The hidden struggle: mental health during the COVID-19 pandemic in South Africa

The COVID-19 pandemic and associated lockdown had a profound impact on mental health in South Africa, particularly among marginalised groups. The University of Johannesburg / Human Sciences Research Council (UJ/HSRC) COVID-19 Democracy survey was a cross-sectional online survey conducted in five rounds covering a 20-month period from mid-April 2020 to November 2021 and involving nearly 45,000 participants. Our findings show that stress, depression, and loneliness were prevalent, especially during the strictest lockdown periods. Women, young adults, and poorer individuals were disproportionately affected, with hunger and unemployment emerging as significant drivers of distress. Psychological distress lessened as lockdown restrictions eased, but feelings of isolation persisted for many. Interestingly, COVID denialists reported lower levels of distress, while those more accepting of vaccines exhibited less psychological distress. The findings emphasise the importance of addressing both socio- economic and mental health vulnerabilities through social protection and targeted interventions during future crises. It further underlines the treatment gaps in South Africa’s mental health services, with system strengthening being vital to address present and future need.