A qualitative participatory study on adolescent mental health and well-being in Sierra Leone

Adolescents in Sierra Leone have endured successive crises including civil conflict, the 2014 to 2016 Ebola virus disease outbreak, and the COVID-19 pandemic, each compounding pre-existing vulnerabilities in mental health, education, and family stability. Despite growing global recognition of adolescent mental health as a public health priority, qualitative evidence documenting how young Sierra Leoneans experience distress, coping, and recovery remains limited. This study examined how adolescents in Sierra Leone experience mental health, well-being, coping, schooling, and post-crisis recovery. A qualitative participatory study was conducted across three districts in Sierra Leone between February and July 2024. Purposive sampling recruited 112 participants, including adolescents aged 13 to 19 years, caregivers, teachers, youth leaders, community health workers, counsellors, and child protection actors. Data were collected through in-depth interviews, focus group discussions, emotion mapping, personal timelines, and guided storytelling. Reflexive thematic analysis was applied. We identified four themes: (1) landscapes of distress, encompassing grief, fear, poverty-related shame, and school disruption; (2) gendered and intersecting vulnerabilities, including early marriage, sexual violence, and differential educational access; (3) coping, resilience, and meaning-making through faith, peer solidarity, creative expression, and aspiration; and (4) navigating support, revealing trust barriers, stigma, and the centrality of informal networks. Adolescent mental health in Sierra Leone is shaped by layered, intersecting crises that exceed individual-level coping. School-based psychosocial support, community-level stigma reduction, and gender-responsive services are urgently needed.