A latent class analysis of young women’s co-occurring health risks in urban informal settlements in Durban, South Africa

IF 4.1 Q1 PSYCHIATRY
Laura J. Brown , Tarylee Reddy , Jenevieve Mannell , Rochelle Burgess , Nwabisa Shai , Laura Washington , Rachel Jewkes , Andrew Gibbs
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Abstract

In South Africa, substance use, violence, and HIV risk disproportionately affect young poor Black women. Few studies have explicitly measured the co-occurrence of these health risks or the impact on mental health and wellbeing for this population. To this aim, we use a person-centred approach to explore the clustering of health risks among young Black women from urban informal settlements in Durban, South Africa, enrolled in an intervention trial. Latent class analysis identified three health risk subgroups with increasing levels of health risk co-occurrence: while all three subgroups had high rates of emotional/economic intimate partner violence, they differed in their levels of the other health risks, with one (“lower-risk”) subgroup defined by experiencing violence against women (VAW), another by the co-occurrence of VAW with problematic alcohol use (i.e. “mid-risk”), and the last (“high-risk”) subgroup by the co-occurrence of VAW, problematic alcohol use and sexual risk behaviour. Descriptive analyses showed that lower education and food insecurity were associated with greater health risk co-occurrence and that this in turn was associated with increased chances of depression and suicidal ideation. Between subgroup differences persisted over time - after two years, the chances of experiencing violence, problematic alcohol use, transactional sex and depression remained elevated for the women who initially experienced more health risks. Persistent yet differing levels of risk suggest the need for urgent structural interventions that address these health risks synergistically while taking account of individual differing primary and secondary prevention needs. Our analyses highlight that social epidemics such as poverty, racism and gender inequality play into the production of poor health outcomes, including poor mental health. These are the underlying structural issues that need to be addressed in order to protect women’s health and reduce harm.

南非德班城市非正式住区年轻妇女共同发生健康风险的潜在阶层分析
在南非,吸毒、暴力和艾滋病毒风险对年轻贫穷的黑人妇女的影响尤为严重。很少有研究明确地衡量这些健康风险的共同发生或对这一人群的心理健康和福祉的影响。为此目的,我们采用以人为本的方法,探讨来自南非德班城市非正式住区的年轻黑人妇女的健康风险聚类,这些妇女参加了一项干预试验。潜在分类分析确定了三个健康风险亚组,其共同发生的健康风险水平不断增加:虽然所有三个亚组在情感/经济上的亲密伴侣暴力发生率都很高,但它们在其他健康风险水平上存在差异,其中一个("低风险")亚组的定义是遭受暴力侵害妇女行为(VAW),另一个亚组的定义是暴力侵害妇女行为与有问题的酒精使用同时发生(即"中等风险"),最后一个("高风险")亚组的定义是暴力侵害妇女行为、有问题的酒精使用和性风险行为同时发生。描述性分析表明,较低的教育水平和粮食不安全与更大的健康风险共存有关,而这反过来又与抑郁和自杀意念的机会增加有关。亚组之间的差异随着时间的推移而持续存在——两年后,经历暴力、酗酒问题、交易性行为和抑郁的几率在最初经历更多健康风险的妇女中仍然升高。持续存在的不同程度的风险表明,需要采取紧急的结构性干预措施,协同处理这些健康风险,同时考虑到个人不同的初级和二级预防需要。我们的分析强调,贫困、种族主义和性别不平等等社会流行病会导致健康状况不佳,包括心理健康状况不佳。为了保护妇女健康和减少伤害,这些都是需要解决的基本结构性问题。
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来源期刊
SSM. Mental health
SSM. Mental health Social Psychology, Health
CiteScore
2.30
自引率
0.00%
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审稿时长
118 days
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