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Mental health in SA is at shocking levels but people are not seeking help

- Wits University

A new study reveals that South Africans suffer higher rates of probable depression and anxiety than other countries.

However, only a quarter of those receive treatment. Complex factors are contributors.

Mental health woes are endemic in South Africa, with adverse childhood experiences, socio-economic status, geographic location, age, marital status and education levels impacting the prevalence of mental illness.

A new paper by the Wits/Medical Research Council Developmental Pathways for Health Research Unit (DPHRU) titled, The prevalence of probable depression and probable anxiety, and the associations with adverse childhood experiences and socio-demographics: A National Survey in South Africa, showed that more than a quarter of South Africans suffer from probable depression with higher levels in certain provinces.

The study was published in the journal Frontiers in Public Health.

Says Dr Ashleigh Craig, an emerging researcher at DPHRU, this is much higher than the data collected in comparative surveys in the US (6.9%: 2011), Germany (5.6%: 2013), and Australia (10%: 2014).

South Africa’s rates of mental illness are also more than double those in Brazil (7.9%: 2016), which is also classified as a low- and middle-income country with high levels of inequality. 

“Mental illness significantly impairs overall health. And, of course, Covid-19 worsened depression and anxiety, with fear, uncertainty and social and economic disruptions arising during the pandemic. Although mental health care was considered an essential service during the lockdown period in South Africa, restrictions on physical contact, in-person consultations, transport, and financial restrictions made access to facilities difficult. Thus, those seeking treatment could not access comprehensive care,” says Craig.

She added that individuals living in poverty and with poor mental health are at an increased risk of remaining poor. “It’s a vicious cycle and has intergenerational effects.”

Early ACEs and mental health woes later

When early Adverse Childhood Experiences (ACEs) were considered independently (apart from other socio-demographic factors like household resources and education), ACEs revealed a much greater risk for depression and anxiety later in life. A previous study shows that the likelihood of having probable depression or probable anxiety increased by 22% or 21%, respectively. This is directly proportional to the number of ACE points an individual has.

Adverse childhood experiences include physical and emotional abuse, neglect, caregiver mental illness and household violence. The more ACEs a child experiences, the more likely they will suffer from poor health in adulthood. A high risk of heart disease, diabetes, poor academic achievement and substance abuse in later life has been associated with ACE scores of four and more. 

The ‘protective factor’ of schooling

The Wits/MRC DPHRU study found that those with little to no education are at an increased risk of probable depression and anxiety, confirming previous findings regarding the protective effect of higher levels of education against anxiety and depression.

“This finding correlates with another recent study on the intergenerational transmission of depression in South Africa. Due to the historical exclusion of certain racial groups from quality education during the apartheid era, many young South Africans continue to bear this burden with the effects felt on their mental health,” says Craig.

Happily ever after?

The DPHRU study showed that older adults who are single, widowed, divorced or separated have worse mental health than those who are not. “Depression is more prevalent in later life, presumably because of a decline in health and the challenges of retirement,” says Craig.

Depression, anxiety and the urban poor

A third of the South African population and 74% of poor South Africans live in rural areas. While it is believed that individuals in more impoverished rural areas are more susceptible to experiencing mental illness, recent reports reveal that young adults in urban areas seem to experience a higher level of depression when compared to their rural counterparts. Nevertheless, the Northern Cape showed the highest rates of both probable depression and anxiety, and this province has a largely rural economy.

Differences in rate of depression and anxiety across SA’s nine provinces

“Our study shows that 25.7% of South Africans are probably depressed, with more than a quarter of respondents reporting moderate to severe symptoms of depression,” says Craig.

But the prevalence of mental illness was different across all nine provinces, with higher rates in the Northern Cape, Eastern Cape, Western Cape, Gauteng and Mpumalanga.

How to heal SA’s mental health?

“Adult mental health services are urgently needed, especially for those identified as most vulnerable. Given the range of probable depression across the country, provincial-level plans and resources should also reflect the proportion of mental health problems,” says Craig.

The DPHRU study provides important evidence for understanding the causes of probable depression and probable anxiety. This may help develop targeted interventions to reduce poor mental health in South Africa.

“Our data also suggest that intervention and counselling programmes should be a priority for older, widowed, divorced or separated adults, and those who are less educated and have fewer resources. This is particularly important in provinces with a relatively higher prevalence of probable depression.”

Despite the high prevalence of mental health problems in South Africa, few primary healthcare facilities have mental health services: “This, in combination with mental health being low on the priority list, spells disaster. We need better implementation of mental healthcare plans, more skilled mental health professionals and more budget for prevention, treatment and support strategies,” says Craig.

Several countries, including Zimbabwe, have introduced mental health services into primary healthcare facilities using ordinary healthcare workers. “They are using their resources well, and South Africa should follow suit, particularly since a lack of resources often explains poor mental health outcomes.”