Background Violent trauma exposures, including child abuse, increase risk for post-traumatic stress disorder (PTSD), comorbid mental health disorders and exacerbate intimate partner violence (IPV) perpetration. Knowledge about pathways between child abuse, poor mental health and IPV perpetration is emerging. Our study describes the pathways between men’s child abuse and IPV perpetration while exploring the mediating effect of poor mental health.

Methods We used data from a two-stage clustered, cross-sectional household survey conducted with 416 adult men in South Africa. We used multinomial regression to identify associated factors and Structural Equation Modelling to test the primary hypothesis that binge drinking PTSD or depressive symptoms mediate the relationship of child abuse and IPV perpetration.

Results Of the men: 88% were physically abused; 20% were sexually abused as children; 24% had PTSD symptoms; 24% had depressive symptoms; 36% binge drank; 56% physically abused and 31% sexually abused partners in their lifetime. 22% of men had one episode and 40% had repeat episodes of IPV perpetration. PTSD risk increased with severity of child trauma or other trauma. PTSD increased the risk for binge drinking. Child or other trauma and PTSD increased the severity of depression. PTSD was comorbid with binge drinking and depression. Neutral and highly equitable gender attitudes were protective against a single episode of IPV perpetration. Child or other trauma, employment in past 12 months and PTSD increased the risk of repeat episodes of IPV perpetration. Highly equitable gender attitudes protected against repeat episodes of IPV perpetration. There was a direct path between the history of child trauma and IPV perpetration and 3 indirect paths showing the mediating effects of PTSD, other trauma and gender attitudes.

Conclusions Child trauma history exacerbates poor mental health and male perpetrated IPV. The observed paths can be explained by a combination of the feminist, social learning and trauma theories. IPV prevention interventions need to address psychosocial support for abused boys and perpetrators.