Browsing by Subject "mental health"

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    Open Access
    A Capability Approach to Examining the Effects of Actual and Anticipated Fear of Crime: Experiences and Perceptions of Black Female Youth in the Cape Flats
    (2020) Beiser, Sarina; Kubeka, Alvina
    The purpose of this study was to examine how the fear of crime affects the capabilities, perceptions and experiences of black female youth, living in the Cape Flats, Cape Town. Qualitative semi structured interviews were conducted with 18 black female participants between the ages of 18 to 30. This study used Garofalo's model of fear of crime and Amartya Sen's capability approach as theoretical frameworks. With the help of these two frameworks, the researcher sought to gauge what influence the fear of crime can have on people's lives and how crime affects young black females living in communities with high crime rates. It also showed how their life choices and opportunities are influenced by living in unsafe communities. The major challenges and problems highlighted by the participants include: Constant trauma of their daily life (leaving their houses, random shootings, unsafe public transport), mental health issues (losing friends and relatives), lack of proper police service (lack of police presence, incompetence of police, corruption), fear for family or friends, lack of trust and support systems (broken families, loss of trust, no role models, lack of social capital), lack of infrastructure (such as safe hospitals or educational challenges), the effects of gangsterism (gangs and drug wars, effects of drugs, families' or friend's involvement in gangsterism) and the lack of opportunities such as unemployment. This study showed how the peoples' capabilities have been affected by the above-mentioned issues and how the fear of crime affected their daily lives. This study also made recommendations for policy makers and social institutions on what can be done to reduce crime rates and make communities with high crime rates safer
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    A comparison of attitudes around collaboration held by traditional healers and professional nurses in the Western Cape
    (2024) Tyhala, Brenda; Kaliski, Sean; Mgweba-Bewana, Lihle
    Background Many mental health care system users consult traditional healers while also seeking biomedical forms of healing. Despite this, there is no formalized working relationship between these two systems, which operate in parallel and independently. The government has taken considerable steps towards facilitating collaboration; however, this has not yielded the desired outcome, because of educational gaps, lack of appreciation, recognition, mutual respect, and mistrust between the two systems. Building a trusting relationship and learning from each other should be prioritized. Aim This study aimed to survey the attitudes of Xhosa-speaking professional nurses and Xhosa-speaking traditional healers, on the treatment of mentally ill people, to assess whether their respective professions could cooperate with regards to the diagnosis and treatment of mentally ill individuals, and to determine the feasibility of future collaboration towards comprehensive mental health care services. Method Thirty Xhosa-speaking professional nurses and 30 Xhosa-speaking traditional healers completed a structured questionnaire. The questionnaire covered practice details, attitudes, perception of the other profession, diagnosis and management of mental illness. Results There was recognition of the one profession by the other and willingness to collaborate for the benefit of the patient by both, professional nurses and traditional healers. There is still an element of mistrust, gaps in knowledge and a superiority complex from both systems. Conclusion There is room for collaboration between traditional healers and biomedical practitioners. Efforts to afford opportunities for both systems to interact and learn from each other need to be supported and prioritized by the government and both professions.
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    An exploration of sociodemographic and psychosocial determinants of cognitive performance in a peri-urban clinic population of people with HIV in Cape Town, South Africa
    (2023) Dreyer, Anna Jane; Joska, John A; Thomas, Kevin G F; Nightingale, Sam
    Introduction. Numerous studies, conducted in many different countries, report that cognitive impairment is highly prevalent in people with HIV (PWH). Such impairment can affect adherence to antiretroviral therapy (ART), and adherence is, in turn, essential for PWH to achieve viral suppression. The gold standard to confirm cognitive impairment is a neuropsychological assessment. However, accurate interpretation of neuropsychological test performance requires consideration of, for instance, how impairment is determined and how accurately the contribution of non-HIV factors to poor cognitive test performance is described. These non-HIV factors include sociodemographic variables (e.g., age, sex, educational attainment), psychosocial variables (e.g., socioeconomic status, food security, quality of life), psychiatric variables (e.g., depression, problematic alcohol use), and other medical co-morbidities. Because many existing studies of PWH do not account for (a) the fact that current quantitative methods for defining cognitive impairment may not accurately reflect HIV-associated brain injury, and (b) possible contributions of non-HIV factors to cognitive test performance, it is possible that the reported prevalence rates of cognitive impairment in PWH are inaccurate (or, at least, do not solely reflect the contributions of HIV disease to the impairment). Another uncertainty in the HIV neuropsychology literature concerns sex differences in the cognitive performance of PWH. Some recent studies suggest that women with HIV (WWH) may present with greater cognitive impairment than men with HIV (MWH). Such a sex difference is of potentially significant concern for South African clinicians because two-thirds of the population of PWH in this country are women. However, there is no definitive empirical evidence regarding whether this sex difference exists to a clinically significant degree (in South Africa, specifically, as well as globally) and what its underlying mechanisms might be. To address the knowledge gaps outlined above, this thesis set out to explore the following aims: (1) investigate sex differences in the cognitive performance of PWH by reviewing the current published literature; (2) determine if sex differences exist in a clinic sample of South African PWH; (3) determine how much variation in reported prevalence rates of HIV-associated cognitive impairment are due to the method used to define impairment, and which method correlates best with MRI biomarkers of HIVrelated brain injury in a South African sample of PWH; (4) investigate the contribution of sociodemographic and psychosocial variables, as well as HIV-disease factors and other medical and psychiatric comorbidities, to cognitive performance in a South African sample of PWH; and (5) investigate associations between cognitive performance and ART adherence in 10 a South African sample of PWH. Each of these aims was explored in a separate study. Hence, this thesis reports on findings from five separate journal manuscripts. Method. Study 1 was a systematic review and meta-analysis summarizing the findings of published studies investigating differences in cognitive performance between WWH and MWH. An extensive systematic search of the literature across several databases found 4062 unique articles of potential interest. After thorough screening of that pool of articles, 11 studies (total N = 3333) were included in the narrative systematic review and 6 studies (total N = 2852) were included in the meta-analysis. Effect sizes were calculated to estimate between-sex differences in cognitive performance, both globally and within discrete cognitive domains. Study 2 investigated sex differences in cognitive performance in a sample of PWH with comorbid MDD (N = 105). All participants were attending community clinics in Khayelitsha, a peri-urban community in Cape Town, South Africa, and were part of a larger research program for a randomised controlled trial of a cognitive-behavioral treatment for ART adherence and depression (CBT-AD). As part of this program, they completed baseline neuropsychological, psychiatric, and sociodemographic assessments. T-tests and multivariable regressions controlling for covariates compared baseline cognitive performance of WWH and MWH, both globally and within discrete cognitive domains. Study 3 applied 20 different quantitative methods of determining cognitive impairment to existing data from a different sample of PWH (N = 148). These individuals had also been recruited from community clinics in Khayelitsha, and had completed a comprehensive neuropsychological assessment and a 3T structural MRI and diffusion tensor imaging (DTI) session. Logistic regression models investigated the association between each method and HIV-related neuroimaging abnormalities. Study 4 again used data from the sample of PWH with comorbid MDD who participated in the larger CBT-AD research program. This study investigated which sociodemographic, psychosocial, psychiatric, and medical variables (as measured at baseline) were associated with baseline cognitive performance. Post-baseline, 33 participants were assigned to CBT-AD and 72 to standard-of-care treatment; 81 participants (nCBT-AD = 29) had a follow-up assessment 8 months post-baseline. This study also investigated whether, from baseline to follow-up, depression and cognitive performance improved significantly more in the participants who had received CBT-AD, and examined associations between post-intervention improvements in depression and cognitive performance. Study 5 assessed ART adherence in the same sample of PWH with comorbid MDD. Mixed-effects regression models estimated the relationship between ART adherence (as measured by both self-report and objective measures, and by degree of HIV viral suppression) with cognitive performance 11 and with other sociodemographic, psychosocial, and psychiatric variables at both baseline and follow-up. Results. Study 1: Analyses suggested that, in terms of overall cognitive functioning, there were no significant differences in cognitive performance between WWH and MWH. However, WWH did perform significantly more poorly than MWH in the domains of psychomotor coordination and visuospatial learning and memory. Additionally, the review suggested that cognitive differences between WWH and MWH might be accounted for by sex-based variation in educational and psychiatric characteristics among study samples. Study 2: Analyses suggested that, in our sample of PWH with comorbid MDD, there were no significant differences in cognitive performance between WWH and MWH. Study 3: Findings suggested that there was marked variation in rates of cognitive impairment (20– 97%) depending on which method was used to define impairment, and that none of these methods accurately reflected HIV-associated brain injury. Study 4: Analyses suggested that less education and greater food insecurity were the strongest predictors of global cognitive performance. Improvement in depression severity was not significantly associated with improved cognitive performance, except in the domain of Attention/Working Memory. Overall, factors associated with cognitive performance were unrelated to HIV disease and other medical factors. Study 5: Analyses identified poor global cognitive performance as a potential barrier to achieving HIV suppression. Conclusion. Taken together, the findings from the five studies contained within this thesis suggest that one oft-mooted sociodemographic influence on cognitive performance in PWH, sex, was not a consistent influence on such performance. However, non-biological (mainly psychosocial and socioeconomic) factors were stronger predictors of cognitive performance in PWH than medical factors (including HIV-disease variables). Current quantitative criteria for defining cognitive impairment in PWH also do not accurately reflect the biological effects of HIV in the brain. The implication of these findings is that research studies may be misclassifying PWH as cognitively impaired and consequently overestimating the prevalence of cognitive impairment in this population. When conducting clinical assessments of PWH, future research studies should measure and consider the strong influence of psychosocial and socioeconomic factors on cognitive test performance. Ideally, a diagnosis of impairment should only be made after a comprehensive clinical assessment that includes a detailed history taking. Overall, we need new criteria for defining cognitive impairment in diverse global populations of PWH. Ideally these criteria should be applicable to both research and clinical settings. Assessing for cognitive impairment among PWH and then providing 12 appropriate support could help achieve viral suppression in patients with non-optimal adherence to ART. At public policy levels, addressing larger psychosocial issues (e.g., food insecurity and low educational attainment) may also help improve cognitive performance in PWH.
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    An exploratory study of the experiences of student support officers offering counselling services to students at TVET Colleges in the Western Cape
    (2025) Naidoo, Sashen; Ward, Catherine; Titi, Neziswa
    This study explored the experiences of student support officers (SSOs) who offer counselling services to students at Technical and Vocational Education and Training (TVET) colleges in the Western Cape province, South Africa. Methodologically, the study employs a phenomenological approach as its focus is on experience-generated knowledge. It is thus located within the qualitative paradigm to give voice and the perspectives of the SSOs. Previous literature demonstrates that students historically sought counselling primarily for academic and career purposes. However, over time, the nature and type of counselling students required became increasingly complex with greater expectations of counsellors at higher education institutions. Therefore, further research is necessary to better understand this consequential phenomenon from the perspective of the SSOs through their meaning-making. This study found that SSOs experienced their role to be ill-defined, fluid and riddled with challenges of language and culture thus affecting the quality of meaningful counselling. This study offers recommendations emanating from interviews with SSOs. This study is germane to governance in TVET colleges in the Western Cape but may offer insights to other institutions of higher learning.
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    An investigation of amygdala and hippocampal subregions and their relation to ageing in anxiety and related disorders
    (2024) Ntwatwa, Ziphozihle; Ipser, Jonathan; Groenewold, Nynke; Stein, Dan; van Honk, Jack
    Background Obsessive-compulsive disorder (OCD) and social anxiety disorder (SAD) are debilitating disorders that are associated with (inconsistent) evidence of hippocampal and amygdala volumetric abnormalities. In addition, both OCD and SAD are associated with accentuated biological aging, as indexed by cellular and molecular markers. Nevertheless, little is known about brain aging in OCD and SAD, or the extent to which inconsistencies in hippocampal and amygdala volume findings in these disorders may be due to the differential effect of age on the subfields from which these structures are composed. Accordingly, this dissertation set out to characterise differences in hippocampal and amygdala subfield volumes between healthy controls (HCs) and participants with OCD and SAD in large-scale MRI datasets and relate these to whole and regional brain aging. Methods Hippocampal and amygdala subfield volumes and brain age estimates were derived from T1 weighted MRI images from the OCD Brain Imaging Consortium (De Wit et al., 2014) and the European and South African Research Network in Anxiety Disorders (Bas-Hoogendam et al., 2017). Subfield volumes were segmented using an automated segmentation algorithm from Freesurfer (v6.0). The brain age analysis was performed by using a previously trained machine learning algorithm that provides brain age estimates for the whole brain, as well as for regions of interest (occipital, frontal, temporal, parietal, cingulate, insula, or cerebellar–subcortical features) (Kaufmann et al., 2019). Differences in relative brain age (brain predicted age difference; brain-PAD) were calculated by subtracting chronological age from the predicted brain age. Between-group differences (diagnosis vs HCs) in volumetric and brain-PAD estimates were assessed using a mixed-effects (d) model adjusted for several covariates. Subgroup analyses were performed to determine the association of the main findings with clinical characteristics. Finally, unique associations between subfield volumes and whole brain age were estimated using partial correlation analysis. Results There was no evidence for a difference in subfield volumes between individuals with OCD and HCs. However, we found that psychotropic medication use was associated with significantly smaller hippocampal dentate gyrus (d=-0.26, pFDR=0.042), molecular layer (d=-0.29, pFDR=0.042) and larger lateral (d=0.23, pFDR=0.049) and basal (d=0.25, pFDR=0.049) amygdala subfields than HCs. Individuals with OCD without psychotropic medication use had significantly smaller hippocampal CA1 (d=-0.28, pFDR=0.016) compared to HCs. No association was found for symptom severity. In contrast to the findings for OCD, individuals with SAD demonstrated significantly smaller basal (d= 0.32, pFDR=0.022), accessory basal (d=-0.42, pFDR=0.005) and corticoamygdaloid transition area (d=0.37, pFDR=0.014) amygdala subfields overall compared to HCs, and larger hippocampal CA3 (d=0.34, pFDR=0.024), CA4 (d=0.44, pFDR= 0.007), dentate gyrus (d=0.35, pFDR= 0.022) and molecular layer (d=0.28, pFDR=0.033). In addition, individuals with SAD without comorbid anxiety disorder had smaller lateral amygdala and hippocampal amygdala transition area, compared to HCs. No association was found for psychotropic medication use and symptom severity. Individuals with OCD (n=375) had significantly higher whole brain-PAD (+1.6 years, pFDR=0.006, d=0.20) compared to HCs (n=335), but no differences were observed in the regional models. The effect on whole brain brain-PAD estimates was largely driven by psychotropic medication use as higher relative brain age was evident in individuals with OCD with psychotropic medication use (+2.98 years, d=0.38, p <0.001) compared to HCs, but not in individuals without psychotropic medication use (+0.57 years, d=0.07, p =0.374) compared to HCs. No association was found for symptom severity. Partial correlation analysis found a significant negative association between hippocampal and amygdala volume and whole brain PAD in the OCD group (R=-0.224, p=0.00001), but not in the HC group (R=0.081, p=0.138), specifically the lateral nucleus (R=-0.18), CAT(R=-0.13), hippocampal fimbria (R=0.17), and hippocampal fissure (R=0.17) were significant in OCD. Individuals with SAD (n=107) had significantly higher whole brain-PAD (+2.5 years, d=0.33, pFDR=0.010) compared to HCs (n=137), and significantly higher regional brain-PAD in the temporal (+3.80 years, d=0.37, pFDR=0.008,), parietal (+3.57 years, d=0.38, pFDR=0.008), occipital (+3.26 years, d = 0.33, pFDR=0.010), and frontal regions (+2.97 years, d=0.33, pFDR=0.010,) compared to HCs. Brain PAD was higher in SAD without comorbid anxiety disorder, without MDD, and without psychotropic medication use. No association was found for symptom severity. There was no partial correlation between subfields and brain age. Discussion & Conclusion The evidence presented in the thesis suggests that 1) differences in subfield volumes between OCD and HCs were influenced by psychotropic medication use, which is consistent with previous studies that suggest that psychotropic medication status is a strong confounder for subcortical brain volumes observed in OCD, 2) differences in subfield volumes between SAD and HCs were observed in the areas associated with sensory information processing and these differences were partially influenced by psychiatric comorbidity, 3) both OCD and SAD were associated with accentuated brain aging with differential patterns in the whole and regional brain, dependent on clinical characteristics, and 4) only OCD relative brain age was associated with subfield volumes. It is unclear whether our findings in OCD and SAD reflect an adaptive response or are a pre-existing risk factor to these disorders, or both. Future longitudinal analysis is required to investigate whether the observed differences in subfield volume and brain age remain over time.
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    Open Access
    Child and Adolescent Mental Health Services in Khartoum State, Sudan: A desktop situational analysis
    (2022) Abdalhai, Khalid Abdallah; de Vries, Petrus J; Mokitimi, Stella
    Background Sudan is a Northeast African country, with 61.7% of its population under 24 years. Data concerning child and adolescent mental health (CAMH) is limited in low-income countries. With a large youth population and significant cultural and linguistic diversity, Sudan has contributed minimal data to global CAMH research. Objectives This study aimed to perform a desktop situational analysis of CAMH services in Khartoum state, Sudan. Methods In chapter 1, we performed a literature review of peer-reviewed publications on PubMed and Google scholar and identified relevant articles through search terms relevant to the focus of the study. In chapter 2, we performed a desktop situational analysis of the national capital of Sudan, Khartoum state, in the calendar years 2019 and 2020. The study used the World Health Organization Assessment Instrument for Mental Health Systems version 2.2 adapted for CAMH. The study covered the six WHO-AIMS domains: 1) policy and legislation, 2) CAMH services, 3) CAMH in primary health care, 4) human resources for CAMH, 5) public education, and 6) monitoring and research. Data sources were identified, and relevant information and documents were reviewed. The data were described in tables and figures using the WHO-AIMS version 2.2 template. Ethical approval was obtained from the Human Research Ethics Committee at the Faculty of Health Sciences, University of Cape Town. Results The desktop situational analysis found no available policy legislation specific to CAMH in Khartoum and no separate budget for CAMH. There was no supervising body for CAMH services in Khartoum. Three mental health tertiary hospitals were found to provide services for children and adolescents with mental health problems, all together with adult mental health services. Essential medicines were available in all facilities, except methylphenidate (a stimulant medication used for ADHD), available only in 3 central pharmacies. At the primary care level, there were limited data about training offered to primary healthcare providers and about the process of referral to specialized CAMH services. A School Mental Health Program (SMHP) existed, which provided services for school-aged children and helped in the early identification and management of CAMH problems. The workforce was small and variable across all levels of care. There was no formal public health awareness campaign identified in Khartoum during the study period and little evidence of formal intersectoral collaboration on CAMHS. A health information system existed in Khartoum, but no CAMH-specific items were reported. No national studies in CAMH were identified. Conclusion This situational analysis represented the first systematic collation of data and information about CAMH services in one of the Sudan states. Findings highlighted some areas of strength, but also many gaps in CAMH services and systems. We acknowledge the need to complement the desktop analysis with in-depth data collection with stakeholders across multiple levels, but hope that this will serve as a first step towards strengthening CAMH services in Khartoum and beyond.
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    Children's social networks and their implications for mental health and well-being
    (2025) Williamson, Elizabeth; Wild, Lauren
    The convoy model of social relations examines social networks as complex and evolving support structures. The exploration of children's social convoys is in its early stages, with limited research investigating how social network characteristics are associated with children's mental health and well-being. The current study aimed to fill this gap by examining the composition of preadolescent South African children's social convoys, as well as the implications of various structural features for mental health and well-being. Cross sectional data from 126 children aged 9- to 12-years-old from five schools across Cape Town and their parents were used in this study. The data were collected using standardised questionnaires and interviews. The findings revealed that children generally nominated parents, siblings, and often grandparents in their inner circles, and placed extended family members, friends, and professionals in the middle and outer circles of their social networks. Correlational and multiple regression analyses indicated that greater inner circle diversity had a positive association with both child- and parent-reported positive affect, and greater contact frequency with friends was negatively associated with total difficulties. Hierarchical multiple regression analyses showed that father absence from the inner circle was associated with more psychological difficulties and a poorer quality of life. Sibling and extended family member presence in the inner circle were associated with more child-reported positive affect, while grandparent presence was associated with more prosocial behaviour. Overall, the findings support both universal and culture-specific trends in children's social network composition, as well as the presence of relationships between specific structural features and mental health and well-being. It is recommended that interventions supporting children's mental health and well-being focus on fostering diverse inner circles by strengthening bonds with fathers and siblings as well as grandparents and extended family members.
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    Depression amongst caregivers of children and adolescents with perinatally acquired HIV in Cape Town, South Africa
    (2022) Booysen, Gillian; Hoare, Jacqueline; Phillips, N
    Background Depression remains the most commonly diagnosed mental health disorder. It adds significantly to the global burden of disease and is responsible for the most years of life lost to disability in both men and women (Rehm & Shield, 2019). The successful roll-out of antiretroviral therapy (ART) to those living with HIV has resulted in the emergence of an increasing population of children and adolescents with perinatally acquired-HIV (PHIV) requiring care. Caregivers of PHIV are at increased risk for the development of depression due to parental, child and socio-economic factors. Few studies have focused on the specific factors associated with caregiver depression in the context of caring for ART-treated and untreated PHIV. Aims and Objectives The aims of this cross-sectional study are to assess the prevalence of depression in caregivers of PHIV compared with caregivers of a HIV-seronegative matched control group (HC). In the HIV-impacted families, a comparison will be drawn between the prevalence of depression in biological and non-biological caregivers. Factors associated with depression in this vulnerable group will be assessed using various caregiver, child and socio-economic measures. Methods Caregivers of 75 PHIV and 30 HC were selected from a community healthcare setting in Cape Town. Results There was no difference found between levels of depression in PHIV caregivers (biological or non-biological) and caregivers of HC. Internalising and externalising child behaviours, poor family resources (including basic needs, money, time for self and time for family) and limited social support were associated with depression in both caregiver groups. In caregivers of HC, parental stress was associated with higher levels of depression. Conclusion Factors independent of HIV status of children may be driving depression in caregivers of children and adolescents in Cape Town, South Africa where HIV is endemic. Thus, this study could facilitate a better understanding of depression in the context of caring for PHIV and better inform interventions in these vulnerable family systems.
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    Elder abuse in South Africa: measurement, prevalence and risk
    (2023) Jacobs, Roxanne; Schneider, Marguerite; Farina, Nicolas
    Abuse towards older people is a global public health and human rights concern and considered a hidden pandemic due to underreporting. It has been estimated that 1 in 6 people aged 60 and older have experienced abuse at some point, with World Health Organization estimating that only 4% of cases are reported. Often older adults do not recognise their situation as an abusive one or may be reluctant to disclose because the abuser is a family member, often an adult child for which the older person feels responsible for. People living with dementia and older persons with significant health concerns are especially vulnerable to elder abuse, with estimates showing that 2 in every 3 people living with dementia have experienced some form of abuse. Rigorous data on the extent of the problem globally is limited, with studies often excluding the self-report of older adults with cognitive impairment, such as dementia. Lack of disclosure may therefore be amplified in people living with dementia with limitations in insight, recall or communication skills. These realities keep elder abuse hidden, while often relying on the self-report of perpetrators to disclose abuse. Screening and identifying elder abuse, especially amongst people with cognitive impairments, are complex. Very little research is published on elder abuse in South Africa, with a complete absence of prevalence estimates, routine reporting, or monitoring and surveillance of issues relating to elder abuse. From the limited data available, elder abuse in South Africa is a serious concern. In South Africa older persons are now, more than ever, expected to manage households, rear children, and financially support their entire household with their pensions. This shift in role makes them especially vulnerable to the impact of the country's high rates of poverty, unemployment, and crime, especially within the home environment. These structural and social determinants of violence are poorly understood in the context of elder abuse. In particular, there is a serious lack of local evidence that supports the understanding, risk, and measurement of elder abuse in South Africa. This study therefore proposed to address these gaps through four sub-studies designed to describe the landscape of elder abuse in South Africa. These sub-studies had the following aims: 1. To provide a situational analysis on current service provisions for dementia and elder abuse for older adults, including people living with dementia and their families (sub-study 1). 2. To cross-culturally adapt the Elder Abuse Screening Tool (EAST) and the Caregiver Abuse Screen (CASE) in South Africa, to detect self-reported abuse and risk of abusing from older persons' and potential perpetrators' perspectives (sub-study 2). 3. To examine the nature of self-reported elder abuse using the Elder Abuse Screening Tool (EAST) to generate evidence on the prevalence, predictors, and perpetrators of abuse (substudy 3). 4. To estimate the prevalence and predictors of risk of abusing using the Caregiver Abuse Screen (CASE) amongst household informants, including carers for people living with dementia (sub-study 4). Sub-study 1: “Dementia in South Africa: a situational analysis” This study comprises of two parts. Part I presents a situational analysis that was conducted in three phases: (1) a desk review guided by a comprehensive topic guide which included the World Health Organization's (WHO) Global Dementia Observatory indicators; (2) multi-sectoral stakeholder interviews to verify the secondary sources used in the desk review, as well as identify gaps and opportunities in policy and service provisions and (3) a SWOT-analysis examining the strengths, weaknesses, opportunities and threats in current care and support provisions in South Africa. Findings highlight the gaps and opportunities with current service provisions and show how structural factors create barriers to diagnosis, support and care. These barriers to diagnosis, care and support create risk for elder abuse and neglect as families and people living with dementia are largely unsupported by formal, community-based services. Part II expands this analysis and provides a closer look at the insights gained from stakeholders interviewed and reports on the status of elder abuse support provisions in South Africa. We found that, like in the case of dementia services, support provisions for elder abuse are poor. While there is a lack of data on the nature and extent of the problem, experts agree that underreporting is a big problem, and that people living with dementia are at greater risk of elder abuse that may include extreme forms of violence. Sub-study 2: “Cross-cultural adaptation of the EAST and CASE screening tools for elder abuse in South Africa” We tested the cultural appropriateness of the EAST (Elder Abuse Screening Tool) and the CASE (Caregiver Abuse Screen) in two regions (Western Cape and Limpopo) and four languages in South Africa (English, Afrikaans, isiXhosa and Northern Sotho (Sepedi)), using a cognitive interviewing methodology. Findings show that questions in the EAST and CASE are generally well understood, but that adaptations of both tools are necessary for use within South Africa. Older persons' fear, knowledge and experience of crime also showed that strangers may deliberately use deception to build trust and abuse. Further validation is needed to determine suitable scoring and use by health and social care practitioners. Sub-study 3: “Prevalence, perpetrators, and predictors of self-reported elder abuse in South Africa: findings from a household survey” Informed by the cognitive interviews in sub-study 2, the adapted EAST was used in a household survey to screen 490 older people for self-reported elder abuse across two areas, Cape Town (Western Cape) and Dikgale (Limpopo). One in ten older adults screened positive for abuse, of which financial abuse was most common. Perpetrators of elder abuse were most often a non-family member with whom the older adult had a relationship with. Higher prevalence of self-reported abuse was strongly predicted by higher levels of the respondent's own functional impairment. This is one of the first studies that explore the relationship between dementia, functional impairment, and elder abuse at a community level in South Africa. Sub-study 4: “Risk of elder abuse in South Africa: a survey of household informants” Within the same household survey, we screened informants of the older adults using the CASE. We found that risk of elder abuse was very high, with half of participants screening positive for abusive dispositions toward an older person. Carers of people living with dementia were four times more likely to be at risk of abusing compared to carers of people free of dementia. However, our multivariate model showed that more severe psychological and behavioural symptoms and increased carer burden are the main associations with elder abuse in this population. Supporting carers to manage stress and reduce burden includes the effective management of neuropsychiatric symptoms and has potential to reduce risk for elder abuse. Overall, the findings of this study showed that elder abuse and risk of abusing is high in South Africa, with perpetrators often being a non-family member with whom the older person has a personal relationship with, or a family member. It provides an important contribution to the available evidence base on elder abuse in a low-or-middle-income country like South Africa and gave insight into understanding elder abuse in context to support targeted efforts to reduce risk of abuse and provide adequate services for older adults, including people living with dementia.
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    Investigating strategies for addressing child and adolescent mental health following exposure to extreme weather events in low- and middle-income countries: A scoping review
    (2022) Kadota, Molly Kaelin; Rother, Hanna-Andrea; Jagarnath, Meryl
    The inevitability of an increase in extreme weather events (EWE) due to climate change will likely influence every determinant of human health and wellbeing. Children and adolescents, defined as anyone under the age of 19, are among the most susceptible because of their unique vulnerabilities (i.e. physiologically, developmentally, biologically, and behaviourally) and lifespans. The effects on physical health are generally well documented, and many climate change adaptation strategies have begun to include them in their considerations. However, the implications of EWE exposure on mental health are less understood, particularly within low- and middle-income countries (LMICs). Populations residing in LMICs are especially vulnerable because of pre-existing conditions like already extreme weather, lack of resources, poor economic conditions, weak health systems, high burden of disease, and poor governance. Therefore, children and adolescents in LMICs maintain a heightened vulnerability to experiencing adverse effects. In Part A, a preliminary literature review determined the breadth of information documenting child and adolescent mental health outcomes following exposure to EWE. Research, mainly from high-income countries (HICs) or international organisations, demonstrating an association between mental health impacts and climate change, focused primarily on adult populations, has increased substantially over the last few years. Experiencing an EWE in childhood or adolescence likely leads to direct (e.g. anxiety, post-traumatic stress disorder, depression, behavioural disorders, and suicidal ideations), indirect (e.g. displacement, loss of sense of place, violence, malnutrition, developmental delays, and disruption of education), and overarching (e.g. general climate anxiety about impending threats) mental health impacts, presenting in both the short- and long-term. The goals of adaptation and mitigation strategies were also presented in the protocol to determine the potential for specific mental health strategies. In Part B, then, a scoping review was conducted to provide a narrative of where adaptation, resilience, and mitigation strategies in LMICs address, and where they do not, child and adolescent mental health impacts following exposures to EWE. A search conducted in June-August 2021 of 12 online databases from the Pubmed, EBSCOhost, and Scopus platforms and grey literature sites like Google Scholar, Microsoft Academic, and NGO pages identified 5,073 relevant records. Search results were limited to documents written in English and filtered by a 2000-2021 date range. In the current LMICs climate change strategies, the review highlighted a general lack of consideration for child and adolescent mental health and resilience. Therefore, eight main themes recurring in the literature were identified as integral components for including child and adolescent mental health in future national strategies and policymaking discussions. The themes provide general guidance, but their addition necessitates country-specific conceptualisation to determine technical considerations (e.g. funding and responsibility) and relevance. This review, therefore, emphasised the necessity for LMICs to begin including child and adolescent mental health in climate change strategies, highlighted key recommendations that were applicable in the LMICs context, and illuminated still existing gaps in the literature and potential areas for future research.
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    Medicine and the Arts Week 5 - Experiences of mental illness through music
    (2015-01-21) Baumann, Sean
    In this video, Sean Baumann, a senior specialist psychiatrist in UCT's Department of Psychiatry and Mental health, discusses the misrepresentation of mental illness in film and theater, particular misrepresentations of schizophrenia-like disorders. He makes the argument that an improved understanding of mental health by viewing it from a first-person perspective would help address this problem. He describes how music can offer rich representations of mental illness. This is the third video in Week 5 of the Medicine and the Arts Massive Open Online Course.
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    Missed opportunities to address mental health of people living with HIV in Zomba, Malawi: a cross-sectional clinic survey
    (2020) Kawiya, Harry Henry; Sorsdahl, Katherine; Lund, Crick
    Background. Common mental disorders (CMDs), including depression and anxiety disorders, and risky alcohol use are highly prevalent among people living with HIV. Yet, many studies have found that most people who suffer from mental disorders do not receive treatment, especially in low-income countries. Given people living with HIV frequent health services, this represents a missed opportunity for identification and treatment that could improve physical and mental health outcomes. The aim of this study was to identify missed opportunities to address mental health of people living with HIV in Malawi. Four types of missed opportunities were operationalised for this study. The first two address missed opportunities for screening or identification For missed opportunity #1, a respondent had to screen positive for mental health problem (depression/anxiety or alcohol use ; and in any of their visits to the clinic in the past 12 months, the clinical officer or nurse did not ask about their mental health. Missed opportunity definition #2 was a more nuanced missed opportunity for identification of probable mental health problems. A respondent had to be undetected for mental health problems; and in any of his or her visits to the clinic in the past 12 months, the clinical officer or nurse did not ask about his or her mental health and s/he wanted to receive advice or treatment about his or her mental health problems. The second to definitions address missed opportunities for treatment. For missed opportunity definition #3, a respondent had to screen positive for mental health problem and if in any of his or her visits to the clinic in the past 12 months, and s/he did not receive advice or treatment. For missed opportunity definition #4, a more nuanced missed opportunity for the treatment of probable mental health problem: a respondent had to screen positive for a mental health problem; s/he wanted to receive advice or treatment about his or her mental health problems/alcohol use; and in any of their visits to the clinic in the past 12 months, s/he did not receive treatment for a mental disorder/risky alcohol use. Methods. A a random of participants receiving HIV care were approached while they were waiting for their consultation at three ART clinics namely: Tisungane, Matawale and Domasi. Those who consented to participants were interviewed in a private room. The Self-Reporting Questionnaire-20 (SRQ-20) and the Alcohol Use Disorders Identification Test (AUDIT) were used to detect probable cases of CMDs and clients consuming alcohol at risky levels. Following v administration of the SRQ-20 and AUDIT, participants were asked if clinical officers (COs) or nurses inquired about their feelings (sad or worried) or alcohol consumption during their routine visits to ART clinics, thus eliciting data on identification by healthcare workers or identification of CMD symptoms. The participants were also asked whether advice or treatment was recommended and whether they would have liked to receive advice or treatment regarding their feelings or risky alcohol use. Descriptive statistics were utilized to calculate prevalence estimates of missed opportunities and multiple logistic regression models were used to determine the factors associated with missed opportunities for mental health service provision. Results. The study had 382 participants. The proportion of participants who screened at risk was 77 (20.2%) for probable CMDs and 16 (4.2%) for risky alcohol use. The proportion of participants who screened at risk for any mental health problem (depression, anxiety and risky alcohol use) was 87 (22.8%). Participants who were asked by clinical officers and nurses about CMD symptoms and alcohol use were 92 (24.1%) and 89 (23.3%) respectively. Of the entire sample, 351 (91.9%) participants wanted to receive advice or treatment and 26 (29.9%) received advice or treatment. Missed opportunities to address the mental health of people living with HIV were found to be as follows: definition #1, 40 participants (46.0%); definition #2, 35 participants (40.2%); definition #3, 87 participants (100%) and definition #4, 66 participants (75.9%). After adjusting for other variables in the model female gender was significantly associated with missed opportunity definition #1. After adjusting for other variables in the model female participants were more likely to meet criteria for missed opportunity definition #2 than male participants. Furthermore, older participants were less likely to meet criteria for missed opportunity definition #2 compared to younger participants. Participants who were employed were less likely to meet criteria for missed opportunity definition #2. In the same vein, participants who were spending less were less likely to meet criteria for missed opportunity definition #2. Given all participants met criteria, we were unable to develop logistic regression models. There were no significant associations for missed opportunity definition #4. Conclusion. Approximately one fifth of the sample recruited screened at risk for CMDs and most clients wanted to receive advice or treatment. Despite over 40% of the participants reporting being asked about CMD symptoms, PHC workers did not provide advice or treatments to 75.9% of clients. There is need to advocate for screening of mental health problems including alcohol use and treatment in all ART clinics in Malawi.
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    Neurocircuitry of attention in methamphetamine induced psychosis: a comparison against schizophrenia patients and healthy controls
    (2022) Hsieh, Jennifer Hsin-Wen; Stein, Dan; Howells, Fleur
    Background Methamphetamine induced psychosis (MAP) and schizophrenia present with similar positive symptoms of psychosis, are characterized by evidence of attentional impairment, and show symptomatic response to treatment with dopamine antagonists. At the same time, MAP is considered a transient condition, while schizophrenia can be conceptualized as a neurodevelopmental disorder. Despite advances in the neurobiology of these two conditions, the extent to which their underlying attentional neurocircuitry show overlaps or differences has not often been directly compared. This thesis compared MAP, schizophrenia and healthy controls, in order to examine overlap and differences in 1) subcortical regulation of cortical inhibition and excitability, 2) resting state cortical and subcortical connectivity, and the dynamics of rhythmic neural activity between states, and 3) cortical-cortical connectivity using event related potential (ERP) responses to stimuli with a continuous performance task (CPT). Methods Outpatients treated for MAP and schizophrenia were recruited through hospitals and psychiatric institutions in the Western Cape. A final cohort of 24 MAP and 28 schizophrenia and 32 healthy control participants were included in the analyses for this thesis. For the cortical silent period (CSP) paradigm, the participant was asked to maintain isometric contraction between the thumb and index finger while TMS pulses at 120% and 140% resting motor threshold (RMT) were delivered to the primary motor cortical area corresponding to the abductor pollicis brevis (APB). Parameters extracted from CSP data included the latency to motor evoked potential (MEP), MEP amplitude and CSP duration. Electroencephalographs (EEGs) were performed with bilateral prefrontal, frontal, frontal temporal, central and parietal electrode locations. Relative EEG frequency power data were extracted from 3 stages during the EEG session, including states of eyes open, eyes closed, and during performance of the CPT. The CPT consisted of a series of random consonant letters. Participants were asked to respond to the letter "S" with a finger press only if it was the 3rd consecutive occurrence. ERP data were extracted and averaged from consecutive cues (S1 and S2), target (S3) and distractor (individual "S") stimuli in the CPT task. ERP data were analysed for group differences in N100, P200, N200 and P300 amplitudes and latencies at each electrode location with sufficient signal quality. Results In the CSP protocol, MAP and schizophrenia groups showed smaller MEP amplitudes at both 120% and 140% RMT stimulation levels in comparison to controls. Both MAP and schizophrenia groups had lower alpha and higher delta relative frequency band power, with schizophrenia showing significant differences from controls at more electrode positions than MAP. While controls demonstrated a decrease in alpha power between the eyes closed and eyes open resting states, this did not occur in MAP or schizophrenia. During the CPT, both MAP and schizophrenia achieved fewer correct targets and showed slower reaction times than healthy controls. In addition, MAP responded more often than the other two groups to the S2 stimulus (which required response inhixii Abstract bition). ERP analysis found smaller N100, larger P200, larger N200 and larger P300 amplitudes in MAP in response to stimuli requiring inhibition than in schizophrenia and controls, whereas schizophrenia showed longer P300 latencies in response to the target and distractor stimuli than in MAP and controls. Conclusions MEP results suggest that MAP and schizophrenia may have similar subcortical dysregulation, suggestive of altered dopaminergic regulation in the basal ganglia-thalamus-cortex loop. EEG frequency power results suggest that MAP and schizophrenia both display an inflexibility of subcortical systems involved in adaptation to environmental changes, suggesting deficiencies in the CT-TRN-TC loop in both MAP and schizophrenia. CPT performance and the pattern of ERP alterations in MAP suggests greater cholinergic impairment during attentional performance in MAP than in schizophrenia. Taken together, while there is considerable overlap in cortical-subcortical inhibition and connectivity in MAP and schizophrenia, there are also important differences; findings that emphasize both the similarities and dissimilarities that are seen clinically.
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    Participant profiles and symptom responses in the initial stages of a South African Mental health managed care programme
    (2019) Hattingh, Leandri; Breuer, Erica; Schneider, Marguerite
    Introduction Continuously rising health care and workplace costs associated with mental illness is demanding attention from health care funders in South Africa’s private health care sector. The majority of mental health care costs are generated by in-hospital care, whilst funded access to ambulatory care is limited in this sector. The Medscheme Mental Health Programme (MMHP) is a collaborative care project which aims to promote the integration of good quality mental health care into the primary care setting. In a “treatment-to-target” approach, symptom score trackers are used to systematically monitor response to treatment in order to help identify and modify suboptimal treatment plans timeously (Hattingh 2017b). Aims This study describes the MMHP participants and pathways into and through the MMHP, and its initial clinical outcomes. Methods Principal members and dependant beneficiaries of two participating medical schemes screened for enrolment on the MMHP between 1 August 2016 and 28 February 2018 were included in the study. Persons younger than 18 years were excluded. Symptoms of major depressive disorder (MDD), generalised anxiety disorder (GAD), posttraumatic stress disorder (PTSD) and alcohol abuse were screened for by using the Patient Health Questionnaire-9 (PHQ-9) (Spitzer, Williams, and Kroenke 2002-2015; Kroenke and Spitzer 2002), the Generalised Anxiety Disorder Questionnaire-7 (GAD-7) (Spitzer, Williams, and Kroenke 2002-2015; Spitzer and Kroenke 2006), the Primary Care Post-Traumatic Stress Disorder Screen (PC-PTSD) US Department of Veteran Affairs (2015); (Prins, Ouimette, and Kimerling 2003) and the Alcohol Use Disorders Identification Test (AUDIT) (Babor et al. 2001). The Medscheme Care Manager administered these questionnaires telephonically to screen candidates for enrolment on the Programme and communicated regularly with the associated clinical practitioner regarding treatment response. A specialist psychiatrist reviewed and provided recommendations on problematic cases at set intervals. Using logistic regression, the association between demographic characteristics and scheme type and the presence of moderate or severe symptoms of 1) depression, 2) generalised anxiety disorder, and 3) post-traumatic stress disorder, was assessed. Percentages of the sample with a single condition, one, two and three comorbidities were also analysed, as well as the proportions of co-occurrence per various combinations of conditions. Wilcoxon signed rank tests were used to determine the change in symptom severity between baseline and 10 weeks in those receiving intervention through the MMHP. Linear regression models were created to analyse the predictors of change in clinical scores. Results In the screened group, 48.6% were found to have moderate to severe symptoms of anxiety on the GAD-7, 53.2% of depression on the PHQ-9, and 33.2% of PTSD on the PC-PTSD. Relatively high rates of possible comorbidity were found in this study, especially between depression and anxiety: of those screening positive for any one condition, 73.8% screened positive on the combination of PHQ-9 and GAD-7. Screening positive on the PHQ-9 was found to be a very strong predictor of concomitant positive screening on the GAD-7 (OR = 36.4, CI = 25.3 - 52.2), and vice versa - screening positively on the GAD-7 strongly predicted positive screening on the PHQ-9 (OR = 36.6, CI = 25.4 - 52.6). Strong associations were demonstrated with females and potential depression (OR = 1.51, CI = 1.03 - 2.21) and/or PTSD (OR = 1.65, CI = 1.18 - 2.31), while younger age was significantly associated with higher likelihood of screening positive for potential depression (OR: 0.99, CI= 0.98 - 1.00), PTSD (OR = 0.97, CI 0.96 - 0.98) and/or generalised anxiety disorder (OR = 0.97, CI = 0.96 - 0.98). There were statistically and clinically significant improvements in clinical scores for all four conditions at Week 10 after enrolment on the MMHP, compared to baseline: 21% reduction in mean scores in the AUDIT, 43% in the GAD-7, 45% in the PHQ-9, and 36% in the PC-PTSD. Conclusion In its current form, the MMHP appears to be successful in reaching significantly symptomatic medical scheme beneficiaries, with possible scope to expand its reach. Certain key design elements such as using clinical data to determine risk and need for intervention, treatment target calculation adjusted for baseline, screening for comorbidity, and current referral sources, appear to be appropriate. Given the absence of a control group, however, further research is required to confirm the outcomes of the intervention.
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    Perinatal Mental Health project
    (2014-09-29) Honikman, Simone; Baron, Emily; Field, Sally; Meintjies, Ingrid; van Heyningen, Thandi
    The Perinatal Mental Health Project (PMHP) addresses mental illness among pregnant and postnatal women and girls. The aim of PMHP is to ensure all women in South Africa have access to mental health care during and after pregnancy, as a routine part of their health care. Maternal mental illnesses, particularly common mental disorders such as depression and anxiety, are very common in low-income and informal settings. While maternal mental illness affects 10% to 15% of women in developed countries, prevalence is almost 40% in South Africa. Most of the women in South Africa who experience maternal mental illness are poor, from disadvantaged communities who face many challenges in accessing health services and treatment.
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    Prevalence of depression and anxiety and associated risk factors among adolescent offenders within the juvenile justice system in Bulawayo and Matabeleland North Province(s), Zimbabwe
    (2024) Marufu, Marshall Takudzwa; Sorsdahl, Katherine; Williams, Petal Petersen; Besada, Donela; Mangez, Walter
    Background The mental health of adolescents is becoming an increasing public health concern. Mental health conditions such as depression and have their onset during childhood. Research has shown that adolescents entering the juvenile justice system are particularly vulnerable to depression and anxiety. Despite the negative consequences associated with these conditions among adolescent offenders, there is a dearth of studies conducted in low and middle countries including Zimbabwe on the prevalence and factors associated with symptoms of depression and anxiety among adolescent offenders between 10-17 years within the juvenile justice system. Thus, the aim of this study is to determine the prevalence and factors associated with symptoms of depression and anxiety among adolescent offenders between 10-17 years within the juvenile justice system in Bulawayo and Matabeleland North Province, Zimbabwe. Methods In total, 130 adolescent offenders aged between 10 and 17 years were recruited in the cross- sectional study using a convenient sampling technique. The Centre for Epidemiological Studies Depression Scale (CES-D-10) and Generalized Anxiety Disorder (GAD-7) were used to measure symptoms of depression and anxiety, respectively. The Alcohol Use Disorders Identification Test (AUDIT), Drug Use Disorders Identification Test (DUDIT), Fagerstrom Test for Nicotine Dependence (FTND), Rosenberg Self-Esteem Scale, and Sexual Risk Behaviour Beliefs and Self-Efficacy Scales were used to measure individual factors associated depression and anxiety. The Juvenile Victimization Questionnaire (JVQ) was used to measure factors associated with mental health conditions at the family level, while the Multidimensional Scale of Perceived Social Support (MSPSS) was used to measure associations at the social level. Means and proportions were used to describe socio- demographic data as well as the prevalence of potential mental health conditions (depression and anxiety). Unadjusted and adjusted associations between individual, family, and social risk factors and the presence of depression and anxiety were also explored. Only those variables that were significant in the unadjusted models were included in the final adjusted regression model. The standard cutoff level for statistical significance used in this analysis is a p-value of 0.05 or less. The findings are presented in the form of odds ratios (ORs) with 95% confidence intervals (CIs). Page | 5 Results The prevalence of depression and anxiety among participants was 18.5% and 10.8% respectively. In total, 7.6% of participants had reported symptoms of both depression and anxiety, highlighting the co-morbidity of mental health conditions among adolescent offenders. After adjusting models, results indicate that adolescents with a known history of mental health problems were more likely to report symptoms of anxiety than those without a known history (OR=15.10, 95% CI 1.86 -122.78). The adjusted models also indicate that adolescents who report more social support are less likely to experience symptoms of anxiety (OR=0.96, 95% CI 0.92 - 0.99). Additionally, the adjusted model shows that participants with high risky sexual behaviour (OR=1.19, 95% CI 1.05-1.35), high self-esteem (OR=1.19, 95% CI 1.05-1.35) and experiencing juvenile victimization or childhood violence (OR=46.87, 95% CI 3.89-565.237) were more likely to have symptoms of depression. Finally, results show that being a first time offender (OR=0.17, 95% CI 0.04-0.80) and having a mother who is alive (OR=0.12, 95% CI 0.02-0.76) are protective factors that reduces the risk of young offenders experiencing symptoms of depression. Conclusion Results from the study show that symptoms of depression and anxiety are prevalent among adolescent offenders within the juvenile justice system and are associated with several risk factors. Selective prevention interventions are recommended for this vulnerable population.
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    Promoting mental health in scarce-resource contexts: emerging evidence and practice
    (2011) Petersen, Inge; Bhana, Arvin; Flisher, Alan J; Swartz, Leslie; Richter, Linda
    Mental health in scarce-resource settings has received considerable attention in the new millennium, in response to the growing evidence on the burden of mental disorders and their cost-effective treatments. The World Health Organization’s (WHO) World Health Report 2001, and The Lancet series on Global Mental Health in 2007, are two major initiatives that synthesised the evidence from these settings. While the former highlighted the burden of mental disorders and the large treatment gaps in all countries, the latter described the exciting new evidence on treatment and prevention for many mental disorders, but also the many barriers to scaling up these treatments. The Lancet series ended with a call to action to scale up services for people with mental disorders, based on evidence and a commitment to human rights. Both these initiatives, however, focused on the extreme end of the distribution of distressing mental health experiences in the population – the end where most individuals would satisfy diagnostic criteria for mental disorder. It is in this context that the larger role of promoting mental health in scarce-resource settings at the level of the population as a whole, or sub-groups targeted on grounds of vulnerability or age, becomes highly relevant. This resource includes contributions from a range of experts makes this a must read text for students and practitioners, policy-makers and planners or anyone with an interest in improving mental and public health in South Africa.
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    TEDI 4 Week 4 - Caring for the care-giver
    (2019-06-01) Couper, Jacqui
    In this video, Jacqui Cooper discusses caring for the carer of children with severe to profound intellectual disabilities. Jacqui discusses the importance of supporting carers and care-workers, given the rates of mental health problems (such as depression) in society. She talks about the importance of authentic self-care and discusses some strategies for effective self-care, both as individuals or as part of a work team, acknowledging the emotional and physical burden of care work on the caregiver and the need for care workers to renew their energy to avoid compassion fatigue or burn-out. She discusses the importance of shared goals within a care team to promote a shared culture and acknowledgement of the need for self-care. She closes with advocating for the importance of developing cultures of self-care and mutual care within the workplace.
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    The experiences of ex-offenders living with a mental disorder within three to twelve months following discharge from psychiatric prison care in Zimbabwe: a qualitative study
    (2022) Mhishi, Wellington; Sorsdahl, Katherine; Williams, Petal Petersen; Mangezi, Walter
    Background: There are significant challenges in many countries to effectively manage service needs of prisoners with a mental illness. In Zimbabwe, there is no literature on the prevalence of mental disorders among prisoners but it is likely to be as high as in other African countries. Apart from high prison populations which often under resourced, it is also reported that ex-offenders from correctional psychiatric institutions face a range of social, economic and personal challenges once released which often hamper their ability to live adaptive crime-free lifestyles. Although there is extensive literature on experiences of offenders within the criminal justice system, few studies have examined the convergence of the factors affecting those ex-offenders living with mental illness' transition from the prison environment to the community, as related to (i) their experiences upon discharge, (ii) barriers to effective community reintegration of this vulnerable population, and (iii) their service needs. The study addresses this gap. Aims & Objectives: The overall aim of the study was to explore the experiences of ex-offenders with a mental illness within a period of three to twelve months following discharge from psychiatric prison care. Specific objectives included: (1) exploring the experiences and needs of ex-offenders with severe mental illness upon discharge from psychiatric prison care; (2) exploring the key drivers and barriers to community re-integration of ex-offenders with severe mental illness after being discharged from psychiatric prison care; and explore available services and identify further service needs of ex-offenders with mental illness after being discharged from psychiatric prison care. Methods: Thirteen ex-offenders with a severe mental illness who were discharged at Chikurubi Maximum Security Prison participated in the study. There is a dedicated psychiatric facility at Chikurubi Maximum Security Prison and it was being funded externally through MSF. Key informant structured interviews were utilised. All ex-offenders were discharged within a period of three to twelve months, were over eighteen (18) years of age and they participated in the study willingly and provided informed consent. Only those based in Harare Metropolitan Province were included. The research participants were interviewed using a qualitative interview schedule which inquired about the experiences and needs of ex-offenders with severe mental illness; key drivers and barriers to community re-integration following discharge and access to mental health services. Interviews were transcribed verbatim and analysed using the framework approach to identify themes. To facilitate analysis of data, the qualitative analysis computer software NVivo 12 was utilised. Results: Findings of the study were grouped according to three main themes. Theme one highlighted how the prison infrastructure and environment negatively impacted on their mental health. This included dilapidated buildings, no running water, electricity shortages, poor ventilation in cells and overcrowding. The second theme focused on the perceived benefits of the comprehensive and integrated mental health services at Chikurubi Hospital. The third theme looked at the experiences and needs upon discharge from psychiatric prison care. Participants had mixed experiences of integration depending on the severity of the crime committed and whether or not they were integrated back into the same community where the crime was committed. Successful reintegration was challenging given the stigma and discrimination experienced as a result of committing a crime and having a mental health illness. The lack of community based services providing recovery focused interventions was also highlighted as a challenge. Conclusions: The study examined experiences of ex-offenders living with mental illness within three to twelve months following discharge from psychiatric prison care. Chikurubi Psychiatric Hospital provided comprehensive quality services through external funding. Upon discharge, community mental health services focused primarily on clinical recovery in the form of medication, impacting on the mental health of the participants as they re-integrated into the community.
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    The role of the astrocytic marker S100B in HIV-associated neurocognitive disorders
    (2019) Groenewald, Engelina; Joska, John; Combrinck, Marc; Naude, Pieter
    There are as yet no ideal biomarkers of HIV-associated neurocognitive disorders. As astrocytosis is a feature of HIV encephalitis, the marker S100β may hold promise as a biomarker of HAND. We explored associations between S100β and neurocognition in individuals with HIV in Cape Town, South Africa, before and after antiretroviral therapy (ART) was initiated. The S100β levels in the cerebrospinal fluid (CSF) of forty-six participants with HIV, but not yet on antiretroviral therapy, was quantified using an enzyme-linked immunoassay (ELISA). A battery of cognitive tests was performed and the global deficit score (GDS) was calculated. In twenty of these patients, the S100β analysis and the cognitive tests were repeated approximately six months after the initiation of ART. There was no significant association between cerebrospinal fluid S100β and GDS at baseline (r= -0.070; p= 0.66) or after six months of ART (r= 0.16; p= 0.52). Cerebrospinal fluid S100β levels at baseline did not predict a change in neurocognition on ART (B(SE) = 0.001, (0.001), β=0.025, p=0.85). S100β in the cerebrospinal fluid may not adequately reflect neurocognitive impairment in individuals with HIV. Our results further demonstrate that CSF S100β levels are not affected by ART, indicating persistent neuroinflammation.