HUBUNGAN ADVERSE CHILDHOOD EXPERIENCES (ACES) DENGAN GEJALA DEPRESI PADA REMAJA AWAL BERDASARKAN ORIENTASI SEKSUAL (ANALISIS DATA SEKUNDER: GLOBAL EARLY ADOLESCENT STUDY GELOMBANG 1 TAHUN 2018)

Annisa' Arifatul Hikmah, dr. Ifta Choiriyyah. MSPH., Ph.D ; dr. Amirah Ellyza Wahdi, MSPH

2024 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Adverse childhood experiences (ACEs) merupakan pengalaman negatif di masa kecil, termasuk pelecehan fisik, emosional, atau seksual, pemisahan orang tua, kekerasan dalam rumah tangga, ketidakstabilan keluarga, kemiskinan, atau kurangnya sosok orang tua. Penelitian di 15 negara GEAS menunjukkan bahwa setengah dari remaja awal pernah mengalami peristiwa negatif di masa kecil. Riwayat ACEs ini lebih sering di alami oleh individu dengan orientasi seksual minoritas dibandingkan dengan individu heteroseksual. Berbagai penelitian di Amerika Serikat menunjukkan adanya hubungan antara ACEs dan depresi remaja, tetapi masih sedikit penelitian yang melihat perbedaan hubungan antara ACEs dan depresi berdasarkan orientasi seksual. Tujuan: Mengeksplorasi hubungan antara ACEs dan gejala depresi pada remaja awal berdasarkan orientasi seksual. Metode: Analisis ini menggunakan data survei GEAS gelombang I tahun 2018 (baseline), yang mewawancarai remaja awal usia 10-14 tahun. Analisis deskriptif dilakukan untuk mengetahui proporsi gejala depresi dan ACEs berdasarkan orientasi seksual. Analisis bivariabel menggunakan uji chi-square dan regresi logistik dilakukan untuk mengetahui faktor-faktor yang berhubungan dengan gejala depresi. Analisis multivariabel dilakukan dengan regresi logistik, uji efek interaksi, dan stratifikasi orientasi seksual untuk melihat ada tidaknya perbedaan risiko gejala depresi berdasarkan ACEs menurut orientasi seksual. Hasil: Dari 4684 responden GEAS baseline, terpilih 3155 remaja awal untuk terlibat dalam penelitian ini. Sebanyak 74,9% terkategorikan heteroseksual, 3,6% minoritas seksual, dan 21,5?lum pernah jatuh cinta atau tidak dapat terkategori. Remaja minoritas seksual memiliki persentase lebih tinggi dalam mengalami >4 ACEs (44,2%) dan >3 gejala depresi (29,2%). Terdapat hubungan signifikan antara >3 gejala depresi dengan mengalami >4 ACEs (aOR: 3,57 95%CI:2,23–5,70), namun tidak ditemukan adanya perbedaan hubungan berdasarkan orientasi seksual. Status ekonomi sangat miskin, lingkungan tidak aman, keinginan putus sekolah, aktivitas seksual berat, intensitas bertemu teman yang sering terbukti berhubungan dengan gejala depresi pada remaja awal. Kesimpulan: Sosialisasi mengenai kelompok remaja dan orientasi seksual kepada masyarakat dan petugas kesehatan penting untuk dilakukan, begitupun dengan penekanan pendidikan seksual komprehensif di sekolah untuk mendorong kesadaran akan pentingnya inklusifitas dalam setiap program kesehatan. Studi longitudinal dan kualitatif terkait topik ini untuk memperdalam wawasan mengenai kesehatan mental, ACEs, dan orientasi seksual pada remaja di Indonesia.

Background: Adverse childhood experiences (ACEs) are negative experiences in childhood, including physical, emotional, or sexual abuse, parental separation, domestic violence, family instability, poverty, or lack of parental figures. Research in 15 countries of adolescents based on sexual orientation. Methods: This analysis uses data from the GEAS wave I survey in 2018 (baseline), which interviewed early adolescents aged 10-14 years. Descriptive analysis was conducted to determine the proportion of depression symptoms and ACEs based on sexual orientation. Bivariate analysis used chi-square tests and logistic regression to identify factors associated with depression symptoms. Multivariable analysis was performed with logistic regression, interaction effect tests, and sexual orientation stratification to see if there were differences in the risk of depression symptoms based on ACEs according to sexual orientation. Results: Out of 4684 baseline GEAS respondents, 3155 early adolescents were selected for this study. A total of 74.9% were categorized as heterosexual, 3.6% as sexual minorities, and 21.5% had never fallen in love or could not be categorized. Sexual minority adolescents had a higher percentage of experiencing >4 ACEs (44.2%) and >3 symptoms of depression (29.2%). There was a significant association between >3 symptoms of depression and experiencing >4 ACEs (aOR: 3.57 95%CI:2.23–5.70), but no difference was found in the relationship based on sexual orientation. Very poor economic status, unsafe environment, desire to drop out of school, heavy sexual activity, and frequent intensity of meeting friends proved to be related to symptoms of depression in early adolescence. Conclusion: Socialization about adolescent groups and sexual orientation to the community and health workers is important to carry out, as well as emphasizing comprehensive sexual education in schools to encourage awareness of the importance of inclusivity in every health program. Longitudinal and qualitative studies are also needed to deepen insights regarding mental health, ACEs, and sexual orientation in adolescents in Indonesiathe GEAS showed that half of the early adolescents had experienced negative events in childhood. Individuals with a sexual minority orientation more often experience this history of ACEs compared to heterosexual individuals. Various studies in the United States show a relationship between ACEs and adolescent depression, but there is still little research that looks at the differences in the relationship between ACEs and depression based on sexual orientation. Objective: To explore the relationship between ACEs and symptoms of depression in early

Kata Kunci : Adverse childhood experiences, depression, sexual and gender minorities, adolescent