Associations of childhood maltreatment with hypertension in South African women: a cross-sectional study

Kim Anh Nguyen; Andre Pascal Kengne; Naeemah Abrahams; Rachel Jewkes; Shibe Mhlongo; Nasheeta Peer

doi:10.1136/bmjopen-2021-057436

Associations of childhood maltreatment with hypertension in South African women: a cross-sectional study

BMJ Open. 2022 Sep 19;12(9):e057436. doi: 10.1136/bmjopen-2021-057436.

Authors

Kim Anh Nguyen¹, Andre Pascal Kengne^{2

3}, Naeemah Abrahams^{4

5}, Rachel Jewkes^{4

6}, Shibe Mhlongo⁴, Nasheeta Peer^{2

3}

Affiliations

¹ Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town and Durban, South Africa Kim.Nguyen@mrc.ac.za.
² Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town and Durban, South Africa.
³ Department of Medicine, University of Cape Town, Observatory, Western Cape, South Africa.
⁴ Gender and Health Research Unit, South African Medical Research Council, Cape Town and Pretoria, South Africa.
⁵ School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
⁶ Office of the Executive Scientist, South African Medical Research Council, Cape Town, South Africa.

Abstract

Objectives: To examine the associations of childhood maltreatment (CM) with hypertension, and the mediating effects of hypertension risk factors on the associations in South African women, using baseline data of the Rape Impact Cohort Evaluation longitudinal study.

Design: Cross-sectional SETTING AND PARTICIPANTS: Self-reported data on CM exposure and its severity in 18-40-year-old women living in KwaZulu-Natal province were assessed. Logistic regression models, adjusted for traditional hypertension risk factors, rape exposure, HIV-infection, other traumatic exposures, depression scores and acute stress reactions (ASR) scores were used to examine the CM-hypertension associations.

Results: Among 1797 women, 220 (12.2%) had hypertension; CM prevalence was higher in women with hypertension than without hypertension overall (70.9% vs 57.2%) and for each abuse type: sexual abuse (20.9% vs 12.4%), physical abuse (51.8% vs 41.5%), emotional abuse (40% vs 27.6%) and parental neglect (35% vs 25.7%). Exposures to 1-2 types and 3-4 types of CM were 46.4% and 24.5%, respectively, in women with hypertension, and lower in women without (42.9% and 14.3%, respectively). Exposures to any CM (adjusted OR: 1.62; 95% CI: 1.19 to 2.25), sexual abuse (1.64; 95% CI: 1.12 to 2.37), emotional abuse (1.57; 95% CI: 1.16 to 2.13), physical abuse (1.43; 95% CI: 1.07 to 1.92) and parental neglect (1.37; 95% CI: 1.00 to 1.86) were associated with hypertension. Exposures to an increasing number of abuse types and cumulative severity of CM overall (1.13; 95% CI: 1.05 to 1.21) and for each CM type were associated with increased odds of hypertension. Alcohol use, other trauma experienced, depression and ASR partially mediated these associations.

Conclusion: CM was associated with hypertension; the effects were greater with multiple abuse types and severe abuse, and were partially mediated by alcohol use, depression, ASR and other traumatic exposures. While CM must be prevented, effective mental health interventions to curb the uptake of unhealthy behaviours and the development of hypertension in women exposed to CM are key.

Keywords: Child protection; EPIDEMIOLOGY; Hypertension; MENTAL HEALTH; PUBLIC HEALTH.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Child
Child Abuse* / psychology
Cross-Sectional Studies
Female
Humans
Hypertension* / epidemiology
Hypertension* / etiology
Longitudinal Studies
South Africa / epidemiology
Young Adult