Developing an Understanding of Complex Trauma Among Child Sexual Assault Survivors in South Africa: Implications for Practice.

South Africa has extraordinarily high levels of CSA with profound immediate and long-term mental health outcomes. This study aimed to investigate the mental health adjustment of children who experienced CSA and accessed support services using mixed methods. Structured interviews using validated mental health screening tools were conducted with children, between the ages of 7-18 years at three intervals over a 10-month period. Semi-structured qualitative interviews were conducted with primary caregivers to explore their views on the child's adjustment, and a validated parenting measure was used to assess parenting practices over time. Nearly 20% of all children met the clinical criteria for depression, but younger children showed increased recovery from depression over time. More than a third (37%) of younger children had full-symptom PTSD at baseline, with about a quarter (24%) of adolescents meeting the full-symptom PTSD criteria. We found that although full-symptom PTSD decreased to 26% for younger children, there was a slight increase (32%) in full-symptom PTSD among adolescents. Children's experiences of poly-victimisation were highlighted through caregiver interviews combined with caregivers' own experiences of unresolved trauma. Therapeutic models need to address the complex nature of trauma that children experience and unresolved trauma experienced by many families to break this intergenerational cycle.