Intimate Partner Violence, Depression, and Anxiety Are Associated With Higher Perceived Stress Among Both Young Men and Women in Soweto and Durban, South Africa.

Tatiana E Pakhomova,Angela Kaida,Mark Brockman,Kalysha Closson,Jenni Smit,Patricia Smith,Mags Beksinska,Stefanie Hornschuh,Glenda Gray,Thumbi Ndung'U,Janan Janine Dietrich

doi:10.3389/frph.2021.638116

Abstract

Objectives: Psychological stress is an important determinant of health, including for mental well-being and sexual health. However, little is known about the prevalence and psychosocial and sexual health correlates of perceived stress among young people in South Africa, where elevated life-stressors are an important driver of health inequities. This study examines the association between intimate partner violence (IPV), psychosocial and sexual health, and perceived stress, by gender, among South African adolescents and young adults.Methods: Using baseline survey data from AYAZAZI, a cohort study enrolling youth (16–24 years) from Durban and Soweto, we used the 10-item Perceived Stress Scale (PSS-10) to measure the degree to which an individual perceives their life situations as unpredictable, uncontrollable, and overloaded. Possible scores range between 0 and 40; higher scores indicating higher perceived stress. Crude and adjusted gender-stratified linear regression models examined associations between sexual health factors, experiences (young women) and perpetration (young men) of IPV, anxiety (APA 3-item Scale, ≥2 = probable anxiety), and depression (10-item CES-D Scale, ≥10 = probable depression) and perceived stress. Multivariable models adjusted for age, income, sexual orientation, and financial dependents.Results: Of the 425 AYAZAZI participants, 60% were young women. At baseline, 71.5% were students//learners and 77.2% earned ≤ ZAR1600 per month (~$100 USD). The PSS-10 had moderate reliability (α = 0.70 for young women, 0.64 for young men). Young women reported significantly higher mean PSS scores than young men [18.3 (6.3) vs. 16.4 (6.0)]. In adjusted linear regression models, among young women experiences of IPV (β = 4.33; 95% CI: 1.9, 6.8), probable depression (β = 6.63; 95% CI: 5.2, 8.1), and probable anxiety (β = 5.2; 95% CI: 3.6, 6.8) were significantly associated with higher PSS scores. Among young men, ever perpetrating IPV (β = 2.95; 95% CI: 0.3, 5.6), probable depression (β = 6; 95% CI: 4.3, 7.6), and probable anxiety (β = 3.9; 95% CI: 2.1, 5.8) were significantly associated with higher perceived stress.Conclusion: We found that probable depression, anxiety, perpetration of IPV among young men, and experiences of IPV among young women, were associated with higher perceived stress. Critical efforts are needed to address the gendered stressors of young men and women and implement services to address mental health within violence prevention efforts.

Highlights

Stress is an important determinant of both psychological and physical well-being, playing a significant role in influencing numerous health outcomes [1, 2]
The stress-generation hypothesis further suggests that exposure to elevated life stressors and negative life events plays a role in predicting future sensitivity to stress and adverse health [22]
Given that the associations between depression, intimate partner violence (IPV), and perceived stress we found were in HIV endemic communities, further research could consider some of the pathways in which perceived stress may play a role in affecting the elevated HIV risk for this group, for young women and adolescent girls who are at an elevated risk for HIV acquisition due to increased structural, biological, and social vulnerabilities [99]

Summary

Introduction

Stress is an important determinant of both psychological and physical well-being, playing a significant role in influencing numerous health outcomes [1, 2]. Perceived stress, which refers to the subjective perceptions of capacity to cope with stressful events or situations [1], is a commonly used measure to interpret or appraise psychological activation in response to environmental stressors [17]. Important factors influencing the relationship between stress and health are tools and mechanisms to cope with stressors, as well as self-efficacy – which refers to an individual’s belief regarding their capacity to manage stressful situations [19]. High, chronic psychological stress is an important contributor to the global disease burden, in particular for structurally marginalized communities [28] due to the high prevalence of life stressors, structural inequities, healthcare exclusion, and limited mental health and social supports [33, 34]

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