Mental health is increasingly recognised as a public health concern in South Africa, with psychological distress used as a measure of poor mental health. A recent paper based on national data from the 2017 South African National HIV Prevalence, Incidence, and Behaviour Survey (SABSSM V) highlights significant gender differences. Women were found to be more likely than men to experience psychological distress. A range of sociodemographic and behavioural factors – such as location, education, alcohol use, employment, and HIV status – contributed to this disparity.
Psychological distress is an outcome of poor mental health and is characterised by a range of symptoms, including anxiety and depression, and behavioural problems. Studies have reported gender differences in vulnerability to psychological distress in South Africa, with significantly higher levels of probable depression among women. Gender disparities arise from biological, psychological, cultural, and socioeconomic factors. Understanding these differences through national surveys is essential to designing targeted interventions. Mental health is increasingly recognised as a significant public health priority in South Africa. The 2023–2030 National Mental Health Policy Framework and Strategic Plan emphasises the need to resource, integrate, and decentralise mental healthcare provision adequately to ensure that mental health needs are addressed effectively across all levels of care.
The SABSSM series is a flagship project of the HSRC, implemented in collaboration with a consortium of partners. Over the past two decades the survey has tracked South Africa’s progress in responding to the HIV epidemic and identified key drivers of the epidemic to inform targeted interventions and guide planning for HIV prevention and management.
A new paper by HSRC researchers, in collaboration with researchers from the University of KwaZulu-Natal and the University of Cape Town, draws on data from the 2017 SABSSM to examine the determinants of gender disparities in psychological distress.
The survey administered the Kessler Psychological Distress Scale (K10), a validated ten-item screening tool that assesses symptoms commonly associated with anxiety and depression, to participants aged 15 years and older. The researchers sought to identify factors that influenced levels of psychological distress, including sociodemographic, socio-behavioural, and health-related factors.
Sociodemographic variables explored included age (15–24, 25–49, and 50 years and older), self-reported gender, race, marital status, education level, employment status, and locality type (urban, rural, informal or tribal areas, and rural formal or farm areas). Socio-behavioural factors included experiences of physical intimate partner violence and alcohol use. Health-related indicators included self-rated health status, perceived risk of HIV infection, and HIV serostatus (positive or negative).
Prevalence of psychological distress
The findings revealed that 19.3% of the survey respondents met the threshold for psychological distress. Figure 1 shows that the prevalence of psychological distress was high among females aged 15–24 years (23.6%) compared to males in the same age group (14.4%). The results also revealed that levels of psychological distress were generally higher among females in all age groups compared to their male counterparts.
Figure 1. Prevalence of psychological distress by age and gender among participants aged 15 years and older, SABSSM 2017
Source: Zungu et al., 2025
These patterns suggest that age shapes exposure to stressors and coping mechanisms, setting the stage for understanding how other sociodemographic factors influence psychological distress.
Residence and locality type
Figure 2 shows that the prevalence of psychological distress was higher among females living in urban areas (23.2%), followed by those who lived in rural informal/tribal areas (20.6%). For males, the prevalence of psychological distress was slightly higher among those who lived in rural informal/tribal areas (17.0%) than those in urban areas (16.6%). Males who lived in rural formal/farm areas experienced a comparatively low prevalence of psychological distress (10.7%).
Figure 2: Prevalence of psychological distress by locality type and gender among participants aged 15 years and older, SABSSM 2017
Source: Zungu et al., 2025
These results suggest that place of residence influences exposure to stressors and access to mental health resources, which may help explain observed gender differences.
Education
Among both sexes, those who had no education/primary level of education had a significantly higher prevalence of psychological distress compared to those who had tertiary education: 24.3% vs 16.7% for females and 18.9% vs 9.1% for males as indicated in Figure 3.
Figure 3. Prevalence of psychological distress by level of education and gender among participants aged 15 years and older, SABSSM 2017
Source: Zungu et al., 2025
This finding indicates that education appears to buffer against psychological distress, reinforcing the importance of equitable access to schooling.
Employment
Figure 4 shows that unemployment was associated with a higher prevalence of psychological distress for both sexes, with males at 19.1% and females at 24.8%.
Figure 4. Prevalence of psychological distress by employment status and gender among participants aged 15 years and older, SABSSM 2017
Source: Zungu et al., 2025
Employment status not only affects economic security but also influences daily stressors and social networks, linking closely with overall health and wellbeing.
Health
Males (28.6%) and females (40.8%) with fair/poor self-rated health had a higher prevalence of psychological distress compared to those who reported excellent/good health (Figure 5).
Figure 5. Prevalence of psychological distress by self-rated health and gender among participants aged 15 years and older, SABSSM 2017
Source: Zungu et al., 2025
Self-rated health reflects both physical and mental wellbeing, which in turn can be affected by factors such as HIV status and substance use.
Figure 6 shows that males living with HIV had a significantly higher prevalence of psychological distress (27.0%) than those not living with HIV (15.6%). Females living with HIV showed similar distress levels to men living with HIV (26.7%), but only slightly more than women without HIV (23.2%).
Figure 6. Prevalence of psychological distress by HIV status and gender among participants aged 15 years and older, SABSSM 2017
Source: Zungu et al., 2025
HIV status contributes to psychological stress through health concerns and social stigma, underscoring the relevance of behavioural factors like alcohol use in shaping distress levels.
Alcohol use
For both sexes, the prevalence of psychological distress was higher among those who drank alcohol excessively and was particularly higher among females (32.7%) than males (22.0%), as shown in Figure 7.
Figure 7. Prevalence of psychological distress by excessive alcohol use and gender among participants aged 15 years and older, SABSSM 2017
Source: Zungu et al., 2025
Patterns of alcohol use illustrate how lifestyle and behavioural factors interact with sociodemographic characteristics to influence psychological distress, completing the picture for targeted interventions.
Implications for gender-sensitive mental health interventions
Sociodemographic and behavioural characteristics, including locality type, educational attainment, excessive alcohol use, employment status, HIV status, and self-rated health, were independently associated with the presence of psychological distress in the South African population. Across all the sociodemographic and behavioural characteristics, females reported higher levels of psychological distress than males, except for HIV status, where the difference was small. By analysing the data through a gender lens, stakeholders can generate evidence that informs the development of targeted, gender-specific, and tailored mental health interventions, thereby fostering an environment that promotes psychological wellbeing for all individuals across diverse communities. The authors also maintain that mental health screening and services should be integrated into healthcare provision to promote awareness and destigmatise mental health challenges among both males and females. “There is also a need to investigate further the causes of these consistently high distress levels among females,” said Prof. Khangelani Zuma, Executive within the HSRC.
Taken together, these findings highlight the complex interplay of gender, sociodemographic, and behavioural factors in shaping psychological distress in South Africa, underscoring the need for integrated, gender-sensitive mental health policies.
Research contacts and acknowledgements
This article was written by Jessie-Lee Smith (science writer) and Lactricia Maja (PhD research trainee), Thembelihle Ginyana (PhD research trainee), Ruth Makgalemane (PhD research trainee), Sinenhlanhla Makhoba (DSTI master’s intern), Kutloano Skhosana (master’s research trainee), Lesiba Ofentse Molopa (researcher), Sbonelo Chamane (master’s research trainee) Dr Sean Jooste (chief research specialist), and Dr Lehlogonolo Makola (senior research specialist). It was based on the paper Determinants of gender disparities in psychological distress in the South African population aged 15 years and older: Findings from the 2017 National HIV prevalence, incidence, behaviour, and communication survey. For more information about this work, contact Dr Nompumelelo Zungu (senior research director) at mzungu@hsrc.ac.za.
The survey team is acknowledged within the following report.
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