Every year, World Mental Health Day on October 10, serves as a crucial reminder of the need for awareness, support, and action to address mental health issues across the globe. This year, the urgency of addressing unmet mental health needs is palpable, and perhaps more critical than ever. But, as we recognize the need to focus on mental health, we should also think of mental health as a human right, and reinforce the idea that everyone, regardless of their background or circumstances, deserves access to mental health care and the opportunity to thrive. On this important day, we want to highlight an often overlooked but critically vulnerable group: young women living in urban slums, particularly in Kampala, Uganda.
The TOPOWA Study: Understanding the Social Drivers of Mental Health
The TOPOWA study (which means to "never give up" in Luganda) is a groundbreaking research project funded by the NIH that is designed to explore the social determinants of mental health among young women living in Kampala’s urban slums. It's a community-based project that leverages our longstanding relationship with the Uganda Youth Development Link (UYDEL). This community-based organization has served thousands and thousands of young people, over the past 30 years, with vocational training, psychosocial support and health referrals. Many of the young people they serve reside in the urban slums across Kampala. And, they have first hand insight on their needs. The young women in the slums face unique and compounding challenges, such as poverty, overcrowding, gender-based violence, substance abuse and other health inequities, all of which exacerbate mental health concerns.
Over the past 15 years we have worked collaboratively to assess and address these needs by conducting mixed methods research to understand the context, the prevalence and strategies for addressing various health concerns and to evaluate intervention strategies. Most of that prior work was centered around alcohol use and prevention of alcohol-related harm and also on sexual and reproductive health issues including HIV and other sexually transmitted infections.
As part of the ongoing TOPOWA study, we examine the prevalence of anxiety, depression, suicidality, and substance use among young women in the slums. The key project component is our prospective cohort study where we follow 300 women for 2 1/2 years to learn more about their mental health concerns, needs and to identify intervention strategies. We check in with the women every three months and ask how they are doing. (There is also quite a bit of science involved and I will post on that separately.) Early results indicate that nearly two-thirds of the participants suffer from at least one mental health condition, with comorbidities (co-occurring conditions) being particularly common.
The early findings are troubling and indicate that anxiety, depression, and suicidality are common, fueled by the harsh realities of life in these urban slums, where access to basic healthcare services, including mental health support, is severely limited.
Image credit: ChatGPT (TOPOWA Project)
Unmet Mental Health Needs in Kampala’s Slums
The prevalence of mental health conditions in Uganda is estimated at 32%, the TOPOWA study finds even higher levels of mental health issues among young women in Kampala’s slums where 65% report one or more mental health concerns. Our preliminary findings indicate that anxiety alone affects over 34% of the study’s participants, and that nearly one in three young women struggles with depression and that 46% report suicidality. The emotional toll is immense, as many of these women navigate not only the daily stressors of poverty, but also the trauma of violence, often with limited social support. Many also have children and they are concerned about how to provide for them.
One of the key insights from the TOPOWA study is the high rate of mental health comorbidity. Approximately 32% of the young women reported two or more mental health conditions, underscoring the complexity of their challenges. This finding highlights the urgent need for comprehensive, integrated mental health services that can address these multiple, overlapping issues.
Environmental Stressors and Resilience
The study also explores the environmental stressors that shape the mental health experiences of these young women. Factors such as overcrowding, poor sanitation, exposure to violence, and economic hardship all contribute to their mental health struggles.
In the formative work conducted as part of the TOPOWA project, we also assessed the link between place and mental health, underscoring how the urban environment, social stressors, and physical attributes of slums influence the mental health of young women. The findings suggest that low-cost public health interventions targeting these environmental factors, such as improved sanitation and community support systems, could play a critical role in alleviating some of the mental health challenges.
The TOPOWA study also emphasizes resilience. Many of these women exhibit incredible strength and determination in the face of adversity. The word "TOPOWA" itself—“never give up”—captures the spirit of resilience that guides their daily lives.
Image credit: ChatGPT (TOPOWA Project)
A Call to Action on World Mental Health Day
On this World Mental Health Day, the findings of the TOPOWA study serve as a stark reminder of the urgent mental health needs of vulnerable populations, particularly young women living in urban slums. The study provides compelling evidence that addressing the mental health of these women requires a multi-faceted approach that includes social support, economic empowerment, and access to integrated mental health services.
We must recognize that mental health is a universal human right, but rights mean little without access.
This World Mental Health Day, let us advocate for increased investment in mental health services, especially in low-resource settings like the urban slums of Kampala. These young women are not just statistics—they are resilient individuals who, given the right support, can overcome immense challenges and lead healthier, more fulfilling lives. Together, we can ensure that mental health support reaches every corner of the world, no matter how hidden or overlooked it may be. If you are not sure where to start, how about taking the free, online mental health training course supported by the WHO? It may be a great start if this is a new topic or you are looking for ideas. The WHO will provide an official certificate of completion. And, over 60,000 people have already completed it.
Image credit: ChatGPT (TOPOWA Project)
Finally, for those that are interested in our TOPOWA research findings, we are very busy analyzing the newly collected data. If you have ideas for next steps or would like to contribute in some way, just let us know. Meanwhile, we have included links below to our recently published articles and some from a previous project that highlight the urgent mental health needs in this population and in neighboring Kenya.
Recent publications from the TOPOWA study:
Life Satisfaction Factors, Stress, and Depressive Symptoms among Young Women Living in Urban Kampala: Findings from the TOPOWA Project Pilot Studies (2024)
Available open access: https://www.mdpi.com/1660-4601/21/2/184
Alcohol Use among Young Women in Kampala City: Comparing Self-Reported Survey Data with Presence of Urinary Ethyl Glucuronide Metabolite (2024)
Available open access: https://www.mdpi.com/1660-4601/21/9/1256
Advancing mHealth Research in Low-Resource Settings: Young Women’s Insights and Implementation Challenges with Wearable Smartwatch Devices in Uganda (2024)
Available open access: https://www.mdpi.com/1424-8220/24/17/5591
A Qualitative Assessment of Place and Mental Health: Perspectives of Young Women Ages 18-24 Living in the Urban Slums of Kampala, Uganda (2022)
Available open access: https://www.mdpi.com/1660-4601/19/19/12935
Related findings on mental health from earlier projects on youth in Kampala:
Violence Exposure, Self-Reported Mental Health Concerns and Use of Alcohol and Drugs for Coping among Youth in the Slums of Kampala, Uganda (2024)
Available open access: https://pubmed.ncbi.nlm.nih.gov/38577222/
The interrelationships of child maltreatment, alcohol use, and suicidal ideation among youth living in the slums of Kampala, Uganda (2021)
Available open access: https://www.sciencedirect.com/science/article/abs/pii/S0145213420305597?via%3Dihub
Suicidal Ideation among Youth Living in the Slums of Kampala, Uganda (2018)
Available open access: https://www.mdpi.com/1660-4601/15/2/298
Related findings on mental health from Kenya:
Methods and associations of suicidality in Kenyan high school students: clinical and public health implications
Available open access: https://www.cambridge.org/core/journals/bjpsych-open/article/methods-and-associations-of-suicidality-in-kenyan-high-school-students-clinical-and-public-health-implications/89EF73598C4D1EA96AD3FC3B4A799683
Find out more about the Uganda Youth Development Link: https://www.uydel.org/