Objective: To investigate the relationships between exposure to life-course traumatic events (TEs) and later life mental, physical, and cognitive health outcomes in the older population of a rural South African community. Method: Data were from baseline interviews with 2,473 adults aged ≥40 years in the population-representative Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI) study, conducted in 2015. We assessed exposure to 16 TEs, and used logistic regression models to estimate associations with depression, post-traumatic stress disorder (PTSD), activities of daily living disability, and cognitive impairment. Results: Participants reported an average of 5 (SD = 2.4) TEs over their lifetimes. Exposure was ubiquitous across sociodemographic and socioeconomic groups. Trauma exposure was associated with higher odds of depression, PTSD, and disability, but not with cognitive health. Discussion: Results suggest that TEs experienced in earlier life continue to reverberate today in terms of mental health and physical disability outcomes in an older population in rural South Africa.
AbrahamsN.MathewsS.MartinL. J.LombardC.JewkesR. (2013). Intimate partner femicide in South Africa in 1999 and 2009. PLOS Medicine, 10(4), Article e1001412. https://doi.org/10.1371/journal.pmed.1001412
2.
AlonsoJ.ChatterjiS.HeY. (2013). The burdens of mental disorders: Global perspectives from the WHO World Mental Health Surveys. Cambridge University Press
3.
AndradeL. H.AlonsoJ.MneimnehZ.WellsJ. E.Al-HamzawiA.BorgesG.. . . KesslerR. C. (2014). Barriers to mental health treatment: Results from the WHO World Mental Health surveys. Psychological Medicine, 44(6), 1303–1317. https://doi.org/10.1017/S0033291713001943
4.
AtwoliL.PlattJ. M.BasuA.WilliamsD. R.SteinD. J.KoenenK. C. (2016). Associations between lifetime potentially traumatic events and chronic physical conditions in the South African Stress and Health Survey: A cross-sectional study. BMC Psychiatry, 16(1), Article 214. https://doi.org/10.1186/s12888-016-0929-z
5.
AtwoliL.PlattJ. M.WilliamsD. R.SteinD. J.KoenenK. C. (2015). Association between witnessing traumatic events and psychopathology in the South African Stress and Health Study. Social Psychiatry & Psychiatric Epidemiology, 50(8), 1235–1242. https://doi.org/10.1007/s00127-015-1046-x
6.
AtwoliL.SteinD. J.WilliamsD. R.MclaughlinK. A.PetukhovaM.KesslerR. C.KoenenK. C. (2013). Trauma and posttraumatic stress disorder in South Africa: Analysis from the South African Stress and Health Study. BMC Psychiatry, 13, Article 182. https://doi.org/10.1186/1471-244X-13-182
BenjetC.BrometE.KaramE. G.KesslerR. C.McLaughlinK. A.RuscioA. M.. . . KoenenK. C. (2016). The epidemiology of traumatic event exposure worldwide: Results from the World Mental Health Survey Consortium. Psychological Medicine, 46(2), 327–343. https://doi.org/10.1017/S0033291715001981
9.
BlanchetteI.RutembesaE.HabimanaE.CaparosS. (2019). Long-term cognitive correlates of exposure to trauma: Evidence from Rwanda. Psychological Trauma: Theory, Research, Practice and Policy, 11(2), 147–155. https://doi.org/10.1037/tra0000388
10.
BreslauN.PetersonE. L.KesslerR. C.SchultzL. R. (1999). Short screening scale for DSM-IV posttraumatic stress disorder. The American Journal of Psychiatry, 156(6), 908–911. https://doi.org/10.1176/ajp.156.6.908
11.
CiarleglioM. M.AslanM.ProctorS. P.ConcatoJ.KoJ.KaiserA. P.VasterlingJ. J. (2018). Associations of stress exposures and social support with long-term mental health outcomes among U.S. Iraq war veterans. Behavior Therapy, 49(5), 653–667. https://doi.org/10.1016/j.beth.2018.01.002
12.
CohnE. G.BreetzkeG. D. (2017). The periodicity of violent and property crime in Tshwane, South Africa. International Criminal Justice Review, 27(1), 60–71. https://doi.org/10.1177/1057567716681637
13.
CreamerM.ParslowR. (2008). Trauma exposure and posttraumatic stress disorder in the elderly: A community prevalence study. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 16(10), 853–856. https://doi.org/10.1097/01.JGP.0000310785.36837.85
14.
DaneseA.McEwenB. S. (2012). Adverse childhood experiences, allostasis, allostatic load, and age-related disease. Physiology & Behavior, 106(1), 29–39. https://doi.org/10.1016/j.physbeh.2011.08.019
15.
DaneseA.MoffittT. E.HarringtonH.MilneB. J.PolanczykG.ParianteC. M.CaspiA. (2009). Adverse childhood experiences and adult risk factors for age-related disease: Depression, inflammation, and clustering of metabolic risk markers. Archives of Pediatrics & Adolescent Medicine, 163(12), 1135–43. https://doi.org/10.1001/archpediatrics.2009.214
16.
FalkinghamJ.EvandrouM.QinM.VlachantoniA. (2019). Accumulated lifecourse adversities and depressive symptoms in later life among older men and women in England: A longitudinal study. Ageing & Society, 1–27. https://doi.org/10.1017/S0144686X19000461
17.
FerraroK. F.ShippeeT. P. (2009). Aging and cumulative inequality: How does inequality get under the skin?The Gerontologist, 49(3), 333–343. https://doi.org/10.1093/geront/gnp034
18.
GeldsetzerP.VaikathM.WagnerR.RohrJ. K.MontanaL.Gómez-OlivéF. X.. . . BerkmanL. F. (2018). Depressive symptoms and their relation to age and chronic diseases among middle-aged and older adults in rural South Africa. The Journals of Gerontology: Series A, Biological Sciences & Medical Sciences, 74, 957–63. https://doi.org/10.1093/gerona/gly145
19.
GersonyR. (1988). Summary of Mozambican refugee accounts of principally conflict-related experience in Mozambique: Report submitted to Ambassador Jonathan Moore, Director, Bureau for Refugee Programs; Dr. Chester A. Crocker, Assistant Secretary of African Affairs. Bureau for Refugee Programs, Department of State.
20.
Gómez-OlivéF. X.MontanaL.WagnerR. G.KabudulaC. W.RohrJ. K.KahnK.. . . BerkmanL. (2018). Cohort profile: Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI). International Journal of Epidemiology, 47, 689–690. https://doi.org/10.1093/ije/dyx247
21.
HardtJ.RutterM. (2004). Validity of adult retrospective reports of adverse childhood experiences: Review of the evidence. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 45(2), 260–273.
22.
HargreavesJ. R.CollinsonM. A.KahnK.ClarkS. J.TollmanS. M. (2004). Childhood mortality among former Mozambican refugees and their hosts in rural South Africa. International Journal of Epidemiology, 33(6), 1271–1278. https://doi.org/10.1093/ije/dyh257
23.
HarlingG.PayneC. F.DaviesJ. I.Gomez-OliveF. X.KahnK.MandersonL.. . . WithamM. D. (2019). Impairment in activities of daily living, care receipt, and unmet needs in a middle-aged and older rural South African population: Findings from the HAALSI study. Journal of Aging and Health. Advance online publication. https://doi.org/10.1177/0898264318821220
24.
HatchS. L.DohrenwendB. P. (2007). Distribution of traumatic and other stressful life events by race/ethnicity, gender, SES and age: A review of the research. American Journal of Community Psychology, 40(3–4), 313–332. https://doi.org/10.1007/s10464-007-9134-z
HendricksonL. C. M.NeylanT. C.NaB.ReganM.ZhangQ.CohenB. E. (2013). Lifetime trauma exposure and prospective cardiovascular events and all-cause mortality: Findings from the heart and soul study. Psychosomatic Medicine, 75(9), 849–855. https://doi.org/10.1097/PSY.0b013e3182a88846
27.
HermanA. A.SteinD. J.SeedatS.HeeringaS. G.MoomalH.WilliamsD. R. (2009). The South African Stress and Health (SASH) study: 12-month and lifetime prevalence of common mental disorders. South African Medical Journal, 99(5), 339–344. https://www.ajol.info/index.php/samj/article/view/50764
28.
KabudulaC. W.HouleB.CollinsonM. A.KahnK.Gómez-OlivéF. X.ClarkS. J.TollmanS. (2017). Progression of the epidemiological transition in a rural South African setting: Findings from population surveillance in Agincourt, 1993–2013. BMC Public Health, 17(1), Article 424. https://doi.org/10.1186/s12889-017-4312-x
29.
KahnK.CollinsonM. A.Gómez-OlivéF. X.MokoenaO.TwineR.MeeP.. . . TollmanS. M. (2012). Profile: Agincourt health and socio-demographic surveillance system. International Journal of Epidemiology, 41(4), 988–1001. https://doi.org/10.1093/ije/dys115
30.
KaminerD.GrimsrudA.MyerL.SteinD. J.WilliamsD. R. (2008). Risk for post-traumatic stress disorder associated with different forms of interpersonal violence in South Africa. Social Science & Medicine, 67(10), 1589–1595. https://doi.org/10.1016/j.socscimed.2008.07.023
31.
KatzS.FordA. B.MoskowitzR. W.JacksonB. A.JaffeM. W. (1963). Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. Journal of the American Medical Association, 185, 914–919.
32.
KaufmanJ.Montalvo-OrtizJ. L.HolbrookH.O’LoughlinK.OrrC.KearneyC.. . . HudziakJ. (2018). Adverse childhood experiences, epigenetic measures, and obesity in youth. The Journal of Pediatrics, 202, 150–156.e3. https://doi.org/10.1016/j.jpeds.2018.06.051
33.
KeinanG.ShriraA.ShmotkinD. (2012). The association between cumulative adversity and mental health: Considering dose and primary focus of adversity. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 21(7), 1149–1158. https://doi.org/10.1007/s11136-011-0035-0
34.
KesslerR. C.Aguilar-GaxiolaS.AlonsoJ.BenjetC.BrometE. J.CardosoG.. . . KoenenK. C. (2017). Trauma and PTSD in the WHO World Mental Health surveys. European Journal of Psychotraumatology, 8(Suppl. 5), Article 1353383. https://doi.org/10.1080/20008198.2017.1353383
35.
KesslerR. C.Aguilar-GaxiolaS.AlonsoJ.ChatterjiS.LeeS.ÜstünT. B. (2009). The WHO World Mental Health (WMH) surveys. Psychiatrie, 6(1), 5–9.
36.
KimhiS.HantmanS.GoroshitM.EshelY.ZysbergL. (2012). Elderly people coping with the aftermath of war: Resilience versus vulnerability. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric Psychiatry, 20(5), 391–401. https://doi.org/10.1097/JGP.0b013e31821106b3
37.
KobayashiL. C.GlymourM. M.KahnK.PayneC. F.WagnerR. G.MontanaL.. . . BerkmanL. F. (2017). Childhood deprivation and later-life cognitive function in a population-based study of older rural South Africans. Social Science & Medicine, 190(Suppl. C), 20–28. https://doi.org/10.1016/j.socscimed.2017.08.009
38.
KobayashiL. C.MateenF. J.MontanaL.WagnerR. G.KahnK.TollmanS. M.. . . BerkmanL. F. (2019). Cognitive function and impairment in older, rural South African adults: Evidence from “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in Rural South Africa.”Neuroepidemiology, 52(1–2), 32–40. https://doi.org/10.1159/000493483
39.
KrauseN.ShawB. A.CairneyJ. (2004). A descriptive epidemiology of lifetime trauma and the physical health status of older adults. Psychology and Aging, 19(4), 637–648. https://doi.org/10.1037/0882-7974.19.4.637
40.
LaiS.ShenC.YangX.ZhangX.XuY.LiQ.ZhouZ. (2019). Socioeconomic inequalities in the prevalence of chronic diseases and preventive care among adults aged 45 and older in Shaanxi Province, China. BMC Public Health, 19(1), Article 1460. https://doi.org/10.1186/s12889-019-7835-5
41.
LevineS. Z. (2013). Evaluating the seven-item Center for Epidemiologic Studies Depression Scale short-form: A longitudinal U.S. community study. Social Psychiatry & Psychiatric Epidemiology, 48(9), 1519–1526. https://doi.org/10.1007/s00127-012-0650-2
42.
MenonB.CherkilS.AswathyS.UnnikrishnanA. G.RajaniG. (2012). The process and challenges in the translation of World Health Organization Quality of Life (WHOQOL-BREF) to a regional language; Malayalam. Indian Journal of Psychological Medicine, 34(2), 149–152. https://doi.org/10.4103/0253-7176.101783
43.
MunroC. A.WennbergA. M.BienkoN.EatonW. W.LyketsosC. G.SpiraA. P. (2019). Stressful life events and cognitive decline: Sex differences in the Baltimore Epidemiologic Catchment Area Follow-Up Study. International Journal of Geriatric Psychiatry, 34(7), 1008–1017. https://doi.org/10.1002/gps.5102
44.
NaidooK.van WykJ. (2019). What the elderly experience and expect from primary care services in KwaZulu-Natal, South Africa. African Journal of Primary Health Care & Family Medicine, 11(1). https://doi.org/10.4102/phcfm.v11i1.2100
45.
NuriusP. S.GreenS.Logan-GreeneP.BorjaS. (2015). Life course pathways of adverse childhood experiences toward adult psychological well-being: A stress process analysis. Child Abuse & Neglect, 45, 143–153. https://doi.org/10.1016/j.chiabu.2015.03.008
46.
OtienoG.MarindaE.BärnighausenT.TanserF. (2015). High rates of homicide in a rural South African population (2000–2008): Findings from a population-based cohort study. Population Health Metrics, 13(1). https://doi.org/10.1186/s12963-015-0054-0
47.
PatelV.SaxenaS.LundC.ThornicroftG.BainganaF.BoltonP.. . . UnÜtzerJ. (2018). The Lancet Commission on global mental health and sustainable development. The Lancet, 392(10157), 1553–1598. https://doi.org/10.1016/S0140-6736(18)31612-X
48.
PayneC. F.KohlerH.-P. (2017). The population-level impact of public-sector antiretroviral therapy rollout on adult mortality in rural Malawi. Demographic Research, 36(37), 1081–1108. https://doi.org/10.4054/DemRes.2017.36.37
49.
PayneC. F.MkandawireJ.KohlerH. P. (2013). Disability transitions and health expectancies among adults 45 years and older in Malawi: A cohort-based model. PLOS Medicine, 10(5), Article e1001435.
50.
PayneC. F.WadeA.KabudulaC. W.DaviesJ. I.ChangA. Y.Gomez-OliveF. X.. . . WithamM. D. (2017). Prevalence and correlates of frailty in an older rural African population: Findings from the HAALSI cohort study. BMC Geriatrics, 17(1). https://doi.org/10.1186/s12877-017-0694-y
51.
PearlinL. I. (2010). The life course and the stress process: Some conceptual comparisons. The Journals of Gerontology, Series B: Psychological Sciences & Social Sciences, 65(2), 207–215. https://doi.org/10.1093/geronb/gbp106
52.
PearlinL. I.MenaghanE. G.LiebermanM. A.MullanJ. T. (1981). The stress process. Journal of Health and Social Behavior, 22(4), 337–356. https://doi.org/10.2307/2136676
53.
PearlinL. I.SchiemanS.FazioE. M.MeersmanS. C. (2005). Stress, health, and the life course: Some conceptual perspectives. Journal of Health and Social Behavior, 46(2), 205–219. https://doi.org/10.1177/002214650504600206
54.
QureshiS. U.LongM. E.BradshawM. R.PyneJ. M.MagruderK. M.KimbrellT.. . . KunikM. E. (2011). Does PTSD impair cognition beyond the effect of trauma?The Journal of Neuropsychiatry and Clinical Neurosciences, 23(1), 16–28. https://doi.org/10.1176/jnp.23.1.jnp16
55.
RadloffL. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306
56.
ReidS. J.PeacockeJ.KornikS.WolvaardtG. (2018). Compulsory community service for doctors in South Africa: A 15-year review. South African Medical Journal/Suid-afrikaanse Tydskrif Vir Geneeskunde, 108(9), 741–747. https://doi.org/10.7196/SAMJ.2018.v108i9.13070
57.
RiemM. M. E.KarremanA. (2019). Childhood adversity and adult health: The role of developmental timing and associations with accelerated aging. Child Maltreatment, 24, 17–25. https://doi.org/10.1177/1077559518795058
58.
RitchieK.JaussentI.StewartR.DupuyA.-M.CourtetP.MalafosseA.AncelinM.-L. (2011). Adverse childhood environment and late-life cognitive functioning. International Journal of Geriatric Psychiatry, 26(5), 503–510. https://doi.org/10.1002/gps.2553
59.
Riumallo-HerlC.CanningD.KabudulaC. (2019). Health inequalities in the South African elderly: The importance of the measure of social-economic status. The Journal of the Economics of Ageing, 14. https://doi.org/10.1016/j.jeoa.2019.01.005
60.
ScottK. M.KoenenK. C.Aguilar-GaxiolaS.AlonsoJ.AngermeyerM. C.BenjetC.KesslerR. C. (2013). Associations between lifetime traumatic events and subsequent chronic physical conditions: A cross-national, cross-sectional study. PLOS ONE, 8(11), Article e80573. https://doi.org/10.1371/journal.pone.0080573
61.
SimbayiL. C.ZumaK.ZunguN. (2019). South African national HIV prevalence, incidence, behaviour and communication survey 2017. HSRC Press.
62.
StataCorp. (2017). Stata Statistical Software: Release 15.
SteffickD. E. (2000). Documentation of affective functioning measures in the health and retirement study. Institute for Social Research, University of Michigan.
66.
SteptoeA.BreezeE.BanksJ.NazrooJ. (2013). Cohort profile: The English longitudinal study of ageing. International Journal of Epidemiology, 42(6), 1640–1648. https://doi.org/10.1093/ije/dys168
67.
SugliaS. F.KoenenK. C.Boynton-JarrettR.ChanP. S.ClarkC. J.DaneseA.. . . ZachariahJ. P. (2018). Childhood and adolescent adversity and cardiometabolic outcomes: A scientific statement from the American Heart Association. Circulation, 137(5), e15–e28. https://doi.org/10.1161/CIR.0000000000000536
68.
SugliaS. F.SapraK. J.KoenenK. C. (2015). Violence and cardiovascular health: A systematic review. American Journal of Preventive Medicine, 48(2), 205–212. https://doi.org/10.1016/j.amepre.2014.09.013
69.
SumnerJ. A.KubzanskyL. D.ElkindM.RobertsA. L.Agnew-BlaisJ.ChenQ.. . . KoenenK. C. (2015). Trauma exposure and posttraumatic stress disorder symptoms predict onset of cardiovascular events in women. Circulation, 132(4), 251–259. https://doi.org/10.1161/CIRCULATIONAHA.114.014492
70.
TettehJ.KogiR.YawsonA. O.MensahG.BiritwumR.YawsonA. E. (2019). Effect of self-rated health status on functioning difficulties among older adults in Ghana: Coarsened exact matching method of analysis of the World Health Organization’s study on global AGEing and adult health, Wave 2. PLOS ONE, 14(11), Article e0224327. https://doi.org/10.1371/journal.pone.0224327
TsolakiM.PapaliagkasV.KountiF.MessiniC.BozikiM.AnogianakisG.VlaikidisN. (2010). Severely stressful events and dementia: A study of an elderly Greek demented population. Psychiatry Research, 176(1), 51–54. https://doi.org/10.1016/j.psychres.2009.06.001
73.
United Nations. (1963). Apartheid in South Africa: Summary of the report of the special committee on the policies of apartheid of the government of South Africa.
74.
VitalianoP. P.FitzpatrickA. L.WilliamsL. E.MontanoM. A.RussoJ. E. (2018). Demographic-specific rates for life events in the cardiovascular health study and comparisons with other studies. Innovation in Aging, 2(1). https://doi.org/10.1093/geroni/igy005
75.
WeinsteinJ. M.FranciscoL. (2005). The civil war in Mozambique: The balance between internal and external influences. In CollierP.SambanisN. (eds), Understanding civil war: Africa (pp. 157–192). World Bank Publications.
76.
WiehnJ.HornbergC.FischerF. (2018). How adverse childhood experiences relate to single and multiple health risk behaviours in German public university students: A cross-sectional analysis. BMC Public Health, 18(1), Article 1005. https://doi.org/10.1186/s12889-018-5926-3
77.
WilliamsD. R.HermanA.KesslerR. C.SonnegaJ.SeedatS.SteinD. J.. . . WilsonC. M. (2004). The South Africa Stress and Health Study: Rationale and design. Metabolic Brain Disease, 19(1–2), 135–147.
78.
World Health Organization World Mental Health Survey Consortium. (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of the American Medical Association, 291(21), 2581–2590. https://doi.org/10.1001/jama.291.21.2581
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