Effect of multi-level interventions on mental health outcomes among adolescents in sub-Saharan Africa: a systematic review

Abstract

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.

Keywords: Anxiety disorders; Depression & mood disorders; MENTAL HEALTH; PUBLIC HEALTH; Substance misuse.

Figure 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. PTSD, post-traumatic stress disorder; RCT, randomised controlled trial.

Figure 2

Effect of multi-level interventions on depression, anxiety and PTSD. ART, antiretroviral therapy; CBT, cognitive and behavioural therapy; IPT, interpersonal therapy; MI, motivational interviewing; PTSD, post-traumatic stress disorder; RCT, randomised controlled trial.

Figure 3

Effect of community-level interventions on depression and anxiety. CBT, cognitive and behavioural therapy; IPT, interpersonal therapy.

Figure 4

Effect of community-level interventions on post-traumatic stress disorder (PTSD) and substance abuse.