Common mental health problems in historically disadvantaged urban and rural communities in South Africa: prevalence and risk factors

  • Juhan M. HavenaarEmail author
  • Mirjan I. Geerlings
  • Lauraine Vivian
  • Marh Collinson
  • Brian Robertson


This paper reports on an epidemiological study of common mental health and substance abuse problems in a historically disadvantaged urban and rural community in South Africa. In the rural Limpopo Province of South Africa, and in a peri-urban township near Cape Town, self-report instruments were used in two random population samples and among respondents at primary care and traditional healer settings, to assess common mental health problems, substance abuse problems and associated problems in social functioning. A high prevalence of mental health and substance abuse problems was observed in both communities, with highest rates in the peri-urban township. Even higher prevalences were found among respondents at primary health care or traditional healers. The study shows that mental health and substance abuse problems constitute a considerable burden of disease among disadvantaged communities in South Africa. The study further underscores the integral role of traditional healers in the mental health care system.

Key words

epidemiology mental health substance abuse primary care traditional healers 



This study was supported by a grant from the South Africa Netherlands Programme for Alternatives in Development (SANPAD). The authors wish to acknowledge the contributions of T. Burmeister and O. Oloyede in the fieldwork procedures.


  1. 1.
    World Bank (1993) World development report. Oxford University Press, Washington DCCrossRefGoogle Scholar
  2. 2.
    WHO (1996) Investing in health and development. Report of the Ad Hoc Committee on health research relating to future intervention options. WHO, GenevaGoogle Scholar
  3. 3.
    Freeman M, de Beer C (1992) Viewing primary mental health care at time of social transition in South Africa. Int J Health Serv 22:339–348PubMedCrossRefGoogle Scholar
  4. 4.
    Bhagwanjee A, Parekh A, Paruk Z, Petersen I, Subedar H (1998) Prevalence of minor psychiatric disorders in an adult African rural community in South Africa. Psychol Med 28:1137–1147PubMedCrossRefGoogle Scholar
  5. 5.
    Rumble S, Swartz L, Parry C, Zwarenstein M (1996) Prevalence of psychiatric morbidity in the adult population of a rural South African village. Psychol Med 26:997–1007PubMedGoogle Scholar
  6. 6.
    Parry CDH (1996) A review of psychiatric epidemiology in Africa: strategies for improving validity when using instruments transculturally. Transcult Psychiatric Res Rev 33:173–178CrossRefGoogle Scholar
  7. 7.
    Pillay AL, Kriel AJ (2006) Mental health problems in women attending district-level services in South Africa. Soc Sci Med 63:587–592PubMedCrossRefGoogle Scholar
  8. 8.
    Strauss PR, Gagiano CA, Van Rensburg PHJJ, de Wet KJ Strauss HJ (1995) Identification of depression in a rural general practice. S Afr Med J 84:755–762Google Scholar
  9. 9.
    Thom RG, Zwi RM, Reinach SG (1993) The prevalence of psychiatric disorders at a primary care clinic in Soweto, Johannesburg. S Afr Med J 83:653–755PubMedGoogle Scholar
  10. 10.
    Macleod C, Masilela TC (1998) Feedback of research results: reflections from a community-based mental health programme. S Afr J Psychol 28:215–221Google Scholar
  11. 11.
    Gater R, de Almeida e Sousa B, Barrientos G Caraveo J, Chandrashekar CR, Dhadphale M, Goldberg D, al Kathiri AH, Mubbashar M, Silhan K, Thong D, Torres-Gonzales F, Sartorius N (2001) The pathways to psychiatric care: a cross-cultural study. Psychol Med 21:761–774Google Scholar
  12. 12.
    Patel V, Todd C, Winston M, Gwanzura F, Simunyu E, Acuda W, Mann A (1997) Common mental disorders in primary care in Harare, Zimbabwe: associations and risk factors. Br J Psychiatry 171:60–64PubMedCrossRefGoogle Scholar
  13. 13.
  14. 14.
    Harding TW, de Arango MV, Baltazar J Climent CE, Ibrahim HH, Ladrido-Ignacio L, Murthy RS, Wig NN (1980) Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries. Psychol Med 10:231–241PubMedCrossRefGoogle Scholar
  15. 15.
    Stevens BC (1972) Dependence of schizophrenic patients on elderly relatives. Psychol Med 2:17–32PubMedGoogle Scholar
  16. 16.
    Kortmann F (1990) Psychiatric case finding in Ethiopia: shortcomings of the Self Reporting Questionnaire. Cult Med Psychiatry 14:381–391PubMedCrossRefGoogle Scholar
  17. 17.
    Wittchen HU, Holsboer F, Jacobi F (2001) Met and unmet needs in the management of depressive disorder in the community and primary care: the size and breadth of the problem. J Clin Psychiatry 62(Suppl 26):23–28PubMedGoogle Scholar
  18. 18.
    Eng PM, Kawachi I, Fitzmaurice G, Rimm EB (2005) Effects of marital transitions on changes in dietary and other health behaviours in US male health professionals. J Epidemiol Commun Health 59:56–62CrossRefGoogle Scholar
  19. 19.
    Fryers T, Melzer D, Jenkins R (2003) Social inequalities and the common mental disorders: a systematic review of the evidence. Soc Psychiatry Psychiatr Epidemiol 38:229–237PubMedCrossRefGoogle Scholar
  20. 20.
    Garenne M (2003) Migration, Urbanisation and Child Health in Africa: a global perspective. In “Africa on the move: African Migration and Urbanisation in Comparative Perspective”. M. Tienda (ed) 2006. Wits University Press, JohannesburgGoogle Scholar
  21. 21.
    Montgomery MR, Stren R (2003) Cities transformed: demographic change and its implications in the developing world. National Academic Press, Washington DCGoogle Scholar
  22. 22.
    Kahn K, Garenne M, Tollman SM, Collinson MA (2007) Mortality trends in a new South Africa (Agincourt 1992–2003): hard to make a fresh start. Scand J Pub Health 35 (Suppl 69):26–34CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Juhan M. Havenaar
    • 1
    Email author
  • Mirjan I. Geerlings
    • 2
  • Lauraine Vivian
    • 3
  • Marh Collinson
    • 4
  • Brian Robertson
    • 3
  1. 1.Dept. of PsychiatryVrije Universiteit Medical Centre AmsterdamAmsterdamThe Netherlands
  2. 2.Julius Center for Health Sciences and Primary CareUniversity Medical CenterUtrechtThe Netherlands
  3. 3.Dept. of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
  4. 4.MRC/Wits University-Rural Public Health Research Unit (Agin Court), School of Public Health, University of WitwatersrandWitwatersrandSouth Africa

Personalised recommendations