Self-identification, mode of diagnosis and treatment, and perceptions of relationships with medical providers of South African Xhosa-speaking traditional healers

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.

Functional Neuroimaging of Adult-to-Adult Romantic Attachment Separation, Rejection, and Loss: A Systematic Review

Romantic attachment rejection (RAR) is a highly prevalent phenomenon among young adults. Rejection by a romantic attachment figure can be a painful and incapacitating experience with lasting negative mental health sequelae, yet the underlying neurobiology of RAR is not well characterized. We systematically reviewed functional neuroimaging studies of adult RAR. Four functional magnetic resonance imaging (fMRI) studies that measured participants' responses to real or imagined RAR and met inclusion criteria were evaluated. These included studies were published between 2004 and 2018. Brain activity in adult participants with an RAR appears to be influenced by the stimulus used to elicit a reaction as well as by attachment styles. Brain regions that show a significant change in activation following a rejection stimulus include cortical regions (cingulate, insular, orbitofrontal, and prefrontal), and subcortical regions (angular gyrus, hippocampus, striatum, tegmental area, and temporal pole) and correspond to (i) pain, distress, and memory retrieval; (ii) reward, romantic love, and dopaminergic circuits; and (iii) emotion regulation and behavioural adaptation. Further neuroimaging studies of adult RAR, as moderated by stimulus and attachment style, are needed to better understand the underlying neurobiology of RAR.

Distant mood monitoring for depressive and bipolar disorders: a systematic review

BACKGROUND

Broadening our knowledge of the longitudinal course of mood symptoms is cardinal to providing effective long-term treatments. Research indicates that patients with mental illness are willing to engage in the use of telemonitoring and mobile technology to assess and monitor their mood states. However, without the provision of distant support, adverse outcomes and events may be difficult to prevent and manage through self-monitoring. Understanding patient perspectives is important to achieving the best balance of self-monitoring, patient empowerment, and distant supporter involvement.

METHODS

This systematic review synthesises quantitative and qualitative evidence of the effectiveness and feasibility of daily/weekly/monthly remote mood monitoring that includes distant support in participants with mood disorders. Inclusion criteria comprised mood monitoring of mood disorder patients as main intervention, study design, method of monitoring, and presence of psychotherapy and psychoeducation. Effectiveness was defined by the change in depression and/or mania scores. Feasibility was determined on participant feedback and completion/attrition rates. Studies were assessed for quality using the Mixed Methods Appraisal Tool version 2018.

RESULTS

Nine studies of acceptable quality met the inclusion criteria. Distant mood monitoring was effective in improving depression scores but not mania scores. Feasibility, as measured through compliance and completion rates and participant feedback, varied.

CONCLUSION

Distant mood monitoring with support may be a useful, acceptable, and feasible intervention for diverse groups of patients in terms of age and ethnicity. Further, it may be effective in improving symptoms of depression, increasing treatment adherence, and facilitating the prevention and management of adverse outcomes. As a task-shifting intervention, distant mood monitoring may help to alleviate the burden on mental health providers in developing countries.

The perceived effectiveness of traditional and faith healing in the treatment of mental illness: a systematic review of qualitative studies

PURPOSE

This work complements a quantitative review by Nortje et al. (Lancet Psychiatry 3(2):154-170, 2016) by exploring the qualitative literature in regard to the perceived effectiveness of traditional and faith healing of mental disorders.

METHOD

Qualitative studies focusing specifically on traditional and/or faith healing practices for mental illness were retrieved from eight databases. Data were extracted  into basic coding sheets to facilitate the assessment of the quality of eligible papers using the COREQ.

RESULTS

Sixteen articles met the inclusion criteria. Despite methodological limitations, there was evidence from the papers that stakeholders perceived traditional and/or faith healing to be effective in treating mental illness, especially when used in combination with biomedical treatment.

CONCLUSION

Patients will continue to seek treatment from traditional and/or faith healers for mental illness if they perceive it to be effective regardless of alternative biomedical evidence. This provides opportunities for collaboration to address resource scarcity in low to middle income countries.