Browsing by Author "Bantjes, Jason"

Now showing 1 - 9 of 9
  • Thumbnail Image
    Item
    Restricted
    Epidemiology of substance use among service users admitted to hospital following a medically serious act of deliberate self-harm: a feasibility study
    (2019) Stanbridge, Jessica A; Lewis, Ian; Bantjes, Jason
    Background: Suicidal behaviour is increasing internationally and in South Africa and is considered a national public health problem (1). Literature has shown that substance use is a potentially modifiable risk factor for both fatal and non-fatal suicidal behavior (2- 6). In South Africa, 43 percent of patients who present to emergency departments with intentional or unintentional injuries meet the criteria for a substance use disorder (SUD) (7). The association between substance use and suicidal behavior has been well established, however, the exact nature of this relationship awaits further investigation and clarification. Aims: The proposed study’s aims are; (i)to determine the patterns of substance abuse and the prevalence of SUDs (past and current) among patients admitted following an act of DSH, (ii) to compare patterns of substance use and the prevalence of SUDs (past and current) among those admitted following an episode of DSH, those admitted to the emergency psychiatric unit for reasons other than DSH and medical patients admitted for reasons other than DSH, (iii) to determine if patterns of substance use or the diagnosis of substance use or the diagnosis of SUDs predicts hospital admission for DSH. It concurrently analyzed preliminary data in order to determine if outcomes of the larger study would be meaningful and significant. Methods: Seventy-six patients were recruited over a period of 19 weeks. Twenty-seven consecutive patients with a medically serious act of DSH were recruited and were matched with a control group based on age range and gender. Demographic data and substance use history were collected using; (i) a self reported questionnaire, (ii) Alcohol Use Disorders Identification Tests (AUDIT), (iii) Drug Use Disorders Identification Test (DUDIT) and (iv) SUD module of the structured clinical interview of the DSM. Results: Findings of the feasibility study indicated low recruitment numbers and data collection challenges. Causes of low recruitment number were multifactorial, including low base rates for self-harm, length of recruitment time, consenting capacity, tight control criteria, exclusion of manic and psychotic patients and declining of patients to participate. Data collection faced challenges including difficult navigation of hospital premises, long data collection times, limited understanding of questions, language barriers and lack of privacy. Formal suicide risk assessment was a challenge for some data collectors. Preliminary data confirmed that substance use is a significant risk factor for DSH. Conclusions: This feasibility study demonstrated the existing protocol can be used to generate meaningful data and identified specific steps to be altered in a scaled-up study. These steps included; expansion of study sites to more institutions to increase recruitment numbers, a wider range in matching criteria for control groups and improved orientation and training of data collectors regarding use of the data collection tool, navigation of the hospital premises, maintaining confidentiality and formal suicide risk assessments. Formal translation of the research tool into other languages was recommended. Despite low recruitment numbers, data collected from this study was meaningful.
  • Thumbnail Image
    Item
    Open Access
    Factors associated with increased suicidal intent among deliberate self-harm patients treated in the emergency room of an urban hospital in South Africa
    (2021) Tayob, Imraan; Lewis, Ian; Bantjes, Jason
    Background: Suicide is the second leading cause of death among 15 to 29 year olds and 79% of global suicides occur in low- to-middle income countries. South Africa has the eight highest rate of suicide in the world, evidence that suicide is a serious public health concern. Identifying socio-demographic and clinical factors associated with high risk of serious self-harm or suicide, may be useful for improving patient care and strengthening appropriate referral pathways. Aim: To determine the sociodemographic and clinical factors associated with elevated levels of suicidal intent among self-harm patients who presented for treatment in the emergency room of an urban hospital in Cape Town, South Africa. Setting: A retrospective folder review of all patients who presented for treatment of deliberate self-harm to Groote Schuur Hospital. Methods: During the time period, 238 consecutive presentations for deliberate self-harm were identified and recorded on a data capture form.which obtained information about demographics, clinical characteristics and suicidal intent. The data was analysed using bivariate and multivariate analyses. Results: In our sample of 238 patients, 128 (54%) self-reported an elevated level of suicidal intent. Being of male gender, higher levels of education and having multiple reasons for selfharm were significant predictors of an elevated level of suicidal intent. Conclusion: Suicide is increasingly recognised as a serious public health problem globally, and in South Africa. Determining the socio demographic and clinical correlates for those at increased risk of suicidal behaviours, provides useful information on identifying vulnerable patients. This allows clinicians to improve patient risk assessment and public health awareness interventions may be closer targeted to at risk groups
  • Thumbnail Image
    Item
    Open Access
    Inequality and mental healthcare utilisation among first-year university students in South Africa
    (2020-01-25) Bantjes, Jason; Saal, Wylene; Lochner, Christine; Roos, Janine; Auerbach, Randy P; Mortier, Philippe; Bruffaerts, Ronny; Kessler, Ronald C; Stein, Dan J
    Abstract Background Addressing inequalities in mental healthcare utilisation among university students is important for socio-political transformation, particularly in countries with a history of educational exclusion. Methods As part of the WHO World Mental Health International College Student Initiative, we investigated inequalities in mental healthcare utilisation among first-year students at two historically “White” universities in South Africa. Data were collected via a web-based survey from first-year university students (n = 1402) to assess 12-month mental healthcare utilisation, common mental disorders, and suicidality. Multivariate logistic regression models were used to estimate associations between sociodemographic variables and mental healthcare utilisation, controlling for common mental disorders and suicidality. Results A total of 18.1% of students utilised mental healthcare in the past 12 months, with only 28.9% of students with mental disorders receiving treatment (ranging from 28.1% for ADHD to 64.3% for bipolar spectrum disorder). Of those receiving treatment, 52.0% used psychotropic medication, 47.3% received psychotherapy, and 5.4% consulted a traditional healer. Treatment rates for suicidal ideation, plan and attempt were 25.4%, 41.6% and 52.9%, respectively. In multivariate regression models that control for the main effects of mental health variables and all possible joint effects of sociodemographic variables, the likelihood of treatment was lower among males (aOR = 0.57) and Black students (aOR = 0.52). An interaction was observed between sexual orientation and first generation status; among second-generation students, the odds of treatment were higher for students reporting an atypical sexual orientation (aOR = 1.55), while among students with atypical sexual orientations, the likelihood of mental healthcare utilisation was lower for first-generation students (aOR = 0.29). Odds of treatment were significantly elevated among students with major depressive disorder (aOR = 1.88), generalised anxiety disorder (aOR = 2.34), bipolar spectrum disorder (aOR = 4.07), drug use disorder (aOR = 3.45), suicidal ideation (without plan or attempt) (aOR = 2.00), suicide plan (without attempt) (aOR = 3.64) and suicide attempt (aOR = 4.57). Likelihood of treatment increased with level of suicidality, but not number of mental disorders. Conclusion We found very low mental healthcare treatment utilisation among first-year university students in South Africa, with enduring disparities among historically marginalised groups. Campus-based interventions are needed to promote mental healthcare utilisation by first-year students in South Africa, especially among male and Black students and first-generation students with atypical sexual orientations.
  • Thumbnail Image
    Item
    Open Access
    Mental health care providers' suggestions for suicide prevention among people with substance use disorders in South Africa: a qualitative study
    (BioMed Central, 2018-12-07) Goldstone, Daniel; Bantjes, Jason; Dannatt, Lisa
    Abstract Background People with substance use disorders (PWSUDs) are a clearly delineated group at high risk for suicidal behaviour. Expert consensus is that suicide prevention strategies should be culturally sensitive and specific to particular populations and socio-cultural and economic contexts. The aim of this study was to explore mental health care providers' context- and population-specific suggestions for suicide prevention when providing services for PWSUDs in the Western Cape, South Africa. Methods Qualitative data were collected via in-depth, semi-structured interviews with 18 mental health care providers providing services to PWSUDs in the public and private health care sectors of the Western Cape, South Africa. Data were analysed inductively using thematic analysis. Results Participants highlighted the importance of providing effective mental health care, transforming the mental health care system, community interventions, and early intervention, in order to prevent suicide amongst PWSUDs. Many of their suggestions reflected basic principles of effective mental health care provision. However, participants also suggested further training in suicide prevention for mental health care providers, optimising the use of existing health care resources, expanding service provision for suicidal PWSUDs, improving policies and regulations for the treatment of substance use disorders, provision of integrated health care, and focusing on early intervention to prevent suicide. Conclusions Training mental health care providers in suicide prevention must be augmented by addressing systemic problems in the provision of mental health care and contextual problems that make suicide prevention challenging. Many of the suggestions offered by these participants depart from individualist, biomedical approaches to suicide prevention to include a more contextual view of suicide prevention. A re-thinking of traditional bio-medical approaches to suicide prevention may be warranted in order to reduce suicide among PWSUDs.
  • Thumbnail Image
    Item
    Open Access
    Motives for deliberate self-harm in a South African tertiary hospital
    (2021) Van Zyl, Petrus Jasper Johannes; Lewis, Ian; Bantjes, Jason
    Background: Although there is a growing body of literature on the epidemiology of deliberate self-harm (DSH) in South Africa, comparatively few studies have investigated the motives for self-harm. No studies have investigated the motives for DSH in Cape Town. Aim: To identify the range of motives for DSH in Cape Town, and how these motives are associated with different sociodemographic factors, the severity of self-injury, and levels of suicidal intent. Methods: Data were collected for 238 consecutive patients presenting with DSH to the emergency department of Groote Schuur Hospital in Cape Town, South Africa. The data were analysed using bivariate and multivariate analyses. Results: Patients engaged in DSH for a range of motives. Interpersonal issues was the most common motive (70%), followed by financial concerns (22%). Male patients were twice as likely as female patients to report interpersonal motives for their self-harm. Patients who reported interpersonal issues were more likely to engage in methods of DSH that involved damage to body tissue. Patients without tertiary education were more likely to report academic concerns as a motive, and patients who reported psychiatric illness as motive for DSH were more likely to require medical interventions than those who did not. Conclusion: This study contributes novel insights into the motives for DSH in the Cape Town context and provides the foundation for continued research on the subject. The study also gives impetus to the development of therapeutic interventions focused on the motives for self-harm.
  • Thumbnail Image
    Item
    Open Access
    Patient factors that predict admission to an emergency psychiatric unit following deliberate self-harm in an urban hospital in South Africa
    (2021) Grobler, Kathryn; Lewis, Ian; Bantjes, Jason
    Background: Suicidal behaviour is increasingly widespread in South Africa and constitutes a significant burden of disease, often within resource-constrained hospital settings. Little is known about the factors associated with psychiatric admission following an act of deliberate self-harm (DSH) in South Africa. Aim: The aim of this study was to investigate the sociodemographic and clinical factors which differentiated DSH patients who were admitted to an emergency psychiatric unit compared to those who were treated in the emergency department and discharged. Setting: Data were collected for 272 consecutive patients presenting to the emergency department of a tertiary, public, urban hospital in South Africa, as a result of self harm, between 16 June 2014 and 29 March 2015, for an initial epidemiological study of DSH at the hospital. This study had a data subset of 174 of those patients (84 admitted to the emergency psychiatric unit and 90 treated in the emergency department and discharged). Methods: This study was a retrospective cross-sectional analysis, and it analysed existing data from the epidemiological study, using bivariate and multivariate logistic regression analysis. Results: Of the patients admitted to the emergency psychiatric unit, a greater proportion of patients were female (61,9%), were not in a relationship (83,3%), had no dependents (60,7%), were unemployed (73,8%), and had a low socioeconomic status (59,5%). Having dependants was associated with an increased likelihood of admission to the emergency psychiatric unit in bivariate analysis; however, when controlling for other sociodemographic variables, this was no longer significant. None of the clinical variables were significantly associated with admission to the emergency psychiatric unit. Conclusion: The lack of significant findings in the sociodemographic and clinical factors associated with an admission to the emergency psychiatric unit (compared to being treated in the emergency department and discharged) is surprising. At face value, it suggests that there are no obvious differences between the two groups. The use of a validated screening tool or more accurate measure of the clinical correlates (e.g. screening tool for substance-related 6 disorders) could have better highlighted, perhaps subtle, differences between the two groups. It is perhaps more important to question whether the perceived risk factors in DSH patients are associated with suicidal behaviour and whether emergency psychiatric unit admission, based on these factors, is more effective at treating DSH short-term, and reducing suicidal behaviour long-term, than say outpatient-based treatment interventions. Clinician-related factors that influence psychiatric admission decisions following DSH is also an important area for future research.
  • Thumbnail Image
    Item
    Open Access
    Perinatal suicidal ideation and behaviour: psychiatry and adversity
    (Springer, 2016) Onah, Michael Nnachebe; Field, Sally; Bantjes, Jason; Honikman, Simone
    Pregnant women are at increased risk for suicidal ideation and behaviours (SIB) compared to the general population. To date, studies have focused on the psychiatric correlates of SIB with lesser attention given to the associated contextual risk factors, particularly in low- and middle-income countries. We investigated the prevalence and associated psychiatric and socio-economic contextual factors for SIB among pregnant women living in low resource communities in South Africa. Three hundred seventy-six pregnant women were evaluated using a range of tools to collect data on socio-economic and demographic factors, social support, life events, interpersonal violence and mental health diagnoses. We examined the significant risk factors for SIB using univariate, bivariate and logistic regression analyses (p ≤ 0.05). The 1-month prevalence of SIB was 18%. SIB was associated with psychiatric illness, notably major depressive episode (MDE) and any anxiety disorder. However, 67% of pregnant women with SIB had no MDE diagnosis, and 65% had no anxiety disorder, while 54% had neither MDE nor anxiety disorder diagnoses. Factors associated with SIB included lower socio-economic status, food insecurity, interpersonal violence, multiparousity, and lifetime suicide attempt. These findings focus attention on the importance of socio-economic and contextual factors in the aetiology of SIB and lend support to the idea that suicide risk should be assessed independently of depression and anxiety among pregnant women.
  • Thumbnail Image
    Item
    Open Access
    Prevalence and sociodemographic correlates of common mental disorders among first-year university students in post-apartheid South Africa: implications for a public mental health approach to student wellness
    (2019-07-10) Bantjes, Jason; Lochner, Christine; Saal, Wylene; Roos, Janine; Taljaard, Lian; Page, Daniel; Auerbach, Randy P; Mortier, Philippe; Bruffaerts, Ronny; Kessler, Ronald C; Stein, Dan J
    Abstract Background There is growing awareness of the need for effective prevention, early detection, and novel treatment approaches for common mental disorders (CMDs) among university students. Reliable epidemiological data on prevalence and correlates are the cornerstones of planning and implementing effective health services and adopting a public health approach to student wellness. Yet, there is a comparative lack of sound psychiatric epidemiological studies on CMDs among university students in low- and middle-income countries, like South Africa (SA). It is also unclear if historically marginalised groups of students are at increased risk for mental health problems in post-apartheid SA. The objective of the study was to investigate the prevalence and sociodemographic correlates of lifetime and 12-month CMDs among university students in SA, with a particular focus on vulnerability among students in historically excluded and marginalised segments of the population. Methods Data were collected via self-report measures in an online survey of first-year students registered at two large universities (n = 1402). CMDs were assessed with previously-validated screening scales. Data were weighted and analysed using multivariate statistical methods. Results A total of 38.5% of respondents reported at least one lifetime CMD, the most common being major depressive disorder (24.7%). Twelve-month prevalence of any CMD was 31.5%, with generalised anxiety disorder being the most common (20.8%). The median age of onset for any disorder was 15 years. The median proportional annual persistence of any disorder was 80.0%. Female students, students who reported an atypical sexual orientation, and students with disabilities were at significantly higher risk of any lifetime or 12-month disorder. Female gender, atypical sexual orientation, and disability were associated with elevated risk of internalising disorders, whereas male gender, identifying as White, and reporting an atypical sexual orientation were associated with elevated risk of externalising disorders. Older age, atypical sexual orientation, and disability were associated with elevated risk of bipolar spectrum disorder. Conclusions Despite advances to promote greater social inclusion in post-apartheid SA, students who identify as female, students with atypical sexual orientations, and students with disabilities are nonetheless at increased risk of CMDs, although students who identify as Black and first-generation students are not.
  • Thumbnail Image
    Item
    Open Access
    Substance use and self-harm: a cross-sectional study of the prevalence, correlates and patterns of medical service utilisation among patients admitted to a South African hospital
    (BioMed Central, 2018-03-06) Breet, Elsie; Bantjes, Jason; Lewis, Ian
    Abstract Background Substance use is a potentially modifiable risk factor for suicidal behaviour. Little is known about the epidemiology of substance use among self-harm patients in South Africa. This study set out to collect epidemiological data about the prevalence, correlates, and patterns of medical service utilisation among self-harm patients who used substances at the time of self-injury. Methods Data from 238 consecutive self-harm patients treated at an urban hospital in South Africa were analysed using bivariate and multivariate statistics. Results Approximately 20% of patients reported substance use at the time of self-harm. When compared to other self-harm patients, higher rates of patients who had used substances: had depressed levels of consciousness on admission; utilised more medical resources and required longer hospital admissions; cited relationship difficulties and financial concerns as reasons for their self-harm; reported a previous episode of self-harm; and intended to die as a result of their injuries. Although the observed differences were not statistically significant (p > 0.05), the proportional differences were congruent with international literature. Conclusion Acute use of substances among self-harm patients warrants more focused research and clinical attention particularly in the context of reducing utilisation of scarce medical resources.