ANXIETY

The following information is to be used as a guide and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

Anxiety is a normal human response to stress or perceived threat; a feeling of worry, unease, or fear that helps us stay alert and safe. However, when anxiety becomes persistent, overwhelming, or disproportionate to the situation, it can develop into an anxiety disorder: a clinical condition that significantly interferes with daily life, relationships, and physical health.

Anxiety disorders are not a sign of weakness or a character flaw. They are recognised medical conditions with biological, psychological, and social dimensions, and they are highly treatable.

Anxiety is the most common mental health condition in the world, affecting an estimated 301 million people globally according to the World Health Organisation (WHO). Yet fewer than one in four people with diagnosed anxiety receive adequate treatment.

ANXIETY IN SOUTH AFRICA

South Africa faces a significant mental health burden, shaped by a complex intersection of socio-economic inequality, historical trauma, high rates of violence, and limited access to mental healthcare services.

A 2022 nationally representative survey published in Frontiers in Public Health found that 17.8% of South African adults showed probable anxiety. Both probable depression and anxiety were most frequently reported among those who were widowed, divorced, or separated; living in urban informal settlements; and those with low income or unemployment.

SOUTH AFRICAN WOMEN ARE DISPROPORTIONATELY AFFECTED

South Africa’s National Mental Health Policy Framework and Strategic Plan 2023–2030 (Department of Health) explicitly recognises that “women are at increased risk of developing depression and anxiety disorders.” Key contextual drivers unique to South Africa include:

Gender-based violence (GBV):

South Africa has one of the highest rates of GBV in the world. According to Statistics SA (via SADAG), one in five women in South Africa experience physical violence and one in 17 suffer sexual violence by a partner. The femicide rate is estimated at nearly five times the global average. Exposure to violence is a significant driver of PTSD and anxiety.

A study in the NIH/PMC database (2022) found that experiences of intimate partner violence (IPV) were significantly associated with higher stress scores, independent of depression and anxiety, underscoring the compounding mental health burden of violence on South African women.
Poverty and unemployment:
Adverse childhood experiences (ACEs):
COVID-19 aftermath:

A WHO brief (2022) reported that the first year of the pandemic triggered a 25% increase in global anxiety and depression, with women more severely impacted than men. South Africa’s pandemic experience, including economic devastation and increased domestic violence during lockdowns, compounded existing vulnerabilities.
Pregnancy & the perinatal period:

A 2024 study published in the South African Journal of Psychiatry found that one in three pregnant women (33%) screened positive for anxiety symptoms. Younger age, lower social support, and unplanned or unwanted pregnancies were associated with higher anxiety risk.

WHY ARE WOMEN MORE VULNERABLE TO ANXIETY?

Research consistently shows that women are twice as likely as men to be diagnosed with an anxiety disorder over their lifetime. This is not simply a matter of women being “more emotional” — it reflects genuine biological, psychological, and social factors.

Biological & genetic factors
Hormonal fluctuations
Trauma and GBV

Exposure to sexual, physical, or emotional violence (including Intimate Partner Violence) is a powerful predictor of anxiety and PTSD. Exposure to GBV creates a state of chronic stress leading to heightened anxiety and hypervigilance. South African women face exceptionally high exposure to GBV across their lifespans.
Prior mental health history

HORMONES AND ANXIETY ACROSS A WOMAN’S LIFESPAN

One of the most important and underappreciated dimensions of anxiety in women is the role of reproductive hormones. Oestrogen and progesterone are not just “sex hormones”; they are powerful neuroactive substances that directly modulate serotonin, GABA (the brain’s calming chemical), and the stress hormone cortisol.

If your anxiety seems to worsen at particular points in your cycle, during pregnancy, postpartum, or around menopause, this is clinically significant information. Tell your healthcare provider; hormonal factors should be part of the assessment of anxiety in women.

Puberty

Many women notice anxiety symptoms that fluctuate with their cycle, particularly in the week before menstruation when progesterone levels rise and then fall sharply. Low progesterone can disrupt GABA signalling, reducing the brain’s capacity to dampen fear responses. Women with premenstrual dysphoric disorder (PMDD) experience severe anxiety and mood changes that are tied directly to hormonal shifts.
Pregnancy and the postpartum period

Both pregnancy and the postpartum period are windows of heightened vulnerability. The sharp decline in oestrogen and progesterone after childbirth can trigger or worsen anxiety. As noted above, South African research from Soweto found 33% of pregnant women screened positive for anxiety symptoms. Women with planned pregnancies and stronger social support had lower rates, highlighting the powerful role of social circumstances alongside biology.
Perimenopause and menopause

According to Johns Hopkins Medicine, when oestrogen and progesterone levels drop during perimenopause, serotonin levels fall too, contributing to increased irritability, nervousness, and anxiety. About four in ten women experience mood symptoms similar to PMS during perimenopause, often at times unrelated to any menstrual cycle.

Women with a prior history of anxiety are at even greater risk during this transition. A 2024 study in ScienceDirect confirmed that women are 1.56–1.61 times more likely to develop an anxiety disorder during perimenopause compared to premenopause.

TYPES OF ANXIETY DISORDER

The term “anxiety disorder” encompasses several distinct conditions. Understanding which type you may be experiencing is an important first step toward getting the right support.

Generalised Anxiety Disorder (GAD)
Panic Disorder
Social Anxiety Disorder
Specific phobias
Post-Traumatic Stress Disorder (PTSD)

Although now classified separately in diagnostic manuals, PTSD is closely linked to anxiety and is especially relevant for South African women given the country’s high rates of gender-based violence (GBV) and trauma exposure. Symptoms include flashbacks, nightmares, hypervigilance, and emotional numbing.
Separation Anxiety & Agoraphobia

RECOGNISING THE SYMPTOMS

Anxiety manifests across four domains: emotional, cognitive (thoughts), physical, and behavioural. Symptoms vary depending on the type of disorder, but commonly include:

Emotional and mood
Persistent worry or dread

Irritability or restlessness

Feeling “on edge” or “wound up”

Sense of impending doom

Difficulty relaxing
Cognitive (thoughts)
Racing or intrusive thoughts

Catastrophising (worst-case scenario thinking)

Difficulty concentrating

Mind going blank under stress

Excessive self-criticism
Physical
Rapid heartbeat or palpitations

Shortness of breath

Muscle tension or headaches

Fatigue and sleep disturbance

Nausea, sweating, trembling
Behavioural
Avoidance of feared situations

Withdrawing from social activities

Seeking constant reassurance

Difficulty completing tasks

Over-checking or repetitive rituals

WHEN TO SEEK HELP

If your anxiety symptoms persist for two weeks or more, are interfering with work, relationships, or daily activities, or are causing you significant distress, please speak to a healthcare provider. Anxiety is highly treatable — early intervention leads to better outcomes.

TREATMENT OPTIONS

The WHO’s 2023 updated Mental Health Gap Action Programme guidelines emphasise both psychological and pharmacological (medication) approaches to anxiety. Treatment should be tailored to the individual, the type of anxiety disorder, life stage, and personal preferences. All treatment should be overseen by a qualified healthcare professional.

Psychological therapy (talking therapies)
The 2023 WHO guidelines recommend Cognitive Behavioural Therapy (CBT) as the first-line psychological treatment for adults with Generalised Anxiety Disorder and Panic Disorder. CBT helps you identify and change unhelpful thought patterns and gradually face feared situations. Other evidence-based approaches include:

Acceptance and Commitment Therapy (ACT): focuses on accepting anxious thoughts rather than fighting them, and committing to values-based action

Mindfulness-Based Stress Reduction (MBSR): structured mindfulness practice that reduces anxiety reactivity

Exposure therapy: particularly effective for specific phobias and PTSD

Interpersonal therapy: useful when anxiety is linked to relationship difficulties or grief
Medication
The 2023 WHO guidelines recommend Selective Serotonin Reuptake Inhibitors (SSRIs) as the first-line medication for Generalised Anxiety Disorder and Panic Disorder in adults. Commonly used SSRIs include sertraline, escitalopram, and fluoxetine. Important considerations for South African women:

Medication decisions during pregnancy and breastfeeding require careful discussion with your doctor; some SSRIs are considered safer than others in these periods

Lorazepam/Ativan work to calm the central nervous system, making them highly effective for treating anxiety. Other benzodiazepines (like Diazepam/Valium) are no longer recommended by the WHO for Generalised Anxiety Disorders or Panic Disorder due to dependency risk. If prescribed, they should only be used for 3–7 days maximum for acute relief.

Medications typically take 4–6 weeks to show full effect; do not stop them suddenly without medical guidance

Generic SSRIs are available in South Africa and can be obtained through public health facilities
Combined approach

Research consistently shows that combining psychological therapy with medication produces better outcomes than either treatment alone for moderate-to-severe anxiety disorders. Your treatment plan may also need to address co-occurring conditions such as depression, substance use, or chronic physical illness; all of which are common alongside anxiety in South African women.
Hormonal and gynaecological considerations

For women whose anxiety is clearly tied to hormonal transitions, options may include hormonal contraception to stabilise menstrual-related anxiety, hormone replacement therapy (HRT) discussion for perimenopausal anxiety, or targeted treatments for PMDD. These decisions should always be made in consultation with a healthcare specialist, balancing mental health benefits against individual risks.

LIFESTYLE INTERVENTIONS THAT CAN HELP

While lifestyle changes alone cannot treat a clinical anxiety disorder, they are powerful complements to professional treatment and can significantly reduce symptom severity. These are evidence-based strategies supported by international health organisations including the WHO and the South African Department of Health:

1. Regular physical activity

Exercise is one of the most evidence-backed anxiety interventions available. Even 30 minutes of moderate activity (walking, dancing, swimming) most days can significantly reduce anxiety symptoms. Exercise increases serotonin and GABA and reduces cortisol. In the South African context, group activities and community exercise can also provide vital social connection.
2. Sleep hygiene

Anxiety and poor sleep feed each other in a vicious cycle. Prioritising 7–9 hours of sleep, maintaining a consistent sleep schedule, and creating a calm sleep environment all reduce anxiety. Avoiding screens and caffeine in the evenings can help. If anxiety is severely disrupting your sleep, discuss this with your healthcare provider.
3. Mindfulness and breathing practices

Slow, diaphragmatic breathing (breathe in for 4 counts, hold for 4, out for 6) activates the parasympathetic nervous system and can interrupt a panic response within minutes. Mindfulness meditation, even 10 minutes daily, has been shown to reduce anxiety disorder symptoms in clinical studies. Free guided meditations are available in multiple South African languages online (e.g. IMISA) and via apps.
4. Limiting alcohol and stimulants

Many South African women use alcohol to cope with anxiety, but alcohol is a central nervous system depressant that worsens anxiety in the long term by disrupting healthy brain signalling and sleep. Similarly, high caffeine intake can worsen palpitations and restlessness. Reducing or eliminating these can provide noticeable anxiety relief.
5. Social support and community connection

Strong social networks are consistently protective against anxiety. Women’s groups, faith communities, neighbourhood networks, and family support all reduce the psychological impact of stressors. In South Africa, where communal identity and ubuntu philosophy are central to many communities, leveraging existing social structures can be a powerful mental health resource.
6. Nutrition

While no specific diet “cures” anxiety, a balanced diet stabilises blood sugar (dips in blood sugar can trigger panic-like symptoms), and nutrients including magnesium, zinc, and B vitamins support nervous system function. Adequate protein intake supports serotonin production. Reducing processed foods and sugar intake may help stabilise mood.
7. Reducing exposure to anxiety-provoking media

Constant exposure to distressing news like crime statistics, political crises, and social media conflict, can maintain heightened anxiety. Intentional media breaks and limiting doomscrolling are evidence-backed strategies. This does not mean avoidance of all news, but setting boundaries around consumption times and platforms.
8. Safety planning for women experiencing GBV

For women whose anxiety is rooted in ongoing danger like intimate partner violence and community violence, lifestyle interventions alone are insufficient. Safety planning with a social worker or counsellor, and connecting with GBV services, is a necessary first step before anxiety can be meaningfully addressed. You deserve to be safe.

RESOURCES FOR SUPPORT

One of the most significant challenges South African women face is accessing mental health care. The South African Society of Psychiatrists (SASOP) reports that an estimated 92% of people living with mental illness in South Africa never receive treatment, and that for common conditions like anxiety and depression, three in four people go without help.

The South African Health Review (2024) confirms that the ratio of psychiatrists and psychologists to the population is critically low, especially in rural areas. There is an average of only 0.31 psychiatrists per 100,000 people in the state sector — compared to the WHO recommendation of at least 1 per 100,000. Around 50% of state hospitals offering psychiatric care have no psychiatrist, and 30% have no clinical psychologist.

Despite these barriers, options are available at multiple levels:

Public sector (free / low cost):

Primary healthcare (PHC) clinics and community health centres are the entry point for mental health services in the public sector. Your local clinic can screen you for anxiety and depression, provide basic counselling, and refer you to a district or regional hospital for specialist care where needed. Generic SSRIs and other medications are available through the public system. While waiting times can be long, your GP or clinic nurse can initiate first-line treatment while a specialist referral is arranged.

SADAG and NGO support: The South African Depression and Anxiety Group (SADAG) is the country’s leading mental health advocacy and support organisation. SADAG offers free telephonic counselling, online support groups, educational resources, and crisis lines. They are a critical and accessible resource for women who cannot afford private care: 0800 21 22 23
Online therapy:

Online and teletherapy platforms have expanded access to psychological care, particularly for women in urban areas with smartphones. Several South African providers offer sliding-scale fees. SACAP (South African College of Applied Psychology) notes these platforms as an increasingly viable option for those unable to access in-person care.
Bonitas Medical Aid:

Bonitas offers comprehensive mental health support across all plan options, including treatment for depression, anxiety, PTSD, and alcohol abuse. Key benefits include access to a dedicated counsellor, coverage for chronic medication, and unlimited hospitalisation for Prescribed Minimum Benefits (PMBs). Learn more about the Bonitas Mental Health Programme here.

HELPLINES AND SUPPORT RESOURCES

SADAG: General Mental Health 0800 21 22 23 (Toll-free, 24/7)
SADAG: Suicide Crisis Line 0800 567 567 (Toll-free, 24/7)
Stop Gender Violence Helpline: 0800 150 150 (Toll-free, for GBV survivors)
LifeLine South Africa: 0861 322 322 (Crisis counselling)
POWA (People Opposing Women Abuse): 011 642 4345 (GBV support for women)
FAMSA (Family & Marriage SA): 011 788 4784 (Relationship & family counselling)

ANXIETY

ANXIETY

The following information is to be used as a guide and at the discretion of the end-user and should not replace a doctor’s opinion.

OVERVIEW

ANXIETY IN SOUTH AFRICA

WHY ARE WOMEN MORE VULNERABLE TO ANXIETY?

HORMONES AND ANXIETY ACROSS A WOMAN’S LIFESPAN

TYPES OF ANXIETY DISORDER

RECOGNISING THE SYMPTOMS

TREATMENT OPTIONS

LIFESTYLE INTERVENTIONS THAT CAN HELP

RESOURCES FOR SUPPORT

FURTHER READING