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Ward-Smith C, Sorsdahl K, van der Westhuizen C. An investigation into symptoms of depression and anxiety and emotion regulation among older adolescents from low-income settings in South Africa. Compr Psychiatry 2024; 132:152476. [PMID: 38552349 DOI: 10.1016/j.comppsych.2024.152476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/20/2024] [Accepted: 03/16/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Mental health conditions (MHC) among adolescents in low- and middle-income countries, including South Africa, are estimated to be high. Adaptive emotion regulation (ER) skills can protect against MHC among adolescents. In South Africa, there is limited adolescent mental health prevalence data as well as little understanding of the associations between MHC and ER among adolescents. This study aimed to address these gaps by describing the psychosocial characteristics of older South African adolescents from low-income settings as well as investigating associations between depression and anxiety symptoms and ER. METHODS We selected 12 schools in collaboration with two NGOs. Learners aged 15-18-years were recruited to complete a tablet-based survey. ER, depression, anxiety, and other psychosocial measures were included. Two multiple linear regression models were used to determine associations between depression symptoms, anxiety symptoms, other psychosocial factors, and ER. RESULTS Of the 733 participants from 12 Western Cape schools, 417 (56.90%) screened at risk for clinically significant anxiety symptoms, 423 (57.70%) participants for depression symptoms, 229 (31.40%) participants for PTSD symptoms and 263 (35.90%) for risky alcohol use. Depression and anxiety scores were found to be significantly positively correlated with ER difficulties and adolescents struggled most with identifying and utilizing adaptive ER strategies. The adjusted linear regression model reported that female gender, clinically significant depressive, anxiety, post-traumatic stress symptoms and risky-alcohol use were all significantly associated with poorer ER scores, while self-esteem was significantly associated with better ER scores. CONCLUSION These findings contribute to the South African adolescent mental health literature and to the research gap on the links between depression and anxiety and ER. Future research should consider further exploration of the relationships between psychosocial factors and ER to inform the urgent development and testing of appropriate adolescent interventions in this setting.
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Affiliation(s)
- C Ward-Smith
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, South Africa.
| | - K Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, South Africa
| | - C van der Westhuizen
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, South Africa
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Sorsdahl K, Van Der Westhuizen C, Hornsby N, Jacobs Y, Poole M, Neuman M, Weiss HA, Myers B. Project ASPIRE: A feasibility randomized controlled trial of a brief intervention for reducing risk of depression and alcohol-related harms among South African adolescents. Psychother Res 2024; 34:96-110. [PMID: 36736329 DOI: 10.1080/10503307.2023.2169083] [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: 07/01/2022] [Accepted: 01/07/2023] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Brief interventions could reduce adolescents' risk of depression and alcohol-related harms, but evidence of their feasibility and acceptability for low-and middle-income countries is lacking. To address this gap, we conducted a feasibility trial of the ASPIRE intervention, a four-session multi-component counselling intervention for South African adolescents. METHOD We recruited 117 adolescents who met our inclusion criteria. Participants were randomly assigned to the ASPIRE intervention or a comparison condition. Outcomes were assessed at baseline, six-week, and three-month post-randomization time points. Primary outcomes were based on feasibility of study procedures and intervention delivery (assessed on seven predetermined progression criteria). Clinical outcomes (risk of depression and alcohol harms) were secondary. RESULTS Despite modifications to all study procedures arising from Covid-19 restrictions, five of the seven key progression criteria were fully met, including: feasibility of data collection and outcome measures, counsellor competencies, randomization and blinding, adverse advents, and acceptability of the intervention. The progression criterion for recruitment and intervention retention were not fully met. CONCLUSION Findings suggest that the ASPIRE intervention was generally feasible to deliver and acceptable to adolescents. However, modifications to the trial design and intervention delivery are needed to optimize the validity of a definitive randomized controlled trial of the ASPIRE intervention.
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Affiliation(s)
- K Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Rondebosch, South Africa
| | - C Van Der Westhuizen
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Rondebosch, South Africa
| | - N Hornsby
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Y Jacobs
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - M Poole
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Rondebosch, South Africa
| | - M Neuman
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - H A Weiss
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - B Myers
- Curtin enAble Institute, Curtin University, Perth, Australia
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Tygerberg, South Africa
- Department of Psychiatry & Mental Health, University of Cape Town, Rondebosch, South Africa
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Gavurova B, Ivankova V, Rigelsky M, Mudarri T, Miovsky M. Somatic Symptoms, Anxiety, and Depression Among College Students in the Czech Republic and Slovakia: A Cross-Sectional Study. Front Public Health 2022; 10:859107. [PMID: 35359763 PMCID: PMC8961809 DOI: 10.3389/fpubh.2022.859107] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 02/14/2022] [Indexed: 12/30/2022] Open
Abstract
Studying in college can be a challenging time for many students, which can affect their mental health. In addition to academic pressure and stressful tasks, another aggravating factor in student life is the ongoing coronavirus disease 2019 (COVID-19) pandemic. The aim of the study was to examine the prevalence of anxiety, depression, and somatic symptoms in Czech and Slovak college students during the COVID-19 pandemic and to evaluate possible socio-demographic determinants of mental health problems. A total of 3,099 respondents participated in this cross-sectional study (Czech Republic: 1,422, Slovakia: 1,677). The analyzes included the Patient Health Questionnaire for somatic symptoms (PHQ-15), the Generalized Anxiety Disorder instrument (GAD-7), and the Patient Health Questionnaire for depression (PHQ-9). Socio-demographic factors were gender, age, family structure, marital status, form of study, degree of study, year of study, field of study, distance between home and college, residence, and housing during the semester. Among Czech students, prevalence of somatic complaints, anxiety and depression was 72.2, 40.3, and 52%, respectively. Among Slovak students, prevalence of somatic complaints, anxiety and depression was 69.5, 34.6, and 47%, respectively. During the COVID-19 pandemic, the most severe mental health problems were identified in a non-negligible part of the sample (Czech Republic: PHQ-15 = 10.1%, GAD-7 = 4.9%, PHQ-9 = 3.4%; Slovakia: PHQ-15 = 7.4%, GAD-7 = 3.5%, PHQ-9 = 2.7%). Regarding the differences between the analyzed countries, a significantly higher score in somatic symptoms, anxiety, and depression was identified in the Czech Republic. Significant differences in mental disorders were found in most socio-demographic characteristics. The main results of the logistic regression analysis revealed that risk factors for mental health disorders in Czech and Slovak students were female gender, younger age, third degree of study, and study of Informatics, Mathematics, Information and Communication Technologies (ICT). Especially in the case of these high-risk groups of students, public policies should consider a response to impending problems. The findings are an appeal for a proactive approach to improving the mental health of students and for the implementation of effective prevention programs, which are more than necessary in the Czech and Slovak college environment.
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Affiliation(s)
- Beata Gavurova
- Department of Addictology, First Faculty of Medicine, Charles University and General Teaching Hospital in Prague, Prague, Czechia
| | - Viera Ivankova
- Faculty of Mining, Ecology, Process Control and Geotechnologies, Institute of Earth Resources, Technical University of Košice, Košice, Slovakia
| | - Martin Rigelsky
- Department of Marketing and International Trade, Faculty of Management and Business, University of Prešov, Prešov, Slovakia
| | - Tawfik Mudarri
- Faculty of Mining, Ecology, Process Control and Geotechnologies, Institute of Earth Resources, Technical University of Košice, Košice, Slovakia
| | - Michal Miovsky
- Department of Addictology, First Faculty of Medicine, Charles University and General Teaching Hospital in Prague, Prague, Czechia
- *Correspondence: Michal Miovsky
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Myers B, Browne FA, Carney T, Kline T, Bonner CP, Wechsberg WM. The Association of Recurrent and Multiple Types of Abuse with Adverse Mental Health, Substance Use, and Sexual Health Outcomes among Out-of-School Adolescent Girls and Young Women in Cape Town, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11403. [PMID: 34769920 PMCID: PMC8582840 DOI: 10.3390/ijerph182111403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/26/2021] [Accepted: 10/27/2021] [Indexed: 12/03/2022]
Abstract
Although physical and sexual abuse exposure is a well-established risk for poor health, the dimensions of abuse associated with health among socially vulnerable adolescent girls and young women (AGYW) remain underexamined. This article describes associations between combinations of abuse type and timing with mental health, substance use, and sexual risk outcomes among a sample of 499 AGYW (aged 16 to 19) who had left school early and were recruited for a cluster randomized trial in Cape Town, South Africa. Approximately one-third (33.5%; 95% CI: 28.7, 38.6) of participants reported lifetime abuse. Exposure to more than one type of abuse was associated with increased risk of depression (β = 3.92; 95% CI: 2.25, 5.59) and anxiety (β = 3.70; 95% CI: 2.11, 5.28), and greater odds of polydrug use (OR = 2.10; 95% CI: 1.02, 4.34) and substance-impaired sex (OR = 2.17; 95% CI: 1.31, 3.86). Exposure to multiple types of abuse during childhood/early adolescence and again in late adolescence was associated with increased risk of depression (β = 4.65; 95% CI: 3.15, 6.14), anxiety (β = 4.35; 95% CI: 2.70, 6.02), and polydrug use (OR = 2.37; 95% CI: 1.03, 5.73). Findings underscore the need for trauma-informed interventions that reduce mental health, substance use, and sexual risks among AGYW who have experienced multiple forms of abuse and recurrent abuse.
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Affiliation(s)
- Bronwyn Myers
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA 6102, Australia
- Alcohol, Tobacco and Other Drug Abuse Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Felicia A Browne
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Tara Carney
- Alcohol, Tobacco and Other Drug Abuse Research Unit, South African Medical Research Council, P.O. Box 19070, Tygerberg 7505, South Africa
- Division of Addiction Psychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town 7701, South Africa
| | - Tracy Kline
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
| | | | - Wendee M Wechsberg
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA
- Maternal and Child Health Department, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27514, USA
- Department of Psychology, North Carolina State University, Raleigh, NC 27529, USA
- Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC 27703, USA
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Hunduma G, Dessie Y, Geda B, Yadeta TA, Deyessa N. Common mental health problems among adolescents in sub-Saharan Africa: A systematic review and meta-analysis. J Child Adolesc Ment Health 2021; 33:90-110. [PMID: 38041439 DOI: 10.2989/17280583.2023.2266451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Background and aim: This review examined the prevalence of mental health problems among adolescents in sub-Saharan Africa.Methods: The review included studies indexed in the MEDLINE, EMBASE, and PsycINFO databases, supplemented by a search on Google Scholar and tracking of references from articles identified. A total of 725 articles were found, of which 28 met the inclusion criteria. Finally, 22 eligible studies were reviewed.Findings: The pooled current prevalence of mental health problems was 23% (95% CI: 18; 28, I2 = 99.41%). Any depression, 19% (95% CI: 9; 30, I2 = 99.64%), and anxiety, 20% (95% CI: 01; 31, I2 = 99.64%), were the most common mental health problems reported. Attention deficit hyperactivity disorder, 5% (95% CI: 3; 7, I2 = 97.60%), and conduct disorders, 15% (95% CI: 8; 22, I2 = 99.58%), were also significant mental health problems among adolescents in the region.Conclusion: About one in five adolescents in sub-Saharan Africa suffer from one or more mental health problems. The findings have important implications for policy and practice as they indicate that mental health problems are a major public health issue among adolescents in sub-Saharan Africa and that there is a need for effective and context-specific interventions that address mental health.
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Affiliation(s)
- Gari Hunduma
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Ethiopia
| | - Yadeta Dessie
- School of Public Health College of Health and Medical Sciences, Haramaya University, Ethiopia
| | - Biftu Geda
- Department of Preventive Medicine, School of Public Health College of Health Sciences, Addis Ababa University, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Ethiopia
| | - Negussie Deyessa
- Department of Nursing, College of Health Sciences, Shashamene Compass, Madda Walabu University, Ethiopia
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Sorsdahl K, van der Westhuizen C, Neuman M, Weiss HA, Myers B. Addressing the mental health needs of adolescents in South African communities: a protocol for a feasibility randomized controlled trial. Pilot Feasibility Stud 2021; 7:69. [PMID: 33726830 PMCID: PMC7961162 DOI: 10.1186/s40814-021-00803-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 02/16/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Like many low- and middle-income countries, almost half of the proportion of the South African population is under the age of 25. Given the peak age of onset for most mental health problems is in adolescence, it is vital that adolescents have access to mental health counselling. There are several initiatives to increase access to mental health counselling in South Africa, primarily through the integration of counselling for common mental disorders (CMD) into primary health care services, but adolescents (15-18 years of age) generally do not utilize these services. To address this gap, we will undertake a study to explore the feasibility of conducting a trial of the effectiveness of a community-based mental health counselling intervention for adolescents at-risk for a CMD. METHODS The study is a feasibility trial of the ASPIRE intervention, a four-session blended multi-component counselling intervention adapted for South African adolescents at risk for depression and alcohol use disorders. We will enrol 100 adolescents from community settings and randomly assign them to the ASPIRE intervention or a comparison condition. Feasibility measures, such as rates of recruitment, consent to participate in the trial and retention, will be calculated. Qualitative interviews with participants and counsellors will explore the acceptability of the intervention. The primary outcomes for a subsequent trial would be reductions in symptoms of depression and days of heavy drinking which will be measured at baseline, 6 weeks, and 3 months post-randomization. DISCUSSION This feasibility trial using a mixed-methods design will allow us to determine whether we can move forward to a larger effectiveness trial of the ASPIRE intervention. TRIAL REGISTRATION The trial is registered with the Pan African Clinical Trials Registry (PACTR20200352214510). Registered 28 February 2020-retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9795.
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Affiliation(s)
- K Sorsdahl
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa.
| | - C van der Westhuizen
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - M Neuman
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - H A Weiss
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England
| | - B Myers
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
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Williams HM, Erlank EC. Traumatic incident reduction: A suitable technique for South African social work practice settings. Health SA 2020; 24:1106. [PMID: 31934416 PMCID: PMC6917392 DOI: 10.4102/hsag.v24i0.1106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 01/30/2019] [Indexed: 11/03/2022] Open
Abstract
It is part of South African social workers’ responsibilities to attend promptly and appropriately to victims of trauma. Overstrained and limited resources in communities influence the availability of debriefing services to traumatised community members. The purpose of this article was to elaborate on the traumatic incident reduction (TIR) technique as a suitable, short-term intervention technique for social work practice settings to address the impact of trauma effectively and timely. A discussion on TIR is presented by contextualising and defining mental health and post-traumatic stress disorder (PTSD) and elaborating on other practice approaches, therapies, techniques and models for addressing trauma and PTSD in social work practice. Given the excessive exposure to trauma experienced by the South African population, it is clear that further trauma counselling services are required and more effective ways must be found to empower communities to deal with trauma. Most approaches for the treatment of trauma in South Africa are specialised and resources are limited; therefore, many communities are excluded from these specialised services. The TIR technique fits appropriately within the ambit of the developmental approach, as embraced by the South African Department of Social Development. It will be beneficial if social workers, auxiliary social workers, community leaders, community volunteers, health care workers and lay counsellors are trained in the TIR technique. Concerted efforts are necessary to empower communities in supporting themselves and developing the necessary skills to address trauma. This initiative will be consistent with the developmental approach sanctioned by the Department of Social Development.
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Affiliation(s)
- H Marili Williams
- Department of Social Work, University of South Africa, Pretoria, South Africa
| | - Elizabeth C Erlank
- Department of Social Work, University of South Africa, Pretoria, South Africa
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Butterworth P, Leach LS. Early Onset of Distress Disorders and High-School Dropout: Prospective Evidence From a National Cohort of Australian Adolescents. Am J Epidemiol 2018; 187:1192-1198. [PMID: 29126193 DOI: 10.1093/aje/kwx353] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 10/25/2017] [Indexed: 11/13/2022] Open
Abstract
Prior research examining whether depression and anxiety lead to high-school dropout has been limited by a reliance on retrospective reports, the assessment of mental health at a single point in time (often remote from the time of high-school exit), and the omission of important measures of the social and familial environment. The present study addressed these limitations by analyzing 8 waves of longitudinal data from a cohort of Australian adolescents (n = 1,057) in the Household, Income and Labor Dynamics in Australia (HILDA) Survey (2001-2008). Respondents were followed from the age of 15 years through completion of or exit from high school. Discrete-time survival analysis was used to assess whether the early experience of a distress disorder (indicated by scores <50 on the 5-item Mental Health Inventory from the Short Form Health Survey) predicted subsequent high-school dropout, after controlling for household and parental socioeconomic characteristics and for tobacco smoking and alcohol consumption. Adolescents with a prior distress disorder had twice the odds of high-school dropout compared with those without (odds ratio = 1.99, 95% confidence interval: 1.24, 3.17). This association was somewhat attenuated but remained significant in models including tobacco and alcohol consumption (odds ratio = 1.74, 95% confidence interval: 1.74; 1.09, 2.78). These results suggest that improving the mental health of high-school students may promote better educational outcomes.
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Affiliation(s)
- Peter Butterworth
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Liana S Leach
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Medicine, Australian National University, Canberra, Australia
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