The Structure of Psychopathology Among Young Adults in Kenya, Namibia, and South Africa

The generalizability of psychopathology constructs across human populations is often assumed, but most evidence comes from Western contexts. The ‘majority world’ (Africa, Asia, Latin America, the Middle East) is underrepresented in psychopathology research. Efforts to reorganize mental disorder classifications provide an opportunity to better integrate evidence from majority-world contexts. In this study we investigated the coviariance structure of common mental health problems among young adults in Kenya, Namibia, and South Africa. The findings suggest a relatively consistent structure across countries, characterized by both universal and culturally specific features. Internalizing consistently emerged as robust higher-order dimensions, with fear and dysregulated sleep, disinhibited negative affect, and substance abuse consistently identified as narrower disorder dimensions. Variation was observed across countries in the alignment of anger symptoms. In Namibia and Kenya, anger was more closely associated with internalizing disorders, whereas in South Africa, it aligned more strongly with externalizing disorders. In contrast to the majority of findings in the West, inattention/hyperactivity loaded primarily on internalizing and showed inconsistent loadings across contexts. These results highlight the intricate interplay between universal and culture-specific aspects of psychopathology and emphasize the importance of incorporating diverse global samples to better distinguish the more universal from the more context-specific aspects of psychopathology. We advocate for a more inclusive, culturally-sensitive approach to investigating mental health across populations.