Globally, mental illnesses are the primary cause of disease burden among children and young people (CYP). This issue disproportionately affects low- and middle-income countries (LMICs), which have predominantly young populations vulnerable to mental disorders. Furthermore, LMICs face severe challenges which affect mental health literacy (MHL), such as low mental health problem recognition, reduced treatment rates or vast treatment gaps for individuals needing treatment and being treated. This lack of access to mental health services is driven by various structural barriers (i.e., inadequate funding, resources, and infrastructure), which could lead to fewer people seeking professional help and experiencing long delays when they do.
Existing synthesised evidence of MHL in children and young people in LMICs is lacking. In this regard, Renwick et al. (2024) conducted a systematic review to examine how CYP in LMICs understand depression and mental health problems, as well as their attitudes toward help-seeking and treatment. The authors reviewed more than 3,500 qualitative and quantitative studies exploring MHL, coping strategies, perceptions of professional services, and barriers to care among children and youth in LMICs (here you can read their PROSPERO’ systematic review protocol).
Knowledge, beliefs and attitudes towards mental illness among CYP in LMICs
The authors identified 58 papers including 36,429 adolescents and youth from 28 upper middle and 26 lower middle-income countries. The main findings illustrated that these CYP often associated depression with sadness, stress, loneliness, family conflict, and social difficulties rather than with formal psychiatric concepts. Indeed self-help and informal coping strategies, such as exercise, music, meditation, and spending time alone, were commonly preferred over professional mental health services.
Social support from family, peers, and teachers were the main sources of mental health, although relationship quality strongly influenced help-seeking behaviors. Moreover, adolescents who experienced family conflict or poor parental relationships were less likely to seek parental support.
In the case of professional mental health care, many participants believed these professionals could help, though they were often less preferred than informal or community-based support. This reduced access to mental health services was conditioned to various barriers including social stigma, poor MHL, lack of confidentiality, limited access to services, and cultural beliefs surrounding mental illness.
Community-based settings for improving mental health literacy among CYP in LMICs
A principal conclusion from Renwick et al. (2024) refers to the key role of community-based settings in improving MHL among CYP. For instance, school-based mental health programs have the potential to improve MHL, reduce stigma, and develop accessible and culturally-designed interventions for these adolescents and youth in LMICs. In addition, school-based program implementation may reduce mental health service use barriers among CYP and, therefore, facilitate early help-seeking behaviours.
In sum, this review suggests that young people in LMICs face major barriers and obstacles to get professional mental health support. These barriers include lack of awareness about mental health problems, social stigma, and a low level of trust in professional healthcare. To encourage CYP to seek professional support, future community-based mental health programs need to combine psychoeducational training with local support systems. Ultimately, this combination may create solid partnerships which could bring together professional care, social communities, and traditional healers.
