Addressing the mental health needs of school-going adolescents aged 10-14 years old in the Western Cape province of South Africa

Mkhize, Mirriam Sinethemba

Addressing the mental health needs of school-going adolescents aged 10-14 years old in the Western Cape province of South Africa

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Psychiatry and Mental Health

Faculty

Faculty of Health Sciences

Abstract

Introduction. Globally, between 10% and 20% of children and adolescents experience common mental health conditions such as depression and anxiety, yet most cases in low- and middle-income countries (LMICs) remain undiagnosed and untreated. This dissertation aims to address the mental health needs of school-going adolescents in South Africa through three phases: (1) investigating prevalence and associated factors, (2) evaluating mental health screening tools, and (3) assessing the feasibility and acceptability of an indicated intervention for adolescents positive for potentially clinically significant symptoms for depression and anxiety and their caregivers. Methods. Phase 1 was conducted with 621 adolescents aged 10–14 from 10 schools to assess depression and anxiety prevalence and associated factors using a tablet-based survey. Phase 2 evaluated the psychometric properties of depression and anxiety screening tools among 500 adolescents. Phase 3 tested the feasibility and acceptability of the co-adapted Early Adolescent Skills for Emotions – South Africa (EASE-SA) intervention among 79 adolescents and 32 caregivers and explored participants' perceptions of the EASE-SA intervention. Results. In phase 1, 33.5% of adolescents experienced depression and 20.9% anxiety symptoms. Significant factors for depression included higher school grades (AOR = 1.65), alcohol use (AOR = 1.62), drug use (AOR = 2.07), and exposure to domestic violence (AOR = 2.12). Anxiety was associated with higher school grades (AOR = 1.69), poor emotional regulation (AOR = 1.03), and cannabis use (AOR = 1.03). Phase 2 found that the Patient Health Questionnaire for Adolescents demonstrated good internal consistency (α = 0.82) and sensitivity (85.7%). The CES-DC showed high sensitivity (95.2%) but lower specificity (56.9%). The GAD-7 exhibited lower sensitivity (54.5%) and poor test–retest reliability (ICC = 0.48). Phase 3, EASE-SA recruited 79 adolescents and 32 caregivers, with 85% and 79% retention rates respectively, implying feasibility of delivering the intervention in school settings. The thematic analysis revealed three main themes: (1) the EASE-SA intervention was found acceptable by adolescents, caregivers, facilitators, and school-based stakeholders; (2) the EASE-SA intervention was feasible for school-based delivery; and (3) perceived benefits of the EASE-SA intervention included participants applying skills learned in daily life, leading to improved relationships, and positive emotional well-being and recommendations for implementation and scale-up, as the key outcomes of the study. Conclusion. This dissertation underscores the pressing mental health needs of adolescents in LMICs and the potential for scalable, evidence-based interventions such as EASESA. By integrating reliable screening tools and culturally adapted interventions, this research offers critical insights for advancing adolescent mental health promotion and prevention, and for indicated interventions in low-resource school settings, informing future implementation and scaling efforts.

Keywords

mental health

adolescents

Reference:

Collections

PhD / Doctoral

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