Childhood trauma, major depressive disorder, suicidality, and the modifying role of social support among adolescents living with HIV in rural Uganda.
Childhood trauma, major depressive disorder, suicidality, and the modifying role of social support among adolescents living with HIV in rural Uganda.
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DOI：
10.1016/j.jadr.2021.100094
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发表时间：
2021-04-01
影响因子：
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通讯作者：
Tsai, Alexander C
中科院分区：
文献类型：
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作者：
Ashaba, Scholastic;Cooper-Vince, Christine;Tsai, Alexander C
背景：童年创伤与撒哈拉以南非洲感染艾滋病毒（ALHIV）的青少年的心理健康问题有关，但对潜在的调节因素知之甚少。方法：我们招募了224名13-17岁的ALHIV患者，收集了儿童创伤、重度抑郁障碍和自杀倾向的信息。我们使用修正的多变量泊松回归来估计心理健康结局变量与儿童创伤之间的关联，并评估社会支持对效果的修正。结果：重度抑郁障碍与情绪虐待（调整相对危险度[ARR] 2.57; 95% CI 1.31-5.04； P=0.006）和身体虐待（ARR 2.16; 95% CI 1.19-3.89； P=0.01）有统计学意义。在社会支持水平低的人群中（ARR 4.30; 95% CI 1.64-11.25； P=0.003），任何虐待与重度抑郁症之间的估计关联具有统计学意义，而在社会支持水平高的人群中（ARR 1.30; 95% CI 0.57-2.98； P=0.52）则无统计学意义。自杀倾向与情绪虐待（ARR 2.03; 95% CI 1.05-3.920； P=0.03）和身体虐待（ARR 3.17; 95% CI 1.60-6.25； P=0.001）也有统计学意义上的显著关联，但社会支持方面没有差异。限制：在乌干达，体罚作为一种纪律形式在学校和家庭中广泛使用；这种文化习俗可能会对身体虐待的报道产生偏见。结论：童年创伤与ALHIV患者的心理健康状况不佳有关，但其影响可能受到社会支持的调节。为改善心理健康结果，需要开展更多的研究，为具有不良童年经历的ALHIV患者制定社会支持干预措施。
BACKGROUND: Childhood trauma is associated with mental health problems among adolescents living with HIV (ALHIV) in sub-Saharan Africa, but little is known about potential moderating factors.METHODS: We enrolled 224 ALHIV aged 13-17 years and collected information on childhood trauma, major depressive disorder, and suicidality. We used modified multivariable Poisson regression to estimate the association between the mental health outcome variables and childhood trauma, and to assess for effect modification by social support.RESULTS: Major depressive disorder had a statistically significant association with emotional abuse (adjusted relative risk [ARR] 2.57; 95% CI 1.31-5.04; P=0.006) and physical abuse (ARR 2.16; 95% CI 1.19-3.89; P=0.01). The estimated association between any abuse and major depressive disorder was statistically significant among those with a low level of social support (ARR 4.30; 95% CI 1.64-11.25; P=0.003) but not among those with a high level of social support (ARR 1.30; 95% CI 0.57-2.98; P=0.52). Suicidality also had a statistically significant association with emotional abuse (ARR 2.03; 95% CI 1.05-3.920; P=0.03) and physical abuse (ARR 3.17; 95% CI 1.60-6.25.; P=0.001), but no differences by social support were noted.LIMITATIONS: Corporal punishment is used widely in schools and homes as a form of discipline in Uganda; this cultural practice could have biased reporting about physical abuse.CONCLUSIONS: Childhood trauma is associated with poor mental health among ALHIV, but its effects may be moderated by social support. More research is needed to develop social support interventions for ALHIV with adverse childhood experiences for improved mental health outcomes.