Ethical clearance with number: 2023/2066-3/UB/SG/IRB/FHS was sort and obtained from the Institutional Review Board of the Faculty of Health Sciences, University of Buea. Participation in the study was purely voluntary with youths signing the consent before being enrolled into the study. For participants who were less than 18 years, an assent was obtained from the parents or guardian of the child through an assent form. We collaborated with the Ministry of Youth and Civic Education to reach out to these youths in the various communities where the study was carried out. Confidentiality was maintained for participant responses through proper storage of the data in an encrypted system. Data was then extracted from the records with confidentiality and securely managed using Open Data kit database with a password for protection.

A community based quantitative cross-sectional survey was conducted. First, Limbe I, Tiko and Buea were selected from among the 10 towns in Fako Division through purposive sampling. These towns were purposely selected because of their high population densities. Consecutive sampling was used by peer educators to collect data from children and young adults aged 10 to 24 years. This sampling technique was used in order to ensure protection of participants’ privacy and wellbeing as using randomized sampling technique may have selected and included participants who were not willing to discuss their mental health experiences. Through our selected sampling method, we were able to purposively select participants who were more likely to provide informed consent or ascent thereby engaging openly in the research process. The study was conducted in three major towns (Buea, Limbe 1 and Tiko) in Fako Division, Southwest Region of Cameroon over a one-year period from May 2023 to July 2024. Fako Division is one of the six divisions in the Southwest Region of Cameroon with Limbe as its administrative capital and Buea as the Regional capital. Looking at the 2005 Cameroon national institute of statistics report, it has a total population of 466,412 and surface area of 2093 km² ( Lele et al., 2023 ).

All youths aged 10 to 24 years in Buea, Limbe I and Tiko who were present and gave their consent or assent (obtained from the parents or guardian) at the time were included in the study. All incompletely filled questionnaires and participants with illnesses which would interfere with providing accurate information were excluded.

Data was collected from 965 participants using structured questionnaires administered by peer educators with lived experience of mental health conditions. The questionnaire consisted of three sections: demographic data, knowledge on mental health, and prevalence of mental health disorders. Peer educators were trained to administer questionnaires and input responses into Kobo Collect (kobo toolbox).

The sample size was determined using the Cochran’s formula [n = (zα/2)²p(1 − p)/d²], an estimated proportion of mental disorders among children and youths was taken as (50%), 95% confidence level, 5% margin of error. This gave a minimum sample size of, n = (1.96)² × 0.5(1 − 0.5)/(0.05)² = 384. A 10% contingency addition was done on the sample size for non-response, the final sample size was 423 participants ( Tesfaye et al., 2021 ).

The study assessed Anxiety, Suicide, depression and substance use. Standardized screening tools were used to determine knowledge and the prevalence of each disorder. The knowledge section was adapted from the Mental Health Knowledge Schedule (MAKS), while the prevalence section used standardized screening tools: Generalized Anxiety Disorder (GAD)-7, CAGE (Cut, Annoyed, Guilty, and Eye) Substance Abuse Screening, Ask Suicide-Screening Questions (ASQ) and Patient Health Questionnaire (PHQ)-9 for depression. To specifically adapt these tools for our context, particularly for displaced individuals translation and back translation for each tool, consulted with community leaders and displaced individuals to ensure that the tools were culturally sensitive and relevant to our context. For anxiety, a score ≥ 5, indicated anxiety while for suicide, a score ≥ 1 indicated a problem. For substance use, a score ≥ 1 indicated a problem and for depression, a score ≥ 10 indicated depression. Anxiety was measured with seven statements, scored 0 - 21, and respondents with scores ≥ 5 were considered to have anxiety. Suicide risk was assessed with four questions, scored 0 - 4, and respondents with scores ≥ 1 considered to have a problem. Depression was assessed with nine statements, scored 0 - 27, and respondents with scores ≥ 10 were considered to have depression. The overall prevalence was determined by the presence of any of these four disorders.

Data analysis was conducted using Statistical Package for the Social Sciences (SPSS) version 25. Descriptive and multivariate logistic analysis was performed, and the level of knowledge was assessed using the median score. An association was sort between level of knowledge and sociodemographic variables. The data was categorized into two groups based on the median score of 32, with scores < 32 indicating inadequate knowledge and scores ≥ 32 indicating adequate knowledge.

Descriptive and summary statistics were represented using tables and figures. Logistic regression was used to determine factors associated with mental disorders, p-value < 0.05 was considered statistically significant.

A total of 965 study participants were recruited successfully, the mean age of the respondents was 17.82 years with a range of 10 to 24 years. Most of the study participants 419 (43.4%) were in the age group of 16 - 20 years, females were 563 (58.3%), Students were 826 (85.6%), majority of the participants were from host population 669 (69.3%) with 365 (37.8%) from the locality of Buea (See Table 1 ).

Almost all (710, 73.6%) of the study participants knew mental health disorders are a kind of medical disorder, and the majority (857, 88.8%) recognize mental health disorders as treatable. Additionally, (697, 62.2%) of the study participants reported mental health disorders are not contagious, and (745, 77.2%) indicated that leaving alone is not a treatment for mental illness. Additionally, many (714, 74.0%) of the respondents indicated that development of mental health problems is identical for males and females. Talking or laughing alone and excessive or unusual happiness were reported as the major symptoms of mental illness by (765, 79.3%) and (704, 73.0%) of the study participants, respectively (See Table 2 ).

The median overall knowledge score value was 32 with the minimum and maximum values of 3 and 43 out of 44 knowledge items. The overall knowledge score showed 54.1%, (522) respondents had inadequate knowledge towards mental health problems (See Figure 1 ).

Using multivariate logistic regression analysis, the association between sociodemographic factors and knowledge of mental health disorders was tested. The logistics regression analysis results, showed that age, gender, and locality were found to have significant association with knowledge of mental disorders with p-value < 0.05 ( Table 3 ).

Out of the 965 participants of this study, the overall prevalence of mental health disorder was 68.8% (664) with 23.9% suffering of anxiety disorder, 30.1% suffering of substance use disorders, 19.2% suffering of suicidal thoughts and 29.0% suffering of depression ( Figure 2 ).

Using Multivariate logistic regression analysis, the association between sociodemographic factors and prevalence of mental health disorders was tested. The logistics regression analysis results, presented in Table 4 show that displacement status (internally displaced person), gender, and locality were found to have significant associations with prevalence of mental health disorders with their respective p-value < 0.05 (See Table 5 ).

Over all, most of the respondents (522, 54.1%) had inadequate knowledge on mental health disorders. This result is similar to a study conducted by ( Djatche et al., 2022 ) who reported that 67.1%. Inadequate knowledge across these studies could reflect that despite the high prevalence of mental health problems across communites worldwide, very few strategies have been designed to increase the level of awareness. Therefore, there is a need for mass sensitization on mental health disorders. Mental health disorders were recognized as medical conditions by 73.6% of the study population, with 88.8% of participants viewing them as treatable. However, this contrasts with a study in Mpumalanga Province, South Africa where most participants attributed mental health issues to pregnancy and witchcraft ( Mboweni et al., 2023 ). Furthermore, 77.2% of the participants identified that being alone is not a treatment for mental disorders and 74.0% of respondents believed that mental health problems occur in both male and female.

The overall prevalence of mental health disorders among youths aged 10 - 24 in the Southwest region of Cameroon was 68.8%, alarmingly high compared to the WHO’s estimated 15% ( WHO, 2022 ). This may reflect specific contextual factors such as socioeconomic stressors or cultural stigma related to mental health. This was also similar to a study done by Djatche et al. (2022) who reported that 71.4% of his study participant had at least one mental health disorder, signifying that many people face mental health disorders which could be caused by either socioeconomic factors, social factors or trauma. This study found a 23.9% anxiety prevalence, consistent with Hofmann et al. (2012) meta-analysis, which reported anxiety prevalence rates among young people ranging from 20% to 25%. The prevalence of substance use was 30.1% which was higher than the global average, reported by the World Health Organization ( WHO, 2022 ). High substance use in Fako division may be due to the ongoing crisis in the Southwest and Northwest regions of the country which has led to school drop outs, high crime wave, unemployment and poverty. To add, there was a 19.2% prevalence of suicidal thoughts among children and adolescence, which differed from the findings of Nock et al. who had a prevalence of 66.0% in the United States of America. This difference could be due to the fact that the latter focused only on adults while this study focused on both children and youths. There was a significant association between gender and mental health disorders (p = 0.009), with males less likely to have a mental disorder (OR = 0.693). This was consistent with the results of Weinberger et al. (2017) and Merikangas et al. (2009) .