The relationship between household asset index (HAI), food insecurity and post-traumatic stress disorder (PTSD) among adults in rural, South Africa:2021-2022

Abstract

Introduction: South Africa has a history of violence and traumatic events (TEs) both during the previous apartheid and emergent democracy eras. Despite the country’s history of TE, the documented prevalence of post-traumatic stress disorder (PTSD), the only mental disorder dependent on a TE is low. Further limited data has examined the relationship between PTSD, poverty and deprivation, contexts which are ubiquitous in South Africa. Therefore, this study aims to fill the gap by addressing several key objectives: a) to estimate the prevalence of probable PTSD at the third of four Waves of an adult cohort in rural South Africa b) to examine the relationship between different TEs, cumulative TE and PTSD in the said cohort, c) to examine the relationship between household asset index (HAI), and food insecurity, among individuals with probable PTSD. Methods: I conducted a secondary analysis of a primary cohort study, the Health and Aging in Africa: Longitudinal Studies in South Africa (HAALSI), set in rural Agincourt, Mpumalanga. The analytical sample was derived from the third Wave of data collected between 2021-2022. Screening tools employed for TE and probable PTSD were the life history questions from the English Longitudinal Studies of Ageing (ELSA) and the seven- item Short Screening Scale for PTSD respectively. Explanatory variables include exposure to TEs and cumulative TE, HAI and food insecurity. Data analysis included calculating descriptive statistics, univariate and multivariate logistic regression, and backward stepwise selection (p<0.05). Results: Out of 3 332 HAALSI Wave 3 participants, 2.44% reported symptoms suggesting the prevalence of probable PTSD. Experiencing at least one TE nearly doubled the risk of probable PTSD (aOR:1.96, CI:0.94–4.09, p=0.074). Evidence of a dose-response relationship between TE and probable PTSD was reflected, with participants reporting five or more TEs scoring higher on the probable PTSD screener (aOR:3.07, CI:1.64–5.77, p<0.001). The iv highest HAI quintile participants were nearly twice as likely to be at risk of probable PTSD (aOR: 1.91, CI:1.10–4.66, p=0.027). Moderate food insecurity increased likelihood five-fold (aOR:4.91, CI: 3.04–7.94, p<0.001), while severe food insecurity increased likelihood nineteen-fold (aOR:18.85, CI: 8.96–39.64, p<0.001). Conclusion: This study confirms PTSD prevalence in rural Mpumalanga aligns with national estimates. TEs, cumulative TE and food insecurity significantly increase probable PTSD risk. Older adults in higher HAI quintiles, who are still affected by poverty and inequality, suggest greater vulnerability. Findings emphasise the need for targeted mental health interventions addressing poverty, TE exposure, and structural inequalities to improve psychological well- being and reduce the prevalence of probable PTSD in vulnerable, low-income populations. Results highlight the need for longitudinal research examining bidirectional relationships between HAI, food insecurity and PTSD. This should be complemented by qualitative research to further explore experiences of HAI and food insecurity.