ABSTRACT

Background: Approximately 56% of Kenya´s population resides in informal settlements (UN-Habitat, 2016). Female residents experience a range of psychosocial stressors including chronic poverty and high rates of interpersonal violence. Despite evidence that this population has some of the worst physical health outcomes in the country (APHRC, 2014), few studies have evaluated their mental health status and its correlates.

Objective: The purpose of this study was to identify risk and protective factors associated with mental health problems (posttraumatic stress & depression) among women living in informal settlements in Kenya. Hypothesized risk factors included economic stress, a history of experiencing childhood abuse and sexual violence, as well as partner-perpetrated psychological and physical abuse. Hypothesized protective factors were supportive relationships with family members and friends and having a sense community connection.

Method: Local community health workers were trained to collect data via individual interviews using validated measures. Participants were recruited using systematic random sampling in two informal settlements in Nakuru County. We used path analysis to test the hypothesized model among a sample of 301 women.

Results: The model had an excellent fit (χ2 = 13.391, df = 8, p =.099; GFI =.99; CFI =.99; RMSEA =.05) and explained 25% of the variance in PTSS and 28% of the variance in depression. All predictor variables except support from friends were statistically significant in the expected direction. Specifically, economic stress, childhood abuse, sexual violence, as well as physical and psychological abuse from one´s partner had significant positive associations with PTSS and depression. Having supportive family members and a sense of being part of the community had significant negative associations with symptoms.

Conclusions: Results highlight the importance of addressing intimate partner and other forms of interpersonal violence in these settings and hold implications for tailoring interventions for this marginalized population.

摘要

背景：大约 56% 的肯尼亚人口居住在非正规住区（联合国人居署，2016 年）。女性居民承受着一系列社会心理压力，包括长期贫困和高发的人际暴力。尽管有证据表明该人群的身体健康状况是全国最差的（APHRC，2014），但很少有研究评估他们的心理健康状况及其相关因素。

目的：本研究的目的是确定生活在肯尼亚非正规住区的妇女与心理健康问题（创伤后应激和抑郁）相关的风险和保护因素。假设的风险因素包括经济压力、经历童年虐待和性暴力的历史，以及伴侣实施的心理和身体虐待。假设的保护因素是与家人和朋友的支持性关系以及良好的社区联系。

方法：当地社区卫生工作者接受培训，使用经过验证的措施通过个人访谈收集数据。参与者是在纳库鲁县的两个非正式定居点通过系统随机抽样招募的。我们使用路径分析在 301 名女性样本中测试假设模型。

结果：该模型具有极好的拟合度（χ2 = 13.391，df = 8，p =.099；GFI =.99；CFI =.99；RMSEA =.05），并解释了 PTSS 中 25% 的方差和 28% 的 PTSS 方差。抑郁症的差异。除朋友的支持外，所有预测变量在预期方向上均具有统计显着性。具体来说，经济压力、童年虐待、性暴力以及伴侣的身体和心理虐待与创伤后应激障碍和抑郁症有显着的正相关。拥有支持性的家庭成员和成为社区一部分的感觉与症状有显着的负相关。

结论：结果强调了在这些环境中解决亲密伴侣和其他形式的人际暴力问题的重要性，并对针对这一边缘化人群制定干预措施具有重要意义。