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van Loggerenberg F, Akena D, Alinaitwe R, Birabwa-Oketcho H, Méndez CAC, Gómez-Restrepo C, Kulenović AD, Selak N, Kiseljaković M, Musisi S, Nakasujja N, Sewankambo NK, Priebe S. Feasibility and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with long-term physical conditions: an exploratory non-controlled study in Bosnia and Herzegovina, Colombia and Uganda. BMC Prim Care 2023; 24:241. [PMID: 37968592 PMCID: PMC10652546 DOI: 10.1186/s12875-023-02197-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
INTRODUCTION The management of long-term physical conditions is a challenge worldwide, absorbing a majority resources despite the importance of acute care. The management of these conditions is done largely in primary care and so interventions to improve primary care could have an enormous impact. However, very little data exist on how to do this. Mental distress is frequently comorbid with long term physical conditions, and can impact on health behaviour and adherence, leading to poorer outcomes. DIALOG+ is a low-cost, patient-centred and solution-focused intervention, which is used in routine patient-clinician meetings and has been shown to improve outcomes in mental health care. The question arises as to whether it could also be used in primary care to improve the quality of life and mental health of patients with long-term physical conditions. This is particularly important for low- and middle-income countries with limited health care resources. METHODS An exploratory non-controlled multi-site trial was conducted in Bosnia and Herzegovina, Colombia, and Uganda. Feasibility was determined by recruitment, retention, and session completion. Patient outcomes (quality of life, anxiety and depression symptoms, objective social situation) were assessed at baseline and after three approximately monthly DIALOG+ sessions. RESULTS A total of 117 patients were enrolled in the study, 25 in Bosnia and Herzegovina, 32 in Colombia, and 60 in Uganda. In each country, more than 75% of anticipated participants were recruited, with retention rates over 90% and completion of the intervention exceeding 92%. Patients had significantly higher quality of life and fewer anxiety and depression symptoms at post-intervention follow-up, with moderate to large effect sizes. There were no significant improvements in objective social situation. CONCLUSION The findings from this exploratory trial suggest that DIALOG+ is feasible in primary care settings for patients with long-term physical conditions and may substantially improve patient outcomes. Future research may test implementation and effectiveness of DIALOG+ in randomized controlled trials in wider primary care settings in low- and middle-income countries. TRIAL REGISTRATION All studies were registered prospectively within the ISRCTN Registry. ISRCTN17003451, 02/12/2020 (Bosnia and Herzegovina), ISRCTN14018729, 01/12/2020 (Colombia) and ISRCTN50335796, 02/12/2020 (Uganda).
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Affiliation(s)
- Francois van Loggerenberg
- Youth Resilience Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Dickens Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Racheal Alinaitwe
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Carlos Gómez-Restrepo
- Departments of Clinical Epidemiology and Biostatistics and Psychiatry and Mental Health, Pontificia Universidad Javeriana, Bogotá, Colombia
| | | | - Nejra Selak
- Primary Care Center Zenica, Zenica, Bosnia and Herzegovina
| | - Meliha Kiseljaković
- Emergency Medical Center of Canton Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Seggane Musisi
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nelson K Sewankambo
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, East London NHS Foundation Trust, London, UK
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Burger JW, Andersen LS, Joska JA. Baseline concussion assessments can identify mental disorders: SCAT-5 and other screening tools in South African club rugby. PHYSICIAN SPORTSMED 2023; 51:472-481. [PMID: 36217827 DOI: 10.1080/00913847.2022.2134977] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/03/2022] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Although mental health screenings are not routinely conducted in rugby, the Sport Concussion Assessment Tool - Fifth Edition (SCAT-5) is widely performed and measures affective, cognitive, sleep, and physical symptoms. This study investigated the psychometric properties of the SCAT-5 to explore its potential as a mental health screening tool. METHODS During preseason for the 2021 Western Province Super League A in South Africa, clinicians conducted mental health assessments of 71 adult male rugby union players. The SCAT-5 Symptom Evaluation, Baron Depression Screener for Athletes (BDSA), Athlete Psychological Strain Questionnaire (APSQ), Center for Epidemiologic Studies-Depression (CES-D), and Generalized Anxiety Disorder-7 (GAD-7) were compared to each other and to fully structured diagnostic interviews by mental health professionals using the Mini International Neuropsychiatric Interview (MINI) 7.0.2. RESULTS Lifetime MINI-defined mental disorders were common, being identified in 33.8% (95% CI 22.79-46.17%). Only 4.29% of participants had a previous diagnosis. Exploratory Factor Analysis indicated a mental health construct of depression/anxiety being measured by the SCAT-5. The SCAT-5 had strong internal consistency (α = 0.94) and showed moderate convergent validity with the CES-D (r = 0.34; p = 0.008) and GAD-7 (r = 0.49; p < 0.0001). The area under the curve for the ability of the SCAT-5 to identify current disorders was 0.87 (p = 0.003), on par with the CES-D and GAD-7. CONCLUSION Since the SCAT-5 has the potential to identify depression and anxiety, it may allow mental health screening without the need for additional measures. Follow-up studies should further explore its discriminative ability in larger samples.
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Affiliation(s)
- James W Burger
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
| | - Lena S Andersen
- Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John A Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
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Khonje V, Hart J, Venter J, Deonarain S, Grossberg S. Acute organophosphorus toxicity in a regional hospital in Johannesburg, South Africa: A retrospective chart review. Afr J Emerg Med 2023; 13:104-108. [PMID: 37152660 PMCID: PMC10160343 DOI: 10.1016/j.afjem.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/23/2023] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
Introduction Intentional and accidental organophosphorus exposures pose a significant healthcare-related burden on South African communities. This study will review the demographics, characteristics and clinical course of patients presenting with features of acute organophosphorus toxicity to a regional Emergency Centre in Johannesburg, South Africa. Methods This was a retrospective chart review of all patients treated for possible acute organophosphorus toxicity from January 2020 to August 2021. Results A total of 205 patients were identified of which 134 patients were included in the study. The median age was 26 years with a male predominance (male= 56%, female=44%). 109 patients (81.3%) survived, 18 patients (13.4%) demised and the outcome of 7 patients (5.2%) was unknown. The median hospital length of stay was 8 days, (IQR= 5-13 days), and the longest hospital stay was 37 days in ICU. Atropinisation dose was significantly higher for intubated patients (median=140.0mg; IQR=90mg-219.5mg) compared to patients who were not intubated (median=60mg; IQR=20.5mg-120mg, p < 0.05). The length of stay was significantly higher for intubated patients (median=11 days; IQR=7-15 days) compared to patients who were not intubated (median=5 days; IQR=3-8 days, p < 0.00). There was a moderate positive correlation between atropinisation dose and length of stay (Correlation coefficient = 0.37, p < 0.00). There was a moderate negative correlation between atropinisation dose and cholinesterase level (Correlation coefficient= - 0.39, p < 0.00). Of those reported to have adverse effects 78.6%, were related to atropine toxicity. Conclusion Our study shows a high mortality rate secondary to organophosphorus toxicity. Significant exposures and thus higher doses of atropine were associated with increased length of stay and need for intubation. We found a high incidence of atropine-related adverse effects. More studies are needed to further establish the balance between the therapeutic and adverse effects of high-dose atropine as a treatment modality for organophosphorus toxicity.
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Affiliation(s)
- Vanessa Khonje
- Emergency Department, Thelle Mogoerane Regional Hospital, Vosloorus, Gauteng, South Africa
- Corresponding author:
| | - Jedd Hart
- Emergency Department, Thelle Mogoerane Regional Hospital, Vosloorus, Gauteng, South Africa
- Division of Emergency Medicine, Faculty of Health Sciences, University of Witwatersrand, Gauteng, South Africa
| | - Jakus Venter
- Emergency Department, Thelle Mogoerane Regional Hospital, Vosloorus, Gauteng, South Africa
- Division of Emergency Medicine, Faculty of Health Sciences, University of Witwatersrand, Gauteng, South Africa
| | - Saisha Deonarain
- Emergency Department, Thelle Mogoerane Regional Hospital, Vosloorus, Gauteng, South Africa
| | - Saul Grossberg
- Emergency Department, Thelle Mogoerane Regional Hospital, Vosloorus, Gauteng, South Africa
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Mindu T, Mutero IT, Ngcobo WB, Musesengwa R, Chimbari MJ. Digital Mental Health Interventions for Young People in Rural South Africa: Prospects and Challenges for Implementation. Int J Environ Res Public Health 2023; 20:1453. [PMID: 36674209 PMCID: PMC9859354 DOI: 10.3390/ijerph20021453] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/04/2023] [Accepted: 01/09/2023] [Indexed: 06/17/2023]
Abstract
Globally, most young people living with mental health conditions lack access to mental health care but have access to a mobile device. The growing access to mobile devices in South Africa has the potential to increase access to mental health care services through digital platforms. However, uptake of digital mental health interventions may be hampered by several factors, such as privacy, confidentiality, informed consent, and affordability. This study identified the prospects and challenges of implementing a mobile phone-based mental health intervention for young people in Ingwavuma area. Data were collected from 93 young people in three villages purposefully selected in Ingwavuma area. Participants included in the study were aged 16-24. Data were collected through a questionnaire. Thematic and descriptive analysis was performed on the qualitative and quantitative data, respectively. Mental health education was low, with only 22% of participants having received prior education on mental health. About 50% of the participants had come across a mental health app, but none of them had used any of these apps; 87% of participants had Internet access; 60% preferred to use social media to contact a health worker; and 92% suggested that use of digital apps would improve mental health literacy among young people. Barriers to access of digital mental health interventions were identified as the high cost of data, restrictive religious beliefs, limited privacy, lack of native languages on most digital platforms, low digital literacy, and complicated user interface. In uMkhanyakude, uptake of digital mental health apps among the young people was low. We recommend that, developers create context-specific digital applications catered for young people from different cultural backgrounds. Socio-economic issues such as affordability also need to be addressed in developing these tools.
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Affiliation(s)
- Tafadzwa Mindu
- Department of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Innocent Tinashe Mutero
- Department of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
| | | | | | - Moses John Chimbari
- Department of Nursing and Public Health, University of KwaZulu-Natal, Durban 4041, South Africa
- Research and Innovation, Great Zimbabwe University, Masvingo P.O. Box 1235, Zimbabwe
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Mpanza DM, Govender P, Voce A. Perspectives of service providers on aftercare service provision for persons with substance use disorders at a Rural District in South Africa. Subst Abuse Treat Prev Policy 2022; 17:60. [PMID: 35962363 PMCID: PMC9373456 DOI: 10.1186/s13011-022-00471-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 11/30/2022] Open
Abstract
Background Provision of aftercare services for persons with substance use disorders (PWSUD) within a rural context is typically met with various intersecting challenges, including unclear policy implications and lack of resources. In the South African context, service providers are expected to provide aftercare services that should successfully reintegrate persons with PWSUD into society, the workforce, family and community life as mandated by Act No. 70 of 2008, despite population diversity. Little has been established on the provision of aftercare services in South Africa and specifically within a rural context. This article explores service providers’ perspectives in aftercare service provision for PWSUD in a rural district. Methods A qualitative exploratory study design was conducted in a rural district in South Africa using semi-structured interviews and focus group discussions with forty-six service providers from governmental and non-governmental institutions, ranging from implementation to policy level of service provision. Data were analyzed thematically using a deductive approach. Codes were predetermined from the questions and the aims and objectives of the study used Beer’s Viable Systems Model as a theoretical framework. NVivo Pro 12 qualitative data analysis software guided the organization and further analysis of the data. Results Four themes emanated from the data sets. Theme 1 on reflections of the interactional state of aftercare services and program content identified the successes and inadequacies of aftercare interventions including relevant recommendations for aftercare services. Themes 2, 3, and 4 demonstrate reflections of service provision from implementation to policy level, namely, identifying existing barriers to aftercare service provision, situating systemic enablers to aftercare service provision, and associated aftercare system recommendations. Conclusions The intersecting systemic complexities of providing aftercare services in a rural context in South Africa was evident. There existed minimal enablers for service provision in this rural district. Service providers are confronted with numerous systemic barriers at all levels of service provision. To strengthen the aftercare system, policies with enforcement of aftercare services are required. Moreover, a model of aftercare that is integrated into the existing services, family centered, sensitive to the rural context and one that encourages the collaboration of stakeholders could also strengthen and sustain the aftercare system and service provision.
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van der Merwe E, Paruk F. Quantifying the burden of the post-ICU syndrome in South Africa: A scoping review of evidence from the public health sector. South Afr J Crit Care 2022; 38. [PMID: 36284926 DOI: 10.7196/SAJCC.2022.v38i2.527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The post-ICU syndrome (PICS) comprises unexpected impairments in physical, cognitive, and mental health after intensive care unit (ICU) discharge, and is associated with a diminished health-related quality of life (HRQOL). A Cochrane review recommended more research in this field from low- and middle-income countries. OBJECTIVES This review aims to examine the extent and nature of publications in the field of PICS in the South African (SA) public health sector. Findings of available local research are contextualised through comparison with international data. METHODS A comprehensive literature search strategy was employed. Inclusion criteria comprised publications enrolling adult patients following admission to SA public hospital ICUs, with the aim to study the main elements of PICS (ICU-acquired neuromuscular weakness, neurocognitive impairment, psychopathology and HRQOL). RESULTS Three studies investigated physical impairment, 1 study psychopathology, and 2 studies HRQOL. Recommended assessment tools were utilised. High rates of attrition were reported. Neuromuscular weakness in shorter-stay patients had recovered at 3 months. Patients who were ventilated for ≥5 days were more likely to be impaired at 6 months. The study on psychopathology reported high morbidity. The HRQOL of survivors was diminished, particularly in patients ventilated for ≥5 days. CONCLUSION This review found a paucity of literature evaluating PICS in the SA public health sector. The findings mirror those from international studies. Knowledge gaps pertaining to PICS in medical, surgical and HIV-positive patients in SA are evident. No publications on neurocognitive impairment or the co-occurrence of PICS elements were identified. There is considerable scope for further research in this field in SA. CONTRIBUTIONS OF THE STUDY This review identified the available publications investigating the post ICU syndrome (PICS) in the South African public healthcare setting. A small number of ground-breaking studies were found. Knowledge gaps in this field were identified.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Machisa MT, Chirwa E, Mahlangu P, Nunze N, Sikweyiya Y, Dartnall E, Pillay M, Jewkes R. Suicidal Thoughts, Depression, Post-Traumatic Stress, and Harmful Alcohol Use Associated with Intimate Partner Violence and Rape Exposures among Female Students in South Africa. IJERPH 2022; 19:ijerph19137913. [PMID: 35805572 PMCID: PMC9266174 DOI: 10.3390/ijerph19137913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 11/16/2022]
Abstract
While ample evidence from high-income country settings indicates the prevalence and risk factors for multiple mental ill-health symptoms in student populations, evidence from low- and middle-income higher education settings remains limited. We determined the frequency, associations, and structural pathways between mental health outcomes and possible risk factors among a sample of 1292 predominantly Black African and female students ages 18–30 years, enrolled at nine purposefully selected public universities and Technical Vocational Education and Training (TVET) campuses. We measured and created a mental ill-health latent outcome consisting of depressive symptoms, post-traumatic stress disorder (PTSD), and suicidal thoughts. We also measured traumatic exposures including childhood trauma, recent intimate partner violence (IPV), non-partner rape, and other life traumatic events. We used structural equation modelling to analyse data. We found that 50% of the surveyed students binge drank, 43% reported depressive symptoms, 9% reported PTSD symptoms, and 21% had suicidal thoughts. Students’ experiences of childhood trauma, food insecurity, other traumatic events, non-partner rape, and IPV impacted the mental ill-health latent. IPV experiences mediated the relationships between experiences of childhood trauma or other trauma and the mental ill-health latent, and the relationship between binge drinking and other life traumatic events. Non-partner rape mediated the relationship between food insecurity and the mental ill-health latent. Binge drinking directly impacted non-partner rape experience. The findings substantiate the need for campus-based mental health promotion, psychosocial services and treatments, and implementation of combined interventions that address the intersections of violence against women and mental health among students in South Africa.
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Affiliation(s)
- Mercilene Tanyaradzwa Machisa
- South African Medical Research Council Gender and Health Research Unit, 1 Soutpansberg Road, Pretoria Private Bag x385, Pretoria 0001, South Africa; (E.C.); (P.M.); (N.N.); (Y.S.); (R.J.)
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 60 York Road, Parktown, Johannesburg 2193, South Africa
- Correspondence:
| | - Esnat Chirwa
- South African Medical Research Council Gender and Health Research Unit, 1 Soutpansberg Road, Pretoria Private Bag x385, Pretoria 0001, South Africa; (E.C.); (P.M.); (N.N.); (Y.S.); (R.J.)
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 60 York Road, Parktown, Johannesburg 2193, South Africa
| | - Pinky Mahlangu
- South African Medical Research Council Gender and Health Research Unit, 1 Soutpansberg Road, Pretoria Private Bag x385, Pretoria 0001, South Africa; (E.C.); (P.M.); (N.N.); (Y.S.); (R.J.)
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 60 York Road, Parktown, Johannesburg 2193, South Africa
| | - Ncediswa Nunze
- South African Medical Research Council Gender and Health Research Unit, 1 Soutpansberg Road, Pretoria Private Bag x385, Pretoria 0001, South Africa; (E.C.); (P.M.); (N.N.); (Y.S.); (R.J.)
| | - Yandisa Sikweyiya
- South African Medical Research Council Gender and Health Research Unit, 1 Soutpansberg Road, Pretoria Private Bag x385, Pretoria 0001, South Africa; (E.C.); (P.M.); (N.N.); (Y.S.); (R.J.)
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 60 York Road, Parktown, Johannesburg 2193, South Africa
| | - Elizabeth Dartnall
- Sexual Violence Research Initiative, 28 High Street, Waterkloof, Pretoria 0145, South Africa;
| | - Managa Pillay
- Department of Basic Education, 222 Struben Street, Pretoria Central, Pretoria 0001, South Africa;
| | - Rachel Jewkes
- South African Medical Research Council Gender and Health Research Unit, 1 Soutpansberg Road, Pretoria Private Bag x385, Pretoria 0001, South Africa; (E.C.); (P.M.); (N.N.); (Y.S.); (R.J.)
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 60 York Road, Parktown, Johannesburg 2193, South Africa
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Monnapula-Mazabane P, Petersen I. Feasibility and acceptability of a mental health stigma intervention for low-income South African caregivers: A qualitative investigation. S Afr J Psychiatr 2022; 28:1824. [PMID: 35402016 PMCID: PMC8991039 DOI: 10.4102/sajpsychiatry.v28i0.1824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 01/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Common mental health illnesses such as depression and anxiety disorders are increasing globally. There remain significant gaps in health services provision and support for mental illness linked to stigma in developing countries. Aim Our study aimed to assess the feasibility and acceptability of a mental health intervention for caregivers of mental health service users. Setting Low-income South African communities. Method Our study qualitatively assessed the feasibility of an anti-stigma mental health intervention for family caregivers in low-income settings. The intervention was structured into five sessions delivered over three days. Caregivers attended all the sessions at a centralised community venue. Semi-structured qualitative interviews were held separately with caregivers (n = 10) and their service users (n = 9) eight weeks post-intervention. Interviews were translated verbatim from local languages to English prior to framework analysis. Results Post-intervention, service users reported improved family relations and understanding of mental illness among family members. The intervention was reported as acceptable and helpful by caregivers as it increased knowledge, fostering better relationships with service users. Group discussions were noted as a critical driver of intervention success. Widespread mental health stigma within communities remained a key concern for caregivers and service users. Conclusion With the government’s drive for deinstitutionalisation, the need to integrate anti-stigma interventions within community mental health services is vital, as is the need for population-wide anti-stigma interventions to support the integration of mental health service users within communities.
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Affiliation(s)
- Portia Monnapula-Mazabane
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Abstract
BACKGROUND South Africa is a low and middle income country facing many challenges in public mental health care and implementation of recovery. AIMS To contribute to what barriers and facilitators to recovery might be for service users in South Africa, from the perspective of service users, carers and service providers from three psychiatric hospitals in the Western Cape province. METHOD Interviews and focus groups were conducted with service users, carers and service providers. Interviews and focus groups were transcribed and analysed using atlas.ti software and reflexive thematic analysis, from the bottom up. RESULTS The barriers, environment, family, public mental health services, stigma and service users' attitude or behaviour generated, were found to be the most salient. The facilitators to recovery generated were support, family or friends, service providers, structure and empowerment. The need for support was identified as an underlying component to all these themes. CONCLUSION Barriers and facilitators to recovery seemed to have both intrapersonal and external sources that intersect at times. Recovery needs to be supported at an individual level, especially through an under-utilised resource such as peer support work, but in conjunction with the development of recovery-enabling environments in services and communities in South Africa.
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Affiliation(s)
- Anneliese de Wet
- Psychology Department, Stellenbosch University, Matieland, Western Cape, South Africa
| | - Chrisma Pretorius
- Psychology Department, Stellenbosch University, Matieland, Western Cape, South Africa
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van Rensburg BJ, Kotzé C, Moxley K, Subramaney U, Zingela Z, Seedat S. Profile of the Current Psychiatrist Workforce in South Africa: Establishing a Baseline for Human Resource Planning and Strategy. Health Policy Plan 2021; 37:492-504. [PMID: 34871396 DOI: 10.1093/heapol/czab144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 11/13/2022] Open
Abstract
The WHO Global Health Observatory Data Repository reports South Africa with 1.52 psychiatrists/100 000 of the population among other countries in Africa with 0.01 psychiatrists/100 000 (Chad, Burundi and Niger) to more than 30/100 000 for some countries in Europe. The overall situation, while being cognizant that mental health care is not only provided by specialist psychiatrists and that the current treatment gap may have to be addressed by strategies such as appropriate task sharing, suggests that there are actually too few psychiatrists to meet the country's mental health care needs. To address the need to develop a strategy to increase the local specialist training and examination capacity, a situational review of currently practicing psychiatrists was undertaken by the [BLINDED] and the [BLINDED], using the South African Society of Psychiatrists (SASOP) membership database. The number, distribution and attributes of practicing psychiatrists were compared with international figures on the ratio of psychiatrists/100 000 population. In April 2019 there were 850 qualified psychiatrists actively practicing in the country and based on the national population figure of 55.6 million people (2016 Census), the psychiatrists/100 000 ratio was 1.53. This indicates no improvement between 2016 to 2019. From the SASOP database, we determined that about 80% of psychiatrists are working in the private sector - a much higher proportion than is usually quoted. As the vast majority of psychiatrists are practicing in urban areas in two provinces, Gauteng (n=350) and Western Cape (n=292), the ratio of psychiatrists/100 000 in these areas is relatively higher, at 2.6 and 5.0 respectively. Whereas rural areas in South Africa are largely without specialist mental health expertise, at a rate of 0.03/100 000 population. This investigation provides a discipline-specific situational review of the attributes and distribution of the current workforce of specialists in the country.
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Affiliation(s)
- Bernard Janse van Rensburg
- Department of Psychiatry, University of the Witwatersrand, Johannesburg; and South African Society of Psychiatrists
| | - Carla Kotzé
- Department of Psychiatry, University of Pretoria; and College of Psychiatrists (Colleges of Medicine of South Africa)
| | - Karis Moxley
- Department of Psychiatry, Stellenbosch University
| | - Ugasvaree Subramaney
- Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand
| | - Zukiswa Zingela
- Department of Psychiatry and Behavioural Sciences, Walter Sisulu University and Nelson Mandela Academic Hospital, Mthatha, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University; and College of Psychiatrists (Colleges of Medicine of South Africa)
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Tsatsi IA, Plastow NA. Optimizing a Halfway House to Meet Mental Health Care Users' Occupational Needs : Optimisation d'une maison de transition pour répondre aux besoins occupationnels des usagers des soins de santé mentale. Can J Occup Ther 2021; 88:352-364. [PMID: 34709087 DOI: 10.1177/00084174211044896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background. Halfway houses (HwH) may support community reintegration of mental health care users and can be effective in meeting occupational needs of residents. However, they are not optimally used in South Africa. Purpose. This study aimed to improve the functioning of a HwH so that it better meets occupational needs of the resident mental health care users. It draws on Doble & Santha; (2008) seven occupational needs. Method. A four-phase Participatory Action Research methodology was used. We conducted thematic analysis to describe met and unmet needs within PAR phases. Findings. Occupational needs of accomplishment, renewal, pleasure and companionship were being met. However, coherence, agency and affirmation needs were not being met. An additional occupational need for interdependence, based on the African ethic of Ubuntu, was identified. Implications. HwH functioning affected residents' experiences of health and wellbeing. Engagement in collective occupations can contribute to meeting the occupational need of interdependence.
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van Loggerenberg F, McGrath M, Akena D, Birabwa-Oketcho H, Méndez CAC, Gómez-Restrepo C, Džubur Kulenoviĉ A, Muhić M, Sewankambo NK, Sikira H, Priebe S. Feasibility, experiences and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with chronic conditions: an exploratory non-controlled trial in Bosnia and Herzegovina, Colombia and Uganda. Pilot Feasibility Stud 2021; 7:180. [PMID: 34593055 PMCID: PMC8481761 DOI: 10.1186/s40814-021-00914-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND DIALOG+ is a resource-oriented and evidence-based intervention to improve quality of life and reduce mental distress. While it has been extensively studied in mental health care, there is little evidence for how to use it in primary care settings for patients with chronic physical conditions. Considering that DIALOG+ is used in existing routine patient-clinician meetings and is very low cost, it may have the potential to help large numbers of patients with chronic physical conditions, mental distress and poor quality of life who are treated in primary care. This is particularly relevant in low- and middle-income countries (LMICs) where resources for specialised services for such patients are scarce or non-existent. METHODS An exploratory non-controlled trial will be conducted to primarily assess the feasibility and acceptability and, secondarily, outcomes of delivering DIALOG+ to patients with chronic physical conditions and poor quality of life in primary care settings in Bosnia and Herzegovina, Colombia and Uganda. Thirty patients in each country will receive DIALOG+ up to three times in monthly meetings over a 3-month period. Feasibility will be assessed by determining the extent to which the intervention is implemented as planned. Experiences will be captured in interviews and focus groups with care providers and participants to understand acceptability. Quality of life, symptoms of anxiety and depression, objective social situation and health status will be assessed at baseline and again after the three-session intervention. DISCUSSION This study will inform our understanding of the extent to which DIALOG+ may be used in the routine care of patients with chronic physical conditions in different primary care settings. The findings of this exploratory trial can inform the design of future full randomised controlled trials of DIALOG+ in primary care settings in LMICs. TRIAL REGISTRATION All studies were registered prospectively (on 02/12/2020 for Uganda and Bosnia and Herzegovina, and 01/12/2020 for Colombia) within the ISRCTN Registry. ISRCTN17003451 (Bosnia and Herzegovina), ISRCTN14018729 (Colombia) and ISRCTN50335796 (Uganda). Protocol version and date: v2.0; 28/07/2020 (Bosnia and Herzegovina), v0.3 02/08/2020 (Colombia) and v1.0, 05/11/2020 (Uganda).
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Affiliation(s)
| | - Michael McGrath
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
| | - Dickens Akena
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Carlos Gómez-Restrepo
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá, Colombia
- Department of Psychiatry and Mental Health, Pontificia Universidad Javeriana, Bogotá, Colombia
- Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Maja Muhić
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nelson K Sewankambo
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hana Sikira
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Stefan Priebe
- Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK
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14
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Booysen D, Mahe-Poyo P, Grant R. The experiences and perceptions of mental health service provision at a primary health centre in the Eastern Cape. S Afr J Psychiatr 2021; 27:1641. [PMID: 34522437 PMCID: PMC8424744 DOI: 10.4102/sajpsychiatry.v27i0.1641] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 05/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Since 1994, the South African healthcare system has undergone several changes to meet the needs of contemporary South Africa. Yet the state of mental healthcare, especially in low-resource areas, remains in a precarious state. Aim This study aimed to explore how persons diagnosed with a mental disorder experience and perceive mental health services in a low-resource community in the Eastern Cape, South Africa. Setting The study was conducted at a primary care clinic in a low resource community setting in the Eastern Cape, South Africa. Method Semi-structured interviews were conducted with eight participants diagnosed with mental illness who had been accessing treatment for at least the past 6 months from a primary health clinic. Thematic analysis was used to analyse and identify pertinent themes. Results The following themes emerged from the data: (1) perceptions of mental disorders – role of culture, (2) experiences of having mental disorders – loss of employment, (3) problem of stigma – social rejection and labelling, (4) experience of distress – sadness and frustration and (5) challenges in accessing treatment – transport fee and shortage of staff. Conclusion This study yielded several lived experiences and perceptions in relation to participants’ feelings, opinions and interpretations of persons living with mental disorders and accessing mental health treatment in their local context. Future interventions should consider provision of more extensive professional help in the form of counsellors and social workers at the clinics, more efficient service delivery and future interventions regarding stigma should incorporate community members into the learning process.
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Affiliation(s)
- Duane Booysen
- Department of Psychology, Faculty of Humanities, Rhodes University, Grahamstown, South Africa
| | - Phumeza Mahe-Poyo
- Department of Psychology, Faculty of Humanities, Rhodes University, Grahamstown, South Africa
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15
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Monnapula-Mazabane P, Petersen I. Mental health stigma experiences among caregivers and service users in South Africa: a qualitative investigation. Curr Psychol 2021; 42:9427-9439. [PMID: 34465971 PMCID: PMC8396139 DOI: 10.1007/s12144-021-02236-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 11/06/2022]
Abstract
The study aimed to understand the nature and context of mental health stigma among people living with a mental health condition and the subsequent effect on their caregivers. Semi-structured qualitative face to face interviews were conducted by trained mental healthcare professionals with mental health service users (n = 26) and caregivers (n = 24) in private rooms at a tertiary health facility, where service users were admitted. Following transcription and translation, data was analysed using framework analysis. There was limited knowledge about their mental health diagnosis by service users and generally low mental health literacy among service users and caregivers. Mental health service users reported experiences of stigma from their own families and communities. Caregivers reported withholding the patient’s diagnosis from the community for fear of being stigmatised, and this fear of stigma carries the risk of negatively affecting care treatment-seeking. Limited mental health knowledge, coupled with a high prevalence of perceived family and community stigma among caregivers and service users, impedes the capacity of caregivers to effectively cope in supporting their family members living with mental illness. There is a need for interventions to provide psychoeducation, reduce community stigma, and support coping strategies for caregivers and people with mental health conditions.
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Affiliation(s)
- Portia Monnapula-Mazabane
- School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, Durban, 4001 South Africa
| | - Inge Petersen
- Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, 4001 South Africa
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16
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van der Watt ASJ, Menze N, Moxley K, Mbanga I, Seedat S, Dass-Brailsford P. Self-identification, mode of diagnosis and treatment, and perceptions of relationships with medical providers of South African Xhosa-speaking traditional healers. Transcult Psychiatry 2021; 58:573-584. [PMID: 34082637 DOI: 10.1177/13634615211015071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is widespread use of traditional medicine in treating common mental disorders in South Africa. We aimed to (i) explore the self-identification of traditional healers (THs; how they refer to themselves, e.g., as healer, spiritualist, sangoma, etc.); (ii) determine if different types of THs treat different conditions (physical/psychological) or use different modes of diagnosis and treatment; (iii) identify factors that influence the willingness of THs to refer patients to biomedical hospitals; and (iv) compare TH practices between two provinces. Participants included Xhosa-speaking THs (mean age = 54.10, SD = 13.57 years) from the Western (n = 50) and Eastern (n = 68) Cape provinces. Participants completed a questionnaire regarding self-identification, mode of diagnosis/treatment, relationship with biomedical hospitals, type of condition(s) treated, and a Patient Health Questionnaire. There were significant associations between the type of TH (as self-identified) and (i) mode of diagnosis, (ii) mode of treatment, and (iii) type of condition(s) treated. Spiritualists, male THs, and THs who had previously been hospitalised for a mental disorder were more likely to treat mental disorders. THs who had previously been hospitalised for mental disorders were more likely to report a willingness to refer patients to biomedical hospitals. Findings highlight the complex practices of Xhosa-speaking THs. Collaboration between THs and mental health care professionals could be facilitated by focusing on male THs, spiritualists, and THs who have previously been hospitalised for mental illness. Future research should provide clearer operational definitions of the type of TH included.
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Affiliation(s)
- A S J van der Watt
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - N Menze
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - K Moxley
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - I Mbanga
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - S Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - P Dass-Brailsford
- Department of Clinical Psychology, The Chicago School of Professional Psychology, Washington, DC, USA
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17
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Monnapula-Mazabane P, Babatunde GB, Petersen I. Current strategies in the reduction of stigma among caregivers of patients with mental illness: a scoping review. South African Journal of Psychology 2021. [DOI: 10.1177/00812463211001530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mental healthcare and wellness are a global concern and have increasingly become an essential service and priority from a human rights perspective. However, negative attitudes towards mental health, such as stigmatisation and discrimination from communities and family members, continue to pose challenges for deinstitutionalisation and home care of mentally ill persons. This study aimed to review the literature on the content and implementation methods of stigma reduction interventions for family/community caregivers of patients with mental illness to inform the development of an anti-stigma intervention for such caregivers in low- and middle-income countries like South Africa. A scoping literature review was conducted of English language studies published from 2008 to 2019 in peer-reviewed journals, using established guidelines for the study objectives. Primary interventions targeting caregivers of mental health patients were searched from PsycINFO, ScienceDirect, CINAHL, and Medline. In total, nine full-text articles were extracted for inclusion in the review, indicating a scarcity of literature on anti-stigma interventions aimed at primary caregivers of mental health patients. Interventions varied in terms of educational content, duration, delivery methods, and sample sizes. Intervention delivery was primarily through face-to-face, telephone, and online methods. Anti-stigma interventions for caregivers of patients with mental illness are varied and show positive short-term impacts on mental health stigma reduction among family caregivers. The evolution of health systems is a feasible approach towards integrating learning and trials that are needed to assess long-term impacts.
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Affiliation(s)
| | - Gbotemi B Babatunde
- School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - Inge Petersen
- School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
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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: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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19
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Hadebe NF, Ramukumba TS. Resilience and social support of young adults living with mental illness in the city of Tshwane, Gauteng province, South Africa. Curationis 2020; 43:e1-e7. [PMID: 33354974 PMCID: PMC7756966 DOI: 10.4102/curationis.v43i1.2084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/17/2020] [Accepted: 10/28/2020] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Young adults living with mental illnesses often experience a flood of powerful negative emotions, including anger, anxiety, and depression. Some of these young adults remain trapped in those negative emotions long after the stressful events that caused them have passed, while resilient young adults without mental illness are able to quickly bounce back to their normal emotional state. OBJECTIVES The objective of the study was to explore social support of young adults living with mental illnesses in the City of Tshwane. METHODS This was a qualitative explorative study done in the City of Tshwane in 2018 among young adults living with mental illnesses, using a semi-structured interview schedule. RESULTS Those young adults living with mental illness who had support from family and friends were able to cope with stressful challenges and had a better outlook for the future, while those who perceived their relationship with friends and family as not supportive reported low self-esteem and difficulties dealing with challenging and stressful situations in their lives. CONCLUSION Resilience was seen in those young people living with mental illness with support from family and friends, who had positive future prospects, those with high self-esteem, and those who were able to adapt to changing situations beyond their control.
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Affiliation(s)
- Nok'khanya F Hadebe
- Adelaide Tambo School of Nursing Science, Faculty of Science, Tshwane University of Technology, Pretoria.
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20
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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21
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Dewet ZT, Kotzé C, Sokudela F. State patients who committed violent crimes and were admitted to Weskoppies Hospital from 2005 to 2014: Profiles and trends. S Afr J Psychiatr 2020; 26:1416. [PMID: 33240546 PMCID: PMC7670009 DOI: 10.4102/sajpsychiatry.v26.i0.1416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/18/2020] [Indexed: 11/01/2022] Open
Abstract
Background Most of the available literature focus on characteristics of violent offenders and trends of crime patterns in the general population. The crime trends in the population of those who may be mentally ill have not been well described. Aim To describe the profiles and trends of mentally ill persons who committed violent crimes prior to admission as state patients. Setting The study was conducted at Weskoppies Psychiatric Hospital. Method A retrospective record review of state patients admitted between 2005 and 2014 was conducted to describe demographic, clinical, forensic and victim profiles of state patients admitted from 2005 to 2014. Trends over time were also assessed. Results Hundred and seventy state patient files were reviewed. The majority were males (91.43%), with a history of substance use (55.0%) %), previous psychiatric treatment (46.4%), and diagnosed with a psychotic disorder (82.1%). The 10 year trend showed that murder was the leading charge during 2006 and 2007. It was surpassed by sexual assault crimes as the most common charge after 2007, except for 2009 when murder was again the most common. From 2010 onward, sexual assault remained the most common offence leading to admission as a state patient. Conclusion This study found changes over time in crime patterns of state patients who committed murder and sexual assault. State patients may have different criminal patterns than the general public. This together with the high rates of substance use and previous psychiatric treatment can be important focus areas for future research.
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Affiliation(s)
- Zukiswa T Dewet
- Weskoppies Psychiatric Hospital, Pretoria, South Africa.,Department of Psychiatry, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Carla Kotzé
- Weskoppies Psychiatric Hospital, Pretoria, South Africa.,Department of Psychiatry, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Funeka Sokudela
- Weskoppies Psychiatric Hospital, Pretoria, South Africa.,Department of Psychiatry, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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22
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Mokwena KE, Ngoveni A. Challenges of Providing Home Care for a Family Member with Serious Chronic Mental Illness: A Qualitative Enquiry. Int J Environ Res Public Health 2020; 17:E8440. [PMID: 33202649 DOI: 10.3390/ijerph17228440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 12/27/2022]
Abstract
The South African Mental Health Act of 2002 advocates the de-institutionalization of treatment of patients with mental disorders, so that the mental health care users or patients are treated in their communities. Although this approach is often used to discharge patients from hospital, no feasibility assessments are conducted to ascertain adequate care for these patients. The objective of the study was to explore the experiences of family members who provide home care for patients with serious mental disorders. A qualitative explorative design was used to interview 20 primary caregivers whose family members were readmitted to a public psychiatric hospital in Pretoria. Data were analysed using NVivo version 11. The findings are that caring for patients with serious mental illness at home is difficult, sometimes unbearable, because the families have to deal with violence perpetrated by the patients, safety concerns, financial difficulties and emotional turmoil, and wish that the patients would be kept in institutions. The absence of required skills and resources to care for the mentally ill at home exposes the patients and their families to emotional, financial and social difficulties, and results in unfavourable outcomes for both the patients and their families.
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Abstract
The current paper sought to thematically present common challenges associated with mental healthcare services in Africa. We largely limited our search for literature materials to studies published from 2003 to 2019 in African countries from which the findings showed that there are common challenges confronting mental healthcare services in Africa. The challenges include: inadequate mental healthcare facilities, funding constraints, shortage of professional healthcare workers, inadequate training and development scheme for mental health workers and weak mental healthcare policies. Implications for policy and practice are disclosed and recommendations are stated to trigger actions to remedy the situation. This information is beneficial for researchers, policymakers, mental healthcare providers and community members who are interested in mental healthcare issues. It was concluded that in order for Africa to enjoy successful mental healthcare service, critical and enduring attention must focus on sound and enforceable government policy on mental healthcare service, provision of adequate and regular funding, availability of adequate mental healthcare facilities, provision of training and development facilities for the mental health professionals and collaboration of mental healthcare providers.
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24
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Botha HF, Koen L, Niehaus DJH, Vava Y, Moxley K, Botha U. Demographic and clinical profile of patients utilising a transitional care intervention in the Western Cape, South Africa. S Afr J Psychiatr 2020; 26:1523. [PMID: 32934842 PMCID: PMC7479413 DOI: 10.4102/sajpsychiatry.v26i0.1523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 06/09/2020] [Indexed: 01/16/2023] Open
Abstract
Background The World Health Organization’s action plan for 2020 has identified the need for service-based data to motivate for more appropriate community-based services. To date, there is no published data from step-up or step-down facilities in South Africa. Aim To describe the demographic and clinical profile of all patients admitted to New Beginnings between 01 January 2011 and 31 December 2015. Setting New Beginnings is an intermediary care facility focused on psychosocial rehabilitation and accommodates 40 patients in a step-up or step-down setting. Methods In this retrospective audit, we reviewed the medical records of all patients (N = 730) admitted to New Beginnings between 01 January 2011 and 31 December 2015. Results Most admissions were male (n = 600; 82.2%), unmarried (92.1%) and unemployed (92.7%) patients with a mean age of 28 years. Only 20.7% had completed their schooling and 37.9% were receiving a disability grant. Most patients lived in the Cape Town Metro area (89%) with their families (94.7%), and 75.6% had no children. Schizophrenia (53.7%) was the most common primary psychiatric diagnosis, and most patients were on a combination of oral and depot treatment (46.8%). Illicit substances were used by 75.9% of patients with 30% using both cannabis and methamphetamine. Most patients (74.9%) had only one admission to New Beginnings. Conclusions These baseline data could inform improved service delivery. Further research is needed to evaluate the success of New Beginnings and highlight the need for more of these facilities in the Western Cape and across South Africa.
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Affiliation(s)
- Henmar F Botha
- 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
| | - Yanga Vava
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karis Moxley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ulla Botha
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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25
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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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Mulaudzi NP, Mashau NS, Akinsola HA, Murwira TS. Working conditions in a mental health institution: An exploratory study of professional nurses in Limpopo province, South Africa. Curationis 2020; 43:e1-e8. [PMID: 32787431 PMCID: PMC7479419 DOI: 10.4102/curationis.v43i1.2081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Professional nurses are responsible for the provision of care, treatment and rehabilitation of all mental healthcare users (MHCUs) in the institutions for mental healthcare. However, professional nurses find themselves in difficult circumstances under which they must provide quality healthcare services to MHCUs. OBJECTIVES The study explored and described the challenges experienced by the professional nurses working in a mental healthcare institution in Limpopo province of South Africa. METHOD A qualitative approach was used to explore and describe the challenges faced by professional nurses working in a mental healthcare institution. The study was conducted from July 2016 to December 2016. Purposive sampling was used to select participants. Data were obtained through individual in-depth interviews with professional nurses between the ages of 26 and 50 years. Data collection continued until data saturation, which occurred after interviewing 18 participants. Tech's open coding method was used to analyse data in this study. RESULTS Four themes emerged from data analysis, namely: inadequate safety measures, inadequate resources, impact of high workload and shortage of staff. The themes were further sub-divided into sub-themes. CONCLUSION The study revealed several challenges that professional nurses face in mental healthcare institutions which might be a barrier to the provision of quality healthcare. Conducive working environments should be established to enable professional health nurses to provide quality nursing care, thereby promoting the health of MHCUs.
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Affiliation(s)
- Ndivhuwo P Mulaudzi
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou.
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27
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Mpanza DM, Govender P, Voce A. Aftercare services to people with substance use disorders: analysis of South African policy. Drugs: Education, Prevention and Policy 2020. [DOI: 10.1080/09687637.2020.1742661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Pragashnie Govender
- Discipline of Occupational Therapy, University of KwaZulu-Natal, Durban, South Africa
| | - Anna Voce
- Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
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Ohrnberger J, Fichera E, Sutton M, Anselmi L. The effect of cash transfers on mental health - new evidence from South Africa. BMC Public Health 2020; 20:436. [PMID: 32245377 PMCID: PMC7118950 DOI: 10.1186/s12889-020-08596-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 03/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mental health and poverty are strongly interlinked. There is a gap in the literature on the effects of poverty alleviation programmes on mental health. We aim to fill this gap by studying the effect of an exogenous income shock generated by the Child Support Grant, South Africa's largest Unconditional Cash Transfer (UCT) programme, on mental health. METHODS We use biennial data on 10,925 individuals from the National Income Dynamics Study between 2008 and 2014. We exploit the programme's eligibility criteria to estimate instrumental variable Fixed Effects models. RESULTS We find that receiving the Child Support Grant improves adult mental health by 0.822 points (on a 0-30 scale), 4.1% of the sample mean. CONCLUSION Our findings show that UCT programmes have strong mental health benefits for the poor adult population.
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Affiliation(s)
- Julius Ohrnberger
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, School of Public Health, 47 Praed Street, St Mary's Campus, London, UK.
| | | | - Matt Sutton
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - Laura Anselmi
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
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29
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Godman B, Grobler C, Van-De-Lisle M, Wale J, Barbosa WB, Massele A, Opondo P, Petrova G, Tachkov K, Sefah I, Abdulsalim S, Alrasheedy AA, Unnikrishnan MK, Garuoliene K, Bamitale K, Kibuule D, Kalemeera F, Fadare J, Khan TA, Hussain S, Bochenek T, Kalungia AC, Mwanza J, Martin AP, Hill R, Barbui C. Pharmacotherapeutic interventions for bipolar disorder type II: addressing multiple symptoms and approaches with a particular emphasis on strategies in lower and middle-income countries. Expert Opin Pharmacother 2020; 20:2237-2255. [PMID: 31762343 DOI: 10.1080/14656566.2019.1684473] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Appropriately managing mental disorders is a growing priority across countries in view of the impact on morbidity and mortality. This includes patients with bipolar disorders (BD). Management of BD is a concern as this is a complex disease with often misdiagnosis, which is a major issue in lower and middle-income countries (LMICs) with typically a limited number of trained personnel and resources. This needs to be addressed.Areas covered: Medicines are the cornerstone of managing patients with Bipolar II across countries including LMICs. The choice of medicines, especially antipsychotics, is important in LMICs with high rates of diabetes and HIV. However, care is currently compromised in LMICs by issues such as the stigma, cultural beliefs, a limited number of trained professionals and high patient co-payments.Expert opinion: Encouragingly, some LMICs have introduced guidelines for patients with BD; however, this is very variable. Strategies for the future include addressing the lack of national guidelines for patients with BD, improving resources for mental disorders including personnel, improving medicine availability and patients' rights, and monitoring prescribing against agreed guidelines. A number of strategies have been identified to improve the treatment of patients with Bipolar II in LMICs, and will be followed up.
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Affiliation(s)
- Brian Godman
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedicial Sciences, University of Strathclyde, Glasgow, UK.,Division of Clinical Pharmacology, Karolinska, Karolinska Institutet, Stockholm, Sweden.,Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, South Africa.,Health Economics Centre, University of Liverpool Management School, Liverpool, UK
| | - Christoffel Grobler
- Elizabeth Donkin Hospital, Port Elizabeth, South Africa.,Walter Sisulu University, East London, South Africa.,Nelson Mandela University, Port Elizabeth, South Africa
| | | | - Janney Wale
- Independent consumer advocate, Brunswick, Australia
| | - Wallace Breno Barbosa
- Department of Social Pharmacy, College of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Amos Massele
- Department of Biomedical Sciences, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Philip Opondo
- Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Guenka Petrova
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Konstantin Tachkov
- Faculty of Pharmacy, Department of Social Pharmacy and Pharmacoeconomics, Medical University of Sofia, Sofia, Bulgaria
| | - Israel Sefah
- Department of Pharmacy, Keta Municipal Hospital, Ghana Health Service, Keta, Ghana
| | - Suhaj Abdulsalim
- Unaizah College of Pharmacy, Qassim University, Buraidah Saudi Arabia
| | | | | | - Kristina Garuoliene
- Department of Pathology, Forensic Medicine and Pharmacology, Faculty of Medicine, Vilnius University, Lithuania and Ministry of Health, Vilnius, Lithuania
| | - Kayode Bamitale
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Dan Kibuule
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Francis Kalemeera
- School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Joseph Fadare
- Department of Pharmacology and Therapeutics, College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria
| | | | | | - Tomasz Bochenek
- Department of Drug Management, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | | | - James Mwanza
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Antony P Martin
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK.,HCD Economics, The Innovation Centre, Daresbury, UK
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Whelan Building, Liverpool University, Liverpool, UK
| | - Corrado Barbui
- WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona Italy
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Arbee F, Subramaney U. Absconding from a psychiatric hospital in Johannesburg, South Africa: Are we seeing a decrease since the implementation of the Mental Healthcare Act? S Afr J Psychiatr 2019; 25:1338. [PMID: 31850152 PMCID: PMC6909399 DOI: 10.4102/sajpsychiatry.v25i0.1338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 08/21/2019] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Absconding from psychiatric facilities, the aetiology and impact of which have major socio-economic implications, has a multifactorial aetiological basis. Absconding patients are at higher risk of self-harm, violence, non-adherence, relapses, substance use and negative media attention. Most health professionals associate absconding with the escape of potentially dangerous psychiatric patients. Absconding causes fear and uncertainty, and portrays psychiatric services negatively. Identification of potential absconders would assist with risk assessment and prevention. AIM The aim of this study was to formulate an absconding rate as well as a descriptive profile of absconders since the inception of democracy and deinstitutionalisation. SETTING The study was conducted at Sterkfontein Hospital, a specialised psychiatric hospital outside Johannesburg. METHODS A retrospective record review of absconders from Sterkfontein Hospital in Johannesburg over 1 year was conducted. RESULTS The absconding rate was 7.83%. The characteristics of the typical absconder included single, unemployed male, early 30s, known to psychiatric services, diagnosed with schizophrenia and co-morbid substance use. An absconder is more likely to be a forensic patient not returning from official leave of absence. CONCLUSION The absconding rate has decreased to less than half that of a previous study, and is within international norms. While the descriptive profile is of limited value, it does appear that psychiatric patients are being treated in a less restrictive manner resulting in fewer absconders and a change in the method of absconding. The implications for clinical practice are firstly that a clearer definition of the term absconding is needed as this will impact risk assessment and management. It is recommended that future studies separate forensic and general populations. Lastly, the formulation and use of a risk assessment tool may be of value.
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Affiliation(s)
- Feroza Arbee
- AKESO Clinic, Parktown, Johannesburg, South Africa
| | - Ugasvaree Subramaney
- Department of Psychiatry, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Franken H, Parker J, Allen R, Wicomb RA. A profile of adult acute admissions to Lentegeur Psychiatric Hospital, South Africa. S Afr J Psychiatr 2019; 25:1244. [PMID: 31616578 PMCID: PMC6779967 DOI: 10.4102/sajpsychiatry.v25i0.1244] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 05/10/2019] [Indexed: 11/11/2022] Open
Abstract
Background The Western Cape province has the highest documented lifetime prevalence of common mental disorders in South Africa. To ensure the efficient, equitable and effective distribution of current resources, there is a need to determine the profile of patients requiring psychiatric admission. Aim To describe patients admitted to the acute adult admissions unit at Lentegeur Hospital. Setting Lentegeur Psychiatric Hospital is situated in Mitchells Plain, Cape Town, and serves about 1 million people from nearby urban and rural areas. Methods This retrospective study involved an audit of all patients (18–60 years of age) admitted between 01 January 2016 and 30 June 2016. The clinical records of 573 adult patients were examined. Results The median age of the cohort was 29 years. Most patients (63%) were educated to the secondary level. Only 12% of the patients were employed, and 37% received disability grants. More than 90% of the patients presented with psychotic symptoms. Of these, 28% presented with a first-episode of psychosis. Of all patients, 20% were referred with manic symptoms and 7% with depressive symptoms. Many patients (62%) used substances concurrently in the period leading up to admission. Significantly more males (73%) used substances compared to females (38%). Cannabis was the most widely used substance (51%), followed by methamphetamine (36%). Recent violent behaviour contributed to 37% of the current admissions. A total of 70 patients (13%) tested positive for human immunodeficiency virus (HIV), and 49 (9%) tested positive for syphilis. Conclusion Substance use and a history of violence contributed to admissions in this population.
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Affiliation(s)
- Herman Franken
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - John Parker
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Robin Allen
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.,Lentegeur Psychiatric Hospital, Cape Town, South Africa
| | - Robert A Wicomb
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Hlongwa EN, Sibiya MN. Challenges affecting the implementation of the Policy on Integration of Mental Health Care into primary healthcare in KwaZulu-Natal province. Curationis 2019; 42:e1-e9. [PMID: 31478729 PMCID: PMC6739558 DOI: 10.4102/curationis.v42i1.1847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 02/14/2019] [Accepted: 03/18/2019] [Indexed: 11/16/2022] Open
Abstract
Background Since the publication of the White Paper for the Transformation of the Health System in South Africa in 1997, which included Policy on Integration of Mental Health Care into primary health care (PHC), there has been an emphasis on the promotion of health as well as the re-engineering of PHC to include the integration of mental health care into PHC. Although South Africa has made significant advances at the level of health-related policy development and legislation in trying to bring the country in line with international trends, there have been challenges with regard to implementation of policies, including that of integration of mental health care into PHC. Objectives The aim of this study was to determine the challenges affecting the implementation of the Policy on Integration of Mental Health Care into PHC in KwaZulu-Natal (KZN) province of South Africa and to seek possible solutions. Method A qualitative exploratory descriptive design was used to determine the challenges affecting the implementation of the Policy on Integration of Mental Health Care into PHC in KZN. The sample consisted of 42 participants of whom 4 were PHC managers, 6 were operational managers and 22 were professional nurses who were directly involved in implementing the policy at the operational level. Results The challenges identified included lack of training in mental healthcare services for staff working in PHC, unavailability of mental health policies, inadequate resources, poor communication between management and staff, lack of skills among PHC nurses in identifying signs of mental illness and misdiagnosis of patients. Conclusion Considering the challenges pertaining to PHC nurses’ abilities and skills to implement the Policy on Integration of Mental Health Care into PHC, PHC-trained nurses should engage in lifelong learning and be encouraged to develop their knowledge, skills and competence throughout their professional lives.
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Mapatwana D, Tomita A, Burns JK, Robertson LJ. Predictors of quality of life among community psychiatric patients in a peri-urban district of Gauteng Province, South Africa. Int J Soc Psychiatry 2019; 65:322-332. [PMID: 31035835 DOI: 10.1177/0020764019842291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Few studies on quality of life (QoL) among people with mental illness have been conducted in South Africa, and none in community dwelling individuals. However, a greater understanding of subjective QoL may inform community-based medical, psychotherapeutic, or social interventions. This study examined the QoL, clinical and sociodemographic characteristics of psychiatric patients attending community mental health clinics in the Gauteng Province of South Africa. METHODS A cross sectional interview-based study was conducted with 121 adult patients attending community psychiatric clinics. To reduce the impact of acute psychiatric symptoms on subjective QoL, only clinically stable patients were included. Sociodemographic details and clinical characteristics were recorded. Subjective QoL was assessed using the World Health Organization QOL-Bref scale (WHOQOL-Bref), and severity of psychiatric illness measured with the Brief Psychiatric Rating Scale, expanded version 4.0 (BPRS-E). RESULTS Just over half of the sample rated their overall QoL as good or very good. Residual psychiatric symptomatology was the strongest predictor of a poor QoL in all four domains of the WHOQOL-Bref. The most severe BPRS scores were for the symptoms of depression, anxiety and somatic concern. Perceived social support significantly predicted a better QoL in the psychological, social relationships and environmental domains. CONCLUSION This study highlights the negative impact of residual psychiatric symptoms on subjective QoL and the importance of social support in enhancing QoL.
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Affiliation(s)
- Dumakazi Mapatwana
- 1 Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Andrew Tomita
- 2 Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,3 KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Jonathan K Burns
- 1 Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.,4 Institute of Health Research, University of Exeter, Exeter, UK
| | - Lesley J Robertson
- 5 Department of Psychiatry, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
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Meiqari L, Al-Oudat T, Essink D, Scheele F, Wright P. How have researchers defined and used the concept of 'continuity of care' for chronic conditions in the context of resource-constrained settings? A scoping review of existing literature and a proposed conceptual framework. Health Res Policy Syst 2019; 17:27. [PMID: 30845968 PMCID: PMC6407241 DOI: 10.1186/s12961-019-0426-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/14/2019] [Indexed: 01/11/2023] Open
Abstract
Background Within the context of the growing burden of non-communicable diseases (NCDs) globally, there is limited evidence on how researchers have explored the response to chronic health needs in the context of health policy and systems in low- and middle-income countries. Continuity of care (CoC) is one concept that represents several elements of a long-term model of care. This scoping review aims to map and describe the state of knowledge regarding how researchers in resource-constrained settings have defined and used the concept of CoC for chronic conditions in primary healthcare. Methods This scoping review adopted the modified framework for interpretive scoping literature reviews. A systematic literature search in PubMed was performed, followed by a study selection process and data extraction, analysis and synthesis. Extracted data regarding the context of using CoC and the definition of CoC were analysed inductively to identify similar patterns; based on this, articles were divided into groups. MaxQDA was then used to re-code each article with themes according to the CoC definition to perform a cross-case synthesis under each identified group. Results A total of 55 peer-reviewed articles, comprising reviews or commentaries and qualitative or quantitative studies, were included. The number of articles has increased over the years. Five groups were identified as those (1) reflecting a change across stages or systems of care, (2) mentioning continuity or lack of continuity without a detailed definition, (3) researching CoC in HIV/AIDS programmes and its scaling up to support management of NCDs, (4) researching CoC in NCD management, and (5) measuring CoC with validated questionnaires. Conclusion Research or policy documents need to provide an explicit definition of CoC when this terminology is used. A framework for CoC is suggested, acknowledging three components for CoC (i.e. longitudinal care, the nature of the patient–provider relationship and coordinated care) while considering relevant contextual factors, particularly access and quality. Electronic supplementary material The online version of this article (10.1186/s12961-019-0426-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lana Meiqari
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands. .,Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium.
| | - Tammam Al-Oudat
- Médecins Sans Frontières, Operational Centre Geneva (MSF-OCG), Geneva, Switzerland
| | - Dirk Essink
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Fedde Scheele
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV, Amsterdam, The Netherlands
| | - Pamela Wright
- Guelph International Health Consulting, Amsterdam, The Netherlands
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Abstract
In this paper, the current situation regarding rural mental health in South Africa is explored. The current status is presented, followed by an attempt to provide approaches and ideas to improve the situation in order to make it more context appropriate and relevant. Issues of staffing, task shifting or sharing, and formal vs informal health care systems are considered and discussed as possible future approaches to improve rural mental health care in South Africa.
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Affiliation(s)
- Richard Vergunst
- a Department of Psychology , Stellenbosch University , Matieland , South Africa
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Botha UA, Koen L, Mazinu M, Jordaan E, Niehaus DJH. Brief Report: A Randomized Control Trial Assessing the Influence of a Telephone-based Intervention on Readmissions for Patients with Severe Mental Illness in a Developing Country. Community Ment Health J 2018; 54:197-203. [PMID: 27900649 DOI: 10.1007/s10597-016-0069-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 11/24/2016] [Indexed: 10/28/2022]
Abstract
Whilst comprehensive post-discharge interventions have been successful in reducing readmissions in our setting, they are possibly not sustainable due to limited resources. We assessed the impact of a more cost-effective telephone-based intervention on readmissions in a developing country over 12 months. 100 patients with severe mental illness were randomized to facilitated care or treatment as usual. All were interviewed prior to discharge and after 12 months. Facilitated care consisted of structured telephonic interviews and motivational support to patients and families. At 12 months no significant differences in either readmissions (p = 0.10) or days in hospital (p = 0.44) could be demonstrated. Substance use was high (64%), particularly methamphetamine (44%) in both groups. The intervention did not have any impact on inpatient usage in our setting. Though this study was limited by its small sample size, the results indicated that affordable post-discharge services may not be comprehensive enough to reduce readmission rates and would have to be tailored to the distinct population of dual diagnosis patients identified in this study.
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Lesch E, de Bruin K, Anderson C. A Pilot Implementation of the Emotionally Focused Couple Therapy Group Psychoeducation Program in a South African Setting. Journal of Couple & Relationship Therapy 2018. [DOI: 10.1080/15332691.2017.1417940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Elmien Lesch
- Psychology Department, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Kathryn de Bruin
- Marital and Family Therapist, Private Practice, San Diego, California, USA
| | - Colleen Anderson
- Clinical Psychologist, Private Practice, Cape Town, South Africa
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Affiliation(s)
- Thabisa Matsea
- Social Work, School for Psycho-social Behavioural Sciences: Social Work Division, North-West University, Potchefstroom, South Africa
| | - Elma Ryke
- Social Work, School for Psycho-social Behavioural Sciences: Social Work Division, North-West University, Potchefstroom, South Africa
| | - Mike Weyers
- Social Work, School for Psycho-social Behavioural Sciences: Social Work Division, North-West University, Potchefstroom, South Africa
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Brooke-Sumner C, Lund C, Petersen I. Bridging the gap: investigating challenges and way forward for intersectoral provision of psychosocial rehabilitation in South Africa. Int J Ment Health Syst 2016; 10:21. [PMID: 26962328 PMCID: PMC4784432 DOI: 10.1186/s13033-016-0042-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 02/10/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intersectoral collaboration between government sectors such as Health and Social Development and non-governmental organisations (NGOs) in communities is crucial for provision of psychosocial rehabilitation (PSR) for those with severe mental illness. This study aims to provide recommendations for strengthening such intersectoral collaboration in South Africa and with relevance to other low and middle income countries (LMIC), particularly African countries. METHODS Twenty-four in-depth semi-structured interviews were conducted with 16 key informants from the South African Department of Health, two key informants from the Department of Social Development, four key informants from the NGO sector and one key informant from a service user organisation at national level. Framework analysis was conducted with NVivo 10 software. RESULTS Challenges to intersectoral work identified were lack of communication between sectors, problems delineating roles, and each sector's perception of lack of support from other sectors. Participant-identified strategies for addressing these challenges included improving communication between sectors, promoting leadership from all levels and formalising intersectoral relationships through appropriate written agreements; as well as ensuring that the available resources for PSR are effectively re-directed to district level. CONCLUSIONS This study has outlined several directions for progress to address challenges for intersectoral working for PSR in South Africa. These may be of relevance to other LMIC, particularly those in Africa. Political will and a long-term view will be necessary to realise these strategies.
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Affiliation(s)
- Carrie Brooke-Sumner
- />School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, Durban, South Africa
| | - Crick Lund
- />Department of Psychiatry and Mental Health, Alan J Flisher Centre for Public Mental Health, University of Cape Town, Cape Town, South Africa
| | - Inge Petersen
- />School of Applied Human Sciences, Discipline of Psychology, University of KwaZulu-Natal, Durban, South Africa
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Mayston R, Alem A, Habtamu A, Shibre T, Fekadu A, Hanlon C. Participatory planning of a primary care service for people with severe mental disorders in rural Ethiopia. Health Policy Plan 2015; 31:367-76. [PMID: 26282860 DOI: 10.1093/heapol/czv072] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/11/2015] [Indexed: 11/13/2022] Open
Abstract
Little is understood about the feasibility and acceptability of primary care-based models of task-sharing care for people with severe mental disorders (SMDs) in low- and middle-income countries (LMICs). A participatory planning approach was adopted in preparation for the transition from hospital-delivered psychiatric care for SMD to a primary care-based, task-sharing model in a rural Ethiopian community. In this article, we present findings from community consultation meetings (n = 4), focus group discussions (n = 7) and in-depth interviews (n = 11) with key stakeholders (healthcare administrators and providers, caregivers, service-users and community leaders) which were carried out over a 2-year period in the context of ongoing dialogue with the community. The principle of local delivery of mental health services was agreed upon by all stakeholder groups. Key reasons for supporting local delivery were increased access for the majority due to proximity, reduced cost and reduced stress related to transportation. However, acceptance of the new service was qualified by concerns about the competence of staff to deliver a comprehensive and dependable service of equal quality to that currently provided at the hospital. Adequate training and support, as well as ensuring consistency of medication supply were identified as key components to ensure success. Encouragingly, our results suggest that there is significant support for the service change and an interest for the mobilization of community resources to support this. One of the study strengths was that we were able to present the different perspectives of multiple stakeholder groups. By nesting the study in an ongoing community-based cohort of people with SMD we were able to interview a more representative and empowered group of caregivers and service users than is often available in LMICs. Despite this, the extent to which service-users are able to express their opinions is likely limited by their marginalized role in rural Ethiopian society.
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Affiliation(s)
- Rosie Mayston
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, De Crespigny Park, London SE5 8AF, UK and
| | - Atalay Alem
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alehegn Habtamu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teshome Shibre
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- Centre for Global Mental Health, Health Service and Population Research Department, King's College London, De Crespigny Park, London SE5 8AF, UK and Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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41
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Affiliation(s)
- Jacqueline Moodley
- Centre for Social Development in Africa, University of Johannesburg, Johannesburg, South Africa
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Pappin M, Wouters E, Booysen FLR, Lund C. Public sector antiretroviral treatment programme in South Africa: health care workers' attention to mental health problems. AIDS Care 2014; 27:458-65. [PMID: 25317991 DOI: 10.1080/09540121.2014.969674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although there is a high prevalence of anxiety and depression amongst people receiving antiretroviral treatment (ART), many patients are not screened, diagnosed or referred for mental health problems. This study aims to determine whether public sector health care workers in South Africa observe, screen, diagnose and refer ART patients that show symptoms of common mental disorders. It also aims to ascertain the extent of mental health training received by public sector health care workers working in ART. The study was cross-sectional in design. Self-administered questionnaires were completed by 40 nurses and structured interviews were conducted with 23 lay workers across the five districts in the Free State between July 2009 and October 2009. STATA version 12 was used to perform statistical data analysis. The health care workers reported observing a high frequency of symptoms of common mental disorders among public sector ART patients. While 70% of nurses screened and diagnosed, only 40% of lay workers screened and diagnosed patients on ART for a mental disorder. Health care workers who had received training in mental health were more likely to screen or diagnose a mental disorder, but only 14% of the workers had received such training. We recommend that health care workers should receive task-specific training to screen and/or diagnose patients on ART for common mental disorders using the guidelines of the South African HIV Clinicians Society. A positive diagnosis should be referred to a health care practitioner for appropriate evidence-based treatment in the form of medication or psychotherapy.
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Affiliation(s)
- Michele Pappin
- a Centre for Development Support , University of the Free State , Bloemfontein , South Africa
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Tsai AC, Tomlinson M, Dewing S, le Roux IM, Harwood JM, Chopra M, Rotheram-Borus MJ. Antenatal depression case finding by community health workers in South Africa: feasibility of a mobile phone application. Arch Womens Ment Health 2014; 17:423-31. [PMID: 24682529 PMCID: PMC4167933 DOI: 10.1007/s00737-014-0426-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 03/04/2014] [Indexed: 12/13/2022]
Abstract
Randomized controlled trials conducted in resource-limited settings have shown that once women with depressed mood are evaluated by specialists and referred for treatment, lay health workers can be trained to effectively administer psychological treatments. We sought to determine the extent to which community health workers could also be trained to conduct case finding using short and ultrashort screening instruments programmed into mobile phones. Pregnant, Xhosa-speaking women were recruited independently in two cross-sectional studies (N = 1,144 and N = 361) conducted in Khayelitsha, South Africa and assessed for antenatal depression. In the smaller study, community health workers with no training in human subject research were trained to administer the Edinburgh Postnatal Depression Scale (EPDS) during the routine course of their community-based outreach. We compared the operating characteristics of four short and ultrashort versions of the EPDS with the criterion standard of probable depression, defined as an EPDS-10 ≥ 13. The prevalence of probable depression (475/1144 [42 %] and 165/361 [46 %]) was consistent across both samples. The 2-item subscale demonstrated poor internal consistency (Cronbach's α ranged from 0.55 to 0.58). All four subscales demonstrated excellent discrimination, with area under the receiver operating characteristic curve (AUC) values ranging from 0.91 to 0.99. Maximal discrimination was observed for the 7-item depressive symptoms subscale: at the conventional screening threshold of ≥10, it had 0.97 sensitivity and 0.76 specificity for detecting probable antenatal depression. The comparability of the findings across the two studies suggests that it is feasible to use community health workers to conduct case finding for antenatal depression.
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Affiliation(s)
- Alexander C. Tsai
- Center for Global Health and Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, MA, US,Harvard Medical School, Boston, MA, US,Address correspondence to: Alexander Tsai, Center for Global Health, Massachusetts General Hospital, 100 Cambridge Street, 15th floor, Boston, MA 02114 USA.
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah Dewing
- Health Systems Research Unit, Medical Research Council of South Africa, Tygerberg, South Africa
| | - Ingrid M. le Roux
- Philani Child Health and Nutrition Project, Khayelitsha, Elonwabeni, Cape Town, South Africa
| | - Jessica M. Harwood
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California at Los Angeles, Los Angeles, CA, US
| | - Mickey Chopra
- Health Section, United Nations Children’s Fund, New York, NY, US
| | - Mary Jane Rotheram-Borus
- Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry, University of California at Los Angeles, Los Angeles, CA, US,Global Center for Child and Families, University of California at Los Angeles, Los Angeles, CA, US
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Lewin AB, Storch EA. Evidence-Based Mental Health Assessment and Care in Low- and Middle-Income Countries: A Promising Campaign. J Cogn Psychother 2014; 28:151-5. [PMID: 32759154 DOI: 10.1891/0889-8391.28.3.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kleintjes S, Lund C, Swartz L. Barriers to the participation of people with psychosocial disability in mental health policy development in South Africa: a qualitative study of perspectives of policy makers, professionals, religious leaders and academics. BMC Int Health Hum Rights 2013; 13:17. [PMID: 23497079 PMCID: PMC3600028 DOI: 10.1186/1472-698x-13-17] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 02/27/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND This paper outlines stakeholder views on environmental barriers that prevent people who live with psychosocial disability from participating in mental health policy development in South Africa. METHOD Fifty-six semi-structured interviews with national, provincial and local South African mental health stakeholders were conducted between August 2006 and August 2009. Respondents included public sector policy makers, professional regulatory council representatives, and representatives from non-profit organisations (NPOs), disabled people's organisations (DPOs), mental health interest groups, religious organisations, professional associations, universities and research institutions. RESULTS Respondents identified three main environmental barriers to participation in policy development: (a) stigmatization and low priority of mental health, (b) poverty, and (c) ineffective recovery and community supports. CONCLUSION A number of attitudes, practices and structures undermine the equal participation of South Africans with psychosocial disability in society. A human rights paradigm and multi-system approach is required to enable full social engagement by people with psychosocial disability, including their involvement in policy development.
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Affiliation(s)
- Sharon Kleintjes
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Valkenberg Hospital, Observatory, Cape Town, 7935, South Africa.
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