BackgroundMaterial and social environmental stressors affect mental health in adolescence. Protective factors such as social support from family and friends may help to buffer the effects of adversity.AimsThe association of violence exposure and emotional disorders was examined in Cape Town adolescents.MethodA total of 1034 Grade 8 high school students participated from seven government co-educational schools in Cape Town, South Africa. Exposure to violence in the past 12 months and post-traumatic stress disorder (PTSD) symptoms were measured by the Harvard Trauma Questionnaire, depressive and anxiety symptoms by the Short Moods and Feelings Questionnaire and the Self-Rating Anxiety Scale.ResultsExposure to violence was associated with high scores on depressive (odds ratio (OR)=6.23, 95% CI 4.2–9.2), anxiety (OR=5.40, 95% CI 2.4–12.4) and PTSD symptoms (OR=8.93, 95% CI 2.9–27.2) and increased risk of self-harm (OR=5.72, 95% CI 1.2–25.9) adjusting for gender and social support.ConclusionsWe found that high exposure to violence was associated with high levels of emotional disorders in adolescents that was not buffered by social support. There is an urgent need for interventions to reduce exposure to violence in young people in this setting.