This proposal seeks five years of support for an epidemiologic survey of the prevalence and mental health consequences of torture in South Africa (SA). The study has seven specific aims: 1) To identify the prevalence and distribution of exposure to trauma during apartheid; 2) To estimate the mental health consequences of trauma exposure by studying the observed associations with appropriate use of targeted comparisons and statistical controls; 3) To study the effects of a series of hypothesized stress-diathesis variables in modifying the associations between stress exposure and mental health; 4) To examine the extent to which some coping resources that were originally protective of mental health during the years of apartheid are currently associated with poor mental health and heightened stress reactivity; 5) To investigate the impact of the Truth and Reconciliation Commission (TRC) on the mental health of South Africans; 6) To estimate the current prevalence and sociodemographic correlates of commonly occurring mental disorders in SA, the role impairments associated with these disorders, and adequacy of current treatment options; and 7) To study predictors of professional help-seeking among South Africans who currently have mental disorders. No nationally representative data exists on these issues in SA. The proposed study provides an unprecedented opportunity to enhance understanding of the mental health consequences of exposure to racial-political violence in the country of origin a short time after transition to majority rule. The project brings together an experienced multidisciplinary team with senior investigators that include the Dean of South Africa's National School of Public Health at MEDUNSA, the director of the first national survey of mental health in the United States, commissioners of the SA TRC, and survey research experts from the University of Michigan.
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