Cumulative adverse childhood experiences and internalizing symptoms among Kenyan adolescents: A multilevel school-based analysis

Abstract Background Kenyan adolescents face substantial burdens of depression and anxiety in the context of widespread psychosocial adversity, yet large-scale, school-based evidence on cumulative adverse childhood experiences (ACEs) remains limited. Methods This secondary analysis used cross-sectional survey data from 15,177 students in 23 secondary schools. Depressive (PHQ-8) and anxiety (GAD-7) symptoms were regressed on cumulative adverse childhood experiences (ACEStotal) and perceived social support (MSPSStotal) using multilevel linear models with random school intercepts, adjusting for age, gender, and school form. Single-level ordinary least squares models with cluster-robust standard errors were estimated as sensitivity analyses. Results Intraclass correlations were modest (ICCPHQ = .024; ICCGAD = .015). Higher ACEStotal predicted higher PHQtotal and GADtotal (b ≈ 0.40–0.46, p < .001), whereas MSPSStotal showed no independent association with either outcome in adjusted models. Sensitivity analyses yielded a similar pattern of findings. Conclusions Cumulative ACEs are a strong and consistent correlate of depression and anxiety among Kenyan secondary school students, underscoring the need for ACE-informed, school-based mental health screening and trauma-informed intervention strategies in low- and middle-income settings.​