South African Journal of Psychiatry - Volume 19, Issue 2, 2013
Volume 19, Issue 2, 2013
Source: South African Journal of Psychiatry 19, pp 25 –30 (2013)More Less
Background. Little attention has been paid to the role of poor mental health among young people with regard to HIV risk behaviour and HIV prevention in Africa.
Objective. To determine the association between mental health, substance use and HIV sexual risk behaviour among a sample of university students in South Africa.
Methods. A cross-sectional survey was conducted among undergraduate students who were recruited conveniently from public campus venues at the University of Limpopo Medical University of Southern Africa (Medunsa) campus. The sample included 722 university students (57.6% men and 42.4% women) with a mean age of 21.7 years (standard deviation ±8.8).
Results. Of the 722 students, 39.5% reported depression, 23.4% screened positive for post-traumatic stress disorder (PTSD), 22% reported hazardous or harmful alcohol use, 33% reported ≥2 sexual partners in the past 12 months, 50% reported inconsistent condom use, 46% reported unknown HIV status of a sexual partner and 20% reported alcohol use in the context of sex in the past 3 months. In multivariate analysis, HIV risk behaviour was associated with, among men, hazardous or harmful alcohol use and having screened positive for PTSD, and among women, being in the 4th or more year of study and current cannabis use.
Conclusion. Poor mental health, including substance use, was found to be associated with HIV risk behaviour. Co-ordinated mental health and sexual and reproductive health services that meet the needs of university students would be desirable.
Depressive features among adult patients receiving antiretroviral therapy for HIV in Rustenburg district, SASource: South African Journal of Psychiatry 19, pp 31 –34 (2013)More Less
Background. Globally, it is estimated that depressive features occur in 15 - 36% of people suffering from chronic diseases and 60% of people with HIV/AIDS. A high prevalence of mental disorders among HIV-infected individuals has been shown in South Africa and other parts of sub-Saharan Africa. Untreated depression leads to poor adherence to treatment and poor quality of life for patients with chronic diseases.
Methods. Using the Zung self-rating scale, we screened for depressive features among adult patients receiving highly active antiretroviral therapy (HAART) who attended primary healthcare facilities in the Rustenburg district of North West Province in South Africa during December 2009.
Results. Among 117 participants, 81 (69.2 %) had mild depressive features, 2 (1.7%) had moderate depressive features, 1 (0.9 %) had severe depressive features and 33 (28.2%) did not have depressive features. Depressive features were more common in males (77.1%) than in females (69.5%), and were most common in patients taking the combination of efavirenz, lamivudine and stavudine.
Conclusion. Depressive features seem to be common among adult patients receiving HAART and attending primary healthcare facilities in the Rustenburg district.
Source: South African Journal of Psychiatry 19, pp 35 –39 (2013)More Less
Objective. To assess the quality of life (QoL) in an outpatient setting among male patients dually diagnosed with schizophrenia and substance use disorder (SUD), and non-substance-using male schizophrenia patients.
Methods. The study was conducted in an outpatient setting with 52 male schizophrenia patients and 49 male schizophrenia patients with SUD comorbidity, who were admitted to Bakirköy Research and Training Hospital between 1 May 2010 and 30 September 2010. The patients had been in remission for a minimum of 6 months. The subjects were re-evaluated for the persistence of the diagnosis by using the Structural Clinical Interview for DSM-IV Axis I disorders (SCID I) socio-demographic data form, and the World Health Organization Quality of Life Scale Brief Version (WHOQOL-BREF) and positive and negative syndrome scale (PANSS) were administered to detect the factors affecting diagnostic stability and clinical course.
Results. Schizophrenia patients with no SUD comorbidity had a significantly earlier age of disease onset than the comorbid group. SUD comorbidity in schizophrenia patients leads to increased rates of unemployment and homicidality. WHOQOL-Bref psychological health scores were significantly lower among patients in the comorbidity group. No statistically significant difference was identified between the groups with regard to the PANSS scores.
Conclusions. It is necessary to focus on the treatment challenges for schizophrenia patients with SUD comorbidity, such as the provision of treatment in criminal justice settings, in which a high proportion of such patients are found.
Effectiveness of psycho-education on depression, hopelessness, suicidality, anxiety and substance use among basic diploma students at Kenya Medical Training CollegeSource: South African Journal of Psychiatry 19, pp 41 –50 (2013)More Less
Objective. To determine the effectiveness of psycho-education on symptom severity in depression, hopelessness, suicidality, anxiety and risk of substance abuse among para-medical students at Kenya Medical Training College (KMTC).
Methodology. A clinical trial drew experimental (N=1 181) and control (N=1 926) groups from different KMTC campuses. Self-administered questionnaires were used to collect data: the researcher-designed social demographic questionnaire was used at baseline only, while Beck's Depression Inventory, Beck's Hopelessness Scale, Beck's Suicide Ideation Scale, Beck's Anxiety Inventory and World Health Organization alcohol, smoking and substance involvement screening test (ASSIST) (for drug abuse) were used for baseline, mid-point and end-point assessments at 3-month intervals. The experimental group received a total of 16 hours of structured psycho-education. All study participants gave informed consent.
Results. Overall, there was no significant reduction in symptom severity between the experimental and control groups at 3 months (p>0.05) but there was a significant difference at 6 months (p<0.05).
Conclusion. Psycho-education was effective in reducing the severity of symptoms of depression, hopelessness, suicidality, anxiety and risk of substance abuse at 6 months.
Exploring the role of Islam in perceptions of mental illness in a sample of Muslim psychiatrists based in JohannesburgSource: South African Journal of Psychiatry 19, pp 52 –54 (2013)More Less
Background. Western definitions of, and approaches to mental illness have been critiqued for their lack of incorporation of cultural and spiritual elements.
Objective. To explore perceptions of mental illness, particularly in terms of the role of Islam in the understanding of mental illness among South African Muslim psychiatrists practising in Johannesburg.
Methods. Using a qualitative design, semi-structured interviews were conducted with a convenience sample of 7 Muslim psychiatrists in the Johannesburg area. Thematic content analysis was used to analyse the transcribed data.
Results. Psychiatrists subscribe to a more biomedical model of illness. The findings of this study also suggest that psychiatrists attempt to remain objective and to refrain from imposing their religious and cultural beliefs on their patients. However, their conceptualisation of mental illness is influenced by their religion and culture. Furthermore, all participating psychiatrists indicated that they always draw on Islamic values when treating their patients. Issues of cultural competence were also highlighted. Psychiatrists indicated that they were open to collaboration with traditional healers and psychologists but that this was quite challenging.
Conclusion. The necessity for formal bodies to develop routes for collaboration between healthcare professionals and traditional healers was brought to the fore. So, too, was the need to incorporate indigenous theory and knowledge into mainstream definitions and approaches to mental illness.
Source: South African Journal of Psychiatry 19 (2013)More Less
Studies comparing pharmaco- v. psychotherapy in HIV-positive patients with depression are of great importance. These are vulnerable patients, both in a psychological sense and because of potential drug interactions. Psychotherapy should play an important role in the treatment of these patients.