Racial disparities in psychological distress in post-apartheid South Africa: results from the SANHANES-1 survey

Abstract

Purpose South Africa has long endured a high prevalence of mental disorders at the national level, and its unique social and historical context could be a contributor to an increased risk of mental health problems. Our current understanding is limited regarding the relative importance of various social determinants to mental health challenges in South Africa, and how existing racial inequities may be explained by these determinants. Methods This study attempted to elucidate potential social determinants of mental health in South Africa using data from the nationally representative South African National Health and Nutrition Examination Survey (SANHANES-1). The main outcome of interest was psychological distress, measured with the Kessler-10 scale. Hierarchical linear regression models included covariates for demographic and socioeconomic factors, count of traumatic events, and a series of stress-related constructs. Analyses were conducted on two populations: the entire sample (n = 15,981), and the African subpopulation (n = 10,723). Results Regression models on the entire sample indicated racial disparities in psychological distress, with Africans experiencing higher distress than White and Coloured individuals. Results within the African sub-population indicated geo-spatial disparities, with Africans in formal urban settings experiencing higher psychological distress than those living in formal and informal rural locales. Across both samples, results indicated a cumulative association between count of stressors and traumatic events and distress. ConclusionWe found racial disparities across several mental health-related domains. Africans had greater exposure to traumatic events, social stressors, and psychological distress. This research is a necessary foundation for public health interventions and policy change to effectively reduce inequities in psychological distress.

Divergence in the size and composition of the race gap in mental health: Evidence from South Africa

“…Numerous studies for South Africa have documented that on average, African adults report significantly more depressive symptoms than non-African adults (e.g. Ardington & Case, 2010 ; Burger et al, 2017 ; Harriman et al, 2022 ; Mungai & Bayat, 2019 ; Tomita & Burns, 2013 ; Williams et al, 2007 , 2008 ). Race differences are typically identified by including a race dummy variable or variables in OLS or probit regressions, and the source of the estimated gap is then uncovered by adding covariates to the regressions and observing how race coefficients change.…”

Divergence in the size and composition of the race gap in mental health: Evidence from South Africa

“…Numerous studies for South Africa have documented that on average, African adults report significantly more depressive symptoms than non-African adults (e.g. Ardington & Case, 2010 ; Burger et al, 2017 ; Harriman et al, 2022 ; Mungai & Bayat, 2019 ; Tomita & Burns, 2013 ; Williams et al, 2007 , 2008 ). Race differences are typically identified by including a race dummy variable or variables in OLS or probit regressions, and the source of the estimated gap is then uncovered by adding covariates to the regressions and observing how race coefficients change.…”

Against the odds: Unveiling the racial dynamics of financial resilience in post‐apartheid South Africa

“…This is linked to apartheid's systemic discrimination and marginalization, which caused lasting trauma and psychological distress. Ongoing socioeconomic disparities have further contributed to higher rates of mental health issues in these communities, such as depression and anxiety (Harriman et al, 2021; Moomal et al, 2009). Elevated depressive symptoms negatively affect consumer behavior, decision‐making, and financial literacy (Bennett et al, 2012), impairing the ability to make informed financial choices (Handel & Schwartzstein, 2018).…”

“…The cultural stigma surrounding mental health issues within certain communities, coupled with limited access to culturally competent mental health services, further exacerbated disparities in mental well‐being (Moomal et al, 2009; Ruane, 2010). Consequently, racial disparities in mental health outcomes are evident in South Africa, with Non‐Whites, particularly Black people, being more susceptible to higher rates of mental disorders compared to White people due to historical racial segregation and discrimination (Harriman et al, 2021). Depression and other mental disorders rank as the second‐highest disease‐based burden in the country, affecting over 7 million individuals, which accounts for approximately 11% of the total population (Institute of Health Metrics, 2019; Jack et al, 2014).…”

The road to recovery: Financial resilience and mental health in post-apartheid South Africa

“…The estimates from the subgroup analysis show that financial resilience is negatively correlated with mental health problems among non-Whites more than it is among Whites. This may be attributable to the fact that non-Whites, especially Africans, generally experience higher levels of mental distress than Whites ( Harriman et al, 2021 ). Again, White South Africans, who constitute a minority group in the country, have access to far more economic resources than non-Whites due to the wealth inequality stemming from apartheid ( Chatterjee et al, 2022 ; Orthofer, 2016 ).…”

“…Orthofer (2016) also highlights the prevalence of racial disparities in terms of economic resources, further exacerbating wealth inequality in favor of the White minority. Evidence indicates that disadvantaged households—which are disadvantaged as a result of these racial and wealth inequalities—are more likely to suffer from mental disorders, including post-traumatic stress disorder (PTSD), in South Africa ( Burns et al, 2017 ; Das-Munshi et al, 2016 ; Harriman et al, 2021 ; Lund et al, 2010 ).…”

Divergence in the size and composition of the race gap in mental health: Evidence from South Africa

“…Numerous studies for South Africa have documented that on average, African adults report significantly more depressive symptoms than non-African adults (e.g. Ardington & Case, 2010 ; Burger et al, 2017 ; Harriman et al, 2022 ; Mungai & Bayat, 2019 ; Tomita & Burns, 2013 ; Williams et al, 2007 , 2008 ). Race differences are typically identified by including a race dummy variable or variables in OLS or probit regressions, and the source of the estimated gap is then uncovered by adding covariates to the regressions and observing how race coefficients change.…”

Against the odds: Unveiling the racial dynamics of financial resilience in post‐apartheid South Africa

“…This is linked to apartheid's systemic discrimination and marginalization, which caused lasting trauma and psychological distress. Ongoing socioeconomic disparities have further contributed to higher rates of mental health issues in these communities, such as depression and anxiety (Harriman et al, 2021; Moomal et al, 2009). Elevated depressive symptoms negatively affect consumer behavior, decision‐making, and financial literacy (Bennett et al, 2012), impairing the ability to make informed financial choices (Handel & Schwartzstein, 2018).…”

“…The cultural stigma surrounding mental health issues within certain communities, coupled with limited access to culturally competent mental health services, further exacerbated disparities in mental well‐being (Moomal et al, 2009; Ruane, 2010). Consequently, racial disparities in mental health outcomes are evident in South Africa, with Non‐Whites, particularly Black people, being more susceptible to higher rates of mental disorders compared to White people due to historical racial segregation and discrimination (Harriman et al, 2021). Depression and other mental disorders rank as the second‐highest disease‐based burden in the country, affecting over 7 million individuals, which accounts for approximately 11% of the total population (Institute of Health Metrics, 2019; Jack et al, 2014).…”

The road to recovery: Financial resilience and mental health in post-apartheid South Africa

“…The estimates from the subgroup analysis show that financial resilience is negatively correlated with mental health problems among non-Whites more than it is among Whites. This may be attributable to the fact that non-Whites, especially Africans, generally experience higher levels of mental distress than Whites ( Harriman et al, 2021 ). Again, White South Africans, who constitute a minority group in the country, have access to far more economic resources than non-Whites due to the wealth inequality stemming from apartheid ( Chatterjee et al, 2022 ; Orthofer, 2016 ).…”

“…Orthofer (2016) also highlights the prevalence of racial disparities in terms of economic resources, further exacerbating wealth inequality in favor of the White minority. Evidence indicates that disadvantaged households—which are disadvantaged as a result of these racial and wealth inequalities—are more likely to suffer from mental disorders, including post-traumatic stress disorder (PTSD), in South Africa ( Burns et al, 2017 ; Das-Munshi et al, 2016 ; Harriman et al, 2021 ; Lund et al, 2010 ).…”

Divergence in the size and composition of the race gap in mental health: Evidence from South Africa

“…Numerous studies for South Africa have documented that on average, African adults report significantly more depressive symptoms than non-African adults (e.g. Ardington & Case, 2010 ; Burger et al, 2017 ; Harriman et al, 2022 ; Mungai & Bayat, 2019 ; Tomita & Burns, 2013 ; Williams et al, 2007 , 2008 ). Race differences are typically identified by including a race dummy variable or variables in OLS or probit regressions, and the source of the estimated gap is then uncovered by adding covariates to the regressions and observing how race coefficients change.…”

Against the odds: Unveiling the racial dynamics of financial resilience in post‐apartheid South Africa

“…This is linked to apartheid's systemic discrimination and marginalization, which caused lasting trauma and psychological distress. Ongoing socioeconomic disparities have further contributed to higher rates of mental health issues in these communities, such as depression and anxiety (Harriman et al, 2021; Moomal et al, 2009). Elevated depressive symptoms negatively affect consumer behavior, decision‐making, and financial literacy (Bennett et al, 2012), impairing the ability to make informed financial choices (Handel & Schwartzstein, 2018).…”

“…The cultural stigma surrounding mental health issues within certain communities, coupled with limited access to culturally competent mental health services, further exacerbated disparities in mental well‐being (Moomal et al, 2009; Ruane, 2010). Consequently, racial disparities in mental health outcomes are evident in South Africa, with Non‐Whites, particularly Black people, being more susceptible to higher rates of mental disorders compared to White people due to historical racial segregation and discrimination (Harriman et al, 2021). Depression and other mental disorders rank as the second‐highest disease‐based burden in the country, affecting over 7 million individuals, which accounts for approximately 11% of the total population (Institute of Health Metrics, 2019; Jack et al, 2014).…”

The road to recovery: Financial resilience and mental health in post-apartheid South Africa

“…The estimates from the subgroup analysis show that financial resilience is negatively correlated with mental health problems among non-Whites more than it is among Whites. This may be attributable to the fact that non-Whites, especially Africans, generally experience higher levels of mental distress than Whites ( Harriman et al, 2021 ). Again, White South Africans, who constitute a minority group in the country, have access to far more economic resources than non-Whites due to the wealth inequality stemming from apartheid ( Chatterjee et al, 2022 ; Orthofer, 2016 ).…”

“…Orthofer (2016) also highlights the prevalence of racial disparities in terms of economic resources, further exacerbating wealth inequality in favor of the White minority. Evidence indicates that disadvantaged households—which are disadvantaged as a result of these racial and wealth inequalities—are more likely to suffer from mental disorders, including post-traumatic stress disorder (PTSD), in South Africa ( Burns et al, 2017 ; Das-Munshi et al, 2016 ; Harriman et al, 2021 ; Lund et al, 2010 ).…”