ABSTRACT
Informal settlements (high population density areas at the outskirts of urban areas characterized by lack basic amenities) in South Africa are consequences of apartheid regime’s discriminatory migrant labour and spatial policy and continue to grow. Living in informal settlements accompanies a mire of social/health challenges that threatens upward mobility, but few studies exist that document drivers of mental health challenges in these settings. We investigated the prevalence and social determinants of poor mental health for young men in informal settlements adjacent to one of the largest cities that is at the heart of HIV endemic in South Africa. This study involved a cross-sectional study with cluster sampling design of 674 young men aged 18–30 years residing in eThekwini informal settlement communities. We assessed the prevalence, and social determinants, of significant depressive (i.e., depression) and post-traumatic stress (i.e., PTS) symptoms using logistic regression. Given the complex survey design of the study, all analyses were adjusted for clustering. The prevalence of depression and PTS in the sample was 46.8% and 14.4% respectively. Results of the multivariable analyses indicated that severe food insecurity (aOR = 2.98, 95% CI:1.70–5.22), crime perpetration (aOR = 1.51, 95% CI:1.05–3.80), severe adverse childhood event (aOR = 2.00, 95% CI: 1.05–3.80), traumatic event exposures (aOR = 2.43, 95% CI:1.56–3.80) and problematic alcohol use (aOR = 1.73, 95% CI:1.20–2.49) were significantly associated with depression. While incomplete secondary education (aOR = 0.45, 95% CI:0.22–0.92), moderate food insecurity (aOR = 2.51, 95% CI:1.04–6.06), traumatic event exposures (aOR = 2.19, 95% CI:1.32–3.64) and problematic alcohol use (aOR = 2.15, 95% CI: 1.24–3.73) were significantly associated with PTS. Our study highlights the exceedingly high levels of poor mental health among young men in informal settlements, with depression and PTS being driven by economic/social conditions. Multilevel interventions that address the individual, interpersonal, and social variables that contribute to poor mental health are needed.
Acknowledgments
First author (VO) was funded by the South African Medical Research Council (KR/2021). The second (AT) and last author (AG) were funded by the UK Global Challenge Research Fund (MR/T029803/1) and managed by the South African Medical Research Council. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. This content is solely the responsibility of the authors and does not necessarily represent the official views of the funder. The authors declare no competing interests.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Author contributions
Substantial contributions to the conception or design of the work (VO, AT, AG), acquisition (AG), analysis (VO), and interpretation of data for the work (VO, AT, AG). VO wrote the first draft of the report. All co-authors contributed to the data interpretation and to the revision of the final report.