Individuals living in more deprived neighbourhoods in South Africa experience more depressive symptoms than their counterparts in wealthier neighbourhoods. This is according to a recent University of Cape Town (UCT) study published in the journal, BMC Psychiatry.

The study, The Association between Neighbourhood Level Deprivation and Depression: evidence from the South African National Income Dynamics Study, found that living environment and employment deprivation were the two deprivation categories most strongly associated with depression.  

The study was conducted by Nicholas Dowdall (UCT graduate and now University of Oxford postgraduate student), Professor Catherine Ward (Head of the Department of Psychology at UCT) and Professor Crick Lund (Director of the Alan J Flisher Centre for Public Mental Health at UCT).

Professor Ward explains: “Living in an environment where few people have a decent income may mean that the neighbourhood has very few resources for people to draw on in time of trouble. It may also mean that people feel hopeless and helpless in the face of what seem to be overwhelming odds – if everyone around them is unemployed, the chances of getting a job may seem much slimmer than in an environment where most people are employed. Both of those are linked to depression in other studies.”
The study has some big implications.

“Firstly, it implies that the area you live in can affect your mental health: regardless of your individual circumstances, living in an environment where people are adequately housed, where they are educated and employed, and have enough income to meet their needs, is better for your mental health,” says Ward.  

“Secondly, it implies that if we wish to reduce depression in South Africa, we need to pay attention to improving people’s living environments, and to making education and employment accessible. That makes preventing depression everyone’s business, and not just the domain of mental health professionals,” adds Ward.

According to the study, being married or living with a partner can also function as a protective factor against common mental disorders.

Controlling for the individual variables meant that this study shows that, aside from individual factors, one’s environment can have a unique effect on one’s risk for depression.

All four domains of neighbourhood deprivation – living environment, employment, education and income, and material deprivation – were associated with depression: the worse the neighbourhood deprivation, the higher the depression scores. Living environment deprivation refers to living in a neighbourhood where many did not have access to water, sanitation, and electricity; where houses were overcrowded; and many people lived in shacks.

Employment deprivation refers to a neighbourhood where many people were unemployed; education deprivation to a neighbourhood where many people had no secondary schooling; and income and material deprivation refers to a neighbourhood where many have low incomes.

While this study can’t clarify why depression is linked to the neighbourhood in this way, the authors do make some educated guesses based on the emerging science in this area.  

Ward elaborates: “For instance, living in an environment where few people have a decent income may mean that the neighbourhood has very few resources for people to draw on in time of trouble. It may also mean that people feel hopeless and helpless in the face of what seem to be overwhelming odds – if everyone around them is unemployed, the chances of getting a job may seem much slimmer than in an environment where most people are employed.  Both of those are linked to depression in other studies.”

The study used nationally-representative data from the National Income Dynamics Study (NIDS) coupled with the data from the South African Indices of Multiple Deprivation (SAIMD). Putting the two datasets together enabled the team to ask a question about the sources of depression that has seldom been asked in a low- or middle-income country before. Prior to this, most of our understanding of the environmental sources of depression has come from high-income countries like the US.

Having both the NIDS and the SAIMD data together meant that this study could control for individual sources of depression. On an individual level, people with higher income were less likely to report depression, while unemployed participants who are actively looking for work experienced more depressive symptoms than the non-economically active participants.

NIDS, which was commissioned by the South African Presidency, provides “nationally representative data on expenditure, income, asserts, access to services, education, employment, health and dimensions of well-being, including depression”, explains the study.

The SAIMD uses data from the South African Census to explore deprivation in different geographic areas. The deprivation indices were constructed along four domains – income and material, employment, education and living environment – and provided an overall deprivation score in each domain for each area.