Psychological Legacies of Intergenerational Trauma under South African Apartheid: Prenatal Stress Predicts Increased Psychiatric Morbidity during Late Adolescence and Early Adulthood in Soweto, South Africa

ABSTRACT Background South Africa’s rates of psychiatric morbidity are among the highest in sub-Saharan Africa and are foregrounded by the country’s long history of political violence during apartheid. Recent evidence suggests that maternal trauma during gestation may intergenerationally impact the developing fetus and elevate the future child’s risk for psychiatric disease. We aim to evaluate the intergenerational effects of prenatal stress experienced during apartheid on late adolescent psychiatric morbidity and also assess the potential ameliorative effects of prenatal social support. Method Participants (n = 1051) come from Birth-to-Twenty, a longitudinal birth cohort study in Soweto-Johannesburg, South Africa’s largest peri-urban township which was the epicenter of violent repression and resistance during the final years of the apartheid regime. Pregnant women were prospectively enrolled in 1990 and completed questionnaires assessing social experiences, and their children’s psychiatric morbidity were assessed at age 17-18. Results Full data were available from 304 mother-child pairs in 2007-8. Pregnant women who experienced worse traumatic stress in 1990 had children who exhibited greater psychiatric morbidity during late adolescence. This relationship was only significant, however, among children born to younger mothers and adolescents who experienced greater concurrent stress. Social support did not buffer the long-term impacts of prenatal stress on future psychiatric morbidity. Conclusion Greater prenatal stress predicted adverse psychiatric outcomes among children born to younger mothers and adolescents who experienced greater concurrent stress. Our findings suggest that prenatal stress may affect adolescent mental health, have stress-sensitizing effects, and represent possible intergenerational effects of trauma experienced under apartheid in this sample.