The Syndemic Effect of Intimate Partner Violence, HIV, and Substance Use on Depression and Suicidal Thoughts Among a Sample of Drug-Involved Women in Kazakhstan

Background and Purpose: Accumulating evidence over the past decade has demonstrated that the effect of co-occurring substance use, violence, and HIV, dubbed the “SAVA syndemic,” on health outcomes, such as depression and mortality, are more deleterious than any one of these individual conditions alone. Despite growing attention, no studies have examined the effect of the SAVA syndemic on depression and suicidal ideation among high-risk women in Kazakhstan, a country that, not only has a notably high prevalence of suicide, but is also experiencing a concentrated epidemic of HIV, and high rates of substance use and violence against women. This paper examines the relationship between the SAVA syndemic and mental health (depression and suicidal ideation) among a sample of high-risk women in Kazakhstan, and identifies risk and protective factors associated with depression/suicidal thoughts.

Methods: 364 drug-involved women and their main partners were enrolled into an intervention study in  Almaty, Kazakhstan. Data reported here are from the baseline survey. Participants were asked a range of questions pertaining to their socio-demographics, mental health, history of IPV, drug and alcohol use, partner risk behaviors, housing status, and food insecurity, among others. Biological assays were used to determine HIV status. A single SAVA syndemic variable was created, coded from zero to three, with zero representing participants with none of the three SAVA conditions (operationalized as co-occurring recent injection drug use, recent IPV, and positive HIV-status) and three representing women who reported all three of the syndemic conditions. Descriptive statistics were used to examine the prevalence of depression and suicidal ideation by the SAVA syndemic continuum, and multivariate logistic regression analyses were used to examine the relationship between the SAVA syndemic variable, other risk and protective factors, and mental health outcomes (depression and suicidal ideation). 

Results: Findings indicated increasing/rising prevalence of both depression and suicidal ideation by the SAVA syndemic continuum. Consistent with the main hypothesis that women who experience the full range of the SAVA syndemic continuum, compared to none, would be disproportionately more likely to have poor mental health outcomes, multivariate analyses showed a 15.5-fold odds (p < .05) of reporting depression, and a 6-fold odds (p < .05) in reporting suicidal ideation disturbances. Findings also indicated that women who experience individual, interpersonal, and socio-structural risks are more likely to report poor mental health outcomes than those who did not; specifically, analyses indicated that social support, education, and food insecurity are associated with depression and suicidal ideation, controlling for the syndemic variable.

Conclusions and Implications: Findings support previous research from other regions on the synergistic effects of the SAVA syndemic on poor mental health outcomes, as well as the importance of strengthening social support networks and access to basic resources. Findings also point to the value of integrated screening assessments and interventions designed to address multiple, commonly co-occurring conditions.