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Mental Health Inequalities in Adolescents Growing Up in Post-Apartheid South Africa: Cross-Sectional Survey, SHaW Study

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  • Jayati Das-Munshi
  • Crick Lund
  • Catherine Mathews
  • Charlotte Clark
  • Catherine Rothon
  • Stephen Stansfeld

Abstract

Background: South Africa is one of the most ‘unequal’ societies in the world. Despite apartheid ending more than 20 years ago, material inequalities remain interwoven with ethnic/racial inequalities. There is limited research on the prevalence/predictors of common mental disorders (CMD) among young people. Adolescence is a unique time-point during which intervention may lead to improved mental health and reduced social problems later. The study objective was to assess mental health disparities in a representative sample of adolescents growing up in South Africa. Methods: Cross-sectional associations of race/ethnicity and material disadvantage with CMD and Post Traumatic Stress Disorder (PTSD) were assessed in a stratified random sample representative of school-attendees, aged 14–15 years, in a large metropolitan area of Cape Town. Validated instruments assessed mental disorders; these included: Harvard Trauma Questionnaire (PTSD); Short Moods and Feelings Questionnaire (depression); Zung self-rated anxiety scale (anxiety). Self-ascribed ethnicity was determined using procedures similar to the South African census and previous national surveys. Results: Response rate was 88% (1034 of 1169 individuals). Adolescents experienced a high prevalence of depression (41%), anxiety (16%) and PTSD (21%). A gradient between material disadvantage and CMD/ PTSD was evident across all ethnic/racial groups. Respondents self-identifying as ‘black’ or ‘coloured’ were disadvantaged across most indicators. After adjusting for confounders, relative to white children, relative risk (RR) of CMD in black children was 2.27 (95% CI:1.24, 4.15) and for PTSD was RR: 2.21 (95% CI:1.73, 2.83). Relative risk of CMD was elevated in children self-identifying as ‘coloured’ (RR: 1.73, 95% CI:1.11, 2.70). Putative mediators (violence, racially motivated bullying, social support, self-esteem) partially accounted for differences in CMD and fully for PTSD. Conclusions: Adolescent mental health inequalities in Cape Town are associated with material disadvantage and self-identification with historically disadvantaged groups.

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  • Jayati Das-Munshi & Crick Lund & Catherine Mathews & Charlotte Clark & Catherine Rothon & Stephen Stansfeld, 2016. "Mental Health Inequalities in Adolescents Growing Up in Post-Apartheid South Africa: Cross-Sectional Survey, SHaW Study," PLOS ONE, Public Library of Science, vol. 11(5), pages 1-16, May.
    • Handle: RePEc:plo:pone00:0154478
    DOI: 10.1371/journal.pone.0154478
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    2. Bronwyn Myers & Felicia A. Browne & Tara Carney & Tracy Kline & Courtney Peasant Bonner & Wendee M. Wechsberg, 2021. "The Association of Recurrent and Multiple Types of Abuse with Adverse Mental Health, Substance Use, and Sexual Health Outcomes among Out-of-School Adolescent Girls and Young Women in Cape Town, South ," IJERPH, MDPI, vol. 18(21), pages 1-13, October.
    3. Xianhua Dai & Nian Gu, 2021. "The Impact of Social Capital on Mental Health: Evidence from the China Family Panel Survey," IJERPH, MDPI, vol. 19(1), pages 1-19, December.
    4. Lai, Angel Hor Yan & Chui, Cheryl Hiu-kwan & Wong, Jade Kin Yu & Leung, Cynthia Tsz Ching & Chen, Zhijun, 2022. "Ethnic identity, perceived classmate support and general self-efficacy in ethnic minority adolescents in rural Chinese school settings," Children and Youth Services Review, Elsevier, vol. 137(C).

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