The prevalence and correlates of common mental disorders among adolescents and young adults in rural South Africa: analysis of household survey data informed by lived experience experts

Depression and anxiety are among the most common mental disorders (CMDs) affecting adolescents and young adults (AYA). CMDs often emerge during adolescence and young adulthood, yet are frequently diagnosed in adulthood. Understanding the burden and correlates of CMDs is essential for informing public mental health interventions. However, limited research incorporates the perspectives of AYA with lived experience of mental health conditions. This study aimed to determine the prevalence and factors associated with CMDs among AYA aged 15–24 years in South Africa, incorporating insights from those with lived experience. First wave South African Population Research Infrastructure Network (SAPRIN) mental health data, collected between March 2021 and April 2022 in three rural areas, were used. AYA with complete mental health information were included. CMDs were the primary outcome, defined as the presence of either depressive symptoms (Patient Health Questionnaire-2 [PHQ-2] score ≥ 3), anxiety symptoms (Generalised Anxiety Disorder-2 [GAD-2] score ≥ 3), or both. Participatory workshops with 17 AYA aged 18–30 years with lived experience of mental health conditions informed the secondary data analysis and interpretation. Exposure variables included age, sex, living with both parents, relationship to the household head, school attendance, and occupation. Multivariable logistic regression was used to examined correlates of CMDs, accounting for clustering by surveillance site. Among n = 11,346 AYA, CMD prevalence was 9.0% (n = 1026). Increased odds of CMDs were associated with having children (adjusted odds ratio [aOR] = 1.27; 95% confidence interval [CI]: 1.04–1.54, p = 0.016), being the head of household, a spouse, or a sibling of the household head (aOR = 1.56; 95% CI: 1.29–1.89; p < 0.001), and being an extended family member of the household head (aOR = 1.26; 95% CI: 1.08–1.46; p = 0.002). CMD prevalence among rural AYA in South Africa was 9.0%, with early parenthood and not being the child of the household head identified as key correlates of increased CMD risk. These findings suggest that early parenthood and family structure may contribute to CMDs. Future research should explore the long-term impacts of these correlates using longitudinal datasets, while considering broader contextual factors. A significant proportion of rural AYA report experiencing CMDs, with early parenthood and not being the child of the household head identified as key risk factors. These findings underscore the need for community-and-school-based social support interventions, alongside economic empowerment initiatives, to address the mental health needs of this population.