Research

Pathways from witnessing community violence to mental health problems among South African adolescents

G Donenberg, P Naidoo, A Kendall, E Emerson, C L Ward, A Kagee, L Simbayi, R Vermaak, A North, J Mthembu, M E Mackesy-Amiti

Abstract


Background. The intersection of violence exposure and mental health problems is a public health crisis for South African (SA) adolescents. Understanding the impact of community violence on adolescent mental health can inform future interventions.

Objectives. To assess pathways between community violence exposure and internalising and externalising problems in SA adolescents receiving mental healthcare, and the roles of parent and peer relationships in these associations.

Methods. Participants (N=120 parent-adolescent pairs) were recruited from four mental health clinics in Western Cape Province to participate in a pilot test of a family-based HIV prevention study. Adolescents reported on their exposure to community violence, parental attachment, peer support of risk behaviour, and mental health. Parents reported on adolescents’ internalising and externalising mental health problems. Participants received transport money (ZAR30 = USD3) and a shopping voucher or cash (ZAR50 = USD5) for their time.

Results. Adolescents were 12 - 18 years old (mean (standard deviation) 14.39 (1.82) years), 53% were male, and 67% and 33% reported black African and mixed-race ethnicity, respectively. Parents were 94% female and reported an average monthly income of ZAR3 973 (USD397). Boys reported significantly higher rates of witnessing community violence than girls. Among boys, significant paths emerged from community violence and low parent attachment to externalising symptoms and from community violence to peer support of risky behaviour. For girls, the only significant path was from low parent attachment to peer support of risky behaviour.

Conclusions. This cross-sectional study sheds new light on the possible pathways from witnessing community violence to mental health problems among SA adolescents. Identifying factors that drive and mitigate psychological distress in the context of persistent community violence is critical to SA’s future and can inform the selection and delivery of appropriate and targeted evidence-based interventions.

 


Authors' affiliations

G Donenberg, Center for Dissemination and Implementation Science, University of Illinois at Chicago, USA; Department of Medicine, University of Illinois at Chicago, USA; Healthy Youths Program, Department of Medicine, University of Illinois at Chicago, USA

P Naidoo, Faculty of Medicine and Health Sciences, University of the Western Cape, Cape Town, South Africa

A Kendall, Center for Dissemination and Implementation Science, University of Illinois at Chicago, USA

E Emerson, Center for Dissemination and Implementation Science, University of Illinois at Chicago, USA

C L Ward, Department of Psychology, Faculty of Humanities, University of Cape Town, South Africa

A Kagee, Department of Psychology, Faculty of Arts and Social Sciences, Stellenbosch University, South Africa

L Simbayi, Human Sciences Research Council, Cape Town, South Africa

R Vermaak, Health Systems Trust, Cape Town, South Africa

A North, Human Sciences Research Council, Cape Town, South Africa

J Mthembu, Human Sciences Research Council, Cape Town, South Africa

M E Mackesy-Amiti, Community Outreach Intervention Projects, School of Public Health, University of Illinois at Chicago, USA

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Keywords

Mental health; South Africa; Adolescents; Violence exposure; Parental attachment

Cite this article

South African Medical Journal 2020;110(2):145-153. DOI:10.7196/SAMJ.2020.v110i2.13929

Article History

Date submitted: 2020-01-29
Date published: 2020-01-29

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