Posttraumatic Stress Disorder Symptoms Mediate the Relationship Between Traumatic Experiences and Drinking Behavior Among Women Attending Alcohol Serving Venues in a South African Township

Abstract

ABSTRACT. Objective: South Africa has high rates of traumatic experiences and alcohol abuse or dependence, especially among women. Traumatic experiences often result in symptoms of posttraumatic stress disorder (PTSD), and PTSD has been associated with hazardous drinking. This article examines the relationship between traumatic events and hazardous drinking among women who patronized alcohol-serving venues in South Africa and examines PTSD as a mediator of this relationship. Method: A total of 560 women were recruited from a Cape Town township. They completed a computerized assessment that included alcohol consumption, history of traumatic events, and PTSD symptoms. Mediation analysis examined whether PTSD symptoms mediated the relationship between the number of traumatic event categories experienced (range: 0-7) and drinking behavior. Results: The mean Alcohol Use Disorders Identifi cation Test score in the sample was 12.15 (range: 0-34, SD = 7.3), with 70.9% reaching criteria for hazardous drinking (AUDIT ≥ 8). The mean PTSD score was 36.32 (range: 17-85, SD = 16.3), with 20.9% meeting symptom criteria for PTSD (PTSD ChecklistCivilian Version ≥ 50). Endorsement of traumatic experiences was high, including adult emotional (51.8%), physical (49.6%), and sexual (26.3%) abuse; childhood physical (35.0%) and sexual (25.9%) abuse; and other types of trauma (83%). All categories of traumatic experiences, except the "other" category, were associated with hazardous drinking. PTSD symptoms mediated 46% of the relationship between the number of traumatic categories experienced and drinking behavior. Conclusions: Women reported high rates of hazardous drinking and high levels of PTSD symptoms, and most had some history of traumatic events. There was a strong relationship between traumatic exposure and drinking levels, which was largely mediated by PTSD symptoms. Substance use interventions should address histories of trauma in this population, where alcohol may be used in part to cope with past traumas. (J. Stud. Alcohol Drugs, 73, 549-558, 2012)

Impact of Sexual Trauma on HIV Care Engagement: Perspectives of Female Patients with Trauma Histories in Cape Town, South Africa

“…It is estimated that one-quarter to one-half of South African women have experienced a lifetime history of physical or sexual assault from a male partner (3-5), and in one study, one in ten experienced sexual assault from a non-partner (5). Because interpersonal violence is often co-occuring (4, 6) and may have a cumulative and interactive effect (7), it can be difficult to determine the independent effects of sexual violence. Experiences of interpersonal violence, and sexual trauma in particular, often result in traumatic stress symptoms, which affect cognitive, behavioral, and emotional functioning (8-10).…”

Traumatic Stress and the Mediating Role of Alcohol Use on HIV-Related Sexual Risk Behavior

“…The study sampling and recruitment procedures have been described in detail previously. 9,27,29 In brief, 12 venues were selected for inclusion in the study, ranging in size (licensed taverns and unlicensed shebeens ), geographic distribution in the township, and ethnic diversity with some venues predominantly attended by Coloured (a recognized South African ethnic group of mixed-race ancestry) or by Black African patrons. From the 12 venues, female patrons were eligible if they attended the venue regularly, were at least 18 years old and lived in the study township.…”

“…26 In addition, traumatic experiences and stress symptoms are associated with increased alcohol use. 27 Therefore, women may try to cope with the traumatic stress by turning to alcohol as a form of self-medication. 28 …”

The Role of Alcohol Expectancies in Drinking Behavior among Women with Alcohol Use Disorder and Comorbid Posttraumatic Stress Disorder

“…Likewise, among a sample of female civilians and veterans with comorbid PTSD and alcohol dependence, Lehavot and colleagues (2013) found that reasons for drinking related to reducing negative affect were associated with amount of alcohol consumed on a typical occasion. This “self-medication hypothesis” also yielded support in samples of female survivors of intimate partner violence (IPV; e.g., sexual assault, domestic violence) (Kaysen et al, 2007; Watt et al, 2012) and adolescents (Dixon et al, 2009). …”