High levels of poor mental health among young men in urban informal settlements in South Africa: a community-based study of social determinants.

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% CI1.70-5.22), crime perpetration (aOR = 1.51, 95% CI1.05-3.80), severe adverse childhood event (aOR = 2.00, 95% CI 1.05-3.80), traumatic event exposures (aOR = 2.43, 95% CI1.56-3.80) and problematic alcohol use (aOR = 1.73, 95% CI1.20-2.49) were significantly associated with depression. While incomplete secondary education (aOR = 0.45, 95% CI0.22-0.92), moderate food insecurity (aOR = 2.51, 95% CI1.04-6.06), traumatic event exposures (aOR = 2.19, 95% CI1.32-3.64) 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.