The science of child and adolescent mental health in Mozambique: A systematic review of prevalence estimates, measurement tools, and interventions.

Mozambique is home to 18 million children and adolescents largely underrepresented in mental health research. We conducted a systematic review of evidence-based resources (prevalence estimates, assessment instruments, and interventions) on mental health-related outcomes addressing individuals aged 0-19 years in Mozambique. We searched PubMed, Web of Science, PsycINFO, CINAHL, Google Scholar, African Index Medicus, and local catalogues. Extraction followed COSMIN and Cochrane manuals (PROSPERO registration: CRD420251016208). The search yielded 81 unique publications, including 61 reports presenting prevalence estimates from 25 studies, 29 reports providing data on 42 assessment instruments, and 9 intervention reports describing 8 intervention trials. The clinical prevalence of mental disorders were estimated in two surveys, conducted in Nampula (ADHD: 13·4%; N = 748, 6-18 years) and Maputo (any mental diagnosis: 23%, anxiety disorders: 17·5%; major depression episode: 8·5%; disruptive behavior disorder: 6·6%; substance use disorders: 4·5%; ADHD: 3·3%; PTSD: 1·2%; N = 486, 12-19 years). Most research focused on psychosocial adversities, with nationally representative adolescent surveys reporting significant exposure to violence (physical/emotional violence annually: 24·86%; girls suffering intimate partner violence: 21·11%; lifetime sexual abuse: 16·55%). National suicide rates were highest among 15-19-year-olds (1·53 per 100,000). Only four instruments were cross-culturally adapted and showed reliable psychometrics (MINI-KID, GAD-7, PHQ-A, and SDQ), whilst unadapted tools performed poorly. There was a single randomized clinical trial which reported a cost-effective intervention for neurodevelopment among high-poverty preschoolers. Children and adolescents in Mozambique face significant psychosocial adversity, and available evidence suggests a substantial burden of mental disorders according to limited clinical data. There are few available instruments assessing mental conditions, and culturally sensitive approaches are warranted for strengthening local research.