Associations between depressive symptoms, sexual behaviour and relationship characteristics: a prospective cohort study of young women and men in the Eastern Cape, South Africa

Abstract

BackgroundPsychological factors are often neglected in HIV research, although psychological distress is common in low- to middle-income countries, such as South Africa. There is a need to deepen our understanding of the role of mental health factors in the HIV epidemic. We set out to investigate whether baseline depressive symptomatology was associated with risky sexual behaviour and relationship characteristics of men and women at baseline, as well as those found 12 months later.MethodsWe used prospective cohort data from a cluster randomized controlled trial of an HIV prevention intervention in the Eastern Cape Province of South Africa. Our subjects were 1002 female and 976 male volunteers aged 15 to 26. Logistic regression was used to model the cross-sectional and prospective associations between baseline depressive symptomatology, risky sexual behaviors and relationship characteristics. The analysis adjusted for the clustering effect, study design, intervention and several confounding variables.ResultsPrevalence of depressive symptoms was 21.1% among women and 13.6% among men. At baseline, women with depressed symptoms were more likely to report lifetime intimate partner violence (AOR = 2.56, 95% CI 1.89-3.46) and have dated an older partner (AOR = 1.37, 95% CI 1.03-1.83). A year later, baseline depressive symptomatology was associated with transactional sex (AOR = 2.60, 95% CI 1.37, 4.92) and intimate partner violence (AOR = 1.67, 95% CI 1.18-2.36) in the previous 12 months. Men with depressive symptoms were more likely to report ever having had transactional sex (AOR = 1.48, 95% CI 1.01-2.17), intimate partner violence perpetration (AOR = 1.50, 95% CI 0.98-2.28) and perpetration of rape (AOR = 1.81, 95% CI 1.14-2.87). They were less likely to report correct condom use at last sex (AOR = 0.50, 95% CI 0.32-0.78). A year later, baseline depressive symptomatology was associated with failure to use a condom at last sex among men (AOR = 0.60, 95% CI 0.40-0.89).ConclusionsSymptoms of depression should be considered as potential markers of increased HIV risk and this association may be causal. HIV prevention needs to encompass promotion of adolescent mental health.

Depressive symptoms after a sexual assault among women: understanding victim-perpetrator relationships and the role of social perceptions

“…16 This scale has been used extensively and validated in South Africa. [17][18][19] Twenty questions were asked and reflected on the feelings, emotions and experiences within the last week as well as their frequency. The score range between 0 and 60 with higher scores indicating more symptoms.…”

“…For this study a score of 16 and more was considered as indicative of high levels of depressive symptomatology, a cut-off used in many other South African studies. 17,19 We also tested a score of 22 or more (i.e. very high levels) in a 2nd logistic regression model.…”

Risk factors associated with mental health issues in adolescents: a integrative review

“…HIV vertical transmition (40,42,(45)(46) Grave sexual violence (13,29,51) HIV risk behaviors (20,43,46) Early sexual activity (42) Problems to adhere to antiretroviral treatment (42) 16.9 function in its psychic structuring. The family relationships containing affection and good communication are protection factors determinants to the adolescent mental health (31) .…”

“…Suffered aggression and physical violence (13,23,29,36,41,48,58) Sexual abuse experience evolving life threatening and physical injuries (13,22,41,43,51,53) Gangs involvement (20,61) Social contact problems and rules violation (25,59) Legal problems, involvement with auto accidents and violent acts practice (59,61) To be not working or studying (12) High frequency of exposition to community violence, theft, assault and firearms use (13) To be institutionalized or living in a shelter (13) Urban poverty (47) 32.0 …”

Incidence of Depression and the Coping Styles used for it by Under Graduate and Post Graduate Pharmacy students: A Comparison

“…It has also resulted in poor academic performance of university scholars [8]. Incidence of depression may also predispose the students to different other health disorders like HIV infection, diabetes and increased risk of suicidal tendency [9][10][11].The common stressors identified include academic stressors, social stresses and financial problems [12]. Coping Strategies refer to different continuous psychological, behavioral and emotional processes to deal with different stressors [13].…”