Trajectories, Risk and Protective Factors of Depressive and Anxiety Symptoms of Adult Injury Patients in Kenya: A Longitudinal Study

Introduction: Injuries account for a significant proportion of the health and economic burden for populations in low- and middle-income countries (LMICs). Many injured individuals suffer from psychological distress; however, little is known about the mental health consequences and associated disability amongst injury survivors in LMICs. This longitudinal study examines trajectories of depressive and anxiety symptoms up to seven months after hospital discharge and the associated risk factors in urban Kenya.

Methods: Adult injury patients (n=644) admitted to Kenyatta National Hospital in Nairobi, Kenya, were enrolled. Each individual was interviewed in the hospital, and at 1, 2-3, and 4-7 months after hospital discharge through phone interviews. Depressive and anxiety symptoms, injury history, socio-demographic variables, and level of disability were assessed.

Latent growth curve analyses were used to model the trajectories of depressive and anxiety symptoms and their risk factors. A manual 3-step approach of auxiliary variables in mixture modeling was used to estimate the association between the risk factors and the trajectories of depressive and anxiety symptoms. Associations between the latent trajectory membership and level of disability at 4-7 months were assessed using the automatic BCH methods.

Results: Two trajectories of depressive and anxiety symptoms were found for the period between hospitalization and up to seven months after hospital discharge: (1) elevated depressive and moderate anxiety symptoms (13%), and (2) low depressive and anxiety symptoms (87%). The elevated symptoms trajectory was associated with being female, residing in a rural area, prior trauma experience, longer hospitalization, worse self-rated health status while in the hospital, and without monetary assistance during hospitalization. Injury survivors in the elevated depressive and moderate anxiety symptoms class showed almost three times higher disability levels at 4-7 months after hospital discharge, and strongly reduced resumption of daily activities and work.

Conclusions: These findings show the burden of depressive and anxiety symptoms several months after physical injury in a predominantly male, urban population in Kenya. The persistence of elevated depressive and moderate anxiety symptoms after hospitalization and associated reduced functioning underscores the importance of identifying populations at risk for preventive and early interventions.