Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, Boston, MA, 02115, USA.
Department of African and African American Studies, Harvard University, 12 Quincy st, Cambridge, MA, 02138, USA.
Soc Psychiatry Psychiatr Epidemiol. 2022 Apr;57(4):843-857. doi: 10.1007/s00127-021-02175-w. Epub 2021 Oct 6.
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.
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).
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.
We 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.
南非长期以来在国家层面上一直存在较高的精神障碍发病率，其独特的社会和历史背景可能是导致心理健康问题风险增加的一个因素。我们目前对于各种社会决定因素对南非心理健康挑战的相对重要性的理解有限，以及这些决定因素如何解释现有的种族不平等现象。
本研究试图利用全国代表性的南非国家健康和营养调查（SANHANES-1）的数据来阐明南非心理健康的潜在社会决定因素。主要研究结果是心理困扰，用 Kessler-10 量表来衡量。分层线性回归模型包括人口统计学和社会经济因素、创伤事件数量以及一系列与压力相关的结构的协变量。分析针对两个人群进行：整个样本（n=15981）和非洲亚群（n=10723）。
整个样本的回归模型表明心理困扰方面存在种族差异，非洲人比白人或有色人种经历更高的困扰。在非洲亚群内的结果表明存在地域差异，在正式城市环境中生活的非洲人比生活在正式和非正式农村地区的人经历更高的心理困扰。在两个样本中，结果都表明压力源和创伤事件的数量与困扰之间存在累积关联。
我们在几个与心理健康相关的领域发现了种族差异。非洲人经历了更多的创伤事件、社会压力源和心理困扰。这项研究是进行公共卫生干预和政策变革以有效减少心理困扰不平等现象的必要基础。
