Background

Sexual victimisation and peer victimisation are pervasive and increase risk for mental illness. Longitudinal studies that compare their unique and cumulative effects are scarce and have been done predominantly in high-income countries. The aims of this study were to examine the prevalence, prospective associations, and gender differences in sexual and peer victimisation and mental health in a low-income, African setting.

Methods

In this prospective cohort study, data were obtained from the 2017 ARISE Adolescent Health Study, a population-representative, two-wave, prospective study of adolescents (aged 12–20 years) from Burkina Faso. A random sample of adolescents was drawn from ten villages, selected to capture the five main ethnic groups, and from one of the seven sectors of Nouna town, Burkina Faso, at two timepoints: Nov 12 to Dec 27, 2017, and Nov 15 to Dec 20, 2018. Standardised interviews were conducted in French or a local language by trained researchers. We measured victimisation exposure as sexual victimisation, peer victimisation, and polyvictimisation, using lifetime frequency of exposure, and we measured mental health symptoms and disorders using the Kutcher Adolescent Depression Scale, the Primary Care Post-Traumatic Stress Disorder screen IV and 5, and a question on lifetime self-harm and number of incidents in the past year. We calculated prevalence of victimisation and mental health symptoms and disorders at the two timepoints, and we used lifetime victimisation at the first timepoint to predict mental health at the second timepoint using logistic and negative binomial regressions. Gender differences were examined using interaction terms.

Findings

Of 2544 eligible adolescents, 1644 participated at time 1 and 1291 participated at time 2. The final sample with data at both timepoints included 1160 adolescents aged 12–20 years (mean 15·1, SE 0·2), of whom 469 (40·4%) were girls and 691 (59·6%) were boys. The majority ethnic group was Dafin (626 [39·1%]), followed by Bwaba (327 [20·5%]), Mossi (289 [16·0%]), Samo (206 [13·0%]), Peulh (166 [9·7%]), and other (30 [1·6%]). After survey weight adjustment, sexual victimisation (weighted percentages, time 1, 256 [13·8%] of 1620; time 2, 93 [7·2%] of 1264) and peer victimisation (weighted percentages, time 1, 453 [29·9%] of 1620; time 2, 272 [21·9%] of 1264) were common, whereas polyvictimisation was more rare (weighted percentages, time 1, 116 [6·6%] of 1620; time 2, 76 [5·7%] of 1264). Longitudinally, sexual victimisation was associated with probable clinical disorder (adjusted odds ratio 2·59, 95% CI 1·15–5·84), depressive symptoms (adjusted incidence rate ratio [aIRR] 1·39, 95% CI 1·12–1·72), and symptoms of post-traumatic stress disorder (aIRR 2·34, 1·31–4·16). Peer victimisation was associated with symptoms of post-traumatic stress disorder (aIRR 1·89, 1·13–3·17) and polyvictimisation was associated with depressive symptoms (aIRR 1·34, 1·01–1·77). Girls reported more sexual victimisation (weighted percentages, 130 [17·3%] of 681 vs 126 [11·4%] of 939), boys reported more peer victimisation (weighted percentages, 290 [33·1%] of 939 vs 163 [25·2%] of 681), and there was a significant interaction between lifetime victimisation and gender for probable clinical disorder (F [degrees of freedom 7, sample 376] 2·16; p=0·030).

Interpretation

Sexual and peer victimisation were common in the study setting and increased risk for mental health problems. Adolescent girls who have been sexually victimised are especially at risk of mental health problems. Interventions targeting sexual and peer violence in low-income settings are needed.

Funding

Alexander von Humboldt Foundation, the Wellcome Trust, Fondation Botnar, and Harvard TH Chan School of Public Health.

中文翻译：

---

布基纳法索青少年的性受害、同伴受害和心理健康结果：一项前瞻性队列研究

背景

性受害和同伴受害普遍存在，并增加了患精神疾病的风险。比较其独特影响和累积影响的纵向研究很少，而且主要是在高收入国家进行的。本研究的目的是调查非洲低收入环境中性和同伴受害以及心理健康的患病率、前瞻性关联和性别差异。

方法

在这项前瞻性队列研究中，数据来自 2017 年 ARISE 青少年健康研究，这是一项针对布基纳法索青少年（12-20 岁）的人口代表性、两波前瞻性研究。青少年随机样本是在两个时间点从布基纳法索努纳镇七个地区之一的 10 个村庄（选择涵盖五个主要民族群体）和 2017 年 11 月 12 日至 12 月 27 日以及 11 月 15 日至2018 年 12 月 20 日。由经过培训的研究人员用法语或当地语言进行标准化访谈。我们使用终生暴露频率将受害暴露测量为性受害、同伴受害和多重受害，并使用库彻青少年抑郁量表、初级保健创伤后应激障碍筛查 IV 和 5 以及关于终生自残和过去一年发生的事件数量的问题。我们计算了两个时间点受害以及心理健康症状和疾病的患病率，并使用第一个时间点的终生受害情况，使用逻辑回归和负二项式回归来预测第二个时间点的心理健康状况。使用交互项检查性别差异。

发现

在 2544 名符合条件的青少年中，1644 名在时间 1 参与，1291 名在时间 2 参与。两个时间点的数据最终样本包括 1160 名 12-20 岁的青少年（平均 15·1，SE 0·2），其中 469 名（40 ·4%）是女孩，691 名（59·6%）是男孩。最多的民族是达芬 (626 [39·1%])，其次是布瓦巴 (327 [20·5%])、莫西 (289 [16·0%])、萨摩 (206 [13·0%]) 、Peulh (166 [9·7%]) 和其他 (30 [1·6%])。调查权重调整后，性受害（加权百分比，时间 1，1620 人中的 256 [13·8%]；时间 2，1264 人中的 93 [7·2%]）和同伴受害（加权百分比，时间 1，453 [29] · 9%]，共 1620 人；时间 2， 272 [1264 人的 21·9%]）很常见，而多重受害则更为罕见（加权百分比，时间 1， 116 [1620 人的 6·6%]；时间 2， 76 [ 5·7%]（1264）。纵向来看，性受害与可能的临床疾病（调整后的比值比 2·59，95% CI 1·15–5·84）、抑郁症状（调整后的发病率比 [aIRR] 1·39，95% CI 1·12）相关。 –1·72），以及创伤后应激障碍的症状（aIRR 2·34、1·31–4·16）。同伴受害与创伤后应激障碍症状相关（aIRR 1·89、1·13–3·17），多重受害与抑郁症状相关（aIRR 1·34、1·01–1·77）。女孩报告了更多的性受害（加权百分比，681 中的 130 [17·3%] vs 939中的 126 [11·4%]），男孩报告了更多的同侪受害（加权百分比，939 中的 290 [33·1%] vs 163） [681 人中的 25·2%]），并且对于可能的临床疾病而言，终生受害与性别之间存在显着的交互作用（F [自由度 7，样本 376] 2·16；p=0·030）。

解释

性和同伴受害在研究环境中很常见，并且增加了心理健康问题的风险。遭受性侵害的青春期女孩尤其面临心理健康问题的风险。需要针对低收入环境中的性暴力和同伴暴力采取干预措施。

资金

亚历山大·冯·洪堡基金会、威康信托基金会、博特纳基金会和哈佛大学陈曾熙公共卫生学院。