Determinants of gender disparities in psychological distress among youth and adults in South Africa: Evidence from the 2017 national population-based household survey

Background Psychological distress has become a significant public health concern, and gender differences in psychological distress are well documented in the literature. This study investigated determinants of gender disparities in psychological distress among youth and adults in South Africa. Methods This study data used obtained from the 2017 National HIV Prevalence, Incidence, Behaviour, and Communication Survey conducted using a multi-stage stratified random cluster sampling design. Multivariate backward stepwise logistic regression models were used to determine the factors associated with psychological distress among males and females. Results In the male model, the odds of psychological distress were significantly higher among those who reported fair/poor self-rated health [AOR=1.7% (95% CI: 1.2-2.4), p=0.003], and excessive alcohol users [AOR=1.6% (95% CI: 1.1-2.3), p=0.008]. The odds were significantly lower among those with tertiary education level [AOR=0.5% (95% CI: 0.3-0.9), p=0.031], those from rural formal/farm areas [AOR=0.6% (95% 0.4-1.0), p=0.046], and those who were HIV negative [AOR=0.7% (95% CI: 0.4-1.0), p=0.051]. In the female model, the odds of psychological distress were significantly higher among those who reported fair/poor self-rated health [AOR=2.6% (95% CI: 2.0-3.4), p<0.001], and excessive alcohol users [AOR=2.0% (95% CI: 1.3-3.1), p=0.002]. The odds were significantly lower among the employed [AOR=0.7% (95% CI: 0.5-0.9), p=0.002], those from rural informal/tribal areas [AOR=0.6% (95% CI: 0.5-0.8), p=0.001], rural formal/farm areas [AOR=0.6% (95% CI: 0.4-0.9), p=0.015], and those with correct HIV knowledge and myth rejection [AOR=0.6% (95% CI: 0.4-0.7), p<0.001]. Conclusion The findings highlight the need for tailored gender-specific interventions and targeting identified high-risk groups. The finding also underscores the importance of integrated interventions to address the adverse effects of harmful alcohol use and HIV-positive serostatus on psychological distress. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Human Sciences Research Council, Research Ethics Committee (REC: 4/18/11/15) I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data cannot be shared publicly because of ethical reasons. Data are available from the Human Sciences Research Council database for researchers who meet the criteria for access to confidential data.