South African Journal of Psychiatry

End-of-life care in South Africa: Important legal developments

2023-02-08T09:51:26+00:00

No Abstract.

Prioritising maternal mental health and infant neurodevelopment research in Africa – A call for action amidst the backdrop of the COVID‑19 pandemic

2023-02-08T09:53:34+00:00

No Abstract.

Second victims of obstetric care – Support for healthcare professionals in KwaZulu-Natal, South Africa

2023-02-08T09:55:56+00:00

No Abstract.

Coulrophobia: An investigation of clinical features

2023-02-08T09:58:48+00:00

Background: Coulrophobia refers to fear or disgust elicited by clowns, or images of clowns, and may be accompanied by significant distress. The medical literature on sociodemographic and clinical features of coulrophobia is, however, sparse.
Aim: This study aimed to investigate coulrophobia sociodemographic and clinical features in an online support group.
Setting: A self-administered questionnaire was distributed to an online support group for coulrophobia.
Methods: Members of the online coulrophobia support group received a link to a selfadministered questionnaire. The questionnaire focused on sociodemographic and clinical features, including fear-related and disgust-related symptoms, and included DSM-5 diagnostic criteria for specific phobia.
Results: Of the 95 survey respondents, 79 were female respondents (mean age: 39.8 ± 12.6 years), with the mean age of onset 9 ± 6.1 years. Coulrophobia symptoms were associated with significant psychological distress and with impaired social functioning. About 7.4% of respondents reported severe anxiety with panic attacks. Comorbid disorders included major depressive disorder (9.5%), obsessive-compulsive disorder (5.3%) and panic disorder
(3.2%). Individuals with fear-related symptoms were more likely to fulfil DSM-5 criteria for specific phobia.
Conclusion: Coulrophobia is a phenomenon that warrants clinical attention, given its association with significant comorbidity, psychological distress and impaired functioning. Several sociodemographic and clinical features are consistent with a diagnosis of specific phobia, although future work employing clinician-administered diagnostic tools is needed to consolidate and extend the findings here.

Mental health distress during the COVID-19 pandemic in Nigeria: Need for psychological intervention

2023-02-08T10:01:52+00:00

Background: The world began to realise the impact of the coronavirus disease 2019 (COVID-19) in January 2020, and since then the number of people infected has exceeded 1 million globally. In less than 1 month following the first reported case in Nigeria, over 180 people had tested positive to the disease. Studies have shown that such rapidly spreading infectious diseases have the potential to create widespread fear, apprehension, panic and anxiety amongst the general public.
Aim: This study aimed at evaluating the impact of information dissemination and public mental healthcare needs during the COVID-19 pandemic in Nigeria. It also hopes to determine if there is an unmet need for telepsychiatry in Nigeria.
Setting: Community-based study covering the North, South and West of Nigeria.
Methods: This was a descriptive cross-sectional study using an on-line survey form via the snowballing sampling method.
Results: Social media was identified as the main source of information concerning COVID-19, and half of the respondents opined that information dissemination was inadequate. Psychological distress was present in 90.5% of the participants and 61.8% admitted that this distress was worsened by fake news and myths concerning COVID-19. However, 53.8% of the participants were willing to access mental healthcare services, with telepsychiatry being the preferred choice.
Conclusion: There is a need to implement a national public mental health service during this emergency. Telepsychiatry has numerous advantages in this context and maybe an opportunity to roll out a novel means of delivering mental healthcare.

From ideation to attempt: A study of suicidality and its correlates amongst patients with schizophrenia in a resource-poor country

2023-02-08T10:05:44+00:00

Background: There is increasing evidence that patients with schizophrenia have high tendency to commit suicide. However, such an act is usually preceded by suicidal behaviours (or suicidality) such as suicidal ideations, suicidal intent, suicidal plans and suicidal attempt. If any of this suicidal behaviour spectrum is missed, then suicide results. In spite of the relevance of such behaviours in the management and prognosis of schizophrenia, there is a paucity of research on the patterns and correlates of suicidal behaviours amongst this population group in sub-Saharan Africa.
Aim: This study assessed the prevalence and pattern of suicidality and its relationship with certain sociodemographic and clinical variables.
Setting: The study was conducted at the outpatient psychiatric clinic of the Lagos University Teaching Hospital, Idi-Araba, Lagos State.
Methods: Suicidal behaviours were assessed amongst 160 randomly selected patients with schizophrenia over a six-month period. The prevalence, pattern and correlates of suicidal behaviour amongst them were also assessed. Data were collated and processed with the eighteenth version of Statistical Package for Social Sciences (SPSS 18).
Results: About 43.1% of the participants exhibited suicidal behaviour. Of these, 5.8% exhibited suicidal plans whilst 75.4% attempted suicide. In terms of severity, one tenth (10%) of those who expressed suicidal behaviour exhibited severe suicidal tendencies. Participants who earned lesser income were more likely to exhibit suicidal behaviour. The same pattern was observed for medication adherence viz a viz suicidal behaviour.
Conclusions: The study brings to the fore the tendency of patients with schizophrenia to commit suicide, hence the need to screen for suicidal behaviour before suicide eventually occurs.

Profile of suicide within the northern part of Ghana: A decade under review

2023-02-08T10:09:36+00:00

Background: Several reports show that suicide is the second and third leading cause of untimely death in young people below the age of 30. Little, however, is known about the profile and trend of suicide in this country due to lack of systematic studies and a lack of national statistics on suicide. This study seeks to examine the profile and pattern of suicide cases recorded within northern Ghana for the past decade.
Aim: This study aimed to report the prevalence of suicide as an independent cause of death; the choice of suicide method and the alleged reasons for suicide within the northern part of Ghana.
Setting: Retrospective review of coroners’ reports within the northern part of Ghana.
Method: In this descriptive study, 309 completed suicides as archived by the office of the coroner were examined. The coroners’ reports of 309 individuals, whose deaths received a suicide verdict or an open verdict in which the cause of death was likely to be suicide from 2008 to 2017, were examined. Student’s t-test was used to ascertain significant age differences between the genders involved.
Results: Amongst the 309 decedents examined, approximately, 61% were male, with ages ranging from 5 to 81 years. Hanging and poisoning were the most commonly used methods to complete suicide accounting for 124 (40.1%) and 102 (33.0%) deaths, respectively. Regarding the reasons for completed suicide, 78 (25.2%) were because of unknown reasons and 66 (21.4%) were because of social stigma. There was a notable decline in the prevalence of suicide from 2014 to 2017 compared with the years from 2010 to 2013.
Conclusion: Suicide was highest in the 30–39 year age group with hanging and poisoning being the most common method employed. Stigmatisation and psychosocial problems arising from chronic illness and economic hardship were significant triggers of suicide amongst the suicide decedents in the northern part of Ghana.

Mental illness and HIV amongst female inmates in Durban, South Africa

2023-02-08T10:12:37+00:00

Background: There is limited data regarding the prevalence of mental illness and human immunodeficiency virus (HIV) amongst female inmates in South Africa. Rehabilitation programmes can only be formulated once the needs of this population have been identified.
Aim: This study aimed to measure the prevalence of mental illnesses, borderline and antisocial personality disorders and HIV amongst female inmates.
Setting: The study was based at a correctional centre in Durban, KwaZulu-Natal, South Africa.
Methods: This study forms part of a larger two-phased, mixed methods, sequential, explanatory design study. In phase one, 126 female inmates were interviewed using a clinical questionnaire and the Structured Clinical Interview for Diagnostics and Statistical Manual (DSM)-5 diagnoses – Research Version.
Results: The following lifetime prevalence rates were found: depressive disorder 70.6%, alcohol use disorder 48.4%, post-traumatic stress disorder (PTSD) 46.8%, borderline personality disorder 33.3%, substance use disorder 31.7%, antisocial personality disorder 15.1% and psychotic disorder 4.8%. The prevalence of current adult attention-deficit and hyperactivity disorder was 9.5%. A total of 39% of the participants admitted to past suicide attempts, whilst 64.3% reported past suicidal ideation and 36.5% had a current episode of a psychiatric disorder. A total of 64.3% of the participants were living with HIV. Although 90.4% had a lifetime psychiatric disorder, only 16.7% were previously diagnosed with a mental illness. The majority of inmates with lifetime disorders had psychiatric comorbidities.
Conclusion: The high prevalence of mental illness and HIV amongst female inmates, and the fact that most with mental illness remain undiagnosed, is concerning. Improved screening, identification and treatment of mental illnesses in this population is needed to ensure optimal mental health outcomes and decreased recidivism.

Characteristics of inpatients in dialectical behaviour therapy modified for a resource-limited setting

2023-02-08T10:15:43+00:00

Background: Emotional dysregulation in psychiatric disorders contributes to morbidity, mortality and healthcare costs. Dialectical behaviour therapy (DBT) is effective in addressing this, but is complex and costly to implement. Recent literature indicates that DBT can be modified for use in resource-limited settings, but little is known about its implementation in African settings.
Aim: To describe the demographic and clinical characteristics of participants in a modified DBT-ST (skills training) programme at a South African psychiatric hospital.
Setting: The study was conducted at Stikland Hospital, a public psychiatric hospital in the Western Cape province, South Africa.
Methods: A retrospective, cross-sectional chart review of patients included in a modified inpatient DBT-ST programme between 30 June 2014 and 30 June 2019 was conducted. Descriptive analyses were performed on the data both as a complete set and after division into several subgroups.
Results: We included 349 records. Two-thirds of the patients completed the programme. Major depressive disorder, borderline personality disorder and substance use disorder were the most prevalent diagnoses. Most patients had psychiatric comorbidities. A total of 90.61% (n = 309) of the patients were exposed to at least one traumatic event and three-quarters (n = 261) had attempted suicide at least once before.
Conclusions: The demographics of our sample did not differ markedly from the international literature. Rather, what stood out was that modified DBT-ST could be a choice in resourcelimited settings for a diagnostically heterogeneous group that displayed significant clinical complexity and high levels of emotional dysregulation. Our findings might suggest that the intervention was well tolerated and possibly most appropriately delivered at the first admission, although further research is required.

Working memory and set-shifting in school-aged children classified as having attention-deficit hyperactivity disorder

2023-02-08T10:18:39+00:00

Background: Attention-deficit hyperactivity disorder (ADHD) is a common psychiatric disorder reported in both children and adults; it is often associated with a variety of executive functioning deficits.
Aim: This study investigated the extent to which working memory and set-shifting are impaired in school children with and without ADHD.
Setting: This included primary schools in Lepelle-Nkumpi Municipality in Limpopo province, South Africa.
Methods: A total of 216 children (108 screened positive for ADHD and 108 matched controls without ADHD symptoms), aged between 6 and 15 years, participated in the study. The performance of the two groups was compared on tests of working memory (Forward and Backward Digit Span subtests of the Wechsler Intelligence Scale for Children – Fourth Edition) and set-shifting (Trail Making Test Part B). The scores were analysed as a function of gender and age.
Results: The group with possible ADHD performed worse than the neurotypical control group on tasks of working memory and set-shifting. The results did not indicate that gender affected performance. However, the younger age group performed worse than the older children.
Conclusion: Children classified as ADHD showed significantly more impairments in working memory and set-shifting than neurotypical controls. Neither test showed any significant difference between male and female performance, whilst age was shown to affect performance on both tests. Early identification and treatment of children with attention-deficit hyperactivity disorder are crucial to their well-being.

Are female bipolar patients of reproductive age aware of the teratogenic risk of sodium valproate? A qualitative study

2023-02-08T10:21:26+00:00

Background: Sodium valproate is considered the most teratogenic of all anticonvulsant drugs. Internationally, new regulations require women to sign risk assessment forms if initiated on it.
Aim: This study aimed to explore patients’ awareness of the teratogenic risk of sodium valproate.
Setting: Weskoppies Psychiatric Hospital, Tshwane, Gauteng.
Methods: We conducted a qualitative study comprising 23 semi-structured interviews with female bipolar patients of reproductive age at a tertiary psychiatric hospital in South Africa.
Results: Patient psychoeducation and self-education is improving as many patients were aware of the risk of teratogenicity of sodium valproate either by being educated or by searching online after developing an interest. Our study identified the need for female patients to be educated about contraceptive use when starting on sodium valproate to avoid pregnancy.
Conclusion: Our study shows that patients are becoming more aware of the teratogenic risk of sodium valproate. This suggests that consultations focusing on the issues of conception and the use of sodium valproate in women of childbearing potential has improved.

A population-based survey of autistic traits in Kenyan adolescents and young adults

2023-02-08T10:27:59+00:00

Background: To date, there have been no large-scale population studies of autistic traits (AUT) conducted in Africa.
Aim: The study aimed to estimate the prevalence and characteristics of autism spectrum disorders in a large sample of Kenyan adolescents and young adults.
Setting: Tertiary academic institutions (87%) and directly from the community (13%).
Methods: Our study surveyed 8918 youths (aged 15–25 years) using the autism spectrum quotient (AQ). Based on AQ scores, we derived groups with low (L-AUT), borderline (B-AUT), and high (H-AUT) autistic traits. Relationships of AUT with demographic factors, psychosis, affectivity and stress were investigated.
Results: Internal consistency of the AQ in the population was excellent (Cronbach’s α = 0.91). Across all participants, 0.63% were estimated as having H-AUT, while 14.9% had B-AUT. Amongst community youth, prevalence of H-AUT was 0.98%. Compared to those with low and borderline traits, H-AUT participants were more likely to be males, to have lower personal and parental educational attainment, and to be of a lower socioeconomic status. The H-AUT group also had higher psychotic and affective symptoms as well as higher psychosocial stress than other groups.
Conclusion: The prevalence of H-AUT amongst Kenyan youth is comparable to Autism spectrum disorder (ASD) rates in many countries. Autistic traits in Kenya are associated with worse social and clinical profiles. Further research on autism across Africa is needed to investigate cross-cultural heterogeneity of this disorder, and to guide healthcare policy.

Promotive factors associated with internalising symptoms amongst college students during the COVID-19 lockdown in Enugu metropolis, Nigeria

2023-02-08T10:31:14+00:00

Background: The outbreak of the coronavirus disease 2019 (COVID-19) pandemic has caused a high burden of psychological distress amongst adolescents.
Aim: This study aimed to evaluate associations of personal strengths including resilience and social support with internalising symptoms amongst college students during the lockdown in the wake of the COVID-19 pandemic.
Setting: The study population included students from senior and junior college classes in public schools in Enugu metropolis, Nigeria.
Method: A school-based cross-sectional study design was employed for the study. A twostage sampling technique was used to select 496 students (mean age = 16.5, s.d. = 1.9 years; 52.2% female) in six out of 33 public colleges in Enugu metropolis, Nigeria during the lockdown period occasioned by the COVID-19 pandemic. Validated questionnaires assessing anxiety, depression, resilience and social support were used to collect information.
Results: Most of the students reported depressive symptoms, whilst just over a third of the sample reported anxiety or both depressive and anxiety symptoms. Chi-square and logistic regression analyses revealed that being male and reporting higher levels of social support and the ability to bounce back from stress were associated with less anxiety. Being younger and reporting a moderate level of support were associated with more depressive
symptoms, whilst the ability to bounce back was associated with fewer depressive symptoms.
Conclusions: Good social support and the ability to bounce back from stress were linked to lower levels of anxiety and depressive symptoms amongst college adolescents during the lockdown in the wake of the COVID-19 pandemic despite high prevalence rates.

Correlates and cascade of HIV care in patients with psychiatric disorders in the Eastern Cape province, South Africa

2023-02-08T10:38:35+00:00

Background: The cascade of human immunodeficiency virus (HIV) care in patients with psychiatric disorders is poorly understood.
Aim: This study determined the prevalence of HIV and described its cascade of care among patients with psychiatric disorders in the Eastern Cape province, South Africa. The study also examined the correlates of HIV comorbidity with psychiatric disorders in the cohort.
Methods: In this cross-sectional study, a total of 368 individuals attending the Psychiatric Outpatients’ Department of Cecilia Makiwane Hospital in Eastern Cape were interviewed with a structured questionnaire. Relevant items on demographics and clinical information were extracted from the medical records. Virologic suppression was defined as viral load < 1000 RNA copies/mL.
Results: The HIV prevalence after the intervention was 18.8% and a significant proportion of participants already knew their status (n = 320; 87.0%). Linkage to care and antiretroviral therapy initiation occurred in 61 participants, of those diagnosed with HIV (88.4%), with 84.1% being eligible for viral load monitoring (n = 58) and 53.4% having achieved virologic suppression. Being female (AOR = 5.48; 95% CI 2.61–11.51) and black (adjusted odds ratio [AOR] = 3.85; 95% confidence interval [CI] 1.06–14.03) were independent predictors of HIV comorbidity in individuals living with psychiatric disorders.
Conclusion: This study found a moderately high prevalence (close to 19%) of HIV in individuals with psychiatric disorders, with a significant correlation with being female and being black people. This study also found a significant gap in the linkage to antiretroviral therapy (ART) initiation and a low rate of virologic suppression of 53.4%. Clinicians, therefore, should monitor and provide interventions for patients with concomitant HIV infection along this cascade of care.

The significance of sleep quality in euthymic bipolar patients from Nigeria

2023-02-08T10:41:55+00:00

Background: Bipolar disorder is highly under-researched in Africa. Existing studies show that racial/ethnic disparities exist for sleep quality. Poor sleep quality in bipolar disorder causes significant morbidity and mortality even during periods of euthymia.
Aim: This study aimed to assess sleep quality and its correlates amongst euthymic patients with bipolar I disorder from Nigeria.
Setting: The study was carried out in a teaching hospital, and state hospital, in Ibadan, Nigeria.
Method: This cross-sectional study was conducted amongst 76 euthymic bipolar patients aged between 18 and 60 years, meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnostic criteria for bipolar disorder. Euthymia was defined as having a score of ≤ 5 on the Young Mania Rating Scale and < 8 on the Hamilton Depression Rating Scale. Sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI).
Results: A total of 37 (48.7%) participants had poor quality sleep. Sleep quality was associated with marital status (p = 0.013) and suicide plan (p = 0.047). Participants with good sleep quality had higher total sleep duration, lower time to fall asleep (sleep latency), better subjective quality of sleep, were less likely to use sleep medications and had less daytime dysfunction than participants with poor sleep quality. All p-values were < 0.05. Subjective quality of sleep, ongoing use of sleep medication, daytime dysfunction were independently associated with poor sleep quality.
Conclusion: Poor sleep quality frequently persists during euthymic periods in patients with bipolar disorder. The correlates identified can be targeted for intervention during treatment.

Influence of first- and second-generation antipsychotics on anthropometric parameters of male psychiatric patients

2023-02-08T10:44:42+00:00

Background: The use of antipsychotic medication, particularly second generation antipsychotics (SGAs) is a major risk factor for cardiovascular disease in people with severe mental illness (SMI). Few studies have compared body measures of people with SMI taking first generation antipsychotics (FGAs) to those taking SGAs.
Aim: We compare body measures between long-term male inpatients using either FGAs or SGAs.
Setting: The study was conducted at Weskoppies Psychiatric Hospital, in Pretoria, Gauteng.
Methods: A total of 30 patients were selected from a list of male inpatients and were included in our study. Each participant had the following anthropometric measures done and these were compared between the two groups: Waist circumference (WC), body mass index (BMI), waist to hip ratio (WHR), waist to height ratio (WHtR) and hip circumference (HC). Hospital records were used to record demographic variables, diagnosis, comorbid disease and
psychotropic medication for each participant.
Results: Participants in the FGA and SGA groups had similar body measures, resulting in similar BMI, WHR and WHtR. Participants had a mean HC of 100.5 cm, 95% confidence interval (CI) (97.68, 103.22). BMI ranged from 21.87 kg/m² to 37.65 kg/m², with an overall mean of 28.5 kg/m², 95% CI (26.69, 30.22). Participants had a mean WHtR of 0.59, 95% CI (0.56, 0.61). Participants had a mean WC of 100.6 cm and 95% CI (96.26, 104.87), and the mean WHR
of both groups was 1.0.
Conclusion: Participants using FGAs and SGAs had similar body measures, and these indicated that this sample of male inpatients with SMI is at high risk for CVD.

Prevalence of depressive symptoms in patients with rheumatoid arthritis at a regional hospital in KwaZulu-Natal, South Africa

2023-02-08T10:49:35+00:00

Background: Depression affects 14.8% – 38.8% of patients with rheumatoid arthritis (RA) in developed countries. The prevalence and risk factors for depression in patients with RA in sub-Saharan Africa is not well established.
Aim: To determine the prevalence of depressive symptoms in patients with RA.
Setting: Public sector regional hospital in South Africa.
Methods: A cross-sectional descriptive study was undertaken with 110 adult RA patients. A structured socio-demographic and clinical questionnaire, the modified health assessment questionnaire (mHAQ), the simplified disease activity index (SDAI) for RA, the patient health questionnaire (PHQ-9), and the Household Food Insecurity Access scale (HFIAS) for nutritional status, were used. Correlates of depressive symptomatology in participants with RA were identified using t-tests and regression analyses.
Results: Most of the participants were women (90.9%), 67% had moderate to severe RA disease on the SDAI score, 92.7% reported functional disability (HAQ score of ≥ 1), and 87.2% reported mild to severe depressive symptoms. Unemployment (p < 0.01), severe food insecurity (p < 0.01) and functional disability (p = 0.02), were significantly associated with the depressive symptoms, but not with disease activity (p = 0.8) or inflammatory markers (p = 0.63). Unemployment (adjusted β = -5.07, p < 0.01) and severe food insecurity (adjusted β = -4.47, p < 0.01) were significantly associated with depressive symptoms, based on the adjusted regression model.
Conclusion: As RA effects functional status, with the impact of the resulting unemployment and food insecurity being associated with depression, affected people should be screened for depression and managed using a multidisciplinary approach, especially considering the role of social determinants in RA patients with depression.

Correlates and cascade of HIV care in patients with psychiatric disorders in the Eastern Cape province, South Africa

2023-02-08T10:52:40+00:00

Common mental disorders amongst frontline healthcare workers during the COVID-19 pandemic in Ethiopia: A cross-sectional study

2023-02-08T10:56:25+00:00

Background: A novel coronavirus had a profound physiological and psychological burden with regards to contracting the disease or uncertainties in the care of infected patients. Especially, at risk are frontline healthcare workers who are participating in the care of such patients.
Aim: This study investigated the burden of mental health problems amongst the frontline health workers during the coronavirus disease 2019 (COVID-19) pandemic in Ethiopia.
Setting: East Hararghe Zone of Oromia Region and Harari Regional State, Ethiopia.
Methods: A cross-sectional study was conducted in three selected hospitals of COVID-19 treatment centers. Simple random sampling was used to select a sample of 423 participants from each hospital. The self-Reporting Questionnaire (SRQ-20) was used to assess the presence of common mental disorders. Binary and multivariable logistic regressions were fitted to identify factors associated with common mental disorders. Statistical significance was declared at a p-value less than 0.05.
Results: The prevalence of common mental disorders amongst frontline healthcare workers was 22.6%. Being female, married, having had direct contact with COVID-19 patients, working in COVID-19 treatment centers and ICU, having any symptoms of COVID-19, current threemonth use of any substances, and poor social support were found to be strong predictors of common mental disorders in frontline health workers during COVID-19 pandemic in Ethiopia.
Conclusion: The considerable proportions of frontline health care workers have common mental health problems. Strategies need to address COVID-19 related mental health problems, and integrate psychosocial intervention to support the frontline health workers is paramount.

The effect of structured psychoeducation on caregiver burden in carers of patients with schizophrenia in Nigeria: A 12-week follow-up investigation

2023-02-08T11:00:05+00:00

Background: Despite robust evidence of the huge burden of caregiving amongst caregivers of patients with schizophrenia, there is a paucity of data in Africa on the interventions to address this enormous burden of caregiving.
Aim: This study aimed to determine the effect of structured psychoeducation intervention on the burden of caregiving in comparison with ‘care as usual’ in a Nigerian Psychiatric Hospital.
Setting: This study was done at the out-patient and in-patient units of the FederalNeuropsychiatric Hospital, Enugu, Nigeria.
Methods: Caregivers of inpatients who fulfilled the International Classification of Diseases (ICD- 10) criteria for diagnosis of schizophrenia were recruited for the study. The caregivers were then allocated into two groups (Group A received structured psychoeducation intervention in addition to ‘care as usual’ whilst group B received only ‘care as usual’). After the baseline assessment, the caregivers were followed up every 4 weeks for a period of 12 weeks. At each interval of followup, caregivers were assessed for caregivers’ burden using the Zarit Burden Interview (ZBI). Repeated measures analysis of variance (mixed type) was used to determine the effects of the interventions on caregivers’ burden in the two arms of the study across the intervals of follow-up.
Results: The attrition rate at week 12 was 10.7%; leaving 130 for the assessment of outcome variable at the end of follow-up. Structured psychoeducation intervention was significantly better than ‘care as usual’ in ameliorating caregivers’ burden [F (1, 123) = 21.75, p < 0.001, Partial Eta Squared = 0.39].
Conclusion: These findings seem to suggest that caregivers who received structured psychoeducation intervention experienced a greater reduction in caregiver burden than those who received ‘care as usual’. Whilst the study addressed short-term effect, the findings of this study are in accord with other studies that have supported the impression that psychoeducational family-based intervention is useful with regard to caregiver burden.

The prevalence and correlates of anxiety and depression amongst essential workers during the COVID-19 lockdown in Ekiti State, Nigeria

2023-02-08T11:03:59+00:00

Background: Essential workers are imperative in the fight against the coronavirus disease (COVID-19) pandemic.
Aim: To assess the prevalence and factors associated with anxiety and depression among essential workers during the COVID-19 pandemic and lockdown.
Setting: This study was set in Ekiti State, Nigeria.
Method: This was a cross-sectional study involving essential workers in Ekiti State Nigeria, during the COVID-19 pandemic and lockdown. A total of 588 essential workers were sampled. Online socio-demographic variables and the Hospital Anxiety and Depression Scale, a 14 item self-reported questionnaire were used.
Results: The prevalence of anxiety and depression among the respondents was 93.4% (CI = 91.2–95.2) and 64.3% (CI = 60.4–68.4) respectively. Among the health workers, the prevalence of anxiety and depression were 96.5% (CI =94.8–98.1) and 66.5% (CI = 60.5–69.8) respectively while the prevalence of anxiety and depressive symptoms among non- health workers were 84.6% (CI = 78.7–90.1) and 61.5% (CI = 54.2–69.4) respectively. The odds ratio (OR) of depressive symptoms was increased among, respondents who were not satisfied with the support they received from the government during the pandemic (AOR = 2.071, CI = 1.350–2.213), respondents that were 35 years and younger (AOR = 1.512, CI = 1.033–2.213) and reduced amongst Christians (AOR = 0.501, CI = 0.286–0.879). The odd of anxiety was increased among health workers compared to non-health workers (AOR = 3.700, CI = 1.744–7.851) and the odds of anxiety was reduced among respondents with previous history of mental illness (AOR = 0.215, CI = 0.049–0.943).
Conclusion: Anxiety and depressive symptoms were common mental illness among essential workers working during the COVID-19 lockdown, therefore their mental health should be adequately considered to sustain the fight against the virus.

Exploring burnout among psychiatric trainees at a South African university

2023-02-08T11:06:47+00:00

Background: The mental health of doctors is increasingly topical, internationally and locally. Of importance is the phenomenon of burnout, a far-reaching repercussion of chronic workrelated stress. Psychiatrists are more vulnerable to stress, burnout and suicide in comparison with other medical specialities. There is a void in published research relating to South African psychiatric trainees.
Aim: The study aimed to investigate burnout and associated factors among psychiatric registrars at a South African university.
Setting: Department of Psychiatry at the University of the Witwatersrand.
Methods: This was a cross-sectional study via an anonymous self-administered questionnaire. The questionnaire comprised three sections: demographics; the Maslach Burnout Inventory Human Services Survey (MBI-HSS) and questions relating to contributing factors, protective factors and consequences of burnout. The MBI-HSS is recognised as the leading measure of burnout, consisting of three subscales: emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA).
Results: The questionnaire was completed by 33 out of 55 psychiatric registrars (60.0% response rate). Data from 31 registrars were used in the analyses, as two registrars did not provide informed consent. Among participants, EE was the most commonly affected, followed by DP and lastly PA. The majority (67.8% or n = 21) had scores in the high category for any one of the three subscales (EE/DP/PA). Significant factors associated with burnout included poor work and non-professional life balance (p = 0.017), utilising annual leave days for work-related tasks (p < 0.001), irregular holidays (p = 0.003) and financial debt (p = 0.026). A possible protective factor was an amicable relationship with fellow psychiatric registrars.
Conclusion: There is evidence of some degree of burnout in more than two-thirds of participants. Associated factors lie largely at an organisational level, and while optimising individual resilience is important, systemic support plays a key role.

Prevalence of depressive symptoms and quality of life among patients with diabetes mellitus with and without HIV infection: A South African study

2023-02-08T11:12:54+00:00

Background: Diabetes mellitus (DM) and human immunodeficiency virus (HIV) infection are both associated with increased risk of mood disorders and poorer quality of life (QOL). This association has not been explored in patients living with comorbid DM and HIV.
Aim: To describe the prevalence of depressive symptoms and impact on the QOL in patients with DM living with and without HIV attending a public sector hospital in South Africa.
Setting: A medical outpatient clinic at a state regional hospital.
Methods: A cross-sectional questionnaire pilot survey was conducted amongst 101 patients with DM attending a specialist medical outpatient service. The assessment was conducted using a structured socio-demographic and clinical questionnaire, the patient health questionnaire 9 (PHQ-9) for depressive symptoms and the World Health Organization QOL scale. The HIV status was confirmed from the clinical records. The correlates of depressive symptomatology in the participants with DM living with and without HIV were identified using t-tests.
Results: The prevalence of depressive symptoms in the participants with DM was 36%. Moderate to severe depression was associated with female gender (p = 0.03) and low educational level (p = 0.02) but not with HIV comorbidity or clinical characteristics of DM. The QOL was influenced by moderate to severe depressive symptoms (QOL in physical p < 0.218 and environmental p < 0.001 domains), but not HIV status (p = 0.218).
Conclusion: A substantial proportion of people with DM reported depressive symptoms, which is slightly higher than the average reported in other out-patient studies. The association of depression with poor QOL highlights the need for integrated mental health access in medical outpatient services. The lack of association between comorbid HIV status and DM with depression or QOL needs to be further explored.

The prevalence of depression and its associated factors among patients with diabetes mellitus attending a tertiary clinic in Gaborone, Botswana

2023-02-08T11:17:23+00:00

Background: Depression is one of the commonest co-existing medical conditions among patients with diabetes mellitus (DM). A bidirectional relationship between depression and DM exists, complicating glycaemic control leading to an increase in diabetic complications. There is a dearth of information regarding the prevalence of depression and associated factors among patients with DM in Botswana.
Aim: This study aimed to determine the prevalence of depression and associated factors among patients with DM. The study also assessed the association between depression and glycaemic control.
Setting: A tertiary diabetic referral clinic in Gaborone, Botswana.
Method: A sample of 260 randomly selected patients with DM was recruited in this crosssectional study. Socio-demographic and clinical characteristics of the patients were collected using a case report form. Depression was evaluated using the Patient Health Questionnaire (PHQ)-9 scale. Multivariate regression analysis was used to determine factors significantly associated with depression.
Results: The mean age (standard deviation [s.d.]) of study participants was 58.4 (11.8) years, and the majority, 160/260 (61.5%), were females. The prevalence of depression was 30.4% and significantly associated with female sex (adjusted odds ratio [AOR] = 5.529, p-value = 0.004), three or more diabetes-related hospitalisations (AOR = 3.886, p-value = 0.049) and inversely associated with systolic blood pressure (SBP) ≥ 140 mmHg (AOR = 0.11, p-value = 0.001).
Conclusion: Depression is a common problem among patients with DM in our setting. Routine screening of depression in diabetic patients to enable early detection and treatment is recommended.

Evaluating the efficacy of an online depression screening tool in South Africa: A pilot study

2023-02-08T11:19:48+00:00

Background: A global increase of 16% in depression rates from 1990 to 2019 highlights the alarming situation in relation to increase in depression. Research has indicated that this rate is likely to increase as a result of the coronavirus disease 2019 (COVID-19) pandemic. In South Africa, the depression life-time prevalence rate is 9.47%. However, the lack of access to mental healthcare services leads to people not receiving much needed information and care. The growing accessibility to the Internet for South Africans offers a solution for the screening and access to self-help information for depression. The Center for Epidemiologic Studies Depression Scale (CESD)-R was adapted for online usage and a website, mddsa.co.za, was piloted in this regard.
Aim: This study reports on the efficacy of the online adapted CESD-R for use in South Africa by reporting on the reliability and criterion validity as well as the user friendliness of the website and the appropriateness of the instant feedback provided.
Setting: The study was conducted in South Africa during COVID lockdown level 1 and 2.
Methods: This study followed a quantitative, cross-sectional research design. A convenience sample of 21 individuals, above the age of 18, with a depression diagnosis and 86 individuals with no mental health diagnosis participated in the study. Participants accessed the screening instrument online at the website.
Results: Internal consistency reliability coefficients exceeded 0.80. T-test and sensitivity and specificity results attested to the accuracy of the tool. All items contributed well to the instrument, including the items that were culturally specific to South Africa. Feedback from participants indicated that the tool was easily comprehensible, the website was user friendly and the instant feedback provided was appropriate.
Conclusion: The online adapted CESD-R evidenced excellent reliability and criterion validity and was able to accurately screen for depression amongst South Africans. The website and the tool have the potential to be utilised to increase access to a screening instrument for individuals who display symptoms of depression and to enhance the opportunity for individuals to practise self-help.

Developing a healthcare worker psychological preparedness support programme for the COVID-19 outbreak

2023-02-08T13:06:41+00:00

Background: The coronavirus disease 2019 (COVID-19) outbreak caused worldwide disruptions to healthcare systems. The emerging evidence indicates that mental health problems have consequently become an occupational hazard in frontline healthcare workers.
Aim: We aimed to develop a psychological preparedness training (PPT) programme to support frontline health workers in three resource-limited hospitals in South Africa dealing with the COVID-19 outbreak and to evaluate its effectiveness using an audit tool. We established a theoretical framework and goals for a psychological preparedness programme to support healthcare workers at the study sites.
Setting: Data were collected at the Dora Nginza Hospital, Nelson Mandela Academic Hospital and Elizabeth Donkin Hospital.
Methods: We employed an observational, descriptive, and cross-sectional design. A group psychological intervention was developed and implemented at the three sites in South Africa, from mid-April 2020 over 20 weeks. We collected data using an audit tool to measure healthcare workers’ perceptions of the outbreak before and after the intervention. We analysed the data to test for a statistically significant difference between the pre-intervention and postintervention audit tools.
Results: We supported 761 healthcare workers during the 20 weeks of the programme. Statistical analysis showed a significant positive change from pre- to post-intervention measures in perceptions of health worker about the outbreak, their anxiety associated with the outbreak, their ability to control reactions to stress and the perception of their ability to support others. Feedback comments indicated that the programme was beneficial for the majority of those who attended.
Conclusion: Health workers who attended the programme reported improvement in stress levels and in perceptions about their ability to cope with the outbreak, as well as in their perceptions of being able to support others.

Job satisfaction, personality traits, and its impact on motivation among mental health workers

2023-02-08T13:09:39+00:00

Background: Working in a resource setting that caters to people’s poor mental health is associated with increased vulnerability to physical, psychological, and social stressors that make motivation to work a difficult goal to attain. One way of viewing physical and social stressors in the workplace is to evaluate job satisfaction which has both intrinsic and extrinsic components. The personality of workers is a component of psychological wellbeing and this determines the way events and situations are perceived. Thus, the achievement of the mission and vision of an organisation will be dependent on the level of motivation of the employees which will be influenced by their predominant personality traits and the level of satisfaction at work.
Aim: My study aimed to sought to highlight the relationship between motivation, job satisfaction and personality dimensions.
Setting: The Neuropsychiatric Hospital, Aro, Abeokuta, Ogun State, Nigeria.
Methods: Our study involved a cross-sectional study of staff showing the relationship between motivation, job satisfaction and personality traits among mental health workers. A total of 146 participants using systematic proportional sampling were analysed with a response rate of 67.3%. A Socio-demographic Questionnaire, Minnesota Satisfaction Questionnaire (Short Version), Big Five Inventory and the Multidimensional Work-Motivation Scale were administered to the participants. In the analysis, linear correlation and linear regression were used to determine the relationship between continuous variables (Normality was determined using kurtosis and skewness) while t-test was used to determine the relationship between categorical independent variables and continuous dependent variables.
Results: The level of significance was set at < 0.05 while higher scores using the Multidimensional Work-Motivation Scale represented motivated participants and vis-a-vis. The sociodemographic variable was explored using descriptive statistics; the relationship between personality, job satisfaction and motivation were explored using t-test. Most of the participants were married (80.8%), female (60.3%), with at least tertiary education (63%) and with an occupational status of class I (76%). The mean age of the participants was 40.29 ± 8.27 with a mean length of service of 13.63 ± 8.49. The most dominant personality traits were agreeableness (97.3%) and conscientiousness (97.3%), and the least was neuroticism (55.5). High agreeableness (0.01), high conscientiousness (0.03), and high openness (0.01) were significant and positively correlated with motivation. The relationship between motivation and gender (t = 4.26; p ≤ 0.001) and occupational status were statistically significant (t = -3.59; p ≤ 0.001).
Conclusion: To proffer a solution to poor motivation in the workplace, human resource department should give more focus to individuals with high scores in agreeableness, conscientiousness, and openness. This is because it appears that they are more likely to be motivated at work and likely to move the organisation to a greater height. Besides, those with high neurotic scores who have already been employed will require some form of psychological remodelling (therapy), so they can contribute meaningfully to the institution.

Community mental health literacy in Tshwane region 1: A quantitative study

2023-02-08T13:12:40+00:00

Background: Although mental health literacy is a major determining factor of mental health outcomes and functional capacity of individuals, there is dearth of research on the issue in South Africa.
Aim: To assess the literacy of three mental disorders, namely major depressive disorder (MDD), schizophrenia and generalised anxiety disorder (GAD) and to compare the resultant assumed literacy level between urban and townships participants.
Setting: Five clinics of region 1 in Tshwane, South Africa.
Method: A cross-sectional descriptive study was performed between November 2019 and January 2020. A total of 385 questionnaires were distributed equally in all five clinics. By means of questions about three fictive cases with clinical pictures indicative of MDD, schizophrenia and GAD the following were assessed: recognising a mental disorder, identifying the cause and knowledge about what would help best.
Results: The majority of participants (67.3%) recognised the clinical picture indicative of schizophrenia as a mental disorder, almost half of the participants (49.9%) recognised the clinical picture indicative of MDD as a mental disorder, whilst just more than one third (36.3%) of participants recognised the clinical picture GAD as a mental disorder. Concerning the causes for the clinical pictures, most participants indicated that stress was the cause for MDD and GAD (77.4% and 68.1%, respectively), whilst indicating that biological or psychological (59.5%) causes are relevant to the clinical picture indicative of schizophrenia symptoms. Fewer participants indicated supernatural causes for any of the clinical case (MDD: 2.6%; schizophrenia 15.3%; GAD 4.2%). Most participants chose professional help as the best option for all three cases (MDD 81.3%, schizophrenia 82.2%, GAD 66.1%). The indicators for health literacy in this study show that urban participants had better knowledge than township participants across all questions about the cases.
Conclusion: Overall, the study indicated a variable knowledge regarding the three mental disorders in region 1 of Tshwane and variable literacy levels in townships compared with urban settings. The results indicate that awareness campaigns should focus on the deficient areas.

Feasibility and acceptability of a mental health stigma intervention for low-income South African caregivers: A qualitative investigation

2023-02-08T13:16:09+00:00

Background: Common mental health illnesses such as depression and anxiety disorders are increasing globally. There remain significant gaps in health services provision and support for mental illness linked to stigma in developing countries.
Aim: Our study aimed to assess the feasibility and acceptability of a mental health intervention for caregivers of mental health service users.
Setting: Low-income South African communities.
Method: Our study qualitatively assessed the feasibility of an anti-stigma mental health intervention for family caregivers in low-income settings. The intervention was structured into five sessions delivered over three days. Caregivers attended all the sessions at a centralised community venue. Semi-structured qualitative interviews were held separately with caregivers (n = 10) and their service users (n = 9) eight weeks post-intervention. Interviews were translated verbatim from local languages to English prior to framework analysis.
Results: Post-intervention, service users reported improved family relations and understanding of mental illness among family members. The intervention was reported as acceptable and helpful by caregivers as it increased knowledge, fostering better relationships with service users. Group discussions were noted as a critical driver of intervention success. Widespread mental health stigma within communities remained a key concern for caregivers and service users.
Conclusion: With the government’s drive for deinstitutionalisation, the need to integrate antistigma interventions within community mental health services is vital, as is the need for population-wide anti-stigma interventions to support the integration of mental health service users within communities.

Depression and quality of life among pregnant women in first and third trimesters in Abeokuta: A comparative study

2023-02-08T13:18:58+00:00

Background: Pregnancy is a dynamic time during which a woman’s emotional state may undergo extensive change. There have been conflicting views about the magnitude of emotional turmoil that occurs during pregnancy. Some investigators suggest that pregnancy is a time of particularly good psychological adjustment; others have reported high levels of psychological challenge.
Aim: Our study aimed to compare the prevalence and correlates of depression in the first and third trimesters of pregnancy and to determine the relationship between quality of life and depressive disorder.
Setting: The antenatal clinic of the State Hospital, Ijaiye.
Method: A descriptive, comparative study of depressive disorder and the quality of life between first- and third-trimester pregnant women (confirmed through a pregnancy test and an abdominopelvic ultrasound).
Result: For each trimester, 285 participants were recruited. The prevalence of depression among the pregnant women who participated in the study was 7.2%. In the first trimester of pregnancy, the prevalence of depression was 30 (10.5%), while it was 11 (3.9%) in the third trimester of pregnancy. Collectively, the relationship between depression and QoL was significant in the overall domain, satisfaction with general health domain (t = 2.27; p = 0.03), psychological domain (t = 2.74; p = 0.010, and environmental domain (t = 4.57; p ≤ 0.01).
Conclusion: Our study also highlights the need to pay closer attention to the psychological well-being and quality of life of all pregnant women and not just on their physical health and the baby’s well-being.

Cyberbullying perpetration and victimisation amongst adolescent psychiatric patients at Lentegeur Hospital, South Africa

2023-02-08T13:33:48+00:00

Background: Cyberbullying is a type of harassment that is perpetrated or experienced by a person or groups of persons via the use of electronic devices, and it frequently occurs amongst young people. Research has shown that cyberbullying is associated with psychiatric comorbidity, which could indicate a need for screening adolescents who present for mental health services.
Aim: This study aimed to determine the prevalence of cyberbullying amongst adolescents. The secondary aim was to determine the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 psychiatric diagnoses associated with cyberbullying.
Setting: Lentegeur Hospital Child and Adolescent Mental Health Service in the Western Cape, South Africa.
Methods: This cross-sectional study included a convenience sample of 97 participants (sampled from both inpatient and outpatient services) between the ages of 13 years and 18 years. Adolescent assent and parental consent were obtained. Demographic and clinical data were collected from patient folders, and the Revised Cyber Bullying Inventory II was used to assess cyberbullying behaviours.
Results: The overall prevalence rate of some form of cyberbullying in this sample was 56.7%, of which 6.2% were cyberbullies, 20.6% were cyber-victims and 29.9% were cyberbullies and cyber-victims. Female participants were more likely to be involved in cyberbullying than males. The most prevalent primary psychiatric diagnoses in adolescents involved in cyberbullying included major depressive disorder (72.4%), schizophrenia (57.1%) and
attention deficit hyperactivity disorder (22%). There was no significant association between cyberbullying and any psychiatric diagnoses.
Conclusion: The high prevalence rate of adolescents involved in cyberbullying suggests that this behaviour is a cause for concern in the South African population. More screening and treatment programmes should be implemented to address this issue.

Differences in alcohol and cannabis use amongst substance use disorder patients with and without comorbid attention-deficit/hyperactivity disorder

2023-02-08T13:22:49+00:00

Background: Substance use disorders (SUDs) continue to be a public health problem. Attention-deficit/hyperactivity disorder (ADHD) is seen as a risk factor for SUD. Prevalence of alcohol and cannabis use amongst adults with SUD and comorbid ADHD impacts both disorders cognitively and behaviourally.
Aim: Our study aimed to compare alcohol and cannabis use between treatment-seeking SUD patients with ADHD and SUD patients without ADHD symptomatology.
Setting: Various rehabilitation centres, including the South African National Council on Alcoholism and Drug Dependence (SANCA) Centres, and Private and Provincial Government Substance Abuse Treatment Centres.
Methods: A cross-sectional study of adults on drug rehabilitation was conducted. Data on socio-demographic information and alcohol and cannabis use from 185 post-detox inpatients were collected. Diagnoses were based on DSM-IV criteria. Attention-deficit/hyperactivity disorder diagnosis was confirmed by the Diagnostic-Interview for ADHD in Adults (DIVA 2.0). SUD+ADHD (n = 52) and SUD-ADHD (n = 128) groups were compared on alcohol and cannabis use as a function of gender.
Results: No significant differences in the use of alcohol between the SUD+ADHD and SUDADHD groups were found. However, the SUD+ADHD group showed increased cannabis consumption. Especially, the SUD+ADHD females showed an earlier age of onset of cannabis use than the SUD-ADHD females and revealed that they use cannabis for a longer period compared with the SUD-ADHD females and SUD+ADHD and SUD-ADHD males.
Conclusion: The results revealed the relationship between ADHD and cannabis use, especially amongst females with ADHD and reinforce the need to consider ADHD in cannabis use SUD in clinical interventions.

A history of depression in patients attending a chronic pain management clinic in South Africa: A retrospective chart review

2023-02-08T13:25:59+00:00

Background: Chronic pain and depression are closely related conditions, which commonly exist as comorbid disorders. Understanding the prevalence of depression in patients presenting with chronic pain is vital for effective pain management.
Aim: Our study aimed to establish the prevalence of a history of depression in patients presenting with chronic pain to a chronic pain management clinic at a tertiary academic hospital and to describe the characteristics of patients with both conditions.
Setting: Groote Schuur Hospital, Chronic Pain Management Clinic, Cape Town, South Africa.
Method: A retrospective review of 665 medical charts of consecutive patients accessing the clinic over a 7-year period was conducted. Baseline, patient-centred data were collected.
Results: Of the 665 charts, 623 were analysed. The median age of patients was 53 years. The prevalence of depression in patients presenting with chronic pain was 32%, three times higher than the national life-time prevalence in South Africa. The majority (77%) of patients with chronic pain and depression were female (p < 0.01). Overall, 51% of the patients assessed were unemployed with low levels of education. The majority of our study patients had received a tricyclic antidepressant at some time prior to presentation.
Conclusion: The high prevalence of a history of depression in patients presenting with chronic pain in our study, emphasises the importance of looking for and understanding the interrelation of the physiological, psychiatric, psychological and socio-economic factors that are common to both depression and chronic pain. Pain relief alone is insufficient to ensure optimal rehabilitation of these patients and integrating the management of their depression should improve patient outcomes and overall well-being.

Correlates of high-dose antipsychotic prescription amongst outpatients with Schizophrenia in a Nigerian Hospital

2023-02-08T13:29:54+00:00

Background: Treatment guidelines recommend the use of antipsychotic monotherapy at effective doses for the treatment of schizophrenia, although about a third of the sufferers still receive high-dose antipsychotic treatment. Current evidence suggests that high-dose antipsychotic prescription (HDAP) not only fails to improve outcomes but also increases side effects.
Aim: Our study aimed to determine the prevalence of HDAP and its association with illness severity, medication adherence behaviour and side effects amongst outpatients with schizophrenia.
Setting: The Federal Neuro-Psychiatric Hospital, Benin-City, Nigeria.
Methods: A cross-sectional study of 320 attendees with schizophrenia at the outpatient department was undertaken. We administered a sociodemographic and antipsychotic medication questionnaire, Mini-International Neuropsychiatric Interview, Positive and Negative Syndrome Scale, Liverpool University Neuroleptic Side Effects Rating Scales and Medication Adherence Rating Scales. High-dose antipsychotic prescription was determined
by the ratio of prescribed daily dose to defined daily dose greater than 1.5.
Results: The prevalence of HDAP was 38.4%. Greater severity of illness, experiencing more side effects and poor medication adherence were significantly associated with HDAP. The major predictors of HDAP were antipsychotic polypharmacy and concurrent anticholinergic use.
Conclusion: We conclude that although the use of HDAP amongst patients with schizophrenia remains common, its persistent use should be discouraged.

Descriptive outcomes for a cohort of high-frequency psychiatric service users in the Western Cape, South Africa after 10 years

2023-02-08T13:37:22+00:00

Background: Assertive community treatment (ACT) is an intervention implemented to manage the effects of deinstitutionalisation. South African studies have reported decreased admissions at 12 and 36 months when a modified ACT intervention is compared with standard care. However, costs associated with the intervention have raised the question of its feasibility in developing countries.
Aim: This study aimed to describe the long-term demographic and clinical outcomes of a group of psychiatric high-frequency users (HFUs) included in the first South African ACT study.
Setting: Stikland Psychiatric Hospital, Cape Town, South Africa.
Methods: Data from 55 HFUs participating in the first South African ACT trial, including both the intervention and control groups, were retrospectively reviewed 10 years after the patients’ inclusion.
Results: Of the 55 HFUs initially included, nine remained in the formal ACT programme whilst 16 received standard care over the full 10 years. Five patients died and two were admitted to long-term wards. The mean number of admissions was 3.73 and the mean number of admission days was 261.11 over the 10 years. Twelve patients were never re-admitted; of these, nine came from the original study intervention group.
Conclusions: This was the first study looking at the long-term outcomes of a group of psychiatric HFUs in an under-resourced setting receiving either a modified ACT intervention or standard outpatient care. Reflecting broadly on the group, there were a larger number of patients in the original ACT group who had no re-admissions and a comparatively higher utilisation of available services during the 10-year follow-up period.

An online mindfulness intervention for medical students in South Africa: A randomised controlled trial

2023-02-08T13:39:47+00:00

Background: Prior to the COVID-19 pandemic, an association was observed between medical students’ stress, possibly because of an intensive academic workload and clinical responsibilities, and mental ill health. The literature has shown the benefit of online mindfulness interventions for different mental health challenges. Unfortunately, there is a paucity of information on their benefit to medical students in South Africa.
Aim: The aim of this study was to explore whether medical students attending an online mindfulness-based intervention (MBI) would show improved resilience and stress management compared with attendance at an online supportive counselling (SC) programme. Secondary to this was the viability of the intervention, for which an in-depth understanding of participants’ experiences was sought.
Setting: The study setting was online through https://zoom.us/.
Methods: Forty-five participants were randomly allocated between two 6-week, teacherfacilitated groups. A repeated measures analysis of variance (ANOVA) of outcome, well-being, perceived stress and self-compassion scores conducted at three time points, as well as thematic analysis of participant feedback, contributed to quantitative and qualitative data.
Results: Participants in both the groups showed significant improvement over time in measures of well-being, perceived stress and subjective stress management. Participants in the mindfulness group showed a statistically significant treatment effect in mindfulness at programme completion. A decrease in self-compassion over time was observed in both the groups.
Conclusion: The results of this study indicate that in this South African medical student cohort, an online MBI and a SC programme are both feasible and show potential for reducing stress, increasing stress management and increasing resilience. Further study in this area is recommended.

Predictors of mass psychogenic illness in a junior secondary school in rural Botswana: A case control study

2023-02-08T13:43:35+00:00

Background: In March 2019, students at Lempu Secondary School in Kweneng District, Botswana displayed symptoms including headache, abnormal leg movements and difficulty walking. Within days, 133 students were admitted to Scottish Livingstone Hospital where mass psychogenic illness (MPI) was diagnosed.
Aim: To identify predictors of this illness.
Setting: Kweneng West District, Botswana.
Methods: This was a case control study using interviewer-administered questionnaires. Cases were students who displayed MPI symptoms from the 2nd of March to the time of the interviews or who were admitted with MPI diagnosis. Analysis was restricted to female students. Logistic regression was used to generate odds ratios. A p value of < 0.05 was considered to demonstrate significant association between variables.
Results: Interviews were conducted with 142 cases and 202 controls. The median age was 15 years. Most of the cases (95.8%) were boarding girls. Residence in school campus (AOR 13.2), history of evaluation by psychologist and/or social worker (AOR 2.6), history of traumatic events (AOR 1.8), contact with sick peers (AOR 2.3) and contact with spiritual healer (AOR 2.0) were independent predictors of MPI. Additionally, perception of adequate security in the dormitories (AOR 0.3) and perception of poor lighting (AOR 6.8) were significant predictors of MPI amongst boarding girls.
Conclusion: The outbreak in Lempu Community Junior Secondary School (CJSS) was typical of mass psychogenic illness affecting mainly boarding girls and was associated with psychological and environmental risk factors. Changing the boarding environment and continuous psychological support are key to preventing future outbreaks. Interventions should also target the identified risk factors.

Impulsivity and psychiatric comorbidity as risk factors for suicide attempts in borderline personality disorder

2023-02-09T11:44:10+00:00

Background: Addressing the risk of suicidality in borderline personality disorder (BPD) is a crucial issue. The notion that impulsive individuals are more likely to plan for suicide attempts is important for many reasons in both theoretical and clinical decision-making.
Aim: The aim of this study was to investigate potential risks of suicidality in BPD and to correlate it to impulsivity.
Setting: The study was conducted at the Institute of Psychiatry, Ain Shams University and Al Mashfa Private Hospital.
Methods: Ninety-one participants were included in the study: 30 patients were diagnosed as BPD without axis I comorbidities, 31 BPD patients had psychiatric comorbidities and 30 healthy subjects were assessed by using Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), Suicide Behavior Questionnaire-Revised (SBQ-R), the Arabic version of Barratt’s Impulsiveness
Scale-11 (BIS-11) and Global Assessment of Functioning scale.
Results: There was a significant difference in suicidality using the SBQ-R between the healthy controls and BPDs without and with comorbidities. Healthy controls showed low suicidality in only 3.3%, while it was higher in both groups of BPD. The total score of BIS was as follows: 62.5 (±10.1 SD) in group A, 79.4 (±12 SD) in group B and 80.3 (±12.5 SD) in group C, which denote mild, moderate and moderate-to-severe degree of impulsivity in group A, B and C, respectively. Suicidality was positively correlated with (AI item: lack of span Attention in Attentional Facet) (r = 0.489, p = 0.006), (PI item: lack of self-control in planning facet) (r = 0.401, p = 0.028), as well as (MII item: lack perseverance in holding off impulsive acts in motor facet) (r = 0.471, p = 0.009).
Conclusion: Proper assessment of associated psychiatric comorbidities and impulsivity among BPD patients will help preventing of future suicidal attempts.

Experience of violence, coping and support for nurses working in acute psychiatric wards

2023-02-08T13:49:14+00:00

Background: Acute psychiatric wards are stressful working environments because of the nature of the mental illness of patients admitted. These patients present with a variety of complex psychiatric problems and social control that require skilled and competent nurses to manage them. The shortage of nurses, especially with advanced psychiatric qualifications or necessary experience, may create challenges for nurses as they navigate this stressful working environment.
Aim: The aim of this study was to explore and describe nurses’ experience of patient violence, coping strategies and received support whilst working in acute wards in psychiatric hospitals.
Setting: This study was conducted in six acute wards of the three psychiatric hospitals in Cape Town, South Africa.
Methods: A qualitative, explorative, descriptive design was conducted using semi-structured interviews to obtain data from 14 nurses working in acute wards in three psychiatric hospitals in the Western Cape.
Results: Five themes were generated using thematic analysis: violence perceived to be ‘part of the job’, contributing factors to patient violence, physical and psychological effects on nurses, adaptive and maladaptive coping strategies and perceived support from stakeholders.
Conclusion: Participants normalised patient violent behaviour as being part of the job to minimise the physical and psychological effects of the traumatic experience. Adaptive and maladaptive coping strategies were used to cope with the traumatic experiences of being assaulted by patients. Recommendations allude to practising self-care and attendance of training in the management of aggressive patients for nurses, to enhance a variety of adaptive
coping strategies.

The profile of offenders accused of rape referred to the Observation Ward of the Free State Psychiatric Complex, Bloemfontein, South Africa, 2011–2015

2023-02-08T13:52:51+00:00

Background: Sexual assault in South Africa has reached alarming proportions. Mental illness amongst offenders accused of rape is one of the complicating factors.
Aim: To describe the sociodemographic, clinical and forensic profile of alleged offenders accused of rape referred to a South African tertiary public psychiatric hospital for forensic evaluation, as well as describe the profile of the reported victims.
Setting: Free State Psychiatric Complex (FSPC) Observation Ward, Bloemfontein, South Africa.
Methods: This cross-sectional retrospective study compiled a sociodemographic, clinical and forensic profile of offenders accused of rape referred to the FSPC for forensic assessment between 2011 and 2015. The study population comprised 159 alleged offenders. Sociodemographic data, mental status, clinical diagnoses, comorbid substance use and forensic outcomes were collected from clinical files.
Results: All accused offenders were male with a median age of 30 years. About half obtained primary school level education. Unemployment was common (37.3%) with 40% receiving government grants. Most accused offenders were single (78.0%). Clinically, schizophrenia spectrum and other psychotic disorders were the most common diagnoses (30.8%), followed by intellectual disability (16.3%). Almost a third of the accused offenders did not suffer from any mental illness. Alcohol (20.1%) and cannabis use disorders (12.6%) were dominant comorbidities. After a 30-day evaluation period, 53.2% of alleged offenders were found competent to stand trial. The verdict of criminal responsibility was made for 43.7% of this sample.
Conclusion: This study contributes data on sociodemographics, psychiatric morbidities and comorbidities and forensic findings amongst alleged offenders of rape referred for forensic assessment.

Qualitative study of mental health attribution, perceptions and care-seeking in Kampala, Uganda

2023-02-09T11:45:38+00:00

Background: Mental health problems contribute to a substantial proportion of the global burden of disease. In Uganda, the World Health Organization estimates that 2.2 million people are affected by mental health disorders. Further research is needed to highlight people’s views about mental health in order to ensure that services are appropriate, accessible and effective.
Aim: This qualitative study aimed to explore perceptions, experiences and care-seeking preferences to inform stakeholders looking to provide contextually appropriate mental health programmes.
Setting: A diverse neighbourhood in central Kampala, Uganda.
Methods: The authors conducted 56 in-depth semi-structured interviews with people over the age of 37 years from November 2018 to May 2019.
Results: Participants discussed interpersonal and systemic issues that affect mental health in their community and the existing coping mechanisms that people employ. Social factors were often associated with mental health problems, with 36% of participants attributing them to economic stressors in particular. Mental health services were often perceived to be unavailable, costly or stigmatised, which can mean that care-seeking is delayed until problems become severe. Some people said they prefer to turn to prayer (25%) or counselling within their family or community (12.5%).
Conclusion: Mental health problems are often attributed to socioeconomic factors, which can also hinder access to services. An understanding of perceptions about mental health can help to align programmes for appropriateness and effectiveness. Our study suggests that beneficial additional services for people living in low-income urban settings in Uganda could include those which are free, community-based or offering financial support.

The magnitude and determinants of depressive symptoms amongst women in early pregnancy in Southern Nigeria: A cross-sectional study

2023-02-09T11:47:07+00:00

Background: Antenatal depression (AD) is prevalent and associated with adverse pregnancy, maternal and child outcomes, yet no study has addressed its magnitude and predictors in early pregnancy in Nigeria.
Aim: To determine the prevalence and factors associated with AD in first half of pregnancy.
Setting: Multicentric health facilities in Southern Nigeria.
Methods: A multicentric health-facilities-based cross-sectional study was conducted from January to July 2018. Using pretested structure interviewer-administered questionnaires, antenatal depressive symptoms were assessed amongst 511 pregnant mothers with the Edinburg Postnatal Depressive Scale tool. Socio-demographic, socio-economic, clinical, family and social factors were also measured. Descriptive statistics, bivariate and multivariable logistic regression analyses were employed to describe and identify factors associated with AD.
Results: The prevalence of antenatal depressive symptoms in early pregnancy in this study was 29.4% (95% confidence interval [CI] 26.6–32.9). Factors independently associated with AD were intimate partner violence (adjusted odds ratios [AOR] = 8.10, 95% CI 5.00–13.14), marital dissatisfaction (AOR 5.48, 95% CI 3.48–8.38), poor social support (AOR 4.70; 95% CI 2.99–7.38), past history of depression (AOR 4.67; 95% CI 2.47–8.80), previous pregnancy complication (AOR 2.50, 95% CI 1.57–3.89), low socio-economic status (AOR 2.41, 95% CI 1.61–3.66) and unplanned pregnancy (AOR 2.35, 95% CI 1.47–3.64).
Conclusions: The prevalence of antenatal depression is high with modifiable risk factors requiring context-specific policies such as provision of family, social and economic support for mothers at the earliest possible contact in the antenatal period.

Prescribing patterns of long-acting injectable antipsychotics in a community setting in South Africa

2023-02-09T10:31:23+00:00

Background: Long-acting injectable antipsychotics (LAI – APs) improve adherence to antipsychotics and decrease functional decline in schizophrenia. Yet they are prescribed late, in patients with established functional decline. Although LAI – APs are widely prescribed in South Africa, there is a paucity of research regarding the prescription profile for LAI – APs.
Aim: This study aimed to describe prescribing practices for LAI – APs at psychiatric clinics.
Setting: Community psychiatric clinics in South Africa.
Methods: A retrospective review of the psychiatric files of all patients on LAI – APs attending the clinics over the study period was conducted. Sociodemographic, clinical and pharmacological information regarding the LAI – AP prescribed was extracted from the files.
Results: A total of 206 charts were examined. The mean age of the study population was 46 (SD ± 12) years. Significantly more patients were male (n = 154; 74.8%), single (n = 184, 89.3%) and unemployed (n = 115; 55.8%) (p < 0.001). Approximately half had a comorbid substance use disorder (47.6%). The most common indication for the prescription of a LAI – AP was non-adherence (66%). Only 9.7% of the patients were prescribed a LAI – AP alone. No
significant socio-demographic or clinical characteristic was associated with this prescribing habit. A LAI – AP was prescribed in combination with an oral antipsychotic, mood stabiliser or antidepressant in 53.9%, 44.7% and 7.8% of patients, respectively.
Conclusion: Long-acting injectable antipsychotics were prescribed mainly following noncompliance with oral antipsychotics and may represent a missed opportunity to prevent functional decline. The high prevalence of LAI – AP polypharmacy has been highlighted.

Effectiveness of cognitive behavioural therapy and social skills training in management of conduct disorder

2023-02-09T10:36:11+00:00

Background: Conduct Disorder (CD) is a repetitive disruptive behaviour that violates the rights of others, manifests in rules violation, aggression, hostility, and deceitfulness and has assumed prominence in its association with juvenile offending and criminality in adulthood. Despite this knowledge, little research attention is given to ascertaining effective psychobehavioural interventions to manage this problem, especially amongst Nigerian
adolescents.
Aim: This study examined the efficacy of two psychobehavioural strategies to manage CD amongst in-school adolescents in Ibadan, Nigeria.
Setting: Ibadan, Southwestern Nigeria.
Method: A randomised controlled trial (RCT) of adolescents with CD was performed. Sixteen participants (aged 12–17 years) who reported high CD from an assessment of 1006 in-school adolescents of selected secondary schools in Ibadan were randomly grouped to receive either cognitive behavioural therapy (CBT), social skills training (SST) or combined CBT and SST. The Frequency of Delinquent Behaviour Scaling Instrument (FDBSI) was used for assessments.
Results: Significant reduction in CD was observed among participants exposed to CBT (t[6] = 8.510), p < 0.05) at 8 weeks, SST (t[6] = 12.728), p < 0.05) at 8 weeks, and combined CBT and SST (t[8] = 12.728, p < 0.05) at the 6 week mark of interventions respectively.
Conclusion: From the study, CBT and SST are effective in managing CD. However, the combined psychobehavioural intervention of CBT and SST was more effective in managing CD, based on a faster therapeutic effect than the independent psychobehavioural intervention of CBT and SST.

Patients’ voices from music therapy at a South African psychiatric hospital

2023-02-09T10:40:09+00:00

Background: In the Life Esidimeni tragedy, crucial voices of mental healthcare users and practitioners were silenced, captured in the Ombud’s report as a ‘failure to listen’. Working against this kind of failure, various therapeutic interventions listen deliberately and uncover the voice of the patient, that is, what matters from his or her subjective perspective in his or her particular circumstances. Amongst these interventions, music therapy provides for this sensitive listening by expanding the scope and means of expression from the verbal to the
musical.
Aim: This article reports on a qualitative exploration of patients’ lived experiences both during and after their course of individual music therapy, expressed both verbally and in the language of active music-making.
Setting: A tertiary public psychiatric hospital in South Africa.
Methods: Audio-video recordings of 131 music therapy sessions and 15 post-therapy interviews were analysed thematically. From three sets of themes accounting for patients’ verbal contents, musical participation and verbal post-therapy reflections, 11 salient voices were identified.
Results: The 11 voices that emerged were (1) the voice of struggle, (2) the voice of disturbance, (3) the voice that feels, (4) the voice of isolation, (5) the powerless voice, (6) the voice that desires, (7) the voice of flow and connection, (8) the reflecting voice, (9) the symbolic voice, (10) the resilient voice and (11) the voice of liberation.
Conclusion: Although mental health practitioners may recognise these voices from their clinical experience, space and opportunity for hearing the voice of each patient should be generated deliberately.

The experiences of clinical psychologists in treating traumatic stress at a tertiary psychiatric hospital in the Eastern Cape: A qualitative study

2023-02-09T10:42:43+00:00

Background: Qualitative data on the experiences of treating post-traumatic stress disorder (PTSD) in a psychiatric setting in a low-resource context is sparse.
Aim: The authors aimed to explore the lived experiences of clinical psychologists who treat patients who are either trauma survivors or perpetrators in a psychiatric hospital.
Setting: A public psychiatric hospital in the Eastern Cape, South Africa.
Method: A total of six individual semi-structured interviews were conducted with three clinical psychologists. Data were analysed using interpretive phenomenological analysis (IPA).
Results: The analysis for each participant identified several significant themes, namely (1) support as a male person, (2) being appreciative, (3) difficult trauma narratives, (4) a mother and a psychologist and (5) fear and hopelessness.
Conclusion: Treating traumatic stress amongst clinical psychologists working in a public psychiatric hospital can lead to experiences of vicarious trauma and traumatic stress. In addition, the participants experienced an added danger in treating high-risk state patients, exposing psychologists to traumatic stress. Furthermore, psychologists recognised the influence of gender and race and its impact on their roles in their personal and professional
lives as practitioners treating traumatic stress.

Depressive symptoms and quality of life prior to metabolic surgery in Cape Town, South Africa

2023-02-09T10:46:20+00:00

Background: Depression has been shown to have a negative impact on the outcomes of metabolic surgery and quality of life (QOL). Currently, there are limited data on mental distress and QOL in metabolic surgery candidates in South Africa.
Aim: This study aimed to determine the prevalence of depressive symptoms at the time of presurgical assessment in participants undergoing metabolic surgery.
Setting: The Obesity and Metabolic Surgery Initiative at Tygerberg Hospital.
Methods: We conducted pre-operatively a retrospective cross-sectional study on patients who underwent metabolic surgery from September 2017 to September 2019. Participants were profiled in terms of metabolic parameters, depressive symptoms and QOL.
Results: Of the 157 participants assessed, 88% were female with a body mass index in the super obese range. Twenty-two percent of participants had depressive symptoms. Metabolic surgery candidates with depressive symptoms had a significantly poorer overall QOL score compared with those without depressive symptoms. When controlling for all other variables, an increase in QOL score was shown to decrease the odds of current depressive symptoms, whilst back pain on non-narcotic medication and having had a stroke were found to increase the odds of current depressive symptoms.
Conclusion: This study highlights the complex interplay between metabolic, clinical and psychiatric factors in patients undergoing metabolic surgery. The study highlights the vital role of a psychiatrist as part of a multidisciplinary team pre- and post-operatively in the early identification of depressive symptoms. Psychiatrists may have an important role to play as part of the multidisciplinary team in metabolic surgery, including screening for mental health problems pre- and post-operatively, providing psychoeducation and relevant pharmacological treatment and psychotherapy where needed.
Contribution: This study expands our limited knowledge of psychiatric comorbidity (in particular depressive symptoms and associated factors) in people undergoing metabolic surgery in low- and middle-income countries.

Systematic review on the prevalence of perinatal depression in Malawi

2023-02-09T10:49:39+00:00

Background: Perinatal depression causes significant burden to women and their families during the perinatal period. However, there is no reliable national prevalence data on perinatal depression in Malawi.
Aim: This systematic review aimed at establishing the pooled prevalence of perinatal depression.
Setting: The study setting is Malawi.
Methods: Two reviewers conducted the search, selection, quality evaluation and data abstraction. Appropriate terms were used to search the CINAHL, PsychINFO, PubMed and ScienceDirect databases. The relevance and the quality of the studies were assessed. The prevalence of prenatal depression was pooled using a random-effects model, which was used to synthesise the data.
Results: The review included a total of eight articles of fair and good quality. This review found a pooled prevalence of antenatal depression of 17.1% (95.0% confidence interval [CI]: 12.5–22.2) and postnatal depression of 19.8% (95.0% CI: 4.6–42.1) with an overall pooled prevalence of perinatal depression of 18.9% (95.0% CI: 14.5–23.8).
Conclusion: This systematic review provided a pooled prevalence of perinatal depression which may be used in the absence of national prevalence data on perinatal depression.
Contribution: This systematic review found a high a pooled prevalence of perinatal depression in Malawi suggesting that mental health should be a key component of maternal health programmes, policies and activities in the local setting.

Impact of completing a psychosocial rehabilitation programme on inpatient service utilisation in South Africa

2023-02-09T10:53:47+00:00

Background: Deinstitutionalisation refers to the process of transferring most of the psychiatric care provision from inpatient state-run institutions to community-based care. However, it has proven difficult to implement and failed to reach its desired targets. New Beginnings (NB) is a transitional care facility that facilitates the transition from in- to outpatient care. To date, no data exist as to whether the intervention provided at NB is effective in reducing psychiatric readmissions.
Aim: To determine if completing a psychosocial rehabilitation (PSR) programme reduces acute inpatient service utilisation and if this is influenced by sociodemographic or clinic factors.
Setting: New Beginnings transitional care facility in South Africa.
Methods: A record review of all NB admissions between January 2011 and December 2015. Demographic and clinical data were collected, including readmissions and days-in-hospital (DIH), 36 months pre- and postindex admission. Patients were divided into a completer group (CG) and a noncompleter group (NCG) for the eight-week PSR programme, and comparative statistical analysis was performed.
Results: Completion of the 8-week voluntary inpatient PSR programme led to a significant decrease (p = 0.017) (CG vs. NCG) in DIH during the 36-month period postindex admission. In addition, both groups showed significantly decreased (p < 0.001) DIH postindex in comparison to pre-index admission.
Conclusions: This study’s findings support that transitional care facilities offering an inpatient PSR programme may reduce inpatient service utilisation for all attendees but especially for those who complete the program. This highlights the need for such facilities that offer interventions tailored for patients with mental illness.
Contribution: This is the first local study highlighting the potentially important role transitional care facilities could play in reducing readmissions.

Prevalence of cannabis use in people with psychosis in KwaZulu-Natal, South Africa

2023-02-09T10:57:54+00:00

Background: There is a high prevalence of cannabis use in patients with schizophrenia spectrum and other psychotic disorders, with comorbid cannabis use in this population being associated with poorer long-term outcomes.
Aim: To determine the prevalence of cannabis use in patients with a schizophrenia spectrum and other psychotic disorders.
Setting: The study was conducted at a psychiatric hospital in Durban, KwaZulu-Natal
Province, South Africa.
Methods: A review of clinical records of patients admitted to the hospital for the period, June 2018 to June 2020, was conducted.
Results: A total of 370 clinical records were reviewed, of which 48.9% reported current and 51.1% lifetime cannabis use. Being male was significantly associated with current and lifetime cannabis use (OR = 4.90, 95% CI 2.49–9.62 and OR = 6.27, 95% CI 3.28–11.95, respectively). Current alcohol use was also associated with current cannabis use (CCU) (OR = 3.06, 95% CI 1.78–5.28), and age 45 years and older was associated with a lower odds of cannabis use
(OR = 0.30, 95% CI 0.09–0.96). Forty-eight per cent of participants were admitted three or more times, and readmission was associated with cannabis use (p = 0.01). There was a lack of association between cannabis use, readmission and human immunodeficiency virus (HIV) status, after controlling for variables such as alcohol use and gender.
Conclusion: Almost 50% of people admitted with schizophrenia spectrum and other psychotic disorders have comorbid current and lifetime cannabis use. There is a need for dual diagnosis units to address comorbid substance use in people with psychotic disorders, as it leads to poorer outcomes.
Contribution: The study found that there is a high prevalence of cannabis use in people with psychosis. Therefore, it is imperative that we revise treatment programs in our psychiatric units and there is an urgent need for dual diagnosis programs that address substance use in this group of patients.

Mental health status of doctors and nurses in a Nigerian tertiary hospital: A COVID-19 experience

2023-02-09T11:01:30+00:00

Background: Healthcare professionals (HCPs) working to save lives during the coronavirus disease 2019 (COVID-19) pandemic are under tremendous physical and psychological pressure, therefore facing the risk of developing challenges with mental health.
Aim: This study aimed primarily to determine the prevalence and factors associated with depression, anxiety and stress among HCPs in a tertiary hospital in Lagos State during the COVID-19 pandemic.
Setting: Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria.
Methods: This was a descriptive cross-sectional study conducted between June and July 2021 among 1452 doctors and nurses in LASUTH, Ikeja, Lagos, Nigeria, selected by the multistage sampling method. Depression, anxiety and stress were assessed using the Patient Health Questionnaire, Generalised Anxiety Disorder and Perceived Stress Scale, respectively.
Results: The majority of respondents were female (72.5%), with two-thirds being nurses. The prevalence of depression, anxiety and stress was 9.8%, 5.0% and 62.4%, respectively. Nurses showed a higher prevalence of these mental health conditions as compared with doctors. Younger HCPs, nurses, those that lost a colleague to COVID-19, and those whose family members were infected with COVID-19 were more likely to be depressed. Nurses and those afraid of being infected were more likely to experience anxiety. Younger HCPs, nurses, history of anxiety and/or depression and previous COVID-19 infection were identified as factors associated with stress.
Conclusion: Stress was the most prevalent mental health condition with nurses being the most affected of the HCPs and at a greater risk of developing challenges with mental health. Psychosocial interventions and stress management techniques are recommended to minimise the risks.
Contribution: This study adds to the few studies on the mental health of HCPs during COVID-19 and calls for in-depth surveys to understand psychosocial challenges among HCPs in Nigeria.

Systematic mapping on availability, extent and distribution of mental health research in Malawi

2023-02-09T11:06:17+00:00

Background: Mental health research is essential in the implementation of evidence-based interventions. This can be impeded by unavailability or limited access to local evidence in low- and middle-income countries (LMICs) such as Malawi.
Aim: The aim of this systematic mapping was to describe the availability, extent and distribution of mental health research conducted in Malawi.
Setting: The study was conducted at Kamuzu University of Health Sciences in Malawi.
Methods: A systematic search of four electronic databases from inception to September 2021 was carried out. All published and unpublished mental health studies in all languages were eligible for inclusion. Studies were screened against inclusion and exclusion criteria, and data were extracted, analysed and presented in tables and as a narrative synthesis.
Results: Cross-sectional studies (33.6%, n = 76) were found to be the most common study design for mental health research in Malawi. More studies were conducted on women (21.2%, n = 48) compared to men (1.3%, n = 3). Mental health research was concentrated in the southern region of the country (44.8%, n = 120) and in the three cities of Lilongwe (17.9%, n = 48), Blantyre (16.4%, n = 44) and Zomba (9.0%, n = 24).
Conclusion: This systematic mapping suggests that there are few studies on mental health in Malawi which are not equally distributed across the country. There is a pressing need to conduct more mental health research using robust designs across disciplines.
Contribution: Research on mental health is urgently needed to produce culturally acceptable data in Malawi.

COVID-19 infection at a psychiatric hospital in KwaZulu-Natal, South Africa: Clinical service planning and challenges

2023-02-09T11:09:15+00:00

Background: South Africa had over 4 million cases of coronavirus disease 2019 (COVID-19) infections and more than 1 million COVID-19-related deaths. Despite the devastating psychological impact of the COVID-19 pandemic, there is little qualitative, critical evaluation of government mental health services in this resource-limited setting.
Aim: The authors describe the clinical service plan and response to the COVID-19 pandemic at a government psychiatric hospital.
Setting: KwaZulu-Natal, South Africa.
Methods: A descriptive narrative overview of the specialised psychiatric hospital’s clinical response (April 2020 – March 2021) to the COVID-19 pandemic was undertaken in the following domains: screening policy; testing and swabbing policy; staff training and monitoring; and restructuring the wards to accommodate mental health care users (MHCUs) with suspected cases of COVID-19.
Results: The in-depth narrative reviews led to the introduction of staff training, routine COVID-19 reverse transcription polymerase chain reaction (RT-PCR) testing of all MHCUs, the creation of designated quarantine and isolation facilities and screening of physical health status of patients with COVID-19 prior to transfer being implemented to prevent an outbreak or increased morbidity or mortality.
Conclusion: Implementing a service plan early which included staff training, screening and routine COVID-19 testing services for psychiatric admissions in a rapidly evolving environment with few additional resources was challenging. The absence of guidelines early in the pandemic that addressed the unique needs of a clinical psychiatric inpatient population is a noteworthy learning point.
Contribution: The article highlights that the inpatient infrastructural requirements and clinical management protocols of acutely psychiatrically ill inpatients, in the context of infectious outbreaks, require dedicated task teams and bespoke policies.

Attention-deficit hyperactivity disorder stigma: The silent barrier to care

2023-02-09T11:49:00+00:00

Background: Attention-deficit hyperactivity disorder (ADHD) is the most common psychiatric disorder in childhood, with symptoms persisting into adulthood in 60% of individuals. If left untreated, the emotional, social and financial consequences can be dire, with many children and adults not reaching their full potential and having a reduced quality of life.
Aim: The study explored parents’ and educators’ understanding and experience of stigma in relation to their children’s ADHD.
Setting: Participants were recruited from six schools in the Cape Town metropole, in which the Goldilocks and The Bear Foundation (which delivers mental health services to underprivileged children) were active.
Methods: A convergent parallel mixed methods research design (consisting of a quantitative survey and an in-depth interview component) was conducted to explore the lack of knowledge about ADHD and stigma as potential barriers to help-seeking behaviour, diagnosis and treatment for children with ADHD.
Results: Instrumental barriers to care had a bigger impact on practical access to care, while attitudinal and stigma-related resources were found to have a significant impact on well-being of individuals. Core to the themes arising from the interviews were questions of how lack of knowledge influences stigma, how stigma materialises in discriminatory behaviour and how stigma acts as a barrier to care.
Conclusion: The findings contribute to the literature by exploring parents’ and educators’ understanding and experience of stigma in relation to their children’s ADHD. A collaborative stakeholder approach is needed for effective, comprehensive and relevant interventions to combat stigma and enhance early identification of and interventions for ADHD.
Contribution: In order to improve access to care, treatment, and well-being of individuals directly or indirectly affected by ADHD, it is crucial that stigma needs to be addressed.

Intimate partner violence, adverse childhood experiences and prenatal substance use in South Africa

2023-02-09T11:17:27+00:00

Background: Intimate partner violence (IPV) is one of the most pressing public health conditions among women worldwide, particularly in sub-Saharan Africa. Intimate partner violence in South Africa, along with human immunodeficiency virus (HIV), is an epidemic that is closely linked to trauma and substance use in women.
Aim: This study aimed to identify factors associated with IPV among pregnant women, with a specific focus on adverse childhood experiences (ACE), prenatal substance use, and HIV status.
Setting: A large public general hospital in the KwaZulu-Natal province.
Methods: The sampled study participants included 223 adult postpartum women (18 – 45 years) based on convenience sampling who recently gave birth. Four separate logistic regression models were fitted to examine the role of ACE, perinatal substance abuse and HIV against threat (model 1), physical violence (model 2), sexual violence (model 3) and any IPV (model 4) outcomes (threat and/or physical and/or sexual violence).
Results: The prevalence of threat, physical violence, sexual violence and any IPV were 19.7%, 16.6%, 1.8% and 20.2%, respectively. The total ACE scores ranged from 0 to 11 (of 13 possible events) with a mean of 3.28 (standard deviation [s.d.] = 2.76), where 14.4% reported using substances during pregnancy (n = 32) as well as 47.1% (n = 105) of participants living with HIV. The authors found that the presence of family support was protective against IPV physical.
Conclusion: It is essential that obstetric services screen and address potential risk factors along the life course pathways from early adversity to adult maternal health that drive IPV, particularly in young women who may lack family support during pregnancy.
Contribution: This research gives insight into the dynamics between IPV, HV, ACE and perinatal substance use facing young women in South Africa

Perceptions and experiences of patients attending an opioid substitution clinic in South Africa

2023-02-09T11:20:47+00:00

Background: Opioid substitution therapy (OST) is endorsed as the recommended treatment for opioid use disorders. Opioid substitution therapy is not widely used in South Africa, so little is known about its perceived clinical utility in this setting. There is also a paucity of qualitative research that explores the subjective experiences of patients using OST.
Aim: To explore patients’ perceptions and experiences attending a South African OST outpatient clinic (OST-OC).
Setting: The OST-OC at Stikland Psychiatric Hospital, Cape Town, South Africa.
Methods: We conducted a qualitative study using semi-structured interviews with eight participants who had been attending the OST-OC for at least 6 months. Transcripts were analysed using Atlas.ti software and thematic content analysis was used to identify themes.
Results: Patients stated that OST helped them to regain and maintain a stable lifestyle. Autonomy and agency, the therapeutic relationship and family support were perceived as contributing to successful patient outcomes. The preference for methadone and buprenorphine treatment depended on individual experiences. Patients valued kindness from staff members but reported that improved interactions with some nonclinical staff could better facilitate treatment. Challenges experienced included stigma and cost.
Conclusions: This study offers insights about OST that are pertinent to low- and middleincome countries. Reducing the cost of OST, collaborative decision-making between staff and patients, and a non-judgemental attitude by clinical staff were recognised as important factors for optimised service delivery.
Contribution: Understanding patients’ experiences of OST in a South African setting will allow for future policy development for the treatment of opioid use disorders in similar settings locally and abroad.

Validation of the Sleep Quality Questionnaire among senior students in Benin City, Nigeria

2023-02-09T11:23:57+00:00

Background: The Sleep Quality Questionnaire (SQQ) is a short and easy-to-understand resourceful tool for measuring poor sleep quality; however, it remains to be validated.
Aim: The focus of this study is to determine its reliability and validity among Nigerian adolescents.
Setting: Four gender-mixed schools within Benin City, Nigeria were selected to participate in the study.
Methods: Questionnaires containing the SQQ, the Sleep Condition Indicator (SCI), which is a validated scale, and the Hospital Anxiety and Depression Scale (HADS) from 377 students selected from the junior and senior secondary school students were analysed.
Results: The mean age calculated was 14.78 years for 174 male and 203 female students. Cronbach’s alpha for the SQQ scale was 0.70. It correlated strongly with the SCI (rho = 0.93, p = 0.00), weakly with the HADS depression (rho = -0.19, p < 0.01) and anxiety (rho = -0.30, p < 0.01), but had no association with gender. Factor analysis revealed three factors with an eigenvalue greater than 1. Factors 1–3 accounted for 31.78%, 15.16% and 11.26% of the variance, respectively, totalling 58.2%. The reliability of each of the three factors was as follows: factor 1, 0.75; factor 2, 0.47; and factor 3, 0.62. The SQQ demonstrated good specificity and sensitivity at a cut-off point of 18.
Conclusion: It is therefore recommended that the SQQ be included in the screening of sleeprelated problems in adolescents, both in the primary and secondary care settings in Nigeria.
Contribution: The research shows that the Sleep Quality Questionnaire is both a reliable and valid screening tool among adolescents in Nigeria. Its brevity and simplicity further promote its use in clinical and non-clinical settings.

Disability and premorbid adjustment in schizophrenia: A retrospective analysis

2023-02-09T11:26:56+00:00

Background: Schizophrenia is highly disabling. Though efforts at genetic mapping to identify those at risk of the illness have been promising but same cannot be said about predicting its associated disability before illness-onset (i.e., during premorbid phase). It is envisaged that Schizophrenia-related disability may be ameliorated if premorbid clinical markers are adequately predictive enough to identify those at risk and worked upon them.
Aim: This study aimed to determine whether there is a relationship between schizophreniarelated disability and premorbid adjustment.
Setting: This cross-sectional study was conducted at the out-patient clinic of the Neuropsychiatric Hospital, Aro, Abeokuta, Ogun State, Nigeria.
Methods: Three hundred patients with the diagnosis of schizophrenia and within the age range of 18–64 years were eligible for the study.
Results: Mean age of the participants was 41.9 ± 10.05 years with a slight female dominance (50.7%). Spearman’s correlation revealed a direct correlation between disability and premorbid adjustment, albeit rather weak (rs = 0.130, p = 0.025).
Conclusion: Pre-diagnostic factors such as premorbid functioning may play a role in the subsequent functioning of an individual post-diagnosis. Other research efforts may focus on yet-to-be identified premorbid factors that may be targets of prevention to reduce disability in schizophrenia.
Contribution: This research serves as a pioneer work on disability and premorbid adjustment and has provided a template for the early identification of those at risk of schizophrenia by providing an intervention opportunity at the premorbid stage.

Factors associated with patient readmission to a specialised psychiatric hospital in the Eastern Cape

2023-02-09T11:31:22+00:00

Background: Hospital readmissions increase healthcare system costs and can place additional strain on already sparse government funds and under-resourced hospitals. Few studies have investigated readmission of patients in mental health facilities in South Africa.
Aim: The study aimed to identify the factors associated with readmission of patients discharged from an acute psychiatric public hospital in South Africa.
Setting: The study was conducted at an acute psychiatric public hospital.
Method: A retrospective review of medical records was conducted for all patients admitted and readmitted between January 2018 and December 2019.
Results: From the pool of patient records analysed (n = 516), 93 (18.02%) were readmitted, of which the majority (75.27%) were male. The average age of patients readmitted was 27.24 ± 11.16 years, which was significantly younger than the total sample (p < 0.05; CI 1.095–7.105). Findings indicated that patients who completed lower levels of education, were unemployed and were diagnosed with substance (mono- or polysubstance) use disorder (n = 93; 100%), schizophrenia (n = 33; 35.48%), bipolar disorder (n = 9; 9.68%) or intellectual disability (n = 9; 9.68%) were more frequently readmitted, with the average length of stay varying widely between patients.
Conclusion: Younger patients and those living with more complex psychiatric conditions, particularly those who are substance abusers, were readmitted more frequently, indicating that these patients may require special consideration for management.
Contribution: The study revealed that patients living with complex psychiatric conditions such as schizophrenia and bipolar disorder were readmitted to hospital more frequently, indicating that management of these patients at the community level is challenging.

Early deviant behaviour as a dimension trait and endophenotype in schizophrenia

2023-02-09T11:33:27+00:00

Background: In psychiatry, there is still a lack of objective biological diagnostic measurements. It is important to investigate measurements or symptom dimensions that can inform diagnostic assessments and allow for a more personalised approach to patients.
Aim: To discuss how early deviant behaviour (EDB) may be seen as a possible continuous symptom dimension trait and endophenotype in schizophrenia.
Methods: Conducting a commentary review by highlighting some important findings from available literature.
Results: Findings regarding EDB in schizophrenia in a South African genetic sample point towards EDB as a progressive subtype of schizophrenia, with very early onset of illness (even prior to the psychotic symptomatology) and a genetic form of illness.
Conclusion: Valuable information can be gained by enquiring into EDB and viewing it as a continuous symptom dimension trait and endophenotype during the psychiatric diagnostic interview.

Psychometric properties of Drug Attitude Inventory among patients with schizophrenia

2023-02-09T11:35:30+00:00

Background: The treatment of patients diagnosed with schizophrenia has remained three-fold physical (pharmacological), psychological and social. Furthermore, the need to monitor adherence to the physical aspect of treatment has been a major concern to mental health practitioners as this usually affects the success of psychological and social treatment.
Aim: My study aimed to determine the psychometric properties of Drug Attitude Inventory (DAI) among patients with schizophrenia. The study was carried out at the Neuropsychiatric Hospital, Aro Abeokuta Ogun State and on an average, about 150 patients were seen daily at the outpatient clinic.
Methods: Internal consistency, item-total correlation (the two-way mixed method with absolute agreement) and Cronbach’s alpha were evaluated using an intra-class correlation coefficient (ICC). This instrument’s level of adequacy was determined using factor analysis (principal component analysis with varimax rotation).
Result: Marital status and level of education were significantly associated with adherence. The Cronbach’s alpha was 0.56 and principal components factor analysis with varimax rotation produced a three-factor solution.
Conclusion: My study has shown that the DAI is a valid and reliable instrument and can be used in a clinical setting where there are limitations with time such as the outpatient clinic.

Neuropsychiatric symptoms in a patient with Cushing’s syndrome

2023-02-09T11:50:06+00:00

Cushing’s syndrome (CS) may present with different neurological and/or psychiatric symptoms including anxiety, depression, cognitive impairment and psychosis. Psychosis is a rare clinical manifestation, with literature limited to case reports. We report a case of a 52-year-old woman with psychosis secondary to CS who was mis-diagnosed as schizophrenia-like psychosis. This case highlights the importance of considering CS as a differential when ruling out medical causes in patients with either new or persistent mental health disturbances.

Case study: New onset of neuropsychiatric symptoms following switching to a dolutegravir regimen

2023-02-09T11:39:40+00:00

Although reports of neuropsychiatric side effects have been reported with efavirenz, these have been limited in comparison with regard to the now recommended dolutegravir regimens. We present a patient with new onset neuropsychiatric manifestations secondary to dolutegravir that resulted in significant physical injuries. The patient was initiated on risperidone for symptomatic control which was subsequently weaned and discontinued following reverting to an original efavirenz antiretroviral regimen, with resolution of neuropsychiatric symptoms. Neuropsychiatric side effects are increasingly noted with dolutegravir, and these should be monitored for on initiation and switching of treatment regimens.