A Systematic Review of the Effectiveness of Interventions for Depression and Anxiety Among Adolescents in Sub-Saharan Africa

Background. Adolescent mental health is a global challenge. In low resource settings, such as Sub-Saharan Africa, adolescent depression and anxiety are disproportionately prevalent and mental health services are inadequate. Community-based mental health promotion and intervention strategies can reduce adolescent mental health stigma and improve uptake and utilization of innovative mental health interventions (Mobrouk et al. 2022). Still, growing awareness of social determinants of mental health underscores that improved adolescent mental health and realization of global adolescent mental health goals (WHO, 2021) hinge on the implementation of efficient and effective interventions that are culturally appropriate and contextually specific for Sub-Saharan African settings. The purpose of this systematic review was to investigate the effectiveness of mental health interventions for treating depression and/or anxiety among adolescents in Sub-Saharan Africa. The specific research question was: How effective are mental health interventions in reducing depression and anxiety among adolescents in Sub Saharan Africa?

Methods. The search strategy followed PRISMA guidelines. The included studies assessed interventions for depression and/or anxiety for adolescents aged 10-19 in any Sub-Saharan country, and were published in English from 2009-2023. The initial search of seven wide-reaching databases yielded 5,754 records from peer-reviewed literature. Of these, 3,346 duplicate records were removed. The remaining 2,408 records were screened at the first level for titles and abstracts and 2,334 records were removed. Finally, 74 records were full-text reviewed at the second level and 49 records were excluded. Ultimately, 25 records were included representing studies conducted in nine countries. Two authors used a data extraction form to generate summary tables addressing study and participant characteristics, intervention characteristics, and risk of bias. The NIMHD Research Framework was used to synthesize study results.

Results. Most studies were conducted in Kenya (n= 11) and Uganda (n = 6). Interventions were conducted in schools (n =14), health facilities (n = 5), communities (n =5), and digitally (n = 2). Of the 25 interventions, 11 targeted depression and 14 targeted both depression and anxiety. Other targeted conditions included self-efficacy, health, and sexual risk-taking. Interventions were provided by a variety of professionals, semi-professionals, and peers, including social workers. All (100%) of the school and health facility-based interventions reported positive effects, as did both digital interventions. Community-based interventions showed mixed evidence of effectiveness with 3 of 5 interventions reporting positive effects.

Conclusions. The effectiveness of interventions in this review can be attributed to several factors: the type of interventions, the theories or conceptual frameworks underpinning the interventions, and cultural relevance to the settings where the interventions were adapted. For these studies, it could be said that “the interventions went to where the problem was.” However, very few of the studies specifically addressed the likely influence of social determinants of mental health on adolescent depression and/or anxiety. Study findings highlight the need to further consider community and societal influences on adolescent mental health in low resource settings (Prencipe et al., 2021), especially if the aim is to promote community and population health benefits and, ultimately, see improved mental health for a new generation.