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Mmethi TG, Modjadji P, Mathibe M, Thovhogi N, Sekgala MD, Madiba TK, Ayo-Yusuf O. Substance Use among School-Going Adolescents and Young Adults in Rural Mpumalanga Province, South Africa. Behav Sci (Basel) 2024; 14:543. [PMID: 39062366 PMCID: PMC11274307 DOI: 10.3390/bs14070543] [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: 03/17/2024] [Revised: 06/17/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024] Open
Abstract
The ongoing public health crisis of substance use among school adolescents and young adults (AYAs) in South Africa is not new in research parlance, amidst the national policy of drug abuse management in schools. In view of no tangible progress to reduce substance use in high schools in the country, we conducted a cross-sectional quantitative study aimed at investigating substance use among adolescents and young adults in the four public high schools selected through multi-stage sampling in rural Mpumalanga province, South Africa. Data on substance use, demographics, household socio-demographics, and related factors were collected via a validated self-administered questionnaire. Hierarchical logistic regression was performed using STATA 18. The study included 402 AYAs aged between 14 and 23 years (18 ± 1 years), and 45% reported substance use in the last twelve months. Alcohol was the most used substance (74%), followed by cigarettes (12%) and cannabis (11%). AYAs used substances out of social influence, curiosity, to find joy, and to eliminate stress, especially in social events, on the streets, and at home, and reported negative physical health outcomes, mainly hallucinations, sleeping disorders, body weakness, and dry mouths. Hierarchical logistic regression showed that the likelihood of substance use was three times in a particular high school (S4) (AOR = 3.93, 95%CI: 1.72-8.99), twice among the grade 12s (AOR = 2.73, 95%CI: 1.46-5.11), over twenty times in the communities with substance availability (AOR = 22.45, 95%CI: 2.75-183.56), almost ten times among AYAs participating in recreational/sports activities (AOR = 9.74, 95%CI: 4.21-22.52), and twice likely to happen in larger households (AOR = 2.96, 95%CI: 1.57-5.58). Prevention and intervention efforts should consider these specific health concerns to develop targeted strategies for mitigating substance use and its adverse consequences in this vulnerable population towards achieving the United Nations' Sustainable Development Goal Target 3.5, which aims to strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and the harmful use of alcohol.
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Affiliation(s)
- Tabeho Godfrey Mmethi
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa; (T.G.M.)
- Department of Community Dentistry, School of Dentistry, University of Pretoria, Pretoria 0208, South Africa
| | - Perpetua Modjadji
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa; (T.G.M.)
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
- Department of Life and Consumer Sciences, College of Agriculture and Environmental Sciences, University of South Africa, Roodepoort, Johannesburg 1709, South Africa
- Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM), School of Health Systems and Public Health, University of Pretoria, Pretoria 0028, South Africa;
| | - Mmampedi Mathibe
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria 0208, South Africa; (T.G.M.)
| | - Ntevhe Thovhogi
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
| | - Machoene Derrick Sekgala
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Cape Town 7505, South Africa
| | - Thomas Khomotjo Madiba
- Department of Community Dentistry, School of Dentistry, University of Pretoria, Pretoria 0208, South Africa
| | - Olalekan Ayo-Yusuf
- Africa Centre for Tobacco Industry Monitoring and Policy Research (ATIM), School of Health Systems and Public Health, University of Pretoria, Pretoria 0028, South Africa;
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Abufarsakh B, Okoli CTC, Darville AK, Williams LB, Garcia AR, Martin C. Tobacco use behavior among adults exposed to cumulative adverse childhood experiences: A systematic review and meta analysis. Addict Behav 2024; 152:107948. [PMID: 38277993 DOI: 10.1016/j.addbeh.2023.107948] [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: 08/30/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Tobacco use remains one of the most used substances among adults globally and substantially impacts individuals and society. Adverse childhood experiences (ACEs) contribute to tobacco use. However, the association between cumulative ACEs and tobacco use behaviors (TUB) has not been established in the literature. In this review, we aimed to estimate the prevalence of ACEs among adult tobacco users and evaluated the relationship between cumulative ACEs and TUB. METHODS We identified original articles published before October 2022 by searching PubMed, CINAHL, and Psych INFO databases. Inclusion criteria were: English language, adults and used instruments assessing for cumulative ACEs defined as four or more ACEs. RESULTS Forty-two studies, totaling 674,087 participants; predominantly cohort and cross-sectional in study design (n = 33). Exposure to 4 ≥ ACEs was significantly associated with increasing the odds of current tobacco use (n = 35), ever or former tobacco use (n = 13), tobacco use initiation, (n = 3) nicotine dependence (n = 1), and ever using electronic cigarettes (n = 1). In the meta-analysis, as compared to those without ACEs, those with 4 ≥ ACEs were twice as likely to have ever used tobacco (OR = 2.16, 95 %CI:1.73-2.70) and approximately four times more likely to have used tobacco currently (OR = 3.73, 95 %CI:2.69-5.18). CONCLUSION The cumulative ACEs exposure can increase the risk for TUB. However, the evidence is limited primarily to cigarette use. Ongoing research into the effects of cumulative ACEs on TUB is needed to integrate trauma-informed intervention in treating tobacco use and guide public health initiatives aimed to reduce the prevalence of ACEs and TUB among adults.
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Affiliation(s)
| | | | - Audrey K Darville
- University of Kentucky College of Nursing, Lexington, KY 40536, USA.
| | | | - Antonio R Garcia
- University of Kentucky College of Social Work, Lexington, KY 40508, USA.
| | - Catherine Martin
- University of Kentucky Health Care Good Samaritan Hospital, Lexington, KY 40508, USA.
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Brown C, Nkemjika S, Ratto J, Dube SR, Gilbert L, Chiang L, Picchetti V, Coomer R, Kambona C, McOwen J, Akani B, Kamagate MF, Low A, Manuel P, Agusto A, Annor FB. Adverse Childhood Experiences and Associations with Mental Health, Substance Use, and Violence Perpetration among Young Adults in sub-Saharan Africa. CHILD ABUSE & NEGLECT 2024; 150:106524. [PMID: 38854869 PMCID: PMC11160582 DOI: 10.1016/j.chiabu.2023.106524] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Background Adverse childhood experiences (ACEs) can have debilitating effects on child well-being, with consequences persisting into adulthood. Most ACE studies have been conducted in high-income countries and show a graded relationship between multiple ACE exposures and adverse health outcomes. Less is known about the types and burden of ACEs in sub-Saharan Africa (SSA). Objective To estimate the pooled prevalence of six individual and cumulative ACE exposures (physical, sexual, and emotional violence; orphanhood; witnessing interparental and community violence) and assess their association with mental health outcomes, substance use, and violence perpetration among young adults in SSA. Participants and setting Aggregate data from the Violence Against Children and Youth Survey (VACS) in Cote d'Ivoire 2018, Kenya 2019, Lesotho 2018, Mozambique 2019, and Namibia 2019 included a sample of 11,498 young adults aged 18-24 years. Methods Cumulative ACEs were defined by an integer count of the total number of individual ACEs (0 to 6). Weighted prevalence and adjusted odds ratios were estimated. Result ACEs prevalence ranged from 7.8% (emotional violence) to 55.0% (witnessing community violence). Strong graded relationships between cumulative ACE exposure and all study outcomes for both males and females were observed. Among females, witnessing interparental violence was the only individual ACE risk factor significantly associated with increased odds of substance use; among males, emotional violence was significantly associated with all outcomes. Conclusion ACEs are associated with adverse mental health, substance use, and violence perpetration in SSA. Gender-specific and culturally sensitive intervention strategies are needed to effectively mitigate ACEs in this population.
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Affiliation(s)
- Colvette Brown
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Stanley Nkemjika
- Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA
| | - Jeffrey Ratto
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Shanta R. Dube
- Levine College of Health Sciences, Wingate University, Wingate, North Carolina
| | - Leah Gilbert
- National Institutes of Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development
| | - Laura Chiang
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Viani Picchetti
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
| | - Rachel Coomer
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Namibia
| | - Caroline Kambona
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Kenya
| | - Jordan McOwen
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Mozambique
| | - Bangaman Akani
- Department of Public Health, Felix Houphouet Boigny University, Abidjan, Cote d’ Ivoire
| | - Maman Fathim Kamagate
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Cote d’ Ivoire
| | - Andrea Low
- International Center for AIDS Care and Treatment Program (ICAP)at Columbia University, NY
| | - Pedro Manuel
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Mozambique
| | | | - Francis B. Annor
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, USA
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Seya MKS, Matthews S, Zhu L, Brown C, Lefevre A, Agathis N, Chiang LF, Annor FB, McOwen J, Augusto A, Manuel P, Kamagate MF, Nobah MT, Coomer R, Kambona C, Low A. Parenting-related positive childhood experiences, adverse childhood experiences, and mental health-Four sub-Saharan African countries. CHILD ABUSE & NEGLECT 2024; 150:106493. [PMID: 37839988 PMCID: PMC11264190 DOI: 10.1016/j.chiabu.2023.106493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/21/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) are associated with poor mental health outcomes and risk-taking behaviors. Positive childhood experiences (PCEs) may mitigate these negative impacts. OBJECTIVE This study 1) assessed the associations between ACEs and negative health outcomes and risk-taking behaviors among young adults, and 2) evaluated whether - and which - PCEs moderate the association between ACEs and these outcomes in sub-Saharan Africa. METHODS This multi-country analysis combined cross-sectional representative survey data from young adults, ages 18-24 years, from the 2019 Kenya, 2018 Lesotho, 2019 Mozambique, and 2019 Namibia Violence Against Children and Youth Surveys. The association between experiencing any ACEs and each health outcome was assessed using Wald's chi-square tests. Multivariable logistic regression analyses assessed the association between each PCE and each outcome of interest. RESULTS Females who experienced any ACEs had higher odds of experiencing moderate to severe mental distress (aOR = 2.7, 95%CI: 1.9, 3.9). Males who experienced any ACEs had higher odds of experiencing suicidal/self-harm behaviors (aOR = 6.7, 95%CI: 2.8, 16.0) and substance use (aOR = 2.5, 95%CI: 1.4, 4.2). In females, strong mother-child relationship was protective against moderate to severe mental distress (aOR = 0.7, 95%CI: 0.6, 0.9), suicidal/self-harm behaviors (aOR = 0.6, 95%CI: 0.4, 0.9), and substance use (aOR = 0.6, 95%CI: 0.4, 0.9). For males, a strong mother-child relationship was protective against suicidal/self-harm behaviors (aOR = 0.5, 95%CI: 0.2, 0.9), and a strong father-child relationship was protective against suicidal/self-harm behaviors (aOR = 0.4, 95%CI: 0.2, 0.7) and substance use (aOR = 0.6, 95%CI: 0.4, 0.8). CONCLUSIONS Strong parenting programs may likely play an important role in improving the psychosocial health of young adults.
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Affiliation(s)
| | - Sarah Matthews
- Division of Violence Prevention, Centers for Disease Control and Prevention, GA, USA
| | - Liping Zhu
- Division of Violence Prevention, Centers for Disease Control and Prevention, GA, USA
| | - Colvette Brown
- Division of Violence Prevention, Centers for Disease Control and Prevention, GA, USA
| | - Adrienne Lefevre
- Division of Violence Prevention, Centers for Disease Control and Prevention, GA, USA
| | - Nickolas Agathis
- Division of Global HIV and Tuberculosis, Center for Global Health Centers for Disease Control and Prevention, GA, USA
| | - Laura F Chiang
- Division of Violence Prevention, Centers for Disease Control and Prevention, GA, USA
| | - Francis B Annor
- Division of Violence Prevention, Centers for Disease Control and Prevention, GA, USA
| | - Jordan McOwen
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Mozambique
| | | | - Pedro Manuel
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Mozambique
| | - Maman Fathim Kamagate
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Cote d'Ivoire
| | - Marie-Therese Nobah
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Cote d'Ivoire
| | - Rachel Coomer
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Namibia
| | - Caroline Kambona
- Division of Global Health HIV and TB, Centers for Disease Control and Prevention, Kenya
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Sreenivasulu M., Prathyusha V, Ezhumalai S, Narayanan G, Murthy P. Adverse Childhood Experiences, Coping and Resilience in Persons with Alcohol Use Disorder and Their Non-drinking Siblings in High-density Families: A Case-control Study. Indian J Psychol Med 2024; 46:139-146. [PMID: 38725730 PMCID: PMC11076933 DOI: 10.1177/02537176231219769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background Adverse childhood experiences (ACEs) increase the odds of alcohol use disorder (AUD). Aim To study the ACEs, coping, and resilience in persons with AUD and their non-drinking siblings from high-density families. Methods The study used a case-control study design. Using purposive sampling, 135 participants were selected; the sample consists of persons with AUD (n = 45), non-drinking siblings (n = 45), and healthy controls (n = 45), selected from out-patient and in-patient services from a government-run de-addiction centre in Bengaluru. Individuals were administered an ACEs questionnaire, Brief-COPE, and Connor-Davison Resilience scale. Descriptive statistics, Friedman's test, and Bonferroni's post-hoc test, Binary Logistic Regression were used for analysis. Results ACEs, coping, and resilience significantly differ across the three groups. Persons with AUD and their non-drinking siblings are comparable in terms of ACEs and having dysfunctional family members. Non-drinking siblings and healthy controls have similar coping and resilience. None of the healthy controls had dysfunctional family members. Conclusion ACEs are more prevalent and more frequent in persons with AUD. Individuals with AUD showed higher avoidant coping and lower resilience than their non-drinking siblings and healthy controls. Early identification of ACEs and interventions to build resilience and coping strategies could prevent individuals from developing AUD in high-density families.
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Affiliation(s)
- Sreenivasulu M.
- Dept. of Psychiatric Social Work, NIMHANS, Bangalore, Karnataka, India
| | - Vasuki Prathyusha
- Dept of Bio-Statistics, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Sinu Ezhumalai
- Dept. of Psychiatric Social Work, NIMHANS, Bangalore, Karnataka, India
| | | | - Pratima Murthy
- Dept of Psychiatry, NIMHANS, Bangalore, Karnataka, India
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6
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Janson S, Nyenga L, Saleem H, Mayo-Wilson LJ, Mushy SE, Iseselo MK, van Draanen J, Tucker J, McPherson M, Conserve DF. Residential and inpatient treatment of substance use disorders in Sub-Saharan Africa: a scoping review. Subst Abuse Treat Prev Policy 2024; 19:6. [PMID: 38212834 PMCID: PMC10782522 DOI: 10.1186/s13011-023-00589-0] [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: 10/15/2023] [Accepted: 12/22/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND With substance use rates increasing in Sub-Saharan Africa (SSA), an understanding of the accessibility and effectiveness of rehabilitative services for people who use alcohol and other drugs (AOD) is critical in the global efforts to diagnose and treat substance use disorders (SUD). This scoping review seeks to address the gaps in knowledge related to the types of research that have been conducted regarding inpatient or residential SUD treatment in SSA, the settings in which the research was conducted, and the study countries. METHODS A search of three databases, PubMED, Scopus, and African Index Medicus, was conducted for publications related to the treatment of SUD in inpatient or residential settings in SSA. Articles were screened at the title/abstract level and at full text by two reviewers. Articles eligible for inclusion were original research, conducted in SSA, published in English, included populations who received or were currently receiving treatment for SUD in inpatient or residential settings, or documented demand for SUD services. RESULTS This scoping review included 82 studies originating from 6 countries in SSA. Three themes emerged within the literature: access and demand for inpatient and residential SUD treatment, quality and outcomes of SUD treatment, and descriptions of the services offered and staffing of these facilities. Barriers to access include financial barriers, limited availability of services, and geographic concentration in cities. Women were shown to access residential and inpatient SUD treatment at lower rates than men, and certain racial groups face unique language and financial barriers in accessing services. Studies indicate mixed success of inpatient and residential SUD treatment in sustained SUD remission for patients. CONCLUSION There are significant gaps in the literature, driven by a lack of longitudinal studies focused on patient outcomes following treatment and the use of a narrow definition of treatment success. Both structural and non-structural barriers, such as stigma and discrimination, are barriers to access. Further research is needed to evaluate approaches to mitigate these barriers and expand access to residential and inpatient SUD treatment.
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Affiliation(s)
- Samuel Janson
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA.
| | - Lily Nyenga
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Haneefa Saleem
- The Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Stella E Mushy
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Masunga K Iseselo
- Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Jenna van Draanen
- University of Washington School of Public Health, Seattle, Washington, USA
- University of Washington School of Nursing, Seattle, Washington, USA
| | - Joseph Tucker
- University of North Carolina School of Medicine, Chapell Hill, North Carolina, USA
| | - Mecca McPherson
- Temple University College of Public Health, Philadelphia, PA, USA
| | - Donaldson F Conserve
- The George Washington University Milken Institute School of Public Health, Washington, DC, USA
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Montague R, Canning SE, Thielking P, Qeadan F. Adverse childhood experiences and psychotropic medication prescription among cancer patients. J Psychosoc Oncol 2023; 42:543-557. [PMID: 38127059 DOI: 10.1080/07347332.2023.2296040] [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] [Indexed: 12/23/2023]
Abstract
BACKGROUND This study aimed at identifying and characterizing adverse childhood experiences (ACEs) in a sample of cancer patients and subsequently evaluating the relationship between ACEs and prescription of psychotropic medication among them. Individuals with ACEs have a higher risk of mental health conditions and are more likely to be prescribed psychotropic medications. METHODS A sample of 178 adult patients receiving Supportive Oncology & Survivorship (SOS) services at Huntsman Cancer Hospital in Utah was obtained. ACEs and Brief Resilient Coping Scale (BRCS) questionnaires were administered confidentially. A multivariable mixed effect model, adjusting for sex, age, and insurance type while controlling for zip-codes clustering were employed. RESULTS Compared to the prevalence of ACEs in the general population, from the CDC-Kaiser Permanente ACEs Study, we found no significant difference in the prevalence of people who had experienced an adverse childhood event (ACEs score > = 1) between our study of cancer patients and the CDC-Kaiser study (67.4% vs. 63.6%, p = 0.29372), but found a significant difference in the prevalence of people who had experienced severe adverse childhood experiences (ACES score > =4) (25.3% vs. 12.1%, p < 0.00001). Furthermore, this study reveals a significant association between an increase of one unit in the total ACEs score and the odds of psychotropic medication prescription in the past 12 months (OR: 1.233; 95% CI: 1.025, 1.483). Those with a total ACEs score of three or more were found to have 280% higher odds of being prescribed psychotropic medication compared to those with ACEs ≤ 2 (OR: 3.822; 95% CI: 1.404,10.407). CONCLUSION A significant proportion of cancer patients have a history of ACEs, and thus trauma-informed care approach is essential during their treatment.
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Affiliation(s)
| | - Sarah Elise Canning
- Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA
| | - Paul Thielking
- Novamind, Toronto, Canada, and Cedarpsychiatry, Murray, UT, USA
| | - Fares Qeadan
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, USA
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8
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Broekhof R, Nordahl HM, Tanum L, Selvik SG. Adverse childhood experiences and their association with substance use disorders in adulthood: a general population study (Young-HUNT). Addict Behav Rep 2023; 17:100488. [PMID: 37077505 PMCID: PMC10106480 DOI: 10.1016/j.abrep.2023.100488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 03/15/2023] [Accepted: 03/25/2023] [Indexed: 03/31/2023] Open
Abstract
Aim To investigate the association of adverse childhood experiences (ACEs) and substance use disorders (alcohol and illicit drug use disorders), specifically by gender, in a large longitudinal non-clinical population study. Methods Data from 8199 adolescents, first assessed for ACE (2006-2008), were linked with subsequent data from the Norwegian Patient Register to obtain diagnoses of a substance use disorder in adulthood (after 12-14 years' follow-up in March 2020). This study used logistic regression analysis to assess the associations between ACEs and substance use disorders with respect to gender. Results Adults with any history of ACEs have a 4.3-fold higher likelihood of developing a substance use disorder. Female adults had a 5.9-fold higher likelihood of developing an alcohol use disorder. Emotional neglect, sexual abuse and physical abuse were the strongest individual ACE predictors for this association. Male adults had a 5.0-fold higher likelihood of developing an illicit drug use disorder (for example stimulants such as cocaine, inhibiter such as opioids, cannabinoids and multiple drugs). Physical abuse, parental divorce and witnessed violence were the strongest individual ACE predictors for this association. Conclusions This study reinforces the association between ACEs and substance use disorders and exposes a gender-specific pattern. Increased attention should be paid to the meaning of individual ACEs as well as to the accumulation of ACEs in the development of a substance use disorder.
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Muwanguzi M, Kaggwa MM, Najjuka SM, Mamun MA, Arinaitwe I, Kajjimu J, Nduhuura E, Ashaba S. Exploring adverse childhood experiences (ACEs) among Ugandan university students: its associations with academic performance, depression, and suicidal ideations. BMC Psychol 2023; 11:11. [PMID: 36639808 PMCID: PMC9838032 DOI: 10.1186/s40359-023-01044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) among university students have been linked to a variety of factors and have been shown to have a dose-response relationship with adult health and behavior. OBJECTIVE To investigate the effect of exposure to ACEs on academic performance, depression, and suicidal ideations among university students. METHODS A cross-sectional survey among university students at a public university in southwestern Uganda was conducted in 2021, integrating the Adverse Childhood Experiences International Questionnaire for assessing ACEs, the Patient Health Questionnaire for assessing depression symptoms and suicidal ideations, and questions assessing the family structure and academic performance as adopted from similar studies. Regression analysis was performed, and 3 models were generated to answer the study hypotheses. RESULTS A total of 653 undergraduate university students with a mean age of 22.80 (± 3.16) years were recruited. Almost all students (99.8%) experienced one or more ACEs, with physical abuse being the common ACE reported. The average depression symptom severity was statistically higher among individuals who experienced any form of ACEs. No relationship was observed between the ACEs experienced and self-rated academic performance. Similarly, on regression analysis, the cumulative number of ACEs was not associated with self-rated academic performance (β = - 0.007; 95% CI - 0.031 to 0.016; p = 0.558). However, the cumulative number of ACEs was positively associated with depression symptom severity (β = 0.684; 95% CI 0.531-0.837; p < 0.001), as well as increased the likelihood of suicidal ideations (aOR = 1.264; 95% CI 01.090-1.465; p < 0.001). CONCLUSIONS The burden of ACEs is exceedingly high among Ugandan university students, highlighting the urgency in strengthening effective child protection strategies to protect Uganda's rapidly growing population from mental ill-health and avoid future psychological disability, a burden to the healthcare system. The study's findings will also be useful to practitioners/policymakers working to prevent/limit child maltreatment globally.
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Affiliation(s)
- Moses Muwanguzi
- grid.33440.300000 0001 0232 6272Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark Mohan Kaggwa
- grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda ,grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
| | - Sarah Maria Najjuka
- grid.11194.3c0000 0004 0620 0548Makerere University, College of Health Sciences, Kampala, Uganda
| | - Mohammed A. Mamun
- CHINTA Research Bangladesh, Savar, Dhaka Bangladesh ,grid.411808.40000 0001 0664 5967Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka Bangladesh
| | - Innocent Arinaitwe
- grid.33440.300000 0001 0232 6272Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jonathan Kajjimu
- grid.33440.300000 0001 0232 6272Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Elicana Nduhuura
- grid.33440.300000 0001 0232 6272Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Scholastic Ashaba
- grid.33440.300000 0001 0232 6272Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
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Oguntayo R, Opayemi AS, Oyeleke JT. Socio-contextual factors and adverse childhood experiences as determinants of substance use disorder among individuals between ages 18-40years in Kano, Nigeria. JOURNAL OF SUBSTANCE USE 2022. [DOI: 10.1080/14659891.2022.2157767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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11
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Risky sexual behaviours among Ugandan university students: A pilot study exploring the role of adverse childhood experiences, substance use history, and family environment. PLoS One 2022; 17:e0277129. [DOI: 10.1371/journal.pone.0277129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 10/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background
University students are known to have risky sexual behaviours (RSBs). The severity of the RSB is influenced by many factors, including the family environment, exposure to adverse childhood events (ACEs), and the use of addictive substances. However, there is limited information about the influence of ACEs and the family environment of these students in low-and medium-income countries (LMICs). Therefore, a pilot study was conducted among university students from a LMIC, Uganda.
Methods
The present study comprised a cross-sectional online survey among Ugandan students at a public university (N = 316; 75% male; 52.2% aged between 18–22 years). The survey included questions relating to socio-demographic information, family environmental information, the Sexual Risk Survey (SRS), and the Adverse Childhood Experiences-International Questionnaire (ACE-IQ).
Results
Over half (53.8%) reported having had sexual intercourse. Males reported over two times higher mean total SRS score compared to females (χ2 = 4.06, p = 0.044). Approximately one-sixth of the sample had drunk alcohol or used illicit psychoactive substances in the past six months (16.1%). Among four regression analysis models, sociodemographic variables predicted the highest variance (13%), followed by family environment variables (10%), and both psychoactive substance use history (past six months) and ACEs individually explained approximately 5% variance in total SRS score, with the final model predicting 33% of the variance in RSB.
Conclusions
The present study demonstrated a gender disparity with males involved in more RSB than females, as has been reported in most previous RSB studies. Family environment, sociodemographic factors, substance use, and ACEs all appear to contribute to RSB among university students. These findings will benefit other researchers exploring factors associated with RSB among university students and will help develop interventions to reduce RSB to protect students from unwanted pregnancies, sexually transmitted diseases, and HIV/AIDS.
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Onaolapo OJ, Olofinnade AT, Ojo FO, Adeleye O, Falade J, Onaolapo AY. Substance use and substance use disorders in Africa: An epidemiological approach to the review of existing literature. World J Psychiatry 2022; 12:1268-1286. [PMID: 36389088 PMCID: PMC9641378 DOI: 10.5498/wjp.v12.i10.1268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/01/2022] [Accepted: 09/07/2022] [Indexed: 02/05/2023] Open
Abstract
The relationship between man and substances that have abuse potentials, and whose use has been associated with the development or progression of substance use disorders has continued to evolve in terms of geography, economic implications, and time. History shows that local plants with psychoactive constituents can get exported worldwide through global travel, commerce, or even conquest. Time and globalization also change people’s relationship with substances of abuse; hence, an area that was initially alien to certain substances might evolve to becoming a trafficking hub, and then a destination. A case in point is Africa where a rapidly increasing prevalence of substance use/abuse and substance use disorder among adolescents and young adults is putting enormous strain on the economy, healthcare system, and society at large. However, there appears to be a paucity of scientific literature and data on the epidemiology, risk assessment, and contributing factors to substance use and the development of substance use disorders across Africa. In this narrative review, we examine extant literature (PubMed, Google scholar, Medline) for information on the prevalence, trends, and influencers of substance use and the development of substance use disorders. This is with a view of understanding the determinants of substance use and factors that influence the development of substance use disorders in the region, and how this information can be channeled towards developing a comprehensive intervention and treatment program.
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Affiliation(s)
- Olakunle James Onaolapo
- Behavioral Neuroscience Unit, Neuropharmacology Subdivision, Department of Pharmacology, Ladoke Akintola University of Technology, Ogbomoso 210214 Oyo, Nigeria
| | - Anthony Tope Olofinnade
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University, Ikeja 100001, Lagos, Nigeria
| | - Foluso Olamide Ojo
- Department of Anatomy, Ladoke Akintola University of Technology, Ogbomoso 210214, Oyo, Nigeria
| | - Olufunto Adeleye
- Department of Anatomy, Ladoke Akintola University of Technology, Ogbomoso 210214, Oyo, Nigeria
| | - Joshua Falade
- Department of Mental Health, Afe Babalola University, Ado-Ekiti 360282, Ekiti, Nigeria
| | - Adejoke Yetunde Onaolapo
- Behavioral Neuroscience Unit, Neurobiology Subdivision, Department of Anatomy, Ladoke Akintola University of Technology, Ogbomoso 210214, Oyo, Nigeria
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Ransing R, de la Rosa PA, Pereira-Sanchez V, Handuleh JIM, Jerotic S, Gupta AK, Karaliuniene R, de Filippis R, Peyron E, Sönmez Güngör E, Boujraf S, Yee A, Vahdani B, Shoib S, Stowe MJ, Jaguga F, Dannatt L, da Silva AK, Grandinetti P, Jatchavala C. Current state of cannabis use, policies, and research across sixteen countries: cross-country comparisons and international perspectives. TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2022. [PMID: 34735077 DOI: 10.4762/2237-6089-2021-0263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
INTRODUCTION Varying public views on cannabis use across countries may explain the variation in the prevalence of use, policies, and research in individual countries, and global regulation of cannabis. This paper aims to describe the current state of cannabis use, policies, and research across sixteen countries. METHODS PubMed and Google Scholar were searched for studies published from 2010 to 2020. Searches were conducted using the relevant country of interest as a search term (e.g., "Iran"), as well as relevant predefined keywords such as "cannabis," "marijuana," "hashish," "bhang "dual diagnosis," "use," "addiction," "prevalence," "co-morbidity," "substance use disorder," "legalization" or "policy" (in English and non-English languages). These keywords were used in multiple combinations to create the search string for studies' titles and abstracts. Official websites of respective governments and international organizations were also searched in English and non-English languages (using countries national languages) to identify the current state of cannabis use, policies, and research in each of those countries. RESULTS The main findings were inconsistent and heterogeneous reporting of cannabis use, variation in policies (e.g., legalization), and variation in intervention strategies across the countries reviewed. European countries dominate the cannabis research output indexed on PubMed, in contrast to Asian countries (Thailand, Malaysia, India, Iran, and Nepal). CONCLUSIONS Although global cannabis regulation is ongoing, the existing heterogeneities across countries in terms of policies and epidemiology can increase the burden of cannabis use disorders disproportionately and unpredictably. There is an urgent need to develop global strategies to address these cross-country barriers to improve early detection, prevention, and interventions for cannabis use and related disorders.
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Affiliation(s)
- Ramdas Ransing
- Department of Psychiatry, BKL Walawalkar Rural Medical College, Maharashtra, India
| | - Pedro A de la Rosa
- Educación de la Afectividad y Sexualidad Humana, Instituto Cultura y Sociedad, Universidad de Navarra, Pamplona, Spain. Human Flourishing Program, Institute for Quantitative Social Science, Harvard University, Cambridge, MA, USA
| | - Victor Pereira-Sanchez
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | | | - Stefan Jerotic
- Clinic for Psychiatry, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Ruta Karaliuniene
- Elblandklinikum Radebeul Clinic for Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
| | | | - Ekin Sönmez Güngör
- Department of Psychiatry, University of Health Sciences, Erenköy Mental Health and Neurological Diseases Training and Research Hospital, Istanbul, Turkey
| | - Said Boujraf
- Clinical Neurosciences Laboratory, Sidi Mohamed ben Abdellah University, Fez, Morocco
| | - Anne Yee
- Department of Psychological Medicine, University Malaya Centre of Addiction Sciences, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bita Vahdani
- Qazvin University of Medical Sciences Qazvin, Iran. Department of Psychology, University of Tehran, Tehran, Iran
| | - Sheikh Shoib
- Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Rainawari, Kashmir, India
| | - M J Stowe
- Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | | | - Lisa Dannatt
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Paolo Grandinetti
- Addictions Service, Department of Territorial Services, ASL Teramo, Teramo, Italy
| | - Chonnakarn Jatchavala
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkla, Thailand
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Jaguga F, Kiburi SK, Temet E, Barasa J, Karanja S, Kinyua L, Kwobah EK. A systematic review of substance use and substance use disorder research in Kenya. PLoS One 2022; 17:e0269340. [PMID: 35679248 PMCID: PMC9186181 DOI: 10.1371/journal.pone.0269340] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/18/2022] [Indexed: 12/27/2022] Open
Abstract
Objectives The burden of substance use in Kenya is significant. The objective of this
study was to systematically summarize existing literature on substance use
in Kenya, identify research gaps, and provide directions for future
research. Methods This systematic review was conducted in line with the PRISMA guidelines. We
conducted a search of 5 bibliographic databases (PubMed, PsychINFO, Web of
Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and
Cochrane Library) from inception until 20 August 2020. In addition, we
searched all the volumes of the official journal of the National Authority
for the Campaign Against Alcohol & Drug Abuse (the African Journal of
Alcohol and Drug Abuse). The results of eligible studies have been
summarized descriptively and organized by three broad categories including:
studies evaluating the epidemiology of substance use, studies evaluating
interventions and programs, and qualitative studies exploring various themes
on substance use other than interventions. The quality of the included
studies was assessed with the Quality Assessment Tool for Studies with
Diverse Designs. Results Of the 185 studies that were eligible for inclusion, 144 investigated the
epidemiology of substance use, 23 qualitatively explored various substance
use related themes, and 18 evaluated substance use interventions and
programs. Key evidence gaps emerged. Few studies had explored the
epidemiology of hallucinogen, prescription medication, ecstasy, injecting
drug use, and emerging substance use. Vulnerable populations such as
pregnant women, and persons with physical disability had been
under-represented within the epidemiological and qualitative work. No
intervention study had been conducted among children and adolescents. Most
interventions had focused on alcohol to the exclusion of other prevalent
substances such as tobacco and cannabis. Little had been done to evaluate
digital and population-level interventions. Conclusion The results of this systematic review provide important directions for future
substance use research in Kenya. Systematic review registration PROSPERO: CRD42020203717.
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Affiliation(s)
- Florence Jaguga
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
- * E-mail:
| | | | - Eunice Temet
- Department of Mental Health & Behavioral Sciences, Moi University
School of Medicine, Eldoret, Kenya
| | - Julius Barasa
- Population Health, Academic Model Providing Access to Healthcare,
Eldoret, Kenya
| | - Serah Karanja
- Department of Mental Health, Gilgil Sub-County Hospital, Gilgil,
Kenya
| | - Lizz Kinyua
- Intensive Care Unit, Aga Khan University Hospital, Nairobi,
Kenya
| | - Edith Kamaru Kwobah
- Department of Mental Health, Moi Teaching & Referral Hospital,
Eldoret, Kenya
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Jayamaha AR, Dharmarathna ND, Herath ND, Ranadeva ND, Fernando MM, Samarasinghe KL, Amarabandu PN, Senanayake B, Darshana T, Renuka N, Rajapakse IH, Gunasekara CP, Meegoda L, Fernando N. The Pattern of Substance Use and Characteristics of the Individuals Enrolled in Residential Treatment at Selected Rehabilitation Centers in Sri Lanka: A Descriptive Cross-Sectional Study. Subst Abuse 2022; 16:11782218221100823. [PMID: 35645565 PMCID: PMC9130826 DOI: 10.1177/11782218221100823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 04/26/2022] [Indexed: 01/23/2023]
Abstract
Introduction: Substance use becomes censorious when it leads to harmful effects on
individuals, their families, and the community. The nature of substance use
in Sri Lankan context is poorly understood and empirical evidences are
sparse. The study aimed to describe patterns of substance use and
characteristics of the individuals enrolled in residential treatment at
selected rehabilitation centers in Sri Lanka. Material and methods: A descriptive cross-sectional study was conducted among 205 individuals
enrolled in selected rehabilitation centers. Pretested
interviewer-administered questionnaire was used to collect data. Data were
analyzed using descriptive statistics. Results: Most of the individuals who enrolled in residential treatment at selected
rehabilitation centers were unmarried (n = 124, 60.5%), Sinhala (n = 186,
90.7%), Buddhist (n = 166, 81.0%), males (n = 202, 98.5%) and belonged to
the young adult age (18-35 years) category (n = 178, 86.8%). All the
participants were poly-drug users and cannabis was the most commonly used
(n = 183, 89.3%) illicit drug followed by heroin (n = 172, 83.9%),
methamphetamine (n = 150, 73.2%) and cocaine (n = 78, 38%). The most
(n = 152, 74.1%) problematic substance for life was heroin. Most of the
participants (n = 149, 72.7%) had used drugs several times per day. The mean
duration of substance use was 7 ± 5 years. Participants (n = 177, 86.3%)
reported that the substances were available in their residential areas and
their friends (n = 197, 96.1%) were also using the substances. Conclusions: Pattern of substance use and characteristics of the individuals were unique
in Sri Lanka and need to be considered when implementing and strengthening
the programs for drug prevention and rehabilitation.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Nilani Renuka
- National Dangerous Drugs Control Board, Colombo, Sri Lanka
| | | | | | - Lalitha Meegoda
- University of Sri Jayewardenepura, Jayewardenepura, Sri Lanka
| | - Neluka Fernando
- University of Sri Jayewardenepura, Jayewardenepura, Sri Lanka
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Mbwayo A, Kumar M, Mathai M, Mutavi T, Nungari J, Gathara R, McKay M, Ssewamala F, Hoagwood K, Petersen I, Bhana A, Huang KY. Strengthening System and Implementation Research Capacity for Child Mental Health and Family Well-being in Sub-Saharan Africa. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2022; 9:37-53. [PMID: 35330916 PMCID: PMC8939896 DOI: 10.1007/s40609-021-00204-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Children in Sub-Saharan Africa (SSA) experience high rates of mental health problems, and the region has limited access to mental health resources and research capacity to address the needs. Despite the success of numerous evidence-based interventions (EBIs) and emerging methodology from the field of implementation science for addressing child mental health needs, most EBIs and implementation science methodology have not been applied in SSA contexts. The SMART-Africa Center aims to address these child welfare, mental health, services, and EBI implementation research gaps by establishing a regional trans-disciplinary collaborative center and studying strategies to strengthening mental health system and implementation research capacity. Our paper describes the overall framework and strategies that SMART-Africa team developed to strengthen capacity in three SSA countries (Ghana, Kenya, and Uganda) while focusing on its contextualization for the Kenyan school-community mental health settings. Methods to document the progress and impacts are also described. METHODS The design of the system and research strengthening activities is guided by a SMART-Africa Capacity Building framework. Two areas of capacity are focused. Mental health system capacity focuses on building political wills, leadership, transdisciplinary partnership, and stakeholders' global competency in evidence child mental health policy, intervention, and service implementation research. Implementation research capacity building focuses on building researchers' implementation research competency by carrying out an EBI implementation research (using a Hybrid Type II effectiveness-implementation). For illustration purpose, we describe how the system strengthening strategies has been applied in Kenya, and how the mixed methods design applied to assess the value and impacts of the capacity building activities. Feedback data and evaluation data collection using qualitative and quantitative methods for both areas of capacity building are still ongoing. Data will be analyzed and compared across countries in 2020-2021. CONCLUSION Our work has shown some feasibility of applying the theory-guided system strengthening model in improving child mental health service system and research capacity in one of the three SMART-Africa partnering countries. Our mental health landscape and resource mapping in Kenya also illustrated that capacity building in SSA countries involved complex dynamic, history, and some overlap efforts with multiple partnerships, and these are critical to consider in training activity and evaluation design.
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Affiliation(s)
- Anne Mbwayo
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | - Manasi Kumar
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | - Muthoni Mathai
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | - Teresia Mutavi
- University of Nairobi, Department of Psychiatry, Nairobi, Kenya
| | | | | | - Mary McKay
- Washington University in St. Louis, St. Louis, USA
| | | | | | | | - Arvin Bhana
- South African Medical Research Council, Cape Town, South Africa
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17
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Hou H, Zhang C, Tang J, Wang J, Xu J, Zhou Q, Yan W, Gao X, Wang W. Childhood Experiences and Psychological Distress: Can Benevolent Childhood Experiences Counteract the Negative Effects of Adverse Childhood Experiences? Front Psychol 2022; 13:800871. [PMID: 35282200 PMCID: PMC8914177 DOI: 10.3389/fpsyg.2022.800871] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Childhood experiences can exert a huge impact on adult psychological conditions. Previous studies have confirmed the effects of adverse childhood experiences (ACEs) and benevolent childhood experiences (BCEs) on psychological distress (e.g., stress, depression, and suicidal ideation) separately, but few studies explored a combined effect of ACEs and BCEs on psychological distress. The aim of this study was to explore a combined effect of ACEs and BCEs on psychological distress among Chinese undergraduates. Methods Participants were undergraduates aged 17–24 years (N = 1,816) and completed a self-reported questionnaire. A series of regression analyses were conducted to examine the association between childhood experiences and psychological distress. Results A total of 65.7% of undergraduates had BCEs, 27.1% of undergraduates had ACEs, and 12.9% of undergraduates had ACEs and BCEs simultaneously. Logistic regression analysis indicated that undergraduates who experienced high ACEs were more likely to have a high risk of psychological distress [odds ratio (ORs) = 1.46, 1.84, and 3.15 for uncertainty stress, depressive symptoms, and suicidal ideation, respectively], while undergraduates who experienced High BCEs were less likely to have psychological distress (ORs = 0.33, 0.22, and 0.32 for uncertainty stress, depressive symptoms, and suicidal ideation, respectively) compared with Low-Both group. The combined effect of ACEs and BCEs (High-Both group) could also play as a protective factor in uncertainty stress (OR = 0.56) and depressive symptoms (OR = 0.47). Conclusion Our findings suggested that ACEs and BCEs could not only predict the psychological distress independently, but also BCEs could counteract the negative effect of ACEs in psychological problems. There is an even greater need to identify and support the victims of ACEs and to increase BCEs in early childhood.
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Affiliation(s)
- Hao Hou
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Caochen Zhang
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Jie Tang
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Jingjing Wang
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Jiaqi Xu
- School of Medical Technology, Xuzhou Medical University, Xuzhou, China
| | - Qin Zhou
- The Affiliated Xuzhou Oriental Hospital of Xuzhou Medical University, Xuzhou, China
| | - Wenjun Yan
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Xiuyin Gao
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Wei Wang
- Department of Community and Health Education, School of Public Health, Xuzhou Medical University, Xuzhou, China
- Center for Medical Statistics and Data Analysis, Xuzhou Medical University, Xuzhou, China
- Key Laboratory of Human Genetics and Environmental Medicine, Xuzhou Medical University, Xuzhou, China
- *Correspondence: Wei Wang,
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Ngarachu EW, Kiburi SK, Owiti FR, Kangethe R. The prevalence and pattern of cannabis use among patients attending a methadone treatment clinic in Nairobi, Kenya. Subst Abuse Treat Prev Policy 2022; 17:12. [PMID: 35168646 PMCID: PMC8845270 DOI: 10.1186/s13011-022-00437-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cannabis use during methadone treatment may negatively impact treatment outcomes. The aim of this study was to determine the prevalence and pattern of cannabis use among patients attending a methadone treatment clinic in Nairobi, Kenya. METHODS This was a retrospective study of 874 patients on methadone therapy at a methadone maintenance treatment clinic in Nairobi, Kenya from December 2014 to November 2018. Data on sociodemographic characteristics and drug use patterns based on urine drug screens was collected from patient files. Data was analyzed using Statistical Package for the Social Sciences (SPSS) for windows version 23.0. RESULTS Point prevalence of cannabis use was 85.8% (95% CI, 83.3 - 88.0) at baseline and 62.7% (95% CI, 59.5 - 65.8) during follow-up. A pattern of polysubstance use was observed where opioids, cannabis and benzodiazepines were the most commonly used drugs. The mean age of the patients was 35.3 (SD 9.0) years with the majority being male, unemployed (76%), (51.4%) had reached primary level of education, and (48.5%) were divorced or separated. University education was associated with reduced risk for cannabis use OR = 0.1 (95% CI, 0.02-0.8, p = 0.031). CONCLUSION Cannabis use is prevalent among patients attending a methadone treatment clinic in Kenya, suggesting need for targeted interventions to address the problem of cannabis use during methadone treatment.
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Affiliation(s)
| | | | | | - Rachel Kangethe
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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19
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Li M, Cassis T, D'Arcy C, Low N, Meng X. Development and Validation of a Brief Form of the Childhood Adversities Questionnaire Among a Population of Mood Disorders. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP2288-NP2312. [PMID: 32618218 DOI: 10.1177/0886260520933038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Childhood adversities have significantly negative consequences on physical and mental health. The Childhood Experience of Care and Abuse Questionnaire, Version 3 (CECA.Q3) interview, as an extended version of the CECA.Q, is widely used in the assessment of childhood adversities. Although its reliability and validity have been demonstrated, the application of CECA.Q3 is limited due to its intensive and lengthy interview. This article aimed to develop and validate a brief form of the CECA.Q3 (CECA.Q3-BF) among a population of mood disorders. Data analyzed were from a clinical sample of 210 patients with mood disorders. Data were randomly split into training and testing datasets. The training data set was used for scale reduction by applying principal component factor analysis, while the testing one was used for cross-validation to examine whether the CECA.Q3-BF could have a good yield of accuracy. The optimal cutoff points of the CECA.Q3 were also tested. Overall, four out of eight subscales had items reduction without compromising their accuracy of measurements for childhood adversities. They are Antipathy (reduced by four items), Neglect (reduced by five items), Psychological Abuse (reduced by 15 items), and Role Reversal (reduced by 11 items). The CECA.Q3-BF removed 35 items (35/100, 35%) from the full CECA.Q3. The accuracy of CECA.Q3-BF was validated in the testing dataset. The CECA.Q3-BF offers a brief but good accuracy of measure for childhood adversities. Future studies are warranted to further validate this brief form. The CECA.Q3-BF is expected to improve the application of CECA.Q3 in clinical and epidemiological surveys, as it significantly reduces the length of the interview and therefore has better compliance.
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Affiliation(s)
- Muzi Li
- McGill University, Montreal, QC, Canada
| | | | - Carl D'Arcy
- University of Saskatchewan, Saskatoon, Canada
| | - Nancy Low
- McGill University, Montreal, QC, Canada
| | - Xiangfei Meng
- McGill University, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
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20
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Adverse childhood experiences, alcohol consumption, and the modifying role of social participation: Population-based study of adults in southwestern Uganda. SSM - MENTAL HEALTH 2022; 2. [DOI: 10.1016/j.ssmmh.2022.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Kiburi SK, Mwangi J, Maina G. Exploring the experiences of clients receiving opioid use disorder treatment at a methadone clinic in Kenya: a qualitative study. Addict Sci Clin Pract 2022; 17:71. [PMID: 36510246 PMCID: PMC9742652 DOI: 10.1186/s13722-022-00352-z] [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: 02/05/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Assessing the experiences of individuals on methadone treatment is essential to help evaluate the treatment program's effectiveness. This study aimed to explore the experiences of patients receiving methadone treatment at a clinic in Nairobi, Kenya. METHOD This study employed an exploratory qualitative study design. Through purposive sampling, participants were enrolled from individuals attending a methadone clinic for at least 2 years. Semi-structured individual interviews were used to collect data on substance use and experience before methadone treatment and experiences after starting methadone treatment, including benefits and challenges. Interviews were transcribed, and NVIVO 12 software was used to code the data using the preidentified analytical framework. Thematic analyses were utilized to identify cross-cutting themes between these two data sets. Seventeen participants were enrolled. RESULTS Seventeen participants were enrolled comprising 70% males, with age range from 23 to 49 years and more than half had secondary education. The interview data analysis identified four themes, namely: (a) the impact of opioid use before starting treatment which included adverse effects on health, legal problems and family dysfunction; (b) learning about methadone treatment whereby the majority were referred from community linkage programs, family and friends; (c) experiences with care at the methadone treatment clinic which included benefits such as improved health, family reintegration and stigma reduction; and (d) barriers to optimal methadone treatment such as financial constraints. CONCLUSION The findings of this study show that clients started methadone treatment due to the devastating impact of opioid use disorder on their lives. Methadone treatment allowed them to regain their lives from the adverse effects of opioid use disorder. Additionally, challenges such as financial constraints while accessing treatment were reported. These findings can help inform policies to improve the impact of methadone treatment.
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Affiliation(s)
- Sarah Kanana Kiburi
- grid.411192.e0000 0004 1756 6158Department of Medicine, Aga Khan University Hospital, Nairobi, Kenya ,grid.16463.360000 0001 0723 4123Discipline of Psychiatry, University of KwaZulu Natal, Durban, South Africa
| | - Jackline Mwangi
- grid.9762.a0000 0000 8732 4964Department of Psychology, Kenyatta University, Nairobi, Kenya
| | - Geoffrey Maina
- grid.25152.310000 0001 2154 235XCollege of Nursing, Prince Albert Campus, University of Saskatchewan, Prince Albert, Canada
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Rojas-Jara C, Polanco-Carrasco R, Caycho-Rodríguez T, Acuña-Espinoza R, González-Serrano C, Roa-Méndez P, Rojas-Román A, Sepúlveda-López MA. Experiencias adversas en la infancia y el uso de drogas en la adolescencia y adultez: un análisis de la evidencia. UNIVERSITAS PSYCHOLOGICA 2021. [DOI: 10.11144/javeriana.upsy20.eaiu] [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
El objetivo de este estudio es la revisión de la evidencia actual sobre la relación entre la vivencia de experiencias adversas en la infancia y el posterior uso de drogas en la adolescencia y adultez, y sus características. La metodología utilizada fue una revisión sistemática de publicaciones científicas, entre el periodo 2013-2017, disponibles en la base de datos Scopus sobre experiencias adversas en la infancia y el uso de drogas en la adolescencia y adultez que arrojó un total de 69 publicaciones incluidas en el estudio. Las experiencias adversas en la infancia presentan una elevada relación con el uso y/o abuso de drogas en la adolescencia y adultez. El consumo de drogas en adolescentes y adultos expuestos a experiencias traumáticas en la infancia se da principalmente en hombres. Las drogas mayormente usadas son alcohol, tabaco, cannabis y fármacos no recetados y, en menor medida, opioides, cocaína y anfetaminas. Las drogas, en este sentido, cumplen el rol de barrera química para distanciar el dolor emocional que deriva del recuerdo de las experiencias traumáticas y su intensa carga psíquica. Se requieren acciones de promoción del buen trato en la infancia, así como el abordaje terapéutico temprano de niños expuestos a experiencias traumáticas.
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Lee WC, Fang SC, Chen YY, Liu HC, Huang MC, McKetin R. Exploring the mediating role of methamphetamine use in the relationship between adverse childhood experiences and attempted suicide. Addict Behav 2021; 123:107060. [PMID: 34343924 DOI: 10.1016/j.addbeh.2021.107060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 06/18/2021] [Accepted: 07/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Methamphetamine (METH) use and adverse childhood experiences (ACEs) has been associated with an increased risk of suicidal behaviour. However, whether METH use underlies the risk of suicide attributable to ACEs is unknown and warrants investigation to inform preventive interventions. In this study, we examined the mediating role of METH use in the relationship between attempted suicide and ACEs. METHOD METH users recruited from a mandatory detoxification center (n = 346) and healthy controls (n = 342) both completed a survey related to 9 types of ACE, which was based the Family Health Questionnaire. A lifetime history of attempted suicide was obtained using the Chinese version of the Composite International Diagnostic Interview. We conducted a bootstrapped mediation analysis to examine the mediating effect of METH use on the association between ACEs and attempted suicide. RESULTS Female gender, METH use, and having multiple (≥3) ACEs were associated with an increased risk of attempted suicide. A dose-response relationship between the number of ACEs and suicide rate was observed among individuals with METH use. METH use significantly mediated the association between ACEs and attempted suicide in those with multiple (2 and 3 ACEs respectively with proportion mediated 0.16 and 0.42) and specific types of ACEs (physical abuse, witnessing maternal battering, household substance abuse, sexual abuse, and parental separation with proportion mediated 0.25, 0.35, 0.38, 0.48, 0.47 respectively). CONCLUSION Our study is the first to demonstrate that METH use partially mediates the association between ACEs and attempted suicide. Addressing METH use in people with ACEs could reduce their suicide risk.
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Merrill KG, Mwansa JK, Miti S, Burke VM, Abrams EA, Frimpong C, Decker MR, Campbell JC, Denison JA. Experiences with a violence and mental health safety protocol for a randomized controlled trial to support youth living with HIV. Glob Health Res Policy 2021; 6:40. [PMID: 34654487 PMCID: PMC8518229 DOI: 10.1186/s41256-021-00224-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 10/03/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Safety protocols are an essential component of studies addressing violence and mental health but are rarely described in the published literature from Sub-Saharan Africa. We designed and implemented a safety protocol within Project YES! (Youth Engaging for Success), which enrolled 276 youth living with HIV (ages 15-24 years) in a randomized controlled trial of a peer-mentoring intervention across four HIV clinics in Ndola, Zambia. METHODS Youth who reported severe violence and/or suicidal thoughts on research surveys or during meetings with youth peer mentors (YPM) were referred to designated healthcare providers (HCP). We explored experiences with the safety protocol using: a) monitoring data of referrals, and b) in-depth interviews with youth (n = 82), HCP (n = 10), YPM (n = 8), and staff (n = 6). Descriptive statistics were generated and thematic analysis of coded transcripts and written memos performed. RESULTS Nearly half of youth enrolled (48% of females, 41% of males) were referred to a HCP at least once. The first referral was most often for sexual violence (35%) and/or suicidal ideation/depression (29%). All referred youth aged 15-17 years and over 80% of referred youth aged 18 + agreed to see a HCP. HCP referred 15% for additional services outside the clinic. Twenty-nine youth, all HCP, all YPM, and all staff interviewed discussed the safety protocol. Most youth felt "encouraged," "helped," "unburdened," and "relieved" by their meetings with HCP; some expressed concerns about meeting with HCP. The safety protocol helped HCP recognize the need to integrate care for violence and mental health with medication adherence support. HCP, YPM, and study staff raised implementation challenges, including youth choosing not to open up to HCP, time and resource constraints, deficiencies in HCP training, and stigma and cultural norms inhibiting referrals outside the clinic for emotional trauma and mental health. CONCLUSIONS Implementing a safety protocol within an HIV clinic-based research study is possible and beneficial for youth and HCP alike. Implementation challenges underscore that HCP in Zambia work in over-stretched healthcare systems. Innovative strategies must address deficiencies in training and resources within HIV clinics and gaps in coordination across services to meet the overwhelming need for violence and mental health services among youth living with HIV.
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Affiliation(s)
- Katherine G Merrill
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
| | | | - Sam Miti
- Arthur Davison Children's Hospital, Ndola, Zambia
| | - Virginia M Burke
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Elizabeth A Abrams
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | | | - Michele R Decker
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jacquelyn C Campbell
- Department of Community-Public Health, Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Julie A Denison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
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Fernandes G, Fernandes M, Vaidya N, De Souza P, Plotnikova E, Geddes R, Holla B, Sharma E, Benegal V, Choudhry V. Prevalence of child maltreatment in India and its association with gender, urbanisation and policy: a rapid review and meta-analysis protocol. BMJ Open 2021; 11:e044983. [PMID: 34373291 PMCID: PMC8354262 DOI: 10.1136/bmjopen-2020-044983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION India is home to 20% of the world's children and yet, little is known on the magnitude and trends of child maltreatment nationwide. The aims of this review are to provide a prevalence of child maltreatment in India with considerations for any effects of gender; urbanisation (eg, urban vs rural) and legislation (Protection of Children from Sexual Offences (POCSO) Act 2012). METHODS AND ANALYSIS A rapid review will be undertaken of all quantitative peer-reviewed studies on child maltreatment in India between 2005 and 2020. Four electronic databases will be systematically searched: PubMed, EMBASE, Cochrane and PsychInfo. The primary outcomes will include all aspects of child maltreatment: physical abuse, sexual abuse, emotional abuse, emotional neglect and physical neglect. Study participants will be between 0 and 18 years and will have reported maltreatment experiences using validated, reliable tools such as the Adverse Childhood Experiences Questionnaire as well as child self-reports and clinician reports. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological appraisal of the studies will be assessed by the Newcastle-Ottawa Quality assessment scale. A narrative synthesis will be conducted for all included studies. Also, if sufficient data are available, a meta-analysis will be conducted. Effect sizes will be determined from random-effects models stratified by gender, urbanisation and the pre-2012 and post-2012 POCSO Act cut-off. I2 statistics will be used to assess heterogeneity and identify their potential sources and τ2 statistics will indicate any between-study variance. ETHICS AND DISSEMINATION As this is a rapid review, minimal ethical risks are expected. The protocol and level 1 self-audit checklist were submitted and approved by the Usher Research Ethics Group panel in the Usher Institute (School of Medicine and Veterinary Sciences) at the University of Edinburgh (Reference B126255). Findings from this review will be disseminated widely through peer-reviewed publications and in various media, for example, conferences, congresses or symposia. PROSPERO REGISTRATION NUMBER CRD42019150403.
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Affiliation(s)
- Gwen Fernandes
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Megan Fernandes
- Department of Surgery, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Nilakshi Vaidya
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Philip De Souza
- Department of Medicine, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Evgeniya Plotnikova
- College of Medicine and Veterinary Medicine, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Rosemary Geddes
- College of Medicine and Veterinary Medicine, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Bharath Holla
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Eesha Sharma
- Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Vivek Benegal
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Vikas Choudhry
- Public Health, Sambodhi Research and Communications Pvt Ltd, Noida, Uttar Pradesh, India
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Jumbe S, Kamninga TM, Mwalwimba I, Kalu UG. Determinants of adolescent substance use in Africa: a systematic review and meta-analysis protocol. Syst Rev 2021; 10:125. [PMID: 33906677 PMCID: PMC8080366 DOI: 10.1186/s13643-021-01680-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 04/20/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Adolescent substance use continues to be a growing major public health concern in Africa. Recent studies infer an overall estimated prevalence of 42% among adolescents in sub-Saharan Africa. Unfortunately, this phenomenon is not adequately documented across many settings in the continent despite known negative health and social consequences on affected individuals and their communities. Little is known about the social context of substance use in Africa among this population. Our aim is to conduct a systematic review, exploring the determinants and associated factors that influence adolescent substance use in Africa. METHODS We will search the following databases (from January 2000 onwards): PubMed, the Cochrane Library, African Journals Online (AJOL), Google Scholar, ScienceDirect and the World Health Organization (WHO) African Index Medicus. We will include population-based observational studies reporting on determinants and/or risk factors of substance use among adolescents (age 10-19 years) across Africa. Two reviewers will independently screen all citations, full-text articles and abstract data. Potential conflicts will be resolved through discussion. Study methodological quality (or bias) will be appraised using appropriate tools. If feasible, we will conduct a random-effects meta-analysis of data. We plan to conduct a meta-synthesis of qualitative studies where appropriate DISCUSSION: This review will describe the range of determinants and associated factors found to significantly influence adolescent substance use in Africa over the last two decades. Documenting this evidence is important as it can potentially inform comprehensive interventions and treatment programmes that are targeted at adolescents and their parents in these settings. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020190158.
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Affiliation(s)
- Sandra Jumbe
- The Institute of Population Health Sciences (IPHS), Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Yvonne Carter Building, 58 Turner Street, London, E1 2AB, UK.
| | - Tony Mwenda Kamninga
- African Institute for Development Policy (AFIDEP), P.O Box 31024, Lilongwe, Malawi
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Lea AJ, Waigwa C, Muhoya B, Lotukoi F, Peng J, Henry LP, Abhyankar V, Kamau J, Martins D, Gurven M, Ayroles JF. Socioeconomic status effects on health vary between rural and urban Turkana. Evol Med Public Health 2021; 9:406-419. [PMID: 34987823 PMCID: PMC8697843 DOI: 10.1093/emph/eoab039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/15/2021] [Indexed: 11/14/2022] Open
Abstract
Background and objectives Understanding the social determinants of health is a major goal in evolutionary biology and human health research. Low socioeconomic status (often operationalized as absolute material wealth) is consistently associated with chronic stress, poor health and premature death in high-income countries. However, the degree to which wealth gradients in health are universal—or are instead made even steeper under contemporary, post-industrial conditions—remains poorly understood. Methodology We quantified absolute material wealth and several health outcomes among a population of traditional pastoralists, the Turkana of northwest Kenya, who are currently transitioning toward a more urban, market-integrated lifestyle. We assessed whether wealth associations with health differed in subsistence-level versus urban contexts. We also explored the causes and consequences of wealth-health associations by measuring serum cortisol, potential sociobehavioral mediators in early life and adulthood, and adult reproductive success (number of surviving offspring). Results Higher socioeconomic status and greater material wealth predicts better self-reported health and more offspring in traditional pastoralist Turkana, but worse cardiometabolic health and fewer offspring in urban Turkana. We do not find robust evidence for either direct biological mediators (cortisol) or indirect sociobehavioral mediators (e.g. adult diet or health behaviors, early life experiences) of wealth–health relationships in either context. Conclusions and implications While social gradients in health are well-established in humans and animals across a variety of socioecological contexts, we show that the relationship between wealth and health can vary within a single population. Our findings emphasize that changes in economic and societal circumstances may directly alter how, why and under what conditions socioeconomic status predicts health. Lay Summary High socioeconomic status predicts better health and more offspring in traditional Turkana pastoralists, but worse health and fewer offspring in individuals of the same group living in urban areas. Together, our study shows that under different economic and societal circumstances, wealth effects on health may manifest in very different ways.
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Affiliation(s)
- Amanda J Lea
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
| | - Charles Waigwa
- Mpala Research Centre, Nanyuki, Kenya
- Department of Biochemistry, School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Benjamin Muhoya
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
- Mpala Research Centre, Nanyuki, Kenya
| | | | - Julie Peng
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
| | - Lucas P Henry
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
| | - Varada Abhyankar
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
| | - Joseph Kamau
- Department of Biochemistry, School of Medicine, University of Nairobi, Nairobi, Kenya
- Institute of Primate Research, National Museums of Kenya, Nairobi, Kenya
| | - Dino Martins
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Mpala Research Centre, Nanyuki, Kenya
| | - Michael Gurven
- Department of Anthropology, University of California: Santa Barbara, Santa Barbara, CA, USA
| | - Julien F Ayroles
- Department of Ecology and Evolution, Princeton University, Princeton, NJ, USA
- Lewis Sigler Institute for Integrative Genomics, Princeton University, Princeton, NJ, USA
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Prior MK, Petra M. Assessing the Effects of Childhood Multitype Maltreatment on Adult Spirituality. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:469-480. [PMID: 33269046 PMCID: PMC7683659 DOI: 10.1007/s40653-019-00288-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Continued research regarding the effects of experiencing multiple types of childhood maltreatment is necessary in gauging the impact of such experiences on survivors. In an effort to contribute to this area of study, the authors investigated the relationship between multitype childhood maltreatment and adult spirituality and compared three established methods of assessing the these effects to investigate the degree to which a researcher's choice of method might affect their findings. Surveys were completed by 254 university students that included data on childhood maltreatment and current spirituality. Findings suggest the presence of a dose response between multitype childhood maltreatment and adult spirituality and that the researcher's assessment method choice can affect findings of the research. In addition, the authors report their findings on the unique effects of five types of childhood maltreatment on adult spirituality. Emotional neglect and emotional abuse were found to be associated with lower levels of spirituality; no significant relationships were found between sexual abuse, physical abuse, and physical neglect and spirituality. The findings suggest the need for further study regarding the effects of experiencing multiple types of childhood maltreatment, the most accurate methods of assessing those effects on survivors, and the relationship between multitype maltreatment and spirituality.
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Affiliation(s)
- Michael K. Prior
- School of Social Justice, Social Work Program, University of Toledo, 2801 W. Bancroft St., MS119, Toledo, OH 43606 USA
| | - Megan Petra
- School of Social Justice, Social Work Program, University of Toledo, 2801 W. Bancroft St., MS119, Toledo, OH 43606 USA
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Someshwar A, Holla B, Pansari Agarwal P, Thomas A, Jose A, Joseph B, Raju B, Karle H, Muthukumaran M, Kodancha PG, Kumar P, Reddy PV, Kumar Nadella R, Naik ST, Mitra S, Mallappagiri S, Sreeraj VS, Balachander S, Ganesh S, Murthy P, Benegal V, Reddy JY, Jain S, Mahadevan J, Viswanath B, Narayanaswamy JC, Sivakumar PT, Kandasamy A, Kesavan M, Mehta UM, Venkatasubramanian G, John JP, Mukherjee O, Purushottam M, Kannan R, Mehta B, Kandavel T, Binukumar B, Saini J, Jayarajan D, Shyamsundar A, Moirangthem S, Vijay Kumar KG, Thirthalli J, Chandra PS, Gangadhar BN, Panicker MM, Bhalla US, Chattarji S, Varghese M, Raghu P, Rao M. Adverse childhood experiences in families with multiple members diagnosed to have psychiatric illnesses. Aust N Z J Psychiatry 2020; 54:1086-1094. [PMID: 32538179 DOI: 10.1177/0004867420931157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Adverse childhood experiences are linked to the development of a number of psychiatric illnesses in adulthood. Our study examined the pattern of adverse childhood experiences and their relation to the age of onset of major psychiatric conditions in individuals from families that had ⩾2 first-degree relatives with major psychiatric conditions (multiplex families), identified as part of an ongoing longitudinal study. METHODS Our sample consisted of 509 individuals from 215 families. Of these, 268 were affected, i.e., diagnosed with bipolar disorder (n = 61), obsessive-compulsive disorder (n = 58), schizophrenia (n = 52), substance dependence (n = 59) or co-occurring diagnoses (n = 38), while 241 were at-risk first-degree relatives who were either unaffected (n = 210) or had other depressive or anxiety disorders (n = 31). All individuals were evaluated using the Adverse Childhood Experiences - International Questionnaire and total adverse childhood experiences exposure and severity scores were calculated. RESULTS It was seen that affected males, as a group, had the greatest adverse childhood experiences exposure and severity scores in our sample. A Cox mixed effects model fit by gender revealed that a higher total adverse childhood experiences severity score was associated with significantly increased risk for an earlier age of onset of psychiatric diagnoses in males. A similar model that evaluated the interaction of diagnosis revealed an earlier age of onset in obsessive-compulsive disorder and substance dependence, but not in schizophrenia and bipolar disorder. CONCLUSION Our study indicates that adverse childhood experiences were associated with an earlier onset of major psychiatric conditions in men and individuals diagnosed with obsessive-compulsive disorder and substance dependence. Ongoing longitudinal assessments in first-degree relatives from these families are expected to identify mechanisms underlying this relationship.
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Affiliation(s)
- Amala Someshwar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India.,National Centre for Biological Sciences (NCBS), Bengaluru, India
| | - Bharath Holla
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Preeti Pansari Agarwal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Anza Thomas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Anand Jose
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Boban Joseph
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Birudu Raju
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Hariprasad Karle
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - M Muthukumaran
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Prabhath G Kodancha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Pramod Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Preethi V Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Ravi Kumar Nadella
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sanjay T Naik
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sayantanava Mitra
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sreenivasulu Mallappagiri
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vanteemar S Sreeraj
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Srinivas Balachander
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Suhas Ganesh
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Janardhan Yc Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Sanjeev Jain
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Jayant Mahadevan
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Biju Viswanath
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Davila IG, Cramm H, Chen S, Aiken AB, Ouellette B, Manser L, Kurdyak P, Mahar AL. Intra-Provincial Variation in Publicly Funded Mental Health and Addictions “Services” Use Among Canadian Armed Forces Families Posted Across Ontario. CANADIAN STUDIES IN POPULATION 2020. [DOI: 10.1007/s42650-020-00027-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kidman R, Piccolo LR, Kohler HP. Adverse Childhood Experiences: Prevalence and Association With Adolescent Health in Malawi. Am J Prev Med 2020; 58:285-293. [PMID: 31810632 PMCID: PMC6981018 DOI: 10.1016/j.amepre.2019.08.028] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Childhood adversity is robustly associated with poor health across the life course. However, very few studies have examined the prevalence and implications of adverse childhood experiences in low- and middle-income countries. The objective of this study is to measure adverse childhood experiences among adolescents in Malawi and examine the association with mental and physical health outcomes. METHODS From 2017 to 2018, baseline data were collected among adolescents aged 10-16 years (n=2,089). Respondents were interviewed in their local language at their homes. Respondents completed questions on childhood adversity (Adverse Childhood Experiences-International Questionnaire), self-rated health, mortality expectations, and mental health (Beck Depression Inventory and Post-Traumatic Stress Disorder Scale). Stunting, obesity, and grip strength were measured. Analyses were conducted in 2018. Frequencies described the prevalence of adverse childhood experiences, and adjusted multivariate models examined whether cumulative adversity predicts current health. RESULTS Adolescents reported a high burden of adversity (i.e., 5 lifetime adverse childhood experiences on average). Adolescents who scored in the top adverse childhood experiences quintile were more likely to report depression (OR=3.11, 95% CI=2.10, 4.60), post-traumatic stress disorder (OR=4.19, 95% CI=2.43, 7.23), worse self-rated health (OR=3.72, 95% CI=2.03, 6.81), and a higher expected likelihood of dying in the next 5 years (RR=5.02, 95% CI=2.15, 7.88) compared with those in the bottom quintile. However, adverse childhood experiences did not demonstrate a graded relationship with obesity, stunting, or grip strength. CONCLUSIONS These patterns are quite consistent with evidence from high-income countries and suggest that primary prevention of adverse childhood experiences should be a priority to ensure lifelong health in low-resources settings.
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Affiliation(s)
- Rachel Kidman
- Program in Public Health, State University of New York at Stony Brook, Stony Brook, New York; Department of Family, Population and Preventive Medicine, State University of New York at Stony Brook, Stony Brook, New York.
| | - Luciane R Piccolo
- Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Hans-Peter Kohler
- Department of Sociology, University of Pennsylvania, Philadelphia, Pennsylvania; Population Studies Center, University of Pennsylvania, Philadelphia, Pennsylvania
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Ramakrishnan N, McPhee M, Sosnowski A, Rajasingaam V, Erb S. Positive urgency partially mediates the relationship between childhood adversity and problems associated with substance use in an undergraduate population. Addict Behav Rep 2019; 10:100230. [PMID: 31828206 PMCID: PMC6889254 DOI: 10.1016/j.abrep.2019.100230] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/05/2019] [Accepted: 10/17/2019] [Indexed: 01/12/2023] Open
Abstract
CTQ and ACE directly predicted DAST-10 scores across all models of direct effects. Positive urgency mediated the relationship between CTQ and ACE on DAST-10 scores. Motor subscale of BIS-11 selectively mediated the effect of CTQ on DAST-10 scores. Childhood adversity, impulsivity, and substance use may be influenced by experience.
Background Childhood adversity predicts the development of substance use problems in young adulthood. Building on past work examining the mediating role of impulsivity in the relationship between childhood maltreatment and substance use in alcohol and nicotine users, this study examined the relationship with other substances in a representative undergraduate sample. In addition, the study aimed to determine whether there was convergence in findings between different measures of childhood adversity and impulsivity. Method 309 undergraduate students completed self-report questionnaires assessing childhood adversity (Childhood Trauma Questionnaire – CTQ; Adverse Childhood Experience Scale – ACE), impulsivity (Short UPPS-P; Barratt Impulsivity Scale – BIS-11) and problems associated with substance use (Drug Abuse Screening Test – DAST-10). Results The SUPPS-P positive urgency facet partially mediated the relationship between CTQ and DAST-10 (b = 0.0039, 95% CI [0.0008, 0.0086]), as well as between ACE and DAST-10 (b = 0.015, 95% CI [0.0014, 0.0446]). The BIS-11 motor facet partially mediated the effect of CTQ on DAST-10 (b = 0.0017, 95% CI [0.0002, 0.0054]). Conclusion Positive urgency partially mediated the relationship between childhood maltreatment and substance use problems for both the CTQ and ACE. While these results are consistent with past studies showing a selective mediation effect of positive urgency in a sample of young adults, they are inconsistent with those showing a selective mediation effect of negative urgency in a sample of heavy drinkers. Together, these findings suggest that the relationship between childhood adversity, impulsivity, and substance use-related problems may be influenced by experience.
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Affiliation(s)
| | - Matthew McPhee
- Department of Psychology, University of Toronto Scarborough, Canada
| | | | | | - Suzanne Erb
- Department of Psychology, University of Toronto Scarborough, Canada
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The role of emotion dysregulation in the relation of childhood trauma to heroin craving in individuals with heroin dependence. Drug Alcohol Depend 2019; 195:132-139. [PMID: 30634108 DOI: 10.1016/j.drugalcdep.2018.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/02/2018] [Accepted: 12/11/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Difficulties in emotion regulation (DER) may be important in heroin craving in individuals with heroin dependence who have experienced childhood trauma (CT). However, no research has been performed on DER in the context of heroin dependence. The aim of this study was to evaluate direct and indirect relations of CT to the subscales of heroin craving (i.e., heroin thoughts and interference, intention to use heroin and control of its consumption, and resistance to thoughts and decisions to use heroin) via DER dimensions in individuals with a DSM diagnosis of heroin dependence. METHODS In a cross-sectional design, 330 males with heroin dependence completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Obsessive-Compulsive Drug Use Scale-Form Heroin (OCDUS-Form Heroin), and the Depression Anxiety Stress Scales (DASS). RESULTS The results revealed that CT had no direct relations to the subscales of heroin craving, but it indirectly was related to all three subscales of heroin craving via one of the DER dimensions named limited access to emotion regulation strategies (Strategies) after adjusting for demographic and clinical factors. CONCLUSIONS The findings suggest that Strategies may be related to heroin craving in individuals with heroin dependence who have CT. This proposes that treatment and prevention attempts focused on training the use of effective emotion regulation strategies may be useful to reduce heroin craving in individuals with heroin dependence who have experienced a history of CT.
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Kumar M, Amugune B, Madeghe B, Wambua GN, Osok J, Polkonikova-Wamoto A, Bukusi D, Were F, Huang KY. Mechanisms associated with maternal adverse childhood experiences on offspring's mental health in Nairobi informal settlements: a mediational model testing approach. BMC Psychiatry 2018; 18:381. [PMID: 30518351 PMCID: PMC6280351 DOI: 10.1186/s12888-018-1953-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/16/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) is a significant public health and social welfare problem in low-and middle income countries (LMICs). However, most ACEs research is based on developed countries, and little is known about mechanisms of early ACEs on adulthood health and offspring's wellbeing for populations in LMICs. This area is needed to guide social welfare policy and intervention service planning. This study addresses these research gaps by examining patterns of ACEs and understanding the role of ACEs on adulthood health (i.e., physical, mental health, experience of underage pregnancy) and offspring's mental health in Kenya. The study was guided by an Integrated Family Stress and Adverse Childhood Experiences Mediation Framework. METHODS Three hundred ninety four mothers from two informal communities in Kariobangi and Kangemi in Nairobi were included in this study. The Adverse Childhood Experiences International Questionnaire (ACE-IQ), the Kessler Psychological Distress Scale (K10), Overall Health and Quality of Life items, and Child Behavior Checklist were used to study research questions. Data was gathered through a one-time interview with mothers. Structural Equational Modeling (SEM) was applied for mediational mechanism testing. RESULTS Among 13 ACE areas, most mothers experienced multiple adversity during their childhood (Mean (SD) = 4.93 (2.52)), with household member treated violently (75%) as the most common ACE. SEM results showedthat all domains of ACEs were associated with some aspects of maternal health, and all three domains of maternal health (maternal mental health, physical health, and adolescent pregnancy) were significantly associated with development of offspring's mental health problems. CONCLUSION ACEs are highly prevalent in Kenyan informal settlements. Consistent with cross cultural literature on family stress model, maternal ACEs are robust predictors for poor child mental health. Preventive interventions for child mental health need to address maternal adverse childhood traumatic experiences as well as their current health in order to effectively promote child mental health.
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Affiliation(s)
- Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Research Department of Clinical Health and Educational Psychology, University College London, London, UK
| | | | - Beatrice Madeghe
- Department of Food and Nutrition Sciences, University of Nairobi, Nairobi, Kenya
| | - Grace Nduku Wambua
- Department of Clinical, Neuro- & Developmental Psychology, Vrije University of Amsterdam, Amsterdam, Netherlands
| | - Judith Osok
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | - David Bukusi
- Head VCT and HIV Care, Kenyatta National Hospital, Nairobi, Kenya
| | - Fred Were
- College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Keng-Yen Huang
- Department of Population Health, New York University School of Medicine, New York, USA
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