Mental Health Inequalities in Adolescents Growing Up in Post-Apartheid South Africa: Cross-Sectional Survey, SHaW Study

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dc.contributor.authorDas-Munshi, Jayatien_ZA
dc.contributor.authorLund, Cricken_ZA
dc.contributor.authorMathews, Catherineen_ZA
dc.contributor.authorClark, Charlotteen_ZA
dc.contributor.authorRothon, Catherineen_ZA
dc.contributor.authorStansfeld, Stephenen_ZA
dc.date.accessioned2016-10-31T07:36:44Z
dc.date.available2016-10-31T07:36:44Z
dc.date.issued2016en_ZA
dc.description.abstractBACKGROUND: South Africa is one of the most 'unequal' societies in the world. Despite apartheid ending more than 20 years ago, material inequalities remain interwoven with ethnic/racial inequalities. There is limited research on the prevalence/predictors of common mental disorders (CMD) among young people. Adolescence is a unique time-point during which intervention may lead to improved mental health and reduced social problems later. The study objective was to assess mental health disparities in a representative sample of adolescents growing up in South Africa. METHODS: Cross-sectional associations of race/ethnicity and material disadvantage with CMD and Post Traumatic Stress Disorder (PTSD) were assessed in a stratified random sample representative of school-attendees, aged 14-15 years, in a large metropolitan area of Cape Town. Validated instruments assessed mental disorders; these included: Harvard Trauma Questionnaire (PTSD); Short Moods and Feelings Questionnaire (depression); Zung self-rated anxiety scale (anxiety). Self-ascribed ethnicity was determined using procedures similar to the South African census and previous national surveys. RESULTS: Response rate was 88% (1034 of 1169 individuals). Adolescents experienced a high prevalence of depression (41%), anxiety (16%) and PTSD (21%). A gradient between material disadvantage and CMD/ PTSD was evident across all ethnic/racial groups. Respondents self-identifying as 'black' or 'coloured' were disadvantaged across most indicators. After adjusting for confounders, relative to white children, relative risk (RR) of CMD in black children was 2.27 (95% CI:1.24, 4.15) and for PTSD was RR: 2.21 (95% CI:1.73, 2.83). Relative risk of CMD was elevated in children self-identifying as 'coloured' (RR: 1.73, 95% CI:1.11, 2.70). Putative mediators (violence, racially motivated bullying, social support, self-esteem) partially accounted for differences in CMD and fully for PTSD. CONCLUSIONS: Adolescent mental health inequalities in Cape Town are associated with material disadvantage and self-identification with historically disadvantaged groups.en_ZA
dc.identifier.apacitationDas-Munshi, J., Lund, C., Mathews, C., Clark, C., Rothon, C., & Stansfeld, S. (2016). Mental Health Inequalities in Adolescents Growing Up in Post-Apartheid South Africa: Cross-Sectional Survey, SHaW Study. <i>PLoS One</i>, http://hdl.handle.net/11427/22347en_ZA
dc.identifier.chicagocitationDas-Munshi, Jayati, Crick Lund, Catherine Mathews, Charlotte Clark, Catherine Rothon, and Stephen Stansfeld "Mental Health Inequalities in Adolescents Growing Up in Post-Apartheid South Africa: Cross-Sectional Survey, SHaW Study." <i>PLoS One</i> (2016) http://hdl.handle.net/11427/22347en_ZA
dc.identifier.citationDas-Munshi, J., Lund, C., Mathews, C., Clark, C., Rothon, C., & Stansfeld, S. (2016). Mental Health Inequalities in Adolescents Growing Up in Post-Apartheid South Africa: Cross-Sectional Survey, SHaW Study. PloS one, 11(5), e0154478. doi:10.1371/journal.pone.0154478en_ZA
dc.identifier.ris TY - Journal Article AU - Das-Munshi, Jayati AU - Lund, Crick AU - Mathews, Catherine AU - Clark, Charlotte AU - Rothon, Catherine AU - Stansfeld, Stephen AB - BACKGROUND: South Africa is one of the most 'unequal' societies in the world. Despite apartheid ending more than 20 years ago, material inequalities remain interwoven with ethnic/racial inequalities. There is limited research on the prevalence/predictors of common mental disorders (CMD) among young people. Adolescence is a unique time-point during which intervention may lead to improved mental health and reduced social problems later. The study objective was to assess mental health disparities in a representative sample of adolescents growing up in South Africa. METHODS: Cross-sectional associations of race/ethnicity and material disadvantage with CMD and Post Traumatic Stress Disorder (PTSD) were assessed in a stratified random sample representative of school-attendees, aged 14-15 years, in a large metropolitan area of Cape Town. Validated instruments assessed mental disorders; these included: Harvard Trauma Questionnaire (PTSD); Short Moods and Feelings Questionnaire (depression); Zung self-rated anxiety scale (anxiety). Self-ascribed ethnicity was determined using procedures similar to the South African census and previous national surveys. RESULTS: Response rate was 88% (1034 of 1169 individuals). Adolescents experienced a high prevalence of depression (41%), anxiety (16%) and PTSD (21%). A gradient between material disadvantage and CMD/ PTSD was evident across all ethnic/racial groups. Respondents self-identifying as 'black' or 'coloured' were disadvantaged across most indicators. After adjusting for confounders, relative to white children, relative risk (RR) of CMD in black children was 2.27 (95% CI:1.24, 4.15) and for PTSD was RR: 2.21 (95% CI:1.73, 2.83). Relative risk of CMD was elevated in children self-identifying as 'coloured' (RR: 1.73, 95% CI:1.11, 2.70). Putative mediators (violence, racially motivated bullying, social support, self-esteem) partially accounted for differences in CMD and fully for PTSD. CONCLUSIONS: Adolescent mental health inequalities in Cape Town are associated with material disadvantage and self-identification with historically disadvantaged groups. DA - 2016 DB - OpenUCT DO - 10.1371/journal.pone.0154478 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - Mental Health Inequalities in Adolescents Growing Up in Post-Apartheid South Africa: Cross-Sectional Survey, SHaW Study TI - Mental Health Inequalities in Adolescents Growing Up in Post-Apartheid South Africa: Cross-Sectional Survey, SHaW Study UR - http://hdl.handle.net/11427/22347 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0154478en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/22347
dc.identifier.vancouvercitationDas-Munshi J, Lund C, Mathews C, Clark C, Rothon C, Stansfeld S. Mental Health Inequalities in Adolescents Growing Up in Post-Apartheid South Africa: Cross-Sectional Survey, SHaW Study. PLoS One. 2016; http://hdl.handle.net/11427/22347.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentCentre for Public Mental Healthen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2016 Das-Munshi et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherChildrenen_ZA
dc.subject.otherMental health and psychiatryen_ZA
dc.subject.otherEthnicitiesen_ZA
dc.subject.otherAdolescentsen_ZA
dc.subject.otherPost-traumatic stress disorderen_ZA
dc.subject.otherSchoolsen_ZA
dc.subject.otherSouth Africaen_ZA
dc.subject.otherDepressionen_ZA
dc.titleMental Health Inequalities in Adolescents Growing Up in Post-Apartheid South Africa: Cross-Sectional Survey, SHaW Studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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