Mental health of adolescent girls and young women worst hit by COVID-19, survey finds

Findings from a recent study led by researchers from the University of Cape Town (UCT) and the South African Medical Research Council (SAMRC) showed that the COVID-19 pandemic and related restrictions severely impacted the mental health of adolescent girls and young women (AGYW) in South Africa.

According to the findings published in Child and Adolescent Psychiatry and Mental Health, the South African government’s COVID-19 control measures, including lockdown and social gathering restrictions led to increased experiences of stress and anxiety, coupled with feelings of boredom, frustration, fear and loneliness. Poor mental health was compounded by strained family relationships, increased fear of domestic violence, household unemployment, economic stress and food insecurity.

Between November 2020 and March 2021, the team conducted a cross-sectional telephone survey with 515 AGYW, and in-depth interviews with 50 AGYW, aged 15 to 24 years. The study focused specifically on AGYW who lived in districts that had been identified as high priority for health interventions, characterised by high HIV prevalence, high rates of teenage pregnancy, and disproportionately affected by socio-structural drivers.

Dr Zoe Duby, the lead author and honorary research associate at UCT’s Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, said the respondents described an overwhelming sense of hopelessness about their current situation and the future. 

On a positive note, despite the multitude of hardships and mental health stressors experienced, Dr Duby said some AGYW respondents articulated an emotional resilience, describing the ways in which they managed to cope in healthy ways and retain hope.

“AGYW who demonstrated resilience described their own ways of coping including taking things one step at a time.”

“Psychological resilience among adolescents and young people, their ability to manage feelings of stress, address stressors they encounter or gain a feeling of coping with their circumstances, is critical to protecting and buffering the impact on mental health.

“AGYW who demonstrated resilience described their own ways of coping including taking things one step at a time, maintaining hope against the odds, and simply accepting their situation and being patient that things will improve,” she said.

Inadequate policies and services

Chantal Fowler, a PhD candidate at UCT and practicing clinical psychologist, co-authored the paper. She said the findings illustrate the remarkable resilience of AGYW, who managed to maintain coping mechanisms despite the multitude of challenges they face.

Dr Catherine Mathews, an honorary member of UCT’s School of Public Health, and the director of the SAMRC’s Health Systems Research Unit, said the findings showed how socioeconomic factors drive stress, depression, and poor mental health among adolescents and young people in South Africa, illustrating how the COVID-19 pandemic has exacerbated problematic socioeconomic factors.

“The distribution of mental health resources across the country is markedly inequitable, particularly in the public-sector health system.”

Despite the high burden of mental health challenges, the authors noted that policies and services specifically targeted at adolescents and young people are woefully inadequate in South Africa.

“The distribution of mental health resources across the country is markedly inequitable, particularly in the public-sector health system. In order to mitigate the negative impacts and buffer against additional COVID-19-specific stressors, the South African government urgently needs to recognise child and adolescent mental health services as a health priority, and develop appropriate, innovative, cost-effective, scalable, evidence-based systemic or multi-level interventions to promote the mental health of adolescents and young people,” Dr Mathews said.

According to the survey, the key to mitigating mental health stressors is addressing structural drivers such as unemployment and food insecurity, stating the importance of a multi-sectoral and coordinated response to address unemployment and food insecurity in order to reduce key drivers of poor mental health and bolster healthy coping mechanisms among adolescents and young people in South Africa today.