South African Journal of Psychiatry最新文献

Background: The coronavirus disease 2019 (COVID-19) pandemic has changed life globally and significantly disrupted psychiatric inpatient care, with infection control measures altering therapeutic environments and exacerbating patient distress. Both staff and inpatients had to quickly adapt to new norms while maintaining care in an already vulnerable setting.

Aim: This study aimed to explore psychiatric inpatients' experience of adapting to the COVID-19 pandemic.

Setting: The study was conducted in Weskoppies Psychiatric Hospital, Tshwane, Gauteng.

Methods: We conducted a qualitative study comprising 15 semi-structured interviews with psychiatric inpatients admitted to Weskoppies Hospital in South Africa during the COVID-19 pandemic, using purposive sampling. Open-ended questions encouraged detailed responses and guided the conversation. Recordings were later transcribed for analysis.

Results: Our study showed that psychiatric inpatients displayed an engagement strategy, rather than a disengagement approach, in adapting to a crisis. They actively tried to control, manage, and change stressful situations by accepting the hospital infrastructure and new COVID-19 rules, seeking social support, and holding on to their faith.

Conclusion: Psychiatric inpatients at Weskoppies Hospital adapted to the COVID-19 pandemic through support from staff, family, hospital systems, and personal coping strategies. These findings highlight the need for holistic, patient-centred care that includes psychosocial and spiritual support during times of crises.

Contribution: This study provided insights into psychiatric inpatients' experiences and can help mental healthcare practitioners to ensure a more positive experience during rehabilitation and reintegration of psychiatric patients into society.

Background: Traditional healers play a significant role in healthcare seeking in South Africa. Many South Africans often seek healthcare services from both medical practitioners and traditional healers simultaneously for the same condition. Despite this, many medical practitioners seem ignorant about the practices of traditional healers.

Aim: This study aimed to explore the similarities and differences between the practices of a traditional healer (TH) and a psychiatrist in training (PIT) regarding an inpatient mental healthcare user (MHCU).

Setting: This study was conducted at an inpatient ward at Weskoppies Hospital, Pretoria.

Methods: An autoethnographic method was utilised in this study.

Results: The TH and PIT evaluated the same MHCU. While doing so, the PIT used participant observation, field notes, and finally a qualitative content analysis. The findings of the content analysis were validated with the TH. Two previously unpublished findings in South African traditional healing emerged: the use of a doll (effigy) and calling on angels.

Conclusion: The TH and PIT followed the same basic steps in evaluating and treating the MHCU, but there were notable differences in the details (subcategories) of those steps. These differences reflect very different epistemologies about mental illness: the PIT used an evidence-based, naturalistic (or positivistic) model, while the TH used a model that can best be designated as transcendent.

Contribution: This study contributes towards an understanding of a TH's approach to a mentally disordered patient.

Background: Adolescence is characterised by profound changes in physical, cognitive, emotional and social functioning and is associated with psychological distress and suicidal tendencies. The family plays a significant role in safeguarding and promoting adolescents' mental health. However, little is known about the influence of family functioning on adolescents' psychological distress and suicidal tendencies in Ghana.

Aim: This study examined the association between family functioning, psychological distress and suicidal tendencies among adolescents in Ghana.

Setting: The study was conducted at three public senior high schools in Accra, Ghana.

Methods: This cross-sectional study randomly recruited 600 students. We analysed the data using Spearman's rho correlation and simultaneous multiple logistic regression.

Results: The study revealed that poor family problem-solving had no statistically significant relationship with adolescents' psychological distress and suicidal tendencies. After covarying by gender and age, poor family communication was not statistically and significantly associated with adolescent psychological distress but had a statistically significant positive association with suicidal tendencies. However, and more importantly, poor family affective involvement predicted both adolescents' psychological distress and suicidal tendencies.

Conclusion: These findings suggest the key role of the family in adolescents' psychological distress and suicidal tendencies, emphasising the need for tailored family psychological interventions in Ghana.

Contribution: This study contributes to the emerging literature on family functioning and its association with adolescent psychological distress and suicidal tendencies, underpinned by the McMaster model of family functioning (MMFF) in the Ghanaian setting.

Background: Statistics indicated that, in 2019, over 3 million of South Africa's population of 58 million people presented as gender non-conforming. This is challenging, as in South Africa, the Western binary concept is still prevalent. In light of the above, South African research on trans and gender-diverse (TGD) interventions is essential. There is limited research on existing TGD group interventions in a South African public context.

Aim: This article aimed to report on the personal reflections of the two clinical psychologists who co-facilitated a support group for TGD people at Chris Hani Baragwanath Academic Hospital (CHBAH). This study highlights the importance of group intervention in particular.

Setting: Chris Hani Baragwanath Academic Hospital in South Africa.

Methods: A reflexive thematic analysis was utilised. Thoughts and self-reflective themes discussed after each group were included. No participants or instruments were utilised in this research.

Results: The following themes were identified in this research: gaps in our knowledge, the role of facilitators, misgendering and gender fluidity, collective self-esteem, corrective experience and basic rights.

Conclusion: This group contributed to our learning and development as facilitators. The role of reparation and empathy as facilitators was highlighted.

Contribution: The results support the importance of support groups for TGD individuals in public healthcare as well as the further development of healthcare professionals. Because of a scarcity of psychological services rendered in public hospitals to TGD people, this article may potentially be a rich source of data for future TGD support groups and/or services.

Background: Perinatal alcohol and non-prescribed substance use may be detrimental to foetal and infant growth.

Aim: This observational study investigated how combined and continued alcohol and non-prescribed substance use throughout antenatal and 1-year postnatal periods were associated with adverse child length and weight outcomes up to 24 months.

Setting: Data from participants (n = 1098) with information on alcohol and non-prescribed substance use and infant and child outcomes, were drawn from a prospective birth cohort in the Drakenstein Child Health Study (DCHS), conducted in the Western Cape province of South Africa.

Methods: Generalised estimating equations were conducted on standardised child length and weight outcomes at 12, 18 and 24 months.

Results: Non-prescribed substances consisted mostly of tobacco use (77%). Child length and weight were significantly lower in those exposed to the combined use of alcohol and substances compared to no-use and all other use groups (p < 0.001), as confirmed by multivariable analyses. Child length and weight were also significantly lower in those exposed to alcohol and/or substance use throughout the antenatal and 1-year postnatal periods, as confirmed by multivariable analyses.

Conclusion: Interventions to address the potential long-term adverse effects of combined alcohol and substance use particularly tobacco use, as well as continuous use throughout antenatal and early postnatal periods on subsequent child growth, are needed.

Contribution: This study has contributed to the field by showing that combined and continued use of alcohol and other substances during pregnancy and postpartum is associated with impaired early child growth.

Background: In South Africa, the South African Police Service (SAPS) is often called to facilitate access to mental healthcare for individuals with severe behavioural disturbances posing risks to themselves or others, as outlined in the Mental Health Care Act (2002). Understanding the experiences of mental healthcare users (MHCUs) and their families during these encounters is essential for improving mental health services.

Aim: To explore the experiences of MHCUs and their families during interactions with SAPS when seeking assistance for hospital admission, focusing on perceptions of SAPS attitudes and responses.

Setting: The study was conducted at the outpatient and inpatient psychiatric departments of Chris Hani Baragwanath Academic Hospital in Southern Johannesburg.

Methods: Between June and December 2023, 15 semi structured interviews were conducted with five inpatients, five outpatients, and five family members. Interviews were audio-recorded, transcribed verbatim, and analysed inductively to identify emergent themes.

Results: Five major themes emerged, highlighting confusion, fear, and feelings of criminalisation. Participants reported inadequate SAPS support, with the escalation of force often worsening anxiety and distress. Families were frequently misinformed, including being advised to call an ambulance, which delayed care. SAPS involvement often led to public embarrassment, affecting MHCUs' dignity.

Conclusion: SAPS responses to mental health emergencies frequently increased distress among MHCUs and families. The findings highlight the need for SAPS training and clear protocols to manage psychiatric crises with care and sensitivity.

Contribution: This study informs interventions aimed at improving SAPS-MHCU interactions.

Background: While women with mental illness are prone to unplanned pregnancies, sexual violence and exposure to teratogenic medications, there is limited knowledge of contraceptive use and counselling in this vulnerable group.

Aim: This study aims to determine the prevalence of contraceptive use and counselling in women of childbearing age attending a psychiatric facility in KwaZulu-Natal Province, South Africa.

Setting: This study was conducted on in- and outpatients attending Townhill Hospital, a tertiary psychiatric facility in Pietermaritzburg that provides specialised services for the uMgungundlovu District and surrounds.

Methods: An interviewer-designed and administered questionnaire was used to obtain data from 186 participants in this quantitative, cross-sectional study. Clinical information was obtained from the participants' medical records.

Results: Among the 186 participants, the prevalence of consistent contraceptive use was 50%, 65.9% of prior pregnancies were unplanned, 35.5% reported a history of forced sex, 25.8% reported having unmet contraceptive needs and 59.7% requested integrated health care services. Only a quarter (25.3%) reported having received contraceptive counselling from their mental health care practitioner, while 31.2% (n = 58) received counselling on medication teratogenicity. Both contraceptive counselling (p = 0.018) and teratogenicity counselling (p = 0.007) were significantly associated with contraceptive use (n = 111).

Conclusion: There is inconsistent contraceptive use and low levels of counselling among women with mental illness. Integrated health care and contraceptive counselling by mental health care practitioners could improve the consistency of contraceptive use in this vulnerable group.

Contribution: Contraceptive counselling should be incorporated into psychiatric services to increase contraceptive uptake and reduce the impact of unplanned pregnancy and teratogenicity in this vulnerable population.

Background: Patients with schizophrenia rely on antipsychotic medication, with adherence being critical for symptom management. Poor adherence leads to relapse, disability and increased healthcare costs.

Aim: This study investigated the impact on antipsychotic adherence among schizophrenia patients on the introduction of an intervention utilising a psychiatric nurse as a virtual treatment buddy.

Setting: Participants were recruited from a psychiatric clinic in KwaZulu-Natal, South Africa.

Methods: This quantitative pre-test-post-test control group study recruited 117 schizophrenia patients. Participants were randomly assigned to an intervention group (n = 82) receiving daily text message support or a control group (n = 35) without support. Pre- and post-intervention questionnaires assessed medication adherence. The McNemar test compared medication cessation frequencies pre- and post-intervention. Pearson's chi-squared test, factor analysis and linear regressions were employed to correlate variables. A p < 0.05 was deemed statistically significant.

Results: Adherence improved from 60.8% to 83.51% post-intervention (p < 0.001). Obstacles to adherence, including inadequate disease knowledge, treatment duration, side effects, misunderstanding instructions and forgetfulness, were reduced post-intervention. Additionally, symptom relapse, rehospitalisation, specialist referrals, the need for more potent medication and employment loss decreased post-intervention.

Conclusion: Virtual buddy support has demonstrated promise in improving medication adherence and minimising adverse effects of discontinuation among schizophrenia patients.

Contribution: This study contributes a method to improving antipsychotic adherence and reducing negative outcomes in schizophrenia patients by emphasising personalised support, education and collaborative care among healthcare providers and support systems.

Background: World Health Organization defines substance use as harmful or hazardous use of psychoactive substances, including alcohol and illicit drugs. There is an increased rate of substance use among youths and adolescents. Substance use significantly increases the risk for mental disorders.

Aim: The aim of this study was to determine the prevalence of substance use and knowledge of its effects among secondary school students in Lagos, Nigeria.

Setting: The study was conducted among Secondary schools in Lagos, Nigeria.

Methods: We conducted a cross-sectional, descriptive study among 800 participants who were selected using a multi-stage sampling method. The instrument for data collection was the amended WHO students' drug-use questionnaire. The data were analysed using Epi Info 7 software.

Results: The lifetime prevalence of substance use was 13.6%, while current users' prevalence was 6.9%. Apart from alcohol consumption, the substance most frequently used was tramadol (52.7%), followed by marijuana (36.4%). Almost all the participants (98.1%) were aware of substance use. Most students (88.7%) were able to identify the effects of substance use, including short-term complications (79.1%) and long-term complications (61.1%).

Conclusion: The high prevalence of alcohol and tramadol use among the participants underscores the need for stricter government policies on the accessibility of these products to adolescents and the need for increased awareness of their effects.

Contribution: The lower knowledge of long-term complications of substance use (61.1%) in comparison to short-term complications (79.1%) underscores the need for further research and increased advocacy on long-term complications of substance use among youths and adolescents.

Background: In African countries, including Zimbabwe, about half of those with depression respond to first-line therapies like problem-solving therapy. Predicting who needs more intensive treatment is challenging. In the US and Europe, tools like the Facial Emotion Perception Test (FEPT) help match treatments to likely responders. However, its applicability in Zimbabwe is unexplored.

Aim: To develop a racially diverse adaptation of the FEPT for Shona-speaking Zimbabweans.

Setting: Outpatient primary healthcare clinics at Marondera Provincial Hospital and Chitungwiza Central Hospital, Zimbabwe.

Methods: Facial Emotion Perception Test was adapted using the Ecological Validity Model's eight constructs through a four-step process: expert consultation, preliminary content adaptation, iterative content adaptation, and finalising adaptation. Three focus groups and 12 cognitive interviews assessed cultural appropriateness, suitability, usability and acceptability of FEPT for Zimbabwean Shona speakers. Fifteen participants, including graduates, primary healthcare workers and individuals with lived experience of depression, took part.

Results: Key adaptations of FEPT-Multiple-Races (MR)-Shona include: (1) added 20 black and 20 Asian face stimuli for cultural relevance; (2) improved stimuli resolution for clarity; (3) extended test duration from 6 to 10 minutes for repeatable tutorials; (4) provided bilingual instructions in Shona and English; (5) shifted to a low-cost touchscreen tablet, familiar to Zimbabwean participants.

Conclusion: The adaptation shows promising cultural relevance and usability for Shona speakers. Further testing with diverse educational and contextual backgrounds is needed to enhance cross-cultural and ecological validity.

Contribution: This study highlights the importance of culturally adapting cognitive performance tools that can potentially improve depression treatment outcomes in low-income countries.