Hatcher Abigail M, Mkhize Sthembiso Pollen, Parker Alexandra, de Kadt Julia
Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
PLOS Glob Public Health. 2022 Nov 2;2(11):e0001079. doi: 10.1371/journal.pgph.0001079. eCollection 2022.
Depressive symptoms are a major burden of disease globally and is associated with violence and poverty. However, much of the research linking these conditions is from resource-rich settings and among smaller, clinical samples. Secondary data from a household survey in Gauteng Province of South Africa examines the cross-sectional association between adult women's elevated depressive symptoms and markers of violence. Using tablet computers, participants self-completed interview modules to screen for depressive symptoms (Patient Health Questionnaire 2-item screener), childhood exposure to physical and sexual abuse (Childhood Trauma Questionnaire 4-item index), as well as past-year exposure to sexual or intimate partner violence (SIPV; WHO Multicountry Study instrument 4-item index). Socio-economic status, food security, education, and income were self-reported. Representative data at the ward level allows for modeling of results using survey commands and mixed-level modeling. Of the 7,276 adult women participating in the household survey, 42.1% reported elevated depressive symptoms. A total of 63.9% reported childhood violence exposure and 5.3% had past-year SIPV. Multi-level modeling suggests that violence is a strong predictor of depressive symptoms. Childhood abuse alone increases the odds of high depressive symptomology, after controlling for individual-level markers of poverty and neighborhood of residence (aOR 1.31, 95%, CI 1.17-1.37). Combined exposure to childhood abuse and past-year SIPV increased odds of reporting elevated depressive symptoms (aOR 2.05, 95%, CI 1.54-2.71). Ward characteristics account for 6% of the variance in depressive symptoms, over and above the contributions of household food security and socio-economic status. Exposure to violence in childhood and past-year SIPV were associated with depressive symptoms among women. These associations persist after controlling for socio-economic markers and latent neighborhood characteristics, which also had significant association with elevated depressive symptoms. These data suggest that efforts to reduce the burden of depressive symptoms may benefit from approaches that prevent violence against women and children.
抑郁症状是全球主要的疾病负担，且与暴力和贫困相关。然而，将这些情况联系起来的大部分研究来自资源丰富的地区，且样本规模较小且为临床样本。南非豪登省一项家庭调查的二手数据，研究了成年女性抑郁症状加重与暴力指标之间的横断面关联。参与者使用平板电脑自行完成访谈模块，以筛查抑郁症状（患者健康问卷2项筛查工具）、童年期遭受身体和性虐待情况（童年创伤问卷4项指标）以及过去一年遭受性暴力或亲密伴侣暴力情况（性暴力或亲密伴侣暴力；世界卫生组织多国研究工具4项指标）。社会经济地位、粮食安全、教育程度和收入均为自我报告。病房层面的代表性数据允许使用调查命令和混合层面模型对结果进行建模。在参与家庭调查的7276名成年女性中，42.1%报告有加重的抑郁症状。共有63.9%报告童年期遭受暴力，5.3%在过去一年遭受性暴力或亲密伴侣暴力。多层次模型表明，暴力是抑郁症状的有力预测因素。仅童年期虐待在控制了个体层面的贫困指标和居住社区因素后，就会增加出现高度抑郁症状的几率（调整后比值比1.31，95%置信区间1.17 - 1.37）。童年期虐待和过去一年遭受性暴力或亲密伴侣暴力的综合暴露会增加报告有加重抑郁症状的几率（调整后比值比2.05，95%置信区间1.54 - 2.71）。病房特征在抑郁症状的方差中占6%，超出了家庭粮食安全和社会经济地位的影响。童年期遭受暴力和过去一年遭受性暴力或亲密伴侣暴力与女性的抑郁症状相关。在控制了社会经济指标和潜在的社区特征后，这些关联依然存在，而这些特征也与抑郁症状加重存在显著关联。这些数据表明，减轻抑郁症状负担的努力可能会从预防针对妇女和儿童的暴力行为的方法中受益。
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