chewers and 15 comparable non-chewers. Based on extensive preparatory work, we assessed khat use, khat dependence according to DSM- IV, traumatic experiences, posttraumatic stress disorder (PTSD), and psychotic symptoms using standardized diagnostic instruments that had been adapted to the Somali language and culture. Hazardous use patterns like chewing for more than 24 h without interruption were frequently reported. All khat users fulfilled the DSM-IV-criteria for dependence and
85% reported functional khat use, i.e., that khat helps them to forget painful experiences. We found that the studied group was heavily burdened by traumatic events and post- traumatic symptoms. Khat users had experienced more traumatic events and had more often PTSD than non-users. Most khat users experience khat-related psychotic symptoms and in a quarter of them we found true psychotic symptoms. In contrast, among control group members no psychotic symptoms could be detected. We found first evidence for the existence and high prevalence of severely hazardous use patterns, comorbid psychiatric symptoms, and khat use as a self-medication of trauma-consequences among male Somali refugees in urban Kenyan refugee settlements. There is a high burden by psychopathology and adequate community-based nterventions urgently need to be developed.
Keywords: khat, PTSD, psychotic symptoms, khat-related psychosis, Somali refugees in Kenya


Ndetei, DM, Khasakhala L, Meneghini L, Aillon JL.  2013.  The relationship between schizoaffective, schizophrenic and mood disorders in patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya. Abstractthe_relationship_between_schizo-affective.pdf

The prevalence of schizoaffective disorder (SAD) and the relationship between schizophrenia (SCZ), SAD and mood disorders (MD) in non-Western countries is unknown. To determine the prevalence of SAD and the relationship between SCZ, SAD and MD in relation to socio-demographic, clinical and therapeutic variables in 691 patients admitted at Mathari Psychiatric Hospital, Kenya. METHOD: A cross-sectional comparative study using both clinician and SCID-1 for DSM-IV diagnoses. RESULTS: Approximately twenty three percent (n=160) met DSM-IV criteria for SAD using SCID-1. There were significant differences between SCZ, SAD and MD regarding: affective and core symptoms of schizophrenia (with the exception of core symptoms of schizophrenia between SCZ and SAD); presence of past trauma; a past suicide attempt; and comorbidity with alcohol and drug abuse disorders. SAD and MD patients took significantly more mood stabilizers than SCZ patients. There were no significant differences between the three groups regarding socio-demographic variables, brief psychiatric rating scale scores, cognitive performance, anxiety and depressive symptoms, presence of obsessions, and usage of both antipsychotics and antidepressants. CONCLUSION: There is no distinct demarcation between the three disorders. This lends support to recent evidence suggesting that SAD might constitute a heterogeneous group composed of both SCZ and MD patients or a middle point of a continuum between SCZ and MD.

Matheka, CW, Karanja J, Ndetei DM, Muriungi SK.  2013.  Alcohol and substance abuse risk among students at the Kenya Medical Training College. AbstractWebsite

The object was to determine alcohol and substance use risk among students at the Kenya Medical Training College (KMTC). Data related to alcohol and substance use were obtained from 3107 first- and second-year basic diploma students from seven of the KMTC campuses in Kenya. Data were collected using a researcher-designed socio-demographic questionnaire and the Alcohol, Smoking and Substance Involvement Screening Test questionnaire. Most of the participants had low risk for alcohol use (98.1%), while a small percentage had moderate (1.7%) and high (0.25%) risk of alcohol use. Low risk of alcohol use was higher in females (99.15%) compared to males (97%). The risk for alcohol and tobacco use was comparable between those below 24 and those above 24 years. All the separated, divorced and widowed students (n=34) (100%) had low risk for sedatives and hallucinogens use. The risk of alcohol and substance use exists among KMTC students at different levels. There is need to screen students for substance use, increase awareness and provide appropriate intervention to prevent drug use and its related co-morbidities.

Khasakhala, LI, Ndetei DM, Mathai M.  2013.  Suicidal behaviour among youths associated with psychopathology in both parents and youths attending outpatient psychiatric clinic in Kenya. Abstractsuicidal_behaviour_among_youths_associated_with_psychopathology_in_both.pdf

Suicide is a major cause of death among youths particularly with psychiatric, alcohol abuse and substance abuse disorders. There are relatively few studies on the relationship between psychiatric and substance abuse disorders with suicidal behaviour from low-income countries. This study examines the relationship between suicidal behaviour and co-existing psychiatric or substance disorders among youths and depressive and alcohol use disorders in their parents. METHOD: The study sample had 678 respondents: 250 youths and 226 and 202 biological mothers and fathers, respectively. RESULTS: This study found a significant statistical association between depressive (p < 0.001), alcohol abuse (p <0.001) and substance abuse (p < 0.001) disorders and suicidal behaviour in youths. There was a significant relationship between maternal depressive disorder (p < 0.001) and perceived maternal rejecting parenting behaviour (p < 0.001) with suicidal behaviour in youths. There was a greater odds of a youth with two to three (odds ratio (OR) = 3.63; p = 0.009) and four or more (OR = 8.23; p < 0.001) co-existing psychiatric disorders to have suicidal behaviour than a youth with only one psychiatric disorder. The results also indicate that a higher proportion of youths between ages 16--18 years had suicidal behaviour than youths below 16 years or above 18 years of age (p = 0.004). CONCLUSION: These findings suggest that youths with psychiatric and substance abuse disorders have mothers living with a depressive disorder. Also, perceived maternal rejecting parenting behaviour contributes significantly to the development of suicidal behaviour later in adolescent years.

Mbwayo, AW, Ndetei DM, Mutiso V, Khasakhala LI.  2013.  Traditional healers and provision of mental health services in cosmopolitan informal settlements in Nairobi, Kenya. Abstracttraditional_healers.pdf

The study aimed to investigate the types of mental illnesses treated by traditional healers, and their methods of identifying and treating mental illnesses in their patients. METHOD: In urban informal settlements of Kibera, Kangemi and Kawangware in Nairobi, Kenya, we used opportunistic sampling until the required number of traditional healers was reached, trying as much as possible to represent the different communities of Kenya. Focus group discussions were held with traditional healers in each site and later an in-depth interview was conducted with each traditional healer. An in-depth interview with each patient of the traditional healer was conducted and thereafter the MINIPLUS was administered to check the mental illness diagnoses arrived at or missed by the traditional healers. Quantitative analysis was performed using SPSS while focus group discussions and in-depth interviews were analysed for emerging themes. RESULTS: Traditional healers are consulted for mental disorders by members of the community. They are able to recognize some mental disorders, particularly those relating to psychosis. However, they are limited especially for common mental disorders. CONCLUSION: There is a need to educate healers on how to recognize different types of mental disorders and make referrals when patients are not responding to their treatments

Ndetei, DM;, Khasakhala L;, Kuria MW;, Mutiso V;, Muriungi S;, Bagaka B.  2013.  A study on assessment of needs, care in the homes and clinical trends among the elderly in Kenya.


D.M., N, Khasakhala LI, Mutiso V, Mbwayo A, Mathai M.  2012.  The Prevalence Of Depression Among Adolescents In Nairobi Public Secondary Schools.
DM, N, SK M, A O, VN M, AW M, LI K, DM B, D M.  2012.  Prevalence and characteristics of psychotic-like experiences in Kenyan youth.
Ndetei, DM, Mamah D, Owoso A, Mbwayo AW, Mutiso VN, Muriungi SK, Khasakhala LI, Barch DM.  2012.  Classes of Psychotic Experiences in Kenyan Children and Adolescents. classes_of_psychotic_experiences_in_kenyan_children.pdf


Mbugua, MN, Kuria MW, Ndetei DM.  2011.  The Prevalence of Depression among Family Caregivers of Children with Intellectual Disability in a Rural Setting in Kenya. Abstractprevalenceof_depression_among_caregivers.pdf

Caregivers of children with intellectual disability have a great responsibility that may be stressful. The psychological well-being of the care giver may affect the quality of care given to children with intellectual disability. Objective. The objective of the study was to determine the risk of depression in care givers of children with intellectual disability.Setting.The study was conducted at Gachie Catholic Parish, Archdiocese of Nairobi (Kenya). Design. Cross sectional, descriptive study. Method. The study was conducted among 114 caregivers registered at the Gachie Parish program (in Kenya) for the intellectual disabled children. A researcher-designed social demographic questionnaire and the Beck depression inventory were administered to those that met the inclusion criteria. Results. Seventy-nine percent (79%) of the caregivers were at risk of clinical depression. Conclusion. Majority of the care givers of children with intellectual disability were at risk of developing clinical depression.

Ndetei, DM, Swales M, Koldobsky N, Kim Y, Fosatti A, Blashfield R, Mulder R, Crawford M, Tyrer P.  2011.  Contemporary Psychiatry In Africa: A Review Of Theory, Practice And Research.
Khasakhala, L, Sorsdahl KR, Harder VS, Williams DR, Ndetei DM.  2011.  Lifetime mental disorders and suicidal behaviour in South Africa.
Ndetei, D, Khasakhala L, Mutiso V, Mbwayo A.  2011.  Epidemiological Patterns of Anxiety Disorders in Kenya.
Mamah, D, Ndetei DM, Khasakhala L, Nsofor T, Constantino JN, Barch DM, Mutiso V, Mbwayo A.  2011.  A survey of psychosis risk symptoms in Kenya.

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