Depression, anxiety and childhood trauma: South African study explores links, prevalence and who’s most at risk

Mental health problems among adults are an ever-increasing public health concern. These include depression, anxiety, and conditions associated with bad childhood experiences such as abuse.

Several factors are known to influence the development of mental illness. These include anxiety, early adversity, socio-economic status, and some demographic characteristics such as where a person lives.

In a recent study we assessed the prevalence of mental health problems among South African adults. We also explored socioeconomic and demographic associations with depression, anxiety and adverse childhood experiences.

We found that South Africans who were exposed to adverse experiences in early childhood had a higher risk of probable depression or probable anxiety in adulthood than people who did not face adversity in childhood. (We say “probable” because our study recorded the presence of symptoms. The respondents weren’t diagnosed by a trained mental health professional.)

We also found that the symptoms of mental illness were more commonly reported by people with certain demographic characteristics. Probable depression and probable anxiety were more frequently reported among adults who were: retired and older than 65 years; widowed, divorced or separated; living in metropolitan areas; and with only primary school education. The characteristics that were significant in our study tend to be associated with relative poverty.

This confirms what has previously been suggested. That poverty and rural-urban differences are associated with mental health risk.

In 2009, nearly 20% of South African adults suffered from impaired mental health. According to a 2013 study, the prevalence of depression was highest in the Eastern Cape (31.4%) – one of the country’s poorest provinces. Research done among informal settlement residents in 2021 found that nearly one in every five women reported moderate to severe levels of anxiety. And more than half of South African adults have been exposed to adverse experiences in childhood and adolescence.

The prevalence of mental illness risk varies across the provinces. The socioeconomic and demographic determinants of mental illness also vary across the provinces. These findings underscore a need for targeted and accessible interventions and counselling programmes.

Mental health problems

We interviewed 3,402 adults across the nine provinces of South Africa between September and October 2021. Most of the participants were under the age of 44. We used clinically validated screening surveys to detect symptoms of depression, anxiety and adverse childhood experiences. Respondents were asked questions about how often – in the previous two-week period – they had been bothered by problems listed in the screening survey.

Probable depression had five levels: minimal, mild, moderate, moderately severe and severe.

More than a quarter (25.7%) of respondents reported moderate to severe symptoms of probable depression. The Northern Cape province reported the highest prevalence (38.8%). The Free State province reported the lowest prevalence (14.7%).

The prevalence of probable depression was highest among:

respondents 65 years or older (39% of this age group showed signs of probable depression)

respondents who were widowed, divorced or separated (32.6%)

those with only primary school education (32.1%)

those who were retired (30.6%)

respondents residing in metropolitan areas (27.0%)

women (26.7%)

those with lower household assets (26.4%).

To estimate probable anxiety, we asked the respondents questions about how often they had experienced general anxiety symptoms.

Our survey suggests that 17.8% of South African respondents had probable anxiety. Once again, the Northern Cape province reported the highest prevalence (29.3%). KwaZulu-Natal province had the lowest prevalence (8.6%).

Probable anxiety was highest among:

respondents aged 65 or older (22.6% of these respondents had probable anxiety)

the unemployed (21.9%)

respondents who had only completed primary school (20.4%)

the widowed, divorced or separated (20.4%)

those living in metropolitan areas (19.7%).

Adverse childhood experiences are potentially traumatic events that occur before the age of 18 years. They can be emotional, physical or sexual abuse, or household dysfunction.

More than one in five respondents reported high exposure to adverse childhood events (23.6%). The Western and Eastern Cape provinces reported the highest mean scores.

High exposure to adverse childhood experiences was also more prevalent among respondents who:

had only a basic level of education (35.1%)

were unemployed (30.8%)

had fewer resources (28.9%)

were aged 45-54 (28.2%)

were married or co-habiting (25.1%)

lived in rural settings (24.9%).

Our findings are in line with existing research. For example the Eastern Cape – one of the poorest provinces in South Africa, with 67.3% of adults living below the poverty line – reported the highest prevalence of adverse childhood experiences.

The importance of our findings

This study provides important evidence of factors linked to depression and anxiety. Our findings could help identify how these associations work, and how to intervene.

Overall, the study found that probable depression, probable anxiety and adverse childhood experience prevalence varied across the nine provinces.

The provincial breakdown of data can inform provincial service provision.

Reports of probable depression, probable anxiety and adverse childhood experiences were drivers. The reports differed markedly based on people’s socioeconomic and demographic characteristics like marital status, age, education attained, employment status and living circumstances. Our evidence suggests that these factors increase the frequency and extent of depression and anxiety independently of one another.

Probable depression and anxiety were associated with adverse childhood experiences and with each other. More than half – 58.1% – of respondents with probable depression also reported probable anxiety.

Our findings, therefore, suggest that reported adverse childhood experiences put people at greater risk of mental health problems in adulthood. That’s another reason to intervene in early childhood.