title: Mediators of interpersonal violence and drug addiction severity among methamphetamine users in Cape Town, South Africa.
abstract: South Africa has high rates of interpersonal violence and a rapidly growing methamphetamine epidemic. Previous research has linked experiences of interpersonal violence to higher rates of substance use, and identified mental health constructs as potential mediators of this association. The aim of this study was to examine the relationship between interpersonal violence and addiction severity among active methamphetamine users in Cape Town, South Africa, and to explore symptoms of posttraumatic stress disorder (PTSD) and substance use coping as mediators of this relationship. A community sample of 360 methamphetamine users was recruited through respondent driven sampling and surveyed on their experiences of violence, mental health, coping, and drug use and severity. A series of one-way ANOVAs were conducted to examine the relationship of self-reported interpersonal violence with drug addiction severity, and multiple mediation analyses were used to determine if PTSD symptoms and substance use coping mediated this relationship. The majority (87%) of the sample reported experiencing at least one instance of interpersonal violence in their lifetime, and the number of violent experiences was associated with increased drug addiction severity. PTSD and substance use coping were significant mediators of this association. Only the indirect effect of substance use coping remained significant for the female sample when the mediation model was conducted separately for men and women. The findings point to the need for integrated treatments that address drug use and PTSD for methamphetamine users in South Africa and highlight the importance of coping interventions for women.
authors.affiliation: Duke University, Duke Global Health Institute, 310 Trent Drive, Trent Hall, Room 329, Durham, NC, 27708, USA. Electronic address: andrea.hobkirk@duke.edu.
authors.forename: Andréa L
authors.initials: AL
authors.lastname: Hobkirk
authors.affiliation: Duke University, Duke Global Health Institute, 310 Trent Drive, Trent Hall, Room 330, Durham, NC, 27708, USA. Electronic address: melissa.watt@duke.edu.
authors.forename: Melissa H
authors.initials: MH
authors.lastname: Watt
authors.affiliation: Durham VA Medical Center, 116B, 508 Fulton St., Durham, NC, 27705, USA. Electronic address: kimberly.green@dm.duke.edu.
authors.forename: Kimberly T
authors.initials: KT
authors.lastname: Green
authors.affiliation: Durham VA Medical Center, 116B, 508 Fulton St., Durham, NC, 27705, USA. Electronic address: jean.beckham@va.gov.
authors.forename: Jean C
authors.initials: JC
authors.lastname: Beckham
authors.affiliation: Stellenbosch University, Faculty of Medicine and Health Sciences, Box 19063, Tygerberg 7505, South Africa. Electronic address: dskinner@sun.ac.za.
authors.forename: Donald
authors.initials: D
authors.lastname: Skinner
authors.affiliation: Duke University School of Medicine, Department of Psychiatry & Behavioral Sciences, Box 90519, Durham, NC, 27708, USA. Electronic address: christina.meade@duke.edu.
authors.forename: Christina S
authors.initials: CS
authors.lastname: Meade
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D019969:Amphetamine-Related Disorders / Q000523:psychology*; D000704:Analysis of Variance; D000697:Central Nervous System Stimulants; D005260:Female; D006801:Humans; D008297:Male; D008694:Methamphetamine; D012742:Sex Offenses / Q000523:psychology; D013019:South Africa; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D014754:Violence / Q000517:prevention & control / Q000523:psychology*
chemical_list: D000697:Central Nervous System Stimulants; D008694:Methamphetamine
keywords: Addiction; Coping; Interpersonal violence; Methamphetamine; PTSD; South Africa