Advancing workplace mental health equity in post-apartheid South Africa: an intersectional mixed-methods study

Abstract

Background Workplace mental health is a global public health priority, yet evidence from African contexts remains limited. This study examined workplace well-being through an intersectional social determinants lens in a South African organisational context to identify equity-relevant disparities and explain the mechanisms producing them. Methods An explanatory sequential mixed-methods design was employed. Quantitative survey data ( n = 87) assessed mental well-being (WEMWBS), perceived stress (PSS-4), work engagement (UWES-3), life satisfaction (SWLS), and flourishing across demographic groups (gender, race, generation, income, education). Qualitative data comprised one focus group discussion ( n = 9) and semi-structured interviews ( n = 10) exploring lived experiences of workplace well-being, stress, and engagement. Data were analysed using non-parametric tests and reflexive thematic analysis, with integration guided by an Intersectional Social Determinants Model. Intersectionality is explored primarily through qualitative inquiry and mixed-methods integration rather than quantitative interaction modelling, given sample size constraints. Results Gender significantly predicted mental well-being ( p = 0.015), with women reporting lower scores. Income significantly predicted mental well-being ( p = 0.033), life satisfaction ( p = 0.011), and perceived stress ( p < 0.001), with higher-income employees reporting better outcomes across all three domains. Race and generation showed no significant main effects. Qualitative findings helped explain these patterns through four mechanisms: (1) gendered unpaid labour and caregiving strain reduced women’s mental well-being, particularly among Black and Mixed ancestry (South Africa) women at specific intersections; (2) Black tax (kin-based financial obligations) appeared to constrain income’s protective effects, sustaining financial strain despite salary parity; (3) restrictive masculine norms constrained men’s emotional expression and help-seeking, masking distress in survey measures; and (4) race operated through intersectional mechanisms rather than as uniform main effects. Conclusion Workplace well-being in post-apartheid South Africa is shaped by intersecting social determinants rather than isolated demographic factors. Culturally responsive, equity-oriented interventions must address structural caregiving burdens, kin obligations, and masculine norm constraints while redistributing workplace demands and resources. Income’s protective effects are socially mediated: Black tax constrains financial benefit even at higher salary levels, challenging the assumption that economic resources operate uniformly in structurally unequal settings. The Intersectional Social Determinants Model offers an organising framework for future inquiry in similar contexts.