What is stress?

Studies show that 20%-90% of the general population is exposed to one or more extreme stressful events in their lives, and between 1.3%-11.2% will develop long-term diseases such as post-traumatic stress disorder (PTSD).² Stress is the body's reaction to pressure, often from new or unexpected situations threatening our sense of self or feeling in control. Stress prompts fight-or-flight responses, which are not always negative because they also act as a warning about impending danger.³

Can stress lead to depression?

The relationship between stress and depression involves intricate interactions between environmental stressors and individual vulnerabilities. Genetic factors and early life events shape the brain’s neural structures, impacting cognitive processing and emotional vulnerability.⁴ For example, childhood abuse and neglect induce long-lasting changes in neural and neuroendocrine systems, potentially leading to hypothalamic–pituitary–adrenal axis (HPA) system hyperactivity and altered neurotransmission. Inflammatory responses, triggered by stress, exacerbate HPA axis stimulation, further affecting neurotransmitters and neuroplasticity. This complex interplay, including psychological, biological, cognitive, genetic, and epigenetic factors, links stress vulnerability to depression development.⁴

What is the prevalence of depression in South Africa?

A recent study (2022) reports that the prevalence of depression in South Africa among adults ranges from 14.7%-38.8%⁵ compared to the global average of 5%.⁶ The highest rates of depression were recorded in the Northern Cape (38.8%), the Eastern Cape (34.7%), and the Western Cape (31.8%).⁵ The lowest rate was reported in the Free State (14.7%).⁵

What stresses South Africans?

In the latest AfroBarometer survey, respondents indicated that unemployment (50%), crime and security (38%), and electricity (32%) were the three major sources of concern.⁷

How does unemployment affect individuals and their families?

Unemployment affects individuals and their families. Individuals may experience symptoms such as headaches, stomach and sleep issues, and a lack of energy. They are also at risk of developing hypertension, as well as cardiovascular and renal diseases. Psychological effects include depression, anxiety, hostility, stress, anger, fear, despair, loneliness, social isolation, and decreased self-esteem, life satisfaction, aspiration levels, concentration, and personal identity. These symptoms and effects may lead to increased marital conflicts, spousal depression, and child abuse.⁸

What happens if you don’t feel safe or secure?

South Africa is regarded as a dangerous country to live due to high crime rates.⁹ The latest crime statistics released by the South African Police Service (SAPS) show during the first three months of 2023, 6289 people were killed, and 10 512 rape cases, 5119 carjackings as well as 34 360 robberies with aggravating circumstances were reported.¹⁰ A local survey showed that 75% of South Africans had experienced a traumatic event in their lifetime and >50% had experienced multiple traumas. The same survey also showed that individuals who have not experienced trauma directly, have been indirectly impacted due to the sudden death of a loved one, hearing about a trauma that occurred to a person they are close to, or witnessing a traumatic incident.⁹ Exposure to crime has long-term psychological effects.¹¹

What is the impact of load shedding?

Results from a survey conducted by the South African Depression and Anxiety Group on the effects of load shedding revealed that 40% of respondents felt depressed as a result of load shedding, 60% struggled with anxiety and panic,¹² and 10% contemplated committing suicide.¹² Furthermore, 96% of respondents fear the economic impact that load shedding may have on the future of the country.¹² The Old Mutual Savings and Investment Monitor 2023 reports that confidence in the country’s economy is at an all-time low, with only 27% of South Africans feeling positive.¹³

Cost-of-living crisis looming

The Global Economic Forum predicts that a cost-of-living crisis is looming and will become a reality within the next two years.¹⁴ Many South Africans are already feeling the pinch with 45% of workers feeling financially stressed,¹³ and 70% of those who are highly stressed, reporting that their financial situation negatively impacts their physiological and psychological health.¹³

How is stress treated?

First-line management is trauma-focused cognitive behavioural therapy, which has been shown to reduce the risk of developing PTSD. There are currently no specific pharmacological agents recommended for the treatment of ASD, but if required, following treatment guidance for PTSD may be useful.²

How is depression treated?

The 2023 American College of Physicians’ living clinical guideline recommends monotherapy with either cognitive behavioural therapy or a second-generation antidepressant as initial treatment. Recommended first-line pharmacological treatment includes selective serotonin reuptake inhibitors or serotonin–norepinephrine reuptake inhibitors.¹⁵

References

1. Chand SP, Arif H. [Updated 2023 Jul 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430847/
2. Fanai M, Khan MAB. Acute Stress Disorder. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560815/
3. Mental Health Foundation. [Internet]. Available at: https://www.mentalhealth.org.uk/explore-mental-health/a-z-topics/stress
4. Tafet GE, Nemeroff CB. The Links Between Stress and Depression: Psychoneuroendocrinological, Genetic, and Environmental Interactions. The Journal of Neuropsychiatry and Clinical Neurosciences, 2015.
5. Craig A, Rochat T, Naicker SN, et al. The prevalence of probable depression and probable anxiety, and associations with adverse childhood experiences and socio-demographics: A national survey in South Africa. Frontiers in Public Health, 2022.
6. Depressive disorder. 2023. [Internet]. Available at: https://www.who.int/news-room/fact-sheets/detail/depression
7. The Institute of Justice and Reconciliation. Jobs are top priority for South African youth, new Afrobarometer survey indicates. Aug 2023. [Internet]. Available at: https://www.afrobarometer.org/articles/jobs-are-top-priority-for-south-african-youth-new-afrobarometer-survey-indicates/
8. De Witte H, Leone RS, Jackson TB. The psychological consequences of unemployment in South Africa. SAJENS, 2012.
9. Kaminer D, Eagle G. Traumatic Stress in South Africa Book. Patterns of trauma exposure in South Africa. Published by: Wits University Press Stable, 2010, pp 8-27.[Internet]. Available at: https://www.jstor.org/stable/10.18772/22010105096.5
10. South African Police Services. Police recorded crime statistics. Republic of South Africa. [Internet]. Available at: file:///C:/Users/Rene.Bosman/Downloads/Fourth-Quarter-Crime-Stats%20(1).pdf
11. Center for Substance Abuse Treatment (US). Trauma-Informed Care in Behavioral Health Services. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2014. (Treatment Improvement Protocol (TIP) Series, No. 57.) Chapter 3, Understanding the Impact of Trauma. Available from: https://www.ncbi.nlm.nih.gov/books/NBK207191/
12. SADAG’s New Load Shedding Survey Results Sheds Some Light On The Impact On Mental Health In South Africa. March 2023. [Internet]. Available at: https://www.sadag.org/index.php?option=com_content&view=article&id=3282:sadag-s-new-load-shedding-survey-results-sheds-some-light-on-the-impact-on-mental-health-in-south-africa&catid=149&Itemid=513
13. Old Mutual. Savings and Investment Monitor 2023. [Internet]. Available at: https://www.oldmutual.co.za/savingsmonitor/
14. World Economic Forum. The Global Risks Report 2023. [Internet]. Available at: https://www3.weforum.org/docs/WEF_Global_Risks_Report_2023.pdf
15. Qaseem A, Owens DK, Etxeandia-Ikobaltzeta I, et al. Nonpharmacologic and Pharmacologic Treatments of Adults in the Acute Phase of Major Depressive Disorder: A Living Clinical Guideline From the American College of Physicians. Annals of Internal Medicine, 2023.