1.1 Background of the study

Adolescence is a critical developmental window during which many mental disorders first appear; depression and anxiety are major contributors to illness and disability in young people worldwide (World Health Organization, 2024). Left unrecognised and untreated, adolescent mental disorders harm school performance, increase risk behaviours and raise the risk of self-harm and long-term socioeconomic disadvantage. Early identification, improved mental-health literacy and easy access to acceptable help pathways therefore matter for both immediate and lifelong outcomes (World Health Organization, 2024). Evidence from Nigeria and across sub-Saharan Africa indicates that adolescent mental-health problems are common and under-treated. School-based depression-literacy interventions have shown immediate improvements in knowledge, attitudes and confidence to help peers, suggesting that literacy programmes can be an important first step to improving recognition and stimulating help-seeking (Atilola et al., 2022). At the same time, systematic syntheses of promotion and prevention programmes in the region find that school- and family-based interventions increase mental-health literacy and can improve help-seeking and self-efficacy when they are well designed and culturally adapted (Sodi et al., 2025). Community-level scoping and implementation reviews further show that task-sharing and community-based models are feasible in low-resource African settings but success depends on context-appropriate training, supervision and referral linkages (Raeber et al., 2024). Nigeria faces a large treatment gap for mental health: workforce shortages, uneven geographic distribution of services, and strong stigma divert many young people toward informal care (family, faith-based or traditional healers) rather than evidence-based services (Fadele et al., 2024). In high-density urban wards such as Mushin, adolescents — and girls in particular — are exposed to layered risks (poverty, exposure to violence, early sexual activity, school disruption and household stressors) that increase their vulnerability to depression and anxiety, while service provision for adolescent mental health remains limited. Local data on the prevalence of probable mental disorders and on help-seeking pathways are therefore essential to design pragmatic, acceptable interventions (school-based literacy, peer support, task-sharing in primary care) that match local needs and resources (Fadele et al., 2024; Atilola et al., 2022).

1.2 Statement of the problem

Although there is growing programmatic interest in adolescent mental health in Nigeria, Mushin Community currently lacks recent, locality-specific evidence on two critical questions: (1) what proportion of adolescent girls experience probable depressive or anxiety symptoms, and (2) where do they actually seek help when distressed? Existing national and regional studies report wide prevalence ranges and document strong barriers to formal help-seeking — limited awareness of services, stigma, beliefs about spiritual causes, cost and lack of adolescent-friendly services — but these patterns vary considerably by community and by gender (Fadele et al., 2024; Raeber et al., 2024). Without community-level measurement in Mushin it is not possible for local health and education managers to prioritise feasible responses (for example, integrating brief problem-management into local primary health clinics, investing in school-based literacy and peer-support, or strengthening referral links to specialist care). Moreover, interventions that succeed elsewhere may fail if they do not account for Mushin’s specific social ecology — patterns of family influence, religious leaders’ role, school attendance, and the presence of informal care providers — all of which shape help-seeking behaviour (Sodi et al., 2025; Atilola et al., 2022).

1.3 Aim and Objectives of the Study

Aim: To assess the burden of common mental-health problems and to describe help-seeking behaviour among adolescent girls in Mushin Community, Mushin LGA, Lagos State, in order to produce locally actionable recommendations for school-, community- and primary-care responses.

Specific objectives:

1. Estimate the prevalence of probable depression and anxiety among adolescent girls aged 10–19 years in Mushin Community.
2. Describe exposure to social determinants associated with poor mental health (recent experience of physical or sexual violence, food insecurity, school truancy, parental absence, household economic stress) and quantify their association with probable disorder.
3. Map help-seeking pathways used by adolescent girls (family, peers, school staff, religious/traditional healers, primary health clinics, mental-health specialists) and estimate the proportion accessing formal services.
4. Measure mental-health literacy and stigma (recognition of symptoms, beliefs about causes, willingness to seek professional help) among girls and a stratified sample of caregivers.
5. Assess service-level readiness at nearby primary health clinics and the presence/capacity of any school counselling services (trained staff, private space, referral mechanisms).
6. Co-design, with adolescents and local stakeholders, a feasible package of interventions (e.g., school depression-literacy sessions, peer-support groups, brief psychological interventions delivered by trained lay workers) and an implementation roadmap for Mushin.

1.4 Research Questions

1. What proportion of adolescent girls (10–19 years) in Mushin Community screen positive for probable depressive or anxiety symptoms?
2. Which social exposures (violence, food insecurity, school problems, household poverty) are associated with higher odds of probable mental disorder among girls in Mushin?
3. What help-seeking pathways do girls follow when distressed, and what proportion access formal health services?
4. How do mental-health literacy and stigma among girls and caregivers relate to help-seeking intentions and behaviours?
5. What existing service capacities and gaps (primary clinics, school counselling, community resources) affect the feasibility of scaled interventions in Mushin?

1.5 Scope of the study

Design: Cross-sectional, mixed-methods study combining a population-based survey, facility and school readiness assessments, and qualitative inquiry. The mixed approach quantifies prevalence and predictors and then explains help-seeking pathways and barriers through qualitative interviews.

Area of study (single area): Mushin Community, Mushin Local Government Area, Lagos State.

Population & inclusion criteria: Adolescent girls aged 10–19 years resident in Mushin Community for ?6 months (in-school and out-of-school). Caregiver modules will sample a stratified subset of parents/guardians. Key informants will include school principals, school counsellors (where present), primary health clinic staff, community and religious leaders. For minors, parental/guardian consent and adolescent assent will be obtained per ethics approvals.

Sampling & sample size (outline): A two-stage sampling frame using schools and households will identify eligible girls. Sample size will be calculated to estimate prevalence of probable depression (expected range 12–30% from regional studies) with ±3–4 percentage-point precision, allowing for clustering and non-response. Oversampling of out-of-school adolescents will ensure representation of higher-risk subgroups.

Instruments & measures:

• Validated screening instruments adapted for local use: PHQ-9 (adolescent version) for depression screening, GAD-7 for anxiety, and a brief wellbeing measure (e.g., WHO-5).

• Mental-health literacy instrument (recognition vignette + help-seeking preferences) and a brief stigma scale.

• Exposure modules: violence (adapted WHO/ISPCAN items for adolescents), household food insecurity (FIES or equivalent), school attendance and functioning, and socio-demographics.

• Facility and school readiness checklists: staff training, private counselling space, adolescent-friendly elements, referral pathways.

• Qualitative guides for in-depth interviews and focus groups exploring explanatory beliefs, triggers for help-seeking, barriers to formal care and community resources.

Analysis: Prevalence estimates with 95% confidence intervals; multivariable logistic regression to identify independent predictors of probable disorder; descriptive and network mapping of help-seeking pathways; thematic analysis of qualitative data to illuminate attitudes, norms and service-related barriers. Findings will be synthesised into a short implementation brief co-developed with local stakeholders.

Ethics & safeguarding: Ethical approval will be obtained from an accredited Institutional Review Board and Lagos State authorities. Special safeguarding procedures will be in place for disclosures of sexual violence or suicidality, including immediate referral pathways and support from trained counsellors. Confidentiality and age-appropriate consent/assent procedures will be strictly observed.

Policy relevance: Local, high-quality evidence on prevalence, predictors and help-seeking in Mushin will allow LGA education and health authorities to prioritise feasible interventions — for example, scaling school depression-literacy, introducing peer-support clubs, training primary-care workers in brief problem-management, and strengthening referral links — rather than investing in costly specialist services that are not currently accessible to most adolescents (Atilola et al., 2022; Sodi et al., 2025; Raeber et al., 2024; Fadele et al., 2024).

References

Atilola, O., Ayinde, O., Obialo, F.-K., Adeyemo, S. O., Adegbaju, D., Anthony, R., Aremu, O., Bello, O., Chukwuemeka, E., Dada, A., Eze, O., Fawole, O., Gbenga, O., Ilesanmi, O., Johnson, P., Kalu, C., Lawal, A., Madu, U., Nwankwo, S., Ogunsola, S., … Robert, A. (2022). Towards school-based mental health programs in Nigeria: The immediate impact of a depression-literacy program among school-going adolescents and their teachers. Child and Adolescent Psychiatry and Mental Health, 16, Article 70.

Fadele, K. P., Igwe, S. C., Toluwalogo, N.-O., Udokang, E. I., Ogaya, J. B., Lucero-Prisno, D. E. 3rd, Adebayo, O., Bello, T., Chukwu, U., Eze, I., & Oladipo, A. (2024). Mental health challenges in Nigeria: Bridging the gap between demand and resources. Global Mental Health, eCollection 2024, e29. doi:10.1017/gmh.2024.19

Raeber, F., Haldemann, M.-I., Ray, S., Huber, J., Firima, F., Fernandez, L. G., Amstutz, A., Gerber, F., Labhardt, N. D., & Belus, J. M. (2024). Community-based models of care for adolescent and adult depression, suicidal behaviour, anxiety, trauma and substance use in Africa: A scoping review. Frontiers in Psychology, 15, Article 1241403.

Sodi, T., Rantho, K., Matlakala, F. K., Wadende, P., Ikhile, D., Dada, S. O., Frost, D., Henry, P., Ishaku, U., Brown, M. O., Musoke, D., Nkoana, S., Phochana, T., Jidong, D., Pwajok, J., Awokoya, T., Banyen, E. R., & Gibson, L. (2025). Types and effectiveness of mental health promotion programmes for young people in sub-Saharan Africa: A systematic review. Cambridge Prisms: Global Mental Health, 12, e27.

World Health Organization. (2024). Mental health of adolescents. World Health Organization. Accessed from https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health