Claire van der Westhuizen

Prevalence and predictors of mental disorders in intentionally and unintentionally injured emergency center patients

Abstract Little is known about the prevalence and predictors of mental disorders among injured emergency center (EC) patients in low- and middle-income countries (LMICs). Patients presenting with either an intentional or unintentional injury were recruited (N = 200). Mental health, injury, and psychological trauma histories were assessed. Descriptive statistics and logistic regressions were conducted, and predictors of current mental disorder were identified. Diagnostic criteria for a current mental disorder, including substance use disorders, were met by 59.5% of the participants. Compared with those with an unintentional injury, the intentionally injured participants were more likely to be diagnosed with a current mental disorder (66.9% vs. 48.8%, p = .01). High frequencies of previous intentional injuries predicted for current mental disorder (OR = 1.46, 95% CI 1.08–1.98), whereas male gender and witnessed community violence predicted substance use disorder diagnoses. The findings indicate that injured EC patients, particularly those with intentional injuries, are at risk for mental disorders. Psychosocial interventions in the EC context can potentially make an important contribution in reducing the burden of mental disorders and injuries in LMICs.

Validation of the Self Reporting Questionnaire 20-Item (SRQ-20) for Use in a Low- and Middle-Income Country Emergency Centre Setting

Common mental disorders are highly prevalent in emergency centre (EC) patients, yet few brief screening tools have been validated for low- and middle-income country (LMIC) ECs. This study explored the psychometric properties of the SRQ-20 screening tool in South African ECs using the Mini Neuropsychiatric Interview (MINI) as the gold standard comparison tool. Patients (n = 200) from two ECs in Cape Town, South Africa were interviewed using the SRQ-20 and the MINI. Internal consistency, screening properties and factorial validity were examined. The SRQ-20 was effective in identifying participants with major depression, anxiety disorders or suicidality and displayed good internal consistency. The optimal cutoff scores were 4/5 and 6/7 for men and women respectively. The factor structure differed by gender. The SRQ-20 is a useful tool for EC settings in South Africa and holds promise for task-shifted approaches to decreasing the LMIC burden of mental disorders.

Assault injury presentation and lifetime psychological trauma in emergency centre patients in South Africa: A cross-sectional study.

There is a paucity of data from emergency centers regarding (a) the prevalence of recurrent assault injury and prior psychological trauma, and (b) psychosocial predictors of assault-injury presentation. Objective: To address the above gaps to identify psychosocial needs and injury-prevention opportunities. Method: Patients presenting with assault or unintentional injuries were recruited from 2 emergency centers (ECs; n = 200) and assessed for injury history, traumatic events, and mental disorders. Descriptive statistics were computed and predictors for assault-injury presentation and recurrent assault injury were identified using logistic regression. Univariate regression models were employed to identify significant variables before entering these into multivariate models. Results: The majority of the participants were male (67%), of whom 43% were between the ages of 25 and 40 years. The median number of lifetime traumatic events was 7. Recurrent assault injury was found in 31%. These injuries were predicted by lifetime traumatic events other than injury (OR = 1.035, 95% CI [1, 1.07]). Assault-injury presentation was significantly less likely in female participants (OR = 0.221, 95% CI [0.1, 0.5]) and was associated with high levels of witnessing community violence (OR = 1.157, 95% CI [1.01, 1.32]). Conclusion: Patients presenting with assault injuries are at risk for injury recurrence, have high levels of past psychological trauma, and should be screened for psychosocial risk. Further research is needed to assess the role of past psychological trauma in risk for assault injury, and clarify treatment needs. The role of EC-based interventions in injury prevention and mental health requires increased recognition in South African policy and practice.

Validation of the Alcohol, Smoking and Substance Involvement Screening Test in a low- and middle-income country cross-sectional emergency centre study.

INTRODUCTION AND AIM Given the high prevalence and detrimental consequences of alcohol or other drug (AOD) use in low- and middle-income countries, a screening tool for early detection in health care, including emergency care, is critical. We set out to validate the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for the South African context. DESIGN AND METHODS We interviewed emergency centre patients (n = 200) in Cape Town for this cross-sectional study conducted from January to March 2013 utilising a questionnaire battery, including the ASSIST and Mini International Neuropsychiatric Interview. Internal consistency (Cronbachs alpha) and screening properties of the ASSIST (receiver operating characteristic analysis) were examined utilising the Mini International Neuropsychiatric Interview AOD use modules as the gold standard. RESULTS Cronbachs alpha for alcohol and illicit drugs ranged from 0.81 to 0.95 indicating good internal consistency. ASSIST cut-off scores show a good sensitivity and specificity for discrimination particularly when distinguishing between substance use and abuse, rather than dependence. For alcohol, the area under the curve was 0.94 for distinguishing between use and abuse, and this dropped to 0.68 for distinguishing between abuse and dependence, while the statistic remained high for both use/abuse and abuse/dependence for illicit drugs: 0.95 and 0.96. DISCUSSION AND CONCLUSION AOD abuse was associated with cut-off scores below the World Health Organization recommended levels, in keeping with various international studies suggesting that individuals with lower scores be offered interventions. The ASSIST was found to be useful for South African health care and holds promise for cost-effective task-shifting approaches in lower resourced settings. [van der Westhuizen C, Wyatt G, Williams JK, Stein DJ, Sorsdahl K. Validation of  the  Alcohol, Smoking and Substance Involvement Screening Test in a low- and middle-income country cross-sectional emergency centre study. Drug Alcohol Rev 2016;35:702-709].

Sensitivity and Specificity of the SRQ-20 and the EPDS in Diagnosing Major Depression Ante- and Postnatally in a South African Birth Cohort Study

We assessed the sensitivity and specificity of the Self-Reporting Questionnaire (SRQ-20) and the Edinburgh Postnatal Depression Scale (EPDS), against the major depression module of the Mini International Neuropsychiatric Interview (MINI). Data were utilised from antenatal (n = 296) and postnatal participants (n = 366) in the Drakenstein Child Health Study (DCHS), a multidisciplinary birth cohort investigating the determinants of child health. Mothers were interviewed using the SRQ-20, the EPDS and the MINI. Receiver operating characteristic (ROC) curve analysis was performed in order to establish optimal cut-off scores. Current major depressive episode was diagnosed in 5% of antenatal and 4% of postnatal participants. At widely used threshold scores, the sensitivity of the tools ranged from 50 to 67%, although the positive predictive values at these scores were much lower (14–25%). Both tools perform acceptably in identifying mothers at risk for major depression perinatally. In identifying appropriate cut-off scores, optimising specificity and maintaining at least 30% sensitivity seems to be a feasible approach given the resourcing of South African mental health services.

Knowledge and training in paediatric medical traumatic stress and trauma-informed care among emergency medical professionals in low- and middle-income countries

ABSTRACT Background: Provision of psychosocial care, in particular trauma-informed care, in the immediate aftermath of paediatric injury is a recommended strategy to minimize the risk of paediatric medical traumatic stress. Objective: To examine the knowledge of paediatric medical traumatic stress and perspectives on providing trauma-informed care among emergency staff working in low- and middle-income countries (LMICs). Method: Training status, knowledge of paediatric medical traumatic stress, attitudes towards incorporating psychosocial care and barriers experienced were assessed using an online self-report questionnaire. Respondents included 320 emergency staff from 58 LMICs. Data analyses included descriptive statistics, t-tests and multiple regression. Results: Participating emergency staff working in LMICs had a low level of knowledge of paediatric medical traumatic stress. Ninety-one percent of respondents had not received any training or education in paediatric medical traumatic stress, or trauma-informed care for injured children, while 94% of respondents indicated they wanted training in this area. Conclusions: There appears to be a need for training and education of emergency staff in LMICs regarding paediatric medical traumatic stress and trauma-informed care, in particular among staff working in comparatively lower income countries.

PW 2832 Evaluation of a substance use screening, brief intervention and referral to treatment (SBIRT) service for injured and non-injured patients in south african emergency centres

Problem substance use makes a significant contribution to the burden of injuries and noncommunicable diseases in South Africa. In 2012, the Western Cape Department of Health funded a randomised controlled trial of substance use SBIRT in emergency centres (ECs). Based on the promising results, the programme was implemented in 2016 in three ECs, offering motivational interviewing-based counselling delivered at the acute EC visit by lay counsellors. This study utilised data from a novel EC SBIRT service (1 August 2016 – 31 July 2017) and compared the characteristics, process and substance use outcome data for injured and non-injured patients. A screening questionnaire was administered to less seriously ill or injured adult patients, and those scoring at moderate-high risk on the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were eligible and received a motivational-interviewing-based session. Data collected included sociodemographics, presenting complaint, substance use days and the ASSIST. A three-month follow-up phone call was conducted to evaluate substance use in a small sample of service users. Process data was collected on the numbers of: patients screened, eligible patients, and sessions given. In total, 13 136 patients were screened. Over half were male, the mean age was 37 years and 43% presented with an injury. Of the non-injured patients, 23% met criteria for problem substance use, compared to 56% of injured patients. Of the eligible patients, 74% were male and 83% received a counselling session. At three-month follow-up there was a significant reduction in substance use days for all patients and injured patients’ alcohol use scores decreased by 6.4 points, compared to 4.7 in the non-injured patients. This EC SBIRT service delivered a substance use intervention to over 80% of eligible patients. Injured patients were more likely to report problem substance use, and showed a greater decrease in substance use scores.

Erratum to: Urban Health Research in Africa: Themes and Priority Research Questions

Oni is with the Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Smit and Parnell are with the African Centre for Cities, University of Cape Town, Cape Town, South Africa; Matzopoulos is with the Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Hunter-Adams and Alaba are with the Health Economics Unit, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Pentecost is with the Department of Anthropology, University of Cape Town, Cape Town, South Africa; Pentecost is with the Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK; Rother is with the Division of Environmental Health and Centre for Environmental and Occupational Health Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Albertyn is with the Children’s Institute, Department of Paediatrics, University of Cape Town, Cape Town, South Africa; Behroozi is with the Primary Health Care Directorate, University of Cape Town, Cape Town, South Africa; Kaba is with the Division of Health Economics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Kaba is with the Division of Medical Microbiology, Department of Clinical Laboratory Sciences, University of Cape Town, Cape Town, South Africa; van der Westhuizen is with the Alan J Flisher Centre for Public Mental Health, Department of Psychiatry andMental Health, University of Cape Town, Cape Town, South Africa; Shung-King is with the Division of Health Policy and Systems, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; Levitt is with the Chronic Disease Initiative for Africa and Division of Diabetic Medicine and Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Lambert is with the Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa. Correspondence: Tolu Oni, Division of Public Health Medicine, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. (E-mail: tolullah.oni@uct.ac.za) The online version of the original article can be found at doi:10.1007/s11524-016-0050-0.