OpenUCT :: Browsing by Subject "Public Mental Health"

Browsing by Subject "Public Mental Health"

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Open Access
Associations between HIV, TB and psychological distress among a sub-sample of a nationally representative study of South African adults: a secondary data analysis
(2022) de Wit, Marizanne; Garman, Emily; Lund, Crick
Introduction: South Africa faces an immense burden of disease, considering that it is the epicentre of the global HIV and TB pandemics. Moreover, the burden of mental ill-health is a growing concern due to its prominent association with infectious diseases. While global research evidence hasshed some light on the effects of psychological distress on communicable diseases such as HIV and TB and vice versa, including the effects of distress on medication adherence, the association between psychological distress and HIV and TB co-morbidity among South African adults remains elusive. Aims: This study aims to determine the prevalence of psychological distress among South Africans adults, what socio-demographic factors are associated with psychological distress, whether HIV or comorbid TB and HIV is associated with psychological distress and finally, to investigate the association between depression and non-adherence among adults who live with HIV or those who have both HIV/TB. Methods: This study made use of cross-sectional data collected in 2017 as part of the fifth wave of nationally representative surveys from the South African National HIV Prevalence, Incidence, Behaviour and Communication Survey (SABSSM). Only participants between the ages of 18-60 who had data on HIV, TB and psychological distress were included (N=20208). Current HIV status, and TB status in the past year was self-reported; however, final HIV status was confirmed via dry blood spot tests. The Kessler-10 screening tool was administered to obtain information on psychological distress using the recommended cut-off score of >16 to indicate the presence of psychological distress and ≤16 to indicate the absence thereof. Descriptive statistics were used to report weighted socio-demographic-, psychological distress, and HIV and TB- characteristics of the sample. Descriptive statistics were also used to report the point prevalence of psychological distress, HIV and HIV/TB comorbidity. Logistic Regression analyses were conducted to assess the associations between demographic factors, socio-economic characteristics, HIV, TB, and psychological distress. Demographic and socioeconomic factors which were significantly associated with psychological distress in univariate analyses were included in subsequent adjusted multilevel logistic regressions to assess the association between HIV, TB, and psychological distress. The association between psychological distress and adherence was assessed among a subsample of participants with HIV using a logistical regression analysis, adjusting for significantly associated demographic and socio-economic factors. All analyses were adjusted for clustering at the small area layer to account for sampling design. Results: The prevalence of psychological distress in this sample was 33.7% (n=6479). A total of 22.2% (n=4851) were HIV positive, 0,08% (n=140) had been diagnosed with TB in the past year and 0,04% (n=84) had co-morbid HIV/TB. Age, race, gender, marital status and education were found to be associated with psychological distress. After controlling for these variables, participants living with HIV were 1.13 times as likely (95%CI=1.01-1.27) to suffer from psychological distress compared to people who did not have HIV, while participants with comorbid TB and HIV were 2.31 times as likely (95%CI=1.16-4.60) to have psychological distress. No association between psychological distress and medication adherence was found (OR=0.75, 95%CI=0.39-1.43). Conclusion: Unemployed black women who are divorced, separated, or widowed, and who have no education are most likely to suffer from psychological distress. Having a positive HIV status is associated with a greater likelihood of being psychologically distressed, which is concerning given the high prevalence of people living with HIV in South Africa. When people living with HIV also develop TB disease, their likelihood of suffering from psychological distress considerably increases compared to people who are not living with HIV. Current mental health services are grossly inadequate to meet the mental health needs of this particularly vulnerable group of public healthcare patients. Integration of mental healthcare in the public health setting is integral in addressing South Africa's mental health needs.
Open Access
Barriers to physical health care in persons with severe mental illness: a facility based mixed method study in Ethiopia
(2015) Merga, Desalegn Bekele; Schneider, Marguerite
People with severe mental illnesses (SMI) face barriers that contribute to poor physical health outcomes. However, these barriers have not been systematically investigated in Ethiopia. Aim: The aim of this study was to examine barriers to care for physical co-morbidities among SMI patients. It achieves this by: i) estimating the prevalence of physical co-morbidities in SMI in-patients in a psychiatric referral hospital over a two month period; ii) describing potential associations of various socio-demographic and clinical factors with the occurrence of physical co- morbidities in admitted patients with SMI; and iii) exploring barriers in recognition and management of these physical comorbidities in the immediate curative medical care environment of admitted SMI patients in the psychiatric referral hospital. Methods: The study used a mixed methods design that included: i) a quantitative cross-sectional facilitybased record review; and ii) a qualitative exploration of potential or experienced barriers to physical health care provision by patients, caregivers, mental and general health professionals. The quantitative component estimated prevalence and examined risk factors associated with the presence of co-morbid physical health conditions among people with SMI. For this, clinical records of all admitted patients with diagnosis of SMI were reviewed over a two-months period. To check the reliability of the clinical records, a pilot test was done for two weeks before actual data collection. By using systematic random sampling of the records reviewed, 30 patients were selected for physician assessment in order to check the accuracy of the information included in records. The qualitative section was conducted using semistructured interviews with SMI patients and their caregivers and focus group discussions with service providers.
Open Access
The benefits and harms of surveying adolescents about intimate partner violence and verbal, physical and sexual abuse by Tracy McClinton Appollis.
(2013) McClinton Appollis Tracy; Mathews, Catherine; Lund, Crick
Includes abstract. Includes bibliographical references.
Open Access
Characteristics associated with attendance of follow-up at a post-rape care centre in Cape Town, South Africa
(2016) Ncube, Nozwelo Ntombizami; Gevers, Anik; Kaminer, Debbie
BACKGROUND: Rape is associated with a range of negative health and mental health consequences. Despite the establishment of post-rape care centres in South Africa, challenges of retaining rape survivors in care continue to be faced across the country. Very little evidence on the characteristics associated with rape survivors who return for follow-up and those lost to care at post-rape care centres has been documented in South Africa. This study sought to identify the demographic factors, rape incident characteristics and social support factors that are associated with attendance of follow-up appointments at a post-rape care centre in Cape Town, South Africa. METHOD: A retrospective case file analysis was conducted on 254 files of rape survivors who presented and were given follow-up appointments at a post-rape care centre in Cape Town, South Africa from September 2010 to August 2011. Data were extracted using a data collection form which was developed using counselling and medical records in the survivors' files and analysed using SPSS version 21. Descriptive statistics were generated on the survivors' demographic information, rape incident information, medical information, and support systems. Chi-squared test and Fisher's exact test were used to test for differences between survivors who completed all their follow-up appointments, those who attended but did not complete follow-up appointments and those lost to care. RESULTS: Of the total sample 64.6% (164) attended their one week follow-up appointment. From those who attended their one week follow-up appointment, 47% (77) came for their six weeks appointment and approximately half of those who attended their six weeks appointments (51%, n=39) attended their three month appointments. Survivors of rape were significantly more likely to attend follow-up appointments if they were female, incurred injuries during the time of the rape, or received family support post-rape. CONCLUSIONS: Female gender, injury during rape and family support were associated with attendance of follow up care in this sample of rape survivors. Recommendations for future research and for enhancing attendance rates at rape treatment centres are considered.
Open Access
Common Mental Disorders Among Adolescents Accessing HIV Treatment In Cape Town, South Africa
(2020) Mtukushe, Bulelwa; Sorsdahl, Katherine; Hoare, Jacqueline
Background: At the present time, data on the prevalence of common mental disorders (CMD) among adolescents living with HIV (ALHIV) in South Africa (SA) is limited. Studies that exist focus mainly on HIV-infected adults with mental health problems besides a few studies investigating depression and anxiety in children and adolescents living in SA. Research on the mental health of this vulnerable population remains very limited. Therefore, this study aims to address this gap by assessing the prevalence of CMD among adolescents living with HIV in SA; and determining the factors associated with CMD among this vulnerable population. Specific objectives: Specific objectives included, assessing the CMD among adolescents accessing ARV treatment; and determining factors associated with CMD among adolescents accessing HIV treatment. Methods: 121 Participants were recruited into the study through convenience sampling and interviewed. To be included in the study, participants had to be 10 to 19 years old; have knowledge of their own HIV-positive status; and presently on HIV treatment. Participants over 18 years were excluded if they did not provide informed consent and those under 18 were excluded if parent consent or adolescent assent was not obtained. Interviews with participants were conducted by study research assistants using a survey questionnaire which included the following mental health measures; Beck Depression Inventory for youth (BDI-Y), Beck Anxiety Inventory for youth (BAI-Y). Data collection for the study took place at two HIV treatment clinics in Cape Town, Groote Schuur hospital and Kuyasa clinic. Two logistic regression models were developed. Unadjusted and adjusted associations between socio-demographics, SES, food insecurity, alcohol use, years child known status and the presence of anxiety and depression were explored through logistic regression. Age, gender and variables that were significant in the unadjusted associations were included in the adjusted logistical regression models. Significance was set at p<0.05. Results: Four main findings emerged from the current study: 13.2% of participants were at risk for anxiety and 13.2% were at risk for depression; 6.6% participants were at risk for both anxiety and depression; the only variable associated with anxiety was socio-economic status and this was only significant in the unadjusted model; and the only variable associated with depression was highest level of schooling completed (i.e. currently in high school/completed high school) and this was significant in both unadjusted and adjusted models. Overall, adolescents with a higher educational level were less likely to develop depressive symptoms (adjusted model: OR=0.10, 95% CI 0.02-0.68). Conclusion: The present study assessed the prevalence of CMD, including determining the factors associated with CMD among adolescents accessing HIV treatment in Cape Town. Findings revealed that participants were at risk for anxiety, depression and comorbid anxiety and depression. Only highest level of schooling completed was found to be a protective factor against depression for this vulnerable population. Based on these findings, considerations for improving mental health outcomes for this population should include, screening for mental health conditions in ARV clinics, early identification and treatment of mental health problems, and evidence-based mental health counselling
Open Access
Common Mental Disorders Among Adolescents Accessing HIV Treatment In Cape Town, South Africa
(2020) Mtukushe, Bulelwa; Sorsdahl, Katherine; Hoare, Jacqueline
Background: At the present time, data on the prevalence of common mental disorders (CMD) among adolescents living with HIV (ALHIV) in South Africa (SA) is limited. Studies that exist focus mainly on HIV-infected adults with mental health problems besides a few studies investigating depression and anxiety in children and adolescents living in SA. Research on the mental health of this vulnerable population remains very limited. Therefore, this study aims to address this gap by assessing the prevalence of CMD among adolescents living with HIV in SA; and determining the factors associated with CMD among this vulnerable population. Specific objectives: Specific objectives included, assessing the CMD among adolescents accessing ARV treatment; and determining factors associated with CMD among adolescents accessing HIV treatment. Methods: 121 Participants were recruited into the study through convenience sampling and interviewed. To be included in the study, participants had to be 10 to 19 years old; have knowledge of their own HIV-positive status; and presently on HIV treatment. Participants over 18 years were excluded if they did not provide informed consent and those under 18 were excluded if parent consent or adolescent assent was not obtained. Interviews with participants were conducted by study research assistants using a survey questionnaire which included the following mental health measures; Beck Depression Inventory for youth (BDI-Y), Beck Anxiety Inventory for youth (BAI-Y). Data collection for the study took place at two HIV treatment clinics in Cape Town, Groote Schuur hospital and Kuyasa clinic. Two logistic regression models were developed. Unadjusted and adjusted associations between socio-demographics, SES, food insecurity, alcohol use, years child known status and the presence of anxiety and depression were explored through logistic regression. Age, gender and variables that were significant in the unadjusted associations were included in the adjusted logistical regression models. Significance was set at p<0.05. Results: Four main findings emerged from the current study: 13.2% of participants were at risk for anxiety and 13.2% were at risk for depression; 6.6% participants were at risk for both anxiety and depression; the only variable associated with anxiety was socio-economic status and this was only significant in the unadjusted model; and the only variable associated with depression was highest level of schooling completed (i.e. currently in high school/completed high school) and this was significant in both unadjusted and adjusted models. Overall, adolescents with a higher educational level were less likely to develop depressive symptoms (adjusted model: OR=0.10, 95% CI 0.02-0.68). Conclusion: The present study assessed the prevalence of CMD, including determining the factors associated with CMD among adolescents accessing HIV treatment in Cape Town. Findings revealed that participants were at risk for anxiety, depression and comorbid anxiety and depression. Only highest level of schooling completed was found to be a protective factor against depression for this vulnerable population. Based on these findings, considerations for improving mental health outcomes for this population should include, screening for mental health conditions in ARV clinics, early identification and treatment of mental health problems, and evidence-based mental health counselling
Open Access
Conceptualisation of mental illness among Christian clergy in Harare, Zimbabwe
(2016) Murambidzi, Ignicious; Kleintjes, Sharon
Background: More than 13% of the global burden of disease is estimated to be due to neuropsychiatric disorders, with over 70% of this burden in low- and middle-income countries. Characterised by severe shortages of human and material resources, formal mental health services alone are inadequate to meet the burden of mental disorders in low- and middle-income countries. New community models and innovative ways of increasing community participation and systematic delegation of specific tasks to other community level professionals have been recommended. Available evidence documents historic clergy involvement in health and wellbeing issues, but they have rarely been viewed as a partner in community mental health care. Aim: This study examines the clergy's conception, recognition of and responses to people with mental illnesses. The purpose of the study is to inform the potential roles and contributions of the clergy to community mental health either as the only contact or as a step in to formal mental health care. Method: Twenty eight in-depth interviews were conducted with clergy from ten church denominations in Harare, Zimbabwe. A framework analysis approach was used for thematic analysis. Nvivo 10 qualitative data software was used to organise the data. Results: Mental illness was conceived as a multifactor phenomenon attributed to both natural (biological and psychosocial) and supernatural (malevolent and benevolent spiritual) causes. Spiritual factors were a dominant theme in both the clergy's views on the causes of, and in their management of mental illness. The clergy were regularly consulted on a variety of emotional and psychological problems. Assistance was readily provided for these problems by all denominations, despite professed capacity gaps in the recognition and management of mental illness, and lack of appropriate training in basic mental health issues. Basic mental health training was recommended by the clergy to enhance clergy capacity for mental health awareness raising, recognition of mental disorders, brief problem focused counseling, and for improving collaborative management for initial and continued informal and formal health care and support. Implications of clergy conceptions, current responses and the perceived role of the church in community mental health are discussed.
Open Access
An evaluation of mhGAP training for primary healthcare workers in Mulanje, Malawi
(2015) Kokota, Demoubly; Lund, Crick; Ahrens, Jennifer
Introduction: There is a large treatment gap for people with mental disorders in Africa and other low resourced countries, estimated to be between 70% and 90%. The treatment gap is mainly due to the lack of trained mental health professionals and inadequate mental health service resources in Africa. There has been a growing global movement championed by the World Health Organisation (WHO) to integrate mental health into primary health care as the most effective way of reducing this treatment gap. This study aimed to investigate the impact of WHO Mental Health Gap Action Programme (mhGAP) training and supervision on primary health workers' knowledge, attitudes, confidence and detection rate of major mental disorders in the district of Mulanje, Malawi. Method: The study was a quantitative evaluation using a quasi-experimental method (single cohort pre- and post-measures) and an interrupted time-series design. Forty-three primary healthcare workers from Mulanje, Malawi completed pre- and post- training questionnaires assessing knowledge, attitudes and confidence regarding the assessment and management of major mental disorders. Rates of diagnosis of major mental disorders were obtained from clinic registers for 5 months prior to and 7 months following training. Results: The results showed a significant change on knowledge and confidence scores but not attitudes. The mean knowledge score showed a statistically significantly increase from 11.8 (standard deviation [SD]: 0.33) before training to 15.1 (SD: 0.38) immediately after training; t(42) = 7.79, p <.01. Mean knowledge score was also significantly higher six month post training (13.9, SD: 2.52) than before training; t(42) = 4.57, p < .01. Similarly, the mean confidence score increased significantly from 39.9 (SD): 7.68) before training to 49.6 (SD: 06.14) immediately after training; t(84) = 8.43, p <.01. Mean confidence score was also significantly higher six month post training (46.8, SD: 6.03) than before training; t(84) = 6.60, p <.01. There was no overall significant difference in mean CAMI scores before, immediately after and 6 months after training in all four of the CAMI components. The F-test statistic and P-value for Authoritarianism, Benevolence, Social Restrictiveness and Community Mental Health Ideology were: F2, 126, 0.05 = 2.5; p =.09, F2, 126, 0.05 = 0.1; p =.9, F2, 126, 0.05 = 0.03; p = 1.0 and F2, 126, 0.05 = 0.04; p = 1.0, respectively. In the months January to May 2014 (before training), median number of cases per month was 77 (inter quartile range [IQR]: 65-87) whereas after training (months June to December) median number of cases was 186 (IQR: 175-197) showing a significant increase in median number of cases before and after the training; p =0.001. Conclusion: The results show clear improvements in the knowledge, confidence and detection of severe mental illness in primary care in Mulanje and demonstrate the potential for narrowing the treatment gap by rolling out mhGAP training nationally in Malawi. The findings of this study add to the growing evidence for policy makers of the effectiveness of mental health training and supervision of primary care workers in a resource-constrained country. Further research is needed to evaluate factors that may lead to change in health worker attitudes, to evaluate training and supervision programmes using more robust evaluation designs, such as randomised controlled trials, and to assess the scale up of mhGAP programmes at larger population levels.
Open Access
An exploration of the perceptions of and risk and protective factors for drug use among young persons aged between 18 and 24 years in Mufakose, Harare, Zimbabwe
(2017) Chivese, Nyamadzawo; Schneider, Marguerite; Sorsdahl, Katherine
Background: Drug use by young people is on the increase globally, regionally and locally, in Zimbabwe. Most of what is known about the risk and protective factors for drug use has been written from studies done in high income countries. Limited studies focused on the low to medium income countries. The available literature for Zimbabwe is a few quantitative studies, done nearly two decades ago. These might not still be relevant today because of the generational changes that have taken place in the society over time. Methods: A qualitative study was conducted in Mufakose, one of the low income high density suburbs of Harare, Zimbabwe. The aim of the study was to find out the reasons why young people in the community were using drugs while others within the same geographical area were not using. A purposive sampling method was used to recruit 40 young people aged between 18 and 24 years who were current drug users, past users and those who had never used drugs at all in their entire lifetime. Individual in-depth interviews and focus group discussions were conducted at two community centres in the community to elicit data from the participants. Data collected from the in-depth interviews and focus group discussions were analysed using NVivo using themes that were derived from literature. Results: Results showed that both risk and protective factors for drug use exist at three levels of human interaction: the micro, meso and macro levels. Micro level risk factors included stressors from the home or living arrangements or workplace, stress due to loss of a loved one, boredom due to unemployment and lack of activities, a lack of commitment to work, sport or school and one's beliefs. Meso level risk factors were exposure to the drug using behaviour by peers and bullying. At family level, exposure to drug use, family conflicts were reported as risk factors. At macro level, drug availability and cost and media influence were cited as risk factors for drug use among the group. For the protective factors leading to non-use, religion was the strongest protective factor at all the three levels. A commitment to work, sport or school was also protective at micro level. Non-exposure to drug using behaviour were protective at the meso level. Conclusion: The current social environment in Zimbabwe together with a breakdown of the country's institutions such as marriage due to death, divorce or migration to other countries. The breakdown has left some children in single parent families vulnerable to a life of drug use. Early initiation into drug use was reported to be through exposure from peers, families and other members of the community as young people in Mufakose are using drugs in-order to escape from the reality of life. Evidence based psychosocial interventions could be used to reduce the impact of drug use among this population.
Open Access
Family planning for women with severe mental illness in rural Ethiopia: a qualitative study
(2017) Kebede, Tigist Zerihun; Sorsdahl, Katherine; Hanlon, Charlotte
Background: Family planning is a crucial issue for all women of reproductive age, but in women with severe mental illness (SMI) there may be particular challenges and concerns. As primary care-based mental health care is expanded in low- and middle-income countries (LMICs), there is an opportunity to improve family planning services for women with SMI. However, research exploring unmet family planning needs of women with SMI in such settings is scarce. Aim: To explore the family planning experiences, unmet needs and preferences of women with SMI who reside in a predominantly rural area of Ethiopia Methods: A qualitative study design was used. Women with SMI who were participating in the ongoing population-based cohort study in Butajira were selected purposively on the basis of responses to a quantitative survey of current family planning utilization. In-depth interviews were conducted with 16 women with SMI who were of reproductive age until theoretical saturation was achieved. Audio files were transcribed in Amharic, translated into English and analysed using a Framework Approach using Open Code qualitative data analysis software. Results: The findings were grouped into four main themes. The first theme focused on the broader context of intimate relationships and sexual life of women with SMI. Sexual violence, assault and exploitation were reported by several respondents, underlining the vulnerability of women with SMI. Lack of control over sexual contact was associated with unwanted pregnancies. The second theme (childbearing and SMI) was around attitudes towards childbearing in women with SMI. Respondents described negative views from community members and some health professionals about the capacity of a woman with SMI to give birth and bring up a child. In most cases, it was assumed that a woman with SMI should not have a child at all. In the third theme (family planning for women with SMI), respondents spoke of their low access to information about family planning and systematic exclusion from existing services. In the fourth theme (preferred family planning services), the respondents had concerns about the ability of primary care workers to understand their specific family planning needs, but also valued proximity of the service and privacy. The importance of addressing health worker and community attitudes was emphasized. Conclusion: This study has provided in-depth perspectives from women with SMI about the broader context of their family planning experience, needs, barriers and how integrated primary care services could better meet their needs. Empowerment of women with SMI to access information and services needs to be an important focus of future efforts to improve the reproductive experiences of this vulnerable group.
Open Access
A formative study on the adaptation of mental health promotion programmes for perinatal depression in West Chitwan
(2017) Subba, Prasansa; Breuer, Erica; Petersen Williams, Petal; Luitel, Prasad
Introduction: Depression in mothers can have debilitating consequences on the women themselves, their infants and their family. Thus, it is imperative to detect and treat perinatal depression early. Due to lack of awareness and stigma, help seeking, detection and treatment for perinatal depression in Nepal remains low. To counter barriers on lack of awareness, stigma and non-detection of mental health problems including depression, alcohol use disorder, psychosis and epilepsy, the PRogramme for Improving Mental Health carE (PRIME) developed and implemented a community sensitization programme and a Community Informant Detection Tool (CIDT). Neither of these programmes has focused on perinatal depression. This study aims to adapt the depression CIDT and the community sensitization programme to include perinatal depression. Methods: The CIDT and community sensitization programme were adapted using the following four steps. Firstly, a qualitative study was conducted with perinatal women with depressive symptoms visiting Meghauli and Dibyanagar health facilities or "gau-ghar clinic" (n=26) and service providers (n=34) to develop a culturally relevant content. Secondly, a draft CIDT and community sensitization manual were prepared based on the qualitative findings. Thirdly, a one-day workshop and several consultation meetings were held with mental health professionals (n=16) to ensure that the content was understandable and applicable to the context. Lastly, based on the workshop findings and consultation meetings, the manual and tools were modified and adapted for perinatal depression. Results: Due to poor awareness and stigma, none of our respondents had ever sought help for depression from the antenatal or postnatal service providers. Using local expressions for common depressive symptoms such as loss of interest, rumination, pessimistic views, extreme worries, restlessness, two separate CIDTs were developed each for antenatal and postnatal depression. Lack of support from the husband and family followed by poverty were the major contributing factors for depression. In addition, cultural factors such as the low position of women in patriarchal society and preference for son exacerbated problems in some women. The community sensitization manual was adapted to include local myths and facts about perinatal depression; causes with examples related to local beliefs; symptoms explained in local idioms; and role of the family. The heads of the families and key community members were recommended as key targets for the community sensitization programmes. Conclusion: It is important for any intervention to be responsive to local understanding and needs. The adapted CIDT and community sensitization manual has integrated the local issues and expressions of symptoms of perinatal depression for women in the Chitwan district.
Open Access
Intimate Partner Violence among Adolescent Girls and Young Women in Bulawayo, Zimbabwe and perceived barriers and facilitators to the provision of psychosocial interventions in salons
(2023) Ndondo, Nonhlanhla Lindelwe; Carney, Tara; Richter, Marlise; Van Der Westhuizen, Claire
Background. Women are disproportionately affected by intimate partner violence (IPV), particularly those in low-to-middle-income countries (LMIC). Recent research data suggests that IPV prevalence among adolescent girls and young women (AGYW) in Zimbabwe is estimated to be 36.5%. Innovative intervention models that leverage gendered spaces to provide IPV support have shown great potential in high income countries, but little is known about these in LMIC settings, including in Zimbabwe. The current qualitative study explored the experiences of IPV among AGYW as well as the feasibility of the use of pre-existing female spaces such as salons to provide psychosocial interventions in Bulawayo, Zimbabwe. Methods. Nine AGYW who had experienced IPV participated in virtual and in-person key-informant interviews. Two focus groups were conducted with salon and spa workers to explore the potential use of salon-based interventions (n=10). Purposive sampling was used as a recruitment strategy. Thematic analysis was used to analyse the data. Results. The findings indicated that in this study, AGYW participants' experiences of IPV consisted mainly of physical IPV such as being beaten with an object, being slapped, or punched with a fist, followed by psychological and lastly, sexual IPV. The results of the study highlighted the factors that seemed to predispose AGYW participants to IPV such as sociocultural influences, economic disempowerment and partner characteristics and behaviours. AGYW participants also discussed the negative physical and mental health impact of the psychological and sexual abuses they had encountered. Both salon workers and the AGYW interviewed identified peer support facilitated by the positive social capital created in salons, as well as the female-centeredness of salons as conducive elements for an acceptable intervention. However, some speculations around confidentiality and accessibility to salons were some of the potential barriers identified for implementing salon based IPV interventions. Conclusion. The findings of this study indicated that there is a need to identify and address IPV, as well as the mental health consequences that AGYW experience due to IPV. While the use of predominantly female spaces, in this case salons, were discussed as feasible spaces to incorporate into IPV support models for AGYW, there were certain barriers which will need to be addressed for this to be considered. In addition, it was clear that the content of such interventions needed to include not only IPV and associated mental health issues, but also include other components such as economic empowerment of AGYW, while also challenging traditional gender norms through salon-based interventions. Furthermore, AGYW alluded to their preference for IPV psychosocial support interventions to be peer-based and female-driven. Salons typically provide these aspects, hence increasing their viability as a choice for community based IPV support
Open Access
Mental health and antiretroviral therapy adherence among people living with HIV attending an HIV clinic in Blantyre, Malawi
(2021) Chasweka, Dennis; Sorsdahl, Katherine; van der Westhuizen, Claire
ABSTRACT Background: Tremendous progress has been achieved in the treatment for HIV/AIDS since the 1980s. This significant improvement and progress in HIV treatment has largely been attributed to antiretroviral therapy (ART). Non-adherence to ART commonly causes ART treatment failure and the development of drugresistant strains of HIV, resulting in increased mortality. Common mental disorders have been found to be strongly associated with non-adherence. In Malawi, where HIV is prevalent, there is a paucity of studies on how common mental disorders are associated with non-adherence. The present study aimed at examining the association between depression, anxiety and alcohol use disorder symptoms and ART adherence among people living with HIV/AIDS (PLWHA) attending an HIV clinic in Blantyre, Malawi. Methods: This was a facility-based quantitative study with a cross-sectional descriptive design with 213 PLWHA attending an HIV clinic. The participants completed a survey consisting of demographics and mental health disorders symptoms screening tools, namely the 9-item Patient Health Questionnaire (PHQ9) for depression symptoms, the Generalized Anxiety Disorder 7-item scale (GAD-7) for anxiety symptoms and the Alcohol Use Disorders Identification Test (AUDIT) for alcohol use and related harms. ART adherence was assessed using pill count, a self-report measure and a combined measure of both pill count and self-report adherence. Results: The prevalence of depressive symptoms among the participants was 32%, 26% for anxiety symptoms and 16% of participants reported any life-time alcohol use. The majority of participants (75.6%) were found to have good pill count-based adherence while only 41.7% and 33.2% of participants reported good adherence on the self-report and combined measures respectively. The results showed that older participants were more likely to self-report good adherence than younger participants (OR=1.03; 95%CI=1.01-1.06, p-value=0.050). The participants who scored higher on the AUDIT were less likely to self-report good adherence to ART (OR=0.88; 95% CI=0.78-1.00, p-value=0.050). Side-effects were statistically significantly associated with both pill-count and combined adherence. The participants that experienced side effects from the treatment were less likely to be adherent on pill count (OR=0.19; 95% CI=0.07-0.53, p-value=0.001) and the combined adherence measure (OR=0.45; 95% CI=0.24-0.83, pvalue=0.011). Alcohol use was again significantly associated with combined adherence. The participants who reported ever having used alcohol were less likely to be adherent to ART on the combined adherence measure (OR=0.51; 95% CI=0.29-0.93, p-value=0.026). No statistically significant association between depressive and anxiety symptoms and ART adherence was found. Conclusion: The findings show that symptoms of common mental disorders were highly prevalent among PLWHA. Alcohol use, younger age group and experiencing side-effects from ART were significantly associated with ART non-adherence. Further research is required to investigate how depression and anxiety is associated with ART adherence among PLWHA in a Malawian population using larger sample sizes. The current study also highlights the need to routinely screen PLWHA for mental health problems. Further research using advanced designs, such as randomized clinical trials incorporating implementation science approaches, is also needed to evaluate the feasibility and effectiveness of integrating mental health services into HIV care in Malawi.
Open Access
The perceived impact of a relative's mental illness on the family members, their reported coping strategies and needs : a Zimbabwean study
(2013) Marimbe-Dube, Bazondile; Lund, C; Cowan, F
Aim of the study is to explore the perceived impact of mental illness, reported coping strategies and reported needs of family members of mentally ill patients attending the Parirenyatwa Annexe Psychiatry Unit in Harare, Zimbabwe.
Open Access
Perspectives on disclosure of HIV status to others among 12-19 year old HIV-infected adolescents attending an HIV care clinic at a tertiary hospital in Harare, Zimbabwe : a qualitative study
(2015) Khan, Rabia; Sorsdahl, Katherine
Introduction: The worldwide commitment to increasing services and access to antiretroviral therapy have resulted in a decline in HIV related mortality. As a result, the focus of HIV care is shifting towards improving the psychological health and quality of life. HIV infected adolescents are a group with unique psychosocial challenges. Given that HIV self disclosure has been recognized as an important challenge affecting their physical as well psychological health it warrants further exploration. Methods: A qualitative study was conducted during September to November 2014 among adolescents (12-19years) attending the HIV care clinic at a tertiary hospital in Harare. Twenty adolescents who were vertically infected with HIV were recruited using purposive sampling techniques to achieve maximum variability in age and sex. In depth interviews were conducted to determine the views of adolescents regarding when, whom and how to self disclose. All the interviews were transcribed verbatim. Data was analyzed using the framework approach. Results: Adolescents identified stigma and discrimination from peers as well as lack of HIV knowledge as important barriers to status disclosure and suggested societal resources like support groups and media to assist them in the disclosure process. Conclusion: HIV status disclosure to others is a challenging task for adolescents and it can be affected by personal as well as social factors. In order to deal with disclosure dilemmas, we have to work with adolescents keeping all these factors in mind to assist them in decision making, there by facilitating healthy supportive relationships and contributing to the wellbeing of HIV-positive adolescents.
Open Access
The prevalence and predictors of antipsychotic medication non-adherence among clients with psychotic disorders in Mzimba, Malawi
(2017) Myaba, Japhet; Sorsdahl, Katherine
Background: Mental, neurological and substance use (MNS) disorders significantly contribute to the burden of diseases worldwide. Schizophrenia is one of the severe forms of MNS disorders. Antipsychotic medications play a significant role in the treatment and management of schizophrenia. However, non-adherence to antipsychotic medication is a recognized problem. At the present time, a majority of the research investigating non-adherence to medication in this population has been conducted in high income countries, with only a few studies available from low and middle income countries such as Malawi. This study aimed at determining the prevalence and predictors of antipsychotic non-adherence among clients with psychosis in Mzimba district, Malawi. The factors were categorized into patient-related, medication related and environmental related. Methodology: This was a hospital based quantitative study conducted in Mzimba, Malawi. 150 patients attending outpatient treatment facilities from three mental health clinics were recruited in the study. All recruited participants had a diagnosis of psychosis. The recruitment process targeted every potential participant during a clinic day. Potential participants were approached by the research assistant after their appointment with the healthcare provider to participate in the study. The following measures were included in the interview administered survey: 1) the Morisky Medication Adherence Scale-8; the Birchwood Insight Scale; the Drug Attitude Inventory-10; the Glasgow Antipsychotic Side-effects Scale; a Social Support questionnaire, and the Alcohol Use Disorder Identification Test. A logistic regression model was developed to investigate the associations between socio demographic and illness related factors and non-adherence to medication. Ethical approval to conduct the study was obtained from the Faculty of Health Sciences Research Ethics Committee at the University of Cape Town before the beginning of the study. Ethical approval was also obtained from National Health Sciences Research Ethics Committee in Malawi. Results: More than half of the participants were male (n=84). The average age of all participants was 34 years of age (sd=9.40). 43.9% of the respondents were identified as non-adherent (n=66). In the unadjusted logistic regression model, the amount of insight a client had about their mental illness, the side effects of antipsychotic medication, and the form or type of medication, were all found to be significantly associated with antipsychotic medication non-adherence. For example, participants with poor insight were less likely to adhere to antipsychotic medication (OR=0.48, 95% CI 0.24-0.95). When these three variables were adjusted for age and gender, they all predicted non-adherence to antipsychotic medication; insight (OR=0.42, 95% CI 0.20-0.90); side effects (OR=1.10. 95% CI 1.03-1.17); and medication type or form (OR=0.30, 95% CI 0.15-0.91). Conclusion: The study was the first study conducted in Mzimba, Malawi to investigate nonadherence rates among patients with psychosis. Similar to other studies conducted globally, the non-adherence rates to antipsychotic medication reported in the present study was high. The risk factors predicting non-adherence have the potential to assist in the development and delivery of interventions to address among this population.
Open Access
The prevalence and predictors of intimate partner violence among women attending a midwife and obstetrics unit in the Western Cape
(2017) Malan, Megan; Sorsdahl, Katherine; Spedding, Maxine, F
Background: Intimate partner violence (IPV) during pregnancy is a common phenomenon across the world. The present study sought to determine the prevalence and predictors of intimate partner violence among pregnant women attending a midwife and obstetrics unit in the Western Cape. Methods: A convenience sample of a hundred and fifty pregnant women (n= 150) attending antenatal appointments at the Mitchell's Plain Midwife and Obstetrics Unit (MOU) were asked to participate in this study. Consenting women participated in an interview where they were asked questions concerning interpersonal violence and other psychosocial constructs, such as history of childhood trauma, exposure to community violence, depressive symptoms and alcohol use. Frequency distributions and descriptive statistics were calculated for categorical and continuous variables. Multivariable logistic models were developed to control for socio-demographics and psychosocial constructs. The first model was based on report of any form of IPV over the previous 12 months, while the remaining three models investigated the disaggregated forms of IPV: physical abuse, sexual abuse and emotional abuse. Results: Overall, the lifetime and 12-month prevalence rate for any IPV was 45% and 32%, respectively. For 12-month IPV, 32% reported general abuse, 29% physical and 20% reported being sexually abused. After adjusting for the effects of the other variables in the model, depressive symptoms, and reporting that this pregnancy was unplanned were significantly associated with the reporting of any IPV in the past 12 months. Looking specifically at 12 months general IPV, women who had depressive symptoms were more likely to experience some form of general IPV (OR= 6.42, CI 2.51-16.41) than women not at risk. Also, women of 'coloured' race were more likely to experience general IPV than Black African respondents (OR= 1.46, 95% CI 0.64-3.34). The model exploring associations for 12-month physical IPV found women who were at risk for depression were more likely to experience physical IPV (OR= 4.42, CI 1.88-10.41) than women not at risk, while the model exploring associations for 12-month sexual IPV found that women who reported experiencing community violence were more likely to report sexual IPV than women who reported no exposure to community violence (OR= 3.85, CI 1.14-13.08). Conclusion: This is the first study, which illustrates high prevalence rates of IPV among pregnant woman at Mitchells Plain MOU. A significant association was found between 12-month IPV and unintended pregnancy. Also, woman who are at risk for depression were found to have an increased chance of experiencing both general and physical IPV. Sexual IPV was associated with high levels of exposure to community violence. Further prospective studies in different centres are needed to address generalisability and the effect of IPV on maternal and child outcomes. Greater recognition of IPV in pregnancy could contribute to improved antenatal care, as well as enhanced policy development for appropriate intervention strategies. Key Words: Intimate partner violence; Interpersonal violence; Domestic violence; Abuse; Pregnancy; Antenatal; Postnatal depression and Community violence
Open Access
Prevalence of moderate and high risk substance use and service needs among psychiatric inpatients at Zomba Mental Hospital in Malawi
(2015) Mafuta, Chitsanzo; Breuer, Erica; Lund, Crick
Background: Mental illness increases risk for substance use and the presence of substance use in people living with mental illness makes diagnosis and treatment of both disorders more complicated. For treatment of either disorder to be successful, both must be identified and treated individually. The substance use burden and service needs of psychiatric inpatients in Malawi are unknown. Objectives: The study aimed to determine prevalence of risky substance use and service needs among psychiatric inpatients. Methods: A cross-sectional study was conducted examining subjective substance use using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) version 3.1 in 323 new inpatients aged ≥18 years. The prevalence of risky and lifetime substance use was calculated in addition to bivariate analysis and linear regression. The kappa statistic was calculated to compare diagnosis of substance use during routine clinical assessment on admission with screening using the ASSIST. Results: ASSIST-linked lifetime prevalence for each substance were alcohol 54.8 %, (95 % CI: 49.3-60.1 %), followed by tobacco 43.7 %, (95 % CI: 38.4-49.1 %), and cannabis 39.0 %, (95 % CI: 33.9-44.4 %). No-one reported any use of amphetamine-type stimulants, hallucinogens, or opioids. The prevalence of moderate risk use, requiring brief intervention were tobacco 19.2 %, (95 % CI: 15.3-23.9 %), cannabis 9.9 %, (95 % CI: 7.1-13.7 %), alcohol 7.1 %, (95 % CI: 4.8-10.5 %), sedatives 1.2 %, (95 % CI: 0.4-3.3 %) and cocaine 0.6 %, (95 % CI: 0-2.4 %). High risk use requiring specialist care was identified for alcohol 18.6 %, (95 % CI: 14.7-23.2 %), cannabis 16.7 %, (95 % CI: 13.0-21.2 %), tobacco 10.8 %, (95 % CI: 7.9 -14.7 %) and inhalants 0.3 %, (95 % CI: -0.1-2.0 %). Interrater agreement for diagnosis of substance use disorder between routine clinical assessment compared to ASSIST questionnaire was Kappa = 0.530 (p < 0.001) which is moderate but statistically significant. The multivariate linear regression to determine the risk factors associated with tobacco, alcohol and cannabis. Males are more likely to use all these substances and have a higher ASSIST score than female patients (p < 0.001). The model indicated that risky alcohol use is significantly higher in Christians than other religions or no religious affiliation (p =.044) while risky cannabis use is significantly higher in rural residents compared to urban residents (p =.042). Conclusions: Results suggest that tobacco, alcohol and cannabis are commonly used among psychiatric inpatients in this population. Most patients use substances at risky levels requiring both brief intervention and specialist care. Although substance use is common, the detection of substance use disorders in admission assessments is moderate and could be improved. The ASSIST questionnaire is useful in screening for substance use in psychiatric inpatient populations and is likely to improve detection and management.
Open Access
Prevalence of substance use and its associated risk factors amongst secondary school students aged 12 to 17 years in Mzuzu, Malawi
(2023) Banda, Zondiwe; Sorsdahl, Katherine; Docrat Sumaiyah; Gamieldien Fadia
Background The use of alcohol and other drugs (AODs) among adolescents has emerged as an increasing public health concern globally and requires an urgent response in low- and middle-income countries (LMICs), particularly in Sub-Saharan Africa, where AOD use is on the rise. Recent systematic reviews of regional evidence have estimated that approximately 40% of adolescents use alcohol or other drugs. This translates to a burden of Disability Adjusted Life Years (DALYs) 2.5 times higher than has been seen in high-income countries. To date, very few studies have investigated the prevalence of AOD use among adolescent school learners in Mzuzu, Malawi. As a result, little is known about the factors that may place these adolescents at increased risk of AOD use. This study therefore endeavours to address these gaps. Methods 421 adolescent school learners aged between 12 and 17 years were recruited in this crosssectional study. Following individual informed assent and parental consent, a self-administered questionnaire was administered to secondary school learners to estimate the prevalence of alcohol and drug use in two public secondary schools within the city of Mzuzu, Malawi. Sociodemographic characteristics of all learners, their household members as well as levels of exposure to victimisation and social support were investigated as factors which may influence alcohol and drug use amongst the sample. Means and proportions were used to describe sociodemographic data as well as the prevalence of lifetime alcohol and drug-use. Unadjusted and adjusted associations between risk factors and lifetime alcohol and drug-use were also explored. Only variables that were significant in unadjusted logistic regression models were included in the final adjusted regression model. The findings are presented in the form of odds ratios (ORs) with 95% confidence intervals (CIs). Results The prevalence of lifetime alcohol-use was 17.1% (n=72) across the sample of secondary school learners. A lower prevalence rate of drug-use was found across the sample, with 7.1% (n=30) of learners reporting any prior use of drugs. In adjusted models, being male, school grade level, attending religious services, sleeping arrangements in the household, household ability to meet subsistence needs, tobacco and alcohol-use by other household members were found to be significantly associated with lifetime alcohol use. In the adjusted models for lifetime drug-use, being male, school grade level, living in a single parent household, sleeping arrangements and alcohol-use and drug-use among household members were found to be significant predictors of drug-use among the sample of learners. Conclusion Results from the study show that alcohol and drug-use are prevalent among adolescent school learners in Mzuzu, Malawi and are associated with several socio-demographic and household factors which place learners at increased risk. This illustrates that AOD use is an issue of concern amongst adolescents in Malawi. There is a need for larger studies to be conducted on AOD use among adolescents in Malawi to generate nationally representative data which would help inform the development and implementation of comprehensive services for the treatment and prevention of alcohol and other drug (AOD) use among adolescent school learners in Malawi.
Open Access
A qualitative study of mental health explanatory models, and the perceived impact of life experiences on mental health, in HIV infected adolescents in rural and urban Uganda
(2017) Nalukenge, Winifred; Van der Westhuizen, Claire; Seeley, Janet
Background: Survival of children and adolescents with HIV/AIDS has greatly improved with antiretroviral treatment. These young people now live with a chronic, rather than a fatal disease, which has brought into focus issues of quality of life, including the emotional and behavioral wellbeing of those living with the disease. HIV infection is associated with poor mental health and a high prevalence of behavioral and emotional problems in affected adolescents. Despite this burden of emotional and behavioral problems, the majority of HIV care services in sub-Saharan Africa do not have mental health care services specifically targeting adolescents with HIV. In order to address mental health in this population, it is important to explore their explanatory models to understand aspects such as how they view their symptoms, and what treatment or support they prefer. At the present time, research is scarce regarding explanatory models of mental disorders in HIV-positive adolescents and no study has been conducted in Uganda. This study aimed to address this gap by exploring the explanatory models of mental disorders and perceived daily life challenges in HIV-infected adolescents who had been diagnosed with a common mental disorder. Methods: This qualitative study was nested in a longitudinal epidemiological study that investigated prevalence, incidence and risk factors for mental health problems in HIV-infected children and adolescents in rural and urban Uganda. In-depth interviews were conducted with adolescents aged 12 to 17 years who had been diagnosed with depression, anxiety or attention deficit hyperactivity disorder (ADHD). Case vignettes were used to enable adolescents to talk about their experiences and daily life challenges. Written consent and assent were sought from caregivers and adolescents respectively. Data were processed and analyzed thematically. NVivo-11 was used to manage data for analysis. Results: Twenty-one adolescents participated in the study. Most adolescents (9/21) in the study were living with their grandparents. Twelve were in primary school and 4 had dropped out. The main findings were: (i) the adolescents had not been informed about their mental disorder diagnoses and none viewed their symptoms as illness, (ii) they attributed their symptoms to daily life problems, such as poverty and interpersonal relationship problems, and did not mention biomedical or spiritual causes, (iii) they thought that their symptoms would improve with time, and financial and emotional support were also important. Conclusion: The findings of this study highlight the need for action at the mental health policy and practice levels. The main areas for such intervention include mental health literacy, screening and intervention in healthcare settings, and psychosocial interventions in community and school settings for affected adolescents and their caregivers.

Browsing by Subject "Public Mental Health"

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