Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa.
J Int AIDS Soc. 2020 Dec;23(12):e25654. doi: 10.1002/jia2.25654.
Experiences of violence during youth contravene young people's rights and increase the risk of depression and poor human immunodeficiency virus (HIV) care outcomes among youth living with HIV (YLWH). Intervention targets for mitigating the negative psychosocial effects of violence are needed, particularly in areas like rural South Africa where violence remains pervasive and mental healthcare is limited. This study aims to quantify the associations between physical and sexual violence and depressive symptoms in YLWH in rural South Africa and explore the modification of these associations by key measures of psychosocial well-being.
We conducted a cross-sectional survey among 362 YLWH ages 12 to 24 in rural South Africa to ascertain participants' history of physical and sexual violence, current depressive symptoms (Center for Epidemiological Studies-Depression Scale) and levels of social support (Medical Outcomes Social Support Scale), resilience (Conner-Davidson Resilience Scale) and self-esteem (Rosenberg Self-Esteem Scale). Log-binomial regression was used to estimate the association between history of physical or sexual violence and clinically meaningful depressive symptoms (scores 16). Effect measure modification by high versus low resilience, social support and self-esteem was assessed using likelihood ratio tests (α = 0.20).
A total of 334 individuals with a median age of 21 (interquartile range: 16 to 23) were included in this analysis. Most participants were female (71.3%), single (81.4%) and attending school (53.0%). Ninety-four participants (28.1%) reported a history of physical or sexual violence and 92 individuals (27.5%) had clinically meaningful depressive symptoms. Meaningful depressive symptoms were significantly higher among participants with a history of physical or sexual violence as compared to those with no history of violence (adjusted prevalence ratio: 2.01; 95% CI: 1.43, 2.83). However, this association was significantly modified by social support (p = 0.04) and self-esteem (p = 0.02).
In this setting, the prevalence of meaningful depressive symptoms was significantly higher among YLWH with a history of physical or sexual violence as compared to those without a history of violence. However, higher levels of self-esteem or social support appeared to mitigate this association. Programmes to improve self-esteem and social support for youth have the potential to minimize depressive symptoms in YLWH who have experienced physical or sexual violence.
青少年时期的暴力经历侵犯了年轻人的权利，并增加了青少年感染艾滋病毒（HIV）者（YLWH）抑郁和不良 HIV 护理结局的风险。需要针对减轻暴力的消极心理社会影响的干预目标，特别是在南非农村等暴力仍然普遍且精神保健有限的地区。本研究旨在量化南非农村 YLWH 中身体和性暴力与抑郁症状之间的关联，并探讨这些关联被关键的心理社会健康措施改变的情况。
我们对南非农村地区 362 名年龄在 12 至 24 岁的 YLWH 进行了横断面调查，以确定参与者的身体和性暴力史、当前抑郁症状（流行病学研究中心抑郁量表）和社会支持水平（医疗结局社会支持量表）、韧性（康纳-戴维森韧性量表）和自尊（罗森伯格自尊量表）。使用对数二项式回归估计身体或性暴力史与临床上有意义的抑郁症状（得分 16）之间的关联。使用似然比检验（α=0.20）评估高韧性、高社会支持和高自尊与低韧性、低社会支持和低自尊之间的效应修正。
共有 334 名中位年龄为 21 岁（四分位距：16 至 23）的个体纳入了本分析。大多数参与者为女性（71.3%）、单身（81.4%）和在校学生（53.0%）。94 名参与者（28.1%）报告有身体或性暴力史，92 名参与者（27.5%）有临床上有意义的抑郁症状。与无暴力史的参与者相比，有身体或性暴力史的参与者抑郁症状明显更严重（调整后的流行率比：2.01；95%CI：1.43，2.83）。然而，这种关联在社会支持（p=0.04）和自尊（p=0.02）方面有显著的修饰作用。
在这种情况下，与无暴力史的参与者相比，有身体或性暴力史的 YLWH 出现有意义的抑郁症状的比例显著更高。然而，较高的自尊或社会支持水平似乎减轻了这种关联。提高青少年自尊和社会支持的方案有可能最大限度地减少经历过身体或性暴力的 YLWH 的抑郁症状。
