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JIVXXX10.1177/0886260516682522Journal of Interpersonal ViolenceOshodi et al.

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Journal of Interpersonal Violence
1­–16
Immediate and Long- © The Author(s) 2016
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DOI: 10.1177/0886260516682522
Outcomes in Adolescent jiv.sagepub.com

Female Rape Survivors

Yewande Oshodi,1,2 Muiruri Macharia,1

Anusha Lachman,1 and Soraya Seedat1

Abstract
Rape is considered a stressful trauma and often has long-lasting health
consequences. Compared with adult females, limited data exist on the
psychological impact of rape in adolescents. The aim of this study was to
assess the prevalence and associated factors of emotional distress in a cohort
of adolescent rape survivors in Cape Town. Participants in this prospective
longitudinal study were 31 adolescent female rape survivors recruited from a
rape clinic in Cape Town and assessed within 2 weeks of the assault. Assessment
measures included a sociodemographic questionnaire and initial screening
with the Child and Adolescent Trauma Survey (CATS), the patient-rated
Children’s Depression Inventory (CDI), and the Multidimensional Anxiety
Scale for Children (MASC). The CATS, CDI, and MASC were repeated at 1,
3, 6, 9, and 12 months post enrollment. Psychiatric diagnoses were made with
the clinician-administered Mini International Neuropsychiatric Interview–
Child and Adolescent version (MINI-Kid). At baseline, on the MINI-Kid,
a definitive diagnosis of major depressive episode was endorsed in 22.6%
of the participants. Stress-related disorders were found in 12.9%, whereas
16.1% had anxiety disorders. There was no diminution of symptoms on self-

1Stellenbosch University, Cape Town, South Africa

2University of Lagos, Nigeria

Corresponding Author:
Soraya Seedat, Department of Psychiatry, Stellenbosch University, Second Floor, Clinical
Building, Tygerberg Campus, Francie van Zijl Drive, Cape Town, Western Cape 7505,
South Africa.
Email: sseedat@sun.ac.za
2 Journal of Interpersonal Violence 

reported psychopathology measures at follow-up assessment over the five

follow-up time points, suggesting persistent psychopathology over a 1-year
period despite repeated clinical assessments and supportive counseling.
Symptoms of anxiety, depression, and posttraumatic stress disorder in this
sample of adolescent female rape survivors were high at enrollment and found
to be persistent, underlining the need for long-term support, screening, and
evidence-based follow-up care.

Keywords
adolescent, rape, female, Africa, emotional distress

Background
Sexual violence against women and children is rampant globally, such that
one in three women will be sexually assaulted in their lifetime, with about
30% to 40% of reported incidents involving minors (García-Moreno, 2013;
World Health Organization, 2004). Although the number of reported rape
cases in South Africa has been fairly stable with a modest decrease of 3% in
the last decade (South African Police Service, 2016), the prevalence of sex-
ual offences in this country remains among the highest in the world (Dartnall
& Jewkes, 2013; Kaminer, du Plessis, Hardy, & Benjamin, 2013). The
Western Cape Province has one of the highest prevalence of rape in the
country (South African Police Service, 2016). Up to 40% of rape and
attempted rape cases reported in South Africa in the late 1990s involved
minors (Jewkes & Abrahams, 2002). In a study that examined exposure to
violence among adolescents across multiple sites in South Africa, 8% of
more than 600 adolescent participants reported that they had been sexually
abused (Kaminer et al., 2013).
Adolescent rape survivors may experience a wide range of immediate and
long-term emotional and mental health consequences following assault.
These include depression, posttraumatic stress disorder (PTSD), anxiety, and
feelings of guilt and shame (Ackard, Neumark-Sztainer, Hannan, French, &
Story, 2001; Kendall-Tackett, Williams, & Finkelhor, 1993). PTSD is diag-
nosed as acute when symptoms are present in the first 3 months after the
index trauma and as chronic when symptoms persist beyond 3 months. The
presence of PTSD symptoms in 1 month after the index trauma is referred to
as an acute stress disorder. Rape survivors are more likely to experience
avoidance symptoms (e.g., not wanting to think or talk or have feelings about
the trauma) and less likely to complete stress-targeting therapies (Murphy
et al., 2014). Rape can also result in other psychological sequelae including
Oshodi et al. 3

sexual dysphoria, eating disorders, sleeping disturbances, substance abuse,

suicide, or suicidal ideation (Johnson, 2004; Raj, Silverman, & Amaro, 2000;
Silverman, Raj, Mucci, & Hathaway, 2001). The risk of experiencing nega-
tive mental health sequelae post rape may be more pronounced in adolescents
given their developmental stage, their relatively limited coping skills com-
pared with adults, and the fewer available resources to assist with recovery.
South Africa’s Western Cape Department of Health (2001) has instituted
policy within its Comprehensive Primary Health Care Services that aims to
provide health managers and health workers with a clear framework on the
management of female and male survivors of rape and sexual assault (14
years and older). The policy is further supported by the “National Standardized
guidelines for the management of rape survivors in South Africa” (South
African National Management Guidelines for Sexual Assault, 2003). Current
guidelines emphasize legal and biological interventions and counseling
options of care immediately post rape. There is, however, no structured long-
term support beyond 3 months or long-term interventions contained in the
management guidelines for rape survivors in this region.
Although much research has addressed the health impact of rape among
female survivors in general, there are limited data on its impact specifically
in adolescent female rape survivors in South Africa and other developing
countries. An understanding of the long-term psychiatric outcomes and the
predictors of outcome in this vulnerable population is vital to discerning the
most appropriate intervention. In this study, we examined the immediate and
long-term mental health outcomes in a cohort of adolescent rape survivors in
Cape Town.

Method
Study Design and Procedure
The study design was a longitudinal naturalistic cohort study and it evaluated
the immediate and long-term mental health outcomes (anxiety, depression,
and PTSD) and emotional distress in adolescent females exposed to rape.
This study was nested within a larger study conducted between 2004 and
2014. The parent study aimed to compare the effectiveness of an early
trauma-focused group cognitive-behavioral therapy (CBT) intervention with
repeated clinical assessments in reducing PTSD and depressive symptoms
over a 1-year follow-up period in adolescents recently exposed to rape.
Adolescents included in the current study received repeated weekly clinical
assessments (comprising a brief mental status examination, completion of
self-report questionnaires, and supportive counseling).
4 Journal of Interpersonal Violence 

Study Participants
Study participants were adolescent female rape survivors aged 14 to 18
years old, recruited from a dedicated rape crises clinic in Cape Town that
provides a multi-disciplinary service for rape survivors. Participants were
recruited within a 2-week period post rape. Participants were included in
the study if they had a recent history of rape, were currently in school,
conversant in English or Afrikaans, not living with the perpetrator, and
willing to provide informed consent. They were excluded if they were
suicidal, had a known past history of a major psychiatric disorder, were
using psychotropic medications, or had received any formal psychother-
apy in the preceding 3 months.
All survivors of rape presenting to the Thuthuzela Rape Crisis Clinic
were managed by staff at the clinic in accordance with the policy and stan-
dardized management guidelines as set out by the Western Cape Department
of Health. The routine treatment provided at these centers to date includes
medical screening forensic/legal support and counseling-related interven-
tions. As standard care, the rape survivors are given the option of being
referred for counseling to a social worker, trained counselor (regional spe-
cific), private therapist (e.g., psychologist), rape crisis, or other local ser-
vices. In addition, a follow-up at 6 weeks and at 3 months post rape is
recommended, with the aim of screening for PTSD and other emotional
disorders.

Screening and Enrollment

Eligible adolescents were referred by clinic nurses to the research assistant
and provided with a brief description of the study. Consenting eligible
adolescents returned for an initial screening interview. A total of 31 par-
ticipants were enrolled and all were screened prior to commencing repeated
clinical assessments (RCA). Assessment measures comprised a
Demographic Questionnaire (devised by the investigators) to collect per-
sonal and family information; the MINI-Kid (Mini International
Neuropsychiatric Interview–Child and Adolescent version); the Child and
Adolescent Trauma Survey (CATS; March, 1999; patient-rated), the
Children’s Depression Inventory (CDI; Kovacs, 1985; patient-rated), and
the Multidimensional Anxiety Scale for Children (MASC; March, Parker,
Sullivan, Stallings & Connors, 1997; patient-rated). All participants were
required to complete the MINI-Kid as baseline at enrollment and the other
listed measures (CATS, CDI, MASC) at enrollment and at 1, 3, 6, 9, and
12 months follow-up.
Oshodi et al. 5

Assessment Measures
Sociodemographic Questionnaire. This captured information on age, ethnicity,
language, and education and also included questions about family and current
living circumstances.

MINI-Kid. This was used to make a definitive psychiatric diagnosis. The

MINI-KID is a structured clinical diagnostic interview designed to identify
current psychiatric disorders in children and adolescents aged 6 to 17 years in
a comprehensive and concise manner. It is modelled from the adult version of
the interview (MINI), which has been validated against the Structured Clini-
cal Interview for Diagnostic and Statistical Manual of Mental Disorders
revised 3th edition (DSM-III-R, 1987; Sheehan et al., 1998) and against the
World Health Organization–designed Composite International Diagnostic
Interview (Lecrubier et al., 1997).

The CATS. The CATS was used to assess the severity of posttraumatic stress
symptoms. The CATS is a self-report screening tool that includes both a
PTSD inventory derived from the MASC (March et al., 1997) and the DSM-
IV criteria for PTSD (APA, 1994). The trauma exposure list includes both
direct (happened to me) and vicarious (happened to someone I know well)
lifetime exposure. The 12 items address the core symptom categories of
PTSD (re-experiencing, avoidance, and hyperarousal) and are rated on a
4-point Likert-type scale (scored as 0, 1, 2, and 3), summed to yield a CATS
score. The CATS score correlates well with other measures of PTSD and a
score of 27 or more suggests a probable diagnosis of PTSD. However, a score
of 15 or more was used here as it has been found to be a more sensitive cutoff
in South African adolescents (Suliman, Kaminer, Seedat, & Stein, 2005).

The CDI. Developed in 1979, the CDI is one of the most widely used self-report
scales for depression in youth (Kovacs, 1992) . It is a brief self-report test for
children and adolescents 7 to 17 years of age to screen for the presence and
severity of depressive symptoms. The CDI evaluates cognitive, affective, and
behavioral symptoms of depression as they relate to children, their functioning
at school and with peers. Each item has three possible responses with 0 indicat-
ing the absence of symptoms, 1 mild symptom, and 2 definite symptoms. The
total score ranges from 0 to 54 and the tool has an excellent reliability of .87, as
measured by Cronbach’s alpha (Sitarenios & Stein, 2004).

The MASC. The MASC is a nine-item, 4-point Likert-type self-report scale

for children and adolescents that assesses anxiety symptoms. The MASC
6 Journal of Interpersonal Violence 

measures a cross section of anxiety problems in children and adolescents. It

consists of 39 items across four basic scales (Physical Symptoms, Harm
Avoidance, Social Anxiety, and Separation/Panic), a scale measuring total
anxiety, and two major indexes (anxiety disorder and inconsistency). It has
been shown to have good internal consistency (α = .60-.85) and high test-
retest reliability (r = .79-.93), as well as good convergent validity, as evi-
denced from its significant correlation with other measures of anxiety (March
et al., 1997).

Ethical Considerations
This study was nested within a larger study and was approved by the Health
Research Ethics Committee of Stellenbosch University (Ethics Reference
Numbers: N04/05/093 and IRB0005239). Informed consent was obtained
from participants who were 18 years of age. Participants who were younger
than 18 years provided assent, while informed consent was obtained from
their parents or legal guardians.

Data Analysis
Data were presented as means (standard deviation) for continuous variables
or medians and 25th to 75th percentiles for skewed data and as counts and
percentages for categorical variables. We used Statistical Package for Social
Sciences version 22 (IBM Corp., 2013) and Statistica version 12 (StatSoft,
2013) for analysis. Using the baseline measurement as reference, paired-sam-
ple t tests and Fischer’s least significant difference (LSD) testing were used
to compare mean differences at the various time points. Variables were log-
transformed to approximate normality prior to analysis where necessary, and
the level of statistical significance was set at p < .05.

Results
Sociodemographic Characteristics
Sociodemographic characteristics are presented in Table 1. Participants (N =
31) ranged in age from 14 to 18 years, with a mean age of 15.4 ± 1.2. The
majority, 28 (90.3%), was of mixed ancestry, and almost all (99%) were in
Grade 7. A small proportion lived with both parents (25.8%) but most lived
with one parent who was often the mother (35.5%). There was also a history
of substance use in participants with 17 (54.8%) smoking cigarettes, 18
(58%) regularly taking alcohol, and one participant (3.3%) admitted to using
Oshodi et al. 7

Table 1. Participants’ Sociodemographic Characteristics.

Variables Frequency
N 31
Age, years (SD) 15.4 (1.2)
Ethnicity, n (%)
Black 2 (6.4))
Mixed ancestry 28 (90.3)
Caucasian 1 (3.3)
Education level, n (%)
Grade 7-9 21 (67.7)
Grade 10-12 10 (32.3)
Who adolescent lives with, n (%)
Both parents 8 (25.8)
Mother alone 11 (35.5)
Others/foster/grand parents 11 (35.5)
Substance use habits, n (%)
Smokes cigarettes 17 (54.8)
Consumes alcohol 18 (58.0)
Smokes cannabis (Dagga) 1 (3.3)
Parental details, n (%)
Mother alive 30 (96.8)
Father alive 28 (90.3)
Married 10 (32.3)
Separated/widowed 13 (41.9)
Single parent 8 (25.8)
Maternal alcohol abuse 13 (43.3)

cannabis. About a third (43.3%) of the mothers of participants also used alco-
hol. The average age of initiation of smoking and alcohol use was 7.9 ± 6.9
and 9.4 ± 7.18 years, respectively.

Participants’ Mental Health Profile

At enrollment, based on the MINI-Kid, almost a quarter (22.6%) of the sample
fulfilled criteria for a current major depressive episode, 12.9% had stress-
related symptoms associated with the rape (although diagnosis of PTSD not
met) and 16.1% had a pre-existing anxiety disorder. Disordered eating (45.2%)
and risk for suicide (54.8%) were also disproportionately high in the group
(Table 2). A range of other general emotional disturbances was noted includ-
ing feelings of terror (90.3%), danger (93.5%), and helplessness (96.8%).
8 Journal of Interpersonal Violence 

Table 2. Participants Mental Health Profile.

Outcomes Frequency n (%)

On MINI-Kid (enrollment)
Major depressive episode 7 (22.6)
Posttraumatic stress symptomsa 4 (12.9)
Anxiety disorder 5 (16.1)
Suicide current risk 17 (54.8)
Adjustment disorder 5 (16.1)
Current alcohol dependence 3 (9.7)
Other emotional symptoms
Felt life was in danger 29 (93.5)
Wished to die 18 (58.1)
Wanted another life 9 (29.0)
Felt helpless 30 (96.8)
Felt terrified 28 (90.3)
Bingeing 14 (45.2)

Note. MINI-Kid = Mini International Neuropsychiatric Interview–Child and Adolescent

version; PTSD = posttraumatic stress disorder.
aDiagnosis of PTSD cannot be made as duration criterion of 1 month not met.

Course of Probable Psychopathology (Anxiety, Depressive, and

Stress Disorder Diagnoses) on Repeat CDI, CATS, and MASC
Assessments
Following the initial enrollment of 31 participants, the number of participants
seen at the follow-up visits at Months 1, 3, 6, 9, and 12 were 31, 26, 28, 24,
and 24, respectively. Retention was, therefore, good and ranged from 77.4%
to 100% over the entire 12 months of follow-up.
There was a persistence of probable psychopathology observed in participants
based on their performance on the screening instruments over time. Scores on the
screening instruments were suggestive of depression, PTSD, and anxiety disor-
ders, and seemed to generally persist with minimal fluctuations as assessed on
repeat screening over the year-long evaluation period (Table 3). The high CATS
(and low CDI) scores at baseline stabilized by the first re-assessment and remained
largely unchanged throughout the year. Likewise, the four-domain index of anxi-
ety (MASC) generally stabilized by the second re-assessment (Month 3), with a
gradual reduction in the harm avoidance score, resulting in a significant difference
between Months 3 and 12 (10.5 vs. 8.0, p = .003). A significant difference
(p = .028) was also noted in separation anxiety scores between Months 1 and 6
(10.8 vs. 9.0) and also between 6 and 9 (9.0 vs. 11.6) on an otherwise flat trend.
Oshodi et al. 9

Table 3. Course of Probable Psychopathology (Anxiety, Depressive, and Stress

Disorders Diagnoses) on Repeat Assessments.

Harm Physical Separation Social

Time Point CDI CATS Avoidance Symptoms Anxiety Anxiety
Baseline 23.8a 23.6a 11.5a 15.8a 14.35a 17.1a
Month 1 24.3a,b,c 18.4 10.3a,b 12.7a.b 10.8c 16.5a
Month 3 25.9b 15.8b 10.5b 11.2b 9.8b,c 16.8a
Month 6 26.5b 16.9b 8.9b,c 10.7b 9b 16.4a
Month 9 26.3b 16.7b 9b,c 12.1b 11.6c 17.8a
Month 12 25.5b 17.5b 8c 11.9b 10.6b,c 17.1a

Note. Mean scores in column followed by the same letter do not differ significantly, whereas if
superscript letters differ then observed difference is statistically significant p ≤ .05.
CDI = Children’s Depression Inventory; CATS = Child and Adolescent Trauma Survey.

Discussion
We assessed early and long-term mental health outcomes in adolescent girls
who had been raped. A number exhibited pre-rape psychopathology in the
form of major depression (22.6%) and anxiety (16.1%), and manifested rape-
related posttraumatic stress symptoms in the first 2 weeks of the event (12.9%).
In addition, despite weekly monitoring and support provided over a 6-week
period, symptoms in the main persisted over the 12-month evaluation period,
with minimal fluctuations. Possibly on account of the timing of initial assess-
ment (i.e., within 2 weeks of the rape event), we found rates of psychopathol-
ogy that were lower than the 2-week prevalence for depression (36.1%) and
1-month rate for PTSD (18.7%) reported in a larger cohort from which the
present study derives (Nöthling, Lammers, Martin, & Seedat, 2015). Response
to rape trauma is complex with considerable inter-individual variation (Briere
& Jordan, 2004), such that some may experience severe symptoms or long-
term distress whereas others do not (Kendall-Tackett et al., 1993).
Victims of sexual assault are known to have a significantly higher risk for
suicide, partly because of the sequelae of increased fear, stress, and anxiety
(Downer & Trestman, 2016). In our highly distressed sample, where an over-
whelming majority admitted to feeling helpless and in danger, the risk for
suicide was similarly high (57%). This rate was almost twice that reported in
a sample of rape victims attending a genitourinary clinic in the United
Kingdom with 30.4% (Petrak, Doyle, Williams, Buchan, & Forster, 1997),
although the difference may partly be accounted for by the adult composition
of the sample who may have acquired better coping skills. In addition to the
aforementioned mental health outcomes, we also noted high rates of
10 Journal of Interpersonal Violence 

bingeing, smoking, and alcohol consumption in our sample, which is in line

with previous trauma-related studies (Ackard et al., 2001; Amstadter et al.,
2009; Vlahov, Galea, Ahern, Resnick, & Kilpatrick, 2004). Although eating
and substance disorders have complex etiologies, they can also be triggered
by sexual assault as part of the mechanisms to cope with the trauma (Springer,
2009). Alcohol consumption is a risk factor for rape and the majority of sex-
ual assaults occur when the perpetrator, the victim, or both have consumed
alcohol (Abbey, Zawacki, Buck, Clinton, & McAuslan, 2004; Turner,
Finkelhor, & Ormrod, 2006).
Although we did not assess the role of alcohol use/abuse in the rape
exposure in the sample, the high rate of alcohol use is noteworthy given the
links between alcohol use and increased vulnerability to sexual assault.
This study reports a history of substance abuse in these survivors, and 9.7%
of the respondents met criteria for alcohol dependence problems at base-
line. Most of their parents also used substances, alcohol, and cigarettes.
Researchers have shown that parental substance abuse is linked to adoles-
cent substance abuse (Schinke, Fang, & Cole, 2008). In addition, poor
parental monitoring and an unstructured home environment are strongly
correlated with substance use especially among girls; parents’ failure to
monitor their children’s activities can put girls at risk of substance use and
other attendant risks (Li, Feigelman, & Stanton, 2000; Schinke et al., 2008).
Similarly, a study by Abbey et al., (2004) found that sexual assaults in ado-
lescents were frequently associated with alcohol consumption, as were
some drugs (Grisso et al., 1999).
In the context of rape trauma, social support is an important posttrauma
factor. We found that only about a quarter of adolescent survivors lived with
both parents at the time of the assault; thus, an overwhelming majority (74%)
may have missed the protective influence of a two-parent family. It has been
noted that adolescents living with two biological or adoptive parents are sig-
nificantly less likely to experience sexual assault, maltreatment, and non-
victimization type of adversity, compared with peers living in single-parent
and stepfamilies (Frazier, 2003).
Post-baseline over five time points, mood, anxiety, and stress-related
symptom scores stabilized slightly from scores obtained at initial assessment,
remaining relatively unchanged and exceeding the clinical cutoffs for psy-
chopathology. Thus, in this sample negative psychological effects mainly
persisted for at least a year post-rape. Previous studies suggest that a reduc-
tion in psychopathological symptoms is common in the first few months in
many victims, but in others symptoms remain elevated even at 2 years post
assault (Frazier, 2003; Koss & Figueredo, 2004), suggesting inter-individual
variation.
Oshodi et al. 11

There is evidence to show that early sexual abuse (Arata, 2000, 2002;
Desai, Arias, Thompson, & Basile, 2002) and childhood physical abuse
(Classen, Palesh, & Aggarwal, 2005; Desai et al., 2002) are significant pre-
dictors of adult sexual abuse and revictimization, thus, highlighting the
need to flag these vulnerable individuals who may require additional sup-
port following early sexual abuse. The Standard Practice Parameter
Guidelines for Trauma in Children and Adolescents include trauma-focused
interventions (Cohen, the Work Group on Quality Issues, & AACAP Work
Group on Quality Issues, 2010). Interventions such as trauma-focused ther-
apies and treatment planning to include treatment for comorbidities are rec-
ommended. Individual variations in response to trauma must also be
accommodated in treatment planning and follow-up scheduling. The cur-
rent practice of counseling in our study location, although sufficient for
more resilient survivors may be inadequate for others who go on to later
develop more complicated emotional outcomes following the rape incident.
This is particularly relevant in a society where exposure to complex
repeated trauma is common and attendant long-term consequences and
risks are well (Gregorowski & Seedat, 2013).
The risks of chronic PTSD, possible neurobiological changes, and poten-
tial long-term mental health consequences in adulthood highlight the need for
interventions that could reduce the negative consequences of rape trauma.
Long-term follow-up for adolescent rape survivors is critical for early identi-
fication of those with more persistent symptoms (suggestive of a higher risk
for psychopathology) that may require require expert intervention. The high
prevalence of trauma and sexual violence in South Africa may require a more
intensive approach to rape management with regard to the emotional health
impact for inclusion into existing policy.
This study has several limitations. First, several participants had pre-exist-
ing psychopathology (i.e., mood and anxiety disorders) that predated the
rape. Adolescents with a past history of psychiatric morbidity prior to enroll-
ment were, therefore, included in the study. In addition, rape-related acute
stress disorder was not assessed for as it is not a module contained within the
MINI-Kid. Posttraumatic stress symptoms were assessed for and, based on
clinical enquiry, were deemed to be a consequence of rape exposure. Second,
psychopathological status at follow-up was solely based on self-report mea-
sures, which may be less precise than clinical interviews, leaving open the
possibility that participants may have been misclassified. It should be noted,
however, that the CATS scale has previously been validated and an appropri-
ate cutoff recommended for South African youth (Suliman et al., 2005).
Third, in view of our focus on longitudinal course of emotional problems, no
appropriate comparison group was available and it is, therefore, unclear how
12 Journal of Interpersonal Violence 

these rates compare with unexposed adolescents. Finally, the sample was
small thus limiting the generalizability of these findings to all rape exposed
adolescents.
Importantly, this study suggests that there are a range of negative immedi-
ate and persistent psychiatric symptoms present in adolescents after rape and
it underscores the need for early intervention in the form of scheduled screen-
ing, follow-up, and long-term monitoring and care. This is particularly cru-
cial given that recent work suggests that, among rape survivors, having a
current mental illness is associated with a significantly reduced odds (odds
ratio [OR] = 0.25) of attending follow-up services thus underlining the impor-
tance of linking post-rape medical care with appropriate mental health ser-
vices (Darnell et al., 2015).

Acknowledgments
The authors thank Lindi Martin (doctoral student at the department of psychiatry,
Stellenbosch University) for coordinating the project and involvement in procuring
the data. We also acknowledge Professor Martin Kidd, of the Centre for Statistical
Consultation at Stellenbosch University for help with the statistical analyses.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The author(s) disclosed receipt of the following financial support for the research,
authorship, and/or publication of this article: This work was supported by the Medical
Research Council Unit on Anxiety Disorders, the South African Research Chair in
PTSD supported by the Department of Science and Technology and the National
Research Foundation, and by a grant from the Harry Crossley Foundation.

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Author Biographies
Yewande Oshodi, MBBS, MPH, FMCPsych, is a senior lecturer and child & adolescent
psychiatrist at the College of Medicine, University of Lagos & Lagos University Teaching
Hospital. Her research interests are in child and adolescent trauma, neurodevelopmental
disorders and adolescent substance abuse. She has recently completed subspecialty fellow-
ship training in Child and Adolescent Psychiatry at Stellenbosch University, Cape Town.
16 Journal of Interpersonal Violence 

Muiruri Macharia, PhD, is a science writer and research administrator at the

Department of Psychiatry, Stellenbosch University, with research interest revolving
around the understanding of ethnic-specific biochemical risk signatures for non-
communicable diseases in South Africa.
Anusha Lachman, MBChB, MMed (Psych), Cert Child Psych, MPhil (C&A psychia-
try), is a lecturer and subspecialist child psychiatrist at the Department of Psychiatrist,
Stellenbosch University. She has special research and academic interests in maternal
and infant mental health, adolescent risky behaviours and neuropsychiatry.
Soraya Seedat, MBChB, MMed (Psych), PhD, is a distinguished professor of psy-
chiatry and head of the Department of Psychiatry, Stellenbosch University. She has
extensive expertise in the assessment and treatment of anxiety disorders with special
interest in clinical and translational work in childhood and adult posttraumatic stress
disorder.