افزایش بسامد ادراک شده خشونت خانگی محله ای با افزایش علائم افسردگی زنان در یک مطالعه طولی ملی در آفریقای جنوبی همراه است

Studies that examine the effects of neighborhood characteristics on mental health show that perceptions of general neighborhood violence are associated with depression across diverse populations (Clark et al., 2008; Velez-Gomez et al., 2013; Wilson-Genderson & Pruchno, 2013). However, to our knowledge, none have examined the specific effect of perceived frequency of neighborhood domestic violence (PFNDV) on residents' mental health, despite knowledge that domestic violence is a potent predictor of depression at the level of the individual. This study investigates the impact of PFNDV on mental health using the South African National Income Dynamics Study (SA-NIDS). NIDS Waves 2 and 3 measure the perceived frequency of six neighborhood violence subtypes through the NIDS household respondent questionnaire and depression through a questionnaire administered to all NIDS participants. Linear regression was used to model the relationship between change in depression symptoms and change in violence subtypes between Waves 2 and 3. We found that two-year increase in PFNDV was significantly correlated with increase of depression symptoms over the same time period for women, independently of individual, household and neighborhood level characteristics, including five other types of neighborhood violence. No other type of violence was associated with increased depression in women in the fully adjusted model. Research and policy implications are discussed.

Studies that examine the effects of neighborhood characteristics on mental health show that perceptions of general neighborhood violence are associated with depression across diverse populations (Clark et al., 2008, Velez-Gomez et al., 2013 and Wilson-Genderson and Pruchno, 2013). However, the specific effect of perceived frequency of neighborhood domestic violence (PFNDV) on residents' mental health has not been examined. Objective measures of neighborhood violence (e.g., neighborhood violent crime statistics) and residents' perceptions of neighborhood violence are both associated with poor mental health among residents, and the impact of objective measures is thought to be mediated by subjective perceptions of neighborhood violence (Weden et al., 2008). Researchers have examined potential pathways for how residents' perceptions of neighborhood violence might affect their mental health. Although risk of personal victimization is slightly higher if resident's report high perceived neighborhood violence, studies suggest that the dominant mediators of personal mental health impact on residents living in neighborhoods with high perceived violence are not actual victimization, but threat-related feelings of mistrust and powerlessness (Ross and Mirowsky, 2009). The rapidly growing research of social-cognitive neuroscience is consistent with such observations. Investigations of “intersubjectivity” or the psychological relationship between people, have found that neuroscientific processes for producing an understanding of one's self are tightly related to processes governing understandings of others—which may partly explain why perceiving one's neighborhood as threatening to others could translate into feelings of being personally threatened, with related impact on personal mental health (Marchetti and Koster, 2014, Murray et al., 2014 and Weden et al., 2008). At the level of the individual, the relationship between personal domestic violence victimization and depression among survivors is well-established in the field of mental health. Exposure to domestic violence leads to high levels of depression, typically doubling the odds of incident depression among survivors (Devries et al., 2013). The epidemic proportions of domestic violence against women are also well known— the WHO estimates that 35% of women worldwide have experienced violence in their lifetime (WHO|Violence against women, 2013). Despite the knowledge that (1) domestic violence is one of the most potent violence subtypes for individual mental health damage; (2) it is a widespread global problem and; (3) it has the potential to affect the health of whole populations via pathways identified through neighborhood violence research, no studies have examined the impact of perceived neighborhood domestic violence on community mental health. Our goal is to advance knowledge in this area using the South African National Income Dynamics Study (SA-NIDS). The NIDS measures neighborhood domestic violence by asking household respondents to report their perception of the frequency of domestic violence in their neighborhood. NIDS is the first national household longitudinal study in South Africa and is implemented by the Southern Africa Labour and Development Research Unit (SALDRU) at the University of Cape Town's School of Economics (NIDS|SALDRU Research|South African Income Surveys, 2014). The NIDS includes a household questionnaire that is administered to the oldest woman in the family or another family member who is knowledgeable about the living arrangements, and a separate, adult questionnaire that is administered to everyone living in the household who is over the age of 15 years. The household respondent is asked to report the PFNDV. Depression is measured through the individual questionnaire, using the Center for Epidemiologic Studies-Depression (CES-D) scale, which is administered to all NIDS participants, including household respondents. The NIDS provides a rare opportunity to examine the effects of PFNDV on depression symptoms among household residents. This design allows for assessment of the impact of domestic violence at a population-level, which may be distinct from that related to individual exposure, and may have the potential to inform public health efforts, prevention strategies, and policies regarding law enforcement and safety in low resource settings. We conducted an analysis of NIDS data to examine relationships between PFNDV and depression symptoms in the 2008, 2010 and 2012 data Waves, controlling for individual, household and neighborhood level variables. We hypothesized that a higher reported PFNDV by household respondents would correlate with higher depression symptoms amongst individual residents and that increase of PFNDV would be associated with increase of depression over the same time period. 2. Materials and methods 2.1. Study population NIDS began in 2008 with a nationally representative sample which included approximately 16,800 adults in 7296 households (7296 household respondents). Four hundred Primary Sampling Units (PSUs) were selected for NIDS Wave 1 to represent independent households in South Africa's nine provinces. Using a multi-stage sampling design, PSUs were drawn randomly from the 3000 PSUs of the 2003 South African Labour Force and General Household surveys, District Council strata. NIDS has been repeated with the same households every two years. Currently, data from Waves 1, 2 and 3 are publically available (2008, 2010, and 2012). NIDS is a multi-dimensional study that uses matched household and individual measures to collect data on demographics, depression, social capital, household income, household events and sub-types of perceived neighborhood violence, including PFNDV, gangs, theft/burglary, murder, drugs/alcohol and violence between different households. In 2008, the individual questionnaire non-response rate was 6.7% and household non-response rate was 31% (Woolard et al., 2010). Non-response, differences from national population and attrition were taken into account in the weighting process (design, calibrated and panel weights) and in survey methodology for 2010 and 2012 Waves. See Leibbrandt and colleagues for details of weighting methods (Leibbrandt et al., 2009). Data from all available Waves of the NIDS were used to examine the relationship between depression and perceived frequency of neighborhood violence (all types) for this study.

As global mental health treatment efforts unfold, LMICs must seek cost effective interventions to both prevent and treat mental illness. This analysis of depression in the context of a population health study identifies PFNDV as a key correlate of women's depression in South Africa. Given that PFNDV is currently repeated in only two consecutive NIDS waves, this study can only be conducted using cross-sectional change analysis, which does not allow for prediction of the direction of causal effect. While research on individual exposure to domestic violence and mental disorders have established causality at the level of the individual, the same mechanism cannot be assumed to operate at a population level with the current NIDS data. As subsequent waves of NIDS are collected, longitudinal investigations to strengthen inferences about causality will be possible. Given that mental health treatment of survivors of domestic violence reduces their risk of re-victimization, it is possible that focusing treatment efforts on survivors of domestic violence may address both primary and secondary prevention goals. In recent years, effective models for feasible and acceptable mental health treatment in low resource settings have developed that use paraprofessionals and trained community therapists to deliver established psychotherapies adapted for the local setting (Bass et al., 2013, Bolton et al., 2003, Meffert et al., 2009, Mutamba et al., 2013, Neuner et al., 2008, Patel et al., 2008, Schauer et al., 2005 and Van Ginneken et al., 2013). Taking these treatments to scale in a clinically and economically effective manner is one of the next steps.