This study employed the methodological framework by Arksey and O’Malley¹⁴ to conduct the scoping review. The steps to be followed were: (1) identify the research question and clear objective(s) to be addressed in the review; (2) identify relevant literature by conducting a literature search on Elton B. Stephens Company host (EBSCOhost) and Google Scholar electronic databases; (3) screen and select studies to be used in the synthesis and data extraction; (4) chart the data; and (5) collate, summarise and report the findings of the synthesis and review.¹⁴ Results are presented according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist¹⁵ and the PRISMA 2020 guidelines.¹⁶ This study uses a similar methodological strategy as described in Mulondo et al.,¹⁷ which was conducted by the same research group.

We followed the PCC (Population, Concept, Context) framework of the Joanna Briggs^{18,19,20,21,22,23,24} Institute (JBI) to convey the inclusion and exclusion criteria.²⁵ The inclusion criteria included all empirical studies about mental health and climate change published about adolescents and young adults in Southern Africa between 2013 and 2023 as this provided a 10-year time period for review. All research designs were included. Relevant non-empirical works including news articles, government reports and other non-scientific publications identified within the literature search were reviewed for content and used to frame understanding of the impact of research findings. The exclusion criteria on language preference of the search were set and limited to English. Studies that did not include clear methodology (insufficient information to determine study design, study population or measures) and results were excluded. Studies that included Southern African participants whose data could not be isolated from participants from other regions of the world were also excluded.

This scoping review includes literature from January 2013 to June 2023. Relevant articles and literature were searched from EBSCOhost, Academic Search Ultimate, Africa-Wide Information, APA PsycArticles, APA PsycInfo, Applied Science & Technology Source Ultimate, Cumulative Index to Nursing and Allied Health Literature (CINAHL) with Full Text, Communication & Mass Media Complete, Health Source: Nursing or Academic Edition, Humanities Source Ultimate, MEDLINE, Sociology Source Ultimate, Business Source Ultimate, GreenFILE and Google Scholar. The researchers consulted literature to ensure they include the relevant words that speak on climate change. An academic search of search words was conducted using full and partial keywords related climate change (climate* change, global warming, climate crisis, climate emergency, greenhouse gas, global heat, temperature change, severe weather, catastrophic weather and extreme weather), AND youth (adolescent, teen, young adult and youth) AND mental health (mental health, mental wellness, depression and anxiety). The university librarian assisted in finalising the key term search strategy and in obtaining relevant study documents which were not easily accessible to the researchers.

The screening of the studies was done by the researchers of this study. Two researchers (Tandrea Carter and Martie Thompson) screened the title and abstract, then they screened the full text of studies that could be potentially eligible. Disagreements were resolved upon discussion with a third researcher (Mutshidzi Mulondo). Seven studies met all inclusion criteria.^{18,19,20,21,22,23,24}

The data extraction table includes authors, year of publication, purpose of study, year study was conducted, study design, geographical location of study, age of population, measure of climate change, mental health impacts and protective factors. Data extraction was conducted by two researchers (Martie Thompson and Tandrea Carter). A research assistant conducted an initial review of the search results identifying duplicates and studies which did not meet inclusion criteria based upon article content and location of study sample. Martie Thompson and Tandrea Carter reviewed any studies identified for possible deletion and made the final determination regarding inclusion. Martie Thompson and Tandrea Carter independently reviewed the remaining articles to determine which ones met the full inclusion criteria (empirical research, location and age of study participants, assessment of the relationship of climate change and mental health). Martie Thompson and Tandrea Carter independently extracted data from the included studies and then jointly reviewed their findings to create the final data extraction table. The completed data extraction sheet has been included as a Table 1.

The study received ethical approval from the University of the Free State under ethics number UFS-HSD2023/0356/2803.

All studies took place in Southern Africa, specifically Botswana (2), South Africa (1), Zimbabwe (1), Namibia (1) and Tanzania (2). The most used study design was a cross-sectional design (n = 4, 67%). The age group of participants in the studies is from 8 years to 23 years. The types of climate change were droughts and floods (n = 5, 83%) and increased temperature (n = 1, 17%). A majority of the mental health effect and loss experiences were characterised as post-traumatic stress disorder (PTSD) (n = 2, 33%), followed by traumatic symptoms (n = 1, 17%), depressive symptoms (n = 1, 17%), fatigue or low concentration and sleepiness (n = 1, 17%) and not specified (n = 1, 17%). The studies did not indicate clear health promotion interventions, instead coping strategies could be classified as personal positive coping strategies (n = 2; 33%) and social support and religious support (n = 2; 33%), while two studies did not specify any health promotion interventions (Table 1). Figure 2 provides an overview per study of the associations of climate change with mental health.

Findings showed that various climate factors (EWEs) contribute significantly to increased mental health challenges among adolescents and young people, and these include drought, floods and increased temperature in adolescents and young adults. Changes in temperature has been found to be another contributing factor to increased mortality rate in populations, and poses a much higher risk on child death rate.²⁹ A South African study by Subramaney et al.³⁰ on climate change and mental health showed a positive relationship between high temperatures and aggression and violent behaviour. A systematic review study by Stanke et al.³¹ on various countries, including some Southern African countries, revealed that drought exposure led to increased under-5 mortality rate, under nutrition and underweight and severe wasting, particularly among children aged between 1 year and 5 years. These findings are further supported by Vins et al.³² who revealed the severe health consequences of exposure to drought. Furthermore, these EWEs cause extreme hard in the lives of adolescents and young adults because of their family home, school physical and economic unpleasant circumstances.³³ Additionally, there is a resultant force of inadequate food and water supply, increased conflict risk and ecological loss.³³ These impacts are more often than not prevalent in low-income and middle-income countries (LMICs), and this includes countries in the Southern Africa³⁴ as well as those with low socioeconomic status (SES).³⁰ With all the above said, experiences of such EWEs by adolescents and young adults often result to climate anxiety, which is seen through various psychological effects on their mental health, as found by Crandon et al.³⁵ It is important to note that there remains a paucity of literature of EWEs impact on the lives of adolescents and young adults in the Southern African region, and this remains an important area of exploration.

Climate change greatly influences the frequency and seriousness of occurrence of the previously mentioned hazardous EWEs.³⁶ Children, youth and females have been found to be the most populations susceptible to the severe climate-related hazards impacts,³⁶ and this is the case in South Africa, including other populations, such as those in rural areas and those who reside near power plants as reported by Barnwell.³⁷ Literature further asserts that adolescents and the youth suffer the direct (injuries, poverty and death) and indirect (disruption to access to children services and conflict and migration) impacts as a result of EWEs that disrupt their daily living.^33,38

Findings of this study revealed that adolescents and young adults experience various severe psychological effects as a result of climate change. These findings are supported by a South African study by Subramaney et al.,³⁰ and found that climate changes poses serious psychological threats to people who have been exposed to life-threatening circumstances such as floods, high temperatures and droughts, are susceptible to acute stress and PTSD; anxiety or psychosis or sleeping disorders; obsessive compulsive disorder (OCD); affective or mood disorders; substance use disorders; and suicide. Depression and domestic violence were also noted as psychological impacts increased by storms.^5,6 It is possible that these influences of EWEs capture both direct physiological processes as well as the psychological impact of traumatic events and losses. There is a need to conduct research to be able to understand the experiences of climate change and mental health of adolescents and young people from their perspective in Southern Africa to make sense of the psychological impacts of climate change on their mental health.

According to the study findings, there were no clear or specific health promotion interventions that are currently implemented by Southern Africa countries in respect to alleviating the impact of climate change on mental health of adolescents and young adults. Nkrumah³⁹ advocates for active inclusion and empowerment of young adults in climate adaptation, resilience and mitigation engagements to help derive adolescent and youth-specific appropriate and effective strategies to curb the burden of mental health as a result of climate change. Global literature speak to the importance of focusing on the long-term effects of climate change of adolescents³⁸; engagement of young climate activists in policy-making and how this helps address mental health challenges as a result of climate change.⁴⁰ Furthermore, there is a need for developing effective and appropriate coping strategies and social support for adolescents and young adults as they relate to climate change.⁴¹ There is a further need to consider the experiences and perceptions of adolescents and young adults to best derive context-and-age specific climate-related intervention strategies in various communities in Southern Africa. Additionally, there remains a need for more research on the protective factors of adolescents and young adults regarding climate change and its impact on mental health in Southern Africa.

This review was not without any limitations. Methodologically, some literature sources indicated ‘children’ instead of ‘adolescents’ and the ages differ per countries. There remains a need for reviews that focus on each identified EWE and its relation to climate change and mental health among adolescents and young people and not always review all EWEs under one review as this limits the depth of reporting on each EWEs. There was a further lack of literature sources from most countries in Southern Africa, and this limited the depth of this review. Strengths of this review included a rigorous review process through applying the PRISMA-ScR guidelines, which enabled authors to identify appropriate and relevant articles to include and exclude in the final synthesis.