Exposure to Violence and Mental Health Outcomes Among Pre-schoolers in a South African Birth Cohort

Lucinda Tsunga, Jon Heron, Marilyn T. Lake, Sarah L. Halligan, Susan Malcolm-Smith, Nadia Hoffman, Heather J. Zar, Abigail Fraser, Dan J. Stein, Kirsten A Donald

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Little is known about the relationship between violence exposure and mental health in preschoolers living in low- and middle-income countries (LMICs). Multiple regression analyses investigated associations between violence exposure and mental health in the Drakenstein Child Health Study (N = 978), a South African birth cohort. Lifetime violence exposure was assessed at age 4.5 years using the parent-report Child Exposure to Community Violence Checklist (CECV). Mental health was assessed at age 5 years using the Child Behaviour Checklist (CBCL 1.5–5). Eighty-three percent of the children were exposed to some form of violence. Internalising and externalising behaviours were positively associated with overall violence exposure (β per one unit change in the overall score = 0.55 [0.16, 0.94] and β = 0.53 [0.23, 0.84], respectively), domestic victimisation (β per one unit change in the subscore = 1.28 [0.28, 2.27]; β = 1.14 [0.37, 1.90]) and witnessing community violence (β = 0.77 [0.15, 1.39]; β = 0.68 [0.19, 1.18]). There was a positive association between polyvictimisation and externalising (β = 1.02 [0.30, 1.73]) but not internalising (β = 0.87 [-0.06, 1.80]) behaviour problems. Evidence for an association of witnessing domestic violence with internalising (β = 0.63 [-0.97, 2.24]) or externalising (β = 1.23 [-0.04, 2.50]) behaviours was less robust. There was no association between community victimisation and internalising or externalising behaviours (β = 0.72 [-1.52, 2.97; β = 0.68 [ -1.06, 2.41]). Observations highlight the risk for mental health problems among preschoolers living in high-violence contexts and emphasize the need for early interventions.

Original languageEnglish
JournalResearch on Child and Adolescent Psychopathology
Early online date11 Jun 2024
Publication statusE-pub ahead of print - 11 Jun 2024

Data Availability Statement

Data can be made available on request. Collaborations for the analysis of data are welcome; the parent study has a large and active group of investigators and postgraduate students and many have successfully partnered with students or researchers from other institutions. Researchers who are interested in collaborations can find more information on our website [http://www.paediatrics.uct.ac.za/scah/dclhs].


  • Community violence
  • Domestic violence
  • Maltreatment
  • Mental health
  • Polyvictimisation
  • Pre-schoolers

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Developmental and Educational Psychology

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