Depressive symptoms among community service doctors in South Africa
DOI:
https://doi.org/10.7196/SAMJ.2026.v116i5.3388Keywords:
mental health of medical doctors , Depression, burnout, junior doctorsAbstract
Background. Medical doctors face occupational stressors threatening their mental health, particularly junior doctors in South Africa. There is a higher prevalence of depressive symptoms among medical doctors compared with the general population. The consequences of this to health systems and the patients doctors treat is a major public health concern. In South Africa, prevalence of depressive symptoms among community service doctors servicing public sector healthcare is largely unknown.
Objectives. To determine the prevalence of possible depression, and predictive factors thereof, among doctors in their community service year in South Africa.
Methods. A national descriptive cross-sectional survey was distributed electronically between October and December 2022. The Patient Health Questionnaire 9 (PHQ-9) was used to screen for depression. Demographic, occupational and individual characteristics were included as potential predictive factors.
Results. A total of 217 participants were included in the analyses. Prevalence of depressive symptoms was 96.3% (standard error 0.13, 95% confidence interval 92.87 - 98.40%). Predictors of higher scores included: women, drug use, feeling neutral or disagreeing that one worked outside of normal working hours, working in KwaZulu-Natal or North West, burnout (emotional exhaustion), working in orthopaedics, obstetrics and gynaecology departments or the National Health Laboratory Service, first choice of placement, financial difficulties, and accessing mental health services. Predictors of a lower score included: perceiving sufficient resources at work, using colleagues to cope, good work-life balance, and certain departments, particularly neurosurgery.
Conclusion. There is an extremely high prevalence of depressive symptoms among community service doctors. Supporting these doctors at an individual, organisational and structural level should be a priority for national policy-makers.
References
1. Søvold LE, Naslund JA, Kousoulis AA, et al. Prioritizing the mental health and wellbeing of healthcare workers: An urgent global public health priority. Front Public Health 2021;9:679397. http://doi. org/10.3389/fpubh.2021.679397
2. Bartholomew A, Sanatkar S, Counson I, Harvey SB. Junior doctors’ mental health and coronavirus disease safety concerns. Aust N Z J Public Health 2022;46(3):307-313. http://doi.org/10.1111/1753- 6405.13213
3. Aljuwaiser S, Brazzelli M, Arain I, Poobalan A. Common mental health problems in medical students and junior doctors – an overview of systematic reviews. J Ment Health 2024;33(6):779-815. https://doi. org/10.1080/09638237.2023.2278095
4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). 5th ed. Washington DC: American Psychiatric Association Publishing; 2013:991.
5. Sturman N, Tan Z, Turner J. ‘A steep learning curve’: Junior doctor perspectives on the transition from medical student to the healthcare workplace. BMC Med Educ 2017;17(1):92. https://doi.org/10.1186/ s12909-017-0931-2
6. Erasmus N. Slaves of the state – medical internship and community service in South Africa. S Afr Med J 2012;102(8):655. https://doi.org/10.7196/samj.5987
7. World Health Organization. 2022. World mental health report: Transforming mental health for all. https://www.who.int/publications/i/item/9789240049338 (accessed 4 October 2023).
8. Hain S, Tomita A, Milligan P, Chiliza B. Retain rural doctors: Burnout, depression and anxiety in medical doctors working in rural KwaZulu-Natal Province, South Africa. S Afr Med J 2021;111(12):1197. https://doi.org/10.7196/samj.2021.v111i12.15841
9. Herman AA, Stein DJ, Seedat S, Heeringa SG, Moomal H, Williams DR. The South Africa Stress and Health (SASH) study: 12-month and lifetime prevalence of common mental disorders. S Afr Med J 2009;99:339-344.
10. South African Medical Association (undated). South African Medical Association. Uniting doctors for the health of the nation. https://samedical.org/ (accessed 13 March 2025).
11. Reid SJ, Peacocke J, Kornik S, Wolvaardt G. Compulsory community service for doctors in South Africa: A 15-year review. S Afr Med J 2018;108(9):741. https://doi.org/10.7196/samj.2018.v108i9.13070
12. Hain S, Tomita A, Milligan P, Chiliza B. Retain rural doctors: Burnout, depression and anxiety in medical doctors working in rural KwaZulu-Natal Province, South Africa. S Afr Med J
2021;111(12):1197. https://doi.org/10.7196/samj.2021.v111i12.15841
13. Van Wijk CH, Martin JH, Maree DJF. Clinical validation of brief mental health scales for use in
South African occupational healthcare. SA J Ind Psychol 2021;47:a1895. https://doi.org/10.4102/sajip.
v47i0.1895
14. Levis B, Benedetti A, Thombs BD, DEPRESsion Screening Data (DEPRESSD) Collaboration. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: Individual participant data meta-analysis. BMJ 2019;l1476. https://doi.org/10.1136/bmj.l1476
15. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 2001;16(9):606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
16. Craig A, Rochat T, Naicker SN, et al. The prevalence of probable depression and probable anxiety, and associations with adverse childhood experiences and socio-demographics: A national survey in South Africa. Front Public Health 2022;10:986531. https://doi.org/10.3389/fpubh.2022.986531
17. Johns G, Samuel V, Freemantle L, Lewis J, Waddington L. The global prevalence of depression and anxiety among doctors during the covid-19 pandemic: Systematic review and meta-analysis. J Affect Disord 2022;298:431-441. https://doi.org/10.1016/j.jad.2021.11.026
18. Nazeema A, Lowton K, Tenea Z, Anic A, Jayrajh P. Study of burnout and depressive symptoms in doctors at a central level, state hospital. South Afr J Psychiatry 2023;29. https://doi.org/10.4102/sajpsychiatry.v29i0.1866 19. Carroll HA, Hook K, Perez OFR, et al. Establishing reliability and validity for mental health screening instruments in resource-constrained settings: Systematic review of the PHQ-9 and key recommendations.
Psychiatry Res 2020;291:113236. https://doi.org/10.1016/j.psychres.2020.113236
20. Mata DA, Ramos MA, Bansal N, et al. Prevalence of depression and depressive symptoms among resident physicians: A systematic review and meta-analysis. JAMA 2015;314(22):2373-2383. http://doi.org/10.1001/
jama.2015.15845
21. Sriharan A, Ratnapalan S, Tricco AC, et al. Occupational stress, burnout, and depression in women in healthcare during COVID-19 pandemic: Rapid scoping review. Front Glob Womens Health 2020;1:596690. https://doi.org/10.3389/fgwh.2020.596690
22. Naidu K, Torline JR, Henry M, Thornton HB. Depressive symptoms and associated factors in medical interns at a tertiary hospital. South Afr J Psychiatry 2019;25. https://doi.org/10.4102/sajpsychiatry.v25i0.1322
23. Kleinschmidt I, Pettifor A, Morris N, MacPhail C, Rees H. Geographic distribution of human immunodeficiency virus in South Africa. Am J Trop Med Hyg 2007;77(6):1163-1169.
24. Calarco CA, Lobo MK. Chapter Six – Depression and substance use disorders: Clinical comorbidity and shared neurobiology. In: Calipari ES, Gilpin NW, eds. Int Rev Neurobiol Academic Press 2021;157:245-309. https://doi.org/10.1016/bs.irn.2020.09.004
25. Shadakshari D, Muliyala KP, Jayarajan D, Kandasamy A. Occupational challenges in physicians with substance use disorder: A qualitative study. Indian J Psychol Med 2022;44(3):253-258. https://doi. org/10.1177/02537176211020520
26. Wijeratne C, Johnco C, Draper B, Earl J. Doctors’ reporting of mental health stigma and barriers to help- seeking. Occup Med Lond 2021;71(8):366-374. https://doi.org/10.1093/occmed/kqab119
27. Aust B, Leduc C, Cresswell-Smith J, et al. The effects of different types of organisational workplace mental health interventions on mental health and wellbeing in healthcare workers: a systematic review. Int Arch Occup Environ Health 2024;97(5):485-522. https://doi.org/10.1007/s00420-024-02065-z
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