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Health literacy, multimorbidity and its effect on mental health in South African adults: a repeated cross-sectional nationally representative panel study

Health literacy, multimorbidity and its effect on mental health in South African adults: a repeated cross-sectional nationally representative panel study
Health literacy, multimorbidity and its effect on mental health in South African adults: a repeated cross-sectional nationally representative panel study
Objective and methods: Health literacy is a key determinant of physical and mental health outcomes, particularly in low- and middle-income settings like South Africa, where multimorbidity is increasingly common. Limited health literacy may hinder effective management of multiple chronic conditions and worsen mental health. Using repeated cross-sectional nationally representative data, this study examined the relationship between health literacy and multimorbidity, with a specific focus on mental health among South African adults (18 years and older).

Results: Most respondents had minimal depression risk, with 21.7% showing probable depression, lower than the 25.7 and 26.2% in Panels 1 (2021) and 2 (2022) respectively. In efforts to further corroborate the odds of having mental or physical health risk with higher levels of ACE exposure, our results confirmed the increased likelihood of depression, anxiety and multimorbidity with increased odds of early adversity, irrespective of differing socio-demographics. The results further revealed that socioeconomic status directly influenced depression, which was partially mediated via health literacy. Additionally, the association between socioeconomic status and multimorbidity was fully mediated by ACE exposure and depression.

Conclusion: One in five South Africans experience depressive symptoms, with notable regional differences. Childhood adversity contributes to increased mental health risk and higher multimorbidity. Health literacy was found to influence the link between socioeconomic status and depression, suggesting that lower literacy increases vulnerability. These findings therefore emphasize the need for targeted interventions to address childhood adversity, improve health literacy, and enhance mental health resources across South Africa.
ACE, South Africa, anxiety, depression, health literacy, mental health, multimorbidity, national representative survey
2296-2565
Gafari, Olatundun
3c7158eb-682c-468c-90a3-6f40a1484255
Norris, Shane A.
1d346f1b-6d5f-4bca-ac87-7589851b75a4
Gafari, Olatundun
3c7158eb-682c-468c-90a3-6f40a1484255
Norris, Shane A.
1d346f1b-6d5f-4bca-ac87-7589851b75a4

Gafari, Olatundun and Norris, Shane A. (2025) Health literacy, multimorbidity and its effect on mental health in South African adults: a repeated cross-sectional nationally representative panel study. Frontiers in Public Health, 13, [1622005]. (doi:10.3389/fpubh.2025.1622005).

Record type: Article

Abstract

Objective and methods: Health literacy is a key determinant of physical and mental health outcomes, particularly in low- and middle-income settings like South Africa, where multimorbidity is increasingly common. Limited health literacy may hinder effective management of multiple chronic conditions and worsen mental health. Using repeated cross-sectional nationally representative data, this study examined the relationship between health literacy and multimorbidity, with a specific focus on mental health among South African adults (18 years and older).

Results: Most respondents had minimal depression risk, with 21.7% showing probable depression, lower than the 25.7 and 26.2% in Panels 1 (2021) and 2 (2022) respectively. In efforts to further corroborate the odds of having mental or physical health risk with higher levels of ACE exposure, our results confirmed the increased likelihood of depression, anxiety and multimorbidity with increased odds of early adversity, irrespective of differing socio-demographics. The results further revealed that socioeconomic status directly influenced depression, which was partially mediated via health literacy. Additionally, the association between socioeconomic status and multimorbidity was fully mediated by ACE exposure and depression.

Conclusion: One in five South Africans experience depressive symptoms, with notable regional differences. Childhood adversity contributes to increased mental health risk and higher multimorbidity. Health literacy was found to influence the link between socioeconomic status and depression, suggesting that lower literacy increases vulnerability. These findings therefore emphasize the need for targeted interventions to address childhood adversity, improve health literacy, and enhance mental health resources across South Africa.

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Accepted/In Press date: 5 August 2025
Published date: 20 August 2025
Keywords: ACE, South Africa, anxiety, depression, health literacy, mental health, multimorbidity, national representative survey

Identifiers

Local EPrints ID: 504219
URI: http://eprints.soton.ac.uk/id/eprint/504219
ISSN: 2296-2565
PURE UUID: 0358515e-1239-498b-8e78-ecb1ef46be1e
ORCID for Olatundun Gafari: ORCID iD orcid.org/0000-0003-3416-5084
ORCID for Shane A. Norris: ORCID iD orcid.org/0000-0001-7124-3788

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Date deposited: 29 Aug 2025 17:13
Last modified: 11 Sep 2025 03:09

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Contributors

Author: Olatundun Gafari ORCID iD
Author: Shane A. Norris ORCID iD

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