Family-level Childhood Adversities and Adult Psychopathology in the South Africa Stress and Health Study: Associations with First Onset DSM-IV Disorders

Background: Extensive epidemiologic research from the United States demonstrates that childhood adversities (CAs) are predictive of several psychiatric outcomes, including depression, anxiety, substance, and externalizing disorders. To date, this has not been explored in a national sample of adults in South Africa. Methods: We examined the joint predictive effects of 11 retrospectively reported CAs on the first onset of DSM-IV disorders throughout the life course in the South Africa Stress and Health Study (SASH), a nationally representative sample of the adults. We utilized substantively plausible regression models of joint CA effects that account for the comorbidity between individual CAs; outcomes included DSM-IV anxiety, mood, externalizing and substance disorders, measured with the WHO Composite International Diagnostic Interview. Results: The results indicated that CAs varied by race, and many CAs were correlated with one another. The best-fitting model for first onset of any disorder included separate indicators for each type of CA, in addition to indicator variables for the number of other CAs reported. Results disaggregated by class of disorder indicated that the majority of individual CAs only reached statistical significance for anxiety disorder. Results disaggregated by life course stage of first onset showed that significant effects of CAs can be observed at each stage of the life course. Discussion: The present study contributes to a growing body of research on the social determinants of mental health in South Africa. Results indicate that a variety of CAs predict onset of mental disorders, particularly anxiety disorders, at multiple stages of the life course.