A Systematic Review of Research and Governance in Child and Adolescent Mental Health in Africa.

Background: Children and adolescents with mental health conditions represent a uniquely vulnerable population, particularly in Africa where mental health systems are under-resourced and understudied. Conducting research with this group raises complex ethical questions that require robust legislative and ethical oversight.

Methods: This systematic review included searches from Medline, Embase, PsycInfo, Global Health and grey literature, conducted without any time restrictions up to 10 September 2023. Publications included focused on individuals aged 0-17. All study designs were included if they addressed governance and regulations in child and adolescent mental health research in Africa. Excluded publications did not report findings specific to children, to Africa, to governance or regulations in mental health research, or had no available full text. Articles were critically appraised using JBI checklists and data was extracted into Excel. Articles were narratively synthesised using frequencies for dates of regulations and ages of consent and coded in NVivo for attitudes toward regulation. The study protocol is available at PROSPERO (CRD42023464864).

Results: This review identified 14 articles from nine countries across Africa. Most regulations were over a decade old, with the most recent from 2017. The publications covered five themes: concerns toward unfavourable existing legislation, concerns about risks of undertaking research on a clinical frontline, a call to action regarding the dearth of African literature in this field, specific recommendations for future research and suggested new research directions.

Conclusions: This study highlights the need for improved research governance and legislation to protect children and adolescents in mental health research in Africa. Overall, most African countries place a low priority on child and adolescent mental health research.