Anthony L. Pillay

Rural and urban South African women's awareness of cancers of the breast and cervix.

Objective : The investigation sought to establish the awareness of breast and cervical cancers among women of African descent, in both rural and urban areas, especially considering the oppression and deprivation experienced by this group. Design : Two groups of randomly selected women in a rural ( n = 70) and urban ( n = 70) area were interviewed using a structured questionnaire assessing their knowledge and attitudes regarding breast and cervical cancer and screening options. Results : The age range of the sample was 21-59 years with a mean of 35.23 years. Almost one-fifth of the women had not heard of these cancers, and almost half were unaware of the breast self-examination technique. Over one-third did not know about tests for breast cancer and more than half were unaware of tests for cervical cancer. Generally lower awareness levels were found in older and rural women who were also significantly more inclined to consult traditional healers (than doctors) about lumps in their breast or abnormal cervical bleeding. Conclusion : The findings are of great concern and represent a significant challenge in post-apartheid South Africa. The need for vigorous health promotion programmes cannot be sufficiently emphasised, especially in view of the benefits of early detection and treatment. There also needs to be particular focus on rural women, considering the inadequate health care resources in their communities and the socio-economic hardships facing them. Women in these communities must be empowered with knowledge about their health and illness prevention options.

South African Clinical Psychology, Employment (In)Equity and the “Brain Drain”:

The current study investigated race, gender and the “brain drain” in the Midlands Hospital (Pietermaritzburg) intern clinical psychology training programme. During the 20-year period between 1981 and 2000 a total of 128 interns were accepted into the programme. Almost three-quarters of the interns were White, and the majority of the sample was unskilled in the predominant language spoken in the region. Approximately 60% of the interns trained were female. No significant increase in the intake of Black interns was observed during the post-apartheid period (i.e.1994 to 2000). However, a significant increase in female interns was noted during that period. At the time of writing this article, almost one-quarter of the interns were working outside South Africa, the majority in Europe. Considering the findings, it is imperative that the profession re-examines its goals in post-apartheid South Africa, and makes concerted efforts to develop the mechanism to attain these. In addition, the profession and government need to take very seriously the “brain drain” problem and jointly develop acceptable ways of alleviating it.

Relationship of age and education with anxiety, depression, and hopelessness in a South African community sample.

In this pilot study approximately one-quarter of a nonrandom community sample of 16 men and 34 women of lower socioeconomic status reported scores implicating moderate to severe depression and anxiety. Higher age and lower education were associated with higher scores on distress.

Developing community mental health services for children in South Africa

As a result of South Africas Apartheid history, mental health care for black people, especially in rural areas, has been grossly inadequate and even non-existent in many areas. Children have been severely neglected in this regard. This paper describes an attempt by clinical psychologists to develop a community intervention programme for children with emotional problems. From their hospital base the authors set out, on a monthly basis, to outlying areas up to 250 km away to (1) train primary care nurses and other personnel in the basic techniques of identifying and dealing with uncomplicated psychological problems of childhood, and (2) render consultations to psychologically disturbed children. The paper argues the need to provide primary care workers with mental health skills and thus integrate childhood mental health care into the primary care structure. Such a move could make mental health care accessible to all inhabitants, thus deviating from the policies of the past.

Family Dynamics, Hopelessness and Psychiatric Disturbance in Parasuicidal Adolescents

Objective: Adolescent parasuicide has often been associated with family disturbance, hopelessness and psychiatric disturbance, but little empirical work has been done to verify these clinical impressions. Method: The present study compares matched groups of hospitalised parasuicidal adolescents, non-psychiatric medically hospitalised adolescents and a control group on measures of family disturbance, hopelessness and psychopathology. Results: The findings reveal significantly higher levels of family disturbance, hopelessness and depressive symptoms in the parasuicidal group. Conclusions: The results suggest that prevention and treatment of adolescent parasuicide should focus on both individual and family dynamics.

Psychopathology in Urban and Rural/Peri-Urban Children Seeking Mental Health Care

While childhood psychopathology may not necessarily be expected to vary between urban and rural children, social and political factors could be influential in the variances in presentation across these different environments. A comparative investigation was undertaken in the KwaZulu-Natal region to examine childhood presentations at (i) an urban psychological clinic in a low socio-economic environment, and (ii) a few visiting psychological clinics serving rural and peri-urban communities. Data were collected over a five-year period. The results revealed several notable differences, for example, attention-deficit/hyperactivity disorder (ADHD) and disruptive behaviour disorders (other than ADHD) were significantly more prevalent in the urban sample. However, mental retardation, post-traumatic stress disorder and sexual abuse were significantly more common in the rural/peri-urban sample. The results are discussed within the context of childrens life experiences, available facilities, and psychopathology detection rates in these two types of environments.

Midlife Depression and the 'Empty Nest' Syndrome in Indian Women

The incidence of midlife depression in Indian (South African) women presenting at a general hospital psychological clinic is reported. Of 56 women aged between 40 and 55 yr. who presented at the clinic during a 2-yr. period, 32 (57.1%) showed clinical depression. Of the depressed 21 were referred primarily for bodily pains in the absence of organic pathology. Feelings of loneliness and isolation related to children leaving home were reported by 19 patients. The breakdown of the extended-family system, through acculturation, and its psychological effects on middle-aged women are discussed.

Depression, anxiety, and hopelessness in sexually abused adolescent girls

50 sexually abused girls showed significantly higher scores on depression, anxiety, and hopelessness than 50 nonabused controls. The 31 subjects who were repeatedly abused showed higher distress than the 19 abused ones. The results are discussed in the context of psychological dynamics, suicidal risk, and the need for intervention.

Anxiety among University Students in South Africa

Of 214 first-year students in an historically Black university, 17.8% scored in the Severe range on the Beck Anxiety Inventory. Sex and rural or urban background were not significant factors.

Psychological symptoms in recently diagnosed cancer patients

The study sought to empirically evaluate levels of depression, anxiety and hopelessness in adults recently diagnosed with cancer. Fifty newly diagnosed cancer patients (with mixed cancer sites) were compared to a group of non-clinical controls using the Beck Depression Inventory, Beck Anxiety Inventory and Hopelessness Scale. The results showed significantly higher levels of depression, anxiety and hopelessness reported by the cancer subjects. Also significant positive correlations were found across these clinical variables. The findings highlight the psychological symptoms manifested by newly diagnosed cancer patients and emphasize the need for concerted efforts to provide appropriate psychological care to such patients. This aspect of the management of cancer patients, especially in the early stages of coping with the diagnosis, is often ignored or superficially handled.