Positive mental health and well-being in Ethiopia: a mixed-methods systematic review

Introduction : Ethiopian mental health research has focused mainly on psychopathology, burden, or service gaps. Positive mental health (PMH) and well-being expand health definitions with resilience, life satisfaction, social support, hope, self-esteem, spirituality, optimism, meaning in life, and psychological capital beyond deficit-orientation.

Materials and methods : A synthesis of PMH studies within Ethiopian populations (1 January 2000–31 December 2025) was conducted. This mixed-methods systematic review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 and analysed studies from PubMed/MEDLINE, Embase, and PsycINFO. Quality was assessed using Joanna Briggs Institute tools, and confidence in the output of qualitative research synthesis (ConQual) evaluation. Heterogeneity in design, measures, and outcomes required narrative synthesis.

Results : Thirty-eight peer-reviewed studies (17 quantitative, 18 qualitative, 3 mixed-methods) involving 12,124 participants were included. Social support was the predominant protective factor associated with quality of life (r = 0.44), life satisfaction (Adjusted Odds Ratio (AOR) = 2.13, p < 0.001), positive coping (AOR = 4.10), resilience (β = 5.67, p = 0.007), and reduced emotional symptoms (β = −0.19, p = 0.001). Others spanned religiosity/spirituality, sense of coherence (AOR = 3.80, p < 0.001), task-oriented coping (β = 1.046, p = 0.001), meaning in life (β = 0.41, p < 0.001), mindfulness (β = 0.31–0.33, p = 0.000), and high self-esteem (r = 0.741, p < 0.0001). Context-dependent risk factors included low income, illiteracy, female gender, and violence exposure. Qualitative findings on PMH highlighted spirituality, social connectedness, belonging, active agency, and traditional systems.

Conclusions : PMH in Ethiopia builds on relational complexity and spiritual resources. Policy and practice should integrate community and religious structures within health promotion frameworks.