Violence prevention for South African male students needs mental health at its core, but the evidence is thin

Introduction

Most talk about gender-based violence at South African universities turns into talk about women, which is understandable when the survivors are overwhelmingly women. A scoping review of 82 studies on sexual violence against university students in sub-Saharan Africa found that the literature mostly concerned female students and victims, with male teachers and students named as the usual perpetrators (Mzilangwe et al., 2025). The same lopsidedness shows up in what institutions actually offer. A review of programmes at universities with medical campuses concluded that evidence on whether prevention and response interventions work is lacking (Hewett et al., 2023). So programmes aimed at men are few, and the ones that exist tend to be small.

My argument is that this gap is not only a matter of numbers. Mental health sits at both ends of the problem. Survivors carry depression and post-traumatic stress for a long time, and in some groups suicidal thoughts as well (Mhlongo et al., 2023; Pienaar et al., 2025). Young men who use violence also report depression and stress (Pakhomova et al., 2021), and one trial suggests depression may be a pathway through which a masculinity-focused programme reduced men’s violence (Oyekunle et al., 2023). Yet the programmes built for male students rarely measure any of this. I argue that prevention work with male students should be designed and evaluated with mental health in view, while keeping responsibility for harm exactly where it belongs. The paper looks first at what survivors carry, then at the mental health of young men, then at the programmes themselves, and ends with what the evidence can and cannot support.

What survivors carry

One of the strongest South African sources on the mental health effects of sexual violence is the Rape Impact Cohort Evaluation. Mhlongo et al. (2023) followed 734 women aged 16 to 40 who attended post-rape care within 20 days of an incident, alongside 786 women recruited from primary health care, for 24 months. At the end, 45.2% of the rape-exposed women met the cut-off for depression and 32.7% for PTSD, both higher than in the comparison group. Scores fell by three months and then stayed roughly flat. Mean depression scores remained above the cut-off, whereas PTSD scores slipped below it. Early supportive counselling, as reported by the women, was not associated with the course of either condition. That last result deserves attention, because counselling is what most campuses reach for first, and the study suggests that a single early contact cannot be assumed to protect anyone (Mhlongo et al., 2023).

Nöthling et al. (2022) looked at the same cohort from a different angle and asked who develops PTSD. Among 639 rape-exposed women assessed within 20 days and followed for six months, the incidence of PTSD at three months was 48.5%, and the cumulative incidence at six months reached 54.8%. Baseline rape stigma, meaning guilt, shame, self-blame and social devaluation, and baseline depression predicted PTSD scores over time, while features of the assault itself did not. The two papers fit together better than the numbers first suggest. PTSD looks very common early and appears to ease with time, while depression lingers (Mhlongo et al., 2023; Nöthling et al., 2022). And stigma is something a university can actually influence, through how reports are handled and how peers talk about people who come forward.

Suicidal thoughts need separate mention. Pienaar et al. (2025) analysed a representative survey of 491 women in Gauteng, collected in 2010, and found that 9% had experienced economic intimate partner violence in the past year, 24.2% reported depressive symptoms and 8% had thought about suicide in the previous month. After adjustment, economic abuse, meaning control over work, money and housing, was linked to both depressive symptoms and suicidal thoughts. Women aged 18 to 24 were more likely than older women to report suicidal thoughts. That age pattern points to young women as a group who are not cushioned by youth, even though the sample was not made up of students and the data are more than a decade old (Pienaar et al., 2025).

None of these three samples is a student sample (Mhlongo et al., 2023; Nöthling et al., 2022; Pienaar et al., 2025), and I want to be upfront about that. The cohort study recruited women using post-rape services and the Gauteng survey covered adult women in households. Student-specific evidence exists, but it is patchy. The sub-Saharan review covered only about a third of the region, found that victims rarely seek help from informal sources or authorities, and called for studies that include both genders and look at victims and perpetrators together (Mzilangwe et al., 2025). So when I carry these findings onto campuses I am reasoning by analogy, and the analogy is reasonable but not proven.

The young men on the other side of the data

Pakhomova et al. (2021) offer a South African dataset that sets young men and young women side by side. They used baseline data from 425 people aged 16 to 24 in Durban and Soweto, 60% of them women and 71.5% students or learners, and measured perceived stress alongside depression, anxiety and violence. Young women reported higher average stress than young men. Among the women, experiencing partner violence, probable depression and probable anxiety were each associated with higher stress. Among the men, ever having perpetrated partner violence, probable depression and probable anxiety were associated with higher stress too. In the men the coefficient for depression (6.0) was roughly twice the one for perpetration (2.95), which suggests depression travelled with stress more strongly. The data are cross-sectional, so the direction of travel is unknown: perpetrating violence might raise stress, or stress might feed into violence, or both might follow from something else (Pakhomova et al., 2021).

Where Pakhomova et al. (2021) could only describe an association, Oyekunle et al. (2023) go further by using a trial. They analysed data from a cluster randomised evaluation of Stepping Stones and Creating Futures, a programme combining gender-focused group work with economic support, among 674 men aged 18 to 30 in urban informal settlements, followed for 24 months. Men in the programme arm reported lower depression at 12 months, and lower depression at that point was linked to less partner violence at 24 months. The direct path from programme to reduced violence shrank from a coefficient of -0.46 to -0.13 once depression was in the model, and it was no longer clearly different from zero (p = 0.50 as reported). The authors read this as depression being one pathway through which the programme worked. If that holds, then mental health is not an add-on to violence prevention for men. It is part of how prevention works.

I would hold that conclusion loosely. The Stepping Stones trial involved young men in informal settlements, not residence students, and the programme bundled gender work with livelihoods support, so the fall in depression could just as easily reflect improved finances as improved masculinity norms (Oyekunle et al., 2023). Mediation analysis also cannot rule out unmeasured causes. Neither study shows that depression causes violence in any simple way, and nothing in them excuses it. What they do show is that a young man’s distress and his use of violence travel together often enough to deserve measurement (Oyekunle et al., 2023; Pakhomova et al., 2021).

What programmes for male students actually look like

De Villiers et al. (2021) describe the closest thing in this literature to a programme built for male university students. They adapted the One Man Can intervention for use with men in residences, working with 15 male student leaders at one South African institution, and ended up with a six-hour session. The researchers report that critical dialogue shifted norms about gender equality and about being a man, and that participants reflected on their own part in preventing sexual violence. It is a useful piece of development work. It is also tiny. Only five of the 15 participants could be found for interviews six months later, and the summary mentions no measure of depression, trauma or suicidal thoughts. The authors themselves note how little attention young men in low- and middle-income countries have received in prevention research (de Villiers et al., 2021).

Adrian et al. (2025) work with younger people, but their findings bear directly on how male-focused prevention might be built. A social norms survey of 1,431 students aged 13 to 19 at three high schools found large gaps, above 20%, between what students believed their peers did and thought, and what peers actually did and thought. Self-reported perpetration of unwanted sexual petting, oral, vaginal and anal sex was 61%, 53%, 53% and 44% among boys, and 42%, 26%, 20% and 18% among girls. Students underestimated how much their peers would back a bystander who steps in, overestimated peer acceptance of gender-based violence and underestimated how far peers would believe a survivor. Those are exactly the perceptions a bystander or norms programme can target. They also connect to the stigma findings above, since a survivor who expects not to be believed is in the position Nöthling et al. (2022) describe.

Set beside the women-focused work, the asymmetry stands out. Machisa et al. (2023) piloted Ntombi Vimbela! with first-year female students, ten workshops of 3.5 hours each, co-delivered by peer facilitators, with a mental wellbeing component built in. One year later, 98 participants completed the follow-up and their depressive symptoms had decreased, alongside improvements in rape myth acceptance and relationship negotiation. That was a single-arm pilot with no comparison group, so the authors rightly call for a randomised trial. Even so, it measured depression. As far as the published summaries show, the men’s programmes in this set did not (de Villiers et al., 2021; Machisa et al., 2023; Oyekunle et al., 2023). When it comes to evidence for men, the best mental health data come from a community trial and not from anything running on a campus.

It helps to separate what these programmes actually pull on. One Man Can, as adapted by de Villiers et al. (2021), works on what it means to be a man and on men’s role in preventing violence, which is the masculinity lever. Adrian et al. (2025) work on perceived peer norms, which sits closer to a bystander lever, because the misperceptions they found concern whether peers would back someone who steps in. Stepping Stones and Creating Futures pulls two levers at once, gender-focused group work and economic support (Oyekunle et al., 2023). Only the last of the three has a design that can say whether a lever worked, and only in the last has anyone asked what happened to the men’s mood along the way. Which lever matters most for a first-year male student in a residence is simply unknown.

The institutional picture does not help. Hewett et al. (2023) combined a rapid literature review with interviews at universities with medical campuses and found an urgent need to define GBV clearly and name it in policy, along with a lack of trust among staff and students in response teams and uncertainty about who does what when an incident is reported. They describe their work as a baseline and call for an evidence-informed framework of the key ingredients of effective prevention and response. If trust in reporting is low, a prevention session for men that surfaces disclosures, from survivors or from men with their own histories, may meet a referral system nobody believes in (Hewett et al., 2023; Mhlongo et al., 2023).

What the evidence can and cannot carry

The evidence supports a modest claim. Programmes for male students should include some attention to mental health, should measure it, and should be tied to services that work. The reasons are cumulative rather than decisive. Depression appears to lie on a route between a gender-focused programme and less violence among young men (Oyekunle et al., 2023), depression and stress travel with perpetration in young men just as they travel with victimisation in young women (Pakhomova et al., 2021), and survivors are likely to be carrying depression long after an early counselling session (Mhlongo et al., 2023). A prevention programme that runs for six hours and then leaves a facilitator with no referral route for a student who discloses suicidal thoughts is not ready for the people who will actually attend.

The evidence does not support more than that. The samples differ in age, setting and exposure: women using post-rape services, adult women in a household survey, young people in two cities, men in informal settlements, school pupils, and 15 residence leaders (Adrian et al., 2025; de Villiers et al., 2021; Mhlongo et al., 2023; Oyekunle et al., 2023; Pakhomova et al., 2021; Pienaar et al., 2025). The designs differ too, from a cluster randomised trial to cross-sectional data to a single-arm pilot to a small qualitative adaptation. I found no study among my ten that reports suicidal thoughts in men, and none that reports mental health among male student victims, which the sub-Saharan review suggests is a wider blind spot (Mzilangwe et al., 2025). The risk is building programmes that see men only as perpetrators and so miss the men who are survivors, as well as the ones who are both. This whole thing is hard to see from the data available, which is basically the point.

The practical implications follow from the gaps. A male-student programme could be piloted with a comparison group and measure depression, PTSD symptoms and suicidal thoughts at baseline and again at about a year, mirroring the follow-up used in the women’s pilot (Machisa et al., 2023). It could test whether changes in mental health carry any of the effect on violence, as Oyekunle et al. (2023) did, but in a student population. It could build in norms work of the kind Adrian et al. (2025) describe, since misperceptions about how peers treat survivors look correctable. And it could be linked to a campus response that students trust, because without that the best-designed session still ends at a closed door (Hewett et al., 2023).

Conclusion

My position is that violence prevention for South African male students has been designed mostly as a conduct and norms problem, when the evidence suggests mental health runs through it at several points. Survivors show persistent depression and high rates of PTSD (Mhlongo et al., 2023; Nöthling et al., 2022), young women report suicidal thoughts (Pienaar et al., 2025), and young men who perpetrate violence report depression and stress (Pakhomova et al., 2021). One trial hints that treating depression is part of how prevention works for men (Oyekunle et al., 2023).

That hint is thin, and it comes from outside the campus (Oyekunle et al., 2023). The programmes made for male university students are small and have not been evaluated for mental health outcomes (de Villiers et al., 2021; Hewett et al., 2023). For anyone designing or funding such programmes, the sensible next step is a properly evaluated pilot that measures mental health in men and survivors alike, is honest about what it cannot show, and is joined to services that students actually use. Until then, claims about what male-focused prevention does for mental health are hopes, and should be written as hopes.

Reference list

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