BMC public health · 2026
Determinants of depression severity among university students in KwaZulu-Natal, South Africa: socio-economic, food security and disaster-related predictors.
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Cele Thobani, Mkhize Xolile
Аннотация
BACKGROUND: Mental health is increasingly recognised as a major public health concern among university students, particularly in low- and middle-income settings where financial insecurity, food access constraints, and environmental disruptions may exacerbate vulnerability. However, limited empirical evidence from South Africa has examined how these structural stressors jointly influence depression severity.
METHODS: A cross-sectional online survey was administered to registered students at a university in KwaZulu-Natal (n = 445). Findings reflect associations within a single institution and should not be interpreted as representative of all university students in KwaZulu-Natal or South Africa. Depression severity was measured using the Patient Health Questionnaire-9 (PHQ-9) and categorised into five ordered levels (none to severe). Socio-demographic, economic, food security, and disaster exposure variables were assessed. An ordered probit model with marginal effects was employed to identify determinants of depression severity.
RESULTS: Approximately 59.8% of students reported moderate-to-severe depressive symptoms. Female students exhibited a 7.4% higher probability of severe depression relative to males. Greater dietary diversity was associated with a 2.4% lower probability of severe symptoms, while reliance on less stable funding sources increased risk by 1.1%. Exposure to the July 2021 unrest and April 2022 floods raised the likelihood of severe depression by 3.5% and 3.4%, respectively. Students with advanced age showed a modest protective effect. Other covariates were not statistically significant.
CONCLUSION: Depression severity among students is associated with gender, food security, financial stability, and exposure to socio-environmental shocks. These findings suggest that university mental health strategies should extend beyond clinical services to include food, financial, and disaster-resilience support. Addressing these determinants aligns with Sustainable Development Goals (SDGs) related to health, food security, education, and climate resilience.
METHODS: A cross-sectional online survey was administered to registered students at a university in KwaZulu-Natal (n = 445). Findings reflect associations within a single institution and should not be interpreted as representative of all university students in KwaZulu-Natal or South Africa. Depression severity was measured using the Patient Health Questionnaire-9 (PHQ-9) and categorised into five ordered levels (none to severe). Socio-demographic, economic, food security, and disaster exposure variables were assessed. An ordered probit model with marginal effects was employed to identify determinants of depression severity.
RESULTS: Approximately 59.8% of students reported moderate-to-severe depressive symptoms. Female students exhibited a 7.4% higher probability of severe depression relative to males. Greater dietary diversity was associated with a 2.4% lower probability of severe symptoms, while reliance on less stable funding sources increased risk by 1.1%. Exposure to the July 2021 unrest and April 2022 floods raised the likelihood of severe depression by 3.5% and 3.4%, respectively. Students with advanced age showed a modest protective effect. Other covariates were not statistically significant.
CONCLUSION: Depression severity among students is associated with gender, food security, financial stability, and exposure to socio-environmental shocks. These findings suggest that university mental health strategies should extend beyond clinical services to include food, financial, and disaster-resilience support. Addressing these determinants aligns with Sustainable Development Goals (SDGs) related to health, food security, education, and climate resilience.