South African Journal of Psychiatry - Volume 18, Issue 1, 2012
Volume 18, Issue 1, 2012
Source: South African Journal of Psychiatry 18, pp 2 –9 (2012)More Less
Introduction. Adolescent substance use has a number of adverse consequences for both the individual and society. Anecdotal evidence suggested the existence of a serious substance use problem among learners in Atteridgeville, part of the City of Tshwane Metropolitan Municipality in Gauteng, South Africa.
Objectives. The objectives of the study were to determine the prevalence rates and age of initiation of substance use among learners attending secondary schools in Atteridgeville, and the factors, if any, associated with cannabis use.
Methods. This was a cross-sectional study. A cluster sampling technique was employed. Twenty-two of the total of 191 grade 8 - 11 classes in the nine Atteridgeville secondary schools were randomly selected, with all 895 learners in the selected classes being invited to participate. Self-administered questionnaires were used to collect data. Statistical analysis was conducted using the survey estimation commands in STATA 10.0.
Results. The lifetime prevalence rates for the three most commonly used substances were 51.4% (95% confidence interval (CI) 41.5 - 61.5%) for alcohol, 25.2% (95% CI 17.1 - 33.3%) for cigarettes and 13.2% (95% CI 8.3 - 18.2%) for cannabis. Alcohol was also found to have the lowest mean age of initiation at 14.6 years (standard deviation 2.0). Based on CRAFFT screening scores, 30.3% (95% CI 24.5 - 36.1%) of learners met the criteria for possible problem substance use. Following multivariate analysis, the factors found to be significantly associated with lifetime cannabis use were age, gender, lifetime cigarette use, lifetime alcohol use, the number of illicit drug users among the learners' five closest friends, and an older sibling with a history of illicit drug use.
Conclusion. The results of the study suggest that substance use among learners in Atteridgeville is widespread and that a comprehensive intervention strategy is required.
Prevalence of psychological distress and associated factors in urban hospital outpatients in South AfricaSource: South African Journal of Psychiatry 18, pp 10 –15 (2012)More Less
Objective. The aim of this study was to assess the prevalence of psychological distress and associated factors among outpatients in an urban hospital in South Africa.
Method. A sample of 1 532 consecutively selected patients (56.4% men and 43.6% women) from various hospital outpatient departments were interviewed with a structured questionnaire.
Results. Based on assessment with the Kessler Psychological Distress Scale, a measure of psychological distress, 17.1% of the patients (15.5% of men and 19.4% of women) had severe psychological distress. Logistic multiple regression identified no income, poor health status, migraine headache and tuberculosis as significant factors associated with severe psychological stress for men. For women the factors identified were lower education, no income, having been diagnosed with a sexually transmitted disease, stomach ulcer and migraine headache.
Conclusion. The study found a high prevalence of psychological distress among hospital outpatients in South Africa. Brief psychological therapies for adult patients with anxiety, depression or mixed common mental health problems treated in hospital outpatient departments are indicated. Accurate diagnosis of co-morbid depressive and anxiety disorders in patients with chronic medical illness is essential in understanding the cause and optimising the management of somatic symptom burden.
Source: South African Journal of Psychiatry 18, pp 16 –21 (2012)More Less
Background and objectives. HIV/AIDS and suicidal behaviour are major public health concerns. The aim of this study was to examine the relationship between hopelessness, depression and suicidal ideation in HIV-infected persons.
Methods. The sample consisted of all adult volunteers attending a voluntary counselling and testing (VCT) HIV clinic at a university-affiliated state hospital. Suicidal ideation and depression were measured using the Beck Hopelessness Scale (BHS) and the Beck Depression Inventory (BDI), respectively, at two intervals, viz. 72 hours and 6 weeks after HIV diagnosis.
Results. Of the 156 patients who tested positive for HIV, 32 (20.5%) had a hopelessness score of 9 or above on the BHS and 130 patients (82.8%) were depressed according to the BDI at 72 hours after diagnosis. Of the 109 patients assessed 6 weeks after diagnosis, 32 (28.8%) had a hopelessness score of >9 on the BHS and 86 (78.2%) were depressed according to the BDI. A moderately positive correlation at both time periods was found between hopelessness and depression. A ROC analysis showed optimal sensitivity, indicating that the HIV-positive depressed patients were at risk for suicidal behaviour.
Conclusion. The significant correlations between hopelessness, depression and suicidal ideation are important markers that should alert healthcare professionals to underlying suicide risks in HIV-positive patients. Early recognition of this and suicide prevention strategies should be incorporated into the treatment offered at VCT HIV clinics.
Predicting frequency of suicide attempts of adolescent outpatients at Weskoppies Hospital using clinical and demographic characteristicsSource: South African Journal of Psychiatry 18, pp 22 –26 (2012)More Less
The prevention of suicide, particularly adolescent suicide, remains one of the biggest challenges in psychiatry.
Objectives. To ascertain: (i) clinical and demographic characteristics; and (ii) possible associations between these characteristics and suicide attempt frequency in a selected patient group at Weskoppies Hospital over 4 months.
Methods. Fifty adolescent outpatients aged between 13 and 17 years with a history of one or more suicide attempts were interviewed to obtain demographic and clinical features. Chi-square and Fisher's exact tests assessed associations between these features and suicide attempt frequency.
Results. Of the subjects, 79% were aged between 15 and 17 years; they were predominantly female (62%) and Caucasian (83%). Mainstream and special education schools were equally represented. Three-quarters had reached grades 8 - 10, and 14% lived with both biological parents, 33% in places of safety and 37% with one divorced parent. The minority of caregivers had a history of alcohol abuse and other substance use.
Twenty-nine per cent of the subjects had attempted suicide on more than 10 occasions and 23% had made a single attempt. The most common methods were wounding (74%), tablet overdose (34%) and hanging (20%). Psychiatric diagnoses included major depressive disorder (64%), bipolar disorder (38%), alcohol abuse (18%) and other substance abuse (24%). Familial features included depression, substance abuse, antisocial behaviour and suicide. Familial suicidal behaviour included suicide attempts by parents (85%), siblings (36%), aunts and uncles (31%) and cousins (44%). Physical and sexual abuse was reported in 52% of families.
Conclusion. Many findings and profiles of other studies were confirmed and point to school and home environments, family psychopathology and psychiatric diagnoses as factors associated with adolescent suicide attempts. Associations between the frequency of suicide attempts and the demographic and clinical characteristics were statistically inconclusive.
Source: South African Journal of Psychiatry 18, pp 27 –31 (2012)More Less
Background and objective. Adolescence is considered a critical stage of life, and one during which body image and self-concept are of particular importance for peer acceptance and approval. Body weight may impact on satisfaction or dissatisfaction in adolescent girls' self-concept. The aim of this research was to determine the association between obesity and self-concept among adolescent girls.
Methods. The study sample consisted of 40 overweight (BMI 25 - 30) 18-year-old girls in their last year of high school. A further 40 girls of the same age with a BMI of 18 - 25 formed a control group. The Offer Self-Image Questionnaire for Adolescents (OSIQ) was used to evaluate their self-concept. Descriptive statistical methods used in analysing the data included calculation of the median and standard deviation of variables, and t-tests were used to compare group differences, with p<0.05 taken as the level of significance.
Results. Statistically significant differences between two groups were found in two components of the OSIQ, sexual attitudes (p=0.044) and psychopathology (p=0.020), but no differences were found in other components such as impulse control, emotional tone, body and self-image, social relations, morals, family relations, mastery of the external world, vocational educational goals and superior adjustment.
Conclusion. Our results suggest that overweight adolescent girls are less adjusted with regard to their sexual attitudes and present with more psychopathology as measured by the OSIQ compared with their peers of average weight.