Effect of multi-level interventions on mental health outcomes among adolescents in sub-Saharan Africa: a systematic review
ObjectiveIn sub-Saharan Africa (SSA), multiple factors contribute to the considerable burden of mental health disorders among adolescents, highlighting the need for interventions that address underlying risks at multiple levels. We reviewed evidence of the effectiveness of community or family-level...
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Published in | BMJ open Vol. 13; no. 10; p. e066586 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
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England
British Medical Journal Publishing Group
03.10.2023
BMJ Publishing Group LTD BMJ Publishing Group |
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Abstract | ObjectiveIn sub-Saharan Africa (SSA), multiple factors contribute to the considerable burden of mental health disorders among adolescents, highlighting the need for interventions that address underlying risks at multiple levels. We reviewed evidence of the effectiveness of community or family-level interventions, with and without individual level interventions, on mental health disorders among adolescents in SSA.DesignSystematic review using the Grades of Recommendation, Assessment, Development and Evaluation approach.Data sourcesA systematic search was conducted on Cochrane Library, MEDLINE, EMBASE, PSYCINFO and Web of Science up to 31 March 2021.Eligibility criteriaStudies were eligible for inclusion in the review if they were randomised controlled trials (RCTs) or controlled quasi-experimental studies conducted in sub-Saharan African countries and measured the effect of an intervention on common mental disorders in adolescents aged 10–24 years.Data extraction and synthesisWe included studies that assessed the effect of interventions on depression, anxiety, post-traumatic stress disorder and substance abuse. Substance abuse was only considered if it was measured alongside mental health disorders. The findings were summarised using synthesis without meta-analysis, where studies were grouped according to the type of intervention (multi-level, community-level) and participants.ResultsOf 1197 studies that were identified, 30 studies (17 RCTs and 3 quasi-experimental studies) were included in the review of which 10 delivered multi-level interventions and 20 delivered community-level interventions. Synthesised findings suggest that multi-level interventions comprise economic empowerment, peer-support, cognitive behavioural therapy were effective in improving mental health among vulnerable adolescents. Majority of studies that delivered interventions to community groups reported significant positive changes in mental health outcomes.ConclusionsThe evidence from this review suggests that multi-level interventions can reduce mental health disorders in adolescents. Further research is needed to understand the reliability and sustainability of these promising interventions in different African contexts.PROSPERO registration numberCRD42021258826. |
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AbstractList | OBJECTIVEIn sub-Saharan Africa (SSA), multiple factors contribute to the considerable burden of mental health disorders among adolescents, highlighting the need for interventions that address underlying risks at multiple levels. We reviewed evidence of the effectiveness of community or family-level interventions, with and without individual level interventions, on mental health disorders among adolescents in SSA.DESIGNSystematic review using the Grades of Recommendation, Assessment, Development and Evaluation approach.DATA SOURCESA systematic search was conducted on Cochrane Library, MEDLINE, EMBASE, PSYCINFO and Web of Science up to 31 March 2021.ELIGIBILITY CRITERIAStudies were eligible for inclusion in the review if they were randomised controlled trials (RCTs) or controlled quasi-experimental studies conducted in sub-Saharan African countries and measured the effect of an intervention on common mental disorders in adolescents aged 10-24 years.DATA EXTRACTION AND SYNTHESISWe included studies that assessed the effect of interventions on depression, anxiety, post-traumatic stress disorder and substance abuse. Substance abuse was only considered if it was measured alongside mental health disorders. The findings were summarised using synthesis without meta-analysis, where studies were grouped according to the type of intervention (multi-level, community-level) and participants.RESULTSOf 1197 studies that were identified, 30 studies (17 RCTs and 3 quasi-experimental studies) were included in the review of which 10 delivered multi-level interventions and 20 delivered community-level interventions. Synthesised findings suggest that multi-level interventions comprise economic empowerment, peer-support, cognitive behavioural therapy were effective in improving mental health among vulnerable adolescents. Majority of studies that delivered interventions to community groups reported significant positive changes in mental health outcomes.CONCLUSIONSThe evidence from this review suggests that multi-level interventions can reduce mental health disorders in adolescents. Further research is needed to understand the reliability and sustainability of these promising interventions in different African contexts.PROSPERO REGISTRATION NUMBERCRD42021258826. Objective In sub-Saharan Africa (SSA), multiple factors contribute to the considerable burden of mental health disorders among adolescents, highlighting the need for interventions that address underlying risks at multiple levels. We reviewed evidence of the effectiveness of community or family-level interventions, with and without individual level interventions, on mental health disorders among adolescents in SSA.Design Systematic review using the Grades of Recommendation, Assessment, Development and Evaluation approach.Data sources A systematic search was conducted on Cochrane Library, MEDLINE, EMBASE, PSYCINFO and Web of Science up to 31 March 2021.Eligibility criteria Studies were eligible for inclusion in the review if they were randomised controlled trials (RCTs) or controlled quasi-experimental studies conducted in sub-Saharan African countries and measured the effect of an intervention on common mental disorders in adolescents aged 10–24 years.Data extraction and synthesis We included studies that assessed the effect of interventions on depression, anxiety, post-traumatic stress disorder and substance abuse. Substance abuse was only considered if it was measured alongside mental health disorders. The findings were summarised using synthesis without meta-analysis, where studies were grouped according to the type of intervention (multi-level, community-level) and participants.Results Of 1197 studies that were identified, 30 studies (17 RCTs and 3 quasi-experimental studies) were included in the review of which 10 delivered multi-level interventions and 20 delivered community-level interventions. Synthesised findings suggest that multi-level interventions comprise economic empowerment, peer-support, cognitive behavioural therapy were effective in improving mental health among vulnerable adolescents. Majority of studies that delivered interventions to community groups reported significant positive changes in mental health outcomes.Conclusions The evidence from this review suggests that multi-level interventions can reduce mental health disorders in adolescents. Further research is needed to understand the reliability and sustainability of these promising interventions in different African contexts.PROSPERO registration number CRD42021258826. In sub-Saharan Africa (SSA), multiple factors contribute to the considerable burden of mental health disorders among adolescents, highlighting the need for interventions that address underlying risks at multiple levels. We reviewed evidence of the effectiveness of community or family-level interventions, with and without individual level interventions, on mental health disorders among adolescents in SSA. Systematic review using the Grades of Recommendation, Assessment, Development and Evaluation approach. A systematic search was conducted on Cochrane Library, MEDLINE, EMBASE, PSYCINFO and Web of Science up to 31 March 2021. Studies were eligible for inclusion in the review if they were randomised controlled trials (RCTs) or controlled quasi-experimental studies conducted in sub-Saharan African countries and measured the effect of an intervention on common mental disorders in adolescents aged 10-24 years. We included studies that assessed the effect of interventions on depression, anxiety, post-traumatic stress disorder and substance abuse. Substance abuse was only considered if it was measured alongside mental health disorders. The findings were summarised using synthesis without meta-analysis, where studies were grouped according to the type of intervention (multi-level, community-level) and participants. Of 1197 studies that were identified, 30 studies (17 RCTs and 3 quasi-experimental studies) were included in the review of which 10 delivered multi-level interventions and 20 delivered community-level interventions. Synthesised findings suggest that multi-level interventions comprise economic empowerment, peer-support, cognitive behavioural therapy were effective in improving mental health among vulnerable adolescents. Majority of studies that delivered interventions to community groups reported significant positive changes in mental health outcomes. The evidence from this review suggests that multi-level interventions can reduce mental health disorders in adolescents. Further research is needed to understand the reliability and sustainability of these promising interventions in different African contexts. CRD42021258826. |
Author | Harling, Guy Copas, Andrew Mthiyane, Nondumiso Rapulana, Antony M Shahmanesh, Maryam |
AuthorAffiliation | 3 School of Laboratory Medicine and Medical Science , University of KwaZulu-Natal , Durban , South Africa 1 Africa Health Research Institute , Durban , South Africa 4 MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt) , University of the Witwatersrand , Johannesburg , South Africa 5 Department of Epidemiology & Harvard Center for Population and Development Studies , Harvard T.H. Chan School of Public Health , Boston , Massachusetts , USA 2 Institute for Global Health , University College London , London , UK |
AuthorAffiliation_xml | – name: 3 School of Laboratory Medicine and Medical Science , University of KwaZulu-Natal , Durban , South Africa – name: 5 Department of Epidemiology & Harvard Center for Population and Development Studies , Harvard T.H. Chan School of Public Health , Boston , Massachusetts , USA – name: 4 MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt) , University of the Witwatersrand , Johannesburg , South Africa – name: 2 Institute for Global Health , University College London , London , UK – name: 1 Africa Health Research Institute , Durban , South Africa |
Author_xml | – sequence: 1 givenname: Nondumiso orcidid: 0000-0002-9881-7267 surname: Mthiyane fullname: Mthiyane, Nondumiso email: Nondumiso.Mthiyane@ahri.org organization: Institute for Global Health, University College London, London, UK – sequence: 2 givenname: Antony M surname: Rapulana fullname: Rapulana, Antony M organization: School of Laboratory Medicine and Medical Science, University of KwaZulu-Natal, Durban, South Africa – sequence: 3 givenname: Guy orcidid: 0000-0001-6604-491X surname: Harling fullname: Harling, Guy organization: Department of Epidemiology & Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA – sequence: 4 givenname: Andrew orcidid: 0000-0001-8968-5963 surname: Copas fullname: Copas, Andrew organization: Institute for Global Health, University College London, London, UK – sequence: 5 givenname: Maryam surname: Shahmanesh fullname: Shahmanesh, Maryam organization: Institute for Global Health, University College London, London, UK |
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Keywords | PUBLIC HEALTH MENTAL HEALTH Anxiety disorders Substance misuse Depression & mood disorders |
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Snippet | ObjectiveIn sub-Saharan Africa (SSA), multiple factors contribute to the considerable burden of mental health disorders among adolescents, highlighting the... In sub-Saharan Africa (SSA), multiple factors contribute to the considerable burden of mental health disorders among adolescents, highlighting the need for... OBJECTIVEIn sub-Saharan Africa (SSA), multiple factors contribute to the considerable burden of mental health disorders among adolescents, highlighting the... Objective In sub-Saharan Africa (SSA), multiple factors contribute to the considerable burden of mental health disorders among adolescents, highlighting the... |
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SubjectTerms | Adolescent Africa South of the Sahara - epidemiology Anxiety Anxiety - therapy Anxiety disorders Child development Cognitive Behavioral Therapy Depression & mood disorders Drug abuse HIV Human immunodeficiency virus Humans Intervention Mental depression Mental disorders Mental Health Outcome Assessment, Health Care Post traumatic stress disorder PUBLIC HEALTH Randomized Controlled Trials as Topic Substance misuse Substance-Related Disorders Systematic review Teenagers |
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Title | Effect of multi-level interventions on mental health outcomes among adolescents in sub-Saharan Africa: a systematic review |
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