A resilience lens on the mental health of adolescents in selected low-middle-income sub-Saharan African countries

Abstract

Contextual challenges in sub-Saharan Africa related to health, education, social dilemmas, poverty, and climate change necessitate evidence on adolescent resilience and its links to mental health outcomes. This study aimed to contribute to knowledge generation on resilience and mental health of young people in the understudied sub-Saharan Africa region by comparing (across gender, age, and country) the mental health outcomes, sociodemographic factors, and resilience of adolescents in nine sub-Saharan African countries. This research was guided by an ecological systems theoretical framework. Purposive sampling was used to collect quantitative survey data on sociodemographic status, experiences of loss, resilience, depression, self-esteem, and feelings of safety from 3,312 adolescents participating in interventions implemented by a regional organisation in Angola, Eswatini, Kenya, Lesotho, Mozambique, Namibia, South Africa, Uganda, and Zambia.

This study contributes to a gap in knowledge on country-level comparative evidence on significant social-ecological resilience pathways that impact mental health outcomes for adolescents in sub-Saharan African countries. The findings indicate that relevant systemic factors interact with each other directly or indirectly (through intrapersonal and caregiver systems) to enable or constrain adolescent mental health outcomes (depression, self-esteem) in this understudied region. The findings indicate the following as significant systemic factors: macrosystem (poverty, inequality, educational limitations, health crises, violence), exosystem (feeling safe in their community, access to electricity, reduced hungry days), mesosystem (being in school, feeling safe in school, feeling safe at home, relationships with peers and caregivers), microsystem (parental loss, looking after younger children or sick people at home), and individual factors (age, country).

In contrast to existing literature, the findings showed that looking after sick people at home was associated with better mental health outcomes; that ambiguous loss and access to electricity at home were associated with worse mental health outcomes, that few gender differences existed, and that levels of self-esteem were comparatively high. The findings provide an evidence-based resilience framework on mental health outcomes for adolescents in sub-Saharan Africa. They further contribute evidence to allocate scarce resources where they can have the most developmental impact in sub-Saharan African youth development and mental health services.