Mental health problems and service gaps experienced by pregnant adolescents and young women in Sub-Saharan Africa: A systematic review

Joan Mutahi; Anna Larsen; Pim Cuijpers; Stefan Swartling Peterson; Jurgen Unutzer; Mary McKay; Grace John-Stewart; Teresa Jewell; John Kinuthia; Fatima Gohar; Joanna Lai; Dalton Wamalwa; Onesmus Gachuno; Manasi Kumar

doi:10.1016/j.eclinm.2022.101289

Mental health problems and service gaps experienced by pregnant adolescents and young women in Sub-Saharan Africa: A systematic review

Joan Mutahi, Anna Larsen, Pim Cuijpers, Stefan Swartling Peterson, Jurgen Unutzer, Mary McKay, Grace John-Stewart, Teresa Jewell, John Kinuthia, Fatima Gohar, Joanna Lai, Dalton Wamalwa, Onesmus Gachuno, Manasi Kumar^*

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Background: Pregnant adolescent girls and young women (AGYW, aged 12–24 years) are at high risk for mental health problems, particularly in the Sub-Saharan African (SSA) region. Methods: We performed a systematic review of mental health studies among pregnant AGYW in SSA published between January 1, 2007 and December 31, 2020 in PubMed, Embase, CINAHL, PsycInfo, and Global Index Medicus following PRISMA guidelines (PROSPERO: CRD42021230980). We used Bronfenbrenner's bioecological model to frame and synthesize results from included studies. Findings: Our search yielded 945 articles from which 18 studies were included (N = 8 quantitative, N = 9 qualitative, N = 1 case report). The most frequently studied mental health problem was depression (N = 9 studies); the most frequently utilized measurement tool was the Edinburgh Postnatal Depression Scale (N = 3). Studies reported life course factors, individual, microsystem, exosystem, macrosystem, and chronosystem-level factors associated with mental health problems. Gaps in mental health service delivery for pregnant AGYW included lack of confidentiality, judgmental healthcare worker attitudes, and lack of services tailored to their unique needs. Interpretation: Gaps remain in research and services for mental health among pregnant AGYW in SSA. Integration of mental health services within school, community, and healthcare settings that are tailored to pregnant AGYW could strengthen health systems within SSA. Funding: Author contributions were supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (F31HD101149 to AL) and the Fogarty International Center (K43TW010716 to MK). The funding agencies had no role in the writing of the manuscript or the decision to submit it for publication. The project itself was not funded.

Original language	English
Article number	101289
Pages (from-to)	1-18
Number of pages	18
Journal	EClinicalMedicine
Volume	44
Early online date	14 Feb 2022
DOIs	https://doi.org/10.1016/j.eclinm.2022.101289
Publication status	Published - Feb 2022

Bibliographical note

Funding Information:
Author contributions were supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development ( F31HD101149 to AL ) and the Fogarty International Center ( K43TW010716 to MK ). The funding agencies had no role in the writing of the manuscript or the decision to submit it for publication. The project itself was not funded.

Funding Information:
Dr. John-Stewart reports grants from NIH, grants from CDC, grants from Thrasher, grants from IMPAACT, personal fees from UW, personal fees from UpToDate, other from Malaika, outside the submitted work. All other authors declare no competing interests.

Publisher Copyright:
© 2022 The Author(s)

Funding

Author contributions were supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development ( F31HD101149 to AL ) and the Fogarty International Center ( K43TW010716 to MK ). The funding agencies had no role in the writing of the manuscript or the decision to submit it for publication. The project itself was not funded. Dr. John-Stewart reports grants from NIH, grants from CDC, grants from Thrasher, grants from IMPAACT, personal fees from UW, personal fees from UpToDate, other from Malaika, outside the submitted work. All other authors declare no competing interests.

Funders	Funder number
National Institutes of Health
Centers for Disease Control and Prevention
Fogarty International Center	K43TW010716
Fogarty International Center
Eunice Kennedy Shriver National Institute of Child Health and Human Development	F31HD101149
Eunice Kennedy Shriver National Institute of Child Health and Human Development

Keywords

Adolescents
Mental health
Pregnant
Sub-Saharan Africa
Young women

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10.1016/j.eclinm.2022.101289

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Mutahi, J., Larsen, A., Cuijpers, P., Peterson, S. S., Unutzer, J., McKay, M., John-Stewart, G., Jewell, T., Kinuthia, J., Gohar, F., Lai, J., Wamalwa, D., Gachuno, O., & Kumar, M. (2022). Mental health problems and service gaps experienced by pregnant adolescents and young women in Sub-Saharan Africa: A systematic review. EClinicalMedicine, 44, 1-18. Article 101289. https://doi.org/10.1016/j.eclinm.2022.101289

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abstract = "Background: Pregnant adolescent girls and young women (AGYW, aged 12–24 years) are at high risk for mental health problems, particularly in the Sub-Saharan African (SSA) region. Methods: We performed a systematic review of mental health studies among pregnant AGYW in SSA published between January 1, 2007 and December 31, 2020 in PubMed, Embase, CINAHL, PsycInfo, and Global Index Medicus following PRISMA guidelines (PROSPERO: CRD42021230980). We used Bronfenbrenner's bioecological model to frame and synthesize results from included studies. Findings: Our search yielded 945 articles from which 18 studies were included (N = 8 quantitative, N = 9 qualitative, N = 1 case report). The most frequently studied mental health problem was depression (N = 9 studies); the most frequently utilized measurement tool was the Edinburgh Postnatal Depression Scale (N = 3). Studies reported life course factors, individual, microsystem, exosystem, macrosystem, and chronosystem-level factors associated with mental health problems. Gaps in mental health service delivery for pregnant AGYW included lack of confidentiality, judgmental healthcare worker attitudes, and lack of services tailored to their unique needs. Interpretation: Gaps remain in research and services for mental health among pregnant AGYW in SSA. Integration of mental health services within school, community, and healthcare settings that are tailored to pregnant AGYW could strengthen health systems within SSA. Funding: Author contributions were supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (F31HD101149 to AL) and the Fogarty International Center (K43TW010716 to MK). The funding agencies had no role in the writing of the manuscript or the decision to submit it for publication. The project itself was not funded.",

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note = "Funding Information: Author contributions were supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development ( F31HD101149 to AL ) and the Fogarty International Center ( K43TW010716 to MK ). The funding agencies had no role in the writing of the manuscript or the decision to submit it for publication. The project itself was not funded. Funding Information: Dr. John-Stewart reports grants from NIH, grants from CDC, grants from Thrasher, grants from IMPAACT, personal fees from UW, personal fees from UpToDate, other from Malaika, outside the submitted work. All other authors declare no competing interests. Publisher Copyright: {\textcopyright} 2022 The Author(s)",

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Mutahi, J, Larsen, A, Cuijpers, P, Peterson, SS, Unutzer, J, McKay, M, John-Stewart, G, Jewell, T, Kinuthia, J, Gohar, F, Lai, J, Wamalwa, D, Gachuno, O & Kumar, M 2022, 'Mental health problems and service gaps experienced by pregnant adolescents and young women in Sub-Saharan Africa: A systematic review', EClinicalMedicine, vol. 44, 101289, pp. 1-18. https://doi.org/10.1016/j.eclinm.2022.101289

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T1 - Mental health problems and service gaps experienced by pregnant adolescents and young women in Sub-Saharan Africa

T2 - A systematic review

AU - Mutahi, Joan

AU - Larsen, Anna

AU - Cuijpers, Pim

AU - Peterson, Stefan Swartling

AU - Unutzer, Jurgen

AU - McKay, Mary

AU - John-Stewart, Grace

AU - Jewell, Teresa

AU - Kinuthia, John

AU - Gohar, Fatima

AU - Lai, Joanna

AU - Wamalwa, Dalton

AU - Gachuno, Onesmus

AU - Kumar, Manasi

N1 - Funding Information: Author contributions were supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development ( F31HD101149 to AL ) and the Fogarty International Center ( K43TW010716 to MK ). The funding agencies had no role in the writing of the manuscript or the decision to submit it for publication. The project itself was not funded. Funding Information: Dr. John-Stewart reports grants from NIH, grants from CDC, grants from Thrasher, grants from IMPAACT, personal fees from UW, personal fees from UpToDate, other from Malaika, outside the submitted work. All other authors declare no competing interests. Publisher Copyright: © 2022 The Author(s)

PY - 2022/2

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KW - Adolescents

KW - Mental health

KW - Pregnant

KW - Sub-Saharan Africa

KW - Young women

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Mental health problems and service gaps experienced by pregnant adolescents and young women in Sub-Saharan Africa: A systematic review

Abstract

Bibliographical note

Funding

Keywords

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