Overlooked and unaddressed: A narrative review of mental health consequences of child marriages

Abstract

Child Marriage (before the age of 18) affects over 12 million young women globally, annually. Despite acknowledgement of the negative impacts of the practice on reproductive health, mental health consequences are largely overlooked. Given the ability for poor mental health to intensify other health and social challenges, understanding the mental health consequences linked to child marriage is vital. Our study is the first to examine how mental health is approached in current literature on child marriage. Our conceptual framework was informed by a rapid assessment of key issues in the field. Systematic searches of papers published between 2000–2020 were completed on four electronic databases with no language restrictions. Our protocol was registered on Prospero (CRD42019139685). Articles were assessed using PRISMA guidelines, and their quality assessed using the Joanna Briggs Institute Critical Appraisal Tools. Of the 4,457 records identified, 21 papers meeting inclusion criteria were analysed using narrative synthesis. The final sample included 5 qualitative, 1 mixed-methods and 15 quantitative studies (14 cross-sectional and 1 longitudinal study) reporting on data from 12 countries, largely in the global south. Intimate partner violence, poverty, challenges in childbirth and isolation were identified as social factors linked to emotional distress by those married as children. Depression was the most reported mental disorder. Anxiety, phobias, psychological distress, substance misuse, negative well-being and anti-social personality disorder were reported less frequently. Findings highlight that while significant emotional distress and specific mental health conditions are linked to child marriage, gaps in our understanding remain. Future studies are needed to; clarify directionality in these relationships; understand the mental health needs of young men, LGBTQI communities and those in humanitarian settings. Given the well documented cyclical relationship between social determinants and mental health conditions, we outline a series of community-oriented interventions which blend psychological, social and structural support to promote mental health and wellbeing in the contexts of child marriage.

Associations between early marriage and preterm delivery: Evidence from lowland Nepal

“…Also, younger girls have a stronger emotional attachment to their own families, which may make the transition more difficult and impact on relations with their in‐laws (Moretti & Peled, 2004; Palriwala, 1993). While large studies on the emotional consequences of child marriage are lacking, there is increasing evidence that adolescents marrying young experience negative mental health consequences (Burgess et al, 2021; Kidman, 2017; Kumar et al, 2018; Oshiro et al, 2011; Raj et al, 2018; Sezgin & Punamäki, 2020). However, the differences in social and cultural contexts between studies limits comparison, and research on the mental health consequences of child marriage in Nepal is limited (Chaulagain et al, 2019).…”

School-based group interpersonal therapy for adolescents with depression in rural Nepal: a mixed methods study exploring feasibility, acceptability, and cost

“…For all the potential advantages of school-based programmes (accessibility, scalability, and efficacy), they usually exclude adolescents who are not in education. In Nepal this is around 12% of adolescents who tend to be from poorer households, are at greater risk of early marriage and child labour and are likely to have more mental health problems than school-going adolescents (Burgess et al ., 2022 ). Although we did not explicitly exclude out of school adolescents, we did not proactively search for them.…”

Maternal mental well-being and recent child illnesses–A cross-sectional survey analysis from Jigawa State, Nigeria

“…With such a definition, the emphasis is on the importance of functionality in one's life, which moves beyond the presence or absence of a mental disorder. While there is a wide range of tools that focus on the diagnosis of disease, fewer tools exist that attempt to grapple with the positive dimensions of mental health, focusing on the capacity and overall wellbeing [23,[38][39][40]. Even fewer have been widely used in sub-Saharan Africa [41,42].…”

“…A study by Akinyemi et al [2016] found the risk of death in childhood was 23% higher in extended family households compared to nuclear family households [15]. Early marriage also remains a common practice in Northern Nigeria [21,22] and has clear relationships to poor mental health outcomes [23]. Given gendered roles within part of our co-design process.…”