Distress, desperation and despair: anxiety, depression and suicidality among rural South African youth.

Common mental disorders (CMDs) affect millions of people worldwide and impose a high cost to individuals and society. Youth are disproportionately affected, as has also been confirmed in South Africa. Mental disorders and substance use disorders often occur as concurrent disorders. Although youth in rural South Africa grow up in difficult social and economic conditions, the study of mental disorders in South Africa has focussed primarily on urban populations. One such rural area in South Africa is the Harry Gwala District, where rates of interpersonal violence and self-inflicted injuries among 15-24-year-old men, are extraordinarily high. Suicide is an important proxy measure of severe emotional distress, predominantly depression and hopelessness. This study reports on rates of fatal self-harm among 15-24-year-old men in the Harry Gwala District. We determined the rates and severity of CMDs and their correlates among 355 young males ranging in age from 14 to 24 years in the Harry Gwala District community. High rates of depression, anxiety, hopelessness and worthlessness were reported. One in four of the young men and boys reported current suicidal thoughts associated with depression, anxiety, feelings of worthlessness and binge drinking. Reports of alcohol use were high, as were those of daily cannabis use. Our findings show high rates of CMDs and alcohol use, and highlight the impact of collective dysphoria on the mental well-being of rural youth in South Africa, who are likely coping through drug and alcohol use.

The combined influence of fat consumption and repeated mental stress on brachial artery flow-mediated dilatation: a preliminary study.

Experienced separately, both acute mental stress and high-fat meal consumption can transiently impair endothelial function, and the purpose of the present study was to investigate their combined impact. On four separate days, 10 healthy men (23 years old) underwent brachial artery flow-mediated dilatation (FMD) tests, before and hourly for 4 h post-consumption of a high-fat (HFM; 54 g fat) or low-fat meal (LFM; 0 g fat; each meal ∼ 1000 calories), with hourly mental stress (mental arithmetic, speech) or control (counting) tasks (conditions HFM+S, LFM+S, HFM and LFM). Data are presented as means ± SD. Plasma triglycerides increased and remained elevated after the high-fat but not the low-fat meal (P = 0.004) and were not affected by mental stress (P = 0.329). Indices of stress reactivity increased during mental stress tasks (mean arterial pressure, ∼ 20 mmHg; heart rate, ∼ 22 beats min(-1); salivary cortisol, ∼ 2.37 nmol l(-1); and plasma noradrenaline, ∼ 0.17 ng ml(-1)) and were not influenced by meal (P > 0.05). There was no effect of the type of meal on FMD (P = 0.562); however, FMD was 4.5 ± 0.5% in the control conditions and 5.8 ± 0.6% in the mental stress conditions (P = 0.087), and this difference was significant when normalized for the shear stress stimulus (FMD/area under the curve of shear stress, P = 0.045). Overall, these preliminary data suggest that postprandial FMD was augmented with mental stress irrespective of meal type. These results are contrary to previous reports of impaired endothelial function after mental stress or fat consumption independently and highlight the need to further investigate the mechanisms underlying the interactions between these factors.

Barriers to access of maternity care in kenya: a social perspective.

OBJECTIVE: In response to high maternal mortality rates, the global community has rallied to improve the state of maternal health worldwide. However, progress towards the fifth Millennium Development Goal, "Improve Maternal Health," has been disappointingly slow. There is a pressing need to address the factors that contribute to maternal mortality, one of which is access to care. This health demand is particularly urgent in countries in sub-Saharan Africa, where maternal mortality is disproportionately high compared with developed countries. The aim of this study was to explore the perceptions rural women have about barriers to access to maternity care in Asembo Bay, Kenya. METHODS: We conducted interviews with individuals and convened a focus group of lay women and care professionals. The results of the interviews and focus group were then analyzed thematically. RESULTS: Common social themes that emerged related to women's access of maternity care in this population included fears associated with HIV testing or disclosure of HIV status, gender inequalities, and attitudes towards facility-based care. CONCLUSION: Data and themes in this study are consistent with previous research and provide a descriptive account of the barriers that prevent rural Kenyan mothers from accessing health care throughout their pregnancies. Each barrier explored here translates into an area of improvement where focus is needed to increase access to care and, ultimately, to reduce maternal mortality in this setting.

Condom Use Trajectories in Adolescence and the Transition to Adulthood: The Role of Mother and Father Support.

Few studies have investigated how mother and father support differ on predicting youths' sexual risk behavior. We therefore examined the influence of parental support on condom use trajectories and its correlates in a predominantly African American sample [(N=627; 53% female; M = 14.86 years (SD=. 64)] from adolescence to young adulthood. We used hierarchical growth curve modeling to examine the relationship between condom use, substance use, psychological distress and parental support prospectively. We found that consistent condom use decreased over time and was associated negatively with psychological distress and substance use. Furthermore, both maternal and paternal support were associated with more condom use over time. We discuss the implications of our findings for HIV prevention programs.

Social support moderates the relationship between gay community integration and sexual risk behavior among gay male couples.

Few studies of partnered gay men consider the social context within which sexual behaviors occur or investigate positive aspects of the social environment that may offset factors that are related to risky sexual behaviors. Fewer still include assessment of both individuals making up couples. Using an ecological framework and an actor-partner multilevel analysis approach, the authors investigate how three dimensions of gay community integration are related to individual sexual risk behavior among 108 individuals in 54 couples. They then investigate how general social support and partner-provided, HIV-specific social support moderate these relationships. An individual's gay community social engagement and general social support interact to predict sexual risk behavior, such that the apparent protective effect of social support is more pronounced among those with less social engagement. The association between partner-reported general social support and safer sexual behaviors is more pronounced among those whose partners disclose their gay identity to more people.

Growth trajectories of sexual risk behavior in adolescence and young adulthood.

OBJECTIVES: Adolescence and young adulthood (ages 18-25 years) are periods of development and change, which include experimentation with and adoption of new roles and behaviors. We investigated longitudinal trajectories of sexual risk behaviors across these time periods and how these trajectories may be different for varying demographic groups. METHODS: We developed multilevel growth models of sexual risk behavior for a predominantly African American sample (n=847) that was followed for 8 years, from adolescence to young adulthood. We investigated differences in growth parameters by race/ethnicity and gender and their interactions. RESULTS: The final model included linear and quadratic terms for both adolescence and young adulthood, indicating acceleration of sexual risk behaviors during adolescence and a peak and deceleration during young adulthood. African American males exhibited the highest rate of sexual risk behavior in ninth grade, yet had the slowest rate of growth. Compared with their White peers, African American males and females exhibited less sexual risk behavior during young adulthood. CONCLUSIONS: Our results suggest that youths of different races/ethnicities and genders exhibit varying sexual risk behavior trajectories.

HIV risk and protection among gay male couples: the role of gay community integration.

This study examined the association between different types of integration in the gay community and HIV risk among gay male couples. Previous research linking gay community integration and involvement among couples to HIV risk has been equivocal. Each partner in 59 gay couples completed a separate anonymous questionnaire that assessed two types of social involvement in the gay community, assimilation into the gay community, and sexual HIV risk behaviors. We used the actor-partner interdependence analysis approach, which maintains the couple as the unit of analysis while allowing for tests of within-couple, between-couple, actor, and partner effects. Analyses revealed that, controlling for symptoms of alcohol problems, going to gay bars and clubs independently predicted more HIV risk.

Adolescent resilience: a framework for understanding healthy development in the face of risk.

Adolescent resilience research differs from risk research by focusing on the assets and resources that enable some adolescents to overcome the negative effects of risk exposure. We discuss three models of resilience-the compensatory, protective, and challenge models-and describe how resilience differs from related concepts. We describe issues and limitations related to resilience and provide an overview of recent resilience research related to adolescent substance use, violent behavior, and sexual risk behavior. We then discuss implications that resilience research has for intervention and describe some resilience-based interventions.