Rethinking Urban Mental Health: What the TOPOWA Project is Teaching Us
- mswahn
- Jan 1
- 8 min read
Through 17 peer-reviewed publications, the TOPOWA Project has helped reshape how women’s mental health is understood in rapidly urbanizing, low-resource settings.
Why TOPOWA? Rethinking Urban Mental Health
This collective and ongoing work demonstrates that mental health in urban settings is deeply influenced by neighborhood conditions, including safety, social ties, environmental stress, and access to opportunity, moving beyond narrow explanations focused only on individual behavior or income. We are exploring ways to rethink urbanicity and how we conceptualize neighborhood effects on mental health based on all that we have learned so far.
TOPOWA also advances new ways of thinking about mental health by connecting everyday social and environmental stressors to underlying emotional and biological responses to adversity. We have written about this in terms of suicidal ideation and depression but also related to infectious diseases. In fact, we provide a contextualized framework for how we can apply the Research Domain Criteria promoted by the National Institutes of Health to Social Determinants of Community Mental Health in Low-Resource-Settings.
Advancing Methods: mHealth, Daily Diaries and Photovoice
At the same time, the TOPOWA study has pushed methodological boundaries making recommendations for how to advance mHealth research in low resource settings and by assessing the feasibility and acceptability of wearable devices and also successfully implementing the use of mobile and wearable technologies. We have also tested the use of a brief daily diary to capture daily experiences of stress, sleep, alcohol marketing exposure, and wellbeing in informal urban communities.
By engaging young women as active contributors through participatory approaches such as Photovoice, the TOPOWA project ensures that lived experience and community insight remain central. Together, these findings reveal a substantial and largely unmet mental health burden, including climate change anxiety, among young women in Kampala’s informal settlements, underscoring the need for accessible, locally grounded, and scalable mental health solutions. However, we have also covered related topics of concerns and importance to the young women including modern contraceptive use.
From Research to Action: Vocational Training and Mental Health
As we move forward, the TOPOWA Project continues to break new ground in our efforts to understand how Socio Economic Strengthening Targeted Training (SeSTT) which is comprised of vocational training and additional psychosocial support, may impact the mental health and well-being of adolescent girls and young women living in Kampala’s urban informal settlements.
With two years of the cohort data collection completed, and another year underway, early trends from our prospective cohort study are encouraging. While we await finalization and publication of these results, we’re optimistic that this research will contribute meaningfully to how we design and implement community-based mental health interventions in low-resource settings. Our qualitative research to date highlights the mental health benefits of vocational training. Next, we are analyzing the potential impact of SeSTT on financial distress, quality of life and other mental health outcomes.
Stakeholder and Media Outreach Engagement, December 2025
Last month we held an outreach event in Kampala (December 19, 2025) with key stakeholders and media representatives to share our findings on the prevalence and comorbidity of mental health concerns of young women in the TOPOWA project. The Nile Post in Uganda did a great summary: https://nilepost.co.ug/health/311675/mental-health-alarm-as-58-of-young-women-in-kampala-slums-report-depression
The key takeaway from the media briefing is that we uncovered alarmingly high rates of mental health challenges and substance use among young women living in Kampala’s informal settlements. The research, conducted with 300 women aged 18–24 years across Banda, Bwaise, and Makindye, presents one of the most comprehensive mental health assessments ever done with young women in these communities.
The study, published in BMC Public Health, found that:
Nearly 3 in 4 young women (74%) reported at least one mental health concern.
Depression was most common (58%), followed by suicidality (46%) and anxiety (35%).
Over 45% experienced two or more mental health conditions at the same time (comorbidity), greatly increasing their risk of harm.
Alcohol use (28%) and drug use (11%) were strongly linked with worse mental health, especially among those with multiple conditions.
What Comes Next for the TOPOWA Project
When the cohort study is completed at the end of 2026, we will have data from 10 time points (implemented roughly every three months). The additional time points will enable us to examine patterns of behaviors and outcomes and also examine closely both the shorter and longer term impact of the intervention (SeSTT). We will also be able to examine the structural drivers (at the more macro level) but also how biomarkers like cortisol (stress hormone) and neuroscience (like fear and threat) may impact mental health outcomes.
At this point we have 17 articles published (see list below) that highlight key findings of the project components already completed (e.g., focus groups, Photovoice and pilot studies) as well as some of the baseline findings from the cohort study. These articles included 36 authors and we always welcome new collaborators so that we can leverage all the data we have collected. The core team and our many collaborators are now busy analyzing and preparing more manuscripts for dissemination.
📌 What’s Next?
In-Depth Analysis: Our team is now exploring how social factors/determinants like poverty, education, quality of life, caregiving, and baseline experiences shape outcomes across the cohort.
Mechanistic Insights: We will soon begin evaluating additional biomarker and neuroscience data to better understand the stress-mental health connection.
Dissemination and Dialogue: We’re committed to sharing findings with community stakeholders, practitioners, and policymakers—locally and globally—and we are always glad to share papers and presentations with anyone interested.
Writing Group: We have also launched an interdisciplinary writing group with mentoring and support to other researchers who would like to contribute to the project and disseminate findings. Reach out to us if this is of interest (and look for the TOPOWA Project Writing Group on LinkedIn).
🔍 What Makes the TOPOWA Study Unique?
Integrated Design: TOPOWA combines psychosocial survey data, wearable technology, daily diaries, biomarkers, and a neuroscience-based fear-conditioning task to explore stress response systems and mental health trajectories in real-world conditions.
Engaged, Longitudinal Approach: Our study follows 300 young women across 10 timepoints over 27-36 months, making it one of the most comprehensive cohort studies of its kind in Africa.
Community Partnership: Guided by youth and professional advisory boards, we prioritize cultural relevance, participant insight, and ethical rigor at every step.
🤝 Stay Engaged
TOPOWA is more than a study—it’s a platform for collaborative, action-oriented research that centers the experiences of young women navigating complex adversity. We are grateful to our partners, funders, and participants for their ongoing support. And, we're always grateful to UYDEL for their partnership and for the fantastic data and project team we have in Kampala and the US.
Follow along as we continue this journey to drive impactful research in global mental health. And if you’re interested in collaboration or learning more, we’d love to hear from you.
Published TOPOWA Papers to Date - Dec 31, 2025 (N=17)
Swahn, M. H., Kalulu, P., Sseviiri, H., Namuyiga, J., Palmier, J., & Twinomuhangi, R. (2026). Rethinking Urbanicity: Conceptualizing Neighborhood Effects on Women’s Mental Health in Kampala’s Urban Slums. International Journal of Environmental Research and Public Health, 23(1), 41. https://doi.org/10.3390/ijerph23010041
McMorrow, S., Swahn, M. H., Palmier, J., Nabulya, A., Nassaka, J., Bello, O. O., & Fritz, A. (2025). A photovoice examination of community strengths and challenges in mental health and wellbeing of young women in three urban communities in Kampala, Uganda. Global health promotion, 17579759251361818. Advance online publication. https://doi.org/10.1177/17579759251361818
Swahn, M.H., Palmier, J., Natuhamya, C., Mobley, K., Gittner, K. B., Lyons, M., Bbosa, G.S., Matovu, G., Mubiru, F., Kavuma, A. (2025). Prevalence and comorbidity of mental health concerns, alcohol and drug use among young women in the urban slums of Kampala, Uganda: findings from the TOPOWA study. BMC Public Health (2025). https://doi.org/10.1186/s12889-025-25602-y
Swahn, M. H., Namuyiga, J., Matovu, G., Natuhamya, C., Palmier, J., Nabulya, A., & Kebirungi, H. (2025). Modern Contraceptive Use Among Young Women in Kampala Slums: Research Findings from the TOPOWA Study. International journal of environmental research and public health, 22(11), 1730. https://doi.org/10.3390/ijerph22111730
Swahn, M. H., Lyons, M. J., Wade-Berg, J. A., Palmier, J., Nabulya, A., & Kasirye, R. (2025). Self-Reported Mental Health Benefits and Impacts of Vocational Skills Training in a Low-Resource Setting: The Lived Experience of Young Women Residing in the Urban Slums of Kampala, Uganda. International journal of environmental research and public health, 22(11), 1698. https://doi.org/10.3390/ijerph22111698
Swahn, M. H., Matovu, G., Natuhamya, C., Murray, K. E., Ndetei, D. M., Palmier, J., Nabulya, A., Wandji, S., & Twinomuhangi, R. (2025). Climate change anxiety among young women living in the urban slums of Kampala, Uganda: findings from the baseline assessment of the TOPOWA cohort study. BMJ public health, 3(2), e002439. https://doi.org/10.1136/bmjph-2024-002439
Swahn, M. H., Culbreth, R. E., Palmier, J., Kavuma, A., & Jovanovic, T. (2025). Applying the Research Domain Criteria to Social Determinants of Community Mental Health in Low-Resource Settings: A Contextualized Framework with Insights from the TOPOWA Study. Community mental health journal, 10.1007/s10597-025-01508-2. Advance online publication. https://doi.org/10.1007/s10597-025-01508-2
Natuhamya, C., Nabukalu, E., Lyons, M., Gittner, K. B., Palmier, J., Culbreth, R., & Swahn, M. H. (2025). Effect of social perspectives in the relationship between suicidal ideation and depression among young women in slums of Kampala, Uganda. BMC psychiatry, 25(1), 568. https://doi.org/10.1186/s12888-025-06930-0
Lyons, M., Palitsky, R., Gittner, K. B., Nabulya, A., Hall, W., Palmier, J., & Swahn, M. H. (2025). Social Drivers of Infectious Disease Transmission and Treatment Among Young Women in Kampala, Uganda's Informal Settlements: A Qualitative Analysis of Focus Group Data From a Community-Based Cohort Study. Health promotion practice, 15248399251328332. Advance online publication. https://doi.org/10.1177/15248399251328332
Nielsen, K. E., Mobley, K., Culbreth, R., Palmier, J. B., Matovu, G., Nabulya, A., & Swahn, M. H. (2025). Wearable technology and daily diaries for studying mental health: lessons learned from pilot studies in Kampala, Uganda. Global mental health (Cambridge, England), 12, e17. https://doi.org/10.1017/gmh.2025.9
Swahn, M. H., Natuhamya, C., Culbreth, R., Palmier, J., Kasirye, R., & Dumbili, E. W. (2025). Alcohol marketing as a commercial determinant of health: daily diary insights from young women in Kampala. Health promotion international, 40(1), daaf002. https://doi.org/10.1093/heapro/daaf002
Swahn, M. H., Nabulya, A., Nassaka, J., & Palmier, J. (2025). Feasibility, Challenges and Lessons Learned: Photovoice Implementation Among Young Women in the Urban Slums in Kampala, Uganda. International Journal of Qualitative Methods, 24. https://doi.org/10.1177/16094069251320860
Nielsen, K., Mobley, K., Culbreth, R., Palmier, J., Nabulya, A., & Swahn, M. H. (2024). Feasibility and acceptability of wearable devices and daily diaries to assess sleep and other health indicators among young women in the slums of Kampala, Uganda. Digital health, 10, 20552076241288754. https://doi.org/10.1177/20552076241288754
Swahn, M. H., Palmier, J., Culbreth, R., Bbosa, G. S., Natuhamya, C., Matovu, G., & Kasirye, R. (2024). Alcohol Use among Young Women in Kampala City: Comparing Self-Reported Survey Data with Presence of Urinary Ethyl Glucuronide Metabolite. International journal of environmental research and public health, 21(9), 1256. https://doi.org/10.3390/ijerph21091256
Swahn, M. H., Gittner, K. B., Lyons, M. J., Nielsen, K., Mobley, K., Culbreth, R., Palmier, J., Johnson, N. E., Matte, M., & Nabulya, A. (2024). Advancing mHealth Research in Low-Resource Settings: Young Women's Insights and Implementation Challenges with Wearable Smartwatch Devices in Uganda. Sensors (Basel, Switzerland), 24(17), 5591. https://doi.org/10.3390/s24175591
Culbreth, R. E., Nielsen, K. E., Mobley, K., Palmier, J., Bukuluki, P., & Swahn, M. H. (2024). Life Satisfaction Factors, Stress, and Depressive Symptoms among Young Women Living in Urban Kampala: Findings from the TOPOWA Project Pilot Studies. International journal of environmental research and public health, 21(2), 184. https://doi.org/10.3390/ijerph21020184
Swahn, M. H., Nassaka, J., Nabulya, A., Palmier, J., & Vaught, S. (2022). A Qualitative Assessment of Place and Mental Health: Perspectives of Young Women Ages 18-24 Living in the Urban Slums of Kampala, Uganda. International journal of environmental research and public health, 19(19), 12935. https://doi.org/10.3390/ijerph191912935
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