Evolution and synergy of healthcare security policies for rare diseases in China: a quantitative content analysis.

This manuscript offers evidence from a subnational high-risk population study on the prevalence and correlates of probable anxiety and depression among young people in Ghana. It highlights mental health as a growing yet under-recognized public health concern in Sub-Saharan Africa. By revealing how socioeconomic disadvantages, school environment and social support affect youth mental well-being, the research advances understanding of specific factors driving psychological distress in low-resource settings. The findings underscore the importance of context-specific, focused mental health strategies that incorporate routine screening, psychological support and community-based interventions within Ghana’s health and education systems. These lessons can serve as a guide for other lower-middle-income countries seeking to reform mental health services for young people. Adolescent mental health issues are emerging as a significant public health concern across many low- and middle-income countries, particularly in Africa (Tinsae et al., ). Depression and anxiety are the two most burdensome mental health conditions that young people experience (WHO, , ). The COVID-19 pandemic increased the global prevalence of depression and anxiety by 25% (Racine et al., ), with children and adolescents disproportionately affected (Ma et al., ; Racine et al., ; Robinson et al., ). According to the 2019 national Global Burden of Disease study, the top 10 contributors to the burden of disease among young people in Ghana and SSA include mental health conditions, which rank in the top 2 (Global Burden of Disease, ; Weobong et al., ). This may be attributed to heightened socioeconomic and social disadvantage (Glozah et al., ) and the poor state of mental health services in primary healthcare. It is important to conduct prevalence studies for two main reasons: first, to assess the need; and second, to provide baseline data. However, the evidence on the burden of mental health conditions in this demographic is patchy due to the paucity of epidemiological research in LMICs (Awenva and Read, ; Mwangi et al., ). We identified only two systematic reviews on the topic; one provided a synthesis of the prevalence of mental distress (undifferentiated manifestations of anxiety and depression symptoms) in Africa (Tinsae et al., ) ( = 18 studies, none from Ghana); the other focused on studies in South Asia (Mudunna et al., ) ( = 117 studies). Very few of these studies had been conducted in community or population settings; almost three-quarters of the studies from South Asia (India and Pakistan) were school-based, and only seven of the studies in Africa (Ethiopia, Tanzania, Uganda, South Africa, Liberia, Nigeria, Benin, Zambia, Mozambique and Morocco) were population-based (Jorns-Presentati et al., ; Ghosh, ; Atewologun et al., ). The prevalence of mental distress among adolescents in Africa was 27% (Jorns-Presentati et al., ; Sequeira et al., ). In South Asia, the prevalence of depression ranged from 21% to 98% in school-based and 18% to 88% in nonschool-based settings. Determinants were largely similar across these two regions: bullying, victimization and the experience of hunger. In the Asian region, poor peer relationships and substance use/abuse were important determinants. Higher education was protective of mental well-being. None of the reviews included country-wide studies.