Millions of refugees are on the move globally, mostly settling in low- and middle-income (LMIC) "host" countries, where they often receive insufficient assistance and encounter a multitude of barriers. Despite a risk for developing mental illness, limited research exists on their struggles and coping strategies in these settings, especially outside of camps. Against this backdrop, our qualitative study aimed to gain a deeper understanding of refugee experiences in Durban, South Africa. We conducted semistructured individual interviews with 18 adult refugees from Zimbabwe and the Democratic Republic of Congo at a community-based support center in Durban. Participants described their problems, effects on mental health, and coping abilities. Interviews were recorded and analyzed for themes. Major problems were reported with work, xenophobia/racism, mental health, physical safety, housing, healthcare, and quality of life. Participants discussed feelings of worry, fear, emotional pain, anger, powerlessness, hopelessness, worthlessness, and passive suicidal ideation. Coping mechanisms consisted of friendships, church, praying, work, physical activities, family, learning the local language, and avoidance of thoughts. Many interviewees expressed a strong desire to either return to their homeland or move elsewhere. Refugees in South Africa face considerable hardships including xenophobia, physical abuse, and work/legal obstructions. More research is needed in LMICs to identify the challenges, psychological effects, and coping in such populations so that appropriate and accessible mental health services can be created for those who require them.

The apartheid regime that governed South Africa from 1948 – 1994 established spatial segregation that is understood to have contributed to the magnitude of neighborhood social disorder in the post-apartheid era. Although a number of neighborhood social disorder characteristics, such as perceived violence and crime in the community, are prominent issues in South Africa, the extent to which these perceived spatial attributes are linked to depression is unknown at the population-level. Multilevel modeling of data from the second wave of the South African National Income Dynamics Study (SA-NIDS) was utilized to examine the relationship between depressive symptomatology and neighborhood social disorder as indicated by the perceived frequency of violent, criminal and illicit activities in the community. Depressive symptomatology was assessed using the 10-item version of the Center for Epidemiologic Studies Depression Scale. A cut off score of ten or higher was used to indicate the presence of significant depressive symptomatology. Results showed that perception of neighborhood social disorder was independently associated with significant levels of depressive symptomatology. Gender, race/ethnicity, perceived health status, and education were significant for individual-level covariates of depression. Community intervention strategies that reduce the risk of neighborhood disorganization and emphasize positive social norms in the neighborhood are warranted. Taking into account the residential de-racialization of a country transitioning from apartheid to non-racial democracy, a longitudinal spatial study design assessing the dynamics between depression and the aforementioned perceptions of neighborhood attributes may also be warranted.

BackgroundGrowing interest in strategies regarding early intervention for psychosis has led to a parallel interest in understanding help-seeking behavior, especially in low- and middle-income countries (LMICs). Nevertheless, few LMIC studies have examined individuals with psychosis in non-urban, non-hospital settings. Using the perspective of formal and informal community service providers, we aimed to uncover descriptions of people with psychosis in a rural South African community and illuminate the potential complexities of their help-seeking journeys.MethodsWe conducted a qualitative study of 40 key informant interviews and seven focus groups with stakeholders (traditional leaders, traditional healers, religious leaders, health care nurses, heads of non-governmental organizations, schoolteachers, community caregivers) in a rural Zulu community (Vulindlela). Thematic analysis of the data was performed using the inductive analysis approach.ResultsInterviewees discussed 32 individuals with probable psychosis in their community and provided rich descriptions of their symptoms. A complex picture of help-seeking behavior, primarily involving informal mental health service providers, emerged. Over half of the reported cases had no contact with formal health services in the course of their help-seeking journey; while more than two-thirds never attended a hospital and only 1 in 8 accessed a psychiatric hospital.ConclusionsOur results highlight the important role of informal care providers in LMICs as well as the need for more research on mental illness and local providers in non-hospital contexts. Community stakeholders can contribute to a fuller understanding of these issues, thereby assisting in the creation of appropriate and effective mental health interventions for rural South African communities like Vulindlela.

Despite improvements in service delivery and patient management, low birth weight among infants has been a persistent challenge in South Africa. The study aimed to explore the relationship between depression before pregnancy and the low birth weight (LBW) of infants in post-apartheid South Africa. This study utilized data from Waves 1 and 2 of the South African National Income Dynamics Study, the main outcome being a dichotomous measure of child LBW (<2500 g) drawn from the Wave 2 child questionnaire. Depressive symptoms of non-pregnant women was the main predictor drawn from the Wave 1 adult questionnaire. Depressive symptoms were screened using the 10-item four-point Likert version of the Center for Epidemiologic Studies Depression Scale (CES-D) instrument. A total score of 10 or greater on the CES-D indicates a positive screen for depressive symptoms. An adjusted logistic regression model was used to examine the relationship between women’s depression before pregnancy and infant LBW. A sample size of 651 women in Wave 1 was linked to 672 newborns in Wave 2. The results of the adjusted logistic regression model indicated depressive symptoms (CES-D ≥ 10) prior to pregnancy were associated with infant LBW (adjusted OR 2.84, 95 % CI 1.08–7.46). Another significant covariate in the model was multiple childbirths. Our finding indicates that women’s depressive symptoms prior to pregnancy are associated with the low birth weight of newborns and suggests that this association may not be limited to depression present during the ante-natal phase.

Few studies have examined depression among immigrants in post-apartheid South Africa, and factors that strengthen the relationship between immigration and depression. The first wave of the National Income Dynamics Study was used to investigate links between immigration and depression (n=15,205). Depression symptoms were assessed using a 10-item version of the Center for Epidemiologic Studies Depression (CES-D) Scale. Immigrants in South Africa had fewer depressive symptoms (CES-D ≥ 10) than locally-born participants (17.1% vs. 32.4%, F = 13.5, p<0.01). Multilevel mixed-effects logistic regression analyses found that among immigrant populations, younger age (adjusted OR=1.03, 95% CI = 1.01-1.05) and black African ethnicity (adjusted OR=3.72, 95% CI = 1.29-10.7) were associated with higher depression. Younger age was associated with lower depression among locally-born study participants (adjusted OR=0.98, 95% CI = 0.97-0.98). The varying relationship between certain demographic factors, depression and the different mental health challenges among these groups requires closer attention.