Trauma as a mediator of childhood adversity and mental illness in South Africa: A path analysis

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Background: South Africa bears a high burden of adverse childhood events (ACEs), which have been identified as a primary factor that can lead to negative mental health outcomes for adults. While studies within South Africa have examined the associations between ACEs, adult trauma and adult mental illness, there is less knowledge of how these preceding factors interact to affect mental distress together and which ACEs are most likely to lead to adverse mental health outcomes. Aim: The main aim of this study was to explore the mediating effects of recent adult trauma on mental illness among patients at two psychiatric hospitals in Johannesburg, South Africa, using path analysis. Setting: This study took place at two public psychiatric facilities in Johannesburg, South Africa. Methods: Surveys were conducted with 309 adults living in Gauteng province. Mediational path analysis explored the association between ACEs, adult traumatic events, and depression, anxiety, and stress. Results: Adult traumatic events partially mediated the association between verbal abuse, emotional neglect, mental illness and substance use in the household as a child and adult mental illness. Adult traumatic events fully mediated the associations between experiencing domestic violence in childhood or child sexual abuse. Conclusion: This study highlights the importance of disaggregating ACEs when exploring their effects while also reinforcing previous findings that ACEs increase the likelihood of experiencing adult trauma and adult mental illness. Contribution: Future studies should further pinpoint which ACEs are most impactful and target those for prevention in childhood and intervention in adulthood to mitigate their deleterious impacts.

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