Symptoms of post-traumatic stress partially mediate the relationship between gender-based violence and alcohol misuse among south african women

Objective: Alcohol misuse is among modifiable risk factors of hypertension and cardiovascular diseases. Previous studies have described the associations of a range of traumatic experiences with problematic alcohol use, but data on possible mediation effects of mental distress are sparse. We examined whether mental ill-health mediated the association between trauma exposure across the lifespan and alcohol misuse. Design and method: We analysed cross-sectional data from a pooled sample of rape-exposed and non-rape-exposed women, 18-40 years-old, living in KwaZulu-Natal, with self-reported data on alcohol misuse (Audit-C cut-off = >3) and exposure to childhood maltreatment (CM), intimate partner violence (IPV), non-partner sexual violence (NPSV), other traumatic events, and mental ill-health including depression, post-traumatic stress symptoms (PTSS). Logistic regression and multiple mediation models were used to test the mediation effects of symptoms of depression and PTSS on the association between abuse/trauma and alcohol misuse. Results: Of 1615 women, 31% (n = 498) reported alcohol misuse. Exposure to any CM (adjusted odds ratio (OR): 1.59, 95% confidence interval (CI): 1.27-1.99), sexual (OR: 1.24, 95%CI: 1.04-1.94), physical (OR:1.39, 95%CI:1.12-1.72) and emotional CM (CA) (OR: 1.31, 95%CI: 1.04-1.66) were independently associated with alcohol misuse. Lifetime exposures to any IPV (OR:2.01, 95%CI:1.59-2.54), physical (OR:2.15, 95%CI:1.72-2.69), emotional (OR:1.61, 95%CI: 1.30-2.01) and economic IPV (OR: 1.35, 95%CI: 1.03-1.78), NPSV (OR: 1.75, 95%CI: 1.32-2.33) and other trauma (OR:2.08, 95%CI:1.62-2.66) were associated with alcohol misuse. Parental neglect and sexual IPV were not associated with alcohol misuse. Exposure to an increasing number of abuse types, and severity of CM (overall, physical and emotional, and parental neglect), IPV (overall, physical and emotional), NPSV and other traumatic events were independently associated with alcohol misuse. PTSS partially mediated the associations of CM, IPV, NPSV and other trauma exposures with alcohol misuse (p-values< = 0.04 for indirect effects), but depression symptoms did not. Conclusions: These findings highlight the need for trauma-informed psychological interventions to prevent and reduce alcohol misuse in women exposed to violence. Women diagnosed with alcohol misuse should be screened for trauma exposures and provided appropriately care, treatment.