The prevalence of depression among people aged 15 and older in South Africa has dropped slightly – from an estimated 5.1% in 2002 to 4.5% in 2024, writes Marcus Low for Spotlight, yet while this is a decrease, it still means more than 2m people had depression in mid-2024.
When taken as a whole, there were an estimated 3.84m new episodes of depression in 2024. Since some people may have had more than one episode, the number of people who developed depression over the year will be slightly lower.
The estimates are from mathematical modelling published as a preprint earlier in March on medRxiv. While Spotlight doesn’t usually report on studies that haven’t yet been peer-reviewed, we made an exception because the estimates fill an important gap in our understanding of depression in South Africa and because of the stature of the authors.
The new modelling drew on several nationally representative surveys of depression conducted in South Africa since 2002.
The researchers estimate that around seven in 10 adults in South Africa have ever had depression at some point in their lifetime.
“Previous studies have suggested that only 10% to 15% of the population ever experiences depression, but our study suggests a much higher proportion, 70%,” Dr Leigh Johnson, the lead scientist on the study, told Spotlight.
“Most of these people experience a single episode and have no recurrences. The common belief is that depression is a frequently recurring condition, but this is true for only a minority of people who experience depression.”
Johnson is from the Centre of Integrated Data and Epidemiological Research at the University of Cape Town (UCT) and is also responsible for Thembisa, the leading mathematical model of HIV in South Africa.
The new modelling also suggests some interesting nuances regarding who is most at risk of depression. In mid-2024, prevalence in women was at 5.3%, well above the estimated 3.6% in men. Older people were significantly more likely to suffer from depression than young people.
HIV has long been known to increase the risk of depression, but the modelling suggests this effect has weakened over time as HIV treatment became more widely available. In 2010, 7.1% of people with HIV had depression compared with 4.9% in the general population.
By 2024, 5.9% of people with HIV had depression, compared with 4.5% of the general population. In other words, the gap decreased from 2.2 percentage points to 1.4.
Increasing, but still very low antidepressant usage
While rates of depression have been relatively stable, the researchers estimate that antidepressant usage rates have almost tripled, from around 1% of the population using antidepressants in 2008, to 2.8% in 2024. In Europe, Australia, Canada, and the United States, rates are between 4% and 16%.
The proportion of women taking antidepressants is more than four times higher than in men – a difference that cannot fully be explained by the higher rates of depression in women. Social factors like stigma are likely to be playing a role.
The differences between the private and public sectors are stark. Around 11% of medical scheme members are estimated to be taking antidepressants, compared with 0.9% in the rest of the population.
“Levels of antidepressant use in the uninsured population are very low, despite a substantially greater prevalence of depression in people of lower socioeconomic status,” the researchers point out.
“Our study shows quite extreme inequality in access to antidepressant treatment in South Africa, with rates of antidepressant use in the private sector being about 12 times those in the public sector. Levels of use in the private sector are quite similar to those in high-income countries, but in South Africa’s uninsured population there are major barriers to accessing mental healthcare,” said Johnson.
One such barrier, say the researchers, is regulatory obstacles that prevent nurses from prescribing antidepressants. This problem is worsened by the shortages of public sector psychiatrists and medical doctors.
“The study highlights the burden of depression in our country, the vast treatment gap, and stark inequities in access between the public and the private sectors, despite on-paper availability of treatments we have known work to mitigate the effects of depression for decades,” the study’s principal investigator, Professor Lara Fairall, told Spotlight.
“There was a clear call to review regulatory barriers to wider access to antidepressants in the 2023 National Mental Health Policy Framework and Strategic Plan, but it has not been followed by definitive action.
“Unlocking these barriers requires clarity of mandate by multiple state and para-statal bodies, including the National Department of Health, the South African Health Products Regulatory Authority and the South African Nursing Council, but the study is a reminder that failure to do so leaves millions of people vulnerable with desperate consequences for themselves, their families and the economy,” adds Fairall who works as a health systems researcher at King’s College London and leads the Knowledge Translation Unit at UCT.
See more from MedicalBrief archives:
South Africa’s strides in tackling post-partum depression
Suicide rates rise among over-50 South Africans
Cape teens struggle with depression – SA study
Depression during and after pregnancy needs more attention, says obstetrician
Depression puts SA girls at higher risk of contracting HIV