Browsing by Subject "Mental disorders"
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- ItemOpen AccessClosing the treatment gap for mental, neurological and substance use disorders by strengthening existing health care platforms: strategies for delivery and integration of evidence-based interventions(2015) Shidhaye, Rahul; Lund, Crick; Chisholm, DanThis paper outlines the main elements and features of a mental health care delivery platform and its delivery channels. These include evidence-based interventions that can be delivered via this platform as well as broader health system strengthening strategies for more effective and efficient delivery of services. The focus is broadly on health systems perspective rather than strictly disorder-oriented intervention analysis. A set of evidence-based interventions within the WHO pyramid framework of self-care, primary care, and specialist care have been identified; the main challenge lies in the translation of that evidence into practice. The delivery of these interventions requires an approach that puts into practice key principles of public health, adopts systems thinking, promotes whole-of-government involvement and is focused on quality improvement. Key strategies for effective translation of evidence into action include collaborative stepped care, strengthening human resources, and integrating mental health into general health care. In order to pursue these principles and strategies using a platform-wide approach, policy makers need to engage with a wide range of stakeholders and make use of the best available evidence in a transparent manner.
- ItemOpen AccessDomestic and intimate partner violence among pregnant women in a low resource setting in South Africa: a facility-based, mixed methods study(BioMed Central, 2018-07-04) Field, Sally; Onah, Michael; van Heyningen, Thandi; Honikman, SimoneBackground Rates of violence against women are reported to be highest in Africa compared to other continents. We aimed to determine associations between mental illness, demographic, psychosocial and economic factors with experience of intimate partner violence (IPV) among pregnant women in a low resource setting in Cape Town and to explore the contextual elements pertaining to domestic violence. Methods We recruited adult women attending antenatal services at a primary-level maternity facility. Demographic, socioeconomic and psychosocial data were collected by questionnaire. The Expanded Mini- International Neuropsychiatric Interview (MINI) Version 5.0.0 was used to assess mental health status and the Revised Conflict Tactic Scale (CTS2) used to assess IPV in the six months prior to the study. Non-parametric tests, Wilcoxon sum of rank test, Fisher Exact and two sample T test and multicollinearity tests were performed. Descriptive, bivariate and logistic regression analyses were conducted to identify associations between the outcome of interest and key predictors. A probability value of p ≤ 0.05 was selected. From counselling case notes, a thematic content analysis was conducted to describe contextual factors pertaining to forms of domestic violence (DV). Results The prevalence of IPV was 15% of a sample of 376 women. Women who were food insecure, unemployed, in stable but unmarried relationships, had experienced any form of past abuse and were not pleased about the current pregnancy were more likely to experience IPV. MINI-defined mental health problems and a history of mental illness were significantly associated with IPV. Qualitative analysis of 95 counselling case notes revealed that DV within the household was not limited to intimate partners and, DV in this context was often perceived as ‘normal’ behaviour by the participants. Conclusions This study contributes towards a greater understanding of the risk profile for IPV amongst pregnant women in low-income settings. Adversity, including food insecurity and mental ill-health are closely associated with IPV during the antenatal period. Advocates against violence against pregnant women are advised to consider that violence in the home may be perpetrated by non-intimate partners and may by enabled by a pervasive belief in the acceptability of the violence.
- ItemOpen AccessGenetic and epigenetic associations with child development and mental health in a South African birth cohort(2025) Moyakhe, Lihle; Koen, Nastassja; Stein, Dan; Dalvie, ShareefaChildhood developmental and mental disorders – including internalising and externalising symptoms – are prevalent in low- and middle-income countries (LMICs) such as South Africa. There is growing interest in the associations between polygenic risk scores (PRS), epigenetic age (EA) deviation, DNA methylation risk scores (MRS), and key neurodevelopmental disorders such as attention-deficit hyperactivity disorder (ADHD). However, most work has thus far been undertaken in high-income countries (HICs) with participants of European ancestry; and populations of African ancestry have been notably under-represented. The Drakenstein Child Health Study (DCHS), an ongoing South African birth cohort study, provides an opportunity to investigate the associations of PRS, EA deviation, and MRS, with childhood developmental and mental health outcomes, in an ancestrally diverse study population. This doctoral project aimed to investigate potential genetic and epigenetic associations with adverse developmental and mental outcomes in children. This aim was addressed via five objectives. First, a systematic review was undertaken to collate existing work (both in HICs and LMICs) on associations between PRS (the weighted sum of risk alleles) and developmental and mental health disorders in childhood and adolescence. A second systematic review focused on associations between EA deviation (relative to chronological age) and the outcomes of interest. Third, empirical analyses of DCHS data investigated the relationship between a PRS for ADHD, and child developmental outcomes, as well as internalising and externalising symptoms. Fourth, the relationship between gestational EA deviation at birth, and child developmental and mental health outcomes in the DCHS, was explored. Finally, the association between MRS (the weighted sum of methylation markers' beta values) at birth, and the outcomes of interest, was investigated. The systematic reviews adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, and standard methods were used to collate and analyse the data. In the DCHS, a PRS for ADHD was generated (target n=958) using summary statistics from the Early Genetics and Lifecourse Epidemiology (EAGLE) consortium (discovery n=17,666). Gestational EA deviation at birth and MRS were calculated using DCHS umbilical cord blood samples (n=275) and summary statistics from the Pregnancy and Childhood Epigenetics (PACE) consortium (n=2,477 for the MRS analyses). Child developmental outcomes (i.e. cognitive, language and motor development) were derived from the Bayley Scales of Infant and Toddler Development, 3rd edition (Bayley-III), and child mental health outcomes (i.e. internalising and externalising symptoms) from the Child Behaviour Checklist (CBCL). Associations of interest were investigated using bivariate and multivariable linear and logistic regression models, controlling for relevant covariates (including sociodemographic characteristics, psychosocial risk factors, child anthropometric measures and genomic principal components). In the first systematic review (of 14 studies, with ~50,000 participants), significant associations between PRS for several mental health disorders and adverse developmental/mental health outcomes were found. For example, a high ADHD PRS was found to be associated with adverse outcomes in childhood and adolescence in 5 of the 14 included studies. Additionally, 4 studies described associations between PRS for bipolar disorder and impaired cognitive function, and poor executive functioning, in children and adolescents; and 2 studies highlighted associations between schizophrenia PRS and ADHD, as well as internalising and externalising symptoms in children. In the second systematic review (of 4 studies with N~700 participants), gestational EA acceleration was found to be significantly associated with internalising symptoms in children. The empirical analyses yielded no significant genetic or epigenetic associations with the developmental or mental health outcomes of interest in the DCHS children. However, trend-level associations were observed - in both the unadjusted and the adjusted models - between gestational EA deviation at birth and child externalising symptoms (at 42 months) in the DCHS (unadjusted β = −0.19, p = 0.072; adjusted β = -0.17, p= 0.10). While limited by sample size and lack of ancestry-matched summary statistics, this work nonetheless represents a novel exploration of the potential genetic and epigenetic underpinnings of developmental and mental disorders in South African children. In future, further studies – ideally with larger sample sizes, ancestry-matched summary statistics and longitudinal developmental phenotype data – would be warranted to expand on this preliminary work. Ultimately, such research may provide insight into the genetic and epigenetic risk factors of developmental and mental health outcomes in children; and may inform targeted early interventions for at-risk children – particularly in resource-limited settings such as South Africa.
- ItemOpen AccessMaternal 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, MarkBackground: 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.
- ItemOpen AccessMoving towards universal health coverage for mental disorders in Ethiopia(BioMed Central, 2019-02-25) Hanlon, Charlotte; Alem, Atalay; Lund, Crick; Hailemariam, Damen; Assefa, Esubalew; Giorgis, Tedla W; Chisholm, DanBackground People with mental disorders in low-income countries are at risk of being left behind during efforts to expand universal health coverage. Aims To propose context-relevant strategies for moving towards universal health coverage for people with mental disorders in Ethiopia. Methods We conducted a situational analysis to inform a SWOT analysis of coverage of mental health services and financial risk protection, health system characteristics and the macroeconomic and fiscal environment. In-depth interviews were conducted with five national experts on health financing and equity and analysed using a thematic approach. Findings from the situation analysis and qualitative study were used to develop recommended strategies for adequate, fair and sustainable financing of mental health care in Ethiopia. Results Opportunities for improved financing of mental health care identified from the situation analysis included: a significant mental health burden with evidence from strong local epidemiological data; political commitment to address that burden; a health system with mechanisms for integrating mental health into primary care; and a favourable macro-fiscal environment for investment in human capabilities. Balanced against this were constraints of low current general government health expenditure, low numbers of mental health specialists, weak capacity to plan and implement mental health programmes and low population demand for mental health care. All key informants referred to the under-investment in mental health care in Ethiopia. Respondents emphasised opportunities afforded by positive rates of economic growth in the country and the expansion of community-based health insurance, as well as the need to ensure full implementation of existing task-sharing programmes for mental health care, integrate mental health into other priority programmes and strengthen advocacy to ensure mental health is given due attention. Conclusion Expansion of public health insurance, leveraging resources from high-priority SDG-related programmes and implementing existing plans to support task-shared mental health care are key steps towards universal health coverage for mental disorders in Ethiopia. However, external donors also need to deliver on commitments to include mental health within development funding. Future researchers and planners can apply this approach to other countries of sub-Saharan Africa and identify common strategies for sustainable and equitable financing of mental health care.
- ItemOpen AccessPrevalence and correlates of atypical patterns of drug use progression: findings from the South African Stress and Health Study(2011) Myers, B; van Heerden, M S; Grimsrud, A T; Myer, L; Williams, D R; Stein, D JAtypical sequences of drug use progression are thought to have important implications for the development of substance dependence. The extent to which this assumption holds for South African populations is unknown. This paper attempts to address this gap by examining the prevalence and correlates of atypical patterns of drug progression among South Africans. Method: Data on substance use and other mental health disorders from a nationally representative sample of 4351 South Africans were analysed. Weighted cross tabulations were used to estimate prevalence and correlates of atypical patterns of drug use progression. Results: Overall, 12.2% of the sample reported atypical patterns of drug use progression. The most common violation was the use of extra-medical drugs prior to alcohol and tobacco. Gender was significantly associated with atypical patterns of drug use with the risk pattern varying by the type of drug. None of the anxiety or mood disorders were associated with atypical patterns of use. Atypical patterns of drug use were not associated with increased risk for a lifetime substance use disorder. Conclusion: Atypical patterns of drug use initiation seem more prevalent in South Africa compared to other countries. The early use of extra-medical drugs is common, especially among young women. Drug availability and social environmental factors may influence patterns of drug use. The findings have important implications for prevention initiatives and future research.
- ItemOpen AccessPrevalence and sociodemographic correlates of common mental disorders among first-year university students in post-apartheid South Africa: implications for a public mental health approach to student wellness(2019-07-10) Bantjes, Jason; Lochner, Christine; Saal, Wylene; Roos, Janine; Taljaard, Lian; Page, Daniel; Auerbach, Randy P; Mortier, Philippe; Bruffaerts, Ronny; Kessler, Ronald C; Stein, Dan JAbstract Background There is growing awareness of the need for effective prevention, early detection, and novel treatment approaches for common mental disorders (CMDs) among university students. Reliable epidemiological data on prevalence and correlates are the cornerstones of planning and implementing effective health services and adopting a public health approach to student wellness. Yet, there is a comparative lack of sound psychiatric epidemiological studies on CMDs among university students in low- and middle-income countries, like South Africa (SA). It is also unclear if historically marginalised groups of students are at increased risk for mental health problems in post-apartheid SA. The objective of the study was to investigate the prevalence and sociodemographic correlates of lifetime and 12-month CMDs among university students in SA, with a particular focus on vulnerability among students in historically excluded and marginalised segments of the population. Methods Data were collected via self-report measures in an online survey of first-year students registered at two large universities (n = 1402). CMDs were assessed with previously-validated screening scales. Data were weighted and analysed using multivariate statistical methods. Results A total of 38.5% of respondents reported at least one lifetime CMD, the most common being major depressive disorder (24.7%). Twelve-month prevalence of any CMD was 31.5%, with generalised anxiety disorder being the most common (20.8%). The median age of onset for any disorder was 15 years. The median proportional annual persistence of any disorder was 80.0%. Female students, students who reported an atypical sexual orientation, and students with disabilities were at significantly higher risk of any lifetime or 12-month disorder. Female gender, atypical sexual orientation, and disability were associated with elevated risk of internalising disorders, whereas male gender, identifying as White, and reporting an atypical sexual orientation were associated with elevated risk of externalising disorders. Older age, atypical sexual orientation, and disability were associated with elevated risk of bipolar spectrum disorder. Conclusions Despite advances to promote greater social inclusion in post-apartheid SA, students who identify as female, students with atypical sexual orientations, and students with disabilities are nonetheless at increased risk of CMDs, although students who identify as Black and first-generation students are not.
- ItemRestrictedThe prevalence of mental disorders among children, adolescents and adults in the Western Cape, South Africa(AOSIS, 2006) Kleintjies, S; Flisher, A J; Fick, M; Railon, A; Lund, C; Molteno, C; Robertson, B AObjective: To provide estimates of the prevalence of selected mental disorders in the Western Cape, based on the consensus achieved by a working group established for this purpose. Method: An expert working group was established to provide technical expertise for the project. Potential risk factors likely to influence local prevalence rates were identified. Annual prevalence rates for adults and for children and adolescents were derived by consensus, informed by a systematic literature review. Prevalence rates were derived for individual disorders and adjusted for comorbidity. Results: The overall prevalence was 25.0% for adults and 17.0% for children and adolescents. Conclusion: Prevalence rates of child, adolescent and adult mental disorders were derived in a short period of time and with the use of minimal resources. Although of unknown validity, they are useful for policy development and for planning service utilisation estimates, resource costing and targets for service development for local mental health needs. This in the absence of an existing methodologically sound national prevalence study. We recommend that policy and programme developers draw on the expertise of local academics and clinicians to promote research-informed planning and policy development in the public sector.
- ItemOpen AccessPrevalences of mental health disorders among low- and lower middle-income countries' children and adolescents exposed to extreme weather events: a systematic review and meta-analysis(2025) Choi, Munkyung Elizabeth; Rother, Andrea; Engel, MarkBackground: Research concerning the disproportionate health consequences of climate change is still unexplored, specifically in one of the most vulnerable populations: children and adolescents living in low- and lower middle-income countries (LLMICs). At present, there is a gap in current literature on how prevalent LLMIC youth mental health burdens are following climate-induced extreme weather events (EWEs). This systematic review serves to uncover these mental health burdens in response to the EWEs projected to intensify in the near future. Methods: The Context Condition Population (CoCoPop) framework for prevalence studies was used to identify eligible studies. Mental health disorders were the condition of interest, in the context of LLMICs under the population of children and adolescents (1 to 19 years of age) who had experienced at least one EWE. MEDLINE via PubMed, PsychINFO, Web of Science Core Collection, Scopus, and CINAHL were databases retrieved using the search strategy. All searches were done in June 2024. Two researchers screened and three extracted the data. Meta-analyses were conducted using R (4.2.3). Results: Twenty-seven studies met the eligibility criteria with a total sample population of 14239 participants. The most prevalently reported mental health disorders identified were anxiety (32.7% 95% CI: 7.1-65.6), depression (33.2% 95% CI: 17.0-51.8), and post-traumatic stress disorder (PTSD) (50.4% 95% CI: 36.7-64.1). Heterogeneity as high in all groups (I² = >90%). Subgroup analyses were conducted, grouped by type of EWE, age, region, time-point measured, and measurement tool standardization. Conclusions: This review provides critical insights into the mental health burdens LLMIC youth face after experiencing EWEs. Anxiety, depression, and PTSD are commonly found prevalent, influenced by factors such as the type of EWE, age, region, different time points measured, and measurement tools' standardization. The high heterogeneity observed across studies highlights the challenges in standardizing mental health measurements, especially in LLMIC settings. Influential factors must be considered to fully comprehend and address the complexities of the vulnerable group's mental health states. LLMIC stakeholders must not only acknowledge mental health disorder repercussions from EWE exposures but also translate such evidence into palpable interventions.