OpenUCT :: Browsing by Author "Tomlinson, Mark"

Browsing by Author "Tomlinson, Mark"

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Open Access
Associations between ADHD symptoms and maternal and birth outcomes: An exploratory analysis in a multi-country cohort of expectant mothers
(2022) Murray, Aja Louise; Taut, Diana; Baban, Adriana; Hemady, Chad Lance; Walker, Susan; Osafo, Joseph; Sikander, Siham; Tomlinson, Mark; Du Toit, Stefani; Marlow, Marguerite; Ward, Catherine L; Fernando, Asvini; Madrid, Bernadette; Thang, Vo Van; Tuyen, Hoang Dinh; Dunne, Michael; Hughes, Claire; Fearon, Pasco; Valdebenito, Sara
ADHD symptoms can adversely impact functioning in a range of domains relevant for maternal well-being and foetal development; however, there has been almost no research examining their impact during pregnancy. We used data (n=1204) from a longitudinal birth cohort study spanning eight countries to address this gap. ADHD symptoms in the third trimester of pregnancy were associated with lower social support from family (b=-0.16, p=.031), friends (b=-0.16, p=.024), and significant others (b=-0.09 p=.001); higher stress (b=0.34, p<.001) and depressive symptoms (b=0.31, p<.001), and increased likelihood of an unwanted pregnancy (b=0.30, p=.009). Significant associations with tobacco use (b=.36, p=.023) and premature birth (b=.35, p=.007) did not survive correction for multiple comparisons and there were no significant associations with alcohol use, low birth weight, or unplanned pregnancy. Results suggest that women with ADHD symptoms could benefit from earlier, more regular screening for mental health difficulties and greater mental health support during pregnancy.
Open Access
Caregiver experiences of public services following child trauma exposure: a qualitative study
(BioMed Central, 2018-04-10) Williamson, Victoria; Halligan, Sarah L; Coetzee, Bronwyne; Butler, Ian; Tomlinson, Mark; Skeen, Sarah; Stewart, Jackie
Background: Many children in low and middle income countries (LMIC) are exposed to trauma. Contact with public services are a potential infuence on parent–child reactions and coping post-trauma. Little is known about how caregivers perceive these interactions. Methods: The aim of this study was to explore caregivers’ experiences of accessing and interacting with public services post-trauma and perceptions of needed improvements to public services in a LMIC context. Qualitative interviews were conducted with 20 female caregivers from a high-risk settlement in South Africa after child trauma exposure. Results: Three themes and seven sub-themes were identifed regarding caregivers’ perceptions of interactions with public services post-trauma. The key themes identifed related to (1) communication and exchanges with law enforcement, (2) consequences of an under-resourced justice system and (3) importance of communication and empathy in the healthcare system. Interactions with police were often positive. However, caregivers explained that police-family communication post-trauma could be improved and may help to lessen caregiver anxiety and concerns for the child’s safety post-trauma. Caregivers perceived the judicial system to be under-resourced as contact with the judicial system was often protracted and caused child anxiety and distress. Medical treatment was reportedly rushed, with extensive waiting times and little information provided to caregivers regarding the child’s injuries or treatment. Some medical staf were perceived as unsympathetic during the child’s treatment which was found to exacerbate caregiver and child distress post-trauma. Conclusions: This study provides insight into caregiver experiences of accessing public services following child trauma exposure in a high-risk LMIC context. Public services were perceived as oversubscribed and under-resourced and negative interactions often infuenced caregiver responses and appraisals of child safety. Given the impact of poor interactions with public services on families post-trauma, additional research is needed to investigate feasible improvements to public services in LMIC.
Open Access
Children affected by HIV/AIDS attending programmes to improve psychosocial well-being: current status and pathways to effective interventions
(2017) Skeen, Sarah Ann; Tomlinson, Mark; Sherr, Lorraine
The HIV/AIDS pandemic has a substantial impact on children across the globe and particularly in sub-Saharan Africa. Across sub-Saharan Africa, there are a number of organisations and programmes providing care and support to children affected by HIV/AIDS. However, this strong programmatic focus on mitigating the impact of HIV/AIDS on children at community level has not been matched with concomitant research investment into the needs of children who attend these programmes at these organisations, their health and development, how these organisations work, and whether they are effective. This thesis attempts to address this gap by reporting on three separate analyses of data from the Child Community Care study in South Africa and Malawi, and a systematic review on interventions to improve psychosocial wellbeing of this group. The first analysis describes developmental outcomes of children affected by HIV/AIDS attending community-based programmes and the types of services these children are receiving. The second analysis reports on the mental health of carers of children affected by HIV. In the third analysis I report on the relationship between different forms of violence and mental health status among children affected by HIV/AIDS in the sample. The fourth part is a systematic review of interventions developed to improve the psychosocial well-being of children affected by HIV/AIDS, published between January 2008 and February 2016. The results of these studies highlight the complex needs of children affected by HIV/AIDS attending these organisations. CBOs are reaching a vulnerable group of children and their families, and are well-placed to intervene with this population. There are promising models of interventions available, although the evidence base remains small. Caregivers should not be neglected in programming; parenting programmes provide a potential mechanism for delivering integrated interventions that address multiple risk factors for caregiver and child wellbeing. Mental health, particularly of caregivers, should be explicitly addressed as a part of CBO programming. However, funding for programming needs to be implemented with opportunities for training and supervision. In addition, there is a need for increased partnerships between practitioners and researchers in order to evaluate existing programmes and to design evaluation studies that suit community settings, and that can feed into the growing evidence base.
Open Access
A cohort study of psychological sequalae in low birth weight children from the Bishop Lavis Community Health Centre
(2007) Micklewood, Neil Ryan; Tomlinson, Mark
The relationship between low birth weight, behavioural inhibition and psychopathology was investigated in 65 seven to nine year-olds and their caregivers who were attendees of a community clinic in a low-income, urban suburb in Cape Town, South Africa. Significant relationships were found between key socioeconomic variables and birth weight status, behavioural inhibition and psychopathology respectively. Low birth weight children were more behaviourally inhibited in anxiety-provoking situations and their caregivers were less engaging than controls. High levels of psychopathology were found, independent of birth weight status and included emotional, hyperactivity, conduct and peer difficulties. Despite this, children had high levels of pro social skills. A model consisting of birth weight and a measure of socioeconomic status was an effective overall predictor of behavioural inhibition status.
Open Access
Correction to: Impact of district mental health care plans on symptom severity and functioning of patients with priority mental health conditions: the Programme for Improving Mental Health Care (PRIME) cohort protocol
(2020-09-29) Baron, Emily C; Rathod, Sujit D; Hanlon, Charlotte; Prince, Martin; Fedaku, Abebaw; Kigozi, Fred; Jordans, Mark; Luitel, Nagendra P; Medhin, Girmay; Murhar, Vaibhav; Nakku, Juliet; Patel, Vikram; Petersen, Inge; Selohilwe, One; Shidhaye, Rahul; Ssebunnya, Joshua; Tomlinson, Mark; Lund, Crick; De Silva, Mary
An amendment to this paper has been published and can be accessed via the original article.
Open Access
A critical evaluation of a community based mother-infant intervention project with special emphasis on infant attachment
(1999) Tomlinson, Mark; Swartz, Leslie
This dissertation critically evaluates a community based mother-infant intervention project in Hanover Park, a deprived area of Cape Town, characterised by poverty, gangsterism and high levels of unemployment. The aim of the project was to assess the impact of an intervention programme in preventing child abuse and neglect and promoting more nurturing parent-child relationships. The sample was drawn from clinic records at the Hanover Park Mid-Obstetric Unit. Twenty-five mother-infant dyads were initially chosen based on high levels of stress and assigned to the intervention group. A control group was subsequently chosen, also drawn from clinic records as well as being matched with the intervention group. Subjects in the intervention group received weekly visits for a two-year period from family support workers, all of whom lived in Hanover Park. The intervention was based on the Healthy Start Programme as developed in Hawaii. A basic socio-demographic questionnaire was administered at the beginning of the project. Mothers were assessed for postnatal depression using the Edinburgh Postnatal . Depression Scale. Anthropometric data was collected throughout the project. At the end of the two-year intervention, infants were assessed using the Griffiths Scales of Mental Development and Ainsworth's Strange Situation. The results were statistically analysed for relationships and differences according to group. Findings revealed that there were no significant differences between the intervention group and the control group on any of the outcome measures. A trend was detected with the Strange Situation results and a power analysis was conducted in order to determine requisite sample size for significance to have been achieved. The result of this algorithm were that for significance to have been achieved (assuming the trend were to continue) a sample size of 74 in each group would have been required. A discussion is presented in terms of the implications of the findings for the utilisation of the Strange Situation measure in a diverse cultural context such as South Africa, as well as the broader cultural implications for the study of attachment in future studies. A detailed methodological and theoretical critique of the Hanover Park Project is also presented in order to glean important lessons for future intervention studies, and more particularly for a treatment-trial which is at present being conducted in Khayelitsha.
Open Access
Early intervention: a foundation for lifelong violence prevention.
(2015) Skeen, Sarah; Tomlinson, Mark; Ward, Catherine L; Cluver, Lucie; Lachman, Jamie M
High levels of violence affect every family in South Africa. Exposure to violence starts early, in both the home and community. There are high levels of physical abuse of children,1 and the national under-five homicide rate is more than double that of other low- and middle-income countries.2 Rates of violence are particularly high in poorer communities in the country, and many children already made vulnerable by poverty are also at risk from increased exposure to violence
Open Access
The effectiveness of problem solving therapy in deprived South African communities: results from a pilot study
(BioMed Central Ltd, 2011) van't Hof, Edith; Stein, Dan; Marks, Isaac; Tomlinson, Mark; Cuijpers, Pim
BACKGROUND:The majority of South Africans with a DSM-IV diagnosis receive no treatment for their mental health problems. There is a move to simplify treatment for common mental disorders (CMDs) in order to ease access. Brief problem solving therapy (PST) might fill the treatment gap for CMD's in deprived communities in South Africa. This pilot study evaluates the feasibility, acceptability and effectiveness of this PST program for CMD's in deprived communities around Cape Town. METHODS: A Dutch problem solving program was adapted and translated into English, Xhosa and Afrikaans and thereafter implemented in townships around Cape Town. An initial attempt to recruit participants for online PST proved difficult, and so the program was adapted to a booklet format. Volunteers experiencing psychological distress were invited to participate in the either individually or group delivered 5-week during self-help program. To evaluate the effectiveness, psychological distress was administered through self-report questionnaires. After completion of the intervention participants also rated the program on various acceptability aspects. RESULTS: Of 103 participants, 73 completed 5 weeks of brief PST in a booklet/workshop format. There were significantly more dropouts in those who used the booklet individually than in the group. Psychological distress measured on the K-10 and SRQ fell significantly and the program was evaluated positively. CONCLUSIONS: The results suggest that brief problem solving in a booklet/workshop format may be an effective, feasible and acceptable short-term treatment for people with CMD's in deprived communities. In this setting, group delivery of PST had lower drop-out rates than individual delivery, and was more feasible and acceptable. Randomized controlled trials are needed to evaluate the effect of brief self-help PST more rigorously.
Open Access
How effective is help on the doorstep? A longitudinal evaluation of community-based organisation support
(Public Library of Science, 2016) Sherr, Lorraine; Yakubovich, Alexa R; Skeen, Sarah; Cluver, Lucie D; Hensels, Imca S; Macedo, Ana; Tomlinson, Mark
Community-based responses have a lengthy history. The ravages of HIV on family functioning has included a widespread community response. Although much funding has been invested in front line community-based organisations (CBO), there was no equal investment in evaluations. This study was set up to compare children aged 9-13 years old, randomly sampled from two South African provinces, who had not received CBO support over time (YC) with a group of similarly aged children who were CBO attenders (CCC). YC baseline refusal rate was 2.5% and retention rate was 97%. CCC baseline refusal rate was 0.7% and retention rate was 86.5%. 1848 children were included--446 CBO attenders compared to 1402 9-13 year olds drawn from a random sample of high-HIV prevalence areas. Data were gathered at baseline and 12-15 months follow-up. Standardised measures recorded demographics, violence and abuse, mental health, social and educational factors. Multivariate regression analyses revealed that children attending CBOs had lower odds of experiencing weekly domestic conflict between adults in their home (OR 0.17; 95% CI 0.09, 0.32), domestic violence (OR 0.22; 95% CI 0.08, 0.62), or abuse (OR 0.11; 95% CI 0.05, 0.25) at follow-up compared to participants without CBO contact. CBO attenders had lower odds of suicidal ideation (OR 0.41; 95% CI 0.18, 0.91), fewer depressive symptoms (B = -0.40; 95% CI -0.62, -0.17), less perceived stigma (B = -0.37; 95% CI -0.57, -0.18), fewer peer problems (B = -1.08; 95% CI -1.29, -0.86) and fewer conduct problems (B = -0.77; 95% CI -0.95, -0.60) at follow-up. In addition, CBO contact was associated with more prosocial behaviours at follow-up (B = 1.40; 95% CI 1.13, 1.67). No associations were observed between CBO contact and parental praise or post-traumatic symptoms. These results suggest that CBO exposure is associated with behavioural and mental health benefits for children over time. More severe psychopathology was not affected by attendance and may need more specialised input.
Open Access
Identifying and treating maternal mental health difficulties in Afghanistan: A feasibility study
(2020-10-27) Tomlinson, Mark; Chaudhery, Deepika; Ahmadzai, Habibullah; Rodríguez Gómez, Sofía; Rodríguez Gómez, Cécile; van Heyningen, Thandi; Chopra, Mickey
Background: The disproportionately high burden of mental disorders in low- and middle-income countries, coupled with the overwhelming lack of resources, requires an innovative approach to intervention and response. This study evaluated the feasibility of delivering a maternal mental health service in a severely-resource constrained setting as part of routine service delivery. Methods: This exploratory feasibility study was undertaken at two health facilities in Afghanistan that did not have specialist mental health workers. Women who had given birth in the past 12 months were screened for depressive symptoms with the PHQ9 and invited to participate in a psychological intervention which was offered through an infant feeding scheme. Results: Of the 215 women screened, 131 (60.9%) met the PHQ9 criteria for referral to the intervention. The screening prevalence of postnatal depression was 61%, using a PHQ9 cut-off score of 12. Additionally, 29% of women registered as suicidal on the PHQ9. Several demographic and psychosocial variables were associated with depressive symptoms in this sample, including nutritional status of the infant, anxiety symptoms, vegetative and mood symptoms, marital difficulties, intimate partner violence, social isolation, acute stress and experience of trauma. Of the 47 (65%) women who attended all six sessions of the intervention, all had significantly decreased PHQ9 scores post-intervention. Conclusion: In poorly resourced environments, where the prevalence of postnatal depression is high, a shift in response from specialist-based to primary health care-level intervention may be a viable way to provide maternal mental health care. It is recommended that such programmes also consider home-visiting components and be integrated into existing infant and child health programmes. Manualised, evidence-based psychological interventions, delivered by non-specialist health workers, can improve outcomes where resources are scarce.
Open Access
Impact of district mental health care plans on symptom severity and functioning of patients with priority mental health conditions: the Programme for Improving Mental Health Care (PRIME) cohort protocol
(BioMed Central, 2018-03-06) Baron, Emily C; Rathod, Sujit D; Hanlon, Charlotte; Prince, Martin; Fedaku, Abebaw; Kigozi, Fred; Jordans, Mark; Luitel, Nagendra P; Medhin, Girmay; Murhar, Vaibhav; Nakku, Juliet; Patel, Vikram; Petersen, Inge; Selohilwe, One; Shidhaye, Rahul; Ssebunnya, Joshua; Tomlinson, Mark; Lund, Crick; De Silva, Mary
Background The Programme for Improving Mental Health Care (PRIME) sought to implement mental health care plans (MHCP) for four priority mental disorders (depression, alcohol use disorder, psychosis and epilepsy) into routine primary care in five low- and middle-income country districts. The impact of the MHCPs on disability was evaluated through establishment of priority disorder treatment cohorts. This paper describes the methodology of these PRIME cohorts. Methods One cohort for each disorder was recruited across some or all five districts: Sodo (Ethiopia), Sehore (India), Chitwan (Nepal), Dr. Kenneth Kaunda (South Africa) and Kamuli (Uganda), comprising 17 treatment cohorts in total (N = 2182). Participants were adults residing in the districts who were eligible to receive mental health treatment according to primary health care staff, trained by PRIME facilitators as per the district MHCP. Patients who screened positive for depression or AUD and who were not given a diagnosis by their clinicians (N = 709) were also recruited into comparison cohorts in Ethiopia, India, Nepal and South Africa. Caregivers of patients with epilepsy or psychosis were also recruited (N = 953), together with or on behalf of the person with a mental disorder, depending on the district. The target sample size was 200 (depression and AUD), or 150 (psychosis and epilepsy) patients initiating treatment in each recruiting district. Data collection activities were conducted by PRIME research teams. Participants completed follow-up assessments after 3 months (AUD and depression) or 6 months (psychosis and epilepsy), and after 12 months. Primary outcomes were impaired functioning, using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS), and symptom severity, assessed using the Patient Health Questionnaire (depression), the Alcohol Use Disorder Identification Test (AUD), and number of seizures (epilepsy). Discussion Cohort recruitment was a function of the clinical detection rate by primary health care staff, and did not meet all planned targets. The cross-country methodology reflected the pragmatic nature of the PRIME cohorts: while the heterogeneity in methods of recruitment was a consequence of differences in health systems and MHCPs, the use of the WHODAS as primary outcome measure will allow for comparison of functioning recovery across sites and disorders.
Open Access
Maternal mental health in primary care in five low- and middle-income countries: a situational analysis
(BioMed Central, 2016-02-16) Baron, Emily C; Hanlon, Charlotte; Mall, Sumaya; Honikman, Simone; Breuer, Erica; Kathree, Tasneem; Luitel, Nagendra P; Nakku, Juliet; Lund, Crick; Medhin, Girmay; Patel, Vikram; Petersen, Inge; Shrivastava, Sanjay; Tomlinson, Mark
Background: The integration of maternal mental health into primary health care has been advocated to reduce the mental health treatment gap in low- and middle-income countries (LMICs). This study reports findings of a cross-country situation analysis on maternal mental health and services available in five LMICs, to inform the development of integrated maternal mental health services integrated into primary health care. Methods: The situation analysis was conducted in five districts in Ethiopia, India, Nepal, South Africa and Uganda, as part of the Programme for Improving Mental Health Care (PRIME). The analysis reports secondary data on the prevalence and impact of priority maternal mental disorders (perinatal depression, alcohol use disorders during pregnancy and puerperal psychosis), existing policies, plans and services for maternal mental health, and other relevant contextual factors, such as explanatory models for mental illness. Results: Limited data were available at the district level, although generalizable data from other sites was identified in most cases. Community and facility-based prevalences ranged widely across PRIME countries for perinatal depression (3–50 %) and alcohol consumption during pregnancy (5–51 %). Maternal mental health was included in mental health policies in South Africa, India and Ethiopia, and a mental health care plan was in the process of being implemented in South Africa. No district reported dedicated maternal mental health services, but referrals to specialised care in psychiatric units or general hospitals were possible. No information was available on coverage for maternal mental health care. Challenges to the provision of maternal mental health care included; limited evidence on feasible detection and treatment strategies for maternal mental disorders, lack of mental health specialists in the public health sector, lack of prescribing guidelines for pregnant and breastfeeding women, and stigmatising attitudes among primary health care staff and the community. Conclusions: It is difficult to anticipate demand for mental health care at district level in the five countries, given the lack of evidence on the prevalence and treatment coverage of women with maternal mental disorders. Limited evidence on effective psychosocial interventions was also noted, and must be addressed for mental health programmes, such as PRIME, to implement feasible and effective services.
Open Access
The perceptions and socio-cultural beliefs of Xhosa speaking people in relation to perinatal distress
(2007) Chonco, Jabulisile C N; Tomlinson, Mark
The current study aims to explore the perceptions and socio-cultural beliefs amongst Xhosa speaking people in relation to perinatal distress. A sample of 20 participants was selected in Cape Town. A grounded theory method of study was used to develop hypotheses relating to perinatal distress. Semi-structured interviews were conducted. The interview material was analysed using the grounded theory method. The findings of the study indicated that within the Xhosa speaking community distress during pregnancy, childbirth and the post-partum period appears to be understood in relation to unavailability of resources such as finance and partner support. The overall conclusion was that in the presence of these resources, a woman might not experience distress.
Open Access
PRIME: a programme to reduce the treatment gap for mental disorders in five low-and middle-income countries
(Public Library of Science, 2012) Lund, Crick; Tomlinson, Mark; De Silva, Mary; Fekadu, Abebaw; Shidhaye, Rahul; Jordans, Mark; Petersen, Inge; Bhana, Arvin; Kigozi, Fred; Prince, Martin
Crick Lund and colleagues describe their plans for the PRogramme for Improving Mental health carE (PRIME), which aims to generate evidence on implementing and scaling up integrated packages of care for priority mental disorders in primary and maternal health care contexts in Ethiopia, India, Nepal, South Africa, and Uganda.
Open Access
Responsible governance for mental health research in low resource countries
(Public Library of Science, 2011) Yasamy, M Taghi; Maulik, Pallab K; Tomlinson, Mark; Lund, Crick; Van Ommeren, Mark; Saxena, Shekhar
aghi Yasamy and colleagues identify challenges facing good research governance in low- and middle-income countries and provide suggestions for a way forward.
Open Access
Setting priorities for mental health care in Nepal: a formative study
(BioMed Central Ltd, 2013) Jordans, Mark; Luitel, Nagendra; Tomlinson, Mark; Komproe, Ivan
BACKGROUND:There is an urgent need to address the massive treatment gap for mental health problems, especially in low income settings. Packages of care integrated in routine primary health care are posited as a strategy to scale-up mental health care, yet more needs to be known about the most feasible and effective way to go about this. METHODS: The study follows a combined methods design that includes engaging an expert panel in a priority setting exercise, running workshops to develop a Theory of Change and conducting in-depth qualitative interviews and focus group discussions with key stakeholders. The results of each research step were taken forward to inform the subsequent one. RESULTS: There was strong endorsement for a system of care that encompasses both the perspectives of health facility and the community. Issues related to increasing access and demand, guaranteeing a sustainable supply of psychotropic medicine, adequate human resourcing, and ensuring positive family involvement came up as priority areas of attention. CONCLUSION: The study underlines many of the known barriers in developing mental health services. At the same time it provides a distinct pathway and concrete recommendations for overcoming these challenges in Nepal.
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Social factors and postpartum depression in Khayelitsha, Cape Town
(2004) Tomlinson, Mark; Swartz, Leslie; Cooper, Peter J; Molteno, Christopher
Social factors, including poverty, are known risk factors for depression. In a previous study conducted in Khayelitsha, a very poor peri-urban settlement near Cape Town, a 34.7% prevalence rate for postpartum depression was found, roughly three times the expected rate internationally. This article is a report on a logistical regression analysis, showing that the odds ratios for the probability of maternal depression at two months were: for the infant being unwanted, OR=4.33, 95% Cl: (1.75; 11.60); for the father's negative attitude towards the infant, OR=6.03, 95% Cl: (2.01; 20.09); and for the mother cohabiting with (as opposed to not living with) a male partner, OR=2.77, 95% Cl: (1.08; 7.69). The odds ratios for the probability of the mother being insensitive towards the infant at two months were: for the mother aged 20 to 24 years, OR=0.40, 95% Cl: (0.10; 1.42); for the mother aged 25 to 29 years, OR=0.24, 95% Cl: (0.06; 0.77); for the mother aged 30 years or older, OR=0.27, 95% CI: (0.07; 0.90); and for the mother receiving no help from her partner, OR=2.12, 95% CI: (1.05; 4.33). Since data were collected cross-sectionally, it is not possible to draw conclusions about causal pathways. The findings support further investigation into the precursors of, and risk factors for, postpartum depression amongst poor South African women.
Open Access
Stepped care for maternal mental health: a case study of the perinatal mental health project in South Africa
(Public Library of Science, 2012) Honikman, Simone; van Heyningen, Thandi; Field, Sally; Baron, Emily; Tomlinson, Mark
Common mental disorders such as anxiety and depression are the third leading causes of disease burden globally for women between 14 and 44 years of age [1]. By 2030, these are expected to rise to first place, ranked above heart disease and road traffic injuries [2]. A recent systematic review reveals that maternal mental disorders are approximately three times more prevalent in low- and middle-income countries (LMICs) than in high-income countries (HICs), where the related burden of disease estimates range between 5.2% and 32.9% [3],4. In HICs, maternal suicide is the leading cause of death during the perinatal period, and while there is a relative dearth of information about maternal suicide in LMICs, the estimates are similarly high [5],[6]. Untreated maternal mental illness affects infant and child growth [7] and the quality of child care [8], resulting in compromised child development [4],[9]. Community-based epidemiological studies in South Africa have shown high prevalence rates of depressed mood amongst pregnant and postnatal women. In a low-income, informal settlement outside of Cape Town, 39% of pregnant women screened positive on the Edinburgh Postnatal Depression Scale (EPDS) for depressed mood [10] and 34.7% of postnatal women were diagnosed with depression [11]. In a rural area of KwaZulu-Natal province with high HIV prevalence, 47% of women were diagnosed with depression in their third trimester of pregnancy [12].
Open Access
'Sticks and stones can break your bones, but words--' : a psychoanalytic case study of the role of the body in trauma and containment
(2008) Mendel, Anya; Kaminer, Debbie; Tomlinson, Mark; Anderson, Rod
The anaclitic relationship between psyche and soma is a basic premise of psychoanalytic thought, and is richly woven into classic and contemporary literature in this field. Yet there is limited work drawing together these disparate references, or focussing directly on the role of the body as anaclitic basis for the mind, particularly in relation to the reciprocal conditions of containment and traumatisation. This qualitative case study aims to explore the usefulness of this particularly body of psychoanalytic theory in making meaning of a two-year therapy process with a child who had been multiply maltreated. Clinical case material from this psycholanalytically-oriented therapy was analysed through the lens of the psychoanalytic literature reviewed. This analysis revealed four themes, which reflect the interplay between physical and psychic skins in the child's relationship to the maternal object (Theme 1) and in his sense of self (Theme 2), and the interaction between bodily and emotional digestion in his intake of goodness (Theme 3) and expulsion of badness (Theme 4). These findings point to the utility and robustness of this particular theoretical framework in understanding and integrating a large corpus of previously bewildering and disjointed case material with a multiply traumatised child. Implications for theory and for practice are indicated.
Open Access
Task sharing of a psychological intervention for maternal depression in Khayelitsha, South Africa: study protocol for a randomized controlled trial
(BioMed Central, 2014-11-21) Lund, Crick; Schneider, Marguerite; Davies, Thandi; Nyatsanza, Memory; Honikman, Simone; Bhana, Arvin; Bass, Judith; Bolton, Paul; Dewey, Michael; Joska, John; Kagee, Ashraf; Myer, Landon; Petersen, Inge; Prince, Martin; Stein, Dan J; Thornicroft, Graham; Tomlinson, Mark; Alem, Atalay; Susser, Ezra
Background: Maternal depression carries a major public health burden for mothers and their infants, yet there is a substantial treatment gap for this condition in low-resourced regions such as sub-Saharan Africa. To address this treatment gap, the strategy of “task sharing” has been proposed, involving the delivery of interventions by non-specialist health workers trained and supervised by specialists in routine healthcare delivery systems. Several psychological interventions have shown benefit in treating maternal depression, but few have been rigorously evaluated using a task sharing approach. The proposed trial will be the first randomised controlled trial (RCT) evaluating a task sharing model of delivering care for women with maternal depression in sub-Saharan Africa. The objective of this RCT is to determine the effectiveness and cost-effectiveness of a task sharing counseling intervention for maternal depression in South Africa. Methods/Design: The study is an individual-level two-arm RCT. A total of 420 depressed pregnant women will be recruited from two ante-natal clinics in a low-income township area of Cape Town, using the Edinburgh Postnatal Depression Scale to screen for depression; 210 women will be randomly allocated to each of the intervention and control arms. The intervention group will be given six sessions of basic counseling over a period of 3 to 4 months, provided by trained community health workers (CHW)s. The control group will receive three monthly phone calls from a CHW trained to conduct phone calls but not basic counseling. The primary outcome measure is the 17-Item Hamilton Depression Rating Scale (HDRS-17). The outcome measures will be applied at the baseline assessment, and at three follow-up points: 1 month before delivery, and 3 and 12 months after delivery. The primary analysis will be by intention-to-treat and secondary analyses will be on a per protocol population. The primary outcome measure will be analyzed using linear regression adjusting for baseline symptom severity measured using the HDRS-17. Discussion: The findings of this trial can provide policy makers with evidence regarding the effectiveness and cost-effectiveness of structured psychological interventions for maternal depression delivered by appropriately trained and supervised non-specialist CHWs in sub-Saharan Africa. Trial registration Clinical Trials (ClinicalTrials.gov): NCT01977326 , registered on 24/10/2013; Pan African Clinical Trials Registry ( http://www.pactr.org ): PACTR201403000676264 , registered on 11/10/2013.