The relationship between sexual violence and mental distress for female adolescents and young women in Malawi
Creators: name: Steiner, Jordan
Publisher: name: No Publisher Supplied
Year: 2021

description: There is an increasing research focus on sexual activity and sexual violence in adolescence and young adulthood globally, and particularly in low- and middle-income countries (LMICs; e.g., Ali et al., 2018; Badoe et al., 2017; Muldoon et al., 2018). Similarly, mental health research is one of the highest-level research priorities for adolescents in LMICs (Nagata et al., 2018). There is also growing evidence of the negative mental health effects of gender-based violence (GBV) and sexual violence on adolescents and young women (e.g., Bacchus et al., 2018; Bradley et al., 2005; Dworkin et al., 2017; Golding, 1999; Houry et al., 2005). However, most of this evidence on sexual violence and mental health effects comes from high-income countries (HICs), without a full understanding of the mental health impact of multiple types, levels, and counts of sexual violence experiences on adolescent girls in sub-Saharan African, LMIC, and Malawian contexts. Existing research illuminating the full impact of sexual violence on mental health needs is lacking, as previous studies within sub-Saharan Africa and Malawi are limited to examining the relationship between unspecified sexual violence experiences and mental health versus understanding the mental health effects of specific and distinctly individual types and patterns of sexual violence against females across the life course and their association with female adolescents’ mental distress outcomes (e.g., de los Angeles et al., 2014; Grose et al., 2019; Omigbodun et al., 2018; Patel et al., 2007; Uzoezie, 2018). This lack of statistics or research on sexual violence and mental distress is partially due to the low use of mental health services and reporting by adolescents and young women in many LMIC contexts (de los Angeles et al., 2014). This dissertation contributes to the literature with an investigation of a continuum and accumulation of sexual violence experiences across a Malawian female’s life course and their relationship to nonspecific psychological distress.This study utilized data from the Violence Against Children Survey (VACS), which offers a nationally representative sample of females aged 13–24 in Malawi to (a) determine the association between different forms of a given type of lifetime sexual violence (unwanted sexual touching, attempted unwanted forced sex, physically forced sex, pressured sex through threats) and mental distress among females aged 13–24 in Malawi, as well as (b) determine the association between the number of types of lifetime sexual violence experiences and mental distress among females aged 13–24 in Malawi (to test a dose-response relationship). Descriptive statistics bivariate and ordered logistic regression were conducted, with the final models controlling for age, level of education, poverty, marriage, other forms of sexual violence, lifetime emotional and physical violence, and lifetime witnessing physical violence in the home and the community.The findings revealed that unwanted sexual touching and attempted unwanted forced sex were associated with greater odds of mental distress in comparison to never experiencing any form of violence. Additionally, isolating these two individual forms of a given type of sexual violence revealed higher odds of mental distress for female adolescents than when investigating any form of sexual violence as a combined variable. When testing the association of both unwanted sexual touching and attempted unwanted forced sex with mental distress, younger respondents were less likely to experience distress compared to the older group, controlling for all other factors, including other forms of sexual violence. Additionally, controlling for witnessing violence in the home and the community, sociodemographic variables, and other forms of sexual violence increased the predictive power between both unwanted sexual touching and attempted unwanted forced sex and negative mental distress outcomes. Although a surprising finding in that it would have been assumed to decrease the predictive power, the difference in effect sizes within the models controlling for the nonsexual violence controls and sociodemographic controls were not significant, so this finding should be considered carefully. Furthermore, experiencing two or three or more types of sexual violence indicated the highest odds of mental distress, compared to a female adolescent experiencing no sexual violence. However, the effect or odds of mental distress reached a threshold or plateau (after a certain number of traumas, the effect does not increase) between experiencing two and three or more types of sexual violence. This plateau was a surprising finding that could result from the types of traumas or types of sexual violence accounted for or that an increasing number of types of sexual violence are considered a potential “tipping point” (i.e., after a certain number of sexual violence experiences, the effect does not increase). However, the difference between two and three or more types of sexual violence is not significant. This dissertation furthers new insight and knowledge to advocate for effective mental health response policies for female Malawian populations as a consequence of multiple types, levels, and counts of sexual violence experiences. This includes policy, practice, and research implications for social work that include evidence to support the provision and expansion of mental health services, consideration of comprehensive and culturally responsive models to respond to the psychological impact of all types and number of experiences of sexual violence across the life course, and a joint research agenda on sexual violence and adolescent mental health. These policy, practice, and research implications are critical for providing holistic, culturally relevant, and pragmatic services to respond to the negative mental health effects of sexual violence experiences for female adolescents and young women in Malawi and sub-Saharan Africa.