A “Both-And” Approach to Cross-Cultural Mental Health Assessment: Examining Depression and Anxiety Symptoms Among Kenyan Adolescents Using both Local and Western-derived Instruments

Background: Cross-cultural mental health assessment faces significant methodological challenges when Western-derived instruments are applied in non-Western settings, potentially missing culturally salient features of psychological distress. This study examines whether locally developed instruments can complement Western tools in understanding adolescent mental health among Kenyan youth.Methods: We evaluated the psychometric properties and complementary utility of the Ndetei-Othieno-Kathuku (NOK) Scale (a locally developed tool in Kenya) alongside standard Western-derived instruments (PHQ-8 for depression, GAD-7 for anxiety) in 2,906 Kenyan adolescents (M age = 15.97, SD=1.45; 57.0% Female) across 40 secondary schools. Using exploratory and confirmatory factor analyses, receiver operating characteristic curves, multidimensional scaling, and network analysis, we examined instrument psychometrics, overlap, and established clinically-elevated symptom thresholds. We also assessed the association of clinically-elevated symptoms with sociodemographic factors.Results: The NOK scales demonstrated poor-to-adequate internal consistency (NOK-Anxiety α = .78; NOK-Depression α = .61) with distinct factor structures from Western instruments. ROC-derived thresholds were 3.5 for depression and 6.5 for anxiety, with moderate diagnostic accuracy (AUC = .72-.77). Prevalence estimates were higher using NOK scales (45.91% depression, 32.11% anxiety) compared to Western instruments (27.28% depression, 21.95% anxiety). Multidimensional scaling revealed clear clustering by instrument origin, while network analysis showed NOK items demonstrated higher centrality, suggesting greater interconnectedness with other symptoms. Age, gender, perceived academic ability, family structure (living with both parents), and parental loss emerged as significant factors associated with clinically-elevated symptoms.Conclusions: Complementary use of locally-developed and Western-derived instruments can provide an enhanced understanding of adolescent mental health in diverse contexts. This "both-and" approach captures culturally specific expressions of distress while maintaining cross-cultural comparability, supporting more comprehensive and culturally responsive assessment practices.