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While numerous studies relate to mental illness, few provide prevalence estimates of diagnosable mental illness (e.g., major depressive disorder as opposed to feeling depressed, or generalized anxiety disorder as opposed to feeling anxious), and fewer still provide national prevalence estimates of diagnosable mental illness. It been proven that most people with alcohol or substance use and anxiety disorders experience them independently, but having both can be a vicious cycle. The symptoms of one disorder can make the symptoms another worse; an anxiety disorder may lead to using alcohol or other substances to self-medicate or alleviate anxiety symptoms. The co-occurrence of substance abuse, particularly alcohol abuse, is common among people who have social anxiety disorder. People with this disorder report that alcohol helps lessen their social anxiety, although it often makes it worse. Alcohol abuse usually develops after the onset of this disorder. PTSD and substance abuse commonly occur together. People suffering from this disorder often use alcohol or drugs to try to ease their anxiety, but substance abuse can exacerbate PTSD symptoms. Mental ill-health is strongly associated with poverty and social deprivation and living in poverty, exposure to stressful life events like crime and violence; inadequate housing, unemployment and social conflict, are all linked to mental ill-health. An overwhelming majority of people with mental and psychosocial disabilities are living in poverty, poor physical health, and are subject to human rights violations. Mental health issues cannot be considered in isolation from other areas of development, such as education, employment, emergency responses and human rights capacity building. Despite overall global socio-economic development and improved social capital large part of this planet continues to be deprived. Poverty is one of the determinants of mental illnesses and social exclusion perpetuates deprivation. Since poverty is associated with exclusion, isolation, feelings of disempowerment, helplessness and hopelessness, it can lead to chronic insecurity and social mistrust, affecting people's mental well-being. Because of its close link to demographic and socio-economic factors, it is imperative that mental health is given as much weight or even more as a development issue and that appropriate programs are designed to address socioeconomic challenges resulting from mental disorders. In South Africa, as in many lowor middle-income countries (LMICs), the burden of mental disorders has grown over the past 20 years. Evidence suggests that nearly one in three South Africans will suffer from a mental disorder in his or her lifetime, a higher prevalence than many lowand middle-income countries. ( ). Based on assessment with the Kessler Psychological Distress Scale, a measure of psychological distress, 17.1% of the patients (15.5% of men and 19.4% of women) had severe psychological distress. Having no income, poor health status, migraine headache and tuberculosis as significant factors associated with severe psychological stress for men. For women the factors identified were lower education, no income, having been diagnosed with a sexually transmitted disease, stomach ulcer and migraine headache. Findings from World Health Organization World Mental Health surveys on the global burden of mental disorders have shown that at least one-third of all patients seen in primary care in LMICs present with common mental disorders (CMDs). Majority of these is not recognized or are ineffectively treated. Although depressive and anxiety disorders are classified as separate diagnostic categories in the ICD-10, 1 the concept of CMDs is valid for public health

south american journal of clinical research

The State of Mental Health in South Africa Cross Examination of the Vicious Cycle of the Demographic and Socio-Economic Factors that Affect Mental Health