From suicidal ideation to hope: Perceived mental health transformation following a culturally adapted multiple family group therapy for adolescents living with HIV in Ghana - A qualitative process evaluation

Adolescents living with HIV (ALHIV) in sub-Saharan Africa experience profound mental health challenges including depression, anxiety, and suicidal ideation. Evidence-based psychological interventions specifically designed for this population remain scarce, particularly family-based approaches in resource-limited settingsThis study explored ALHIV's perceived mental health transformation following participation in culturally adapted Multiple Family Group Therapy (MFGT) in Ghana.Qualitative study nested within a randomized controlled trial (NCT06701942) conducted in Lower Manya Krobo District, Ghana. Nineteen ALHIV who completed the 10-MFGT core content sessions. MFGT intervention participated in three focus group discussions. Data were analyzed using Braun and Clarke's reflexive thematic analysis.Three major themes emerged: (1) Pre-Intervention Mental Health Crisis, (2) Psychological Change Mechanisms, and (3) Mental Health Transformation. Pre-intervention, ALHIV described experiencing profound mental health crisis-level distress including active suicidal ideation with method-specific planning, emotional dysregulation, and existential foreclosure. Intervention mechanisms facilitating transformation included cognitive reframing through culturally resonant metaphors, dual-level universality (peer and intergenerational family), biomedical knowledge (U = U) as psychological intervention, and emotional catharsis in safe spaces. Post-intervention, participants described substantial perceived improvements in mental health characterized by reduced suicidal ideation, emotional regulation gains, reduced anxiety, and greater psychological peace.Culturally adapted family-based group therapy was associated with meaningful mental health improvements, including reduced suicidal ideation. Participants described shifts in emotional wellbeing, coping, and family cohesion, though the qualitative design precludes causal claims. Findings support the feasibility of task-shifted, family-centered interventions in resource-limited settings and underscore the need to integrate mental health screening and family-based support into HIV diagnosis protocols. Trial registration Clinical trials.gov ( NCT06701942 )