Conceptualisations of positive mental health and wellbeing among children and adolescents in low- and middle-income countries: A systematic review and narrative synthesis

Background Mental illnesses are the leading causes of global disease burden. The impact is heightened in low- and middle-income countries (LMICs) due to embryonic care systems and extant barriers to healthcare access. Understanding children and adolescents' conceptualisations of mental health wellbeing in these settings is important to optimize health prevention and promotion initiatives. Objective To systematically review and synthesize children and adolescents' conceptualisations and views of mental health and wellbeing in LMICs. Design Ten databases were systematically searched from inception to July 2020 and findings from included studies were synthesized. Results Twenty papers met eligibility criteria comprising qualitative, quantitative and mixed methods studies. Children and adolescents identified aspects of mental health and wellbeing, including positive affect and outlook and having sufficient personal resources to face daily challenges. Identified factors recognized the importance of activating both kin and lay networks in supporting and maintaining wellbeing. Conceptualisations of mental health and wellbeing were varied and influenced by culture, developmental stage and gender. Discussion and Conclusions Irrespective of environmental and sociocultural influences on concepts of wellbeing and mental health, children and adolescents in LMICs can conceptualise these constructs and identify how they pursue positive mental health and wellbeing important for developing age and culture-appropriate community mental health strategies. Our review highlights the need to extend inquiry to wider developmental stages and both across and within specific populations in LMICs. Patient and Public Involvement Initial results were presented at stakeholder workshops, which included children, adolescents, parents and health professionals held in Indonesia in January 2019 to allow the opportunity for feedback.