Understanding the contextual determinants, barriers and facilitators of mental health for adolescent girls and young women in Burundi: Insights from lived experiences.

Adolescent girls and young women (AGYW) in Burundi face substantial mental health risks stemming from trauma, displacement, bereavement, and sexual violence, compounded by poverty, social upheaval, and limited mental health services. Stigma and marginalization further constrain help-seeking. This study examines the distinct mental health challenges faced by AGYW in Burundi, exploring how socio-cultural and structural factors shape their psychological well-being and identifying key barriers and facilitators to accessing mental health support. Seven focus group discussions (FGDs; total n = 55; 7-8 participants each, ages 15-24) were conducted using purposive sampling to ensure diversity by ethnicity, disability status, and school enrollment. Data was analyzed thematically using a preliminary coding framework. Four thematic domains emerged: (1) contextual conditions shaping mental health; (2) barriers to service access; (3) facilitators for improving access; and (4) intervention needs. Stigma and low community awareness contributed to isolation and silence around distress. Structural barriers, including poverty, food insecurity, and unstable home environments, limit service uptake and educational engagement, with daily survival needs often superseding care-seeking. Facilitators included culturally relevant, community-based approaches and school settings as potential safe spaces for support. Priorities include stigma reduction, community awareness, and school-based delivery models that address gender-based violence and societal norms.