Adolescent self-harm in Ghana: a qualitative interview-based study of first-hand accounts

Background: Recent prevalence studies suggest that self-harm among adolescents in sub-Saharan Africa is as common as it is in high income countries. However, very few qualitative studies exploring first-person accounts of adolescent self-harm are available from sub-Saharan Africa. We sought to explore the experiences and first-person perspectives of Ghanaian adolescents reporting self-harm - for deeper reflections on the interpretive repertoires available in their cultural context for making sense of self-harm in adolescents. Methods: Guided by a semi-structured interview protocol, we interviewed one-to-one 36 adolescents (24 in-school adolescents and 12 street-connected adolescents) on their experiences of self-harm. We applied experiential thematic analysis to the data. Results: Adolescents’ description of the background to their self-harm identified powerlessness in the family context and unwanted adultification in the family as key factors leading up to self-harm among both in-school and street-connected adolescents. Adolescents’ explanatory accounts identified the contradictory role of adultification as a protective factor against self-harm among street-connected adolescents. Self-harm among in-school adolescents was identified as a means of “enactment of tabooed emotions and contestations”, as a “selfish act and social injury”, as “religious transgression”, while it was also seen as improving social relations. Conclusions: The first-person accounts of adolescents in this study implicate familial relational problems and interpersonal difficulties as proximally leading to self-harm in adolescents. Self-harm in adolescents is interpreted as an understandable response, and as a strong communicative signal in response to powerlessness and family relationship difficulties. These findings need to be taken into consideration in the planning of services in Ghana and are likely to be generalisable to many other countries in sub-Saharan Africa

Attitudinal and motivational aspects of aberrant driving in a West African country.

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Exploring links between socio-ecological systems and psychological distress: a case study in rural Uganda

Poor mental health is a leading contributor to the global burden of disease, but there is a patchy understanding of how it is influenced by people’s interactions with ecological systems. In a theorygenerating study, we asked how interactions with ecosystems were perceived to influence stressors associated with psychological distress in a rural Ugandan case study. We conducted and thematically analysed 45 semi-structured interviews with residents of Nyabyeya Parish. Poverty and food 30 insecurity were the primary reported causes of ‘thinking too much’ and related idioms suggesting psychological distress. Households bordering a conservation area reported that crop losses from wildlife contributed to food insecurity. But, forest resources were important safety nets for those facing poverty and food insecurity. Commercial agricultural expansion also emerged as a salient theme in residents’ lives, reportedly exacerbating poverty and food insecurity among poorer 35 households but contributing incomes to wealthier ones. Our exploratory study suggests how two globally prevalent land uses – nature conservation and commercial agriculture – may influence social determinants of psychological distress in our study area. We highlight co-benefits and trade-offs between global sustainability goals that could be managed for mental health