Mental health research in Botswana: a semi-systematic scoping review

Cultural adaptation of a brief psychological intervention for PTSD in severe mental illness: a Botswana context

High rates of trauma exposure among patients with severe mental illness (SMI) in Botswana highlight the need for appropriate interventions. Culturally adapted interventions have been reported to be more acceptable, effective and feasible. This study aimed to culturally adapt the Brief Relaxation, Education and Trauma Healing (BREATHE), a brief psychological intervention to treat post-traumatic stress disorder (PTSD) among people with SMI in Botswana. The cultural adaptation process followed the steps outlined by previous research. They included a community assessment to identify needs, selecting an appropriate intervention and consultations with experts and stakeholders. Individual interviews and focus groups were conducted with patients living with SMI and mental health professionals, respectively, to inform domains of the intervention to be adapted. BREATHE was adapted to be culturally congruent to Botswana by following the ecological validity model framework and using data from the interviews. Examples of the adaptation include language that was translated to Setswana, and spoken English and the content that was revised to reflect the traumatic experiences and demographics of the Botswana population. The study underscores the utility of using evidence-based frameworks to culturally adapt interventions. The adaptation process resulted in a culturally relevant BREATHE for patients with comorbid PTSD and SMI in Botswana.

Developing a Psychiatry Residency Program in a Low- and Middle-Income Country: Botswana's Experience

Like many other low- and middle-income countries, Botswana has struggled to address the shortage of doctors, particularly specialists. In 2009, the country's first medical school offering an undergraduate medical program was established. A needs and feasibility assessment was conducted with relevant stakeholders to explore the need for specialty training programs in all medical school departments. As a result, three residency programs were established a year after the undergraduate program, but psychiatry was not included in this first crop of residency programs. Existing strengths in the university and healthcare systems were leveraged to successfully establish a four-year Master of Medicine residency program in psychiatry, which began in January 2020. The program aims to produce psychiatrists who are familiar with the local mental health needs. The first batch of students completed their training in December 2023. This paper reflects on and describes the development of a psychiatry residency program in Botswana and contributes a process grounded in educational program development models and educational theories that others can utilize. Botswana's experience may be helpful to other low- and middle-income countries, particularly in sub-Saharan Africa, that want to establish and run a locally developed residency program in psychiatry.

Perceptions of nurses working in mental health services regarding the recovery-oriented care approach: Findings from Africa

BACKGROUND

The recovery-oriented care approach in mental health is recognised as the vision for mental health. People with a diagnosis of mental illness value the support and the individualistic approach emphasised in the recovery-oriented mental health care approach as they believe it facilitates their recovery. However, as a developing country, Botswana has a long way to go in availing mental health care resources to people with mental illness, let alone adopting new mental health approaches such as recovery.

AIM

The study aimed to explore the perceptions of nurses working in mental health care facilities of recovery-oriented mental health care.

METHODS

Four mental health facilities from Botswana consented to participate in the study. A descriptive qualitative approach was utilised to explore nurses' views on how they perceive recovery from mental illness. Thirty nurses participated in the focus group discussions across the four study sites. All participants consented to participate and to be recorded. Tesch's (in Qualitative enquiry and research design: Choosing among five approaches. 3th ed. SAGE, 2013:198) thematic analysis was used for this study.

RESULTS

Three main themes were identified in participants' perceptions of recovery-oriented care mental health: Recovery from mental illness is possible, the Meaning of recovery from mental illness and Factors facilitating recovery from mental illness.

PUBLIC CONTRIBUTION

The study offers a perspective into how nurses perceive recovery-oriented approaches from a developing country and add to the gap existing in recovery-oriented mental health care approach from the African context.

Youth perspectives of working with near peer youth lay counsellors: The Safe Haven Pilot

Youth living with HIV (YLWH) have higher rates of common mental disorders (CMDs) when compared with HIV-negative youth. We adapted the Friendship Bench to create a problem solving-based counselling intervention in Botswana delivered by near peer youth lay counsellors for YLWH called Safe Haven. In August 2020, and from June to August 2021, we conducted 22 semistructured interviews with youth aged 13-25 years with mild-to-moderate symptoms of CMDs. Two independent coders carried out an inductive thematic analysis of the transcribed interviews with discrepancies discussed to consensus. Safe Haven was seen as largely acceptable among the youth. Youth felt Safe Haven was a place where they had freedom of expression and could receive practical advice from well-trained and approachable counsellors. Trained youth lay peer counsellors show promise to meet the mental health needs of mild and moderately symptomatic youth, where mental health professionals are in short supply.

Family members' experiences of courtesy stigma associated with mental illness

Background

The stigma of mental illness has been in existence from medieval times to date and it is extended to families of people diagnosed with mental illness. Families with a member diagnosed with a mental illness experience courtesy stigma of mental illness and it affects the quality of their lives.

Aim

This study aimed to explore and describe the experiences of courtesy stigma of families with a member diagnosed with a mental illness in Lobatse, Botswana.

Setting

The study was conducted at a psychiatric hospital in Lobatse, Botswana.

Methods

A qualitative contextual phenomenological design was used for this study. The population comprised of members from families with a person diagnosed with a mental illness and the sample size was 15 participants. Semi-structured in-depth individual interviews were conducted telephonically.

Results

The study yielded three main themes and related subthemes. The themes were: families' experiences of received stigma, families' experiences of stigma by association, and families' experiences of internal stigma.

Conclusion

Families with a member diagnosed with mental illness experience received stigma, associated stigma and internal stigma. The families experienced that they received dehumanising labels from the public because of their association with their mentally ill family members.

Contribution

With the insights gained from the findings of this study, programmes can be developed that raise awareness on stigma of mental illness and to promote support of families of people diagnosed with a mental illness.

Nurses' Perceptions on How Recovery-Oriented Mental Health Care Can Be Developed and Implemented

Aim

This study explored how nurses working in inpatient mental health units perceived the development and implementation of a recovery-oriented mental healthcare programme (ROMHCP).

Background

The recovery-oriented mental healthcare approach (ROMHCA) in mental health is regarded as the future of mental health services and has been implemented in different countries worldwide. However, regarding developing and implementing the recovery approach, Africa appears to have been left behind by the rest of the continents.

Design

The study used a qualitative approach to describe how a recovery-oriented mental healthcare approach could be developed.

Methods

Thirty nurses who worked in Botswana's four inpatient mental health facilities consented and voluntarily participated in the study. Data were collected from February to mid-March 2022 through online focus group discussions and analysed using thematic analysis. The COREQ checklist was used to report the findings.

Results

Two main themes emerged as follows: (i) developing and implementing a recovery-oriented mental healthcare programme is possible and (ii) certain elements are required to develop and implement ROMHCP.

Conclusion

The participants believed that people diagnosed with mental illness could recover from the illness and suggested how it could be achieved. They also contended that the programme's success would lie mainly with multisectoral support from policymakers, facilities, hospital personnel, patients, and the community. Clinical Relevance. ROMHCP has the potential to benefit people with mental illness in the country. In addition, it would allow nurses to improve their knowledge and skills in managing mental illnesses. Patient or Public Contribution. The patients and the general public did not contribute to the study's concept, design, and outcomes. However, the nurses working in mental health facilities volunteered to participate in the study.

The prevalence of substance use disorders and associated patterns among patients admitted to a psychiatric hospital in Botswana

OBJECTIVE

Substance use disorders (SUDs) have risen substantially, especially in developing nations, and has become one of the world's most significant public health and socioeconomic challenge. This study aimed to determine the prevalence and patterns of substance use disorders among patients admitted at the main psychiatric hospital, Sbrana Psychiatric Hospital in Botswana.

METHOD

The study design was descriptive cross-sectional, involving patients admitted to a psychiatric hospital. SUDs were assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) v13.0. Bivariate analysis was conducted to determine the association between socio-demographic characteristics and SUDs. Multivariate logistic regression was performed to rule out the effect of confounders.

RESULTS

The final analysis involved one hundred and one (101) participants. Participants ages ranged from 18-60 years with over half (59.4%) being male. Majority of participants (85.1%) had ever used studied substances; with 63.4% found to have substance use disorders. The most frequently used substances were tobacco, cannabis, alcohol and cocaine at 58.4%, 42.6%, 34.7% and 12.8% respectively. SUDs were more common among participants who were male, younger age of 18-35 years, single, tertiary education and unemployed.

CONCLUSIONS

There is a high prevalence of substance use and SUDs among psychiatric patients in Botswana. Structured screening and interventions to manage substance use disorders should be part of routine care at the psychiatric health care facilities in Botswana. Consideration should be given to screening all patients admitted to psychiatric hospitals in Botswana for SUDs using the ASSIST.

Building a Community Based Mental Health Program for Adolescents in Botswana: Stakeholder Feedback

BACKGROUND

When planning interventions for adolescents, adult interventions should not be used 'as is' in youth settings. Stakeholder engagement can help understand the overall adolescent mental health ecosystem and adapt existing evidence-based interventions for the youth.

OBJECTIVE

To understand the overall mental health needs of adolescents in Botswana and the necessary adaptations required for an adolescent lay counselor based intervention in the country.

METHODS

We used the theory of change model and the nominal group technique in five stakeholder meetings. Meetings were held to discuss the mental health needs of youth in Botswana and identify priorities for a lay counsellor based intervention modelled after the Friendship Bench intervention, an existing mental health intervention for adults.

RESULTS

The root causes of mental health problems among Botswana's youth identified by stakeholders included limited mental health knowledge among the youth and the community, family problems, poor communication, low self-esteem, the rapid growth of technology, and biological/genetic predisposition. Structurally barriers included: mental illness-related stigma, lack of psychosocial support, incomplete follow up for health services, cultural beliefs about mental illness, and fragmented mental health services. The stakeholders envisage a program that could empower adolescents and youth counselors to address mental health concerns for a healthier community. The group identified and prioritized several key elements of an effective lay counselor intervention.

CONCLUSIONS

A diverse group of community stakeholders can illustrate critical mental health needs and elements that countries could use to adapt and contextualize a lay counsellor based mental health intervention for new populations such as the youth.

Depression and suicidal behavior among adolescents living with HIV in Botswana: a cross-sectional study

BACKGROUND

Depression and suicidal behavior are the main causes of disability and morbidity, especially in adolescents living with HIV (ALWHIV). Data regarding these are lacking in Botswana, a country with a predominantly youthful population and ranked among the top four in the world most affected by HIV. Therefore, the present study aimed to estimate the prevalence of depression and suicidal behavior and explore their associated factors in Botswana ALWHIV.

METHODS

Responses were obtained from 622 ALWHIV using the DSM-5 and the Mini-International Neuropsychiatric Interview for Children and Adolescents.

RESULTS

The mean age (SD) of the participants was 17.7 (1.60) years and more males (54.3%) participated than females. Depression and suicidal behavior rates among adolescents were 23% and 18.9%, respectively. Female participants were more likely to be depressed (AOR = 1.96; 95% CI 1.11-3.45) and have suicidal behaviour (AOR = 6.60; 95% CI 3.19-13.7). Loss of mother (AOR = 2.87; 95% CI 1.08-7.62) and viral load of 400 copies and above (AOR = 5.01; 95% CI 2.86-8.78) were associated with depression. Alcohol use disorder (AOR = 3.82; 95% CI 1.83-7.96) and negative feelings about status (AOR = 8.79; 95% CI 4.62-16.7) were associated with suicidal behavior. Good support (AOR = 0.42; 95% CI 0.23-0.76) and increased frequency of religious activities were protective (AOR = 0.33; 95% CI 0.14-0.79) against depression and suicidal behaviour, respectively.

CONCLUSION

Therefore, routine psychologic screening, which includes identifying psychological stressors and maladaptive coping, family and caregiver support services, and psychosocial support platforms, should be integrated into the management package for ALWHIV in Botswana.

A systematic review of substance use and substance use disorder research in Kenya

Objectives

The burden of substance use in Kenya is significant. The objective of this study was to systematically summarize existing literature on substance use in Kenya, identify research gaps, and provide directions for future research.

Methods

This systematic review was conducted in line with the PRISMA guidelines. We conducted a search of 5 bibliographic databases (PubMed, PsychINFO, Web of Science, Cumulative Index of Nursing and Allied Professionals (CINAHL) and Cochrane Library) from inception until 20 August 2020. In addition, we searched all the volumes of the official journal of the National Authority for the Campaign Against Alcohol & Drug Abuse (the African Journal of Alcohol and Drug Abuse). The results of eligible studies have been summarized descriptively and organized by three broad categories including: studies evaluating the epidemiology of substance use, studies evaluating interventions and programs, and qualitative studies exploring various themes on substance use other than interventions. The quality of the included studies was assessed with the Quality Assessment Tool for Studies with Diverse Designs.

Results

Of the 185 studies that were eligible for inclusion, 144 investigated the epidemiology of substance use, 23 qualitatively explored various substance use related themes, and 18 evaluated substance use interventions and programs. Key evidence gaps emerged. Few studies had explored the epidemiology of hallucinogen, prescription medication, ecstasy, injecting drug use, and emerging substance use. Vulnerable populations such as pregnant women, and persons with physical disability had been under-represented within the epidemiological and qualitative work. No intervention study had been conducted among children and adolescents. Most interventions had focused on alcohol to the exclusion of other prevalent substances such as tobacco and cannabis. Little had been done to evaluate digital and population-level interventions.

Conclusion

The results of this systematic review provide important directions for future substance use research in Kenya.

Systematic review registration

PROSPERO: CRD42020203717.

Psychosocial predictors of anxiety and depression in a sample of healthcare workers in Botswana during the COVID-19 pandemic: A multicenter cross-sectional study

Objectives:

This study aimed to investigate the psychological impact of the COVID-19 outbreak on healthcare workers across multiple hospitals in different districts in Botswana.

Methods:

We conducted a cross-sectional study in five public-funded hospitals from three districts in Botswana from 1 June 2020 to 30 October 2020. We used the neuroticism subscale of the 44-item Big Five Inventory, Patient Health Questionnaire, the Oslo 3-item Social Support Scale, the Anxiety Rating Scale, and the 14-item Resilience Scale to obtain data from 355 healthcare workers.

Results:

The participants’ mean age (standard deviation) was 33.77 (6.84) years. More females (207, 59%) responded than males (144, 41%). Anxiety and depression were experienced by 14% and 23% of the participants, respectively. After multiple regression analyses, neuroticism predicted depression (B = 0.22; p < 0.01) and anxiety disorder (B = 0.31; p < 0.01). Lower educational status (B = −0.13; p = 0.007) predicted anxiety and younger age (B = −0.10; p = 0.038) predicted depression, while resilience negatively correlated with both disorders.

Conclusion:

There is a need to develop and implement interventions targeted at these identified risk and protective factors that can be easily delivered to healthcare workers during this pandemic.