Spatial structure of depression in South Africa: A longitudinal panel survey of a nationally representative sample of households

Internal migration and depressive symptoms: exploring selection and outcomes in a South African cohort

Introduction

Investigations of migration effects on mental health conditions, including depression are sparse in low- and middle-income countries (LMIC), yet mental health may play a role in a decision to migrate, and migration in turn can impact on mental health outcomes.

Methods

This paper uses two waves of data from the Migrant Health Follow-Up Study, a young adult cohort of 3092 internal migrants and residents of the Agincourt study site in rural northeast South Africa to explore the relationship between internal migration and depressive symptoms, as measured on the Centre for Epidemiological Studies Depression (CES-D) scale. We employ logistic regression analysis to investigate selectivity of migrants are in relation to depressive symptoms, and we fit generalised linear -models to analyse depressive symptoms (CES-D scores) as a function of migration status and sociodemographic and health characteristics, accounting for temporal sequence.

Results

Although we observe systematically low reporting of depressive symptoms, average CES-D scores are lower among migrants (comprising approximately 53% of the cohort) compared to Agincourt residents at both survey timepoints. We do not find evidence of a selection effect in relation to mental health among those newly migrating between Wave 2 and 3 (n=1393). In analyses of the CES-D score outcome, the significant influence of migration status on depressive symptoms is reduced with the inclusion of controls in the models. Consistent employment and higher levels of education are associated with lower CES-D scores, while diagnosis of a chronic condition is associated with higher scores.

Conclusion

The relationship between migration and depressive symptoms is influenced by factors preceding a migration and destination-place characteristics and experiences. Further examination of the role of migration at different stages of the process, along with continuing attention to psychosocial measurement considerations for LMIC subpopulations, can improve our understanding of these complex interrelationships and contribute to evidence.

Recent advances in the synthesis of antidepressant derivatives: pharmacologic insights for mood disorders

Mood disorders, including depression, remain a significant global health concern, necessitating continuous efforts to develop novel and more effective antidepressant therapies. Although there have been significant advancements in comprehending the biology of Major Depressive Disorder (MDD), a considerable number of people suffering from depression do not exhibit positive responses to the pharmacologic treatments now available. This study specifically examines emerging targets and potential future approaches for pharmaceutical interventions in the treatment of MDD. The discussion revolves around novel therapeutic agents and their effectiveness in treating depression. The focus is on the specific pathophysiological pathways targeted by these agents and the amount of evidence supporting their use. While conventional antidepressants are anticipated to continue being the primary treatment for MDD in the foreseeable future, there is currently extensive research being conducted on numerous new compounds to determine their effectiveness in treating MDD. Many of these compounds have shown encouraging results. This review highlighted the recent advances in the synthesis of antidepressant derivatives and explores their pharmacologic insights for the treatment of mood disorders.

Depression, an unmet health need in Africa: Understanding the promise of ketamine

In Africa, there is currently a paucity of data on the epidemiology of depression, its treatment and management. The prevalence of depression is severely underestimated, with unique circumstances and societal risk factors associated with depression and its public awareness. Treating and managing depression is confounded by an inaccessibility to efficient and low-cost treatments for patients with depression. The aetiology of depression is multifactorial, with various theories implicating multiple neuronal networks. Despite this, the treatment of depression is one-dimensional focussing on outdated theories of depression and mainly targeting dysfunctional neurotransmitter pathways. Hence, it is not surprising that there is a significant increase in the prevalence of patients suffering from treatment resistant depression (TRD), with a large portion of patients deriving little clinical benefit from these traditional anti-depressant therapies. This highlights the need for more effective treatment strategies for depression, especially applicable to resource limited environments such as Africa, where there is little investment in public healthcare resources towards managing mental health disorders. The clinical potential of using ketamine in managing depression has received considerable attention in the past two decades, with the FDA approving esketamine for the management of TRD in 2019. This widespread attention has significantly increased ketamine's appeal as a novel antidepressant. Consequently, many ketamine infusion clinics have been established in Africa. However, there is little regulation or guidance for ketamine infusions. Furthermore, while esketamine is expensive and hence inaccessible to a large portion of the African population, racemic ketamine is significantly cheaper and has demonstrated clinical potential. However, there is currently a limited understanding of the neurological mechanisms of action of racemic ketamine in treating and managing depression, especially in a diverse African population. Therefore, this review aims to provide an African context of depression and the therapeutic potential of ketamine by highlighting aspects of its molecular mechanism of action.

A raster-based spatial clustering method with robustness to spatial outliers

Spatial clustering is an essential method for the comprehensive understanding of a region. Spatial clustering divides all spatial units into different clusters. The attributes of each cluster of the spatial units are similar, and simultaneously, they are as continuous as spatially possible. In spatial clustering, the handling of spatial outliers is important. It is necessary to improve spatial integration so that each cluster is connected as much as possible, while protecting spatial outliers can help avoid the excessive masking of attribute differences This paper proposes a new spatial clustering method for raster data robust to spatial outliers. The method employs a sliding window to scan the entire region to determine spatial outliers. Additionally, a mechanism based on the range and standard deviation of the spatial units in each window is designed to judge whether the spatial integration should be further improved or the spatial outliers should be protected. To demonstrate the usefulness of the proposed method, we applied it in two case study areas, namely, Changping District and Pinggu District in Beijing. The results show that the proposed method can retain the spatial outliers while ensuring that the clusters are roughly contiguous. This method can be used as a simple but powerful and easy-to-interpret alternative to existing geographical spatial clustering methods.

Perspectives on common chronic diseases in adult cancer patients in South Africa

There is a rising noncommunicable disease (NCD) burden in low- and middle-income countries. Sub-Saharan Africa (SSA) bears a higher burden than the global average with South Africa (SA) enduring the highest regional burden. SA among other southern African countries also bears a high prevalence of HIV and other chronic communicable diseases. Having a perspective on common chronic diseases in the ever-increasing numbers of adult cancer patients in SA will inform our understanding of approaches to better manage them. This commentary reviews regional and national studies and data of low- and middle-income countries and particularly SA on the chronic infectious and NCD multimorbidity burden among adult cancer patients. It also reflects on the considerable health system challenges of managing discordant multimorbidity among adult cancer patients within the SA Public Health System. Despite the critical need to better manage the growing MM burden in general and particularly the high prevalence of discordant multimorbidity among cancer patients, there is a dearth of research into MM management generally and in LMICs particularly.

Depression and Its Phytopharmacotherapy-A Narrative Review

Depression is a mental health disorder that develops as a result of complex psycho-neuro-immuno-endocrinological disturbances. This disease presents with mood disturbances, persistent sadness, loss of interest and impaired cognition, which causes distress to the patient and significantly affects the ability to function and have a satisfying family, social and professional life. Depression requires comprehensive management, including pharmacological treatment. Because pharmacotherapy of depression is a long-term process associated with the risk of numerous adverse drug effects, much attention is paid to alternative therapy methods, including phytopharmacotherapy, especially in treating mild or moderate depression. Preclinical studies and previous clinical studies confirm the antidepressant activity of active compounds in plants, such as St. John's wort, saffron crocus, lemon balm and lavender, or less known in European ethnopharmacology, roseroot, ginkgo, Korean ginseng, borage, brahmi, mimosa tree and magnolia bark. The active compounds in these plants exert antidepressive effects in similar mechanisms to those found in synthetic antidepressants. The description of phytopharmacodynamics includes inhibiting monoamine reuptake and monoamine oxidase activity and complex, agonistic or antagonistic effects on multiple central nervous system (CNS) receptors. Moreover, it is noteworthy that the anti-inflammatory effect is also important to the antidepressant activity of the plants mentioned above in light of the hypothesis that immunological disorders of the CNS are a significant pathogenetic factor of depression. This narrative review results from a traditional, non-systematic literature review. It briefly discusses the pathophysiology, symptomatology and treatment of depression, with a particular focus on the role of phytopharmacology in its treatment. It provides the mechanisms of action revealed in experimental studies of active ingredients isolated from herbal antidepressants and presents the results of selected clinical studies confirming their antidepressant effectiveness.

Spatial analysis and modelling of depression relative to social vulnerability index across the United States

According to the Substance Abuse and Mental Health Services Administration, about 21 million adults in the US experience a major depressive episode. Depression is considered a primary risk factor for suicide. In the US, about 19.5% of adults are reported to be experiencing a depressive disorder, leading to over 45,000 deaths (14.0 deaths per 100,000) due to suicides. To our knowledge, no previous spatial analysis study of depression relative to the social vulnerability index has been performed across the nation. In this study, county-level depression prevalence and indicators were compiled. We analysed the geospatial distribution of depression prevalence based on ordinary least squares, geographically weighted regression, and multiscale geographically weighted regression models. Our findings indicated that the multiscale model could explain over 86% of the local variance of depression prevalence across the US based on per capita income, age 65 and older, belonging to a minority group (predominantly negative impacts), and disability (mainly positive effect). This study can provide valuable insights for public health professionals and policymakers to address depression disparities.

The Determinants of Market Participation and Its Effect on Food Security of the Rural Smallholder Farmers in Limpopo and Mpumalanga Provinces, South Africa

Addressing the disproportionate burden of food insecurity in South Africa requires targeted efforts to help smallholder farmers to access markets. The purpose of this study was to assess determinants of market participation and its contribution to household food security. The secondary data used in this study were collected from 1520 respondents; however, 389 smallholder farmers participated in the market. The Household Food Insecurity Access Scale revealed that out of the total sample size, 85% of the households were food insecure while 15% were food secure. Gender of household head, receiving social grants and higher wealth index positively impacted market participation. Having a family member with HIV had a negative impact on market participation among smallholder farmers. The results from the extended ordered probit regression model showed that household size, having a family member with HIV and agricultural assistance had a positive and significant contribution to the household food insecurity situation of the smallholder farmers. On the other hand, the educational level of household head, ownership of livestock, age of household head, gender of household head, and having access to social grants had a negative and significant effect on the food insecurity status. Access to education and the market can improve household food security. Linking smallholder farmers, particularly women and aged farmers, to markets should form an intrinsic part of the government's efforts to improve farming and food security and increase access to diversified food.

COVID-19 risk perceptions and depressive symptoms in South Africa: Causal evidence in a longitudinal and nationally representative sample

BACKGROUND

Studies worldwide have highlighted the acute and long-term depressive impacts of psychosocial stressors due to the 2019 coronavirus disease (COVID-19) pandemic, particularly in low- and middle-income countries. Among the wide range of risk factors for depression that transpired during pandemic, greater perceptions of individual vulnerability to the COVID-19 have emerged as a major predictor of increased depressive risk and severity in adults.

METHODS

We estimated the extent to which COVID-19 risk perceptions affected adult depressive symptoms in a longitudinal, nationally representative sample in South Africa. We used covariate balanced propensity scores to minimize the bias from treatment assignment to estimate average causal effects of COVID-19 risk perceptions.

RESULTS

The point prevalence of perceived COVID-19 infection risk increased between the third and fifth months of the pandemic, which corresponded with elevations in national COVID-19 infection rates. Approximately 33% of adults met or surpassed the PHQ-2 cut-off score of 2. An increase in perceived risk of COVID-19 infection predicted worse depressive symptoms in adults four months later.

CONCLUSIONS

Our findings highlight the widespread mental health burdens of the COVID-19 pandemic and emphasize the importance of greater psychological resources and structural changes to promote equitable access to COVID-19 risk mitigation policies.

An Age-Period-Cohort Approach to Analyse Late-Life Depression Prevalence in Six European Countries, 2004-2016

Late-life depression is a condition that affects an ever-growing share of the population in ageing societies. While depression prevalence varies across countries for a myriad of reasons, generational factors, expressed in the shared experience of birth cohorts, may also play a part in such differentials. This paper describes the presence of age, period, and cohort (APC) effects in late-life depression prevalence trends (for adults aged 50 and above) for selected countries in Europe, using the Survey of Health and Ageing and Retirement of Europe (SHARE). We analysed six countries during the 2004-2016 period: Denmark, Sweden, and Germany, with a lower baseline prevalence, and Italy, Spain, and France, with a higher baseline prevalence. By applying a set of APC statistical models to visualise linear and nonlinear effects, we found that all countries followed a J-shaped curve when describing the transversal and longitudinal age trajectories of late-life depression. We also found a combination of nonlinear effects present in Germany, France and Sweden in males, indicating that younger male cohorts had a higher relative risk of depression. In females, we found nonlinear cohort effects, indicating that younger and older cohorts presented a higher risk of depression in Sweden and Germany and a lower risk in Spain. The presence of an increased risk for younger male cohorts may be indicative of a new trend in some countries, which may reduce the sex gap in prevalence. Future analysis should focus on the causes and mechanisms that lead to differential risks across cohorts.

An exploration of factors characterising unusual spatial clusters of COVID-19 cases in the East Midlands region, UK: A geospatial analysis of ambulance 999 data

Complex interactions between physical landscapes and social factors increase vulnerability to emerging infections and their sequelae. Relative vulnerability to severe illness and/or death (VSID) depends on risk and extent of exposure to a virus and underlying health susceptibility. Identifying vulnerable communities and the regions they inhabit in real time is essential for effective rapid response to a new pandemic, such as COVID-19. In the period between first confirmed cases and the introduction of widespread community testing, ambulance records of suspected severe illness from COVID-19 could be used to identify vulnerable communities and regions and rapidly appraise factors that may explain VSID. We analyse the spatial distribution of more than 10,000 suspected severe COVID-19 cases using records of provisional diagnoses made by trained paramedics attending medical emergencies. We identify 13 clusters of severe illness likely related to COVID-19 occurring in the East Midlands of the UK and present an in-depth analysis of those clusters, including urban and rural dynamics, the physical characteristics of landscapes, and socio-economic conditions. Our findings suggest that the dynamics of VSID vary depending on wider geographic location. Vulnerable communities and regions occur in more deprived urban centres as well as more affluent peri-urban and rural areas. This methodology could contribute to the development of a rapid national response to support vulnerable communities during emerging pandemics in real time to save lives.

Depressive symptoms and violence exposure in a population-based sample of adult women in South Africa

Depressive symptoms are a major burden of disease globally and is associated with violence and poverty. However, much of the research linking these conditions is from resource-rich settings and among smaller, clinical samples. Secondary data from a household survey in Gauteng Province of South Africa examines the cross-sectional association between adult women's elevated depressive symptoms and markers of violence. Using tablet computers, participants self-completed interview modules to screen for depressive symptoms (Patient Health Questionnaire 2-item screener), childhood exposure to physical and sexual abuse (Childhood Trauma Questionnaire 4-item index), as well as past-year exposure to sexual or intimate partner violence (SIPV; WHO Multicountry Study instrument 4-item index). Socio-economic status, food security, education, and income were self-reported. Representative data at the ward level allows for modeling of results using survey commands and mixed-level modeling. Of the 7,276 adult women participating in the household survey, 42.1% reported elevated depressive symptoms. A total of 63.9% reported childhood violence exposure and 5.3% had past-year SIPV. Multi-level modeling suggests that violence is a strong predictor of depressive symptoms. Childhood abuse alone increases the odds of high depressive symptomology, after controlling for individual-level markers of poverty and neighborhood of residence (aOR 1.31, 95%, CI 1.17-1.37). Combined exposure to childhood abuse and past-year SIPV increased odds of reporting elevated depressive symptoms (aOR 2.05, 95%, CI 1.54-2.71). Ward characteristics account for 6% of the variance in depressive symptoms, over and above the contributions of household food security and socio-economic status. Exposure to violence in childhood and past-year SIPV were associated with depressive symptoms among women. These associations persist after controlling for socio-economic markers and latent neighborhood characteristics, which also had significant association with elevated depressive symptoms. These data suggest that efforts to reduce the burden of depressive symptoms may benefit from approaches that prevent violence against women and children.

Validation and measurement invariance of the Occupational Depression Inventory in South Africa

This study aimed to validate the recently developed Occupational Depression Inventory (ODI) in South Africa. A total of 327 employees (60% female) participated in the study. Bifactor exploratory structural equation modeling analysis indicated that the ODI can be considered essentially unidimensional. The ODI displayed strong scalability (e.g., scale-level H = 0.657). No monotonicity violation was detected. The reliability of the instrument, as indexed by Cronbach's alpha, McDonald's omega-total, Guttman's λ2, and the Molenaar-Sijtsma statistic, was highly satisfactory. Measurement invariance was observed across age groups, sexes, and ethnicities, as well as between our sample and the ODI's original validation sample. As expected, the ODI showed both a degree of convergent validity and a degree of discriminant validity vis-à-vis a measure of "cause-neutral" depressive symptoms. Moreover, the ODI manifested substantial associations, in the anticipated directions, with measures of work engagement, job satisfaction, and life satisfaction. Overall, the ODI exhibited excellent structural and psychometric properties within the South African context. Consistent with previous research, this study suggests that occupational health specialists can confidently rely on the ODI to investigate job-related distress.

Intersections of Sex Work, Mental Ill-Health, IPV and Other Violence Experienced by Female Sex Workers: Findings from a Cross-Sectional Community-Centric National Study in South Africa

Female sex workers (FSWs) are at increased risk of mental health problems, including mood disorders and substance abuse, and we need to understand the origins of these to treat and prevent them, and particularly understand how the context in which they sell sex impacts their mental health. We conducted a multi-stage, community-centric, cross-sectional survey of 3005 FSWs linked to SW programmes in twelve sites across all nine provinces of South Africa. We interviewed adult women who had sold sex in the preceding six months, who were recruited via SW networks. We found that FSWs have very poor mental health as 52.7% had depression and 53.6% has post-traumatic stress disorder (PTSD). The structural equation model showed direct pathways from childhood trauma and having HIV+ status to mental ill-health. Indirect pathways were mediated by food insecurity, controlling partners, non-partner rape, harmful alcohol use, substance use to cope with SW, indicators of the circumstances of SW, i.e., selling location (on streets, in taverns and brothels), frequency of selling and experiencing SW stigma. All paths from childhood trauma had final common pathways from exposure to gender-based violence (non-partner rape or intimate partner violence) to mental ill-health, except for one that was mediated by food insecurity. Thus, FSWs’ poor mental health risk was often mediated by their work location and vulnerability to violence, substance abuse and stigma. The potential contribution of legal reform to mitigate the risks of violence and mental ill-health are inescapable. Treatment of mental ill-health and substance abuse should be an essential element of FSW programmes.

Distress, desperation and despair: anxiety, depression and suicidality among rural South African youth

Common mental disorders (CMDs) affect millions of people worldwide and impose a high cost to individuals and society. Youth are disproportionately affected, as has also been confirmed in South Africa. Mental disorders and substance use disorders often occur as concurrent disorders. Although youth in rural South Africa grow up in difficult social and economic conditions, the study of mental disorders in South Africa has focussed primarily on urban populations. One such rural area in South Africa is the Harry Gwala District, where rates of interpersonal violence and self-inflicted injuries among 15-24-year-old men, are extraordinarily high. Suicide is an important proxy measure of severe emotional distress, predominantly depression and hopelessness. This study reports on rates of fatal self-harm among 15-24-year-old men in the Harry Gwala District. We determined the rates and severity of CMDs and their correlates among 355 young males ranging in age from 14 to 24 years in the Harry Gwala District community. High rates of depression, anxiety, hopelessness and worthlessness were reported. One in four of the young men and boys reported current suicidal thoughts associated with depression, anxiety, feelings of worthlessness and binge drinking. Reports of alcohol use were high, as were those of daily cannabis use. Our findings show high rates of CMDs and alcohol use, and highlight the impact of collective dysphoria on the mental well-being of rural youth in South Africa, who are likely coping through drug and alcohol use.

Space-time clustering of recently-diagnosed tuberculosis and impact of ART scale-up: Evidence from an HIV hyper-endemic rural South African population

In HIV hyperendemic sub-Saharan African communities, particularly in southern Africa, the likelihood of achieving the Sustainable Development Goal of ending the tuberculosis (TB) epidemic by 2030 is low, due to lack of cost-effective and practical interventions in population settings. We used one of Africa’s largest population-based prospective cohorts from rural KwaZulu-Natal Province, South Africa, to measure the spatial variations in the prevalence of recently-diagnosed TB disease, and to quantify the impact of community coverage of antiretroviral therapy (ART) on recently-diagnosed TB disease. We collected data on TB disease episodes from a population-based sample of 41,812 adult individuals between 2009 and 2015. Spatial clusters (‘hotspots’) of recently-diagnosed TB were identified using a space-time scan statistic. Multilevel logistic regression models were fitted to investigate the relationship between community ART coverage and recently-diagnosed TB. Spatial clusters of recently-diagnosed TB were identified in a region characterized by a high prevalence of HIV and population movement. Every percentage increase in ART coverage was associated with a 2% decrease in the odds of recently-diagnosed TB (aOR = 0.98, 95% CI:0.97–0.99). We identified for the first time the clear occurrence of recently-diagnosed TB hotspots, and quantified potential benefit of increased community ART coverage in lowering tuberculosis, highlighting the need to prioritize the expansion of such effective population interventions targeting high-risk areas.