The Impact of Financial Stress on Mental Wellbeing in Africa: A Systematic Review Volume 66- Issue 4

Celestine Kpurugbara¹*, Adejumoke Awosanya², Yusuff Awosanya¹ and Kwapnoe Aaron Peter¹

• ¹DFAB Research, United Kingdom
• ²Lecturer in Global Public Health, School of Health & Life Sciences, Teesside University, United Kingdom

Received: August 14, 2026; Published: August 31, 2026

*Corresponding author: Celestine Kpurugbara, DFAB Research, United Kingdom

DOI: 10.26717/BJSTR.2026.66.010364

Abstract PDF

Financial stress has recently gained significant recognition as key determinant of mental wellbeing, specifically in Africa, where poverty, unemployment and unstable economy are common. Existing research examined this relationship, However, evidence remained fragmented, context specific and lacked generalisation. This study aims to assess the impact of this relationship in Africa through a systematic review of available evidence. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Sixteen studies were identified across multiple databases, Qualitative studies were analysed using Thematic synthesis, Narrative synthesis was used to analyse quantitative studies, and findings were merged using triangulation method. Quantitative studies demonstrated consistent association between financial stress and depression, anxiety, and psychological distress. The key drivers were poverty, unemployment, household economic shocks, food and financial instability. Qualitative studies reported the experience of financial hardship as chronic anxiety, feeling of hopelessness, emotional exhaustion, social withdrawal and feeling of shame and guilt, these were commonly expressed contextually as ‘‘too many thoughts’’ and ‘‘thinking too much’’. The triangulation of both studies showed a significant convergence that identified financial stress as multidimensional determinant of mental wellbeing, particularly driven by structural inequalities and socioeconomic deprivation across Africa. This outcome showed significant impact and consistent relationship between financial stress and mental wellbeing across, and underscore the need to strengthen social protection, reduce structural inequalities and integration of a culturally responsive mental health intervention services within the primary healthcare in Africa.

Keywords: Financial Stress; Mental Wellbeing; Mental Health; Africa; Social Determinants of Health; Depression; Anxiety; Emotional Distress; Psychological Distress

Abbreviations: PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; WHO: World Health Organisation; PEO: Population Exposure and Outcome; MHD: Mental Health Disorders; MeSH: Medical Subject Headings; AFSMWF: African Financial Stress and Mental Wellbeing Framework

Mental health is increasingly recognised as a component of overall health and a fundamental human right [1]. Contemporary perspective of health considers mental wellbeing as a key aspect of health, underscoring the importance of resilience and social capital in managing daily stressor [2]. Although, achieving overall health is broad and unrealistic, considering that only few people achieve such standard of health [3]. Consequently, disruption in mental wellbeing and Mental Health Disorders (MHD) have significantly contributed to global disease burden of health [4]. Globally, MHD is among the leading cause of morbidity and disability, affecting one billion people [5]. This figure reflects improved health surveillance and awareness rather than a sole disease prevalence [4]. MHD are underestimated due to classification and reporting gap across regions [6]. Recent global crisis including COVID-19 and economic disruptions, have influenced mental wellbeing and led to financial stress that undermines both economic and individual wellbeing [6,5].

Globally, MHD cost over US$1trillion in lost productivity [7]. These effects are driven by an interaction of psychological, biological, environmental and socioeconomic factors [8]. Socioeconomic deprivation significantly shapes health outcomes, creating a social gradient of health where lower income is associated with poorer health outcomes [9]. Financial stress derived from socioeconomic deprivation, specifically in deprived regions influences health outcomes [10,11]. Within Africa, structural inequalities steer anxiety, depression and suicidal ideation [12]. Persistent income disparities, unemployment, poverty and economic instability intensify vulnerability to MHD [13,14]. Statistically, in Africa, over 150 million people are affected, yet 85% lacks access to treatment [15]. This gap is sustained by underfunding, poor primary healthcare, stigma and under-reporting, particularly in rural settings [16,17]. Nigeria and Uganda allocate less than 3% of health budget to mental health, which is lesser when compared to high-income countries [18,12,15]. Additionally, cultural and traditional beliefs also influence how MHD is treated, diagnosed and expressed [19].

The rationale for this study was informed by the growing global significance of financial stress and mental wellbeing, yet evidence within Africa remain fragmented and contextually shallow. Studies are limited in design, scope and coverage, often targeting isolated systems or short-term effect which offers little insights. Studies in Malawi [20] and Nigeria [21] demonstrated this association, however, their findings remained context-specific and lacks generalisation across Africa. Additionally, most studies adopt the Western Biomedical framework, which lacks socio-cultural realities in Africa. Such frameworks medicalise mental health outcomes and often overlook socio-cultural factors that shape how emotional distress is experienced, interpreted and expressed across Africa settings [22]. This study bridges the existing knowledge gap by consolidating fragmented evidence, analysing the relationship between financial stress and mental wellbeing, identify the socio-economic determinant and develop a conceptual framework.

Objectives

• To assess the relationship between financial stress and mental wellbeing in Africa.

• To explore the determinants of financial stress and mental wellbeing in Africa.

• To develop a conceptual framework that explains financial stress and mental wellbeing in Africa

Study Design

This study adopts a systematic review because it offers a rigorous, transparent and replicable method of identifying, synthesising and appraising available research evidence to answer a research question [23]. The Cochrane Handbook for Systematic Reviews of Interventions or the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guided this study in ensuring the process maintained methodological credibility, reproducible, comprehensive, properly documented and minimised bias [24,25]. Although, scoping review effectively map broad evidence, they lack analytical depth and critical appraisal system needed to explain how financial stress impacts mental wellbeing [26]. Findings from systematic reviews are increasingly used to inform decision-making, particularly in healthcare and public sector [27]. However, they require and are dependent on wide range of databases and may overlook unpublished articles, risking publication bias [28]. This approach was most suitable for this study considering the fragmented nature of existing evidence. The review was registered on PROSPERO: CRD420261326617.

Research Question

What is the impact of financial stress on mental wellbeing in Africa?

Question Framework

This study adopted the Population, Exposure and Outcome (PEO) question framework, which supports the formulation of clear and focused research question that is essential for structuring search strategy and ensuring methodological transparency [29,30]. Although the Sample, Phenomenon of Interest, Design, Evaluation and Research type (SPIDER) has been used in similar study by [31], it has been critiqued for limitation beyond qualitative studies [32]. PEO framework was appropriate for exploring how financial stress (Exposure) impacts, mental wellbeing (Outcome), particularly within Africa (populations).

Eligibility Criteria

(Table 1).

Table 1: Inclusion and exclusion criteria.

Search Strategy

A comprehensive search strategy was applied across multiple academic databases including, Medline, PsycINFO, CINAHL, Amed, Eric and PubMed. Together, they offer wider coverage of biomedical, psychological, public health and community-based research that supports the study aim. The search strategy combined Medical Subject Headings (MeSH) and free-text terms, using Boolean operators (AND, OR) and truncations, (except for the population). To enhance credibility, the search was conducted independently by three authors on the 12^th April, 27^th April and 15^th May, 2026 respectively and all discrepancies were discussed and resolved through discussion with the fourth author. The search terms below were informed by the modified version used in similar studies by [33]and [34].

((Mental health difficulties*) OR (Emotional Health*) OR (Poor mental health*) OR (Subjective wellbeing*) OR (Emotional health*) OR (Mood disorders*) OR (Mental disorders*) OR (Anxiety*) OR (Depression*) OR (Psychological distress*) OR (Mental health status*) OR (Psychological wellbeing*)) AND ((Economic difficulty*) OR (Socioeconomic adversity*) OR (indebtedness*) OR (Financial burden*) OR (Resource insufficiency*) OR (Economic hardship*) OR (Financial worry*) OR (Economic adversity*) OR (Debt burden*) OR (Income insecurity*) OR (Poverty*) OR (Economic stress*) OR (Financial strain*) OR (Financial hardship*)) AND ((African countries) OR (Southern Africa) OR (Central Africa) OR (East Africa) OR (Ethiopia) OR (Eswatini) OR (Eritrea) OR (Equatorial Guinea) OR (Egypt) OR (West Africa) OR (Africa South of the Sahara) OR (sub-Saharan Africa) OR (Zimbabwe) OR (Zambia) OR (Uganda) OR (Tunisia) OR (Togo) OR (Tanzania) OR (Sudan) OR (South Sudan) OR (South Africa) OR (Somalia) OR (Sierra Leone) OR (Seychelles) OR (Senegal) OR (Sao Tome and Principe) OR (Rwanda) OR (Nigeria) OR (Niger) OR (Namibia) OR (Mozambique) OR (Morocco) OR (Mauritius) OR (Mauritania) OR (Mali) OR (Malawi) OR (Madagascar) OR (Libya) OR (Liberia) OR (Lesotho) OR (Kenya) OR (Guinea-Bissau) OR (Guinea) OR (Ghana) OR (Gambia) OR (Gabon) OR (Djibouti) OR (Ivory coast) OR (Cote d’Ivoire) OR (Congo) OR (Comoros) OR (Chad) OR (Central African Republic) OR (Cameroon) OR (Cabo Verde) OR (Burundi) OR (Burkina Faso) OR (Botswana) OR (Benin) OR (Angola) OR (Algeria))

Additional Google scholar search was conducted using the research title as the search terms.

Study Selection

The initial phase involved screening titles and abstracts after removing duplicates, in-line with PRISMA guidelines. All studies were uploaded to a shared excel spreadsheet and colour coded to support transparent screening process among authors: green for eligible studies, yellow for studies with discrepancies, and red for studies that failed to meet the inclusion criteria. The final screening stage involved retrieval and reviewing of full-text articles coded green. Each article was assessed rigorously against the inclusion to ensure alignment. Discrepancies were resolved through discussion among all authors to ensure methodological integrity.

Quality Appraisal

The Raby and McNaughton critical appraisal framework was selected to evaluate the methodological rigour of included studies across key domains, including clarity of research questions, study design, Setting, sampling, data collection methods, data collection, analysis, findings, conflicts of interest and ethics [35]. Its ability to assess both qualitative and quantitative studies made it suitable for this study. Although, standardised quality appraisal tools are increasingly advocated for [36], this tool remains flexible, yet robust for evaluating strengths, weakness and overall credibility of included studies [35]. Included studies generally demonstrated clear research aims, suitable study design that aligned with research aim and objectives. Qualitative studies were generally stronger with exploring lived experiences of how financial stress impacts mental wellbeing, whereas quantitative studies generally used validated mental health measurement tools and appropriate statistical analysis. A notable methodical strength was demonstrated by Madeghe et al., (2020), whose mixed method approach provided stronger methodological triangulation of findings. However, key limitations were reliance on cross-sectional data that limited the establishment of causal relationships. Additionally, adoption of self-reporting, limited information around sampling procedures and reflexivity were other identified potential limitations, particularly with the qualitative studies (Table 2).

Table 2: Raby and McNaughton quality appraisal framework of included studies.

Data Extraction

To ensure credibility and transparency, data was extracted using Excel spreadsheet and captured key information such as, study title, author/year of publication, study aims, study settings, study design/ strategy, sample size, findings and study limitation (Table 3).

Table 3: Data extraction sheet.

Overview of Included Studies

Sixteen studies were retrieved; this includes studies conducted across multiple African countries such as Nigeria, Uganda, Kenya, South Africa, Zimbabwe, Zambia, Ghana, Malawi and Tanzania. Methodologically, five studies were qualitative, nine quantitative and and two mixed-methods studies. Furthermore, sample size ranged from 30 participants to 13,719, demonstrating a diverse population, spanning across adolescents, young adults, pregnant women, women of reproductive age, and refugees or participants living with a disease condition. Qualitative studies were conducted across seven countries including Nigeria, Zambia, Uganda, Kenya, Ghana, Malawi and Tanzania. Across these countries, financial stress was consistently demonstrated to impact mental wellbeing despite differences in culture and socioeconomic realities. In Nigeria, currency redesign policy led to psychological impact of financial on participants. Illness related income loss was reported as mediator of emotional distress in Zambia. Poverty, unemployment and food insecurity were key drivers of anxiety and hopelessness among young adults in Ghana, Malawi and Tanzania. Financial insecurity deepened the psychological burden experienced by perinatal women living with HIV in Kenya. Whereas chronic poverty and economic hardship were key mediators of mental distress in Uganda. Quantitative studies spanned across six countries including Uganda, South Africa, Kenya, Nigeria, and Zimbabwe. Financial stress was consistently reported with poorer mental wellbeing. Research from Uganda reported the highest level of depression, anxiety, psychological distress and reduced mental wellbeing, whereas, study from South Africa demonstrated a unique association between economic shock and psychological distress. Additionally, the principal source of financial stress varied but the direction was consistent across studies, this ranges from poverty, unemployment, household economic shock, caregiving burden and food insecurity. In Zimbabwe, socioeconomic disadvantage was a significant mediator of depressive symptoms among women (Figure 1).

Figure 1

Data Synthesis

This was performed in three stages, first, qualitative studies were analysed using thematic synthesis in line with the [37] framework. This framework enabled the identification of recurring experiences and expression of attributed meanings. This approach was suitable because it allows progression from inductive data interpretation to the development of higher-order interpretative explanations, offering deeper depth into how financial stress impacts mental wellbeing in Africa. The second stage applied the Narrative Synthesis, following the framework by [38] for the analysis of quantitative studies. This approach was appropriate due to the heterogeneity of included studies in terms of population characteristics, measurement of outcome and statistical approaches, allowing the examination of patterns of association between financial stress and mental health outcome. The final stage involved a triangulation approach, integrating findings from both qualitative and quantitative studies to identify areas of convergence and divergence. This process strengthened the overall interpretation of findings by combining experiential evidence with statistical associations which enhanced the contextual depth and robustness of the study (Table 4).

Table 4: Thematic mapping and quotes.

Thematic Synthesis of Qualitative Studies

Financial Stress as a Key Determinant of Psychological Distress: Financial stress emerged as key driver of psychological distress across included studies. Participants consistently linked financial hardship with stress, anxiety, feeling of hopelessness, worry, emotional exhaustion and depressive syndrome (Hall et al., 2019; Madeghe et al., 2021; Tuthill et al., 2021; Ani, Ajayi-Ojo & Batisai 2024) [39,40,41]. Within Africa, financial stress was reported as an immediate and pervasive lived experience that compounds to shape every aspect of daily life, for instance, financial lack resulted in an inability to feed properly, access healthcare service, afford transportation fees, achieve education and maintain employment, leading to continual psychological burden on an individual (Tuthill et al., 2021 [40] and Hall et al., 2024). Psychological distress was perceived as a normal and expected response to financial hardship, representing both material deprivation and emotional strain that produce a continuous circle of worry, hopelessness and emotional exhaustion among Africans (Miller et al., 2021) [42].

Socio-Cultural Mediators: Financial stress was mediated by socio- cultural responsibilities, and rarely affects an individual in isolation. Poverty led to domestic conflicts, such as arguments triggered by an inability to meet family needs or fulfil societal expectations (Madeghe et al., 2021) [39]. Wellbeing was evaluated through the lens of socio-cultural expectations including participant’s capability to fulfil family and social responsibilities (Madeghe et al., 2021; Tuthill et al., 2021) [39,40]. Failure produced negative feelings such as shame, guilt and incompleteness which intensified psychological distress beyond financial hardship itself (Madeghe et al., 2021; Tuthill et al., 2021and Mainga et al., 2022) [39,40,43]. Additionally, financial stress disrupted social relationships, that serves as social capital, resulting in conflicts, withdrawal from social gatherings, avoidance of friends due to failure to meet the socio-cultural responsibilities (Bwanika et al., 2022; Mainga et al., 2022) [44,43]. This also eroded cultural norms that bolstered community cohesion and culture.

Community Perception of Mental Health Distress: Participants expressed mental health outcomes as ‘‘thinking too much’’, ‘‘too many thoughts’’ and ‘‘worrying too much’’. These expressions were rooted in cultural understanding rather than biomedical diagnosis often reported as depression and anxiety (Bwanika et al., 2022) [44]. Importantly, these expressions extend beyond a linguistic difference to reflect culturally situated perceptions of mental health outcomes within the African communities. Unemployment, financial insecurity and inability to fulfil social expectations primarily generated emotional distress. Consequently, financial distress was conceived as an understandable response to difficult life circumstances and exposures rather than an individual psychiatric disorder. This was socially interpreted through local explanatory models of illness, rather than the western biomedical models, showing how culture influenced the understanding of mental distress.

Structural Vulnerabilities: Financial distress was situated within wider structural inequalities rather than an individual exposure. Unemployment, food insecurity, unstable economy and government policies drove financial hardship. For instance, participants living with tuberculosis reported sustained difficulties with maintaining employment in Zambia (Mainga et al., 2022) [43], Kenyan women reported that pregnancy and diagnosis of HIV infection limited their employment opportunities (Tuthill et al., 2021) [40]. Similarly, In Nigeria, the Naira cash redesign policy was attributed to disruption in cash flow and daily financial transactions, resulting to heightened financial stress [38, 41]. These outcomes demonstrated structural vulnerabilities which precedes and shapes financial stress experienced by participants and subsequently resulting poorer health outcomes.

Narrative Synthesis of Quantitative Studies

Financial Stress and Depression: Depression was the most frequently reported mental health outcomes. Kinyanda et al. (2011) [45] reported that poverty related factors, including unemployment, lower socioeconomic status, inability to meet family needs and absence of formal education were significantly associated with depression among Ugandan adults. Similarly, Appiah-Kubi et al. (2026) [46], using the structural equation modelling, demonstrated that perceived financial hardship significantly induced depression (β = 0.38), particularly among adolescents, teenagers and young adults. Additionally Machisa and Shamu (2022) [47] reported poor economic and lower socioeconomic conditions to significantly influence depressive symptoms among women.

Financial Stress and Anxiety: Studies by Yakubu et al. (2025) and Ani et al. (2024) [48,41] reported a significant association between financial stress and anxiety. This was evident through the high prevalence of anxiety among civil servants and other participants who were experiencing financial hardship. Additionally, financial hardship that resulted from government policies was associated with poor psychological wellbeing, heightened uncertainty, reduced job satisfaction and emotional distress.

Economic Shocks and Impact on Mental Wellbeing: Studies by Bhushan et al. (2025) [49] reported high levels of depressive symptoms among households that were experiencing economic shocks. Similarly, (Bhushan et al., 2025) demonstrated the association between financial resilience and improved mental health outcomes in South African households. Collectively, household participants with higher financial resilience showed lesser mental health vulnerabilities, suggesting a buffering effect offered by high socioeconomic status.

Vulnerable Population Group: Financial stress was disproportionately associated with vulnerable population groups. Tutlam et al. (2025) [50] reported that unemployment, orphanhood and stigma significantly influenced mental health outcomes among vulnerable groups such as refugee adolescents and youths living with HIV in Uganda. Similarly, In Nigeria, financial strain among pregnant women significantly increased depression and overall mental wellbeing, noting food insecurity, intimate partner violence and lack of social support network as key drivers (Wellington, 2023) [51]. Katana et al. (2020) [52] reported that caregivers experiencing heightened financial burden were more likely to develop depression, due to the substantial cost of caregiving and its impact on psychological wellbeing.

Protective Measures: Protective measures that reduced the negative impact of financial stress were reported amongst several studies. For instance, Machisa and Shamu (2022) [47] reported that access to emergency financial resources and social capital reduced the likelihood of depression among Zimbabwean women. Additionally, the availability of social support networks was identified to weaken the correlation between financial stress and prenatal depression among pregnant women in Nigeria (Wellington, 2024).

Triangulation of Qualitative and Quantitative Findings

Financial Stress as a Key Determinant of Mental Health Outcomes: Financial stress was key determinant of mental health outcomes among participants. These experiences were described qualitatively as stress, hopelessness, emotional distress, overthinking, too many thoughts and worrying too much. Quantitatively, studies identified financial stress to be associated with high levels of depression, anxiety and psychological distress. This convergence, further strengthens the association and multidimensional relationship between financial stress and mental wellbeing within the African population.

Financial Stress Operating as A Structural Pathway: Both methodological findings streamlined financial stress to operate from a wider structural pathway, linked with poverty, unemployment, food insecurity, unstable economy and lack of economic opportunities. Qualitatively evidence attributed emotional stress to persistent systemic economic issues, whereas, quantitative studies reported socioeconomic disadvantage as the key predictor of mental health outcomes.

Vulnerable Groups and Corresponding Disproportionate Burden: Vulnerable groups such as pregnant women, refugees, adolescents and individuals living with chronic illness were disproportionately impacted because financial stress interacted with their pre-existing social and health-related vulnerabilities to intensify the development of mental health conditions.

Social Support and Financial Resilience as a Buffer to Mental Distress: Protective buffering role was provided through social support networks and financial resilience within the communities. Qualitative studies reported that family and community support networks were good coping resources, whereas, quantitative studies demonstrated that access to emergency funds, stronger community social networks, and greater financial resilience significantly served as buffers that improved mental health outcomes within the community.

Overview

Evidence from this study demonstrated a consistent relationship between financial stress and mental health outcomes. Across population groups, this was associated with increased depression, anxiety, psychological distress, emotional exhaustion, suicidal ideation and reduced overall wellbeing. The triangulation of both qualitative and quantitative findings further showed a stronger convergence, as quantitative studies statistically linked financial stress to adverse mental health outcomes, whereas qualitative evidence gave contextual insights into how participants experienced, expressed and interpreted this relationship within their socio-cultural environments. Within Africa, financial stress was driven by broader structural inequalities, influenced by complex interactions at individual, household and community levels.

Financial Stress as a Key Determinant of Mental Wellbeing

Participants experiencing financial stress reported high levels of depression, anxiety, psychological distress and reduced overall well being. This aligned with existing finding from low-and middle-income countries, which identified financial stress as key driver of MHD [10,11]. This review shows that financial stress influences mental wellbeing through diverse pathways. For instance, economic hardship creates feelings of fear, hopelessness, worries, too many thoughts and uncertainty about the future, rooted in the inability to meet basic personal and family needs. These pressures gradually erode coping capacity, ultimately influencing mental health outcomes. This pattern aligned with the transactional model of stress which posits that stress occurs when perceived individuals demands exceed available resources [53]. Overall, the finding situate this relationship to extend beyond material deprivation, encompassing a broader social and emotional dimension of overall wellbeing.

Poverty and Structural Inequalities

Financial stress was largely shaped by structural inequalities within Africa. Poverty was consistently reported as a key determinant of poor health outcomes. High levels of depression, anxiety and emotional distress was reported among low-income participants, underscoring the significant psychological burden associated with structural inequalities. This supports the social determinants of health framework, that posit health outcomes are shaped by broader social, economic and environmental conditions, rather than a sole biological or individual factor [9]. Aligning this with this review, poverty, unemployment, income instability and lack of social protective factors, created conditions that influenced individual vulnerabilities to MHD. Additionally, this review positioned Africa differently from Western countries where social welfare systems, unemployment benefits and access to mental health services provide protection. In contrast, structural issues persist within the African context, including widespread poverty, limited employment opportunities and weak healthcare. This positions financial stress as a chronic challenge rather than an episodic situation that persists to imply long-term psychological consequences. Tackling this would require an effective intervention plan that incorporate socio-economic reforms, rather than just a clinical intervention.

Unemployment, Informal Employment and Economic Instability

Unemployed participants and those affected by economic instability reported higher levels of psychological distress, depression and anxiety than participants in stable employment. This highlights the African realities where informal employment constitutes a significant fraction of the economy. Arguably, informal employment provides financial relief for individuals and households, However, it is faced with challenges of unstable income and lack of financial protection in the event of an economic shock or vulnerabilities. Such events generate financial instability and persistent worries that extend to influence mental wellbeing. Employment is closely linked to social identity, family responsibility and community expectations. Consequently, financial insecurity extends to generate social and psychological pressure that compounds mental distress. This finding also align with existing research that situates employment to functions as both economic resources and psychological mediator of health outcomes [54].

Cultural Context

This review demonstrates the cultural realities within Africa contexts and how these shape the interpretation, understanding and expression of financial stress and MHD, particularly through the lens of socio-cultural expectations. Comparatively, the Western context focuses on individual economic conditions, whereas, the African realities attribute financial stress to the inability to meet family and community expectations. This leads to feelings of shame, social exclusion and perceived failure within the socio-cultural system. Additionally, traditional and spiritual beliefs strongly influence the perception of MHD and health-seeking behaviours. This supports the argument that the application of the Western biomedical framework of health may not resonate with African realities (Letsoalo et al., 2024) [55]. This calls for the adoption of a culturally responsive framework that combines the biomedical and socio-cultural understanding of mental wellbeing for effective intervention practice in Africa.

Vulnerable Population Group

Pregnant women, young people, university students, refugees and those in informal employment were reported as vulnerable groups. Women, particularly pregnant women reported heightened psychological distress linked with the impact of financial stress, highlighting existing gender inequalities, income instability and caregiving responsibilities. Young people reported significant mental health challenges driven by unemployment, access to educational funds and economic uncertainty [56,21]. Heightened vulnerabilities were reported among refugees due to displacement, relief plans, poverty and limited access to mental health services. These findings aligned with the existing research that shows financial stress often interact with other social disadvantage to generate a compounding effect [57].

Policy Implication

This review identified several implications for policy development and practice across Africa, these include; demonstrating that mental wellbeing cannot be understood as a separate issue from the socioeconomic factors that amplify it within the African context. This highlights the need for policy advocacy that moves beyond treatment focused-approach to addressing the structural inequalities that influence health outcomes in Africa. Additionally, strengthening mental health practice would require improving social protection systems and the integration of accessible community-based mental health practices that are targeted at reducing substantial treatment gaps and improving community awareness initiatives at the community levels. This would demand cross-sectoral collaboration, strengthened mental health services and sustained funding for locally generated research evidence with recommendation for policy initiatives that improve economic stability and the integration of culturally acceptable frameworks that align with African realities.

Strengths and Limitations

The strength of this review lies in its methodological rigour that allows the triangulation of qualitative and quantitative studies, merging statistical association with lived experiences of participants to provide a more comprehensive understanding of the phenomenon. However, limitations of this review included variability in most studies, particularly in study design, sample size, population characteristics and outcome measurements, as most studies considered cross-sectional data which restrict causal interpretation over time. Additionally, included studies were mostly concentrated within a limited geographical region which potentially reduced generalised representation of Africa.

Development of Conceptual Framework

Findings from this researched informed the development of the African Financial Stress and Mental wellbeing Framework (AFSMWF). This conceptual framework integrates structural and socio-cultural pathways that interplay to shape financially induced mental health outcomes in Africa. At the structural level, macroeconomic and institutional factors including weak labour market, government policies, unemployment, poverty, informal employment, poor Primary Healthcare and limited or absent social protection systems were consistently identified as core drivers of financial stress. This positioned financial stress as a downstream effect of systemic vulnerabilities rather than an individual financial failure. Socio-culturally, this framework situates financial stress and mental wellbeing to be contextually interpreted, expressed and diagnosed through cultural norms and practices. These communal practices often lead to stigma, social exclusion and feeling of shame, which leads to a complete dependence on community-based or spiritual responses rather than biomedical intervention. Within this framework, financial stress and mental wellbeing is conceptualised as a daily and cumulative exposure rather than a short-term crisis. Notably, this highlights financial feedback loops where declining mental wellbeing reduces productivity, employability and social participation, that in turn heightens financial instability and reinforce the cycle of emotional distress.

Conclusion

This review reveals that financial stress significantly influences mental health outcomes, demonstrating that poverty, unemployment, income instability, economic shocks and structural inequalities constantly result in high levels of depression, anxiety, psychological and emotional distress. This causes financial stress to operate within the complex cultural and socioeconomic contexts that influence how mental health is understood, interpreted and expressed in Africa. Additionally, this review supports the social determinant of the health framework that illustrates how mental wellbeing is strongly rooted in structural inequalities. Addressing this challenge would require an integrated approach that combines mental health services with socioeconomic intervention targeted at reducing poverty and stabilising the economy. Such strategies should adopt indigenous practice that aligns with the African realities.

1. (2022) WHO. World Mental Health report: Transforming Mental Health for All - Executive Summary.
2. Piao X, Xie J, Shunsuke Managi (2024) Continuous worsening of population emotional stress globally: universality and variations. BMC Public Health 24(1).
3. Schramme T (2023) Health as Complete Well-Being: The WHO Definition and beyond. Public Health Ethics 16(3): 210-218.
4. Fan Y, Fan A, Yan Z, Fan D (2025) Global burden of mental disorders in 204 countries and territories, 1990-2021: results from the global burden of disease study 2021. BMC Psychiatry 25(1).
5. (2025b) WHO. WHO releases new reports and estimates highlighting urgent gaps in mental health.
6. Vigo D, Thornicroft G, Atun R (2016) Estimating the true global burden of mental illness. The Lancet Psychiatry 3(2): 171- 178.
7. R Moradiya N (2025) The global hidden costs of mental health disorders: Socioeconomic impacts and policy solutions: Systematic review. World Journal of Biology Pharmacy and Health Sciences 21(3): 326-334.
8. Mezzina R, Gopikumar V, Jenkins J, Saraceno B, Sashidharan SP (2022) Social vulnerability and mental health inequalities in the “syndemic”: Call for action. Frontiers in Psychiatry 13(13): 1-14.
9. Marmot M (2015) Marmot Indicators 2015 - Institute of Health Equity. Institute of Health Equity.
10. Richardson T, Elliott P, Roberts R (2013) The relationship between personal unsecured debt and mental and physical health: A systematic review and meta-analysis. Clinical Psychology Review 33(8): 1148-1162.
11. Sweet E, Nandi A, Adam EK, McDade TW (2013) The high price of debt: Household financial debt and its impact on mental and physical health. Social Science & Medicine 91(91): 94-100.
12. Atewologun F, Adigun OA, Okesanya OJ, Hassan HK, Olabode ON (2025) A comprehensive review of mental health services across selected countries in sub-Saharan Africa: assessing progress, challenges, and future direction. Discover Mental Health 5(1).
13. Sankoh O, Sevalie S, Weston M (2018) Mental health in Africa. The Lancet Global Health 6(9): e954-e955.
14. Essel-Gaisey F, Okyere MA, Forson R, Chiang TF (2023) The road to recovery: Financial resilience and mental health in post-apartheid South Africa. SSM - population health 23(7-8).
15. (2025b) WHO | Regional Office for Africa. Mental health conditions affect 150 million in Africa amid insufficient care services. ---14
16. Sala G, Schafer A (2025) Comprehensive planning for mental health system reform - Lessons learned from the WHO Special Initiative for Mental Health. Cambridge Prisms: Global Mental Health 12: 1-18.
17. Okechukwu CE (2020) Shortage of psychiatrists: A barrier to effective mental health-care delivery in Nigeria. International Journal of Noncommunicable Diseases 5(1): 22.
18. Nicholas A, Joshua O, Elizabeth O (2022) Accessing Mental Health Services in Africa: Current state, efforts, challenges and recommendation. Annals of Medicine and Surgery 81: 104421.
19. Galvin M, Chiwaye L, Moolla A (2023) Perceptions of causes and treatment of mental illness among traditional health practitioners in Johannesburg, South Africa. South African Journal of Psychology 53(3).
20. Scheve A, Bandawe C, Kohler HP, Kohler IV (2022) Mental health and life-course shocks in a low-income country: Evidence from Malawi. SSM - Population Health 19: 101098.
21. Uthman TJ, Oladele OP, Babatunde SI, Emmanuel AT (2025) Exploring the Relationship Between Economic Hardship and Suicidal Ideation Among Gen Z and Millennials: A Comparative Study.
22. Acha-Anyi Asongu, Sabihah Moola (2024) A Decolonized Framework for a Medical Treatment Team Approach to Mental Healthcare in the South African Context. South African Review of Sociology 54(1): 78-99.
23. Muka T, Glisic M, Milic J, Verhoog S, Bohlius J, et al. (2020) A 24-step Guide on How to design, conduct, and Successfully Publish a Systematic Review and meta-analysis in Medical Research. European Journal of Epidemiology 35(1): 49-60.
24. Strawbridge R, Sharma D, Kisely S, Cristea I, Young A, et al. (2022) Enhancing the quality of systematic reviews and meta-analyses. BJPsych Open 11(6).
25. Shaheen N, Shaheen A, Ramadan A, Hefnawy MT, Ramadan A, et al. (2023) Appraising Systematic reviews: a Comprehensive Guide to Ensuring Validity and Reliability. Frontiers in Research Metrics and Analytics 8(8).
26. Iqbal S, Macarena Chepo, Hébert M, Vindrola-Padros C (2024) To scope or not to scope? The benefits and challenges of integrating scoping studies in rapid qualitative research and evaluation. Evaluation and Program Planning 108: 102495-102495.
27. Cumpston M, Li T, Page MJ, Chandler J, Welch VA, et al. (2021) Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database of Systematic Reviews 10(10).
28. Mallett R, Hagen-Zanker J, Slater R, Duvendack M (2012) The Benefits and Challenges of Using Systematic Reviews in International Development Research. Journal of Development Effectiveness 4(3): 445-455.
29. Covvey JR, McClendon C, Gionfriddo MR (2023) Back to the basics: Guidance for formulating good research questions. Research in Social and Administrative Pharmacy 20(1): 66-69.
30. MacFarlane A, Russell-Rose T, Shokraneh F (2022) Search Strategy Formulation for Systematic Reviews: Issues, Challenges and Opportunities. Intelligent Systems with Applications 15(1).
31. Wakida EK, Talib ZM, Akena D, Okello ES, Kinengyere A, et al. (2018) Barriers and facilitators to the integration of mental health services into primary health care: a systematic review. Systematic Reviews 7(1).
32. Methley AM, Campbell S, Chew-Graham C, McNally R, Cheraghi-Sohi S (2014a) PICO, PICOS and SPIDER: a Comparison Study of Specificity and Sensitivity in Three Search Tools for Qualitative Systematic Reviews. BMC Health Services Research 14(1): 1-10.
33. Saade S, Lamarche AP, Khalaf T, Makke S, Legg A (2023) What barriers could impede access to mental health services for children and adolescents in Africa? A scoping review. BMC Health Services Research 23(1).
34. Guan N, Guariglia A, Moore Xu F, Al-Janabi H (2022) Financial Stress and Depression in Adults: A Systematic Review. PLOS One 17(2).
35. Raby P, McNaughton RJ (2021) A simplified approach to Critically appraising research evidence. Nurse researcher 29(1): 32-41.
36. Hannes K, Lockwood C, Pearson A (2010) A comparative analysis of three online appraisal instruments’ ability to assess validity in Qualitative research. Qualitative health research 20(12): 1736-1743.
37. Thomas J, Harden A (2008) Methods for the Thematic Synthesis of Qualitative Research in Systematic Reviews. BMC Medical Research Methodology 8(1): 1-10.
38. Popay J (2006) Guidance on the conduct of narrative synthesis in systematic reviews: A product from the ESRC Methods Programme. ResearchGate.
39. Madeghe BA, Kogi Makau W, Ngala S, Kumar M (2021) Risk factors and experiences of prepartum depression in urban- low-income settlement Nairobi Kenya: A mixed-method study. F1000Research 9: 1495.
40. Tuthill EL, Maltby AE, Odhiambo BC, Akama E, Pellowski JA, et al. (2021) “I found out I was pregnant, and I started feeling stressed”: A longitudinal qualitative perspective of mental health experiences among perinatal women living with HIV. AIDS Behav 25(12): 4154-4168.
41. Ani JI, Ajayi Ojo VO, Kezia Batisai (2024) Financial scarcity, psychological well-being and perceptions: an evaluation of the Nigerian currency redesign policy outcomes. BMC Public Health 24(1).
42. Miller AP, Ziegel L, Mugamba S, Kyasanku E, Wagman JA, et al. (2021) Not enough money and too many thoughts: Exploring perceptions of mental health in two Ugandan districts through the Mental Health literacy Framework. Qual Health Res 31(5): 967-982.
43. Mainga T, Gondwe M, Mactaggart I, Stewart RC, Shanaube K, et al. (2022) Qualitative study of patient experiences of mental distress during TB investigation and treatment in Zambia. BMC Psychol 10 (1): 179.
44. Bwanika JM, Hawkins C, Kamulegeya L, Onyutta P, Musinguzi D, et al. (2022) Qualitative study of mental health attribution, perceptions and care-seeking in Kampala, Uganda. S Afr J psychiatr 28: 1690.
45. Kinyanda E, Woodburn P, Tugumisirize J, Kagugube J, Ndyanabangi, et al. (2011) Poverty, life events and the risk for depression in Uganda. Soc psychiatry psychiatr epidemiol 46(1): 35-44.
46. Kubi AJ, Amoako EO, Achulo SH, Small E, Sharma B, et al. (2026) The complex role of financial hardship in understanding depression among youth in Uganda. J Affect Disord 392: 120193.
47. Machisa M Shamu S (2022) Associations between depressive symptoms, socio-economic factors, traumatic exposure and recent intimate partner violence experiences among women in Zimbabwe: A cross-sectional study. BMC Women’s Health 22(1): 248.
48. Yakubu Y, Mabweh Danladi Mashat, Obadiah AA, Akwa E, Oklewu VF, et al. (2025) Depression, anxiety and job dissatisfaction: consequences of economic hardship in a lower middle-income country. BMC Psychology 13(1): 1215.
49. Bhushan NL, Madson G, Kelly NK, Kahn K, Gomez Olive FX, et al. (2025) The relationship between household economic shocks, depression, and elevated stress-responsive biomarkers among adolescent girls and young women in rural South Africa (HPTN 068). J Affect Disord 391: 119924.
50. Tutlam NT, Kizito S, Nabunya P, Naseh M, Nabbosa I, et al. (2025) Social determinants of mental health outcomes among refugee adolescents and youth living with HIV in refugee settlements in Uganda: A cross-sectional analysis. AIDS behav 29(11): 3432-3443.
51. Wellington OA (2023) Financial strain and prenatal depression among pregnant women in Ibadan, Nigeria: Mediating pathways of intimate partner violence, food insecurity, and social support. European Journal of Mental Health 18: 1-16.
52. Katana PV, Abubakar A, Nyongesa, MK, Ssewanyana D, Mwangi P, et al. (2020) Economic burden and mental health of primary caregivers of perinatally HIV infected adolescents from Kilifi, Kenya. BMC public health 20(1): 504.
53. Folkman S, Lazarus R (1984) Stress: Appraisal and coping. Encyclopedia of Behavioral Medicine 1(1): 1913-1915.
54. Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, et al. (2018) The Lancet Commission on global mental health and sustainable development. The Lancet 392(10157): 1553-1598.
55. Letsoalo DL, Ally Y, Tsabedze WF, Mapaling C (2024) Challenging the nexus: Integrating Western psychology and African cultural beliefs in South African mental health care. Psychology in Society 66 (2): 45-66.
56. Gisemba Onsarigo T, Esau M, Anthony M, Katakanya S, Ayugi I (2024) Investigating the Impact of Financial Anxiety on the Mental Well-Being of Youth in Ishaka Division, Uganda. International Journal of Research Publication and Reviews Journal.
57. Jackson SE, Cox S, Holmes J, Angus C, Robson D, et al. (2025) Paying the price: Financial hardship and its association with psychological distress among different population groups in the midst of Great Britain’s cost-of-living crisis. Social Science & Medicine 364: 117561.
58. Abbo C (2011) Profiles and outcome of traditional healing practices for severe mental illnesses in two districts of Eastern Uganda. Global Health Action 4(1): 7117.
59. Adepoju (2020) Africa turns to telemedicine to close mental health gap. The Lancet Digital Health 2(11): e571-e572.
60. Adil M, Nagu N, Rustam A, Wahyuni, Idrawahyuni, et al. (2022). Interpretive Paradigm on Development of Science and Accounting Research. International Journal of Humanities Education and Social Sciences (IJHESS) 1(4).
61. Aem Ngibise KA, Sakyi L, Adwan Kamara L, Cooper TD, Weobong B, et al. (2024). Development and Implementation of Mental Healthcare Plans in Three Districts in Ghana: A Mixed-Method Process Evaluation Using Theory of Change. Community Mental Health Journal 61(3): 509-522.
62. Agberotimi SF, Akinsola OS, Oguntayo R, Olaseni AO (2020) Interactions Between Socioeconomic Status and Mental Health Outcomes in the Nigerian Context Amid COVID-19 Pandemic: A Comparative Study. Frontiers in Psychology, pp. 11559819.
63. Ahamed J (2024) The Pursuit of Subjective Well-Being Through Financial Well-Being, Relationship Quality, and Spiritual Well-Being: A Configuration Approach with Fuzzy-Set Qualitative Comparative Analysis (fsQCA). Journal of Family and Economic Issues, p. 46.
64. Ahmed A, Pereira L, Jane K (2024) Mixed Methods Research: Combining Both Qualitative and Quantitative Approaches. ResearchGate.
65. Alloush M (2024) Income, Psychological Well-being, and the Dynamics of Poverty. Economic Development and Cultural Change 72(4).
66. Almutairi R, Alsarraf A, Alkandari D, Ashkanani, H Albazali A (2024) Dissecting through the literature: A review of the critical appraisal process. Cureus 16(5).
67. Alvaro C, Lyons RF, Warner G, Hobfoll SE, Martens J, et al. (2010). Conservation of resources theory and research use in health systems. Implementation Science 5(1).
68. Alvesson M, Sköldberg K (2018) Reflexive Methodology. SAGE Publications Inc.
69. (2025) American Psychiatric Association. DSM-5-TR® Update: Supplement to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
70. Amoah DK (2024) How different theories of development address the relationship between the urban informal economy and poverty in the labour market. Discover Global Society 2(1).
71. Ampomah IG, Malau Aduli BS, Malau Aduli AEO, Emeto TI (2020) Effectiveness of Integrated Health Systems in Africa: A Systematic Review. Medicina 56(6): 271.
72. Amzat J, Razum O (2017) African Culture and Health. Towards a Sociology of Health Discourse in Africa, p. 65-77.
73. Anjorin O, Wada YH (2022) Impact of traditional healers in the provision of mental health services in Nigeria. Annals of Medicine and Surgery 82: 104755.
74. Ataguba JEO, Day C, McIntyre Di (2015) Explaining the role of the social determinants of health on health inequality in South Africa. Global Health Action 8(1): 28865.
75. Atilola O (2012) Partaking in the global movement for occupational mental health: what challenges and ways forward for sub-Sahara Africa?. International Journal of Mental Health Systems 6(1).
76. Bamer AM, McMullen K, Gibran N, Holavanahalli R, Schneider JC (2020) Factors Associated with Attrition of Adult Participants in a Longitudinal Database: A National Institute on Disability, Independent Living, and Rehabilitation Research Burn Model System Study. Journal of Burn Care & Research 41(2): 270-279.
77. Bannatyne AJ, Jones C, Craig BM, Jones D, Forrest K (2023) A systematic review of mental health interventions to reduce self-stigma in medical students and doctors. Frontiers in Medicine, p. 10.
78. Barnett Page E, Thomas J (2009) Methods for the synthesis of qualitative research: A critical review. BMC Medical Research Methodology 9(1).
79. Barrass L, Joshi E, Dawe J, Rubbo B, Redaniel MT, et al. (2024) The association between socioeconomic position and depression or suicidal ideation in low- and middle-income countries in Southeast Asia: a systematic review and meta-analysis. BMC Public Health 24(1): 3507.
80. Bass J, Neugebauer R, Clougherty KF, Verdeli H, Wickramaratne Ndogoni L, et al. (2006) Group interpersonal psychotherapy for depression in rural Uganda: 6-month outcomes. British Journal of Psychiatry 188(6): 567-573.
81. Batuo ME, Kararach G, Malki I (2022) The dynamics of income inequality in Africa: An empirical investigation on the role of macroeconomic and institutional forces. World Development, pp. 157105939.
82. Bello UM, Kannan Chutiyami M, Salihu D, Cheong AMY, Miller T, et al. (2022) Prevalence of Anxiety and Depression Among the General Population in Africa During the COVID-19 Pandemic: A Systematic Review and Meta-Analysis. Frontiers in Public Health 10.
83. Ben-Zur H (2019) Transactional Model of Stress and Coping. Encyclopedia of Personality and Individual Differences, p. 1-4.
84. Berhe KT, Gesesew HA, Ward R (2024) Traditional healing practices, factors influencing to access the practices and its complementary effect on mental health in sub-Saharan Africa: a systematic review. BMJ Open 14(9): e083004-e083004.
85. Berman NG, Parker RA (2002) Meta-analysis: Neither quick nor easy. BMC Medical Research Methodology 2(1).
86. Bolton Bass J, Neugebauer R, Verdeli H, Clougherty KF, Wickramaratne Speelman L, et al. (2003) Group Interpersonal Psychotherapy for Depression in Rural Uganda. JAMA 289(23): 3117.
87. Booth A (2022) Systematic Approaches to a Successful Literature Review. SAGE Publications Ltd.
88. Borgstede M, Scholz M (2021) Quantitative and Qualitative Approaches to Generalization and Replication-A Representationalist View. Frontiers in Psychology 12(1): 1-9.
89. Bovey M, Hosny N, Dutray F, Heim E (2025) Trauma-related cultural concepts of distress: A systematic review of qualitative literature from the Middle East and North Africa, and Sub-Saharan Africa. SSM - Mental Health 7: 100402.
90. Brackett A, Batten J (2022) Ensuring rigor in systematic reviews: Part 7, critical appraisal of systematic review quality. Heart & Lung 53(1): 32-35.
91. Bramer WM, Rethlefsen ML, Kleijnen J, Franco OH (2017) Optimal Database Combinations for Literature Searches in Systematic reviews: a Prospective Exploratory Study. Systematic Reviews 6(1): 245.
92. Bridges S, Disney R (2010) Debt and depression. Journal of Health Economics 29(3): 388-403.
93. BROWN TH, HOMAN (2023) The Future of Social Determinants of Health: Looking Upstream to Structural Drivers. The Milbank Quarterly 101(S1): 36-60.
94. Calvès AE, Schoumaker (2004) Deteriorating Economic Context and Changing Patterns of Youth Employment in Urban Burkina Faso: 1980-2000. World Development 32(8): 1341-1354.
95. Campbell C, Burgess R (2012) The role of communities in advancing the goals of the Movement for Global Mental Health. Transcultural Psychiatry 49(3-4): 379-395.
96. Campbell M, Katikireddi SV, Sowden A, Thomson H (2019) Lack of transparency in reporting narrative synthesis of quantitative data: a methodological assessment of systematic reviews. Journal of Clinical Epidemiology 105(1): 1-9.
97. Candace I J Nykiforuk, Ana Paula Belon, Evelyne de Leeuw, Harris, Lisa Allen Scott, et al. (2023) An action-oriented public health framework to reduce financial strain and promote financial wellbeing in high-income countries. International Journal for Equity in Health 22(1).
98. Carroll C, Booth A (2014) Quality assessment of qualitative evidence for systematic review and synthesis: Is it meaningful, and if so, how should it be performed?. Research Synthesis Methods 6(2): 149-154.
99. Carroll C, Booth A (2015) Quality assessment of qualitative evidence for systematic review and synthesis: Is it meaningful, and if so, how should it be performed?. Research Synthesis Methods 6(2): 149-154.
100. Caruana E, Roman M, Sánchez JH, Solli (2015) Longitudinal Studies. Journal of Thoracic Disease 7(11): 537-540.
101. Casella CB, Kousoulis AA, Kohrt BA, Bantjes J, Kieling C, et al. (2025) Data gaps in prevalence rates of mental health conditions around the world: a retrospective analysis of nationally representative data. The Lancet Global Health 13(5): e879-e887.
102. Chandrakumar S, Vivek R (2023) A Critical Review of the Mixed Method Application and Its Criticism. Social Work and Education 10(2): 242-253.
103. Clark AM (2016) Why Qualitative Research Needs More and Better Systematic Review. International Journal of Qualitative Methods 15(1): 160940691667274.
104. Cleland JA (2017) The Qualitative Orientation in Medical Education Research. Korean Journal of Medical Education 29(2): 61-71.
105. Cooke A, Smith D, Booth A (2012) Beyond PICO: the SPIDER Tool for Qualitative Evidence Synthesis. Qualitative Health Research 22(10): 1435-1443.
106. Cooper S (2016) Research on help-seeking for mental illness in Africa: Dominant approaches and possible alternatives. Transcultural Psychiatry 53(6): 696-718.
107. Correia MITD (2023) Ethics in research. Clinical Nutrition Open Science 47(1): 121-130.
108. Creswell JW, Creswell JD (2018) Research design: Qualitative, quantitative, and Mixed Methods Approaches. (5^th)., London: SAGE Publications.
109. Creswell JW, Creswell JD (2023) Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. SAGE Publications Ltd.
110. Crowe L, Butterworth (2016) The role of financial hardship, mastery and social support in the association between employment status and depression: results from an Australian longitudinal cohort study. BMJ Open 6(5): e009834.
111. Dahlgren G, Whitehead M (1991) Policies and Strategies to Promote Social Equity in health. Background Document to WHO - Strategy Paper for Europe. ResearchGate.
112. Daniel NA, Liu X, Thomas ET, Eraneva-Dibb E, Ahmad AM, et al. (2024) Brief CBT-based psychological interventions to improve mental health outcomes in refugee populations: a systematic review and meta-analysis. European journal of psychotraumatology 15(1).
113. Davies BR, Allen NB (2017) Trauma and homelessness in youth: Psychopathology and intervention. Clinical Psychology Review 54: 17-28.
114. Dawit Wondimagegn, Pain C, Seifu N, Cartmill C, Azeb Asaminew Alemu (2023) Reimagining global mental health in Africa. BMJ Global Health 8(9): e013232.
115. Dibekulu D (2020) An Overview of Data Analysis and Interpretations in Research. ResearchGate.
116. Dote Pardo JS, Parra-Domínguez J (2025) The mind-money connection: how financial health shapes mental well-being (and vice versa). Mental Health and Social Inclusion 30(1): 24-35.
117. Dowdall N, Ward CL, Lund C (2017) The association between neighbourhood-level deprivation and depression: evidence from the south african national income dynamics study. BMC Psychiatry 17(1).
118. Drentea (2000) Age, Debt and Anxiety. Journal of Health and Social Behavior 41(4): 437.
119. Drente, Reynolds JR (2012) Neither a Borrower Nor a Lender Be. Journal of Aging and Health 24(4): 673-695.
120. Dung Ezekiel Jidong, Tarela Juliet Ike, Murshed M, Pam Patrick Nyam, Husain N, et al. (2024) Interventions for Self-Harm and Suicidal Ideation in Africa: A Systematic Review. Archives of suicide research 29(1): 1-25.
121. (2025) EBSCO. EBSCOhost Research Platform | EBSCO. EBSCO Information Services, Inc.
122. Egger D, Haushofer J, Miguel E, Niehaus Walker M, Abraham J, et al. (2019) NBER WORKING PAPER SERIES GENERAL EQUILIBRIUM EFFECTS OF CASH TRANSFERS: EXPERIMENTAL EVIDENCE FROM KENYA for excellent research assistance; Innovations for Poverty Action for data collection fieldwork; the Busara Center for Behavioral Economics for piloting work; GiveDirectly for fruitful collaboration
123. Elum ZA, Emodi AI (2025) Gender, poverty and food security: Perceptions and implications for urban households in Nigeria. Scientific African 28: e02703.
124. Engel GL (1977) The Need for a New Medical model: a Challenge for Biomedicine. Science 196(4286): 129-136.
125. Erciyes E (2020) Paradigms of Inquiry in the Qualitative Research. European Scientific Journal ESJ 16(7).
126. Eshetu EB, SA Woldesenbet (2011) Are there particular social determinants of health for the world’s poorest countries?. African Health Sciences 11(1): 108-15.
127. Ezeugwu CR, Ojedokun O (2020) Masculine norms and mental health of African men: what can psychology do?. Heliyon, 6(12).
128. Faregh N, Lencucha R, Ventevogel Dubale BW, Kirmayer LJ (2019) Considering culture, context and community in mhGAP implementation and training: challenges and recommendations from the field. International Journal of Mental Health Systems 13(1).
129. (2025a) Financing Mental Health in Africa: Results of country studies Final Report.
130. Fitch C, Hamilton S, Bassett, Davey R (2011) The relationship between personal debt and mental health: a systematic review. Mental Health Review Journal 16(4): 153-166.
131. Flemming K, Booth A, Garside R, Tunçalp Ö, Noyes J (2019) Qualitative evidence synthesis for complex interventions and guideline development: clarification of the purpose, designs and relevant methods. BMJ Global Health 4(Suppl 1): e000882.
132. Flemming K, Noyes J (2021) Qualitative Evidence Synthesis: Where Are We at?. International Journal of Qualitative Methods, 20: 160940692199327.
133. Fryers T, Melzer D, Jenkins R (2003) Social inequalities and the common mental disorders. Social Psychiatry and Psychiatric Epidemiology 38(5): 229-237.
134. Gadhave DG, Sugandhi VV, Saurav Kumar Jha, Nangare SN, Gupta G, et al. (2024) Neurodegenerative Disorders: Mechanisms of Degeneration and Therapeutic Approaches with Their Clinical Relevance. Ageing Research Reviews 99: 102357.
135. Galal S (2023) Africa: unemployment rate by country. Statista.
136. Gamage ANKK (2025) Research design, philosophy, and quantitative approaches in scientific research methodology. Scholars Journal of Engineering and Technology13(02): 91-103.
137. Gibbs A, Jewkes R, Willan S, Washington L (2018) Associations between poverty, mental health and substance use, gender power, and intimate partner violence amongst young (18-30) women and men in urban informal settlements in South Africa: A cross-sectional study and structural equation model. PLOS ONE 13(10): e0204956.
138. Greco T, Zangrillo A, G Biondi-Zoccai, G Landoni (2024) Meta-analysis: pitfalls and hints. Heart, Lung and Vessels 5(4)219-
139. Gureje O, Alem A (2000) Mental health policy development in Africa. Bulletin of the World Health Organization 78(4): 475-482.
140. Gusenbauer M, Gauster SP (2024) How to Search for Literature in Systematic Reviews and meta-analyses: a Comprehensive step-by-step Guide. Technological Forecasting and Social Change, pp. 212123833.
141. Gyamerah AO, Odiase OJ, Habib HH, Achana F, Canizares A, et al. (2025) Factors shaping the mental health of healthcare workers during the COVID-19 pandemic: a qualitative study in Ghana. BMC health services research 25(1): 388.
142. Hassan MF, Mohd Hassan N, Kassim ES, Utoh Said YM (2021) Financial Wellbeing and Mental Health: A Systematic Review. Studies of Applied Economics 39(4).
143. Haushofer J, Shapiro J (2016) The Short-term Impact of Unconditional Cash Transfers to the Poor: Experimental Evidence from Kenya. The Quarterly Journal of Economics 131(4): 1973-2042.
144. Hawker S, Payne, Kerr C, Hardey M, Powell J (2002) Appraising the evidence: Reviewing disparate data systematically. Qualitative Health Research 12(9): 1284-1299.
145. Hearn S (2016) What Do We Mean by ‘Impact?’ Research to Action.
146. Higgins JPT, LópezLópez JA, Becker BJ, Davies SR, Dawson S, et al. (2019) Synthesising Quantitative Evidence in Systematic Reviews of Complex Health Interventions. BMJ Global Health 4(1): e000858.
147. Hilton M (2024) JBI critical appraisal checklist for systematic reviews and research syntheses (product review). Journal of the Canadian Health Libraries Association / Journal de l Association de bilbiothèques de la santé du Canada 45(3): 180-183.
148. Hobfoll SE, Halbesleben J, Neveu JP, Westman M (2018) Conservation of Resources in the Organizational Context: The Reality of Resources and Their Consequences. Annual Review of Organizational Psychology and Organizational Behavior 5(1): 103-128.
149. Huber M (2011) How should we define health?. BMJ 343(343).
150. Huey S, Park A, Galán C, Wang C (2023) 19:18.1-18.28 The Annual Review of Clinical Psychology is online at clinpsy. Annu Rev Clin Psychol.
151. Jalali A, Arash Ziapour, Karimi Z, Rezaei M, Emami B, et al. (2024). Global prevalence of depression, anxiety, and stress in the elderly population: a systematic review and meta-analysis. BMC Geriatrics 24(1).
152. Jalili R, Gilani N, Najafi B, Gordeev VS, Doshmangir L (2025) Health financial resilience in individuals and households: a scoping review of components, strategies and outcomes. BMC Public Health 25(1).
153. Jecker NS, Atuire CA, Kenworthy N (2022) Realizing Ubuntu in Global Health: An African Approach to Global Health Justice. Public Health Ethics 15(3).
154. Johnson NE, Malimabe M, Yoon GH, Osborn TL, Falgas-Bague I, et al. (2025) Integration of local realities to address mental health in Africa. The Lancet Psychiatry.
155. Junjie M, Yingxin M (2022) The Discussions of Positivism and Interpretivism. Global Academic Journal of Humanities and Social Sciences 4(1): 10-14.
156. Kaggwa MM, Harms S, Mamu MA (2022) Mental health care in Uganda. The Lancet Psychiatry 9(10): 766-767.
157. Kechi IA, Inungu JN, Jayaraman R, Mumford VE (2025) Utilization of mental health services among Black African immigrants in the US: Integrative literature review. Electronic Journal of General Medicine 22(5): em685.
158. Keyes CLM (2002) The Mental Health Continuum: From Languishing to Flourishing in Life. Journal of Health and Social Behavior 43(2): 207-222.
159. Keyes CLM (2007) Promoting and protecting mental health as flourishing: A complementary strategy for improving national mental health. American Psychologist 62(2): 95-108.
160. Keynejad R, Spagnolo J, Thornicroft G (2021) WHO mental health gap action programme (mhGAP) intervention guide: updated systematic review on evidence and impact. Evidence Based Mental Health 24(3).
161. Khanday SA, Khanam D (2023) THE RESEARCH DESIGN. ResearchGate.
162. Kilbourne AM, Keyser D, Pincus HA (2010) Challenges and Opportunities in Measuring the Quality of Mental Health Care. The Canadian Journal of Psychiatry 55(9): 549-557.
163. Kleinman A (1987) Anthropology and Psychiatry. British Journal of Psychiatry 151(4): 447-454.
164. Kleintjes S, Schneider M (2023) History and politics of mental health policy and care in South Africa. SSM - Mental Health 3(1).
165. Knizek BL, Mugisha J, Kinyanda E, Hagen J, Hjelmeland H (2024) “When you are alone you have a narrow mind, but when you are with others you think broader into the other aspects.” A qualitative study on the role of sense of belonging and mattering in attempted suicide in Uganda. International Journal of Qualitative Studies on Health and Well-being 19(1).
166. Kohn R, Saxena S, Levav I, Saraceno B (2004) The treatment gap in mental health care. Bulletin of the World Health Organization 82(11): 858-866.
167. Koomson I (2024) Examining the Link Between Financial Inclusion and Mental Distress: Empirical Evidence from Rural South Africa. Sustainable development goals series, p. 69-89.
168. Koopmans E, Schiller C (2022) Understanding Causation in Healthcare: An Introduction to Critical Realism. Qualitative Health Research 32(8-9): 1207-1214.
169. Kpanake L (2018) Cultural concepts of the person and mental health in Africa. Transcultural Psychiatry 55(2): 198-218.
170. Kung CSJ, Pudney SE, Shields MA (2022) Economic gradients in loneliness, social isolation and social support: Evidence from the UK Biobank. Social Science & Medicine 306: 115122.
171. Lau J, J P Ioannidis, C H Schmid (1997) Quantitative Synthesis in Systematic Reviews. Annals of Internal Medicine 127(9): 820-826.
172. Lavis JN (2009) How Can We Support the Use of Systematic Reviews in Policymaking?. PLoS Medicine 6(11): e1000141.
173. Leibbrandt M (2019) Exploring psychological well-being and poverty dynamics in South-Africa: evidence from NIDS waves 1-5. SALDRU Working Papers.
174. Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche C, et al. (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 339(339): b2700.
175. Lim WM (2024) What Is Qualitative research? an Overview and Guidelines. Australasian Marketing Journal (AMJ) 33(2): 199-229.
176. Lisy K, Porritt K (2016) Narrative Synthesis: Considerations and Challenges. International Journal of Evidence-Based Healthcare 14(4): 201.
177. Livingston V, Jackson Nevels B, Reddy V (2022) Social, Cultural, and Economic Determinants of Well-Being. Encyclopedia 2(3): 1183-1199.
178. Lizarondo L, Stern C, Apostolo J, Carrier J, de Borges K, et al. (2022). Five common pitfalls in mixed methods systematic reviews - lessons learned. Journal of Clinical Epidemiology, pp. 148.
179. Long HA, French DP, Brooks J (2020) Optimising the Value of the Critical Appraisal Skills Programme (CASP) Tool for Quality Appraisal in Qualitative Evidence Synthesis. Research Methods in Medicine & Health Sciences 1(1): 31-42.
180. Lotenna Olisaeloka, Echezona Udokanma, Ashraf A (2024) Psychosocial interventions for depression among young people in Sub-Saharan Africa: a systematic review and meta-analysis. International journal of mental health systems 18(1).
181. Lovero KL, Dos F, Come AX, Wainberg ML, Oquendo MA (2023) Suicide in Global Mental Health. Current Psychiatry Reports 25(6): 255-262.
182. Lund C (2012) Poverty and mental health: a review of practice and policies. Neuropsychiatry 2(3): 213-219.
183. Lund C, Breen A, Flisher AJ, Kakulma R, Corrigall J, et al. (2010) Poverty and common mental disorders in low and middle income countries: A systematic review. Social Science & Medicine 71(3): 517-528.
184. Lund C, Petersen I, Kleintjes S, Bhana A (2012) Mental Health Services in South Africa: Taking stock. African Journal of Psychiatry 15(6): 402-405.
185. Maara J, Cirillo C, Ángeles G, Prencipem L, Marlous deMilliano, et al. (2023) Impacts of cash transfer and “cash plus” programs on self- perceived stress in Africa: Evidence from Ghana, Malawi, and Tanzania. SSM-Population Health 22: 101403-101403.
186. Mabunda D, Oliveira D, Sidat M, Cavalcanti MT, Cumbe V, et al. (2022) Cultural adaptation of psychological interventions for people with mental disorders delivered by lay health workers in Africa: scoping review and expert consultation. International Journal of Mental Health Systems 16(1).
187. Maffre Maviel G, Rouquette A, Davisse Paturet C, Descarpentry A, Sapin A, et al. (2025) Experience of financial hardship and depression: a longitudinal population-based multi-state analysis. Epidemiology and Psychiatric Sciences, p. 34.
188. Magnus Jørgensen, Sara Madeleine Kristensen, Breivik K (2023) Scar, vulnerability, or both? A longitudinal study of the association between depressive tendencies and global negative self-esteem from early adolescence to young adulthood with gender as a moderating factor. Personality and Individual Differences 214: 112349-112349.
189. Martinez EC, Ghattas E, Salolin VP, García-González OY, Fermin MD, et al. (2025). A comprehensive guide to conduct a systematic review and meta-analysis in medical research. Medicine 104(33): e41868-e41868.
190. (2023) Mental Health Foundation. Poverty and mental health.
191. Methley AM, Campbell S, Chew Graham C, McNally R, Cheraghi-Sohi S (2014b) PICO, PICOS and SPIDER: a Comparison Study of Specificity and Sensitivity in Three Search Tools for Qualitative Systematic Reviews. BMC Health Services Research 14(1): 1-10.
192. Miake Lye IM, Mak S, Begashaw MM, Shekelle G (2025) Using Google to Search for evidence: How Much Is enough?. One Center’s experience. Systematic Reviews 14(1).
193. Mkhwanazi S, Gibbs A (2021) Risk factors for generalized anxiety disorder among young women and men in informal settlements in South Africa: A cross-sectional study. SSM - Mental Health 1(3): 100010.
194. Mokgobi M (2014) Understanding traditional African healing. African journal for physical health education, recreation, and dance 20(Suppl 2): 24.
195. Mokomane Z (2024) Indigenous Social Protection in Africa: Pathways to Resilience and Sustainable Development.
196. Mokona H, Yohannes K, Ayano G (2020) Youth unemployment and mental health: prevalence and associated factors of depression among unemployed young adults in Gedeo zone, Southern Ethiopia. International Journal of Mental Health Systems 14(1).
197. Monicca Thulisile Bhuda, Phemelo Olifile Marumo (2022) Ubuntu Philosophy and African Indigenous Knowledge Systems: Insights from decolonization and indigenization of research. Gender and Behaviour 20(1): 19133-19151.
198. Mpanje D, Gibbons, McDermott R, Omia DO, Olungah CO (2022) Social capital undergirds coping strategies: evidence from two informal settlements in Nairobi. Journal of International Humanitarian Action 7(1).
199. Muchemwa M, Sodi T (2025) Depressive symptoms and employment status change in South Africa: A longitudinal study. Acta Psychologica 258: 105194.
200. Murthy RS (2025) ‘Mental health’ in low- and middle-income countries. Oxford University Press eBooks 2: 449-460.
201. Mutiso VN, Pike K, Musyimi CW, Rebello TJ, Tele A, et al. (2018) Feasibility of WHO mhGAP-intervention guide in reducing experienced discrimination in people with mental disorders: a pilot study in a rural Kenyan setting. Epidemiology and Psychiatric Sciences 28(2): 156-167.
202. Mwakalila E (2022) Income inequality: a recipe for youth unemployment in Africa. SN Business & Economics 3(1).
203. Nayar KR (2013) Social Determinants of Health: A critique. Academia.edu.
204. Ndu M, Teachman G, Martin J, Elysee Nouvet (2024) “It’s what we perceive as different”: an interpretative phenomenological analysis of Nigerian women’s characterization of their health during the COVID-19 pandemic. BMC Women s Health 24(1).
205. Ndung’u JG, Éva Bíró (2024) Evaluating the impact of financial worry on mental health: a cross-sectional study among Kenyan radiographers. BMC Public Health 24(1).
206. Ngubane NP, De Gama BZ (2024) The influence of culture on the cause, diagnosis and treatment of serious mental illness (ufufunyana): Perspectives of traditional health practitioners in the Harry Gwala district, KwaZulu-Natal. Culture Medicine and Psychiatry 48(3): 634-654.
207. Ngui D, Ndung’u N, Shimeles A (2023) Poverty, Inequality and Social Protection Programs in Africa: Lessons from the COVID-19 Pandemic. Journal of African Economies 32(Supplement_2): ii3-ii9.
208. Nguyen Cousins T, Upton M (2025) Determinants of financial well-being among online financial education learners: a mixed-methods study. Discover Psychology 5(1).
209. Niohuru I (2023) Disease Burden and Mortality. Springer eBooks, p. 35-85.
210. Noyes J, Booth A, Moore G, Flemming K, Tunçalp Ö, et al. (2020) Synthesising quantitative and qualitative evidence to inform guidelines on complex interventions: Clarifying the purposes, designs and outlining some methods. BMJ Global Health 4(1).
211. Noyes J, Popay J, Pearson A, Hannes K, Booth A (2008) Qualitative Research and Cochrane Reviews. Cochrane Handbook for Systematic Reviews of Interventions, pp. 571-591.
212. Nutbeam D (1998) Evaluating Health Promotion--Progress, Problems and solutions. Health Promotion International 13(1): 27-44.
213. Omona K, Bashabire NBM, Bulamu R, Mugabe B, Balamaga SS, et al. (2025) Mental health in low-income countries: A call to improve mental health in Uganda. PLOS Mental Health 2(4).
214. (2025) Organisation for Economic Co-operation and Development (OECD). Health.
215. Osman W, Ncube F, Shaaban K, Alaa Dafallah (2024) Prevalence, predictors, and economic burden of mental health disorders among asylum seekers, refugees and migrants from African countries: A scoping review. PloS one 19(6): e0305495-e0305495.
216. Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A (2016) Rayyan—a Web and Mobile App for Systematic Reviews. Systematic Reviews 5(1).
217. Pabel A, Pryce J, Anderson A (2021) Research Paradigm Considerations for Emerging Scholars.
218. Palinkas LA (2014) Qualitative and Mixed Methods in Mental Health Services and Implementation Research. Journal of Clinical Child & Adolescent Psychology 43(6): 851-861.
219. Park CL, Kubzansky LD, Chafouleas SM, Davidson RJ, Keltner D, et al. (2022) Emotional Well-Being: What It Is and Why It Matters. Affective Science 4(1).
220. Park YS, Konge L, Artino AR (2020) The Positivism Paradigm of Research. Academic Medicine 95(5): 690-694.
221. Patel NM, Savaliya GV, Mehta, PJ, Kataria LR (2025) Global Disparities in Mental Health Systems: A Comparative Cross-sectional Study of Ten Countries with Different Income Levels. Indian Journal of Psychological Medicine.
222. Patel P, Kennedy A, Carr S, Gillard S, Harris P, et al. (2022) Service user experiences of mental health assessments: a systematic review and thematic synthesis of qualitative literature. Journal of Mental Health 34(1): 1-14.
223. Peddie N, Agnew S, Crawford M, Dixon D, MacPherson I, et al. (2021) The impact of medication side effects on adherence and persistence to hormone therapy in breast cancer survivors: A qualitative systematic review and thematic synthesis. The Breast 58: 147-159.
224. Peetz J, Robson J (2025) A Bidirectional Link between Financial Communication in Romantic Relationships and Financial Stress. Journal of Family and Economic Issues 46: 973-984.
225. Perestrelo ED, Sanyang S, Jumaa JA (2025) The burden and associated social determinants of mental health among adolescent girls and young women in Sub-Saharan Africa. Discover Public Health 22(1).
226. Perkins JM, Nyakato VN, Kakuhikire B, Tsai AC, Subramanian S, et al. (2017) Food insecurity, social networks and symptoms of depression among men and women in rural Uganda: a cross-sectional, population-based study. Public Health Nutrition 21(5): 838-848.
227. Pervin N, Mokhtar M (2022) The Interpretivist Research Paradigm: A Subjective Notion of a Social Context. ResearchGate 11(2): 419-428.
228. Porritt K, Gomersall J, Lockwood C (2014) JBIʼs Systematic Reviews. AJN, American Journal of Nursing 114(6): 47-52.
229. Rahim AA, Abdul Manaf R, Juni MH, Ibrahim N (2021) Health System Governance for the Integration of Mental Health Services into Primary Health Care in the Sub-Saharan Africa and South Asia Region: A Systematic Review. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, p. 58.
230. Ranganathan P, Aggarwal R (2018) Study designs: Part 1 - an Overview and Classification. Perspectives in Clinical Research 9(4): 184-186.
231. Richardson T (2022) The psychology of the relationship between money and mental health problems.
232. Robinson KA, Akinyede O, Dutta T, Sawin VI, Li T, et al. (2013). Framework for determining research gaps during systematic review: Evaluation. Agency for Healthcare Research and Quality (US).
233. Rodgers M, South E, Harden M, Whitehead M, Sowden A (2025) Contextual factors in systematic reviews: understanding public health interventions in low socioeconomic status and disadvantaged populations. Archives of Public Health 83(1).
234. Rose TC, Daras K, Manley J, McKeown M, Halliday E, et al. (2023) The mental health and wellbeing impact of a Community Wealth Building programme in England: a difference-in-differences study. The Lancet Public Health 8(6).
235. Ryan R, Deci E (2001) On Happiness and Human potentials: A review of research on hedonic and eudaimonic well-being. Annual Review of Psychology 52(1): 141-166.
236. Ryu S, Fan L (2022) The Relationship between financial worries and psychological distress among U.S. Adults. Journal of Family and Economic Issues 44(1): 16-33.
237. Sarfo JO, Attigah DK (2025) Reflecting on reflexivity and positionality in qualitative research: What, Why, When, and How? Journal of Advocacy, Research and Education 12(1).
238. Saunders M, Lewis P, Thornhill A (2009) Understanding Research Philosophies and Approaches.
239. Schwartz Shea P, Yanow D (2013) Interpretive Research Design. Routledge.
240. Sekhon M, Thurah A de, Fragoulis GE, Schoones J, Stamm TA, et al. (2024) Synthesis of guidance available for assessing methodological quality and grading of evidence from qualitative research to inform clinical recommendations: a systematic literature review. RMD Open 10(2): e004032.
241. Seligman M (2011) Flourish: A visionary new understanding of happiness and well-being. psycnet.apa.org.
242. Setegn Fentahun, Gidey Rtbey, Girum Nakie, Fantahun Andualem, Techilo Tinsae, et al. (2025) Burden of perceived stress among university students in Africa: a systematic review and meta-analysis. BMC Public Health 25(1).
243. Shorten A, Smith J (2017) Mixed Methods research: Expanding the evidence base. Evidence Based Nursing 20(3): 74-75.
244. Singh J (2013) Critical Appraisal Skills Programme. CASP Appraisal Tools. ResearchGate.
245. Solar O, Irwin AA (2010) Social Determinants of Health Discussion Paper 2 A ConCePtuAl FrAmework for ACtion on tHe SoCiAl DeterminAntS oF HeAltH.
246. Songo S (2024) Contextualising Cultural Sensitivity in Eurocentric and Afrocentric Perspectives for Psychological Practice and Research in Africa. Annual Review of Critical Psychology 17: 225-238.
247. Sturgeon JA, Arewasikporn A, Okun MA, Davis MC, Ong AD, et al. (2016) The Psychosocial Context of Financial Stress. Psychosomatic Medicine 78(2): 134-143.
248. Sutton AJ, Cooper NJ, Jones DR (2009) Evidence synthesis as the key to more coherent and efficient research. BMC Medical Research Methodology 9(1).
249. Talamonti D, Schneider J, Gibson B, Forshaw M (2023) The impact of national and international financial crises on mental health and well-being: a systematic review. Journal of Mental Health 33(4).
250. Tanlaka EF, Aryal S (2025) Interpretivist constructivism: A valuable approach for qualitative nursing research. Open Journal of Therapy and Rehabilitation 13(01): 8-19.
251. Taylor KS, Mahtani KR, Aronson JK (2021) Summarising good practice guidelines for data extraction for systematic reviews and meta-analysis. BMJ Evidence-Based Medicine 26(3): 88-90.
252. Techilo Tinsae, Shegaye Shumet, Girmaw Medfu Takelle, Gidey Rtbey, Mamaru Melkam, et al. (2024) The burden and its determinants of mental health distress among adolescents dwelling in Africa: A systematic review and meta-analysis. Child and Adolescent Psychiatry and Mental Health 18(1).
253. Tenny S, Brannan J, Brannan G (2022) Qualitative Study. National Library of Medicine.
254. Tibbetts J, Chapman C, O’Dean S, Butterworth P, Slade T (2025) The Longitudinal relationship between financial hardship and Mental Health - A Systematic Review of the Evidence. SSM - Mental Health, p. 8.
255. Trudel Fitzgerald C, Millstein RA, von Hippel C, Howe CJ, Tomasso LP, et al. (2019) Psychological well-being as part of the public health debate? Insight into dimensions, interventions, and policy. BMC Public Health 19(1).
256. Turin TC, Raihan M, Chowdhury N (2024) Paradigms of approaches to research. Bangabandhu Sheikh Mujib Medical University Journal 17(2): 1-4.
257. Ungar M (2011) The social ecology of resilience: addressing contextual and cultural ambiguity of a nascent construct. The American Journal of Orthopsychiatry 81(1): 1-17.
258. Valizadeh A, Moassefi M, Nakhostin Ansari A, Hosseini Asl SH, Saghab Torbati M, et al. (2022) Abstract screening using the automated tool Rayyan: results of effectiveness in three diagnostic test accuracy systematic reviews. BMC Medical Research Methodology 22(1).
259. Ventevogel P, Jordans M, Reis R, de Jong J (2013) Madness or sadness? local concepts of mental illness in four conflict-affected African communities. Conflict and Health 7(1).
260. Vesely CK, Brown EL, Mehta S, Horner CG (2022) ‘Staying Afloat’: A mixed methods study of the financial and psychological well-being of early childhood educators. Early Childhood Education Journal, p. 52.
261. Viola E, Martorana M, Ceriotti D, Marta De Vito, Damiano De Ambrosi, et al. (2024) The effects of cultural engagement on health and well-being: a systematic review. Frontiers in Public Health 12: 1369066.
262. Wang X, Cheng Z (2020) Cross-sectional studies: Strengths, weaknesses, and recommendations. Chest 158(1): 65-71.
263. Weich S, Lewis G (1998) Poverty, unemployment, and common mental disorders: population based cohort study. BMJ 317(7151): 115-119.
264. Weida EB, Phojanakong P, Patel F, Chilton M (2020) Financial health as a measurable social determinant of health. PLOS ONE 15(5).
265. Whiteford HA, Ferrari AJ, Degenhardt L, Feigin V, Vos T (2015) The global burden of mental, neurological and substance use disorders: An Analysis from the Global Burden of Disease Study 2010. PLOS ONE 10(2): e0116820.
266. (2023) WHO Mental Health Gap Action Programme (mhGAP).
267. Williams SA, Baldeh M, Bah AJ, Dennis F, Robinson DR, et al. (2025) Pathways to mental health services across local health systems in sub-Saharan Africa: Findings from a systematic review. PLOS One 20(6): e0324064.
268. Williams V, Boylan AM, Nunan D (2020) Critical appraisal of qualitative research: Necessity, partialities and the issue of bias. BMJ Evidence-Based Medicine 25(1).

269. Willis MEH (2022) Critical realism and qualitative research in psychology. Qualitative Research in Psychology 20(2): 1-24.
270. (2024) World Bank Poverty, Prosperity, and Planet Report 2024. World Bank.
271. (2019b) World bank Group. Unemployment, total (% of total labor force) (modeled ILO estimate) - Sub-Saharan Africa | Data.
272. (1948) World Health Organization. Constitution of the world health organization. World Health Organization.
273. (2021a) World Health Organization. Comprehensive Mental Health Action Plan 2013 -2030.
274. (2021b) World Health Organization. Mental Health ATLAS 2020.
275. (2022) World Health Organization (WHOb). Barriers to mental health care in Africa. WHO | Regional Office for Africa.
276. (2024) Worldometer Population of Africa (2019) - Worldometers. Worldometers.info.
277. Yeboah SA (2025) The Role of Financial Inclusion in Building Household Resilience to Climate and Economic Shocks in Sub-Saharan Africa: A Systematic Review.
278. Hill VZ (2011) The connections between self-esteem and psychopathology. Journal of Contemporary Psychotherapy 41(3): 157-164.
279. Zhang Z, Chen X, Wu S, Chen X, Wang X, et al. (2025) Global, regional and national burden of anxiety and depression disorders from 1990 to 2021, and forecasts up to 2040. Journal of Affective Disord 393(Pt A): 120299.
280. Hall BJ, Garabiles MR, Hoop J, Pereira A, Prencipe L, et al. (2019) Perspectives of adolescent and young adults on poverty-related stressors: A qualitative study in Ghana, Malawi and Tanzania. BMJ Open 9(10): e027047.