South African Journal of Psychiatry最新文献

Background: Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder, with a prevalence rate of 5% - 8%. Clinical practice guidelines have been developed internationally to standardise the care and management of patients with ADHD.

Aim: To assess compliance with clinical guidelines on the management of children with ADHD in two hospitals in the Eastern Cape province using the National Institute for Health and Care Excellence (NICE) guidelines as the gold standard.

Setting: Paediatric departments of two hospitals in the Buffalo City Municipality, Eastern Cape province, South Africa.

Methods: A clinical audit was conducted on children and adolescents diagnosed with ADHD attending neurodevelopmental clinics (NDCs). Patient folders were reviewed between June 2021 and December 2021, and data were collected using a 16-point audit tool based on the NICE guidelines for ADHD.

Results: A total of 111 patient folders met the inclusion criteria. Of the 16 audit standards, 8 demonstrated over 80% compliance, while 2 achieved fair compliance (50% - 79%). Significant gaps were identified in the 6 standards with poor compliance (< 50%). Co-morbidities were highly prevalent, with 83% of patients presenting with at least one co-existing condition.

Conclusion: The audit demonstrated overall good clinical compliance with the NICE guidelines for ADHD management, but it also exposed gaps in psycho-social interventions, caregiver support and the availability of structured support groups.

Contribution: This study highlights service gaps in resource-limited settings and is expected to further inform government policy planning in developing auxiliary services and multidisciplinary support for children with ADHD and their families in such settings.

Background: South Africa has been experiencing a persistently high unemployment rate among young people. This high youth unemployment is a stressor to young people, which may culminate in mental health issues.

Aim: The study aimed to describe the self-reported mental health effects of unemployment among young people in Mdantsane township, Eastern Cape province.

Setting: The study was conducted in Mdantsane township, at the Lingomso Youth Centre in the Eastern Cape province, South Africa.

Methods: A descriptive qualitative approach was used. Participants were recruited purposively until data saturation. Data were collected through individual face-to-face interviews. Thematic analysis was conducted using a six-step approach.

Results: The sample comprised 19 young people aged between 19 years and 29 years, and most were men. Two themes emerged: theme one was negative effects, which were characterised by substance use, feelings of worthlessness, stress and anxiety, masking of personality, and social isolation; theme two was that social support buffered the potential adverse effects of unemployment, and this was supported by interdependent role relationships that protected individuals from the effects of unemployment.

Conclusion: There is a need to recognise mental health issues emanating from unemployment, like social isolation, to enable comprehensive, appropriate interventions for young people.

Contribution: This study contributes to understanding mental health issues experienced by unemployed young people. Findings can be used to develop targeted interventions in a large township, such as Mdantsane, in South Africa.

Background: The prevalence of post-traumatic stress disorder (PTSD) is uncertain globally, and there is a paucity of information in South Africa. Perinatal PTSD may impair maternal functioning and negatively affect their parenting ability.

Aim: This study aimed to determine the prevalence and associated factors of PTSD in an antenatal population in South Africa.

Setting: The study was conducted at Johan Heyns Community Health Centre in Sedibeng district, Gauteng province.

Methods: A cross-sectional questionnaire-based survey was conducted in which the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) was administered among women attending the Johan Heyns antenatal clinic. The PCL-5 is a validated screening tool for PTSD, which comprises 20 items scored on a 5-point Likert scale for symptom severity. A total score ≥ 31 indicates at least moderate PTSD.

Results: Of the 98 pregnant women who participated in the study, 53 (54%) reported having experienced or witnessed a traumatic event. Total PCL-50 scores ranged from 0-65 (mean 13.8 standard deviation [s.d. = 18.1]), with at least one intrusion symptom endorsed by 37 women, followed by cognition and mood change by 36, arousal and reactivity by 32, and avoidance by 24. Sixteen women (16.3%) screened positive for PTSD (mean score 49.2 [s.d. = 12.7]). While univariate analysis found no significant associations with PTSD, alcohol use was associated with an increased risk of PTSD on multivariate analysis (RR 2.7; [95% confidence interval [CI] 1.1-7.0; p = 0.036).

Conclusion: Post-traumatic stress disorder is common among antenatal women in Sedibeng district and may be associated with alcohol use in pregnancy.

Contribution: This study highlights the importance of screening pregnant women for PTSD to ensure early intervention and management.

Background: Anxiety, depression, and suicidal ideation are prevalent mental health conditions among university students. Persistent anxiety and depression are associated with morbidity and suicidal ideation predicts suicide. Namibian mental health data are limited.

Aim: This study aimed to determine and analyse the prevalence and predictors of anxiety, depression, and suicidal ideation among Namibian public university students.

Setting: The study was conducted at six campuses of the two Namibian public universities.

Methods: A quantitative, cross-sectional, descriptive study was conducted among 578 purposively sampled students, using self-administered questionnaire, incorporating Beck's Anxiety Inventory, Patient Health Questionnaire-9, and Columbia Suicide Severity Rating Scale. Data were analysed in SPSS version 30, including descriptive statistics, bivariate regression, Pearson's correlation coefficients, and hierarchical multiple regression.

Results: Among 578 respondents, 50.7% reported moderate to severe anxiety, 73.2% met depression criteria, and 9.1% reported an active suicidal plan. Current mental illness was significantly associated with depression and suicidal ideation (p < 0.001). Depression was predicted by current mental illness (β = 0.276, p < 0.001) and family conflict (β = -0.144, p < 0.001), while suicidal ideation was predicted by current mental illness (β = -0.198, p < 0.001), (p < 0.001), family conflict (β = -0.171, p < 0.001), and age (β = -0.103, p = 0.007).

Conclusion: Anxiety, depression, and suicidal ideation are highly prevalent among Namibian university students, necessitating increased mental health awareness and institutional interventions to prevent suicidality.

Contribution: This study provides empirical evidence on the anxiety, depression, and suicidal ideation among Namibian public university students.

Background: Anxiety is a common psychological response among caregivers of children with severe illnesses, yet limited research has explored its prevalence and associated factors in guardians of children with severe malaria in Malawi. Understanding the severity of anxiety and its correlates is crucial for supporting caregiver mental health and improving paediatric outcomes.

Aim: This study aimed to determine the prevalence and severity of anxiety, and identify social, demographic and clinical factors associated with anxiety among guardians of children admitted with severe malaria.

Setting: The study setting was the Peadiatric ward of Thyolo District Hospital in Malawi.

Methods: A cross-sectional study was conducted involving 187 guardians of children diagnosed with severe malaria. Data were collected using a structured questionnaire incorporating socio-demographic and clinical information, alongside the Generalised Anxiety Disorder 7-item (GAD-7) scale. Descriptive statistics, Chi-square tests and logistic regression were used to analyse the data.

Results: Mild anxiety was the most common (79.7%) among participants, followed by moderate (10.7%) and minimal (9.6%), with no cases of severe anxiety. Significant socio-demographic factors associated with higher anxiety included age (p < 0.001), guardian type (p < 0.001), education level (p < 0.001), area of residence (p < 0.001) and source of income (p < 0.001). Clinically, longer hospital stays (p < 0.001) and repeated admissions (p < 0.001) were significantly associated with increased anxiety severity.

Conclusion: Anxiety is prevalent among guardians of children with severe malaria, with several socio-demographic and clinical factors contributing to its severity. The findings highlight the importance of integrating psychological support services into paediatric care settings.

Contribution: This study underscores the need for routine anxiety screening, mental health support and context-specific interventions targeting caregivers of hospitalised children with severe illnesses in low-resource settings.

Background: Insomnia disorder is a modifiable risk factor for maternal and offspring psychopathology, yet it remains overlooked in low-resource settings like Malawi, where maternal mental health services are underprioritised.

Aim: To assess the prevalence and associated psychiatric factors for insomnia disorder among pregnant women at Kamuzu Central Hospital (KCH).

Setting: Antenatal care unit (ANC) at KCH, Lilongwe.

Methods: A cross-sectional design was employed. Systematic random sampling was used to select 110 pregnant women. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate insomnia. Descriptive and logistic regression established the association between socio-demographic, obstetric, sleep arrangement and biometric factors and sleep quality.

Results: The prevalence of insomnia disorder was found to be 79.1% (mean PSQI = 8.77 ± 3.79), indicating significant sleep disturbances. Logistic regression revealed a significant association with gestation, participants in the second trimester (adjusted odds ratio [AOR] = 5.21, 95% confidence interval [CI]: 1.49-18.26, p = 0.010) being at higher risk and increased odds among married women (odds ratio [OR] = 0.14, 95% CI: 0.13-0.48, p = 0.038) and those sharing bed (OR = 5.28, 95% CI: 1.14-24.55, p = 0.034) at higher risk of poor sleep quality.

Conclusion: Poor sleep quality is common among pregnant women in Malawi, with trimester-specific and psychosocial predictors elevating psychiatric risks.

Contribution: Integration of sleep screening and perinatal mental health interventions into antenatal care is urgently needed in the second trimester to mitigate adverse maternal and offspring outcomes.

Background: Parents with a history of alcohol consumption contribute to their children's drinking behaviour.

Aim: This study aimed to investigate the influence of parents' history of alcohol use on their children's drinking habits.

Setting: The study was conducted at a contact learning university in South Africa.

Methods: A cross-sectional quantitative study with 350 undergraduate university students was conducted.

Results: The independent samples t-test results revealed that students who had parents with a history of alcohol use (M = 4.20, standard deviation [s.d.] = 2.95) scored significantly higher on hazardous alcohol use compared to their counterparts whose parents did not have a history of alcohol use (M = 2.47, s.d. = 2.70). The results also showed that students who had parents with a history of alcohol use (M = 5.78, s.d. = 4.48) scored significantly higher on harmful alcohol use compared to students with parents who did not have a history of alcohol use (M = 2.98, s.d. = 3.66). Moreover, students who had parents with a history of alcohol use (M = 4.42, s.d. = 3.20) scored significantly higher on alcohol dependence symptoms than those whose parents did not have a history of alcohol use (M = 1.95, s.d. = 2.61).

Conclusion: Parents with a history of alcohol use influence their children's drinking habits. The observed drinking habits can affect children's health and interrupt their university studies.

Contribution: Investing in university alcohol prevention programmes could reduce the surge of alcohol abuse among students and promote healthy drinking habits.

Background: There is a strong link between chronic pain and neurocognitive impairment. The co-occurrence of the two disorders often leads to a poor quality of life and significant disability.

Aim: To determine the prevalence of neurocognitive impairments in adults with chronic pain.

Setting: The study was conducted at a tertiary hospital in Pietermaritzburg, KwaZulu-Natal.

Methods: This cross-sectional study was conducted at a pain clinic within a tertiary hospital in Pietermaritzburg, KwaZulu-Natal. Participants were required to be clinic attendees, proficient in English, and have a minimum of a Grade 7 education. Exclusion criteria included neurological disorders, significant language barriers, or ineligible age. Recruitment used purposive sampling with informed consent. Data were collected using socio-demographic and clinical questionnaires, namely, the Mini-Mental State Examination (MMSE), the Montreal Cognitive Assessment (MoCA), and the Physical Self-Maintenance Scale (PSMS). The primary outcome was the prevalence of neurocognitive impairment; secondary outcomes examined associations with demographic and clinical factors using both descriptive and inferential statistics.

Results: A total of 105 participants (59 females and 46 males) were enrolled in the study. The mean age of the participants was 55.1 ± 6.75 years. A total of 73.3% (n = 77) of participants screened positive for neurocognitive impairment on MoCA and 55.2% on MMSE.

Conclusion: Chronic pain is associated with impairments in neurocognitive performance, particularly in short-term memory and executive functioning.

Contribution: A significant correlation was found between lower education levels and neurocognitive impairment (p = 0.02 for MoCA, p = 0.04 for MMSE).

Background: Diagnosing and treating vitamin B₁₂ deficiency in psychiatric populations is important, but the justification for routine screening in patients without risk factors or physical findings remains uncertain, especially in resource-limited settings.

Aim: This study aimed to assess the clinical utility and cost-effectiveness of routine vitamin B₁₂ screening in adult psychiatric inpatients.

Setting: The study was conducted at Townhill Hospital, a tertiary psychiatric facility in South Africa.

Methods: A retrospective chart review was performed for the period 01 July 2021 to 31 December 2022. Data collected included demographics, clinical diagnoses, medications, risk factors for deficiency, vitamin B₁₂ test results, associated costs, and clinical responses to abnormal findings.

Results: Of 366 patients (168 male, 198 female; mean age 35.95 ± 13.44 years), the mean serum vitamin B₁₂ level was 423.86 mmol/L (SD ± 233.37), with a median of 359 mmol/L. Vitamin B₁₂ deficiency was identified in eight patients (2.2%). The cost per deficient patient was R5780.73. Statistically significant associations were found between low B₁₂ levels and pregnancy, vegetarian diet, abdominal surgery, and metformin use (p < 0.05). Only half of the deficient patients received replacement therapy.

Conclusion: Routine vitamin B₁₂ screening in the absence of physical findings or known risk factors is not clinically or economically justified. Targeted screening should be considered to optimise resource use and patient outcomes.

Contribution: In resource-constrained environments, prioritising high-yield interventions is essential to improving care efficiency.

Background: Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) and affective disorders often coexist, leading to suboptimal health outcomes. Poor management of this comorbidity can result in decreased medication adherence, increased hospitalisations and diminished quality of life.

Aim: To determine the predictors and correlates of depression and suicidality among children and adolescents living with HIV and AIDS in Maiduguri, Nigeria.

Setting: This study was conducted at the antiretroviral therapy (ART) clinic of the University of Maiduguri Teaching Hospital, Nigeria.

Methods: A cross-sectional study was conducted to recruit 160 children and adolescents with HIV and AIDS who are attending ART clinics. Participants were selected using a systematic random sampling approach. The Schedule for Affective Disorders and Schizophrenia for School-Aged Children Present and Lifetime Version (K-SADS-PL), which is both a screening and diagnostic instrument, was administered to identify those with depression and suicidality.

Results: Suicidality and depression rates were found to be 30.6% and 45.0%, respectively. Frequent hospital admissions and medication non-adherence were significantly associated with both depression and suicidality.

Conclusion: This study highlights the significant mental health burden among children and adolescents living with HIV and AIDS. The association between frequent hospitalisations, medication non-adherence and emotional disorders emphasises the need for integrated mental health services within HIV and AIDS care.

Contribution: This study offers insightful information about the mental health situation of children and adolescents living with HIV and AIDS (CALWHA), contributing to a deeper understanding of their unique needs and informing the development of targeted interventions.