Systematic review and meta-analysis of child and adolescent mental health in South Africa

Abstract Introduction Reliable epidemiological data are crucial to make evidence-based decisions about youth mental health. Yet little is known about the epidemiology of child and adolescent mental health in sub-Saharan Africa. We conducted a systematic review and meta-analysis on the prevalence of mental disorders, suicidal behaviors, mental well-being and mental health awareness/literacy among children and adolescents in South Africa (SA). Methods We searched PubMed, PsycINFO, Web of Science, Scielo.org, and Google Scholar from their inception to 19th February 2025. We performed random effects meta-analysis for all disorders that had 5 or more prevalence estimates. Meta-regressions were used to investigate factors associated with prevalence estimates. Results We screened 12,768 records and identified 40 studies with 56 prevalence estimates for mental disorders and 30 prevalence estimates for suicidality. Across all studies on mental disorders, the pooled prevalence for all disorders was 8.53% [6.1; 11.9] (k=56, N=39,962), with significant heterogeneity (I²=99.0%, Q (55) = 5467.0, p<.001). Pooled prevalence estimates for depressive disorders, anxiety disorders, PTSD and behavioural disorders were 10.1% [4.9; 19.9], 6.7% [3.4; 12.8], 17.6% [8.5; 33.1], 3.9% [1.8; 8.5], respectively. All other disorders had 5 or fewer prevalence estimates. Pooled prevalence estimates for suicidal ideation, plan and attempt were 12.0% [7.8; 18.0] (k=10, N=41489), 11.8% [7.7; 17.6] (k=8, N=39,928), and 10.3% [6.2; 16.6] (k=9, N=40,294), respectively. No papers reported mental well-being, quality of life, mental health literacy, mental health awareness, or cognitive impairment. It is not possible to reliably assess the mental health of SA’s youth due to the small number of studies, narrow focus on few disorders and heterogeneity. Conclusion There is clear need for a reliable national survey of child and adolescent mental health in SA, using well validated instruments that can assess a wide range of disorders and mental well-being among a representative sample of young people.