Promotive and preventive interventions for adolescent mental health in Sub-Saharan Africa: a combined scoping and systematic review.

Introduction: Poor mental health in adolescence is associated with mental, physical and social problems in later life. Adolescence is, therefore, a critical time for promoting mental well-being and preventing mental illness, particularly in sub-Saharan Africa, where adolescents are exposed to a multitude of risk factors for poor mental health. This review aimed to map the current use, effectiveness and cultural sensitivity of promotive/preventive adolescent mental health interventions in the region. Methods: A combined scoping and systematic review was conducted using the Arksey and O'Malley framework through searches in MEDLINE, CINAHL, Global Health, PsycINFO and the Cochrane Database of Systematic Reviews, covering January 2000 to December 2021. Results: This review identified 79 papers, related to 61 unique interventions. Only five universal, school-based programmes were identified; most studies targeted orphans or HIV positive adolescents. Psychosocial interventions-aimed at strengthening knowledge, expression and psychosocial skills-produced mixed results. Structural interventions were often community-based and had limited psychosocial programming. Those that focused on HIV prevention, gender equity and parenting also produced mixed results; evidence was strongest for economic-livelihood programmes. Few studies described cultural sensitivity in detail. Some explained how the intervention aligned with local worldviews/values; had context-specific content; were based on explorations of relevant concepts; or integrated spiritual/cultural practices. Conclusion: Preventive/promotive interventions for adolescent mental health in sub-Saharan Africa are limited in terms of geographical spread, but broad in terms of intervention types. Targeted approaches reflect realities that adolescents in the region face in relation to socioeconomic deprivation, family disruption and poor physical health. Yet, universal interventions that focus on general well-being are limited and lack a consideration of contemporary developments in the region such as increased social media use, suicide and obesity. Economic livelihood interventions showed most consistent evidence of effectiveness. Future studies could do more to consider/report cultural sensitivity.