Systematic Review and Meta-analysis of Prevalence of Mental Disorders and Suicidality Among Children and Adolescents Living with HIV in South Africa.

Despite progress in HIV prevention and treatment, global data suggests that youth living with HIV remain at risk of mental disorders and suicidality. However, reliable epidemiological data from South Africa (SA) are limited. We conducted a systematic review and meta-analysis to synthesize evidence on the prevalence of mental disorders and suicidality among SA children and adolescents (≤ 19 years) living with HIV. Following PRISMA guidelines, we searched PubMed, PsycINFO, Web of Science, Scielo (SA), and Google Scholar published before 19th February 2025. Twelve studies published between 2010 and 2024 met inclusion criteria, yielding 33 prevalence estimates for mental disorders and nine for suicidality. All studies used non-probability samples and screening instruments. Random-effects meta-analyses produced pooled apparent prevalence estimates of 11.5% for depression, 8.6% for anxiety, and 2.3% for PTSD, with substantial heterogeneity (I² >90%). After adjusting for measurement error related to screening tool sensitivity and specificity, pooled true prevalence estimates were markedly lower: 3.9% for depression, 4.0% for anxiety, and 1.3% for PTSD. Estimates of suicidality were sparse and highly variable, with suicidal ideation ranging from 1% to 42% and suicide attempts from 0.2% to 20%. Overall, the evidence base is geographically constrained and methodologically limited. When appropriately adjusted, the burden of mental disorders among young people living with HIV in SA appears more modest and heterogeneous than commonly reported, highlighting the need for improved measurement, broader diagnostic coverage, longitudinal designs, and nationally representative studies focused on structural and contextual determinants of mental health risk across childhood and adolescence.