South African Journal of Psychiatry最新文献

Background: Additional human resources are needed to provide mental health services in underserved areas in South Africa (SA). Clinical associates, the mid-level medical worker cadre in SA, could potentially be used to deliver these services.

Aim: The study explored the self-reported knowledge, confidence, and current practices of clinical associates related to mental health assessment and management.

Setting: South Africa.

Methods: A cross-sectional study was conducted. The link to the electronic questionnaire was distributed to clinical associates via databases and social media. Data were analysed with Stata v17.

Results: Of the 209 participants, 205 (98.1%) indicated they had training on management of patients with mental illness during their undergraduate degree and 192 (91.9%) had a mental health rotation. Few (10.7%) had any additional mental health training. Most participants rated their knowledge of priority mental disorders as 'good' or 'excellent'. Only 43.2% of the participants felt quite or very confident to perform a mental health examination. Participants who felt quite or very confident to manage patients presenting with suicide risk, aggression, and confusion were 44.9%, 46.9% and 53.1%, respectively. Factors associated with a confidence score of 75% and higher were male gendered, working in Gauteng or Northern Cape provinces, and in a rural area. The majority of participants were already involved in mental health assessment and management in their current work.

Conclusion: Clinical associates have a contribution to make in mental health service provision, but this may need to be supplemented by additional practical training.

Contribution: Potential gaps in training have been identified.

Background: In the context of disease outbreaks, healthcare workers are exposed to multiple physical and psychological stressors, which may result in severe mental health outcomes. Although existing literature explores this impact, it is focused on frontline workers, with limited evidence exploring the mental well-being of mental healthcare workers (MHCWs).

Aim: To explore post-traumatic stress symptoms (PTSS) and associated factors among MHCWs within the context of the coronavirus disease 2019 (COVID-19) pandemic.

Setting: Four academic hospitals in the Gauteng province, South Africa, with specialised psychiatric units.

Methods: A cross-sectional study design was used. Participants were selected using a simple random sampling technique and invited to participate in structured interviews. Measurement tools included a demographic questionnaire, the post-traumatic stress disorder checklist for DSM-5 and the Brief Resilient Coping Scale.

Results: A total of 120 MHCWs participated. The prevalence of PTSS was 11.7%. The MHCWs' profession was a significant predictor of the occurrence of PTSS (p = 0.046), with nurses being the most affected. Other socio-demographic, employment, COVID-19-related factors and coping skills were not predictors of PTSS.

Conclusion: An elevated prevalence of PTSS has been found and was significantly associated with the profession of the MHCW. It is recommended that existing employee wellness programmes be strengthened to promote mental well-being and improve resilience among MHCWs, particularly vulnerable employee groups.

Contribution: This study provides insight into the prevalence of PTSS among MHCWs following the COVID-19 outbreak, as well as associated factors.

Background: Burnout impacts patient care and staff well-being. Emergency department (ED) staff are at an elevated risk for burnout. Despite an acceleration in burnout research due to the coronavirus disease 2019 (COVID-19) pandemic, there is limited data on the nature and prevalence of burnout in the South African emergency medicine setting.

Aim: This study determined the prevalence of burnout in ED staff (doctors, nurses and non-clinical staff) at Tygerberg Hospital and explored staff awareness and utilisation of interventions.

Setting: The study was conducted at Tygerberg Hospital, South Africa.

Methods: This cross-sectional study used the Maslach Burnout Inventory to assess burnout via a self-administered electronic survey in a convenience sample of 109 ED staff. Quantitative data were analysed with descriptive and inferential statistics. Qualitative data were analysed using thematic analysis.

Results: A total of 46 participants (45.10%) experienced burnout, with 73 participants (71.57%) at high risk for emotional exhaustion or depersonalisation. The prevalence of burnout in doctors was 57.89%, non-clinical staff was 25.93%, and nursing staff was 50.00%. Burnout was higher in doctors and nursing staff compared to non-clinical staff, with high emotional exhaustion and depersonalisation found in interns and specialist professional nurses. The level of intervention awareness was 41.8% and the level of intervention utilisation was 8.82%. Thematic analysis identified awareness, accessibility and reactive utilisation as barriers to utilisation with opportunities to reduce burnout and enhance resilience.

Conclusion: Coordinated health system and organisational efforts are required to optimise intervention strategies to reduce burnout.

Contribution: Guidance on the design and planning of intervention strategies considering at risk groups, intervention-related factors, and non-clinical staff.

Background: Major neurocognitive disorder presents many challenges to patients, families and healthcare systems, especially when a patient requires admission to a psychiatric hospital.

Aim: To identify characteristics of older patients with major neurocognitive disorder at risk of prolonged admission in a psychiatric hospital.

Setting: A tertiary psychiatric hospital in Gauteng province, South Africa.

Methods: The authors conducted a retrospective review of the hospital database and clinical files. Clinical and demographic data were collected from the files of 50 inpatients, 60 years and older, who were diagnosed with major neurocognitive disorder and admitted between 2015 and 2019. Anonymised data from patient records were captured on an electronic spreadsheet and analysed using T-tests and analysis of variance (ANOVA) to investigate the relationship between patient characteristics and length of hospital admission.

Results: The mean duration of admission was 18.29 months. Involuntary admission status (β = 0.239, p = 0.049), level of assistance required (moderate level of assistance [β = 0.378, p = 0.005]; high level of assistance [β = 0.336, p = 0.015]), availability of social support (β = -0.319, p = 0.016) and the presence of behavioural or psychological problems (β = 0.437, p = 0.002) were significantly correlated with longer admission. Using a stepwise regression model, the only significant variable associated with a shorter length of stay was the presence of social support (β = -0.512, p = 0.009). Age, type of major neurocognitive disorder and number of comorbidities were not correlated with the duration of admission (p > 0.005).

Conclusion and contribution: Social support plays an important role in the management of patients with major neurocognitive disorder. The findings in this study highlight healthcare shortages and a need for adequate placement facilities in South Africa for patients who have no other form of support.

Background: Autism spectrum disorder (ASD) is a neurodevelopmental disorder with deficits in social communication and interaction, restricted and repetitive patterns of behaviour, interests and activities. Autism spectrum disorder is associated with multiple comorbidities. As a result, caregivers of children with ASD experience increased levels of burden and poor quality of life. However, there is a paucity of information on the burden.

Aim: The study aimed to describe the sociodemographic profiles and determine the extent of the burden experienced by caregivers of children and adolescents with ASD.

Setting: The Child, Adolescent and Family Unit (CAFU) outpatient services at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).

Methods: A quantitative, descriptive, cross-sectional study was done. Two self-administered questionnaires were used: a sociodemographic questionnaire and the 12-item Zarit Burden Interview questionnaire.

Results: The questionnaires were completed by 77 caregivers, of which the majority were female (n = 56 or 72.3%), mothers to children with ASD (n = 49 or 64.3%) and identified as Christian (p < 0.001). Most had completed secondary school or had a tertiary education (p = 0.003) and were employed (p < 0.001). Among the caregivers, 41.6% experienced mild to moderate burden, 33.8% experienced high burden and only 24.9% reported no to mild burden.

Conclusion: Caregivers of children and adolescents with a diagnosis of ASD are mostly mothers and experience mild to moderate levels of caregiver burden, suggesting the need for improved screening and psychosocial support programmes.

Contribution: This study highlights the burden experienced by primary caregivers of children with ASD and is one of the few comprehensive studies on this issue within the context of South Africa.