Trauma symptoms and their correlates among Zimbabwean adolescents: Baseline results from a cluster randomized controlled trial.

Adolescent mental health is an urgent global priority, yet services remain severely inaccessible throughout Southern Africa. Zimbabwean youth are particularly vulnerable to mental health challenges from adverse childhood experiences including food insecurity, sexual and emotional violence, climate change-induced disasters, and national economic difficulties but research is extremely limited. To address this gap, this study examined trauma symptoms and resilience among a large school-based sample of urban and rural Zimbabwean adolescents. A cluster randomized controlled trial was conducted to evaluate the impact of Singing to the Lions, a biopsychosocial workshop for trauma-affected youth in Zimbabwe. Adolescents were randomized by school (n = 13) to an immediate intervention arm or waitlist control arm. Baseline data, including adolescents' demographics, trauma symptoms, and resilience characteristics were analyzed to investigate the prevalence of trauma symptoms and that association with resilience characteristics. The baseline sample (n = 1,342) ranged in age from 12-18 years (x-=14.8); the majority of children were girls (54.6%) and rural (52.4%). Of 18 possible trauma symptoms, youth endorsed an average of 7.6 trauma symptoms (SD = 4.5) with significantly higher rates among girls (t[1325]=3.39, p = .0007). Trauma symptoms were significantly inversely correlated with resilience characteristics including self-esteem (r = -.36, p < .001), hope (r = -.07, p = .01), self-calming (r = -.30, p < .001), and social support (r = -.23, p < .001); however, there was no association between symptoms and self-efficacy. No statistically significant differences in trauma symptom prevalence were found based on children's age, grade, or community (rural versus urban). The high prevalence of trauma symptoms and expressions of trauma found in this study are consistent with the limited previous adolescent mental health research from Sub-Saharan Africa. Results contribute to the sparse knowledge base on trauma-affected youth and adolescent mental health in Zimbabwe more broadly and highlight the need for evidence-based practices that are culturally grounded and contextually specific for the region.