Dr Zoe Duby unpacks the realities shaping young women’s mental health
Mental health is often viewed as a personal challenge, one that can be overcome through resilience, determination or access to counselling. But for many adolescent girls and young women in South Africa, emotional wellbeing is shaped by forces far beyond the individual. Poverty, food insecurity, violence, gender inequality and limited access to support all influence whether young women are able to cope with life’s challenges or are left struggling in silence.
These realities are explored in “Girls get stressed due to the situation we are facing”: Multi-level mental health stressors and resilience enablers among adolescent girls and young women in South Africa, a study led by Dr Zoe Duby, Senior Scientist in the Health Systems Research Unit at the South African Medical Research Council (SAMRC). Drawing on the lived experiences of adolescent girls and young women, the study examines the complex social, economic and environmental factors that shape mental wellbeing while identifying the relationships and resources that foster resilience.
With nearly two decades of experience in qualitative public health research across sub-Saharan Africa, Dr Duby’s work focuses on HIV, sexual and reproductive health, mental health, gender and health equity. What continues to drive her research is a desire to understand why some people have opportunities to make informed decisions about their health while others do not.
“What drives my passion for this field is the persistent inequity I see in who is able to access care, whose voices are heard and valued, and who is able to enact healthy informed decisions about their own lives and health,” she says. “Health equity depends on understanding and addressing these factors, improving access to respectful, appropriate and non-judgemental care, and creating conditions where people can enact real choice and dignity.”
The study was inspired by a recurring pattern Dr Duby and her colleagues observed while working with adolescent girls and young women across South Africa. Time and again, they found that mental health could not be separated from young women’s experiences of HIV, sexuality, relationships, pregnancy and the communities in which they live. Rather than asking only what causes emotional distress, the researchers wanted to understand what enables resilience.
“We wanted to understand better not only what creates distress, but also what helps young women cope and stay resilient,” she explains.
The findings paint a sobering picture. Many participants described emotional distress linked to financial hardship, family conflict, violence, stigma and social pressure. Others spoke of feeling isolated, with few trusted adults or safe spaces where they could openly discuss their challenges. These realities are often intensified in rural and underserved communities, where access to psychologists, social workers and youth-friendly mental health services remains limited. Yet the research also uncovered important sources of strength, including supportive families, trusted friendships, faith communities, social workers and spaces where young women felt heard without judgement.
For Dr Duby, these findings reinforce the need to rethink how mental health is addressed. “Psychological distress is not happening in a vacuum,” she says. “If mental health is treated only as an individual problem, the response will miss the factors that are creating and sustaining the distress in the first place.”
She believes strengthening mental health support requires integrating routine screening and psychosocial care into primary healthcare, equipping nurses and lay counsellors to provide early support, and investing in safe community spaces where young people can build supportive relationships. Such approaches are particularly important in rural communities, where specialist services are often scarce and barriers to care remain high.
Despite the challenges, Dr Duby remains optimistic. “Hope lies in the fact that many adolescent girls and young women already show agency, insight, and determination in how they respond to the challenges they face,” she says. Strengthening families, schools, communities and healthcare systems, she believes, can create environments where young women are not simply expected to cope but are genuinely supported to thrive. Her research offers an important reminder that improving mental health is not only about treating illness, but about building a society where every young woman has the opportunity to live with dignity, belonging and hope.