Functional impairment and depression amongst adults living in South Africa

Abstract

BACKGROUND: Depression has been increasingly acknowledged as a mental health concern, an expanding burden of disease. South Africa has attempted to alleviate inequalities experienced by the differently abled population, but the effects of inequality are still far-reaching placing both the fully abled and the differently abled both at a surmountable amount of risk for depression. Numerous studies within South Africa have examined the association between different ability and depression, but within the last decade, none have focused on susceptibility of depression as compared between the unimpaired, the physically handicapped and the sensory impaired. Given that South Africa is to undergo an epidemiological transition, it is imperative that its progress in combating this disease be tracked. A vital move if goal number 7 of the SDG’s which asserts adequate mental and physical wellbeing for all South Africans, is to be achieved. The study aims to compare the likelihood of depression amongst those who are sensory impaired and physically handicapped, and those with no impairment. METHODS: The study was investigative with a focus on the relationship between type of functional ability and Depression as an outcome in the year 2017. Secondary data was used from the National Income Dynamics Study years 2008, 2012 and 2017. Of the entire population, 4,962,554 were unimpaired, 16,597 were physically handicapped and 50,649 had sensory impairments. All participants of the study had to be present within the years 2008, 2012 and 2017, and all individuals with co-occurring illnesses or who developed such illnesses before 2017 were removed from the study. Percentage distributions were based on selected controls and depression as well as percentage prevalence of depression. Adjusted and unadjusted Mixed effect regression models were used at the multivariate level. RESULTS: The prevalence rate of depression was 0.24 in 2017. Individuals who are functionally different had a lower risk of developing depression based on the accumulative effects of social factors [O.R: 0.21]. Furthermore, when adjusted for, the effects of being female (p-value: 0.053), ether white or colored (p-value:0.001 and 0.000) and residing in Urban but informal locations (p-value:0.024) were significant on depression. Having spent R2000-R5000 and having spent over R5000 on household food in the last month (p-value: 0.055 and 0.003), 4 perceiving household wealth as low or high (p-value: 0.000 and 0.002) and being unrelated to the household head (p-value:0.041) were all risky for depression. In isolation of other contributing factors while their effects were diluted when adjusted for (<0.05% level of significance). CONCLUSION: In determining the nature of the relationship between functional status and depression, results showed that functional impairment, race and geographical location are solely risky for developing depression. While they mediate the effect of sex on depression. Functionally impaired individuals are less likely to develop depression based on accumulative effects than those with full functioning ability. In short, those who are able, female, reside in urban locations and identify as being of African ethnicity have an increased susceptibility to depression, drawing attention to severe disparities in equality still lingering within South Africa.