Adolescent Health Series The status of adolescent mental health research, practice and policy in sub-Saharan Africa: A narrative review

The role of breastfeeding, antibiotics and antimalarial medicinal exposure in paediatric depression amongst children aged under 5: a population-based study

BACKGROUND

Although paediatric depression is a recognised problem worldwide, there is limited data on its prevalence in children aged under 5 years, and the role of breastfeeding and medicinal exposure. This study examined whether lack of breastfeeding, and exposure to antimalarial and antibiotic medicines, contribute to depression in Nigerian children aged under 5.

METHODS

The study examined data from 31,103 children (mean age, 2.11 years (SD, 1.421)), collected during the 6th round of the MICS (Multiple Indicator Cluster Surveys), completed in 2021. A series of binary logistic regression models were used to analyse the data.

RESULTS

Children exposed to antimalarial medicines, specifically ACT (AOR = 1.760, 95%CI [1.316-2.355]), and artesunate injections (AOR = 1.757, 95%CI [1.150-2.684]), and those who were not breastfed (AOR = 0.776, 95%CI [0.625-0.963]), had greater odds of depression, after adjusting for potential confounders. The association between ACT medication use and depression was salient in male children (AOR = 2.347, 95%CI [1.547-3.559]), whereas the relationship between breastfeeding and depression was primarily observed in female children (AOR = 0.689, 95%CI [0.498-0.951]). Robustness checks including variations in managing missing data, breastfeeding measurement, and analysis across subgroups for multiple covariates (e.g., geographical area, mothers' education, wealth index, medical symptoms), highlighted the importance of contextual factors.

CONCLUSIONS

This is the first population-based study to examine the role of breastfeeding and medicinal use in suspected depression amongst children aged under 5, from sub-Sharan Africa. Overall, exposure to antimalaria treatment, particularly ACT, and inadequate breastfeeding may help identify young children susceptible to paediatric depression.

CLINICAL TRIAL NUMBER

Not applicable.

Anxiety, depression, and post-traumatic stress and associated risk factors among out-of-school girls in western Kenya

BACKGROUND

Many adolescent girls drop out of school in sub-Saharan Africa. Mental health problems in this population and their risk factors are a neglected research area.

METHODS

This community-based cross-sectional survey studied 904 out-of-school girls in rural western Kenya. Outcome variables were a positive screen for anxiety (GAD-7), depression (PHQ-A), post-traumatic stress disorder (PTSD; PCL-C), and a composite measure for overall symptom severity. Survey data were analysed with univariable and multivariable binary logistic and multiple linear regression analyses using SPSS 29.0.

FINDINGS

The prevalence of probable anxiety was 10.6%, of probable depression 15.9%, and of probable PTSD 18.0%. One of the three items on suicidal ideation or past suicide attempt was reported by 40.2% of girls. In multivariable analyses controlling for age, fear of sexual assault and functional limitations due to menstruation were uniquely associated with each of the outcome variables, and exposure to physical violence to each outcome except anxiety. Other risk factors showed a less consistent relationship with outcome. The cross-sectional study design precludes any temporal and causal inference for the reported significant associations.

CONCLUSION

Out-of-school girls constitute a vulnerable group with high levels of PTSD and suicide risk. Multi-level and multi-sector interventions are needed to help these girls cope with their mental health problems and to address mutable risk factors such as gender-based partner and non-partner sexual and physical violence, poor menstrual hygiene, and poverty.

Parental involvement in school-based mental health interventions for young people in low-resource settings: A qualitative study from Zimbabwe and Ghana

BACKGROUND

Young people in low-resource settings are disproportionately affected by mental health problems, yet access to formal mental healthcare remains limited. However, schools in these regions have increasingly become the primary settings for mental health interventions, offering an accessible and supportive environment for mental health services. Recognising the critical role schools play in providing mental health services for young people, there has been a growing emphasis on involving parents in school-based mental health (SBMH) interventions in low-resource settings. This study explored the mechanisms for effectively involving parents in SBMH interventions for young people in Zimbabwe and Ghana.

METHODS

Cross-sectional qualitative research was conducted in Harare, Zimbabwe and Navrongo, Ghana. This study is a sub-analysis of a larger formative qualitative study which aimed to identify evidence for adapting interventions for depression and anxiety for young people aged 15-24 in Zimbabwe, and 15-18 in Ghana, and test the feasibility of the adapted intervention. We utilised semi-structured in-depth interviews, key informant interviews and focus group discussions with various stakeholders until data saturation was achieved. All interviews were audiotaped and later transcribed verbatim and translated to English for analysis. Data for this study were inductively coded and analysed using thematic analysis.

RESULTS

Effective mechanisms for engaging parents in SBMH include routine parent-teacher meetings, interface meetings between parents and school-based mental healthcare providers, and direct parental participation in sessions. However, while parental involvement is key for SBMH interventions, it can be problematic. In some cases, parents may unintentionally breach their children's privacy and confidentiality or may be the source of their children's mental health problems.

CONCLUSION

The study's findings underscore the importance of parents as vital partners in SBMH interventions. Given the positive impact of parental involvement, it is essential to incorporate parents into the design and implementation of these interventions. By leveraging the insights from this study, interventionists can develop and implement more effective and low-cost SBMH interventions, which can significantly improve mental health outcomes for young people in low-resource settings.

Friendship Bench intervention to address depression and improve HIV care engagement among adolescents living with HIV in Malawi: Study protocol for a pilot randomized controlled trial

BACKGROUND

Adolescents in Sub-Saharan Africa are disproportionately affected by the HIV epidemic. Comorbid depression is prevalent among adolescents living with HIV (ALWH) and poses numerous challenges to HIV care engagement and retainment. We present a pilot trial designed to investigate feasibility, fidelity, and acceptability of an adapted and an enhanced Friendship Bench intervention (henceforth: AFB and EFB) in reducing depression and improving engagement in HIV care among ALWH in Malawi.

METHODS

Design: Participants will be randomized to one of three conditions: the Friendship Bench intervention adapted for ALWH (AFB, n = 35), the Friendship Bench intervention enhanced with peer support (EFB, n = 35), or standard of care (SOC, n = 35). Recruitment is planned for early 2024 in four clinics in Malawi. Participants: Eligibility criteria (1) aged 13-19; (2) diagnosed with HIV (vertically or horizontally); (3) scored ≥  13 on the self-reported Beck's Depression Inventory (BDI-II); (4) living in the clinic's catchment area with intention to remain for at least 1 year; and (5) willing to provide informed consent. Interventions: AFB includes 6 counseling sessions facilitated by young, trained non-professional counselors. EFB consists of AFB plus integration of peer support group sessions to facilitate engagement in HIV care. SOC for mental health in public facilities in Malawi includes options for basic supportive counseling, medication, referral to mental health clinics or psychiatric units at tertiary care hospitals for more severe cases. Outcomes: The primary outcomes are feasibility, acceptability, and fidelity of the AFB and EFB assessed at 6 months and 12 months and compared across 3 arms. The secondary outcome is to assess preliminary effectiveness of the interventions in reducing depressive symptoms and improving HIV viral suppression at 6 months and 12 months.

DISCUSSION

This pilot study will provide insights into youth-friendly adaptations of the Friendship Bench model for ALWH in Malawi and the value of adding group peer support for HIV care engagement. The information gathered in this study will lead to a R01 application to test our adapted intervention in a large-scale cluster randomized controlled trial to improve depression and engagement in HIV care among ALWH.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT06173544).

Apriori algorithm based prediction of students' mental health risks in the context of artificial intelligence

Introduction

The increasing prevalence of mental health challenges among college students necessitates innovative approaches to early identification and intervention. This study investigates the application of artificial intelligence (AI) techniques for predicting student mental health risks.

Methods

A hybrid predictive model, Prophet-LSTM, was developed. This model combines the Prophet time series model with Long Short-Term Memory (LSTM) networks to leverage their strengths in forecasting. Prior to model development, association rules between potential mental health risk factors were identified using the Apriori algorithm. These highly associated factors served as inputs for the Prophet-LSTM model. The model's weight coefficients were optimized using the Quantum Particle Swarm Optimization (QPSO) algorithm. The model's performance was evaluated using data from a mental health survey conducted among college students at a Chinese university.

Results

The proposed Prophet-LSTM model demonstrated superior performance in predicting student mental health risks compared to other machine learning algorithms. Evaluation metrics, including the detection rate of psychological issues and the detection rate of no psychological issues, confirmed the model's high accuracy.

Discussion

This study demonstrates the potential of AI-powered predictive models for early identification of students at risk of mental health challenges. The findings have significant implications for improving mental health services within higher education institutions. Future research should focus on further refining the model, incorporating real-time data streams, and developing personalized intervention strategies based on the model's predictions.

Mental health and help-seeking behaviors among Mozambican youth: insights from a post-pandemic National Survey Amidst Internal Conflict

PURPOSE

This study aimed to investigate the prevalence and sociodemographic determinants of major depressive disorder (MDD) and generalized anxiety disorder (GAD) among Mozambican youth aged 15-24 years, as well as their help-seeking behaviors.

METHODS

Data from 8,154 youth participants in the 2022-23 Mozambique Demographic Health Survey were analyzed. MDD and GAD were assessed using the PHQ-9 and GAD-7 scales, respectively. Univariate and multivariate logistic regression analyses were conducted to examine associations between sociodemographic factors and mental health outcomes and health-seeking behaviors.

RESULTS

The prevalence of MDD and GAD among Mozambican youth was 7.5% for each condition. However, only 9.3% of those with either MDD or GAD sought help for their symptoms, primarily from family and friends. Females had significantly higher odds of experiencing both MDD and GAD but lower help-seeking behavior as compared to males. Unemployment, lower household wealth, and being single were associated with higher odds of both disorders and lower odds of help-seeking behaviors. Higher education increased the odds of GAD and help-seeking behaviors. Significant regional variations were observed, with conflict-affected regions including Cabo Delgado, Nampula, and Zambezia showing the highest prevalence of MDD and GAD.

CONCLUSION

This study reveals substantial mental health challenges among Mozambican youth, with notable disparities across sociodemographic groups and regions. The low rates of help-seeking behavior underscore the need for targeted interventions to improve mental health awareness and access to services for socio-demographically vulnerable youth.

Any better? A follow-up content analysis of adolescent sexual and reproductive health inclusion in Global Financing Facility country planning documents

BACKGROUND

The Global Financing Facility (GFF) supports national reproductive, maternal, newborn, child, adolescent health, and nutrition needs. Previous analysis examined how adolescent sexual and reproductive health was represented in GFF national planning documents for 11 GFF partner countries.

OBJECTIVES

This paper furthers that analysis for 16 GFF partner countries as part of a Special Series.

METHODS

Content analysis was conducted on publicly available GFF planning documents for Afghanistan, Burkina Faso, Cambodia, CAR, Côte d'Ivoire, Guinea, Haiti, Indonesia, Madagascar, Malawi, Mali, Rwanda, Senegal, Sierra Leone, Tajikistan, Vietnam. Analysis considered adolescent health content (mindset), indicators (measure) and funding (money) relative to adolescent sexual and reproductive health needs, using a tracer indicator.

RESULTS

Countries with higher rates of adolescent pregnancy had more content relating to adolescent reproductive health, with exceptions in fragile contexts. Investment cases had more adolescent content than project appraisal documents. Content gradually weakened from mindset to measures to money. Related conditions, such as fistula, abortion, and mental health, were insufficiently addressed. Documents from Burkina Faso and Malawi demonstrated it is possible to include adolescent programming even within a context of shifting or selective priorities.

CONCLUSION

Tracing prioritisation and translation of commitments into plans provides a foundation for discussing global funding for adolescents. We highlight positive aspects of programming and areas for strengthening and suggest broadening the perspective of adolescent health beyond the reproductive health to encompass issues, such as mental health. This paper forms part of a growing body of accountability literature, supporting advocacy work for adolescent programming and funding.

Adolescent mental health in sub-Saharan Africa: crisis? What crisis? Solution? What solution?

Addressing adolescent mental health care across sub-Saharan Africa faces numerous challenges, including underfunded public health systems, a shortage of mental health professionals, barriers to access, and pervasive stigma. Untreated adolescents often experience worsening symptoms, academic and social difficulties, physical health risks, and engage in risky behaviours. Early detection and appropriate treatment of common mental health conditions can support adolescents in developing robust social and emotional foundations and enhancing their mental well-being. Ensuring adolescents receive the mental health care required for healthy development depends on collaborative, evidence-based solutions that consider the contextual challenges of sub-Saharan Africa. Innovative community-based solutions to mental health services may significantly improve accessibility and support adolescents close to their homes and schools. For example, co-creation and peer-delivered interventions with professional supervision may enhance uptake and reduce stigma. This short article adds to the current debate arguing for working with communities and implementing community mental health services for common mental health conditions. Sensitivity to community-specific challenges and building referral networks are crucial for effective care. Investing in these strategies, alongside increasing mental health literacy, could lead to affordable and significant interventions to address adolescent mental health.

The Impact of the Alma-Ata Declaration on Global Pediatric Health Disparities: An Intersectional Perspective

Purpose of Review

The purpose of this review is to examine the impact of the Alma-Ata Declaration on global pediatric health disparities, highlighting the potential value of innovative research approaches such as intersectional quantitative studies in broadening our understanding of how the drivers of marginalization and social privilege intertwine to reinforce (or diminish each other) in the development of pediatric health disparity.

Recent Findings

Despite the global reach of the Alma-Ata Declaration and decades of its implementation, pediatric health disparities persist, with poorer health outcomes and greater exposure to adverse social contexts borne by children living in low and middle income countries (LMICs).

Summary

This paper explores degree to which the Alma-Ata Declaration through its proxy pediatric policy, the Integrated Management of Childhood Illnesses (IMCI), has been able to reduce global pediatric health disparities and suggests the use of intersectional analytical approaches as a means of addressing shortfalls in effectiveness of pediatric health policies.

Meta-Analysis: Prevalence of Youth Mental Disorders in Sub-Saharan Africa

Youth in sub-Saharan Africa (SSA) face limited access to professional mental health resources. A comprehensive assessment of the prevalence of mental disorders would build an understanding of the scope of the need. We conducted systematic searches in PsycInfo, Pubmed, AfriBib and Africa Journals Online to identify prevalence rates for five disorders (anxiety, depression, conduct disorder, attention problems and post-traumatic stress) among SSA youth with a mean age of less than 19 years. We calculated a random-effects pooled prevalence for each disorder and assessed possible moderators. The meta-analysis included 63 studies with 55,071 participants. We found the following pooled prevalence rates: 12.53% post-traumatic stress disorder (PTSD), 15.27% depression, 6.55% attention-deficit hyperactivity disorder, 11.78% anxiety and 9.76% conduct disorder. We found high heterogeneity across the studies, which may have resulted from differences in samples or measurement tools. Reported prevalence rates were not explained by the sample (i.e., special or general population), but whether the psychometric tool was validated for SSA youth affected the reported prevalence of PTSD and anxiety. In a meta-regression, prevalence rates were associated with the disorder type, with a higher prevalence of depression and PTSD. We found the mean age significantly moderated the prevalence in univariate meta-regression, with increased age correlated with greater prevalence. Our findings suggest there is a need to explore reasons for varying prevalence rates further and to develop interventions that support youth mental health in SSA, particularly interventions for depression and PTSD. Limitations included a lack of standardization in psychometric tools and limited reporting on research methods, which influenced quality rating. Importantly, the search only considered studies published in English and was conducted 2 years ago. Although recent estimates reported slightly higher than our prevalence estimates, these reviews together highlight the prevalence and importance of youth mental health difficulties in SSA.

Elevated stress-responsive biomarkers are associated with HIV acquisition in young women in rural South Africa

OBJECTIVE

Biological markers of stress have been associated with HIV progression and pathogenesis but not with HIV incidence. We sought to determine if elevated stress-responsive biomarkers would be associated with incident HIV among adolescent girls and young women (AGYW).

DESIGN

We conducted a case-cohort study within the HIV Prevention Trials Network (HPTN) 068 study among 949 AGYW in South Africa. Cases were AGYW who tested HIV-positive during the eight-year follow-up. Unmatched controls were randomly selected from the HIV-negative population at enrollment.

METHODS

Dried blood spots from cases and controls were tested from enrollment (2011-2012) for C-reactive protein (CRP), herpes simplex virus type-1 (HSV-1) antibody titers, and cytomegalovirus (CMV) antibody titers. Cox proportional hazards models estimated the association between each biomarker and time to incident HIV.

RESULTS

Compared to AGYW with the lowest CRP levels, those with medium and high CRP levels had a higher hazard ratio (HR) of incident HIV [HR: 1.45, 95% confidence interval (CI): 0.95, 2.21; HR: 1.50, 95% CI: 0.98, 2.30, respectively], although not statistically significant. The relative hazard of incident HIV was also higher among AGYW who were CMV seropositive vs. seronegative (low antibodies HR: 2.18, 95% CI: 1.2, 3.87; medium HR: 2.25, 95% CI: 1.28, 3.95; high HR: 1.78, 95% CI: 0.99, 3.21). Those with the highest HSV-1 antibody levels experienced an increased hazard of HIV compared to those who were HSV-1 seronegative (HR: 1.58, 95% CI: 1.03, 2.44).

CONCLUSIONS

Biological stress may increase AGYW's susceptibility to HIV acquisition through changes in immune function, viral infection, and increased biological vulnerability to disease.

Adolescent mental health services in West Africa: a comparative analysis of Burkina Faso, Ghana, and Niger

BACKGROUND

Adolescent mental health (AMH) is a critical issue worldwide, particularly in West Africa, where it is intensified by socio-economic, cultural, and security challenges. Insecurity and the presence of mining sites expose adolescents to hazardous environments, substance abuse, and adulterated alcohol, further aggravating their mental health. Despite these severe issues, research on AMH in this region remains limited. This study aims to analyze the provision of AMH services in Burkina Faso, Ghana, and Niger, highlighting the unique challenges these countries face within the broader West African healthcare context.

METHODS

The study adopted a multi-stage, stratified sampling design to collect data from primary healthcare centers (PHCs) in the three countries. Using STATA.17, Descriptive analysis was conducted on the data related to availability of AMH services, types of mental health disorders treated, resources available, and OPD attendance rates. The analysis also incorporated factors such as the rural-urban divide and the presence of national guidelines for AMH services.

RESULTS

The findings reveal a significant shortfall in the provision of AMH services across the region, with less than 30% of PHCs across all the countries offering these services. The study also highlights a pronounced rural-urban disparity in AMH service availability, a general absence of national guidelines for AMH care, and low OPD attendance rates.

CONCLUSION

The study highlights the urgent need for comprehensive policy reform and targeted interventions to enhance AMH services in West Africa. Key policy reforms should include the development and implementation of national guidelines for AMH care and integration of AMH services into primary healthcare. Additionally, efforts should focus on capacity building through the training of mental health professionals, increasing public awareness to reduce stigma, and ensuring equitable resource allocation across rural and urban areas. Improving AMH care is essential not only for the well-being of adolescents but also for driving broader socio-economic development in the region.

Knowledge, attitudes, and practices on child and adolescent mental health among healthcare workers in sub-Saharan Africa: a scoping review

INTRODUCTION

Child and adolescent mental health is a global priority. In sub-Saharan Africa, despite the high burden, there is a gap in health services for children and adolescents with mental health disorders. To bridge this gap, healthcare workers require a good understanding of child and adolescent mental health, the right attitude, and practices geared to improving child and adolescent mental health. This scoping review examined the knowledge, attitudes, and practices related to child and adolescent mental health among sub-Saharan African healthcare workers.

METHODS

The search was restricted between January 2010, the year when the Mental Health Gap Action Programme guidelines were launched, and April 2024. The review followed the methodological framework proposed by Arksey and O'Malley for conducting scoping reviews. The databases searched included CINHAL, PubMed, Web of Science, PsycINFO, and grey literature databases. Additional articles were identified through cited references of the studies included. A data extraction template was used to retrieve relevant text. A narrative synthesis approach was adopted to explore the relationships within and between the included studies.

RESULTS

The literature search yielded 4658 studies. Among these, 817 were identified as duplicates, and 3740 were excluded after screening. Only twenty-one articles met the criteria for inclusion in the review. The findings showed that healthcare workers have insufficient knowledge of child and adolescent mental health, hold negative attitudes toward children and adolescents with mental health problems, and exhibit poor practices related to child and adolescent mental health.

CONCLUSION

It is crucial to build capacity and improve healthcare workers' practices, knowledge, and attitudes toward child and adolescent mental health in sub-Saharan Africa. This could lead to better access to mental health services for children and adolescents in the region.

Friendship Bench Intervention to Address Depression and Improve HIV Care Engagement Among Adolescents Living with HIV in Malawi: Study Protocol for a Pilot Randomized Controlled Trial

Background

Adolescents in Sub-Saharan Africa are disproportionately affected by the HIV epidemic. Comorbid depression is prevalent among adolescents living with HIV (ALWH) and poses numerous challenges to HIV care engagement and retainment. We present a pilot trial designed to investigate feasibility, fidelity, and acceptability of an adapted and an enhanced Friendship Bench intervention (henceforth: AFB and EFB) in reducing depression and improving engagement in HIV care among ALWH in Malawi.

Methods

Design:: Participants will be randomized to one of three conditions: the Friendship Bench intervention adapted for ALWH (AFB, n=35), the Friendship Bench intervention enhanced with peer support (EFB, n=35), or standard of care (SOC, n=35). Recruitment is planned for early 2024 in four clinics in Malawi.Participants:: Eligibility criteria (1) aged 13-19; (2) diagnosed with HIV (vertically or horizontally); (3) scored ≥ 13 on the self-reported Beck's Depression Inventory (BDI-II); (4) living in the clinic's catchment area with intention to remain for at least 1 year; and (5) willing to provide informed consent.Interventions:: AFB includes 6 counseling sessions facilitated by young, trained non-professional counselors. EFB consists of AFB plus integration of peer support group sessions to facilitate engagement in HIV care. SOC for mental health in public facilities in Malawi includes options for basic supportive counseling, medication, referral to mental health clinics or psychiatric units at tertiary care hospitals for more severe cases.Outcomes:: The primary outcomes are feasibility, acceptability, and fidelity of the AFB and EFB assessed at 6 months and 12 months and compared across 3 arms. The secondary outcome is to assess preliminary effectiveness of the interventions in reducing depressive symptoms and improving HIV viral suppression at 6 months and 12 months.

Discussion

This pilot study will provide insights into youth-friendly adaptations of the Friendship Bench model for ALWH in Malawi and the value of adding group peer support for HIV care engagement. The information gathered in this study will lead to a R01 application to test our adapted intervention in a large-scale cluster randomized controlled trial to improve depression and engagement in HIV care among ALWH.

Multisystemic supports and adolescent resilience to depression over time: A South African mixed methods study

In sub-Saharan countries, like South Africa, there is scant understanding of adolescent resilience to depression over time; the multisystemic resource combinations that support such resilience; and whether more diverse resource combinations yield better mental health dividends. In response, we conducted a longitudinal concurrent nested mixed methods study with 223 South African adolescents (mean age: 17.16 years, SD = 1.73; 64.60% girls; 81.60% Black). Using longitudinal mixture modeling, the quantitative study identified trajectories of depression and associations between trajectory membership and resource diversity. Using a draw-and-write methodology and reflexive thematic analyses, the qualitative study explored the resource diversity associated with each trajectory. Taken together, these studies identified four depression trajectories (Stable Low; Declining; Worsening; Chronic High) with varying resource diversity at baseline and over time. Resource diversity was inclusive of personal, relational, contextual, and culturally valued resources in both the Stable Low and Declining trajectories, with emphasis on relational supports. Personal resources were emphasized in the Worsening and Chronic High trajectories, and culturally valued and contextual resources de-emphasized. In summary, resource constellations characterized by within and across system diversity and cultural responsiveness are more protective and will be key to advancing sub-Saharan adolescent mental health.

Effectiveness of school-based psychological interventions for the treatment of depression, anxiety and post-traumatic stress disorder among adolescents in sub-Saharan Africa: A systematic review of randomized controlled trials

BACKGROUND

Mental disorders among adolescents represent a high burden and early onset. They compromise their physical health, survival, and future potential. On the other hand, young people have inadequate access to essential health services in sub-Saharan Africa. We aimed to review school-based psychological interventions, contents, delivery, and evidence of effectiveness designed to treat depression, anxiety, or posttraumatic stress symptoms among adolescents and young adults aged 10-24.

METHOD

We searched articles on the following databases: PubMed, Scopus, Embase, and Science Direct from 17/10/2022 to 30/12/2022. Furthermore, relevant studies were searched from advanced google scholar, google and identified reference lists. We used MeSH browser for key words: psychological interventions, depression, anxiety, posttraumatic stress disorder and lists of Sub-Saharan Africa countries. We combined words using standard Boolean operators (OR, AND). The quality of studies was evaluated using the Cochrane Collaboration's risk of bias tool and the results were presented as a narrative synthesis since the interventions were very heterogenous.

RESULTS

Fourteen randomized controlled trials were included for systematic review and more than half (57.14%) were from Kenya and Nigeria. Common school-based psychological interventions were cognitive behavioral therapy and Shamiri interventions (an intervention that focuses on youths to cultivate a growth mindset, practice gratitude and take the value). More than half (57.14%) of the interventions were delivered by non-specialists like teachers, lay providers and community health workers. Nearly one-fifth of the interventions were used individual modality. School-based psychological interventions provided by non-specialists also produced a greater reduction in adolescents' depressive, anxiety, and post-traumatic stress symptoms compared to the control groups.

CONCLUSION

Cognitive behavioral therapy and Shamiri interventions were the common treatment delivered in school settings. The range of interventions could be effectively delivered by non- professionals that promote task-shifting of psychological interventions from very scarce mental health specialists in these countries.

TRIAL REGISTRATION

Trial Registration: Prospero CRD42022378372. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022378372.

The association between family adversity and youth mental health outcomes

BACKGROUND

The association between family adversity and young people's mental health outcomes in communities that experience economic instability has not been well explored in the South African context. Furthermore, the overtime interaction between resilience factors, family adversity, and young people's psychological functioning in African settings, like South Africa, is under-investigated.

PURPOSE

This study investigates the relationship between family adversity and conduct problems and depression at two-time points in a sample of youths in two South African communities stressed by their dependency on economically volatile oil and gas industries.

METHOD

This article draws on longitudinal data generated by the Resilient Youth in Stressed Environments (RYSE) study in South Africa, which included 914 and 528 (wave 1 and 3) adolescents and emerging adults (14-27-year-olds; M age = 18.36 years) living in Secunda/eMbalenhle and Sasolburg/Zamdela. Participants were sampled at baseline (wave 1) and 18-24 months later (wave 3). They self-reported experience of community violence, family adversity, resilience-enabling resources, conduct difficulties, and depression symptoms. Regression analyses were used to examine the unadjusted and adjusted association of family adversity on conduct problem and depression.

RESULTS

About 60% of participants reported high family adversity. Regressions, however, revealed no association between family adversity and conduct problems and depression cross-sectionally and over time. Individual resilience, biological sex, and experience of victimization in the community, however, were associated with conduct difficulty while all three resilience factors were associated with decreased depression among participants.

CONCLUSION

Our study sheds light on the risk and protective factors for mental health outcomes of adolescents and youths who reside in volatile, turbulent communities and experience ongoing familial challenges. To effectively support the mental well-being of young individuals in such contexts, interventions must consider the potential ambivalence of the resilience factors they aim to strengthen.

Risk and protective factors for mental health and wellbeing among adolescent orphans

Background

Research has demonstrated the importance of understanding risk factors for mental health and wellbeing. Less research has focused on protective factors that protect mental health and promote wellbeing in diverse contexts. Estimating structural paths from risk protective factors to psychopathology and wellbeing can inform prioritization of targeted investment in adolescent health programs that seek to modify factors that are most closely associated with mental wellbeing.

Study objective

The purpose of this study was to examine risk factors (e.g. emotional neglect, emotional abuse, physical neglect, stigma) and protective factors (e.g. community relationships, self-esteem, and autonomy) among adolescent orphans, protective associations with depression, anxiety and externalizing behaviors and promotive associations with hope, happiness, and health.

Methods

The analytic sample was collected between January and March of 2019 and included 350 adolescent orphans ages 10-15 from three districts in Tanzania. Participants completed survey interviews, 75-90 min in length, that measured risk and protective factors, psychological symptoms, and mental wellbeing measures.

Results

Results of the fitted structural equation model indicated that structural paths from protective factors to psychopathology (β = -0.53, p = 0.015) and mental wellbeing (β = 0.72, p = 0.014) outcomes were significant. Structural paths from risk factors to psychopathology (β = -0.34, p = 0.108) and mental wellbeing (β = -0.24, p = 0.405) were not significant.

Conclusion

In a sample of vulnerable youth, protective factors (e.g. community relationships, self-esteem, and autonomy) were significantly associated with reduced depression, anxiety and externalizing behaviors and increased hope, happiness, and health in a structural equation model that included risk factors (emotional neglect, emotional abuse, physical neglect). Results suggest that strong community relationships, self-esteem and autonomy may be important modifiable factors to target in intervention programs aimed at supporting adolescent mental wellbeing.

Mental health and psychosocial interventions integrating sexual and reproductive rights and health, and HIV care and prevention for adolescents and young people (10-24 years) in sub-Saharan Africa: a systematic scoping review

Background

Interventions targeting combined sexual and reproductive health, Human Immunodeficiency Virus (HIV) management and mental health care in sub-Saharan Africa (SSA) are few. There is a need to address common determinants of poor mental, psychosocial and sexual and reproductive health and rights (SRHR) through multimodal and multipronged interventions for adolescents. The main objective of this study was to identify whether and how interventions targeting adolescent SRHR and HIV with a focus on pregnant and parenting adolescents in SSA include mental health components and how these components and their outcomes have been reported in the literature.

Methods

We carried out a two process scoping review approach between 01.04.2021 and 23.08.2022. In the first stage, we searched the PubMed database to identify studies focusing on adolescents and young people aged 10 to 24 from 2001 to 2021. We identified studies focusing on HIV and SRHR that had mental health and psychosocial aspects to the interventions. Our search yielded 7025 studies. Of these 38 were eligible based on our screening criteria that covered interventions, and on further scrutiny, using PracticeWise, an established coding system, we identified select problems and practices to provide a more granular assessment of how interventions developed for this context mapped on to specific problems. At this second stage process, we selected 27 studies for inclusion as actual interventional designs for further systematic scoping of their findings and we used the Joanna Briggs Quality Appraisal checklist to rate these studies. This review was registered within the International Prospective Register of Systematic Reviews (PROSPERO), number CRD42021234627.

Findings

Our first set of findings is that when coding problems and solutions, mental health concerns were the least common category of problems targeted in these SRHR/HIV interventions; nevertheless, psychoeducation and cognitive behavioral strategies such as improved communication, assertiveness training, and informational support were offered widely. Of the 27 interventional studies included in the final review, 17 RCTs, 7 open trials, and 3 mixed designs, represented nine countries of the 46 countries in SSA. Intervention types included peer, community, family, digital, and mixed modality interventions. Eight interventions focused on caregivers and youth. Social or community ecology associated problems (being an orphan, sexual abuse, homelessness, negative cultural norms) were the most common risk factors and were more frequent than medical issues associated with HIV exposure. Our findings highlight the relevance and centrality of social issues related to adolescent mental and physical health along with the need to strengthen multimodal interventions along the lines of problems we have identified in our review.

Interpretation

Combined interventions jointly addressing adolescent SRHR, HIV, and mental health have been relatively understudied, despite evidence that adverse social and community factors are rampant in this population.

Funding

MK was funded by Fogarty International CenterK43 TW010716-05 and lead the initiative.

Common mental health problems among adolescents in sub-Saharan Africa: A systematic review and meta-analysis

Background and aim: This review examined the prevalence of mental health problems among adolescents in sub-Saharan Africa.Methods: The review included studies indexed in the MEDLINE, EMBASE, and PsycINFO databases, supplemented by a search on Google Scholar and tracking of references from articles identified. A total of 725 articles were found, of which 28 met the inclusion criteria. Finally, 22 eligible studies were reviewed.Findings: The pooled current prevalence of mental health problems was 23% (95% CI: 18; 28, I2 = 99.41%). Any depression, 19% (95% CI: 9; 30, I2 = 99.64%), and anxiety, 20% (95% CI: 01; 31, I2 = 99.64%), were the most common mental health problems reported. Attention deficit hyperactivity disorder, 5% (95% CI: 3; 7, I2 = 97.60%), and conduct disorders, 15% (95% CI: 8; 22, I2 = 99.58%), were also significant mental health problems among adolescents in the region.Conclusion: About one in five adolescents in sub-Saharan Africa suffer from one or more mental health problems. The findings have important implications for policy and practice as they indicate that mental health problems are a major public health issue among adolescents in sub-Saharan Africa and that there is a need for effective and context-specific interventions that address mental health.