Psychological and Physical Co-Morbidity among Urban South African Women

Emily Mendenhall,Linda M Richter,Shane A Norris,Alan Stein,Willem Daniel Francois Venter

doi:10.1371/journal.pone.0078803

Abstract

ObjectivesThere is substantial evidence for the links between poverty and both physical and mental health; but limited research on the relationship of physical and mental health problems exists in low- and middle-income countries. The objective of this paper is to evaluate the prevalence and co-morbidity of psychological distress among women with common physical diseases in a socio-economically disadvantaged urban area of South Africa.MethodsWomen enrolled in the Birth to twenty (Bt20) cohort study were evaluated for this paper. Bt20 was founded in 1990 and has followed more than 3,000 children and their caregivers since birth; this study evaluates the health of the caregivers (average age 44) of these children. Psychological distress was evaluated by administering the General Health Questionnaire (GHQ-28) and we evaluated the presence of physical disease by self-report.ResultsForty percent of the sample presented with psychological distress using the GHQ scoring method. More than half of the women who reported a history of a physical disease, including diabetes, heart attack, asthma, arthritis, osteoporosis, epilepsy, and tuberculosis, reported psychological disorder. Presence of one physical disease was not associated with increased rates of psychological distress. However, women who reported two diseases had increased rates of psychological symptoms, and this upward trend continued with each additional physical disease reported (measured to five).ConclusionsThese data indicate high prevalence rates of co-morbid psychological distress among women with physical disease. This argues for the need of greater mental health support for women living with physical diseases.

Highlights

The co-occurrence of mental health problems and communicable diseases, such as HIV [1], and noncommunicable diseases (NCDs), such as type 2 diabetes [2], present major challenges for public health systems in low- and middle-income countries (LMICs)
Little is known about the co-morbidity of mental and physical health conditions in South African populations or sub-Saharan Africa more generally
Very few population-level estimates of common mental disorders exist in South Africa, but available studies indicate that common mental disorders, including depression and anxiety, are higher in urban [5] versus rural areas [6] and among women compared to men [7]

Summary

Introduction

The co-occurrence of mental health problems and communicable diseases, such as HIV [1], and noncommunicable diseases (NCDs), such as type 2 diabetes [2], present major challenges for public health systems in low- and middle-income countries (LMICs). In Sub-Saharan Africa HIV contributes to a major burden of disease; for example, in South Africa, which is among the most affected countries, the rates among men are 32.9% and women are 46.3% [3]. Mental and behavioral disorders comprise 7.4 percent of the burden of disease globally [4]. Both major depressive disorder and anxiety contribute to a substantial portion of the total burden of disease in southern sub-Saharan Africa, as do social problems such as interpersonal violence [4]. Mental distress is higher among people with diabetes and hypertension [8] and HIV and AIDS [9]

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Conclusion