OpenUCT :: Browsing by Author "Ward, Catherine L"

Browsing by Author "Ward, Catherine L"

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Open Access
Applying behavioural science to issues of public health in South Africa: The case for social norms intervention
(2017) Ganz, Gary; Neville, Fergus G; Ward, Catherine L
In the effort to address behavioural risk factors – which contribute significantly to the global burden of disease – there is a growing movement in public health towards the use of interventions informed by behavioural science. These interventions have the benefit of being amenable to testing in randomised controlled trials, are cost-effective and, when scaled up, can have significant public health benefits. A subset of these interventions attempts to change behaviour by shifting social norms perception (what I think everyone else does and thinks). We surveyed the work on social norms intervention and considered its applicability to issues of public health in South Africa. Social norms interventions have widespread and significant potential to address issues of public health in South Africa; policymakers should look to these interventions as cost-effective tools to address key issues. More broadly, we advocate for an expansion of the use of behavioural science in developing public policy in South Africa.
Open Access
Association of Child Maltreatment with South African Adults’ Wages: Evidence from the Cape Area Panel Study
(Springer Berlin Heidelberg, 2018-09-07) Zheng, Xiaodong; Fang, Xiangming; Fry, Deborah A; Ganz, Gary; Casey, Tabitha; Hsiao, Celia; Ward, Catherine L
Child maltreatment is a prevalent public health problem in both developed and developing countries. While many studies have investigated the relationship between violence against children and health of the victims, little is known about the long term economic consequences of child maltreatment, especially in developing countries. Using data from the Cape Area Panel Study, this paper applies Heckman selection models to investigate the relationship between childhood maltreatment and young adults’ wages in South Africa. The results show that, on average, any experience of physical or emotional abuse during childhood is associated with a later 12% loss of young adults’ wages. In addition, the correlation between physical abuse and economic consequence (14%) is more significant than the relationship between emotional abuse and wages (8%) of young adults; and the higher the frequency of maltreatment, the greater the associations with wages. With respect to gender differences, wage loss due to the experience of childhood maltreatment is larger for females than males. Specifically, males’ wages are more sensitive to childhood emotional abuse, while females’ wages are more likely to be affected by childhood physical abuse. These results emphasize the importance of prioritizing investments in prevention and intervention programs to reduce the prevalence of child maltreatment and to help victims better overcome the long-term negative effect.
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
Do South African mothers shake their babies? incidence and risk factors for infant abuse in Cape Town
(2019) Nefdt, Kirsten C; Ward, Catherine L
Abusive head trauma from shaking is a recognised common cause of fatal head injury in young children globally, although there is little evidence of its occurrence in South Africa. This is perplexing given that the country has amongst the highest reported under-five child mortality and infanticide rates worldwide. To determine whether infants under one-year are violently shaken, a cross-sectional study was conducted with 385 mothers and other primary female caregivers (ages 18 to 60 years; mean age = 27 years) from three high-risk communities in Cape Town. Semi-structured interviews were used to examine: (1) the incidence of shaking, (2) the triggers for shaking, (3) the risk factors for shaking, thoughts of shaking, and knowledge of the dangers of shaking, and (4) the methods used to console crying infants. Results showed that 13.2% (n = 51) of all participants self-reported violent shaking, and 20% (n = 77) had thoughts of shaking their infants. Following a content analysis, three primary triggers for shaking were identified, these were: inconsolable infant crying, feeling angry or frustrated, and being stressed. Findings from a thematic analysis also showed that shaking occurred during a momentary loss of control, and participants seemed to have limited support at the time. The results from three hierarchical logistic regression analyses showed that (1) alcohol use, infant age, a lower knowledge of the dangers of shaking, inconsolable crying, and having thoughts of shaking, predicted shaking, (2) caregiver age, infant age, knowledge of the dangers of shaking, and caregiver responses to infant crying, predicted having thoughts of shaking, and (3) social support, caregiver history of childhood abuse, and having thoughts of shaking, predicted knowledge of the dangers of shaking. Finally, a content analysis revealed three protective factors for infant crying, these were: (1) having easy, contented children, (2) not feeling stressed in response to infant crying, and (3) leaving an infant alone to self-soothe. Taken together, the current findings have programmatic implications that may help prevent the violent shaking of young children in South Africa.
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
Engagement in parenting programmes: exploring facilitators of and barriers to participation
(2016-03-16) Wessels, Inge; Lester, Soraya; Ward, Catherine L
The large-scale delivery of evidence-based parenting programmes is key to nation building in South Africa. In order to achieve change, parents must participate in these programmes. This policy brief aims to contribute to an understanding of participation by exploring the barriers and facilitators encountered by a sample of parents who were invited to take part in one of two local parenting programmes. Recommendations to improve recruitment and retention strategies are provided.
Open Access
Exploring the impact of rape on women's occupations
(2003) Sonnie, Waheeda; Ward, Catherine L; Van Niekerk, Lana
This qualitative study, with elements of co-operative enquiry and phenomenology, endeavoured to describe the impact of rape on the occupations of women who have been raped. Data were gathered from participants who were clients at Rape Crisis, Observatory, through 4 unstructured focus groups and analyses to explore changes in their occupations. What emerged was that the participants were all dissatisfied with their occupations. The overwhelming impact of symptoms of Post Traumatic Stress Disorder (PTSD) on all their occupations was discussed. A dynamic between Person, Occupation and Environment impacted on the occupational engagement and avoidance by the participant. Recommendations for the rape survivors, service providers and family members were made.
Open Access
Injury-related behaviour among South African high-school students at six sites
(2006) Flisher, Alan J; Ward, Catherine L; Liang, Holan; Onya, Handsome; Mlisa, Nomfundo; Terblanche, Susan; Bhama, Susan; Parry, Charles D H; Lombard, Carl J
Objectives. To document and compare prevalence rates of adolescent injury-related risk behaviours at six sites in South Africa. Design. The identical self-administered instrument was used at all sites. Prevalence rates (with 95% confidence intervals) were calculated taking the multistage cluster sampling strategy into account. Setting and subjects. In Cape Town, Durban, Port Elizabeth and Mankweng participants were drawn from either grades 8 or 9, and grade 11, while in Queenstown and Umtata they were drawn from grade 11 only. We selected 39 schools in Cape Town and Durban, 33 in Port Elizabeth and 20 in each of the rural areas. Outcome measures. Road-related risk behaviour, violence, and suicide attempts. Results. Across the sites there were high rates of risk behaviour in all domains. For example, in the 12 months preceding the survey an estimated 52.8% of grade 11 males in Cape Town had travelled in the front seat of a motor vehicle without a seatbelt, 33.0% of grade 8 males in Mankweng had bullied others, while 44.5% of the same group had been bullied, and 18.6% of females in Port Elizabeth had attempted suicide. Rates were lower in rural areas for behaviour involving motor vehicles, but there were no consistent urban-rural findings for violence-related behaviour. Females were at higher risk of suicidal behaviour and males were at higher risk of other injury-related behaviour. Conclusions. There is a need for effective interventions to reduce the extent of injury-related risk behaviour in adolescents in urban and rural settings.
Open Access
Investigating the impact of a parenting intervention within a rural South African community: a longitudinal social network analysis
(2021) Kleyn, Lisa Marguerite; Ward, Catherine L; Hewstone, Miles C; Wölfer, Ralf
Colder, harsher parenting attitudes and behaviours negatively impact children's behaviour and development, and have been linked to heightened levels of violence towards children. Parenting interventions can improve outcomes by reducing violent and increasing non-violent parenting behaviours. I investigated how changes associated with a low-cost positive parenting intervention spread through a rural, low-income, South African community. Specifically, I assessed whether exposure to a community-wide social activation process and Parenting for Lifelong Health (PLH) programmes (focused on violence prevention in low-resource settings) significantly predict: (1) improved parenting, and (2) change in the communication networks of female caregivers in the whole community, while controlling for variables such as psychiatric symptoms, parenting stress, and alcohol misuse. Additionally, I investigated whether ties to parenting programme attendees in the communication network predicted improved parenting. Afrikaans-speaking female caregivers (n = 235; mean age 35.92 years), with children aged between 1½ and 18 years old, participated in the intervention; three waves of data were collected (January 2016, June 2017, and February 2019). The social network was measured based on a peer nomination procedure (of study participants whom “you talk to about parenting”). To analyse the role of interpersonal ties as pathways for spreading intervention effects, I make use of Social Network Analysis (SNA), in the form of nominations of people with whom respondents discuss parenting, together with self-report measures of parenting-related outcomes (from caregivers and their children). I then trace the extent to which both the social activation process and the parenting programmes are effective, in part, via their diffusion throughout the community. SNA was used to disentangle whether network changes improved parenting practices (i.e., selection effects) or whether reported improvements in parenting practices improved caregiver information networks (i.e., socialisation effects). Analysis of data from waves 1 and 2 indicated that community-wide improvements in parenting behaviour were evidenced. The significant predictors of improvement were social activation “dose” received, change in network centrality and the influence of indirect exposure to the parenting programmes via attendees. Furthermore, attending at least one session of a parenting programme offered in the intervention significantly predicted change in the caregivers' communication networks, indicating the spread of social influence through their network. The small subset of caregivers (n = 51; 21.7%) attending one or more sessions of a parenting programme evidenced greater activity (i.e., covariate ego effect) and potential influence (i.e., covariate alter effect) within the communication network compared to caregivers who did not attend any programme sessions. This subset of attending caregivers were more likely to reach out to other caregivers to speak about parenting after being exposed to the intervention, and both sought and received social support from other caregivers. Follow-up assessment using a third wave of data showed that while attendees remained socially influential within the caregiver network the overall community improvement was not sustained. These results illustrate the value of social network analysis for ascertaining the pathways through which the intervention achieved its impact and tracking the evolution of social norms within a community. The results indicate an association between spill-over effects from attendees to non-attendees and community-wide changes through targeted interventions.
Open Access
Measuring dysfunctional parenting: Psychometrics of three versions of the Parenting Scale
(2022) Prandstetter, Katharina; Waller, Franziska; Heinrichs, Nina; Hutchings, Judy; Ward, Catherine L; Danila, Ingrid; Lachman, Jamie M; Foran, Heather M
Abstract Objective: This study assessed the psychometric properties of three versions of the Parenting Scale (PS; original PS, 13-item version, and 10-item version) in three European middle-income countries. Background: The PS is one of the most frequently used questionnaires for measuring dysfunctional discipline strategies. Although its validity has been extensively investigated in American samples, there are mixed results regarding the recommended number of items and subscales, raising the question of replicability across European middle-income countries. Method: Multigroup confirmatory factor analysis (MCFA) and item response theory (IRT) were applied to N = 835 parents from North Macedonia, Moldova, and Romania. Results: All three versions were significantly correlated with parental- and child-related variables. Confirmatory factor analysis indicated the best model fit for the 10-item version, and configural and partial metric invariance across countries could be established for this version. Item response theory analyses also supported this measure. Conclusions: Our findings show that the 10-item version performed better than the 13-item version and the original PS both overall and on the country level. Reliability values were somewhat lower than reported in studies from the United States. Implications: The 10-item version constitutes a promising short measure for assessing dysfunctional parenting in European middle-income countries for researchers and practitioners.
Open Access
Narratives of gang desistance amongst former gang members
(2018) Kelly, Jane Frances; Ward, Catherine L
Gangs are found all over the world, including South Africa. In Cape Town specifically, gang involvement is a critical problem in need of intervention. Despite this, little research has explored the perspectives of former gang members on leaving and staying out of the gang. Understanding how and why individuals desist from gangs has important implications for policymakers, the criminal justice system, and in the development of effective interventions, which is particularly important in low- and middle-income countries like South Africa, where very little is known about desistance from gangs, and where economic and other conditions that may lead to gang involvement are different from those in high-income countries. Drawing on a narrative theoretical framework as well as the theory of critical realism, this research sought to examine how former South African gang members understand and make sense of their desistance from gang involvement, focusing on exiting the gang life as well as maintaining a reformed lifestyle after exiting, despite the challenges this may present. Two rounds of life history interviews were conducted with twelve former gang members from a Cape Town community with a high prevalence of gangsterism. Thematic narrative analysis was used to analyse the interview data. Findings revealed that the participants’ narratives of desistance focused on a profound transformation in identity in which they moved away from the hardened, stoic gangster identity and embraced a more prosocial identity, such as that of a positive role model in the community. This transformation was a process punctuated with key turning points (such as incarceration or becoming religious) that prompted active reflection on the gang life and contributed to their decision to desist. The participants’ narratives also focused on their agency in the desistance process, which included forming a purposive intention to change their lives, committing to and maintaining this change, in spite of challenges they faced (for example, a relapse into drugs), taking personal responsibility for their pasts and striving for more independence in the future. Importantly, it also involved actively drawing on protective resources (such as meaningful and practical support from loved ones and religious belief systems) and prosocial identities (for example, being a caring husband and father) available to them within their environments, thus illustrating how the desistance process is an interaction between inner and outer resources. Therefore, it is imperative that interventions that assist desisting gangsters are targeted not only on an individual level, but a contextual level too, ensuring that individuals have access to the kinds of resources in their environment that will support their desistance.
Open Access
Neuropsychiatric profile of a cohort of perinatally infected HIV positive children after one year of antiretroviral medication
(2012) Nassen, René; Joska, John; Ward, Catherine L
The Highly Active Antiretroviral Therapy (HAART) era in the mid-nineties signalled a dramatic change in the long-term outcome of Human Immunodeficiency Virus (HIV). Many children have shown significant neurologic benefit, and in particular, a decline in the incidence of HIV encephalopathy. As increasing numbers of children have survived into adolescence and early adulthood new challenges have arisen, such as the detection and characterization of milder forms of HIV-associated neurocognitive deficits in children previously thought to be asymptomatic...
Open Access
Predictors of Attendance and the Impact of Attendance on Outcomes for a Parenting Programme in Two Southeast Asian Countries
(2020) Janowski, Roselinde Katharina; Ward, Catherine L; Lachman, Jamie M
Background: Children living in low- and middle-income countries (LMICs) experience alarmingly high rates of maltreatment, frequently at the hands of caregivers. Group-based parenting programmes show promise for reducing and preventing child maltreatment, as well as for improving positive parenting, child behaviour problems, and caregiver mental health. However, parenting programmes can only benefit families if caregivers participate in them. Using secondary data, this study thus aimed to 1) identify factors that affect attendance and 2) investigate the impact of attendance on outcomes within two randomised controlled trials of Parenting for Lifelong Health (PLH) for Young Children for caregivers of children aged 2-9 years in Thailand (N = 120) and 2-6 years in the Philippines (N = 120). The interventions were delivered within existing service delivery systems in both countries, over eight weekly sessions (Thailand) or 12 sessions every second week (Philippines). Method: To address the first aim of this study, multivariable logistic regression models with robust sandwich estimators were used to examine family baseline characteristic as predictors of caregiver attendance in sessions. An exploratory approach was taken to test a range of factors that have previously been linked to attendance in parenting programmes, including economic and educational, social and health, parenting and child behaviour, and sociodemographic characteristics. To address the second aim, caregiver self-reports and observational assessments (Thailand only) from baseline, post-test, and follow-up were analysed using complier average causal effect (CACE) analyses to test the impact of attendance variability on the primary outcomes of child maltreatment, as well as secondary outcomes of positive parenting, dysfunctional parenting, child behaviour problems, and caregiver mental health. Results: Caregivers in Thailand attended 82.3% of sessions while those in the Philippines attended 61.8%. Overall, few baseline factors were significantly associated with attendance. In Thailand, caregivers who were less educated and those who were older were significantly more likely to attend sessions. In the Philippines, caregivers who were less healthy, those that who used more emotional abuse, and those who had boys rather than girls were significantly more likely to attend. Notably, caregivers who experienced higher rates of intimate partner violence significantly attended 8% fewer sessions in the Philippines. A comparison of CACE estimates to intention-to-treat estimates at post-test and at follow-up showed greater benefits of the intervention amongst caregivers who attended more sessions. Specifically, the strongest intervention effects were found for caregivers who attended at least 75% of the programme. Conclusion: This study showed no evidence that disadvantages related to lower socio-economic status were associated with attendance, suggesting that it is possible for vulnerable families in LMICs to attend parenting programmes. However, developing retention strategies that target subgroups who are at greater risk of missing sessions is especially important as higher attendance at sessions is positively related to greater improvements in caregiver and child outcomes.
Open Access
Prevalence of Depression and Its Relationship to Care Engagement among Men Living with HIV
(2022) Mwanga, Martha Oshosen; Ward, Catherine L
Background: The study was focused on the prevalence of depression among men living with HIV, who are in HIV care, and assessed the relationship between depression and care engagement. Several factors have been associated with care engagement among people living with HIV, including depression, but also lack disclosure due to stigmatization, poor social support, high pill burden, poor knowledge of ART, as well as young or old age. However, little is known about how these risk factors play out in men, as most of literature have been directed on women. Objectives: To understand the prevalence of depression in men living with HIV, attending Mawenzi Care and Treatment Clinic, and the effect of depression on care engagement. Method: A cross-sectional survey was conducted in the Mawenzi CTClinic, in Moshi, Kilimanjaro, Tanzania. Adult men living with HIV, 18 years and above, were invited to participate. A composite, continuous scale was developed to measure care engagement. At the clinic participants were asked about their medication adherence, their clinic cards were also checked for their viral load. Self-reported medication adherence and viral load were combined to form the outcome variable or as an indicator of patient care engagement. A total of 203 participants were enrolled in the study, with a mean age of 48 years. Results: The prevalence of depression among men living with HIV was 47.8 %: 35.0 % had mild symptoms, 8.9% moderate symptoms, and 3.9% severe symptoms. There was an indirect relationship between predictors: stigma was associated with depression and depression was associated with care engagement. Conclusion: HIV-related stigma and depression should not be underestimated because of their association with each other. Symptoms of depression need to be treated early, to reduce their effects on care engagement and hence disease progression.
Open Access
Prevention of child mental health problems through parenting interventions in Southeastern Europe (RISE): study protocol for a multi-site randomised controlled trial
(2021-12-27) Tăut, Diana; Băban, Adriana; Frantz, Inga; Dănilă, Ingrid; Lachman, Jamie M; Heinrichs, Nina; Ward, Catherine L; Gardner, Frances; Fang, Xiangming; Hutchings, Judy; Raleva, Marija; Lesco, Galina; Murphy, Hugh; Foran, Heather
Background Childhood adversities, such as poor parental practices, exposure to violence, and risk behaviours strongly impact children’s future mental and behavioural problems. Adversities affect families living in disadvantaged environments and low- and middle-income countries (LMICs) to a greater extent than in high-income countries. Parenting programmes are an effective way to alleviate them, although their outreach and scalability is still limited in LMICs. Methods/design A multi-site randomised controlled trial will be conducted in North Macedonia, Republic of Moldova and Romania to test the efficacy and cost-effectiveness of an optimised version of the promising Parenting for Lifelong Health Programme for Young Children (PLH-YC, 5 sessions), against a standard lecture on parenting issues (control group, 1 session). At least 864 participants who report having children between 2 and 9 years old who display elevated levels of behavioural difficulties will be randomised on a 1:1 basis to the intervention and control groups. The primary outcome will consist of parent report of child oppositional aggressive behaviour. Post-test (four months) and follow-up (12 months) assessments will provide information on short- and longer-term effects of PLH-YC compared to the parenting lecture in the control group. Discussion This randomised trial will test the efficacy of PLH-YC in alleviating child behavioural problems and assess the cost-effectiveness, transportability across three different cultural contexts, and potential for scalability of the programme. Trial registration ClinicalTrials.gov ., Registration number: NCT04721730 ( https://clinicaltrials.gov/ct2/show/NCT04721730 ). Registered 13.01.2021
Open Access
Psychotherapy with an adolescent girl in a mixed-race stepfamily in post-apartheid South Africa
(2011) Marks, Beulah; Ward, Catherine L
This thesis explored issues brought to therapy by a biracial stepfamily in post-apartheid South Africa. Since this is likely to become a more common family type, the thesis examined the literature on biracial stepfamilies , so as to reflect on the therapy and determine whether race and cultural differences were the most important cause of family dysfunction. While race and culture emerged as an important stressor, pathology in the family system was found to be crucial in the therapy. Considerations for counsellors are addressed and further South African research in this area is called for.
Open Access
Sexual violence against children in South Africa: A nationally representative cross-sectional study of prevalence and correlates
(The Lancet Global Health, 2018) Ward, Catherine L; Artz, Lillian; Leoschut, Lezanne; Kassanjee, Reshma; Burton, Patrick
Background We could identify no nationally representative South African studies of sexual violence against children. Methods A multistage sampling frame, stratified by province, urban/rural and race group, selected households. Within households, children aged 15-17 years were interviewed after obtaining parental consent. The final sample was 5,631 (94.6% participation rate). Findings 9.99% (95%CI 8.65-11.47) of boys and 14.61% (95%CI 12.83-16.56) of girls reported some lifetime sexual victimisation. Physical abuse, emotional abuse, neglect, family violence, and other victimisations, were all strongly associated with sexual victimisation. The following were associated with greater risk of sexual abuse (adjusted OR); school enrolment (OR 2.12; 95%CI 1.29-3.48); urban dwelling (OR 0.59; 95%CI 0.43-0.80); having a flush toilet (OR 1.43; 95%CI 1.04-1.96); having a substance-misusing parent ( OR 2.37; 95%CI 1.67-3.36); being disabled (OR 1.42; 95%CI 1.10-1.82); female but not male caregivers’ poorer knowledge of the child’s whereabouts, friends and activities (OR 1.07; 95%CI 0.75-1.53) and poorer quality of the relationship with the child (OR 1.20; 95%CI 0.55-2.60). Respondents’ own substance misuse (OR 4.72; 95%CI 3.73-5.98) and high-risk sexual behaviour (OR 3.71; 95%CI 2.99-4.61) were the behaviours most frequently associated with sexual abuse, with mental health conditions far less prevalent but nonetheless strongly associated with sexual victimisation (PTSD OR 2.81, 95%CI 1.65-4.78; depression OR 3.43, 95% CI 2.26-5.19; anxiety OR 2.48, 95%CI 1.61-3.81). Interpretation Sexual violence is widespread among both girls and boys, and is associated with serious health problems. Associated factors require multi-sectoral responses to prevent sexual violence or mitigate consequences.
Open Access
Spare the rod and save the child: Assessing the impact of parenting on child behaviour and mental health
(2015) Ward, Catherine L; Gould, Chandré; Kelly, Jane; Mauff, Katya
Parenting has a considerable impact on children’s behaviour and mental health. Improving child health and behaviour requires an understanding of the relationship between parenting practices; contexual factors such as parental mental health, intimate partner violence, substance abuse and poverty; and children’s behaviour. In this article the authors report the findings of a survey of parenting and child behaviour in a small rural South African community. The findings show that corporal punishment, the stress of parenting and parental mental health are significantly associated with both children’s internalising (depression and anxiety) and externalising (rulebreaking and aggression) symptoms. Intimate partner violence in the home was also associated with children’s externalising symptoms. These findings imply that parent support and training, and an increase in services to address intimate partner violence and mental health problems, should be prioritised as part of a national violence reduction strategy.
Open Access
Substance abuse and HIV risk behaviours amongst primary health care service users in Cape Town
(2005) Flisher, Alan J; Bresick, Graham F; Sterling, Stacy A; Bresick, Graham F; Sterling, Stacy A; Distiller, Greg B; Weisner, Constance M; Ward, Catherine L; Mertens, Jennifer R
Objective: To document prevalence of, and association between, substance use and HIV risk behaviours among primary care patients.Method: Cross-sectional survey. Four primary care clinics in Cape Town. We selected clinics using stratified sampling, and systematically selected 131 patients from attendance logs. We assessed substance use with the Alcohol, Smoking and Substance Involvement Screening Test, and HIV risk with items addressing injection drug use, blood-sharing rituals, and sexual risk behaviours. Results: Substances most used at hazardous levels were tobacco (28.2%) and alcohol (14.8%). Among possible HIV risk factors, highest prevalence was participation in blood-sharing rituals (25%), and having had an STI (19.8%). An association between substance use and sexual risk behaviours was only found among those aged 18-24. Conclusion: In younger patients, presence of substance use or HIV risk behaviours increases the probability that the other is present.
Open Access
The association between neighbourhood-level deprivation and depression: evidence from the south african national income dynamics study
(2017) Dowdall, Nicholas; Ward, Catherine L; Lund, Crick
BACKGROUND: Depression contributes substantially to the burden of disease in South Africa. Little is known about how neighbourhoods affect the mental health of the people living in them. METHODS: Using nationally representative data (N=11,955) from the South African National Income Dynamics Study and the South African Indices of Multiple Deprivation (SAIMD) modelled at small-area level, this study tested associations between neighbourhood-level deprivation and depression, after controlling for individual-level covariates. RESULTS: Results showed a significant positive association between neighbourhood-level deprivation and depression using the composite SAIMD (β = 0.31 (0.15); p=0.04) as well as the separate deprivation domains. Living environment deprivation (β =0.53 (0.16); p=0.001) and employment deprivation (β = 0.38 (0.13); p=0.004), respectively, were the two most salient domains in predicting this relationship. CONCLUSIONS: Findings supported the hypothesis that there is a positive association between living in a more deprived neighbourhood and depression, even after controlling for individual-level covariates. This study suggests that alleviating structural poverty could reduce the burden of depression in South Africa.