The growing burden of mental health and the role of digital technologies in the Global South: policies, cultural contexts, and community-based transformations—a systematic review of gray literature evidence

Abstract

Background Mental health conditions are among the fastest growing and most inequitably distributed global disease burdens. Structural determinants- poverty, conflict, climate change, and the COVID-19 pandemic compound a persistent mismatch between internationally developed policy frameworks and the cultural and infrastructural realities of populations in the Global South. Objective This systematic review identified, appraised, and synthesized gray literature evidence on (1) the growing mental health burden across Global South regions (2015–2025); (2) digital technology responses in Global South LMIC contexts; and (3) policy, cultural, and community-based factors shaping mental health transformation efforts. Methods A pre-registered systematic gray literature review spanned five source tiers. Following systematic screening and AACODS quality appraisal, 140 records published between 2015 and 2025 were included. Results Four themes emerged: (1) an accelerating, structurally driven mental health burden across Global South regions; (2) a severe and entrenched treatment gap sustained by chronic underinvestment, workforce shortages, and stigma; (3) a rapidly expanding but uneven digital mental health landscape, in which SMS-based and CHW-mediated platforms achieve substantially greater reach than smartphone-dependent tools; and (4) significant structural, cultural, and policy barriers constraining scale-up. The effectiveness of digital mental health interventions (DMHIs) varies by modality, population, and setting, and is not a single generalizable finding. Conclusion The mental health burden in the Global South is growing faster than existing systems can address. Transformative progress requires sustained investment in CHW-mediated digital tools, culturally co-designed platforms, decolonized research partnerships, and mental health policies that center Global South communities as co-producers of their own mental health futures.