Creative Commons Attribution 4.0 International LicenseHorn, RebeccaArakelyan, StellaWurie, HajaAger, Alastair2021-05-192021-05-192021-06-11Horn, R., Arakelyan, S., Wurie, H. and Ager, A. (2021) ‘Factors contributing to emotional distress in Sierra Leone: a socio-ecological analysis’, International Journal of Mental Health Systems, 15(1), p. 58. Available at: https://doi.org/10.1186/s13033-021-00474-y.1752-4458https://doi.org/10.1186/s13033-021-00474-yhttps://eresearch.qmu.ac.uk/handle/20.500.12289/11253Stella Arakelyan - ORCID: 0000-0003-0326-707X https://orcid.org/0000-0003-0326-707XAlastair Ager - ORCID: 0000-0002-9474-3563 https://orcid.org/0000-0002-9474-3563Replaced AM with VoR 2021-06-24.Background There is increasing global evidence that mental health is strongly determined by social, economic and environmental factors, and that strategic action in these areas has considerable potential for improving mental health and preventing and alleviating mental disorders. Prevention and promotion activities in mental health must address the needs prioritised by local actors. The aim of this study was to identify stressors with the potential to influence emotional wellbeing and distress within the general population of Sierra Leone, in order to contribute to an inter-sectoral public mental health approach to improving mental health within the country.Methodology Respondents were a convenience sample of 153 respondents (60 women, 93 men) from five districts of Sierra Leone. Using freelisting methodology, respondents were asked to respond to the open question ‘What kind of problems do women/men have in your community?’. Data analysis involved consolidation of elicited problems into a single list. These were then organised thematically using an adaptation of the socio-ecological model, facilitating exploration of the interactions between problems at individual, family, community and societal levelsResults Overall, respondents located problems predominantly at community and societal levels. Although few respondents identified individual-level issues, they frequently described how problems at other levels contributed to physical health difficulties and emotional distress. Women identified significantly more problems at the family level than men, particularly related to relationships with an intimate partner. Men identified significantly more problems at the societal level than women, primarily related to lack of infrastructure. Men and women were equally focused on problems related to poverty and lack of income generating opportunities.Conclusion Poverty and inability to earn an income underpinned many of the problems described at individual, family and community level. Actions to address livelihoods, together with improving infrastructure and addressing gender norms which are harmful to both men and women, are likely key to improving the wellbeing of the Sierra Leone population.en© The Author(s) 2021http://creativecommons.org/licenses/by/4.0/PsychosocialMental HealthSierra LeoneSocio-ecologicalFreelistingQualitativeArticle2021-06-24