School-based mental health interventions in sub-Saharan Africa: A scoping review of effectiveness and evaluation practices

Abstract

BACKGROUND: Mental health challenges among adolescents in sub-Saharan Africa are rising amid limited access to services. Schools are increasingly recognised as viable platforms for delivering mental health interventions, especially in low-resourced settings. OBJECTIVE: This scoping review synthesises evidence on school-based mental health interventions implemented across sub-Saharan Africa, focusing on their effectiveness, delivery models, and evaluation practices. METHODS: Guided by PRISMA 2020, a comprehensive search was conducted across four databases (Scopus, PsycINFO, Web of Science, and EBSCOhost) for studies published between 2010 and 2024. Inclusion criteria were empirical studies evaluating school-based mental health interventions targeting adolescents (aged 10 to 19 years) in sub-Saharan Africa. Fifteen studies met the criteria and were narratively synthesised. RESULTS: The most targeted conditions were depression, anxiety, and posttraumatic stress disorder. Effective intervention types included cognitive behavioural therapy, psychoeducation, economic empowerment, and family-strengthening programmes. Most interventions were delivered by non-specialists (e.g., teachers and lay counsellors) and showed significant positive effects on mental health outcomes. However, evaluation methods varied widely, with inconsistent use of standardised tools and limited follow-up assessments. Barriers included stigma, infrastructural limitations, and inadequate cultural adaptation. CONCLUSION: School-based mental health interventions in sub-Saharan Africa demonstrated a strong potential to support adolescent well-being, especially when tailored to local contexts and delivered by trained non-specialists. However, methodological gaps and underrepresentation of certain countries persist. Future efforts should prioritise standardisation, longitudinal evaluation, digital delivery innovation, and broader geographic coverage. These findings have critical implications for education and health policy across the region.