Mapping Mental Health Awareness Programs Among Adolescents in South Africa: A Scoping Review.

Objectives

Identifying the research questions

The search was conducted to map available scientific evidence regarding mental health awareness promotion programs among adolescents in SA. The research questions are as follows:

Questions

Search strategy

A systematic literature search was conducted across the following databases: ScienceDirect, Google Scholar, Sabinet, and the Wiley Online Library to identify articles relevant to the research questions. A hand search was performed to find relevant articles meeting the eligibility criteria. Boolean terms were employed as well as the keywords: mental health, adolescents, awareness and programs. The search strategy was supported by eligibility criteria, the search focused on the title, abstract and key words only.

Eligibility criteria

The concept context framework was used to determine the eligibility of the studies for inclusion. The concept of interest is to describe the common mental disorders among adolescents in SA, to identify factors associated with poor mental health outcomes among adolescents and programs implemented to promote mental health awareness as well as their challenges/effectiveness. The search was conducted on articles published between January 2020- April 2025 only, to include the most recent evidence on mental health awareness programs among adolescents. Other studies that match the research’s aim were also selected for further processing. The review excluded literature outside the search period, articles not written in English and those that are not related to programs to promote metal health awareness among adolescents. The search also included grey literature within the search period.

Study selection

A systematic approach was followed for the identification of relevant literature. A tittle and abstract relevance screening form was developed by the researcher after applying the search parameters. The primary reviewer performed the search strategy on the databases to retrieve publications and remove all duplicates. The titles and abstracts were reviewed to prevent waste of resources in obtaining articles that do not meet the minimum inclusion criteria. Two independent reviewers (Prof T Lumadi & Dr B Tlou) screened all the retrieved tittles and abstracts and evaluate them for eligibility using the inclusion criteria. Reviewers performed full-text screening.

Charting the data

To perform data extraction, the researcher developed a data charting form (see Table 1) to capture key characteristics of each study, including publication type and year, sector of study, use of terminology from established frameworks, types of data sources, quality assessment methods, number of reviewers involved, and any reported challenges or limitations. Extracted data also encompassed information on the author(s), date of publication, study objectives and research questions, geographical setting, target population, study design, and sample size. The data were systematically organized to align with and address each of the research questions

Quality appraisal

The Critical appraisal skills program tool (CASP) was adapted to assess the quality of the included studies. Questions were generated to modify the CASP qualitative checklist tool. Each question had a comment box to record the reasons for given responses. Quality assessment was done by the reviewers, and the final scores were discussed for consensus.

Collating, summarizing, and reporting on the data

The results of this scoping review were analyzed using thematic analysis approach where codes were generated and themes created, reviewed, and then defined to answer each research question. Findings were discussed and finalized by the review team. Implications of the findings were explored to find out how they relate to the study’s aims and further research in the field. The data collected was organized into subgroups. The findings were analyzed and reported according to the research question.

Characteristics of the included studies

Table 2 summarizes the characteristics of the included studies. Among the included studies, many studies about mental health regarding adolescents were published in 2023 (see Table 2). All studies were published between Jan 2020- Jan 2025. Most studies did not report the duration taken to conduct the review. Reviews included varied methodology and publication limitations.

Table 3 summarizes studies on adolescent mental health in South Africa, focusing on the prevalence of common mental disorders, associated risk factors, and the implementation of mental health programs. Notably, a significant number of studies have investigated various risk factors contributing to poor mental health outcomes among adolescents. These findings underscore the complexity of adolescent mental health and the need for targeted interventions (see Table 3).

Common mental health disorders among adolescents in SA

In SA, studies consistently demonstrate a high prevalence of common mental disorders (CMDs), particularly depression, anxiety, and post-traumatic stress disorder (PTSD), among adolescents (Pickstone-Taylor, Davids, de Bever, & de Vries, 2024). According to Mental Health Situational Analysis: SA (2024) mental illness accounts for approximately 45% of the disease burden in individuals aged 10–24 years in SA, with depression and anxiety identified as leading contributors. Moreover, surveys also estimate that around 20% of South African youth experience depression and related conditions annually (Tomlinson, Kleintjes & Lake, 2022).

Mkhize, Van der Westhuizen & Sorsdahl (2024) discovered that depression is widely recognized as the most prevalent mental health disorder among South African adolescents, with estimates ranging significantly depending on the population and region studied. Furthermore, 44.8% of adolescents living with HIV (ALWHIV) reported depressive symptoms, with 36.8% experiencing mild to moderate symptoms and 25.6% exhibiting suicidal behaviors (Gantsho, Talatala, & Mdaka, 2024). Similarly, studies in Cape Town report depression rates as high as 41%, anxiety at 16%, and PTSD at 21% among adolescents (Ward-Smith, Sorsdahl & van der Westhuizen, 2024; UNICEF, 2024). A study by Chukwuere, Ojong-Alasia, Sehularo & Manyedi (2021) further confirms that depression rates are highest during mid-adolescence (ages 13–18), with various sociocultural and economic stressors contributing to its onset, with an estimation of 4–8% prevalence rate of depression, while regional data suggest even higher figures, such as 41% in Cape Town and 21% among Grade 8 and 11 learners in Durban.

There are noticeable variations in mental health prevalence across provinces (Craig, et al., 2022; Chukwuere, et al., 2021). The Western Cape has the highest reported rates of mental illness in South Africa, with estimates showing that 40% of the population live with some form of mental disorder, including anxiety (19%), mood disorders (14%), and substance use disorders (21%) (UNICEF, 2023). Despite these findings, there is still limited data on rural-urban differences in prevalence and contributing factors, although informal settlements and urban poverty have been linked to elevated depression rates (Chukwuere et al., 2021).

Suicidal behavior among adolescents constitutes a significant public health issue in South Africa. According to the South African National Youth Risk Behaviour Survey, approximately 24% of adolescents in Grades 8 to 11 reported persistent feelings of sadness or hopelessness, while 21% disclosed having attempted suicide at least once (Statistics South Africa, 2022). Bantjes et al. (2023) highlighted this concern, indicating that roughly 22% of Black South African youth have either considered or attempted suicide. Orri, et al., (2022) further highlight national averages showing that between 4.2% and 15.6% of adolescents experience suicidal ideation, 2.4% to 12.5% engage in planning, and 1.9% to 6.3% carry out suicide attempts. These behaviors are frequently associated with underlying mental health conditions, particularly depression and anxiety. Additionally, mental health challenges among adolescents are compounded by learning difficulties, with an estimated 9,620 children (approximately 0.4%) in Gauteng reported to have learning disabilities, which further impact their psychosocial well-being (Bloom, et al., 2022).

Traumatic experiences

Kaminer, et al., (2022) discovered a high prevalence of trauma exposure among adolescents in South Africa, which is strongly associated with a range of mental health challenges. This widespread exposure is largely attributed to high rates of maltreatment and community violence, with many young people experiencing multiple forms of violence throughout their developmental years. Such experiences significantly increase the risk of developing posttraumatic stress disorder (PTSD), particularly when the exposure is frequent or severe (Masakala, et al., 2023). Compounding these risks, pervasive poverty and unemployment create a context of chronic family adversity, which can undermine caregivers’ ability to support adolescents in coping with trauma. Moreover, studies have reported a 15% prevalence of depression and conduct disorder symptoms among South African adolescents, with these mental health issues often linked to stressors such as romantic relationship breakups, family instability, interpersonal conflict, and personal concerns related to academic performance, body image, and physical health (Kaminer,et al., 2022).

Donenberg, et al., (2020) highlights the severe public health crisis faced by South African adolescents due to the intersection of violence exposure, mental health issues, and economic inequality. South Africa has one of the highest violence rates globally, with a homicide rate five times the world average, particularly affecting economically disadvantaged areas. In Western Cape Province, gang violence and adolescent homicides are especially prevalent. Nearly 70% of adolescents report experiencing or witnessing violence, and a significant portion has encountered extreme forms of violence, such as seeing a murder (Mthembu et al., 2024). This exposure, alongside high rates of mental illness contribute to a cycle of violence and poor mental health among South African youth.

In addition to these challenges, South Africa has one of the highest rates of intimate partner violence (IPV), a factor closely associated with adverse mental health outcomes including depression, anxiety, and PTSD (Pakhomova et al., 2021). Family dynamics also play a crucial role, with parental acceptance acting as a protective factor and parental rejection contributing to increased emotional distress. These social and familial factors are particularly significant for adolescent girls and young women (AGYW) in South Africa, who face heightened vulnerabilities due to the interplay of gender-based violence, economic disadvantage, and limited access to supportive resources in high-risk environments (Rodriguez et al., 2025).

Adverse childhood experience and bullying

Adverse Childhood Experiences (ACEs) refer to exposure to potentially traumatic events during early life that can significantly disrupt a child’s physical, emotional, and social development, thereby increasing the risk of a wide range of health problems (Brown, et al., 2024). ACEs typically involve various forms of abuse (physical, sexual, emotional), neglect, and household dysfunction. These experiences are both common and detrimental, with far-reaching consequences across multiple aspects of life. For example, Kappel et al. (2021) reported that in the largest birth cohort study conducted in Africa, 88% of young adults in South Africa had experienced at least one ACE, while 35% had experienced four or more. Furthermore, Bonner, et al., (2021) demonstrated that ACEs are predictive of suicidality, with over 3% of children and adolescents reporting a suicide attempt in the past 30 days, a figure that exceeds the 2.4% lifetime prevalence reported in the original CDC/Kaiser ACE study among individuals exposed to a single ACE. This elevated susceptibility to poor mental health outcomes following ACE exposure also appears to contribute to an increased likelihood of engaging in risk-taking behaviors, such as substance use ( Department of health, 2024).

In a study conducted in the Free State, it was emphasized that bullying is a traumatic experience with serious implications for both the physical and mental health of those involved (Masakala, et al., 2023). Exposure to bullying has been consistently linked to negative academic performance and a range of health problems. Victims often report somatic complaints, including headaches, general weakness, and pain in areas such as the stomach, chest, and limbs, which reflect the psychosomatic impact of bullying. Moreover, bullying is associated with both internalizing symptoms such as anxiety, depression, and post-traumatic stress and externalizing symptoms like conduct disorders (Van der Westhuizen, 2021). Notably, even perpetrators of bullying display similar psychological difficulties, including conduct problems and long-term associations with depression. A study by Armitage (2021) further confirms that both bullies and victims are at heightened risk for suicidality and non-suicidal self-injury. Further added that individuals who are both bullies and victims (“bully-victims”) tend to experience the poorest health, social, and educational outcomes during childhood and adolescence, with particularly severe mental health consequences.

Substance abuse

A study conducted in Cape Town, South Africa, highlights the significant prevalence of substance use among South African youth, particularly among adolescent girls and young women (AGYW), who also face elevated rates of depression and anxiety (Bonner, et al., 2021). A conceptual analysis by Rikhotso, et al., (2024) discovered that substance use and mental health challenges are closely interconnected and contribute to a range of broader public health concerns within this population. Data indicate that nearly half of secondary school leaners report having consumed alcohol at some point, with 13% initiating alcohol use before the age of 13 (Mathibe, Cele, & Modjadji, 2022). Additionally, 13% report lifetime use of marijuana (dagga), and 10% report using illicit substances such as methamphetamine (tik) or methaqualone (Mandrax). These figures are particularly troubling given the well-established link between substance use and negative mental health outcomes, including depression and anxiety disorders, among adolescents and young adults both in South Africa and globally.

Social media

Hendricks & Kanjiri (2021) found that social media usage is on the rise in rural areas of KwaZulu-Natal (KZN), with young people being the main users. The expansion of social media has led to greater awareness of upcoming social events. However, concerns have emerged regarding its impact on mental health, particularly depression, due to increased social comparison. While social media is seen as having potential societal benefits, it has also raised concerns about negative effects such as addiction and depression (Lukose, Mwansa, Ngandu & Oki, 2023). Similarly, a systematic review by Senekal, et al., (2023) notes that despite the positive aspects of social media, issues like anxiety can arise. Findings further highlight how anxiety and other negative emotional outcomes can harm the psychosocial well-being of young people. The intense desire for self-expression and validation on social media can be risky, with harmful consequences when this behavior leads to social rejection. Additionally, the sharing of violent videos can promote aggressive behavior, potentially resulting in property damage. Social media use is also closely tied to peer pressure, with evidence of campaigns and subsequent disruptive behaviors being linked to peer influence (Hendricks & Kanjiri, 2021).

Teenage mothers and HIV

Adolescent mothers often face significant challenges in adjusting to the demands and responsibilities of parenthood (Mabila, et al., 2023). Research by Field, Abrahams & Honikman (2020) indicates that pregnant and parenting adolescents are at heightened risk for negative physical and mental health outcomes compared to their adult counterparts, with an increased vulnerability to common mental disorders (CMDs) such as depression and anxiety. Mabila, et al., (2023) further notes that limited knowledge of child development, inadequate social support, and the burdens associated with parenting contribute to elevated levels of stress, depression, and anxiety among adolescent girls and young women. These mental health challenges are compounded by broader sociocultural, environmental, and economic adversities, as well as psychosocial stressors. Adolescent parents often face these challenges in isolation and poverty, with many lacking accesses to the necessary resources and support systems to cope effectively.

In addition, a study conducted in Johannesburg by Gantsho, Talatala & Mdaka (2024) highlights the increased vulnerability of adolescents living with HIV (ALWHIV) to developing depressive symptoms. This is attributed to the relationship between HIV and depression, where each condition exacerbates the other. HIV infection acts as a significant psychological stressor that predisposes adolescents to depression, while depression in turn negatively impacts HIV-related health outcomes. These include poor treatment adherence, the presence of opportunistic infections, reduced viral suppression, accelerated decline in CD4 cell counts, and faster progression to AIDS (Gantsho, Talatala, & Mdaka, 2024).

Discrimination among LGBTQs

Moagi, Van De Wath, Jiyane & Rikhotso (2021) emphasized that stigmatization, discrimination, and victimization are critical factors contributing to mental health issues among LGBT individuals. Additionally, social exclusion plays a significant role in exacerbating these challenges. The violence, discrimination, and stigma experienced by LGBT individuals because of their sexual and gender minority status have a profound and negative effect on their mental well-being. Research shows that lesbian, gay, and bisexual (LGB) individuals report significantly higher instances of adverse childhood experiences, such as sexual abuse, physical abuse, and peer victimization, compared to their heterosexual counterparts. These pre-existing stressors further intensify the mental health difficulties faced by LGB individuals.

Integrated School Health Policy (ISHP)

In 2012, the South African government introduced the Integrated School Health Policy (ISHP) as a national framework to guide the delivery of comprehensive school health and psychosocial support services (Pillay, Patel, & Setlhare-Kajee, 2023). This policy is a collaborative effort involving key stakeholders, namely the Departments of Basic Education (DBE), Health (DoH), and Social Development (DSD), and is implemented at national, provincial, and district levels. The ISHP outlines the roles of various school-based actors, including principals, School Governing Bodies (SGBs), School-Based Support Teams (SBSTs), and educators, in promoting learner wellbeing and coordinating with external partners such as NGOs, the South African Police Service (SAPS), and community organisations.

Despite this comprehensive structure, recent studies highlight significant challenges in policy implementation, particularly in under-resourced public schools (Shuro & Waggie, 2021). These challenges include insufficient teacher training on psychosocial issues and a lack of effective integration with support stakeholders. Although the ISHP emphasizes the importance of multisectoral collaboration and stakeholder accountability, evidence suggests widespread non-compliance and inadequate school-level capacity to address critical learner vulnerabilities such as poverty, sexual abuse, substance use, gangsterism, and teenage pregnancy (Mbatha, McCrindle, & Shirinde, 2024). Furthermore, limited research exists on teachers’ perspectives regarding the availability and effectiveness of psychosocial interventions, suggesting a gap between policy intentions and on-the-ground realities.

Early adolescent skills for emotions

In response to the global burden of adolescent mental health challenges, the World Health Organization (WHO) and UNICEF introduced the Early Adolescent Skills for Emotions (EASE) program in 2019 (WHO, 2023). Designed for adolescents aged 10 to 15 years with internalizing disorders such as anxiety and depression, EASE is a group-based, low-intensity psychological intervention that incorporates core elements of Cognitive Behavioral Therapy (CBT), including psychoeducation, stress management, behavioral activation, and problem-solving. The program comprises seven group sessions for adolescents and three for their caregivers, and it is structured to be delivered by non-specialist facilitators, making it especially suitable for low- and middle-income contexts. Initial trials in Lebanon and Jordan demonstrated the intervention’s feasibility and acceptability, though further refinements were recommended (WHO & UNICEF, 2023).

In South Africa, Mkhize adapted and piloted EASE in four Cape Town schools as part of her doctoral research, involving 79 adolescents and 33 caregivers. The South African adaptation (EASE-SA) aimed to evaluate the intervention’s feasibility and acceptability in a low-resource setting. Results indicated positive outcomes, with adolescents reporting improved emotional regulation and coping abilities, and caregivers observing enhanced parenting practices and communication (Mkhize, van der Westhuizen, & Sorsdahl, 2024). Despite these encouraging findings, several implementation challenges emerged, including inconsistent attendance, logistical barriers such as transport and scheduling, and the need for cultural contextualization of the materials (Campion, Javed, Saxena, & Sharan, 2022). These findings underscore the necessity of community engagement, resource planning, and contextual adaptation for successful mental health interventions in under-resourced settings.

HASHTAG

The HASHTAG program, introduced in South Africa in 2021, was designed to support adolescent mental health among learners aged 11 to 15 through a school-based, dual-component approach (Babatunde, et al., 2020). The first component, Thriving Environment in Schools (TES), adopts a whole-school strategy aimed at fostering a positive school climate and enhancing students’ social and emotional well-being by cultivating a sense of connectedness. The second component, Thrive Together (TT), consists of structured group sessions that equip adolescents with skills for mental health promotion and risk reduction. The intervention was co-developed and piloted in Khayelitsha, ensuring some degree of contextual relevance (Laurenzi et al., 2023). Khayelitsha is a large peri-urban area outside of Cape Town, in the Western Cape, and is typical of many of the deeply entrenched social and economic challenges facing youth in South Africa. Despite its comprehensive design, the program encountered substantial implementation barriers, including insufficient resources, cultural contextual challenges, and concerns about long-term sustainability. Furthermore, the lack of robust evaluation mechanisms and minimal observable improvements in adolescent mental health outcomes have left the program’s overall effectiveness uncertain (Babatunde et al., 2020).