Does interpersonal violence mediate the association between adverse childhood experiences and internalizing symptoms among women?

Adverse childhood experiences (ACEs) and violence against women are both urgent public health crises, especially in low- and middle-income countries. ACEs and interpersonal violence are both linked to the development of internalizing mental health outcomes. However, the role of interpersonal violence in the association between ACEs and internalizing symptoms among women in South Africa has yet to be established. Therefore, this study aimed to assess whether interpersonal violence mediated the association between ACEs and internalizing symptoms among women in Soweto, South Africa. Data from baseline and 18-month follow-up from a large, longitudinal cohort that participated in the Bukhali trial (N = 862) were used in the current study. Mediation analyses examined the associations between ACEs, interpersonal violence victimization (violence exposure, violence dose, and number of perpetrators), and internalizing symptoms (i.e., anxiety, depression). The moderating role of perpetrator identity in the relationship between violence dose and internalizing symptoms was examined using regression. Results indicated that violence exposure, violence dose, and the number of perpetrators significantly mediated the association between ACEs and internalizing symptoms. Additionally, violence from a relative or distant individual strengthened the association between violence dose and internalizing symptoms compared to violence from an intimate partner. Results from this study highlight that interpersonal violence is an important risk factor in the developmental cascade from ACEs to internalizing symptoms in women in Soweto.