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ORIGINAL RESEARCH article

Front. Public Health

Sec. Public Mental Health

Volume 13 - 2025 | doi: 10.3389/fpubh.2025.1622005

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

Provisionally accepted
  • 1University of the Witwatersrand, Johannesburg, South Africa
  • 2University of Southampton, Southampton, United Kingdom

The final, formatted version of the article will be published soon.

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 sociodemographics. 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.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 emphasise the need for targeted interventions to address childhood adversity, improve health literacy, and enhance mental health resources across South Africa.

Keywords: Depression, Anxiety, ACE, Mental Health, multimorbidity, South Africa, national representative survey, health literacy

Received: 02 May 2025; Accepted: 05 Aug 2025.

Copyright: © 2025 Craig, Mabetha, Gafari and Norris. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Ashleigh Craig, University of the Witwatersrand, Johannesburg, South Africa

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