South African Journal of Psychiatry <p>The journal is the leading psychiatric journal of Africa. It provides open-access scholarly reading for psychiatrists, clinical psychologists and all with an interest in mental health. It carries empirical and conceptual research articles, reviews, editorials, and scientific letters related to psychiatry. It publishes work from various places in the world, and makes special provision for the interests of Africa. It seeks to serve its readership and researchers with the most topical content in psychiatry for clinical practice and academic pursuits, including work in the subspecialty areas of psychiatry.</p><p>Submissions in English (full article) will be considered for publication.</p><p>Other websites related to this journal: <a title="" href="" target="_blank"></a></p> AOSIS en-US South African Journal of Psychiatry 1608-9685 <p><a title="" href="" target="_blank"></a></p><h2>Copyright</h2><p>The author(s) retain copyright on work published by AOSIS unless specified otherwise.</p><h2>Licensing and publishing rights</h2><p>Author(s) of work published by AOSIS are required to grant AOSIS the unlimited rights to publish the definitive work in any format, language and medium, for any lawful purpose.</p><p>AOSIS requires journal authors to publish their work in open access under the <span style="text-decoration: underline;">Creative Commons Attribution 4.0 International (CC BY 4.0) licence</span>.</p><p>Read more here: <a href="" target="_blank"><strong></strong></a></p><p>The authors retain the non-exclusive right to do anything they wish with the published article(s), provided attribution is given to the applicable journal with details of the original publication, as set out in the official citation of the article published in the journal. The retained right specifically includes the right to post the article on the authors’ or their institution’s websites or in institutional repositories.</p><p>Previously published work may have been published under a different licence. We advise the community that if they would like to reuse the work to consult the applicable licence at article level.</p> Social anxiety disorder and childhood trauma in the context of anxiety (behavioural inhibition), impulsivity (behavioural activation) and quality of life <p><strong>Background:</strong> Social anxiety disorder (SAD) is one of the most prevalent psychiatric disorders in South Africa. Previous studies have linked childhood trauma with the development of SAD. The behavioural inhibition system (BIS) and the behavioural activation system (BAS), two dimensions of personality related to anxiety and impulsivity, respectively, are said to influence the development of psychopathology, including SAD. Both SAD and childhood trauma have an impact on quality of life. This study investigated the relationship between BIS, BAS and quality of life in patients with SAD with and without exposure to childhood trauma, compared to healthy controls.</p><p><strong>Method:</strong> Data were collected for 102 adults. A total of 76 participants met SAD criteria, of which 51 were exposed to childhood trauma and 25 were not. The remaining 26 participants were demographically matched healthy controls. Measures of anxiety, impulsivity and quality of life were obtained by administering Carver and White’s BIS/BAS scales and the Quality of Life Enjoyment and Satisfaction Questionnaire – Self Report.</p><p><strong>Results:</strong> A positive correlation was found between the severity of SAD symptoms and the amount of childhood trauma exposure. No significant differences in impulsivity were found across the three groups. Healthy controls reported significantly lower anxiety and a better quality of life than both groups with SAD, while no differences were found between patients with SAD and childhood trauma and those without childhood trauma.</p><p><strong>Conclusion:</strong> More childhood trauma exposure appears to be associated with greater SAD severity. The lack of differences in BIS, BAS and quality of life in patients with SAD with or without childhood trauma requires further investigation.</p> Carolien J.W.H. Bruijnen Susanne Y. Young Melanie Marx Soraya Seedat Copyright (c) 2019-03-04 2019-03-04 25 Patients’ opinions about referral from a tertiary specialist psychiatric hospital to primary healthcare <p><strong>Background:</strong> Referral of patients from tertiary specialist psychiatric hospitals to primary healthcare settings is a worldwide goal. This is of particular importance in South Africa with its considerable burden of mental disorders and limited resources. However, patients are often reluctant to be referred and studies have shown that patients may prefer a dedicated psychiatric service over an integrated primary healthcare service.</p><p><strong>Aim:</strong> This study explored the opinions of patients receiving care at a tertiary psychiatric hospital’s outpatient department (OPD) about referral to a primary healthcare clinic (PHCC).</p><p><strong>Setting:</strong> The study was conducted at Weskoppies Psychiatric Hospital OPD.</p><p><strong>Methods:</strong> This was a qualitative study based on grounded theory. Participants were recruited through purposive-theoretical sampling. Data were collected by means of individual interviews and mini-essays.</p><p><strong>Results:</strong> From the 80 participants, 18 had individual interviews and 62 wrote mini-essays. Thirty-nine participants had previously attended a PHCC, while 41 had not. Perceived advantages of referral to PHCCs included: close proximity to participants’ homes, resulting in saving on travelling time and transport costs, as well as the convenience of receiving psychiatric and other medical treatment at the same healthcare facility. Perceived disadvantages of PHCCs included: unavailability of treatment; lack of doctor-based care; lack of specialised care; loss of established relationships with hospital healthcare workers; mistreatment by PHCC nursing staff; longer waiting times; more stigmatisation.</p><p><strong>Conclusion:</strong> The perceived disadvantages of referral from a tertiary psychiatric hospital to a PHCC outweighed the perceived advantages. Nonetheless, participants expressed willingness for such a referral if their concerns were addressed.</p> Rene Hattingh Pierre M. Joubert Copyright (c) 2019-03-04 2019-03-04 25 The relationship between locus of control and depression: A cross-sectional survey with university students in Botswana <p><strong>Background:</strong> Research has consistently revealed a positive association between external locus of control and depression. Little, if any, research has investigated locus of control and depression in the sociocultural context of Botswana.</p><p><strong>Aim:</strong> To explore the relationship between locus of control and depression among undergraduate students in Botswana and to determine the impact of age and gender on this relationship.</p><p><strong>Setting:</strong> University of Botswana.</p><p><strong>Methods:</strong> A sample of 272 students was surveyed through a self-administered questionnaire, which included the Levenson’s multidimensional locus of control scale, the Beck Depression Inventory-II and demographic questions. Data analysis utilised descriptive statistics, correlation analysis, independent samples <em>t</em>-tests and standard multiple regression analysis.</p><p><strong>Results:</strong> Of the 272 participants, 47.3% scored low (minimal) levels of depression, 23.4% scored mild levels, 18.0% scored moderate levels and 11.3% scored severe levels of depression. Students who believed that they were in control of events in their lives were less likely to present with depressive symptoms (<em>r</em> = -0.29, p = 0.000), while students who believed that chance (<em>r</em> = 0.45, <em>p</em> = 0.000) or powerful others (<em>r</em> = 0.40, <em>p</em> = 0.000) controlled their lives were more likely to have high depression scores. Both internal and external locus of control, together with age, explained 31% of the variance in depression scores; gender made no significant contribution to levels of depression.</p><p><strong>Conclusion:</strong> The study results draw attention to locus of control as one of the cognitive variables associated with depression. Further research is needed to determine how locus of control can be addressed in the treatment and prevention of depression in university contexts.</p> Tsholofelo Khumalo Ilse E. Plattner Copyright (c) 2019-03-04 2019-03-04 25 The psycho-social and clinical profile of women referred for psycho-legal evaluation to forensic mental health units in South Africa <p><strong>Background:</strong> There is a paucity of research on women offenders in the South African context, particularly those referred for forensic psychiatric observation. Little is known about their life histories, the nature of their offences or the psycho-social contexts that enable, or are antecedents to, women’s criminal offending.</p><p><strong>Aims:</strong> This research study, the largest of its kind in South Africa, examined the psycho-social contexts within which women offenders referred for psychiatric evaluation come to commit offences. The profiles of both offenders and victims, as well as reasons for referral and forensic mental health outcomes, were investigated.</p><p><strong>Methods:</strong> A retrospective record review of 573 cases, spanning a 12-year review period, from six different forensic psychiatric units in South Africa, was conducted.</p><p><strong>Results:</strong> The findings describe a population of women offenders who come from backgrounds of socio-demographic and socio-economic adversity, with relatively high pre-offence incidences of being victims of abuse themselves, with significant levels of mental ill-health and alcohol abuse permeating their life histories. The majority of index offences which led to court-ordered forensic evaluations were for violent offences against the person, with murder being the single most common index offence in the sample. Most victims of violence were known to the accused. There were also relatively high rates of psychotic and mood-spectrum disorders present, with relatively low rates of personality disorders. The majority of women were deemed to be trial competent and criminally responsible in relation to their index offences.</p><strong>Conclusion:</strong> It is recommended that more standardised and gender-sensitive forensic mental health assessment approaches, documentation and reporting be employed throughout the country. Future research should compare male and female offending patterns and forensic mental health profiles. Mohammed Nagdee Lillian Artz Carmen Corral-Bulnes Aisling Heath Ugasvaree Subramaney Helena G. de Clercq Helmut Erlacher Carla Kotze Gian Lippi Samantha Naidoo Funeka Sokudela Copyright (c) 2019-03-04 2019-03-04 25 Fine motor deficits and attention deficit hyperactivity disorder in primary school children <p><strong>Background:</strong> Many children with attention deficit hyperactivity disorder (ADHD) display motor deficiencies during their daily routine, which may have impact on their developmental course. Children with ADHD who experience motor deficiencies often display deficits in tasks requiring movements, such as handwriting.</p><p><strong>Aim:</strong> This study investigated deficiencies in fine motor skills in primary school children with ADHD. The study further sought to establish whether ADHD subtypes differ in deficiencies of fine motor performance, recorded for both the dominant and non-dominant hands.</p><p><strong>Methods:</strong> The Disruptive Behavior Disorders Rating Scale, completed by educators and parents, was used to screen for ADHD symptoms. Researchers confirmed the diagnosis of ADHD. Motor functioning was assessed using the Grooved Pegboard and Maze Coordination. The children diagnosed with ADHD were matched for age and gender with controls without ADHD. The sample consisted of an ADHD group (160) and control group (160) of primary school children from the Moletjie area.</p><p><strong>Results:</strong> Children with ADHD (predominantly inattentive subtype) and ADHD (combined subtype) performed significantly more poorly than the control group on the Grooved Pegboard (p &lt; 0.05) with both the dominant and non-dominant hand. No significant difference between the hyperactivity and impulsiveness subtype and the controls were found. There was no difference on the Maze Coordination Task (<em>p</em> &gt; 0.05) between the ADHD subtypes and the controls.</p><p><strong>Conclusion:</strong> Difficulties in fine motor skills are prevalent in children with ADHD, particularly in the ADHD-PI and ADHD-C. Problems are encountered in distal, complex, speeded tasks. The effect may lead to poor handwriting and academic performance.</p> Maria Mokobane Basil J. Pillay Anneke Meyer Copyright (c) 2019-03-04 2019-03-04 25 Maternal alcohol use during pregnancy in a general national population in South Africa <p><strong>Objective:</strong> Alcohol use in pregnancy is linked with various negative health effects on the infant. The aim of this study was to examine the prevalence of maternal alcohol use during pregnancy and socio-demographic and health correlates.</p><p><strong>Methods:</strong> Data of ever-pregnant women from the cross-sectional ‘South African National Health and Nutrition Examination Survey (SANHANES-1) 2011–2012’ were analysed. The sample included 5089 adolescents and adult women aged 15–55 years. They responded to questions on alcohol use, socio-demographic and health indicators.</p><p><strong>Results:</strong> The results indicated that 3.7% (95.0% confidence interval [CI] = 3.1, 4.5) of South African women had engaged in alcohol use during their pregnancy. In adjusted analysis, being mixed race, not employed, poor self-rated health status, ever been diagnosed with tuberculosis and having partial post-traumatic stress disorder were found to be associated with alcohol use during pregnancy.</p><p><strong>Conclusions:</strong> The study findings suggest links between socio-demographic and health variables and prenatal alcohol use, which may have public health policy implications.</p> Karl Peltzer Supa Pengpid Copyright (c) 2019-03-04 2019-03-04 25 A hermeneutic analysis of delusion content from the casebooks of the Grahamstown Lunatic Asylum, 1890–1907 <p><strong>Background and objectives:</strong> This study sought to investigate the content of the delusions recorded in the casebooks of the Grahamstown Lunatic Asylum as a means to explore how the colonial context shaped or influenced psychopathology. To this end, the study aimed to (1) identify the sociopolitical events of the time period that were reflected in the delusion content presented by the patients and (2) pinpoint discernible patterns in the delusion content based on the race and gender of the patient. The study was delimited to the period of Dr T.D. Greenlees’ tenure as medical superintendent, 1890–1907.</p><p><strong>Methodology:</strong> The study sampled the casebook records of 400 patients. A qualitative analysis of the casebooks was followed by adopting a Gadamerian approach to hermeneutics. The analysis drew upon the clearly articulated method and step-by-step approach for Gadamerian hermeneutics outlined by Fleming, Gaidys and Robb.</p><p><strong>Results:</strong> The sociocultural and political events of South Africa during the turn of the 20th century had a marked influence on the content of the patients’ delusions. The South African War (1899–1902), the rinderpest epidemic of 1896–1898, diamond mining in Kimberley and the discovery of gold in the Witwatersrand were common features in the delusion content. Moreover, there is evidence of discernible patterns in the content of the delusions based on the race and gender of the patients.</p><p><strong>Conclusion:</strong> The study identified how the colonial context influenced the delusional content presented by the patients of the Grahamstown Lunatic Asylum. Of key significance is the fact that the study retrieved themes in the delusional content presented by black subjects that were silenced, omitted or censored from psychiatric texts published during colonialism.</p> Rory du Plessis Copyright (c) 2019-03-04 2019-03-04 25