Context Matters: Urban Typology and Pandemic-Related Mental Health Decline in Low-Income South African Settings

Aim: We explored the negative impact of the COVID-19 pandemic on self-reported mental health and perceived social and economic challenges in very-low- to low- to middle-income households in four urban typologies in South Africa: formal township dwellings, backyard dwellings, inner-city high-density apartments, and informal settlement dwellings. The purpose was to inform urban policy and crisis-response planning. Methods: Structured interviews were conducted with 1330 adults from a stratified random sample from each urban typology during the third SARS-CoV-2 wave. Results: Respondents reported increases in anxiety (28.5%), depression (23.9%), and decreased social connectedness (20.0%). Conversely, some respondents reported improved mental health, with decreases in anxiety (16.3%), depression (18.4%), and increased social connectedness (17.5%). Anxiety and depression were more prevalent in formal township dwellings and high-density apartments than in informal settlements. Financial concerns, worries about isolation, crime, and community violence, and fear of COVID-19 infection and stigma were mostly associated with decreased mental health. Conclusions: Our findings suggest that residents from different urban typologies were affected differently by the COVID-19 pandemic. This research demonstrates the impact of environmental disasters on mental health in urban communities, which is mediated by social and economic problems.