Does experiencing a traumatic life event increase the risk of intimate partner violence for young women? A cross-sectional analysis and structural equation model of data from the Stepping Stones and Creating Futures intervention in South Africa

OBJECTIVES: To investigate associations and potential pathways between women's lifetime exposure to traumatic events and their recent experiences of intimate partner violence (IPV). SETTING: South African informal settlements near Durban. PARTICIPANTS: 677 women, living in informal settlements, aged 18-30 years, currently out of school or formal employment. PRIMARY AND SECONDARY OUTCOME MEASURES: Self-reported experiences of IPV in the past 12 months and exposure to traumatic neighbourhood events (including witnessing murder, being robbed or kidnapped, witnessing and experiencing rape). RESULTS: Exposure to traumatic events was common among the 677 women surveyed. Over 70% had experienced at least one in their lifetime; one quarter (24%) had experienced 3 or more different events. Women exposed to any traumatic event had a 43% increase in the odds of experiencing IPV in comparison to those with no exposure (aOR 1.43, p≤0.000). Exposure to non-partner rape is more strongly associated with IPV than any other traumatic experience. Pathways from exposure to traumatic events and non-partner rape to recent IPV experience are mediated by a latent variable of poor mental health. Food insecurity is associated with all forms of traumatic experience, and is also indirectly associated with IPV through views by women that are unsupportive of gender equality. CONCLUSIONS: Women living in South African informal settlements who witness or experience traumatic events were likely to experience IPV, and this increases when women were exposed to multiple types of events. Our model suggests that experiencing traumatic events, and non-partner rape in particular, has negative effects on women's mental health in ways that may increase their vulnerability to IPV. IPV prevention interventions should consider the broader impacts of women's exposure to neighbourhood violence and severe poverty on IPV risk in settings where these are endemic. TRIAL REGISTRATION NUMBER: NCT03022370; post-results