Emotion regulation strategies among young men in rural areas and urban informal settlements in South Africa: a qualitative exploratory study

Emotional dysregulation (ED), the inability to manage emotional responses effectively is a well-documented major symptom of poor mental health, especially in high-income countries. Evidence from these settings links ED to adverse childhood experiences, chronic poverty, and structural disadvantage. ED has also been associated with increased risk of HIV acquisition and intimate partner violence (IPV) perpetration, particularly among men. Despite these established associations, research on ED remains limited in sub-Saharan Africa, including South Africa, where both HIV and IPV remain epidemicespecially in low-resource communities such as rural areas and urban informal settlements. Therefore, we explored emotion regulation strategies among young men (aged 18-30) living in urban informal settlements and rural communities in KwaZulu-Natal (KZN), South Africa. We conducted 22 audio-recorded face-to-face interviews using a semi-structured interview guide, guided by the six domains of ED in Difficulties in Emotion Regulation Scale (DERS-16) as our conceptual framework. Data were analysed deductively using the domains of ED in DERS-16 as main themes. Participants seemed to struggle with emotion regulation likely resulting in ED, which was probably attributed to adverse childhood experiences, poverty and intensified by local constructions of masculinity. Common but ineffective emotion regulation strategies included emotion suppression and numbing with alcohol and sex, aligned with dominant masculine norms. Men's struggles with impulsivity resulting from ED frequently manifested as violence perpetration, notably against female partners. ED seemed to also compromise men's ability to achieve personal goals and establish stable livelihoods. Participants' emotion regulation descriptions closely matched ED domains on DERS-16 suggesting its potential suitability in measuring ED among this population. Emotional dysregulation appears prevalent among men in marginalized KZN communities and is closely linked to increased risks of IPV and HIV. Future research is necessary to deepen understanding of these connections and inform effective interventions.