Examining the relationship between physical and sexual violence and psychosocial health in young people living with HIV in rural South Africa

Abstract

Introduction 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. Methods 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). Results 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). Conclusions 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.

Prevalence and factors associated with common mental disorders in young people living with HIV in sub‐Saharan Africa: a systematic review

“…Various screening tools based on different cut‐off scores were also used to measure depressive (Table 2) or anxiety symptoms (Table 3). These screening tools included the 9‐item patient health questionnaire [76] used in six studies [49,53,57,60,77, 78], the centre for epidemiologic studies depression scale [79] used in four studies [51,54,56,62], the child depression inventory [80] used in four studies [58,59,81,82], Beck’s depression inventory [83] used in three studies [48,61,84], the revised children’s depression rating scale [85] used by Kim et al . [28], the hospital anxiety and depression scale [86] used by Sale & Gadanya [47], Reynold’s adolescent depression Scale [87] used by Paul et al .…”

“…Twenty‐nine studies reported the prevalence of either major depression or depressive symptoms [45‐67,77,78,81]. Of these, seven studies [50,55,58,59,65,66,78] additionally reported the prevalence of anxiety or its symptoms.…”

“…Recent reviews from SSA involving YLWH provide an overview of some of these factors because of broadly covering multiple psychiatric disorders [13,14], focussing on only one correlate – ART adherence [14] or including HIV‐positive young people up to 19 years only [13,14]. In this review, 19 studies reported the correlates of either major depression [64], symptoms of major depression [65] or depressive symptoms among YLWH [28,48,49,53,54,56,58,61,62,66,67,69,77,78,81,82,84]. Of these, four studies concurrently investigated correlates of anxiety symptoms [58,66,69,78].…”

“…YLWH were exclusively on ART in most studies (n = 17). Eight studies [46,[53][54][55][56][57][58][59] recruited ART experienced (majority) and ART na€ ıve participants, whereas six studies [45,48,[60][61][62][63] did not provide information on participant ART-use status. In eight studies [52,55,59,61,[64][65][66][67] YLWH were exclusively perinatally HIV-infected.…”

“…(Additional file S3) shows the quality scores of included studies according to their study designs, based on the Newcastle-Ottawa risk of bias assessment tool. Two studies were graded to be of very good quality [55,69], twelve of good quality [28,53,54,58,[64][65][66][67]77,78,82,84], nine of satisfactory quality [45, [49][50][51]56,61,62,68,81] and seven of unsatisfactory quality [46][47][48]57,59,60,63]. One study [52], available only as an abstract publication, provided relevant mental health data for this review.…”