1
|
Velloza J, Ndimande‐Khoza N, Mills L, Concepcion T, Gumede S, Chauke H, Verhey R, Chibanda D, Hosek S, Weiner BJ, Celum C, Delany‐Moretlwe S. Integrating a mental health intervention into PrEP services for South African young women: a human-centred implementation research approach to intervention development. J Int AIDS Soc 2024; 27 Suppl 1:e26274. [PMID: 38965973 PMCID: PMC11224591 DOI: 10.1002/jia2.26274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 05/01/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Adolescent girls and young women (AGYW) who may benefit from HIV pre-exposure prophylaxis (PrEP) face high levels of common mental disorders (e.g. depression, anxiety). Common mental disorders can reduce PrEP adherence and increase HIV risk, yet mental health interventions have not been well-integrated into PrEP delivery. METHODS We conducted a four-phase human-centred design process, from December 2020 to April 2022, to understand mental health challenges among AGYW in Johannesburg, South Africa and barriers to integrated mental health and PrEP services. In the "Discover" phase, we conducted in-depth interviews with AGYW and key informants (KIs) in Johannesburg. We conducted a rapid qualitative analysis, informed by the Consolidated Framework for Implementation Research (CFIR), to identify facilitators and barriers of integrated mental health and PrEP services and mapped barriers to potential implementation strategies. In the "Design" and "Build" phases, we conducted stakeholder workshops to iteratively adapt an evidence-based mental health intervention, the Friendship Bench, and refine implementation strategies for South African PrEP delivery settings. In the "Test" phase, we piloted our adapted Friendship Bench package. RESULTS Interviews with 70 Discover phase participants (48 AGYW, 22 KIs) revealed the importance of integrated mental health and PrEP services for South African AGYW. Interviewees described barriers and implementation strategies for mental health and PrEP services around the CFIR domains: intervention characteristics (e.g. challenges with AGYW "opening up"); outer Johannesburg setting (e.g. community stigma); inner clinic setting (e.g. judgemental healthcare providers); characteristics of counsellors (e.g. training gaps); and the implementation process (e.g. need for demand creation). The Design and Build workshops included 13 AGYW and 15 KIs. Implementation barriers related to the quality and accessibility of public-sector clinic services, lay counsellor training, and community education and demand creation activities were prioritized. This led to 12 key Friendship Bench adaptations and the specification of 10 implementation strategies that were acceptable and feasible in initial pilot testing with three AGYW. CONCLUSIONS Using a human-centred approach, we identified determinants and potential solutions for integrating mental health interventions within PrEP services for South African AGYW. This design process centred stakeholders' perspectives, enabling rapid development of an adapted Friendship Bench intervention implementation package.
Collapse
Affiliation(s)
- Jennifer Velloza
- Department of Epidemiology & BiostatisticsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | | | - Lisa Mills
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Tessa Concepcion
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Sanele Gumede
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | - Hlukelo Chauke
- Wits RHIUniversity of the WitwatersrandJohannesburgSouth Africa
| | | | | | - Sybil Hosek
- Department of MedicineUniversity of Illinois ChicagoChicagoIllinoisUSA
| | - Bryan J. Weiner
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
| | - Connie Celum
- Department of Global HealthUniversity of WashingtonSeattleWashingtonUSA
- Department of MedicineUniversity of WashingtonSeattleWashingtonUSA
- Department of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | | |
Collapse
|
2
|
Mebrahtu H, Chimbindi N, Zuma T, Dreyer J, Mthiyane N, Seeley J, Shahmanesh M, Sherr L, Harling G. Incident pregnancy and mental health among adolescent girls and young women in rural KwaZulu-Natal, South Africa: an observational cohort study. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2024; 29:2371414. [PMID: 39035705 PMCID: PMC11259029 DOI: 10.1080/02673843.2024.2371414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
Pregnancy can place adolescent girls and young women (AGYW) at risk of poor mental health. However, evidence linking youth pregnancy to mental health in resource-limited settings is limited, especially where HIV incidence is high. We analysed a population-representative cohort of AGYW aged 13-25 in rural KwaZulu-Natal to assess how adolescent pregnancy predicts subsequent mental health. Among 1851 respondents, incident pregnancy (self-reported past-12-month) rose from 0.7% at age 14 to 22.1% by 18. Probable common mental disorder (CMD; 14-item Shona Symptom Questionnaire) prevalence was 19.1%. In adjusted Poisson regression recent pregnancy was associated with slightly higher probable CMD (adjusted prevalence ratio [aPR] 1.19, 95%CI 0.96-1.49), and stronger association among 13-15 year-olds (aPR 3.25, 95%CI 1.50-7.03), but not with HIV serostatus. These findings suggest a possible incremental mental health impact of being pregnant earlier than peers, pointing to the need for age-appropriate mental health interventions for AGYW in resource-limited settings.
Collapse
Affiliation(s)
- Helen Mebrahtu
- Institute for Global Health, University College London, London, UK
| | - Natsayi Chimbindi
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Thembelihle Zuma
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, UK
| | - Jaco Dreyer
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Nondumiso Mthiyane
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Maryam Shahmanesh
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Guy Harling
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, South Africa
| |
Collapse
|
3
|
Kvalsvig JD, Taylor M, Watt KG, Desmond C. The impact of family support and organization on adolescents during school closure under Covid-19 lockdown regulations in an area of South Africa. PLoS One 2023; 18:e0288501. [PMID: 37561806 PMCID: PMC10414574 DOI: 10.1371/journal.pone.0288501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Accepted: 06/28/2023] [Indexed: 08/12/2023] Open
Abstract
The Covid-19 pandemic and resultant disruptions to schooling presented significant challenges for many families. Well organised families have been shown to have a protective effect on adolescent wellbeing in periods of shock. At the onset of the Covid-19 pandemic, Asenze, a population-based cohort study, was conducting a third wave of data collection in peri-urban South Africa, examining risk and protective factors during adolescence. By March 2020, n = 272 adolescents and their caregivers (n = 241) in the cohort had been assessed when in-person data collection was halted by lockdown measures countrywide. During this cessation we undertook a brief telephonic qualitative sub-study to explore whether families enrolled in the cohort were able to cohabit cohesively and undertake distance learning during lockdown. A purposeful sample of 20 families (caregivers n = 20, adolescents n = 24) recently assessed in the Wave 3 of the main study, participated in semi-structured interviews. Quantitative data from Waves 1-3 of the main study was used to measure family function, adolescent cognitive function, and profile adolescent and caregivers. The quantitative and qualitative data were integrated to illustrate the dynamics of the participants' lives before and during lockdown. We found that families classified as well-organized before lockdown, were more likely to report co-operation during lockdown. Adolescents who were self-motivated, had access to smartphones or the internet, and were supported by both family and educators, were well-placed to continue their education without much disruption. However, few schools instituted distance learning. Of the adolescents who were not assisted- some studied on their own or with peers, but others did no schoolwork, hindered by a lack of digital connectivity, and poor service delivery. The experience of adolescence and caregivers in the Asenze Cohort during lockdown highlight the importance of family functioning for adolescent wellbeing in crisis, as well as the need for access to health, mental health, and social services, communication upgrades, and enhancements to the education system during peaceful times, to make a difference to young lives in times of crisis.
Collapse
Affiliation(s)
- Jane D. Kvalsvig
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Myra Taylor
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Kathryn G. Watt
- Centre for Rural Health School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Chris Desmond
- Centre for Rural Health School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
4
|
Doku PN, Ananga MK, Jehu-Appiah N, Akohene KM, Debrah TP, Nsatimba F. Child maltreatment mediates the relationship between HIV/AIDS family dysfunction trajectories and psychosocial problems among adolescents. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001599. [PMID: 36963031 PMCID: PMC10021166 DOI: 10.1371/journal.pgph.0001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/24/2023] [Indexed: 03/12/2023]
Abstract
The relationship between parental HIV/AIDS status or death and child mental health is well known, although the role of child maltreatment as a confounder or mediator in this relationship remains uncertain. This study examined the potential path mechanism through child maltreatment mediating the link between HIV/AIDS family dysfunction trajectories and psychosocial problems. A cross-sectional survey was conducted in the Lower Manya Municipal Assembly of Ghana. A questionnaire which consisted of the Strengths and Difficulties Questionnaire (SDQ), Social and Health Assessment (SAHA), Rosenberg Self-Esteem Scale (RSES) and the Conflict Tactics Scale (CTS) was completed by 291 adolescents. Controlling for relevant sociodemographic confounders, mediation analyses using linear regression were fitted to examine whether the association between family dysfunction and psychosocial problems is mediated by child maltreatment. The results indicate that, among adolescents, child maltreatment fully mediated the association between being orphaned by AIDS and self-esteem (b = .59 [95%CI .32, .91]), delinquency and risky behaviours (b = .56 [95%CI .31, .86]) and peer problems (b = .74 [95%CI .48, 1.03]). Similarly, child maltreatment fully mediated the association between living with an HIV/AIDS-infected parent and self-esteem (b = .78 [95%CI .43, 1.23]), delinquency and risky behaviours (b = .76 [95%CI .45, 1.11]), depression/emotional problems (b = .64 [95%CI .40, .92]) and peer problems (b = .94 [95%CI .66, 1.26]). Partial mediation was found for hyperactivity. Child maltreatment mediates the association between the family dysfunction trajectories of parental HIV/AIDS or death and psychosocial problems among adolescents. This implies that efforts to address child maltreatment among families affected by HIV/AIDS may be helpful in the prevention of psychosocial problems among these children, thus enhancing their wellbeing. The findings therefore underscore the need for comprehensive psychosocial interventions that addresses both the unique negative exposures of HIV/AIDS and maltreatment for children affected by HIV.
Collapse
Affiliation(s)
- Paul Narh Doku
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Mark Kwame Ananga
- School of Public Health, University of Health and Allied Sciences, Ho, Ghana
| | | | - Kofi Mensah Akohene
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Frederick Nsatimba
- Department of Mental Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| |
Collapse
|
5
|
Mutero IT, Mindu T, Cele W, Manyangadze T, Chimbari MJ. Engaging youth in stakeholder analysis for developing community-based digital innovations for mental health of young people in Ingwavuma community, in KwaZulu-Natal Province, South Africa. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4239-e4251. [PMID: 35507734 PMCID: PMC10084098 DOI: 10.1111/hsc.13817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 03/09/2022] [Accepted: 04/12/2022] [Indexed: 06/14/2023]
Abstract
South Africa faces a critical shortage of mental health service professionals and support for young people with common mental health disorders is inadequate. Social relationships that provide support to adolescents in South African communities are increasingly declining due to socio-economic pressures. Developing ethical digital mental health innovations has potential to address provide services particularly in rural communities where mental health facilities are scarce. The active involvement of young people is critical to maximising uptake and reducing apathy on the use of digital innovations for mental health. Using the nominal group technique this study engaged young people in identifying stakeholders for setting up a community-based mental health intervention in a rural community. Use of nominal group technique for stakeholder analysis proved to a useful tool for engaging young people. The stakeholder identification and analysis provided a base for inclusivity in developing digital innovations for mental health through identifying multi-sector community stakeholders. It revealed that young people in the community have varying perceptions about the level of power and interest which their peers, family members, local leaders, health workers and social development organisations have in developing digital mental health interventions. This research contributes to our understanding of the ways in which to leverage young people's participation in project planning and decision-making and building strong teams and alliances for developing digital innovations for mental health in marginalised rural communities.
Collapse
Affiliation(s)
| | | | - Winnie Cele
- University of KwaZulu‐NatalDurbanSouth Africa
| | | | - Moses John Chimbari
- University of KwaZulu‐NatalDurbanSouth Africa
- Great Zimbabwe UniversitySchool of Medical and Health SciencesMasvingoZimbabwe
| |
Collapse
|
6
|
Mhungu A, Sixsmith J, Burnett E. Adolescent Girls and Young Women's Experiences of Living with HIV in the Context of Patriarchal Culture in Sub-Saharan Africa: A Scoping Review. AIDS Behav 2022; 27:1365-1379. [PMID: 36318422 PMCID: PMC10129999 DOI: 10.1007/s10461-022-03872-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2022] [Indexed: 04/28/2023]
Abstract
Adolescent girls and young women (AGYW) in sub-Saharan Africa are disproportionately affected by the human immunodeficiency virus (HIV) due to socio-cultural gender, power, and economic disparities. This scoping review examined the literature to explore what is known about AGYW's everyday personal, relational, and social experiences of HIV to help shape future protective HIV policy and practice. Six databases were searched: Medline, CINAHL, Scopus, ASSIA, Google Scholar, and ProQuest, resulting in a total of 12,581 articles. Of these, 40 articles were included in the review. Key themes generated from the thematic analysis were relational and psychosocial challenges, inhibiting sexual expression, poverty, stigma, and discrimination; managing health in everyday life; agency and resilience; and personal space and social support. In conclusion, the review found a lack of understanding of AGYW's everyday experiences of living with HIV from their own perspectives. There was also little consideration of the role of patriarchal culture and how this constrains AGYW's ability to negotiate their relationships. Further research is needed to reveal AGYW's perspectives on living with HIV in sub-Saharan Africa.
Collapse
Affiliation(s)
- Alington Mhungu
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland.
| | - Judith Sixsmith
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland
| | - Emma Burnett
- School of Health Sciences, University of Dundee, 11 Arlie Place, DD1 4HN, Dundee, Scotland
| |
Collapse
|
7
|
Chimbindi N, Ngema U, Ngwenya N, Gibbs A, Groenewald C, Harling G, Mthiyane N, Nkosi B, Seeley J, Shahmanesh M. The sexual and reproductive health needs of school-going young people in the context of COVID-19 in rural KwaZulu-Natal, South Africa. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2022; 21:162-170. [PMID: 35901293 DOI: 10.2989/16085906.2022.2095921] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background: The impact of school closures due to COVID-19 raised widespread concerns about children's health and well-being. We examine the impact on the sexual health needs of learners in the context of COVID-19 related lockdowns in rural KwaZulu-Natal, South Africa.Methods: In july-November 2020 and August-November 2021 we conducted 24 in-depth interviews and 8 group discussions with teachers and learners from 4 schools, community members and key education stakeholders. All interviews were conducted by telephone. We used a thematic analysis approach and Nvivo 12 software to manage the data.Results: Four main themes related to the COVID-19 pandemic emerged from the data: the sexual and reproductive health (SRH) of learners in the lead-up to the pandemic; the impact of COVID-19 on learners' SRH and wellbeing; the opportunities schools provided to support sexual well-being of learners during the pandemic; and the role of schools in supporting SRH for learners during the pandemic. Learners and stakeholders reported that the SRH of young people was affected by alcohol misuse, poor SRH knowledge and few pathways to link learners with services. Stakeholders working with schools reported that a lack of access to biomedical interventions (e.g., contraception) increased learner pregnancies. Gender-based violence in learners' households was reported to have increased during the COVID-19 pandemic related to loss of income. School closures disrupted the provision of a safe space to provide SRH and HIV-education through Life Orientation lessons and school nurse talks. This loss of a safe space also left learners vulnerable to sexual and physical violence. However, once schools re-opened, daily COVID-19 screening in schools provided the opportunity to identify and support vulnerable children who had other social needs (food and uniforms).Conclusion: The COVID-19 pandemic may have increased SRH needs and vulnerability of school-going children in a high HIV-burden rural setting. School shutdowns reduced the opportunity for schools to provide a vital safe space and information to enhance SRH for adolescents. Schools play a vital health promotion and social protection role.
Collapse
Affiliation(s)
- Natsayi Chimbindi
- Africa Health Research Institute, KwaZulu-Natal, Durban & Mtubatuba, South Africa.,Institute for Global Health, University College London, London, United Kingdom.,University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Ursula Ngema
- Africa Health Research Institute, KwaZulu-Natal, Durban & Mtubatuba, South Africa
| | - Nothando Ngwenya
- Africa Health Research Institute, KwaZulu-Natal, Durban & Mtubatuba, South Africa.,Institute for Global Health, University College London, London, United Kingdom.,University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Andrew Gibbs
- Institute for Global Health, University College London, London, United Kingdom.,University of KwaZulu-Natal, KwaZulu-Natal, South Africa.,Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa
| | - Candice Groenewald
- Centre for Community Based Research, Human Sciences Research Council, Durban, South Africa.,Department of Psychology, Rhodes University, Makhanda, South Africa
| | - Guy Harling
- Africa Health Research Institute, KwaZulu-Natal, Durban & Mtubatuba, South Africa.,Institute for Global Health, University College London, London, United Kingdom.,University of KwaZulu-Natal, KwaZulu-Natal, South Africa.,MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa.,Department of Epidemiology & Harvard Centre for Population and Development Studies, Harvard TH Chan School of Public Health, Boston, USA
| | - Nondumiso Mthiyane
- Africa Health Research Institute, KwaZulu-Natal, Durban & Mtubatuba, South Africa.,Institute for Global Health, University College London, London, United Kingdom
| | - Busisiwe Nkosi
- Africa Health Research Institute, KwaZulu-Natal, Durban & Mtubatuba, South Africa.,Institute for Global Health, University College London, London, United Kingdom.,University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, Durban & Mtubatuba, South Africa.,University of KwaZulu-Natal, KwaZulu-Natal, South Africa.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, Durban & Mtubatuba, South Africa.,Institute for Global Health, University College London, London, United Kingdom.,University of KwaZulu-Natal, KwaZulu-Natal, South Africa
| |
Collapse
|
8
|
Nxumalo V, Nxumalo S, Smit T, Khoza T, Mdaba F, Khumalo T, Cislaghi B, McGrath N, Seeley J, Shahmanesh M, Harling G. Protocol: Mapping social networks, social influence and sexual health among youth in rural KwaZulu-Natal, the Sixhumene cohort study. Wellcome Open Res 2022; 7:164. [PMID: 36324699 PMCID: PMC9608251 DOI: 10.12688/wellcomeopenres.17896.1] [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] [Accepted: 05/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Sexual behaviour and sexually transmitted infections are strongly affected by social connections, and interventions are often adapted more readily when diffused through social networks. However, evidence on how young people acquire ideas and change behaviour through the influence of important social contacts is not well understood in high-HIV-prevalence settings, with the result that past peer-led HIV-prevention interventions have had limited success. Methods: We therefore designed a cohort study (named Sixhumene or ‘we are connected’) to follow young people in three rural and small-town communities in uMkhanyakude district, KwaZulu-Natal, South Africa, and the people that these youth identify as important in their lives. We will interview them five times over three years, at each visit collecting information on their socioeconomic, social and sexual health lives, and testing them for HIV and herpes simplex virus 2 (HSV-2). We will use this information to understand how these young people’s sexual health decisions are formed. This will include evaluating how poor sexual health outcomes are correlated across social networks, how youth mimic the attitudes and behaviours of those around them, who is at greatest risk of acquiring HIV and HSV-2, and who might be most influential within communities and thus best able to promote protective interventions. Discussion: The information gathered through this study will allow us to describe social connection and influence spread through these real-world social networks, and how this leads to sexual health outcomes. Sixhumene will provide vital inputs for mathematical models of communities and spreading processes, as well as inform the development of effective interventions to protect the sexual health of community members through appropriate targeting with optimised messaging requiring fewer resources.
Collapse
Affiliation(s)
- Vuyiswa Nxumalo
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Theresa Smit
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Thandeka Khoza
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Fikile Mdaba
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Thulile Khumalo
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Nuala McGrath
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
- Faculty of Social Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, WC1E 6JB, UK
| | - Guy Harling
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu Natal, Durban, 4041, South Africa
- MRC/Wits-Agincourt Unit, University of the Witwatersrand, Johannesburg, Gauteng, 2193, South Africa
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Harvard Center for Population and Development Studies, Harvard Univeristy, Cambridge, MA, 02138, USA
| |
Collapse
|
9
|
Theron L, Rothmann S, Makhnach A, Ungar M. Adolescent Mental Health Resilience and Combinations of Caregiver Monitoring and Warmth: A Person-centred Perspective. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:2860-2870. [PMID: 36254162 PMCID: PMC9560922 DOI: 10.1007/s10826-022-02287-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 05/22/2023]
Abstract
Caregiver monitoring and warmth have protective mental health effects for adolescents, including vulnerable adolescents. However, combinations of the aforesaid parenting behaviours and their relationship with adolescent mental health are underexplored, especially among younger and older South African (SA) adolescents challenged by structural disadvantage. Hence, the purpose of this study was to investigate unique profiles of caregiver monitoring and warmth and their associations with depression and conduct problems as reported by younger and older adolescents from disadvantaged SA communities. Latent profile and linear regression analyses were used to examine cross-sectional survey data generated by 891 adolescents from two disadvantaged SA communities (62.2% aged 13-17 [average age: 16.13]; 37.5% aged 18-24 [average age: 20.62]). Two profiles emerged. The first, i.e. substantial caregiver warmth and some monitoring, was associated with younger and older adolescent reports of statistically significantly fewer symptoms of depression and conduct problems. The second, i.e. caregiver monitoring without much warmth, was associated with significantly more symptoms of depression or conduct problems among younger and older adolescents. Traditional gender effects (i.e. higher depression symptoms among girls; higher conduct problem symptoms among boys) were amplified when caregiver monitoring was combined with low warmth. In short, protecting the mental health of younger and older adolescents from disadvantaged communities requires higher levels of caregiver warmth combined with moderate levels of caregiver supervision. Because stressors associated with disadvantaged communities jeopardise warm parenting, supporting caregiver resilience to those stressors is integral to supporting adolescent mental health.
Collapse
Affiliation(s)
- Linda Theron
- Department of Educational Psychology, University of Pretoria, Pretoria, South Africa
| | | | - Alexander Makhnach
- Institute of Psychology of the Russian Academy of Sciences, Moscow, Russia
| | - Michael Ungar
- Resilience Research Centre, Dalhousie University, Halifax, NS Canada
| |
Collapse
|
10
|
Myers B, Browne FA, Carney T, Kline T, Bonner CP, Wechsberg WM. The Association of Recurrent and Multiple Types of Abuse with Adverse Mental Health, Substance Use, and Sexual Health Outcomes among Out-of-School Adolescent Girls and Young Women in Cape Town, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11403. [PMID: 34769920 PMCID: PMC8582840 DOI: 10.3390/ijerph182111403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/03/2022]
Abstract
Although physical and sexual abuse exposure is a well-established risk for poor health, the dimensions of abuse associated with health among socially vulnerable adolescent girls and young women (AGYW) remain underexamined. This article describes associations between combinations of abuse type and timing with mental health, substance use, and sexual risk outcomes among a sample of 499 AGYW (aged 16 to 19) who had left school early and were recruited for a cluster randomized trial in Cape Town, South Africa. Approximately one-third (33.5%; 95% CI: 28.7, 38.6) of participants reported lifetime abuse. Exposure to more than one type of abuse was associated with increased risk of depression (β = 3.92; 95% CI: 2.25, 5.59) and anxiety (β = 3.70; 95% CI: 2.11, 5.28), and greater odds of polydrug use (OR = 2.10; 95% CI: 1.02, 4.34) and substance-impaired sex (OR = 2.17; 95% CI: 1.31, 3.86). Exposure to multiple types of abuse during childhood/early adolescence and again in late adolescence was associated with increased risk of depression (β = 4.65; 95% CI: 3.15, 6.14), anxiety (β = 4.35; 95% CI: 2.70, 6.02), and polydrug use (OR = 2.37; 95% CI: 1.03, 5.73). Findings underscore the need for trauma-informed interventions that reduce mental health, substance use, and sexual risks among AGYW who have experienced multiple forms of abuse and recurrent abuse.
Collapse
Affiliation(s)
- Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Alcohol, Tobacco and Other Drug Abuse Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Felicia A Browne
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Abuse Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Tracy Kline
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | | | - Wendee M Wechsberg
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
- Maternal and Child Health Department, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27514, USA
- Department of Psychology, North Carolina State University, Raleigh, NC 27529, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27703, USA
| |
Collapse
|