Adverse childhood experiences, mental distress, self-harm and suicidality, and cumulative HIV risk by sex in Lesotho

Elizabeth W Perry Mohling; Manderley Recinos; Japheth Nkiriyehe Kwiringira; Erick Phung; Connie Olwit; Monica H Swahn; Greta Massetti; Shannon Self-Brown

doi:10.1016/j.chiabu.2024.106701

Adverse childhood experiences, mental distress, self-harm and suicidality, and cumulative HIV risk by sex in Lesotho

Child Abuse Negl. 2024 Apr:150:106701. doi: 10.1016/j.chiabu.2024.106701. Epub 2024 Feb 23.

Authors

Elizabeth W Perry Mohling¹, Manderley Recinos², Japheth Nkiriyehe Kwiringira³, Erick Phung², Connie Olwit², Monica H Swahn⁴, Greta Massetti⁵, Shannon Self-Brown²

Affiliations

¹ School of Public Health, Georgia State University, Atlanta, GA, USA; National SafeCare Training and Research Center, Georgia State University, Atlanta, GA, USA; Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA, USA. Electronic address: eperry12@gsu.edu.
² School of Public Health, Georgia State University, Atlanta, GA, USA; National SafeCare Training and Research Center, Georgia State University, Atlanta, GA, USA; Center for Research of Interpersonal Violence, Georgia State University, Atlanta, GA, USA.
³ Department of Sociology, Kyambogo University, Kampala, Uganda.
⁴ WellStar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, USA.
⁵ Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Abstract

Background: Adverse childhood experiences (ACEs) have been understudied in low- and middle-income countries, especially in sub-Saharan Africa.

Objectives, participants, setting: We explored associations between mental distress, self-harm or suicidality, and HIV risk and individual and cumulative ACEs (sexual, emotional, and physical violence; witnessing community and interparental violence; orphanhood) among youth aged 13-24 in Lesotho.

Methods: Multivariable logistic regressions stratified by sex using nationally representative 2018 Lesotho Violence Against Children and Youth Survey (n_female = 7101; n_male = 1467) data.

Results: Over 75 % of males and females experienced at least 1 ACE. Among males, physical and community violence were significantly associated with mental distress; orphan status and emotional violence was associated with self-harm/suicidality. Males who witnessed interparental violence had higher odds of disclosing 2 types and 3 or more types of HIV risk versus none. Among females, being a double orphan and having experienced sexual, emotional, physical, community, and interparental violence were significantly associated with mental distress and any self-harm/suicidality in both models. Females who experienced physical violence had higher odds of disclosing 3 or more risk types versus no risk. Statistically significant associations emerged between cumulative ACEs and mental distress, self-harm/suicidality, and higher levels of HIV risk for both males and females.

Conclusions: Differential patterns of associations between ACEs and mental health problems and HIV risk emerged by sex. Scalable, integrated individual and community efforts to prevent ACEs, provide mental health supports, and encourage safer sexual behaviors among those exposed are needed and could benefit youth in Lesotho.

Keywords: ACE score; ACEs; Adverse childhood experiences; Global health; Sub-Saharan Africa; VACS; Violence against children and youth survey.

MeSH terms

Adolescent
Adverse Childhood Experiences*
Child
Female
HIV Infections* / epidemiology
Humans
Lesotho / epidemiology
Male
Sexual Behavior
Suicide*

Grants and funding

CC999999/ImCDC/Intramural CDC HHS/United States