The Association of Recurrent and Multiple Types of Abuse with Adverse Mental Health, Substance Use, and Sexual Health Outcomes among Out-of-School Adolescent Girls and Young Women in Cape Town, South Africa.

Bronwyn Myers,Courtney Peasant Bonner,Felicia A. Browne,Wendee M. Wechsberg,Tracy Kline,Tara Carney

doi:10.3390/ijerph182111403

Abstract

Although physical and sexual abuse exposure is a well-established risk for poor health, the dimensions of abuse associated with health among socially vulnerable adolescent girls and young women (AGYW) remain underexamined. This article describes associations between combinations of abuse type and timing with mental health, substance use, and sexual risk outcomes among a sample of 499 AGYW (aged 16 to 19) who had left school early and were recruited for a cluster randomized trial in Cape Town, South Africa. Approximately one-third (33.5%; 95% CI: 28.7, 38.6) of participants reported lifetime abuse. Exposure to more than one type of abuse was associated with increased risk of depression (β = 3.92; 95% CI: 2.25, 5.59) and anxiety (β = 3.70; 95% CI: 2.11, 5.28), and greater odds of polydrug use (OR = 2.10; 95% CI: 1.02, 4.34) and substance-impaired sex (OR = 2.17; 95% CI: 1.31, 3.86). Exposure to multiple types of abuse during childhood/early adolescence and again in late adolescence was associated with increased risk of depression (β = 4.65; 95% CI: 3.15, 6.14), anxiety (β = 4.35; 95% CI: 2.70, 6.02), and polydrug use (OR = 2.37; 95% CI: 1.03, 5.73). Findings underscore the need for trauma-informed interventions that reduce mental health, substance use, and sexual risks among AGYW who have experienced multiple forms of abuse and recurrent abuse.

Highlights

Like many low- and middle-income countries (LMICs) [1,2], mental health concerns are highly prevalent among South African adolescents and young adults between the ages of 15 and 24, with an estimated 30% to 40% of this age cohort being at elevated risk of depression, anxiety, or problematic substance use [3,4,5,6]
Similar to findings from population and longitudinal studies from high-income countries [36,53], our findings indicate that AGYW exposed to any physical and sexual abuse are more likely to have symptoms of depression and anxiety, more problematic patterns of substance use, and greater risk of condomless sex than AGYW who have never been exposed to these forms of abuse
The high rates of physical and sexual abuse exposure in study participants suggest that current efforts to prevent abuse against socially vulnerable AGYW in South Africa are insufficient

Summary

Introduction

Like many low- and middle-income countries (LMICs) [1,2], mental health concerns are highly prevalent among South African adolescents and young adults between the ages of 15 and 24, with an estimated 30% to 40% of this age cohort being at elevated risk of depression, anxiety, or problematic substance use [3,4,5,6]. Compared with their male age counterparts, adolescent girls and young women (AGYW) appear vulnerable for mental health concerns [3,4,7].

Results

Discussion

Conclusion