How to Cite:
Upendo Jonas, Bernaderha Rushahu, Lwimiko Sanga, "Towards Integrated Mental Health Systems in African Universities: A Systematic Review and Meta-Synthesis of Interventions, Barriers, and Policy Gaps" International Journal of Humanities Science Innovations and Management Studies, Vol. 2, No. 4, pp. 18-30, 2025.

Abstract:
Background: Globally, mental health disorders such as depression, anxiety, and stress are rising sharply among university students, with recent global estimates showing up to 40% affected. In African universities, however, responses to this crisis remain fragmented, underfunded, and under-researched. Objective: This systematic review evaluates the effectiveness, diversity, and contextual barriers of university-based mental health support services in Africa, contextualized against global prevalence benchmarks from recent umbrella reviews. Methods: Following PRISMA guidelines, 38 eligible studies from 15 African countries were analyzed, encompassing randomized controlled trials, cross-sectional surveys, cohort, and qualitative designs. Risk of bias was assessed using CASP, JBI, and RoB 2.0 tools. Findings were synthesized narratively and compared against global prevalence trends drawn from umbrella meta-analyses (Paiva et al., 2025). Results: Support services across African universities are mostly limited to basic counseling and awareness efforts. Peer-led interventions and digital platforms show promise but remain underutilized. Barriers include stigma, professional shortages, and policy fragmentation. Compared to global prevalence estimates of 35–41% for CMD symptoms, student service uptake across African campuses remains below 10%. The review identifies integrated, multi-tiered interventions and policy alignment as critical enablers of success. Conclusion: There is an urgent need to institutionalize mental health services within African higher education systems through policy mandates, capacity investment, and stigma reduction. A proposed African University Mental Health Systems Model (AUMH-SM) offers a roadmap for reform, embedding mental health into university governance, student services, and national health strategies.

Keywords: Common Mental Disorders, Mental Health Services, African Universities, Student Well-Being, Policy Integration, Systematic Review.

References:
[1] K. Amone-P’Olak, H. Burger, and J. Ormel, "The Effectiveness of Mental Health Interventions for University Students in Sub-Saharan Africa: A Scoping Review,” BMC Psychiatry, vol. 21, pp. 125-135, 2021.
[2] R. Arjadi et al., Internet-based Behavioral Activation Intervention for Depression in Indonesia: A Randomized Controlled Trial,” Internet Interventions, vol. 2, no. 4, pp. 434-442, 2015.
[3] E. Aromataris, and Z. Munn, JBI Manual for Evidence Synthesis, Joanna Briggs Institute, 2020.
[4] Andrew Booth et al., Systematic Approaches to a Successful Literature Review, 3rd ed., Sage Publications. 2016.
[5] CASP, Critical Appraisal Skills Programme (CASP) Qualitative Checklist, 2018. [Online]. Available: https://casp-uk.net/casp-tools-checklists/
[6] J. Chipps, S. Ramlall, and M. Mars, "Videoconferencing in the Management of Mental Health Disorders:" A Systematic Review,” South African Journal of Psychiatry, vol. 18, no. 1, pp. 17-24, 2012.
[7] S. Clement et al., "What is the Impact of Mental Health-Related Stigma on Help-Seeking? A Systematic Review of Quantitative and Qualitative Studies," Psychological Medicine, vol. 45, no. 1, pp. 11–27, 2015.
[8] Berihun Assefa Dachew, Telake Azale Bisetegn, and Resom Berhe Gebremariam, " Prevalence of Mental Distress and Associated Factors Among Undergraduate Students of University of Gondar, Northwest Ethiopia: A Cross-Sectional Institutional Based Study," PLOS One, vol. 10, no. 3, pp. 1-10, 2015.
[9] O. Gureje, and A. Alem, "Mental Health Policy Development in Africa," Bulletin of the World Health Organization, vol. 78, no. 4, pp. 475-482, 2000.
[10] S. Hartley et al., "How Do Carers of Disabled Children Cope? The Ugandan Perspective," Child: Care, Health and Development, vol. 31, no. 2, pp. 167-180, 2005.
[11] Julian P. T. Higgins et al., Cochrane Handbook for Systematic Reviews of Interventions, 2nd ed., pp. 1-736, 2019.
[12] A. K. Ibrahim et al., "A Systematic Review of Studies of Depression Prevalence in University Students," Journal of Psychiatric Research, vol. 47, no. 3, pp. 391-400, 2013.
[13] H. Jack et al., "Recruitment and Retention of Mental Health Workers in Ghana." PLOS ONE, vol. 9, no. 2, 2014.
[14] B. N. Kaiser et al., "Strategies for Reducing Mental Illness Stigma in Africa: A Systematic Review," Social Science & Medicine, vol. 144, pp. 9-19, 2015.
[15] Martha Anne Kitzrow "The Mental Health Needs of Today’s College Students: Challenges and Recommendations," NASPA Journal, vol. 41, no. 1, pp. 167-181, 2003.
[16] E. Kohls, et al., "Mental Health First Aid Training for the Public in Germany: A Systematic Review," BMC Psychiatry, vol. 17, pp. 51, 2017.
[17] Kohn Robert et al., "The Treatment Gap in Mental Health Care," Bulletin of the World Health Organization, vol. 82, no. 11, pp. 858–866, 2004.
[18] D. Kokole, R. Chireshe, and J. Mapfumo, "Mental Health Service Needs of University Students: Perspectives of Zimbabwean University Counselors," Journal of Psychology in Africa, vol. 30, no. 5, pp. 456-462, 2020.
[19] S. H. Lovibond, and P. F. Lovibond, Manual for the Depression Anxiety Stress Scales, 2nd Ed., Psychology Foundation, 1995.
[20] D. Moher et al., "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLoS Medicine, vol. 6, no. 7, 2009.
[21] S. Moola et al., "Chapter 7: Systematic Reviews of Etiology and Risk," JBI Manual for Evidence Synthesis, Joanna Briggs Institute, 2020.
[22] John A Naslund et al., "The Future of Mental Health Care: Peer-to-Peer Support and Social Media," Epidemiology and Psychiatric Sciences, vol. 25, no. 2, pp. 113-122, 2017.
[23] K. Oppong Asante, and J. Andoh-Arthur, "Prevalence and Determinants of Depressive Symptoms Among University Students in Ghana," Journal of Affective Disorders, vol. 171, pp. 161-166, 2015.
[24] M. Ouzzani et al., "Rayyan- A Web and Mobile App for Systematic Reviews," Systematic Reviews, vol. 5, no. 1, 2016.
[25] Matthew J Page et al., "The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews," BMJ, vol. 372, no. 71, 2021.
[26] Vikram Patel et al., "The Lancet Commission on Global Mental Health and Sustainable Development" The Lancet, vol. 392, no. 10157, pp. 1553-1598, 2018.
[27] Inge Petersen et al., "Lessons from Case Studies of Integrating Mental Health into Primary Health Care in South Africa and Uganda," International Journal of Mental Health Systems, vol. 10, no. 71, 2016.
[28] Petersen, A. Bhana, and K. Baillie, "The Feasibility of Adapted Problem-Solving Therapy for Depression Among Young People in South African Higher Education," South African Journal of Psychology, vol. 46, no. 1, pp. 79-90, 2016.
[29] Paul N. Pfeiffer M.D et al., "Efficacy of Peer Support Interventions for Depression: A Meta-Analysis," General Hospital Psychiatry, vol. 33, no. 1, pp. 29-36, 2011.
[30] Jennie Popay et al., "Guidance on the Conduct of Narrative Synthesis in Systematic Reviews, A Product from ESRC Methods Programme,” pp. 1-92, 2006.
[31] Debra Rickwood et al., "Young people’s help-seeking for mental health problems." Australian e-Journal for the Advancement of Mental Health, vol. 4, no. 3, pp. 218–251, 2005.
[32] Khadijah Shamsuddin et al., "Correlates of Depression, Anxiety, and Stress Among Malaysian University Students," Asian Journal of Psychiatry, vol. 6, no. 4, pp. 318-323, 2013.
[33] Jonathan A C Sterne et al., "RoB 2: A Revised Tool for Assessing Risk of Bias in Randomized Trials," BMJ, vol. 366, no. l4898, 2019.
[34] James Thomas, and Angela Harden, "Methods for the Thematic Synthesis of Qualitative Research in Systematic Reviews," BMC Medical Research Methodology, vol. 8, no. 45, pp. 1-10, 2008.
[35] A.C. Tricco, et al., "PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation," Annals of Internal Medicine, vol. 169, no. 7, pp. 467-473, 2018.
[36] UNESCO, Mental Health and Well-being of Higher Education Students: Policy Brief, 2021.
[37] L. E. Van Zyl, and S. Rothmann, "Beyond Smiling: The Evaluation of University Counseling Services in South Africa." South African Journal of Psychology, vol. 42, no. 3, pp. 386-395, 2012.
[38] "World Health Organization (WHO), World mental health report: transforming mental health for all, WHO Press, 1-296, 2022.
[39] World Health Organization, Mental Health Atlas 2020. Geneva: WHO Press, 2021.