Poor mental health and sexual risk behaviours in Uganda: a cross-sectional population-based study.

BACKGROUND: Poor mental health predicts sexual risk behaviours in high-income countries, but little is known about this association in low-income settings in sub-Saharan Africa where HIV is prevalent. This study investigated whether depression, psychological distress and alcohol use are associated with sexual risk behaviours in young Ugandan adults. METHOD: Household sampling was performed in two Ugandan districts, with 646 men and women aged 18-30 years recruited. Hopkins Symptoms Checklist-25 was used to assess the presence of depression and psychological distress. Alcohol use was assessed using a question about self-reported heavy-episodic drinking. Information on sexual risk behaviour was obtained concerning number of lifetime sexual partners, ongoing concurrent sexual relationships and condom use. RESULTS: Depression was associated with a greater number of lifetime partners and with having concurrent partners among women. Psychological distress was associated with a greater number of lifetime partners in both men and women and was marginally associated (p = 0.05) with having concurrent partners among women. Psychological distress was associated with inconsistent condom use among men. Alcohol use was associated with a greater number of lifetime partners and with having concurrent partners in both men and women, with particularly strong associations for both outcome measures found among women. CONCLUSION: Poor mental health is associated with sexual risk behaviours in a low-income sub-Saharan African setting. HIV preventive interventions should consider including mental health and alcohol use reduction components into their intervention packages, in settings where depression, psychological distress and alcohol use are common.

Urbanicity of place of birth and symptoms of psychosis, depression and anxiety in Uganda.

BACKGROUND: The mechanism underlying the association between urban birth/upbringing and increased schizophrenia risk is unknown. This study explored whether an urban effect might be present in a low-income country setting, where the ;urban' environment may have radically different components, for example urban architecture, pollution levels or social cohesion. AIMS: To investigate the potential association of urbanicity of place of birth and symptoms of psychosis, depression and anxiety in Uganda. METHOD: Ugandans aged 18-30 years (n = 646) were interviewed using the Peters et al Delusions Inventory (PDI-21), the Hopkins Symptoms Checklist (HSCL-25) and psychoticism items from the Symptoms Checklist 90-items version (SCL-90) in Mbarara and Kampala districts and asked about their birthplace. RESULTS: Urban birth (but not semi-urban) was associated with more lifetime psychotic experiences, especially grandiosity, and more symptoms of psychosis, depression and anxiety during the past week. CONCLUSIONS: The urban risk factor for schizophrenia may be universally present across different levels of human development, albeit the nature of the mechanism remains elusive.