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Senaratne DNS, Thakkar B, Smith BH, Hales TG, Marryat L, Colvin LA. The impact of adverse childhood experiences on multimorbidity: a systematic review and meta-analysis. BMC Med 2024; 22:315. [PMID: 39143489 PMCID: PMC11325707 DOI: 10.1186/s12916-024-03505-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 06/14/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been implicated in the aetiology of a range of health outcomes, including multimorbidity. In this systematic review and meta-analysis, we aimed to identify, synthesise, and quantify the current evidence linking ACEs and multimorbidity. METHODS We searched seven databases from inception to 20 July 2023: APA PsycNET, CINAHL Plus, Cochrane CENTRAL, Embase, MEDLINE, Scopus, and Web of Science. We selected studies investigating adverse events occurring during childhood (< 18 years) and an assessment of multimorbidity in adulthood (≥ 18 years). Studies that only assessed adverse events in adulthood or health outcomes in children were excluded. Risk of bias was assessed using the ROBINS-E tool. Meta-analysis of prevalence and dose-response meta-analysis methods were used for quantitative data synthesis. This review was pre-registered with PROSPERO (CRD42023389528). RESULTS From 15,586 records, 25 studies were eligible for inclusion (total participants = 372,162). The prevalence of exposure to ≥ 1 ACEs was 48.1% (95% CI 33.4 to 63.1%). The prevalence of multimorbidity was 34.5% (95% CI 23.4 to 47.5%). Eight studies provided sufficient data for dose-response meta-analysis (total participants = 197,981). There was a significant dose-dependent relationship between ACE exposure and multimorbidity (p < 0.001), with every additional ACE exposure contributing to a 12.9% (95% CI 7.9 to 17.9%) increase in the odds for multimorbidity. However, there was heterogeneity among the included studies (I2 = 76.9%, Cochran Q = 102, p < 0.001). CONCLUSIONS This is the first systematic review and meta-analysis to synthesise the literature on ACEs and multimorbidity, showing a dose-dependent relationship across a large number of participants. It consolidates and enhances an extensive body of literature that shows an association between ACEs and individual long-term health conditions, risky health behaviours, and other poor health outcomes.
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Affiliation(s)
- Dhaneesha N S Senaratne
- Chronic Pain Research Group, Division of Population Health & Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK.
| | - Bhushan Thakkar
- Chronic Pain Research Group, Division of Population Health & Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Blair H Smith
- Chronic Pain Research Group, Division of Population Health & Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Tim G Hales
- Institute of Academic Anaesthesia, Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - Louise Marryat
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Lesley A Colvin
- Chronic Pain Research Group, Division of Population Health & Genomics, School of Medicine, University of Dundee, Ninewells Hospital, Dundee, DD1 9SY, UK
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Satinsky EN, Kakuhikire B, Baguma C, Cooper-Vince CE, Rasmussen JD, Ashaba S, Perkins JM, Ahereza P, Ayebare P, Kim AW, Puffer ES, Tsai AC. Caregiver preferences for physically harsh discipline of children in rural Uganda. JOURNAL OF FAMILY VIOLENCE 2024; 39:861-874. [PMID: 38962696 PMCID: PMC11218336 DOI: 10.1007/s10896-023-00536-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 07/05/2024]
Abstract
Purpose Physically harsh discipline is associated with poor developmental outcomes among children. These practices are more prevalent in areas experiencing poverty and resource scarcity, including in low- and middle-income countries. Designed to limit social desirability bias, this cross-sectional study in rural Uganda estimated caregiver preferences for physically harsh discipline; differences by caregiver sex, child sex, and setting; and associations with indicators of household economic stress and insecurity. Method Three-hundred-fifty adult caregivers were shown six hypothetical pictographic scenarios depicting children whining, spilling a drink, and kicking a caregiver. Girls and boys were depicted engaging in each of the three behaviors. Approximately half of the participants were shown scenes from a market setting and half were shown scenes from a household setting. For each scenario, caregivers reported the discipline strategy they would use (time out, beating, discussing, yelling, ignoring, slapping). Results Two thirds of the participants selected a physically harsh discipline strategy (beating, slapping) at least once. Women selected more physically harsh discipline strategies than men (b = 0.40; 95% confidence interval [CI], 0.26 to 0.54). Participants shown scenes from the market selected fewer physically harsh discipline strategies than participants shown scenes from the household (b = -0.51; 95% CI, -0.69 to -0.33). Finally, caregivers selected more physically harsh discipline strategies in response to boys than girls. Indicators of economic insecurity were inconsistently associated with preferences for physically harsh discipline. Conclusions The high prevalence of physically harsh discipline preferences warrant interventions aimed at reframing caregivers' approaches to discipline.
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Affiliation(s)
- Emily N. Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | | | - Phionah Ahereza
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Andrew W. Kim
- Department of Anthropology, University of California, Berkeley, CA, USA
| | - Eve S. Puffer
- Department of Psychology, Duke University, Durham, NC, USA
| | - Alexander C. Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
- Harvard Medical School, Boston, MA, USA
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Long T, Murphy A, Elbarazi I, Ismail-Allouche Z, Horen N, Masuadi E, Trevithick C, Arafat C. Prevalence of adverse childhood experiences and their cumulative impact associated lifetime health outcomes in the Emirate of Abu-Dhabi, United Arab Emirates. CHILD ABUSE & NEGLECT 2024; 151:106734. [PMID: 38484508 DOI: 10.1016/j.chiabu.2024.106734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/09/2024] [Accepted: 03/04/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Adverse Childhood Experiences have been associated with poor health outcomes later in life. OBJECTIVE The objective of the study was to determine the relationship between cumulative ACEs, risky health behaviors, chronic diseases, and mental health among a large-scale sample from the Emirate of Abu Dhabi. PARTICIPANTS AND SETTING A retrospective cross-sectional study was performed with 922 participants over the age of 18, living in Abu Dhabi. METHODS The Adverse Childhood Experiences International Questionnaire (ACE-IQ) was used to assess ACEs, alongside a survey of adult health outcomes, mental health outcomes, and risk-taking behaviors. RESULTS Logistic regression models examined the association between retrospective ACEs and these outcomes. The respondents reported an average of 1.74 ACEs. The most prevalent ACEs were household violence, parental death or divorce, and community violence. The accumulation of ACEs significantly predicts increases in the risk of a variety of adult-onset health morbidities, all measured mental health morbidities, and all measured risk-taking behaviors, with evidence of thresholds of ACE accumulation dictating risk. CONCLUSIONS The baseline presence of ACEs among this Abu Dhabi sample, along with the associated risks of physical and mental health morbidities, and risk-taking behaviors play a significant role in understanding the extent, nature, and associated sequalae of ACEs in this population; providing nuanced context for early intervention. Our findings will inform the planning and implementation of specific prevention and awareness raising programs while promoting safe environments where children are healthy and can thrive.
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Affiliation(s)
- Toby Long
- Georgetown University, Center for Child and Human Development, Box 571485, Washington, DC 20007, USA.
| | - Anthony Murphy
- School of Psychology, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates
| | | | - Neal Horen
- Georgetown University, Center for Child and Human Development, Box 571485, Washington, DC 20007, USA
| | - Emad Masuadi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, United Arab Emirates
| | - Claire Trevithick
- Georgetown University, Center for Child and Human Development, Box 571485, Washington, DC 20007, USA
| | - Cairo Arafat
- Early Childhood Authority, Abu Dhabi, United Arab Emirates
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Whitten T, Tzoumakis S, Green MJ, Dean K. Global Prevalence of Childhood Exposure to Physical Violence within Domestic and Family Relationships in the General Population: A Systematic Review and Proportional Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2024; 25:1411-1430. [PMID: 37300288 PMCID: PMC10913340 DOI: 10.1177/15248380231179133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Efforts to identify and prevent childhood exposure to physical violence within domestic and family relationships must be underpinned by reliable prevalence estimates to ensure the appropriate allocation of resources and benchmarks for assessing intervention efficacy. We conducted a systematic review and meta-analysis of the global prevalence of childhood exposure to physical domestic and family violence separately as a victim or witness. Searches were conducted in Criminal Justice Abstracts, Embase, Scopus, PubMed, PsychInfo, and Google Scholar. Studies were included if they were peer-reviewed, published in English, had a representative sample, unweighted estimates, and were published between January 2010 and December 2022. One-hundred-and-sixteen studies comprising 56 independent samples were retained. Proportional meta-analysis was conducted to calculate the pooled prevalence for each exposure. Pooled prevalence estimates were also stratified by region and sex. The global pooled prevalence of childhood exposure to physical domestic and family violence as a victim or witness was 17.3% and 16.5%, respectively. Prevalence estimates were highest in West Asia and Africa (victim = 42.8%; witness = 38.3%) and lowest for the Developed Asia Pacific region (victim = 3.7%; witness = 5.4%). Males were 25% more likely than females to be the victim of physical domestic and family violence during childhood, while both were equally likely to have witnessed it. These findings suggest that childhood exposure to domestic and family violence is relatively common, affecting around one-in-six people by 18 years of age globally. Regional variations in prevalence estimates may reflect underlying economic conditions, cultural norms, and service availability.
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Affiliation(s)
- Tyson Whitten
- Center for Law and Justice, Charles Sturt University, Port Macquarie, NSW, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales, Kensington, NSW, Australia
| | - Stacy Tzoumakis
- Discipline of Psychiatry and Mental Health, University of New South Wales, Kensington, NSW, Australia
- School of Criminology and Criminal Justice, Griffith University, Southport, Queensland, Australia
- Griffith Criminology Institute, Griffith University, Mount Gravatt, QLD, Australia
| | - Melissa J. Green
- Discipline of Psychiatry and Mental Health, University of New South Wales, Kensington, NSW, Australia
- Neuroscience Research Australia, Randwick, NSW, Australia
| | - Kimberlie Dean
- Discipline of Psychiatry and Mental Health, University of New South Wales, Kensington, NSW, Australia
- Justice Health and Forensic Mental Health Network, Matraville, NSW, Australia
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Almulla AF, Algon AAA, Maes M. Adverse childhood experiences and recent negative events are associated with activated immune and growth factor pathways, the phenome of first episode major depression and suicidal behaviors. Psychiatry Res 2024; 334:115812. [PMID: 38442479 DOI: 10.1016/j.psychres.2024.115812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 02/01/2024] [Accepted: 02/21/2024] [Indexed: 03/07/2024]
Abstract
This research assessed the effects of adverse childhood experiences (ACEs) and negative life events (NLEs) on forty-eight cytokines/chemokines/growth factors, in 71 FE-MDMD patients and forty heathy controls. ACEs are highly significantly associated with the classical M1 macrophage, T helper (Th)-1, Th-1 polarization, IRS, and neurotoxicity immune profiles, and not with the alternative M2, and Th-2 immune profiles. There are highly significant correlations between ACEs and NLEs and different cytokines/chemokines/growth factors, especially with interleukin (IL)-16, CCL27, stem cell growth factor, and platelet-derived growth factor. Partial Least Squares analysis showed that 62.3 % of the variance in the depression phenome (based on severity of depression, anxiety and suicidal behaviors) was explained by the regression on IL-4 (p = 0.001, inversely), the sum of ACEs + NLEs (p < 0.0001), and a vector extracted from 10 cytokines/chemokines/growth factors (p < 0.0001; both positively associated). The latter partially mediated (p < 0.0001) the effects of ACE + NLEs on the depression phenome. In conclusion, part of the effects of ACEs and NLEs on the depression phenome is mediated via activation of immune and growth factor networks. These pathways have a stronger impact in subjects with lowered activities of the compensatory immune-regulatory system.
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Affiliation(s)
- Abbas F Almulla
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu 610072, China; Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand; Medical Laboratory Technology Department, College of Medical Technology, The Islamic University, Najaf, Iraq
| | - Ali Abbas Abo Algon
- Research Group of Organic Synthesis and Catalysis, University of Pannonia, Egyetem u. 10, 8200 Veszprém, Hungary
| | - Michael Maes
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610072, China; Key Laboratory of Psychosomatic Medicine, Chinese Academy of Medical Sciences, Chengdu 610072, China; Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand; Cognitive Impairment and Dementia Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand; Department of Psychiatry, Medical University of Plovdiv, Plovdiv, Bulgaria; Research Institute, Medical University Plovdiv, Plovdiv, Bulgaria; Kyung Hee University, 26 Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Korea.
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Perry Mohling EW, Recinos M, Kwiringira JN, Phung E, Olwit C, Swahn MH, Massetti G, Self-Brown S. Adverse childhood experiences, mental distress, self-harm and suicidality, and cumulative HIV risk by sex in Lesotho. CHILD ABUSE & NEGLECT 2024; 150:106701. [PMID: 38402043 PMCID: PMC11238702 DOI: 10.1016/j.chiabu.2024.106701] [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: 05/29/2023] [Revised: 02/08/2024] [Accepted: 02/12/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been understudied in low- and middle-income countries, especially in sub-Saharan Africa. OBJECTIVES, PARTICIPANTS, SETTING We explored associations between mental distress, self-harm or suicidality, and HIV risk and individual and cumulative ACEs (sexual, emotional, and physical violence; witnessing community and interparental violence; orphanhood) among youth aged 13-24 in Lesotho. METHODS Multivariable logistic regressions stratified by sex using nationally representative 2018 Lesotho Violence Against Children and Youth Survey (nfemale = 7101; nmale = 1467) data. RESULTS Over 75 % of males and females experienced at least 1 ACE. Among males, physical and community violence were significantly associated with mental distress; orphan status and emotional violence was associated with self-harm/suicidality. Males who witnessed interparental violence had higher odds of disclosing 2 types and 3 or more types of HIV risk versus none. Among females, being a double orphan and having experienced sexual, emotional, physical, community, and interparental violence were significantly associated with mental distress and any self-harm/suicidality in both models. Females who experienced physical violence had higher odds of disclosing 3 or more risk types versus no risk. Statistically significant associations emerged between cumulative ACEs and mental distress, self-harm/suicidality, and higher levels of HIV risk for both males and females. CONCLUSIONS Differential patterns of associations between ACEs and mental health problems and HIV risk emerged by sex. Scalable, integrated individual and community efforts to prevent ACEs, provide mental health supports, and encourage safer sexual behaviors among those exposed are needed and could benefit youth in Lesotho.
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Affiliation(s)
- Elizabeth W Perry Mohling
- School of Public Health, Georgia State University, Atlanta, GA, USA; National SafeCare Training and Research Center, Georgia State University, Atlanta, GA, USA; Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA, USA.
| | - Manderley Recinos
- School of Public Health, Georgia State University, Atlanta, GA, USA; National SafeCare Training and Research Center, Georgia State University, Atlanta, GA, USA; Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA, USA
| | | | - Erick Phung
- School of Public Health, Georgia State University, Atlanta, GA, USA; National SafeCare Training and Research Center, Georgia State University, Atlanta, GA, USA; Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA, USA
| | - Connie Olwit
- School of Public Health, Georgia State University, Atlanta, GA, USA; National SafeCare Training and Research Center, Georgia State University, Atlanta, GA, USA; Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA, USA
| | - Monica H Swahn
- WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, USA
| | - Greta Massetti
- Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Shannon Self-Brown
- School of Public Health, Georgia State University, Atlanta, GA, USA; National SafeCare Training and Research Center, Georgia State University, Atlanta, GA, USA; Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA, USA
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Ferrajão P, Tourais B, Elklit A. Attachment Anxiety and Dissociation Mediate Associations Between Polytrauma and Somatization in Kenyan Adolescents. J Trauma Dissociation 2024; 25:83-98. [PMID: 37401367 DOI: 10.1080/15299732.2023.2231958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/12/2023] [Indexed: 07/05/2023]
Abstract
The experience of several potentially traumatic events (PTE) is a risk factor for higher somatization symptoms severity among adolescents. Attachment orientations and dissociation may influence the link between exposure to PTE and somatization symptoms severity. We analyzed the associations between direct exposure to PTE and somatization symptoms in Kenyan adolescents and explored the mediating role of attachment orientations and dissociation symptoms in the associations between direct exposure to PTE with somatization symptoms severity. A sample of 475 Kenyan adolescents completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modeling employing Preacher and Hayes' procedures (2008). Attachment anxiety and dissociation symptoms mediate the association between direct exposure to traumatic events and somatization symptoms. Higher exposure to traumatic events was significantly associated with higher attachment anxiety levels, which was associated with higher levels of dissociation symptoms, which was then associated with higher somatization symptoms severity. High levels of attachment anxiety and dissociation might aggravate somatization symptoms differently according to sex, which might be seen as a psychological distress mechanism subsequent to exposure to multiple PTE in African adolescents.
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Affiliation(s)
- Paulo Ferrajão
- Faculdade de Ciências Sociais E Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Bárbara Tourais
- Faculdade de Ciências Sociais E Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Ask Elklit
- National Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark
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Guo X, Lin L, Qin K, Li J, Chen W, Guo VY. Adverse childhood experiences and depressive symptoms among middle-aged or older adults in China and the mediating role of short sleep duration. J Affect Disord 2023; 340:711-718. [PMID: 37597778 DOI: 10.1016/j.jad.2023.08.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Limited research has simultaneously examined the link between adverse childhood experiences (ACEs), short sleep duration, and depressive symptoms among middle-aged or older Chinese adults. This study aims to investigate the association between ACEs and later-life depressive symptoms, and to examine the mediating role of short sleep duration (<6 h/night) in this association. METHODS Data of 11,452 participants aged ≥45 years were obtained from the China Health and Retirement Longitudinal Study. Information on ACEs, depressive symptoms, and sleep duration were reported via questionnaires. The mediating effect of short sleep duration in the association between ACEs and depressive symptoms was examined by Baron and Kenny's causal steps method and Karlson/Holm/Breen (KHB) method. RESULTS Compared to non-exposed group, exposure to ACEs was significantly associated with increased odds of depressive symptoms in a dose-response pattern. The odds ratio of depressive symptoms increased from 1.27 (95 % CI: 1.11-1.46) for one ACE to 3.38 (95 % CI: 2.92-3.90) for ≥4 ACEs. The KHB method identified significant mediating role of short sleep duration in the association between experiencing three or more ACEs and depressive symptoms, with the proportional mediation estimated at 8.96 % and 8.85 % for the groups with 3 ACEs and ≥4 ACEs, respectively. The results were consistent across genders and gender did not moderate these associations. LIMITATIONS The cross-sectional design limited the ability to make causal inference. CONCLUSIONS ACEs were positively associated with depressive symptoms, and short sleep duration partially mediated this association. Promoting optimal sleep duration among ACE-exposed individuals might improve their mental health.
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Affiliation(s)
- Xun Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Li Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Kang Qin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Jinghua Li
- Department of Biostatistics, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Weiqing Chen
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Vivian Yawei Guo
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
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Kim AW, Rieder AD, Cooper-Vince CE, Kakuhikire B, Baguma C, Satinsky EN, Perkins JM, Kiconco A, Namara EB, Rasmussen JD, Ashaba S, Bangsberg DR, Tsai AC, Puffer ES. Maternal adverse childhood experiences, child mental health, and the mediating effect of maternal depression: A cross-sectional, population-based study in rural, southwestern Uganda. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2023; 182:19-31. [PMID: 37212482 PMCID: PMC10524293 DOI: 10.1002/ajpa.24758] [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: 07/01/2022] [Revised: 02/09/2023] [Accepted: 05/08/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVES This study aimed to examine the intergenerational effects of maternal adverse childhood experiences (ACEs) and child mental health outcomes in rural Uganda, as well as the potentially mediating role of maternal depression in this pathway. Additionally, we sought to test the extent to which maternal social group membership attenuated the mediating effect of maternal depression on child mental health. METHODS Data come from a population-based cohort of families living in the Nyakabare Parish, a rural district in southwestern Uganda. Between 2016 and 2018, mothers completed surveys about childhood adversity, depressive symptoms, social group membership, and their children's mental health. Survey data were analyzed using causal mediation and moderated-mediation analysis. RESULTS Among 218 mother-child pairs, 61 mothers (28%) and 47 children (22%) showed symptoms meeting cutoffs for clinically significant psychological distress. In multivariable linear regression models, maternal ACEs had a statistically significant association with severity of child conduct problems, peer problems, and total child difficulty scores. Maternal depression mediated the relationship between maternal ACEs and conduct problems, peer problems, and total difficulty, but this mediating effect was not moderated by maternal group membership. CONCLUSIONS Maternal depression may act as a potential mechanism linking maternal childhood adversity with poor child mental health in the next generation. Within a context of elevated rates of psychiatric morbidity, high prevalence of childhood adversity, and limited healthcare and economic infrastructures across Uganda, these results emphasize the prioritization of social services and mental health resources for rural Ugandan families.
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Affiliation(s)
- Andrew Wooyoung Kim
- Department of Anthropology, University of California, Berkeley, California, USA
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Amber D Rieder
- Duke Global Health Institute, Durham, North Carolina, USA
| | | | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychology, University of Southern California, Los Angeles, California, USA
| | - Jessica M Perkins
- Peabody College, Vanderbilt University, Nashville, Tennessee, USA
- Vanderbilt Institute of Global Health, Nashville, Tennessee, USA
| | - Allen Kiconco
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | | | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health and Science University - Portland State University School of Public Health, Portland, Oregon, USA
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Eve S Puffer
- Duke Global Health Institute, Durham, North Carolina, USA
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Byansi W, Galvin M, Chiwaye L, Luvuno Z, Kim AW, Sundararajan R, Tsai AC, Moolla A. Adverse childhood experiences, traumatic events, and mental health among adults at two outpatient psychiatric facilities in Johannesburg, South Africa: a cross-sectional analysis. BMC Psychiatry 2023; 23:581. [PMID: 37563695 PMCID: PMC10413614 DOI: 10.1186/s12888-023-05085-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/07/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Adverse childhood experiences and adult trauma, including sexual abuse, physical abuse, neglect, and interpersonal violence, are highly prevalent in low-resource settings and associated with adverse psychological outcomes. However, there is limited focus on the impact of ACEs and trauma on mental health in sub-Saharan Africa. Therefore, this study examines the impact of traumatic events and ACEs on depression, anxiety, and stress scores among outpatients receiving psychiatric care at two public mental health treatment facilities in Johannesburg, South Africa. METHODS A sample of 309 participants were recruited between January and June 2022 at Helen Joseph Hospital and Alexandra 18th Avenue Clinic. Participants completed screening measures for mental health outcomes, including the 9-item Patient Health Questionnaire (PHQ-9), the 7-item General Anxiety Disorder scale (GAD-7) and the 10-item Perceived Stress Scale. We fitted modified Poisson and linear regression models to estimate the impact of ACEs and adult experiences of trauma on depression, anxiety, and stress scale scores. RESULTS 47.57% (n = 147) of participants screened positive for anxiety, 44.66% (n = 138) for depression, and 17% (n = 54) for severe stress. More females screened positive for anxiety (65.31%), depression (65.94%), and stress (77.78%). Each ACE was associated with a 12% increased risk of depression, a 10% increased risk of anxiety, and a 17% increased risk of stress. In separately estimated models, each additional traumatic event during adulthood was associated with a 16% increased risk for depression, an 8% increased risk of anxiety, and a 26% increased risk of stress. Across all models, being male and self-reported physical health were consistently associated with a reduced risk for depression, anxiety, and stress. CONCLUSIONS ACEs and experiences of traumatic events as adults were associated with significantly increased risks of anxiety, depression, and severe stress. Given high exposure to ACEs and trauma and the associated impact on the mental health of individuals, families, and communities, there is a need to strengthen and scale innovative combination interventions that address multiple stressors impacting people in low-resource settings.
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Affiliation(s)
- William Byansi
- School of Social Work, Boston College, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | - Michael Galvin
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Boston Medical Center, Department of Psychiatry, Boston, MA, USA
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - Lesley Chiwaye
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - Zoleka Luvuno
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
| | - Andrew W Kim
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
- Department of Anthropology, University of California, Berkeley, United States
| | - Radhika Sundararajan
- Weill Cornell Center for Global Health, New York City, New York, United States
- Department of Emergency Medicine, Weill Cornell Medicine, New York City, New York, United States
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Aneesa Moolla
- Faculty of Health Sciences, Health Economics and Epidemiology Research Office, University of the Witwatersrand, Johannesburg, South Africa
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11
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Agathis NT, Annor FB, Xu L, Swedo E, Chiang L, Coomer R, Hegle J, Patel P, Forster N, O’Malley G, Ensminger AL, Kamuingona R, Andjamba H, Nshimyimana B, Manyando M, Massetti GM. Strong Father-Child Relationships and Other Positive Childhood Experiences, Adverse Childhood Experiences, and Sexual Risk Factors for HIV among Young Adults Aged 19-24 Years, Namibia, 2019: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6376. [PMID: 37510608 PMCID: PMC10378761 DOI: 10.3390/ijerph20146376] [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: 03/31/2023] [Revised: 07/07/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023]
Abstract
Using cross-sectional data from the 2019 Namibia Violence Against Children and Youth Survey and sex-stratified multivariable models, we assessed the associations between four different positive childhood experiences (PCEs) and having ≥3 adverse childhood experiences (ACEs), including ≥3 ACE-PCE interaction terms, and seven sexual risk factors for HIV acquisition among young adults aged 19-24 years. One PCE, having a strong father-child relationship, was inversely associated with two risk factors among women (lifetime transactional sex (OR, 0.4; 95% CI, 0.2-0.7) and recent age-disparate sexual relationships (OR, 0.3; 95% CI, 0.2-0.5)), and significantly interacted with having ≥3 ACEs for three risk factors among women (not knowing a partner's HIV status, infrequently using condoms, and ever having an STI) and one among men (having multiple sexual partners in the past year). The other PCEs were significantly associated with ≤1 HIV risk factor and had no significant interaction terms. Strong father-child relationships may reduce HIV acquisition risk and mitigate the effect of childhood adversity on HIV risk among young adults in Namibia.
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Affiliation(s)
- Nickolas T. Agathis
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Francis B. Annor
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Likang Xu
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Elizabeth Swedo
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Laura Chiang
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
| | - Rachel Coomer
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Private Bag, Windhoek 12029, Namibia
| | - Jennifer Hegle
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Pragna Patel
- Division of Global HIV and TB, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Norbert Forster
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Gabrielle O’Malley
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Alison L. Ensminger
- International Training and Education Center for Health, Department of Global Health, University of Washington, Seattle, WA 98195, USA
| | - Rahimisa Kamuingona
- Ministry of Gender Equality, Poverty Eradication, and Social Welfare, Private Bag, Windhoek 13359, Namibia
| | - Helena Andjamba
- Ministry of Gender Equality, Poverty Eradication, and Social Welfare, Private Bag, Windhoek 13359, Namibia
| | - Brigitte Nshimyimana
- Ministry of Gender Equality, Poverty Eradication, and Social Welfare, Private Bag, Windhoek 13359, Namibia
| | - Molisa Manyando
- US Agency for International Development, Washington, DC 20004, USA
| | - Greta M. Massetti
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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12
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Zhang Y, Li Y, Jiang T, Zhang Q. Role of body mass index in the relationship between adverse childhood experiences, resilience, and mental health: a multivariate analysis. BMC Psychiatry 2023; 23:460. [PMID: 37353758 PMCID: PMC10290297 DOI: 10.1186/s12888-023-04869-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 05/13/2023] [Indexed: 06/25/2023] Open
Abstract
OBJECTIVES Depression among adolescents is a global concern. Adverse childhood experiences (ACEs) have been correlated with negative physical and mental health such as obesity and depression; however, increasing evidence has suggested that their correlation might be moderated by BMI and resilience. In this study, we aim to explore (1) whether resilience moderate the risk of mental health by ACEs; (2) whether BMI is a moderator of this relationship. STUDY DESIGN Adolescents were obtained from 4 grade college students by a multi-stage convenience sampling method in the period of May to Jun, 2022. METHODS We use the Connor-Davidson Resilience scale, Depression, Anxiety and Stress Scale-21 Item (DASS-21) questionnaires to measure the ACEs, BMI, resilience and mental health. The primary exposure was ACEs and the primary outcome was mental health; while resilience and BMI were moderators. Multivariable linear regression model was used to establish the relationship of ACEs, resilience and BMI against mental health status. Moderate analysis was employed by PROCESS method to explore the relationship between these variables. RESULTS A total of 3600 individuals were initially enrolled, after excluding 22 with invalid questionnaires, 3578 adolescents were finally included. The mean age was (20.53 ± 1.65) years old. After adjusted for covariates, multivariable linear regression suggest that the high level ACEs (, β =0.58, , 95%CI:0.54,0.62, P < 0.01), resilience (, β=-0.27, 95%CI: , 95%CI: -0.28,-0.26, P < 0.01) were associated with higher depression symptoms, and BMI (, β =0.073, 95%CI: 0.002-0.15, P < 0.05) was associated with higher depression symptoms. There is also the interaction between resilience, ACEs and mental health (depression, anxiety and stress symptoms). In the relationship between ACEs and mental health, resilience and BMI played a moderator role. CONCLUSIONS The moderate analysis also provided further evidence of a link between resilience, ACEs, BMI and mental health. The findings shed new light on potential mechanisms between ACEs and mental health, including the effects of the co-interaction of resilience and BMI, adding to previous literature. ACEs may be a profound variable to measure adolescents' psychosocial environment to influence mental health, and resilience moderate this effect and is also moderated by BMI.
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Affiliation(s)
- Yi Zhang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yonghan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Tian Jiang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
| | - Qiu Zhang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China.
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Li Q, Wang X, Wong SYS, Yang X. Impacts of combined childhood exposures to poor neighborhood quality, peer friendships and family relationships on adult depression: A seven-year longitudinal study. J Affect Disord 2023:S0165-0327(23)00728-0. [PMID: 37244546 DOI: 10.1016/j.jad.2023.05.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 05/21/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Little is known about how multisystemic childhood exposures predict adult depression. This study aims to examine the effects of multisystemic childhood exposures on the onset and remission of adult depression. METHODS Data were drawn from the China Health and Retirement Longitudinal Survey (CHARLS) (wave 1-4), which is a nationally representative longitudinal survey of people 45 years of age or older in China. Childhood family relationships (CFR), childhood peer friendships (CPF), and childhood neighborhood quality (CNQ) scores were recoded into binary (No = 0, Yes = 1) according to the first quantile value. Participants were divided into four groups based on the total number of poor childhood exposures (group 0-3). The generalized linear mixed model was used to test the longitudinal relationship between combined poor childhood exposures and adult depression. RESULTS Of the 4696 participants (55.1 % males), 22.5 % suffered from depression at baseline. The incidence of depression increased from group0 to group3 in four waves, reaching the peak in wave 2018 (incidence of group0 to group3: 14.1 %, 18.5 %, 22.8 %, 27.4 %, p < 0.001), with declining remission rates that reached its lowest in wave 2018 (50.8 %, 41.3 %, 34.3 %, 31.7 %, p < 0.001). The persistent depression rate increased from group0 to group3 (2.7 %, 5.0 %, 8.1 %, 13.0 %, p < 0.001). The risk of depression in group1 (AOR = 1.50, 95%CI: 1.27-1.77), group2 (AOR = 2.43, 95%CI: 2.01-2.94) and group3 (AOR = 4.24, 95%CI: 3.25-5.54) were significantly higher than that in group0. LIMITATIONS Childhood histories were collected via self-reported questionnaires, and thus recall bias was inevitable. CONCLUSIONS Multisystem poor childhood exposures jointly increased the onset and persistence of adult depression, as well as reduced the remission rate of depression.
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Affiliation(s)
- Qian Li
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Xin Wang
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Samuel Yeung-Shan Wong
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong.
| | - Xue Yang
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen 518172, China.
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14
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Tan M, Mao P. Type and dose-response effect of adverse childhood experiences in predicting depression: A systematic review and meta-analysis. CHILD ABUSE & NEGLECT 2023; 139:106091. [PMID: 36787671 DOI: 10.1016/j.chiabu.2023.106091] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 01/30/2023] [Accepted: 02/03/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Researchers have documented that adverse childhood experiences (ACEs) are associated with adverse long-term consequences for mental health, including increased risk for depression. However, the type and dose-response effects of ACE on depression risk need further exploration. OBJECTIVE We aimed to synthesize the evidence on the relationship between ACEs measured by ACE International Questionnaire (ACE-IQ) and depression in type and quantity. PARTICIPANTS AND SETTING Individuals with ACEs. METHODS A systematic search was carried out of all published articles, up to November 2022, in eight electronic databases. Fixed- and random-effect models and dose-response were used. RESULTS Exposure to ACEs, including household dysfunction, was associated with a higher risk of depression (ORs ranged from 1.34 to 3.17). The numbers of ACE acted as a nonlinear predictor of depression. CONCLUSIONS These analyses provided important evidence that ACEs, regardless of type or quantity, may be a risk factor for depression development. Prevention of ACEs and interventions for supporting those affected by ACEs are necessary.
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Affiliation(s)
- Minghui Tan
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, Hunan, China; Xiangya School of Nursing, Central South University, Changsha 410013, China
| | - Ping Mao
- Nursing Department, Third Xiangya Hospital, Central South University, Changsha, Hunan, China; Xiangya School of Nursing, Central South University, Changsha 410013, China; Key Laboratory of Nursing of Hunan Province, Changsha 410013, China.
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15
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Bellis MA, Hughes K, Cresswell K, Ford K. Comparing relationships between single types of adverse childhood experiences and health-related outcomes: a combined primary data study of eight cross-sectional surveys in England and Wales. BMJ Open 2023; 13:e072916. [PMID: 37068903 PMCID: PMC10111913 DOI: 10.1136/bmjopen-2023-072916] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/29/2023] [Indexed: 04/19/2023] Open
Abstract
OBJECTIVES Adverse childhood experiences (ACEs) show strong cumulative associations with ill-health across the life course. Harms can arise even in those exposed to a single ACE type but few studies examine such exposure. For individuals experiencing a single ACE type, we examine which ACEs are most strongly related to different health harms. DESIGN Secondary analysis of combined data from eight cross-sectional general population ACE surveys. SETTING Households in England and Wales. PARTICIPANTS 20 556 residents aged 18-69 years. MEASURES Ten self-reported outcomes were examined: smoking, cannabis use, binge drinking, obesity, sexually transmitted infection, teenage pregnancy, mental well-being, violence perpetration, violence victimisation and incarceration. Adjusted ORs and percentage changes in outcomes were calculated for each type of ACE exposure. RESULTS Significance and magnitude of associations between each ACE and outcome varied. Binge drinking was associated with childhood verbal abuse (VA), parental separation (PS) and household alcohol problem (AP), while obesity was linked to sexual abuse (SA) and household mental illness. SA also showed the biggest increase in cannabis use (25.5% vs 10.8%, no ACEs). Household AP was the ACE most strongly associated with violence and incarceration. PS was associated with teenage pregnancy (9.1% vs 3.7%, no ACEs) and 5 other outcomes. VA was associated with 7 of the 10 outcomes examined. CONCLUSION Exposure to a single ACE increases risks of poorer outcomes across health-harming behaviours, sexual health, mental well-being and criminal domains. Toxic stress can arise from ACEs such as physical and SA but other more prevalent ACEs (eg, VA, PS) may also contribute substantively to poorer life course health.
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Affiliation(s)
- Mark A Bellis
- Faculty of Health, Liverpool John Moores University, Liverpool, UK
- WHO Collaborating Centre for Investment in Health & Well-being, Public Health Wales, Wrexham, UK
| | - Karen Hughes
- WHO Collaborating Centre for Investment in Health & Well-being, Public Health Wales, Wrexham, UK
- Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Katie Cresswell
- Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Bangor, UK
| | - Kat Ford
- Public Health Collaborating Unit, School of Medical and Health Sciences, Bangor University, Bangor, UK
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Zhai M, Yu B, Li J, Liu X, Yuan L, Liu D, Wang H, Yan H. Relationship between adverse childhood experiences, depression and suicidal behaviors in adulthood among young men who have sex with men: A prospective cohort study. J Psychiatr Res 2023; 161:455-460. [PMID: 37059030 DOI: 10.1016/j.jpsychires.2023.03.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 03/11/2023] [Accepted: 03/27/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Suicidal behaviors have been a crucial public health issue among young men who have sex with men (YMSM). Adverse childhood experiences (ACEs) and depression are important predictors of suicidal behaviors. Few studies have examined the underlying mechanisms. This study aims to examine the mediation mechanism from ACEs to depression and further to suicidal ideation based on a prospective cohort study of YMSM. METHOD Study data were derived from 499 YMSM recruited from three cities (Wuhan, Changsha and Nanchang) of China from September in 2017 to January in 2018. ACEs (abuse, neglect and household challenges), depressive symptoms and suicidal behaviors (suicidal ideation, suicidal plan and suicidal attempt) were measured at the baseline, the first wave and second wave follow-up survey, respectively. Mediation modeling analysis was used for data analysis only for suicidal ideation due to the low frequency of suicidal plan and attempt. RESULTS An estimated 17.86% of YMSM reported suicidal ideation, 2.27% ever made a suicidal plan and 0.65% of YMSM had a suicidal attempt in the past six months. The effect of ACEs on suicidal ideation was fully mediated through depressive symptoms (indirect effect [95%CI] = 0.011 [0.004,0.022]). Among the three subconstructs of ACEs, childhood abuse and neglect could increase the risk of suicidal ideation in adulthood by increasing depressive symptoms (indirect effect = 0.020 [0.007,0.042] for childhood abuse, and 0.043 [0.018,0.083] for neglect), but not for household challenges (indirect effect = 0.003 [-0.011,0.018]). CONCLUSIONS ACEs could affect suicidal ideation through depression, particularly for childhood abuse and neglect. Preventive strategies may focus on the treatment of depression and psychological counseling, especially for YMSM who ever experienced negative experiences in childhood.
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Affiliation(s)
- Mengxi Zhai
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Bin Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China; Population and Health Research Center, Wuhan University, Wuhan, Hubei Province, China
| | - Jiayu Li
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Xin Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Liang Yuan
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Dan Liu
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Huihao Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Hong Yan
- Department of Epidemiology and Health Statistics, School of Public Health, Wuhan University, Wuhan, Hubei Province, China.
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Zhang T, Kan L, Jin C, Shi W. Adverse childhood experiences and their impacts on subsequent depression and cognitive impairment in Chinese adults: A nationwide multi-center study. J Affect Disord 2023; 323:884-892. [PMID: 36566934 DOI: 10.1016/j.jad.2022.12.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adverse childhood experiences (ACES) are prevalent and have long-lasting effects. This study explored how ACE exposure is associated with subsequent depression and cognitive impairment and whether sociodemographic characteristics modify that association. METHOD This study used data on 14,484 participants of the 2015 China Health and Retirement Longitudinal Study (CHARLS) and 2014 CHARLS life history survey. Depression was assessed using the 10-item Center for Epidemiologic Studies Depression scale. Cognitive performance was evaluated via three composite measures: episodic memory, mental intactness, and global cognition. Twelve ACE indicators were measured using a validated questionnaire. Multiple regression models and stratified analyses explored the relationship between ACES and subsequent depression and cognitive impairment, as well as potential modifiers. RESULTS Compared with individuals without ACES, those who experienced four or more ACES had a higher risk of subsequent depression (adjusted odds ratio, aOR = 2.65, 95 % confidence intervals [CIs]: 2.21 to 3.16), poorer mental intactness (β = -0.317 [-0.508 to -0.125]), and worse global cognition (-0.437 [-0.693 to -0.181]). Trend analyses showed a dose-response association between accumulated ACES and subsequent depression and cognitive impairment. No modifications of those associations by age, sex, educational level, or family's financial status during childhood were observed. LIMITATIONS Self-reported measures could favour recall bias. CONCLUSION Our study suggests that ACES increase the risk of subsequent depression and cognitive impairment in Chinese adults regardless of sociodemographic characteristics. These findings provide important implications for mitigating the adverse effects of early-life stress and promoting health in adulthood.
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Affiliation(s)
- Tiantian Zhang
- School of Social Development and Public Policy, Fudan University, Shanghai, China; Fudan University Center for Population and Development Policy Studies, Fudan University, Shanghai, China; Fudan Institute on Ageing, Fudan University, Shanghai, China
| | - Lena Kan
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Changbo Jin
- Tongji University School of Medicine, Shanghai, China.
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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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Xiao W, Rong F, Li S, Xu H, Jin Z, Li R, Yu W, Tao F, Wan Y. Co-occurrence patterns of adverse childhood experiences and their associations with non-suicidal self-injury and suicidal behaviors and gender difference among middle school students: A three-city survey in China. J Affect Disord 2023; 320:140-147. [PMID: 36181912 DOI: 10.1016/j.jad.2022.09.124] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/15/2022] [Accepted: 09/26/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Previous research has found increasing evidence of adverse childhood experiences (ACEs) leading to non-suicidal self-injury (NSSI) and suicidal behaviors. Most studies have focused on a certain type or timing of ACEs or the patterns of multiple types; however, few of them have examined the patterns of ACEs combined types and timing and the gender differences in the association between ACEs and self-harming behaviors. METHODS A cross-sectional survey was conducted in three Chinese cities from November 2020 to May 2021. We asked 16,853 middle school students to anonymously complete a questionnaire to provide the details of their own ACEs and NSSI or suicidal behaviors. RESULTS Latent class analysis identified four classes: high ACEs (10 %), high abuse/neglect (20.3 %), moderate ACEs (26.7 %) and low ACEs (43 %). Logistic regression models demonstrated that students in the high ACEs, high abuse/neglect and moderate ACEs subgroups were more likely to engage in NSSI and suicidal behaviors than students with low ACEs. Compared with boys, girls had a higher probability of engaging in NSSI and suicidal behaviors when exposed to the same level of ACEs. CONCLUSION Co-occurrence of ACEs is associated with high risk of NSSI and suicidal behaviors. Our findings recognized the most dangerous patterns and latent class membership, which supply the evidence for policy makers to adopt preventive measures to protect high-risk individuals. Strategies to relieve the impact of ACEs, especially on girls, need to be considered comprehensively. LIMITATIONS The study was limited by cross-sectional design, as causality could not be confirmed. In addition, because our survey was retrospective, potential recall bias can not be ignored.
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Affiliation(s)
- Wan Xiao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Fan Rong
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Shuqin Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Huiqiong Xu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Zhengge Jin
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Ruoyu Li
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Weiqiang Yu
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Fangbiao Tao
- Department of Maternal, Child & Adolescent Health, School of Public Health, Anhui Medical University, Anhui, China; Anhui Provincial Key Laboratory of Population Health & Aristogenics, Anhui, China
| | - Yuhui Wan
- Teaching Center for Preventive Medicine, School of Public Health, Anhui Medical University, Anhui, China.
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Masiano SP, Tembo TA, Yu X, Wetzel E, Mphande M, Chitani M, Mkandawire A, Khama I, Mazenga A, Abrams E, Ahmed S, Kim MH. The prevalence, incidence, and recurrence of intimate partner violence and its association with adverse childhood experiences among pregnant and breastfeeding women living with HIV in Malawi. Ther Adv Infect Dis 2023; 10:20499361221148875. [PMID: 36654873 PMCID: PMC9841851 DOI: 10.1177/20499361221148875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/15/2022] [Indexed: 01/15/2023] Open
Abstract
Background Intimate partner violence (IPV) is associated with suboptimal HIV treatment outcomes, but its distribution and risk factors among certain subpopulations of people living with HIV in resource-limited settings are not well known. We examined the prevalence, incidence, and recurrence of IPV and its association with adverse childhood experiences (ACEs) among pregnant/breastfeeding women living with HIV in Malawi. Methods This study used longitudinal data for 455 pregnant women living with HIV continuously enrolled in the VITAL Start trial. IPV was assessed at baseline and months 1, 6, and 12 using the widely validated WHO IPV survey. Forms of IPV assessed were physical IPV, emotional IPV, and sexual IPV measured as prevalence, incidence, and recurrence. ACE histories were assessed using WHO's ACE International Questionnaire (ACE-IQ) tool. Logistic and log-binomial regressions were used in multivariable analyses that controlled for factors such as depression and alcohol use. Results Participants' mean age was 27.6 ± 5.7 years. Forty-three percent (43%) reported IPV prevalence, 13% reported IPV incidence, and another 13% reported IPV recurrence, with emotional IPV being the most commonly reported IPV type. Over 96% reported experiencing ⩾1 ACE. In regression analysis, cumulative ACE scores were significantly associated with IPV prevalence and IPV recurrence and in both cases, the magnitude of association was greatest for sexual IPV compared with physical IPV and emotional IPV. ACE scores were not significantly associated with IPV incidence. Conclusions IPV is highly prevalent among pregnant women living with HIV and continues to occur throughout the pregnancy and postpartum period; its graded relationship with ACEs is a concern in resource-limited settings where HIV/AIDS remains a public health concern. Strategies aimed to address the needs of pregnant/breastfeeding women living with HIV may benefit from the regular screening of this population for IPV and ACE, including in antenatal care clinics.
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Affiliation(s)
- Steven P. Masiano
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Healthcare Delivery and Implementation Science Center, Cleveland Clinic, Cleveland, OH, USA
| | - Tapiwa A. Tembo
- Baylor College of Medicine Children’s Foundation Malawi, PBag B397, Lilongwe 3, Malawi
| | - Xiaoying Yu
- Department of Biostatistics & Data Science, School of Public and Population Health, The University of Texas Medical Branch, Galveston, TX, USA
| | - Elizabeth Wetzel
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Mtisunge Mphande
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Mike Chitani
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Angella Mkandawire
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Innocent Khama
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Alick Mazenga
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
| | - Elaine Abrams
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Saeed Ahmed
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Maria H. Kim
- Baylor College of Medicine Children’s Foundation Malawi, Lilongwe, Malawi
- Baylor International Pediatric AIDS Initiative, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA
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21
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Ashaba S, Kakuhikire B, Baguma C, Satinsky EN, Perkins JM, Rasmussen JD, Cooper-Vince CE, Ahereza P, Gumisiriza P, Kananura J, Bangsberg DR, Tsai AC. Adverse childhood experiences, alcohol consumption, and the modifying role of social participation: population-based study of adults in southwestern Uganda. SSM - MENTAL HEALTH 2022; 2:100062. [PMID: 35463801 PMCID: PMC9023342 DOI: 10.1016/j.ssmmh.2022.100062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Adverse childhood experiences (ACEs) include multiple forms of child maltreatment, including abuse and neglect, as well as other forms of household dysfunction. Studies from Uganda have revealed a high prevalence of child abuse, as well as one of the highest levels of alcohol consumption in Africa. Few population-based studies from Africa have estimated associations between ACEs and adult alcohol use, or assessed the potential buffering effects of social participation. Methods This cross-sectional, population-based study was conducted in a rural parish in southwestern Uganda between 2016 and 2018. We assessed self-reported ACEs using a modified version of the Adverse Childhood Experiences - International Questionnaire (ACE-IQ) scale. We measured heavy alcohol consumption using a 3-item scale previously validated in this population. We measured social participation using a 10-item scale eliciting participants' membership and participation in different community groups over the past two months. We fitted multivariable Poisson regression models to estimate the associations between ACEs and heavy alcohol consumption, and to assess for the potential buffering effects of social participation. Results We estimated statistically significant associations between the total ACE score and heavy alcohol consumption (adjusted relative risk [ARR] per ACE=1.17; 95% CI, 1.09-1.25; P ≤0.001). Social participation had a statistically significant moderating effect on the association between total ACE score and heavy alcohol consumption (P=0.047 for interaction): the estimated association between total ACE score and heavy alcohol consumption among study participants who did not participate in a community group was larger, with a narrower confidence interval (ARR=1.21 per ACE; 95% CI, 1.11-1.33; P<0.001), while the estimated association among study participants who did participate in a community group was smaller and less precisely estimated (ARR=1.12 per ACE; 95% CI, 1.02-1.24; P=0.02). Conclusions Our findings demonstrate an association between ACEs and heavy alcohol consumption behavior among adults in rural Uganda. The adverse effects of ACEs were buffered in part by social participation. To prevent or reduce harmful alcohol use behaviors among adults, it is important to address the chronic stress caused by ACEs.
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Affiliation(s)
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | | | | | | | - Phionah Ahereza
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Justus Kananura
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda
- Oregon Health and Science University - Portland State University School of Public Health, Portland, OR, USA
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Center for Global Health, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
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22
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Ferrajão P, Frias F, Ramos J, Elklit A. A latent class analysis of adverse childhood life events in Ugandan adolescents. JOURNAL OF PSYCHOLOGY IN AFRICA 2022. [DOI: 10.1080/14330237.2022.2121471] [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]
Affiliation(s)
- Paulo Ferrajão
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Francisco Frias
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Joana Ramos
- Faculdade de Ciências Sociais e Tecnologia, Universidade Europeia, Lisbon, Portugal
| | - Ask Elklit
- National Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark
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Klabbers RE, Ashaba S, Stern J, Faustin Z, Tsai AC, Kasozi J, Kambugu A, Ventevogel P, Bassett IV, O'Laughlin KN. Mental disorders and lack of social support among refugees and Ugandan nationals screening for HIV at health centers in Nakivale refugee settlement in southwestern Uganda. JOURNAL OF GLOBAL HEALTH REPORTS 2022; 6. [PMID: 37168525 PMCID: PMC10168545 DOI: 10.29392/001c.39600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Exposure to potentially traumatic events and daily stressors in humanitarian settings puts refugees and asylum seekers (henceforth collectively referred to as refugees) at increased risk for mental disorders. Little is known about how mental disorder prevalence compares between refugees and national populations who live in the same settings and are exposed to many of the same daily challenges. We aimed to compare the proportions of refugees and Ugandan nationals screening positive for mental disorders in a Ugandan refugee settlement to inform targeted health interventions. Given displacement’s disruptive effect on social networks and the importance of social support for mental health, we also aimed to assess social support. Methods Refugees and Ugandan nationals voluntarily testing for HIV at health centers in Nakivale Refugee Settlement were screened for post-traumatic stress disorder (PTSD CheckList-6 – Civilian Version [PCL-6]), depression (Patient Health Questionnaire-9 [PHQ-9]), anxiety (General Anxiety Disorder-7 [GAD-7]), and lack of social support (Brief Social Support Scale [BS6]). The association between refugee versus Ugandan national status and the four outcomes was assessed using log-binomial regression. Results Screening surveys were completed by 5,513 participants, including 3,622 refugees and 1,891 Ugandan nationals. A positive screen for PTSD, depression, anxiety and lack of social support was found for 2,388 (44%), 1,337 (25%), 1,241 (23%) and 631 (12%) participants, respectively. Refugee status was associated with a higher prevalence of a positive screen for PTSD (prevalence ratio (PR)=1.15; 95% confidence interval (CI)=1.08-1.23), depression (PR=1.22; 95% CI=1.11-1.36), anxiety (PR=1.28; 95% CI=1.14-1.42), and lack of social support (PR=1.50; 95% CI=1.27-1.78). When adjusted for the other outcomes, the higher prevalence of a positive screen for PTSD, anxiety and lack of social support for refugees remained statistically significant. Conclusions Elevated symptoms of mental disorders are found among refugees and Ugandan nationals testing for HIV in Nakivale Refugee Settlement. The significant association between refugee status and PTSD, anxiety and lack of social support symptoms highlights the distinct needs of this population. To determine the prevalence of mental disorders in these populations, comprehensive assessment, including psychological and neuropsychological testing, is needed.
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Affiliation(s)
- Robin E. Klabbers
- University of Washington, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | | | - Joshua Stern
- University of Washington, Seattle, Washington, USA
| | | | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julius Kasozi
- United Nations High Commissioner for Refugees, Kampala, Uganda
| | - Andrew Kambugu
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Peter Ventevogel
- United Nations High Commissioner for Refugees, Geneva, Switzerland
| | - Ingrid V. Bassett
- Harvard Medical School, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kelli N. O'Laughlin
- University of Washington, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
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Kaggwa MM, Najjuka SM, Bongomin F, Mamun MA, Griffiths MD. Prevalence of depression in Uganda: A systematic review and meta-analysis. PLoS One 2022; 17:e0276552. [PMID: 36264962 PMCID: PMC9584512 DOI: 10.1371/journal.pone.0276552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 10/09/2022] [Indexed: 11/07/2022] Open
Abstract
Background Depression is one of the most studied mental health disorders, with varying prevalence rates reported across study populations in Uganda. A systematic review and meta-analysis was carried out to determine the pooled prevalence of depression and the prevalence of depression across different study populations in the country. Methods Papers for the review were retrieved from PubMed, Scopus, PsycINFO, African Journal OnLine, and Google Scholar databases. All included papers were observational studies regarding depression prevalence in Uganda, published before September 2021. The Joanna Briggs Institute Checklist for Prevalence Studies was used to evaluate the risk of bias and quality of the included papers, and depression pooled prevalence was determined using a random-effects meta-analysis. Results A total of 127 studies comprising 123,859 individuals were identified. Most studies were conducted among individuals living with HIV (n = 43; 33.9%), and the most frequently used instrument for assessing depression was the Depression sub-section of the Hopkins Symptom Checklist (n = 34). The pooled prevalence of depression was 30.2% (95% confidence interval [CI]: 26.7–34.1, I2 = 99.80, p<0.001). The prevalence of depression was higher during the COVID-19 pandemic than during the pre-pandemic period (48.1% vs. 29.3%, p = 0.021). Refugees had the highest prevalence of depression (67.6%; eight studies), followed by war victims (36.0%; 12 studies), individuals living with HIV (28.2%; 43 studies), postpartum or pregnant mothers (26.9%; seven studies), university students (26.9%; four studies), children and adolescents (23.6%; 10 studies), and caregivers of patients (18.5%; six studies). Limitation Significantly high levels of heterogeneity among the studies included. Conclusion Almost one in three individuals in Uganda has depression, with the refugee population being disproportionately affected. Targeted models for depression screening and management across various populations across the country are recommended. Trial registration Protocol registered with PROSPERO (CRD42022310122).
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry, Mbarara University of Science & Technology, Mbarara, Uganda
- African Centre for Suicide Prevention and Research, Mbarara, Uganda
- Department of Psychiatry and Behavioural Neurosciences, Forensic Psychiatry Program, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - Sarah Maria Najjuka
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Mohammed A. Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Mark D. Griffiths
- Psychology Department, Nottingham Trent University, Nottingham, United Kingdom
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25
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Masiano SP, Yu X, Tembo T, Wetzel E, Mphande M, Khama I, Mkandawire A, Chitani M, Liwimbi O, Udedi M, Mazenga A, Nyasulu P, Abrams E, Ahmed S, Kim MH. The relationship between adverse childhood experiences and common mental disorders among pregnant women living with HIV in Malawi. J Affect Disord 2022; 312:159-168. [PMID: 35752220 PMCID: PMC9892657 DOI: 10.1016/j.jad.2022.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/28/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) have been linked to common mental disorders (CMDs) such as anxiety and depressive thoughts. We examined the prevalence of ACEs and their association with CMDs among pregnant women living with HIV (PWLHIV) in Malawi-an HIV endemic resource-limited setting. METHODS This is a cross-sectional study of 798 PWLHIV enrolled in the VITAL Start trial in Malawi (10/2018 to 06/2021) (NCT03654898). ACE histories were assessed using WHO's Adverse Childhood Experiences International Questionnaire (ACE-IQ) tool. Depressive symptoms (somatic complaints, reduced vital energy, anxiety, and depressive thoughts) were assessed using WHO's Self Reporting Questionnaire 20-Item (SRQ-20) tool. Log-binomial regressions were used to examine the association between cumulative ACEs and each depressive symptom, as well as identify ACEs driving this association. RESULTS The mean age of our sample was 27.5 years. Over 95 % reported having experienced ≥1 ACE. On average, each participant reported four ACEs; 11 % reported sexual abuse. About 52 % and 44 % reported anxiety and depressive thoughts, respectively. In regressions, cumulative ACE scores were significantly associated with depressive symptoms-even after adjusting for multiple testing. This association was primarily driven by reports of sexual abuse. LIMITATIONS Data on maternal ACEs were self-reported and could suffer from measurement error because of recall bias. CONCLUSIONS ACEs are widespread and have a graded relationship with depressive symptoms in motherhood. Sexual abuse was found to be a primary driver of this association. Earlier recognition of ACEs and provision of trauma-informed interventions to improve care in PWLHIV may reduce negative mental health sequelae.
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Affiliation(s)
- Steven P Masiano
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Healthcare Delivery and Implementation Science Center, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Xiaoying Yu
- Department of Biostatistics & Data Science, School of Public Health and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Tapiwa Tembo
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Elizabeth Wetzel
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Mtisunge Mphande
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Innocent Khama
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Angella Mkandawire
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mike Chitani
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Olive Liwimbi
- Ministry of Health, Zomba Mental Hospital, Zomba, Malawi
| | - Michael Udedi
- Ministry of Health, NCDs and Mental Health Unit, Lilongwe, Malawi; University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA
| | - Alick Mazenga
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Phoebe Nyasulu
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Elaine Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Saeed Ahmed
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Maria H Kim
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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26
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Jiang Y, Jiang T, Xu LT, Ding L. Relationship of depression and sleep quality, diseases and general characteristics. World J Psychiatry 2022; 12:722-738. [PMID: 35663298 PMCID: PMC9150039 DOI: 10.5498/wjp.v12.i5.722] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/14/2022] [Accepted: 04/28/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Depression is the most common type of depressive disorder. The most common sleep disorder associated with depression is insomnia. Insomnia and depression are closely related.
AIM To investigate the relationship of designed questionnaire items and depression, and analyze the related factors with depression.
METHODS Questionnaire included Patient Health Questionnaire-9 (PHQ-9) and Pittsburgh sleep quality index (PSQI), 12 kinds of diseases, 8 general characteristics, and 20 insomnia characteristics, totally 56 items were filled out by 411 patients enrolled.
RESULTS All the 9 items of PHQ-9, 6 components of PSQI (except sleep duration), education, living situation, exercise, years of insomnia, western medicine treatment, Chinese medicine treatment, psychotherapy, kinds of insomnia, treatment expected to treat insomnia, psychological counseling, habit of 1 h before bed, habit of lunch break, diagnosed depression, coronary heart disease, mental illness showed significant difference between without and with depression group. By univariate analysis and multivariate analysis. The odds ratio of education, exercise, kinds of insomnia, habit of 1 h before bed, diagnosed depression, coronary heart disease (P = 0.01) showed significant difference. Their odds ratios were 0.71 (0.55, 0.93), 2.09 (1.32, 3.31), 0.76 (0.63, 0.91), 0.89 (0.81, 0.98), 0.32 (0.17, 0.60), 0.43 (0.23, 0.79).
CONCLUSION We demonstrated that education, exercise, kinds of insomnia, habit of 1 h before bed, diagnosed depression and coronary heart disease affect the depression.
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Affiliation(s)
- Yan Jiang
- Yuetan Community Health Service Center Fuxing Hospital, Capital Medical University, Beijing 100045, China
| | - Tao Jiang
- Department of Medicine Innovation Research, Chinese PLA General Hospital, Beijing 100853, China
| | - Li-Tao Xu
- Yuetan Community Health Service Center Fuxing Hospital, Capital Medical University, Beijing 100045, China
| | - Lan Ding
- Yuetan Community Health Service Center Fuxing Hospital, Capital Medical University, Beijing 100045, China
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27
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An X, Guo W, Wu H, Fu X, Li M, Zhang Y, Li Y, Cui R, Yang W, Zhang Z, Zhao G. Sex Differences in Depression Caused by Early Life Stress and Related Mechanisms. Front Neurosci 2022; 16:797755. [PMID: 35663561 PMCID: PMC9157793 DOI: 10.3389/fnins.2022.797755] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/02/2022] [Indexed: 11/26/2022] Open
Abstract
Depression is a common psychiatric disease caused by various factors, manifesting with continuous low spirits, with its precise mechanism being unclear. Early life stress (ELS) is receiving more attention as a possible cause of depression. Many studies focused on the mechanisms underlying how ELS leads to changes in sex hormones, neurotransmitters, hypothalamic pituitary adrenocortical (HPA) axis function, and epigenetics. The adverse effects of ELS on adulthood are mainly dependent on the time window when stress occurs, sex and the developmental stage when evaluating the impacts. Therefore, with regard to the exact sex differences of adult depression, we found that ELS could lead to sex-differentiated depression through multiple mechanisms, including 5-HT, sex hormone, HPA axis, and epigenetics.
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Affiliation(s)
- Xianquan An
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
- Department of Anesthesiology, Second Hospital of Jilin University, Changchun, China
| | - Wanxu Guo
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, Second Hospital of Jilin University, Changchun, China
| | - Huiying Wu
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, Second Hospital of Jilin University, Changchun, China
| | - Xiying Fu
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, Second Hospital of Jilin University, Changchun, China
| | - Ming Li
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, Second Hospital of Jilin University, Changchun, China
| | - Yizhi Zhang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, Second Hospital of Jilin University, Changchun, China
| | - Yanlin Li
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, Second Hospital of Jilin University, Changchun, China
| | - Ranji Cui
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, Second Hospital of Jilin University, Changchun, China
| | - Wei Yang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetic, Second Hospital of Jilin University, Changchun, China
| | - Zhuo Zhang
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Zhuo Zhang,
| | - Guoqing Zhao
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
- Guoqing Zhao,
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28
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Jurinsky J, Perkins JM, Kakuhikire B, Nyakato VN, Baguma C, Rasmussen JD, Satinsky EN, Ahereza P, Kananura J, Audet CM, Bangsberg DR, Tsai AC. Ease of marital communication and depressive symptom severity among men and women in rural Uganda: cross-sectional, whole-population study. Soc Psychiatry Psychiatr Epidemiol 2022; 57:343-352. [PMID: 34355265 PMCID: PMC8792190 DOI: 10.1007/s00127-021-02135-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/22/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Depression is a major contributor to the global burden of disease. The extent to which marital communication may influence depression in contexts with little mental health support is unknown. METHODS We conducted a whole-population study of married adult residents of eight villages in a rural region of southwestern Uganda. Depression symptom severity was measured using a modified version of the Hopkins Symptom Checklist for Depression, with > 1.75 classified as a positive screen for probable depression. Respondents were asked to report about ease of marital communication ('never easy', 'easy once in a while', 'easy most of the time' or 'always easy'). Sex-stratified, multivariable Poisson regression models were fit to estimate the association between depression symptom severity and marital communication. RESULTS Among 492 female and 447 male participants (response rate = 96%), 23 women and 5 men reported communication as 'never easy' and 154 women and 72 men reported it as 'easy once in a while'. Reporting communication as 'never easy' was associated with an increased risk of probable depression among women (adjusted relative risk [ARR], 2.06; 95% confidence interval [CI], 1.08-3.93, p = 0.028) and among men (ARR, 7.10; 95% CI 1.70-29.56, p = 0.007). CONCLUSION In this whole-population study of married adults in rural Uganda, difficulty of marital communication was associated with depression symptom severity. Additional research is needed to assess whether communication training facilitated by local leaders or incorporated into couples-based services might be a novel pathway to address mental health burden.
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Affiliation(s)
| | - Jessica M. Perkins
- Peabody College, Vanderbilt University, Nashville, TN, USA,Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA,Corresponding author: Dr. Jessica M. Perkins, , Phone: (615) 875-3289, Fax: 615-343-2661
| | | | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Emily N. Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston MA USA
| | - Phionah Ahereza
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Justus Kananura
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Carolyn M. Audet
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA,University of Witwatersrand, Johannesburg, South Africa
| | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda,Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda,Center for Global Health, Massachusetts General Hospital, Boston MA USA,Harvard Medical School, Boston, MA, USA,Mongan Institute, Massachusetts General Hospital, Boston MA USA
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29
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Kaggwa MM, Namatanzi B, Kule M, Nkola R, Najjuka SM, Al Mamun F, Hosen I, Mamun MA, Ashaba S. Depression in Ugandan Rural Women Involved in a Money Saving Group: The Role of Spouse's Unemployment, Extramarital Relationship, and Substance Use. Int J Womens Health 2021; 13:869-878. [PMID: 34588819 PMCID: PMC8473717 DOI: 10.2147/ijwh.s323636] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background Rural women are highly prevalent to depression, where spouse-related factors, including extramarital affairs and poverty, intensify its likelihood of occurrence. However, women engaged with a Money-Saving Group (MSG) are financially self-dependent, which can reduce the risk of depression suffering. Despite this, there is less study among this cohort, which led us to investigate the prevalence and associated factors of depression among the Ugandan women involved in MSG. Methods This was a cross-sectional study in Uganda among rural married or cohabiting women aged 18 to 45 years engaged in MSG. The survey was carried out within a total of 153 participants (33.3 ± 6.7 years) in April 2021. Information related to socio-demographic of the participants, their spouse characteristics, and depression were collected. Results About 65.4% of the participants had depressive symptoms (based on the cutoff 10/27 at the PHQ-9). But, 8.15 times (CI: 2.83–23.44, p<0.001) and 16.69 times (CI: 4.85–57.39, p<0.001), higher risk of depression were observed, if the participants’ spouses were using an addictive substance and had been involved in an extramarital relationship, respectively. Similarly, there was an increased likelihood of depression when the participant or spouse was unemployed. Conclusion This study observed a higher prevalence of depression, which suggests paying attention to this cohort. Thus, there should be routine screening for depression among married women involved in MSG at lower-level health facilities in rural settings, especially those with spouses engaged in substance use, having an extramarital relationship, and being unemployed.
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Affiliation(s)
- Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Moses Kule
- Department of Psychiatry, Mbarara Regional Referral Hospital, Mbarara, Uganda
| | - Rahel Nkola
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Firoj Al Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, 1342, Bangladesh.,Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Ismail Hosen
- CHINTA Research Bangladesh, Savar, Dhaka, 1342, Bangladesh.,Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Mohammed A Mamun
- CHINTA Research Bangladesh, Savar, Dhaka, 1342, Bangladesh.,Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Scholastic Ashaba
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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30
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Kim AW, Kakuhikire B, Baguma C, North CM, Satinsky EN, Perkins JM, Ayebare P, Kiconco A, Namara EB, Bangsberg DR, Siedner MJ, Tsai AC. Adverse childhood experiences and adult cardiometabolic risk factors and disease outcomes: Cross-sectional, population-based study of adults in rural Uganda. J Glob Health 2021; 11:04035. [PMID: 34386213 PMCID: PMC8325920 DOI: 10.7189/jogh.11.04035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Cardiovascular diseases (CVD) pose a major threat to public health in sub-Saharan African communities, where the burden of these classes of illnesses is expected to double by 2030. Growing research suggests that past developmental experiences and early life conditions may also elevate CVD risk throughout the life course. Greater childhood stress and adversity are consistently associated with a range of adult CVDs and associated risk factors, yet little research exists on the long-term effects of early life stress on adult physical health outcomes, especially CVD risk, in sub-Saharan African contexts. This study aims to evaluate the associations between adverse childhood experiences and adult cardiometabolic risk factors and health outcomes in a population-based study of adults living in Mbarara, a rural region of southwestern Uganda. Methods Data come from an ongoing, whole-population social network cohort study of adults living in the eight villages of Nyakabare Parish, Mbarara. A modified version of the Adverse Childhood Experiences-International Questionnaire (ACEs) assessed past exposure to physical, emotional, and sexual adversity. Participants also took part in a health fair where medical histories on cardiometabolic risk factors and cardiovascular diseases were gathered. Multiple logistic regression models estimated the associations between ACEs and cardiometabolic risk factors and health outcomes. Results Data were available on 545 adults. The average number of ACEs was 4.9 out of a possible 16. The cumulative number of ACEs were associated with having a history of heart attack and/or heart failure (adjusted odds ratio (AOR) = 1.11, 95% confidence interval (CI) = 0.999-1.234, P = 0.051), but the estimated association was not statistically significant. ACEs did not have statistically significant associations with any others measures of adult cardiometabolic risk and CVD. Conclusions Adverse childhood experiences are not associated with a range of adult cardiometabolic risk factors and health outcomes in this sample of rural Ugandan adults. Further research in this sample is necessary to identify the pathways that may motivate these null relationship and possibly protect against adverse cardiometabolic and cardiovascular health outcomes.
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Affiliation(s)
- Andrew Wooyoung Kim
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Crystal M North
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Division of Pulmonary and Critical Care, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Emily N Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | | | - Allen Kiconco
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - David R Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda.,Oregon Health and Science University - Portland State University School of Public Health, Portland, Oregon, USA
| | - Mark J Siedner
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA.,Medical Practice Evaluation Center and Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA, USA
| | - Alexander C Tsai
- Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA.,Mbarara University of Science and Technology, Mbarara, Uganda.,Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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