The referral trajectories for young people with depression in low-resource settings: A qualitative study from Ghana and Zimbabwe
5 affiliations
- 1Department of Psychiatry & Mental Health, Kamuzu University of Health Sciences, Blantyre, Malawi
- 2Herse-Nord TB Initiative (HNTI), Kamuzu University of Health Sciences, Blantyre, Malawi
- 3Institute of Psychiatry, Psychology & Neurology, King’s College London, London, England
- 4Department of Global Public Health and Family Medicine, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- 5Malawi Liverpool-Welcome Trust, Kamuzu University of Health Sciences, Blantyre, Malawi
Abstract
Background: Unlike in psychiatric disorders such as psychosis where treatment trajectories are well defined, little is known about pathways to care for depression which is increasingly prevalent among young people across the globe. Whilst empirical evidence is slowly becoming available on pathways to care for common mental disorders in the general population in Ghana and Zimbabwe, there is no study that specifically considered treatment pathways for young people. Objectives: This study explored trajectories used by young people (15–24 years) to access specialised mental healthcare in order to determine referral pathways for depression in Ghana and Zimbabwe. Methodology: This sub-analysis forms part of a larger formative, exploratory, descriptive qualitative study conducted within the Youth in Mind consortium. The study engaged 172 participants including young people, healthcare providers, policymakers, faith-based and traditional healers, lay health workers, and school staff across Ghana (N = 105) and Zimbabwe (N = 67) who were sampled purposively and using snowball techniques until saturation was reached. Data were analysed using an iterative combination of inductive and deductive coding, followed by thematic analysis. Results: Diagnostic and treatment trajectory for young people's access to specialized mental healthcare are complex in both Ghana and Zimbabwe and punctuated with several barriers that culminate in delayed access to treatments. Chief among the barriers facing young people are the catastrophic costs linked with accessing specialized mental health care, lack of autonomy of the youth, long waiting times perpetuated by a limited number of specialists and stigma. Opportunities for optimising access included the use of referral cards, which sped up the referral process, improved communication among referring agents, and establishment of youth corners in some hospitals in Zimbabwe to address concerns of privacy. Conclusion: The findings highlight that pathways to specialised mental healthcare in Ghana and Zimbabwe are inherently complex, hindered by intersecting structural, financial, and social barriers. To mitigate these challenges, a multi-faceted strategy is essential. This should include systemic interventions such as task-shifting, the implementation of streamlined referral tools, dedicated youth-friendly services, and concerted efforts to reduce stigma and costs, thereby fostering more equitable and timely access to care.
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BibTeX
@article{makiyi2026referral,
title = {{The referral trajectories for young people with depression in low-resource settings: A qualitative study from Ghana and Zimbabwe}},
author = {Precious Makiyi and Rufaro Mushonga and Rebecca Jopling and Raymond Akawire Aborigo and Franklin Glozah and Kimberley Goldsmith and Benedict Weobong and Dixon Chibanda and Melanie Abas and James January and Moses Kumwenda},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0358255},
url = {https://doi.org/10.1371/journal.pone.0358255},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The referral trajectories for young people with depression in low-resource settings: A qualitative study from Ghana and Zimbabwe
AU - Precious Makiyi
AU - Rufaro Mushonga
AU - Rebecca Jopling
AU - Raymond Akawire Aborigo
AU - Franklin Glozah
AU - Kimberley Goldsmith
AU - Benedict Weobong
AU - Dixon Chibanda
AU - Melanie Abas
AU - James January
AU - Moses Kumwenda
PY - 2026
DA - 2026/10/05
JO - PLOS One
DO - 10.1371/journal.pone.0358255
UR - https://doi.org/10.1371/journal.pone.0358255
AB - Background: Unlike in psychiatric disorders such as psychosis where treatment trajectories are well defined, little is known about pathways to care for depression which is increasingly prevalent among young people across the globe. Whilst empirical evidence is slowly becoming available on pathways to care for common mental disorders in the general population in Ghana and Zimbabwe, there is no study that specifically considered treatment pathways for young people. Objectives: This study explored trajectories used by young people (15–24 years) to access specialised mental healthcare in order to determine referral pathways for depression in Ghana and Zimbabwe. Methodology: This sub-analysis forms part of a larger formative, exploratory, descriptive qualitative study conducted within the Youth in Mind consortium. The study engaged 172 participants including young people, healthcare providers, policymakers, faith-based and traditional healers, lay health workers, and school staff across Ghana (N = 105) and Zimbabwe (N = 67) who were sampled purposively and using snowball techniques until saturation was reached. Data were analysed using an iterative combination of inductive and deductive coding, followed by thematic analysis. Results: Diagnostic and treatment trajectory for young people's access to specialized mental healthcare are complex in both Ghana and Zimbabwe and punctuated with several barriers that culminate in delayed access to treatments. Chief among the barriers facing young people are the catastrophic costs linked with accessing specialized mental health care, lack of autonomy of the youth, long waiting times perpetuated by a limited number of specialists and stigma. Opportunities for optimising access included the use of referral cards, which sped up the referral process, improved communication among referring agents, and establishment of youth corners in some hospitals in Zimbabwe to address concerns of privacy. Conclusion: The findings highlight that pathways to specialised mental healthcare in Ghana and Zimbabwe are inherently complex, hindered by intersecting structural, financial, and social barriers. To mitigate these challenges, a multi-faceted strategy is essential. This should include systemic interventions such as task-shifting, the implementation of streamlined referral tools, dedicated youth-friendly services, and concerted efforts to reduce stigma and costs, thereby fostering more equitable and timely access to care.
SN - 1932-6203
ER -