Prevalence and sociodemographic correlates of common mental disorders among first-year university students in post-apartheid South Africa: implications for a public mental health approach to student wellness

Abstract

Background: There is growing awareness of the need for effective prevention, early detection, and novel treatment approaches for common mental disorders (CMDs) among university students. Reliable epidemiological data on prevalence and correlates are the cornerstones of planning and implementing effective health services and adopting a public health approach to student wellness. Yet, there is a comparative lack of sound psychiatric epidemiological studies on CMDs among university students in low-and middle-income countries, like South Africa (SA). It is also unclear if historically marginalised groups of students are at increased risk for mental health problems in post-apartheid SA. The objective of the study was to investigate the prevalence and sociodemographic correlates of lifetime and 12-month CMDs among university students in SA, with a particular focus on vulnerability among students in historically excluded and marginalised segments of the population. Methods: Data were collected via self-report measures in an online survey of first-year students registered at two large universities (n = 1402). CMDs were assessed with previously-validated screening scales. Data were weighted and analysed using multivariate statistical methods. Results: A total of 38.5% of respondents reported at least one lifetime CMD, the most common being major depressive disorder (24.7%). Twelve-month prevalence of any CMD was 31.5%, with generalised anxiety disorder being the most common (20.8%). The median age of onset for any disorder was 15 years. The median proportional annual persistence of any disorder was 80.0%. Female students, students who reported an atypical sexual orientation, and students with disabilities were at significantly higher risk of any lifetime or 12-month disorder. Female gender, atypical sexual orientation, and disability were associated with elevated risk of internalising disorders, whereas male gender, identifying as White, and reporting an atypical sexual orientation were associated with elevated risk of externalising disorders. Older age, atypical sexual orientation, and disability were associated with elevated risk of bipolar spectrum disorder.

Maltreatment during childhood and risk for common mental disorders among first year university students in South Africa

“…Studies from high-income countries suggest that CMDs are considerably more prevalent among university students than the general population, partly because of heightened stress associated with social and academic transitions from school to university [ 3 – 5 ]. Similar findings have been reported for South Africa, a low- to middle-income country (LMIC), where lifetime and 12 month prevalence estimates for any CMD among university students are 39% and 32%, respectively [ 6 ]—higher than the 30% and 17% reported for the general population [ 7 ]. These prevalence estimates are comparable with those found among university students in other countries [ 8 , 9 ] and are of global concern given the deleterious effects that untreated CMDs have on students’ academic performance [ 8 – 10 ], social functioning and quality of life [ 11 , 12 ], self-harm, and death by suicide [ 13 – 16 ].…”

“…The design of effective mental health interventions requires reliable epidemiological data on risk factors for CMDs [ 6 , 17 ]. Yet information on risk factors for CMDs among South African university students has been limited to socio-demographic correlates [ 6 ].…”

“…The design of effective mental health interventions requires reliable epidemiological data on risk factors for CMDs [ 6 , 17 ]. Yet information on risk factors for CMDs among South African university students has been limited to socio-demographic correlates [ 6 ]. In keeping with studies from other contexts [ 13 , 17 ], findings suggest that vulnerability for CMDs is heightened among students who identify as female, report a non-heterosexual sexual orientation, or have disabilities [ 6 ].…”

Inequality and mental healthcare utilisation among first-year university students in South Africa

“…Among those who accessed mental healthcare, 52.0% made use of psychotropic medication, 47.3% received psychotherapy, and 5.4% sought treatment from a traditional healer for their mental health problems. Elsewhere we have reported on the prevalence and sociodemographic correlates of common mental disorders in this sample [26], and on the epidemiology of non-fatal suicidal behaviour [27]. Below we present an analysis of factors associated with utilisation of mental healthcare in this sample.…”

Psychiatric epidemiological survey of university students in Botswana: rationale and methods of the Youth Mental Health Study (YMHS)

“…Unipolar depression is the most prevalent disorder among university students. [16][17][18] In Botswana, non-random small studies have found that between 40% 7 and 55% 8 of university students in their earlier 20s screen positive for depression (Beck Depression Inventory score of 14 and above). A systematic review of predictors of depression among university students has shown that depressive symptoms are predicted by multiple biopsychosocial variables.…”