Adolescents’ perceptions of mental health and mental health problems in post-conflict settings

Background

Adolescent mental health is a global public health priority, yet little is known about how young people in post‑conflict settings conceptualise mental health and mental health problems. Understanding their perspectives is crucial for designing culturally appropriate support and prevention strategies. This study explored how adolescents in Somalia perceive mental health and mental health problems.

Methods

Ten focus group discussions were conducted between September 2022 and June 2025 with 81 adolescents aged 12–19 years in Hargeisa and Borama, Somalia. The sample included school‑attending (n = 63) and non‑attending (n = 18) adolescents, with balanced gender representation (44 females, 37 males). Data were analysed using reflexive thematic analysis.

Results

Preliminary findings indicate that adolescents often perceive mental health and mental health problems as closely related or overlapping concepts. Mental health was associated with emotional calmness, clear thinking, and social belonging. In contrast, mental health problems were understood as involving emotional distress, neglect of physical self‑care, disengagement from spiritual practices, and experiences of social exclusion. Gender norms shaped these perceptions, influencing how emotional distress and coping were interpreted and expressed among girls and boys. Adolescents also perceived that stigma surrounding mental illness limited open discussion, resulting in many adolescents not talking about their own mental health problems.

Conclusions

These findings show that adolescents in post‑conflict Somalia conceptualise mental health and mental health problems through culturally, religiously, and socially shaped norms. Mental health interventions should be culturally sensitive, address stigma and social norms, and build on adolescents’ existing understandings to improve acceptability and access.

Key messages

• Adolescents in post-conflict Somalia perceive mental health as “normal” and “like us”, while mental health problems are seen as “crazy” and “not normal”, reflecting stigma.

• Adolescent perceptions of mental health and mental health problems are shaped by stigma, gender norms, and cultural beliefs in this post-conflict setting.