Prevalence of Mental Health Problems Among Adolescents in Africa: An Umbrella Review–A Systematic Review of Systematic Reviews

Prevalence of Mental Health Problems Among Adolescents in Africa: An Umbrella Review–A Systematic Review of Systematic Reviews | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Systematic Review Prevalence of Mental Health Problems Among Adolescents in Africa: An Umbrella Review–A Systematic Review of Systematic Reviews Joseph Mickton Maseke, Genesis Sunganani Chorwe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7324331/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract BACKGROUND Systematic reviews with varying perspectives have been conducted on mental health problems that affect adolescents and young people in Africa. The majority of these reviews were conducted at the national or regional level. The objectives of this review were to determine the frequency of adolescents’ mental health problems in Africa and to evaluate the risk factors for mental health problems among adolescents in Africa. METHODS A systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and the search strategy process was employed to search multiple databases (MEDLINE, PubMed, PsycINFO, Scopus) and Google Scholar guided by the Joanna Briggs Institute (JBI). MeSH terms were created to search for eligible articles and data extraction was managed by Endnote. Included systematic reviews were those that reported the prevalence of mental health problems among adolescents and youths aged 10–19 years in Africa, and data were analyzed using MedCalc. The search yielded 862 records, of which 261 were assessed for eligibility, 31 met the inclusion criteria, and 12 articles were selected. RESULTS The pooled prevalence of adolescents with mental health problems in Africa shows depression accounted for 37.8% ( 95% CI: 30.7 to 45.2, I2 = 99.84%), psychiatric disorders 24.5% (CI: 20.69 to 28.5, I2 = 99.63%), anxiety 29.96% (CI:21.5 to 39.2, I2 = 99.90%), suicide ideation 23.94%(CI:18.3 to 30.1, I2 = 99.92%), substance abuse disorders 31.2% (CI:13.7 to 52.0, I2 = 99.90%), ADHD 5.95% (CI: 4.2 to 8.1, I2 = 98.48%), emotional and behavioral problems 40.8%(CI: 40.5 to 41., I2 = 0.00%) and Conduct Disorders 15% (95% CI: 8; 22, I2 = 99.58%). The reported risk factors are socioeconomic and environmental, family related, community and social, individual, and health-related factors. CONCLUSION Adolescents in Africa have one or more mental health problems, and the Sub-Saharan Africa (SSA ) region is facing a major crisis. The results have significant ramifications for African policy and practice since they show that mental health problems are a significant issue that impact the majority of adolescents throughout the continent and require agent interventions. Psychiatry Adolescents Prevalence Mental health problems Sub-Saharan Africa Africa Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 1. INTRODUCTION Adolescence which is ages of 10–19 is a period of psychological and physical transition accompanied by a number of risk factors that increase the vulnerability of the developing adolescent brain and mind to mental health problems 1 . Adolescents with mental health problems may experience emotional, social, and cognitive disruptions, as well as changes in their feelings, thoughts, and behaviors. Adolescents frequently suffer from a variety of mental health problems such as substance abuse, psychiatric illnesses, anxiety, depression and ADHD 2 . Numerous aspects of adolescents’ lives, such as school, grades, decision-making, and health, can be affected by mental health problems. Additionally, they may coexist with other behavioral and health hazards, including a higher chance of drug use, exposure to violence, and riskier sexual conduct 3 . Adolescents worldwide have very high rates of prevalence, chronicity, and morbidity of mental disorders 4 . According to Burns (2016), the adolescent population worldwide is vulnerable to mental illness, contributing to the high prevalence of mental and substance use disorders. Globally, 10–20% of children and adolescents are thought to struggle with mental health problems 4 . Similarly, according to Schulte-Körne (2016), 10 and 20% of adolescents suffer from mental health problems, but these issues go undiagnosed and untreated in the World. According to Polanczyk et al. (2015), psychotic disorders among adolescents account for 13.4% worldwide, 25.2%), according to a global study by Racine et al. (2021), and also conduct disorder (CD) among adolescents worldwide ranges from 2–10% 5 . Several studies worldwide and in Africa have shown that poor mental health in adolescents affects their general health and development issues, such as poor academic performance, substance misuse, aggression, and poor reproductive and sexual health. According to Erskine et al. (2015), adolescent populations are particularly susceptible to mental illness, contributing to the high prevalence of mental and substance use disorders worldwide. According to Silva et al. (2020), the prevalence of mental disorders affecting children and adolescents has increased noticeably worldwide over the past 30 years. In Africa, adolescents between the ages of 10 and 19 make up the majority of the population, which is approximately 23% 6 . All adolescents worldwide are vulnerable to mental health problems, but adolescents from Africa are particularly vulnerable because of the continent's higher rates of chronic poverty and diseases such as HIV/AIDS. Worse circumstances are present in the sub-Saharan region of Africa. Owing to the COVID-19 pandemic, mental health problems are now more likely to occur. The risk and burden of mental health problems in Africa must be urgently reduced through evidence-based adolescent mental health interventions. One in seven children and adolescents (14.3%) in sub-Saharan Africa is reported to experience significant psychological difficulties, and one in ten (9.5%) met the criteria for a psychiatric diagnosis, whether using ICD 10 or DSM V, according to a systematic review that was solely concerned with the prevalence of child mental health problems 7 . Additionally, this systematic review found that several risk factors that lead to mental health problems are common in low-income countries, along with poor living circumstances, high rates of HIV and AIDS, and other factors that worsen mental health problems in adolescents. A recent systematic review by Jörns-Presentati et al. (2021) found that the prevalence of mental health problems among adolescents in Sub-Saharan Africa is estimated that depression account for 27% of the population between the ages of 10 and 19 years, anxiety disorders for 30%, emotional and behavioral issues for 41%, and suicidal ideation for 12%. Furthermore, a review also reported that prevalence of post-traumatic stress disorder (PTSD) was 21%. According to a study by Ogundipe et al. (2018), 42% of adolescents in SSA had a substance use disorder, with prevalence estimates varying greatly among the sample determined by exposure to risk factors. Too et al. (2021) conducted a systematic review in SSA reported the prevalence of depression among adolescents to be 40.8%, anxiety 45.6%, and the risk factors which were associated with causing mental health problems were HIV-related stigma, economic hardships, poor family support, and chronic illnesses. The literature has pointed out that there are several risk factors associated with mental health problems among adolescents, such as poverty, bullying, moving from a rural to an urban area, and exposure to peers who use drugs 36 . In SSA, another systematic review by Quarshie et al. (2020) found that the prevalence of mental health problems, such as psychotic disorders and suicidal ideation, was 26% and 27%, respectively. The study also identified several risk factors, including academic failure; physical, emotional, and sexual abuse; romantic relationship issues; family conflict; and a lack of social support. In Nigeria, a systematic review done by Cui et al. (2022) found that prevalence of depression among adolescents who were students was 26%, and risk factors reported were academic stress, uncertain career directions, alcohol and life styles, geographic location, program of study, age, and marital status. This agrees with many research studies conducted in SSA, where most of the prevalence of mental health problems is high and common risk factors associated with mental health problems are poverty, family dynamics, violence, trauma, HIV, poor social support and also COVID 19 8–9-7 2. METHODS This Umbrella review used systematic reviews that were conducted within Africa and used the Preferred Reported Items for Systematic Review and Meta-Analyses (PRISMA) checklist. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42023417025. 2.1. Eligibility criteria All systematic reviews published in English that presented the prevalence of specific mental health problems among adolescents were included. Articles were searched and included from inception until March 2024. All systematic reviews that reported the prevalence of mental health problems among adolescents, but were conducted outside Africa, were excluded. Systematic reviews conducted in Africa published in English that did not exclusively report prevalence estimates of adolescents’ mental health were also excluded. 2.2. Source of information and search strategy A search of different systematic reviews was performed using different databases, including PubMed, CINAHL, PsychINFO, ERIC (Education Resources Information Center), SABINET, ProQuest, Science Direct, and Google Scholar. Articles published between March 2023 and March 2024 were searched. The keywords used to search for articles were mental health problems, “mental health challenges, ” mental disorders, “prevalence, AND Africa. The electronic search produced 864 articles relevant to the topic, which were managed in Endnote version x7.8. Duplicates were removed, leaving 262 articles. MeSH terms used to search the articles was (((((((((((((((((((Systematic review) OR (prevalence)) AND (frequency)) OR (mental health illness)) OR (mental health disorders)) OR (mental health challenges)) OR (mental health problems)) OR (depression)) OR (mental disabilities)) OR (Adolescents)) OR (youths)) OR (young people)) OR (children)) AND (young adults)) OR (Africa)) OR (southern Africa)) OR (central Africa)) OR (north Africa)) OR (West Africa)) OR (East Africa). 2.3. Study selection process Articles were selected in two phases. In the first phase, systematic review titles and abstracts were screened independently by two authors (JM and GC), and selected articles were then reviewed by two authors together, where a disagreement discussion was conducted to reach a consensus. The kappa score was computed to assess the degree of consensus, and a score of 0.965 was used as a measure of agreement. A kappa score which ranges between 0.81–1.00 is considered as almost perfect agreement 10 . In the second phase, screening was performed using PICOS. The PICOS framework, which refers (Population, Intervention, Comparison, Outcome and Setting) was used to screen all the selected articles from the first phase 42 . In this phase of the selection process, articles were independently reviewed by two reviewers (J. M. and G. C.) by applying and extracting the participant, intervention, outcome, and setting (PIOS) criteria. Systematic reviews that met the criteria were selected and full articles were accessed. Articles that did not meet the criteria were excluded after a thorough review by two authors (J. M. and G. C.). 2.4. Data extraction Articles were searched and transferred to Endnote version x7.8 as a reference manager. Thereafter, an Excel spreadsheet was developed, and data were exported from Endnote to the Excel spreadsheet. The items extracted and included were review title, Authors, Publication year, number of included studies, age range of the population, geographic location, risk factors, total number of samples, and prevalence estimates. Prevalence estimates were recorded in a separate table (Tables 1 and 2) because of a variety of mental health problems. 2.5. Assessment of methodological quality of systematic reviews Quality assessment of an umbrella review is crucial for evaluating the methodological rigor of the included systematic reviews and their findings 11 , 42 . The methodological caliber of the included studies was evaluated using the critical appraisal tool developed by the Johanna Briggs Institute (JBI) to rate the methodological rigor of systematic studies. The tool has 11 items with the following scales: Yes (1), No (2), Unclear (3), and Not Applicable (4). Two reviewers (J.M. and G.C.) retrieved the full articles of the included studies and performed a double-blind evaluation of the methodological quality of the studies. The quality of the tool was assessed based on the average score for each study receives 12 . 2.6. Statistical analysis The primary outcome of this review was the prevalence of mental health problems among adolescents in Africa; hence, the pooled prevalence of mental health problems was computed using MedCalc.version 23.0.5. A random-effects model was employed to assess the pooled prevalence of mental health problems across the included studies in Africa because the chosen studies had random samples from a larger population in an effort to generalize the findings beyond the included research 13 . To characterize the percentages of overall prevalence variation among the included reviews due to heterogeneity, I2 statistics were computed. Higher numbers of heterogeneity show an increase in heterogeneity, whereas a value of 0% indicates no heterogeneity at all 14 . Forest plots and tables were generated using MedCalc.version 23.0.5. 3. RESULTS 3.1. Literature search and selection This umbrella review was conducted with a focus on articles published only in English. The PRISMA flow diagram was used to show the number of studies that were found, screened, and either included or excluded at each stage of the review 16 . Electronic databases were searched using the Medical Subject Headings terms generated, and 864 records were identified. Duplicates were removed, leaving 262 records. Screening of the titles and abstracts resulted in 31 articles as a fit for methodological quality assessment. These 31 articles were retrieved for a detailed, full-text assessment, and only 12 articles fulfilled the inclusion criteria, 19 studies did not meet the eligibility criteria, eight articles failed because they had no prevalence estimates, and 11 used improper outcome measures. 3.2. Main study characteristics This umbrella review included 12 systematic reviews published from inception to March 2024, focusing on the prevalence of mental health problems among adolescents in Africa. The reviews incorporated systematic reviews that examined a range of mental health problems, including depression, anxiety, psychiatric and substance use disorders, emotional and conduct disorders, and ADHD, among adolescents aged 10–19 years. Nevertheless, the age range of one of the included studies was 0–16 years. This study was included because it contained relevant data suitable for this umbrella review. The included studies had a maximum age of 26. Of the 12 included studies, nine were reviews conducted in Sub-Saharan Africa (SSA), one each in Nigeria and Ethiopia, and another Africa-based epidemiological systematic review. The study population (Tables 2 and 3 ) comprised adolescents from several African regions, including North Africa, Sub-Saharan Africa, and East Africa. Both urban and rural populations were represented in the original study, which had sample sizes ranging from 176 to over 10,000 adolescents, and the total number of samples from the included studies was 543,884. However, research from Central and West Africa was noticeably underrepresented, with a notable concentration of studies from Nigeria, South Africa, Ethiopia, and Kenya. In the majority of meta-analyses, statistical measures of heterogeneity (I2 values) ranged from 98.48–99.92%, showing significant variation in prevalence estimates. However, only emotional and behavioral problems had 0.00% heterogeneity. This showed that the included studies did not exhibit any observed heterogeneity. Table 3 Key Characteristics of Included Systematic Reviews on Prevalence of Mental Health Problems among Adolescents in Africa Author(s) & Year Region/ country Study Design Primary studies included in Systematic review Sample Size (n) Age Range (Years) Mekuriaw et al(2020) Ethiopia Systematic review and meta-analysis 10 5,558 16–22 Cui et al (2022) Nigeria Systematic Review and Meta-Analysis 18 8,125 18–26 Jorns-Presentati et al(2021) SSA Systematic review 37 97 616 10–19 Too et al (2021) SSA Systematic review 31 9935 10–24 Quarshire et al (2020) SSA Systematic review 74 205,132 10–25 Olashore et al (2021) SSA Systematic review and meta-analysis 15 1,363 12–19 Ogundipe et al (2018) SSA Systematic review and meta-analysis 27 143 201 10–19 Ayano et al(2020) Africa Systematic review and meta-analysis 12 11,465 10–19 Cortina et al (2012) SSA Systematic review 11 9,713 0–16 Dessauvagie et al (2020) SSA Systematic review 14 5,136 10–19 Roberts et al (2021) SSA Systematic review 1 176 10–19 Handuma et al (2021) SSA Systematic review and meta-analysis 22 46, 464 10–19 3.3. Heterogeneity of Studies The included studies showed significant variability across systematic reviews. These studies showed clinical, methodological, and statistical heterogeneity. Clinical heterogeneity studies varied in population targets, such as age, sex, disease severity, comorbidities, diagnostic methods employed, geographic regions covered, clinical area, and methodological heterogeneity, whereby studies varied in inclusion and exclusion criteria, search strategies employed, risk of bias assessments conducted, data extraction methods, and quality of primary studies included. These studies also had statistical heterogeneity whereby most of the included reviews reporting high I² statistics, often exceeding 75%. I² Statistic computed to measure heterogeneity for the studies reported prevalence of depression (n = 6) showed heterogeneity of 99.8%, which is high (Fig. 2 ), psychotic disorders (n = 6) was 99.63%(Fig. 3 ), anxiety disorders (n = 4) was 99.90%(Fig. 4 ), Suicidal Ideation(n = 2) was 99.92%(Fig. 5 ), substance abuse reported 99.90%(Fig. 6 ), ADHD was 98.48%(Fig. 8 ). Emotional and behavioral problems were 0.00%, showing no heterogeneity at all (Fig. 7 ). 3.4. Prevalence of Mental Health Disorders These findings indicate that mental health problems are highly prevalent among African adolescents (Table 4 ). The most common mental health problems were depression, psychotic disorders, anxiety, suicidal ideation, substance use disorders, emotional and behavioral problems, and the least problem is ADHD. The pooled prevalence of depression prevalence is at 37.8%95% CI (CI: 30.7 to 45.2) (Table 5 ), and results shows that there is high heterogeneity (). The random effect pooled prevalence estimate of psychotic disorders was 24.5% (CI: 20.7 to 28.5,, I2; thus inconsistency = 99.63%) (Table 6 &Figure 2 ). Table 6 and Fig. 2 show asymmetry, indicating a small study effect, which was confirmed by the p-value of the Egger regression intercept, which was statistically significant (P = 0.7216). Pooled prevalence estimate for anxiety disorder was 30% (CI: 21.496 to 39.2, P < 0.0001, 99.90%) (Fig. 3 ). Egger’s test for small study effects was statistically significant (P = 0.7924)(Table 7 and Fig. 3 ). Pooled prevalence of suicidal ideation was found to be 23.9% at 95% CI (CI: 18.3 to 30.01, P < 0.0001, I2: 99.92%). The Egger's test at 95% CI showed P < 0.000 ( Table 8 and Fig. 4 ). The pooled prevalence of substance abuse was 31.2% (95% CI 13.7 to 52.0). This result was highly heterogeneous (I2 99.90%), P < 0.0001)( Table 9 and Fig. 4 ). Pooled prevalence of emotional and behavioral problems was 40.1% (95% CI: 40.5 to 41.1, P = 0.774, I2 = 0.00% at 95% CI (Table 10 and Fig. 7 ). The random effects pooled prevalence estimate for ADHD was 6% (95% CI: 4.1 to 8.1, P < 0.0001, I2 = 98.48%)( Table & Fig. 7 ). Only one review presented prevalence of Conduct disorder and had total sample population of 46, 464 with prevalence of 15% (95% CI: 8; 22, I2 = 99.58%). Table 4 Prevalence estimates for mental health problems affecting adolescents in Africa Author and Year of Publication Age Setting Psychotic disorders Depression Suicidal ideation Substance use disorder Conduct disorder ADHD emotional and behavioural disorders PTSD Psychological distress Anxiety Mekuriaw et al (2020) 16–22 Ethiopia 37.7% 21.6% Cui et al (2022) 18–24 Nigeria 26% Jorns-Presentati et al (2021) 10–19 SSA 26.9% 21% 40.8% 22% 14% 29.8% Too et al (2021) 10–24 SSA 40.8% 45.6% Quarshire et al (2020) 10–25 SSA 26% 27% Olashore et al (2021) 12–19 SSA 23.6% 26% Ogundipe et al (2018) 10–19 SSA 41.6% Ayano et al (2020) 8–19 Africa 7% Cortina et al (2012) 0–16 SSA 14.3% Dessauvagie et al (2020) 10–19 SSA 25% 41% Roberts et al (2021) 10–19 SSA 22% 92.9% Handuma et a(2021) 10–19 SSA 23% 19% 15% 5% 20% Table 5 Prevalence of depression Study Sample size Proportion (%) 95% CI Cui et al (2022) 8125 26 25.1 to 27.0 Jorns-Presentati et al (2021) 97616 29 28.7 to 29.3 Too et al (2021) 9935 41 39.8 to 41.7 Olashore et al (2021) 1363 24 21.8 to 26.4 Roberts et al (2021) 176 93 88.4 to 96.4 Handuma et al (2021) 46464 19 18.0 to 19.4 Pooled prevalence 163679 38 30.7 to 45.2 Table 6 Prevalence of Psychotic disorders Study Sample size Proportion (%) 95% CI Quarshire et al (2020) 205132 26 25.8 to 26.2 Cortina et al (2012) 9713 14 13.6 to 15.0 Dessauvagie et al (2020) 5136 25 23.8 to 26.2 Roberts et al (2021) 176 22 16.3 to 29.0 Handuma et al (2021) 46464 23 22.6 to 23.4 Mekuriaw et al (2020) 5558 38 36.4 to 39.0 Total (random effects) 272179 25 20.7 to 28.5 Table 7 Prevalence of Anxiety disorders Study Sample size Proportion (%) 95% CI Jorns-Presentati et al (2021) 97616 30 29.4 to 30.0 Too et al (2021 9935 46 44.6 to 46.6 Olashore et al (2021 1363 26 23.7 to 28.4 Handuma et al (2021) 46464 20 19.6 to 20.4 Total (random effects) 155378 30 21.5 to 39.2 Table 8 Prevalence of suicidal ideation Study Sample Size Proportion (%) 95% CI Jorns-Presentati et al (2021) 97616 21 20.7 to 21.3 Quarshire et al (2020) 205132 27 26.8 to 27.2 Total (random effects) 302748 24 18.3 to 30.1 Table 9 Prevalence of substance abuse Study Sample size Proportion (%) 95% CI Mekuriaw et al (2020) 5558 22 20.5 to 22.7 Ogundipe et al (2018) 143201 42 41.3 to 41.9 Total (random effects) 148759 31 13.7 to 52.0 Table 10 Showing prevalence of emotional and behavioral problems Study Sample size Proportion (%) 95% CI Jorns-Presentati et al (2021) 97616 41 40.5 to 41.1 Dessauvagie et al (2020) 5136 41 39.7 to 42.4 Total (random effects) 102752 41 40.5 to 41.1 Table 11 Prevalence of ADHD Study Sample size Proportion (%) 95% CI Ayano et al (2020) 11465 7 6.5 to 7.5 Handuma et al (2021) 46464 5 4.8 to 5.2 Total (random effects) 57929 6 4.2 to 8.1 Table 12 Risk factors for mental health problems among adolescents in Africa. Author(s) & Year Region/ Country Study Design Age Range (Years) Risk Factors Mekuriaw et al(2020) Ethiopia Systematic review and meta-analysis 16–22 Academic stress, Substance Use, Academic and Social Pressures, Lack of Mental Health Resources Cui et al (2022) Nigeria Systematic Review and Meta-Analysis 18–26 Academic stress, Uncertain career directions, alcohol and life styles, Geographic Location, Program of Study, Age and Marital Status Jorns-Presentati et al(2021) SSA Systematic review 10–19 Socioeconomic Conditions, Educational Disruptions, Exposure to Trauma, HIV and Health-Related Stressors, Family Dynamics Too et al (2021) SSA Systematic review 10–24 HIV-related stigma, economic hardships, poor family support, chronic illness Quarshire et al (2020) SSA Systematic review 10–25 Academic failure, sexual, emotional, and physical abuse, romantic relationship problems, family conflict, poor social support. Olashore et al (2021) SSA Systematic review and meta-analysis 12–19 Social stigma, family dysfunction, economic hardship, lack of social support, and poor access to mental health services Ogundipe et al (2018) SSA Systematic review and meta-analysis 10–19 Poor parenting. Family dysfunctional Ayano et al(2020) Africa Systematic review and meta-analysis 10–19 Comorbidity Cortina et al (2012) SSA Systematic review 0–16 Exposure to violence Dessauvagie et al (2020) SSA Systematic review 10–19 Poverty, trauma and bullying, Lack of social support. Roberts et al (2021) SSA Systematic review 10–19 Verbal/Physical abuse, Economic difficulties, Relationship difficulties, HIV infection, food insecurity, Intimate partner violence Handuma et al (2021) SSA Systematic review and meta-analysis 10–19 HIV and AIDS, Exposure to violence and trauma, poverty, Orphanhood, Socioeconomic disadvantages, and high levels of deprivation 3.5. Risks factors for mental health problems According to the included systematic reviews, mental health problems among adolescents in Africa are linked to a variety of factors, including socioeconomic and environmental, family related, community and social, individual, and health-related factors. The socioeconomic and environmental factors that have been highlighted include urbanization, geographic and regional positions, poverty, food insecurity, unemployment, unstable living conditions, lack of access to education, academic stress, disruptions in education, and lack of mental health resources. Genetics, family history, and family dynamics were all mentioned in systematic reviews on family related factors. Community and societal factors that have been reported include alcohol usage, substance use, lifestyle problems, and exposure to violence. Individual characteristics, such as age, gender, and marital status, were also established. HIV infection, health-related stressors, and comorbid conditions have also been acknowledged. 4. DISCUSSION A significant prevalence rate with a range of risk factors was found based on the 12 included systematic reviews that reported the prevalence of various mental health problems and risk factors among African adolescents. The total random effect for depression was 37.8%. Globally pooled prevalence estimates of depression among adolescents are 25.2% 17 . This shows that prevalence estimate of 37.8% in Africa is of higher side compared to that of the World. Depression among adolescents is a growing global concern, with prevalence rates varying significantly across regions and populations. Racine et al. (2021) further reported that in comparison to pre-pandemic estimations, the prevalence of depression symptoms among adolescents worldwide doubled during COVID-19. In Sub-Saharan Africa, a recent systematic review by Jörns-Presentati et al. (2021) found that the prevalence of depression among adolescents was 29.0%, which is also higher compared to the global estimates. A systematic review by Pozuelo et al. (2022) reported that adolescents in low-and middle-income countries (LMICs) have higher rates of risky conduct and depressive symptoms. Most African countries are in the Low- and Middle-income levels and hence experience high levels of depression compared to other continents. This shows that adolescents suffering from depression in LMICs bear two burdens. The pooled prevalence of psychotic disorders among African adolescents is 24.5%. Globally, psychotic disorders among adolescent’s account for 13.4%, which is lower than that of Africa 4 . A systematic review by Quarshie et al. (2020) indicated that approximately 26% of adolescents in sub-Saharan Africa experience psychotic disorders. This review highlights the significant gaps in research and data quality regarding psychotic disorders across the continent, reflecting the challenges in mental health infrastructure and diagnostic resources in many African regions. Other systematic reviews conducted in Africa also noted that data on psychotic disorders, specifically among adolescents in sub-Saharan Africa, are extremely limited but suggest a significant prevalence related to various risk factors 21 – 22 . The pooled prevalence of anxiety disorders among African adolescents is 30%. According to the majority of included systematic reviews, anxiety disorders are more common in sub-Saharan Africa. For instance, anxiety was reported to be 29.8% in a systematic review of the prevalence of mental health problems in sub-Saharan Africa conducted by Jörns-Presentati et al. (2021). Numerous studies conducted in Africa have shown that living with parents who have AIDS, orphanages caused by the disease, and wars are the main causes of the increased prevalence of anxiety disorders in the continent. The prevalence of anxiety was estimated to be 45.6% in review by Too et al. (2021) on the factors linked to prevalent mental illnesses in young people living with HIV in sub-Saharan Africa. As this review focused on adolescents living with HIV, it showed a remarkably high frequency. Numerous studies claim that high levels of anxiety are strongly correlated with low- and middle-income countries (LMIC) 4 – 17 . The prevalence of suicidal ideation in Africa among adolescents was found to be 23.9%. The prevalence of suicidal thoughts among adolescents varies internationally and across the continent. For example, a global systematic review and meta-analysis found that suicidal ideation and attempts among youth vary from 14.3–22.6% depending on the location 25 . These findings agree to the pooled prevalence of suicidal ideation in Africa which is 23.9%). Consistent with these results, a study on prevalence and associated factors of suicide ideation and attempt among adolescent high school students in Dangila Town, Northwest Ethiopia, established prevalence of suicide ideation and attempt was 22.5% 26 . the pooled prevalence of substance abuse among adolescents in Africa according to studies was 31.2%. However, data on the prevalence of adolescent substance addiction worldwide are limited. However, according to studies alcohol and illegal substance use account for 14% of the overall health burden among young males between the ages of 20 and 24 Worldwide 27 . Adolescent substance misuse is also prevalent in Africa, particularly in SSA. Ogundipe et al. (2018) conducted a systematic review of studies in SSA and found that 41.6% of adolescents used drugs and substances. The most prevalent substances that adolescents abuse are alcohol, cannabis, and tobacco, which affect 10% to over 30% of African adolescents. Cannabis is one of the most commonly used illegal substances; lifetime consumption can range from 4–20% in different African nations. The use of more potent drugs, such as cocaine and heroin, remains low but is a concern in urban centers. In terms of regions, West African countries like Nigeria and Ghana experience the highest prevalence of substance abuse, South Africa has one of the highest rates of adolescent substance abuse, with alcohol and cannabis being widely reported, while in East African countries such as Kenya, Uganda, and Tanzania, there is a high prevalence of substance abuse, and most abused substances are alcohol, khat, and cannabis. According to Wazema and Madhavi (2017) and Gebrie et al. (2018), khat is a stimulant-affecting plant that is frequently abused in Ethiopia, Burundi, and Kenya. Based on these findings, it is evident that substance abuse is a significant mental health problem among African adolescents. The random effect pooled prevalence estimate for emotional and behavioral problems was 40.1%. Emotional and behavioral issues among adolescents are a global issue and it is important to effectively preventing and treating in adolescents to improve their psychological well-being has been shown by past research conducted in Bangladesh 31 . According to Al-Mamun et al. (2024), 9.09% of Bangladeshi adolescents experience an emotional problem. According to this review, this rate is significantly lower than that in Africa. The prevalence of emotional and behavioral problems among adolescents in sub-Saharan Africa was 40.8% 19 . These findings indicate that emotional and behavioral problems are significant in Africa and require agent intervention. The pooled prevalence of ADHD was 5.95%. According to Al-Wardat et al. (2024), a systematic review conducted in the Middle East and Northern Africa, the prevalence rate of ADHD was 10.3% (95% CI, 0.081 to 0.129), which is greater than the findings of all other systematic reviews conducted in Africa and other nations. Given the disparities in prevalence rates and the fact that ADHD is common in Africa, prevention, early detection, and treatment of the disorder should be prioritized to support mental health and wellness throughout the continent. Prevalence of Conduct Disorder (CD) was reported in only one systematic review (n = 1), with a total sample population of 46, 464 and the pooled prevalence of Conduct disorder was 15%. According to a global report, the prevalence rates of conduct disorder (CD) among adolescents worldwide ranges from 2–10% 5 . However, the majority of research conducted in Africa indicates that CD is high among adolescents in Africa; for example, a study conducted in Kenya found that the prevalence of CD among adolescents was 31.4% 33 , and another study conducted in Nigeria to determine the prevalence of CD among adolescents in secondary school found that a prevalence rate of 14.5%. When comparing the findings of this umbrella review to global reports, it is clear that the incidence of CD is high in Africa. The prevalence rates of 31.4% and 14.5%, respectively, reported by Gitonga et al. (2017) in Kenya and Ojuope and Ekundayo (2020) in Nigeria, are greater than the global prevalence rate. What is intriguing about all of these published studies is that sex and family characteristics are risk factors for CD. It was observed that CD is more prevalent in boys than in girls and that children from dysfunctional or underprivileged homes are more prone to develop it. Socioeconomic and environmental factors are the most prevalent risk factors highlighted in this comprehensive analysis as being connected to mental health problems in adolescents. Poverty and unemployment, food insecurity and unstable living conditions, lack of educational access, academic stress and disruptions to education, lack of mental health resources, urbanization, and geographic and regional positions are all considered socioeconomic and environmental factors. In support of these findings, Jörns-Presentati et al. (2021) found that adolescents in Africa who experienced poverty and unemployment were more likely to experience mental health problems with the situation being worse in sub-Saharan African nations. According to a scoping review conducted in sub-Saharan Africa by Mabrouk et al. (2022), academic stress, persistent poverty, food insecurity, and limited access to education have all contributed to adolescents' poor mental health. Similarly, a systematic review conducted in SSA by Quarshie et al. (2020) discovered that poverty, lack of resources, and academic stress contribute to the development of mental health issues in adolescents, including suicide. A study by Jörns-Presentati et al. (2021) highlighted family dynamics, genetics, and family history as family related factors reported in a systematic review. Alcohol consumption, drug use, lifestyle, and exposure to violence are examples of documented community and social factors. According to Mabrouk et al. (2022), exposure to abuse, domestic violence, and violence is a risk factor for poor mental health among adolescents. Age, gender, and marital status have been mentioned as individual determinants. The literature has also stressed that bullying, moving from a rural to an urban area, and exposure to peers who use drugs are factors that influence mental health problems among adolescents 36 . HIV infection, health-related stressors, and comorbidities are health-related issues that have been observed. According to a study conducted in Nigeria by Cui et al. (2022), age, sex, and marital status have all been identified as risk factors. For instance, the study found that young female adolescents were more likely to experience depression than older married students. Furthermore, Mabrouk et al. (2022) and Jörns-Presentati et al. (2021) found that having HIV and other health-related factors, such as cancer, increases the likelihood of acquiring mental health issues. The COVID-19 pandemic is another recent health-related problem that has been shown to increase stress on the mental health of adolescents 19 . These documented risk factors pose a heavy burden on African adolescents' lives, which is further compounded by the dearth of mental healthcare services available to them, particularly in sub-Saharan Africa. Strengths and Limitations Conducting an umbrella review to determine the prevalence of mental health problems among African adolescents has unique strengths and limitations. First, this review has consolidated several research findings in Africa and provided an in-depth overview of mental health problems affecting adolescents in Africa. Second, the review saved time and other resources in establishing the current prevalence of mental health problems among adolescents in Africa. Finally, this umbrella review provides insight into methodological quality. Despite the strengths mentioned above, there are also limitations to conducting this systematic review. First, conducting an umbrella review and meta-analyses in Africa, where there are diverse regions with noteworthy differences and overlaps of culture, healthcare systems between countries even within some countries, and the significant economic instability of many African nations provided a major challenge to depend on existing systematic reviews. Despite the high-quality methodological rigor applied, some of the systematic reviews included outdated studies, and some may have been biased in the methodology process. Additionally, because of Africa's diversity, certain areas or nations were underrepresented because insufficient research was conducted there. For instance, few systematic reviews have been conducted in Northern Africa; the majority have been conducted in Sub-Saharan Africa, Eastern Africa, and Western Africa. Many nations in Sub-Saharan Africa were excluded from the majority of systematic reviews, as some of them lacked published research. Second, some of the relevant studies could not be located or were not published by the time of searching for data. The final limitation was the selection of articles that were published only in English. This means that the data were limited. 5. CONCLUSION This review discusses the current prevalence and risk factors of mental health problems among adolescents in Africa. The pooled prevalence of mental health problems among adolescents from the included systematic reviews shows that the prevalence of mental health problems among adolescents is high, and various risk factors are associated with the problem. Addressing these challenges is crucial for fostering well-being among adolescents in Africa because mental health is integral to educational outcomes, social development, and long-term economic productivity. Thus, the findings call for urgent policy actions and collaborative frameworks tailored to the unique sociocultural realities of the continent to prevent, identify, and effectively manage mental health issues among adolescents. Declarations CONFLICT OF INTEREST STATEMENT The authors have no conflicts of interest to disclose. ETHINCAL CONSIDERATIONS This study was registered by Prospero and used secondary data. FUNDING SOURCES This Umbrella review had no funding. ACKNOWLEDGMENTS We wish to acknowledge the support of all librarians and IT officers from Kamuzu University of Health Sciences and Daeyang University for helping locate articles. References Kapur S (2015) Adolescence: the stage of transition. Horiz Holist Educ 2(3):233–250 Herpertz-Dahlmann B, Bühren K, Remschmidt H (2013) Growing up is hard: mental disorders in adolescence. 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Wiley, Hoboken (NJ). 10.1002/9781119536604 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. 10.1136/bmj.n71 Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S (2021) Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: a meta-analysis. JAMA Pediatr 175(11):1142–1150. 10.1001/jamapediatrics.2021.2482 Pozuelo JR, Desborough L, Stein A, Cipriani A (2022) Systematic review and meta-analysis: depressive symptoms and risky behaviors among adolescents in low- and middle-income countries. J Am Acad Child Adolesc Psychiatry 61(2):255–276. 10.1016/j.jaac.2021.05.005 Jörns-Presentati A, Napp AK, Dessauvagie AS, Stein DJ, Jonker D, Breet E et al (2021) The prevalence of mental health problems in sub-Saharan adolescents: a systematic review. PLoS ONE 16(5):e0251689. 10.1371/journal.pone.0251689 Polanczyk GV, Salum GA, Sugaya LS, Caye A, Rohde LA (2015) Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 56(3):345–365. 10.1111/jcpp.12381 Quarshie EN, Waterman MG, House AO (2020) Self-harm with suicidal and non-suicidal intent in young people in sub-Saharan Africa: a systematic review. BMC Psychiatry 20:1–26. 10.1186/s12888-020-02744-z Adjorlolo S, Setordzi M (2021) Psychosis in adolescents in Africa: a scoping review for current understanding and future directions. Cogent Psychol 8(1):1949173. 10.1080/23311908.2021.1949173 Too EK, Abubakar A, Nasambu C, Koot HM, Cuijpers P, Newton CR, Nyongesa MK (2021) Prevalence and factors associated with common mental disorders in young people living with HIV in sub-Saharan Africa: a systematic review. J Int AIDS Soc 24(Suppl 2):e25705. 10.1002/jia2.25705 Erskine HE, Baxter AJ, Patton G, Moffitt TE, Patel V, Whiteford HA, Scott JG (2017) The global coverage of prevalence data for mental disorders in children and adolescents. Epidemiol Psychiatr Sci 26(4):395–402. 10.1017/S2045796015001158 Van Meter AR, Knowles EA, Mintz EH (2023) Systematic review and meta-analysis: international prevalence of suicidal ideation and attempt in youth. J Am Acad Child Adolesc Psychiatry 62(9):973–986. 10.1016/j.jaac.2022.07.867 Amare T, Woldeyhannes SM, Haile K, Yeneabat T, Psychiatry J (2018) ;2018:7631453. 10.1155/2018/7631453 Degenhardt L, Stockings E, Patton G, Hall WD, Lynskey M (2016) The increasing global health priority of substance use in young people. Lancet Psychiatry 3(3):251–264. 10.1016/S2215-0366(15)00575-2 Ogundipe O, Amoo EO, Adeloye D, Olawole-Isaac A (2018) Substance use among adolescents in sub-Saharan Africa: a systematic review and meta-analysis. S Afr J Child Health 12(Suppl 1):S79–S84. 10.7196/SAJCH.2018.v12i2.1524 Wazema DH, Madhavi K (2017) Prevalence of Khat abuse and associated factors among undergraduate students of Jimma University, Ethiopia. Int J Res Med Sci 3(7):1751–1757. 10.18203/2320–6012.ijrms20150264 Gebrie A, Alebel A, Zegeye A, Tesfaye B (2018) Prevalence and predictors of khat chewing among Ethiopian university students: a systematic review and meta-analysis. PLoS ONE 13(4):e0195718. 10.1371/journal.pone.0195718 Al-Mamun F, Islam J, Muhit M, Mamun MA (2024) Prevalence of emotional and behavioral problems among adolescents in Bangladesh. Soc Psychiatry Psychiatr Epidemiol 1–11. 10.1007/s00127-024-02567-8 Al-Wardat M, Etoom M, Almhdawi KA, Hawamdeh Z, Khader Y (2024) Prevalence of attention-deficit hyperactivity disorder in children, adolescents and adults in the Middle East and North Africa region: a systematic review and meta-analysis. BMJ Open 14(1):e078849. 10.1136/bmjopen-2023-078849 Gitonga M, Muriungi S, Ongaro K, Omondi M (2017) Prevalence of conduct disorder among adolescents in secondary schools: a case of Kamukunji and Olympic Mixed Sub–County secondary schools in Nairobi County, Kenya. Afr J Clin Psychol 1:85–101 Ojuope AV, Ekundayo OO (2020) Conduct disorder and its relationship with socio–demographic factors among secondary school adolescents in Ondo State, Nigeria. Am J Appl Psychol 9(3):60–65. 10.11648/j.ajap.20200903.12 Mabrouk A, Mbithi G, Chongwo E, Too E, Sarki A, Namuguzi M et al (2022) Mental health interventions for adolescents in sub-Saharan Africa: A scoping review. Front Psychiatry 13:937723. 10.3389/fpsyt.2022.937723 Blakemore SJ (2019) Adolescence and mental health. Lancet 393(10185):2030–2031. 10.1016/S0140-6736(19)31013-X Cui S, Ajayi B, Kim E, Egonu R (2022) A systematic review and meta-analysis of depression prevalence amongst Nigerian students pursuing higher education. J Behav Brain Sci 12(11):589–598. 10.4236/jbbs.2022.1211035 Burns J (2016) Psychosocial determinants of mental disorders. In: Burns J, Roos L (eds) Textbook of psychiatry for Southern Africa, 2nd edn. Oxford University Press Southern Africa, Cape Town, pp 72–90 Schulte-Körne G (2016) Mental health problems in a school setting in children and adolescents. Dtsch Arztebl Int 113(11):183. 10.3238/arztebl.2016.0183 Erskine HE, Moffitt TE, Copeland WE, Costello EJ, Ferrari AJ, Patton G et al (2015) A heavy burden on young minds: the global burden of mental and substance use disorders in children and youth. Psychol Med 45(7):1551–1563. 10.1017/S0033291714002888 Silva SA, Silva SU, Ronca DB, Gonçalves VSS, Dutra ES, Carvalho KMB (2020) Common mental disorders prevalence in adolescents: a systematic review and meta-analyses. PLoS ONE 15(4):e0232007. 10.1371/journal.pone.0232007 Smith V, Devane D, Begley CM, Clarke M (2011) Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Med Res Methodol 11:15. 10.1186/1471-2288-11-15 Table 2 Table 2 is not available with this version. Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7324331","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Systematic Review","associatedPublications":[],"authors":[{"id":497531448,"identity":"4da24695-4a26-46c9-a9fe-3060ff98b020","order_by":0,"name":"Joseph Mickton 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INTRODUCTION","content":"\u003cp\u003eAdolescence which is ages of 10\u0026ndash;19 is a period of psychological and physical transition accompanied by a number of risk factors that increase the vulnerability of the developing adolescent brain and mind to mental health problems \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Adolescents with mental health problems may experience emotional, social, and cognitive disruptions, as well as changes in their feelings, thoughts, and behaviors. Adolescents frequently suffer from a variety of mental health problems such as substance abuse, psychiatric illnesses, anxiety, depression and ADHD \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Numerous aspects of adolescents\u0026rsquo; lives, such as school, grades, decision-making, and health, can be affected by mental health problems. Additionally, they may coexist with other behavioral and health hazards, including a higher chance of drug use, exposure to violence, and riskier sexual conduct \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Adolescents worldwide have very high rates of prevalence, chronicity, and morbidity of mental disorders\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. According to Burns (2016), the adolescent population worldwide is vulnerable to mental illness, contributing to the high prevalence of mental and substance use disorders. Globally, 10\u0026ndash;20% of children and adolescents are thought to struggle with mental health problems \u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. Similarly, according to Schulte-K\u0026ouml;rne (2016), 10 and 20% of adolescents suffer from mental health problems, but these issues go undiagnosed and untreated in the World. According to Polanczyk et al. (2015), psychotic disorders among adolescents account for 13.4% worldwide, 25.2%), according to a global study by Racine et al. (2021), and also conduct disorder (CD) among adolescents worldwide ranges from 2\u0026ndash;10% \u003csup\u003e5\u003c/sup\u003e. Several studies worldwide and in Africa have shown that poor mental health in adolescents affects their general health and development issues, such as poor academic performance, substance misuse, aggression, and poor reproductive and sexual health. According to Erskine et al. (2015), adolescent populations are particularly susceptible to mental illness, contributing to the high prevalence of mental and substance use disorders worldwide. According to Silva et al. (2020), the prevalence of mental disorders affecting children and adolescents has increased noticeably worldwide over the past 30 years.\u003c/p\u003e\u003cp\u003eIn Africa, adolescents between the ages of 10 and 19 make up the majority of the population, which is approximately 23% \u003csup\u003e6\u003c/sup\u003e. All adolescents worldwide are vulnerable to mental health problems, but adolescents from Africa are particularly vulnerable because of the continent's higher rates of chronic poverty and diseases such as HIV/AIDS. Worse circumstances are present in the sub-Saharan region of Africa. Owing to the COVID-19 pandemic, mental health problems are now more likely to occur. The risk and burden of mental health problems in Africa must be urgently reduced through evidence-based adolescent mental health interventions. One in seven children and adolescents (14.3%) in sub-Saharan Africa is reported to experience significant psychological difficulties, and one in ten (9.5%) met the criteria for a psychiatric diagnosis, whether using ICD 10 or DSM V, according to a systematic review that was solely concerned with the prevalence of child mental health problems \u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. Additionally, this systematic review found that several risk factors that lead to mental health problems are common in low-income countries, along with poor living circumstances, high rates of HIV and AIDS, and other factors that worsen mental health problems in adolescents. A recent systematic review by J\u0026ouml;rns-Presentati et al. (2021) found that the prevalence of mental health problems among adolescents in Sub-Saharan Africa is estimated that depression account for 27% of the population between the ages of 10 and 19 years, anxiety disorders for 30%, emotional and behavioral issues for 41%, and suicidal ideation for 12%. Furthermore, a review also reported that prevalence of post-traumatic stress disorder (PTSD) was 21%. According to a study by Ogundipe et al. (2018), 42% of adolescents in SSA had a substance use disorder, with prevalence estimates varying greatly among the sample determined by exposure to risk factors. Too et al. (2021) conducted a systematic review in SSA reported the prevalence of depression among adolescents to be 40.8%, anxiety 45.6%, and the risk factors which were associated with causing mental health problems were HIV-related stigma, economic hardships, poor family support, and chronic illnesses. The literature has pointed out that there are several risk factors associated with mental health problems among adolescents, such as poverty, bullying, moving from a rural to an urban area, and exposure to peers who use drugs \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. In SSA, another systematic review by Quarshie et al. (2020) found that the prevalence of mental health problems, such as psychotic disorders and suicidal ideation, was 26% and 27%, respectively. The study also identified several risk factors, including academic failure; physical, emotional, and sexual abuse; romantic relationship issues; family conflict; and a lack of social support. In Nigeria, a systematic review done by Cui et al. (2022) found that prevalence of depression among adolescents who were students was 26%, and risk factors reported were academic stress, uncertain career directions, alcohol and life styles, geographic location, program of study, age, and marital status. This agrees with many research studies conducted in SSA, where most of the prevalence of mental health problems is high and common risk factors associated with mental health problems are poverty, family dynamics, violence, trauma, HIV, poor social support and also COVID 19 \u003csup\u003e8\u0026ndash;9-7\u003c/sup\u003e\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003cp\u003eThis Umbrella review used systematic reviews that were conducted within Africa and used the Preferred Reported Items for Systematic Review and Meta-Analyses (PRISMA) checklist. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42023417025.\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1. Eligibility criteria\u003c/h2\u003e\u003cp\u003eAll systematic reviews published in English that presented the prevalence of specific mental health problems among adolescents were included. Articles were searched and included from inception until March 2024. All systematic reviews that reported the prevalence of mental health problems among adolescents, but were conducted outside Africa, were excluded. Systematic reviews conducted in Africa published in English that did not exclusively report prevalence estimates of adolescents\u0026rsquo; mental health were also excluded.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2. Source of information and search strategy\u003c/h2\u003e\u003cp\u003eA search of different systematic reviews was performed using different databases, including PubMed, CINAHL, PsychINFO, ERIC (Education Resources Information Center), SABINET, ProQuest, Science Direct, and Google Scholar. Articles published between March 2023 and March 2024 were searched. The keywords used to search for articles were mental health problems, \u0026ldquo;mental health challenges, \u0026rdquo; mental disorders, \u0026ldquo;prevalence, AND Africa. The electronic search produced 864 articles relevant to the topic, which were managed in Endnote version x7.8. Duplicates were removed, leaving 262 articles. MeSH terms used to search the articles was (((((((((((((((((((Systematic review) OR (prevalence)) AND (frequency)) OR (mental health illness)) OR (mental health disorders)) OR (mental health challenges)) OR (mental health problems)) OR (depression)) OR (mental disabilities)) OR (Adolescents)) OR (youths)) OR (young people)) OR (children)) AND (young adults)) OR (Africa)) OR (southern Africa)) OR (central Africa)) OR (north Africa)) OR (West Africa)) OR (East Africa).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3. Study selection process\u003c/h2\u003e\u003cp\u003eArticles were selected in two phases. In the first phase, systematic review titles and abstracts were screened independently by two authors (JM and GC), and selected articles were then reviewed by two authors together, where a disagreement discussion was conducted to reach a consensus. The kappa score was computed to assess the degree of consensus, and a score of 0.965 was used as a measure of agreement. A kappa score which ranges between 0.81\u0026ndash;1.00 is considered as almost perfect agreement \u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. In the second phase, screening was performed using PICOS. The PICOS framework, which refers (Population, Intervention, Comparison, Outcome and Setting) was used to screen all the selected articles from the first phase\u003csup\u003e\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. In this phase of the selection process, articles were independently reviewed by two reviewers (J. M. and G. C.) by applying and extracting the participant, intervention, outcome, and setting (PIOS) criteria. Systematic reviews that met the criteria were selected and full articles were accessed. Articles that did not meet the criteria were excluded after a thorough review by two authors (J. M. and G. C.).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4. Data extraction\u003c/h2\u003e\u003cp\u003eArticles were searched and transferred to Endnote version x7.8 as a reference manager. Thereafter, an Excel spreadsheet was developed, and data were exported from Endnote to the Excel spreadsheet. The items extracted and included were review title, Authors, Publication year, number of included studies, age range of the population, geographic location, risk factors, total number of samples, and prevalence estimates. Prevalence estimates were recorded in a separate table (Tables\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and 2) because of a variety of mental health problems.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.5. Assessment of methodological quality of systematic reviews\u003c/h2\u003e\u003cp\u003eQuality assessment of an umbrella review is crucial for evaluating the methodological rigor of the included systematic reviews and their findings \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u003c/sup\u003e. The methodological caliber of the included studies was evaluated using the critical appraisal tool developed by the Johanna Briggs Institute (JBI) to rate the methodological rigor of systematic studies. The tool has 11 items with the following scales: Yes (1), No (2), Unclear (3), and Not Applicable (4). Two reviewers (J.M. and G.C.) retrieved the full articles of the included studies and performed a double-blind evaluation of the methodological quality of the studies. The quality of the tool was assessed based on the average score for each study receives\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.6. Statistical analysis\u003c/h2\u003e\u003cp\u003eThe primary outcome of this review was the prevalence of mental health problems among adolescents in Africa; hence, the pooled prevalence of mental health problems was computed using MedCalc.version 23.0.5. A random-effects model was employed to assess the pooled prevalence of mental health problems across the included studies in Africa because the chosen studies had random samples from a larger population in an effort to generalize the findings beyond the included research\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. To characterize the percentages of overall prevalence variation among the included reviews due to heterogeneity, I2 statistics were computed. Higher numbers of heterogeneity show an increase in heterogeneity, whereas a value of 0% indicates no heterogeneity at all\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Forest plots and tables were generated using MedCalc.version 23.0.5.\u003c/p\u003e\u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e3.1. Literature search and selection\u003c/h2\u003e\u003cp\u003eThis umbrella review was conducted with a focus on articles published only in English. The PRISMA flow diagram was used to show the number of studies that were found, screened, and either included or excluded at each stage of the review \u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Electronic databases were searched using the Medical Subject Headings terms generated, and 864 records were identified. Duplicates were removed, leaving 262 records. Screening of the titles and abstracts resulted in 31 articles as a fit for methodological quality assessment. These 31 articles were retrieved for a detailed, full-text assessment, and only 12 articles fulfilled the inclusion criteria, 19 studies did not meet the eligibility criteria, eight articles failed because they had no prevalence estimates, and 11 used improper outcome measures.\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003e3.2. Main study characteristics\u003c/h2\u003e\u003cp\u003eThis umbrella review included 12 systematic reviews published from inception to March 2024, focusing on the prevalence of mental health problems among adolescents in Africa. The reviews incorporated systematic reviews that examined a range of mental health problems, including depression, anxiety, psychiatric and substance use disorders, emotional and conduct disorders, and ADHD, among adolescents aged 10\u0026ndash;19 years. Nevertheless, the age range of one of the included studies was 0\u0026ndash;16 years. This study was included because it contained relevant data suitable for this umbrella review. The included studies had a maximum age of 26. Of the 12 included studies, nine were reviews conducted in Sub-Saharan Africa (SSA), one each in Nigeria and Ethiopia, and another Africa-based epidemiological systematic review. The study population (Tables\u0026nbsp;2 and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e3\u003c/span\u003e) comprised adolescents from several African regions, including North Africa, Sub-Saharan Africa, and East Africa. Both urban and rural populations were represented in the original study, which had sample sizes ranging from 176 to over 10,000 adolescents, and the total number of samples from the included studies was 543,884. However, research from Central and West Africa was noticeably underrepresented, with a notable concentration of studies from Nigeria, South Africa, Ethiopia, and Kenya. In the majority of meta-analyses, statistical measures of heterogeneity (I2 values) ranged from 98.48\u0026ndash;99.92%, showing significant variation in prevalence estimates. However, only emotional and behavioral problems had 0.00% heterogeneity. This showed that the included studies did not exhibit any observed heterogeneity.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eKey Characteristics of Included Systematic Reviews on Prevalence of Mental Health Problems among Adolescents in Africa\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor(s) \u0026amp; Year\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegion/\u003c/p\u003e\u003cp\u003ecountry\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStudy Design\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePrimary studies included in Systematic review\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSample Size (n)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eAge Range\u003c/p\u003e\u003cp\u003e(Years)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMekuriaw et al(2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEthiopia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review and meta-analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5,558\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e16\u0026ndash;22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCui et al (2022)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNigeria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic Review and Meta-Analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8,125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e18\u0026ndash;26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJorns-Presentati et al(2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e97 616\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eToo et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9935\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuarshire et al\u003c/p\u003e\u003cp\u003e(2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e205,132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOlashore et al\u003c/p\u003e\u003cp\u003e(2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review and meta-analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1,363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e12\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOgundipe et al (2018)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review and meta-analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e143 201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAyano et al(2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAfrica\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review and meta-analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e11,465\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCortina et al\u003c/p\u003e\u003cp\u003e(2012)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e9,713\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e0\u0026ndash;16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDessauvagie et al\u003c/p\u003e\u003cp\u003e(2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e5,136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRoberts et al\u003c/p\u003e\u003cp\u003e(2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHanduma et al\u003c/p\u003e\u003cp\u003e(2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review and meta-analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e46, 464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003e3.3. Heterogeneity of Studies\u003c/h2\u003e\u003cp\u003eThe included studies showed significant variability across systematic reviews. These studies showed clinical, methodological, and statistical heterogeneity. Clinical heterogeneity studies varied in population targets, such as age, sex, disease severity, comorbidities, diagnostic methods employed, geographic regions covered, clinical area, and methodological heterogeneity, whereby studies varied in inclusion and exclusion criteria, search strategies employed, risk of bias assessments conducted, data extraction methods, and quality of primary studies included. These studies also had statistical heterogeneity whereby most of the included reviews reporting high I\u0026sup2; statistics, often exceeding 75%. I\u0026sup2; Statistic computed to measure heterogeneity for the studies reported prevalence of depression (n\u0026thinsp;=\u0026thinsp;6) showed heterogeneity of 99.8%, which is high (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e), psychotic disorders (n\u0026thinsp;=\u0026thinsp;6) was 99.63%(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e), anxiety disorders (n\u0026thinsp;=\u0026thinsp;4) was 99.90%(Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e), Suicidal Ideation(n\u0026thinsp;=\u0026thinsp;2) was 99.92%(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e5\u003c/span\u003e), substance abuse reported 99.90%(Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e6\u003c/span\u003e), ADHD was 98.48%(Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e8\u003c/span\u003e). Emotional and behavioral problems were 0.00%, showing no heterogeneity at all (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003e3.4. Prevalence of Mental Health Disorders\u003c/h2\u003e\u003cp\u003eThese findings indicate that mental health problems are highly prevalent among African adolescents (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The most common mental health problems were depression, psychotic disorders, anxiety, suicidal ideation, substance use disorders, emotional and behavioral problems, and the least problem is ADHD. The pooled prevalence of depression prevalence is at 37.8%95% CI (CI: 30.7 to 45.2) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e5\u003c/span\u003e ), and results shows that there is high heterogeneity (). The random effect pooled prevalence estimate of psychotic disorders was 24.5% (CI: 20.7 to 28.5,, I2; thus inconsistency\u0026thinsp;=\u0026thinsp;99.63%) (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e6\u003c/span\u003e \u0026amp;Figure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e6\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e2\u003c/span\u003e show asymmetry, indicating a small study effect, which was confirmed by the p-value of the Egger regression intercept, which was statistically significant (P\u0026thinsp;=\u0026thinsp;0.7216). Pooled prevalence estimate for anxiety disorder was 30% (CI: 21.496 to 39.2, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, 99.90%) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Egger\u0026rsquo;s test for small study effects was statistically significant (P\u0026thinsp;=\u0026thinsp;0.7924)(Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e7\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Pooled prevalence of suicidal ideation was found to be 23.9% at 95% CI (CI: 18.3 to 30.01, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, I2: 99.92%). The Egger's test at 95% CI showed P\u0026thinsp;\u0026lt;\u0026thinsp;0.000 ( Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e8\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e). The pooled prevalence of substance abuse was 31.2% (95% CI 13.7 to 52.0). This result was highly heterogeneous (I2 99.90%), P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001)( Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e9\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e4\u003c/span\u003e). Pooled prevalence of emotional and behavioral problems was 40.1% (95% CI: 40.5 to 41.1, P\u0026thinsp;=\u0026thinsp;0.774, I2\u0026thinsp;=\u0026thinsp;0.00% at 95% CI (Table\u0026nbsp;\u003cspan refid=\"Tab9\" class=\"InternalRef\"\u003e10\u003c/span\u003e and Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e7\u003c/span\u003e). The random effects pooled prevalence estimate for ADHD was 6% (95% CI: 4.1 to 8.1, P\u0026thinsp;\u0026lt;\u0026thinsp;0.0001, I2\u0026thinsp;=\u0026thinsp;98.48%)( Table \u0026amp; Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e7\u003c/span\u003e). Only one review presented prevalence of Conduct disorder and had total sample population of 46, 464 with prevalence of 15% (95% CI: 8; 22, I2\u0026thinsp;=\u0026thinsp;99.58%).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence estimates for mental health problems affecting adolescents in Africa\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"14\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c14\" colnum=\"14\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor and Year of Publication\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSetting\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePsychotic disorders\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eDepression\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eSuicidal ideation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eSubstance use disorder\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eConduct disorder\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eADHD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e\u003cp\u003eemotional and behavioural disorders\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c12\"\u003e\u003cp\u003ePTSD\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c13\"\u003e\u003cp\u003ePsychological distress\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c14\"\u003e\u003cp\u003eAnxiety\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMekuriaw et al (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u0026ndash;22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEthiopia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e37.7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e21.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCui et al (2022)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e18\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNigeria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJorns-Presentati et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e26.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e21%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e40.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u003cp\u003e22%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u003cp\u003e14%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e29.8%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eToo et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e40.8%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e45.6%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuarshire et al (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e27%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOlashore et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e23.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e26%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOgundipe et al (2018)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e41.6%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAyano et al (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfrica\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e7%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCortina et al (2012)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e0\u0026ndash;16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14.3%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDessauvagie et al (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e41%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRoberts et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e92.9%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHanduma et a(2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e19%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e15%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e5%\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c14\"\u003e\u003cp\u003e20%\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of depression\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSample\u0026nbsp;size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProportion\u0026nbsp;(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95%\u0026nbsp;CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCui et al (2022)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.1 to 27.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJorns-Presentati et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e97616\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e28.7 to 29.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eToo et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9935\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.8 to 41.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOlashore et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.8 to 26.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRoberts et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e93\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e88.4 to 96.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHanduma et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.0 to 19.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePooled prevalence\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e163679\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e30.7 to 45.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of Psychotic disorders\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSample\u0026nbsp;size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProportion\u0026nbsp;(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95%\u0026nbsp;CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuarshire et al (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e205132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25.8 to 26.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCortina et al (2012)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9713\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.6 to 15.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDessauvagie et al (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.8 to 26.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRoberts et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e176\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16.3 to 29.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHanduma et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22.6 to 23.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMekuriaw et al (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5558\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e36.4 to 39.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal (random effects)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e272179\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.7 to 28.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 7\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of Anxiety disorders\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSample\u0026nbsp;size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProportion\u003c/p\u003e\u003cp\u003e(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95%\u0026nbsp;CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJorns-Presentati et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e97616\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29.4 to 30.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eToo et al (2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9935\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e46\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e44.6 to 46.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOlashore et al (2021\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1363\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23.7 to 28.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHanduma et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e19.6 to 20.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal (random effects)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e155378\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e21.5 to 39.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab7\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 8\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of suicidal ideation\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSample\u003c/p\u003e\u003cp\u003eSize\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProportion\u0026nbsp;(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95%\u0026nbsp;CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJorns-Presentati et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e97616\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.7 to 21.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuarshire et al (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e205132\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e26.8 to 27.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal (random effects)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e302748\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18.3 to 30.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab8\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 9\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of substance abuse\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSample\u0026nbsp;size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProportion\u0026nbsp;(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95%\u0026nbsp;CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMekuriaw et al (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5558\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e20.5 to 22.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOgundipe et al (2018)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e143201\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e41.3 to 41.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal (random effects)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e148759\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e13.7 to 52.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab9\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 10\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eShowing prevalence of emotional and behavioral problems\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSample\u0026nbsp;size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProportion\u0026nbsp;(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95%\u0026nbsp;CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJorns-Presentati et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e97616\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.5 to 41.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDessauvagie et al (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5136\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e39.7 to 42.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal (random effects)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e102752\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e40.5 to 41.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab10\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 11\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003ePrevalence of ADHD\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSample\u0026nbsp;size\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eProportion\u0026nbsp;(%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e95%\u0026nbsp;CI\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAyano et al (2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11465\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e6.5 to 7.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHanduma et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e46464\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.8 to 5.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTotal (random effects)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e57929\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.2 to 8.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab11\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 12\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRisk factors for mental health problems among adolescents in Africa.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAuthor(s) \u0026amp; Year\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegion/\u003c/p\u003e\u003cp\u003eCountry\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStudy Design\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAge Range\u003c/p\u003e\u003cp\u003e(Years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eRisk Factors\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMekuriaw et al(2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEthiopia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review and meta-analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16\u0026ndash;22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAcademic stress, Substance Use, Academic and Social Pressures, Lack of Mental Health Resources\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCui et al (2022)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNigeria\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic Review and Meta-Analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18\u0026ndash;26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAcademic stress, Uncertain career directions, alcohol and life styles, Geographic Location, Program of Study, Age and Marital Status\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eJorns-Presentati et al(2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSocioeconomic Conditions, Educational Disruptions, Exposure to Trauma, HIV and Health-Related Stressors, Family Dynamics\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eToo et al (2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHIV-related stigma, economic hardships, poor family support, chronic illness\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eQuarshire et al\u003c/p\u003e\u003cp\u003e(2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u0026ndash;25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eAcademic failure, sexual, emotional, and physical abuse, romantic relationship problems, family conflict, poor social support.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOlashore et al\u003c/p\u003e\u003cp\u003e(2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review and meta-analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSocial stigma, family dysfunction, economic hardship, lack of social support, and poor access to mental health services\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOgundipe et al (2018)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review and meta-analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePoor parenting. Family dysfunctional\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAyano et al(2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAfrica\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review and meta-analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eComorbidity\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCortina et al\u003c/p\u003e\u003cp\u003e(2012)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e0\u0026ndash;16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eExposure to violence\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eDessauvagie et al\u003c/p\u003e\u003cp\u003e(2020)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePoverty, trauma and bullying, Lack of social support.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRoberts et al\u003c/p\u003e\u003cp\u003e(2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eVerbal/Physical abuse, Economic difficulties, Relationship difficulties, HIV infection, food insecurity, Intimate partner violence\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHanduma et al\u003c/p\u003e\u003cp\u003e(2021)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSSA\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSystematic review and meta-analysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e10\u0026ndash;19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eHIV and AIDS, Exposure to violence and trauma, poverty,\u003c/p\u003e\u003cp\u003eOrphanhood, Socioeconomic disadvantages, and high levels of deprivation\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e3.5. Risks factors for mental health problems\u003c/h2\u003e\u003cp\u003eAccording to the included systematic reviews, mental health problems among adolescents in Africa are linked to a variety of factors, including socioeconomic and environmental, family related, community and social, individual, and health-related factors. The socioeconomic and environmental factors that have been highlighted include urbanization, geographic and regional positions, poverty, food insecurity, unemployment, unstable living conditions, lack of access to education, academic stress, disruptions in education, and lack of mental health resources. Genetics, family history, and family dynamics were all mentioned in systematic reviews on family related factors. Community and societal factors that have been reported include alcohol usage, substance use, lifestyle problems, and exposure to violence. Individual characteristics, such as age, gender, and marital status, were also established. HIV infection, health-related stressors, and comorbid conditions have also been acknowledged.\u003c/p\u003e\u003c/div\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eA significant prevalence rate with a range of risk factors was found based on the 12 included systematic reviews that reported the prevalence of various mental health problems and risk factors among African adolescents. The total random effect for depression was 37.8%. Globally pooled prevalence estimates of depression among adolescents are 25.2%\u003csup\u003e17\u003c/sup\u003e. This shows that prevalence estimate of 37.8% in Africa is of higher side compared to that of the World. Depression among adolescents is a growing global concern, with prevalence rates varying significantly across regions and populations. Racine et al. (2021) further reported that in comparison to pre-pandemic estimations, the prevalence of depression symptoms among adolescents worldwide doubled during COVID-19. In Sub-Saharan Africa, a recent systematic review by J\u0026ouml;rns-Presentati et al. (2021) found that the prevalence of depression among adolescents was 29.0%, which is also higher compared to the global estimates. A systematic review by Pozuelo et al. (2022) reported that adolescents in low-and middle-income countries (LMICs) have higher rates of risky conduct and depressive symptoms. Most African countries are in the Low- and Middle-income levels and hence experience high levels of depression compared to other continents. This shows that adolescents suffering from depression in LMICs bear two burdens. The pooled prevalence of psychotic disorders among African adolescents is 24.5%. Globally, psychotic disorders among adolescent\u0026rsquo;s account for 13.4%, which is lower than that of Africa\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. A systematic review by Quarshie et al. (2020) indicated that approximately 26% of adolescents in sub-Saharan Africa experience psychotic disorders. This review highlights the significant gaps in research and data quality regarding psychotic disorders across the continent, reflecting the challenges in mental health infrastructure and diagnostic resources in many African regions. Other systematic reviews conducted in Africa also noted that data on psychotic disorders, specifically among adolescents in sub-Saharan Africa, are extremely limited but suggest a significant prevalence related to various risk factors\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. The pooled prevalence of anxiety disorders among African adolescents is 30%. According to the majority of included systematic reviews, anxiety disorders are more common in sub-Saharan Africa. For instance, anxiety was reported to be 29.8% in a systematic review of the prevalence of mental health problems in sub-Saharan Africa conducted by J\u0026ouml;rns-Presentati et al. (2021). Numerous studies conducted in Africa have shown that living with parents who have AIDS, orphanages caused by the disease, and wars are the main causes of the increased prevalence of anxiety disorders in the continent. The prevalence of anxiety was estimated to be 45.6% in review by Too et al. (2021) on the factors linked to prevalent mental illnesses in young people living with HIV in sub-Saharan Africa. As this review focused on adolescents living with HIV, it showed a remarkably high frequency. Numerous studies claim that high levels of anxiety are strongly correlated with low- and middle-income countries (LMIC) \u003csup\u003e\u003cspan additionalcitationids=\"CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. The prevalence of suicidal ideation in Africa among adolescents was found to be 23.9%. The prevalence of suicidal thoughts among adolescents varies internationally and across the continent. For example, a global systematic review and meta-analysis found that suicidal ideation and attempts among youth vary from 14.3\u0026ndash;22.6% depending on the location\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. These findings agree to the pooled prevalence of suicidal ideation in Africa which is 23.9%). Consistent with these results, a study on prevalence and associated factors of suicide ideation and attempt among adolescent high school students in Dangila Town, Northwest Ethiopia, established prevalence of suicide ideation and attempt was 22.5%\u003csup\u003e26\u003c/sup\u003e. the pooled prevalence of substance abuse among adolescents in Africa according to studies was 31.2%. However, data on the prevalence of adolescent substance addiction worldwide are limited. However, according to studies alcohol and illegal substance use account for 14% of the overall health burden among young males between the ages of 20 and 24 Worldwide\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Adolescent substance misuse is also prevalent in Africa, particularly in SSA. Ogundipe et al. (2018) conducted a systematic review of studies in SSA and found that 41.6% of adolescents used drugs and substances. The most prevalent substances that adolescents abuse are alcohol, cannabis, and tobacco, which affect 10% to over 30% of African adolescents. Cannabis is one of the most commonly used illegal substances; lifetime consumption can range from 4\u0026ndash;20% in different African nations. The use of more potent drugs, such as cocaine and heroin, remains low but is a concern in urban centers. In terms of regions, West African countries like Nigeria and Ghana experience the highest prevalence of substance abuse, South Africa has one of the highest rates of adolescent substance abuse, with alcohol and cannabis being widely reported, while in East African countries such as Kenya, Uganda, and Tanzania, there is a high prevalence of substance abuse, and most abused substances are alcohol, khat, and cannabis. According to Wazema and Madhavi (2017) and Gebrie et al. (2018), khat is a stimulant-affecting plant that is frequently abused in Ethiopia, Burundi, and Kenya. Based on these findings, it is evident that substance abuse is a significant mental health problem among African adolescents. The random effect pooled prevalence estimate for emotional and behavioral problems was 40.1%. Emotional and behavioral issues among adolescents are a global issue and it is important to effectively preventing and treating in adolescents to improve their psychological well-being has been shown by past research conducted in Bangladesh\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. According to Al-Mamun et al. (2024), 9.09% of Bangladeshi adolescents experience an emotional problem. According to this review, this rate is significantly lower than that in Africa. The prevalence of emotional and behavioral problems among adolescents in sub-Saharan Africa was 40.8% \u003csup\u003e19\u003c/sup\u003e. These findings indicate that emotional and behavioral problems are significant in Africa and require agent intervention. The pooled prevalence of ADHD was 5.95%. According to Al-Wardat et al. (2024), a systematic review conducted in the Middle East and Northern Africa, the prevalence rate of ADHD was 10.3% (95% CI, 0.081 to 0.129), which is greater than the findings of all other systematic reviews conducted in Africa and other nations. Given the disparities in prevalence rates and the fact that ADHD is common in Africa, prevention, early detection, and treatment of the disorder should be prioritized to support mental health and wellness throughout the continent. Prevalence of Conduct Disorder (CD) was reported in only one systematic review (n\u0026thinsp;=\u0026thinsp;1), with a total sample population of 46, 464 and the pooled prevalence of Conduct disorder was 15%. According to a global report, the prevalence rates of conduct disorder (CD) among adolescents worldwide ranges from 2\u0026ndash;10%\u003csup\u003e5\u003c/sup\u003e. However, the majority of research conducted in Africa indicates that CD is high among adolescents in Africa; for example, a study conducted in Kenya found that the prevalence of CD among adolescents was 31.4%\u003csup\u003e33\u003c/sup\u003e, and another study conducted in Nigeria to determine the prevalence of CD among adolescents in secondary school found that a prevalence rate of 14.5%. When comparing the findings of this umbrella review to global reports, it is clear that the incidence of CD is high in Africa. The prevalence rates of 31.4% and 14.5%, respectively, reported by Gitonga et al. (2017) in Kenya and Ojuope and Ekundayo (2020) in Nigeria, are greater than the global prevalence rate. What is intriguing about all of these published studies is that sex and family characteristics are risk factors for CD. It was observed that CD is more prevalent in boys than in girls and that children from dysfunctional or underprivileged homes are more prone to develop it.\u003c/p\u003e\u003cp\u003eSocioeconomic and environmental factors are the most prevalent risk factors highlighted in this comprehensive analysis as being connected to mental health problems in adolescents. Poverty and unemployment, food insecurity and unstable living conditions, lack of educational access, academic stress and disruptions to education, lack of mental health resources, urbanization, and geographic and regional positions are all considered socioeconomic and environmental factors. In support of these findings, J\u0026ouml;rns-Presentati et al. (2021) found that adolescents in Africa who experienced poverty and unemployment were more likely to experience mental health problems with the situation being worse in sub-Saharan African nations. According to a scoping review conducted in sub-Saharan Africa by Mabrouk et al. (2022), academic stress, persistent poverty, food insecurity, and limited access to education have all contributed to adolescents' poor mental health. Similarly, a systematic review conducted in SSA by Quarshie et al. (2020) discovered that poverty, lack of resources, and academic stress contribute to the development of mental health issues in adolescents, including suicide. A study by J\u0026ouml;rns-Presentati et al. (2021) highlighted family dynamics, genetics, and family history as family related factors reported in a systematic review. Alcohol consumption, drug use, lifestyle, and exposure to violence are examples of documented community and social factors. According to Mabrouk et al. (2022), exposure to abuse, domestic violence, and violence is a risk factor for poor mental health among adolescents. Age, gender, and marital status have been mentioned as individual determinants. The literature has also stressed that bullying, moving from a rural to an urban area, and exposure to peers who use drugs are factors that influence mental health problems among adolescents\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. HIV infection, health-related stressors, and comorbidities are health-related issues that have been observed. According to a study conducted in Nigeria by Cui et al. (2022), age, sex, and marital status have all been identified as risk factors. For instance, the study found that young female adolescents were more likely to experience depression than older married students. Furthermore, Mabrouk et al. (2022) and J\u0026ouml;rns-Presentati et al. (2021) found that having HIV and other health-related factors, such as cancer, increases the likelihood of acquiring mental health issues. The COVID-19 pandemic is another recent health-related problem that has been shown to increase stress on the mental health of adolescents\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e. These documented risk factors pose a heavy burden on African adolescents' lives, which is further compounded by the dearth of mental healthcare services available to them, particularly in sub-Saharan Africa.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eStrengths and Limitations\u003c/strong\u003e\u003cp\u003eConducting an umbrella review to determine the prevalence of mental health problems among African adolescents has unique strengths and limitations. First, this review has consolidated several research findings in Africa and provided an in-depth overview of mental health problems affecting adolescents in Africa. Second, the review saved time and other resources in establishing the current prevalence of mental health problems among adolescents in Africa. Finally, this umbrella review provides insight into methodological quality. Despite the strengths mentioned above, there are also limitations to conducting this systematic review. First, conducting an umbrella review and meta-analyses in Africa, where there are diverse regions with noteworthy differences and overlaps of culture, healthcare systems between countries even within some countries, and the significant economic instability of many African nations provided a major challenge to depend on existing systematic reviews. Despite the high-quality methodological rigor applied, some of the systematic reviews included outdated studies, and some may have been biased in the methodology process. Additionally, because of Africa's diversity, certain areas or nations were underrepresented because insufficient research was conducted there. For instance, few systematic reviews have been conducted in Northern Africa; the majority have been conducted in Sub-Saharan Africa, Eastern Africa, and Western Africa. Many nations in Sub-Saharan Africa were excluded from the majority of systematic reviews, as some of them lacked published research. Second, some of the relevant studies could not be located or were not published by the time of searching for data. The final limitation was the selection of articles that were published only in English. This means that the data were limited.\u003c/p\u003e\u003c/p\u003e"},{"header":"5. CONCLUSION","content":"\u003cp\u003eThis review discusses the current prevalence and risk factors of mental health problems among adolescents in Africa. The pooled prevalence of mental health problems among adolescents from the included systematic reviews shows that the prevalence of mental health problems among adolescents is high, and various risk factors are associated with the problem. Addressing these challenges is crucial for fostering well-being among adolescents in Africa because mental health is integral to educational outcomes, social development, and long-term economic productivity. Thus, the findings call for urgent policy actions and collaborative frameworks tailored to the unique sociocultural realities of the continent to prevent, identify, and effectively manage mental health issues among adolescents.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eCONFLICT OF INTEREST STATEMENT\u003c/h2\u003e\u003cp\u003eThe authors have no conflicts of interest to disclose.\u003c/p\u003e\u003ch2\u003eETHINCAL CONSIDERATIONS\u003c/h2\u003e\u003cp\u003eThis study was registered by Prospero and used secondary data.\u003c/p\u003e\u003ch2\u003eFUNDING SOURCES\u003c/h2\u003e\u003cp\u003eThis Umbrella review had no funding.\u003c/p\u003e\u003ch2\u003eACKNOWLEDGMENTS\u003c/h2\u003e\u003cp\u003eWe wish to acknowledge the support of all librarians and IT officers from Kamuzu University of Health Sciences and Daeyang University for helping locate articles.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKapur S (2015) Adolescence: the stage of transition. 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BMC Med Res Methodol 11:15. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/1471-2288-11-15\u003c/span\u003e\u003cspan address=\"10.1186/1471-2288-11-15\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Table 2","content":"\u003cp\u003eTable 2 is not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Kamuzu University of Health Sciences","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Adolescents, Prevalence, Mental health problems, Sub-Saharan Africa, Africa","lastPublishedDoi":"10.21203/rs.3.rs-7324331/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7324331/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBACKGROUND\u003c/h2\u003e\u003cp\u003eSystematic reviews with varying perspectives have been conducted on mental health problems that affect adolescents and young people in Africa. The majority of these reviews were conducted at the national or regional level. The objectives of this review were to determine the frequency of adolescents\u0026rsquo; mental health problems in Africa and to evaluate the risk factors for mental health problems among adolescents in Africa.\u003c/p\u003e\u003ch2\u003eMETHODS\u003c/h2\u003e\u003cp\u003eA systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, and the search strategy process was employed to search multiple databases (MEDLINE, PubMed, PsycINFO, Scopus) and Google Scholar guided by the Joanna Briggs Institute (JBI). MeSH terms were created to search for eligible articles and data extraction was managed by Endnote. Included systematic reviews were those that reported the prevalence of mental health problems among adolescents and youths aged 10\u0026ndash;19 years in Africa, and data were analyzed using MedCalc. The search yielded 862 records, of which 261 were assessed for eligibility, 31 met the inclusion criteria, and 12 articles were selected.\u003c/p\u003e\u003ch2\u003eRESULTS\u003c/h2\u003e\u003cp\u003eThe pooled prevalence of adolescents with mental health problems in Africa shows depression accounted for 37.8% ( 95% CI: 30.7 to 45.2, I2\u0026thinsp;=\u0026thinsp;99.84%), psychiatric disorders 24.5% (CI: 20.69 to 28.5, I2\u0026thinsp;=\u0026thinsp;99.63%), anxiety 29.96% (CI:21.5 to 39.2, I2\u0026thinsp;=\u0026thinsp;99.90%), suicide ideation 23.94%(CI:18.3 to 30.1, I2\u0026thinsp;=\u0026thinsp;99.92%), substance abuse disorders 31.2% (CI:13.7 to 52.0, I2\u0026thinsp;=\u0026thinsp;99.90%), ADHD 5.95% (CI: 4.2 to 8.1, I2\u0026thinsp;=\u0026thinsp;98.48%), emotional and behavioral problems 40.8%(CI: 40.5 to 41., I2\u0026thinsp;=\u0026thinsp;0.00%) and Conduct Disorders 15% (95% CI: 8; 22, I2\u0026thinsp;=\u0026thinsp;99.58%). The reported risk factors are socioeconomic and environmental, family related, community and social, individual, and health-related factors.\u003c/p\u003e\u003ch2\u003eCONCLUSION\u003c/h2\u003e\u003cp\u003eAdolescents in Africa have one or more mental health problems, and the Sub-Saharan Africa (SSA\u003cb\u003e)\u003c/b\u003e region is facing a major crisis. The results have significant ramifications for African policy and practice since they show that mental health problems are a significant issue that impact the majority of adolescents throughout the continent and require agent interventions.\u003c/p\u003e","manuscriptTitle":"Prevalence of Mental Health Problems Among Adolescents in Africa: An Umbrella Review–A Systematic Review of Systematic Reviews","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-12 04:06:50","doi":"10.21203/rs.3.rs-7324331/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"bd2e6679-e576-4568-a865-704ba0d10cc2","owner":[],"postedDate":"August 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":52945412,"name":"Psychiatry"}],"tags":[],"updatedAt":"2025-08-12T04:06:50+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-12 04:06:50","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7324331","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7324331","identity":"rs-7324331","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}