Mental health interventions for refugees in Africa: a scoping review of implementation and motivations

ABSTRACT

Background: The global refugee crisis and rising instability have intensified mental health challenges, particularly among refugee populations. Various stakeholders have introduced interventions to address issues such as trauma, stress, anxiety, and depression. However, the specific interventions being implemented in African contexts, their effectiveness, and the motivations behind them remain unclear. This scoping review explores two research questions: (1) What mental health interventions are being implemented among refugees in Africa, and what key findings, recommendations, and challenges have been reported? (2) What are the underlying motivations for implementing these interventions?

Methods: We conducted a systematic search of Web of Science, PubMed, and PsycINFO for articles published between 2010 and 2024. Guided by PRISMA standards and Arksey and O'Malley's scoping review framework, we addressed the first research question by summarizing data in tabular form. For the second question, we performed qualitative content analysis to identify common motivational themes, which were also presented in summary tables and expanded upon in the discussion.

Results: Twelve studies met the inclusion criteria. Overall, the interventions produced positive mental health outcomes. Common recommendations included partnering with local organizations, implementing regular suicide prevention efforts, and customizing digital tools to community needs. Thematic analysis revealed five motivations driving intervention efforts: community needs, recognition of risk and protective factors, adaptability and scalability, holistic mental health approaches, and emphasis on evidence-based practices.

Conclusion: There is a limited number of mental health interventions implemented in refugee communities across Africa. Many lack alignment with the specific needs of the populations they aim to serve. Future efforts should prioritize culturally informed, evidence-based mental health interventions that are both context-sensitive and scalable.

HIGHLIGHTS

• This scoping review examines the motivations and implementation strategies of mental health interventions for refugees in Africa.

• Key findings highlight the role of cultural adaptations, funding constraints, and collaboration with local organizations in intervention success.

• The study provides insights for policymakers, practitioners, and researchers on improving the accessibility and sustainability of refugee mental health programmes.

1. Background

The global refugee crisis has led to a dramatic increase in displaced populations, with more than 122 million people forcibly displaced from their homes as of June 2024 due to war, violence, and persecution (United Nations High Commissioner on Refugees [UNHCR, 2024]). Many displaced, particularly in low-income countries that already face significant socio-economic challenges. Uganda is a prime example, being home to approximately two million refugees (Ahimbisibwe, 2018) and ranking in the top five refugee-receiving nations behind Iran, Turkey, Colombia, and Germany (UNHCR, 2024). While much attention has been given to the physical needs of refugees, their mental health remains a critical issue, especially given the trauma of displacement, ongoing resettlement stressors, and limited access to adequate mental health services (Hynie, 2018). Understanding the motivations behind the establishment of mental health interventions for refugees in these settings is essential to ensure the effectiveness, sustainability, and cultural appropriateness of the services provided. This scoping review examines the key motivations behind the development of refugee mental health interventions in Africa, exploring the factors that influence their development and implementation.

The significance of this research lies in its relevance to the current global situation. Refugee numbers are at an all-time high, driven by conflicts, political instability, and climate change (Fransen & De Haas, 2022). Despite the acute need for mental health services in these settings, interventions are often limited, under-resourced, and not always designed for the specific needs of refugee populations (Tol et al., 2018).

Current knowledge about refugee mental health interventions largely focuses on the types of services provided and their outcomes (Murray et al., 2010). Evidence-based interventions like Cognitive Behavioral Therapy (CBT), Interpersonal Psychotherapy (IPT), and Problem Management Plus (PM+) have been implemented to address mental health issues such as post-traumatic stress disorder (PTSD), anxiety, and depression among refugees (Lakin et al., 2022). While these interventions have shown effectiveness in reducing symptoms of mental distress, particularly in short-term contexts, the drivers behind their implementation in low-income countries remain underexplored. Mental health services for refugees are often initiated by international humanitarian organizations (Priebe et al., 2016), but the extent to which these programmes are adapted to local contexts or shaped by local government priorities is unclear. Additionally, little is known about how low-income countries prioritize mental health services for refugees within broader health strategies.

This study addresses a critical gap in knowledge on the motivations behind refugee mental health interventions in Africa. The purpose of this scoping review is to: (1) identify the key findings, recommendations, and challenges identified in studies focused on refugee mental health interventions in Africa and (2) assess motivations behind the establishment of the mental health intervention among refugee communities in Africa. By examining the factors influencing these interventions, it sheds light on the challenges and opportunities for scaling up mental health services tailored to displaced populations in resource-limited settings, with a focus on the roles of local governments, international organizations, and donor agencies.

2. Methods

This review followed the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist and explanation (Tricco et al., 2018), which includes 20 essential reporting items and 2 optional items. It is further guided by the five stages recommended by Arksey and O’Malley. These stages include: (1) identifying the research question, (2) finding relevant studies, (3) selecting studies, (4) charting the data, and (5) collating, summarizing, and reporting results (Arksey & O'Malley, 2005).

2.1. Identifying the research questions

Two specific research questions guided the entire review process, including study search and identification, data extraction, and results reporting. These research questions were: (1) What refugee mental health interventions are being implemented in Africa, and what key findings, recommendations, and challenges have been identified in related studies? And (2) What are the motivations driving the establishment of mental health interventions within refugee communities in Africa?

2.2. Identifying relevant studies

A list of search terms was created based on the research questions. These terms included ‘refugee’ AND ‘mental health interventions’ AND ‘Africa’ AND ‘driver’ OR ‘motivation.’ The search was then expanded with terms like ‘Refugee,’ ‘Displaced person,’ ‘Asylum seeker,’ ‘Forced migrant,’ ‘Internally displaced person,’ ‘IDP,’ AND ‘Mental health program,’ ‘Psychosocial intervention,’ ‘Mental health support,’ ‘Psychological intervention,’ ‘Psychotherapy,’ ‘Mental health service,’ ‘Counseling,’ ‘Trauma-informed care,’ AND ‘Africa,’ ‘African countries,’ ‘Sub-Saharan Africa,’ ‘East Africa,’ ‘West Africa,’ ‘Central Africa,’ ‘North Africa,’ ‘Southern Africa,’ ‘Uganda,’ AND ‘Driver,’ ‘Factor,’ ‘Determinant,’ ‘Motivation,’ ‘Influence,’ ‘Reason,’ or ‘Catalyst.’ Terms were adjusted per each database's requirements, and the search was conducted using PubMed, Web of Science, and PsycINFO/ProQuest, chosen for their extensive publications on mental health interventions among marginalized populations, including refugee communities.

2.3. Selecting studies

The study was guided by the following inclusion and exclusion criteria:

2.3.1. Inclusion criteria

• Publication date: Peer reviewed articles published between 2010 and 2024 will be considered to ensure the inclusion of recent and relevant studies.

• Focus area: Studies focused specifically on mental health interventions targeted at refugee populations and involved original data collection (e.g. qualitative, quantitative, or mixed methods and Randomized Control Trials (RCTs)) were considered. This ensured the inclusion of primary research providing firsthand evidence

• Geographic scope: The research had been conducted in one or more African countries, emphasizing region-specific insights into mental health challenges and interventions.

2.3.2. Exclusion criteria

• Interventions conducted outside of African countries were excluded, as the focus is on region-specific mental health strategies for refugees.

• Articles published before 2010 were excluded to maintain a focus on more recent literature.

• Desk reviews, scoping reviews, systematic reviews, and meta-analyses were excluded, as the objective is to review studies involving original data collection rather than secondary analysis.

The references of the identified articles from the three search engines were downloaded and uploaded to Covidence, a software tool commonly used for organizing scoping reviews and systematic reviews’ data. Three independent reviewers, the first, third, and fourth authors were involved in the review process, examining both titles and abstracts in Covidence. The first author is currently a PhD student in the Department of Human Development and Family Studies specializing in Couples and Family Therapy at a university in the Midwest in the United States and holds bachelor’s and master’s degrees in Community and Clinical Psychology from a university in Uganda. The third author was held both bachelor's and master’s degrees in Community and Clinical Psychology from a university in Uganda. The fourth author was an undergraduate student majoring in Psychology in a predominantly PhD-led research lab in a university in the Midwest in the U.

After the initial review, any conflicts were resolved collaboratively to ensure transparency throughout the process (Luberenga et al., 2023). Based on the initial review of study titles and abstracts, articles meeting the inclusion criteria were selected for full-text review. The first, third and fourth authors engaged in this process. Following the review, the team met to discuss and resolve any conflicts, deciding by consensus whether each article should proceed to the data extraction phase or be excluded.

2.4. Charting data

Articles that met all inclusion criteria were selected for data extraction. Using Covidence software, relevant information was charted, including author names, study aim/purpose, Intervention, Population + Sample size, Study design, Outcome measures and Instruments Used, sampling methods, Motivating factors, Recommendations & implications, and Study gaps/Challenges. The charted data was designed to ensure alignment with the study questions, allowing for a comprehensive analysis based on the extracted information (Table 1).

Table 1.

Characteristics of the Mental Health Interventions among Refugees.

Author name and year of publication	Study purpose/Aim	Intervention	Population + Sample size	Study design	Outcome measures	Instruments used
Lasater et al., 2020	Exploring the uptake, acceptability and participation of women in the BFS Program, explore the needs and experiences of staff delivering the BFS programme, and assess whether and how participation in BFS activities is associated with improved maternal and child outcomes	The Baby Friendly Spaces (BFS) Program	N = 201 women living in Nguenyyiel refugee camp aged 12 or older breastfeeding a child under the age of 2	Mixed methods	General psychological distress, depression symptoms, PTSD	World Health Organization Disability Assessment Schedule, Kessler Psychological Distress Scale-6 item, Patient Health Questionnaire, PTSD Checklist, WHO BREAST Feed Observation Form, MUAC, Illness Inventory
Ingabire and Richters, 2020	Exploring factors contributing to suicidal ideation, attempts and death, investigate existing support and referral mechanisms, and provide recommendations regarding prevention and care strategies	Community-based socio-therapy	N = 279 Congolese refugees in Rwanda aged 15–50 years	Exploratory qualitative		Focus group discussion, In-depth interviews
Burchert, 2024	Evaluating the effectiveness of the Step-by Step programme as a self-guided intervention with optional message-based contact on demand support on reducing psychological distress, functional impairment, PTSD and self-identified problems	Step-by-Step (SbS) programme	N = 538 Arabic speaking Syrian refugees with a basic literacy level and internet access	Two-arm pragmatic randomized controlled trial	Psychological distress, impaired functioning, PTSD and self-identified problems	Hopkins Symptom Checklist, WHO Disability Assessment Schedule (WHODAS 2.0), PTSD Checklist for DSM-5
Stark et al., 2024	Examining the effectiveness of the Journey of Life (JoL) on caregiver well-being and caregiving behaviours	Journey of life (JoL). Group-based curriculum delivered over the course of 12 sessions	N = 1307 refugees in Kiryandongo refugee settlement, Uganda	A waitlist-control quasi-experimental design	Mental distress social support	World Health Organization Disability Assessment Schedule (WHODAS), Parental warmth and affection (warmth) subscale of the Parental Acceptance and Rejection Questionnaire (PARQ), parental undifferentiated rejection (undifferentiated subscale of the PARQ) and attitudes toward VAC (VAC subscale of the Child Protection Index (CPI)).
Lambert et al., 2024	Investigating gender differences in mental health by examining specific risk (trauma exposure, adaptation challenges, and discrimination) and protective factors (marital status, literacy, and social resources) in relation to posttraumatic stress symptoms and depression	No specific intervention studied; findings suggest potential gender-sensitive mental health programming	N = 667 adult Congolese refugees in Uganda	Quantitative	Trauma exposure, adaptation challenges, discrimination, PTSS, depression	Perceived Needs Scale (HESPER), Social Capital Assessment Tool, Adapted Social Capital Assessment Tool, and PTSD Checklist for DSM-5 Hopkins Symptom Checklist
Augustinavicius et al., 2023	Assessing whether participation in Self Help Plus (SH+) versus enhanced usual care (EUC) resulted in reduced incidence of probable mental disorder and increased positive mental health and well-being post-intervention among South Sudanese refugee women in Uganda	Self Help Plus (SH+)	N = 694 South Sudanese refugee women in Uganda	Randomized control trial	The primary outcome for both trials was psychological distress posttraumatic stress symptoms depression symptom	WHODAS, PCL-6, PHQ-9, WHO-5 and AAQ-II
David et al., 2023	Exploring the adverse conditions that increase vulnerability to mental health problems and the psycho- logical symptoms and coping mechanisms reported by internally displaced adolescents	No formal intervention studied; highlights need for psychosocial support for internally displaced adolescents	N = 15 internally displaced adolescents	Phenomenological qualitative approach	Psychological symptoms (trauma, post-traumatic stress disorder (PTSD) symptoms)	Semi-structured interview
Tippens et al., 2021	Understanding the prevalence of psychological distress among Congolese refugees during a period of structural vulnerability and political violence	No formal intervention studied emphasizes the need for targeted mental health and psychosocial support (MHPSS) for urban-displaced adults.	N = 245 urban-displaced Congolese aged between and 80 in Kenya	Mixed methods (qualitative and quantitative) descriptive analyses	Psychological distress	Self-reporting questionnaire (SRQ-20)
Kaiser et al., 2020	Exploring the mental health and psychosocial (MHPS) burden, existing resources and coping mechanisms, and remaining needs among internally displaced persons (IDPs) and host communities in Borno State, Nigeria	No specific intervention assessed; study identifies a high mental health burden among IDPs and host communities in Borno State and suggests the need for solutions-focused and tailored mental health and psychosocial (MHPS) interventions.	N = 66 internally displaced persons (IDPs) and host communities in Borno State, Nigeria. Half children and half adults (18+)	Mixed methods	Severe symptoms of distress	Qualitative data (Free listing combined with brief interviews) and the 6-item assessment tool are part of the MHPS needs assessment from the Toolkit for Humanitarian Setting
Meinhart et al., 2023	Examining the linkage between psychosocial wellbeing and parenting behaviours among caregivers in Kiryandongo Settlement, Uganda	Journey of Life programme	N = 1323 caregivers in Kiryandongo Settlement, Uganda	Quantitative	Parenting rejection and acceptance	Information on instruments not provided
Logie et al., 2023	Examining the association between water insecurity and depression among refugee youth in Bidi Bidi, Uganda	Sexual and gender-based violence education comic book	N = 115 refugee youth aged 16 and 24 years in Bidi Bidi	Quantitative	Depression	Patient Health Questionnaire (PHQ-9), Household Water Insecurity Experiences scale, and the Brief Resilient Coping Scale
Swan and Im, 2021	Exploring exposure to trauma and demographic and psychological factors as predictors of mental health symptoms among Somali refugees in Kenya, and what increases/ decreases common mental health symptoms	No formal intervention assessed; study suggests that programmes encouraging problem-sharing may help address Somali refugee mental health needs	N = 86 Somali refugee youth, aged 15–34 years, who were living in East Leigh	Quantitative	Anxiety, depression, PTSD	Hopkins Symptom Checklist- 25, PTSD Check List- Civilian Version

2.5. Collating, summarizing and reporting review results

The entire scoping review process, from the initial title and abstract review to the final studies included, follows PRISMA-ScR guidelines (Tricco et al., 2018), specifically illustrated through the PRISMA-ScR flowchart (see Figure 1). The first research question explored key findings, recommendations, and challenges reported in refugee mental health intervention studies in Africa, is answered using a table that details (see Table 2). Missing information will be marked as ‘NS’ (Not Specified). The second research question explored the motivations behind these interventions, was assessed qualitatively using standard content analysis of full-text articles meeting review criteria. The goal was to qualitatively analyze common themes in the motivations behind interventions (see Table 3; White & Marsh, 2006). Relevant themes were identified, briefly interpreted, and supported by quotes to strengthen the findings.

Figure 1.

PRISMA flow chart summarizing the article identified.

Table 2.

Summary of Findings, Recommendations, and Research Gaps.

Author	Study results/ findings	Recommendations and Implications	Challenges/ Study Gaps
Lasater et al., 2020	Improved maternal and child health outcomes through psychosocial support and positive caregiving practices.	Establishing new data and coordinating with local partners prior to research Putting into consideration the cultural and environmental context of emergencies Establishing and troubleshooting new data and monitoring system prior to conducting research	Trial conflicts which resulted in the creation of volatile and unpredictable environment Extreme heat Data system challenges such as staff capacity, disruption and turnover issues
Ingabire and Richters, 2020	Suicidal ideation and behaviour among refugees were primarily triggered by post-migration stressors. Gender role changes and misunderstandings of gender equality policies contributed significantly to family conflicts. Existing support mechanisms, such as community-based socio-therapy and faith-based interventions, are helpful but often lack cultural sensitivity.	Conducting regular suicide prevention campaigns and the potential triggers of suicide Organizing basic support training on the basic support skills for people who experience suicidal ideations	Some support system not being culturally sensitive
Burchert, 2024	Participants in the Step-by-Step programme demonstrated greater improvements in psychological distress and daily functioning compared to those in the control group	Further user-centered adaptations are required to improve adherence and effectiveness while maintaining scalability Future research and implementation should put a strong focus on rural areas Tailoring digital intervention, such as SbS, to meet diverse contextual and individual needs	Not provided
Stark et al., 2024	The JoL intervention significantly improved mental distress. Cohen's d analysis further highlighted the intervention's strong effects, particularly on parental warmth/affection.	Results add to a growing evidence base around the role of caregiver mental health and parenting behaviours in the aftermath of war and displacement Programs like the JoL have the potential to support families and communities as the numbers of those displaced continue to rise worldwide	Lack of randomization in the quasi-experimental The COVID-19 pandemic introduced an additional stressor on refugee caregivers. While intervention adaptations were made because of the pandemic, the study was unable to examine the extent that COVID-19 directly influenced intervention effectiveness
Lambert et al., 2024	Males are more likely to report depression when they faced challenges adjusting to life in the settlement, experienced discrimination as refugees, or encountered a higher number of conflict-related traumatic events. For males, literacy and discrimination showed stronger associations with depression, while for females, rape had a stronger link to depression. Post-traumatic stress symptoms (PTSS) were observed to be more pronounced in males.	Adapting the programming to be gender sensitive. Programs that build resilience among the population should increase, for women this would be social and for men those would be group membership talking about goals and activities. It would be better to do a longitudinal study to clarify some of the interpretations	Limited study design The study took place during the daytime and therefore only included those who were at home at the time It also took place in December 2020, when there was a pandemic Self-reported data could also be unreliable. Cultural context and applicability to the Congolese refugee context is of concern. Ceiling effect was shown because 95% of participants lacked access of basic needs
Augustinavicius et al., 2023	A single factor for mental health problems was identified, with all factor loadings greater than 0.30 and acceptable internal consistency (α = 0.70). The incidence of probable mental disorders post-intervention was significantly lower among participants in SH + compared to EUC. Participation in SH + versus EUC was associated with increased subjective well-being and enhanced psychological at post-intervention assessment.	SH +  may be appropriate for both indicated and selective prevention of probable mental disorders, as well as for promoting positive mental health and well-being. Key features of SH+, such as its delivery via pre-recorded audio sessions by minimally trained facilitators and its large-group format, highlight its scalability potential. SH +  could significantly reduce the mental health burden in humanitarian settings if scaled appropriately	Reliance on secondary data as neither the pilot nor RCT studies were specifically designed preventive promotive effects The latent variable for mental health problems and the threshold for probable mental disorder were retrospectively generated The mental health problems variable was not validated within these sample
David et al., 2023	The thematic analysis revealed that displacement, while causing profound mental health challenges and vulnerabilities, was universally experienced as a transformative life-changing process. Female participants predominantly adopted high-risk coping strategies, such as begging and engaging in transactional sex, to meet basic needs. Despite traumatic experiences, some participants exhibited resilience by adopting religious behavioural coping strategies, which they found essential for mitigating past traumatic memories.	Requiring a suitable support plan that focuses on females IDAs basic needs. There is need for displaced adolescents’ survival means and coping mechanisms to be closely monitored and strengthened with appropriate support and protection services owing to the risks of recourse to high-risk survival behaviours	Unable to interview younger adolescents 10–13 years of age owing to low communication skills
Tippens et al., 2021	Factors contributing to increased distress included perceiving oneself as having a useful role in their family or community, feeling confused or uncertain about what to do, and fear of leaving home for medical care. Ethnic Banyamulenge Congolese adults without legal refugee status were significantly more likely to experience psychological distress.	The use of longitudinal designs would be more important Future research could benefit from identifying if other additional psychosocial services and support (i.e. social economic status, having a trusting person to talk with when feeling distressed, a sense of hope) are importantly related to psychological distress	PI was a white American woman, which could've influenced social desirability Participants were not matched based on sex, ethnicity, or other characteristics Small sample size Cross sectional study prohibits casual inference
Kaiser et al., 2020	Adult men exhibited the highest rates of symptom burden, indicating that traditional approaches targeting women and children may overlook this vulnerable group. Qualitative data from free lists, interviews, and group discussions underscored the mental health and psychosocial support (MHPS) needs that could be addressed with solutions-focused approaches. Participants emphasized the disruption of community and political leadership structures, as well as the collapse of economic and livelihood activities.	Focusing on low-skill MHPS interventions that can be delivered by lay community members Accounting for the surprising finding that adult men experienced a higher degree of mental health symptoms Supporting restoration of traditional leadership structures and livelihoods as important components of the rebuilding process Addressing stigma surrounding drug abuse and rape	The survey was conducted immediately after qualitative data collection was completed. If these phases had been more distinct, there would have potentially been time to incorporate assessment items that arose from qualitative data collection specifically in this setting (e.g. thinking too much) The mental health survey was a short assessment of common distress symptoms The survey would have benefited from a sampling frame to draw a true random sample. This study was conducted in collaboration with an NGO, which might have encouraged participants to emphasize the importance of NGO support in the humanitarian response
Meinhart et al., 2023	Increased social support and positive attitudes were significantly associated with higher levels of parental warmth and affection. Positive attitudes, reduced, and increased were significantly linked to more favourable outcomes in parental undifferentiated rejection.	As parenting programing for refugees continues to develop, there is need to advocate for emphasis to be placed on the critical and synergistic linkage between wellbeing and parenting behaviours, as well as consideration to be given to the potential value of programing to move beyond individual level intervention by considering the broader ecosystem	This sample of predominately women limits the generalizability of study findings among the broader community population of caregivers, and speaks to the challenge in engaging men who are caregivers in interventions related to women and children's well being Absentee or neglectful parenting was not distinctly measured and may be uniquely challenging to address given they’re in active inherencies
Logie et al., 2023	Water insecurity was independently associated with higher levels of depression severity.	Water insecurity could be integrated in refugee mental health promotion by policymakers and community-based programmers Future studies can employ non-random sampling wit refugee youth	The use convenience sampling may limit generalizability of findings
Swan and Im, 2021	Willingness to share problems was a significant predictor of decreased mental health symptoms in most models.	Implementing programmes to encourage problem sharing may help address Somali refugee mental health needs Further research is needed to explore the differential impact of trauma exposure and various psychosocial factors on Somali refugee mental health. continued research exploring the differential impact of trauma exposure and various psychosocial factors (e.g. social support, coping, stigma) on Somali refugee mental health could help us understand and address the needs of this population	The use snowballing sampling limits generalizability of the findings Given the lack of culturally validated psychosocial measures in the research setting, it was sometimes difficult to use entire existing measures to operationalize psychosocial factors

Table 3.

Themes for Motivations Behind the Implementation of Refugee Mental Health Interventions.

Theme	Definition	Supporting Studies
Community Needs	Addressing specific vulnerabilities and distress	Lasater et al. (2020): Baby Friendly Spaces programme to support pregnant and lactating women. Meinhart et al. (2023): Highlighted pervasive well-being and mental health needs among refugees in Uganda. Logie et al. (2023): Association between water insecurity and depression among refugee youth in Uganda.
Risk and Protective Factors	Mitigating risks and promoting resilience	Ingabire and Richters (2020): Focused on addressing suicidal behaviour in refugee camps. Kaiser et al. (2020): Resilience-promoting factors among conflict-affected communities. Swan and Im (2021): Informal support systems and cultural assets as protective factors.
Adaptability and Scalability	Addressing the capacity of interventions to be adjusted to different cultural, social, and resource-constrained settings while maintaining their effectiveness. Scalability refers to the ability of these interventions to expand and reach larger populations without significant loss of quality or fidelity.	Burchert (2024): WHO's Step-by-Step intervention adapted for various refugee populations. Lambert et al. (2024): Emphasized understanding cultural and gendered differences in mental health challenges.
Holistic Approaches to Mental Health	Addressing the multifaceted nature of mental health challenges by integrating physical health, social well-being, and cultural practices alongside psychological interventions.	Lasater et al. (2020): Integrated child health interventions. Stark et al. (2024): Highlighted caregivers’ roles in mediating impacts of forced displacement on children.
Focus on Evidence-Based Practices	Reliance on interventions grounded in scientific research and validated by rigorous studies to ensure efficacy and reliability in diverse refugee contexts.	Stark et al. (2024): Noted the lack of evidence-based programming and the need for more research Augustinavicius et al. (2023): Secondary analysis of SH + intervention outcomes.

3. Results

The search across three databases identified 252 articles. No additional articles were found through grey literature sources or citation searches. After uploading the references to Covidence, ten duplicate articles were automatically removed. Out of the remaining 242 articles screened by title and abstract, 211 were excluded, leaving 31 articles for full-text review. Of these, 19 were excluded after review, resulting in 12 articles that met the inclusion criteria and from which data were subsequently extracted.

The studies encompass a range of objectives related to mental health among refugees, which are categorized into thematic areas for clarity and better understanding:

3.1. Mental health interventions

Four studies evaluated interventions aimed at improving mental health outcomes among refugees. Lasater et al. (2020) examined the uptake and acceptability of the Baby Friendly Spaces Program among breastfeeding women in the Nguenyyiel refugee camp in Ethiopia, highlighting its association with improved maternal and child outcomes. Burchert (2024) evaluated the effectiveness of the Step-by-Step self-guided intervention in reducing psychological distress among Arabic-speaking Syrian refugees in Egypt. Stark et al. (2024) assessed the impact of the Journey of Life intervention on caregiver well-being and behaviours in Uganda’s Kiryandongo refugee settlement. Lastly, Augustinavicius et al. (2023) conducted a retrospective analysis of the Self Help Plus programme, examining its effect on reducing the incidence of probable mental disorders among South Sudanese refugee women in Uganda.

3.2. Risk factors and vulnerabilities

Other studies have investigated the risk factors contributing to mental health challenges in refugee populations. Ingabire and Richters (2020) examined factors contributing to suicidal ideation and attempts among Congolese refugees in Rwanda, alongside existing support mechanisms and prevention strategies. David et al. (2023) explored adverse conditions increasing vulnerability to mental health problems among internally displaced adolescents. Tippens et al. (2021) studied the prevalence of psychological distress among urban-displaced Congolese in Kenya. Kaiser et al. (2020) investigated the mental health and psychosocial burden among internally displaced persons and host communities in Nigeria's Borno State.

3.3. Gender differences in mental health

Some studies have specifically examined gender-related differences in mental health. Lambert et al. (2024) aimed to unpack gender differences in mental health among adult Congolese refugees in Uganda by analyzing specific risk and protective factors.

3.4. Caregiver and youth mental health

Research has also focused on the mental health of caregivers and youth. Meinhart et al. (2023) examined the linkage between psychosocial well-being and parenting behaviours among caregivers in Uganda. Logie et al. (2023) investigated the association between water insecurity and depression among refugee youth in Uganda's Bidi Bidi settlement. Swan and Im (2021) explored predictors of mental health symptoms among Somali refugee youth in Kenya.

3.5. Geographic distribution of studies and target populations

The studies targeted diverse refugee groups, including women, adolescents, and caregivers, across various African countries, with a particular emphasis on the unique contexts of mental health interventions in these regions. Specifically, five studies were conducted in Uganda (Augustinavicius et al., 2023; Lambert et al., 2024; Logie et al., 2023; Meinhart et al., 2023; Stark et al., 2024), focusing on refugee caregivers and youth in settlements such as Kiryandongo and Bidi Bidi. Two studies were conducted in Kenya (Swan & Im, 2021; Tippens et al., 2021) focusing on urban-displaced Congolese populations. Two other studies were conducted in Nigeria (David et al., 2023; Kaiser et al., 2020) examining the mental health burden of internally displaced persons and host communities. Ethiopia, Rwanda, and Egypt had one study each (Burchert, 2024; Ingabire & Richters, 2020; Lasater et al., 2020). The geographic distribution of these studies highlights the focus on specific refugee settlements and urban areas in Africa, underscoring the varied contexts in which mental health interventions are being implemented.

3.6. Mental health outcomes and measurement tools

The studies assessed various mental health outcomes, such as psychological distress, depression, PTSD, functional impairment, social support, and caregiving behaviours. The outcome measures included standardized instruments, such as the Kessler Psychological Distress Scale (K6; measuring general psychological distress) (Kessler et al., 2003), the Patient Health Questionnaire (PHQ-9) (Kroenke et al., 2001); assessing symptoms of depression, the PTSD Checklist (PCL; evaluating post-traumatic stress symptoms) (Weathers et al., 2013), and the World Health Organization Disability Assessment Schedule (WHODAS; assessing functional impairment) (World Health Organization [WHO], 2010).

3.7. Themes for motivations behind the establishment of mental health intervention

Thematic analyses yielded diverse motivations behind the implementation of mental health intervention programmes for refugees in Africa. Adaptability and scalability emerged as the most prevalent theme, present in four studies. Community needs and risk and protective factors were highlighted in three studies each, while focus on evidence-based practices and holistic approaches to mental health were evident in two studies respectively. These themes highlight the multidimensional drivers of mental health programming in resource-constrained and culturally diverse settings.

3.7.1. Addressing community needs

The theme of community needs underscores the necessity of tailoring interventions to the specific vulnerabilities and stressors experienced by refugees. For instance, Lasater et al. (2020) demonstrated how Baby Friendly Spaces addressed the needs of pregnant and lactating women, offering both physical safety and psychosocial support. Similarly, Meinhart et al. (2023) highlighted the pervasive mental health challenges faced by refugees in Uganda, while Logie et al. (2023) linked water insecurity to depression among youth. These studies collectively point to the critical role of understanding and addressing the immediate and context-specific challenges of refugee communities.

3.7.2. Mitigating risks and promoting resilience

Risk and protective factors emerged as a vital focus, with interventions aiming to mitigate risks such as suicidal behaviour (Ingabire & Richters, 2020) and promote resilience through informal support systems and cultural assets (Swan & Im, 2021). Additionally, Kaiser et al. (2020) highlighted resilience-promoting factors in conflict-affected communities, reinforcing the importance of leveraging community strengths and protective mechanisms to enhance mental health outcomes.

3.7.3. Ensuring adaptability and scalability

The theme of adaptability and scalability reflects the need for interventions that can be effectively implemented in diverse cultural and resource-limited contexts while maintaining their efficacy. Burchert (2024) emphasized the adaptability of WHO's Step-by-Step intervention across different refugee populations, while Lambert et al. (2024) focused on understanding cultural and gendered differences to ensure interventions remain relevant and impactful. Scalability remains a critical consideration for expanding these interventions to larger populations without compromising their quality.

3.7.4. Embracing holistic approaches

Mental health interventions increasingly recognize the need for holistic approaches, integrating physical health, social well-being, and cultural practices with psychological support. Lasater et al. (2020) incorporated child health interventions alongside mental health programming, while Stark et al. (2024) emphasized the role of caregivers in mitigating the effects of forced displacement on children. These studies highlight the importance of addressing the interconnected dimensions of well-being in refugee populations.

3.7.5. Focusing on evidence-based practices

Finally, a focus on evidence-based practices ensures the reliability and efficacy of interventions in diverse refugee contexts. Stark et al. (2024) noted the limited availability of evidence-based programming and called for rigorous research to validate interventions. Augustinavicius et al. (2023) demonstrated the value of secondary analyses, providing critical insights into the outcomes of the SH + intervention and reinforcing the need for evidence-informed decision-making.

4. Discussion

The evidence on various mental health interventions implemented globally remains high (Murray et al., 2014a,b), even though the motivations behind the implementation of some of these interventions are not well known. This scoping review spanned a limited number of interventions implemented in Africa. A continent with 54 countries has undergone many instabilities for decades (Radelet, 2010). These instabilities include coup d'état, civil wars, and persecutions, which have forced many people to run away from their home counties to seek refuge in neighbouring counties (Rwengabo, 2014). Systematic search and analysis indicated only twelve interventions implemented in this population (refugee communities), which is alarming, especially among the population that is more vulnerable to experiencing various mental health problems such as depression, anxiety, PTSD and many more. It is also important to note that, despite the limited number of interventions implemented on the continent, all identified studies have been conducted in English, with none focusing on French-speaking Sub-Saharan Africa in relation to psychological interventions or refugee mental health and well-being The review further indicated various mental interventions implemented in this population. While many of these interventions show promise and report positive outcomes, it is important to note that only a few have undergone rigorous evaluation to qualify as evidence-based treatments (EBTs). For instance, Self-Help Plus (SH+) has been tested in multiple randomized controlled trials (RCTs) across different low-resource and humanitarian settings and is supported by WHO as a scalable intervention (Purgato et al., 2021; Tol et al., 2020). In contrast, programmes such as the Journey of Life or Baby Friendly Spaces – while widely implemented – lack robust empirical trials that evaluate their long-term efficacy. The absence of such evaluations across many programmes raises concerns about their scalability and replicability and underscores the need for more rigorous implementation science in these settings (Murray et al., 2014). Interventions such as Baby Friedly Spaces Program (Lasater et al., 2020), Step by Step (Burchert, 2024), Journey of Life Group Based Curriculum (Stark et al., 2024), Self-help Plus (Augustinavicius et al., 2023), Community based sociotherapy (Ingabire & Richters, 2020) and many others were reported in this review. Even though we acknowledge that these interventions have done a tremendous job at improving the mental health problems of refugees, they are implemented for a small number of people, thus leaving the majority not receiving the mental health services. In the identified studies, the total number of people receiving the various interventions was less than 3000 in a continent with over 10 million refugees. Also, these interventions are tailored/ developed to reach a specific category of people, such as parents, refugee youths, adolescents, and urban or rural refugees. Even though this is promising, as different communities of people might be more susceptible to experiencing specific mental health issues compared to others (Turner et al., 2013), the generalizability of these interventions is one of the most significant limitations of the interventions being implemented.

Another notable gap in the interventions reviewed is the lack of clarity around the specific mental health disorders being targeted. While some interventions aim to alleviate general psychological distress or promote resilience, others are more focused on treating clinical symptoms of depression, PTSD, or anxiety. For example, studies evaluating SH + and Narrative Exposure Therapy (NET) in refugee settings often target trauma-related disorders explicitly (Neuner et al., 2008; Purgato et al., 2021). The heterogeneity in focus raises important questions about whether future interventions in African refugee settings should be disorder-specific – such as trauma-focused – or adopt a broader, transdiagnostic approach (Kazdin & Rabbitt, 2013). Given the high prevalence of trauma-related symptoms among refugees, a hybrid model may be most appropriate, depending on context-specific needs assessmentsAdditionally, the content analysis of the studies reported various motivations behind implementing mental health interventions. Some interventions were implemented following the specific needs of a specific population with the hope that the intervention employed would help alleviate that population's mental health issues or problems (Lasater et al., 2020; Logie et al., 2023; Meinhart et al., 2023). Other interventions focused on reducing the risk of mental health problems among refugees by enhancing protective factors such as resilience (Ingabire & Richters, 2020; Kaiser et al., 2020; Swan & Im, 2021). Furthermore, the adaptability and scalability of the intervention and holistic approach to mental health were other reasons refugee mental health services were implemented (Burchert, 2024; Lambert et al., 2024). However, these interventions can be adjusted to different cultural and social settings while maintaining effectiveness.

Furthermore, the review calls for or indicates the need for more evidence-based mental health interventions to be implemented in refugee communities across Africa. Surprisingly, after a thorough literature review, the final analysis did not indicate any evidence based mental health intervention in this population. In a world that is undergoing the evolution of mental health intervention, and more calls are being made emphasizing the implementation of interventions that are empirically supported, vulnerable populations like refugees would be more emphasized and prioritized, which is not the case. Therefore, the reviews call for the cultural adaptation of evidence-based mental health interventions to be tailored to the population's specific needs. Cultural adaptation of the interventions will emphasize the role of language, religion, culture, and socioeconomic status, all of which are vital components in the refugee population and to other people all over. This will be important in improving the mental health of refugees across Africa.

Compared to interventions implemented in other global settings – such as Europe, the Middle East, or North America – mental health programmes in African refugee contexts are often less structured, underfunded, and less frequently evaluated (Silove et al., 2017). In countries like Germany, the Netherlands, and Sweden, trauma-focused interventions such as TF-CBT and NET have been culturally adapted and tested for effectiveness among refugee children and adults (Neuner et al., 2004; Pfeiffer et al., 2019). These settings benefit from stronger governmental support, research infrastructure, and access to trained mental health professionals. Drawing from these examples can inform how interventions in Africa might be refined and evaluated while ensuring cultural appropriateness and feasibility.

By understanding the deeper reasons behind implementing the mental health intervention in the refugee community, we increase researchers’, practitioners’, policymakers’, and other stakeholders’ knowledge about conditions and intervention strategies that influence refugee mental health. The potential impact of this research is significant. We advocate for a shift from short-term, crisis-driven approaches to more sustainable and culturally appropriate strategies, contributing to global mental health policy.

5. Implications for practice, future research, and emerging challenges

The findings of this review have important implications for both practice and research. Mental health interventions in African refugee contexts must continue to address context-specific needs while adopting adaptable, scalable, and holistic approaches. Investing in culturally relevant, evidence-based practices will further enhance their effectiveness. Looking ahead, increasing global instability, forced migration, and protracted displacement are likely to intensify challenges such as urbanization of settlements, intergenerational trauma, climate-related displacement, and limited access to culturally appropriate digital interventions. If unaddressed, these factors may exacerbate psychological distress and undermine the efficacy of existing programmes. Future research must therefore anticipate and respond to these evolving dynamics through community-centered designs, longitudinal evaluations, and active integration of refugee voices to ensure mental health responses remain relevant and impactful.

6. Conclusion

Understanding the motivations behind refugee mental health interventions is crucial. This knowledge not only enables stakeholders to track and evaluate programmatic goals but also empowers mental health researchers, practitioners, policymakers, organizations, and other stakeholders to play a more effective role in their impact. Several factors drive the establishment of these interventions, ranging from addressing identified community needs – where gaps are recognized, and interventions are introduced to bridge them – to the cultural adaptation of programmes to meet the specific requirements of populations. Considering cultural factors is critical, as they significantly influence the success of these initiatives.

It is encouraging that many implementers prioritize delivering evidence-based interventions, which ensures that service users benefit from approaches validated by research. This provides hope for future improvements in mental health services. However, it is concerning that only a limited number of studies focus on refugee mental health interventions, especially in Africa and other low-income countries in general. After an extensive search, only 12 articles met the inclusion criteria for exploring the motivations behind these interventions. Given the ongoing conflicts worldwide, stakeholders must adopt a broader perspective. While providing refugees with basic livelihoods is essential, prioritizing mental health interventions is equally critical, as there is no health without mental health. Alarmingly, funding priorities often influence intervention implementation, with only three out of the twelve interventions driven primarily by community needs. The remaining nine were established for other reasons.

Tailoring interventions to meet the cultural and community needs of refugees is vital. These populations face unique challenges, including adjusting to new environments and dealing with a range of mental health problems. Future developers, implementers, and researchers applying for funding must carefully consider which programmes receive the most support and the motivations behind their establishment.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Registration

This scoping review was registered in the Open Science Framework database with registration DOI – https://doi.org/10.17605/OSF.IO/FD6YN

Data availability statement

This study is a scoping review, and no primary data were collected or analyzed. All data used in this study are derived from previously published sources, which are cited within the manuscript.

Supplemental Material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/20008066.2025.2498868.