Exposure to community violence increases teen boys' risk for mental illness

On 19 September, a 13-year-old girl was caught up in a gang shooting in the Cape Flats. She survived. Eleven-year-old Nehemiah Claassen was not so lucky. His death, just weeks before, brought community members out onto the streets to demand an end to gang violence. As many as 90% of adolescents in the Western Cape have seen community violence, by some estimates. What impact does chronic violence have on adolescents’ mental health? By Andrea Teagle

Teenagers growing up in South Africa are exposed to some of the highest rates of violence in the world. Focusing on a sample of adolescents who accessed mental health care in the Western Cape, a team of researchers, led by Dr Geri Donenberg of the University of Illinois at Chicago, found that exposure to violence was linked to mental-health problems in boys. 

However, rather than internalising these problems, which would result in depression or anxiety, the boys were acting out, displaying delinquency, aggression and violence. And the greater the exposure to violence, the more externalised mental-health problems the boys displayed.

“We are suffering from gendered violence, community violence — many types of violence because we are quite desensitised as a country …” said HSRC researcher Dr Jacqueline Mthembu, who was part of the study team. “And the cycle of violence is influenced by our youth observing normalised problem-solving behaviour. Unfortunately, masculinities, in relation to violence specifically, are about boys showing strength and toughness and sometimes acting violently.”

Local and international research has previously shown a strong link between witnessing and experiencing violence and mental-health problems in teens. However, Mthembu said, “This connection hasn’t been made among this group of youth … children with diagnosed mental illnesses.”

Adolescents already struggling with mental health were potentially at higher risk; however, the authors note that, because the adolescents are already connected to mental health-care services, interventions looking specifically at the psychological effects of violence might be implemented more easily.

Parents, friends and mental health  
The study team expected that exposure to violence might explain some of the mental-health struggles of teens. However, they wanted to dig a little deeper to understand some of the avenues from witnessing violence to mental-health problems.

They recruited 120 guardians and their adolescent kids from four public mental health-care facilities in the Western Cape. In most cases, the caretakers were the kids’ mothers or otherwise their grandmothers.  Then, they collected information about exposure to violence, the teens’ mental health, their relationships with their parents, and what their friends were like. They wanted to see how these variables interacted by applying a model called the Social-Personal Framework. This model is based on past research and proposes specific pathways through which violence can lead to mental-health problems.

The framework proposes that social support (or lack thereof) can influence the effects that exposure to violence has on mental health. For example, a kid exposed to violence might withdraw from their parents, or start hanging out with friends who encourage risky behaviours. Both of these might lead to mental-health problems. Conversely, if a kid has a strong relationship with caregivers, that might make them less likely to suffer mental-health issues.

The team was also interested in how the mental-health effects may manifest. The model includes two categories of symptoms of mental-health problems: internalised symptoms (depression and anxiety) and externalised symptoms (impulsivity, aggression, etc.). Based on previous research, the authors expected that exposure to community violence would be more strongly associated with externalised problems than internalised problems. They also expected that boys might face higher rates of violence than girls. 

In July 2018, the South African National Defence Force was deployed to assist the police to quell gang violence in the Cape Flats, Cape Town.
Photo: Ashraf Hendricks, GroundUp (CC BY-ND 4.0)

Cycles of violence
The first surprise was that boys and girls were both exposed to high levels of community violence, with boys’ exposure only slightly greater. “The idea that boys are more [often] on the streets or in the community and girls are more homebound does not play out here,” the authors pointed out. “Because when it comes to community violence, girls and boys are exposed at similar levels.”

A regression analysis revealed that boys exposed to violence had significantly more mental-health problems, and these problems were externalised. Exposure to violence was also linked to having risk-approving friends, which in turn was linked to externalised mental-health problems.
Why are these psychological impacts externalised? Theory suggests that this happens when kids become desensitised to normalised violence, or internalise violence as a legitimate way of resolving conflict, the authors write. Kids might also behave aggressively to avoid feeling hopeless or scared. According to social-learning theory, children model their relationships on early experiences; boys who witness violence might identify with the aggressor and mimic this behaviour, maintaining the cycles of violence.

“The stress of [feeling like you have to act] in a certain way, as a man, as a boy, as a boy aspiring to [be] a man, will always be there, unless we reconstruct or deconstruct what it means to be a man,” Mthembu said. Strong parental attachment was linked to lower externalised mental-health problems among boys in the study, suggesting that parental support might help to mitigate this effect. Previous research has yielded mixed results on the buffering effects of parental support.

It is also possible that causality went in the opposite direction — for example, boys with externalised problems might seek out risk-encouraging peers and violent situations — or a third factor (such as poverty) might be independently responsible for both social-environment and mental-health problems. Because the study was cross-sectional, it provided only a snapshot of the associations between the variables, and could not confirm the proposed pathways or causality

Gender-specific interventions
Interestingly, the study did not find a significant relationship between exposure to violence and mental-health issues among girls. The only significant association was that between low parental attachment and peer support of risky behaviour.

Other research has suggested that mental-health problems among girls are more closely correlated with exposure to sexual violence than community violence. Although exposure to community violence can sometimes work as a proxy for other types of violence, the possible role of sexual violence on girls’ mental health was not directly captured in this study.

“The take-home from this paper is about the importance of context-specific, gender-specific interventions that are not just located in the school programme, but are more localised [and] that anyone can access,” Mthembu said.

Author: Andrea Teagle, a science writer in the HSRC’s Impact Centre