Adolescents’ Risk Factors and Lived Experiences of Bullying Victimisation, Depression and Suicidality: Effect of a Teacher-led Anti-Bullying Psychoeducation Program in Nairobi County

Abstract

Many adolescents at some point in their lives experience bullying victimisation at school. This has been amplified by its co-occurrence with depression and suicide that has also been linked to bullying. In recent years the need for empirically proven effective programs targeted at bullying and has increased significantly globally and locally. The study investigated psychosocial dynamics impacting the mental health of adolescents in public secondary schools in Nairobi County, Kenya, focusing on bullying victimisation, depression, and suicidal behaviour. It also assessed the impact of a Teacher-led anti-bullying psychoeducation program on these dynamics within the educational context. A concurrent parallel mixed methods design incorporating a two group post-test only control group design in the quantitative arm was used. A total of 539 students across 5 schools formed the sample for the study. The study population comprised form 1 students who had attended the selected secondary schools for at least one month. The study instruments included a questionnaire and guides for in-depth interviews and focus group discussions. For quantitative data, predictors of depression were assessed using a generalized linear model (GLM), using a backward stepwise Poisson distribution with a log-link function, was used to estimate both the unadjusted prevalence ratios (uPR) and the adjusted prevalence ratios (aPR). Variables were included into the multivariable model based on a relaxed p-value of 0.2 in the univariable analysis. The qualitative data was transcribed and analysed thematically. The prevalence of depression was 14.5% among adolescents joining secondary school students in Nairobi County, with a mean PHQ-A score of 6.16 (SD=3.16). Among males, the prevalence of depression was 15.9% (n=34) compared to females who had a prevalence of 13.5% (n=44). Suicide risk among adolescents was found to be 20.0% (n=108) with a mean SBQ-R score of 4.88(SD=2.90). Majority (85.7%) of the students had experienced bullying victimisation. Depression was the only statistically significant predictor of bullying victimisation in multivariable analysis (aPR=1.33; 95%CI=1.05-1.68, p=.026). In the depression multivariable model, the risk of suicidal behaviour [aPR=3.07, CI (1.94-4.88); p<.001] and lifetime alcohol use [aPR=2.24, CI (1.36-3.68); p=.001] remained as statistically significant predictors. Bullying victimisation was retained in the multivariable model, but it was not statistically significant [aPR=2.88, CI (0.90-9.24); p=.075]. From the qualitative findings, students had experienced bullying victimisation and depression and witnessed suicidal attempts. Additionally, school-related gender-based violence was an emergent form of bullying victimisation in mixed secondary schools. Ultimately, the psychoeducation program was not effective in reducing bullying victimisation, depression, and suicide

risk. It is possible that these issues are deep-seated and perhaps needful of a longer- term continuing intervention. It is recommended that interventions targeting

adolescent alcohol use should be commenced early in the secondary school period given a likelihood of earlier age of onset. School-based cognitive behavioural therapy is an emerging intervention that needs to be explored further to reduce and prevent bullying victimisation, depression, and suicidality in secondary schools. The National School Health Policy should be reviewed to create a framework for reporting and addressing adolescent bullying, depression, and suicidal behaviour in the school setting.