Centering the Mental Health of Adolescent Girls and Young Women in Africa: A Scoping Review

Background and Purpose: In Sub-Saharan Africa (SSA), one out of every seven children suffer from major psychological problems. Across SSA, adolescent girls and young women are three times more likely than boys to experience depressive disorders (Nabunya et al., 2020). Despite this problem, minimal research centers global adolescent mental health for young females ages 12-25, and the lack of studies focused on young females is of significant concern. This scoping review examines the multilevel (i.e. individual, family and community) risk and protective factors associated with important mental health outcomes among young females in African countries.

Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines. Inclusion criteria were: 1) sample includes girls and/or young women from African countries (mean age between 12-25); 2) primary mental health or well-being outcome; 3) studies that studies that inform what we know about what is associated with mental health; 4) peer-reviewed journal articles from 2000 to the present; and, 5) published in English. Database searches were conducted in PsychInfo, PubMed, and Global Health. Keywords were developed in consultation with a research librarian. Included studies were assessed for methodological quality and data were extracted and synthesized.

Results: A total of 1010 records were identified. After title/abstract and full-text reviews (n=101), a total of 10 studies were included. Quantitative and qualitative studies were equally represented. Most regions in Africa were represented in the research. Uganda was the only post-conflict country represented in the included studies, and the remaining studies were done in no conflict countries. More studies focused on risk factors. Across studies, community-level risk factors (e.g., cultural ceremonies relating to female genital cutting and menstrual poverty) were often related to bodily autonomy. More recent studies focused on the impact of COVID-19 restrictions in the community on mental health. Family-level risk factors included household loss of income, economic and food insecurity, and fear of infection and/or death of family members. Individual-level risk factors included hopelessness, online dating, general health symptoms, high-risk sexual behavior, and interpersonal violence. Self-concept and self-esteem emerged as important protective factors on the individual level, and family-level protective factors were related to social relationships. Community-level protective factors were related to community events such as cultural rites of passage targeted at young girls and women. Most of the studies were conducted within school and community settings.

Conclusions and Implications: Taken together, this review uncovered key risk and protective factors at the individual, family, and community levels of the ecosystem that are important to consider when understanding mental health outcomes among young females across Africa. Developing strategies for intervention within schools and community-based settings could be key levers for change. The importance of understanding the current research cannot be overstated as the field grapples with how to address the global adolescent mental health needs of children in Africa. These findings point to the importance of global mental health research, practice and policy focused on reducing global mental health inequities.