Association between sexual violence and depression is mediated by perceived social support among female University students in the Kingdom of Eswatini

Background Gender-based violence is a tool that primarily functions to maintain gendered power hierarchies. As manifestations of gender-based violence, sexual assault and street harassment have been shown to have significant effects on mental wellbeing in the global North, however there is little research centering the experiences and consequences of gendered harassment in the Africa region. Methods We analyzed a cross-sectional random sample of women attending a major university in Eswatini in 2017 to measure the prevalence of street harassment among female university students and assess the relationship between experiences of sexual assault, sexualized street harassment, and mental health outcomes in this population. Results We found that in the previous 12 months, women reported experiencing high levels of sexual assault (20%), street harassment (90%), and depression/anxiety (38%). Lifetime sexual assault, past 12 months sexual assault, and street harassment were all significantly associated with symptoms of depression. We created a structural model to test hypothesized causal pathways between street harassment, previous experiences of sexual assault, and symptoms of depression, with social support as a potential mediator. We found that a history of sexual violence significantly mediated the association between street harassment and depression, and that social support mediated a large proportion of the association between both forms of gender-based violence and depression. Conclusion Sexualized street harassment is associated with increased anxiety and depression for nearly all women, however the effects are especially pronounced for women who have previous experiences of sexual violence. Sexualized street harassment functions as a tool to maintain gendered power hierarchies by reminding women of ongoing threat of sexual violence even in public spaces. Social support and solidarity among women is a potentially important source of resiliency against the physical and mental harms of all forms of gender based violence. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Funding was provided by a Sexual Violence Research Initiative (SVRI) and World Bank Development Marketplace Research Grant (PI: RFM). www.svri.org Additional support was provided by the National Institutes of Mental Health (K01MH112436, PI: RFM) www.nimh.nih.gov The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study was approved by the University of California, San Diego Institutional Review Board and the University of Eswatini Scientific Ethics Review Committee I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data are available at https://dataverse.harvard.edu/dataset.xhtml?persistentId=doi:10.7910/DVN/WJPGIL