Mental health difficulties, coping mechanisms and support systems among school-going adolescents in Ghana: A mixed-methods study.

Noella Dufie Addy,Silvia Runge-Ranzinger,Pauline Grys,Faith Agbozo,Eugene Kofuor Maafo Darteh

doi:10.1371/journal.pone.0250424

Abstract

BackgroundAlthough adolescents are highly vulnerable to mental health challenges, they receive little attention, especially in developing countries. We investigated the mental health difficulties (MHDs) faced by adolescent students in four senior high schools in Ghana, their coping strategies and support systems.MethodsIn this convergent mixed-methods study, quantitative data was obtained using validated strengths and difficulties questionnaire to assess the mental health of 405 adolescents. Qualitative data was collected through in-depth interview with 18 teachers and seven focused group discussions with 35 students. Adjusted odds ratios (OR) for MHDs were estimated through ordinal logistic regression in Stata 14.2. Qualitative data was analyzed inductively and deductively using ATLAS.ti 7.1.ResultsOver half (58.5%) experienced peer (20.5%), emotional (16.3%), conduct (13.3%) and hyperactivity (3.0%) problems, whereas 5.4% exhibited prosocial behaviours. MHDs were associated with females (OR = 2.27, 95% CI: 1.47–3.50), bullying (OR = 1.72, CI: 1.07–2.75), domestic violence (OR = 1.87, CI: 1.10–3.17), substance abuse (OR = 8.14, CI: 1.41–46.8), academic pressure (OR = 2.40, CI: 1.30–4.42) and self-perceived poor school performance (OR = 7.36 CI: 2.83–19.16). Qualitatively, we identified financial challenges, spiritual influences, intimate relationships, bullying, and domestic violence as the main themes attributed to MHDs. Coping strategies included isolation, substance use and spiritual help. The main school-based support system was the guidance and counselling unit, but there were complaints of it been ineffective due to trust and confidentially issues, and non-engagement of qualified counsellors.ConclusionsAs many triggers of MHDs emanate in schools, we need mental health-friendly school environments where trained psychotherapists head counselling centres. We propose incorporating mental health education into school curricula and generating surveillance data on adolescent’s mental health.

Highlights

As mental health gains global priority and centrality to health and development agendas, efforts have intensified to focus on the mental health of adolescents
mental health difficulties (MHDs) were associated with females (OR = 2.27, 95% confidence interval (CI): 1.47–3.50), bullying (OR = 1.72, CI: 1.07– 2.75), domestic violence (OR = 1.87, CI: 1.10–3.17), substance abuse (OR = 8.14, CI: 1.41–46.8), academic pressure (OR = 2.40, CI: 1.30–4.42) and self-perceived poor school performance (OR = 7.36 CI: 2.83–19.16)
We identified financial challenges, spiritual influences, intimate relationships, bullying, and domestic violence as the main themes attributed to MHDs

Summary

Introduction

As mental health gains global priority and centrality to health and development agendas, efforts have intensified to focus on the mental health of adolescents (typically defined as persons in their second decade of life [10–19 years]). This is imperative as adolescence is characterized by extensive physical and social development whereby capabilities essential for successful progression into adulthood are established [1]. Globally,10–20% of adolescents experience mental health disorders [4]. We investigated the mental health difficulties (MHDs) faced by adolescent students in four senior high schools in Ghana, their coping strategies and support systems

Methods

Results

Conclusion