The Relationship between Sexual Violence and Mental Health Outcomes for Adolescents Girls and Young Women in Malawi

Background/Purpose:  Malawi is a country in southeastern Africa and is ranked as the 19^th least developed country in the world. Within this context, sexual violence (SV), is an issue of concern. However, mental health response within the country may be inadequate to respond to the consequences of this violence.  Recent studies in Malawi demonstrate that more than 22 % of girls experience SV at some point in their lives, with other studies finding that almost 40% of Malawian girls have experienced forced sexual initiation. Although there is a perception in the country that SV has a significant mental health impact, studies demonstrate that across Malawi systems in place are inadequate to respond to SV consequences, including psychosocial and mental health impacts. Common disorders like depression and anxiety, estimated at 10-30% of the entire Malawian population, often go untreated. In order to provide further evidence for necessary mental health responses by social workers and other health professionals to SV, there is, therefore, a need to investigate the mental health consequences of SV in Malawi, particularly among female adolescents. This paper therefore aims to contribute to the literature by investigating a 1) continuum of SV experiences in their relationship to nonspecific psychological distress, 2) the accumulation of SV experiences and their relationship to nonspecific psychological distress, and 3) determine the impact of polyvictimization on the relationships identified in the first two aims, which has never sufficiently been done previously. This is to better respond to the needs and mental health consequences of the experiences of SV and gendered violence of adolescent girls in Low- and Middle-Income Countries (LMIC), Sub-Saharan Africa and Malawi.

Methods:  In 2013, 2,162 adolescents between the ages of 13-24 were interviewed as part of the nationally representative Violence Against Children Survey (VACS). This current study used secondary data analyses of 1,029 females’ experiences of SV within this study.  Descriptive analysis and multilevel ordered logistical regression were run, with final models controlling for age, education, poverty, marriage, witnessing violence, physical violence, emotional violence variables, as well as other forms of SV while also moderating for emotional, physical and witnessing violence to investigate multiplicative interaction effects.  

Results: Results indicate that females who have experienced each individual and more severe type of SV in their lifetime will experience greater moderate or serious mental distress than those who have not experienced each individual form of SV, particularly as severity increases. Also, the higher the number of types of experiences of SV, the greater the likelihood of experiencing moderate or serious mental distress.

Implications: The results propose that different types and number of experiences of SV affects the lives of adolescent girls in unique and increasingly traumatic ways, by revealing their experiences of mental distress. Therefore, ongoing efforts of social workers, counselors, and policymakers should create connection among social service agencies, sustain community-based interventions for systematic change, and create an environment that supports disclosure of all types of SV and provides support for their consequences within LMIC.