Tomita Andrew, Ncama Busisiwe P, Moodley Yoshan, Davids Rashieda, Burns Jonathan K, Mabhaudhi Tafadzwanashe, Modi Albert T, Slotow Rob
Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
PLOS Clim. 2022 Apr 6;1(4):0000024. doi: 10.1371/journal.pclm.0000024.
Sub-Saharan Africa faces unprecedented disasters, with climate change expected to exacerbate the frequency and severity of unpredictable and stressful catastrophic events. Unlike developed nations, reconstruction in developing nations is hindered by resource constraints, with certain communities potentially experiencing multiple and enduring effects of disasters. Despite the potential danger of such cumulative community disaster exposure on mental health (e.g. depression), large-scale population-level evidence for the region is limited. We investigated the association between exposure to cumulative disaster and the first onset of depression in a nationally representative survey in South Africa. We used panel data from the South African National Income Dynamics Study (SA-NIDS) from 2008-2017, consisting of 17,255 adult study participants who were depression free at baseline. Risk of first depression onset between individuals exposed and unexposed to community disaster was measured, accounting for multiple disaster exposure over time by fitting generalized estimating equation (GEE) regression models. Data on the geographic location of disasters were obtained from the South African government gazette, and mapped with the government delineated SA-NIDS households' locations. Of the sampled individuals, 2,986 were exposed to disaster during the study duration (17.3%). Increased cumulative community disaster was significantly associated with the likelihood of depression onset (adjusted relative risk [aRR] = 1.20, p<0.01, 95% CI: 1.09-1.33), even after controlling for socio-demographic factors. In sub-group analyses, greater likelihood of depression onset was found among females [but not in men] (aRR = 1.23, p<0.01, 95% CI: 1.09-1.38), Black African [but not in other population group] (aRR = 1.21, p<0.01, 95% CI: 1.09-1.36), lower education attainment group [but not in tertiary and above educational attainment group] (aRR = 1.20, p<0.01, 95% CI: 1.08-1.33), and lower income attainment group [but not in the top income quartile group] (aRR = 1.24, p<0.01, 95% CI: 1.11-1.38), due to cumulative community disaster. Although cumulative community disaster exposure was significantly associated with the first onset of depression, its negative impact may be more pronounced among individuals considered chronically socially vulnerable (i.e. the groups above) in South Africa. Given that many individuals in South Africa rely on social, food parcel relief, and health services from government/public sector, timely access to community-based supportive intervention is needed for disaster survivors, prioritizing socially vulnerable groups to help mitigate problems associated with mental health challenges.
撒哈拉以南非洲面临着前所未有的灾难，预计气候变化将加剧不可预测且带来压力的灾难性事件的发生频率和严重程度。与发达国家不同，发展中国家的重建受到资源限制的阻碍，某些社区可能会经历灾难的多重和持久影响。尽管这种社区灾难的累积暴露对心理健康（如抑郁症）存在潜在危险，但该地区大规模的人口层面证据有限。我们在南非一项具有全国代表性的调查中，研究了累积灾难暴露与抑郁症首次发作之间的关联。我们使用了2008年至2017年南非国民收入动态研究（SA-NIDS）的面板数据，该数据由17255名基线时无抑郁症的成年研究参与者组成。通过拟合广义估计方程（GEE）回归模型，测量了暴露于社区灾难和未暴露于社区灾难的个体之间首次患抑郁症的风险，并考虑了随时间的多重灾难暴露情况。灾难地理位置的数据来自南非政府公报，并与政府划定的SA-NIDS家庭位置进行了映射。在抽样个体中，2986人在研究期间暴露于灾难（17.3%）。即使在控制了社会人口学因素之后，累积社区灾难的增加与抑郁症发作的可能性显著相关（调整后的相对风险[aRR]=1.20，p<0.01，95%置信区间：1.09-1.33）。在亚组分析中，发现女性[而非男性]（aRR=1.23，p<0.01，95%置信区间：1.09-1.38）、非洲黑人[而非其他人群]（aRR=1.21，p<0.01，95%置信区间：1.09-1.36）、低教育程度组[而非高等及以上教育程度组]（aRR=1.20，p<0.01，95%置信区间：1.08-1.33）以及低收入组[而非最高收入四分位数组]（aRR=1.24，p<0.01，95%置信区间：1.11-1.38）因累积社区灾难而患抑郁症发作的可能性更大。尽管累积社区灾难暴露与抑郁症的首次发作显著相关，但其负面影响在南非被认为长期处于社会弱势的个体（即上述群体）中可能更为明显。鉴于南非许多人依赖政府/公共部门的社会、食品包裹救济和医疗服务，灾难幸存者需要及时获得基于社区的支持性干预，优先考虑社会弱势群体，以帮助减轻与心理健康挑战相关的问题。
