{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T16:34:12Z","timestamp":1792514052472,"version":"4.5.0"},"reference-count":57,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2021,4,22]],"date-time":"2021-04-22T00:00:00Z","timestamp":1619049600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Although adolescents are highly vulnerable to mental health challenges, they receive little attention, especially in developing countries. We investigated the mental health difficulties (MHDs) faced by adolescent students in four senior high schools in Ghana, their coping strategies and support systems.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>In this convergent mixed-methods study, quantitative data was obtained using validated strengths and difficulties questionnaire to assess the mental health of 405 adolescents. Qualitative data was collected through in-depth interview with 18 teachers and seven focused group discussions with 35 students. Adjusted odds ratios (OR) for MHDs were estimated through ordinal logistic regression in Stata 14.2. Qualitative data was analyzed inductively and deductively using ATLAS.ti 7.1.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>Over half (58.5%) experienced peer (20.5%), emotional (16.3%), conduct (13.3%) and hyperactivity (3.0%) problems, whereas 5.4% exhibited prosocial behaviours. MHDs were associated with females (OR = 2.27, 95% CI: 1.47\u20133.50), bullying (OR = 1.72, CI: 1.07\u20132.75), domestic violence (OR = 1.87, CI: 1.10\u20133.17), substance abuse (OR = 8.14, CI: 1.41\u201346.8), academic pressure (OR = 2.40, CI: 1.30\u20134.42) and self-perceived poor school performance (OR = 7.36 CI: 2.83\u201319.16). Qualitatively, we identified financial challenges, spiritual influences, intimate relationships, bullying, and domestic violence as the main themes attributed to MHDs. Coping strategies included isolation, substance use and spiritual help. The main school-based support system was the guidance and counselling unit, but there were complaints of it been ineffective due to trust and confidentially issues, and non-engagement of qualified counsellors.<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>As many triggers of MHDs emanate in schools, we need mental health-friendly school environments where trained psychotherapists head counselling centres. We propose incorporating mental health education into school curricula and generating surveillance data on adolescent\u2019s mental health.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0250424","type":"journal-article","created":{"date-parts":[[2021,4,22]],"date-time":"2021-04-22T20:03:21Z","timestamp":1619121801000},"page":"e0250424","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":48,"title":["Mental health difficulties, coping mechanisms and support systems among school-going adolescents in Ghana: A mixed-methods study"],"prefix":"10.1371","volume":"16","author":[{"given":"Noella Dufie","family":"Addy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7707-5658","authenticated-orcid":true,"given":"Faith","family":"Agbozo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Runge-Ranzinger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pauline","family":"Grys","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,4,22]]},"reference":[{"key":"pone.0250424.ref001","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1016\/j.adolescence.2017.03.009","article-title":"Effectiveness of a pragmatic school-based universal intervention targeting student resilience protective factors in reducing mental health problems in adolescents","volume":"57","author":"J Dray","year":"2017","journal-title":"Journal of adolescence"},{"issue":"16","key":"pone.0250424.ref002","doi-asserted-by":"crossref","first-page":"3397","DOI":"10.1017\/S0033291716002282","article-title":"Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort","volume":"46","author":"K Beckman","year":"2016","journal-title":"Psychological medicine"},{"key":"pone.0250424.ref003","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.socscimed.2018.12.030","article-title":"Adolescent mental health and unemployment over the lifespan: Population evidence from Sweden","volume":"222","author":"V Mousteri","year":"2019","journal-title":"Social Science & Medicine"},{"issue":"1","key":"pone.0250424.ref004","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.jad.2013.06.010","article-title":"Subthreshold depression in children and adolescents\u2013a systematic review","volume":"151","author":"R Wesselhoeft","year":"2013","journal-title":"Journal of affective disorders"},{"key":"pone.0250424.ref005","unstructured":"World Health Organization. Adolescent mental health Factsheet. 2018."},{"issue":"10036","key":"pone.0250424.ref006","doi-asserted-by":"crossref","first-page":"2423","DOI":"10.1016\/S0140-6736(16)00579-1","article-title":"Our future: a Lancet commission on adolescent health and wellbeing","volume":"387","author":"GC Patton","year":"2016","journal-title":"The Lancet"},{"issue":"9783","key":"pone.0250424.ref007","doi-asserted-by":"crossref","first-page":"2093","DOI":"10.1016\/S0140-6736(11)60512-6","article-title":"Global burden of disease in young people aged 10\u201324 years: a systematic analysis","volume":"377","author":"FM Gore","year":"2011","journal-title":"The Lancet"},{"issue":"1","key":"pone.0250424.ref008","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1186\/1471-2458-13-288","article-title":"Poor mental health in Ghana: who is at risk?","volume":"13","author":"H Sipsma","year":"2013","journal-title":"BMC public health"},{"key":"pone.0250424.ref009","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.jad.2014.09.025","article-title":"Prevalence and determinants of depressive symptoms among university students in Ghana","volume":"171","author":"KO Asante","year":"2015","journal-title":"Journal of affective disorders"},{"issue":"10024","key":"pone.0250424.ref010","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.1016\/S0140-6736(15)00234-2","article-title":"Suicide and suicidal behaviour","volume":"387","author":"G Turecki","year":"2016","journal-title":"The Lancet"},{"key":"pone.0250424.ref011","unstructured":"World Health Organization. Global health estimates 2016. World Health Organization, Geneva https:\/\/wwwwhoint\/healthinfo\/global_burden_disease\/en\/. 2019;29."},{"key":"pone.0250424.ref012","unstructured":"World Health Organization. Global accelerated action for the health of adolescents: guidance to support country implementation: summary. Global accelerated action for the health of adolescents: guidance to support country implementation: summary: World Health Organization Geneva; 2017."},{"issue":"4","key":"pone.0250424.ref013","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1016\/j.jadohealth.2016.06.020","article-title":"Interventions for adolescent mental health: an overview of systematic reviews","volume":"59","author":"JK Das","year":"2016","journal-title":"Journal of Adolescent Health"},{"issue":"10176","key":"pone.0250424.ref014","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/S0140-6736(18)32427-9","article-title":"Progress in adolescent health and wellbeing: tracking 12 headline indicators for 195 countries and territories, 1990\u20132016","volume":"393","author":"PS Azzopardi","year":"2019","journal-title":"The Lancet"},{"key":"pone.0250424.ref015","author":"H Frankish","year":"2018","journal-title":"Mental health for all: a global goal"},{"key":"pone.0250424.ref016","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.ijer.2018.01.012","article-title":"The relationships between school climate and adolescent mental health and wellbeing: A systematic literature review","volume":"88","author":"JM Aldridge","year":"2018","journal-title":"International Journal of Educational Research"},{"issue":"11\u201312","key":"pone.0250424.ref017","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1080\/0267257X.2018.1513056","article-title":"Peer socialisation: brand-related bullying in the school classroom","volume":"34","author":"WP Williams","year":"2018","journal-title":"Journal of Marketing Management"},{"issue":"2","key":"pone.0250424.ref018","first-page":"1","article-title":"Stress, stressors and coping strategies among secondary school students in a Malaysian government secondary school: Initial findings","volume":"11","author":"MSB Yusoff","year":"2010","journal-title":"ASEAN Journal of Psychiatry"},{"issue":"1","key":"pone.0250424.ref019","first-page":"26","article-title":"Academic stress, parental pressure, anxiety and mental health among Indian high school students","volume":"5","author":"S Deb","year":"2015","journal-title":"International Journal of Psychology and Behavioral Sciences"},{"issue":"1","key":"pone.0250424.ref020","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s40653-017-0157-9","article-title":"Trauma, family factors and the mental health of homeless adolescents","volume":"12","author":"NG Milburn","year":"2019","journal-title":"Journal of Child & Adolescent Trauma"},{"key":"pone.0250424.ref021","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.socscimed.2013.04.026","article-title":"Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review","volume":"90","author":"F Reiss","year":"2013","journal-title":"Social science & medicine"},{"issue":"3","key":"pone.0250424.ref022","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1001\/archpediatrics.2011.592","article-title":"Prevalence of child mental health problems in sub-Saharan Africa: a systematic review","volume":"166","author":"MA Cortina","year":"2012","journal-title":"Archives of pediatrics & adolescent medicine"},{"issue":"4","key":"pone.0250424.ref023","doi-asserted-by":"crossref","first-page":"392","DOI":"10.3109\/09540261.2014.928270","article-title":"Social determinants of mental health","volume":"26","author":"J Allen","year":"2014","journal-title":"International review of psychiatry"},{"issue":"3","key":"pone.0250424.ref024","first-page":"136","article-title":"Understanding campus culture and student coping strategies for mental health issues in five Canadian colleges and universities","volume":"47","author":"D Giamos","year":"2017","journal-title":"Canadian Journal of Higher Education\/Revue canadienne d\u2019enseignement sup\u00e9rieur"},{"issue":"2","key":"pone.0250424.ref025","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1037\/cou0000249","article-title":"Racial-ethnic microaggressions, coping strategies, and mental health in Asian American and Latinx American college students: A mediation model","volume":"65","author":"D Sanchez","year":"2018","journal-title":"Journal of counseling psychology"},{"key":"pone.0250424.ref026","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.3389\/fpsyg.2015.01028","article-title":"A multi-method exploratory study of stress, coping, and substance use among high school youth in private schools","volume":"6","author":"NR Leonard","year":"2015","journal-title":"Frontiers in psychology"},{"issue":"5","key":"pone.0250424.ref027","first-page":"958","article-title":"Coping strategies for stress used by adolescent girls in Riyadh, Kingdom of Saudi Arabia","volume":"30","author":"H Raheel","year":"2014","journal-title":"Pakistan journal of medical sciences"},{"key":"pone.0250424.ref028","unstructured":"World Health Organization. Knowledge Summary: Women\u2019s, Children\u2019s and Adolescents\u2019 Health. Adolescent Mental Health: Time for Action. World Health Organization, Geneva. 2019; https:\/\/www.who.int\/pmnch\/knowledge\/publications\/AMH.pdf?ua=1."},{"key":"pone.0250424.ref029","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/09638237.2020.1739253","article-title":"Mental health challenges in academia: comparison between students of the various educational levels in Ghana","author":"DK Ahorsu","year":"2020","journal-title":"Journal of Mental Health"},{"key":"pone.0250424.ref030","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.mhp.2019.01.009","article-title":"Alcohol use by school-going adolescents in Ghana: Prevalence and correlates","volume":"13","author":"KO Asante","year":"2019","journal-title":"Mental Health & Prevention"},{"issue":"4","key":"pone.0250424.ref031","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1007\/s12187-017-9495-2","article-title":"Gender, age, religion and positive mental health among adolescents in a Ghanaian socio-cultural context","volume":"11","author":"A Wilson","year":"2018","journal-title":"Child Indicators Research"},{"issue":"1","key":"pone.0250424.ref032","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s13034-019-0293-0","article-title":"Cannabis and amphetamine use and its psychosocial correlates among school-going adolescents in Ghana","volume":"13","author":"KO Asante","year":"2019","journal-title":"Child and adolescent psychiatry and mental health"},{"issue":"1","key":"pone.0250424.ref033","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13104-019-4300-6","article-title":"The relationship between psychological distress and bullying victimisation among school-going adolescents in Ghana: a cross-sectional study","volume":"12","author":"DK Arhin","year":"2019","journal-title":"BMC research notes"},{"key":"pone.0250424.ref034","author":"JW Creswell","year":"2013","journal-title":"Steps in conducting a scholarly mixed methods study"},{"key":"pone.0250424.ref035","unstructured":"Ghana Statistical Service. 2010 Population and Housing Census. Regional Analytical Report, Volta region. Accra, Ghana Ghana Statistical Service, 2013."},{"issue":"3","key":"pone.0250424.ref036","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1007\/s007870050057","article-title":"The Strengths and Difficulties Questionnaire: A pilot study on the validity of the self-report version","volume":"7","author":"R Goodman","year":"1998","journal-title":"European child & adolescent psychiatry"},{"issue":"1","key":"pone.0250424.ref037","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1752-4458-9-1","article-title":"Correlates of psychological functioning of homeless youth in Accra, Ghana: a cross-sectional study","volume":"9","author":"KO Asante","year":"2015","journal-title":"International journal of mental health systems"},{"issue":"9826","key":"pone.0250424.ref038","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1016\/S0140-6736(12)60149-4","article-title":"Adolescence and the social determinants of health","volume":"379","author":"RM Viner","year":"2012","journal-title":"The lancet"},{"issue":"2","key":"pone.0250424.ref039","doi-asserted-by":"crossref","first-page":"9","DOI":"10.3390\/bs6020009","article-title":"Young love: Romantic concerns and associated mental health issues among adolescent help-seekers","volume":"6","author":"M Price","year":"2016","journal-title":"Behavioral Sciences"},{"issue":"1","key":"pone.0250424.ref040","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1177\/0022146513520432","article-title":"Caught in a bad romance: Adolescent romantic relationships and mental health","volume":"55","author":"B Soller","year":"2014","journal-title":"Journal of health and social behavior"},{"issue":"1","key":"pone.0250424.ref041","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.adolescence.2013.10.004","article-title":"Prevalence of DSM-IV mental disorders, deliberate self-harm and suicidal ideation in early adolescence: An Irish population-based study","volume":"37","author":"H Coughlan","year":"2014","journal-title":"Journal of adolescence"},{"issue":"1","key":"pone.0250424.ref042","doi-asserted-by":"crossref","DOI":"10.1136\/bmjpo-2017-000139","article-title":"Epidemiological survey of mental health in adolescent school children of Gujarat, India","volume":"1","author":"S Nair","year":"2017","journal-title":"BMJ paediatrics open"},{"issue":"5","key":"pone.0250424.ref043","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1080\/00981389.2017.1284704","article-title":"Strategies to destigmatize mental illness in South Africa: Social work perspective","volume":"56","author":"TC Matsea","year":"2017","journal-title":"Social work in health care"},{"issue":"11","key":"pone.0250424.ref044","doi-asserted-by":"crossref","first-page":"1191","DOI":"10.1007\/s00127-010-0290-3","article-title":"The stigma of mental illness in Southern Ghana: attitudes of the urban population and patients\u2019 views","volume":"46","author":"A Barke","year":"2011","journal-title":"Social psychiatry and psychiatric epidemiology"},{"issue":"1","key":"pone.0250424.ref045","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4102\/phcfm.v9i1.1404","article-title":"Community perceptions of mental illness in rural Uganda: An analysis of existing challenges facing the Bwindi Mental Health Programme","volume":"9","author":"A Shah","year":"2017","journal-title":"African journal of primary health care & family medicine"},{"key":"pone.0250424.ref046","first-page":"1","article-title":"Knowledge, Attitudes and Perceptions about Mental Illness in Ekom Iman Community in Akwa Ibom State, South-South Nigeria","author":"HE Jombo","year":"2019","journal-title":"Asian Journal of Medicine and Health"},{"issue":"1","key":"pone.0250424.ref047","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4102\/phcfm.v11i1.1941","article-title":"Indigenous and faith healing for mental health in Ghana: An examination of the literature on reported 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