Prevalence and sociodemographic correlates of common mental disorders among first-year university students in post-apartheid South Africa: implications for a public mental health approach to student wellness

Jason Bantjes,Christine Lochner,Ronald C Kessler,Wylene Saal,Ronny Bruffaerts,Randy P Auerbach,Philippe Mortier,Daniel Page,Janine Roos,Dan J Stein,Lian Taljaard

doi:10.1186/s12889-019-7218-y

Abstract

BackgroundThere is growing awareness of the need for effective prevention, early detection, and novel treatment approaches for common mental disorders (CMDs) among university students. Reliable epidemiological data on prevalence and correlates are the cornerstones of planning and implementing effective health services and adopting a public health approach to student wellness. Yet, there is a comparative lack of sound psychiatric epidemiological studies on CMDs among university students in low- and middle-income countries, like South Africa (SA). It is also unclear if historically marginalised groups of students are at increased risk for mental health problems in post-apartheid SA. The objective of the study was to investigate the prevalence and sociodemographic correlates of lifetime and 12-month CMDs among university students in SA, with a particular focus on vulnerability among students in historically excluded and marginalised segments of the population.MethodsData were collected via self-report measures in an online survey of first-year students registered at two large universities (n = 1402). CMDs were assessed with previously-validated screening scales. Data were weighted and analysed using multivariate statistical methods.ResultsA total of 38.5% of respondents reported at least one lifetime CMD, the most common being major depressive disorder (24.7%). Twelve-month prevalence of any CMD was 31.5%, with generalised anxiety disorder being the most common (20.8%). The median age of onset for any disorder was 15 years. The median proportional annual persistence of any disorder was 80.0%. Female students, students who reported an atypical sexual orientation, and students with disabilities were at significantly higher risk of any lifetime or 12-month disorder. Female gender, atypical sexual orientation, and disability were associated with elevated risk of internalising disorders, whereas male gender, identifying as White, and reporting an atypical sexual orientation were associated with elevated risk of externalising disorders. Older age, atypical sexual orientation, and disability were associated with elevated risk of bipolar spectrum disorder.ConclusionsDespite advances to promote greater social inclusion in post-apartheid SA, students who identify as female, students with atypical sexual orientations, and students with disabilities are nonetheless at increased risk of CMDs, although students who identify as Black and first-generation students are not.

Highlights

There is growing awareness of the need for effective prevention, early detection, and novel treatment approaches for common mental disorders (CMDs) among university students
Despite advances to promote greater social inclusion in post-apartheid South Africa (SA), students who identify as female, students with atypical sexual orientations, and students with disabilities are at increased risk of CMDs, students who identify as Black and first-generation students are not
Entering university typically entails leaving home, adapting to a new social environment, increased academic pressure, greater opportunities for substance misuse, and financial pressure. This transition often coincides with the emergence of psychopathology [13, 14], as pre-existing mental health problems are exacerbated or new symptoms emerge in response to novel environmental stressors [8, 15, 16]. Consistent with these observations, data collected in 21 countries as part of the World Health Organisation (WHO) World Mental Health Surveys indicated that an average of 20.3% of college students across countries had 12-month DSM-IV disorders; 83.1% of which had pre-matriculation onsets [3]

Summary

Introduction

There is growing awareness of the need for effective prevention, early detection, and novel treatment approaches for common mental disorders (CMDs) among university students. Mental illness has a profound and deleterious effect on social adjustment to university life [5, 6], impeding academic attainment, and leading to adverse health outcomes including death by suicide [7,8,9] Based on these observations, there is a growing awareness of the need for effective prevention, early detection, and novel treatment approaches for CMDs among university students within a public mental health paradigm [9, 10]. Entering university typically entails leaving home, adapting to a new social environment, increased academic pressure, greater opportunities for substance misuse, and financial pressure This transition often coincides with the emergence of psychopathology [13, 14], as pre-existing mental health problems are exacerbated or new symptoms emerge in response to novel environmental stressors [8, 15, 16]. There is a dearth of research investigating bipolar spectrum disorder among university students in SA

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