title: Structural Pathways between Child Abuse, Poor Mental Health Outcomes and Male-Perpetrated Intimate Partner Violence (IPV).
abstract: BACKGROUND
  Violent trauma exposures, including child abuse, are risk factors for PTSD and comorbid mental health disorders. Child abuse experiences of men exacerbate adult male-perpetrated intimate partner violence (IPV). The relationship between child abuse, poor mental health and IPV perpetration is complex but research among the general population is lacking. This study describes the relationship and pathways between history of child abuse exposure and male-perpetrated IPV while exploring the potentially mediating effect of poor mental health.
  
  
  METHODS
  We analysed data from a randomly selected, two-stage clustered, cross-sectional household survey conducted with 416 adult men in Gauteng Province of South Africa. We used multinomial regression modelling to identify associated factors and Structural Equation Modelling (SEM) to test the primary hypothesis that poor mental health (defined as abusing alcohol or having PTSD or depressive symptoms) mediates the relationship between child abuse and IPV perpetration.
  
  
  RESULTS
  Eighty eight percent of men were physically abused, 55% were neglected, 63% were emotionally abused and 20% were sexually abused at least once in their childhood. Twenty four percent of men had PTSD symptoms, 24% had depressive symptoms and 36% binge drank. Fifty six percent of men physically abused and 31% sexually abused partners at least once in their lifetime. Twenty two percent of men had one episode and 40% had repeat episodes of IPV perpetration. PTSD symptomatology risk increased with severity of child trauma and other trauma. PTSD severity increased the risk for binge drinking. Child trauma, other trauma and PTSD symptomatology increased the severity of depressive symptoms. PTSD symptomatology was comorbid with alcohol abuse and depressive symptoms. Child trauma, having worked in the year before the survey, other trauma and PTSD increased the risk of repeat episodes of IPV perpetration. Highly equitable gender attitudes were protective against single and repeat episodes of IPV perpetration. There was a direct path between the history of child trauma and IPV perpetration and three other indirect paths showing the mediating effects of PTSD, other trauma and gender attitudes.
  
  
  CONCLUSIONS
  Child trauma is a risk factor for both poor mental health and male-perpetrated IPV among men in Gauteng. Male-perpetrated IPV in these settings should be explained through a combination of the Trauma, Feminist, and Intergenerational Transmission of Family Violence theories. Prevention interventions for male- perpetrated IPV in South Africa need to incorporate strategies and therapies to address poor mental health conditions.
authors.affiliation: Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.|School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Mercilene T
authors.initials: MT
authors.lastname: Machisa
authors.affiliation: School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Nicola
authors.initials: N
authors.lastname: Christofides
authors.affiliation: Gender and Health Research Unit, South African Medical Research Council, Pretoria, South Africa.|School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Rachel
authors.initials: R
authors.lastname: Jewkes
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000453:epidemiology*; D002648:Child; D002649:Child Abuse; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology*; D006801:Humans; D000066511:Intimate Partner Violence; D008016:Life Change Events; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D055815:Young Adult