{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T23:08:01Z","timestamp":1790809681479,"version":"4.1.0"},"reference-count":66,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T00:00:00Z","timestamp":1612137600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Background: Sexual and gender minority (SGM) people in Kenya face pervasive socio-cultural and structural discrimination. Persistent stress stemming from anti-SGM stigma and prejudice may place SGM individuals at increased risk for negative mental health outcomes. This study explored experiences with violence (intimate partner violence and SGM-based violence), mental health outcomes (psychological distress, PTSD symptoms, and depressive symptoms), alcohol and other substance use, and prioritization of community needs among SGM adults in Western Kenya. Methods: This study was conducted by members of a collaborative research partnership between a U.S. academic institution and a Kenyan LGBTQ civil society organization (CSO). A convenience sample of 527 SGM adults (92.7% ages 18\u201334) was recruited from community venues to complete a cross-sectional survey either on paper or through an online secure platform. Results: For comparative analytic purposes, three sexual orientation and gender identity (SOGI) groups were created: (1) cisgender sexual minority women (SMW; 24.9%), (2) cisgender sexual minority men (SMM; 63.8%), and (3) gender minority individuals (GMI; 11.4%). Overall, 11.7% of participants reported clinically significant levels of psychological distress, 53.2% reported clinically significant levels of post-traumatic stress disorder (PTSD) symptoms, and 26.1% reported clinically significant levels of depressive symptoms. No statistically significant differences in clinical levels of these mental health concerns were detected across SOGI groups. Overall, 76.2% of participants reported ever using alcohol, 45.6% home brew, 43.5% tobacco, 39.1% marijuana, and 27.7% miraa or khat. Statistically significant SOGI group differences on potentially problematic substance use revealed that GMI participants were less likely to use alcohol and tobacco daily; and SMM participants were more likely to use marijuana daily. Lifetime intimate partner violence (IPV) was reported by 42.5% of participants, and lifetime SGM-based violence (SGMV) was reported by 43.4%. GMI participants were more likely than other SOGI groups to have experienced both IPV and SGMV. Participants who experienced SGMV had significantly higher rates of clinically significant depressive and PTSD symptoms. Conclusions: Despite current resilience demonstrated by SGM adults in Kenya, there is an urgent need to develop and deliver culturally appropriate mental health services for this population. Given the pervasiveness of anti-SGM violence, services should be provided using trauma-informed principles, and be sensitive to the lived experiences of SGM adults in Kenya. Community and policy levels interventions are needed to decrease SGM-based stigma and violence, increase SGM visibility and acceptance, and create safe and affirming venues for mental health care. Political prioritization of SGM mental health is needed for sustainable change.<\/jats:p>","DOI":"10.3390\/ijerph18031311","type":"journal-article","created":{"date-parts":[[2021,2,1]],"date-time":"2021-02-01T11:40:48Z","timestamp":1612179648000},"page":"1311","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Mental Health Challenges and Needs among Sexual and Gender Minority People in Western Kenya"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1011-1751","authenticated-orcid":false,"given":"Gary W.","family":"Harper","sequence":"first","affiliation":[{"name":"Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Crawford","sequence":"additional","affiliation":[{"name":"Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Lewis","sequence":"additional","affiliation":[{"name":"Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline Rucah","family":"Mwochi","sequence":"additional","affiliation":[{"name":"Western Kenya LBQT Feminist Forum, Kisumu 40100, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cecil","family":"Okoth","sequence":"additional","affiliation":[{"name":"Nyanza Rift Valley and Western Kenya (NYARWEK) LGBTI Coalition, Kisumu 40100, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5744-9632","authenticated-orcid":false,"given":"Laura","family":"Jadwin-Cakmak","sequence":"additional","affiliation":[{"name":"Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Peter","family":"Onyango","sequence":"additional","affiliation":[{"name":"Nyanza Rift Valley and Western Kenya (NYARWEK) LGBTI Coalition, Kisumu 40100, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manasi","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, School of Medicine, University of Nairobi, Nairobi 00100, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5842-5229","authenticated-orcid":false,"given":"Bianca D.M.","family":"Wilson","sequence":"additional","affiliation":[{"name":"The Williams Institute, School of Law, University of California Los Angeles, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,2,1]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1080\/07491409.2020.1745598","article-title":"Living in a Liminal Space: Feminist and LGBT Alliances in Kenya","volume":"43","year":"2020","journal-title":"Women\u2019s Stud. Commun."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1080\/17441692.2019.1611895","article-title":"The sexual health needs of sexual minority women in Western Kenya: An exploratory community assessment and public policy analysis","volume":"14","author":"Wilson","year":"2019","journal-title":"Glob. Public Health"},{"key":"ref_3","unstructured":"Kenya Law (2019). Petition 150 & 234 of 2016 (Consolidated), National Council for Law Reporting."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S251","DOI":"10.1097\/QAD.0000000000000846","article-title":"Depression, substance abuse and stigma among men who have sex with men in coastal Kenya","volume":"29","author":"Secor","year":"2015","journal-title":"AIDS"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1507","DOI":"10.1097\/QAD.0000000000001847","article-title":"Depressive symptoms and problematic alcohol and other substance use in 1476 gay, bisexual, and other MSM at three research sites in Kenya","volume":"32","author":"Korhonen","year":"2018","journal-title":"AIDS"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1517","DOI":"10.1007\/s10461-017-1941-0","article-title":"Depressive Symptoms, Alcohol and Drug Use, and Physical and Sexual Abuse Among Men Who Have Sex with Men in Kisumu, Kenya: The Anza Mapema Study","volume":"22","author":"Kunzweiler","year":"2018","journal-title":"AIDS Behav."},{"key":"ref_7","unstructured":"Kenya Human Rights Commission (KHRC) (2011). The Outlawed among Us: A Study of the LGBTI Community\u2019s Search for Equality and Non-Discrimination in Kenya, KHRC."},{"key":"ref_8","unstructured":"Kenya National Commission on Human Rights (KNCHR) (2012). Realising Sexual and Reproductive Health Rights in Kenya: A Myth or Reality?, KNCHR."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1712","DOI":"10.1080\/00918369.2014.951261","article-title":"Men Who Have Sex With Men in Kisumu, Kenya: Comfort in Accessing Health Services and Willingness to Participate in HIV Prevention Studies","volume":"61","author":"Okall","year":"2014","journal-title":"J. Homosex."},{"key":"ref_10","unstructured":"Karugu, N., and Mbaru, M. (2011). Lived Realities, Imagined Futures: Baseline Study on LGBTI Organising in Kenya, African Women\u2019s Development Fund."},{"key":"ref_11","unstructured":"Alimi, B. (2021, January 23). If You Say Being Gay is Not African, You don\u2019t Know Your History. Available online: https:\/\/www.theguardian.com\/commentisfree\/2015\/sep\/09\/being-gay-african-history-homosexuality-christianity."},{"key":"ref_12","first-page":"651","article-title":"The Invention of Homophobia in Africa","volume":"5","author":"Bertolt","year":"2019","journal-title":"J. Adv. Soc. Sci. Humanit."},{"key":"ref_13","unstructured":"Eguchi, S., and Calafell, B. (2019). \u201cQueerly ambivalent\u201d: Navigating global and local normativities in postcolonial Ghana. Queer Intercultural Communication: The Intersectional Politics of Belonging in and across Differences, Rowman & Littlefield Publishers."},{"key":"ref_14","unstructured":"Murray, S.O., and Roscoe, W. (1998). Boy-Wives and Female Husbands: Studies of African Homosexualities, St. Martin\u2019s Press."},{"key":"ref_15","unstructured":"Epprecht, M. (2008). Unspoken Facts: A History of Homosexualities in Africa, Gays and Lesbians of Zimbabwe."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1102","DOI":"10.1080\/14747731.2019.1654750","article-title":"Eurocentrism, state-centrism and sexual self-determination in the construction of a global democratic organization","volume":"16","author":"Teivainen","year":"2019","journal-title":"Globalizations"},{"key":"ref_17","unstructured":"Bakshi, S., Jivraj, S., and Posocco, S. (2016). Decoloniality, queerness and giddha. Decolonizing Sexualities: Transnational Perspectives, Critical Interventions, Counterpress."},{"key":"ref_18","unstructured":"Morgan, R., and Wieringa, S. (2005). Tommy Boys, Lesbian Men, and Ancestral Wives: Female Same-Sex Practices in Africa, Jacana Media. Chapter nine."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"69","DOI":"10.2307\/3773320","article-title":"Is the Female Husband a Man? Woman\/Woman Marriage among the Nandi of Kenya","volume":"19","author":"Oboler","year":"1980","journal-title":"Ethnology"},{"key":"ref_20","unstructured":"Ekine, S., and Abbas, H. (2013). Contesting narratives of queer Africa. Queer African Reader, Pambazuka Press."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1016\/j.pcl.2016.07.003","article-title":"Stigma and Minority Stress as Social Determinants of Health Among Lesbian, Gay, Bisexual, and Transgender Youth: Research Evidence and Clinical Implications","volume":"63","author":"Hatzenbuehler","year":"2016","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_22","unstructured":"Patterson, C.J., and D\u2019Augelli, A.R. (2013). Minority stress and the health of sexual minorities. Handbook of Psychology and Sexual Orientation, Oxford University Press."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1207\/s15374424jccp3302_23","article-title":"Stressors and Child and Adolescent Psychopathology: Measurement Issues and Prospective Effects","volume":"33","author":"Grant","year":"2004","journal-title":"J. Clin. Child. Adolesc. Psychol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Dorenwend, B.P. (1998). Symptoms, functioning, and health problems in a massively traumatized population: The legacy of the Cambodian tragedy. Adversity, Stress, and Psychopathology, Oxford University Press.","DOI":"10.1093\/oso\/9780195121926.001.0001"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/0049-089X(84)90017-6","article-title":"Life events and psychological well-being: A reexamination of theoretical and methodological issues","volume":"13","author":"McLanahan","year":"1984","journal-title":"Soc. Sci. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.2307\/2676357","article-title":"The role of adversity and stress in psychopathology: Some evidence and its implications for theory and research","volume":"41","author":"Dohrenwend","year":"2000","journal-title":"J. Health Soc. Behav."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1038","DOI":"10.1177\/1359105316642831","article-title":"Continuous traumatic stress as a mental and physical health challenge: Case studies from South Africa","volume":"23","author":"Kaminer","year":"2018","journal-title":"J. Health Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1037\/a0022688","article-title":"Minority stress and mental health among Dutch LGBs: Examination of differences between sex and sexual orientation","volume":"58","author":"Kuyper","year":"2011","journal-title":"J. Couns. Psychol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Srivastava, A., Sivasubramanian, M., and Goldbach, J.T. (2020). Mental health and gender transitioning among hijra individuals: A qualitative approach using the minority stress model. Cult. Health Sex., 1\u201315.","DOI":"10.1080\/13691058.2020.1727955"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1007\/s10508-014-0266-6","article-title":"Minority Stress in Lesbian, Gay, and Bisexual Young Adults in Australia: Associations with Psychological Distress, Suicidality, and Substance Use","volume":"43","author":"Lea","year":"2014","journal-title":"Arch. Sex. Behav."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1329","DOI":"10.1007\/s10508-016-0694-6","article-title":"The Internalized Homophobia Scale for Vietnamese Sexual Minority Women: Conceptualization, Factor Structure, Reliability, and Associations with Hypothesized Correlates","volume":"45","author":"Nguyen","year":"2016","journal-title":"Arch. Sex. Behav."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1016\/j.socscimed.2012.01.008","article-title":"Adapting the minority stress model: Associations between gender non-conformity stigma, HIV-related stigma and depression among men who have sex with men in South India","volume":"74","author":"Logie","year":"2012","journal-title":"Soc. Sci. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1037\/sgd0000032","article-title":"Does the Minority Stress Model Generalize to a Non-U.S. Sample? An Examination of Minority Stress and Resilience on Depressive Symptomatology Among Sexual Minority Men in Two Urban Areas of Brazil","volume":"1","author":"Dunn","year":"2014","journal-title":"Psychol. Sex. Orientat. Gend. Divers."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1080\/19317611.2015.1068902","article-title":"Shame, Internalized Homonegativity, and Religiosity: A Comparison of the Stigmatization Associated with Minority Stress with Gay Men in Australia and Malaysia","volume":"28","author":"Brown","year":"2015","journal-title":"Int. J. Sex. Health"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Ogunbajo, A., Iwuagwu, S., Williams, R., Biello, K.B., Kahler, C.W., Sandfort, T.G.M., and Mimiaga, M.J. (2020). Experiences of minority stress among gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria, Africa: The intersection of mental health, substance use, and HIV sexual risk behavior. Glob. Public Health, 1\u201315.","DOI":"10.1080\/17441692.2020.1834598"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1007\/s10508-017-0987-4","article-title":"Depression and Associated Factors Among Gay and Heterosexual Male University Students in Nigeria","volume":"47","author":"Oginni","year":"2018","journal-title":"Arch. Sex. Behav."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1007\/s10508-015-0565-6","article-title":"Gender Nonconformity, Discrimination, and Mental Health Among Black South African Men Who Have Sex with Men: A Further Exploration of Unexpected Findings","volume":"45","author":"Sandfort","year":"2016","journal-title":"Arch. Sex. Behav."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2481","DOI":"10.1007\/s10508-018-1168-9","article-title":"Gender Expression and Mental Health in Black South African Men Who Have Sex with Men: Further Explorations of Unexpected Findings","volume":"47","author":"Sandfort","year":"2018","journal-title":"Arch. Sex. Behav."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Armstrong, R., Silumbwe, A., and Zulu, J.M. (2020). Mental health, coping and resilience among young men who have sex with men in Zambia. Cult. Health Sex., 1\u201315. epub ahead of print.","DOI":"10.1080\/13691058.2020.1788726"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1111\/josi.12226","article-title":"The Benefits and Challenges of Health Disparities and Social Stress Frameworks for Research on Sexual and Gender Minority Health","volume":"73","author":"Frost","year":"2017","journal-title":"J. Soc. Issues"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e234","DOI":"10.1016\/S2352-3018(17)30020-6","article-title":"Improving HIV prevention and care for African GBMSM","volume":"4","author":"Graham","year":"2017","journal-title":"Lancet HIV"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"S261","DOI":"10.1097\/QAD.0000000000000905","article-title":"Resilience among gay\/bisexual young men in Western Kenya: Psychosocial and sexual health outcomes","volume":"29","author":"Harper","year":"2015","journal-title":"AIDS"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"420","DOI":"10.1037\/sgd0000340","article-title":"Gender role strain and the precarious manhood of sexual minority Kenyan men","volume":"6","author":"Granderson","year":"2019","journal-title":"Psychol. Sex. Orientat. Gend. Divers."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1080\/10894160.2016.1147007","article-title":"Narrating sexual identities in Kenya: \u201cChoice,\u201d value, and visibility","volume":"21","author":"Zingsheim","year":"2017","journal-title":"J. Lesbian Stud."},{"key":"ref_45","unstructured":"Wilson, B.D.M., Choi, S.K., Augustaitis, L., Jadwin-Cakmak, L., Neubauer, L.C., and Harper, G.W. (2019). The Sexual and Gender Minorities in Western Kenya: Health and Rights Concerns of People Assigned Female at Birth, The Williams Institute."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Charlson, F.J., Diminic, S., Lund, C., Degenhardt, L., and Whiteford, H.A. (2014). Mental and Substance Use Disorders in Sub-Saharan Africa: Predictions of Epidemiological Changes and Mental Health Workforce Requirements for the Next 40 Years. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0110208"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1503","DOI":"10.1007\/s10508-014-0314-2","article-title":"Using a Two-Step Method to Measure Transgender Identity in Latin America\/the Caribbean, Portugal, and Spain","volume":"43","author":"Reisner","year":"2014","journal-title":"Arch. Sex. Behav."},{"key":"ref_48","unstructured":"Derogatis, L.R., and Savitz, K.L. (2000). The SCL\u201390\u2013R and Brief Symptom Inventory (BSI) in primary care. Handbook of Psychological Assessment in Primary Care Settings, Lawrence Erlbaum Associates Publishers."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1080\/09540120701408910","article-title":"Psychological distress symptoms of individuals seeking HIV-related psychosocial support in western Kenya","volume":"19","author":"Reece","year":"2007","journal-title":"AIDS Care"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1080\/09638230701530192","article-title":"Measuring psychological distress symptoms in individuals living with HIV in western Kenya","volume":"17","author":"Shacham","year":"2008","journal-title":"J. Ment. Health"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40359-016-0162-z","article-title":"Prevalence of psychological symptoms among adults with sickle cell disease in Korle-Bu Teaching Hospital, Ghana","volume":"4","author":"Anim","year":"2016","journal-title":"BMC Psychol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"S76","DOI":"10.1080\/09540121.2018.1510109","article-title":"Factors associated with viral suppression among HIV-positive Kenyan gay and bisexual men who have sex with men","volume":"30","author":"Kunzweiler","year":"2018","journal-title":"AIDS Care"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: Validity of a brief depression severity measure","volume":"16","author":"Kroenke","year":"2001","journal-title":"J. Gen. Intern. Med."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1097\/QAI.0000000000000210","article-title":"Reliability and validity of depression assessment among persons with HIV in sub-Saharan Africa: Systematic review and meta-analysis","volume":"66","author":"Tsai","year":"2014","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Tagurum, Y.O., Chirdan, O.O., Obindo, T., Bello, D.A., Afolaranmi, T.O., Hassan, Z.I., and Yilgwan, C. (2015). Prevalence of Violence and Symptoms of Post-Traumatic Stress Disorder among Victims of Ethno-Religious Conflict in Jos, Nigeria. J. Psychiatry, 18.","DOI":"10.4172\/Psychiatry.1000178"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Johnson, K., Scott, J., Sasyniuk, T., Ndetei, D., Kisielewski, M., Rouhani, S., Bartels, S., Mutiso, V., Mbwayo, A., and Rae, D. (2014). A national population-based assessment of 2007\u20132008 election-related violence in Kenya. Confl. Health, 8.","DOI":"10.1186\/1752-1505-8-2"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1185\/135525703125002360","article-title":"The primary care PTSD screen (PC-PTSD): Development and operating characteristics","volume":"9","author":"Prins","year":"2003","journal-title":"Prim. Care Psychiatry"},{"key":"ref_58","unstructured":"National Authority for the Campaign against Alcohol and Drug Abuse (NACADA) (2012). Rapid Situation Assessment of Drug and Substance Abuse in Kenya, NACADA."},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Derogatis, L. (2001). BSI 18: Brief: Symptom Inventory 18: Administration, Scoring, and Procedure Manual, Pearson Assessments.","DOI":"10.1037\/t07502-000"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1093\/fampra\/cmq049","article-title":"Post-traumatic stress disorder screening test performance in civilian primary care","volume":"27","author":"Freedy","year":"2010","journal-title":"Fam. Pract."},{"key":"ref_61","unstructured":"Kenya Ministry of Health (2015). Kenya Mental Health Policy 2015\u20132030: Towards Attaining the Highest Standard of Mental Health."},{"key":"ref_62","unstructured":"Kenya Ministry of Health Mental Health (2020, December 30). Taskforce Urges Government to Declare Mental Health a National Emergency Nairobi, Tuesday 7 July  2020. Available online: https:\/\/www.health.go.ke\/mental-health-taskforce-urges-government-to-declare-mental-health-a-national-emergency-nairobi-tuesday-july-7-2020\/#."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"13494","DOI":"10.3390\/ijerph121013494","article-title":"Probable Post Traumatic Stress Disorder in Kenya and Its Associated Risk Factors: A Cross-Sectional Household Survey","volume":"12","author":"Jenkins","year":"2015","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"e25598","DOI":"10.1002\/jia2.25598","article-title":"Enrolment characteristics associated with retention among HIV negative Kenyan gay, bisexual and other men who have sex with men enrolled in the Anza Mapema cohort study","volume":"23","author":"Kunzweiler","year":"2020","journal-title":"J. Int. AIDS Soc."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s11606-008-0846-z","article-title":"Validity\/reliability of PHQ-9 and PHQ-2 depression scales among adults living with HIV\/AIDS in Western Kenya","volume":"24","author":"Monahan","year":"2009","journal-title":"J. Gen. Intern. Med."},{"key":"ref_66","doi-asserted-by":"crossref","unstructured":"Kendagor, A., Gathecha, G., Ntakuka, M.W., Nyakundi, P., Gathere, S., Kiptui, D., Abubakar, H., Ombiro, O., Juma, P., and Ngaruiya, C. (2018). Prevalence and determinants of heavy episodic drinking among adults in Kenya: Analysis of the STEPwise survey, 2015. BMC Public Health, 18.","DOI":"10.1186\/s12889-018-6057-6"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/3\/1311\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:18:26Z","timestamp":1760159906000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/3\/1311"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,2,1]]},"references-count":66,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["ijerph18031311"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18031311","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,2,1]]}}}