OpenUCT :: Browsing by Subject "Mental health"

Browsing by Subject "Mental health"

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Open Access
A situational analysis of child and adolescent mental health services and systems in the Western Cape Province of South Africa
(BioMed Central, 2022-01-25) Mokitimi, Stella; Schneider, Marguerite; de Vries, Petrus J
Background Even though child and adolescent mental health is a global health priority, services are very limited, particularly in low- and middle-income countries (LMIC), and therefore need comprehensive strengthening. This requires knowledge of the hardware elements of the system (human resources, financing, medicines, technology, organisational structure, service infrastructure, and information systems). This study sought to examine these elements of child and adolescent mental health (CAMH) services and systems in the Western Cape Province of South Africa. Methods The World Health Organization Assessment Instrument of Mental Health Systems (WHO-AIMS) version 2.2 of 2005 was adapted to identify key variables of interest in CAMH. Data were collected for the calendar year 2016 and focused on the public health sector. We outlined findings based on best available data across the six domains of the WHO-AIMS. Results In domain 1, we found no provincial CAMH policy or implementation plans to support the national CAMH policy and were unable to identify a CAMH-specific budget. In domain 2, there was no dedicated provincial leadership structure for CAMH, and no dedicated or ‘child- and adolescent-friendly’ mental health services at primary or secondary care levels. At tertiary level, there were only three specialist CAMH teams. The majority of CAMH resources were based in the City of Cape Town, with limited resources in the rural districts. Essential medicines were available in all facilities, and the majority of children and adolescents had access to free services. In domain 3, data were limited about the extent of training offered to primary healthcare staff, and little or no psychosocial interventions were available in primary care. Domain 4 identified a small and variable CAMH workforce across all levels of care. In domain 5, few public health campaigns focused on CAMH, and little evidence of formal intersectoral collaboration on CAMH was identified. Domain 6 identified significant limitations in health information systems for CAMH, including lack of child- and adolescent-specific and disaggregated data to establish baselines for policy development, monitoring, evaluation and CAMH research. Conclusions This study identified significant structural weaknesses in CAMH and presents a clear call for action to strengthen services and systems in the province and in South Africa. it would be important to expand research also to include provider and user perspectives for service strengthening.
Open Access
A situational analysis of child and adolescent mental health services in Ghana Uganda South Africa and Zambia
(2010) Kleintjies, Sharon Rose; Lund, Christopher; Flisher, A J; MHaPP Research Programme Consortium
Objective: Approximately one in five children and adolescents (CA) suffer from mental disorders. This paper reports on the findings of a situational analysis of CA mental health policy and services in Ghana, Uganda, South Africa and Zambia. The findings are part of a 5 year study, the Mental Health and Poverty Project, which aims to provide new knowledge regarding multi-sectoral approaches to breaking the cycle of poverty and mental ill-health in Africa. Method: The World Health Organization’s Assessment Instrument for Mental Health Systems (WHO-AIMS) Version 2.2 was used to collect quantitative information on mental health resources. Mental health policies and legislation were analysed using the WHO Policy and Plan, and Legislation Checklists. Qualitative data were collected through focus groups and interviews. Results: Child and adolescent mental health (CAMH) - related legislation, policies, services, programmes and human resources are scarce. Stigma and low priority given to mental health contribute to low investment in CAMH. Lack of attention to the impoverishing impact of mental disorders on CA and their families contribute to the burden. Conclusion: Scaling up child and adolescent mental health services (CAMHS) needs to include anti-stigma initiatives, and a greater investment in CAMH. Clear policy directions, priorities and targets should be set in country-level CAMH policies and plans. CAMHS should be intersectoral and include consideration of the poverty- mental health link. The roles of available mental health specialists should be expanded to include training and support of practitioners in all sectors. Interventions at community level are needed to engage youth, parents and local organizations to promote CAMH.
Open Access
A structural equation modelling of the buffering effect of social support on the report of common mental disorders in Zimbabwean women in the postnatal period
(BioMed Central, 2019-02-28) Kaseke, Tanaka; January, James; Tadyanemhandu, Catherine; Chiwaridzo, Matthew; Dambi, Jermaine M
Objective Globally, 13–20% of women experience a common mental disorder (CMD) postnatally. Unfortunately, the burden of CMDs is disproportionally substantial in women from low-income countries. Nevertheless, there is a growing recognition of the buffering effect of social support (SS) on psychiatric morbidity and the need for mental well-being support services/interventions. This study evaluated the relationship between psychiatric morbidity and SS levels, and factors influencing the mental health functioning of Zimbabwean women postnatally. Data were collected from 340 mothers and were analysed through structural equation modelling. Results The mothers’ mean age was 26.6 (SD 5.6) years. The mean Multidimensional Scale of Perceived Social Support score was 42.7 (SD 10.8), denoting high levels of SS. Additionally, 29.1% of the population reported excessive psychiatric morbidity, the median Shona Symptoms Questionnaire score was 5 (IQR: 2–8). The structural equation model demonstrated the buffering effects of SS on psychiatric morbidity (r = − 0.585, p = 0.01), and accounted for 70% of the variance. Being unmarried, increased maternal age, lower educational and income levels were associated with poorer maternal mental health. There is a need for routine; surveillance and treatment of CMDs in women in the postnatal period, including integration of low-cost, evidenced-based and task-shifting SS interventions.
Open Access
“A turn in the road, but still a rough journey” - Parent and child perspectives of outcomes after pre-adolescent inpatient psychiatric admission
(BioMed Central, 2023-09-02) Swart, Tania T.; Davids, Eugene L.; de Vries, Petrus J.
Background Research regarding the outcomes of child and adolescent psychiatric inpatients appears insufficient and neglected. Where data are available, the majority of studies focus on adolescents. This study aimed (a) to describe child and parental perspectives of short-, medium- and long-term outcomes of children who have had a pre-adolescent inpatient psychiatric admission, and (b) to analyse these dyadic experiential data to identify outcome variables of importance to families and service users that could be used in future outcomes-based research. Methods The study employed a qualitative methodology, using semi-structured in-depth interviews of ten parent-child dyads to (a) collect the perspectives of children who have had an inpatient psychiatric admission at a pre-adolescent unit and their parents, and (b) to analyse the experiences of inpatient admission and perceived outcomes after discharge using thematic analysis. Results Overall, inpatient psychiatric admission was viewed as a positive and empowering experience by parents and children. Clear short-term benefits were reported as a result of new diagnoses, medications and new skills gained through the admission process. More than half of parent-child dyads reported long-term benefits, but many families commented on ongoing challenges. Thematic analysis identified diagnostic certainty, acquisition of cognitive and behavioural skills, appropriate educational environment, peer relationships, sustained follow-up and medication management, and parent-child relationships, as important contributors to outcomes. Importantly, the presence or lack of these elements influenced outcomes. Conclusions The study explored parent-child dyadic perspectives about their experiences of inpatient mental health admissions for pre-adolescents and perceived outcomes after admission. The majority of families found inpatient admission positive and helpful, and thematic analysis identified a number of functional variables that may predict outcome. However, positive outcomes were associated with ongoing difficulties over time, as indicated by the theme “a turn in the road, but still a rough journey”.
Open Access
Accelerating Sustainable Development Goals for South African adolescents from high HIV prevalence areas: a longitudinal path analysis
(2021-11-11) Meinck, Franziska; Orkin, Mark; Cluver, Lucie
Background Adolescents experience a multitude of vulnerabilities which need to be addressed in order to achieve the Sustainable Development Goals (SDGs). In sub-Saharan Africa, adolescents experience high burden of HIV, violence exposure, poverty, and poor mental and physical health. This study aimed to identify interventions and circumstances associated with three or more targets (“accelerators”) within multiple SDGs relating to HIV-affected adolescents and examine cumulative effects on outcomes. Methods Prospective longitudinal data from 3401 adolescents from randomly selected census enumeration areas in two provinces with > 30% HIV prevalence carried out in 2010/11 and 2011/12 were used to examine six hypothesized accelerators (positive parenting, parental monitoring, free schooling, teacher support, food sufficiency and HIV-negative/asymptomatic caregiver) targeting twelve outcomes across four SDGs, using a multivariate (multiple outcome) path model with correlated outcomes controlling for outcome at baseline and socio-demographics. The study corrected for multiple-hypothesis testing and tested measurement invariance across sex. Percentage predicted probabilities of occurrence of the outcome in the presence of the significant accelerators were also calculated. Results Sample mean age was 13.7 years at baseline, 56.6% were female. Positive parenting, parental monitoring, food sufficiency and AIDS-free caregiver were variously associated with reductions on ten outcomes. The model was gender invariant. AIDS-free caregiver was associated with the largest reductions. Combinations of accelerators resulted in a percentage reduction of risk of up to 40%. Conclusion Positive parenting, parental monitoring, food sufficiency and AIDS-free caregivers by themselves and in combination improve adolescent outcomes across ten SDG targets. These could translate to the corresponding real-world interventions parenting programmes, cash transfers and universal access to antiretroviral treatment, which when provided together, may help governments in sub-Saharan Africa more economically to reach their SDG targets.
Open Access
Attitudes of primary health care providers towards people with mental illness: evidence from two districts in Zambia
(2011) Kapungwe, A; Cooper, S; Mayeya, J; Mwanza, J; Mwape, L; Sikwese, A; Lund, C; Mental Health and Poverty Project Research Programme Consortium
The aim of this study was to explore health care providers’ attitudes towards people with mental illness within two districts in Zambia. It sought to document types of attitudes of primary health care providers towards people suffering from mental illness and possible predictors of such attitudes. This study offers insights into how health care providers regard people with mental illness that may be helpful in designing appropriate training or re-training programs in Zambia and other low-income African countries. Method: Using a pilot tested structured questionnaire, data were collected from a total of 111 respondents from health facilities in the two purposively selected districts in Zambia that the Ministry of Health has earmarked as pilot districts for integrating mental health into primary health care. Results: There are widespread stigmatizing and discriminatory attitudes among primary health care providers toward mental illness and those who suffer from it. These findings confirm and add weight to the results from the few other studies which have been conducted in Africa that have challenged the notion that stigma and discrimination of mental illness is less severe in African countries. Conclusion: There is an urgent need to start developing more effective awareness-raising, training and education programmes amongst health care providers. This will only be possible if there is increased consensus, commitment and political will within government to place mental health on the national agenda and secure funding for the sector. These steps are essential if the country is improve the recognition, diagnosis and treatment of mental disorders, and realize the ideals enshrined in the progressive health reforms undertaken over the last decade.
Open Access
Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: a systematic review
(2016) Hanlon, Charlotte
Abstract Background Little is known about the interventions required to build the capacity of mental health policy-makers and planners in low- and middle-income countries (LMICs). We conducted a systematic review with the primary aim of identifying and synthesizing the evidence base for building the capacity of policy-makers and planners to strengthen mental health systems in LMICs. Methods We searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Web of Science, Scopus, CINAHL, LILACS, ScieELO, Google Scholar and Cochrane databases for studies reporting evidence, experience or evaluation of capacity-building of policy-makers, service planners or managers in mental health system strengthening in LMICs. Reports in English, Spanish, Portuguese, French or German were included. Additional papers were identified by hand-searching references and contacting experts and key informants. Database searches yielded 2922 abstracts and 28 additional papers were identified. Following screening, 409 full papers were reviewed, of which 14 fulfilled inclusion criteria for the review. Data were extracted from all included papers and synthesized into a narrative review. Results Only a small number of mental health system-related capacity-building interventions for policy-makers and planners in LMICs were described. Most models of capacity-building combined brief training with longer term mentorship, dialogue and/or the establishment of networks of support. However, rigorous research and evaluation methods were largely absent, with studies being of low quality, limiting the potential to separate mental health system strengthening outcomes from the effects of associated contextual factors. Conclusions This review demonstrates the need for partnership approaches to building the capacity of mental health policy-makers and planners in LMICs, assessed rigorously against pre-specified conceptual frameworks and hypotheses, utilising longitudinal evaluation and mixed quantitative and qualitative approaches.
Open Access
Building the capacity of policy-makers and planners to strengthen mental health systems in low- and middle-income countries: a systematic review
(BioMed Central, 2016-10-21) Keynejad, Roxanne; Semrau, Maya; Toynbee, Mark; Evans-Lacko, Sara; Lund, Crick; Gureje, Oye; Ndyanabangi, Sheila; Courtin, Emilie; Abdulmalik, Jibril O; Alem, Atalay; Fekadu, Abebaw; Thornicroft, Graham; Hanlon, Charlotte
Background: Little is known about the interventions required to build the capacity of mental health policy-makers and planners in low- and middle-income countries (LMICs). We conducted a systematic review with the primary aim of identifying and synthesizing the evidence base for building the capacity of policy-makers and planners to strengthen mental health systems in LMICs. Methods: We searched MEDLINE, Embase, PsycINFO, Web of Knowledge, Web of Science, Scopus, CINAHL, LILACS, ScieELO, Google Scholar and Cochrane databases for studies reporting evidence, experience or evaluation of capacity-building of policy-makers, service planners or managers in mental health system strengthening in LMICs. Reports in English, Spanish, Portuguese, French or German were included. Additional papers were identified by hand-searching references and contacting experts and key informants. Database searches yielded 2922 abstracts and 28 additional papers were identified. Following screening, 409 full papers were reviewed, of which 14 fulfilled inclusion criteria for the review. Data were extracted from all included papers and synthesized into a narrative review. Results: Only a small number of mental health system-related capacity-building interventions for policy-makers and planners in LMICs were described. Most models of capacity-building combined brief training with longer term mentorship, dialogue and/or the establishment of networks of support. However, rigorous research and evaluation methods were largely absent, with studies being of low quality, limiting the potential to separate mental health system strengthening outcomes from the effects of associated contextual factors. Conclusions: This review demonstrates the need for partnership approaches to building the capacity of mental health policy-makers and planners in LMICs, assessed rigorously against pre-specified conceptual frameworks and hypotheses, utilising longitudinal evaluation and mixed quantitative and qualitative approaches.
Open Access
Can mental health treatments help prevent or reduce intimate partner violence in low- and middle-income countries? A systematic review
(BioMed Central, 2019-02-14) Tol, W A; Murray, S M; Lund, C.; Bolton, P; Murray, L K; Davies, T; Haushofer, J; Orkin, K; Witte, M; Salama, L; Patel, V; Thornicroft, G; Bass, J K
Background Epidemiological research suggests an interrelationship between mental health problems and the (re)occurrence of intimate partner violence (IPV). However, little is known about the impact of mental health treatments on IPV victimization or perpetration, especially in low- and middle-income countries (LMIC). Methods We conducted a systematic review to identify prospective, controlled studies of mental health treatments in LMIC. We defined ‘mental health treatment’ as an intervention for individuals experiencing mental ill health (including substance misuse) including a substantial psychosocial or pharmacological component. Studies had to measure a mental health and IPV outcome. We searched across multi-disciplinary databases using a structured search strategy. Screening of title/abstracts and full-text eligibility assessments were conducted by two researchers independently, data were extracted using a piloted spreadsheet, and a narrative synthesis was generated. Results We identified seven studies reported in 11 papers conducted in five middle-income countries. With the exception of blinding, studies overall showed acceptable levels of risk of bias. Four of the seven studies focused on dedicated mental health treatments in various populations, including: common mental disorders in earthquake survivors; depression in primary care; alcohol misuse in men; and alcohol misuse in female adult sex workers. The dedicated mental health treatments targeting depression or alcohol misuse consistently reduced levels of these outcomes. The two studies targeting depression also reduced short-term IPV, but no IPV benefits were identified in the two alcohol-focused studies. The other three studies evaluated integrated interventions, in which a focus on substance misuse was part of efforts to reduce HIV/AIDS and violence against particularly vulnerable women. In contrast to the dedicated mental health interventions, the integrated interventions did not consistently reduce mental ill health or alcohol misuse compared to control conditions. Conclusions Too few studies have been conducted to judge whether mental health treatments may provide a beneficial strategy to prevent or reduce IPV in LMIC. Key future research questions include: whether promising initial evidence on the effects of depression interventions on reducing IPV hold more broadly, the required intensity of mental health components in integrated interventions, and the identification of mechanisms of IPV that are amenable to mental health intervention.
Open Access
Change in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder: a repeat cross sectional community survey in Nepal
(2019-10-22) Luitel, Nagendra P; Garman, Emily C; Jordans, Mark J D; Lund, Crick
Abstract Background Despite the availability of evidence-based treatment, there is a substantial gap between the number of individuals in need of mental health care and those who receive treatment. The aim of this study was to assess changes in treatment coverage and barriers to mental health care among adults with depression and alcohol use disorder (AUD) before and after implementation of a district mental health care plan (MHCP) in Nepal. Methods The repeat population-based cross-sectional community survey was conducted with randomly selected adults in the baseline (N = 1983) and the follow-up (N = 1499) surveys, 3 years and 6 months apart. The Patient Health Questionnaire and Alcohol Use Disorder Identification Test were used to screen people with probable depression and AUD. Barriers to seeking mental health care were assessed by using a standardized tool, the Barriers to Care Evaluation Scale (BACE). Results The proportion of the participants receiving treatment for depression increased by 3.7 points (from 8.1% in the baseline to 11.8% in the follow-up) and for AUD by 5.2 points (from 5.1% in the baseline to 10.3% in the follow-up study), however, these changes were not statistically significant. There was no significant reduction in the overall BACE score in both unadjusted and adjusted models for both depression and AUD. The possible reasons for non-significant changes in treatment coverage and barriers to care could be that (i) the method of repeat population level surveys with a random sample was too distal to the intervention to be able to register a change and (ii) the study was underpowered to detect such changes. Conclusion The study found non-significant trends for improvements in treatment coverage and barriers to mental health care following implementation of the district mental health care plan. The key areas for improvement in the current strategy to improve treatment coverage and barriers to mental health care included change in the content of the existing community sensitization program, particularly for changing attitude and intention of people with mental illness for seeking care.
Open Access
Child and adolescent mental health policy in South Africa: history, current policy development and implementation, and policy analysis
(BioMed Central, 2018-06-26) Mokitimi, Stella; Schneider, Marguerite; de Vries, Petrus J
Background Mental health problems represent the greatest global burden of disease among children and adolescents. There is, however, lack of policy development and implementation for child and adolescent mental health (CAMH), particularly in low- and middle-income countries (LMICs) where children and adolescents represent up to 50% of populations. South Africa, an upper-middle income country is often regarded as advanced in health and social policy-making and implementation in comparison to other LMICs. It is, however, not clear whether this is the case for CAMH. The national child and adolescent mental health policy framework of 2003 was developed to guide the establishment of CAMH policies provincially, using a primary care and intersectoral approach. This policy provided a framework for the nine South African provinces to develop policies and implementation plans, but it is not known whether this has happened. The study sought to examine the history and current state of CAMH policy development and implementation, and to perform a systematic analysis of all available CAMH service-related policies. Methods A comprehensive search was performed to identify all provincial mental health and comprehensive general health policies across South African provinces. The Walt and Gilson policy triangle framework (1994) was used for analysis. Results No South African province had a CAMH policy or identifiable implementation plans to support the national CAMH policy. Provincial comprehensive general health policies addressed CAMH issues only partially and were developed mainly to address the challenges with HIV/AIDS, TB, maternal and child mortality and adherence to the millennium development goals. The process of policy development was typically a consultative process with internal and external stakeholders. There was no evidence that CAMH professionals and/or users were included in the policy development process. Conclusions In spite of South Africa’s upper-middle income status, the absence of any publically-available provincial CAMH policy documents was concerning, but in keeping with findings from other LMICs. Our results reinforce the neglect of CAMH even at policy level in spite of the burden of CAMH disorders. There is an urgent need to develop and implement CAMH policies in South Africa and other LMICs. Further research will be required to identify and explore the barriers to policy development and implementation, and to service development and scale-up in CAMH.
Open Access
Child mental health in Sierra Leone: a survey and exploratory qualitative study
(2016) Yoder, Hélène N C; Tol, Wietse A; Reis, Ria; de Jong, Joop T V M
Abstract Background This study complements the growing amount of research on the psychosocial impact of war on children in Sierra Leone by examining local perceptions of child mental health, formal and informal care systems, help-seeking behaviour and stigma. Methods The study combined: (1) a nationwide survey of mental health care providers, with (2) exploratory qualitative research among service users and providers and other stakeholders concerned with child and adolescent mental health, with a particular emphasis on local explanations and stigma. Results Formal mental health care services are extremely limited resulting in an estimated treatment gap of over 99.8 %. Local explanations of child mental health problems in Sierra Leone are commonly spiritual or supernatural in nature, and associated with help-seeking from traditional healers or religious institutions. There is a considerable amount of stigma related to mental disorders, which affects children, their caregivers and service providers, and may lead to discrimination and abuse. Conclusions Child and Adolescent Mental Health (CAMH) care development in Sierra Leone should cater to the long-term structural effects of war-violence and an Ebola epidemic. Priorities for development include: (1) the strengthening of legal structures and the development of relevant policies that strengthen the health system and specifically include children and adolescents, (2) a clearer local distinction between children with psychiatric, neurological, developmental or psychosocial problems and subsequent channelling into appropriate services (3) supplementary CAMH training for a range of professionals working with children across various sectors, (4) specialist training in CAMH, (5) integration of CAMH care into primary health care, education and the social welfare system, (6) further research on local explanations of child mental disorders and the effect they have on the well-being of the child, and (7) a careful consideration of the role of religious healers as care providers.
Open Access
Cross-sectional associations between mental health indicators and social vulnerability, with physical activity, sedentary behaviour and sleep in urban African young women
(2022-07-10) Draper, Catherine E; Cook, Caylee J; Redinger, Stephanie; Rochat, Tamsen; Prioreschi, Alessandra; Rae, Dale E; Ware, Lisa J; Lye, Stephen J; Norris, Shane A
Background Relationships between mental health and multiple health behaviours have not been explored in young South African women experiencing social constraints. The aim of this study was to identify associations between mental health indicators and risk factors with physical activity, sedentary behaviour, and sleep, amongst young women living in Soweto, a predominantly low-income, urban South African setting. Methods For this cross-sectional study, baseline measurements for participants (n = 1719, 18.0–25.9 years old) recruited for the Healthy Life Trajectories Initiative were used including: physical activity, sedentary behaviour (sitting, screen and television time), sleep (duration and quality), depression and anxiety indicators, emotional health, adverse childhood experiences, alcohol-use risk; social vulnerability, self-efficacy, and social support. Results Multiple regression analyses showed that depression (β = 0.161, p < 0.001), anxiety (β = 0.126, p = 0.001), adverse childhood experiences (β = 0.076, p = 0.014), and alcohol-use risk (β = 0.089, p = 0.002) were associated with poor quality sleep. Alcohol-use risk was associated with more screen time (β = 0.105, p < 0.001) and television time (β = 0.075, p < 0.016). Social vulnerability was associated with lower sitting time (β = − 0.187, p < 0001) and screen time (β = − 0.014, p < 0.001). Higher self-efficacy was associated with more moderate- to vigorous-intensity physical activity (β = 0.07, p = 0.036), better-quality sleep (β = − 0.069, p = 0.020) and less television time (β = − 0.079, p = 0.012). Having no family support was associated with more sitting time (β = 0.075, p = 0.022). Binomial logistic regression analyses supported these findings regarding sleep quality, with anxiety and depression risk doubling the risk of poor-quality sleep (OR = 2.425, p < 0.001, OR = 2.036, p = 0.003 respectively). Conclusions These findings contribute to our understanding of how mental health indicators and risk factors can be barriers to health behaviours of young women in Soweto, and that self-efficacy and social support can be protective for certain of these behaviours for these women. Our results highlight the uniqueness of this setting regarding associations between mental health and behaviours associated with non-communicable diseases risk.
Open Access
Evaluating the role of levels of exposure to a task shared depression counselling intervention led by behavioural health counsellors: outcome and process evaluation
(2019-06-10) Selohilwe, One; Bhana, Arvin; Garman, Emily C; Petersen, Inge
Background In the context of a large treatment gap for common mental disorders (CMDs) and shortage of mental health specialists in low- and middle-income countries, there is increasing evidence of the effectiveness of task sharing of counselling interventions to increase access to mental health care for CMDs at primary health care level. This study evaluated the relationship between levels of exposure to a task-shared counselling intervention and psychosocial outcomes (depression, functional disability, internalised stigma and social support) in chronic care service users with comorbid depression in South Africa guided by the Medical Research Council process evaluation framework. Implementation and participant-level factors that promote greater exposure were also investigated. Method The study design was a cohort study comprising of 173 participants referred by primary health care nurses for the task-shared counselling intervention. The study site comprised four primary health care facilities in a sub-district of the Dr. Kenneth Kaunda district in the North West Province of South Africa. The participants were assessed for psychosocial outcomes at three time points: baseline, 3 months and at 12 months. The number of counselling sessions each participant was exposed to was collected for each participant. Linear regression models were used to test the influence of counselling exposure on each of the psychosocial variables between baseline and endline. In-depth qualitative interviews were conducted on 29 randomly selected participants, stratified according to exposure to counselling sessions, and analysed using framework analysis. Findings Findings from the cohort study indicated a significant reduction in depression severity at 12 months. Internalised stigma and functional disability improved from baseline to endline. Participants receiving 5–8 sessions have the greatest reduction in PHQ9 scores from baseline to endline (β = − 2.46, 95% CI − 5.06 to 0.15) compared to those with 0 sessions (β = − 0.51, 95% CI − 3.62 to 2.60, p = 0.064). The WHODAS scores decreased significantly more from baseline to endline among those who received 5–8 sessions (β = − 10.73, 95% CI − 19.86 to 1.59) compared to those with 0 sessions (β = 2.25, 95% CI − 8.65 to 13.14, p = 0.021). No significant differences as a function of levels of counselling exposure from baseline to endline was observed for OSS-3 scores. An improvement in ISMI scores from 1–4 sessions to 5–8 sessions was found (β = − 4.05, 95% CI − 7.30 to − 0.80, p = 0.015). The qualitative process evaluation indicated that the service was acceptable and accessible; but that session attendance was hindered by women’s’ caregiving burden, poor counsellor attributes and poor referral processes. Conclusion Exposure to a greater number of sessions (5–8 sessions) was found to optimize functional ability, reduce stigma, and potentially reduce depression symptoms. In order to enhance session attendance, lay counsellor delivered psychosocial interventions need to pay attention to (i) counsellor selection criteria, particularly person-centred care qualities; and (ii) strengthening referral processes in contexts where mental health literacy is low.
Open Access
From mental health policy development in Ghana to implementation: What are the barriers?
(2010) Awenva, A D; Read, U M; Ofori-Attah, A L; Doku, V C K; Akpalu, B; Flisher, Alan; Lund, Crick; Osei, A O; Flisher, A J; MHaPP Research Programme Consortium
Objective: This paper identifies the key barriers to mental health policy implementation in Ghana and suggests ways of overcoming them. Method: The study used both quantitative and qualitative methods. Quantitatively, the WHO Mental Health Policy and Plan Checklist and the WHO Mental Health Legislation Checklist were employed to analyse the content of mental health policy, plans and legislation in Ghana. Qualitative data was gathered using in-depth interviews and focus group discussions with key stakeholders in mental health at the macro, meso and micro levels. These were used to identify barriers to the implementation of mental health policy, and steps to overcoming these. Results: Barriers to mental health policy implementation identified by participants include: low priority and lack of political commitment to mental health; limited human and financial resources; lack of intersectoral collaboration and consultation; inadequate policy dissemination; and an absence of research-based evidence to inform mental health policy. Suggested steps to overcoming the barriers include: revision of mental health policy and legislation; training and capacity development and wider consultation. Conclusion: These results call for well-articulated plans to address the barriers to the implementation of mental health policy in Ghana to reduce the burden associated with mental disorders.
Open Access
Histories of forced sex and health outcomes among Southern African lesbian and bisexual women: a cross-sectional study
(BioMed Central Ltd, 2015) Sandfort, Theo; Frazer, M; Matebeni, Zethu; Reddy, Vasu; Southey-Swartz, Ian; Southern African Lesbian and Bisexual Women Research Team
BACKGROUND: Experiences of forced sex have been shown to be prevalent in Southern Africa. Negative outcomes of forced sex have been documented in general populations of women and men and include alcohol abuse, drug use, mental health problems, mental distress, sexual health problems and poor overall health. This study is the first to examine experiences of forced sex and associated health problems among lesbian and bisexual women in Southern Africa. METHODS: This study is based on data collected as part of a collaborative endeavor involving various Southern African community-based organizations. Lesbian and bisexual women in four Southern African countries participated in a cross-sectional survey, for a total study sample of 591. RESULTS: Nearly one-third of participants had been forced to have sex at some time in their lives. Thirty-one percent of all women reported to have experienced forced sex at least once in their life: 14.9% reported forced sex by men only; 6.6% reported forced sex by women only; 9.6% had had forced sexual experiences with both men and women. Participants experienced forced sex by men as more serious than forced sex by women; forced sex by women was more likely to involve intimate partners compared to forced sex by men. Participants who experienced forced sex by men were more likely to report drug problems, mental distress and lower sense of belonging. Forced sex by women was associated with drinking problems and mental distress. Having experienced forced sex by both men and women was associated with lower sense of belonging to the LGBT community, drug use problem and mental distress. CONCLUSIONS: The findings indicate that forced sex among Southern African women is a serious issue that needs further exploration. Clinicians should be made aware of the prevalence and possible consequences of forced sex among lesbian and bisexual women. Policies and community interventions should be designed to address this problem.
Open Access
Impact of exercise training on symptoms of depression, physical activity level and social participation in people living with HIV/AIDS: a systematic review and meta-analysis
(2022-05-16) Ibeneme, Sam C; Uwakwe, Victor C; Myezwa, Hellen; Irem, Franklin O; Ezenwankwo, Fortune E; Ajidahun, Tunde A; Ezuma, Amarachi D; Okonkwo, Uchenna P; Fortwengel, Gerhard
Background Symptoms of depression are prevalent in people living with human immune deficiency virus/acquired immune deficiency syndrome (PLWHA), and worsened by lack of physical activity/exercises, leading to restriction in social participation/functioning. This raises the question: what is the extent to which physical exercise training affected, symptoms of depression, physical activity level (PAL) and social participation in PLWHA compared to other forms of intervention, usual care, or no treatment controls? Method Eight databases were searched up to July 2020, according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) protocol. Only randomised controlled trials involving adults who were either on HAART/HAART-naïve and reported in the English language, were included. Two independent reviewers determined the eligibility of the studies, extracted data, assessed their quality, and risk of bias using the Physiotherapy Evidence Database (PEDro) tool. Standardised mean difference (SMD) was used as summary statistics for the mean primary outcome (symptoms of depression) and secondary outcomes (PAL and social participation) since different measuring tools/units were used across the included studies. Summary estimates of effects were determined using a random-effects model (I2). Results Thirteen studies met the inclusion criteria with 779 participants (n = 596 participants at study completion) randomised into the study groups, comprising 378 males, 310 females and 91 participants with undisclosed gender, and with an age range of 18–86 years. Across the studies, aerobic or aerobic plus resistance exercises were performed 2–3 times/week, at 40–60 min/session, and for between 6-24 weeks, and the risk of bias vary from high to low. Comparing the intervention to control groups showed significant difference in the symptoms of depression (SMD = − 0.74, 95% confidence interval (CI) − 1.01, − 0.48, p ≤ 0.0002; I2 = 47%; 5 studies; 205 participants) unlike PAL (SMD = 0.98, 95% CI − 0.25, 2.17, p = 0.11; I2 = 82%; 2 studies; 62 participants) and social participation (SMD = 0.04, 95% CI − 0.65, 0.73, p = 0.91; I2 = 90%; 6 studies; 373 participants). Conclusion Physical exercise training could have an antidepressant-like effect in PLWHA but did not affect PAL and social participation. However, the high heterogeneity in the included studies, implies that adequately powered randomised controlled trials with clinical/methodological similarity are required in future studies. Trail Registration number INPLASY202040048.
Open Access
Improving adherence in mental health service users with severe mental illness in South Africa: a pilot randomized controlled trial of a treatment partner and text message intervention vs. treatment as usual
(BioMed Central, 2017-11-09) Sibeko, Goodman; Sibeko, Goodman; Mall, Sumaya; Williams-Ashman, Peter; Thornicroft, Graham; Susser, Ezra S; Lund, Crick; Stein, Dan J; Milligan, Peter D
Objectives: Medication non-adherence is a significant problem in treatment of severe mental disorders and is associated with poor clinical outcomes and increased demand on services. Task-shifting interventions incorporating mobile health may improve adherence in mental health service users in low- and middle-income countries. Seventy-seven participants were recruited from a psychiatric hospital in Cape Town, with 42 randomized to receive the intervention and 35 to treatment as usual. Intervention pairs underwent treatment-partner contracting and psychoeducation, and received monthly text message reminders of clinic appointments. Primary outcomes were intervention acceptability and feasibility. Secondary outcome for efficacy were adherence to clinic visit; relapse; quality of life; symptomatic relief and medication adherence. Results: Treatment partner and psychoeducation components were acceptable and feasible. The text message component was acceptable but not feasible in its current form. Efficacy outcomes favoured the intervention but did not reach statistical significance. A treatment-partner intervention is acceptable and feasible in a low- and middle-income setting. Work is needed to ensure that additional components of such interventions are tailored to the local context. Appropriately powered efficacy studies are needed. Trial Registration PACTR PACTR201610001830190, Registered 21 October 2016 (Retrospectively registered)
Open Access
Information systems for mental health in six low and middle income countries: cross country situation analysis
(BioMed Central, 2016-09-26) Upadhaya, Nawaraj; Jordans, Mark J D; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Hanlon, Charlotte; Kigozi, Fred; Kizza, Dorothy; Lund, Crick; Semrau, Maya; Shidhaye, Rahul; Thornicroft, Graham; Komproe, Ivan H; Gureje, Oye
Background: Research on information systems for mental health in low and middle income countries (LMICs) is scarce. As a result, there is a lack of reliable information on mental health service needs, treatment coverage and the quality of services provided. Methods: With the aim of informing the development and implementation of a mental health information subsystem that includes reliable and measurable indicators on mental health within the Health Management Information Systems (HMIS), a cross-country situation analysis of HMIS was conducted in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda), participating in the ‘Emerging mental health systems in low and middle income countries’ (Emerald) research programme. A situation analysis tool was developed to obtain and chart information from documents in the public domain. In circumstances when information was inadequate, key government officials were contacted to verify the data collected. In this paper we compare the baseline policy context, human resources situation as well as the processes and mechanisms of collecting, verifying, reporting and disseminating mental health related HMIS data. Results: The findings suggest that countries face substantial policy, human resource and health governance challenges for mental health HMIS, many of which are common across sites. In particular, the specific policies and plans for the governance and implementation of mental health data collection, reporting and dissemination are absent. Across sites there is inadequate infrastructure, few HMIS experts, and inadequate technical support and supervision to junior staff, particularly in the area of mental health. Nonetheless there are also strengths in existing HMIS where a few mental health morbidity, mortality, and system level indicators are collected and reported. Conclusions: Our study indicates the need for greater technical and resources input to strengthen routine HMIS and develop standardized HMIS indicators for mental health, focusing in particular on indicators of coverage and quality to facilitate the implementation of the WHO mental health action plan 2013–2020.
Open Access
Information systems for mental health in six low and middle income countries: cross country situation analysis
(2016) Upadhaya, Nawaraj; Jordans, Mark J D; Abdulmalik, Jibril; Ahuja, Shalini; Alem, Atalay; Hanlon, Charlotte; Kigozi, Fred; Kizza, Dorothy; Lund, Crick; Semrau, Maya; Shidhaye, Rahul; Thornicroft, Graham; Komproe, Ivan H; Gureje, Oye
Abstract Background Research on information systems for mental health in low and middle income countries (LMICs) is scarce. As a result, there is a lack of reliable information on mental health service needs, treatment coverage and the quality of services provided. Methods With the aim of informing the development and implementation of a mental health information sub-system that includes reliable and measurable indicators on mental health within the Health Management Information Systems (HMIS), a cross-country situation analysis of HMIS was conducted in six LMICs (Ethiopia, India, Nepal, Nigeria, South Africa and Uganda), participating in the ‘Emerging mental health systems in low and middle income countries’ (Emerald) research programme. A situation analysis tool was developed to obtain and chart information from documents in the public domain. In circumstances when information was inadequate, key government officials were contacted to verify the data collected. In this paper we compare the baseline policy context, human resources situation as well as the processes and mechanisms of collecting, verifying, reporting and disseminating mental health related HMIS data. Results The findings suggest that countries face substantial policy, human resource and health governance challenges for mental health HMIS, many of which are common across sites. In particular, the specific policies and plans for the governance and implementation of mental health data collection, reporting and dissemination are absent. Across sites there is inadequate infrastructure, few HMIS experts, and inadequate technical support and supervision to junior staff, particularly in the area of mental health. Nonetheless there are also strengths in existing HMIS where a few mental health morbidity, mortality, and system level indicators are collected and reported. Conclusions Our study indicates the need for greater technical and resources input to strengthen routine HMIS and develop standardized HMIS indicators for mental health, focusing in particular on indicators of coverage and quality to facilitate the implementation of the WHO mental health action plan 2013–2020.