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Antenatal depressive symptoms in Kenyan women living with HIV: contributions of recent HIV diagnosis, stigma, and partner violence.

ABSTRACT: Depression among pregnant women living with HIV (WLWH) in sub-Saharan Africa leads to poor pregnancy and HIV outcomes. This cross-sectional analysis utilized enrollment data from a randomized trial (Mobile WAChX, NCT02400671) in six Kenyan public maternal and child health clinics. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), stigma with the Stigma Scale for Chronic Illness, and intimate partner violence (IPV) with the Abuse Assessment Screen. Correlates of moderate-to-severe depressive symptoms ("depression", PHQ-9 score ≥10) were assessed using generalized estimating equation models clustered by facility. Among 824 pregnant WLWH, 9% had depression; these women had more recent HIV diagnosis than those without depression (median 0.4 vs. 2.0 years since diagnosis, p = .008). Depression was associated with HIV-related stigma (adjusted Prevalence Ratio [aPR]:2.36, p = .025), IPV (aPR:2.93, p = .002), and lower social support score (aPR:0.99, p = .023). Using population-attributable risk percent to estimate contributors to maternal depression, 81% were attributable to stigma (27%), recent diagnosis (24%), and IPV (20%). Integrating depression screening and treatment in prevention of mother-to-child HIV transmission programs may be beneficial, particularly in women recently diagnosed or reporting stigma and IPV.

SUBMITTER: Osborn L

PROVIDER: S-EPMC8758509 | biostudies-literature | 2022 Jan

REPOSITORIES: biostudies-literature

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Antenatal depressive symptoms in Kenyan women living with HIV: contributions of recent HIV diagnosis, stigma, and partner violence.

Osborn Lusi L Ronen Keshet K Larsen Anna M AM Richardson Barbra B Khasimwa Brian B Chohan Bhavna B Matemo Daniel D Unger Jennifer J Drake Alison L AL Kinuthia John J John-Stewart Grace G

AIDS care 20210927 1

Depression among pregnant women living with HIV (WLWH) in sub-Saharan Africa leads to poor pregnancy and HIV outcomes. This cross-sectional analysis utilized enrollment data from a randomized trial (Mobile WAChX, NCT02400671) in six Kenyan public maternal and child health clinics. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9), stigma with the Stigma Scale for Chronic Illness, and intimate partner violence (IPV) with the Abuse Assessment Screen. Correlates of m ...[more]

PMID: 34579601

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Project description:Gender inequitable beliefs, blaming attitudes, externalised and internalised stigma are commonly recognised barriers for intimate partner violence (IPV) survivors seeking help. However, the measurement of IPV stigma, its associations with inequitable gender beliefs and impacts on survivor disclosure, help-seeking behaviours, and mental health outcomes remain understudied. We explored women's agreement with statements about gendered power dynamics and violence in intimate heterosexual relationships, before identifying and psychometrically testing scales derived for measuring community norms and beliefs underlying stigma to IPV. We used data from a nationally representative sample of 596 women living in Botswana. Exploratory factor analysis (EFA) occurred with responses of IPV survivors, and involved items from the Community Ideas about Gender Relations, Community Ideas about Rape, and Gender Equitable Women Scales. For each EFA identified scale, we estimated reliability (McDonald's omega (ω)) and correlation with psychosocial outcomes related to IPV stigma. Among IPV survivors, we also considered whether survivors had disclosed their experience of abuse to others prior to the interview. Some 40.9% (n = 244) of women have experienced physical and/or sexual IPV at least once in their lives. Among them, an EFA of 31 gender beliefs and norms identified three latent variables: community norms about male dominance over female partners (C-MDP) (11 items; ω = 0.86); respondent beliefs about male dominance over female partners (I-MDP) (12 items; ω = 0.83); and survivor blaming attitudes (SBA) for the IPV they experienced (8-items; ω = 0.83). Some 15% of survivors had attempted suicide in the past, 8% had disclosed having suicidal thoughts, 49% were considered at risk for depression, and 18% at risk for post-traumatic stress disorder. Survivors who more strongly endorsed C-MDP appeared more likely to have attempted suicide (p = 0.04), and less likely to have disclosed their IPV experience prior to the study (p = 0.002). Survivors who more strongly endorsed SBA appeared more likely to have had suicidal thoughts (p = 0.02) and greater post-traumatic stress symptoms (p = 0.06). C-MDP, I-MDP and SBA appear related to psychosocial and disclosure outcomes. Gendered social norms may play an important role in understanding how survivors experience IPV stigma. We recommend further research into culture-informed practices that act to socialise such norms.

Project description:BackgroundIntimate partner violence (IPV) and alcohol use are interrelated public health issues. Heavy and frequent alcohol use increase the risk of IPV, but the relationship between alcohol use and IPV (including recent and lifetime IPV victimization and perpetration) has not been well described among persons living with HIV (PWH) in sub-Saharan Africa.MethodsWe used baseline data from the Drinker's Intervention to Prevent Tuberculosis study. All participants were PWH co-infected with tuberculosis and had an Alcohol Use Disorders Identification Test - Consumption (AUDIT-C) positive score (hazardous drinking) and positive urine ethyl glucuronide test, indicating recent drinking. High-risk drinking was defined as AUDIT-C > 6 and/or alcohol biomarker phosphatidylethanol (PEth) ≥ 200 ng/mL. We measured IPV using the Conflict Tactics Scale. We estimated the association between alcohol use level and recent (prior six months) IPV victimization (recent perpetration was too low to study) using multivariable logistic regression models adjusted for gender, age, assets, education, spouse HIV status, religiosity, depressive symptoms, and social desirability. We additionally estimated the interaction of alcohol use and gender on IPV victimization and the association between alcohol use and lifetime victimization and perpetration.ResultsOne-third of the 408 participants were women. Recent IPV victimization was reported by 18.9% of women and 9.4% of men; perpetration was reported by 3.1% and 3.6% of women and men. One-fifth (21.6%) of those reporting recent IPV victimization also reported perpetration. In multivariable models, alcohol use level was not significantly associated with recent IPV victimization (p = 0.115), nor was the interaction between alcohol use and gender (p = 0.696). Women had 2.34 times greater odds of recent IPV victimization than men (p = 0.016). Increasing age was significantly associated with decreased odds of recent IPV victimization (p = 0.004).ConclusionPrevalence of IPV victimization was comparable to estimates from a recent national survey, while perpetration among men was lower than expected. Alcohol use level was not associated with IPV victimization. It is possible that alcohol use in this sample was too high to detect differences in IPV. Our results suggest that women and younger PWH are priority populations for IPV prevention.

Project description:This study evaluates associations between childhood social environments and current intimate partner conflict tactics in early adulthood. The subsample for this study (n = 251 men) were participants in a larger community-based study of men's mental and behavioral health in semirural Kenya. A survey questionnaire was administered by trained interviewers, including validated recall measures from childhood, collective self-esteem and impulsivity, and the conflict tactics scale short form. Analyses utilized regression and mediation methods. The recall measures evaluated the degree of relational warmth and safety recalled from early childhood and forms of abuse, neglect and dysfunction present in the childhood home. Collective self-esteem assessed the perceived value of one's social groups and one's value as a member of these groups. Impulsivity measured the propensity to act without thinking. The conflict tactics scale evaluates the presence and frequency of specific behaviors following intimate partner conflict, which lead to two factors-negotiation-based tactics and violence tactics. More early memories of relational warmth, responsiveness, and safety during childhood predict fewer violent intimate conflict tactics. More adverse childhood experiences predict more violent conflict tactics and fewer negotiation-based conflict tactics. Self-esteem and impulsivity mediated associations between recalled childhood experiences and conflict tactics. Further research is required to explore other predisposing factors, psychological processes, and cultural and social norms surrounding the use of violent and nonviolent intimate partner conflict resolution by young men in Sub-Saharan Africa. Violence prevention strategies and policies should explicitly link intimate partner violence prevention with prevention of violence against boys. Interventions should recognize men who perpetrate intimate partner violence are more likely victims of violent childhoods than men who do not perpetrate intimate partner violence. Promoting collective self-esteem and reducing impulsivity among young men may reduce violence against women.

Project description:BackgroundWhile the link between alcohol use and male-perpetrated intimate partner violence (IPV) has been well-established, research is needed to test whether psychosocial factors interact with alcohol use to exacerbate IPV perpetration. We tested whether depressive symptoms influenced the strength and/or direction of the alcohol-IPV relationship among men with HIV in Vietnam.MethodsThis study is a secondary analysis using data from a randomized controlled trial conducted in Thai Nguyen, Vietnam. Participants were clinic patients with HIV and hazardous alcohol use. Questionnaires were administered at baseline, three, six, and 12 months. Alcohol use was assessed as proportion of days alcohol abstinent. Analyses were restricted to males who reported being married/cohabitating at baseline (N = 313). Multilevel growth models were used to test whether time-varying depressive symptoms modified the time-varying effect of alcohol use on IPV perpetration.ResultsTime-varying depressive symptoms modified the effect of proportion of days alcohol abstinent on IPV perpetration. However, the pattern of effect modification was not as expected, as reporting depressive symptoms weakened the alcohol-IPV relationship. At times when participants screened negative for depressive symptoms, those who reported higher proportion of days alcohol abstinent than usual had significantly lower odds of IPV perpetration (Odds Ratio [OR] = 0.17, 95% Confidence Interval 0.06, 0.45, p = 0.0004). At times when participants screened positive for depressive symptoms, there was no observed effect of alcohol use on IPV perpetration (OR = 4.28, 95% CI 0.80, 22.78, p = 0.09).ConclusionThe findings highlight the complex nature of the alcohol-IPV relationship and the need to investigate the intersection between hazardous drinking, mental health, and IPV. Men who concurrently report depressive symptoms and heightened alcohol use may be socially isolated from an intimate partner or experiencing fatigue, leading to less alcohol-related IPV perpetration. Mental health interventions addressing depression and alcohol misuse integrated into HIV services may reduce IPV perpetration.

Dataset Information

Antenatal depressive symptoms in Kenyan women living with HIV: contributions of recent HIV diagnosis, stigma, and partner violence.

Publications

Antenatal depressive symptoms in Kenyan women living with HIV: contributions of recent HIV diagnosis, stigma, and partner violence.

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