Objective: To investigate food insecurity and related coping strategies among South African households and their associations with anxiety and depression. Design: Cross-sectional study. Food insecurity and coping strategies were assessed using a modified Community Childhood Hunger Identification Project and the Coping Strategies Index questionnaires. The GAD-7 and PHQ-9 were used to assess anxiety and depression risk. Ordered logistic regressions were used to test associations between food insecurity and related coping strategies, and anxiety and depression. Setting: South Africa during COVID-19, October 2021. Participants: Nationally representative sample of 3,402 adults, weighted to 39,640,674 South African households. Results: About 20.4% of South African households were food insecure, with the most affected being from the lowest socio-economic groups. Shifting from “food secure” to “at risk” or from “at risk” to “food insecure” group was associated with 1.7 times greater odds of being in a higher category of anxiety or depression (p<0.001). All coping strategies were used to some extent in South African households, with 46.0% relying on less preferred and less expensive foods, and 20.9% sending a household member to beg for food. These coping strategies were mostly used by food insecure households. Although the odds of moving to a higher category of anxiety and depression were observed among all coping strategies (all p<0.001), begging for food was associated with the highest odds (odds ratio=2.3). Conclusions: Food insecurity remains a major health threat in South Africa. Public measures to address mental health should consider reductions in food insecurity as part of their strategy.

Objective and methodsMental health problems among adults are a growing public health concern, and middle-income countries such as South Africa are disproportionally affected. Using a large scale nationally representative weighted survey, we assessed the prevalence of probable depression, probable anxiety, and adverse childhood experiences (ACEs), and explored associations between probable depression, probable anxiety, ACEs, socio-economic status, and demographic characteristics.ResultsNationally, 25.7, 17.8, and 23.6% of respondents, respectively, reported scores of ≥10 on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), indicating probable depression or probable anxiety, and an ACE score of ≥4 (high exposure). Overall probable depression prevalence across South Africa varied from 14.7 to 38.8%. Both probable depression and probable anxiety were more frequently reported among adults who were: retired and older (&gt;65 years of age), and widowed, divorced, or separated; living in metropolitan areas; and only had primary school education. In a multivariable adjusted logistic regression, the likelihood of reporting probable depression or probable anxiety was also found to increase with each standard deviation increase in the ACE score (p &lt; 0.001), independent of other socio-demographic determinants.ConclusionThe prevalence of probable depression among respondents in South Africa varies significantly across the nine provinces. Furthermore, higher ACE score and several socio-demographic determinants were associated with a higher likelihood of probable depression and probable anxiety. Adult mental health services are urgently needed to identify groups of the population vulnerable to mental health problems for better targeting of interventions. Given the range of probable depression prevalence across the country, provincial level plans and resources should also reflect the burden of mental health problems in that province.

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