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

Psychological distress, characterized by symptoms such as anxiety, depression, and emotional suffering, is a major public health issue with well-documented gender disparities. This study examined the determinants of gender differences in psychological distress among South Africans aged 15 years and older using data from the 2017 South African National HIV Prevalence, Incidence, Behaviour, and Communication Survey. The cross-sectional survey employed a multi-stage stratified random cluster sampling design. Psychological distress was measured using the Kessler 10-item Psychological Distress Scale (K10), where a score of ≥20 indicated some level of distress. Of the 8,148 participants, the weighted prevalence of psychological distress was 19.3% (95% CI: 17.8-20.9), with a significantly higher prevalence among females (22.2%, 95% CI: 20.2-24.4) than males (16.4%, 95% CI: 14.4-18.6). Multivariable backward stepwise logistic regression models were used to identify factors associated with psychological distress for each gender, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Among males, higher odds of distress were associated with fair/poor self-rated health (AOR = 1.7, 95% CI: 1.2-2.4) and excessive alcohol use (AOR = 1.6, 95% CI: 1.1-2.3). Protective factors included tertiary education (AOR = 0.5, 95% CI: 0.3-0.9), residence in rural formal/farm areas (AOR = 0.6, 95% CI: 0.4-1.0), and being HIV negative (AOR = 0.7, 95% CI: 0.4-1.0). For females, distress was significantly associated with fair/poor self-rated health (AOR = 2.6, 95% CI: 2.0-3.4) and excessive alcohol use (AOR = 2.0, 95% CI: 1.3-3.1). Lower odds were found among the employed (AOR = 0.7, 95% CI: 0.5-0.9), residents of rural informal/tribal (AOR = 0.6, 95% CI: 0.5-0.8) and rural formal/farm areas (AOR = 0.6, 95% CI: 0.4-0.9), and those with accurate HIV knowledge and myth rejection (AOR = 0.6, 95% CI: 0.4-0.7). The findings emphasize the need for gender-specific mental health interventions targeting modifiable risk factors to reduce psychological distress in South Africa.