Table 2.

Details of all included studies.

First author and reference	Study type	Country	Sample size (N) and age	Aim	Findings
Ruangkanchanasetr et al. (35)	Cross-sectional	Thailand (Bangkok)	2,311 students (12–18 years)	To identify the prevalence of risk behaviors and related factors	High prevalence of risk behaviors (e.g., substance abuse, suicidal tendencies, injury) found; risk factors included poor self-esteem, poor school performance, and family factors
Habib and Seif El Din (53)	Intervention Study	Egypt (Alexandria)	334 (12–14 years) (n = 17 completed the intervention)	To evaluate the effectiveness of a Cognitive Behavior Therapy (CBT) program in reducing depressive symptoms	The CBT intervention resulted in significant improvement in self-esteem and reduction in depression symptoms 3 months after the completion of a 9-session program
Zhang et al. (43)	Cross-sectional	China (Shandong Province)	927 (14–15 years)	To investigate and compare the mental health problems and coping styles of adolescents in urban and rural areas and associations with socioeconomic status	Students in rural low-SES areas (especially females) had more mental health problems; maladaptive coping (venting/fantasizing) related to poorer mental health
He et al. (38)	Cross-sectional	China (Rural Hubei)	875 590 were ‘LBC’ (9–12 years)	To explore the risk of depression in Left-behind children and identify associated factors such as SES and social support	Left-behind children had a significantly higher risk of depression; low social support and low SES were associated with increased depression risk
Cortina et al. (36)	Prevalence Study	South Africa (Rural, Limpopo Province)	1,025 children (aged 10–12)	To determine the prevalence of mental health problems (emotional, conduct, and hyperactivity symptoms) in a rural, setting, and to identify associated risk factors, including perception/ connectedness to school	Teachers identified high levels of behavioral, conduct and emotional problems; second-generation refugee status and large household size were risk factors
Nik-Azin et al. (33)	Psychometric Validation Study	Iran (Yazd City)	551 students (11–19 years)	The Persian version of the Kidscreen-52 questionnaire was validated with mental health measures (anxiety, depression) and self-esteem	The Kidscreen-52 showed good internal consistency and acceptable construct validity; significant associations were found between self esteem and the KIDSCREEN-52 dimensions
Vawda (49)	Prevalence Study	South Africa (Durban)	222 (13–14 years)	To investigate the prevalence of suicidal behavior and associated psychological factors (social support, coping)	Low levels of self-esteem and perceived social support were associated with higher levels of suicidal behavior; alcohol use, depression, perceived stress, friends’ suicidal thoughts or ideation were risk factors for suicidal behavior
Leventhal et al. (26)	RCT	India (Rural Bihar)	2,308 rural females (12–14 years)	To evaluate the effectiveness of a 5-month school-based Resilience Curriculum (RC) program	The RCT showed significant improvements in measures of emotional resilience, self-efficacy, social–emotional assets, and wellbeing compared to controls. No effect on depression was detected. There was a small, negative effect of the intervention on anxiety.
Harrison et al. (32)	Cross-sectional	Jamaica (Metropolis)	524 (mean 14.9 years)	To determine the prevalence of Disordered Eating Behaviors (DEBs) and identify associated risk and protective factors, including self-esteem and mood	Risk factors for DEBs were: being female, history of sexual abuse and higher negative affect scores. A protective factor for participants was living with their father.
Satyanarayana et al. (27)	Cross-sectional	India (urban setting)	452 females (16–19 years)	To examine the associations among gender disadvantage, psychological distress, and resilience	A negative relationship was found between resilience and distress. Gender disadvantage (gender discrimination, violence and sexual harassment and barriers to personal growth) was associated with moderate and severe distress.
McMullen et al (25),	RCT	Uganda	620 with 170 reported post-intervention data (13–18 years)	To evaluate if a school-based, teacher-led life skills intervention was effective in increasing self-efficacy, prosocial behavior and a sense of connectedness and reducing internalizing problems	There was a significant increase in self-efficacy and connectedness and reduction in internalizing problems (depression and anxiety symptoms) following completion of the intervention compared to the control group.
Gardner and Lambert (52)	Cross-sectional	Jamaica	334 (10–18 years)	To examine the interacting effects of Trait-Emotional Intelligence (TEI) on the associations between self-esteem and depressive symptoms	Older adolescents had greater depressive symptoms and lower self-esteem. TEI’s buffered the association between self-esteem and depressive symptoms
Nsabimana et al. (24)	Cross-sectional	Rwanda	178 (Aged 9–16)	To investigate if institutionalization negatively impacts children’s psychological adjustment (externalizing/internalizing problems and self-esteem)	Institutionalized children had significantly more externalizing behavior problems. Self-esteem of non-orphans in families was highest, highlighting the protective role of family
Mwakanyamale et al. (54)	Cross-sectional	Tanzania	1,000 (13–21 years)	To describe the relationship between childhood psychological maltreatment, self-esteem, psychological distress, depression and anxiety	Psychological maltreatment positively correlated with psychological distress and negatively correlated with self-esteem
Pandey et al. (47)	Prevalence study	Nepal	6,531 students (12–17 years)	To estimate the prevalence of suicidal ideation and identify the associated factors	Anxiety, loneliness, and female gender were risk factors for both suicidal ideation and attempts; having 3 or more close friends was a protective factor against suicidal attempt
Rana et al. (34)	Prevalence study	India (Chandigarh, North India)	667 (12-15 years)	To estimate the prevalence and correlates of bullying	Bully-victims had the highest mental health problems. Predictors of bullying included: being male, having ‘abnormal’ emotions, and poor peer relations. Self-esteem was not found to correlate with bullying.
Arora et al. (28)	Qualitative Study	Guyana	40 (12–17 years) (and 17 adults)	To explore youth and adult stakeholders’ perspectives on risk and protective factors for suicide	Risk factors included: pressure and expectations, adults’ negative responses to youth, limited coping, and exposure to suicide; protective factors included: positive social support and involvement in community activities
El-Abbassy et al. (45)	Intervention	Egypt 54% rural, 46% urban	80 (13–15 years)	To examine the efficacy of a Positive Psychology Intervention (PPI) in promoting mental health, life satisfaction, self-esteem, optimism and happiness	The PPI led to increases in self-efficacy, self-esteem, optimism, life satisfaction, and happiness scores from pre-intervention to post-intervention
Garbett et al. (31)	Pilot RCT	Urban India	166 (11 years)	To evaluate a culturally adapted school-based body image intervention “Dove Confident Me”	The intervention demonstrated high acceptability and preliminary efficacy and significant improvements in body esteem and positive affect scores; no significant effects were found on internalization, life engagement, eating pathology, self-esteem or negative affect
Addy et al. (44)	Mixed-Methods Study	Ghana (rural and peri-urban)	Quantitive study - 405 (12–20 years) Qual – 53 participants including 35 students	To investigate mental health problems, coping strategies, and the student’s support systems	Risk factors included being female, bullying, domestic violence, substance abuse, and academic pressure, coping involving isolation, substance use, and spiritual help; school counseling units were often ineffective
Avanci et al. (29)	Prevalence study	Brazil (São Gonçalo, Rio de Janeiro) Urban dwellers	862 (13–19 years)	To determine the prevalence of Post Traumatic Stress Disorder symptoms in trauma-exposed students and investigate associated factors (sociodemographic, individual, and family)	Significant risk factors included social functional impairment and violence. Resilience and social support were not significantly associated with the presence of PTSD symptoms.
Wang et al. (42)	Cross-sectional	Rural China (Gansu province)	2,989 (7–15 years)	To examine the relationship between primary caregivers’ mental health and school-aged children’s outcomes (mental health, resilience, academic performance)	Caregiver mental health problems were negatively correlated with all student outcomes (student mental health, resilience, academic performance)
Berry et al. (30)	Quasi-experimental Trial	South Africa (Cape Town Metropolitan area)	113 (12–22 years)	To assess outcome of depression, resilience and positive parenting in young people who participated in a 20 week adolescent parenting program which included biological and nonbiological parents	Positive parenting and resilience improved in both groups. Depression rates increased for non-biological parents in the intervention group. High depression risk was associated with smaller improvements in supportive parenting.
(46)	Short-term Longitudinal	Peru (throughout the nation)	1,334 (11–17 years)	To investigate whether social-ecological resilience (personal resources and caregiver relationship) related to changes in internalizing symptoms (anxiety and depression) during the COVID-19 lockdown	Adolescents with higher levels of personal, caregiver, and overall resilience had lower levels of anxiety and depressive symptoms; resilience moderated the change in anxiety symptoms over time
She et al. (48)	RCT	China (Shanghai, rural and urban)	653 (9 to 16 years)	To test the feasibility and effectiveness of a volunteer-led, 8-week mindfulness intervention	No statistically significant differences were found for mindfulness, resilience, anxiety, or depression outcomes in the intervention vs. control groups
Alshammari (57)	Cross-sectional	Jordan (Irbid governorate)	2,741 (13–18 years)	To explore the risk and protective factors related to health behaviors (tobacco, diet) and mental health and psychological variables (depression, life satisfaction, self-esteem)	The importance of social support (from family, friends, and significant others) was a protective factor against depressive symptoms and higher self-esteem and life satisfaction
Edet et al. (37)	Cross-sectional	Nigeria (Calabar)	332 (11–20 years)	To assess the relative importance of social support and family affluence in depression and self-esteem	Social support was of greater importance than family affluence; respondents with low social support had significantly higher depression and lower self-esteem scores, regardless of their family affluence. Social support and female gender predicted depression; social support and age was positively associated with self-esteem
Lewis-Smith et al. (39)	RCT	India (Delhi)	568 11–14 years)	To evaluate the efficacy of a school-based mixed-gender body image intervention (“Dove Confident Me”)	The intervention led to significant improvements in body image at post-intervention and 3-month follow-up. Significant improvements were found for internalization, life disengagement, disordered eating, self-esteem, and negative affect.
Tran et al. (40)	RCT	Vietnam (Hanoi)	1,084 (15–16 years)	To evaluate the effects of a universal school-based mental health promotion program, ‘Happy House’	At 2 weeks post-intervention, the program participants showed significant reductions in depressive symptoms and higher psychological well-being. Coping and self-efficacy were higher in the intervention group at 2-week and 6-month follow-up. The effect on depressive symptoms was no longer significant at 6 months.
Cherewick et al. (56)	Cross-sectional	India (Darjeeling) urban, peri-urban, and rural	274 (10–14 years)	To analyze the relationship between autistic traits and internalizing symptoms among early adolescents and examine the moderating effect of self-efficacy	Higher internalizing symptoms were associated with higher autistic traits; self-efficacy (academic, social, and emotional dimensions) moderated the relationship
Coetzee et al. (50)	Pilot Test	South Africa (Western Cape)	222 (9–11 years)	To determine the feasibility and acceptability of ‘4 Steps To My Future’ (4STMF), a universally delivered classroom-based mental health program	The program was acceptable and feasible. Exploratory outcomes showed significant pre-post improvements in self-esteem and emotion regulation.
Ward-Smith et al. (55)	Cross-sectional	South Africa (Western Cape)	733 (15–18 years)	To investigate associations between depression and anxiety symptoms and Emotion Regulation (ER)	Female gender, higher depressive symptoms, anxiety, PTSD symptoms and risky-alcohol use were significantly associated with poorer ER, whereas self-esteem was significantly associated with better ER
Chen et al. (51)	Cross-sectional	China (Guangdong Province)	686 (11–16 years)	To assess whether shift-and-persist strategies were associated with depressive symptoms and have Socio Economic Status (SES) may be related	Use of more frequent shift-and-persist strategies was associated with fewer depressive symptoms, with stronger effects among those with lower SES.
Wan et al. (41)	Cross-sectional	China (Rural, 8 provinces)	4,708 (12 years)	To examine whether left-behind families and gender inequality places children at higher risk of Adverse Childhood Experiences (ACEs) and depressive symptoms	There was a positive association between the number of ACEs reported and symptoms of depression and low self-esteem
Zook et al. (23)	Intervention Study	Democratic Republic of Congo	483 females (10–14 years)	To assess whether a 12 week music therapy Healing in Harmony (HiH) program improved mental health and school attendance	The HiH program was associated with improvements in depression and higher self-esteem post-intervention and at 17 month follow up
Fine et al. (22)	Cross-sectional qualitative Study	9 LIMCs: Chile, China, Democratic Republic of the Congo, Egypt, Indonesia, Jamaica, Jordan, Kenya, Malawi; 4 HICs: Belgium, Sweden, Switzerland, United States	71 (12–19 years)	To understand adolescents’ perspectives on mental health challenges, risk and protective factors, and coping strategies in multi-country settings	In LMICs and HICs young people emphasized coping, and social and contextual factors (friends, family school, poverty, violence) to be associated with mental health problems and barriers to help-seeking.