Department of Psychology, University of Warwick, Warwick, UK.
Department of Psychology, University of Warwick, Warwick, UK; Division of Health Sciences, Warwick Medical School, Warwick, UK.
Lancet Psychiatry. 2024 Feb;11(2):134-142. doi: 10.1016/S2215-0366(23)00399-1.
Sexual victimisation and peer victimisation are pervasive and increase risk for mental illness. Longitudinal studies that compare their unique and cumulative effects are scarce and have been done predominantly in high-income countries. The aims of this study were to examine the prevalence, prospective associations, and gender differences in sexual and peer victimisation and mental health in a low-income, African setting.
In this prospective cohort study, data were obtained from the 2017 ARISE Adolescent Health Study, a population-representative, two-wave, prospective study of adolescents (aged 12-20 years) from Burkina Faso. A random sample of adolescents was drawn from ten villages, selected to capture the five main ethnic groups, and from one of the seven sectors of Nouna town, Burkina Faso, at two timepoints: Nov 12 to Dec 27, 2017, and Nov 15 to Dec 20, 2018. Standardised interviews were conducted in French or a local language by trained researchers. We measured victimisation exposure as sexual victimisation, peer victimisation, and polyvictimisation, using lifetime frequency of exposure, and we measured mental health symptoms and disorders using the Kutcher Adolescent Depression Scale, the Primary Care Post-Traumatic Stress Disorder screen IV and 5, and a question on lifetime self-harm and number of incidents in the past year. We calculated prevalence of victimisation and mental health symptoms and disorders at the two timepoints, and we used lifetime victimisation at the first timepoint to predict mental health at the second timepoint using logistic and negative binomial regressions. Gender differences were examined using interaction terms.
Of 2544 eligible adolescents, 1644 participated at time 1 and 1291 participated at time 2. The final sample with data at both timepoints included 1160 adolescents aged 12-20 years (mean 15·1, SE 0·2), of whom 469 (40·4%) were girls and 691 (59·6%) were boys. The majority ethnic group was Dafin (626 [39·1%]), followed by Bwaba (327 [20·5%]), Mossi (289 [16·0%]), Samo (206 [13·0%]), Peulh (166 [9·7%]), and other (30 [1·6%]). After survey weight adjustment, sexual victimisation (weighted percentages, time 1, 256 [13·8%] of 1620; time 2, 93 [7·2%] of 1264) and peer victimisation (weighted percentages, time 1, 453 [29·9%] of 1620; time 2, 272 [21·9%] of 1264) were common, whereas polyvictimisation was more rare (weighted percentages, time 1, 116 [6·6%] of 1620; time 2, 76 [5·7%] of 1264). Longitudinally, sexual victimisation was associated with probable clinical disorder (adjusted odds ratio 2·59, 95% CI 1·15-5·84), depressive symptoms (adjusted incidence rate ratio [aIRR] 1·39, 95% CI 1·12-1·72), and symptoms of post-traumatic stress disorder (aIRR 2·34, 1·31-4·16). Peer victimisation was associated with symptoms of post-traumatic stress disorder (aIRR 1·89, 1·13-3·17) and polyvictimisation was associated with depressive symptoms (aIRR 1·34, 1·01-1·77). Girls reported more sexual victimisation (weighted percentages, 130 [17·3%] of 681 vs 126 [11·4%] of 939), boys reported more peer victimisation (weighted percentages, 290 [33·1%] of 939 vs 163 [25·2%] of 681), and there was a significant interaction between lifetime victimisation and gender for probable clinical disorder (F [degrees of freedom 7, sample 376] 2·16; p=0·030).
Sexual and peer victimisation were common in the study setting and increased risk for mental health problems. Adolescent girls who have been sexually victimised are especially at risk of mental health problems. Interventions targeting sexual and peer violence in low-income settings are needed.
Alexander von Humboldt Foundation, the Wellcome Trust, Fondation Botnar, and Harvard TH Chan School of Public Health.
性侵犯和同伴侵害在全球范围内普遍存在，并增加了患精神疾病的风险。比较其独特和累积效应的纵向研究很少，而且主要在高收入国家进行。本研究的目的是在一个低收入的非洲环境中，检查性侵犯和同伴侵害以及心理健康的流行率、前瞻性关联和性别差异。
在这项前瞻性队列研究中，数据来自 2017 年 ARISE 青少年健康研究，这是一项对来自布基纳法索的青少年（年龄在 12-20 岁之间）进行的具有代表性的两波前瞻性研究。从十个村庄和努纳镇的七个区之一随机抽取青少年样本，以捕捉五个主要的族群，并在两个时间点进行：2017 年 11 月 12 日至 12 月 27 日和 2018 年 11 月 15 日至 12 月 20 日。由经过培训的研究人员用法语或当地语言进行标准化访谈。我们使用终生暴露的频率来衡量性侵犯、同伴侵害和多方面侵害的暴露情况，使用 Kutcher 青少年抑郁量表、初级保健创伤后应激障碍筛查 IV 和 5，以及关于一生中自残和过去一年中发生事件次数的问题来衡量心理健康症状和障碍。我们计算了两个时间点的侵害和心理健康症状和障碍的流行率，并使用第一次时间点的终生侵害来预测第二次时间点的心理健康，使用逻辑回归和负二项回归。使用交互项来检查性别差异。
在 2544 名符合条件的青少年中，有 1644 名在时间 1 点参加了研究，有 1291 名在时间 2 点参加了研究。最终在两个时间点都有数据的样本包括 1160 名 12-20 岁的青少年（平均年龄 15.1，SE 0.2），其中 469 名（40.4%）是女孩，691 名（59.6%）是男孩。最大的族群是达芬（327 [20.5%]），其次是布瓦巴（289 [16.0%]）、莫西（206 [13.0%]）、萨莫（166 [9.7%]）和其他（30 [1.6%]）。经过调查权重调整后，性侵犯（加权百分比，时间 1，1620 名中的 256 名[13.8%]；时间 2，1264 名中的 93 名[7.2%]）和同伴侵害（加权百分比，时间 1，1620 名中的 453 名[29.9%]；时间 2，1264 名中的 272 名[21.9%]）很常见，而多方面侵害则较为罕见（加权百分比，时间 1，1620 名中的 116 名[6.6%]；时间 2，1264 名中的 76 名[5.7%]）。纵向研究显示，性侵犯与可能的临床疾病（调整后的优势比 2.59，95%置信区间 1.15-5.84）、抑郁症状（调整后的发病率比[aIRR]1.39，95%置信区间 1.12-1.72）和创伤后应激障碍症状（aIRR 2.34，1.31-4.16）相关。同伴侵害与创伤后应激障碍症状相关（aIRR 1.89，1.13-3.17），多方面侵害与抑郁症状相关（aIRR 1.34，1.01-1.77）。女孩报告的性侵犯较多（加权百分比，681 名中的 130 名[17.3%]；939 名中的 126 名[11.4%]），男孩报告的同伴侵害较多（加权百分比，939 名中的 290 名[33.1%]；681 名中的 163 名[25.2%]），终生侵害和性别之间存在显著的交互作用（自由度为 7，样本为 376；F [2.16；p=0.030]）。
性侵犯和同伴侵害在研究环境中很常见，并增加了心理健康问题的风险。遭受过性侵犯的青少年女孩尤其容易出现心理健康问题。需要在低收入环境中针对性侵犯和同伴暴力问题进行干预。
亚历山大·冯·洪堡基金会、惠康基金会、博特纳基金会和哈佛 T.H.陈公共卫生学院。
