Browsing by Subject "Mental Health"

Now showing 1 - 15 of 15
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    Characteristics of domestic homicide perpetrated by persons with severe mental illness - a forensic psychiatry observation population-based study
    (2017) Bruwer, Marise; Kaliski, Sean
    Background: Domestic homicide (killing of a person aged 16 or older by a family member or a current or former partner) accounts for 50% - 70% of homicides perpetrated by offenders with mental illness. Despite these statistics, surprisingly little is currently known about the characteristics of domestic homicides perpetrated by those with severe mental illness. To the best of our knowledge, domestic homicide in the context of severe mental illness has not been researched in South Africa. Objective: To investigate domestic homicides by offenders with severe mental illness referred to the Forensic Mental Health Service at Valkenberg Hospital for forensic psychiatric observation. Methods: A five-year retrospective folder review was conducted to obtain data on the characteristics of offenders and victims, as well as the circumstances surrounding the homicide. Results: The majority of the offenders in our sample were young (mean age of 31), single, unemployed males who were known to mental health care services. Substance use disorders and non-adherence to medication were common. Psychotic disorders were the most prevalent diagnoses. The majority of victims were male and a significant minority of the domestic homicides were parricides (28.6%). The incident took place at the victim's residence or the victim and perpetrator's shared residence in most cases. Stabbing was the most common method used. Almost half of the perpetrators were psychotic when the incident took place and 60% of these were first episode psychoses. In spite of the high prevalence of substance use disorders (66.7%), only 23.8% of the sample reported that they were intoxicated when they committed the offence. Conclusions: The majority of our sample was known to mental health care services. This implies that there were potential missed opportunities to prevent these lethal assaults. Our research identified treatment adherence, comorbid substance use disorders and aggressive treatment of first episode psychosis as a possible focus of future interventions in order to prevent domestic homicides due to mental illness.
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    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.
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    Fat Mass and Obesity-Associated (FTO) Gene Polymorphisms Are Associated with Physical Activity, Food Intake, Eating Behaviors, Psychological Health, and Modeled Change in Body Mass Index in Overweight/Obese Caucasian Adults
    (2014) Harbron, Janetta; van der Merwe, Lize; Zaahl, Monique; Kotze, Maritha; Senekal, Marjanne
    The fat mass and obesity-associated (FTO) gene is currently recognized as the most robust predictor of polygenic obesity. We investigated associations between the FTO rs1421085 and rs17817449 polymorphisms and the FTO rs1421085–rs17817449 haplotype and dietary intake, eating behavior, physical activity, and psychological health, as well as the effect of these associations on BMI. N = 133 treatment seeking overweight/obese Caucasian adults participated in this study. Genotyping was performed from whole blood samples. Weight and height was measured and a non-quantified food frequency questionnaire was completed to assess food group intake. Validated questionnaires were completed to assess physical activity (Baecke questionnaire), psychological health (General Health questionnaire, Rosenburg self-esteem scale and Beck Depression Inventory), and eating behavior (Three Factor Eating questionnaire). The risk alleles of the FTO polymorphisms were associated with poorer eating behaviors (higher hunger, internal locus for hunger, and emotional disinhibition scores), a higher intake of high fat foods and refined starches and more depressive symptoms. The modeled results indicate that interactions between the FTO polymorphisms or haplotypes and eating behavior, psychological health, and physical activity levels may be associated with BMI. The clinical significance of these results for implementation as part of weight management interventions needs further investigation.
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    Health systems context(s) for integrating mental health into primary health care in six Emerald countries: a situation analysis
    (2017) Mugisha, James; Abdulmalik, Jibril; Hanlon, Charlotte; Petersen, Inge; Lund, Crick; Upadhaya, Nawaraj; Ahuja, Shalini; Shidhaye, Rahul; Mntambo, Ntokozo; Alem, Atalay; Gureje, Oye; Kigozi, Fred
    Abstract Background Mental, neurological and substance use disorders contribute to a significant proportion of the world’s disease burden, including in low and middle income countries (LMICs). In this study, we focused on the health systems required to support integration of mental health into primary health care (PHC) in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda. Methods A checklist guided by the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) was developed and was used for data collection in each of the six countries participating in the Emerging mental health systems in low and middle-income countries (Emerald) research consortium. The documents reviewed were from the following domains: mental health legislation, health policies/plans and relevant country health programs. Data were analyzed using thematic content analysis. Results Three of the study countries (Ethiopia, Nepal, Nigeria, and Uganda) were working towards developing mental health legislation. South Africa and India were ahead of other countries, having enacted recent Mental Health Care Act in 2004 and 2016, respectively. Among all the 6 study countries, only Nepal, Nigeria and South Africa had a standalone mental health policy. However, other countries had related health policies where mental health was mentioned. The lack of fully fledged policies is likely to limit opportunities for resource mobilization for the mental health sector and efforts to integrate mental health into PHC. Most countries were found to be allocating inadequate budgets from the health budget for mental health, with South Africa (5%) and Nepal (0.17%) were the countries with the highest and lowest proportions of health budgets spent on mental health, respectively. Other vital resources that support integration such as human resources and health facilities for mental health services were found to be in adequate in all the study countries. Monitoring and evaluation systems to support the integration of mental health into PHC in all the study countries were also inadequate. Conclusion Integration of mental health into PHC will require addressing the resource limitations that have been identified in this study. There is a need for up to date mental health legislation and policies to engender commitment in allocating resources to mental health services.
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    Integrating mental health into primary health care in Zambia: a care provider's perspective
    (BioMed Central Ltd, 2010) Mwape, Lonia; Sikwese, Alice; Kapungwe, Augustus; Mwanza, Jason; Flisher, Alan; Lund, Crick; Cooper, Sara
    BACKGROUND:Despite the 1991 reforms of the health system in Zambia, mental health is still given low priority. This is evident from the fragmented manner in which mental health services are provided in the country and the limited budget allocations, with mental health services receiving 0.4% of the total health budget. Most of the mental health services provided are curative in nature and based in tertiary health institutions. At primary health care level, there is either absence of, or fragmented health services.AIMS:The aim of this paper was to explore health providers' views about mental health integration into primary health care. METHODS: A mixed methods, structured survey was conducted of 111 health service providers in primary health care centres, drawn from one urban setting (Lusaka) and one rural setting (Mumbwa). RESULTS: There is strong support for integrating mental health into primary health care from care providers, as a way of facilitating early detection and intervention for mental health problems. Participants believed that this would contribute to the reduction of stigma and the promotion of human rights for people with mental health problems. However, health providers felt they require basic training in order to enhance their knowledge and skills in providing health care to people with mental health problems.RECOMMENDATIONS:It is recommended that health care providers should be provided with basic training in mental health in order to enhance their knowledge and skills to enable them provide mental health care to patients seeking help at primary health care level. CONCLUSION: Integrating mental health services into primary health care is critical to improving and promoting the mental health of the population in Zambia.
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    Mental Health Stigma: What is being done to raise awareness and reduce stigma in south Africa?
    (2010) Kakuma, Ritsuko; Kleintjies, Sharon Rose; Lund, C; Drew, N; Green, A
    Objective: Stigma plays a major role in the persistent suffering, disability and economic loss associated with mental illnesses. There is an urgent need to find effective strategies to increase awareness about mental illnesses and reduce stigma and discrimination. This study surveys the existing anti-stigma programmes in South Africa. Method: The World Health Organization’s Assessment Instrument for Mental Health Systems Version 2.2 and semi-structured interviews were used to collect data on mental health education programmes in South Africa. Results: Numerous anti-stigma campaigns are in place in both government and non-government organizations across the country. All nine provinces have had public campaigns between 2000 and 2005, targeting various groups such as the general public, youth, different ethnic groups, health care professionals, teachers and politicians. Some schools are setting up education and prevention programmes and various forms of media and art are being utilized to educate and discourage stigma and discrimination. Mental health care users are increasingly getting involved through media and talks in a wide range of settings. Yet very few of such activities are systematically evaluated for the effectiveness and very few are being published in peer-review journals or in reports where experiences and lessons can be shared and potentially applied elsewhere. Conclusion: A pool of evidence for anti-stigma and awareness-raising strategies currently exists that could potentially make a scientific contribution and inform policy in South Africa as well as in other countries.
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    Perinatal mental health care in a rural African district, Uganda: a qualitative study of barriers, facilitators and needs
    (2016) Nakku, Juliet E M; Okello, Elialilia S; Kizza, Dorothy; Honikman, Simone; Ssebunnya, Joshua; Ndyanabangi, Sheila; Hanlon, Charlotte; Kigozi, Fred
    Abstract Background Perinatal mental illness is a common and important public health problem, especially in low and middle-income countries (LMICs). This study aims to explore the barriers and facilitators, as well as perceptions about the feasibility and acceptability of plans to deliver perinatal mental health care in primary care settings in a low income, rural district in Uganda. Methods Six focus group discussions comprising separate groups of pregnant and postpartum women and village health teams as well as eight key informant interviews were conducted in the local language using a topic guide. Transcribed data were translated into English, analyzed, and coded. Key themes were identified using a thematic analysis approach. Results Participants perceived that there was an important unmet need for perinatal mental health care in the district. There was evidence of significant gaps in knowledge about mental health problems as well as negative attitudes amongst mothers and health care providers towards sufferers. Poverty and inability to afford transport to services, poor partner support and stigma were thought to add to the difficulties of perinatal women accessing care. There was an awareness of the need for interventions to respond to this neglected public health problem and a willingness of both community- and facility-based health care providers to provide care for mothers with mental health problems if equipped to do so by adequate training. Conclusion This study highlights the acceptability and relevance of perinatal mental health care in a rural, low-income country community. It also underscores some of the key barriers and potential facilitators to delivery of such care in primary care settings. The results of this study have implications for mental health service planning and development for perinatal populations in Uganda and will be useful in informing the development of integrated maternal mental health care in this rural district and in similar settings in other low and middle income countries.
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    Perinatal psychological distress in the South African context: The road to task shifting evidence based interventions
    (2017) Spedding, Maxine F; Sorsdahl, Katherine R; Stein, Dan J; Naledi, Tracey
    Inadequate public health resources coupled with a chronically overburdened health system leave a large proportion of South Africans unable to access mental health care. Low-income pregnant women with common mental disorders (CMDs) are arguably more vulnerable to falling through the treatment gap, given the low rates of detection during pregnancy and the numerous additional barriers to care. The direct and indirect financial and personal costs associated with perinatal mental illness are substantial, while the high prevalence rates of perinatal CMDs make this an area in need of urgent attention. Integrating task shifting approaches into perinatal primary health care services is a promising solution. The first chapter introduces the thesis, providing context to the studies that are presented in later chapters and an overview of the research questions that informed them. The second chapter constitutes a systematic review of the literature relevant to the studies. Chapters 3 to 6 report on the findings of the studies, briefly described in the abstract below. The prevalence and risk factors associated with perinatal psychological distress - a plausible precursor for common mental disorders (CMDs) - are not widely understood in under-resourced settings. The first study (Chapter 3) investigates the prevalence and predictors of psychological distress in the antenatal period. Data were collected from 664 pregnant women who reported for antenatal care to any one of 11 Midwife and Obstetric Units (MOU) across the greater Cape Town area. Psychological distress was measured using the Symptom Response Questionnaire (SRQ-20; cut-off value of 7/8), while data pertaining to risk factors were collected via a demographic questionnaire, the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the Multidimensional Scale of Perceived Social Support (MSPSS). The prevalence of antenatal psychological distress was 38.6%. Risk factors included low socio-economic status (SES) (OR = 1.45, 95% CI: 1.24-1.68); recent physical abuse and/or rape (OR = 1.94, 95% CI: 1.57-2.40); complications during a previous delivery (OR = 1.18, 95% CI: 1.01-1.38); having given birth before (OR = 1.61, 95% CI: 1.21-2.14). The high prevalence rate of psychological distress is consistent with those found in other South African studies of perinatal CMDs. Appropriate, context-specific, and effective interventions are better served by investigating a broader range of symptoms associated with perinatal CMDs in these settings. The second study (Chapter 4) examines the mental health literacy (MHL) of pregnant women, including their perceptions of the causes of mental illness during pregnancy and best treatment approaches. Understanding the factors that represent barriers to accessing care is important to the development of accessible interventions. Globally, low levels of mental health literacy have often been identified as one such treatment barrier. However, little is known about how pregnant women perceive and understand mental illness during this time, particularly in South Africa. A convenience sample of 262 pregnant women attending routine antenatal appointments at a Midwife and Obstetrics Unit (MOU) were recruited to participate in the study. Participants were presented with one of five possible vignettes, depicting a woman with perinatal mental illness, as defined by the DSM 5, including ante- and postnatal depression, panic disorder, substance dependence and schizophrenia. Participants were then asked to provide a diagnosis and completed two scales assessing aspects of mental health literacy. The results from this study showed that more than three quarters of respondents (77.4%) did not identify the signs and symptoms described in the vignettes as those consistent with mental illness. More than half of all participants (57.5%) were of the view that all the disorders depicted were "typical of a weak character", while stress was the most widely held explanation for symptoms of all disorders. Participants were most confident in the therapeutic potential of psychological services, especially consulting with a counsellor or social worker. These were closely followed by lifestyle and self-help options as the most endorsed means to addressing psychiatric symptoms during pregnancy. Notably, seeking help from a spiritual or religious advisor was comparably as popular among participants as seeking help from a psychologist or social worker. Given the elevated prevalence of perinatal mental illness, these findings are cause for concern. Developing socio-culturally nuanced understandings of how perinatal mental illness is perceived should be emphasized as central to the development of successful interventions. The third study (Chapters 5 and 6) investigates the feasibility and acceptability of, as well as the preliminary responses to an adapted Problem Solving Therapy (PST) intervention to treat psychological distress. Given the large treatment gap that exists in public mental health, support for task shifting evidence based mental health treatments is growing. However, the gaps in our knowledge are threefold. First, most research has used lay counsellors to deliver interventions. No research has used Registered Counsellors (RC) to conduct interventions. Second, very little is known about the potential outcomes of task shifting an adapted PST intervention to reduce symptoms of psychological distress. Third, data regarding the feasibility and acceptability of such interventions in South African Midwife and Obstetric Units (MOUs) is very limited. Results from the study are presented in two chapters. Chapter 5 focuses on the intervention participants. Thirty-eight women who screened positive for high CMD symptoms on the Edinburgh Postnatal Depression Scale (EPDS) at their first antenatal visit were recruited to participate in the intervention. Of these, 22 completed the preand post-intervention interviews. Using mixed methods, preliminary responses to the threesession PST intervention, as well as participants' perceptions of the intervention's feasibility and acceptability were explored. Primary outcomes included psychological distress as measured by the Symptom Response Questionnaire (SRQ-20) and CMD symptoms, as measured by the EPDS. A short semi-structured post-intervention interview was also conducted approximately three months after each participant's last session. On the primary outcome measures, significant reductions were seen on EPDS scores (z = -3.0, p < 0.01) as well as the SRQ-20 scores (z = -3.5, p = <0.01). Several significant reductions were also seen on secondary outcomes. Reductions in impairment to functioning were also noted, with all three Sheehan disability scales reflecting less disruption to work (z = -2.3, p = 0.02), social life (z = -3.3, p < 0.01), as well as family and home responsibilities (z = -2.5, p = 0.01). Perceived Stress Scale scores were also significantly reduced (z = -3.4, p < 0.01). Significant changes were seen on two problem-solving styles, with reduced 'negative problem orientation' scores (z = -3.1, p < 0.01) and 'avoidant style' scores (z = -3.0, p < 0.01) Participants felt that the intervention was feasible and acceptable. The intervention's acceptability lay primarily in the opportunity for participants to talk confidentially to a non-judgmental and empathic person about their problems. The intervention materials seemed to serve as an extension of the therapeutic process. Factors that were identified by participants as representing potential barriers to the intervention included lack of transport or money, work commitments and stigma. Chapter 6 explores the intervention's feasibility and acceptability from the perspectives of 6 stakeholders who were involved with the project. Semi-structured interviews were conducted with each stakeholder. Data from the interviews showed that the stakeholders felt that the intervention was helpful to patients and a valuable resource for the facility to have. Some expressed concern about how stigma associated with mental illness might be a barrier to patients who need mental health care. To the staff, the project's value seemed to lie primarily in the support it provided in managing emotionally distressed patients. Having a resource to refer patients to appeared to provide overburdened staff with some relief. None of the stakeholders reported that the screening and referral procedures added to their workload. Some stakeholders felt detection of psychological problems among patients was compromised without mental health screening. Staff felt that a walk-in counselling service would serve to improve future interventions. Limitations to the first study included its cross-sectional design and use of a screening tool to measure the prevalence of psychological distress. The second study was limited by the employment of vignettes to collect data. While they are useful tools to elicit population-specific responses, their adaption for those purposes means that they are not standardised. The study was further limited by the use of a convenience sample. Finally, the third study was limited by a small sample size owing to low retention rates. However, low retention rates are not uncommon among antenatal and low-income populations, where structural barriers to accessing care are often more pronounced. The lack of a comparison group was an additional limitation. In conclusion, data from this study support task shifting evidence based treatments to Registered Counsellors to treat the highly prevalent antenatal psychological distress. Difficulties distinguishing CMD symptoms from normal pregnancy experiences may influence the uptake of counselling services and represent a barrier to care. Improving mental health literacy may be a necessary supplement to future interventions. Future research should focus on evaluating real-world models of integrated mental health in primary care settings. How psycho-education programmes might impact upon the uptake of services at antenatal care facilities will also contribute to broadening our knowledge of developing effective and appropriate interventions.
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    Poverty, AIDS and child health: Identifying highest-risk children in South Africa
    (2013) Cluver, Lucie; Boyes, Mark; Orkin, Mark; Sherr, Lorraine
    BACKGROUND: Identifying children at the highest risk of negative health effects is a prerequisite to effective public health policies in Southern Africa. A central ongoing debate is whether poverty, orphanhood or parental AIDS most reliably indicates child health risks. Attempts to address this key question have been constrained by a lack of data allowing distinction of AIDS-specific parental death or morbidity from other causes of orphanhood and chronic illness. OBJECTIVES: To examine whether household poverty, orphanhood and parental illness (by AIDS or other causes) independently or interactively predict child health, developmental and HIV-infection risks. METHODS: We interviewed 6 002 children aged 10 - 17 years in 2009 - 2011, using stratified random sampling in six urban and rural sites across three South African provinces. Outcomes were child mental health risks, educational risks and HIV-infection risks. Regression models that controlled for socio-demographic co-factors tested potential impacts and interactions of poverty, AIDS-specific and other orphanhood and parental illness status. RESULTS: Household poverty independently predicted child mental health and educational risks, AIDS orphanhood independently predicted mental health risks and parental AIDS illness independently predicted mental health, educational and HIV-infection risks. Interaction effects of poverty with AIDS orphanhood and parental AIDS illness were found across all outcomes. No effects, or interactions with poverty, were shown by AIDS-unrelated orphanhood or parental illness. CONCLUSIONS: The identification of children at highest risk requires recognition and measurement of both poverty and parental AIDS. This study shows negative impacts of poverty and AIDS-specific vulnerabilities distinct from orphanhood and adult illness more generally. Additionally, effects of interaction between family AIDS and poverty suggest that, where these co-exist, children are at highest risk of all.
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    The prevalence of and factors associated with antipsychotic polypharmacy in patients with serious mental illness: Findings from a cross-sectional study in a low-middle income country
    (2017) Armstrong, Kerryn; Temmingh, Henk
    Rationale: Antipsychotic polypharmacy (APP) appears to be a common practice worldwide despite treatment guidelines advising against the practice for most patients in view of lack of evidence and possible risk of harm. Our study aimed to address deficiencies in local and international research by examining the current prevalence of APP in a South African context and investigating a broad range of patient, illness and treatment characteristics that may be associated with the practice. In doing so, we aimed to provide an indication of possible areas to be addressed in order to improve local mental health care practice. Methods: We conducted a cross-sectional study of discharge records using Valkenberg Hospital's electronic patient database. We collected data on patient, illness and treatment characteristics for patients discharged on one or more antipsychotic agent from January to June 2014. Hierarchical multivariable logistic regression analysis was conducted to assess the relationship between APP and demographic and clinical variables and prescription patterns were analysed. Results: Discharge records of 565 patients were examined. The prevalence of APP in our study population was 29.03% (95% CI= 25.31%-32.96%). Analysis of demographic and clinical characteristics revealed that age>29, male sex, diagnosis of schizophrenia compared to bipolar and substance-induced disorders, co-morbid intellectual disability, co-morbid substance use, greater number of hospital admissions and high-dose prescribing were significantly associated with APP. While highest rates of APP in patients with schizophrenia and schizoaffective disorders occurred, APP was also observed in a number of patients with bipolar and substance-induced disorders. Prescription patterns demonstrated the prominent use of first-generation antipsychotics and long acting injectables in APP combinations. Patients receiving APP were significantly more likely to have anticholinergic agents and sodium valproate co-prescribed in their treatment regimen. Discussion: The prevalence of APP found in our study is fairly high in comparison with international rates. Antipsychotic prescription patterns reflect a complex interplay among patient, illness and treatment characteristics of our population. Our findings indicate that patients receiving APP may be those with greater illness severity, complexity, chronicity and treatment resistance, with complicating factors including co-morbid substance use involved. While APP is most common in patients with schizophrenia, antipsychotics may also be used in combination to manage mood and psychotic symptoms in patients with schizoaffective, bipolar and substance-induced disorders. The frequent use of long acting injectables in combinations may suggest concern over compliance in our population. The positive associations of APP with high-dose prescribing and co-prescription of anticholinergic medication contributes to concern over the safety of APP. Conclusion Our study suggests concern over current local practice in that combination antipsychotic agents were prescribed for a number of patients with a range of psychiatric diagnoses without sufficient evidence for efficacy of this practice and at possible cost of increased adverse effects. Additional research is needed examining the practice of APP across diagnoses, focusing on the multiple aspects affecting local practice and various contributing factors that could be targeted for intervention. This would be a positive step towards improving the quality of our service and providing optimal patient management in a resource-limited setting.
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    Psychiatric morbidity and readiness for change : a study of methamphetamine dependent subjects in Cape Town
    (2011) Akindipe, Taiwo; Stein, Dan J; Wilson, Don
    Methamphetamine users may suffer from a range of co-morbid psychiatric disorders. Predictors of treatment outcome in substance dependence may include both such co-morbidity and readiness for change. The nature of the relationship between psychiatric co-morbidity and readiness for change has not been systematically studied. Therefore, this study aimed to assess the prevalence and patterns of psychiatric disorders in individuals dependent on methamphetamine; determine whether there is a relationship between such co-morbidity and readiness for change; and identify factors associated with readiness for change in this group.
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    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.
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    Stakeholder perceptions of mental health stigma and poverty in Uganda
    (BioMed Central Ltd, 2009) Ssebunnya, Joshua; Kigozi, Fred; Lund, Crick; Kizza, Dorothy; Okello, Elialilia
    BACKGROUND:World wide, there is plentiful evidence regarding the role of stigma in mental illness, as well as the association between poverty and mental illness. The experiences of stigma catalyzed by poverty revolve around experiences of devaluation, exclusion, and disadvantage. Although the relationship between poverty, stigma and mental illness has been documented in high income countries, little has been written on this relationship in low and middle income countries.The paper describes the opinions of a range of mental health stakeholders regarding poverty, stigma, mental illness and their relationship in the Ugandan context, as part of a wider study, aimed at exploring policy interventions required to address the vicious cycle of mental ill-health and poverty. METHODS: Semi-structured interviews and focus group discussions (FGDs) were conducted with purposefully selected mental health stakeholders from various sectors. The interviews and FGDs were audio-recorded, and transcriptions were coded on the basis of a pre-determined coding frame. Thematic analysis of the data was conducted using NVivo7, adopting a framework analysis approach. RESULTS: Most participants identified a reciprocal relationship between poverty and mental illness. The stigma attached to mental illness was perceived as a common phenomenon, mostly associated with local belief systems regarding the causes of mental illness. Stigma associated with both poverty and mental illness serves to reinforce the vicious cycle of poverty and mental ill-health. Most participants emphasized a relationship between poverty and internalized stigma among people with mental illness in Uganda. CONCLUSION: According to a range of mental health stakeholders in Uganda, there is a strong interrelationship between poverty, stigma and mental illness. These findings re-affirm the need to recognize material resources as a central element in the fight against stigma of mental illness, and the importance of stigma reduction programmes in protecting the mentally ill from social isolation, particularly in conditions of poverty.
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    The Impact of Extreme Weather Events on Mental Health in Africa: A Mixed-Methods Systematic Review
    (2022) Deglon, Michaele; Dalvie, Mohamed Aqiel; Abrams, Amber
    Introduction: The psychosocial impacts of extreme weather events are contributing to the burden of mental illness, exacerbated by pre-existing vulnerabilities. Despite an emerging global interest in this association, Africa remains poorly represented in the literature. Methods: A mixed-methods systematic review of peer-reviewed studies was conducted to determine the adverse mental health outcomes associated with extreme weather events in Africa (2008-2021). The review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Results: A total of 12 204 peer-reviewed articles were identified of which 12 were retained for analysis. These studies were all conducted in 8 countries in Sub-Saharan Africa. Adverse mental health outcomes were identified resulting from flood (n=4), drought (n=4), extreme heat (n=1), bushfire (n=1), and multiple events (n=2). Findings included pathological outcomes with predictable symptomatology including mood disorders; trauma- and stressor-related disorders; and suicide. Additionally, conditions indicating psychological distress which were below the pathological threshold including emotion regulation difficulties, disturbed sleep, alcohol use, stress, and anxiety. The quantitative evidence for the association between extreme weather events and mental health was limited primarily by a lack of longitudinal data, exposure gradient, and comparison to an unaffected group, as well as a failure to provide an objective exposure measure. The qualitative evidence for this association was complimentary but without sufficient clinical measurement these outcomes cannot be verified as psychological morbidities. In addition, this review provided insight into the mental health of vulnerable communities affected by extreme weather events including those living in poverty, farmers, pastoralists, women, and children. Conclusion: This review provided some preliminary evidence for the association between extreme weather events and adverse mental health outcomes for populations in Africa. The review also provides insight to vulnerable populations affected by extreme weather events. Future research with stronger designs and methodologies are recommended.
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    The views of healthcare providers on providing a brief treatment to address methamphetamine use among patients with a dual diagnosis
    (2020) Dannatt, Lisa; Sorsdahl, Katherine; Stein, Dan
    BACKGROUND: Methamphetamine (MA) use disorder in individuals with severe mental disorders (SMDs) has significant impact on clinical presentation and care. Although treatments exist, these are met by significant challenges. Notably, brief treatments for MA use within the general population have been feasible, acceptable and effective. An individualized, integrated treatment for MA use within a psychiatric inpatient setting would allow adjustment of the treatment according to individual patient needs. It is important to understand the patient needs and potential service barriers to care before formulating a treatment. This study begins to address this gap by seeking to understand the views of healthcare providers on a brief treatment to address MA use among patients with a dual diagnosis. METHODS: Thirteen key stakeholders working with patients with mental disorders including severe mental disorders and co morbid MA use were interviewed using an open-ended semi- structured interview schedule designed to explore their views on a brief treatment for MA use among patients with a dual diagnosis. Interviews were transcribed and the framework approach was used to conduct data analysis. RESULTS: Numerous themes emerged from the data. First, there are multiple risk factors for MA use. Second, this use has a significant impact on multiple aspects of patient presentation and care including individual impacts, family impacts, and impact on care. Third, although treatments for MA use disorders exist, these have significant challenges at multiple levels. Lastly, the integration of a modified brief treatment for MA use in patients with dual diagnosis would be possible if it was adjusted to patient-specific needs within the existing system and if the team adapting the treatment were cognizant of existing and potential challenges. CONCLUSIONS: The adaptation and integration of a brief treatment for MA use among patients with severe mental disorders was considered possible and even necessary if existing and potential challenges were carefully addressed.