Psychological Medicine

Original Articles

Twelve-month mental disorders in South Africa: prevalence, service use and demographic correlates in the population-based South African Stress and Health Study

D. R. Williamsa1 c1, A. Hermana2, D. J. Steina3, S. G. Heeringaa4, P. B. Jacksona5, H. Moomala6 and R. C. Kesslera7

a1 Harvard University School of Public Health, Boston, MA, USA

a2 National School of Public Health, Medunsa, South Africa

a3 Department of Psychiatry and Mental Health, University of Cape Town, South Africa

a4 Survey Research Center, University of Michigan, Ann Arbor, MI, USA

a5 Department of Sociology, Indiana University, Bloomington, IN, USA

a6 University of Witwatersrand, Johannesburg, South Africa

a7 Department of Health Care Policy, Harvard University Medical School, Boston, MA, USA


Background South Africa's history and current social conditions suggest that mental disorders are likely to be a major contributor to disease burden, but there has been no national study using standardized assessment tools.

Method The South African Stress and Health Study was a nationally representative in-person psychiatric epidemiological survey of 4351 adults (aged 18 years) that was conducted as part of the WHO World Mental Health (WMH) Survey Initiative between January 2002 and June 2004. Twelve-month prevalence and severity of DSM-IV disorders, treatment, and sociodemographic correlates were assessed with Version 3.0 of the WHO Composite International Diagnostic Interview (CIDI 3.0).

Results The 12-month prevalence of any DSM-IV/CIDI disorder was 16.5%, with 26.2% of respondents with disorder classified as severe cases and an additional 31.1% as moderately severe cases. The most common disorders were agoraphobia (4.8%), major depressive disorder (4.9%) and alcohol abuse or dependence (4.5%). Twenty-eight percent of adults with a severe or moderately severe disorder received treatment compared to 24.4% of mild cases. Some 13.8% of persons with no disorder received treatment. Treatment was mostly provided by the general medical sector with few people receiving treatment from mental health providers.

Conclusions Psychiatric disorders are much higher in South Africa than in Nigeria and there is a high level of unmet need among persons with severe and moderately severe disorders.

(Received October 16 2006)

(Revised June 11 2007)

(Accepted June 21 2007)

(Online publication October 01 2007)


c1 Address for correspondence: Professor D. R. Williams, Harvard School of Public Health, 677 Huntington Avenue, Room 615, Boston, MA, USA. (Email: