South African Journal of Psychiatry - Volume 18, Issue 4, 2012
Volume 18, Issue 4, 2012
Sociodemographic and health correlates of sleep problems and duration in older adults in South AfricaAuthor K. PeltzerSource: South African Journal of Psychiatry 18, pp 150 –156 (2012)More Less
Objective. To investigate sleeping problems, sleep duration and associated factors in a national probability sample of older South Africans who participated in the Study of Global Ageing and Adult Health (SAGE) in 2008.
Methods. In 2008 I conducted a national population-based cross-sectional study with a sample of 3 840 South African individuals aged ≥50 years. A questionnaire was used to survey sociodemographic characteristics and health variables, and anthropometric and blood pressure measurements were recorded.
Results. Of the participants, 9.1% reported having a sleeping problem at the time of the study. The average number of self-reported hours of sleep was 8.6 (SD ±2.1), with 11.6%, 45.1%, 20.0%, and 23.5% reporting ≤6, 7 - 8, 9, and ≥10 h, respectively. In multivariable analysis, depression, cognitive impairment, lack of social cohesion, and moderate or severe activity limitations were associated with having a current sleeping problem. In terms of sociodemographic and health variables, a short sleep duration was associated with: white, Indian/Asian or coloured ethnicity; daily tobacco use; and moderate and severe activity limitations. In participants aged 60 - 79 years, lower wealth, hypertension, risky drinking and lower health-related quality of life were associated with a long sleeping duration.
Conclusion. This study robustly characterised the prevalence of sleeping problems and specific associated risk factors in a large sample in South Africa. This can help to direct future healthcare efforts.
Source: South African Journal of Psychiatry 18, pp 157 –163 (2012)More Less
Objective. To investigate cognitive functioning and associated factors in a national probability sample of older South Africans who participated in the Study of Global AGEing and Adult Health (SAGE) in 2008.
Methods. In 2008 we conducted a national population-based cross-sectional study with a sample of 3 840 adults aged ≥50 years in South Africa. We administered a questionnaire surveying socio-demographic characteristics, health variables, and anthropometric and blood pressure measurements. Multivariate regression analyses were used to assess the association of socio-demographic factors and health variables with cognitive functioning.
Results. Mean variables in the sample were: 5.9 recalled words, a verbal fluency of 9.9 words in a specified category (animals), a forward and backward digit span of 5.2 and 3.2, respectively, and an overall mean cognition score of 48.5. Higher overall cognitive functioning (a combination of memory and executive functioning) was positively associated with: younger age; white, Indian/Asian or coloured ethnicity; being married; a higher level of education; greater wealth; a higher level of physical activity; a greater quality of life; and a better subjective health status.
Conclusions. Our findings can be used to refine future projections of cognitive function and healthcare needs in ageing middle-income societies such as those in South Africa.
Social capital, pathway to care and duration of untreated psychosis : findings from a low- and middle-income country contextSource: South African Journal of Psychiatry 18, pp 163 –170 (2012)More Less
Background. Socio-environmental factors are associated with an increased incidence of psychosis and may affect the pathway to care in first-episode psychosis (FEP).
Objective. To determine the relationship between individual- and neighbourhood-level socio-environmental factors (household income and rated measures of neighbourhood social capital) and duration of untreated psychosis (DUP) in South Africa.
Methods. We obtained data regarding sociodemographics, evolution of symptoms and pathway to care from interviews with 54 consecutively admitted FEP patients at Town Hill Hospital. Caregivers and clinical notes were also consulted. A population-based survey of social capital was conducted in the residential neighbourhood of each patient at onset. Cox regression analyses were used to test whether socioeconomic factors and overall neighbourhood social capital scores and sub-scores were associated with DUP.
Results. After controlling for age at onset, gender and income, a shorter DUP was independently associated with police involvement in pathways to care, while non-black ethnicity and greater levels of total social capital were associated with a longer DUP. Community participation, neighbourhood connectedness, and trust and safety were specifically associated with a longer DUP.
Conclusions. Individual factors including greater age at onset and police involvement in the care pathway were significantly associated with shorter DUP in this middle-income setting. Paradoxically, aspects of social capital pertaining to greater community involvement were associated with delays in pathways to appropriate care. It is possible that community members opted to care for individuals with early psychosis longer before sending them to formal health services. This is especially likely in contexts where mental health services are scarce and inaccessible, which has important implications for mental health education campaigns.
Syphilis sero-positivity in recently admitted and long-term psychiatric inpatients : screening, prevalence and diagnostic profileSource: South African Journal of Psychiatry 18, pp 171 –175 (2012)More Less
Background. Syphilis research has neglected the prevalence of the disease among psychiatric patients, and traditional syphilis screening has been reported as inadequate.
Objectives. (i) To assess the syphilis prevalence among psychiatric patients; (ii) to compare psychiatric diagnoses of syphilis-infected and -uninfected patients; (iii) to assess self-reported high-risk sexual behaviour; (iv) to establish syphilis/HIV co-morbidity; and (v) to investigate the performance of the rapid plasma reagin (RPR) test in syphilis screening, compared with the Treponema pallidum haemagglutination (TPHA) test.
Methods. Psychiatric inpatients at Weskoppies Hospital, Pretoria, who consented to participate in the study (N=195) were categorised according to gender and length of admission (long-term or recent). Non-treponemal RPR, confirmatory TPHA, HIV-rapid and HIV enzyme-linked immunosorbent assay (ELISA) tests were performed. A reactive TPHA test was used to diagnose syphilis.
Results. The estimated prevalence of syphilis was 11.7%. There was no significant association between TPHA sero-positivity and primary psychiatric diagnosis or self-reported high-risk sexual behaviour. Significant co-morbidity existed between syphilis and HIV (p=0.012). Compared with the TPHA test, the RPR test performed poorly, identifying only 2/23 patients who had a sero-positive TPHA test (8.7% sensitivity and 100% specificity).
Conclusions. The prevalence of syphilis was higher than anticipated, supporting the need for routine testing. The significant co-morbidity and alarming prevalence of HIV and syphilis warrant testing for both conditions in all psychiatric admissions. Current syphilis screening with a single RPR test is inadequate; both RPR and TPHA tests should be performed.
Personality, depressive symptoms and prior trauma exposure of new recruits at two Metropolitan Police Service academies in South AfricaSource: South African Journal of Psychiatry 18, pp 176 –180 (2012)More Less
Background. Police officers are predisposed to trauma exposure. The development of depression and post-traumatic stress disorder (PTSD) may be influenced by personality style, prior exposure to traumatic events and prior depression.
Objectives. To describe the personality profiles of new Metropolitan Police Service (MPS) officers, and to determine the association between personality profiles, trauma exposure and depressive symptoms.
Methods. We performed a cross-sectional analysis of 139 new recruits at two MPS academies in South Africa. A questionnaire elucidating traumatic life events and personality profiles was developed using the Millon Clinical Multiaxial Inventory-III (MCMI-III). Depressive symptoms were measured using the Hamilton Depression Rating Scale (HAMD).
Results. Almost all subjects (99.3%) had previous trauma exposure, most commonly the unexpected death of a loved one and motor vehicle accidents. Prevalence of clinical depression was low (mean HAMD 3.57; standard deviation ±3.37). Personality characteristics revealed a high prevalence of anxiety (64.7%; 95% CI 56.8 - 72.6), depressive clinical patterns (34.5%; 95% CI 26.6 - 42.2), paranoia (33.1 %; 95% CI 26.6 - 42.2) and major depression (10.3%; 95% CI 5.1 - 15.1). There were no significant associations between any of the traumatic events and depressive symptoms, nor were there any significant associations between any of the personality variables and HAMD score (p>0.05).
Conclusion. The presence of depressive symptoms among MPS officers was low, with no significant associations between traumatic events, personality variables and depressive symptoms.