Browsing by Author "Sorsdahl, Katherine"

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    Adapting an intervention of brief problem-solving therapy to improve the health of women with antenatal depressive symptoms in primary healthcare in rural Ethiopia
    (BioMed Central, 2022-09-09) Bitew, Tesera; Keynejad, Roxanne; Myers, Bronwyn; Honikman, Simone; Sorsdahl, Katherine; Hanlon, Charlotte
    Background Evidence-based brief psychological interventions are safe and effective for the treatment of antenatal depressive symptoms. However, the adaptation of such interventions for low- and middle-income countries has not been prioritised. This study aimed to select and adapt a brief psychological intervention for women with antenatal depressive symptoms attending primary healthcare (PHC) in rural Ethiopia. Methods We employed the Medical Research Council (MRC) framework for the development and evaluation of complex interventions. Alongside this, we used the ADAPT-ITT model of process adaptation and the ecological validity model (EVM) to guide content adaptation. We conducted formative work, comprising a qualitative study, a series of three participatory theories of change workshops and an expert adaptation workshop to assess the needs of the target population and to select an intervention for adaptation. The adaptation process followed a series of steps: (1) training Ethiopian mental health experts in the original South African problem-solving therapy (PST version 0.0) and an initial adaptation workshop leading to PST Version 1.0. (2) Version 1.0 was presented to perinatal women and healthcare professionals in the form of a ‘theatre test’, leading to further adaptations (version 2.0). (3) Local and international stakeholders reviewed version 2.0, leading to version 3.0, which was used to train 12 PHC staff using clinical cases. (4) Finally, feedback about PST version 3.0 and its delivery was obtained from PHC staff. Results In the first step, we modified case examples and terminology from the South African model, introduced an in-session pictorial flipchart for this low literacy setting, and added strategies to facilitate women’s engagement before translating into Amharic. In the second step, adaptations included renaming of the types of problems and inclusion of more exercises to demonstrate proposed coping strategies. In the third step, the components of motivational interviewing were dropped due to cultural incongruence. In the final step, refresher training was delivered as well as additional training on supporting control of women’s emotions to address PHC staff training needs, leading to the final version (version 4.0). Conclusion Using a series of steps, we have adapted the content and delivery of brief PST to fit the cultural context of this setting. The next step will be to assess the feasibility and acceptability of the intervention and its delivery in antenatal care settings.
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    Brief problem-solving therapy for antenatal depressive symptoms in primary care in rural Ethiopia: protocol for a randomised, controlled feasibility trial
    (2021-01-30) Bitew, Tesera; Keynejad, Roxanne; Myers, Bronwyn; Honikman, Simone; Medhin, Girmay; Girma, Fikirte; Howard, Louise; Sorsdahl, Katherine; Hanlon, Charlotte
    Background Despite a high prevalence of antenatal depression in low- and middle-income countries, there is very little evidence for contextually adapted psychological interventions delivered in rural African settings. The aims of this study are (1) to examine the feasibility of procedures for a future fully powered efficacy trial of contextually adapted brief problem solving therapy (PST) for antenatal depression in rural Ethiopia, and (2) to investigate the acceptability, fidelity and feasibility of delivery of PST in routine antenatal care. Methods Design: A randomised, controlled, feasibility trial and mixed method process evaluation. Participants: Consecutive women attending antenatal clinics in two primary care facilities in rural Ethiopian districts. Eligibility criteria: (1) disabling levels of depressive symptoms (Patient Health Questionnaire (PHQ-9) score of five or more and positive for the 10th disability item); (2) gestational age 12–34 weeks; (3) aged 16 years and above; (4) planning to live in the study area for at least 6 months; (5) no severe medical or psychiatric conditions. Intervention: Four sessions of adapted PST delivered by trained and supervised antenatal care staff over a maximum period of eight weeks. Control: enhanced usual care (EUC). Sample size: n = 50. Randomisation: individual randomisation stratified by intimate partner violence (IPV). Allocation: central phone allocation. Outcome assessors and statistician masked to allocation status. Primary feasibility trial outcome: dropout rate. Primary future efficacy trial outcome: change in PHQ-9 score, assessed 9 weeks after recruitment. Secondary outcomes: anxiety symptoms, trauma symptoms, intimate partner violence, disability, healthcare costs at 9 weeks; postnatal outcomes (perinatal and neonatal complications, onset of breast feeding, child health) assessed 4–6 weeks postnatal. Other trial feasibility indicators: recruitment, number and duration of sessions attended. Audio-recording of randomly selected sessions and in-depth interviews with purposively selected participants, healthcare providers and supervisors will be analysed thematically to explore the acceptability and feasibility of the trial procedures and fidelity of the delivery of PST. Discussion The findings of the study will be used to inform the design of a fully powered efficacy trial of brief PST for antenatal depression in routine care in rural Ethiopia. Trial registration The protocol was registered in the Pan-African clinical trials registry, (PACTR): registration number: PACTR202008712234907 on 18/08/2020; URL: https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9578 .
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    Brief psychotherapy administered by non-specialised health workers to address risky substance use in patients with multidrug-resistant tuberculosis: a feasibility and acceptability study
    (2021-01-19) Calligaro, Gregory L; de Wit, Zani; Cirota, Jacqui; Orrell, Catherine; Myers, Bronwyn; Decker, Sebastian; Stein, Dan J; Sorsdahl, Katherine; Dawson, Rodney
    Background Only 55% of multidrug-resistant tuberculosis (MDR-TB) cases worldwide complete treatment, with problem substance use a risk for default and treatment failure. Nevertheless, there is little research on psychotherapeutic interventions for reducing substance use amongst MDR-TB patients, in general, and on their delivery by non-specialist health workers in particular. Objectives To explore the feasibility and acceptability of a non-specialist health worker-delivered 4-session brief motivational interviewing and relapse prevention (MI-RP) intervention for problem substance use and to obtain preliminary data on the effects of this intervention on substance use severity, depressive symptoms, psychological distress and functional impairment at 3 months after hospital discharge. Methods Between December 2015 and October 2016, consenting MDR-TB patients admitted to Brewelskloof Hospital who screened at moderate to severe risk for substance-related problems on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were enrolled, and a baseline questionnaire administered. In the 4 weeks prior to planned discharge, trained counsellors delivered the MI-RP intervention. The baseline questionnaire was re-administered 3 months post-discharge and qualitative interviews were conducted with a randomly selected sample of participants (n = 10). Results Sixty patients were screened: 40 (66%) met inclusion criteria of which 39 (98%) were enrolled. Of the enrolled patients, 26 (67%) completed the counselling sessions and the final assessment. Qualitative interviews revealed participants’ perceptions of the value of the intervention. From baseline to follow-up, patients reported reductions in substance use severity, symptoms of depression, distress and functional impairment. Conclusion In this feasibility study, participant retention in the study was moderate. We found preliminary evidence supporting the benefits of the intervention for reducing substance use and symptoms of psychological distress, supported by qualitative reports of patient experiences. Randomised studies are needed to demonstrate efficacy of this intervention before considering potential for wider implementation. Trial registration South African National Clinical Trials Register ( DOH-27-0315-5007 ) on 01/04/2015 ( http://www.sanctr.gov.za )
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    Common Mental Disorders Among Adolescents Accessing HIV Treatment In Cape Town, South Africa
    (2020) Mtukushe, Bulelwa; Sorsdahl, Katherine; Hoare, Jacqueline
    Background: At the present time, data on the prevalence of common mental disorders (CMD) among adolescents living with HIV (ALHIV) in South Africa (SA) is limited. Studies that exist focus mainly on HIV-infected adults with mental health problems besides a few studies investigating depression and anxiety in children and adolescents living in SA. Research on the mental health of this vulnerable population remains very limited. Therefore, this study aims to address this gap by assessing the prevalence of CMD among adolescents living with HIV in SA; and determining the factors associated with CMD among this vulnerable population. Specific objectives: Specific objectives included, assessing the CMD among adolescents accessing ARV treatment; and determining factors associated with CMD among adolescents accessing HIV treatment. Methods: 121 Participants were recruited into the study through convenience sampling and interviewed. To be included in the study, participants had to be 10 to 19 years old; have knowledge of their own HIV-positive status; and presently on HIV treatment. Participants over 18 years were excluded if they did not provide informed consent and those under 18 were excluded if parent consent or adolescent assent was not obtained. Interviews with participants were conducted by study research assistants using a survey questionnaire which included the following mental health measures; Beck Depression Inventory for youth (BDI-Y), Beck Anxiety Inventory for youth (BAI-Y). Data collection for the study took place at two HIV treatment clinics in Cape Town, Groote Schuur hospital and Kuyasa clinic. Two logistic regression models were developed. Unadjusted and adjusted associations between socio-demographics, SES, food insecurity, alcohol use, years child known status and the presence of anxiety and depression were explored through logistic regression. Age, gender and variables that were significant in the unadjusted associations were included in the adjusted logistical regression models. Significance was set at p<0.05. Results: Four main findings emerged from the current study: 13.2% of participants were at risk for anxiety and 13.2% were at risk for depression; 6.6% participants were at risk for both anxiety and depression; the only variable associated with anxiety was socio-economic status and this was only significant in the unadjusted model; and the only variable associated with depression was highest level of schooling completed (i.e. currently in high school/completed high school) and this was significant in both unadjusted and adjusted models. Overall, adolescents with a higher educational level were less likely to develop depressive symptoms (adjusted model: OR=0.10, 95% CI 0.02-0.68). Conclusion: The present study assessed the prevalence of CMD, including determining the factors associated with CMD among adolescents accessing HIV treatment in Cape Town. Findings revealed that participants were at risk for anxiety, depression and comorbid anxiety and depression. Only highest level of schooling completed was found to be a protective factor against depression for this vulnerable population. Based on these findings, considerations for improving mental health outcomes for this population should include, screening for mental health conditions in ARV clinics, early identification and treatment of mental health problems, and evidence-based mental health counselling
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    Common Mental Disorders Among Adolescents Accessing HIV Treatment In Cape Town, South Africa
    (2020) Mtukushe, Bulelwa; Sorsdahl, Katherine; Hoare, Jacqueline
    Background: At the present time, data on the prevalence of common mental disorders (CMD) among adolescents living with HIV (ALHIV) in South Africa (SA) is limited. Studies that exist focus mainly on HIV-infected adults with mental health problems besides a few studies investigating depression and anxiety in children and adolescents living in SA. Research on the mental health of this vulnerable population remains very limited. Therefore, this study aims to address this gap by assessing the prevalence of CMD among adolescents living with HIV in SA; and determining the factors associated with CMD among this vulnerable population. Specific objectives: Specific objectives included, assessing the CMD among adolescents accessing ARV treatment; and determining factors associated with CMD among adolescents accessing HIV treatment. Methods: 121 Participants were recruited into the study through convenience sampling and interviewed. To be included in the study, participants had to be 10 to 19 years old; have knowledge of their own HIV-positive status; and presently on HIV treatment. Participants over 18 years were excluded if they did not provide informed consent and those under 18 were excluded if parent consent or adolescent assent was not obtained. Interviews with participants were conducted by study research assistants using a survey questionnaire which included the following mental health measures; Beck Depression Inventory for youth (BDI-Y), Beck Anxiety Inventory for youth (BAI-Y). Data collection for the study took place at two HIV treatment clinics in Cape Town, Groote Schuur hospital and Kuyasa clinic. Two logistic regression models were developed. Unadjusted and adjusted associations between socio-demographics, SES, food insecurity, alcohol use, years child known status and the presence of anxiety and depression were explored through logistic regression. Age, gender and variables that were significant in the unadjusted associations were included in the adjusted logistical regression models. Significance was set at p<0.05. Results: Four main findings emerged from the current study: 13.2% of participants were at risk for anxiety and 13.2% were at risk for depression; 6.6% participants were at risk for both anxiety and depression; the only variable associated with anxiety was socio-economic status and this was only significant in the unadjusted model; and the only variable associated with depression was highest level of schooling completed (i.e. currently in high school/completed high school) and this was significant in both unadjusted and adjusted models. Overall, adolescents with a higher educational level were less likely to develop depressive symptoms (adjusted model: OR=0.10, 95% CI 0.02-0.68). Conclusion: The present study assessed the prevalence of CMD, including determining the factors associated with CMD among adolescents accessing HIV treatment in Cape Town. Findings revealed that participants were at risk for anxiety, depression and comorbid anxiety and depression. Only highest level of schooling completed was found to be a protective factor against depression for this vulnerable population. Based on these findings, considerations for improving mental health outcomes for this population should include, screening for mental health conditions in ARV clinics, early identification and treatment of mental health problems, and evidence-based mental health counselling
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    Comparing dedicated and designated models of integrating mental health into chronic disease care: study protocol for a cluster randomized controlled trial
    (BioMed Central, 2018-03-16) Myers, Bronwyn; Lund, Crick; Lombard, Carl; Joska, John; Levitt, Naomi; Butler, Christopher; Cleary, Susan; Naledi, Tracey; Milligan, Peter; Stein, Dan J; Sorsdahl, Katherine
    Background In low- and middle-income countries (LMIC), it is uncertain whether a “dedicated” approach to integrating mental health care (wherein a community health worker (CHW) has the sole responsibility of delivering mental health care) or a “designated” approach (wherein a CHW provides this service in addition to usual responsibilities) is most effective and cost-effective. This study aims to compare the effectiveness and cost-effectiveness of these two models of service integration relative to treatment as usual (TAU) for improving mental health and chronic disease outcomes among patients with HIV or diabetes. Methods/Design This is a cluster randomised trial. We will randomise 24 primary health care facilities in the Western Cape Province of South Africa to one of three study arms. Within each cluster, we will recruit 25 patients from HIV and 25 from diabetes services for a total sample of 1200 participants. Eligible patients will be aged 18 years or older, take medication for HIV or diabetes, and screen positive on the Alcohol Use Disorder Identification Test for hazardous/harmful alcohol use or depression on the Centre for Epidemiology Scale on Depression. Participants recruited in clinics assigned to the designated or dedicated approach will receive three sessions of motivational interviewing and problem-solving therapy, while those recruited at TAU-assigned clinics will be referred for further assessment. Participants will complete an interviewer-administered questionnaire at baseline, and at 6 and 12 months post-enrolment to assess change in self-reported outcomes. At these end points, we will test HIV RNA viral load for participants with HIV and HbA1c levels for participants with diabetes. Primary outcomes are reductions in self-reported hazardous/harmful alcohol use and risk of depression. Secondary outcomes are improvements in adherence to chronic disease treatment, biomarkers of chronic disease outcomes, and health-related quality of life. Mixed-effect linear regression models will model the effect of the interventions on primary and secondary outcomes. The cost-effectiveness of each approach will be assessed using incremental cost-effectiveness ratios. Discussion Study findings will guide decision-making around how best to integrate mental health counselling into chronic disease care in a LMIC setting. Trial registration Pan African Clinical Trials Registry, Trial registration number: ACTR201610001825403 . Registered 17 October 2016.
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    Efficacy of an alcohol-focused intervention for improving adherence to antiretroviral therapy (ART) and HIV treatment outcomes – a randomised controlled trial protocol
    (2014-09-12) Parry, Charles D; Morojele, Neo K; Myers, Bronwyn J; Kekwaletswe, Connie T; Manda, Samuel O; Sorsdahl, Katherine; Ramjee, Gita; Hahn, Judith A; Rehm, Jürgen; Shuper, Paul A
    Abstract Background Little research has examined whether alcohol reduction interventions improve antiretroviral therapy (ART) adherence and HIV treatment outcomes. This study assesses the efficacy of an intervention for reducing alcohol use among HIV patients on ART who are hazardous/harmful drinkers. Specific aims include adapting a blended Motivational Interviewing (MI) and Problem Solving Therapy (PST) intervention for use with HIV patients; evaluating the efficacy of the intervention for reducing alcohol consumption; and assessing counsellors’ and participants’ perceptions of the intervention. Methods/Design A randomised controlled trial will evaluate the intervention among ART patients in public hospital-based HIV clinics in Tshwane, South Africa. We will recruit patients who are HIV-positive, on ART for at least 3 months, and classified as harmful/hazardous drinkers using the AUDIT-3. Eligible patients will be randomly assigned to one of three conditions. Patients in the experimental group will receive the MI-PST intervention to reduce harmful/hazardous alcohol use. Patients in the equal-attention wellness intervention group will receive an intervention focused on addressing health risk behaviours. Patients in the control condition will receive treatment as usual. Participants will complete an interviewer-administered questionnaire at baseline and 3, 6 and 12 months post-randomisation to assess alcohol consumption, ART adherence, physical and mental health. We will also collect biological specimens to test for recent alcohol consumption, CD4 counts and HIV RNA viral loads. The primary outcome will be reduction in the volume of alcohol consumed. Secondary outcomes include reduction in harmful/hazardous use of alcohol, reduction in biological markers of drinking, increase in adherence rates, reductions in viral loads, and increases in CD4 T-cell counts. A process evaluation will ascertain counsellors’ and participants’ perceptions of the acceptability and effectiveness of the interventions. Discussion We have obtained ethical approval and approval from the study sites and regional and provincial health departments. The study has implications for clinicians, researchers and policy makers as it will provide efficacy data on how to reduce harmful/hazardous alcohol consumption among HIV patients and will shed light on whether reducing alcohol consumption impacts on HIV treatment adherence and other outcomes. Trial registration Pan African Clinical Trials Register Number: PACTR201405000815100 .
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    An exploration of the perceptions of and risk and protective factors for drug use among young persons aged between 18 and 24 years in Mufakose, Harare, Zimbabwe
    (2017) Chivese, Nyamadzawo; Schneider, Marguerite; Sorsdahl, Katherine
    Background: Drug use by young people is on the increase globally, regionally and locally, in Zimbabwe. Most of what is known about the risk and protective factors for drug use has been written from studies done in high income countries. Limited studies focused on the low to medium income countries. The available literature for Zimbabwe is a few quantitative studies, done nearly two decades ago. These might not still be relevant today because of the generational changes that have taken place in the society over time. Methods: A qualitative study was conducted in Mufakose, one of the low income high density suburbs of Harare, Zimbabwe. The aim of the study was to find out the reasons why young people in the community were using drugs while others within the same geographical area were not using. A purposive sampling method was used to recruit 40 young people aged between 18 and 24 years who were current drug users, past users and those who had never used drugs at all in their entire lifetime. Individual in-depth interviews and focus group discussions were conducted at two community centres in the community to elicit data from the participants. Data collected from the in-depth interviews and focus group discussions were analysed using NVivo using themes that were derived from literature. Results: Results showed that both risk and protective factors for drug use exist at three levels of human interaction: the micro, meso and macro levels. Micro level risk factors included stressors from the home or living arrangements or workplace, stress due to loss of a loved one, boredom due to unemployment and lack of activities, a lack of commitment to work, sport or school and one's beliefs. Meso level risk factors were exposure to the drug using behaviour by peers and bullying. At family level, exposure to drug use, family conflicts were reported as risk factors. At macro level, drug availability and cost and media influence were cited as risk factors for drug use among the group. For the protective factors leading to non-use, religion was the strongest protective factor at all the three levels. A commitment to work, sport or school was also protective at micro level. Non-exposure to drug using behaviour were protective at the meso level. Conclusion: The current social environment in Zimbabwe together with a breakdown of the country's institutions such as marriage due to death, divorce or migration to other countries. The breakdown has left some children in single parent families vulnerable to a life of drug use. Early initiation into drug use was reported to be through exposure from peers, families and other members of the community as young people in Mufakose are using drugs in-order to escape from the reality of life. Evidence based psychosocial interventions could be used to reduce the impact of drug use among this population.
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    Family experiences and the role of the family in the development of substance use in adolescents and young adults in Zimbabwe: a qualitative study
    (2022) Chido, Ratidzai Madzvamutse; Sorsdahl, Katherine; Van Der Westhuizen, Claire
    Background Mental disorders including substance use disorders are a leading cause of disease burden, contributing 16% of the global burden of disease in young people aged 10 to 19 years. Substance use in adolescents and young people cannot be viewed outside of the family system. The family may influence the development of substance use problems in young people and the family system is an important part of recovery. The burden of substance use on family members is, however, often overlooked with emphasis being placed on the need to involve families in treatment of individuals using substances but little said about care for the family members themselves. There is need for a better understanding of the experiences of family members affected by substance use in young people and their own perceptions of the family's role in influencing adolescents' substance use. This study aimed to explore the experiences of families who have dealt with adolescent psychoactive substance use and their perceptions on how families can influence the development or avoidance of substance use in young people. Methods This was an exploratory qualitative study eliciting the experiences of nineteen family members dealing with substance use in young people aged less than 24 years purposively sampled from families of young people being managed for substance-related conditions at a tertiary mental health unit in Harare, Zimbabwe. Potential participants were identified using admission and outpatient registers and invited to take part in the study. In-depth interviews were conducted in Shona or English using a semi-structured interview guide exploring the experiences of family members dealing with substance use in a young person as well as their perceptions on the role of the family in development of substance use. The interviews were voice recorded, transcribed verbatim and the data were analysed in NVivo 12 using the framework approach. Ethical approval was granted from the University of Cape Town, Faculty of Health Sciences Human Research Ethics Committee and the Medical Research Council of Zimbabwe and the Institutional Ethics Review Boards for Harare Central Hospital. Results Five themes emerged from the data namely: Perceived causes of substance use in young people; Discovery of the substance use; Impact of the substance use; Family coping strategies and Family suggested interventions. Substance use by a young person affected family life, affecting family members and siblings emotionally, causing conflict in the family and burdening the family finances. Family members struggled with physical health problems; emotional distress, fear; helplessness; hopelessness; guilty, stigma and isolation, social and occupational consequences as a result of substance use by a young person in the family. Families also described various ways in which they attempted to cope with the challenges with spirituality highlighted as a key coping strategy. Participants suggested the family can be a mitigating factor against substance use in young people through having a better understanding about substance use, improved communication; providing an emotionally supportive home environment; creating healthier value systems in the family; actively supervising and monitoring of young people; encouraging young people to engage in meaningful work; facilitating admission for medical rehabilitation when needed as well as providing spiritual support. Conclusion There is a substantial but hidden burden of substance use on families and caregivers. This study illustrates the need for health services to provide better support for affected families, improving access to care and support for family members of young people using substances at risky levels. Further research is needed to explore how existing frameworks for structured support may be adapted for and implemented in the local setting. Substance use, particularly in young people, remains a family condition and the family needs to be not only included in treatment of young people but to be cared for themselves as well.
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    Family planning for women with severe mental illness in rural Ethiopia: a qualitative study
    (2017) Kebede, Tigist Zerihun; Sorsdahl, Katherine; Hanlon, Charlotte
    Background: Family planning is a crucial issue for all women of reproductive age, but in women with severe mental illness (SMI) there may be particular challenges and concerns. As primary care-based mental health care is expanded in low- and middle-income countries (LMICs), there is an opportunity to improve family planning services for women with SMI. However, research exploring unmet family planning needs of women with SMI in such settings is scarce. Aim: To explore the family planning experiences, unmet needs and preferences of women with SMI who reside in a predominantly rural area of Ethiopia Methods: A qualitative study design was used. Women with SMI who were participating in the ongoing population-based cohort study in Butajira were selected purposively on the basis of responses to a quantitative survey of current family planning utilization. In-depth interviews were conducted with 16 women with SMI who were of reproductive age until theoretical saturation was achieved. Audio files were transcribed in Amharic, translated into English and analysed using a Framework Approach using Open Code qualitative data analysis software. Results: The findings were grouped into four main themes. The first theme focused on the broader context of intimate relationships and sexual life of women with SMI. Sexual violence, assault and exploitation were reported by several respondents, underlining the vulnerability of women with SMI. Lack of control over sexual contact was associated with unwanted pregnancies. The second theme (childbearing and SMI) was around attitudes towards childbearing in women with SMI. Respondents described negative views from community members and some health professionals about the capacity of a woman with SMI to give birth and bring up a child. In most cases, it was assumed that a woman with SMI should not have a child at all. In the third theme (family planning for women with SMI), respondents spoke of their low access to information about family planning and systematic exclusion from existing services. In the fourth theme (preferred family planning services), the respondents had concerns about the ability of primary care workers to understand their specific family planning needs, but also valued proximity of the service and privacy. The importance of addressing health worker and community attitudes was emphasized. Conclusion: This study has provided in-depth perspectives from women with SMI about the broader context of their family planning experience, needs, barriers and how integrated primary care services could better meet their needs. Empowerment of women with SMI to access information and services needs to be an important focus of future efforts to improve the reproductive experiences of this vulnerable group.
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    Maternal participant experience in a South African birth cohort study enrolling healthy pregnant women and their infants
    (BioMed Central, 2016-07-19) Barnett, Whitney; Brittain, Kirsty; Sorsdahl, Katherine; Zar, Heather J; Stein, Dan J
    Background: Critical to conducting high quality research is the ability to attract and retain participants, especially for longitudinal studies. Understanding participant experiences and motivators or barriers to participating in clinical research is crucial. There are limited data on healthy participant experiences in longitudinal research, particularly in low- and middle-income countries. This study aims to investigate quantitatively participant experiences in a South African birth cohort study. Methods: Maternal participant experience was evaluated by a self-administered survey in the Drakenstein Child Health Study, a longitudinal birth cohort study investigating the early life determinants of child health. Pregnant mothers, enrolled during the second trimester, were followed through childbirth and the early childhood years. Satisfaction scores were derived from the participant experience survey and quantitatively analyzed; associations between satisfaction scores and sociodemographic variables were then investigated using a linear regression model. Results: Data were included from 585 pregnant mothers (median age 26.6 years), who had participated in the study for a median time of 16 months. Overall participant satisfaction was high (median score 51/60) and associated with increased attendance of study visits. Reasons for participating were a belief that involvement would improve their health, their child’s health or the health of family and friends. Potential reasons for leaving the study were inconvenience, not receiving clinical or study results, and unexpected changes in study visits or procedures. Variables associated with higher overall satisfaction scores were no prior participation in research, higher socioeconomic status, less intensive follow-up schedules and having experienced stressful life events in the past year. Conclusions: Satisfaction scores were high and associated with increased visit attendance. Participants’ perceived benefits of study participation, most notably the potential for an improvement in the health of their child, were a significant motivator to enroll and remain in the study. The consistent theme of perceived health benefits as a motivator to join and remain in the study raises the question of whether participation in research results in actual improvements in health.
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    Maternal participant experience in a South African birth cohort study enrolling healthy pregnant women and their infants
    (2016) Barnett, Whitney; Brittain, Kirsty; Sorsdahl, Katherine; Zar, Heather J; Stein, Dan J
    Abstract Background Critical to conducting high quality research is the ability to attract and retain participants, especially for longitudinal studies. Understanding participant experiences and motivators or barriers to participating in clinical research is crucial. There are limited data on healthy participant experiences in longitudinal research, particularly in low- and middle-income countries. This study aims to investigate quantitatively participant experiences in a South African birth cohort study. Methods Maternal participant experience was evaluated by a self-administered survey in the Drakenstein Child Health Study, a longitudinal birth cohort study investigating the early life determinants of child health. Pregnant mothers, enrolled during the second trimester, were followed through childbirth and the early childhood years. Satisfaction scores were derived from the participant experience survey and quantitatively analyzed; associations between satisfaction scores and sociodemographic variables were then investigated using a linear regression model. Results Data were included from 585 pregnant mothers (median age 26.6 years), who had participated in the study for a median time of 16 months. Overall participant satisfaction was high (median score 51/60) and associated with increased attendance of study visits. Reasons for participating were a belief that involvement would improve their health, their child’s health or the health of family and friends. Potential reasons for leaving the study were inconvenience, not receiving clinical or study results, and unexpected changes in study visits or procedures. Variables associated with higher overall satisfaction scores were no prior participation in research, higher socioeconomic status, less intensive follow-up schedules and having experienced stressful life events in the past year. Conclusions Satisfaction scores were high and associated with increased visit attendance. Participants’ perceived benefits of study participation, most notably the potential for an improvement in the health of their child, were a significant motivator to enroll and remain in the study. The consistent theme of perceived health benefits as a motivator to join and remain in the study raises the question of whether participation in research results in actual improvements in health.
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    Mental disorders and violence-related injuries : prevention opportunities in emergency centres
    (2014) Van der Westhuizen, Claire; Sorsdahl, Katherine; Stein, Dan J
    Mental disorders and violence-related injuries make significant contributions to the global disease burden, mostly affecting young people. In emergency centres, mental disorders and violence-related injuries are commonly seen and, according to international data, violently injured patients are at-risk for mental disorders. Despite the scale of this problem, little evidence exists, especially from low- and middle-income-countries, regarding predictors of mental disorder and violence-related injuries, and data concerning interventions have not been synthesised.
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    Mental health and antiretroviral therapy adherence among people living with HIV attending an HIV clinic in Blantyre, Malawi
    (2021) Chasweka, Dennis; Sorsdahl, Katherine; van der Westhuizen, Claire
    ABSTRACT Background: Tremendous progress has been achieved in the treatment for HIV/AIDS since the 1980s. This significant improvement and progress in HIV treatment has largely been attributed to antiretroviral therapy (ART). Non-adherence to ART commonly causes ART treatment failure and the development of drugresistant strains of HIV, resulting in increased mortality. Common mental disorders have been found to be strongly associated with non-adherence. In Malawi, where HIV is prevalent, there is a paucity of studies on how common mental disorders are associated with non-adherence. The present study aimed at examining the association between depression, anxiety and alcohol use disorder symptoms and ART adherence among people living with HIV/AIDS (PLWHA) attending an HIV clinic in Blantyre, Malawi. Methods: This was a facility-based quantitative study with a cross-sectional descriptive design with 213 PLWHA attending an HIV clinic. The participants completed a survey consisting of demographics and mental health disorders symptoms screening tools, namely the 9-item Patient Health Questionnaire (PHQ9) for depression symptoms, the Generalized Anxiety Disorder 7-item scale (GAD-7) for anxiety symptoms and the Alcohol Use Disorders Identification Test (AUDIT) for alcohol use and related harms. ART adherence was assessed using pill count, a self-report measure and a combined measure of both pill count and self-report adherence. Results: The prevalence of depressive symptoms among the participants was 32%, 26% for anxiety symptoms and 16% of participants reported any life-time alcohol use. The majority of participants (75.6%) were found to have good pill count-based adherence while only 41.7% and 33.2% of participants reported good adherence on the self-report and combined measures respectively. The results showed that older participants were more likely to self-report good adherence than younger participants (OR=1.03; 95%CI=1.01-1.06, p-value=0.050). The participants who scored higher on the AUDIT were less likely to self-report good adherence to ART (OR=0.88; 95% CI=0.78-1.00, p-value=0.050). Side-effects were statistically significantly associated with both pill-count and combined adherence. The participants that experienced side effects from the treatment were less likely to be adherent on pill count (OR=0.19; 95% CI=0.07-0.53, p-value=0.001) and the combined adherence measure (OR=0.45; 95% CI=0.24-0.83, pvalue=0.011). Alcohol use was again significantly associated with combined adherence. The participants who reported ever having used alcohol were less likely to be adherent to ART on the combined adherence measure (OR=0.51; 95% CI=0.29-0.93, p-value=0.026). No statistically significant association between depressive and anxiety symptoms and ART adherence was found. Conclusion: The findings show that symptoms of common mental disorders were highly prevalent among PLWHA. Alcohol use, younger age group and experiencing side-effects from ART were significantly associated with ART non-adherence. Further research is required to investigate how depression and anxiety is associated with ART adherence among PLWHA in a Malawian population using larger sample sizes. The current study also highlights the need to routinely screen PLWHA for mental health problems. Further research using advanced designs, such as randomized clinical trials incorporating implementation science approaches, is also needed to evaluate the feasibility and effectiveness of integrating mental health services into HIV care in Malawi.
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    Missed opportunities to address mental health of people living with HIV in Zomba, Malawi: a cross-sectional clinic survey
    (2020) Kawiya, Harry Henry; Sorsdahl, Katherine; Lund, Crick
    Background. Common mental disorders (CMDs), including depression and anxiety disorders, and risky alcohol use are highly prevalent among people living with HIV. Yet, many studies have found that most people who suffer from mental disorders do not receive treatment, especially in low-income countries. Given people living with HIV frequent health services, this represents a missed opportunity for identification and treatment that could improve physical and mental health outcomes. The aim of this study was to identify missed opportunities to address mental health of people living with HIV in Malawi. Four types of missed opportunities were operationalised for this study. The first two address missed opportunities for screening or identification For missed opportunity #1, a respondent had to screen positive for mental health problem (depression/anxiety or alcohol use ; and in any of their visits to the clinic in the past 12 months, the clinical officer or nurse did not ask about their mental health. Missed opportunity definition #2 was a more nuanced missed opportunity for identification of probable mental health problems. A respondent had to be undetected for mental health problems; and in any of his or her visits to the clinic in the past 12 months, the clinical officer or nurse did not ask about his or her mental health and s/he wanted to receive advice or treatment about his or her mental health problems. The second to definitions address missed opportunities for treatment. For missed opportunity definition #3, a respondent had to screen positive for mental health problem and if in any of his or her visits to the clinic in the past 12 months, and s/he did not receive advice or treatment. For missed opportunity definition #4, a more nuanced missed opportunity for the treatment of probable mental health problem: a respondent had to screen positive for a mental health problem; s/he wanted to receive advice or treatment about his or her mental health problems/alcohol use; and in any of their visits to the clinic in the past 12 months, s/he did not receive treatment for a mental disorder/risky alcohol use. Methods. A a random of participants receiving HIV care were approached while they were waiting for their consultation at three ART clinics namely: Tisungane, Matawale and Domasi. Those who consented to participants were interviewed in a private room. The Self-Reporting Questionnaire-20 (SRQ-20) and the Alcohol Use Disorders Identification Test (AUDIT) were used to detect probable cases of CMDs and clients consuming alcohol at risky levels. Following v administration of the SRQ-20 and AUDIT, participants were asked if clinical officers (COs) or nurses inquired about their feelings (sad or worried) or alcohol consumption during their routine visits to ART clinics, thus eliciting data on identification by healthcare workers or identification of CMD symptoms. The participants were also asked whether advice or treatment was recommended and whether they would have liked to receive advice or treatment regarding their feelings or risky alcohol use. Descriptive statistics were utilized to calculate prevalence estimates of missed opportunities and multiple logistic regression models were used to determine the factors associated with missed opportunities for mental health service provision. Results. The study had 382 participants. The proportion of participants who screened at risk was 77 (20.2%) for probable CMDs and 16 (4.2%) for risky alcohol use. The proportion of participants who screened at risk for any mental health problem (depression, anxiety and risky alcohol use) was 87 (22.8%). Participants who were asked by clinical officers and nurses about CMD symptoms and alcohol use were 92 (24.1%) and 89 (23.3%) respectively. Of the entire sample, 351 (91.9%) participants wanted to receive advice or treatment and 26 (29.9%) received advice or treatment. Missed opportunities to address the mental health of people living with HIV were found to be as follows: definition #1, 40 participants (46.0%); definition #2, 35 participants (40.2%); definition #3, 87 participants (100%) and definition #4, 66 participants (75.9%). After adjusting for other variables in the model female gender was significantly associated with missed opportunity definition #1. After adjusting for other variables in the model female participants were more likely to meet criteria for missed opportunity definition #2 than male participants. Furthermore, older participants were less likely to meet criteria for missed opportunity definition #2 compared to younger participants. Participants who were employed were less likely to meet criteria for missed opportunity definition #2. In the same vein, participants who were spending less were less likely to meet criteria for missed opportunity definition #2. Given all participants met criteria, we were unable to develop logistic regression models. There were no significant associations for missed opportunity definition #4. Conclusion. Approximately one fifth of the sample recruited screened at risk for CMDs and most clients wanted to receive advice or treatment. Despite over 40% of the participants reporting being asked about CMD symptoms, PHC workers did not provide advice or treatments to 75.9% of clients. There is need to advocate for screening of mental health problems including alcohol use and treatment in all ART clinics in Malawi.
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    Negative attributions towards people with substance use disorders in South Africa: Variation across substances and by gender
    (Biomed Central Ltd, 2012) Sorsdahl, Katherine; Stein, Dan; Myers, Bronwyn
    BACKGROUND:Little research has examined attitudes towards people who use substances in low and middle income countries (LMIC). Therefore, the present study examined the attributions made by the general South African population about people who use substances and whether these attributions differ by the type of substance being used, the gender of the person using the substance, or the characteristics of the person making the attribution.METHOD:A convenience sample of 868 members of the general public was obtained through street-intercept methods. One of 8 vignettes portraying alcohol, cannabis, methamphetamine or heroin, with either a male or female as the protagonist was presented to each respondent. Respondents' attitudes towards the specific cases were investigated. RESULTS: Respondents held equally negative views of the presented substances, with the exception of the cannabis vignette which was considered significantly less "dangerous" than the alcohol vignette. Respondents were more likely to offer "help" to women who use alcohol, but more likely to suggest "coercion into treatment" for men. Individuals who scored higher on the ASSIST were more likely to hold negative attitudes towards substance users and black African respondents were more likely to offer help to individuals who use substances. CONCLUSION: The stigma associated with substance use in South Africa is high and not necessarily dependent on the drug of choice. However, a range of factors, including gender of the substance user, and ethnicity of the rater, may impact on stigma. Interventions designed to strengthen mental health literacy and gender-focused anti-stigma campaigns may have the potential to increase treatment seeking behaviour.
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    Packages of care for attention-deficit hyperactivity disorder in low-and middle-income countries
    (Public Library of Science, 2010) Flisher, Alan J; Sorsdahl, Katherine; Hatherill, Sean; Chehil, Sonia
    In the sixth in a series of six articles on packages of care for mental disorders in low- and middle-income countries, Alan Flisher and colleagues discuss the treatment of attention-deficit hyperactivity disorder.
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    Patient outcomes and experience of a task-shared screening and brief intervention service for problem substance use in South African emergency centres: a mixed methods study
    (2021-05-12) van der Westhuizen, Claire; Malan, Megan; Naledi, Tracey; Roelofse, Marinda; Myers, Bronwyn; Stein, Dan J; Lahri, Sa’ad; Sorsdahl, Katherine
    Abstract Background Screening, brief intervention and referral to treatment (SBIRT) programmes have resulted in generally positive outcomes in healthcare settings, particularly for problem alcohol use, yet implementation is hampered by barriers such as concerns regarding the burden on healthcare professionals. In low-resourced settings, task-sharing approaches can reduce this burden by using non-professional healthcare workers, yet data are scarce regarding the outcomes and acceptability to patients within a SBIRT service. This study aims to evaluate patient-reported outcomes, patient acceptability, perceived benefits and recommendations for improving a task-shared SBIRT service in South African emergency centres (ECs). Methods This mixed methods study incorporates quantitative substance use screening and patient satisfaction data collected routinely within the service at three hospitals, and qualitative semi-structured interviews with 18 EC patient beneficiaries of the programme exploring acceptability and perceived benefits of the programme, as well as recommendations to improve the service. Approximately three months after the acute EC visit, a sub-sample of patients were followed up telephonically to assess patient-reported satisfaction and substance use outcomes. Results Of the 4847 patients eligible for the brief intervention, 3707 patients (76%) used alcohol as their primary substance and 794 (16%) used cannabis. At follow-up (n = 273), significant reductions in substance use frequency and severity were noted and over 95% of patients were satisfied with the service. In the semi-structured interviews, participants identified the non-judgemental caring approach of the counsellors, and the screening and psychoeducation components of the intervention as being the most valuable, motivating them to decrease substance use and make other positive lifestyle changes. Study participants made recommendations to include group sessions, market the programme in communities and extend the programme’s reach to include a broader age group and a variety of settings. Conclusions This task-shared SBIRT service was found to be acceptable to patients, who reported several benefits of a single SBIRT contact session delivered during an acute EC visit. These findings add to the SBIRT literature by highlighting the role of non-professional healthcare workers in delivering a low-intensity SBIRT service feasible to implement in low-resourced settings.
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    Perspectives on disclosure of HIV status to others among 12-19 year old HIV-infected adolescents attending an HIV care clinic at a tertiary hospital in Harare, Zimbabwe : a qualitative study
    (2015) Khan, Rabia; Sorsdahl, Katherine
    Introduction: The worldwide commitment to increasing services and access to antiretroviral therapy have resulted in a decline in HIV related mortality. As a result, the focus of HIV care is shifting towards improving the psychological health and quality of life. HIV infected adolescents are a group with unique psychosocial challenges. Given that HIV self disclosure has been recognized as an important challenge affecting their physical as well psychological health it warrants further exploration. Methods: A qualitative study was conducted during September to November 2014 among adolescents (12-19years) attending the HIV care clinic at a tertiary hospital in Harare. Twenty adolescents who were vertically infected with HIV were recruited using purposive sampling techniques to achieve maximum variability in age and sex. In depth interviews were conducted to determine the views of adolescents regarding when, whom and how to self disclose. All the interviews were transcribed verbatim. Data was analyzed using the framework approach. Results: Adolescents identified stigma and discrimination from peers as well as lack of HIV knowledge as important barriers to status disclosure and suggested societal resources like support groups and media to assist them in the disclosure process. Conclusion: HIV status disclosure to others is a challenging task for adolescents and it can be affected by personal as well as social factors. In order to deal with disclosure dilemmas, we have to work with adolescents keeping all these factors in mind to assist them in decision making, there by facilitating healthy supportive relationships and contributing to the wellbeing of HIV-positive adolescents.
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    Prevalence and associated factors of caregiving burden among caregivers of individuals with severe mental illness: A hospital based study at St John of God Hospitaller services in Mzuzu, Malawi
    (2019) Banda, Richard; Schneider, Marguerite; Sorsdahl, Katherine
    Background: Severe mental illnesses (SMI) cause significant impairment for those living with the illnesses and often rely on caregivers for the ongoing care. Available evidence suggests that individuals responsible for caregiving may get distressed due to the caregiving experience, a phenomenon researchers call caregiver burden. Following the shift to community-centered mental health services, several studies on caregiving burden have been conducted in high income countries (HIC). However, there remains scarcity of data on the subject in SubSaharan Africa including Malawi. Therefore, the present study investigated the prevalence and associated factors of caregiving burden among caregivers of individuals with SMI at St John of God Hospitaller Services (SJOGHS) in Mzuzu-Malawi. Methods: The study adopted a hospital based cross sectional study. Recruitment took place at two outpatient departments of SJOGHS. Informal caregivers who were 18 years and above were asked to participate. The study recruited 139 caregivers and two research assistants approached participants at the waiting area. Caregivers who gave consent were asked questions about their caregiving activities using the Zarit Burden Interview (ZBI) (maximum score, 88). Data analysis was done using frequency distributions and descriptive statistics. The study used non-parametric tests such as a chi-square on all categorical measurements to test associations between variables and parametric tests such as t test on all continuous variables. The unadjusted and adjusted associations between socio-demographic factors and caregiving burden was conducted using logistic regression models. Results: On average, most caregivers experienced mild to moderate caregiving burden on the ZBI score (31.5 ± 16.7). In the adjusted model after controlling for caregivers’ gender, caregivers’ age, level of education, social support, care recipients’ age and care recipients’ gender, only caregivers’ age, social support and care recipients’ age remained significantly associated with caregiving burden. Older caregivers were more likely to experience caregiving burden than younger caregivers (OR=1.03, 95% CI 1.00-1.06), caregivers with social support were 71 % less likely to develop caregiving burden than those without social support (OR=0.29, 95% CI 0.14-0.62) and caregivers of older care recipients were less likely to experience caregiving burden than those of younger care recipients (OR=0.26, 95% CI 0.11-0.64). v Conclusion: Even though the caregiving burden found in this study was low compared to other previous studies in some arguably developed countries such as Iran and Turkey, it remains high in other developing countries such as Ghana and Nigeria. The low burden in this study, could be attributed to several factors and context in which the study was conducted. One such factor is the routine psychoeducation that the hospital often conducts for caregivers during the subsequent monthly reviews of their care recipients. An important follow up would be to investigate caregiving burden among caregivers who are unable to access the services at SJOGHS. The results of this study are important to guide policy in the formation of effective community programs that may assist mitigate the burden of informal caregivers. Finally, to understand the importance and implications of informal caregiving, further studies are needed in Malawi.