A Systematic Review of Mental Health Research in sub-Saharan Africa: Methodological Considerations and A New Path Forward

Little research has investigated explanatory models and treatments for mental health in sub-Saharan Africa. As a result, diagnostic systems and interventions remain limited in their ability to identify and effectively treat psychological disorders across diverse cultural contexts in the region. Contrary to Western conceptions, mental health in sub-Saharan Africa is nested within pan-African cultural values and knowledge systems, which prioritize community, ancestral and family needs over individual ones. These systems offer important insights for uncovering yet-unknown aspects of mental health. Guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), we evaluated 133 studies on mental health in sub-Saharan Africa. We analyzed each study for emic (culture-specific understanding of symptoms), etic (importing systems to assess universal aspects) or combined (merging both universal and culture-specific elements) approaches; study design; research location, and author-characteristics (e.g., proportion of authors from the region). Imported (etic) methodologies predominated (69.4%), though the majority (56.7%) of first authors were affiliated with sub-Saharan African institutions. Studies were nearly evenly split between observational and interventional designs. Research was geographically concentrated in South African metropolitan areas, while Central Africa was notably underrepresented. Within South Africa, although overall studies emphasized universal aspects, emic approaches were more common when studies were led by regional first authors, compared to other sub-Saharan contexts. Despite this, the predominance of foreign funding and training in South Africa may still privilege etic approaches; shifting decision-making power to local researchers could tip the distribution of emic and etic studies. Mental health research in sub-Saharan Africa continues to rely heavily on importing outside diagnostic frameworks and interventions, which de-emphasize local African knowledge systems. At the same time, findings also present a more nuanced picture of the current state of mental health research in sub-Saharan Africa, suggesting avenues for further research and underscoring the need for more blended emic-etic approaches, locally funded researchers, and a broader cultural representation outside of South Africa. A blended emic-etic approach, which balances universals and incorporates region-and language-specific cultural concepts, is discussed. This approach ensures relevant clinical care in sub-Saharan Africa and has the potential to advance knowledge in mental health, globally.