Relationships between Violence and Mental Health in Vulnerable Youth in Baltimore and Johannesburg

Background:  Globally, urban youth who live in poor neighborhoods experience more violence than their rural or wealthier peers.  These experiences include personally being hurt, observing violence against others, and fearing violence and are often associated with a variety of mental health sequelae. 

Objectives: 1) Describe frequencies of violent experiences in adolescents ages 15-19 from Baltimore and Johannesburg; 2) Test the association between violent experiences and depression; 3) Test whether adult social support confounds this relationship.

Study: ACASI interviews were conducted amongst a sample of adolescents from low-income communities in both cities.  Adolescents were recruited through respondent-driven sampling. 

Results: Youth in both cities experienced violence at high rates.  At 13.8% (Baltimore) and 3.2% (Johannesburg), few reported no experiences of violence.  Approximately a quarter of adolescents in Baltimore and 20% in Johannesburg reported only fear.  Just under a quarter in Baltimore and 10% in Johannesburg reported having observed violence (with or without fear).  The highest level of violence – being hurt or threatened, with or without a weapon – was reported by 41.2% and 67.1% in Baltimore and Johannesburg respectively.  In both cities, violent experiences were significantly associated with depression while social support was significantly associated with decreased depression.  When controlled for as a confounder, social support remained significantly associated with decreased depression in Johannesburg but not Baltimore.

Conclusions: The results suggest that adolescents in Johannesburg and Baltimore experience high levels of violence but that enhancing social support mechanisms for young people in these vulnerable settings may help decrease levels of depression.