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Miedema SS, Stamatakis C, Tracy A, Hegle J, Kamagate MF, McOwen J, Augusto A, Manuel P, Coomer R, Kambona C, Ramphalla P, Niolon P, Patel P, Annor FB. Patterns of adverse childhood experiences and their associations with mental distress, substance use and sexual risk behaviors in Sub-Saharan Africa. CHILD ABUSE & NEGLECT 2024; 150:106494. [PMID: 37806930 DOI: 10.1016/j.chiabu.2023.106494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/02/2023] [Accepted: 09/29/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Multiple adverse childhood experiences (ACEs) are associated with poor sexual and mental health outcomes in low- and middle-income countries (LMICs). Less well understood is how discrete and gendered clustering of ACEs may influence health. OBJECTIVE To assess how multiple ACEs co-occur and how dominant patterns of co-occurrence are associated with mental distress, substance use, and sexual risk behaviors among young women and men in Sub-Saharan Africa. PARTICIPANTS AND SETTING We used pooled data of young men and women aged 19-24 from comparable, nationally representative Violence Against Children and Youth Surveys (VACS) conducted in Cote d'Ivoire, Kenya, Lesotho, Mozambique, and Namibia (nf = 7183; nm = 2207). METHODS We estimated sex-disaggregated latent classes of six ACEs among young women and men. We ran Bolck-Croon-Hagenaars (BCH) distal outcome analysis to test the sex-stratified relationships between ACEs latent classes and health outcomes. RESULTS A six class solution best fit the female data. Classes included witnessing violence and experiencing physical violence (PV); experiencing PV; high ACEs; witnessing community violence; orphanhood; and low ACEs exposure. Among males, the best-fitting three-class solution included experiencing PV and witnessing community violence; high ACEs; and low ACEs exposure. Membership in the high ACEs class was associated with mental distress among females and males, and substance use among males. No differences in sexual risk behavior were identified by class membership among either females or males. CONCLUSIONS Discrete clusters of co-occurring ACEs are associated with elevated odds of mental distress among females, and mental distress and substance use among males. Preventing ACEs may improve mental health among young women and men in LMICs in Sub-Saharan Africa.
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Affiliation(s)
- Stephanie Spaid Miedema
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Caroline Stamatakis
- Division of Global HIV/TB, Center for Global Health, Centers for Disease Control and Prevention, Rwanda
| | | | - Jennifer Hegle
- Division of Global HIV/TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Jordan McOwen
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | | | - Pedro Manuel
- Centers for Disease Control and Prevention, Maputo, Mozambique
| | - Rachel Coomer
- Centers for Disease Control and Prevention, Windhoek, Namibia
| | | | | | - Phyllis Niolon
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Pragna Patel
- Division of Global HIV/TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Francis B Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Khanal G, Selvamani Y. Association of perceived childhood socio-economic status and health with depressive symptoms among middle-aged and older adults in India: using data from LASI Wave I, 2017-2018. BMC Geriatr 2024; 24:226. [PMID: 38443843 PMCID: PMC10916066 DOI: 10.1186/s12877-024-04800-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/10/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Childhood adverse experience has been linked with poor health outcomes across the life course. Nevertheless, whether such an association or direction could be projected to older people's life remains still unclear and needs to generate more evidence, particularly in India. Therefore, this study was conducted to examine the association of childhood socio-economic status and health with depressive symptoms amongst middle- aged and older adults in India. METHODS The data for the study was drawn from national representative survey "Longitudinal Ageing Study in India (LASI)" Wave I, 2017-2018 in order to conduct cross-sectional study. Multivariable regression analysis was used to examine the association of childhood socioeconomic status and health with depressive symptoms in the older population. RESULTS Poor childhood health was significantly and positively associated with depressive symptoms (AoR: 1.56, CI: 1.19, 2.04). Likewise, respondents who were bedridden for a month during their childhood had high odds of developing depressive symptoms (AoR: 1.16 CI: 1.01, 1.34). In addition to this, the odds of having depressive symptoms increased significantly among the average (AoR: 1.28 CI: 1.08, 1.51) and poor childhood socioeconomic status group (AoR: 1.31 CI: 1.11, 1.55) as compared to the higher socioeconomic category. CONCLUSIONS Childhood socioeconomic status and health have a significant role in determining mental health in later life. Results suggest that considering childhood socioeconomic status and health is important while diagnosing depression in older population in order to identify the significant associated factors in early childhood and thus help in preventing depressive symptoms in later life.
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Affiliation(s)
- Gayatri Khanal
- School of Public Health, SRM Institute of Science and Technology (SRMIST), Kattankulathur-603 203 Chengalpattu District, Chennai, Tamil Nadu, India
| | - Y Selvamani
- School of Public Health, SRM Institute of Science and Technology (SRMIST), Kattankulathur-603 203 Chengalpattu District, Chennai, Tamil Nadu, India.
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Kim AW, Said Mohamed R, Norris SA, Naicker S, Richter LM, Kuzawa CW. Childhood adversity during the post-apartheid transition and COVID-19 stress independently predict adult PTSD risk in urban South Africa: A biocultural analysis of the stress sensitization hypothesis. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 182:620-631. [PMID: 37283092 PMCID: PMC10700668 DOI: 10.1002/ajpa.24791] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 04/28/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES The COVID-19 pandemic in South Africa introduced new societal adversities and mental health threats in a country where one in three individuals are expected to develop a psychiatric condition sometime in their life. Scientists have suggested that psychosocial stress and trauma during childhood may increase one's vulnerability to the mental health consequences of future stressors-a process known as stress sensitization. This prospective analysis assessed whether childhood adversity experienced among South African children across the first 18 years of life, coinciding with the post-apartheid transition, exacerbates the mental health impacts of psychosocial stress experienced during the 2019 coronavirus (COVID-19) pandemic (ca. 2020-2021). MATERIALS AND METHODS Data came from 88 adults who participated in a follow-up study of a longitudinal birth cohort study in Soweto, South Africa. Childhood adversity and COVID-19 psychosocial stress were assessed as primary predictors of adult PTSD risk, and an interaction term between childhood adversity and COVID-19 stress was calculated to evaluate the potential effect of stress sensitization. RESULTS Fifty-six percent of adults exhibited moderate-to-severe PTSD symptoms. Greater childhood adversity and higher COVID-19 psychosocial stress independently predicted worse post-traumatic stress disorder symptoms in adults. Adults who reported greater childhood adversity exhibited non-significantly worse PTSD symptoms from COVID-19 psychosocial stress. DISCUSSION These results highlight the deleterious mental health effects of both childhood trauma and COVID-19 psychosocial stress in our sample and emphasize the need for greater and more accessible mental health support as the pandemic progresses in South Africa.
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Affiliation(s)
- Andrew Wooyoung Kim
- Department of Anthropology, University of California, Berkeley, Berkeley, California, USA
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rihlat Said Mohamed
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A Norris
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
- Global Health Research Institute, School of Human Development and Health, University of Southampton, Southampton, UK
| | - Sara Naicker
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Linda M Richter
- SAMRC Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Christopher W Kuzawa
- Department of Anthropology, Northwestern University, Evanston, Illinois, USA
- Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
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Tsheole P, Makhado L, Maphula A. Childhood Trauma and Exposure to Violence Interventions: The Need for Effective and Feasible Evidence-Based Interventions. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1760. [PMID: 38002851 PMCID: PMC10670457 DOI: 10.3390/children10111760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Several crimes in South Africa cause physical, economic, and mental problems. Xenophobic attacks, mob justice, and other violent conduct directly traumatise children. Service delivery riots and physical and sexual abuse are examples. This evaluation evaluates childhood trauma and exposure to violence interventions. The review describes the therapeutic methods for traumatised children exposed to violence, the healthcare professionals administering them, and the strategies used to tailor the interventions. The researcher systematically searched PsycINFO, Google Scholar, PubMed, Science Direct, and EBSCOhost. Literature from 2011 to 31 July 2023 was searched, and 19 papers were chosen for further review after the systematic search. The authors conducted an eligibility evaluation according to PRISMA guidelines. A thorough review of article texts identified 19 papers that met eligibility standards. Only nineteen studies have validated trauma and violence therapies for children. An effective multi-phased intervention that is feasible and adaptable to varied socioeconomic backgrounds is needed. Further studies on the mental health benefits of brief trauma intervention treatment are needed.
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Affiliation(s)
- Petunia Tsheole
- Department of Psychology, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
| | - Lufuno Makhado
- Public Health, Faculty of Health Care Sciences, University of Venda, Thohoyandou 0950, South Africa; (L.M.); (A.M.)
| | - Angelina Maphula
- Public Health, Faculty of Health Care Sciences, University of Venda, Thohoyandou 0950, South Africa; (L.M.); (A.M.)
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Byansi W, Galvin M, Chiwaye L, Luvuno Z, Kim AW, Sundararajan R, Tsai AC, Moolla A. Adverse childhood experiences, traumatic events, and mental health among adults at two outpatient psychiatric facilities in Johannesburg, South Africa: a cross-sectional analysis. BMC Psychiatry 2023; 23:581. [PMID: 37563695 PMCID: PMC10413614 DOI: 10.1186/s12888-023-05085-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Adverse childhood experiences and adult trauma, including sexual abuse, physical abuse, neglect, and interpersonal violence, are highly prevalent in low-resource settings and associated with adverse psychological outcomes. However, there is limited focus on the impact of ACEs and trauma on mental health in sub-Saharan Africa. Therefore, this study examines the impact of traumatic events and ACEs on depression, anxiety, and stress scores among outpatients receiving psychiatric care at two public mental health treatment facilities in Johannesburg, South Africa. METHODS A sample of 309 participants were recruited between January and June 2022 at Helen Joseph Hospital and Alexandra 18th Avenue Clinic. Participants completed screening measures for mental health outcomes, including the 9-item Patient Health Questionnaire (PHQ-9), the 7-item General Anxiety Disorder scale (GAD-7) and the 10-item Perceived Stress Scale. We fitted modified Poisson and linear regression models to estimate the impact of ACEs and adult experiences of trauma on depression, anxiety, and stress scale scores. RESULTS 47.57% (n = 147) of participants screened positive for anxiety, 44.66% (n = 138) for depression, and 17% (n = 54) for severe stress. More females screened positive for anxiety (65.31%), depression (65.94%), and stress (77.78%). Each ACE was associated with a 12% increased risk of depression, a 10% increased risk of anxiety, and a 17% increased risk of stress. In separately estimated models, each additional traumatic event during adulthood was associated with a 16% increased risk for depression, an 8% increased risk of anxiety, and a 26% increased risk of stress. Across all models, being male and self-reported physical health were consistently associated with a reduced risk for depression, anxiety, and stress. CONCLUSIONS ACEs and experiences of traumatic events as adults were associated with significantly increased risks of anxiety, depression, and severe stress. Given high exposure to ACEs and trauma and the associated impact on the mental health of individuals, families, and communities, there is a need to strengthen and scale innovative combination interventions that address multiple stressors impacting people in low-resource settings.
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Affiliation(s)
- William Byansi
- School of Social Work, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | - Michael Galvin
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Boston Medical Center, Department of Psychiatry, Boston, MA, USA
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - Lesley Chiwaye
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - Zoleka Luvuno
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew W Kim
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Anthropology, University of California, Berkeley, United States
| | - Radhika Sundararajan
- Weill Cornell Center for Global Health, New York City, New York, United States
- Department of Emergency Medicine, Weill Cornell Medicine, New York City, New York, United States
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Aneesa Moolla
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
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Somefun OD, Theron L, Höltge J, Ungar M. Resilience to depression: the role of benevolent childhood experiences in a South African sample. Front Psychol 2023; 14:1209504. [PMID: 37546432 PMCID: PMC10401265 DOI: 10.3389/fpsyg.2023.1209504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Background Studies elsewhere show that benevolent childhood experiences (BCEs) have protective mental health value. However, this protective value has never been investigated in an African context. Given the need to better understand what might support mental health resilience among African young people, this study explores the relationship between BCEs and depressive symptoms among a South African sample of young adults living in a community dependent on the economically volatile oil and gas industry. Methods A sample of young adults in an oil and gas community in South Africa (N = 313, mean age 20.3 years, SD = 1.83, range from 18 to 26; majority Black African) completed self-report questionnaires to assess BCEs and depressive symptoms (Beck Depression Inventory-II). The analysis controlled for socio-demographics and experience of family adversity. Multinomial logistic regressions were used to examine the association of BCEs with depressive symptoms using STATA 17. Results The majority (86.4% of the sample) reported all 10 BCEs. Of the 10 BCEs, having at least one good friend was the most reported (94%) compared to 75% of the sample reporting having a predictable home routine, such as regular meals and a regular bedtime. The unadjusted multinomial logistic regression analysis indicated that having at least one good friend, comforting beliefs, and being comfortable with self were associated with lower odds of moderate depression. The adjusted results showed no association between BCEs and the depression of young adults in this sample. Conclusion In this South African sample, our results do not show protective associations between BCEs and depression. This could be as a result of the homogeneity in our sample. It is also possible that the BCEs explored could not counteract the effect of chronic risk factors in the lives of the young people in this study context. Further research is needed to understand this complexity.
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Affiliation(s)
| | - Linda Theron
- Department of Educational Psychology, University of Pretoria, Pretoria, South Africa
| | - Jan Höltge
- Department of Psychology, University of Hawai’i at Mānoa, Honolulu, HI, United States
| | - Michael Ungar
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
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Oyekunle V, Tomita A, Gibbs A. High levels of poor mental health among young men in urban informal settlements in South Africa: a community-based study of social determinants. PSYCHOL HEALTH MED 2023; 28:2606-2620. [PMID: 35699350 DOI: 10.1080/13548506.2022.2088816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/07/2022] [Indexed: 10/18/2022]
Abstract
Informal settlements (high population density areas at the outskirts of urban areas characterized by lack basic amenities) in South Africa are consequences of apartheid regime's discriminatory migrant labour and spatial policy and continue to grow. Living in informal settlements accompanies a mire of social/health challenges that threatens upward mobility, but few studies exist that document drivers of mental health challenges in these settings. We investigated the prevalence and social determinants of poor mental health for young men in informal settlements adjacent to one of the largest cities that is at the heart of HIV endemic in South Africa. This study involved a cross-sectional study with cluster sampling design of 674 young men aged 18-30 years residing in eThekwini informal settlement communities. We assessed the prevalence, and social determinants, of significant depressive (i.e., depression) and post-traumatic stress (i.e., PTS) symptoms using logistic regression. Given the complex survey design of the study, all analyses were adjusted for clustering. The prevalence of depression and PTS in the sample was 46.8% and 14.4% respectively. Results of the multivariable analyses indicated that severe food insecurity (aOR = 2.98, 95% CI:1.70-5.22), crime perpetration (aOR = 1.51, 95% CI:1.05-3.80), severe adverse childhood event (aOR = 2.00, 95% CI: 1.05-3.80), traumatic event exposures (aOR = 2.43, 95% CI:1.56-3.80) and problematic alcohol use (aOR = 1.73, 95% CI:1.20-2.49) were significantly associated with depression. While incomplete secondary education (aOR = 0.45, 95% CI:0.22-0.92), moderate food insecurity (aOR = 2.51, 95% CI:1.04-6.06), traumatic event exposures (aOR = 2.19, 95% CI:1.32-3.64) and problematic alcohol use (aOR = 2.15, 95% CI: 1.24-3.73) were significantly associated with PTS. Our study highlights the exceedingly high levels of poor mental health among young men in informal settlements, with depression and PTS being driven by economic/social conditions. Multilevel interventions that address the individual, interpersonal, and social variables that contribute to poor mental health are needed.
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Affiliation(s)
- Victoria Oyekunle
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-NatalKwaZulu-Natal, Durban, South Africa
| | - Andrew Gibbs
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
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Ramsoomar L, Gibbs A, Chirwa ED, Machisa MT, Alangea DO, Addo-Lartey AA, Dunkle K, Jewkes R. Pooled analysis of the association between mental health and violence against women: evidence from five settings in the Global South. BMJ Open 2023; 13:e063730. [PMID: 36921941 PMCID: PMC10030569 DOI: 10.1136/bmjopen-2022-063730] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES To describe associations between men's poor mental health (depressive and post-traumatic stress symptomatology) and their perpetration of intimate partner violence (IPV) and non-partner sexual violence (NPSV), and women's mental health and their experiences of IPV and NPSV in five settings in the Global South. DESIGN A pooled analysis of data from baseline interviews with men and women participating in five violence against women and girls prevention intervention evaluations. SETTING Three sub-Saharan African countries (South Africa, Ghana and Rwanda), and one Middle Eastern country, the occupied Palestinian territories. PARTICIPANTS 7021 men and 4525 women 18+ years old from a mix of self-selecting and randomly selected household surveys. MAIN OUTCOME MEASURES All studies measured depression symptomatology using the Centre for Epidemiological Studies-Depression, and the Harvard Trauma Scale for post-traumatic stress disorder (PTSD) symptoms among men and women. IPV and NPSV were measured using items from modified WHO women's health and domestic violence and a UN multicountry study to assess perpetration among men, and experience among women. FINDINGS Overall men's poor mental health was associated with increased odds of perpetrating physical IPV and NPSV. Specifically, men who had more depressive symptoms had increased odds of reporting IPV (adjusted OR (aOR)=2.13; 95%CI 1.58 to 2.87) and NPSV (aOR=1.62; 95% CI 0.97 to 2.71) perpetration compared with those with fewer symptoms. Men reporting PTSD had higher odds of reporting IPV (aOR=1.87; 95% CI 1.44 to 2.43) and NPSV (aOR=2.13; 95% CI 1.49 to 3.05) perpetration compared with those without PTSD. Women who had experienced IPV (aOR=2.53; 95% CI 2.18 to 2.94) and NPSV (aOR=2.65; 95% CI 2.02 to 3.46) had increased odds of experiencing depressive symptoms compared with those who had not. CONCLUSIONS Interventions aimed at preventing IPV and NPSV perpetration and experience must account for the mental health of men as a risk factor, and women's experience.
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Affiliation(s)
- Leane Ramsoomar
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- School of Health Systems and Public Health, University of the Pretoria, Gauteng, South Africa
| | - Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- Department of Psychology, University of Exeter, Exeter, Devon, UK
| | - Esnat D Chirwa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Mercilene T Machisa
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Deda Ogum Alangea
- Department of Population, Family & Reproductive Health, University of Ghana School of Public Health, Legon, Accra, Ghana
| | - Adolphina Addoley Addo-Lartey
- Department of Population, Family & Reproductive Health, University of Ghana School of Public Health, Legon, Accra, Ghana
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, Gauteng, South Africa
- School of Health Systems and Public Health, University of the Pretoria, Gauteng, South Africa
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Claudius M, Shino EN, Job S, Hofmann D, Thalmayer AG. Still Standing Inside: A Local Idiom Related to Trauma among Namibian Speakers of Khoekhoegowab. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14323. [PMID: 36361207 PMCID: PMC9657148 DOI: 10.3390/ijerph192114323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/18/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Euro-centric psychiatric conceptualizations often ignore the interplay of local with universal factors in psychological suffering. Emic, locally focused perspectives can enrich etic knowledge to provide culturally sensitive care and to better elucidate the role of culture in mental illness. This study explored the idiom Tsûsa ǃNaeǃkhais xa hâǃnâ/mâǃnâ/ǂgâǃnâhe hâ (a terrible event has entered a person and remains standing inside), which was understood to relate to experiences of trauma and post-traumatic stress, among speakers of Khoekhoegowab, a southern-African click language. Semi-structured interviews were conducted with 16 participants from six urban and rural communities in Namibia. Questions probed perceptions of the idiom in terms of etiology, course, and risk and resilience factors from a socio-ecological framework. Five key themes were identified using thematic analysis: origin in a shocking event; intrusive recurrence of memories, "it keeps on coming back"; the close interplay between mental and physical suffering; the importance of active engagement in healing through prayer and acceptance; and the role of the community in both alleviating and amplifying distress. Our findings highlight local norms and strategies for adaptive coping, and the benefits of exploring local idioms to elucidate the braiding together of universal and cultural elements in psychological distress.
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Affiliation(s)
- Milena Claudius
- Institute of Psychology, University of Bern, 3012 Bern, Switzerland
- Department of Psychology and Professional Counseling, Webster University Geneva, 1293 Bellevue, Switzerland
| | - Elizabeth N. Shino
- Department of Psychology and Social Work, Faculty of Health Sciences & Veterinary Medicine, University of Namibia, Windhoek 10026, Namibia
| | - Sylvanus Job
- Department of Humanities and Arts, Faculty of Education & Human Sciences, University of Namibia, Windhoek 10026, Namibia
| | - Daniel Hofmann
- Department of Psychology, University of Zurich, 8050 Zurich, Switzerland
| | - Amber Gayle Thalmayer
- Department of Psychology, University of Zurich, 8050 Zurich, Switzerland
- Institute of Psychology, University of Lausanne, 1015 Lausanne, Switzerland
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Vivalya BMN, Vagheni MM, Piripiri AL, Masuka RK, Omba AN, Mankubu AN, Andjafono DOLE, Kitoko GMB. Prevalence and factors associated with relapse and long hospital stay among adult psychiatric patients with a history of childhood trauma. Psychiatry Res 2022; 316:114745. [PMID: 35917653 DOI: 10.1016/j.psychres.2022.114745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 11/27/2022]
Abstract
This cross-sectional multicentre-based study determined the magnitude of relapse, long hospital stay and factors of mental illness associated with a history of childhood trauma. We assessed 335 adult psychiatric patients and living in conflict areas, using a questionnaire established from items of the Adverse Childhood Experience International Questionnaire, Multidimensional Scale of Perceived Social Support, Rosenberg Self-esteem Questionnaire, Relapse Assessment Tool, and Self-report of hospital stay. Logistic regression analyses were used to determine associations between predictors and relapse and long hospital stay. 298 participants (88.9%) had experienced childhood adversities, among which 44.4% reported more than five childhood traumas. Relapse occurred in 40.9% of participants, whereas long hospital stay occurred in 71.1% of cases. Predictors of long hospital stay were emotional abuse, substance use and living in rural settings. Being an employed and experiencing a childhood trauma committed by a parent increase the likelihood risk of relapse of mental illness associated with childhood trauma. Being treated by childhood trauma-focused interventions decreases the risk of relapse and shorter the length of hospital stay. Building a mental health capacity should be centered on detecting patients with childhood trauma committed by the parent, those with low-self esteem, and victims of emotional abuse.
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Affiliation(s)
- Bives Mutume Nzanzu Vivalya
- Department of Psychiatry, Kampala International University Western Campus Bushenyi, Uganda; Department of Internal Medicine, Masereka General Referral Hospital, North-Kivu, Democratic Republic of the Congo.
| | | | - Astride Lina Piripiri
- Kinshasa School of Public Health, Faculty of Medicine University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Rock Kasereka Masuka
- Faculty of Medicine, Catholic University of Graben, Butembo, Democratic Republic of the Congo
| | - Ally Ndjukendi Omba
- Department of psychiatry, University of Kinshasa, Democratic Republic of Congo
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Machisa MT, Chirwa E, Mahlangu P, Nunze N, Sikweyiya Y, Dartnall E, Pillay M, Jewkes R. Suicidal Thoughts, Depression, Post-Traumatic Stress, and Harmful Alcohol Use Associated with Intimate Partner Violence and Rape Exposures among Female Students in South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137913. [PMID: 35805572 PMCID: PMC9266174 DOI: 10.3390/ijerph19137913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022]
Abstract
While ample evidence from high-income country settings indicates the prevalence and risk factors for multiple mental ill-health symptoms in student populations, evidence from low- and middle-income higher education settings remains limited. We determined the frequency, associations, and structural pathways between mental health outcomes and possible risk factors among a sample of 1292 predominantly Black African and female students ages 18–30 years, enrolled at nine purposefully selected public universities and Technical Vocational Education and Training (TVET) campuses. We measured and created a mental ill-health latent outcome consisting of depressive symptoms, post-traumatic stress disorder (PTSD), and suicidal thoughts. We also measured traumatic exposures including childhood trauma, recent intimate partner violence (IPV), non-partner rape, and other life traumatic events. We used structural equation modelling to analyse data. We found that 50% of the surveyed students binge drank, 43% reported depressive symptoms, 9% reported PTSD symptoms, and 21% had suicidal thoughts. Students’ experiences of childhood trauma, food insecurity, other traumatic events, non-partner rape, and IPV impacted the mental ill-health latent. IPV experiences mediated the relationships between experiences of childhood trauma or other trauma and the mental ill-health latent, and the relationship between binge drinking and other life traumatic events. Non-partner rape mediated the relationship between food insecurity and the mental ill-health latent. Binge drinking directly impacted non-partner rape experience. The findings substantiate the need for campus-based mental health promotion, psychosocial services and treatments, and implementation of combined interventions that address the intersections of violence against women and mental health among students in South Africa.
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Affiliation(s)
- Mercilene Tanyaradzwa Machisa
- South African Medical Research Council Gender and Health Research Unit, 1 Soutpansberg Road, Pretoria Private Bag x385, Pretoria 0001, South Africa; (E.C.); (P.M.); (N.N.); (Y.S.); (R.J.)
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 60 York Road, Parktown, Johannesburg 2193, South Africa
- Correspondence:
| | - Esnat Chirwa
- South African Medical Research Council Gender and Health Research Unit, 1 Soutpansberg Road, Pretoria Private Bag x385, Pretoria 0001, South Africa; (E.C.); (P.M.); (N.N.); (Y.S.); (R.J.)
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 60 York Road, Parktown, Johannesburg 2193, South Africa
| | - Pinky Mahlangu
- South African Medical Research Council Gender and Health Research Unit, 1 Soutpansberg Road, Pretoria Private Bag x385, Pretoria 0001, South Africa; (E.C.); (P.M.); (N.N.); (Y.S.); (R.J.)
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 60 York Road, Parktown, Johannesburg 2193, South Africa
| | - Ncediswa Nunze
- South African Medical Research Council Gender and Health Research Unit, 1 Soutpansberg Road, Pretoria Private Bag x385, Pretoria 0001, South Africa; (E.C.); (P.M.); (N.N.); (Y.S.); (R.J.)
| | - Yandisa Sikweyiya
- South African Medical Research Council Gender and Health Research Unit, 1 Soutpansberg Road, Pretoria Private Bag x385, Pretoria 0001, South Africa; (E.C.); (P.M.); (N.N.); (Y.S.); (R.J.)
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 60 York Road, Parktown, Johannesburg 2193, South Africa
| | - Elizabeth Dartnall
- Sexual Violence Research Initiative, 28 High Street, Waterkloof, Pretoria 0145, South Africa;
| | - Managa Pillay
- Department of Basic Education, 222 Struben Street, Pretoria Central, Pretoria 0001, South Africa;
| | - Rachel Jewkes
- South African Medical Research Council Gender and Health Research Unit, 1 Soutpansberg Road, Pretoria Private Bag x385, Pretoria 0001, South Africa; (E.C.); (P.M.); (N.N.); (Y.S.); (R.J.)
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 60 York Road, Parktown, Johannesburg 2193, South Africa
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12
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Hatcher AM, Mkhize SP, Parker A, de Kadt J. Depressive symptoms and violence exposure in a population-based sample of adult women in South Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001079. [PMID: 36962572 PMCID: PMC10021317 DOI: 10.1371/journal.pgph.0001079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 09/19/2022] [Indexed: 03/26/2023]
Abstract
Depressive symptoms are a major burden of disease globally and is associated with violence and poverty. However, much of the research linking these conditions is from resource-rich settings and among smaller, clinical samples. Secondary data from a household survey in Gauteng Province of South Africa examines the cross-sectional association between adult women's elevated depressive symptoms and markers of violence. Using tablet computers, participants self-completed interview modules to screen for depressive symptoms (Patient Health Questionnaire 2-item screener), childhood exposure to physical and sexual abuse (Childhood Trauma Questionnaire 4-item index), as well as past-year exposure to sexual or intimate partner violence (SIPV; WHO Multicountry Study instrument 4-item index). Socio-economic status, food security, education, and income were self-reported. Representative data at the ward level allows for modeling of results using survey commands and mixed-level modeling. Of the 7,276 adult women participating in the household survey, 42.1% reported elevated depressive symptoms. A total of 63.9% reported childhood violence exposure and 5.3% had past-year SIPV. Multi-level modeling suggests that violence is a strong predictor of depressive symptoms. Childhood abuse alone increases the odds of high depressive symptomology, after controlling for individual-level markers of poverty and neighborhood of residence (aOR 1.31, 95%, CI 1.17-1.37). Combined exposure to childhood abuse and past-year SIPV increased odds of reporting elevated depressive symptoms (aOR 2.05, 95%, CI 1.54-2.71). Ward characteristics account for 6% of the variance in depressive symptoms, over and above the contributions of household food security and socio-economic status. Exposure to violence in childhood and past-year SIPV were associated with depressive symptoms among women. These associations persist after controlling for socio-economic markers and latent neighborhood characteristics, which also had significant association with elevated depressive symptoms. These data suggest that efforts to reduce the burden of depressive symptoms may benefit from approaches that prevent violence against women and children.
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Affiliation(s)
- Abigail M Hatcher
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sthembiso Pollen Mkhize
- Gauteng City Regional Observatory, University of Johannesburg and University of the Witwatersrand, Johannesburg, South Africa
| | - Alexandra Parker
- Gauteng City Regional Observatory, University of Johannesburg and University of the Witwatersrand, Johannesburg, South Africa
| | - Julia de Kadt
- Gauteng City Regional Observatory, University of Johannesburg and University of the Witwatersrand, Johannesburg, South Africa
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Starnes JR, Di Gravio C, Irlmeier R, Moore R, Okoth V, Rogers A, Ressler DJ, Moon TD. Characterizing multidimensional poverty in Migori County, Kenya and its association with depression. PLoS One 2021; 16:e0259848. [PMID: 34784390 PMCID: PMC8594838 DOI: 10.1371/journal.pone.0259848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 10/27/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Narrow, unidimensional measures of poverty often fail to measure true poverty and inadequately capture its drivers. Multidimensional indices of poverty more accurately capture the diversity of poverty. There is little research regarding the association between multidimensional poverty and depression. METHODS A cross-sectional survey was administered in five sub-locations in Migori County, Kenya. A total of 4,765 heads of household were surveyed. Multidimensional poverty indices were used to determine the association of poverty with depression using the Patient Health Questionnaire (PHQ-8) depression screening tool. RESULTS Across the geographic areas surveyed, the overall prevalence of household poverty (deprivation headcount) was 19.4%, ranging from a low of 13.6% in Central Kamagambo to a high of 24.6% in North Kamagambo. Overall multidimensional poverty index varied from 0.053 in Central Kamagambo to 0.098 in North Kamagambo. Of the 3,939 participants with depression data available, 481 (12.2%) met the criteria for depression based on a PHQ-8 depression score ≥10. Poverty showed a dose-response association with depression. CONCLUSIONS Multidimensional poverty indices can be used to accurately capture poverty in rural Kenya and to characterize differences in poverty across areas. There is a clear association between multidimensional poverty and depressive symptoms, including a dose effect with increasing poverty intensity. This supports the importance of multifaceted poverty policies and interventions to improve wellbeing and reduce depression.
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Affiliation(s)
- Joseph R. Starnes
- Department of Pediatrics, Vanderbilt University Medical Center, Ashville, Tennessee, United States of America
- Lwala Community Alliance, Rongo, Migori County, Kenya
- * E-mail:
| | - Chiara Di Gravio
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Rebecca Irlmeier
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Ryan Moore
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
| | - Vincent Okoth
- Lwala Community Alliance, Rongo, Migori County, Kenya
| | - Ash Rogers
- Lwala Community Alliance, Rongo, Migori County, Kenya
| | | | - Troy D. Moon
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America
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The prevalence and correlates of depression before and after the COVID-19 pandemic declaration among urban refugee adolescents and youth in informal settlements in Kampala, Uganda: A longitudinal cohort study. Ann Epidemiol 2021; 66:37-43. [PMID: 34785396 PMCID: PMC8590831 DOI: 10.1016/j.annepidem.2021.11.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 11/03/2021] [Accepted: 11/04/2021] [Indexed: 12/27/2022]
Abstract
Purpose There is scant research examining urban refugee youth mental health outcomes, including potential impacts of the COVID-19 pandemic. We examine prevalence and ecosocial risk factors of depression in the periods before and after the COVID-19 pandemic declaration among urban refugee youth in Kampala, Uganda. Methods Data from a cohort of refugee youth (n = 367) aged 16–24 years were collected in periods before (February 2020) and after (December 2020) the WHO COVID-19 pandemic declaration. We developed crude and adjusted generalized estimating equation logistic regression models to examine demographic and ecosocial factors (food insecurity, social support, intimate partner violence) associated with depression, and include time-ecosocial interactions to examine if associations differed before and after the pandemic declaration. Results The prevalence of depression was high, but there was no significant difference before (27.5%), and after (28.9%) the pandemic declaration (P = .583). In adjusted models, food insecurity (aOR: 2.54; 95% CI: 1.21–5.33) and experiencing violence (aOR: 2.53; 95% CI: 1.07–5.96) were associated with increased depression, and social support was associated with decreased depression (aOR: 0.85; 95% CI: 0.81–0.89). Conclusions These findings highlight the urgent need for interventions to address chronic depression, food insecurity, and ongoing effects of violence exposure among urban refugee youth in Kampala.
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Vinaccia Alpi S, Ortega Bechara A. Variables asociadas a la ansiedad-depresión en estudiantes universitarios. UNIVERSITAS PSYCHOLOGICA 2021. [DOI: 10.11144/javeriana.upsy19.vaad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
La salud, como un estado subjetivo de bienestar, responde a las características del contexto sociodemográfico. Estudios previos sugieren que los indicadores de salud mental entre estudiantes universitarios son comparativamente menores que los del resto de la población, probablemente debido a la interacción de factores contextuales. Este estudio busca evaluar la relación entre variables sociodemográficas, ansiedad y depresión en estudiantes de una universidad en la costa Atlántica colombiana. En un diseño transversal, los participantes (n = 6.224) completaron la escala PROMIS y un cuestionario de información sociodemográfica. Mediante análisis descriptivos se examinaron la incidencia y comorbilidad de la ansiedad-depresión. El efecto de las variables sociodemográficas en la ansiedad-depresión se analizó con un modelo regresión logística. Resultados. 55.7 % de los participantes presentaron síntomas de ansiedad, 32.2 % presentaron síntomas de depresión, y 28.9 % presentaron comorbilidad. El sexo, estado civil, grupo étnico y estrato socioeconómico fueron predictores significativos de la ansiedad-depresión. Los hallazgos indican que la ansiedad y la depresión son frecuentes entre estudiantes universitarios. La importancia de desarrollar intervenciones para promover la salud en el desempeño profesional de los estudiantes es discutida.
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Abstract
Globally, 10–20% of children and adolescents experience mental health conditions, but most of them do not receive the appropriate care when it is needed. The COVID-19 deaths and prevention measures, such as the lockdowns, economic downturns, and school closures, have affected many communities physically, mentally, and economically and significantly impacted the already-neglected children and adolescents’ mental health. As a result, evidence has shown that many children and adolescents are experiencing psychological effects such as depression and anxiety without adequate support. The consequences of not addressing the mental health conditions in children and adolescents extend through adulthood and restrict them from reaching their full potential. The effects of COVID-19 on children and adolescents’ mental health highlight the urgent need for multisectoral home-grown solutions to provide early diagnosis and treatment and educate caregivers on home-based interventions and community outreach initiatives to address children and adolescents’ mental health challenges during this pandemic and beyond.
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Pathways to Depression and Poor Quality of Life Among Adolescents in Western Kenya: Role of Anticipated HIV Stigma, HIV Risk Perception, and Sexual Behaviors. AIDS Behav 2021; 25:1423-1437. [PMID: 32737818 DOI: 10.1007/s10461-020-02980-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Depression is a major cause of disease burden and is linked to poor quality of life (QOL) among adolescents. We examined the roles of sexual behaviors, HIV risk perception, and anticipated HIV stigma on depressive symptomatology and QOL among 4096 adolescents in a rural region of western Kenya with a high burden of HIV. Participants were aged 15-19 years, had not been tested for HIV in the previous 6 months, and had never been diagnosed with HIV. Anticipated stigma and risk perception were directly associated with depressive symptomatology and QOL. There was evidence of small indirect effects-through stigma-of risk perception on depressive symptomatology and QOL. Gender moderated relationships between sexual behavior and risk perception, depressive symptomatology, and QOL. Results suggest that developing effective gender-based interventions to address stigma, sexual behavior, and risk perception may be important for improving adolescent well-being in high HIV prevalence contexts.
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18
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Bell J, Sharma S, Malone S, Levy M, Reast J, Ciecieląg J, Gogolina S, Ansons T, Fourie S, Braz R, Little K, Hasen N. Targeting interventions for HIV testing and treatment uptake: An attitudinal and behavioural segmentation of men aged 20-34 in KwaZulu-Natal and Mpumalanga, South Africa. PLoS One 2021; 16:e0247483. [PMID: 33690691 PMCID: PMC7946194 DOI: 10.1371/journal.pone.0247483] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 02/08/2021] [Indexed: 11/19/2022] Open
Abstract
Despite recent improvements, men still have worse HIV outcomes than women in South Africa. This study describes how young men form distinct behavioural and attitudinal subgroups, and is intended to inform the design of targeted interventions to encourage HIV testing and initiation on antiretroviral therapy. Data were collected using a cross-sectional survey with questions on men’s attitudes, beliefs and behaviours around HIV/AIDS. A total of 2,019 men were randomly sampled from eight district municipalities in KwaZulu-Natal and Mpumalanga provinces between October 2018 and January 2019. Men were eligible to participate if they were aged 20–34, Black African, had an education level below university graduation, were aware of HIV and were willing to disclose whether they had tested for HIV. Each participant responded to a questionnaire asking about their demographic characteristics, reported sexual behaviour, engagement with HIV testing and treatment services, alcohol consumption, HIV knowledge, attitudes to gender equity and reported level of depressive symptoms. Data were analysed using canonical correlation, hierarchical clustering and factor analysis techniques to produce five groups of men. The results were synthesised using Human Centred Design principles to suggests areas for potential intervention for each segment. The results showed that men vary based on their attitudes to gender and masculinity, use of alcohol, testing and treatment behaviour, HIV-related fears and preferences for testing modalities. Segment 1 (21%) avoids the topic of HIV, perhaps fearful of the impact on his life. Segment 2 (23%) is well connected to his community and has social concerns about HIV. Segment 3 (15%) struggles with more distal determinants of HIV acquisition such as unemployment and poor mental health. Segment 4 (25%) has concerns about the lifestyle changes that would be required if he were HIV positive. Segment 5 (16%) has a strong traditional mindset and is fearful of the ramifications of HIV in his community. The results will be used to design targeted interventions to increase HIV testing and treatment rates among young men in South Africa. Further research is required to understand the impact of interventions designed in this way.
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Affiliation(s)
- James Bell
- Ipsos Healthcare, London, United Kingdom
- * E-mail:
| | | | - Shawn Malone
- Population Services International, Johannesburg, South Africa
| | | | | | | | | | - Tamara Ansons
- Global Science Organisation, Ipsos, London, United Kingdom
| | | | | | - Kristen Little
- Population Services International, Washington, DC, United States of America
| | - Nina Hasen
- Population Services International, Washington, DC, United States of America
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19
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Yang C, Chen P, Xie J, He Y, Wang Y, Yang X. Childhood Socioeconomic Status and Depressive Symptoms of Young Adults: Mediating Role of Childhood Trauma. Front Psychiatry 2021; 12:706559. [PMID: 34916967 PMCID: PMC8670566 DOI: 10.3389/fpsyt.2021.706559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/25/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Studies have shown that low childhood socioeconomic status (SES) is associated with a high prevalence of depressive symptoms. Childhood trauma, as a potential consequence of low SES, may play an important part, but the mediation effect of childhood trauma remains to be elucidated. Methods: A cross-sectional survey was conducted among 1,807 university students. The MacArthur Scale of Subjective Social Economic Status-Youth Version, Childhood Trauma Questionnaire, and Beck Depression Inventory were used to measure childhood SES, childhood trauma, and current depressive symptoms, respectively. A structural equation model (SEM) was employed to demonstrate the mediating role of childhood trauma on the association between childhood SES and depressive symptoms. Results: The SEM demonstrated that childhood SES had significant indirect effects upon depressive symptoms via childhood trauma. Childhood trauma accounted for 89.3% of the total effect, indicating a profound mediation effect. Conclusions: The effect of childhood SES on the depressive symptoms of young adults was mediated by childhood trauma, which emphasizes the importance of early prevention and intervention of child neglect/abuse.
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Affiliation(s)
- Caiyan Yang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Peiyi Chen
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Junyi Xie
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yongtong He
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China
| | - You Wang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China.,Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Gaungzhou, China.,Guangdong Provincial Key Laboratory of Tropical Diseases, Southern Medical University, Guangzhou, China
| | - Xueling Yang
- Department of Psychology, School of Public Health, Southern Medical University, Guangzhou, China.,Department of Psychiatry, Zhujiang Hospital, Southern Medical University, Gaungzhou, China.,Guangdong Provincial Key Laboratory of Tropical Diseases, Southern Medical University, Guangzhou, China
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20
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Gibbs A, Dunkle K, Ramsoomar L, Willan S, Jama Shai N, Chatterji S, Naved R, Jewkes R. New learnings on drivers of men's physical and/or sexual violence against their female partners, and women's experiences of this, and the implications for prevention interventions. Glob Health Action 2020; 13:1739845. [PMID: 32202227 PMCID: PMC7144308 DOI: 10.1080/16549716.2020.1739845] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/29/2020] [Indexed: 11/09/2022] Open
Abstract
Background: Understanding the drivers of intimate partner violence (IPV), perpetrated by men and experienced by women, is a critical task for developing effective prevention programmes.Objectives: To provide a comprehensive assessment of the drivers of IPV.Methods: A comprehensive review of the drivers of IPV, at the end of a six-year programme of research through the What Works to Prevent Violence Against Women and Girls Global Programme with reference to other important research in the field.Results: Broadly, we argue that IPV is driven by poverty, patriarchal privilege, and the normative use of violence in interpersonal relationships. These factors also increase childhood trauma, poor mental health and substance misuse, and poor communication and conflict in relationships, which in turn impact on IPV. Disability status, and contexts of armed conflict, or post-conflict, further reinforce and exacerbate these risks. We move beyond describing associations towards describing the causal pathways through which these factors operate to increase IPV.Conclusions: Specific recommendations about the future of further research on drivers of IPV include a greater focus on understanding the causal pathways from drivers to IPV and clearly delineating association from causality in studies, particularly for women and girls with disabilities, in armed conflicts, and adolescent girls and young women. To achieve this, we recommend extensive in-depth qualitative research, and complex quantitative modeling studies. Understanding drivers and causal pathways better will enable the identification of points of entry for the development of more effective IPV prevention interventions.
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Affiliation(s)
- Andrew Gibbs
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Kristin Dunkle
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Leane Ramsoomar
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Samantha Willan
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Nwabisa Jama Shai
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Sangeeta Chatterji
- Johns Hopkins School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ruchira Naved
- Health Systems and Population Studies Division, Icddr,b, Dhaka, Bangladesh
| | - Rachel Jewkes
- Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Cape Town, South Africa
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21
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Christofides NJ, Hatcher AM, Rebombo D, McBride RS, Munshi S, Pino A, Abdelatif N, Peacock D, Levin J, Jewkes RK. Effectiveness of a multi-level intervention to reduce men's perpetration of intimate partner violence: a cluster randomised controlled trial. Trials 2020; 21:359. [PMID: 32334615 PMCID: PMC7183134 DOI: 10.1186/s13063-020-4185-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 02/19/2020] [Indexed: 11/20/2022] Open
Abstract
Background Men’s perpetration of intimate partner violence (IPV) limits gains in health and wellbeing for populations globally. Largely informal, rapidly expanding peri-urban settlements, with limited basic services such as electricity, have high prevalence rates of IPV. Evidence on how to reduce men’s perpetration, change social norms and patriarchal attitudes within these settings is limited. Our cluster randomised controlled trial aimed to determine the effectiveness of the Sonke CHANGE intervention in reducing use of sexual and/or physical IPV and severity of perpetration by men aged 18–40 years over 2 years. Methodology The theory-based intervention delivered activities to bolster community action, including door-to-door discussions, workshops, drawing on the CHANGE curriculum, and deploying community action teams over 18 months. In 2016 and 2018, we collected data from a cohort of men, recruited from 18 clusters; nine were randomised to receive the intervention, while the nine control clusters received no intervention. A self-administered questionnaire, using audio-computer assisted software, asked about sociodemographics, gender attitudes, mental health, and the use and severity of IPV. We conducted an intention-to-treat analysis at the cluster level comparing the expected risk to observed risk of using IPV while controlling for baseline characteristics. A secondary analysis used latent classes (LCA) of men to see whether there were differential effects of the intervention for subgroups of men. Results Of 2406 men recruited, 1458 (63%) were followed to 2 years. Overall, we saw a reduction in men’s reports of physical, sexual and severe IPV from baseline to endpoint (40.2% to 25.4%, 31.8% to 15.8%, and 33.4% to 18.2%, respectively). Intention-to-treat analysis showed no measurable differences between intervention and control clusters for primary IPV outcomes. Difference in the cluster-level proportion of physical IPV perpetration was 0.002 (95% confidence interval [CI] − 0.07 to 0.08). Similarly, differences between arms for sexual IPV was 0.01 (95% CI − 0.04 to 0.06), while severe IPV followed a similar pattern (Diff = 0.01; 95% CI − 0.05 to 0.07). A secondary analysis using LCA suggests that among the men living in intervention communities, there was a greater reduction in IPV among less violent and more law abiding men than among more highly violent men, although the differences did not reach statistical significance. Conclusion The intervention, when implemented in a peri-urban settlement, had limited effect in reducing IPV perpetrated by male residents. Further analysis showed it was unable to transform entrenched gender attitudes and use of IPV by those men who use the most violence, but the intervention showed promise for men who use violence less. Trial registration ClinicalTrials.gov, NCT02823288. Registered on 30 June 2016.
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Affiliation(s)
- Nicola J Christofides
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa.
| | - Abigail M Hatcher
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa.,Division of HIV, Infectious Disease, and Global Medicine, University of California, SanFrancisco, USA
| | - Dumisani Rebombo
- Sonke Gender Justice, Juta Street, Braamfontein, Johannesburg, South Africa
| | - Ruari-Santiago McBride
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa
| | - Shehnaz Munshi
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa
| | - Angelica Pino
- Sonke Gender Justice, Juta Street, Braamfontein, Johannesburg, South Africa
| | - Nada Abdelatif
- South African Medical Research Council, 1 Soutpansberg Road, Pretoria, South Africa
| | - Dean Peacock
- Sonke Gender Justice, Juta Street, Braamfontein, Johannesburg, South Africa
| | - Jonathan Levin
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa
| | - Rachel K Jewkes
- Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, 27 St Andrews Rd, Parktown, Johannesburg, 2193, South Africa.,South African Medical Research Council, 1 Soutpansberg Road, Pretoria, South Africa
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Winter SC, Obara LM, McMahon S. Intimate partner violence: A key correlate of women's physical and mental health in informal settlements in Nairobi, Kenya. PLoS One 2020; 15:e0230894. [PMID: 32240207 PMCID: PMC7117691 DOI: 10.1371/journal.pone.0230894] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 02/08/2020] [Indexed: 01/09/2023] Open
Abstract
Globally, one billion people live in informal settlements, and that number is expected to triple by 2050. Studies suggests that health in informal settlements is a serious and growing concern, yet there is a paucity of research focused on health outcomes and the correlates of health in these settlements. Studies cite individual, environmental and social correlates to health in informal settlements, but they often lack empirical evidence. In particular, research suggests that high rates of violence against women (VAW) in informal settlements may be associated with detrimental effects on women's health, but few studies have investigated this link. The purpose of this study was to fill this gap by empirically exploring associations between women's experiences of intimate partner violence (IPV) and their physical and mental health. Data for this study were collected in August 2018 in Mathare Valley Informal Settlement in Nairobi, Kenya. A total of 550 randomly-selected women participated in surveys; however, analyses for this study were run on a subpopulation of the women (n = 361). Multivariate logistic regressions were used to investigate the link between psychological, sexual, and emotional IPV and women's mental and physical health. Results suggest that while some socioeconomic, demographic, and environmental variables were significantly associated with women's mental and physical health outcomes, all types of IPV emerged key correlates in this context. In particular, women's experiences of IPV were associated with lower odds of normal-high physical health component scores (based on SF-36); higher odds of gynecological and reproductive health issues, psychological distress (based on K-10), depression, suicidality, and substance use. Findings from this study suggest that policies and interventions focused on prevention and response to VAW in informal settlements may make critical contributions to improving health for women in these rapidly growing settlements.
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Affiliation(s)
- Samantha C. Winter
- Columbia School of Social Work, Columbia University, New York, New York, United States of America
- * E-mail:
| | - Lena Moraa Obara
- Department of Sociology and Social Work, University of Nairobi, Nairobi, Kenya
| | - Sarah McMahon
- Center on Violence Against Women and Children, Rutgers, The State University of New Jersey, New Brunswick, New Jersey, United States of America
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23
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Treves-Kagan S, Maman S, Khoza N, MacPhail C, Peacock D, Twine R, Kahn K, Lippman SA, Pettifor A. Fostering gender equality and alternatives to violence: perspectives on a gender-transformative community mobilisation programme in rural South Africa. CULTURE, HEALTH & SEXUALITY 2020; 22:127-144. [PMID: 31429663 PMCID: PMC7905832 DOI: 10.1080/13691058.2019.1650397] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 07/28/2019] [Indexed: 06/10/2023]
Abstract
Gender-based violence and violence against children are significant problems in South Africa. Community mobilisation and gender-transformative programming are promising approaches to address and reduce violence. A quantitative evaluation of One Man Can, a gender-transformative community mobilisation programme in South Africa, found mixed results in increasing gender-equitable behaviours and reducing violence. To better understand these findings, we analyse longitudinal qualitative data from community mobilisers, community members and community action teams, exploring individual and community-level factors that facilitate and hinder change. Interviews and focus groups were transcribed and analysed. Participants self-reported changes in their gender-equitable attitudes and use of violence as a result of participation in the programme, although some participants also reported opposition to shifting to a more gender-equitable culture. Facilitators to change included the internalisation of gender-transformative messaging and supportive social networks, which was buoyed by a shared vocabulary in their community generated by One Man Can. Because the programme targeted a critical mass of community members with gender-transformative programming, mobilisers and community action teams were held accountable by community members to model non-violent behaviour. Results reinforce the importance of addressing facilitators and barriers to change at both individual and community levels.
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Affiliation(s)
- Sarah Treves-Kagan
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California San Francisco, CA, USA
| | - Suzanne Maman
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Nomhle Khoza
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine MacPhail
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Society, University of Wollongong, Wollongong, NSW, Australia
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Dean Peacock
- Division of Social and Behavioural Sciences, University of Cape Town School of Public Health, Cape Town, South Africa
- Sonke Gender Justice, Cape Town, South Africa
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheri A. Lippman
- Center for AIDS Prevention Studies (CAPS), Department of Medicine, University of California San Francisco, CA, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
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24
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Associations Between Lifetime Traumatic Experiences and HIV-Risk Behaviors Among Young Men Living in Informal Settlements in South Africa: A Cross-Sectional Analysis and Structural Equation Model. J Acquir Immune Defic Syndr 2020; 81:193-201. [PMID: 30893127 PMCID: PMC6553984 DOI: 10.1097/qai.0000000000002010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: Qualitative research emphasizes men's experiences of trauma increase HIV risk. We seek to understand associations between experience of traumatic events and HIV-risk behaviors among heterosexual men in 2 trials in urban informal settlements in South Africa. Methods: Cross-sectional surveys among men in Johannesburg and Durban, South Africa, enrolled in intervention trials. Adjusted logistic regression and structural equation modeling assessed associations between men's experiences of poverty and traumatic events, and HIV-risk behaviors (inconsistent condom use, transactional sex, and number of sex partners). We explored mediated pathways from trauma to HIV risk through mental health and alcohol, and gender attitudes. Results: Among 2394 men, in adjusted logistic regression, transactional sex and 4 or more sex partners were associated with witnessing the murder of a family member, witnessing a murder of a stranger, experiencing excessive pain, been kidnapped, and witnessing a rape. More consistent condom use was associated with witnessing the murder of a family member, being kidnapped, and witnessing a rape. In 3 separate structural equation modeling pathways were consistent, trauma directly increased transactional sex, and past year sexual partners, and increased consistent condom use. Risk was increased through mental health pathways, and gender inequitable attitudes and practices. Conclusion: Men's HIV-risk behaviors in this population emerge at the confluence of poverty, traumatic experiences, and gender inequalities. Effective HIV-prevention interventions needs to reduce men's experiences of poverty and trauma, transform gender norms, and reduce the mental health impact of trauma.
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Manyema M, Richter LM. Adverse childhood experiences: prevalence and associated factors among South African young adults. Heliyon 2019; 5:e03003. [PMID: 31890957 PMCID: PMC6926197 DOI: 10.1016/j.heliyon.2019.e03003] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 04/17/2019] [Accepted: 12/04/2019] [Indexed: 01/23/2023] Open
Abstract
While adverse childhood experiences (ACEs), as described by the CDC-Kaiser Permanente Study, are reportedly common in both high and low-income settings, evidence on the epidemiology of ACEs in low-income settings is scarce. This study aimed to determine the prevalence of ACEs reported in young adulthood and assess their association with childhood maternal, household and community factors. We used data from the 22–23 year wave of the Birth to Twenty Plus (Bt20+) study in South Africa, the largest and longest running birth cohort in Africa. With ACEs as the main outcome measure, their association with childhood factors was assessed using regression models. As demonstrated in high-income settings, ACEs are highly prevalent in this young adult population in a middle income country. Both household and community socio-economic status in childhood was associated with the experience of ACEs and the likelihood of experiencing multiple ACEs. The attenuation of significance in adjusted models suggested that individual ACEs are correlated and may exert their effects through other ACEs. Interventions for the prevention of ACEs need to be directed not only at individuals but households as well as communities.
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Affiliation(s)
- Mercy Manyema
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand School of Public Health Building, Wits Education Campus, 7 York Road, Parktown, Johannesburg, South Africa.,MRC/Wits Developmental Pathways for Health Research Unit, Second Floor School of Public Health Building, University of the Witwatersrand (Education Campus), 7 York Road, Parktown, South Africa
| | - Linda M Richter
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand School of Public Health Building, Wits Education Campus, 7 York Road, Parktown, Johannesburg, South Africa
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Ahulu LD, Gyasi-Gyamerah AA, Anum A. Predicting risk and protective factors of generalized anxiety disorder: a comparative study among adolescents in Ghana. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2019. [DOI: 10.1080/02673843.2019.1698440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Lynda Dede Ahulu
- Clinical Psychology Unit, Accra Psychiatric Hospital , Accra, Ghana
| | | | - Adote Anum
- Department of Psychology, University of Ghana , Legon, Ghana
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