A scoping review protocol on mental health interventions for women exposed to gender-based violence in Sub-Saharan Africa

Abstract

Background

Gender-based violence against women in Sub-Saharan Africa is highly prevalent, with profound mental health consequences including depression, post-traumatic stress disorder (PTSD), and anxiety. Despite growing recognition of this public health crisis, evidence on mental health interventions remains fragmented across countries and populations, with limited synthesis of what interventions work, for whom, and under what conditions in African contexts.

Objective

To systematically map and synthesize evidence on mental health interventions for women who have experienced violence across Sub-Saharan Africa, identifying types of interventions evaluated, outcome measures used, and critical research gaps.

Methods

This scoping review will follow the Arksey and O’Malley framework and adhere to PRISMA-ScR guidelines. We will search PubMed, MEDLINE, CINAHL, Scopus, and African Journals Online for studies published between 2010 and December 2025. Eligible studies will include empirical research examining mental health interventions for women aged 15 years and above who have experienced any form of gender-based violence in Sub-Saharan African countries, with outcomes measuring depression, anxiety, PTSD, suicide-related behaviors, or psychological distress. Two independent reviewers will conduct screening and data extraction, with disagreements resolved through discussion or third-reviewer consultation.

Expected outcomes

This scoping review will provide a comprehensive map of the current evidence base on mental health interventions for violence-exposed women in Sub-Saharan Africa, highlighting effective approaches, identifying implementation strategies including task-shifting and service integration, and revealing critical gaps to inform future research priorities and evidence-based policy development.

Supplementary Information

The online version contains supplementary material available at 10.1007/s44192-026-00461-0.

Introduction

Background and rationale

Gender-based violence represents a significant public health crisis across Sub-Saharan Africa, with prevalence rates among the highest globally [1]. Recent estimates indicate that over four in 10 women (44.94%) across 25 Sub-Saharan African countries report experiencing at least one form of gender-based violence, with prevalence varying by country from 10.76% in Comoros to 60.27% in Sierra Leone [1]. In Eastern and Southern Africa specifically, 42% of women experience physical or sexual violence in their lifetimes [2], while the lifetime prevalence of gender-based violence ranges from 56 to 71% across Sub-Saharan Africa [3].

This widespread exposure to violence creates substantial mental health burdens, with affected women experiencing elevated rates of post-traumatic stress disorder, depression, anxiety, and suicidal ideation compared to their non-exposed counterparts [4–6]. Mental health disorders affect most gender-based violence survivors, typically manifesting as depression, anxiety, and post-traumatic stress disorder [3, 7, 8]. Among women in Sub-Saharan Africa who have experienced gender-based violence, GBV exposure is frequently associated with high rates of PTSD, and adverse childhood experiences that compound vulnerability to anxiety, depression, and social withdrawal further compounding their vulnerability to mental health sequelae arising from GBV [9]. In South Africa, 12.9% of adolescent rape survivors were found to have some type of stress-related disorder, and 16.1% had anxiety specifically, while 22.6% had undergone or were currently undergoing a major depressive episode since their rape [10]. Women who are subjected to non-partner sexual violence are 2.6 times more likely to experience anxiety and depressive episodes than women who have not been victimized, and the lifetime prevalence of PTSD in women who have experienced sexual assault is 50% [10]. The cumulative burden of these mental health consequences is substantial: Sub-Saharan Africa bears the highest rate of disability-adjusted life years for depression at 1137 per 100,000 people globally [11], underscoring the urgency of addressing mental health needs among GBV survivors in the region.

Despite this clear need, mental health services across Sub-Saharan Africa remain severely limited, with significant gaps in availability, accessibility, and cultural appropriateness [4, 12]. Many countries in the region have critical shortages of mental health professionals, with Uganda having only 0.08 psychiatrists per 100,000 people, placing it among the countries with the lowest psychiatrist-to-population ratios worldwide [13]. An estimated 75% of those with serious mental health disorders such as depression or PTSD never receive any treatment at all [10]. Additionally, while traditional healing systems are widely used by women experiencing distress following GBV, they remain largely unintegrated with formal mental health services [14], creating fragmented care pathways that leave many survivors without access to evidence-based psychological support.

Various types of mental health interventions have been developed to address the psychological needs of women who have experienced violence, including cognitive behavioral therapy (CBT), which focuses on changing maladaptive thought patterns and behaviors; advocacy interventions that help women navigate resources and develop safety plans; interpersonal therapy that addresses relationship difficulties; narrative exposure therapy for trauma processing; mindfulness-based approaches; and psychoeducational programs that provide information about trauma responses and coping strategies [4, 15, 16, 17]. Previous studies have demonstrated that these interventions can be effective in reducing symptoms of depression, anxiety, and PTSD, improving quality of life, and enhancing safety outcomes among violence survivors [16, 18, 19]. A systematic review of interventions in Sub-Saharan Africa found that psychological empowerment interventions were particularly effective for managing gender-based violence-related symptoms [20].

However, systematic reviews have identified that only a limited number of randomized controlled trials have evaluated psychological interventions specifically tailored for women experiencing intimate partner violence in low- and middle-income countries, including Sub-Saharan Africa [19]. Current understanding of how mental health interventions specifically impact violence recovery outcomes in this context remains fragmented and limited. While international literature demonstrates the potential effectiveness of various psychological interventions for trauma survivors, the applicability and effectiveness of these approaches within Sub-Saharan African contexts are poorly understood [21]. This knowledge gap is particularly concerning given the unique cultural, social, and economic factors that influence both violence experiences and recovery processes in the region [22, 23].

The limited evidence base hampers policy development and service planning, leaving practitioners and policymakers without clear guidance on which interventions are most effective, how services should be delivered, and what outcomes can realistically be expected. Furthermore, much of the existing research has been conducted in high-income settings, raising questions about the transferability of findings to resource-constrained environments with different cultural contexts and health system structures [24].

Beyond the immediate consequences of violence exposure, there is growing recognition that poor mental health can itself be a risk factor for subsequent violence perpetration and re-victimization, creating a cyclical relationship between mental health and violence [25]. Depression, PTSD, and other trauma-related sequelae can undermine protective coping capacities, increase vulnerability to further abuse, and diminish women’s ability to access safety and support resources. Accordingly, strengthening mental health is not merely a clinical imperative but also a violence prevention strategy. Effective mental health interventions can interrupt harmful cycles of violence by restoring women’s psychological resources, enhancing agency and safety-seeking behaviors, and reducing the likelihood of future re-occurrence of violence. This prevention dimension reinforces the urgency of understanding which mental health interventions are available, accessible, and effective in the Sub-Saharan African context [25].

Research gap and need for scoping review

While several systematic reviews have examined mental health interventions for violence-exposed women globally or in low- and middle-income countries [16, 19], no comprehensive scoping review has specifically mapped the evidence across Sub-Saharan Africa. The core problem driving this review is multidimensional: we do not know which mental health interventions have been designed or adapted for the Sub-Saharan African context, whether existing interventions are reaching the women who need them, and whether the interventions evaluated in high-income settings are culturally appropriate or practically feasible in this region. These are fundamentally questions of evidence mapping, cultural adaptation gaps, and implementation knowledge, not primarily questions of comparative effectiveness that a meta-analysis would address. A meta-analysis would be premature and methodologically inappropriate at this stage given the anticipated heterogeneity in study designs, populations, intervention components, and outcome measures, as well as the expectation that many relevant studies will be qualitative or mixed-methods in design. A scoping review is therefore the most appropriate and rigorous methodology because the research question is broad, encompassing diverse intervention types, populations, settings, and outcomes; the evidence base is likely heterogeneous in terms of study designs and methodologies; the primary aim is to map the breadth of available evidence and identify evidence gaps, cultural adaptation gaps, and methodological gaps rather than assess intervention effectiveness through quantitative synthesis; and the regional focus allows for examination of contextual factors unique to Sub-Saharan Africa. The findings will directly inform practitioners about what options exist and policymakers about where investment in primary research is most urgently needed.

Scoping reviews are increasingly recognized as valuable tools for mapping evidence in complex topic areas and identifying gaps in the literature [26]. The Arksey and O’Malley [27] framework provides a rigorous and transparent approach to conducting scoping reviews, which has been further refined by subsequent methodological guidance from the Joanna Briggs Institute and PRISMA-ScR reporting standards [28]. This methodological approach will enable us to comprehensively capture the diversity of interventions, implementation strategies, and outcomes that have been examined across Sub-Saharan African contexts.

Objective

The primary objective of this scoping review is to comprehensively identify and characterize the available evidence regarding mental health interventions for women who have experienced gender-based violence in Sub-Saharan Africa. Specifically, this review aims to: (1) map the types of mental health interventions that have been evaluated across Sub-Saharan African countries, including their, delivery modalities, and implementation approaches; (2) document the outcome measures and psychological recovery indicators used to assess intervention impact; (3) identify evidence gaps (where little or no research exists), cultural adaptation gaps (where interventions have not been designed or tested for Sub-Saharan African contexts), and methodological gaps (where research designs are insufficient to guide practice or policy);

Conceptual framework

Defining violence recovery outcomes

The conceptual framework guiding this scoping review articulates how three interconnected domains, gender-based violence exposure, mental health sequelae, and mental health interventions, relate to one another and collectively shape violence recovery outcomes. At the first level, gender-based violence exposure (encompassing intimate partner violence, sexual violence, and community-based violence) directly produces adverse mental health consequences including depression, anxiety, PTSD, and psychological distress. At the second level, these mental health consequences are not merely endpoints: poor mental health can, in turn, amplify vulnerability to further violence by weakening coping resources and diminishing agency, thereby creating cyclical patterns that require interruption [25]. At the third level, mental health interventions operate on the psychological sequelae of violence, targeting the mechanisms, maladaptive cognitions, emotional dysregulation, interpersonal disruption, social isolation, through which GBV impairs well-being. The effectiveness and accessibility of these interventions are moderated by contextual factors including healthcare system capacity, cultural appropriateness, delivery modality, and provider characteristics (particularly task-shifting to non-specialist providers). At the fourth level, successful intervention produces violence recovery outcomes across psychological, relational, and social domains. This framework thus positions mental health intervention not only as a clinical response to violence, but also as a mechanism for interrupting cycles of violence and promoting long-term well-being. It draws on social-ecological theory [29], trauma-informed care principles [30], and resilience frameworks [31, 32] to account for the multi-level influences on women’s recovery trajectories in Sub-Saharan African contexts. The sub-sections below elaborate on the key components of this framework.

Violence recovery outcomes represent a complex, multidimensional construct that encompasses the various ways women heal and rebuild their lives following experiences of gender-based violence. Recovery is conceptualized as a preferred outcome for assessing intervention effectiveness in the context of intimate partner violence, though measurement tools remain in nascent form [33]. The process of transformation includes four key stages: loss of self, shifts in thinking, reclaiming self, and reinventing identity, providing an ecological view of survivors that addresses healing and recovery rather than simply focusing on leaving abusive relationships [34].

Recovery outcomes can be categorized across multiple domains. Research has identified three interconnecting recovery objectives: reconnection with the self, others, and the world [35]. Reconnection with the self involves reclaiming one’s identity and making decisions autonomously; reconnection with others involves feeling a sense of belonging in the community; and reconnection with the world involves developing a positive view of the world and finding fulfillment and personal growth [35]. A qualitative metasynthesis identified four domains of healing from sexual violence: managing psychological and physical symptoms, rebuilding relationships and social connections, finding meaning and purpose, and developing a positive sense of self [36]. From a resilience perspective, recovery outcomes include the capacity of individuals facing adverse circumstances to navigate their way to psychological, social, cultural, and physical resources that sustain their well-being [31].

For this scoping review, we will focus on psychological recovery indicators as measured through validated mental health outcomes including depression, anxiety, PTSD, suicide-related behaviors, and general psychological distress. These outcomes represent critical dimensions of mental health recovery that are commonly assessed in intervention research and have established measurement tools suitable for Sub-Saharan African contexts [23]. It is also important to recognize that recovery is rarely linear or uniform. The Trauma Recovery Rubric (TRR), developed through participatory methods including social network mapping, body mapping, lifelines, and card-based exercises with GBV survivors across four countries, identifies seven broad recovery pathways: normalisation, minimising, consumed/trapped, shutdown/frozen, surviving, seeking and fighting for integration, and finding integration/equanimity [35]. These pathways highlight that women’s healing journeys vary considerably, and that mental health care must be sufficiently flexible to meet survivors at different points along their recovery continuum. This review will attend to how the interventions identified engage with these varied recovery trajectories and whether outcome measurement approaches are sensitive enough to capture the diversity of healing experiences among women in Sub-Saharan Africa.

Typology of mental health interventions for violence victims

Mental health interventions for women who have experienced violence can be categorized into several distinct but often overlapping types, each with unique theoretical foundations, mechanisms of change, and evidence bases. This typology was developed through an iterative process informed by existing systematic reviews and scoping literature [15, 16, 19], WHO guidelines on mental health interventions for survivors of violence, and the research team’s expertise in the Sub-Saharan African context. It is important to acknowledge that this typology is inherently shaped by the available evidence base, which tends to be skewed toward structured, manualized, and individually delivered interventions, largely because these are more amenable to rigorous experimental evaluation. As Horn [37] has argued in the context of African feminist approaches to emotional well-being, the global mental health field risks reproducing colonial hierarchies of knowledge by privileging Western, biomedical models of therapy over the diverse healing traditions and community practices that are central to well-being in African contexts. This review explicitly seeks to surface evidence of culturally grounded and community-based approaches alongside the more commonly evaluated clinical interventions. Understanding this typology provides a framework for organizing and interpreting the diverse interventions that may be identified in this scoping review.

Trauma-focused cognitive-behavioral interventions represent evidence-based approaches that directly address traumatic memories and their cognitive and behavioral consequences [38]. These include Cognitive Processing Therapy, which focuses on challenging maladaptive beliefs about the trauma; Prolonged Exposure Therapy, which uses systematic exposure to trauma memories to reduce avoidance; and Narrative Exposure Therapy, which constructs a coherent narrative of traumatic experiences [39]. These interventions typically involve structured protocols delivered over 8–16 sessions and have demonstrated efficacy in reducing PTSD symptoms in diverse cultural contexts [21].

Interpersonal and relational therapies focus on improving interpersonal functioning and relationships, which are often disrupted by violence exposure [40]. Interpersonal Psychotherapy (IPT) addresses role transitions, interpersonal disputes, grief, and interpersonal deficits that contribute to depression and other mental health problems. IPT has been successfully adapted for low-resource settings and delivered by non-specialist providers with demonstrated effectiveness for depression in violence-exposed populations [4, 41].

Transdiagnostic psychological interventions target common underlying mechanisms across multiple mental health problems rather than specific diagnostic categories [42]. Problem Management Plus (PM+) is a brief transdiagnostic intervention developed by the World Health Organization that addresses both practical problems and emotional distress through problem-solving, behavioral activation, stress management, and strengthening social support [43]. These interventions are particularly valuable in resource-limited settings where specialist mental health services are scarce and comorbidity is common [44].

Arts-based and expressive therapies utilize creative expression through visual arts, music, dance, drama, or other artistic modalities as therapeutic tools [45]. These approaches may be particularly culturally congruent in Sub-Saharan African contexts where oral traditions, music, dance, and creative expression hold cultural significance [46]. Arts-based therapies provide nonverbal pathways for processing trauma, which may be important given that trauma affects brain regions involved in language and verbal processing [47]. Collective dance, movement, and song have long formed part of women’s healing traditions across Africa, and can reduce social isolation and stigma, ease emotional distress, and foster social and spiritual connections in culturally familiar ways. This category therefore extends beyond formalized clinical arts therapies to include community-based expressive practices that support recovery.

Body-based and somatic therapies encompass approaches that engage the body as a primary vehicle for trauma processing and recovery, based on the understanding that traumatic experiences are often held somatically, in bodily sensations, posture, movement, and physiological arousal patterns [47]. Somatic therapies, yoga-based interventions, and trauma-sensitive movement practices recognize that talk-based therapies alone may be insufficient to access trauma stored in the body. There is emerging evidence for body-based approaches in African settings, including yoga-based interventions for survivors of gender-based violence and trafficking. Body-based therapies also align with many African healing traditions that integrate physical practices, movement, and communal embodied expression as core elements of recovery [48, 49]. This review will capture evidence for somatic and body-based approaches alongside more conventional talk therapies. Eye Movement Desensitisation and Reprocessing (EMDR) is also included within this category, as it involves bilateral sensory stimulation alongside cognitive processing of traumatic memories [50]. EMDR has an extensive evidence base for PTSD and related conditions, and is recommended by the WHO as a potential intervention to address mental health problems linked to sexual violence and intimate partner violence when delivered by trained professionals with an understanding of violence against women [51]. EMDR may therefore represent an important intervention type to surface in the Sub-Saharan African evidence base.

Empowerment and advocacy interventions focus on enhancing women’s agency, self-efficacy, and ability to access resources and navigate systems [52]. These interventions often combine psychoeducation about violence and trauma with practical support in areas such as safety planning, legal advocacy, economic empowerment, and accessing community resources. Empowerment approaches align with feminist frameworks that view recovery as involving both psychological healing and social change [53].

Mindfulness and acceptance-based interventions teach individuals to observe thoughts and feelings without judgment and to accept difficult internal experiences rather than avoiding them [54]. Mindfulness-Based Stress Reduction, Acceptance and Commitment Therapy, and other mindfulness-infused approaches have shown promise for trauma-related symptoms and may be adapted to incorporate culturally relevant meditation or contemplative practices [55].

Psychoeducational and skill-building interventions provide information about trauma, violence, and mental health while teaching practical coping skills [56]. These interventions normalize trauma responses, reduce self-blame, teach emotion regulation and coping strategies, and may be delivered in group formats that provide peer support. Psychoeducational approaches are often more scalable and may serve as first-line interventions in stepped-care models [57].

Integrated and multicomponent interventions combine elements from multiple therapeutic approaches or integrate mental health care with other services such as economic empowerment, parenting support, or reproductive health care [58]. Integrated interventions may address multiple dimensions of recovery simultaneously and align with holistic, contextually grounded approaches to healing. This scoping review will characterize which types of interventions have been evaluated in Sub-Saharan African contexts and identify patterns in their theoretical foundations, delivery modalities, and outcomes. It is important to acknowledge a significant limitation of this typology: it does not encompass integrated livelihood and mental health strategies that address structural determinants of poor mental health, including poverty, food insecurity, and housing instability, which are particularly pertinent in the Sub-Saharan African context. The global mental health field is increasingly recognizing that addressing these structural drivers is essential to sustainable recovery, particularly for GBV survivors whose vulnerability is compounded by economic dependence and social marginalization. This represents an important boundary condition of the current review, and we will note where such integration is partially captured within the evidence base.

Theoretical models of recovery and healing

Several overarching theoretical frameworks underpin approaches to violence recovery and healing among women, providing the conceptual foundation for intervention development and implementation.

Trauma-Informed Care Models emphasize creating safety for individuals seeking care by understanding the effects of trauma and its close links to health and behavior, focusing on safety, community, attachment, processing, and empowerment [30]. Trauma-informed approaches represent a fundamental shift from thinking ‘What’s wrong with you?’ to considering ‘What happened to you?’, adopting strengths-based models that see the service user as the expert in their own life and as having had the skills to survive [59]. The Trauma Recovery and Empowerment Model (TREM) draws on cognitive-behavioral, skills training, and psychoeducational techniques to address recovery and healing from sexual, physical, and emotional abuse, consisting of three major components: empowerment strategies, direct trauma processing, and skills building for communication, decision-making, and establishing safer relationships [60].

Social-Ecological Models recognize that the context of traumatic events significantly influences both initial and sustained responses to trauma, treatment needs, selection of prevention and intervention strategies, and ways of providing hope and promoting recovery [61, 62]. These models examine individual, relational, community, and cultural factors, acknowledging that recovery occurs within nested systems of influence. Social-ecological frameworks are particularly relevant for understanding violence and recovery in Sub-Saharan African contexts, where extended family networks, community structures, and cultural norms play significant roles in both violence perpetration and healing processes [34].

Resilience Frameworks conceptualize resilience as a multidimensional and transactional process across systems, examining individual, relational, community, and cultural factors related to resilience in violence-exposed women [31]. Rather than viewing resilience as a fixed individual trait, contemporary frameworks emphasize the dynamic interaction between individuals and their environments in fostering adaptive outcomes following adversity [32]. From a resilience perspective, recovery outcomes include the capacity of individuals facing adverse circumstances to navigate their way to psychological, social, cultural, and physical resources that sustain their well-being [31]. Contemporary trauma-informed therapy frameworks acknowledge the widespread prevalence of trauma and focus on recognizing trauma symptoms, understanding their root causes, and providing safe, supportive environments that address individual experiences while fostering healing and resilience [63]. These theoretical models collectively emphasize the importance of holistic, culturally responsive, and empowerment-based approaches to supporting women’s recovery from violence.

Methodology

Study design

This scoping review will employ the methodological framework developed by Arksey and O’Malley [27], which provides a systematic approach to mapping the breadth of research evidence in a particular area. The framework consists of five stages: identifying the research question, identifying relevant studies, study selection, charting the data, and collating, summarizing and reporting the results. The reporting of this scoping review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines, which ensures transparent and comprehensive reporting of scoping reviews, facilitating reproducibility and enabling readers to assess the methodological rigor of the review process [28]. This standardized approach enhances the credibility and reliability of the findings while supporting evidence synthesis in the field of mental health services for women experiencing violence (supplementary file 1-Research checklist).

Research question

What mental health interventions have been evaluated for women exposed to violence in Sub-Saharan Africa, and what evidence exists regarding their impact on psychological recovery indicators (depression, anxiety, PTSD, suicide-related behaviors, and psychological distress)?

Eligibility criteria

Inclusion criteria

Population: Women aged 15 years and above who have experienced any form of gender-based violence in Sub-Saharan Africa, including intimate partner violence, sexual violence, and community-based violence. Even though sexual violence is increasingly prevalent in adolescents below 15 years [64], the lower age threshold of 15 years was selected for several intersecting reasons.

First, the World Health Organization (WHO) defines adolescence as the second decade of life, spanning ages 10–19 years, a period during which significant physical, psychological, and social changes occur, and during which adolescents develop more advanced patterns of thinking, reasoning, and an increasing sense of responsibility and independence [65]. Gender-based violence, including intimate partner violence and sexual violence, is prevalent among adolescent girls in this period, with earliest experiences frequently occurring during mid-to-late adolescence.

Second, the age of 15 is consistent with established regional survey frameworks, including the Demographic and Health Surveys (DHS) programme, which uses 15 years as the standard lower bound for collecting data on violence experiences from women and girls across Sub-Saharan Africa, ensuring our threshold aligns with the primary data infrastructure of the region.

Third, and critically, the decision to set the threshold at 15 years is grounded in research ethics governance. Adolescents under 18 years are classified as children in many legal settings under the Convention on the Rights of the Child, and children generally lack capacity to participate in research autonomously [66]. Mandatory disclosure obligations and distinct ethical safeguards apply to research involving children that do not apply to adults, and the determination of a child’s best interests must account for age, maturity, environment, and experience [67]. The WHO’s Guidance on Ethical Considerations in Planning and Reviewing Research Studies on Sexual and Reproductive Health in Adolescents specifically notes that gaps in research ethics guidance have led to the exclusion of adolescents from crucial research, an outcome that is counter to their best interests [66]. By setting the threshold at 15, we balance the imperative to include mid-to-late adolescent girls, who are disproportionately affected by GBV yet underrepresented in intervention research, while respecting the distinct developmental, legal, and ethical frameworks that govern research with younger children. Studies focusing exclusively on children under 15 years are therefore excluded from this review.”

Intervention: Mental health services encompassing both formal and informal interventions. Formal services include structured psychological therapies (e.g., cognitive-behavioral therapy, interpersonal therapy, narrative exposure therapy), counseling services, psychiatric care, and mental health programs delivered by trained professionals or lay providers. Informal services include peer support programs, community-based interventions, and traditional healing practices integrated with mental health approaches.

Outcomes: Mental health outcomes representing psychological sequelae of violence exposure and indicators of recovery. These include validated measures of depression (e.g., PHQ-9, BDI, CES-D), anxiety (e.g., GAD-7, BAI, HSCL anxiety subscale), PTSD (e.g., PCL, HTQ, PDS), suicide-related behaviors (e.g., suicidal ideation, suicide attempts, self-harm), and psychological distress (e.g., K10, HSCL-25, GHQ-12). Studies must report at least one of these mental health outcomes using standardized assessment tools or validated measures.

Study designs: All empirical studies including randomized controlled trials, quasi-experimental studies, cohort studies, case-control studies, cross-sectional studies, and qualitative studies that provide evidence on the impact of mental health services on mental health outcomes among violence-exposed women.

Geographic scope: Studies conducted in any of the 48 countries classified as Sub-Saharan Africa according to the World Bank classification.

Language and timeframe: Publications in English language published between January 2010 and December 2025 to capture contemporary evidence while ensuring relevance to current service delivery contexts.

Exclusion criteria

• Studies focusing exclusively on children under 15 years.

• Studies that do not specifically examine women’s experiences or include mixed-gender samples without disaggregated results for women.

• Non-empirical studies including theoretical papers, opinion pieces, editorials, and narrative reviews without systematic methodology.

• Studies in mixed geographic samples without disaggregated results for Sub-Saharan African participants.

• Studies examining mental health services that do not report outcomes for depression, anxiety, PTSD, suicide-related behaviors, or psychological distress.

Search strategy

Electronic databases

A comprehensive search strategy will be conducted across multiple electronic databases to ensure comprehensive coverage of the available literature. Primary databases will include PubMed for biomedical literature, MEDLINE via EBSCO for additional health sciences coverage, CINAHL (Cumulative Index to Nursing and Allied Health Literature) for nursing and allied health research, Scopus for multidisciplinary scientific literature, and African Journals Online (AJOL) to capture research published in African-based journals that may not be indexed in major international databases. This multi-database approach is essential for capturing the full scope of relevant research, as evidence suggests that single-database searches can miss a substantial proportion of relevant studies, particularly in low- and middle-income country contexts.

Grey literature and additional sources

To complement electronic database searches and reduce publication bias, additional sources will be systematically explored to identify relevant grey literature and unpublished studies. Grey literature databases will be searched to capture reports, theses, dissertations, and other non-peer-reviewed publications that may contain valuable evidence not available in peer-reviewed journals. Reference lists of all included studies will be manually reviewed through backward citation tracking to identify additional relevant publications that may have been missed by database searches. Expert consultations will be conducted with researchers and practitioners working in the field of gender-based violence and mental health in Sub-Saharan Africa to identify unpublished studies, ongoing research, and grey literature sources. Organizational websites of key international agencies including the World Health Organization (WHO), UN Women, United Nations Population Fund (UNFPA), and regional bodies such as the African Union will be systematically searched for relevant reports, policy documents, and evaluation studies. This comprehensive approach to searching both published and grey literature will help ensure that the scoping review captures the full breadth of available evidence, including implementation research and program evaluations that may not be published in academic journals.

Search terms and strategy development

The search strategy will employ a combination of controlled vocabulary terms, including Medical Subject Headings (MeSH) for PubMed and MEDLINE, and CINAHL subject headings, along with free-text keywords to ensure comprehensive retrieval of relevant literature. Search terms will be organized into four main concept areas that reflect the key elements of the research question: population (women exposed to violence), intervention (mental health services), outcomes (depression, anxiety, PTSD, suicide-related behaviors, psychological distress), and geography (Sub-Saharan Africa). Mental health service terms will include both broad terms such as mental health services, psychological interventions, counseling, psychotherapy, therapy, psychiatric treatment, and mental health care, as well as specific intervention types such as cognitive behavioral therapy, CBT, interpersonal therapy, IPT, narrative exposure therapy, trauma-focused therapy, problem management, mindfulness, and arts therapy. Violence-related terms will encompass violence, gender-based violence, intimate partner violence, IPV, domestic violence, sexual violence, abuse, assault, rape, and sexual assault. Mental health outcome terms will include depression, depressive disorder, anxiety, anxiety disorders, PTSD, post-traumatic stress disorder, posttraumatic stress, suicide, suicidal ideation, suicide attempt, self-harm, psychological distress, mental health outcomes, psychiatric symptoms, and trauma. Geographic terms will include the umbrella term Sub-Saharan Africa as well as individual country names for all 48 countries in the region.

Search terms will be combined using appropriate Boolean operators, with OR used to combine synonyms within each concept area and AND used to combine the different concept areas. The search strategy will be adapted to each database’s specific indexing system, search syntax, and functionality, taking into account differences in controlled vocabulary, field codes, proximity operators, and truncation symbols. The search strategy will be developed iteratively through pilot testing, with refinements made to optimize the balance between sensitivity (capturing all potentially relevant studies) and specificity (limiting retrieval of irrelevant studies). A sample of the search strategy is provided in Table 1.

Table 1.

Sample PubMed search strategy

Concept	Search terms
Population	(women[MeSH] OR woman OR female OR girls OR adolescent)
Exposure	(“gender-based violence“[MeSH] OR “intimate partner violence” OR “domestic violence” OR “sexual violence” OR abuse OR assault OR rape)
Intervention	(“mental health services“[MeSH] OR “psychotherapy“[MeSH] OR counseling OR therapy OR “psychiatric treatment” OR “psychological intervention” OR CBT OR IPT)
Outcomes	(depression[MeSH] OR anxiety[MeSH] OR “PTSD“[MeSH] OR “post-traumatic stress disorder” OR suicide OR “psychological distress” OR “mental health outcomes”)
Geography	(“Sub-Saharan Africa” OR Kenya OR “South Africa” OR Ghana OR Nigeria OR Tanzania OR Uganda OR Ethiopia OR Rwanda OR [… all 48 SSA countries])
Limits	English language; 2010–2025; Humans

Study selection process

The study selection process will follow a systematic two-stage screening approach to ensure rigorous and transparent identification of relevant studies, consistent with best practices in evidence synthesis methodology [68]. In the first stage, two independent reviewers will conduct title and abstract screening of all citations retrieved from the comprehensive search strategy. Each citation will be assessed against predetermined inclusion and exclusion criteria, with reviewers using a standardized screening form to ensure consistency. Studies will be classified as include, exclude, or uncertain based on the information available in the title and abstract. Any studies marked as include or uncertain by either reviewer will proceed to full-text screening.

In the second stage, the same two independent reviewers will examine complete manuscripts of all studies that passed title and abstract screening to make final inclusion decisions. Full-text screening will involve detailed assessment against all eligibility criteria, including verification of appropriate population, relevant interventions, suitable mental health outcomes, appropriate study designs, correct geographic setting, and publication parameters.

Throughout both screening stages, disagreements between reviewers will be resolved through a consultation with a third expert reviewer. The complete study selection process, including the number of studies identified through database searching and other sources, the number of duplicates removed, the number of studies screened at title/abstract level, the number of full-text articles assessed for eligibility, and the number of studies included in the final review with reasons for exclusions at each stage, will be documented using a PRISMA flow diagram.

Data extraction

A standardized data extraction form will be developed specifically for this scoping review to systematically capture relevant information from all included studies. The data extraction form will be designed through an iterative process, beginning with identification of key data elements based on the research objectives, followed by pilot testing on a representative sample of studies to ensure the form captures all necessary information and is feasible to complete. The data extraction form will be pilot tested on a random sample of 10% of included studies, with the two primary reviewers independently extracting data from the same studies and then comparing results to identify ambiguities, missing data fields, or inconsistencies in interpretation. Based on pilot testing results, the form will be refined and finalized before proceeding with full data extraction. Data extraction will be conducted independently by two trained reviewers for all included studies, with discrepancies identified through comparison of completed extraction forms. Discrepancies will be resolved through discussion between the two reviewers, with consultation of a third reviewer when consensus cannot be reached. Regular calibration meetings will be held throughout the data extraction process to ensure consistency in interpretation and coding decisions.

Study characteristics will be systematically extracted including bibliographic details (authors, year), geographic information (country, urban/rural setting, contextual details), methodological characteristics (study design, pilot versus full-scale trial, duration including follow-up), and sample characteristics (size, group allocation, age, recruitment methods, violence exposure types).

Intervention characteristics will be comprehensively documented including service type categorization per the conceptual framework typology, intervention name and manualized protocols, delivery setting and format, duration and intensity, and group size where applicable. Provider characteristics including qualifications, training, supervision, and fidelity monitoring will be extracted, with specific attention to task-shifting approaches. Theoretical frameworks and cultural adaptation processes will be documented, including formal adaptation procedures, stakeholder engagement, context-specific modifications, and adaptation frameworks utilized.

Mental health outcome measures will be extracted for all relevant domains (depression, anxiety, PTSD, suicide-related behaviors, psychological distress), documenting measurement instruments, assessment timing, mean scores, standard deviations, change scores, effect sizes, statistical significance, and remission rates. For qualitative and mixed-methods studies, findings regarding intervention acceptability, barriers, facilitators, and participant experiences will be extracted. Implementation outcomes, including acceptability, appropriateness, feasibility, fidelity, penetration, sustainability, and cost-effectiveness, will be documented when reported. A sample of the data extraction format is provided as a supplementary file (Supplementary File 2: Data Extraction Format).

Data synthesis and presentation

Data will be synthesized using both narrative and tabular formats to provide a comprehensive overview of the evidence, following established guidance for reporting scoping reviews [69]. Descriptive statistics will be used to summarize key study characteristics. Geographic distribution of studies will be mapped across Sub-Saharan African countries using tables. Intervention characteristics will be presented in detailed tables categorizing studies by intervention type according to the typology presented in the conceptual framework. Narrative synthesis will complement the tabular presentations by describing key patterns, themes, and findings emerging from the data.

Quality appraisal

As this is a scoping review focused on mapping the breadth of available evidence rather than assessing intervention effectiveness through quantitative synthesis, formal quality appraisal of individual studies will not be conducted [27, 69]. This approach is consistent with scoping review methodology as originally outlined by Arksey and O’Malley [27] and subsequently endorsed by the Joanna Briggs Institute methodological guidance for scoping reviews [69].

Discussion

This scoping review is expected to yield several important outcomes that will advance understanding of mental health interventions for violence-exposed women in Sub-Saharan Africa. First, the review will provide a comprehensive evidence map documenting the types, characteristics, and distribution of mental health interventions that have been evaluated across the region [70]. Based on preliminary scoping searches and existing systematic reviews in related areas, we anticipate identifying between 10 and 30 studies representing diverse intervention approaches including trauma-focused cognitive-behavioral therapies, interpersonal therapies, transdiagnostic interventions, and potentially culturally grounded or arts-based approaches [19]. The evidence map will likely reveal geographic clustering of research in East and Southern African countries with established research infrastructure, such as Kenya, South Africa, Uganda, and Tanzania, with substantial gaps in West and Central African countries [24].

Second, the review will characterize implementation approaches that have been utilized to deliver mental health interventions in resource-constrained Sub-Saharan African contexts. Task-shifting is of particular importance in this context, given the profound shortage of specialist mental health professionals across the region. Most Sub-Saharan African countries have fewer than one psychiatrist per 100,000 people, for example, Uganda has only approximately 0.08 psychiatrists per 100,000 population [13], making specialist delivery of mental health interventions at scale practically impossible. In this context, the adaptation of evidence-based interventions for delivery by community health workers, nurses, peer counselors, and other non-specialist providers is not merely a pragmatic accommodation but a fundamental prerequisite for any realistic mental health response to GBV at population level. We expect to identify evidence of task-shifting strategies whereby interventions originally developed for delivery by specialist mental health professionals have been adapted for non-specialist providers [21, 57]. Documenting training approaches, supervision models, fidelity monitoring mechanisms, and reported outcomes from task-shifted interventions will provide critical insights for policymakers and programme planners seeking to scale up mental health services for GBV survivors across the region. Additionally, we anticipate finding examples of mental health interventions integrated within existing health service platforms such as HIV care, maternal and child health services, or primary care, which represents another pragmatic implementation approach for improving access to mental health services [4, 71].

Third, the review will catalogue outcome measures that have been employed to assess intervention impact on mental health recovery. We expect to find that depression and PTSD outcomes are most commonly measured, given their high prevalence among violence-exposed women and the availability of validated brief screening instruments [23, 72]. The review will document whether instruments have been validated in Sub-Saharan African populations, identify commonly used measures, and note any gaps or inconsistencies in outcome measurement.

Fourth, a critical outcome will be systematic identification of research gaps across multiple dimensions. We anticipate identifying substantial geographic gaps with entire countries or regions having no published research. Population gaps are expected in terms of underrepresentation of specific groups such as adolescent girls, older women, women with disabilities, and women experiencing particular forms of violence. Intervention gaps may include limited research on prevention-focused interventions, combined mental health and violence prevention approaches, or integration of traditional healing practices. Methodological gaps are likely to include limited long-term follow-up, lack of cost-effectiveness analyses, insufficient implementation research, and need for more rigorous study designs.

Limitations

Several limitations should be acknowledged. First, restricting to English-language publications may exclude relevant French and Portuguese research from Francophone and Lusophone Sub-Saharan African countries. We will partially mitigate this by searching African Journals Online, which indexes multilingual publications with English abstracts. Second, consistent with scoping review methodology, we will not conduct quality appraisal or risk of bias assessment, meaning all identified studies will be included regardless of methodological quality. Key methodological characteristics will be transparently reported. Third, heterogeneity in interventions, outcomes, and designs will preclude meta-analysis, providing descriptive overview rather than comparative effectiveness conclusions. Fourth, the 2010-onwards timeframe excludes earlier research but focuses on contemporary evidence relevant to current contexts. Fifth, requiring validated mental health outcome measures may exclude studies examining other important outcomes. Finally, the review represents a temporal snapshot in an active research area. Despite these limitations, this scoping review will provide valuable evidence synthesis, identify critical gaps, and inform future research, practice, and policy.

Ethics and dissemination

Ethical considerations

As this scoping review will exclusively analyze publicly available published and grey literature, formal ethical approval from an institutional review board is not required [28]. No primary data collection involving human participants will be conducted. All included studies will have obtained necessary ethical approvals as documented in their respective publications.

Dissemination plan

The findings of this scoping review will be disseminated through multiple channels to ensure broad reach among researchers, practitioners, policymakers, and other stakeholders. Primary dissemination will be through peer-reviewed publication in an open-access journal to ensure accessibility. Conference presentations will be delivered at relevant international and regional meetings.

Supplementary Information

Below is the link to the electronic supplementary material.

Author contributions

Conceptualization of the study: D.S.B, E.K, M.S, S.A; Design and methods: D.S.B, E.K, S.A; First draft preparation: D.S.B and E.K. Review and editing of protocol: DSB, E.K, M.S, S.A. All authors read the final draft and approved the published version. DSB is the guarantor responsible for the overall content of the paper.

Funding

The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

This manuscript is a scoping review protocol and does not involve the collection of primary data from human participants. As such, formal ethical approval was not required for this study. The review will be conducted in accordance with the ethical principles outlined in the Declaration of Helsinki and will adhere to the Joanna Briggs Institute (JBI) methodological guidance for scoping reviews. All data to be extracted will be sourced from publicly available published literature. This is a scoping review protocol and does not involve direct participation of human subjects. No primary data will be collected from individuals, and therefore consent to participate is not required.

Consent for publication

Not applicable. This manuscript does not contain individual personal data, images, videos, or any identifiable information relating to individual participants. All authors have reviewed the final manuscript and consented to its submission and publication.

Competing interests

The authors declare no competing interests.