More than half of adolescents in South African townships are living with symptoms of anxiety and depression and the ways they are trying to cope with stress may be making their struggles worse.
A new study published in the Journal of Child & Adolescent Mental Health has revealed 58% of adolescents in Etwatwa, Gauteng, showed levels of anxiety, while 55% displayed symptoms of depression.
The research was conducted by University of Cape Town master’s student Busisiwe Hlatshwayo, under the supervision of associate professor Lauren Wild.
The study surveyed 415 pupils aged 15-19 from two secondary schools in Etwatwa, using a cross-sectional survey design. Girls were especially affected, reporting significantly more symptoms than boys.
“I was born and raised in Etwatwa,” Hlatshwayo said.
“Most of the experiences that the children from this area have gone through, I’ve probably experienced too, the social and economic challenges. I’ve also seen a lot of adolescents around me committing suicide, children very close to where I live. That really prompted me to look at coping strategies.”
It is this personal connection that drove her to investigate how young people in her community cope with stress and whether those strategies help or harm their mental health.
Hlatshwayo said the high numbers were shocking but not entirely unexpected. “While the high rates of anxiety and depression were very surprising and shocking for me, I do want to say that given what exists out there in terms of research, it was not entirely unexpected, especially because we have had studies conducted about low socioeconomic backgrounds where they’ve found high levels of poverty, anxiety, as well as food insecurity.”
The study found that certain coping behaviours, including substance abuse, behavioural disengagement, denial, venting and self-blame, were strongly linked to higher levels of anxiety and depression.
“Blaming yourself doesn't make the stress go away,” said Hlatshwayo. “Especially in uncontrollable situations, it can cause worse emotional distress. You still find yourself with the same stressor.”
Behavioural disengagement, essentially giving up, was another common response. While it might offer temporary relief, it often leads to feelings of helplessness. “You're diverting your attention away from the stressor,” she said. “But because there's no resolution, it can intensify the feeling of helplessness.”
Substance use, though reported less frequently, also predicted worse mental health outcomes. “It impacts cognitive functioning, planning, decision-making, judgment, making it difficult to respond to environmental stimuli,” the study noted.
Interestingly, strategies typically seen as positive, such as planning, active coping and seeking support, did not show a protective effect in this context. “The effectiveness of coping strategies may vary according to the context. Adolescents living in poverty face uncontrollable stressors, which may limit their ability to effectively use strategies we deem adaptive,” said Hlatshwayo.
We need to address the broader contextual factors, food insecurity and socioeconomic hardships. Because you can teach coping strategies but if the environment doesn’t change, it’s not enough
— Master’s student Busisiwe Hlatshwayo
One of the study's key insights is the “goodness of fit” hypothesis, the idea that coping strategies only work when they match the nature of the stressor.
“If the adolescents use problem-focused coping in an uncontrollable situation, it can make emotional distress worse because they cannot come up with a solution for the stress they’re experiencing,” said Hlatshwayo. “Coping is not one-size-fits-all — it must match the realities young people face.”
In Etwatwa, many stressors such as poverty, food insecurity and violence are beyond the control of teenagers. “They still go to school. There's nothing they can do in that situation,” she said.
This mismatch may explain why strategies like planning or seeking instrumental support did not help. “We did not find seeking instrumental support to have a direct protective effect in this context,” she added.
The gender gap in mental health was stark. Girls reported significantly more symptoms of anxiety and depression than boys, a finding consistent with global research.
“It's a combination of social pressures, cultural expectations and gender-based risks,” said Hlatshwayo. “Girls are exposed to higher rates of sexual violence, early pregnancy and interpersonal stressors.'
She also pointed to rumination, the tendency to dwell on negative thoughts, as a key factor. “Girls tend to engage in rumination, which intensifies psychological distress.”
Body image issues, often worsened by early purbetal timing in girls, also play a key role. “You may get children who are not happy about how they look and that can make them vulnerable to anxiety and depression.”
, also play a key role. “You may get children who are not happy about how they look and that can make them vulnerable to anxiety and depression.”
The study calls for school-based interventions tailored to the realities of township life. “Adolescents in this township do not have the luxury of walking to a mental health facility,” said Hlatshwayo. “We do not have those types of resources.”
She recommends psychoeducational programmes that teach coping strategies appropriate for the context and are gender-sensitive. “We need interventions that meet gender-specific needs, that address interpersonal stress and rumination.”
She also stressed the need to go beyond the individual. “We need to address the broader contextual factors, food insecurity and socioeconomic hardships. Because you can teach coping strategies, but if the environment doesn’t change, it’s not enough.”
An ideal programme, she said, would include flexible coping tools, family and community involvement, and easy access to professional counselling. “Partnerships with mental health organisations are crucial. As much as we teach students, they also need professional support.”
While the study is cross-sectional and cannot determine causality, it offers a powerful snapshot of the mental health crisis facing South African adolescents in low-income communities.
Hlatshwayo hopes future research will explore the directionality of effects, whether poor coping leads to distress, or distress impairs coping. “That would help us tailor interventions more effectively,” she said.
For now, her message is clear: “We already know what adolescents in this context are going through. These findings can be used to support them practically, urgently and with compassion.”
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