News & events


07 May 2024

Mental health among migrants in South Africa

Human Sciences Research Council (HSRC)

Pretoria, Monday 6 May 2024 – The study examines the mental health of external migrants in South Africa, a subject which has previously attracted little attention from researchers. Drawing on a unique survey covering ten township communities, the study focuses on depression as a key driver of mental health. Research results established material deprivation, discrimination, and contact with diverse host populations as significant contributors to depression within this group. These findings offer valuable insights for policymakers to develop targeted interventions to support external migrants’ mental wellbeing and facilitate their integration into South African society.  

Photo by Lucxama Sylvain


Over the last few decades, the number of people moving to South African cities has grown significantly.  Although most of these new arrivals are internal migrants, a notable proportion are foreign nationals. Indeed, the number of external migrants living in South African townships have grown over the last few decades.  Successfully integrating this group into South African society is essential for the health of our democracy. A fact that we are reminded of as we approach the 2024 National and Provincial Elections.

We know very little about the wellbeing of external migrants in South Africa. This knowledge gap is especially pronounced when it comes to the mental health and overall wellbeing of foreign nationals who are poor and working-class.  The dearth of data on the wellbeing of external migrants in the country can be contrasted with Europe where there have been extensive studies on the subject.

The present study is part of a growing number of quantitative studies in the South African field of Quality of Life (QoL) research. It assessed the QoL of external migrants subjectively by asking them to rate their own lives and helped fill an important knowledge gap. But researching this issue is not only academically pertinent but also holds practical implications. It can be used to inform interventions that are needed to support the successful integration of external migrants into society. For a democracy like ours to succeed, we need such programmes to help build social cohesion.

Drawing on subjective survey tools in order to understand mental health, the study focused on depression. Considering a significant public health concern by the World Health Organisation, depression has a major impact on the social functioning and overall wellbeing of any person. While there have been limited studies of depression in the general South African population, this work has generally ignored the international migrant population. Most existing QoL surveys just simply do not contain enough external migrants to make it possible to assess depression amongst this group. Consequently, the study drew on unique surveys covering ten different township communities.


Freedom House South Africa enlisted Social Surveys Africa to conduct the Community Level Social Dynamics Survey (CLSDS) across ten township communities, representing impoverished working-class areas where foreign nationals coexist with locals. During this research project, Freedom House Southern Africa partnered with the Africa Centre for Migration Studies and the Safety and Violence Initiative

With strict sample quotas ensuring gender, age, and nationality balance, approximately 400 respondents were interviewed in each of the ten communities as part of the CLSDS. The survey was restricted to residents aged 18 and older. Fieldworkers covered communities across the provinces of Gauteng, Western Cape, Eastern Cape, Limpopo, KwaZulu-Natal, and the North West.  Fieldwork was carried out in two phases between July 2016 and February 2017. 

The total number of interviews gathered was 4,052. About a fifth (18%) of these interviews were with non-migrants, 70% were with internal migrants from elsewhere in South Africa and 12% were with external migrants. The migrants identified in the survey primarily originated from other countries in Southern Africa (such as Mozambique, Zimbabwe, and Lesotho).

Depression amongst external migrants

The CLSDS questionnaire included the depression module of the Patient Health Questionnaire (known as PHQ-9).  The range of questions about mental state produced valuable data to understand depression levels across the ten township communities.  The vast majority of adults showed no depressive disorder, with only a small proportion experiencing subthreshold or moderate depression, and an even smaller fraction suffering from major depression. When compared to external migrants, the mean level of depression severity was higher among non-migrants and internal migrants. Amongst external migrants, women consistently reported higher depression levels than men.

Table 1: Mean Level of Depression Severity (PHQ-9) Scale (0-10) by gender and migration status

 M [95% Cl]M [95% CI]
Non-internal migrant1.13(0.090)0.951.301.42(0.09)1.241.60
Long-term internal migrant1.30(0.070)0.071.441.64(0.07)1.511.77
Medium-term internal migrant1.28(0.107)0.111.491.47(0.11)1.261.69
Short-term internal migrant1.15(0.100)0.101.351.52(0.13)1.271.77
External migrant1.00(0.101)

Note: 1. The Level of Depression Severity Scale was ranged 0 to 10, with the higher value indicating the higher severity of depression.; 2. Standard error in parenthesis.

A range of statistical methods were employed to investigate determinants of depression severity among external migrants. Deprivation emerged as a strong predictor of depression, suggesting that material conditions significantly impact migrants’ QoL. This finding shed light on the critical role of socioeconomic factors in migrants’ mental health amongst this group. Additionally, facing multiple forms of discrimination was associated with higher depression levels. Increased societal integration, measured as contact with South African locals, was also linked to improved mental health. This highlights the potential importance of social connections in mitigating depression among foreign nationals.

Even after a range of alternatives were accounted for, gender remained a robust predictor of depression in the study.  The results show that female migrants are disproportionately affected by depression.  This may be due to gendered division of labour amongst female foreign nationals as well as a heightened level of exposure to sexual abuse and domestic violence amongst this group. Further research is therefore required to understand this compelling finding.


The present study has limitations, notably its cross-sectional design which precludes causal inference. Moreover, it focuses solely on first-generation migrants, overlooking potential differences in QoL between different migration generations. In addition, the study only looked at one type of mental health (i.e. depression), but to truly understand wellbeing amongst this group, more nuanced assessments are needed.  Finally, the sample for this research, though extensive, is limited to ten township communities.  We need a more inclusive survey to capture the full diversity of this population and genuinely understand its QoL.

Despite the limitations described above, the study contributes valuable insights for our understanding of the mental health challenges faced by external migrants in South Africa. The data makes clear that improving the QoL of external migrants require approaches that address various aspects of migrants’ lives and ensure their equitable treatment and participation in society. This will necessitate robust reform of legal frameworks and further support for mechanisms to uphold migrants’ rights and combat discrimination effectively.

The Immigration Amendment Bill was introduced for debate in the South African Parliament on April 5th 2024 with the aim of reforming the Immigration Act of 2002. As the parliament debate this important piece of legislation, it needs to remember the importance of creating successful integration programmes. Such programmes can help better integrate external migrants into the economic and social fabric of the country. The data provided in this study can help policymakers design targeted interventions to support and enhance migrants’ mental wellbeing. This work suggests that such interventions should encompass a spectrum of initiatives (including protections against discrimination, access to essential services, and programmes facilitating cultural assimilation and employment opportunities) with a particular focus on women. The success of such intervention is crucial for achieving social cohesion and preventing the kind of conflict that undermines South Africa’s democracy.

By Dr Steven Gordon, Senior Research Specialist of the Developmental, Capable and Ethical State (DCES) division at the Human Sciences Research Council (HSRC)

This article is a summary of Chapter 12 of State of the Nation 2024 edition. The HSRC invites you to attend the upcoming book launch of State of the Nation: Quality of Life and Wellbeing, which is scheduled to take place on 14 May 2024 in Pretoria. Register your attendance here.


Details of the launch

Date:                            14 May 2024  

Time:                           15:30 – 18:30

Venue:                         CSIR Convention Centre, Meiring Naude Road, Brummeria, Pretoria

Registration Link:

Human Sciences Research Council (HSRC)

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