Poor mental health among male students and its links to their perpetration of sexual violence against women students in higher education institutions in Africa: protocol for a scoping review

Abstract

Introduction

The way men are socialised into their masculine roles has been shown to contribute to male-perpetrated sexual violence (SV) against women students in higher education institutions (HEIs). Global North studies further emphasise men’s poor mental health and its intersection with the construction of masculinities as one of the risk factors for male-perpetrated SV against women. The purpose of this scoping review is to map out the literature on male college/university students’ poor mental health and links to their perpetration of SV against women students in Africa.

Methods and analysis

For this scoping review, we will search for relevant studies from the following electronic databases: Scopus, ERIC, PsycINFO, PubMed, Web of Science and CINAHL. Furthermore, we will search for additional studies in Google Scholar and the Directory of Open Access Journals. Additionally, we will search for relevant grey literature. To search for articles in electronic databases, a combination of search techniques will be used, including phrase searching, Boolean operators (AND, OR, NOT), Truncation, Wildcats, Field search, Proximity search, citation chaining and filters. The eligibility of studies for inclusion will be assessed through the population, concept, context (PCC) framework. Using the PCC framework, we will focus on studies which report on the mental health challenges experienced by male students (of any age) and SV perpetrated by male students against women students at HEIs (ie, colleges and universities) in Africa. We will only include peer-reviewed articles and grey literature from Africa published in English between 1995 and 2025. Empirical studies using any methodology, including qualitative, quantitative and mixed-methods studies will be included. Once relevant studies have been identified, these will be charted. We will collate and summarise the data according to variation (breadth) and key components (depth), combining quantitative and qualitative syntheses. The findings will provide descriptive insights into the nature of research in this area, together with the drivers of, and linkages between male students’ poor mental health and their perpetration of SV.

Ethics and dissemination

The scoping review will not require ethical approval because we will collate data from published peer-reviewed journal articles and grey literature that are already in the public domain; therefore, no primary data will be collected. The review results will be submitted for publication to an open-access, peer-reviewed journal. The findings will be disseminated on electronic and print platforms. There may also be opportunities to present the findings at conferences and South African government seminars.

Study registration

Open Science Framework, https://doi.org/10.17605/oSF.IO/4KV8R.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• The systematic and structured approach that will be followed in this review will enable a comprehensive mapping of the literature on this topic in Africa, while maintaining transparency in the title search, article screening, study selection and data extraction.

• Drawing data from both diverse sources (ie, peer-reviewed articles in electronic databases and grey literature) and study methodologies will enhance the depth and contextual relevance of the review findings.

• Restricting studies to those published in English may limit the reach of this review, potentially excluding key literature published in French, Portuguese and Arabic, which in turn might introduce selection bias.

Introduction

Scholars have rightly argued that male-perpetrated sexual violence (SV) should be understood as an indication of a man’s preoccupation with demonstration of (hetero) sexual performance and sexual dominance over others.¹ In the Global North, poor mental health has been identified as an additional factor shaping male-perpetrated SV. SV is defined as ‘any sexual act, attempts to obtain a sexual act, or acts to traffic for sexual purposes, directed against a person using coercion, harassment or advances made by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work’.²

Survivors of SV are disproportionately women, and they face poor mental health, higher rates of substance use and an increased likelihood of acquiring sexually transmitted infections or HIV,³,⁷ along with negative economic and social consequences for individuals, communities and society.⁸ Globally, about 25% of women students at universities have experienced male-perpetrated sexual assault, posing a serious educational risk.⁹ Despite campaigns to raise awareness about SV,¹⁰ male-perpetrated sexual assaults are widespread and very common in Africa.¹¹,¹³

The WHO defines mental health as ‘a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community’.¹⁴ South African research has alluded to poor mental health as a risk factor for men’s perpetration of SV. Quantitative studies conducted in South African higher education institutions (HEIs) have sought to establish the prevalence of common mental health disorders including depression, anxiety, post-traumatic stress disorder, psychological distress, alcohol misuse and drug use among students. The same common mental health disorders will be explored in this review. These studies on adult men have highlighted poor mental health as a risk factor for SV perpetration.¹⁵ Furthermore, they have shown that men’s own experiences of trauma, such as child sexual abuse, adversity during childhood, their witnessing of domestic violence, particularly against their mothers, are important risk factors for future perpetration of SV.¹⁶,¹⁸ South African studies further show that additional factors that shape perpetration of SV include experiencing stressful circumstances such as high unemployment rates, emotional neglect, unstable family structures, the emergence of violent masculinities, and historical and ongoing political and economic marginalisation, particularly among black African men.¹⁹,²²

The principal theory guiding most research in Southern Africa on men’s perpetration of SV, including rape, is Connell’s theory of gender and power.²³ Investigations into men and masculinities frequently use Connell’s concept of hegemonic masculinity to clarify the rationale and mechanisms by which gender inequality is maintained.²⁴ Connell posited that in any context, various masculinities coexist, but one cultural model of masculinity is universally regarded as ideal and superior to others.^{25 26} While masculinities may be different in different cultures, they are characterised by various forms of legitimising men’s dominance over women.²⁷

Different theories explore the connection between male-perpetrated rape and the idealised masculinity, including in HEIs, in South Africa. Some scholars argue that the idealised masculinity in college and university campuses in South Africa condones violence and performance of masculine ‘norms’ that can lead to sexual aggression against women students.^{28 29} Other scholars contend that when men fail to embody idealised masculinity, they may resort to violent forms of behaviour, focusing on controlling and disciplining women.^{30 31}

While these theories have broadened our insights on the impact of masculinities on male perpetration of SV, they do not explain how poor mental health informs male-perpetrated SV. In Africa, mental health is a recognised risk factor for the perpetration of SV by men, yet there is scarcity of evidence-based interventions aimed at addressing this and integrating it with gender transformative programmes, which dominate the approach to violence prevention. In South Africa, some recent studies suggest that there may be a relationship between poor mental health and violence in young men, this is specifically the case in urban informal settlements in South Africa,³² in population-based samples³³ and in young men in rural KwaZulu-Natal.³⁴ The evidence base of this relationship from Africa, stemming from limited literature and qualitative research, is currently not strong.³²,³⁴ The proposed scoping review seeks to answer the following question: What research evidence exists on the relationship between poor mental health and perpetration of SV among men in HEIs in Africa?

Thus, this proposed scoping review aims to advance knowledge on the links between men’s poor mental health and SV perpetration in Africa. Furthermore, it aims to explore whether there are specific aspects of the context of higher education that fuel male students’ mental ill-health (eg, stress, depression and anxiety) and SV (including rape, sexual assault and sexual harassment) perpetration against women students in HEIs in Africa.

Methods and analysis

The methodology for this scoping review will draw from the framework suggested by Arksey and O’Malley³⁵ and extended by Levac and the Joanna Briggs Institute.³⁶ The scoping review will be guided by five steps:

1. Identifying the research question

2. Identifying relevant studies

3. Study selection

4. Charting the data

5. Collating, summarising and reporting results.

Step 1: Identifying the research question

The main research question guiding this scoping review is: What research evidence exists on the relationship between poor mental health among male students and their perpetration of SV against women students in HEIs in Africa? Research subquestions are as follows:

1. What is the extent, range and nature of research in this area, for example, number of studies, where, who, aims/objectives, focus, outcomes assessed, methodologies used, theories/concepts used/developed, etc.?

2. What are the drivers of male students’ poor mental health?

3. What is the link between male students’ poor mental health and their perpetration of SV, and the context, processes and meanings that may shape these drivers and linkages?

Step 2: Identifying relevant studies

To identify relevant studies for this review, we will search the following electronic databases: Scopus, ERIC, PsycINFO, PubMed, Web of Science and CINAHL. We will search ERIC, PsycINFO and CINAHL via the EBSCOhost platform. In addition to these, a Google Scholar and Directory of Open Access Journals search will be conducted to find additional literature. Further, the review will include grey literature. To identify more articles, we will also perform a backward citation for studies that have been included. We will also search the reference lists of all included studies and key references (eg, relevant systematic reviews) and contact authors of included studies and/or experts in the field for additional references.

To search for articles in the different databases, a combination of search techniques will be used. These will include phrase searching, Boolean operators (AND, OR, NOT), Truncation, Wildcats, Field search, Proximity search, citation chaining and filters. The aim of this will be to manage and limit article searches based on the inclusion criteria of this scoping review which are outlined below. Following the population, concept, context (PCC) approach, the searches will focus on four core concepts: Male Students; Mental Health; Sexual Violence Perpetration; Higher Education Institutions and Geography (low-middle-income countries/Africa). For each concept, keywords, synonyms, relevant subject headings or Medical Subject Headings (MeSH) will be generated as applicable. A complete list of all 54 African countries will also be included in all database searches. In consultation with an information specialist at the South African Medical Research Council, we have developed preliminary search strategies for each database (online supplemental file 1). To finalise our search strategy, we will apply an iterative approach to check whether known articles that meet our eligibility criteria were found by the search. We will also identify missing keywords and MeSH terms to add to our search strategy from the iterative process. To keep an up-to-date record of articles that have been found, researchers involved in the review will use a table template (online supplemental file 2).

Step 3: Study selection

The third step when undertaking reviews entails the selection of studies that will be included in the scoping review. Once all articles have been identified, they will be downloaded, and screening of articles will be managed using the Rayyan software. The planned process of selecting studies is outlined in figure 1. Here, the first step is to screen study titles using the PPC as a guide. The second step involves the inclusion of full-text articles that have been identified as relevant to the review. In the second step, the screening of the study for inclusion will be done by two reviewers, who will do the screening independently. Should there be disagreements between the two reviewers regarding including or excluding studies resulting from the screening of full-text articles, these will be resolved through a discussion between all review authors.

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram describing the process of article review and inclusion and exclusion for the scoping review.

Inclusion and exclusion criteria

We identified the PCC mnemonic for this scoping review.

Population: Male students (any age) at HEIs (ie, colleges and universities).

Concept: Mental health challenges experienced by male students; SV (any sexual act, attempts to obtain a sexual act, or acts to traffic for sexual purposes, directed against a person using coercion, harassment or advances made by any person regardless of their relationship to the victim, in any setting, including but not limited to home and work) perpetrated by male students (those who identify as cisgender) against women students.

Context: Published, peer-reviewed academic and grey literature articles from Africa published between 1995 and 2025.

The scoping review will include articles focusing on the mental health of male students in Africa which have been published between 1995 and 2025. This time frame is practical for limiting the number of studies. We will include articles published in English. The review will include epidemiological studies, observational studies, evaluation studies (baseline or endline findings) that have employed either qualitative, quantitative or mixed-methods study designs, and which explore the mental health of male students in Africa and their perpetration of SV against women students.

Step 4: Charting the data

Here, the focus is on answering the scoping review research question. This step entails a descriptive summary of the nature and findings of studies that have been included in the review. Study characteristics and details will be extracted using a table, which will contain information on study author(s), title, year of publication, study location, type of study, study population, how participants were recruited, the response rate and key study findings (online supplemental file 2). To ensure that the data extraction table captures relevant information, two reviewers will separately complete the table first. Once there is agreement that the data extraction table captures the necessary and relevant information needed to answer the review question, each reviewer will complete the data extraction table. At the end, the data extraction table of all reviewers will be collated; following this, the whole review team will discuss discrepancies. We will not assess the methodological quality of the included studies in line with the convention for scoping reviews.³⁵

Step 5: Collating, summarising and reporting the result

In this stage, we will gather, summarise and report the findings from the extracted and charted data of the previous phase. We will synthesise the data according to variation (breadth) and key components (depth), combining quantitative and qualitative syntheses to provide an overview of findings. First, we will conduct a numerical descriptive analysis of all the included studies according to different categories, for example, study design (qualitative, quantitative and mixed), participants, outcomes assessed, focus, contexts, country, etc. This will provide insights into the extent, range and nature of research in this area. Second, we will conduct a qualitative narrative synthesis by identifying and summarising key components in relation to mental health, SV perpetration, drivers, linkages and contexts across the data. This will offer descriptive insights into the mental health issues encountered by male students in Africa and their potential connections to SV perpetration. The summary will outline the broader context and highlight key factors influencing mental health among male students, as well as ongoing initiatives in Africa related to this subject. It may also suggest ways to engage more effectively with male students experiencing mental health challenges. Additionally, the results will address implications for future research, practices and policies.

Ethics and dissemination

This study will not require ethical approval because we will collate data from published peer-reviewed journal articles and grey literature that are already in the public domain; therefore, no primary data will be collected. A team of reviewers experienced in evidence synthesis, public health, mental health and in engaging with men on issues of violence, including SV, will collaborate in collating the data. This approach aims to minimise potential bias and ensure that we present an accurate reflection of the literature’s scope. The review will be submitted for publication to an open-access, peer-reviewed journal.

This protocol is registered at the Open Science Framework (https://doi.org/10.17605/OSF.IO/4KV8R)

Discussion

To our knowledge, this is the first scoping review of the relationship between male students’ mental health and SV in Africa. Knowledge in this field has been produced disproportionately from studies conducted in the Global North, and thus theory in this area is largely dependent on a canon of scholarship that is often Eurocentric, limited and inevitably partial. The review will map evidence and generate new findings and insights that will aid in describing the mental health challenges faced by male students in HEIs in Africa. By so doing, the scoping review will contribute to redressing the knowledge gap and help cultivate theory and attendant practices in this area that are appropriately informed by the needs, priorities and contexts of different settings and populations in Africa. Additionally, the proposed review will provide insights into how mental health of men (ie, male college/university students) in Africa influences SV perpetration against women students in HEIs. Furthermore, the findings of this scoping review will carry implications for researchers and programme implementers seeking to develop mental health promotion and SV prevention interventions for use with male students in HEIs in Africa.

Depending on the findings of the scoping review, the findings may serve as a resource for policy makers to gain a comprehensive understanding of the mental health issues affecting male students in HEIs, as well as the risk factors for their perpetration of SV against women students. Furthermore, the findings may inform policy makers in making decisions regarding interventions and programmes aimed at enhancing the mental health of male students in HEIs. Additionally, the insights generated from this scoping review will enable the identification of gaps in mental health support for male students and such data can be used to adapt existing mental health interventions and programmes or to develop new strategies. Lastly, the findings of this scoping review will be significant in raising new questions for future research in this important but neglected area.

The strengths of the proposed scoping review lie in the systematic and structured approach that will be followed. This approach will enable a comprehensive mapping of the literature on this topic in Africa, while maintaining transparency in the title search, article screening, study selection and data extraction. Moreover, the fact that the data will be drawn from both diverse sources (i.e, peer-reviewed articles in electronic databases and grey literature) and studies with diverse methodologies will enhance the depth and contextual relevance of the review findings. However, the proposed scoping review has some limitations. For example, the restriction of studies to those published in English may limit the reach of this review, potentially excluding key literature published in French, Portuguese and Arabic. This, in turn, might introduce selection bias.