Browsing by Author "Kaminer, Debra"

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    An exploration of South African university students utilization of and engagement with mental health-related information on Instagram
    (2023) Lekgothoane, Lesego; Kaminer, Debra
    Mental health difficulties are prevalent among university students in South Africa and globally, but help-seeking is low due to a variety of structural and attitudinal barriers. It is therefore important to find novel ways of offering mental health information and support through modalities that are both accessible and acceptable to students. Although there has been much concern about the role of social networking sites (SNS) in creating risk for mental health difficulties, SNS are also increasingly being utilized by young adults to access mental health-related content for purposes of education, awareness, and support. However, there has not been any research to date on how university students in South Africa use and engage with mental health-related content on SNS. The current mixed methods study explored South African university students' experiences of accessing and using mental health-related information on Instagram. In the first phase of the study, an online survey was administered to Psychology students (n= 335) at a South African university, exploring use of Instagram to access mental health content. A content analysis was then performed on the ten most commonly accessed mental health-related Instagram accounts listed by survey participants. Finally, seven participants who completed the survey took part in semi-structured interviews to further explore their experiences of using Instagram to access mental health content. A combination of descriptive statistics and thematic analysis was used to analyze data across the three phases. The most common types of mental health content accessed by participants included mental health awareness and psycho-education, inspiration, coping strategies, as well as memes and humour. The most significant qualitative themes from the findings included using Instagram to improve awareness and management of one's own and other people's mental health symptoms, develop better coping mechanisms, find self-care tips, experience connectedness and social support, normalise mental health difficulties and validate and alleviate negative feelings. A small minority of participants reported that accessing mental health-related content on Instagram was unhelpful or triggering. Overall, the findings indicate that Instagram offers an accessible and acceptable source of mental health information, coping strategies, connectedness and validation for participants struggling with mental health issues. Limitations of the study and directions for future research are discussed.
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    Antisocial Personality Disorder Comorbidity in Methamphetamine Use Disorder: Sociodemographic, clinical and childhood trauma correlates
    (2021) Rall, Edrich; Kaminer, Debra; Lochner, Christine
    Personality pathology, especially antisocial personality disorder (ASPD), often occurs in patients with methamphetamine use disorder (MAUD). However, little is known about potential risk factors for this dual diagnosis, and the impact of this comorbidity on both the severity of MAUD and levels of functional impairment. Casting light on such phenomena may aid in early identification of treatment targets, assist in the management of patients in this particular population, and contribute to development of treatment strategies. This crosssectional study described and compared sociodemographic, clinical and childhood trauma correlates in patients with a dual diagnosis of MAUD and ASPD (MAUD+ASPD) and those with MAUD without ASPD (MAUD-ASPD). The contribution of sociodemographic and childhood trauma variables in predicting membership of the MAUD+ASPD group was also investigated. A sample of 62 adult patients with a primary diagnosis of MAUD took part in the study. A sociodemographic questionnaire was completed and well established diagnostic measures of ASPD (The Mini-International Neuropsychiatric Interview; MINI) and MAUD (Structured Clinical Interview; SCID - 5) were used to determine diagnostic status. Illness severity was evaluated with the Yale-Brown Obsessive Compulsive scale (adapted for MAUD) (Y-BOCS-du) and functional impairment was assessed with the Sheehan Disability Scale (SDS). Histories of exposure and severity of childhood trauma (CT) were measured using the CTQ-SF. Of the 62 participants, 14 (23%) had MAUD and had MAUD+ASPD whereas 48 (77%) had MAUD without ASPD (MAUD-ASPD). Bivariate analyses found significant group differences in terms of gender (df =1) = 8.05; p =< 0.01), language (df = 2) = 7.12; p = 0.03), and level of physical neglect (F(1, 60) = 2.33; M = 9.85; SD = 4.23; p = 0.04). The MAUD+ASPD group members were mostly male (N = 9; 64%), English-speaking and with histories of increased physical neglect. Logistic regression suggested that male gender (beta = 1.08; OR = 8.65; p = 0.01) and English language (beta = 1.55; OR = 11.38; p = 0.03) significantly predicted ASPD comorbidity. There were no significant differences in clinical severity or functional impairment between the MAUD+ASPD and MAUD-ASPD groups. In conclusion, this study indicated that male gender and having English as a first language are associated with MAUD+ASPD but other sociodemographic variables, CT histories and clinical severity and impairment were not. Men who use MA are thus more prone to antisocial behaviour, which complicates their substance use condition. Treatment approaches for MAUD may benefit from developing adaptations that cater for challenges specific to comorbid ASPD. Additionally, the finding regarding first language warrants further investigation. Recommendations for future research are suggested.
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    Coping Motives as a Mediator of the Relationship between Trauma Exposure and Substance Misuse in South African Adolescents
    (2022) Assim, Ayesha; Kaminer, Debra
    South African adolescents experience high rates of trauma exposure in their homes and communities, which places them at a greater risk of developing substance misuse. Studies in high-income countries have shown that substance misuse in traumatised adults is driven by their ‘coping motives': maladaptive beliefs that substances help cope with negative affect. However, very few studies to date have explored this risk pathway in trauma-exposed adolescents, particularly in lower resource contexts. The current study examined whether coping motives mediate the relationship between different forms of trauma exposure (child maltreatment versus community violence) and different forms of problems related to substance use (alcohol and marijuana) in a sample of South African adolescents. High school learners at three government schools in Cape Town (N = 688; M age = 15.03) completed self-report measures of child maltreatment and community-based trauma exposure, alcohol and marijuana use, alcohol and marijuana-related problems, and motives for using alcohol and marijuana. Child maltreatment and community violence exposure both predicted alcohol-related problems while child maltreatment, but not community violence exposure, predicted marijuana-related problems. Coping motives, and to a lesser extent conformity motives, partially mediated the relationship between child maltreatment and alcohol-related problems, while coping motives but no other motives partially mediated the relationship between child maltreatment and marijuana-related problems. The relationship between community violence exposure and alcohol-related problems was not mediated by any alcohol use motives. The findings suggest that coping motives increase the risk that adolescents who experience child maltreatment will have substance use problems. Targeting coping motives could be an important focus for substance misuse interventions for trauma-exposed South African adolescents.
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    Developing a manualised task-sharing counselling intervention for perinatal common mental disorders in the South African context
    (2022) Boisits, Sonet; Kaminer, Debra; Lund, Crick
    Background: Symptoms of depression and anxiety are highly prevalent amongst perinatal women in low-resource settings of South Africa, but there is no access to standardised counselling support for these conditions in public health facilities. The aim of this study was to report on the development of a maternal mental health counselling intervention for routine treatment of mild to moderate symptoms of depression and anxiety for primary healthcare in South Africa, as part of the Health Systems Strengthening in sub-Saharan Africa (ASSET) study. Methods: A four-phase study process informed the counselling intervention and training manual designed to train lay health workers. We first conducted a review of manuals from seven counselling interventions for depression and anxiety in low- and middle-income countries and two local health system training programmes to gather information on common counselling components used across maternal mental health and other evidence-based task-sharing interventions. Thereafter, semi-structured interviews were conducted with 20 health workers and 37 pregnant women from four Midwife Obstetric Units in Cape Town to explore mental health views and needs. In the third stage, multi-sector stakeholder engagements further informed the choice of intervention design and service provider. In the final phase, a four-day pre implementation pilot training with community-based health workers refined the counselling content and training material. Results: The manual review identified problem-solving, psychoeducation, basic counselling skills and behavioural activation as common counselling components across interventions. The interviews found that participants mostly identified symptoms of depression and anxiety in behavioural terms and lay health workers and pregnant women demonstrated their understanding through a range of contextual terms. Perceived causes of symptoms related to interpersonal conflict and challenging social circumstances. Stakeholder engagements identified a three session counselling model as most feasible for delivery as part of existing health care practices and community health workers in ward-based outreach teams as the best placed delivery agents. Pilot training of a three-session intervention with community-based health workers resulted in minor adaptations of the counselling assessment method. Conclusion: The study demonstrates how common therapeutic elements can be adapted to a local context and developed into an evidence-based manualised therapeutic programme while remaining sensitive to a health system's needs. While a problem-solving counselling approach, delivered in a structured format, was best suited for training lay health workers, input from health workers and perinatal mothers informed the manualised counselling content. The latter was a critical supplement to align the programme with contextual needs. Stakeholder engagements helped to align the intervention design to health system requirements and guidelines. Structured training practices and ongoing supervision of mental health workers are vital to develop counselling skills over time and to enhance personal support.
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    Developing a task-sharing psychological intervention to treat mild to moderate symptoms of perinatal depression and anxiety in South Africa: a mixed-method formative study
    (2021-03-15) Boisits, Sonet; Abrahams, Zulfa; Schneider, Marguerite; Honikman, Simone; Kaminer, Debra; Lund, Crick
    Background Symptoms of depression and anxiety are highly prevalent amongst perinatal women in low-resource settings of South Africa, but there is no access to standardised counselling support for these conditions in public health facilities. The aim of this study is to develop a task-sharing psychological counselling intervention for routine treatment of mild to moderate symptoms of perinatal depression and anxiety in South Africa, as part of the Health Systems Strengthening in sub-Saharan Africa (ASSET) study. Methods We conducted a review of manuals from seven counselling interventions for depression and anxiety in low- and middle-income countries and two local health system training programmes to gather information on delivery format and common counselling components used across task-sharing interventions. Semi-structured interviews were conducted with 20 health workers and 37 pregnant women from four Midwife Obstetric Units in Cape Town to explore perceptions and needs relating to mental health. Stakeholder engagements further informed the intervention design and appropriate service provider. A four-day pilot training with community-based health workers refined the counselling content and training material. Results The manual review identified problem-solving, psychoeducation, basic counselling skills and behavioural activation as common counselling components across interventions using a variety of delivery formats. The interviews found that participants mostly identified symptoms of depression and anxiety in behavioural terms, and lay health workers and pregnant women demonstrated their understanding through a range of local idioms. Perceived causes of symptoms related to interpersonal conflict and challenging social circumstances. Stakeholder engagements identified a three-session counselling model as most feasible for delivery as part of existing health care practices and community health workers in ward-based outreach teams as the best placed delivery agents. Pilot training of a three-session intervention with community-based health workers resulted in minor adaptations of the counselling assessment method. Conclusion Input from health workers and pregnant women is a critical component of adapting existing maternal mental health protocols to the context of routine care in South Africa, providing valuable data to align therapeutic content with contextual needs. Multisector stakeholder engagements is vital to align the intervention design to health system requirements and guidelines.
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    Employee perspectives on the association of work stress and mental health at an institution of higher learning in the Western Cape Province, Southern Africa
    (2024) Mbambo, Samukelisiwe; Kaminer, Debra
    Work stress has been identified as an epidemic within the workplace in South Africa and other parts of the world. Work stress has been shown to negatively affect employees' mental health, leading to the onset or exacerbation of common mental disorders such as chronic depression and anxiety. A strong body of evidence suggests that higher education institutions are high stress environments. Therefore, employees in higher education institutions experience significant work stress, resulting in poor mental health. A number of studies have investigated the link between work stress and mental health. However, there is a paucity of research on how local academic staff experience the impact of work stress on their psychological well-being and mental health. The aim of this study was to investigate employees' experiences of work stress, and the impact thereof on their mental health. A qualitative methodological approach was utilised. Eligible participants were academic staff from a local tertiary institution. Semistructured interviews were utilised in a virtual format, and data was analysed using thematic analysis. The four themes that emerged from the analysis were reported in two categories. The findings revealed the adverse impact of work stress on psychological well-being, and also shed light on how academic staff members cope with work stress and improve their psychological well-being and mental health. Therefore, there is a negative association between work stress and mental health, and academic employees are making use of varying coping mechanisms to curb the impact of stress on their mental health such as attending therapy sessions, engaging support systems, and creating boundaries, for example, planning, organising, and time management, especially during the Covid-19 pandemic. Finally, the findings of this study contribute to the existing body of knowledge on the relationship between work stress and mental health in the workplace from a South African perspective. Keywords: academic staff; mental health; psychological well-being; qualitative research; higher education institutions (HEIs); thematic analysis; work stress; work stressors.
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    Predictors of symptom severity and treatment attendance amongst rape and sexual assault survivors attending a Cape Town crisis counselling service
    (2019) Dollman, Nicola; Kaminer, Debra
    Despite the prevalence of rape in South Africa and its association with a high risk of mental health difficulties, little research has examined the specific predictors of post-rape symptom severity or counselling retention rates of treatment-seeking rape survivors. This mixed methods study aimed to investigate predictors of symptom severity and treatment attendance amongst rape survivors attending a crisis counselling service in Cape Town. The quantitative phase of the research was comprised of a retrospective chart review of 482 intake files at three Rape Crisis counselling centres in Cape Town between 2012 and 2016. The qualitative phase involved four focus group interviews with 25 Rape Crisis counsellors at these three counselling centres. Quantitative data were analysed using bivariate statistics, a multiple linear regression and a zero-truncated negative binomial. Multiple linear regression analysis revealed that being English-speaking, reporting being raped (as opposed to reporting a sexual assault or attempted rape), and rape by an unknown perpetrator were associated with increased symptom severity. A zero-truncated negative binomial revealed that increased symptom severity, being male and identifying as a race other than black or coloured were associated with longer time in treatment. Counsellors perceived lower reported symptom severity to be influenced by clients’ ability to identify symptoms, while poverty, poor social support, experiences of other trauma and knowing the perpetrator were perceived to increase symptom severity. Being a survivor of drug-alcohol facilitated rape/incapacitated rape and having practical obstacles to attending treatment were perceived by counsellors to result in shorter treatment attendance. Motivation for attending counselling was also perceived to influence length of attendance. There was both convergence and divergence between the quantitative and qualitative results. The implications of the findings for future research and delivering counselling to rape survivors are discussed. Keywords: Rape; sexual assault; symptom severity; treatment attendance.
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    Relationship between online-learning self-efficacy and risk for psychological distress and harmful substance use in South African university students
    (2022) Henning, Tiffany Joy; Kaminer, Debra
    The COVID-19 pandemic brought about rapid emergency changes in learning formats at universities globally, with a mass migration to online learning. Students' level of online learning self-efficacy (OLSE) may be an important determinant of how they cope with these changes. This study explored whether sociodemographic and online learning context factors are associated with OLSE among South African university students, whether OLSE predicts psychological distress and harmful substance use, and whether level of perceived social support moderates these relationships. It also examined whether psychological distress mediates the relationship between OLSE and problematic substance use. A cross-sectional online survey was administered to students from the University of Cape Town (n = 627). Students who had higher levels of access to online learning resources, and students who were white had higher levels of OLSE, while students on a government bursary and those living in university residences rather than with family members had lower OLSE. Lower OLSE was found to be a significant predictor of higher psychological distress and increased harmful substance use, when controlling for sociodemographic and online learning context factors. Psychological distress mediated the relationships between OLSE and harmful alcohol and marijuana use. Perceived social support did not moderate the relationships between OLSE and mental health difficulties or substance use. These findings indicate that OLSE is an important predictor of how university students cope with online learning demands and suggest that students with lower OLSE should be identified and better supported with strategies to improve their OLSE levels. Further, students with lower OLSE levels may need greater mental health support from universities within the context of online learning, as the existing social supports do not appear to be adequately protective for students.
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    South African university students' user experience of mobile applications for anxiety and depression
    (2024) Chipps, Wesley; Spedding, Maxine; Kaminer, Debra
    Background: Globally, university students have been shown to be disproportionately affected by common mental disorders (CMDs). The primary CMDs reported by students have been anxiety and depression. Research on South African students has proven no exception. Moreover, this predicament is worsened by low rates of help-seeking, historically entrenched systemic inequality regarding access to resources, a lack of culturally appropriate interventions, and a population that tends to be overly self-reliant. Objective: With the prevalence of CMDs in mind, as well as the many challenges students face, it was deemed worth exploring current, available alternatives. Given some evidence for the use of mobile mental health (MMH) applications (apps) among university students in high income countries, the current study aimed to investigate South African university students' user experience of MMH apps for depression and anxiety. Methods: South African students in the psychology department of the University of Cape Town were recruited to make use of two MMH apps, Headspace and Woebot, for two weeks total, but one week per app. They then completed online questionnaires related to their experience of using these apps, and semi-structured interviews were conducted, recorded, and transcribed by the researcher. Due to a lack of meaningful data from the online questionnaires, only the semi-structured interviews were used for analysis. Braun and Clarke's (2006) method of thematic analysis was used to analyse the data. Results: After analysing the semi-structured individual interviews, themes were defined, described, and discussed. The participants expressed that the apps facilitated insight and self-awareness, and were found to be supportive, encouraging, and convenient. However, they valued different aspects of the two apps, with each offering something that the other did not. The importance of each design was also highlighted as a vital factor in the overall user experience, while affordability was also emphasised for the student population in particular. Conclusion: The two apps were found to be accessible and acceptable for participants in this South African university setting. Additionally, user experience design enhanced their experiences. However, as each app offered different approaches and benefits, the integration of features could be something to work towards. There are also important ethical considerations that need to be factored before recommending them. Further research and development are required in order to address these concerns.
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    Truth commission testimony : relation to psychiatric status and forgiveness among South African survivors of human rights violations
    (2005) Kaminer, Debra; De la Rey, Cheryl
    The present study aimed to examine the degree to which giving TRC testimony is related to current psychiatric status and forgiveness attitudes among survivors of human rights abuses. A literature review examined the degree to which the TRC's claims are supported by the existing theoretical and empirical literature on trauma narratives and on forgiveness, and guided the way that psychological outcomes were assessed in the current study. Sunivors (n=134) who gave public, private or no testimony to the TRC completed standardised instruments measuring demographic variables, exposure to human rights abuses, current psychiatric status and forgiveness attitudes towards the perpetrator(s).