Extreme weather events and pathways to mental health outcomes in sub-Saharan Africa: A systematic review

• Floods, droughts, and extreme rainfall were linked to psychological distress, anxiety, depression, and post-traumatic stress disorder. • Social support was identified as an important coping mechanism which may reduce negative outcomes from EWEs. • EWEs impact mental health through direct psychological trauma and indirect socioeconomic pathways. • Social support and religion are protective, while adolescents, women, and resource-limited groups are at higher risk. Climate change has led to more frequent and intense extreme weather events (EWEs) globally, with sub-Saharan Africa (SSA) being disproportionately affected. Given the region’s socioeconomic vulnerability and strong reliance on agriculture for subsistence, EWEs have the potential to affect the local population’s mental health. The present systematic review synthesizes evidence on the impacts of EWEs on mental health in SSA, examining moderators and the pathways by which EWEs affect mental health, and identifying particularly vulnerable populations. In accordance with the PRISMA guidelines, we searched the PubMed, PsycINFO, and Web of Science databases and grey literature sources for relevant publications up to June 2024. Of the 3,242 initially identified articles, 15 peer-reviewed journal articles from seven countries met the inclusion criteria. Studies examined floods (n = 8), droughts (n = 7), and heavy rainfall (n = 1) as EWEs, and reported psychological distress, anxiety, depression, and post-traumatic stress disorder (PTSD) as mental health outcomes. Findings indicate that EWEs affect mental health through both direct pathways, reflecting immediate psychological trauma from exposure, and indirect pathways, operating through displacement, economic instability, and water and food insecurity. Moderators included protective factors such as social support and religion, as well as risk factors such as being an adolescent, being female, and being economically disadvantaged. There were few longitudinal studies, a limited examination of heatwaves, and a lack of culturally sensitive strategies for mental health support, indicating evidence gaps. As the incidence of EWEs increases across SSA, there is an urgent need for expanded research, improved health systems, and targeted interventions for vulnerable populations.