The relationship between household economic shocks, depression, and elevated stress-responsive biomarkers among adolescent girls and young women in rural South Africa (HPTN 068)

Abstract

Background: Common mental health disorders (CMDs) significantly contribute to the global burden of disease among adolescent girls and young women (AGYW). In South Africa, the high proportion of AGYW experiencing CMDs in part reflects adversity in early life and resulting chronic stress, particularly through exposure to poor economic conditions such as frequent household economic shocks. Yet, longitudinal evidence for the relationship between household economic shocks, CMDs, and chronic stress among AGYW is limited. Methods: Data are from the HIV Prevention Trials Network (HPTN) 068 study in rural South Africa (2012-2019). AGYW, 13-20 at baseline, were followed annually for up to 6 years. Exposures included experience of any shock, type of shock (illness/death, agricultural, wealth), and number of shocks (0, 1, ≥2). We calculated risk ratios for the association between exposures and depressive symptoms (CESD-10 > 16)), stratified by grant receipt, and odds ratios for the association between exposures and stress-responsive biomarkers (C-reactive protein (CRP), cytomegalovirus (CMV), herpes simplex virus type-1 (HSV-1)) and HIV infection. Results: Among 1892 AGYW, unadjusted analyses suggested a relationship between experiencing any shock (RR: 1.10, 95 % CI: 1.00-1.22), or increased shocks (RR: 1.05, 95 % CI: 1.00-1.11), and depressive symptoms. In adjusted analyses, experiencing any shock (OR: 1.21, 95 % CI: 1.04-1.34), increased shocks (OR: 1.19, 95 % CI: 1.03-1.38), and wealth shocks (OR: 1.20, 95 % CI: 1.03-1.29) were associated with increased CRP. We found no relationship between shocks and HIV acquisition. Conclusion: AGYW experiencing economic adversity in early adolescence are at increased risk for depressive symptoms and elevated stress-biomarker levels during the transition to adulthood.