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Mhlongo S, Mason-Jones AJ, Ford K. Sexual, reproductive and mental health among young men (10-24) in low-and-middle income countries: a scoping review. Front Reprod Health 2023; 5:1119407. [PMID: 38111839 PMCID: PMC10725937 DOI: 10.3389/frph.2023.1119407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 11/06/2023] [Indexed: 12/20/2023] Open
Abstract
Background The relationship between SRH and mental health among men is not well documented, especially in the 10-24 age group. This scoping review aimed to investigate what is known about the association between SRH and mental health among young men (10-24) in LMICs. Methods Embase, APA PsycInfo, MEDLINE(R) ALL, ASSIA and the Cochrane Library of Database of Systematic Reviews were searched from the year of establishment up to August 2022. The review was reported using the PRISMA-ScR checklist. Results A total of (n = 2636) studies were identified from the five databases. After the completion of screening, only ten studies (n = 8 cross-sectional, n = 1 mixed methods and n = 1 qualitative) met the eligibility criteria and were included in the review. The findings suggest that there is a reciprocal relationship between mental health and SRH. Sperm concentration and total sperm count were found to be lower in depressed men. Poor mental health was associated with early sexual debut, higher rates of sexual activity and an increased number of sexual partners. Poor mental health was also found among men who had sex with men (MSM). In addition, we found a relationship between sexual abuse, sexual coercion and poor mental health. Conclusion The findings of this unique study indicate that poor mental health is associated with poor SRH outcomes and vice versa among young men (10-24) living in LMICs. However, further research will be needed to establish the temporal relationship between SRH and mental health outcomes.
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Abrahams N, Chirwa E, Mhlongo S, Seedat S, Myers B, Peer N, Kengne AP, Garcia-Moreno C, Lombard C, Jewkes R. Pathways to adverse pregnancy outcomes: exploring the mediating role of intimate partner violence and depression: results from a South African rape cohort study. Arch Womens Ment Health 2023; 26:341-351. [PMID: 37032357 PMCID: PMC10191987 DOI: 10.1007/s00737-023-01312-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 03/23/2023] [Indexed: 04/11/2023]
Abstract
Adverse pregnancy outcomes (APOs) are common occurrences that contribute to negative maternal and child health outcomes. Our aim was to test the hypothesis that trauma exposure and depression are drivers of the better-recognised risk factors for miscarriage, abortion and stillbirths. Our comparative cohort study based in Durban, South Africa recruited women who reported a recent rape (n = 852) and those who had never experienced rape (n = 853), with follow-up for 36 months. We explored APOs (miscarriage, abortion or stillbirth) among those having a pregnancy during follow-up (n = 453). Potential mediators were baseline depression, post-traumatic stress symptoms, substance abuse, HbA1C, BMI, hypertension and smoking. A structural equation model (SEM) was used to determine direct and indirect paths to APO. Overall, 26.6% of the women had a pregnancy in the follow-up period and 29.4% ended in an APO, with miscarriage (19.9%) the most common outcome, followed by abortion (6.6%) and stillbirths (2.9%). The SEM showed two direct pathways from exposure to childhood trauma, rape and other trauma, to APO which were ultimately mediated by hypertension and/or BMI, but all paths to BMI were mediated by depression and IPV-mediated pathways from childhood and other trauma to hypertension. Food insecurity mediated a pathway from experiences of trauma in childhood to depression. Our study confirms the important role of trauma exposure, including rape, and depression on APOs, through their impact on hypertension and BMI. It is critical that violence against women and mental health are more systematically addressed in antenatal, pregnancy and postnatal care.
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Affiliation(s)
- N Abrahams
- Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa.
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, 7935, Cape Town, South Africa.
| | - E Chirwa
- Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - S Mhlongo
- Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
| | - S Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Francie van Zijl Dr, Parow, Cape Town, 7505, South Africa
- Department of Psychiatry, Faculty of Medicine and Health Sciences, South African Research Chair in Posttraumatic Stress Disorder, Stellenbosch University, Cape Town, South Africa
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - B Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, 6102, Australia
- Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa
| | - N Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa
| | - A P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Rondebosch, Cape Town, 7700, South Africa
| | - C Garcia-Moreno
- HRP (The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction), Department of Sexual and Reproductive Health and Research, World Health Organization (WHO), 1211, Geneva, Switzerland
| | - C Lombard
- Biostatistics Unit, South African Medical Research Council, Francie van Zijl Dr, Parow Valley, 7501, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Francie Van Zijl Dr, Parow Valley, Cape Town, 7501, South Africa
- Office of the Executive Scientist, South African Medical Research Council, Pretoria, 0001, South Africa
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Matzopoulos R, Prinsloo M, Mhlongo S, Marineau L, Cornell M, Bowman B, Mamashela TA, Gwebushe N, Ketelo A, Martin LJ, Dekel B, Lombard C, Jewkes R, Abrahams N. South Africa's male homicide epidemic hiding in plain sight: exploring sex differences and patterns in homicide risk in a retrospective descriptive study of postmortem investigations. medRxiv 2023:2023.02.02.23285093. [PMID: 36778369 PMCID: PMC9915815 DOI: 10.1101/2023.02.02.23285093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background South Africa has homicide rates six times the global average, predominantly among men, but little is known about male victims. As part of the country's first ever study of male homicide we compared 2017 male and female victim profiles for selected covariates, against global averages and previous estimates for 2009. Methods We conducted a retrospective descriptive study of routine data collected through postmortem investigations, calculating age-standardised mortality rates for manner of death by age, sex and province and male-to-female incidence rate ratios with 95% confidence intervals. We then used generalised linear models and linear regression models to assess the association between sex and victim characteristics including age and mechanism of injury (guns, stabs and blunt force) within and between years. Findings 87% of 19,477 homicides in 2017 were males, equating to seven male deaths for every female, with sharp force and firearm discharge the most common external causes. Rates were higher among males than females at all ages, and up to eight times higher among males aged 15-44 years. Provincial rates varied overall and by sex, with the highest comparative risk for men vs. women in the Western Cape Province (11.4 males for every 1 female). Male homicides peaked during December and were highest on weekends, underscoring the prominent role of alcohol as a risk factor. Significantly more males tested positive for alcohol than females. Interpretation The massive, disproportionate and enduring homicide risk borne by adult South African men highlights the negligible prevention response. Only through challenging the normative perception of male invulnerability can we begin to address the enormous burden of violence impacting men. There is an urgent need to address the insidious effect of such societal norms alongside implementing structural interventions to overcome the root causes of poverty and inequality and better control alcohol and firearms. Funding South African Medical Research Council and Ford Foundation.
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Mhlongo S, Seedat S, Jewkes R, Myers B, Chirwa E, Nöthling J, Lombard C, Peer N, Kengne A, Garcia-Moreno C, Dunkle K, Abrahams N. Depression and post-traumatic stress symptoms two years post-rape and the role of early counselling: Rape Impact Cohort Evaluation (RICE) study. Eur J Psychotraumatol 2023; 14:2237364. [PMID: 37642373 PMCID: PMC10467520 DOI: 10.1080/20008066.2023.2237364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 03/16/2023] [Accepted: 06/06/2023] [Indexed: 08/31/2023] Open
Abstract
Background: Survivors of sexual violence are at higher risk of adverse mental health outcomes compared to those exposed to other interpersonal traumas.Objective: To examine the trajectory of both post-traumatic stress disorder (PTSD) and depression as well as the role of early counselling over 24 months among rape survivors.Method: The South African Rape Impact Cohort Evaluation (RICE) study enrolled women aged 16-40 years attending post-rape care services within 20 days of a rape incident (n = 734), and a comparison group (n = 786) was recruited from primary health care. Women were followed for 24 months; the main study outcomes were depression and PTSD. Reports of early supportive counselling by the exposed group were also included. The analysis included an adjusted joint mixed model with linear splines to account for correlated observations between the outcomes.Results: At 24 months, 45.2% of the rape-exposed women met the cut-off for depression and 32.7% for PTSD. This was significantly higher than levels found among the unexposed. Although a decline in depression and PTSD was seen at 3 months among the women who reported a rape, mean scores remained stable thereafter. At 24 months mean depression scores remained above the depression cut-off (17.1) while mean PTSD scores declined below the PTSD cut-off (14.5). Early counselling was not associated with the trajectory of either depression or PTSD scores over the two years in rape-exposed women with both depression and PTSD persisting regardless of early counselling.Conclusion: The study findings highlight the importance to find and provide effective mental health interventions post-rape in South Africa.
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Affiliation(s)
- S. Mhlongo
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - S. Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Research Chair in Posttraumatic Stress Disorder, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- South African Medical Research Council Unit on the Genomics of Brain Disorders, Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R. Jewkes
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
- Office of the Executive Scientist, South African Medical Research Council, PretoriaSouth Africa
| | - B. Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Western Australia
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - E. Chirwa
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - J. Nöthling
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - C. Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - N. Peer
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - A.P. Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - C. Garcia-Moreno
- Department of Sexual and Reproductive Health and Research, World Health Organization (WHO)Geneva, Switzerland
| | - K. Dunkle
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - N. Abrahams
- Gender & Health Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health and Family Medicine: Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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