Associations between Developing Sexuality and Mental Health in Heterosexual Adolescents: Evidence from Lower- and Middle-Income Countries—A Scoping Review
Abstract
:1. Introduction
1.1. Background
1.2. Aim
2. Materials and Methods
2.1. Methodology
2.2. Data Sources and Search Strategy
2.3. Study Eligibility Criteria
2.4. Data Extraction and Synthesis
3. Results
3.1. Characteristics of Identified Studies
3.2. Quality Assessment
3.3. Major Themes
3.4. Relationship of Sexuality and Mental Health
3.5. Social and Cultural Influences
3.6. Lack of Support from Parents and Teachers
3.7. Myths and Misconceptions Related to Sexuality in LMICs
3.8. Challenges in Seeking Sexuality Information and Services among Adolescents Lack of Adequate Knowledge, Awareness, and Services on Sexuality
3.9. Violation of Adolescents’ Rights to Privacy and Confidentiality
3.10. Educational Needs among Adolescents Related to Sexuality and Mental Health
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
S # | Title, Author, Country, and Year | Population Sample and Age | Purpose of the Study | Study Design and Method | Main Findings |
---|---|---|---|---|---|
1 | A Different Approach in Developing a Sexual Self-Concept Scale for Adolescents in Accra, Ghana Authors: Biney, A. A. E. Country: Ghana Year: 2016 | Quantitative:
| To explore if there are significant relationships between adolescents’ sexual self-concept and their sexual and mental health | Mixed Method: Quantitative:
| Quantitative findings:
|
2 | Mental Well-being and Self-reported Symptoms of Reproductive Tract Infections among Girls: Findings from a Cross-sectional Study in an Indian Slum Authors: Khopkar, S. A., Kulathinal, S., Virtanen, S. M., & Säävälä, M. Country: India | 10–18-year-old adolescent girls (n = 85) | To assess the associations between socio-demographic variables, physical health indicators, and adolescent post-menarcheal girls’ mental well-being. | Quantitative study: Cross-sectional personal interview survey | The mean and standard deviation of the mental well-being score (scale 0 to 12) were 8 and 3. Each post-menarcheal girl in the inner-city slum was classified as having a low (score 0 to 8) or high (score 9 to 12) score. A total of 36 girls had low scores, while 49 had high scores. The level of maturation gave an indication of potentially being related to worsening mental well-being scores. |
Year: 2017 | Nearly every other post-menarcheal girl reported having experienced symptoms suggestive of reproductive tract infections during the last twelve months. | ||||
3 | Emotional and Psychosocial Aspects of Menstrual Poverty in Resource-Poor Settings: A Qualitative Study of the Experiences of Adolescent Girls in an Informal Settlement in Nairobi Authors: Crichton, J., Okal, J., Kabiru, C. W., & Zulu, E. M. Country: Nairobi, Kenya Year: 2013 | Adolescent girls aged 12 to 17 years to ensure our sample reflected variations in age (12–14, 15–17 age groups) | To examine the impact of menstrual poverty on the emotional well-being of adolescent girls in an informal settlement in Nairobi, Kenya | Qualitative study purposive quota sampling open-ended interview questions 15 in-depth interviews (IDIs) and 10 focus group discussions (FGDs) A total of 87 girls participated in FGDs | Girls experienced psychosocial deprivations, including limited access to information and lack of emotional and practical support with menstruation from parents and family members. Lack of reliable access to menstrual products was a major cause of physical discomfort, embarrassment, anxiety, fear of being stigmatized and low mood. Participants used language, such as “feeling bad,” feeling “stressed”, or “fearful” and “wanting to cry”, to describe the emotional distress. Negative feelings were associated with menstrual poverty and caused anxiety during school days. Hormone-related symptoms of fatigue and mood symptoms, including tension and depressed mood, are highly prevalent among menstruating girls regardless of social context or menstrual poverty. |
4 | Unmet medical care and sexual health counseling needs: a cross-sectional study among university students in Uganda Authors: Kyagaba, E., Asamoah, B. O., Emmelin, M., & Agardh, A. Country: Uganda Year: 2014 | n = 1954 students below the age of 24 56% male and 44% female | To investigate unmet medical care and sexual health counseling needs among the study population chosen (Ugandan university students) in order to see how these needs are associated with mental health, social capital, religion, and sexual behavior. | Quantitative study: self-administered questionnaire containing 132 items | The majority of students (81%) reported having good self-rated health, but 51% said they had unmet medical needs, and 26% reported unmet sexual health counseling needs. Students with high mental health scores (i.e., poor mental health, p-value < 0.001) who practiced inconsistent condom use (p-value 0.0059, p-value 0.006), who had experienced sexual coercion (p-value < 0.001), and who had poor self-rated health (p-value < 0.001) had a higher prevalence of both unmet medical care and sexual health counseling needs. The association between risky sexual behaviors among men and unmet sexual and reproductive health service needs explained by the fear of being stigmatized or punished for sexual activity when seeking care. Poor mental health is highly stigmatized and individuals who are perceived as having a low mental health status seem to be less willing to seek health care. |
5 | Adolescents’ Responses to an Unintended Pregnancy in Ghana: A Qualitative Study Authors: Aziato, L., Hindin, M. J., Maya, E. T., Manu, A., Amuasi, S. A., Lawerh, R. M., & Ankomah, A. Country: Ghana Year: 2016 | 92 adolescents girls, aged 13–19 years | To investigate the experiences and perceptions of adolescents who have experienced a recent pregnancy and undergone a termination of pregnancy. To clarify if the sample had indeed experienced pregnancy | Qualitative study: A vignette-based focus group approach with fifteen FGDs | Adolescents reported that the characters in the vignettes would feel sadness, depression, and regret from unintended pregnancies. Most participants believed the parents of a pregnant adolescent in the vignette would not be happy about the pregnancy and the parents’ potential reactions would range from sadness and annoyance to anger and abuse. Health care professionals are a source of stress as they are likely to be judgmental and disrespectful. |
6 | Menarche stories: reminiscences of college students from Lithuania, Malaysia, Sudan, and the United States. Authors: Joan, C. C., & Zittel, P. C. B Country: 26 Lithuanians, 27 Americans, 20 Malaysians, and 23 Sudanese Year: 1998 | 26 Lithuanian, 27 American, 20 Malaysian, and 23 Sudanese girls The Malaysian students were 19 to 20 years old The Sudanese women’ s average age was 20 years old | This study aims to understand and analyze the experience of first menstruation, emotional reaction, preparedness, sources of information about menstruation, changes in body image, and celebrations of this rite of passage. | Qualitative study: Female psychology students were invited to write the story of their first menstruation. | The most common emotions mentioned by the Malaysians were fear and embarrassment, followed closely by worry. The most common emotion mentioned by the Sudanese was fear; also common were anxiety, embarrassment, and anger. |
7 | Physical, Social, and Political Inequities Constraining Girls’ Menstrual Management at Schools in Informal Settlements of Nairobi, Kenya. Authors: Girod, C., Ellis, A., Andes, K. L., Freeman, M. C., & Caruso, B. A. Country: Kenya Year: 2017 | Schoolgirls 6–11 post-menarchal girls in grades 6–8 | This study documents differences between girls’ experience of menstruation at public schools (where the Kenyan government provides menstrual pads) and private schools (where pads are not provided) in two informal settlements of Nairobi, Kenya. | Qualitative study: focus group discussion (FGD) with girls | Girls experienced fear and anxiety due to harassment from male peers and had incomplete information about menstruation from teachers. Girls in every school had fear and anxiety about getting infections. They worried about negative health outcomes due to poor menstrual management, and they believed that urine splattering onto the vulva could cause urinary tract infections, gonorrhea, or infertility. |
8 | Adolescent perception of reproductive health care services in Sri Lanka. Authors: Agampodi, S. B., Agampodi, T. C., & Piyaseeli, U. K. D. Country: Sri Lanka Year: 2008 | 32 adolescents between 13 males and 19 females 17–19 years of age | The purpose of this study was to explore the perceived reproductive health problems, health-seeking behaviors, knowledge about available services and barriers to reach services among a group of adolescents in Sri Lanka in order to improve reproductive health service delivery. | Qualitative study: four focus group discussions | Psychological distresses due to various reasons and problems regarding the menstrual cycle and masturbation are the most common health problems. |
9 | The importance of a positive approach to sexuality in sexual health programs for unmarried adolescents in Bangladesh. Authors: van Reeuwijk, M., & Nahar, P. Country: Bangladesh. Year: 2013 | Young, unmarried adolescents of 12–18 years | To explore the mismatch that exists between what unmarried adolescents in Bangladesh experience, want and need with regard to their sexuality and what they receive from their society, which negatively impacts on their understanding of sexuality and their well-being. | Qualitative study: in-depth interviews, focus group discussion, observations, and content analysis | Many girls expressed worries and various misconceptions about the issue of virginity and were insecure about their ability to prove their own virginity. Boys were curious about masturbation and wet dreams and about the size and shape of the penis and duration of intercourse. Boys felt bad for having wet dreams and a number felt guilty after masturbating. |
10 | Adolescent and Parental Reactions to Puberty in Nigeria and Kenya: A Cross-Cultural and Intergenerational Comparison. Authors: Bello, B. M., Fatusi, O., Adepoju, O. E., Maina, W., Kabiru, C. W., Sommer, M., & Mmari, K. Country: Nigeria and Kenya Year: 2017 | Sixty-six boys and girls (aged 11 to 13 years) | To assess the reactions of adolescents and their parents to puberty in urban poor settings in two African countries Nigeria (Ile-Ife) in West Africa, and Kenya (Nairobi) in East Africa and compared the experiences of current adolescents to that of their parents’ generation. | Qualitative study | Adolescents’ reactions to puberty-related bodily changes varied from anxiety, shame, to pride, and an increased desire for privacy. |
11 | Factors impacting on menstrual hygiene and their implications for health promotion. Authors: Lahme, A. M., Stern, R., & Cooper Country: Zambia Year: 2018 | 51 respondents, aged 13–20 years | This paper explores the factors influencing the understanding, experiences and practices of menstrual hygiene among adolescent girls in Mongu District, Western Province of Zambia. | Explorative Qualitative study Six focus group discussions | Girls suffer from poor menstrual hygiene, originating from lack of knowledge, culture and tradition, and socio-economic and environmental constraints, leading to inconveniences, humiliation and stress. This leads to reduced school attendance and poor academic performance, or even dropouts, and ultimately infringes upon the girls’ human rights. |
12 | Menstrual knowledge and practices of female adolescents in Vhembe district, Limpopo Province, South Africa Authors: Ramathuba, D. U. Country: South Africa Year: 2015 | 14–19 years 273 secondary school girls doing Grades 10–12 | This study sought to assess the knowledge and practices of secondary school girls towards menstruation in the Thulamela municipality of Limpopo Province, South Africa. | A quantitative descriptive study design | 73% of girls reported having fear and anxiety at the first experience of bleeding |
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Spider Tool | Justification |
---|---|
S—Sample | Adolescents (10–19 years) |
PI—Phenomenon of Interest | Experiences of developing sexuality and associated mental health issues/psychological well-being |
D—Design | Qualitative, quantitative, mixed methods |
E—Evaluation | Experience and perceptions of adolescent girls and boys |
R—Research type | Mixed method designs |
Spider Tool | Search Terms |
---|---|
S—Sample | “young” OR “teen*” OR “youth*” OR “low and middle-income countr*” OR “Developing countr*” OR “South Asia” OR “low and middle-income countr*” |
PI—Phenomenon of Interest | “sex” OR “sexual health” OR “sexuality” OR “mental health” OR “puberty” OR “stress*” OR “anxiety” OR “mental disorder* OR “depress*” OR “psychological well-being” |
D—Design | “questionnaire*” OR “survey*” OR “interview*” OR “focus group*” OR “case stud*” OR “observ*” |
Study Design | Selected Studies | Appraisal Score |
---|---|---|
Qualitative Studies | Crichton, Kenya, 2013 | 100% (****) |
Aziato et al., Ghana, 2016 | 50% (**) | |
Girod et al., Kenya, 2017 | 100% (****) | |
Joan et al., Malaysia, 1998 | 50% (**) | |
Agampodi et al., Sri Lanka, 2008 | 50% (**) | |
van Reeuwijk, Bangladesh, 2016 | 100% (****) | |
Bello et al., Kenya, 2017 | 100% (****) | |
Lahme et al., Zambia, 2018 | 75% (***) | |
Quantitative Studies | Kyagaba et al., Uganda, 2014 | 100% (****) |
Khopkar et al., India, 2017 | 75% (***) | |
Ramathuba, South Africa, 2015 | 75% (***) | |
Mixed Method | Biney, Ghana, 2016 | 100% (****) |
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Punjani, N.S.; Papathanassoglou, E.; Hegadoren, K.; Hirani, S.; Mumtaz, Z.; Jackson, M. Associations between Developing Sexuality and Mental Health in Heterosexual Adolescents: Evidence from Lower- and Middle-Income Countries—A Scoping Review. Adolescents 2022, 2, 164-183. https://doi.org/10.3390/adolescents2020015
Punjani NS, Papathanassoglou E, Hegadoren K, Hirani S, Mumtaz Z, Jackson M. Associations between Developing Sexuality and Mental Health in Heterosexual Adolescents: Evidence from Lower- and Middle-Income Countries—A Scoping Review. Adolescents. 2022; 2(2):164-183. https://doi.org/10.3390/adolescents2020015
Chicago/Turabian StylePunjani, Neelam Saleem, Elizabeth Papathanassoglou, Kathleen Hegadoren, Saima Hirani, Zubia Mumtaz, and Margot Jackson. 2022. "Associations between Developing Sexuality and Mental Health in Heterosexual Adolescents: Evidence from Lower- and Middle-Income Countries—A Scoping Review" Adolescents 2, no. 2: 164-183. https://doi.org/10.3390/adolescents2020015
APA StylePunjani, N. S., Papathanassoglou, E., Hegadoren, K., Hirani, S., Mumtaz, Z., & Jackson, M. (2022). Associations between Developing Sexuality and Mental Health in Heterosexual Adolescents: Evidence from Lower- and Middle-Income Countries—A Scoping Review. Adolescents, 2(2), 164-183. https://doi.org/10.3390/adolescents2020015