Understanding the mental health of adolescents and young adults in rural South Africa through participatory research

Most mental health problems in adulthood begin during adolescence. Factors such as poverty, violence, and unemployment contribute to the high burden of mental health problems. In Africa, the lack of resources for diagnosis, treatment, and management exacerbates the situation. Research on adolescent mental health has mostly focused on negative psychological effects, while positive attributes like coping, resilience, and emotional growth have been overlooked. This study explored factors affecting the mental health of adolescents and young adults and to collaboratively identify potential interventions using a participatory research approach. After reviewing the literature, we developed scenarios on issues such as unemployment, violence, poverty and HIV, which were adapted by peer supervisors into role-plays that reflect their local realities. We conducted workshops with ten peer navigators and eight young people, who listed problems affecting their mental health and identified possible interventions. Data from the workshops were synthesized to create a preliminary conceptual framework, which was then refined with input from three professional nurses who work in adolescent-friendly clinics. Young people and peer navigators identified romantic relationships and alcohol use as both contributors to mental health problems and coping strategies for stressors like poverty and violence. These behaviours were also linked to sexual and reproductive health (SRH) risks including unprotected sex. Cultural and spiritual experiences, such as the ancestral calling to become a traditional healer were also described as common in the community and were linked to emotional distress. Participants recommended family-strengthening and community-based interventions to build resilience and promote positive parenting, while respecting existing traditional practices. This study enhances our understanding of mental health challenges among young people and emphasizes the importance of strengthening protective factors such as resilience. It offers guidance for developing culturally appropriate mental health interventions. Further research is needed to examine causal pathways and explore how SRH services and traditional healing practices can be integrated into mental health strategies.