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Stockton MA, Mazinyo EW, Mlanjeni L, Nogemane K, Ngcelwane N, Sweetland AC, Basaraba CN, Bezuidenhout C, Sansbury G, Lovero KL, Olivier D, Grobler C, Wall MM, Medina-Marino A, Nobatyi P, Wainberg ML. Validation of a brief screener for broad-spectrum mental and substance-use disorders in South Africa. Glob Ment Health (Camb) 2023; 11:e4. [PMID: 38283876 PMCID: PMC10808975 DOI: 10.1017/gmh.2023.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/29/2023] [Accepted: 12/13/2023] [Indexed: 01/30/2024] Open
Abstract
In low-resource settings, valid mental health screening tools for non-specialists can be used to identify patients with psychiatric disorders in need of critical mental health care. The Mental Wellness Tool-13 (mwTool-13) is a 13-item screener for identifying adults at risk for common mental disorders (CMDs) alcohol-use disorders (AUDs), substance-use disorders (SUD), severe mental disorders (SMDs), and suicide risk (SR). The mwTool-13 is administered in two steps, specifically, only those who endorse any of the initial three questions receive the remaining ten questions. We evaluated the performance of mwTool-13 in South Africa against a diagnostic gold standard. We recruited a targeted, gender-balanced sample of adults, aged ≥18 years at primary and tertiary healthcare facilities in Eastern Cape Province. Of the 1885 participants, the prevalence of CMD, AUD, SMD, SR, and SUD was 24.4%, 9.5%, 8.1%, 6.0%, and 1.6%, respectively. The mwTool-13 yielded high sensitivities for CMD, SMD, and SR, but sub-optimal sensitivities for AUD and SUD (56.7% and 64.5%, respectively). Including a single AUD question in the initial question set improved the tool's performance in identifying AUD and SUD (sensitivity > 70%), while maintaining brevity, face-validity, and simplicity in the South African setting.
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Affiliation(s)
- Melissa Ann Stockton
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ernesha Webb Mazinyo
- Research Unit, Foundation for Professional Development, Buffalo City Metro, Eastern Cape Province, South Africa
- University of California Global Health Institute, University of California, San Francisco, USA
| | - Lungelwa Mlanjeni
- Research Unit, Foundation for Professional Development, Buffalo City Metro, Eastern Cape Province, South Africa
| | - Kwanda Nogemane
- Buffalo City Metro Health District, Eastern Cape Provincial Department of Health, Bisho, South Africa
| | - Nondumiso Ngcelwane
- Buffalo City Metro Health District, Eastern Cape Provincial Department of Health, Bisho, South Africa
| | - Annika C. Sweetland
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Cale Neil Basaraba
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Charl Bezuidenhout
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | | | - Kathryn L. Lovero
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, USA
| | - David Olivier
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Christoffel Grobler
- Faculty of Medicine, School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
| | - Melanie M. Wall
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
- New York State Psychiatric Institute, New York, USA
| | - Andrew Medina-Marino
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Phumza Nobatyi
- Buffalo City Metro Health District, Eastern Cape Provincial Department of Health, Bisho, South Africa
| | - Milton L. Wainberg
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, USA
- New York State Psychiatric Institute, New York, USA
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2
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Joska JA, Lee JS, Andersen LS, Stanton AM, O' Clereigh C, Safren S. "Trajectories of treatment response in a cognitive-behavioral therapy intervention for depression and adherence in persons with HIV in South Africa". J Affect Disord 2023; 343:136-143. [PMID: 37797752 PMCID: PMC11195445 DOI: 10.1016/j.jad.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/08/2023] [Accepted: 10/02/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND People with HIV (PHW) are at greater risk of depression than the general population. Insight into the time-to-treatment-response and predictors of response to psychotherapy may improve implementation in primary care. METHODS We assessed depression treatment response among 80 participants in a trial of cognitive-behavioral therapy for adherence and depression (CBT-AD) for PWH with MDD and suboptimal antiretroviral therapy (ART) adherence. Participants self-reported depressive symptoms (CESD) at each therapy session. Clinicians assessed participants' depression (HAMD), along with potential predictors of response, every four months for one year. Latent class analyses examined classes of responders for the active and the post-treatment phases. Regression analyses identified predictors of class membership for each phase. RESULTS During the active treatment phase (CESD) we identified an early response (at session 2 and with continued trajectory of improvement) and a non-response group. There were also two classes during post-treatment (HAM-D): early responders (4-month) and late responders (12-month). Distress aversion was associated with lower likelihood of early response to CBT-AD (aOR = 0.74, 95%CI[0.56-0.90], p = .009), and social support was associated with increased likelihood of early response (aOR = 2.24, 95%CI[1.07-5.46], p = .045). LIMITATIONS Self-reported depression during the treatment phase may have resulted from social desirability bias. CONCLUSIONS Most participants responded to CBT-AD early during treatment (89 %) and had sustained improvements in depression by 4 months (80 %). Distress aversion was a risk factor for late response, and social support was protective. Future research is needed to assess the optimal dose of CBT-AD in resource limited settings.
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Affiliation(s)
- John A Joska
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Jasper S Lee
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amelia M Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Conall O' Clereigh
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Steven Safren
- Department of Psychology, University of Miami, Miami, FL, USA
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Edeh NC, Eseadi C. Mental health implications of suicide rates in South Africa. World J Clin Cases 2023; 11:8099-8105. [PMID: 38130796 PMCID: PMC10731174 DOI: 10.12998/wjcc.v11.i34.8099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/02/2023] [Accepted: 11/29/2023] [Indexed: 12/06/2023] Open
Abstract
Mental health challenges are a severe issue that could lead to suicide if not properly addressed. South Africa has a significant burden of mental health issues, which contributes to the soaring rate of suicide. Adequate mental health-care provision could reduce the high suicide rate in South Africa. Since the apartheid regime, the country has made a series of efforts to improve mental health. This study aimed to review and examine available literature on mental health and suicide issues in South Africa and demonstrate the policy implications. This study adopted a narrative review approach. Electronic databases (PubMed, Scilit, Google Scholar and Semantic Scholar) were used to identify published articles in the English language with crucial search terms that included mental health, South African mental health policy, South Africa, suicide and policy. Literature suggests that at the provincial level, there are no adequate mental health policies, and the implementation of the country's mental health policy is faced with many challenges, such as a shortage of professionals and finances. The review also showed that task sharing and counselling have been pilot-tested and shown to be effective methods for the prevention of mental illness and promotion of positive mental health. This study concludes that the mental health treatment gap still exists in South Africa, and this needs to be tackled using effective, multi-level counselling interventions and policy initiatives. Adequate mental health-care provision and effective implementation of mental health policy could reduce the high rate of suicide in South Africa.
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Affiliation(s)
- Nkechinyere C Edeh
- Department of Social Science Education, University of Nigeria, Nsukka 41001, Enugu State, Nigeria
| | - Chiedu Eseadi
- Department of Educational Psychology, University of Johannesburg, Johannesburg 2006, Gauteng, South Africa
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Rall D, Swartz L. To queue or not to queue: Facility managers and mental health care users' experiences of integrated health care in a rural South African district. Int J Soc Psychiatry 2023; 69:1890-1897. [PMID: 37246418 PMCID: PMC10685676 DOI: 10.1177/00207640231177832] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND A key feature of South Africa's state health care strategy since 1994 has been the development and expansion of services towards integrated health care at primary health care level. Within the new system, emphasis has been on the integration of patients with mental health care needs with other patients where multiple health conditions and needs would be addressed simultaneously. As part of a larger study into mental health care in a predominantly rural district, we investigated the experiences of facility managers and mental health service users in rural clinics within the system of care. We were interested both in their views as to the advisability of the integrated model and the ways in which they managed any challenges they may have experienced within the system at local level. METHODS Data were collected through once-off semi-structured interviews with facility managers and mental health care service users to gather qualitative information. Narratives were transcribed and translated into English. Transcriptions were imported to Atlas.ti 22 and analysed through Thematic Analysis. RESULTS The integration of mental health care into routine primary health services poses challenges to treatment delivery and to patients who come for treatment. Our study also suggests resegregating mental health care as a possible solution to facilitate service delivery and treatment to service users. CONCLUSION This research provided first insights into facility managers' and service users' views of integrated mental health care at primary health care level in this district. While mental health care services have been expanded and integrated into primary health care over recent years, the system may not have been as streamlined as in other parts of the country. The integration of mental health into primary health care can pose various challenges to facilities, health care providers, and mental health service users. Managers in these constrained circumstances have observed that resegregating mental health care from physical treatment, as in the past, may be deemed more effective for health care provision and reception. Generalised integration of mental health treatment with physical care should be approached with caution unless there is wider scale provisioning and greater organisational change.
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Affiliation(s)
- Divan Rall
- Department of Psychology, Stellenbosch University, Matieland, Stellenbosch, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Matieland, Stellenbosch, South Africa
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Kagee A. Identifying cases of common mental disorders in the context of HIV care in low and middle income countries. AIDS Care 2023; 35:1590-1593. [PMID: 36404288 DOI: 10.1080/09540121.2022.2147479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 11/09/2022] [Indexed: 11/22/2022]
Abstract
One of the key behavioural factors inhibiting adherence to antiretroviral therapy (ART) is the presence of common mental disorders (CMDs). Correct identification of CMDs can facilitate referral for treatment, the amelioration of symptoms, and consequently improved adherence to ART. To save time and resources, screening is an alternative to conducting diagnostic interviews in case identification. However, an elevated score on a screening instrument does not indicate caseness for a mental health condition, given poor sensitivity and low positive predictive values of many screeners. A large number of false positives means that many people would be incorrectly identified as having a mental health condition and inappropriately referred for treatment. A large number of false negatives means that people who actually require treatment will not be identified as such and may thus go untreated. Thus it is recommended that public health services in low resource countries consider a two-stage approach to screening. When implementing routine screening, only those persons who screen above a commonly used cut-point would undergo a diagnostic interview to determine the presence of a common mental disorder. True cases may then be referred for treatment where these are available, such as anti-depressive medication or psychological treatment.
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Affiliation(s)
- Ashraf Kagee
- Department of Psychology, Alan Flisher Centre for Public Mental Health, Faculty of Arts and Social Sciences, Stellenbosch University, Stellenbosch 7602, South Africa
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Primary health care nurses' mental health knowledge and attitudes towards patients and mental health care in a South African metropolitan municipality. BMC Nurs 2023; 22:25. [PMID: 36707801 PMCID: PMC9883930 DOI: 10.1186/s12912-023-01188-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 01/23/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND In South Africa, there are on-going calls to integrate mental health services into existing primary health care (PHC) programmes such as Tuberculosis (TB). Successful service integration and quality service delivery partially depend on healthcare providers' mental health-related knowledge and attitudes. The aim of this study was to assess PHC nurses' mental health knowledge and attitudes towards mental health patients and mental health care. METHODS This was a cross-sectional survey involving the distribution of self-administered questionnaires among PHC nurses across 47 clinics. Data on socio-demographics, stigma-related mental health knowledge, and nurses' attitudes towards people with mental health problems and mental health care were subjected to descriptive and multiple regression analyses. RESULTS Out of 205 respondents, the majority were female (n = 178, 86.8%). The nurses' median age was 50 (interquartile range: 39-56). Their mean mental health knowledge score was 23.0 (standard deviation [sd]: 3.07) out of 30. Nurses were less knowledgeable about the employment (n = 95, 46.3%), recovery (n = 112, 54.6%), and help-seeking behaviour (n = 119, 58.0%) of people with mental health problems. Professional nurses had a significantly higher mean mental health knowledge score than enrolled/assistant nurses (22.8 vs. 21.1, t203 = 4.775, p < 0.001). Regarding attitudes, the nurses' mean attitude score was 40.68 (sd: 9.70) out of 96. Two in every five nurses (n = 91, 44.4%) scored above the mean attitude score, implying that they were inclined to have negative (stigmatising) attitudes towards people with mental problems and mental health care. Age (p = 0.048), job category (p < 0.001), and prior in-service mental health training (p = 0.029) made a unique contribution to predicting nurses' attitudes. CONCLUSION Gaps were established in PHC nurses' stigma-related mental health knowledge. A significant proportion of nurses had a propensity for negative (stigmatising) attitudes towards mental health patients and mental health care. Efforts towards integration of mental health into TB services in this metropolitan and similar settings should address mental health knowledge deficits and factors influencing nurses' negative attitudes. In-service training on mental health should be optimised, with attention to older nurses and enrolled/nursing assistants.
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Andersen LS, Stanton AM, Magidson JF, Joska JA, O'Cleirigh C, Lee JS, Kagee A, Witten JA, Safren SA. Cognitive and Behavioral Contributions to Depression Severity, Quality of Life, and Functioning Among People Living With HIV in South Africa. Behav Ther 2023; 54:91-100. [PMID: 36608980 DOI: 10.1016/j.beth.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 01/28/2022] [Accepted: 07/10/2022] [Indexed: 01/11/2023]
Abstract
Cognitive-behavioral treatments for depression typically address both behavioral (e.g., activation) and cognitive (e.g., rumination) components, and consequently improve quality of life (QOL) and function in high-resource settings. However, little is known about the cross-cultural applicability and relative contribution of these components to depression symptom severity, QOL, and functional impairment in South Africa and other resource-limited global settings with high HIV prevalence rates. Persons with HIV (N = 274) from a peri-urban community outside Cape Town, South Africa, were administered multiple measures of depression (Hamilton Depression Scale, Centre for Epidemiological Studies Depression Scale, South African Depression Scale), cognitive and behavioral components related to depression (Ruminative Response Scale, Behavioral Activation for Depression Scale), and measures of QOL and functioning (Sheehan Disability Scale, Quality of Life Enjoyment and Satisfaction Scale-Short Form). Multiple linear regression models were fit to assess the relative contribution of behavioral and cognitive components to depression severity, QOL, and functional impairment in this population. Models accounting for age and sex revealed that lower levels of behavioral activation (BA) were significantly associated with all measures of depression, as well as with QOL and functional impairment (all ps < .01). Rumination was associated with all measures of depression (all ps < .01), but not with QOL or functional impairment. The consistent and unique association of BA with depression, QOL, and functional impairment bolsters its importance as a treatment target for this population.
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Davies T, Lund C, Schneider M. Implementation of a task-shared psychosocial intervention for perinatal depression in South Africa: A grounded theory process evaluation. SSM - MENTAL HEALTH 2022; 2:100056. [PMID: 36776724 PMCID: PMC9912697 DOI: 10.1016/j.ssmmh.2021.100056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Perinatal depression carries significant levels of disability for both women and their infants, but there is a large treatment gap for this condition in low and middle-income countries (LMICs). To address this gap, task-sharing using community health workers (CHWs) to provide psychosocial interventions for perinatal depression is increasingly common. Many of these interventions have shown significant positive effects on maternal mood, however not all have done so. This study used data from a task-shared psychosocial intervention for perinatal depression in Cape Town, South Africa, the 'Africa Focus on Intervention Research for Mental Health' (AFFIRM-SA) randomised controlled trial (RCT). It aimed to examine the processes that occurred within the delivery of the counselling intervention, and to use these findings to provide recommendations for psychosocial task sharing in LMICs. A grounded theory analysis was conducted of 234 counselling session transcripts from 39 randomly selected participants from the RCT. This revealed that the effectiveness of the intervention was compromised by the negative influence of participants' socio-economic context, and by counselling strategies that did not align with what was intended in the counselling manual. Despite this, participants provided spontaneous accounts of improvement in mood and cognition, and reasons for these improvements, interpreted as elements that were therapeutically effective for them. Most of these elements aligned with previously identified 'common elements' of therapy. Recommendations for future research and practice include conducting participatory formative research, using an iterative and responsive research design informed by implementation science, incorporating contextually appropriate strategies in interventions such as addressing social determinants of mental health, conducting intensive training and supervision, adopting a staged approach to managing depression, and using common elements of therapy as the basis for psychosocial interventions.
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Affiliation(s)
- Thandi Davies
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa
| | - Crick Lund
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa
- King’s Global Health Institute, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF, United Kingdom
| | - Marguerite Schneider
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700, South Africa
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9
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Decolonising myself? South African mental health care and the problem of professionalism. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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10
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Spatial clustering of codeine use and its association with depression: a geospatial analysis of nationally representative South African data. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Van der Watt ASJ, Dalvie N, Seedat S. Weekly telephone mood monitoring is associated with decreased suicidality and improved sleep quality in a clinical sample. Psychiatry Res 2022; 317:114821. [PMID: 36088835 DOI: 10.1016/j.psychres.2022.114821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 01/04/2023]
Abstract
Sleep disturbances and suicidality are common presentations of mood and anxiety disorders. If not closely monitored post-discharge, patients may be at an increased risk of symptom worsening and completed suicide. We explored the associations between telephone mood monitoring, suicidality, and sleep quality in a clinical sample. Fifty inpatients (mean age = 39.49, SD = 11.17; female = 74%) with a mood and/or anxiety disorder were telephonically monitored weekly post-discharge for16 weeks for depression and mania. Suicidality and sleep quality were assessed at intake (pre-discharge), and at weeks 4, 8, 12, and 16 post-discharge. ANOVA indicated that suicidality significantly decreased, and sleep quality improved over 16 weeks. Linear regression analysis indicated that depression severity at week 1 post-discharge significantly predicted suicidality and sleep quality at week 16. Mania severity at week 1 post-discharge predicted sleep quality, but not suicidality, at week 16. Participants generally had positive experiences of the monitoring and perceived it as helpful. Monitoring of mood state, suicidality, and sleep quality post-discharge may allow for early detection of relapse when initiated at 1-week post-discharge. This is a potentially cost-effective intervention and may relieve the burden on the mental healthcare system, especially when face-to-face consultations are not possible.
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Affiliation(s)
- A S J Van der Watt
- Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa.
| | - N Dalvie
- Department of Psychiatry, Lentegeur Hospital, Cape Town, Western Cape, South Africa
| | - S Seedat
- Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa
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12
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Hassem T, Laher S. Evaluating the Efficacy of Ethical Guidelines for Online Screening of Mental Health in South Africa. Front Psychol 2022; 13:875911. [PMID: 35911022 PMCID: PMC9331289 DOI: 10.3389/fpsyg.2022.875911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022] Open
Abstract
Despite the rapid growth in digital mental health options, a systematic review conducted on the ethics of developing online mental health screening instruments highlighted that there were no formal guidelines in this area. This lack of formal guidelines and the results of the systematic review led to the development of formal guidelines for online mental health screening tools in South Africa. This study aimed to explore the efficacy of these draft guidelines using a qualitative design with two samples of individuals recognised as experts in the field of mental health. Sample one consisted of a purposive sample of 15 experts who commented on the appropriateness of the draft guidelines. The second sample consisted of 9 experts who completed the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument to assess the guidelines. Both samples were in agreement on the relevance of the core content areas in the guidelines, namely purpose and scope, modes of testing, psychometric properties, informed consent, ensuring minimal risk to participants, feedback as well as data security. There was also agreement on the appropriateness of the methods used to develop the guidelines. The use of the guidelines was supported with the suggestion that issues of risk and suicidality be explored further.
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13
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Kagee A. Distress among cancer patients: some considerations in identification and treatment. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1177/00812463221106262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article discusses the merits of screening for distress in the context of a chronic illness, such as cancer, with a particular focus on resource-constrained health care systems such as those in low-and-middle income countries. Despite calls for distress to be considered a vital sign, like pain it is not objectively verifiable as it relies solely on the person’s subjective appraisal. Accordingly, the Distress Thermometer has limited validity considering its concordance with the Hospital Anxiety and Depression Scale, which itself has limitations in terms of its psychometric properties. Indeed, an elevated score on a self-report measure does not indicate caseness for a mental health condition. Distress is often self-limiting and transient, whereas common mental disorders require evidence-informed treatment. In the context of scarce resources as is the case in low-and-middle income countries, efforts should instead be directed at identifying common mental disorders among persons living with cancer and others who have serious health threats. Such an approach will increase the likelihood of resources being directed at those who are most likely to benefit from psychological interventions. Where persons living with cancer indicate the need for psychosocial services, ways to manage distress include problem-solving therapy, motivational interviewing, and mindfulness-based stress reduction.
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Affiliation(s)
- Ashraf Kagee
- Department of Psychology, Stellenbosch University, South Africa
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14
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Aarø LE, Davids EL, Mathews C, Wubs AG, Smith ORF, de Vries PJ. Internalizing problems, externalizing problems, and prosocial behavior - three dimensions of the strengths and difficulties questionnaire (SDQ): A study among South African adolescents. Scand J Psychol 2022; 63:415-425. [PMID: 35388463 DOI: 10.1111/sjop.12815] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 11/28/2022]
Abstract
This study aimed to examine the factor structure of the Strengths and Difficulties Questionnaire Self-Report version (SDQ-S), its psychometric properties and measurement invariance by gender and language spoken at home, among secondary school students in Western Cape, South Africa. A sample of 3,542 adolescents in Grade 8 (Mean age = 13.7 years) completed the SDQ-S in a three-language questionnaire (Afrikaans, English and isiXhosa). The data were collected from 42 secondary schools in Cape Town, South Africa. Confirmatory factor analyses with the WLSMV estimator with adjustment for cluster effects (schools) were applied. The SDQ-S was originally developed to cover five domains: four "difficulty" domains (hyperactivity/inattention, emotional, conduct, and peer) and one "strengths" domain (prosocial behavior). When the five factors were tested on the data for the current study, poor fit was obtained. After excluding four items, a three-factor solution with no cross-loadings and no correlated error terms obtained acceptable fit. The results are consistent with previous studies. Strong measurement invariance across genders and language spoken at home was confirmed. In studies of community samples, the use of the SDQ-S scale as an instrument with a three-factor dimension (internalizing, externalizing and prosocial) may be more appropriate than using the original five-factor model.
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Affiliation(s)
- Leif Edvard Aarø
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Eugene L Davids
- Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Catherine Mathews
- Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Annegreet Gera Wubs
- Department of Health Promotion and Development, University of Bergen, Bergen, Norway
| | - Otto R F Smith
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Petrus J de Vries
- Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Division of Child & Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
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Hassem T. Evaluating the efficacy of an online depression screening tool in South Africa: A pilot study. S Afr J Psychiatr 2022; 28:1687. [PMID: 35281958 PMCID: PMC8905393 DOI: 10.4102/sajpsychiatry.v28i0.1687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 08/06/2021] [Indexed: 11/07/2022] Open
Abstract
Background A global increase of 16% in depression rates from 1990 to 2019 highlights the alarming situation in relation to increase in depression. Research has indicated that this rate is likely to increase as a result of the coronavirus disease 2019 (COVID-19) pandemic. In South Africa, the depression life-time prevalence rate is 9.47%. However, the lack of access to mental healthcare services leads to people not receiving much needed information and care. The growing accessibility to the Internet for South Africans offers a solution for the screening and access to self-help information for depression. The Center for Epidemiologic Studies Depression Scale (CESD)-R was adapted for online usage and a website, mddsa.co.za, was piloted in this regard. Aim This study reports on the efficacy of the online adapted CESD-R for use in South Africa by reporting on the reliability and criterion validity as well as the user friendliness of the website and the appropriateness of the instant feedback provided. Setting The study was conducted in South Africa during COVID lockdown level 1 and 2. Methods This study followed a quantitative, cross-sectional research design. A convenience sample of 21 individuals, above the age of 18, with a depression diagnosis and 86 individuals with no mental health diagnosis participated in the study. Participants accessed the screening instrument online at the website. Results Internal consistency reliability coefficients exceeded 0.80. T-test and sensitivity and specificity results attested to the accuracy of the tool. All items contributed well to the instrument, including the items that were culturally specific to South Africa. Feedback from participants indicated that the tool was easily comprehensible, the website was user friendly and the instant feedback provided was appropriate. Conclusion The online adapted CESD-R evidenced excellent reliability and criterion validity and was able to accurately screen for depression amongst South Africans. The website and the tool have the potential to be utilised to increase access to a screening instrument for individuals who display symptoms of depression and to enhance the opportunity for individuals to practise self-help.
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Affiliation(s)
- Tasneem Hassem
- Department of Psychology, Faculty of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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Mokitimi S, Schneider M, de Vries PJ. A situational analysis of child and adolescent mental health services and systems in the Western Cape Province of South Africa. Child Adolesc Psychiatry Ment Health 2022; 16:6. [PMID: 35078503 PMCID: PMC8787885 DOI: 10.1186/s13034-022-00440-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Even though child and adolescent mental health is a global health priority, services are very limited, particularly in low- and middle-income countries (LMIC), and therefore need comprehensive strengthening. This requires knowledge of the hardware elements of the system (human resources, financing, medicines, technology, organisational structure, service infrastructure, and information systems). This study sought to examine these elements of child and adolescent mental health (CAMH) services and systems in the Western Cape Province of South Africa. METHODS The World Health Organization Assessment Instrument of Mental Health Systems (WHO-AIMS) version 2.2 of 2005 was adapted to identify key variables of interest in CAMH. Data were collected for the calendar year 2016 and focused on the public health sector. We outlined findings based on best available data across the six domains of the WHO-AIMS. RESULTS In domain 1, we found no provincial CAMH policy or implementation plans to support the national CAMH policy and were unable to identify a CAMH-specific budget. In domain 2, there was no dedicated provincial leadership structure for CAMH, and no dedicated or 'child- and adolescent-friendly' mental health services at primary or secondary care levels. At tertiary level, there were only three specialist CAMH teams. The majority of CAMH resources were based in the City of Cape Town, with limited resources in the rural districts. Essential medicines were available in all facilities, and the majority of children and adolescents had access to free services. In domain 3, data were limited about the extent of training offered to primary healthcare staff, and little or no psychosocial interventions were available in primary care. Domain 4 identified a small and variable CAMH workforce across all levels of care. In domain 5, few public health campaigns focused on CAMH, and little evidence of formal intersectoral collaboration on CAMH was identified. Domain 6 identified significant limitations in health information systems for CAMH, including lack of child- and adolescent-specific and disaggregated data to establish baselines for policy development, monitoring, evaluation and CAMH research. CONCLUSIONS This study identified significant structural weaknesses in CAMH and presents a clear call for action to strengthen services and systems in the province and in South Africa. it would be important to expand research also to include provider and user perspectives for service strengthening.
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Affiliation(s)
- Stella Mokitimi
- grid.7836.a0000 0004 1937 1151Division of Child and Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700 South Africa ,grid.415742.10000 0001 2296 3850Red Cross War Memorial Children’s Hospital, Klipfontein Road, Rondebosch, 7700 South Africa
| | - Marguerite Schneider
- grid.7836.a0000 0004 1937 1151Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, South Africa
| | - Petrus J. de Vries
- grid.7836.a0000 0004 1937 1151Division of Child and Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, 7700 South Africa
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17
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Pilar M, Jost E, Walsh-Bailey C, Powell BJ, Mazzucca S, Eyler A, Purtle J, Allen P, Brownson RC. Quantitative measures used in empirical evaluations of mental health policy implementation: A systematic review. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221141116. [PMID: 37091091 PMCID: PMC9924289 DOI: 10.1177/26334895221141116] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Mental health is a critical component of wellness. Public policies present an opportunity for large-scale mental health impact, but policy implementation is complex and can vary significantly across contexts, making it crucial to evaluate implementation. The objective of this study was to (1) identify quantitative measurement tools used to evaluate the implementation of public mental health policies; (2) describe implementation determinants and outcomes assessed in the measures; and (3) assess the pragmatic and psychometric quality of identified measures. Method Guided by the Consolidated Framework for Implementation Research, Policy Implementation Determinants Framework, and Implementation Outcomes Framework, we conducted a systematic review of peer-reviewed journal articles published in 1995-2020. Data extracted included study characteristics, measure development and testing, implementation determinants and outcomes, and measure quality using the Psychometric and Pragmatic Evidence Rating Scale. Results We identified 34 tools from 25 articles, which were designed for mental health policies or used to evaluate constructs that impact implementation. Many measures lacked information regarding measurement development and testing. The most assessed implementation determinants were readiness for implementation, which encompassed training (n = 20, 57%) and other resources (n = 12, 34%), actor relationships/networks (n = 15, 43%), and organizational culture and climate (n = 11, 31%). Fidelity was the most prevalent implementation outcome (n = 9, 26%), followed by penetration (n = 8, 23%) and acceptability (n = 7, 20%). Apart from internal consistency and sample norms, psychometric properties were frequently unreported. Most measures were accessible and brief, though minimal information was provided regarding interpreting scores, handling missing data, or training needed to administer tools. Conclusions This work contributes to the nascent field of policy-focused implementation science by providing an overview of existing measurement tools used to evaluate mental health policy implementation and recommendations for measure development and refinement. To advance this field, more valid, reliable, and pragmatic measures are needed to evaluate policy implementation and close the policy-to-practice gap. Plain Language Summary Mental health is a critical component of wellness, and public policies present an opportunity to improve mental health on a large scale. Policy implementation is complex because it involves action by multiple entities at several levels of society. Policy implementation is also challenging because it can be impacted by many factors, such as political will, stakeholder relationships, and resources available for implementation. Because of these factors, implementation can vary between locations, such as states or countries. It is crucial to evaluate policy implementation, thus we conducted a systematic review to identify and evaluate the quality of measurement tools used in mental health policy implementation studies. Our search and screening procedures resulted in 34 measurement tools. We rated their quality to determine if these tools were practical to use and would yield consistent (i.e., reliable) and accurate (i.e., valid) data. These tools most frequently assessed whether implementing organizations complied with policy mandates and whether organizations had the training and other resources required to implement a policy. Though many were relatively brief and available at little-to-no cost, these findings highlight that more reliable, valid, and practical measurement tools are needed to assess and inform mental health policy implementation. Findings from this review can guide future efforts to select or develop policy implementation measures.
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Affiliation(s)
- Meagan Pilar
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Department of Infectious Diseases, Washington University School of Medicine,
Washington University in St. Louis, St. Louis, MO, USA
| | - Eliot Jost
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of
Medicine, Washington University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Amy Eyler
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management, New York
University School of Global Public Health, Global Center for Implementation Science, New York University, New York, NY, USA
| | - Peg Allen
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin
J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
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18
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Thela L, Talatala M, Chiliza B. Addressing the Needs of People with Schizophrenia in South Africa During the COVID-19 Pandemic. SCHIZOPHRENIA BULLETIN OPEN 2022; 3:sgac048. [PMID: 35996533 PMCID: PMC9384532 DOI: 10.1093/schizbullopen/sgac048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Research indicates that most people with Schizophrenia from low to middle-income countries do not receive adequate healthcare. Inadequate policies, lack of funding, poor service planning and neglect are some barriers to adequate care. Intrinsic barriers to care include stigma, lack of insight, and pathways to care that are often driven by cultural beliefs, and many systemic challenges. South Africa was not spared from the scourge of COVID-19, hosting a third of all reported cases in Africa. In a country with disparities, it would be of interest to get insight into the situation concerning the healthcare needs of people with Schizophrenia during the pandemic. A pandemic such as COVID-19 placed enormous strains on already limited and unequally distributed health care resources. In this paper, we discuss: (1) The South African healthcare system (with respect to Schizophrenia care). (2) COVID-19 policies related to the care of people with Schizophrenia (testing, access to vaccine). (3) Managing people with Schizophrenia amid the COVID-19 pandemic. (4) Recommendations.
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Affiliation(s)
- Lindokuhle Thela
- Discipline of Psychiatry, University of KwaZulu-Natal , Durban , South Africa
| | - Mvuyiso Talatala
- Department of Psychiatry, University of Witwatersrand , Johannesburg , South Africa
| | - Bonginkosi Chiliza
- Discipline of Psychiatry, University of KwaZulu-Natal , Durban , South Africa
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19
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Safren SA, O'Cleirigh C, Andersen LS, Magidson JF, Lee JS, Bainter SA, Musinguzi N, Simoni J, Kagee A, Joska JA. Treating depression and improving adherence in HIV care with task-shared cognitive behavioural therapy in Khayelitsha, South Africa: a randomized controlled trial. J Int AIDS Soc 2021; 24:e25823. [PMID: 34708929 PMCID: PMC8552453 DOI: 10.1002/jia2.25823] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 09/10/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Major depressive disorder, highly prevalent among people with HIV (PWH) globally, including South Africa, is associated with suboptimal adherence to antiretroviral therapy. Globally, there are insufficient numbers of mental health providers and tested depression treatments. This study's aim was to test task-shared cognitive-behavioural therapy for adherence and depression (CBT-AD) in HIV, delivered by clinic nurses in South Africa. METHODS This was a two-arm randomized controlled effectiveness trial (recruitment: 14 July 2016 to 4 June 2019, last follow 9 June 2020). One-hundred-sixty-one participants with clinical depression and virally uncontrolled HIV were recruited from primary care clinics providing HIV care, in Khayelitsha, South Africa. Arm 1 was task-shared, nurse-delivered CBT-AD; and arm 2 was enhanced treatment as usual (ETAU). Primary outcomes (baseline to 4 months) were blinded Hamilton Depression Rating Scale (HAM-D) scores, and weekly adherence via real-time monitoring (Wisepill). Secondary outcomes were adherence and depression over 4-, 8- and 12-month follow-ups, proportion of participants with undetectable viremia and continuous CD4 cell counts at 12 months. Additional analyses involved viral load and CD4 over time. RESULTS At 4 months, the HAMD scores in the CBT-AD condition improved by an estimated 4.88 points more (CI: -7.86, -1.87, p = 0.0016), and for weekly adherence, 1.61 percentage points more per week (CI: 0.64, 2.58, p = 0.001) than ETAU. Over follow-ups, CBT-AD had an estimated 5.63 lower HAMD scores (CI: -7.90, -3.36, p < 0.001) and 23.56 percentage points higher adherence (CI: 10.51, 34.21, p < 0.001) than ETAU. At 12 months, adjusted models indicated that the odds of having an undetectable viremia was 2.51 greater at 12 months (CI: 1.01, 6.66, p = 0.047), and 3.54 greater over all of the follow-ups (aOR = 3.54, CI: 1.59, 20.50; p = 0.038) for those assigned CBT-AD. CD4 was not significantly different between groups at 12 months or over time. CONCLUSIONS Task-shared, nurse-delivered, CBT-AD is effective in improving clinical depression, ART adherence and viral load for virally unsuppressed PWH. The strategy of reducing depression to allow patients with self-care components of medical illness to benefit from adherence interventions is one to extend. Implementation science trials and analyses of cost-effectiveness are needed to translate findings into clinical practice. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02696824 https://clinicaltrials.gov/ct2/show/NCT02696824.
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Affiliation(s)
| | - Conall O'Cleirigh
- Department of PsychologyHarvard Medical SchoolBostonMassachusettsUSA
- Department of PsychiatryMassachusetts General HospitalBostonMassachusettsUSA
| | - Lena S. Andersen
- Department of PsychiatryUniversity of Cape TownCape TownSouth Africa
| | | | - Jasper S. Lee
- Department of PsychologyUniversity of MiamiMiamiFloridaUSA
| | | | - Nicholas Musinguzi
- Department of Internal MedicineMbarara University of Science and TechnologyMbararaUganda
| | - Jane Simoni
- Department of PsychologyUniversity of WashingtonSeattleWashingtonUSA
| | - Ashraf Kagee
- Department of PsychologyStellenbosch UniversityStellenboschSouth Africa
| | - John A. Joska
- Department of PsychiatryUniversity of Cape TownCape TownSouth Africa
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20
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Stanton AM, Lee JS, Wirtz MR, Andersen LS, Joska J, Safren SA, van Zyl-Smit R, O'Cleirigh C. Tobacco Use and Health-Related Quality of Life Among Individuals with Depression Who Are Receiving Treatment for HIV in Cape Town, South Africa. Int J Behav Med 2021; 28:417-430. [PMID: 33511574 PMCID: PMC8266737 DOI: 10.1007/s12529-020-09951-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tobacco use is the leading cause of preventable death worldwide, and prevalence rates are high among people living with HIV (PLWH), particularly in men. Depression is also common among PLWH, especially among smokers, who may use tobacco to manage mood. Although HIV and depression have been linked to functional impairment and poor health-related quality of life (HRQOL), little research has examined the degree to which smoking impacts these relationships in low- and middle-income countries with high HIV burden. METHOD Participants (N = 289) were people living with HIV (PLWH) who were being assessed for inclusion in a study targeting depression as a barrier to HIV medication adherence. Linear regression models measured the effect of gender on tobacco use (assessed by the WHO-ASSIST) and on each of the five HRQOL functional impairment domains (assessed by the SF-21). Separate multivariable regression models examined the relationships between habitual tobacco use, defined as daily, almost daily, or weekly use, and the HRQOL domains. RESULTS The prevalence of habitual tobacco use was 23.9% (48.1% among men, 15.5% among women). Habitual tobacco use was associated with decreased cognitive functioning for the whole sample (B = - 8.99, p < 0.05) and with lower levels of pain-related impairment for men (B = 18.1, p < 0.05). Although men reported more tobacco use (B = 8.50, p < 0.001), they reported less pain-related limitations than women (B = 8.70, p < 0.05). CONCLUSIONS In our sample, men reported higher rates of habitual tobacco use than women. Smoking was associated with cognitive impairment and with less pain-related impairment among men. Future smoking cessation treatments tailored to PLWH who have symptoms of depression may benefit from strategies that consider pain management as a pathway to habitual smoking and recognize that motivations for use may differ by gender.
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Affiliation(s)
- Amelia M Stanton
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 761, Boston, MA, 02114, USA.
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02115, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA.
| | - Jasper S Lee
- Department of Psychology, The University of Miami, P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - Megan R Wirtz
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
| | - Lena S Andersen
- Department of Psychiatry, The University of Cape Town, Groote Schuur Drive, Observatory, Cape Town, 7925, South Africa
| | - John Joska
- Department of Psychiatry, The University of Cape Town, Groote Schuur Drive, Observatory, Cape Town, 7925, South Africa
| | - Steven A Safren
- Department of Psychology, The University of Miami, P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - Richard van Zyl-Smit
- Department of Psychiatry, The University of Cape Town, Groote Schuur Drive, Observatory, Cape Town, 7925, South Africa
| | - Conall O'Cleirigh
- Department of Psychiatry, Massachusetts General Hospital, One Bowdoin Square, Suite 761, Boston, MA, 02114, USA
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02115, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, 02114, USA
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21
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Elias L, Singh A, Burgess RA. In search of 'community': a critical review of community mental health services for women in African settings. Health Policy Plan 2021; 36:205-217. [PMID: 33543248 DOI: 10.1093/heapol/czaa140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2020] [Indexed: 11/14/2022] Open
Abstract
Community is deemed a central resource for the improvement of health, across disciplines, contexts and conditions. However, what is meant by this term is rarely critically explored. In Global Mental Health, considerable efforts in recent years have been directed towards scaling up 'community' approaches, with variable success, creating the need to better understand approaches to its use. Our study contributes to this need, through a critical review of studies engaging with the term 'community' in relation to women's mental health services in African settings. Our review explored 30 peer-reviewed articles from the past 15 years, which were systematically evaluated for quality of evidence. Studies were then analysed using a blend of conventional and directed content analysis to unpack perspectives on the term's use in intervention and phenomenological studies. We identified four broad categories of community: (1) place (shared geographical location or institutional affiliation), (2) practice (belongingness to a shared activity or profession), (3) symbols (meanings and experiences associated with shared community life) and (4) identity (diagnostic identity around a mental health condition). Analysis identified community of place as the most common primary focus of interest across the sample, with 80% of papers referencing this dimension. We noted that in studies where communities of practice were the focus, this was in relation to leveraging local knowledge to inform or support service delivery of intervention programmes, often designed by outsiders. Implications for future policy and mental health services research are discussed.
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Affiliation(s)
- Lauren Elias
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK
| | - Aneeha Singh
- International Research and Exchanges Board (South & South East Asia Centre), 1275 K Street, NW, Suite 600 Washington, DC 20005, USA
| | - Rochelle A Burgess
- Institute for Global Health, University College London, 30 Guilford Street, London WC1N 1EH, UK.,Research Associate, Department of Social Work, University of Johannesburg, South Africa
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22
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Nwakasi C, Brown JS, Subedi S, Darlingtina E. Depression, functional disability, and accessing health care among older Ghanaians and South Africans: a comparative study based on WHO study on global ageing and adult health (SAGE). Aging Ment Health 2021; 25:1077-1085. [PMID: 32338059 DOI: 10.1080/13607863.2020.1758904] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES The study explored the association and variabilities between mild depression, functional disability, and healthcare access among older Ghanaians and South Africans. METHOD The data used in this study was based on the Cross-sectional wave 1 (2007-2010) data from WHO's Study on Global Ageing and Adult Health (SAGE). Using multiple binary logistic regression, responses from a sample of 4558 Ghanaians and 3076 South Africans were analyzed to investigate hypothesized patterns. RESULTS The proportion of mild depression (MD) is 6.0 % and 7.53% for older Ghanaians and older South Africans, respectively. At 95% Confidence Interval, increased severity (mild and high levels) of functional disability are associated with increased odds of MD in Ghanaian and South African older adults. Apart from South African older adults, older Ghanaians in the study who do not receive healthcare when needed have increased odds of MD than those who do. Sociodemographic and socioeconomic factors are also associated with MD. DISCUSSION An untreated, persistent MD may lead to worse conditions with fatal outcomes. Since mental health care is lacking in both countries, this study may inform policies directed towards support for formal and informal long-term care, and healthcare access to reduce the risks of depression.
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Affiliation(s)
- Candidus Nwakasi
- Department of Health Policy and Management, Providence College, Providence, RI, USA
| | - J Scott Brown
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
| | - Sree Subedi
- Department of Behavioral and Social Sciences, Miami University, Oxford, OH, USA
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Marangu E, Mansouri F, Sands N, Ndetei D, Muriithi P, Wynter K, Rawson H. Assessing mental health literacy of primary health care workers in Kenya: a cross-sectional survey. Int J Ment Health Syst 2021; 15:55. [PMID: 34074318 PMCID: PMC8170792 DOI: 10.1186/s13033-021-00481-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 05/25/2021] [Indexed: 11/10/2022] Open
Abstract
AIM To assess mental health literacy of health workers in primary health care services in Kenya. BACKGROUND Mental illness is common in Kenya, yet there are fewer than 500 specialist mental health workers to serve Kenya's population of over 50 million. The World Health Organization recommends the integration of mental health care into primary health care services to improve access to and equity of this care, especially in low and middle-income countries. An important step to integrating mental health care into primary health care services is to determine mental health literacy levels of the primary health care workforce. METHOD A cross-sectional survey using Jorm's Mental Health Literacy Instrument (adapted for the Kenyan context) was administered to 310 primary health care workers in four counties of Kenya. RESULTS Of the 310 questionnaires distributed, 212 (68.3%) were returned. Of the respondents, 13% had a formal mental health qualification, while only 8.7% had received relevant continuing professional development in the five years preceding the survey. Just over one third (35.6%) of primary health care workers could correctly identify depression, with even fewer recognising schizophrenia (15.7%). CONCLUSIONS This study provides preliminary information about mental health literacy among primary health care workers in Kenya. The majority of respondents had low mental health literacy as indicated by their inability to identify common mental disorders. While identifying gaps in primary health care workers' mental health knowledge, these data highlight opportunities for capacity building that can enhance mental health care in Kenya and similar low and middle-income countries.
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Affiliation(s)
- Elijah Marangu
- National Indigenous Knowledges Education Research Innovation (NIKERI) Institute, Deakin University, 75 Pigdons Road, Waurn Ponds, VIC, 3216, Australia.
| | - Fethi Mansouri
- Institute for Citizenship & Globalisation, Deakin University, Burwood Campus, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | | | - David Ndetei
- Department of Psychiatry, Nairobi University, P.O Box 48423-00100, Nairobi, Kenya
| | - Peterson Muriithi
- School of Population Health, Nairobi University, P.O Box 19676-00202 KNH, Nairobi, Kenya
| | - Karen Wynter
- School of Nursing & Midwifery, Deakin University, Burwood Campus. Building Y, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Helen Rawson
- Nursing & Midwifery, Monash University, Level 3, Building 13D. 35 Rainforest Walk, Clayton, VIC, 3800, Australia
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Myburgh N, Muris P, Loxton H. Promoting braveness in children: A pilot study on the effects of a brief, intensive CBT-based anxiety prevention programme conducted in the South African context. CHILD CARE IN PRACTICE : NORTHERN IRELAND JOURNAL OF MULTI-DISCIPLINARY CHILD CARE PRACTICE 2021; 30:655-677. [PMID: 39734475 PMCID: PMC11670885 DOI: 10.1080/13575279.2021.1902785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2024]
Abstract
Background Children within historically disadvantaged non-Western South African communities are considered as particularly vulnerable to the development of anxiety problems. Although the need for accessible mental health interventions is evident, this need has remained unmet in a country with extreme socio-economic disparities and a lack of mental health resources. Cognitive behavioural therapy-based (CBT-based) interventions that employ brief and intensive delivery methods may overcome existing barriers to access to mental health services faced by many South African children and may ameliorate the burden placed on under-resourced mental health care services. Aim To provide preliminary evidence on the effectiveness of a brief, intensive CBT-based anxiety prevention intervention conducted in a South African context. Method A mixed-methods approach, with quantitative and qualitative data, was used to evaluate the effects of the CBT-based programme in a sample of 21 farmworkers' children aged 9 to 14 years living in disadvantaged rural communities of the Western Cape. A quasi-experimental design with an immediate intervention (experimental) group and a delayed intervention (control) group was applied in the quantitative component of the study. The qualitative component was based on focus group data. Results In general, positive effects were noted for the CBT-based anxiety prevention programme in these vulnerable children. Quantitative data revealed a trend reflecting a reduction of self-reported anxiety levels. Qualitative support for the acquisition and application of the CBT-based programme skills was also found. Conclusion This pilot study indicates that a brief, intensive CBT-based prevention programme holds promise for the effective reduction of anxiety in vulnerable South African children.
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Affiliation(s)
- Naomi Myburgh
- Department of Psychology, University of Stellenbosch, Stellenbosch, South Africa
| | - Peter Muris
- Department of Psychology, University of Stellenbosch, Stellenbosch, South Africa
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Helene Loxton
- Department of Psychology, University of Stellenbosch, Stellenbosch, South Africa
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de Lima IB, Bernadi FA, Yamada DB, Vinci ALT, Rijo RPCL, Alves D, Furegato ARF. The use of indicators for the management of Mental Health Services. Rev Lat Am Enfermagem 2021; 29:e3409. [PMID: 33852681 PMCID: PMC8040785 DOI: 10.1590/1518-8345.4202.3409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 07/31/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify indicators that can be used in the management of Mental Health Services. METHOD an integrative review in which we adopted the Population, Concept, and Context strategy to formulate the following Guiding Question: "Which indicators can be used for the management of mental health services?". RESULTS a total of 22 articles were included and divided into two main groups: countries with initial high income (54%) as well as low- and middle-income countries (46%). We identified 5 studies that had experienced the use of indicators, 5 studies that had reported partial implementation, 9 studies that did not report use or implementation, 1 study on the indicator selection process, 1 as an implementation pilot, and a final study with a discussion for implementation. High-income countries also find it difficult to implement mental health indicators. The main difficulties in adopting the use of indicators are lack of basic mental health services, financial resources, legislation, political interest, and guidelines for its management. CONCLUSION it is unusual to find a descriptive comparison of quality monitoring programs at the system level in the technical-scientific literature related to mental health indicators.
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Affiliation(s)
- Inacia Bezerra de Lima
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | | | - Diego Bettiol Yamada
- Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | | | | | - Domingos Alves
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Antonia Regina Ferreira Furegato
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Muzvondiwa B, Batterham R. Building health system responsiveness to noncommunicable diseases for Gweru District adults, Zimbabwe: a case study. JOURNAL OF HEALTH RESEARCH 2021. [DOI: 10.1108/jhr-07-2020-0248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
Gweru District, Zimbabwe faces a major challenge of noncommunicable diseases (NCDs). Globally, health systems have not responded successfully to problems in prevention and management of NCDs. Despite numerous initiatives, reorienting health services has been slow in many countries. Gweru District has similar challenges. The purpose of this paper is to explore what the health systems in Zimbabwe have done, and are doing to respond to increasing numbers of NCD cases in adults in the nation, especially in the district of Gweru
Design/methodology/approach
The study employed a descriptive narrative review of the academic and grey literature, supplemented by semi-structured key informant interviews with 14 health care staff and 30 adults living with a disease or caring for an adult with a disease in Gweru District.
Findings
Respondents identified many limitations to the response in Gweru. Respondents said that screening and diagnosis cease to be helpful when it is difficult securing medications. Nearly all community respondents reported not understanding why they are not freed of the diseases, showing poor understanding of NCDs. The escalating costs and scarcity of medications have led people to lose trust in services. Government and NGO activities include diagnosis and screening, provision of health education and some medication. Health personnel mentioned gaps in transport, medication shortages, poor equipment and poor community engagement. Suggestions include: training of nurses for a greater role in screening and management of NCDs, greater resourcing, outreach activities/satellite clinics and better integration of diverse NCD policies.
Research limitations/implications
Participant responses were greatly influenced by the current political and economic situation in Zimbabwe, so responses may reflect short-term crises rather than long-term trends.
Originality/value
This research offers an understanding of NCD strategies and their limitations from the bottom-up, lived experience perspective of local health care workers and community members.
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Baker N, Naidu K. The Challenges Faced by Mental Health Care Users in a Primary Care Setting: A Qualitative Study. Community Ment Health J 2021; 57:285-293. [PMID: 32476082 DOI: 10.1007/s10597-020-00647-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
Over the past two decades, the value and benefits of integrated mental health care services have been increasingly recognised. Despite the potential benefits, barriers exist at primary care level to receiving mental health care services, interfering with continuity of care. We conducted semi-structured interviews with mental healthcare users at a primary care clinic in South Africa, to explore their experiences of receiving mental health care services. A convenience sample of 15 participants identified challenges such as limited infrastructure, organisation, medication, services in local communities, allied mental health care services, communication and long waiting times. Mental health care users felt uncared for and disrespected, especially if they were treated by unskilled and overworked staff. Mental health care users described clinic visits as stressful and frustrating. Mental health care users described marked challenges in mental health care service provision in a South African primary health care setting.
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Affiliation(s)
- Nadia Baker
- Department of Psychiatry, Weskoppies Hospital, University of Pretoria, Private Bag x323, Arcadia, 0007, South Africa
| | - Kalai Naidu
- Department of Psychiatry, Weskoppies Hospital, University of Pretoria, Private Bag x323, Arcadia, 0007, South Africa.
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Policymaking through a knowledge lens: Using the embodied-enacted-inscribed knowledge framework to illuminate the transfer of knowledge in a mental health policy consultation process - A South African case study. PLoS One 2021; 16:e0244940. [PMID: 33439892 PMCID: PMC7806173 DOI: 10.1371/journal.pone.0244940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 12/18/2020] [Indexed: 11/19/2022] Open
Abstract
Background Marrying principles of evidence-based policymaking, with its focus on what works, with principles of consultative policymaking, with its focus on what works for whom, means finding ways to integrate multiple knowledge inputs into policy decisions. Viewed through the lens of the embodied-enacted-inscribed knowledge framework, policy consultation is a site of knowledge enactment, where the embodied knowledge enacted by individuals engages with the inscribed knowledge contained in policy documents, creating new forms of embodied and inscribed knowledge that move beyond these spaces. Aim Using this knowledge framework, this study aimed to trace the movement of knowledge inputs through South Africa’s mental health policy consultation summit. Methods Breakaway group session transcripts from the national consultation summit were thematically analysed to identify the types of knowledge that participants explicitly drew on (experiential or evidence-based) during discussions and how these knowledge inputs were used, responded to, and captured. Findings Findings suggest that there was little explicit reference to either evidence-based or experiential knowledge in most of the talk. While slightly more evidence-based than experiential knowledge claims were made, this did not render these claims any more likely to be responded to or engaged with in group discussions, or to be inscribed in group recommendations. Discussion The importance of designing participatory processes that enable optimal use of knowledge inputs in these enacted spaces is discussed. Conclusion Attending to the specific ways in which knowledge is transformed and moved through a policy consultation process has the potential to enhance the value that consultation offers policymakers.
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Card M, McGlynn K. Primary health care nurses’ perceptions of the socio-ecology of mental illness among patients: An exploratory study. JOURNAL OF PSYCHOLOGY IN AFRICA 2020. [DOI: 10.1080/14330237.2020.1842599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Melissa Card
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
| | - Kim McGlynn
- Department of Psychology, University of Johannesburg, Johannesburg, South Africa
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Sprague C, Woollett N, Hatcher AM. Enhancing agency for health providers and pregnant women experiencing intimate partner violence in South Africa. Glob Public Health 2020; 15:1820-1835. [PMID: 32552366 PMCID: PMC7641912 DOI: 10.1080/17441692.2020.1780290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 06/01/2020] [Indexed: 10/24/2022]
Abstract
Global policy frameworks call for strengthening the role of health systems to address intimate partner violence (IPV) and support women's agency, yet the evidence of health system responses remains slender in low- and middle-income countries (LMICs). In South Africa, 25-35% of pregnant women experience IPV, posing long-term health risks. We utilised agency as a theoretical construct, applying qualitative methods to investigate health professionals' experiences of a randomised controlled trial intervention to address IPV in pregnant women in five antenatal clinics (ANC) in Johannesburg (2011-2016). In-depth interviews (n = 16) were supplemented by participant observation, debriefing and field notes. Health providers viewed the intervention as enhancing health promotion agency and advancing help-seeking agency for IPV-exposed patients. Intervention nurses reported their own self-efficacy improved, and their relational and collective agency expanded. On-going supervision, mentorship and feedback were essential to establish the knowledge and skill-building necessary for providers to improve self-efficacy in intervention delivery. Integrating mental health services into primary ANC services is recommended. Findings offer insight into the untapped potential for LMIC health settings to become transformative, gender-responsive social systems, for patients and health professionals, in ways that advance women's agency, health, human rights and SDGs.
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Affiliation(s)
- Courtenay Sprague
- Department of Conflict Resolution, Human Security &
Global Governance, McCormack Graduate School of Policy and Global Studies,
University of Massachusetts Boston, Boston, MA, USA
- Department of Nursing, College of Nursing and Health
Sciences, University of Massachusetts Boston, Boston, MA, USA
- Wits Reproductive Health and HIV Institute, Faculty of
Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nataly Woollett
- School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - Abigail M. Hatcher
- School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Department of Health Behavior, Gillings School of Global
Health, University of North Carolina, Chapel Hill, North Carolina, USA
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Mkabile S, Swartz L. 'I Waited for It until Forever': Community Barriers to Accessing Intellectual Disability Services for Children and Their Families in Cape Town, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8504. [PMID: 33212851 PMCID: PMC7698324 DOI: 10.3390/ijerph17228504] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Intellectual disability is more common in low- and middle-income countries than in high-income countries. Stigma and discrimination have contributed to barriers to people with intellectual disability accessing healthcare. As part of a larger study on caregiving of children with intellectual disability in urban Cape Town, South Africa, we interviewed a sub-group of families who had never used the intellectual disability services available to them, or who had stopped using them. METHODS We employed a qualitative research design and conducted semi-structured interviews to explore the views and perspectives of parents and caregivers of children with intellectual disability who are not using specialised hospital services. We developed an interview guide to help explore caregivers' and parents' views. RESULTS Results revealed that caregivers and parents of children with intellectual disability did not use the intellectual disability service due to financial difficulties, fragile care networks and opportunity costs, community stigma and lack of safety, lack of faith in services and powerlessness at effecting changes and self-stigmatisation. CONCLUSION Current findings highlight a need for increased intervention at community level and collaboration with community-based projects to facilitate access to services, and engagement with broader issues of social exclusion.
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Affiliation(s)
- Siyabulela Mkabile
- Department of Psychology, Stellenbosch University, Stellenbosch 7602, South Africa;
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7735, South Africa
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Stellenbosch 7602, South Africa;
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Haine P, Booysen DD. Life after training: Professional experiences of early career clinical and counselling psychologists in South Africa. JOURNAL OF PSYCHOLOGY IN AFRICA 2020. [DOI: 10.1080/14330237.2020.1821317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Phillipa Haine
- Department of Psychology, Rhodes University, Makhanda, South Africa
| | - Duane D Booysen
- Department of Psychology, Rhodes University, Makhanda, South Africa
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Hassem T, Laher S. The ethics of online screening for mental health in South Africa: A systematic review. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2020. [DOI: 10.1080/00207411.2020.1802693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Tasneem Hassem
- Psychology, University of the Witwatersrand, Johannesburg, South Africa
| | - Sumaya Laher
- Psychology, University of the Witwatersrand, Johannesburg, South Africa
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Payne A, Koen L, Niehaus DJH, Smit IM. Burnout and job satisfaction of nursing staff in a South African acute mental health setting. S Afr J Psychiatr 2020; 26:1454. [PMID: 32832126 PMCID: PMC7433218 DOI: 10.4102/sajpsychiatry.v26i0.1454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 03/18/2020] [Indexed: 11/03/2022] Open
Abstract
Background Psychiatric nurses constitute a fundamental part of the mental health care system in South Africa. However, high levels of burnout and job dissatisfaction among nursing staff have been associated with reduced empathy and quality of care, and poor service delivery. Stikland Psychiatric Hospital is a state psychiatric hospital situated in Belville and provides all levels of psychiatric care to a large part of the Cape metro region. To our knowledge, no previous studies have examined burnout and job satisfaction among nurses in this setting. Aim We assessed the relationship between burnout and job satisfaction among the nursing staff. Setting The study was conducted at Stikland Psychiatric Hospital, Cape Town, South Africa. Methods This cross-sectional study used the Copenhagen Burnout Inventory and an established job satisfaction questionnaire to assess burnout and job satisfaction among 127 staff members associated with psychiatric nursing. Results In this population comprising mostly female (83.5%) nurses, scores for personal, work-related and client-related burnout were relatively high, but job satisfaction was also high. Higher levels of burnout were significantly associated (Pearson's linear correlation, r = -0.077, p < 0.01) with lower levels of job satisfaction. There were no significant associations between burnout or job satisfaction and gender, rank or years of experience. Conclusions If mental health service delivery is to be optimised, supportive or preventative processes should be implemented to reduce the prevalence of burnout in psychiatric nurses. This study adds to the scarce local knowledge and provides information that can be used to inform the development of supportive strategies for psychiatric nursing staff in South Africa.
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Affiliation(s)
- Anthea Payne
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Liezl Koen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Daniel J H Niehaus
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Inge-Marli Smit
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Joska JA, Andersen LS, Smith-Alvarez R, Magidson J, Lee JS, O'Cleirigh C, Safren SA. Nurse-Delivered Cognitive Behavioral Therapy for Adherence and Depression Among People Living With HIV (the Ziphamandla Study): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e14200. [PMID: 32012114 PMCID: PMC7055790 DOI: 10.2196/14200] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/14/2019] [Accepted: 09/24/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is an unmet need to develop effective, feasible, and scalable interventions for poor adherence and depression in persons living with HIV in low- and middle-income countries (LMIC). OBJECTIVE This study aims to investigate the effectiveness of a nurse-delivered cognitive behavioral therapy (CBT) intervention for adherence and depression (CBT-AD) among persons living with HIV who are failing first-line antiretroviral therapy (ART) in Cape Town, South Africa. METHODS This study is a 2-arm randomized controlled trial of CBT-AD integrated into the HIV primary care setting in South Africa. A total of 160 participants who did not achieve viral suppression from their first-line ART and have a unipolar depressive mood disorder will be randomized to receive either 8 sessions of CBT-AD or enhanced treatment as usual. Participants will be assessed for major depressive disorder using the Mini International Neuropsychiatric Interview at baseline and 4, 8, and 12 months. The primary outcomes are depression on the Hamilton Depression Scale (HAM-D; as assessed by a blinded assessor) at the 4-month assessment and changes in ART adherence (assessed via real-time, electronic monitoring with Wisepill) between baseline and the 4-month assessment. Secondary outcomes are HIV viral load and CD4 cell count at the 12-month assessment as well as ART adherence (Wisepill) and depression (HAM-D) over follow-up (4-, 8-, and 12-month assessments). RESULTS The trial commenced in August 2015 and recruitment began in July 2016. Enrollment was completed in June 2019. CONCLUSIONS Results of this study will inform whether an existing intervention (CBT-AD) can be effectively administered in LMIC by nurses with training and ongoing supervision. This will present unique opportunities to further explore the scale-up of a behavioral intervention to enhance ART adherence among persons living with HIV with major depression in a high-prevalence setting, to move toward achieving The Joint United Nations Programme on HIV/AIDS 90-90-90 goals. TRIAL REGISTRATION ClincialTrials.gov NCT02696824; https://clinicaltrials.gov/ct2/show/NCT02696824. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/14200.
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Affiliation(s)
- John A Joska
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Lena S Andersen
- HIV Mental Health Research Unit, Neuroscience Institute, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Jessica Magidson
- Department of Psychology, University of Maryland, College Park, MD, United States
| | - Jasper S Lee
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Conall O'Cleirigh
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Steven A Safren
- Department of Psychology, University of Miami, Coral Gables, FL, United States
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Hassem T, Laher S. A systematic review of online depression screening tools for use in the South African context. S Afr J Psychiatr 2019; 25:1373. [PMID: 31824743 PMCID: PMC6890541 DOI: 10.4102/sajpsychiatry.v25i0.1373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/21/2019] [Indexed: 11/01/2022] Open
Abstract
Background According to the World Health Organization, the alarming increase in rates of depression globally has become a serious concern. In 2010, the prevalence rate of depression in South Africa was 4.6%. Given the context of South Africa where the majority of the population have limited access to healthcare facilities and 59.3% of the population have access to the Internet, an online depression screening tool would have much to offer. Objective To determine whether online depression screening tools would be suitable for use in South Africa. Methods This study presents a systematic review of online depression screening tools to determine whether one would be suitable for use in South Africa. Articles were accessed from seven electronic databases from 1970 to 2018. All articles included in the review were critically appraised. Results A total of 17 articles met the inclusion criteria. From the results, there was only one screening tool available on an open access platform for use by the general population. The most common depression online screening tools were the Beck Depression Inventory-II (BDI-II), the Center for Epidemiology Studies Depression Scale (CES-D) and the Patient Health Questionnaire (PHQ-9). It was also evident that there were negligible differences in the psychometric properties of online versus paper versions of the online screening tools. Furthermore, there were very few studies that considered the African or South African population and no online screening tools for major depressive disorder (MDD) developed in these contexts. Conclusion There appears to be a need for a depression screening tool to be adapted for online usage in South Africa. It is recommended that the online screening tool should be adapted from the three commonly used online depression screening tools: PHQ-9, CES-D and BDI-II.
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Affiliation(s)
- Tasneem Hassem
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
| | - Sumaya Laher
- Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa
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Docrat S, Besada D, Cleary S, Daviaud E, Lund C. Mental health system costs, resources and constraints in South Africa: a national survey. Health Policy Plan 2019; 34:706-719. [PMID: 31544948 PMCID: PMC6880339 DOI: 10.1093/heapol/czz085] [Citation(s) in RCA: 138] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2019] [Indexed: 11/14/2022] Open
Abstract
The inclusion of mental health in the Sustainable Development Goals represents a global commitment to include mental health among the highest health and development priorities for investment. Low- and middle-income countries (LMICs), such as South Africa, contemplating mental health system scale-up embedded into wider universal health coverage-related health system transformations, require detailed and locally derived estimates on existing mental health system resources and constraints. The absence of these data has limited scale-up efforts to address the burden of mental disorders in most LMICs. We conducted a national survey to quantify public expenditure on mental health and evaluate the constraints of the South African mental health system. The study found that South Africa's public mental health expenditure in the 2016/17 financial year was USD615.3 million, representing 5.0% of the total public health budget (provincial range: 2.1-7.7% of provincial health budgets) and USD13.3 per capita uninsured. Inpatient care represented 86% of mental healthcare expenditure, with nearly half of total mental health spending occurring at the psychiatric hospital-level. Almost one-quarter of mental health inpatients are readmitted to hospital within 3 months of a previous discharge, costing the public health system an estimated USD112 million. Crude estimates indicate that only 0.89% and 7.35% of the uninsured population requiring care received some form of public inpatient and outpatient mental healthcare, during the study period. Further, mental health human resource availability, infrastructure and medication supply are significant constraints to the realization of the country's progressive mental health legislation. For the first time, this study offers a nationally representative reflection of the state of mental health spending and elucidates inefficiencies and constraints emanating from existing mental health investments in South Africa. With this information at hand, the government now has a baseline for which a rational process to planning for system reforms can be initiated.
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Affiliation(s)
- Sumaiyah Docrat
- Department of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, Western Cape, South Africa
| | - Donela Besada
- Health Systems Research Unit, South Africa Medical Research Council, Cape Town, South Africa
| | - Susan Cleary
- School of Public Health and Family Medicine, Health Economics Unit, University of Cape Town, Cape Town, South Africa
| | - Emmanuelle Daviaud
- Health Systems Research Unit, South Africa Medical Research Council, Cape Town, South Africa
| | - Crick Lund
- Department of Psychiatry and Mental Health, Alan J. Flisher Centre for Public Mental Health, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, Western Cape, South Africa
- Health Service and Population Research Department, Centre for Global Mental Health, King’s Global Health Institute, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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van Heyningen T, Myer L, Tomlinson M, Field S, Honikman S. The development of an ultra-short, maternal mental health screening tool in South Africa. Glob Ment Health (Camb) 2019; 6:e24. [PMID: 31662879 PMCID: PMC6796322 DOI: 10.1017/gmh.2019.21] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/01/2019] [Accepted: 08/21/2019] [Indexed: 12/26/2022] Open
Abstract
PURPOSE The burden of common perinatal mental disorders (CPMD) in low-and-middle-income countries is substantially higher than high-income countries, with low levels of detection, service provision and treatment in resource-constrained settings. We describe the development of an ultra-short screening tool to detect antenatal depression, anxiety disorders and maternal suicidal ideation. METHODS A sample of 376 women was recruited at a primary-level obstetric clinic. Five depression and anxiety symptom-screening questionnaires, demographics and psychosocial risk questionnaires were administered. All participants were assessed with the Mini-International Neuropsychiatric Interview (MINI), a structured, diagnostic interview. Screening tool items were analysed against diagnostic data using multiple logistic regression and receiver operating curve (ROC) analysis. RESULTS The prevalence of MINI-defined major depressive episode (MDE) and/or anxiety disorders was 33%. Overall, 18% of participants expressed suicidal ideation and behaviour, 54% of these had no depression or anxiety diagnosis. Multiple logistic regression identified four screening items that were independently predictive of MDE and anxiety disorders, investigating depressed mood, anhedonia, anxiety symptoms and suicidal ideation. ROC analysis of these combined items yielded an area under the curve of 0.83 (95% CI 0.78-0.88). A cut-off score of 2 or more offered a sensitivity of 78% and specificity of 82%. CONCLUSION This novel screening tool is the first measure of CPMD developed in South Africa to include depressed mood, anxiety symptoms and suicidal ideation. While the tool requires further investigation, it may be useful for the early identification of mental health symptoms and morbidity in the perinatal period.
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Affiliation(s)
- T. van Heyningen
- Perinatal Mental Health Project, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - L. Myer
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - M. Tomlinson
- Department of Global Health, Institute for Life Course Health Research, Stellenbosch University, Cape Town, South Africa
| | - S. Field
- Perinatal Mental Health Project, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - S. Honikman
- Perinatal Mental Health Project, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Saal W, Kagee A, Bantjes J. Utility of the Beck Depression Inventory in measuring major depression among individuals seeking HIV testing in the Western Cape, South Africa. AIDS Care 2019; 30:29-36. [PMID: 30021462 DOI: 10.1080/09540121.2018.1499856] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The Beck Depression Inventory (BDI) is often used to screen individuals for symptoms of major depressive disorder (MDD). Yet, its effectiveness in correctly discriminating between MDD cases and non-cases among individuals seeking HIV testing has not been investigated. We report on the effectiveness of the BDI-I in predicting caseness for MDD with the Structured Clinical Interview for the DSM (SCID) as a gold standard. A total of 500 HIV test-seekers were recruited at five non-medical testing sites in the Western Cape, South Africa. Receiver operating characteristic curve analysis was used to determine the extent to which the screening instrument was able to discriminate between MDD caseness or non-caseness. The SCID-based prevalence of MDD was 14.4%. The BDI-I predicted MDD with 67% sensitivity and 67% specificity, with an area under the curve (AUC) of 77%. The positive and negative predictive values were 0.25 and 0.92, respectively. Even though the BDI-I is often used to screen large numbers of people for depression, especially in psychiatric and medical settings, its ability to predict MDD is limited. Persons screening positive for MDD may still require evaluation with a clinical interview by a trained professional to be diagnosed with depression.
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Affiliation(s)
- W Saal
- a Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
| | - A Kagee
- a Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
| | - J Bantjes
- a Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
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Mutyambizi-Mafunda V, Myers B, Sorsdahl K, Lund C, Naledi T, Cleary S. Integrating a brief mental health intervention into primary care services for patients with HIV and diabetes in South Africa: study protocol for a trial-based economic evaluation. BMJ Open 2019; 9:e026973. [PMID: 31092660 PMCID: PMC6530312 DOI: 10.1136/bmjopen-2018-026973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Depression and alcohol use disorders are international public health priorities for which there is a substantial treatment gap. Brief mental health interventions delivered by lay health workers in primary care services may reduce this gap. There is limited economic evidence assessing the cost-effectiveness of such interventions in low-income and middle-income countries. This paper describes the proposed economic evaluation of a health systems intervention testing the effectiveness, cost-effectiveness and cost-utility of two task-sharing approaches to integrating services for common mental disorders with HIV and diabetes primary care services. METHODS AND ANALYSIS This evaluation will be conducted as part of a three-armed cluster randomised controlled trial of clinical effectiveness. Trial clinical outcome measures will include primary outcomes for risk of depression and alcohol use, and secondary outcomes for risk of chronic disease (HIV and diabetes) treatment failure. The cost-effectiveness analysis will evaluate cost per unit change in Alcohol Use Disorder Identification Test and Centre for Epidemiological Studies scale on Depression scores as well as cost per unit change in HIV RNA viral load and haemoglobin A1c, producing results of provider and patient cost per patient year for each study arm and chronic disease. The cost utility analyses will provide results of cost per quality-adjusted life year gained. Additional analyses relevant for implementation including budget impact analyses will be conducted to inform the development of a business case for scaling up the country's investment in mental health services. ETHICS AND DISSEMINATION The Western Cape Department of Health (WCDoH) (WC2016_RP6_9), the South African Medical Research Council (EC 004-2/2015), the University of Cape Town (089/2015) and Oxford University (OxTREC 2-17) provided ethical approval for this study. Results dissemination will include policy briefs, social media, peer-reviewed papers, a policy dialogue workshop and press briefings. TRIAL REGISTRATION NUMBER PACTR201610001825405.
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Affiliation(s)
- Vimbayi Mutyambizi-Mafunda
- Health Economics Unit, University of Cape Town School of Public Health and Family Medicine, Cape Town, Western Cape, South Africa
| | - Bronwyn Myers
- Alcohol and Drug Abuse Research Unit, South African Medical Research Council, Tygerburg, Western Cape, South Africa
| | - Katherine Sorsdahl
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Crick Lund
- Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, Western Cape, South Africa
- Institute of Psychiatry, Psychology and Neuroscience, Health Services and Population Research, King's College London, London, UK
| | - Tracey Naledi
- Desmond Tutu HIV Research Centre, University of Cape Town School of Public Health and Family Medicine, Observatory, Western Cape, South Africa
- Western Cape Department of Health, Cape Town, Western Cape, South Africa
| | - Susan Cleary
- Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Observatory, Western Cape, South Africa
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Naidoo P, Nyembezi A, Thomas E, Lachman A, Kagee A. Perceived barriers and facilitators for healthy behaviours among parents of adolescents receiving mental health care in a public hospital in Cape Town, South Africa: A qualitative study. J Child Adolesc Ment Health 2019; 31:39-50. [PMID: 30961448 DOI: 10.2989/17280583.2019.1584107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: To explore the perceived barriers and facilitators for healthy behaviours among parents and caregivers of adolescents receiving mental health care in Cape Town, South Africa. Method: Thirty-five qualitative in-depth interviews were conducted with parents and caregivers of adolescents receiving mental health treatment by six facilitators matched for language. The data was analysed using thematic analysis. Results: The participants were predominantly female (n = 28, 80%) and parents (n = 29, 83%) of the adolescents. Personal barriers to good health included unhealthy eating, substance use and physical inactivity. Environmental barriers were inherited medical conditions, the easy availability of unhealthy foods and the absence of recreational facilities in communities. Perceived facilitators to good health were parental role modelling, planning and preparing healthy meals, exercise opportunities providing by walking long distances to work, and doing physically demanding jobs and household chores. Conclusion: Parents and caregivers are essential to adolescents' healthy development as they may influence adolescent health behaviours. It is likely that the promotion of positive health behaviours may be achieved though family-based interventions.
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Affiliation(s)
- Pamela Naidoo
- a Department of Psychiatry , Stellenbosch University , Tygerberg , South Africa
| | - Anam Nyembezi
- b School of Public Health , University of the Western Cape , Bellville , South Africa
| | - Eileen Thomas
- a Department of Psychiatry , Stellenbosch University , Tygerberg , South Africa
| | - Anusha Lachman
- a Department of Psychiatry , Stellenbosch University , Tygerberg , South Africa
| | - Ashraf Kagee
- c Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
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Furst MA, Gandré C, Romero López-Alberca C, Salvador-Carulla L. Healthcare ecosystems research in mental health: a scoping review of methods to describe the context of local care delivery. BMC Health Serv Res 2019; 19:173. [PMID: 30885186 PMCID: PMC6423877 DOI: 10.1186/s12913-019-4005-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 03/12/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Evidence from the context of local health ecosystems is highly relevant for research and policymaking to understand geographical variations in outcomes of health care delivery. In mental health systems, the analysis of context presents particular challenges related to their complexity and to methodological difficulties. Method guidelines and standard recommendations for conducting context analysis of local mental health care are urgently needed. This scoping study reviews current methods of context analysis in mental health systems to establish the parameters of research activity examining availability and capacity of care at the local level, and to identify any gaps in the literature. METHODS A scoping review based on a systematic search of key databases was conducted for the period 2005-2016. A systems dynamics/complexity approach was adopted, using a modified version of Tansella and Thornicroft's matrix model of mental health care as the conceptual framework for our analysis. RESULTS The lack of a specific terminology in the area meant that from 10,911 titles identified at the initial search, only 46 papers met inclusion criteria. Of these, 21 had serious methodological limitations. Fifteen papers did not use any kind of formal framework, and five of those did not describe their method. Units of analysis varied widely and across different levels of the system. Six instruments to describe service availability and capacity were identified, of which three had been psychometrically validated. A limitation was the exclusion of grey literature from the review. However, the imprecise nature of the terminology, and high number of initial results, makes the inclusion of grey literature not feasible. CONCLUSION We identified that, in spite of its relevance, context studies in mental health services is a very limited research area. Few validated instruments are available. Methodological limitations in many papers mean that the particular challenges of mental health systems research such as system complexity, data availability and terminological variability are generally poorly addressed, presenting a barrier to valid system comparison. The modified Thornicroft and Tansella matrix and related ecological production of care model provide the main model for research within the area of health care ecosystems.
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Affiliation(s)
- Mary Anne Furst
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, 63 Eggleston Rd Acton ACT, Canberra, 2601 Australia
| | - Coralie Gandré
- URC-Eco Ile-de-France, F-75004 Paris, France
- University Paris Diderot, Sorbonne Paris Cité, ECEVE, UMRS 1123, F-75010 Paris, France
- Inserm, ECEVE, U1123, F-75010 Paris, France
| | | | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Health and Medicine, Australian National University, 63 Eggleston Rd Acton ACT, Canberra, 2601 Australia
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Lovero KL, Lammie SL, van Zyl A, Paul SN, Ngwepe P, Mootz JJ, Carlson C, Sweetland AC, Shelton RC, Wainberg ML, Medina-Marino A. Mixed-methods evaluation of mental healthcare integration into tuberculosis and maternal-child healthcare services of four South African districts. BMC Health Serv Res 2019; 19:83. [PMID: 30704459 PMCID: PMC6357439 DOI: 10.1186/s12913-019-3912-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 01/17/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The South African National Mental Health Policy Framework and Strategic Plan 2013-2020 was adopted to address the country's substantial burden and inadequate treatment of mental illness. It outlines measures toward the goal of full integration of mental health services into primary care by 2020. To evaluate progress and challenges in implementation, we conducted a mixed-methods assessment of mental health service provision in tuberculosis and maternal-child healthcare services of four districts in South Africa. METHODS Forty clinics (ten per district) were purposively selected to represent both urban and rural locations. District-level program managers (DPMs) for mental health, tuberculosis, and maternal-child healthcare were qualitatively interviewed about district policy and procedures for management of mental illness and challenges in integrating mental health services into primary care. Clinic nurses and mental health practitioners (MHPs) completed a quantitative questionnaire to assess their engagement with stepped care for patients with mental illness. Qualitative and quantitative data were collected concurrently and compared to triangulate progress in implementation of integrated services. RESULTS A total of 59 nurses and 17 MHPs completed questionnaires, and nine DPMs were interviewed (total n = 85). DPMs indicated that nurses should screen for mental illness at every patient visit, although only 43 (73%) nurses reported conducting universal screening and 26 (44%) reported using a specific screening tool. For patients who screen positive for mental illness, DPMs described a stepped-care approach in which MHPs diagnose patients and then treat or refer them to specialized care. However, only 7 (41%) MHPs indicated that they diagnose mental illness and 14 (82%) offer any treatment for mental illness. Addressing challenges to current integration efforts, DPMs highlighted 1) insufficient funding and material resources, 2) poor coordination at the district administrative level, and 3) low mental health awareness in district administration and the general population. CONCLUSIONS Though some progress has been made toward integration of mental health services into primary care settings, there is a substantial lack of training and clarity of roles for nurses and MHPs. To enhance implementation, increased efforts must be directed toward improving district-level administrative coordination, mental health awareness, and financial and material resources.
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Affiliation(s)
- Kathryn L. Lovero
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive #24, New York, NY 10032 USA
| | - Samantha L. Lammie
- Emory University School of Medicine, 1648 Pierce Dr NE, Atlanta, GA 30307 USA
- Foundation for Professional Development, 173 Mary Rd, Die Wilgers, Pretoria, 0184 South Africa
| | - André van Zyl
- Foundation for Professional Development, 173 Mary Rd, Die Wilgers, Pretoria, 0184 South Africa
| | - Sharon N. Paul
- Foundation for Professional Development, 173 Mary Rd, Die Wilgers, Pretoria, 0184 South Africa
| | - Phuti Ngwepe
- Foundation for Professional Development, 173 Mary Rd, Die Wilgers, Pretoria, 0184 South Africa
| | - Jennifer J. Mootz
- Emory University School of Medicine, 1648 Pierce Dr NE, Atlanta, GA 30307 USA
| | - Catherine Carlson
- School of Social Work, University of Alabama, 3026 Little Hall, Box 870314, Tuscaloosa, AL 35487-0314 USA
| | - Annika C. Sweetland
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive #24, New York, NY 10032 USA
| | - Rachel C. Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, 722 W. 168th St. #941, New York, NY 10032 USA
| | - Milton L. Wainberg
- New York State Psychiatric Institute, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive #24, New York, NY 10032 USA
| | - Andrew Medina-Marino
- Foundation for Professional Development, 173 Mary Rd, Die Wilgers, Pretoria, 0184 South Africa
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Spatial structure of depression in South Africa: A longitudinal panel survey of a nationally representative sample of households. Sci Rep 2019; 9:979. [PMID: 30700798 PMCID: PMC6354020 DOI: 10.1038/s41598-018-37791-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/05/2018] [Indexed: 12/18/2022] Open
Abstract
Wider recognition of the mental health burden of disease has increased its importance as a global public health concern. However, the spatial heterogeneity of mental disorders at large geographical scales is still not well understood. Herein, we investigate the spatial distribution of incident depression in South Africa. We assess depressive symptomatology from a large longitudinal panel survey of a nationally representative sample of households, the South African National Income Dynamics Study. We identified spatial clusters of incident depression using spatial scan statistical analysis. Logistic regression was fitted to establish the relationship between clustering of depression and socio-economic, behavioral and disease risk factors, such as tuberculosis. There was substantial geographical clustering of depression in South Africa, with the excessive numbers of new cases concentrated in the eastern part of the country. These clusters overlapped with those of self-reported tuberculosis in the same region, as well as with poorer, less educated people living in traditional rural communities. Herein, we demonstrate, for the first time, spatial structuring of depression at a national scale, with clear geographical ‘hotspots’ of concentration of individuals reporting new depressive symptoms. Such geographical clustering could reflect differences in exposure to various risk factors, including socio-economic and epidemiological factors, driving or reinforcing the spatial structure of depression. Identification of the geographical location of clusters of depression should inform policy decisions.
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Siyothula ETB. Clinical psychology service distribution and integration into primary health care in KwaZulu-Natal, South Africa. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1177/0081246318815337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inadequate investment in mental health care by the governments of both high- and low-income countries contributes to recurrent challenges of uneven distribution of and access to mental health services between urban and non-urban communities. While recent research has acknowledged the role of mental health in well-being and the cost of failure to invest in the sector, prioritising mental health to the same degree as physical health remains a challenge. This article highlights the unequal distribution of mental health services, and psychological services in particular, in KwaZulu-Natal. This is achieved by considering the background of psychology in South Africa and KwaZulu-Natal and then examining the ratio of clinical psychologists to the KwaZulu-Natal population. Furthermore, the article explores the geographical distribution of psychological services in KwaZulu-Natal and concludes with a discussion of the impact of uneven mental health service distribution on service provision and utilisation in non-urban areas of KwaZulu-Natal.
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Affiliation(s)
- Evy-Terressah Busisiwe Siyothula
- Department of Behavioural Medicine, University of KwaZulu-Natal, South Africa
- Fort Napier Hospital, KwaZulu-Natal Department of Health, South Africa
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Tomita A, Ramlall S. A Nationwide Panel Study on Religious Involvement and Depression in South Africa: Evidence from the South African National Income Dynamics Study. JOURNAL OF RELIGION AND HEALTH 2018; 57:2279-2289. [PMID: 29305744 DOI: 10.1007/s10943-017-0551-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Panel data from the South African National Income Dynamics Study, a nationally representative sample of households (years 2008, 2010 and 2012), were used to examine the longitudinal association between religious involvement and depression risk. Approximately 89.6-91.8% identified themselves as religiously affiliated, while 88.0-90.3% perceived religion to be important in South Africa during the observed study periods. A short-term association between religious involvement and significant depressive symptomatology was not detected, but logistic regression models that accounted for the clustering of repeated observations within participants indicated that, over time, those with religious affiliations (aOR 0.85, 95% CI 0.76-0.96) were at a lower risk than those not affiliated. Furthermore, individuals who reported religious activity as being important (aOR 0.81; 95% CI 0.73-0.91) were at less risk of significant depressive symptomatology over time than those rating religious activity as not important. Our study points to the potentially important role of religious involvement as an emerging area of investigation toward improving mental health at a population level in resource-limited settings.
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Affiliation(s)
- Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Private Bag X7, Durban, South Africa.
- KwaZulu-Natal Research Innovation and Sequencing (KRISP), Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.
- Africa Health Research Institute, University of KduuwaZulu-Natal, Durban, South Africa.
| | - Suvira Ramlall
- Department of Psychiatry, Nelson R Mandela School of Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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van de Water T, Rossouw J, Yadin E, Seedat S. Adolescent and nurse perspectives of psychotherapeutic interventions for PTSD delivered through task-shifting in a low resource setting. PLoS One 2018; 13:e0199816. [PMID: 29990372 PMCID: PMC6038985 DOI: 10.1371/journal.pone.0199816] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 06/14/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This investigation compared the perceived effectiveness of supportive counselling (SC) and prolonged exposure for adolescents (PE-A) by treatment users (adolescents with PTSD) and non-specialist treatment providers (supervised nurses). METHOD Adolescent participants and nurse providers were purposively recruited to share their experiences of trial participation through face to face semi-structured in-depth interviews and treatment-specific focus groups (all recorded). Twelve adolescent participant transcripts (ten interviews and two focus groups) and three nurse provider transcripts were doubly transcribed. Thematic content analysis was applied using Atlas.ti software. Two emerging themes are presented in this paper: 1) Perceptions of the intervention and 2) Usefulness of the intervention. RESULTS Regardless of treatment arm, adolescents experienced warm counselling relationships and described the process of extending trust to the counselor. Adolescents in the PE-A arm provided clear descriptions of session structure and treatment rationale compared with adolescents receiving SC. The most helpful tools were breathing retraining and imaginal exposure for PE-A and creation of distraction strategies during non-directive SC. Adolescents in both arms continued to use the techniques acquired during treatment and reported symptom improvement. Participants who received SC acknowledged ongoing reexperiencing. Nurses perceived SC to be an immediately transferable skill, but feedback on their preference for one intervention over the other was inconclusive. CONCLUSION Both PTSD treatment strategies, implemented by non-specialists, were perceived as helpful. Overall, adolescents reported warm therapeutic relationships and a reduction in PTSD symptoms. Nurses stated that they would require institutional support to ensure delivery of these interventions in a scalable and sustainable manner.
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Affiliation(s)
- Tanya van de Water
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Jaco Rossouw
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, Pennsylvania, United States of America
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
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Kagee A, Bantjes J, Saal W, Sefatsa M. Utility of the Posttraumatic Stress Scale–Self-report version in screening for posttraumatic stress disorder among persons seeking HIV testing. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1177/0081246318779191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The literature on the utility of self-report instruments in determining caseness for posttraumatic stress disorder in South Africa is sparse. We administered the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders–Research Version and the Posttraumatic Stress Scale–Self-report version to a sample of 500 South African community members seeking HIV testing. Of our original sample of 500, 306 (61.2%) reported an index event for posttraumatic stress disorder and 25 (5.0%) met the criteria for this diagnosis. The Posttraumatic Stress Scale–Self-report displayed internal consistency of .95 as measured by Cronbach’s alpha. Using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders as a gold standard, we conducted receiver operating curve analysis among the 306 participants who reported an index traumatic event to determine the extent to which the Posttraumatic Stress Scale–Self-report as a screening instrument successfully discriminated between participants who did and did not meet the diagnostic criteria for posttraumatic stress disorder. The Posttraumatic Stress Scale–Self-report yielded sensitivity of .76 and specificity of .78, with an area under the curve of .837. Positive and negative predictive values were .24 and .97, respectively. Our findings suggest that the Posttraumatic Stress Scale–Self-report may be effectively used to screen for posttraumatic stress disorder among community samples, including persons seeking HIV testing.
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Affiliation(s)
- Ashraf Kagee
- Department of Psychology, Stellenbosch University, South Africa
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, South Africa
| | - Wylene Saal
- Department of Psychology, Stellenbosch University, South Africa
| | - Mpho Sefatsa
- Department of Psychology, Stellenbosch University, South Africa
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Zinatsa F, Engelbrecht M, van Rensburg AJ, Kigozi G. Voices from the frontline: barriers and strategies to improve tuberculosis infection control in primary health care facilities in South Africa. BMC Health Serv Res 2018; 18:269. [PMID: 29636041 PMCID: PMC5894140 DOI: 10.1186/s12913-018-3083-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/28/2018] [Indexed: 11/12/2022] Open
Abstract
Background Tuberculosis (TB) infection control at primary healthcare (PHC) level remains problematic, especially in South Africa. Improvements are significantly dependent on healthcare workers’ (HCWs) behaviours, underwriting an urgent need for behaviour change. This study sought to 1) identify factors influencing TB infection control behaviour at PHC level within a high TB burden district and 2) in a participatory manner elicit recommendations from HCWs for improved TB infection control. Method A qualitative case study was employed. TB nurses and facility managers in the Mangaung Metropolitan District, South Africa, participated in five focus group and nominal group discussions. Data was thematically analysed. Results Utilising the Information Motivation and Behaviour (IMB) Model, major barriers to TB infection control information included poor training and conflicting policy guidelines. Low levels of motivation were observed among participants, linked to feelings of powerlessness, negative attitudes of HCWs, poor district health support, and general health system challenges. With a few exceptions, most behaviours necessary to achieve TB risk-reduction, were generally regarded as easy to accomplish. Conclusions Strategies for improved TB infection control included: training for comprehensive TB infection control for all HCWs; clarity on TB infection control policy guidelines; improved patient education and awareness of TB infection control measures; emphasis on the active role HCWs can play in infection control as change agents; improved social support; practical, hands-on training or role playing to improve behavioural skills; and the destigmatisation of TB/HIV among HCWs and patients.
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Affiliation(s)
- Farirai Zinatsa
- Centre for Development Support, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300, South Africa
| | - Michelle Engelbrecht
- Centre for Health Systems Research and Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300, South Africa.
| | - André Janse van Rensburg
- Centre for Health Systems Research and Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300, South Africa
| | - Gladys Kigozi
- Centre for Health Systems Research and Development, University of the Free State, Nelson Mandela Road, Bloemfontein, 9300, South Africa
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