Jason Bantjes

Suicide and poverty in low-income and middle-income countries: a systematic review

Suicide is the 15th leading cause of death worldwide, with over 75% of suicides occurring in low-income and middle-income countries. Nonetheless, evidence on the association between suicide and poverty in low-income and middle-income countries is scarce. We did a systematic review to understand the association between suicidal ideations and behaviours and economic poverty in low-income and middle-income countries. We included studies testing the association between suicidal ideations and behaviours and economic poverty in low-income and middle-income countries using bivariate or multivariate analysis and published in English between January, 2004, and April, 2014. We identified 37 studies meeting these inclusion criteria. In 18 studies reporting the association between completed suicide and poverty, 31 associations were explored. The majority reported a positive association. Of the 20 studies reporting on the relationship between non-fatal suicidal ideations and behaviours and poverty, 36 associations were explored. Again, almost all studies reported a positive association. However, when considering each poverty dimension separately, we found substantial variations. These findings show a consistent trend at the individual level indicating that poverty, particularly in the form of worse economic status, diminished wealth, and unemployment is associated with suicidal ideations and behaviours. At the country level, there are insufficient data to draw clear conclusions. Available data show a potential benefit in addressing economic poverty within suicide prevention strategies, with particular attention to both chronic poverty and acute economic events.

Epidemiology of suicide in South Africa: Setting an agenda for future research

This article offers a synthesis and critical overview of published studies on the prevalence and correlates of completed suicide in South Africa. It examines the evidence that suicide is a serious public health problem and highlights what remains unknown about suicide in South Africa. Reflections are offered on the implications of these studies for subsequent research. Focus areas are suggested for future research in order to provide the information needed to inform public health efforts to reduce the morbidity and mortality associated with suicidal behaviour. This article is of interest to scholars who seek to plan suicide research in South Africa, public health officials who wish to design suicide prevention programmes, and others who wish to gain an overview of the prevalence and correlates of completed suicide in the country.

Barriers and facilitators to participation in physical activity: The experiences of a group of South African adolescents with cerebral palsy

Participation in regular physical activity promotes physical health and psychosocial well-being. Interventions are thus needed to promote physical activity, particularly among groups of individuals, such as persons with disability, who are marginalised from physical activity. This study explored the experiences of a group of South African adolescents with cerebral palsy. In-depth semi-structured interviews were conducted with 15 adolescents with cerebral palsy. The results provided insight into a range of factors that promote and hinder participation in physical activity among adolescents with cerebral palsy in resource-scarce environments.

Poverty and suicide research in low- and middle-income countries: systematic mapping of literature published in English and a proposed research agenda

Approximately 75% of suicides occur in low- and middle-income countries (LMICs) where rates of poverty are high. Evidence suggests a relationship between economic variables and suicidal behaviour. To plan effective suicide prevention interventions in LMICs we need to understand the relationship between poverty and suicidal behaviour and how contextual factors may mediate this relationship. We conducted a systematic mapping of the English literature on poverty and suicidal behaviour in LMICs, to provide an overview of what is known about this topic, highlight gaps in literature, and consider the implications of current knowledge for research and policy. Eleven databases were searched using a combination of key words for suicidal ideation and behaviours, poverty and LMICs to identify articles published in English between January 2004 and April 2014. Narrative analysis was performed for the 84 studies meeting inclusion criteria. Most English studies in this area come from South Asia and Middle, East and North Africa, with a relative dearth of studies from countries in Sub-Saharan Africa. Most of the available evidence comes from upper middle-income countries; only 6% of studies come from low-income countries. Most studies focused on poverty measures such as unemployment and economic status, while neglecting dimensions such as debt, relative and absolute poverty, and support from welfare systems. Most studies are conducted within a risk-factor paradigm and employ descriptive statistics thus providing little insight into the nature of the relationship. More robust evidence is needed in this area, with theory-driven studies focussing on a wider range of poverty dimensions, and employing more sophisticated statistical methods.

The Development and Utilisation of a Suicide Risk Assessment Interview Schedule

Suicide is increasingly widespread in South Africa and is considered to constitute a serious public health problem. It is not only the most common emergency encountered by mental health care professionals but also has the distinction of being one of the few potentially fatal psychological conditions. The accurate determination of suicide risk in clinical practice is difficult. Despite vast amounts of research, no one assessment tool or method, when applied to individual clients, has been demonstrated to be ultimately superior in helping clinicians to accurately estimate risk. A clinicians failure to adequately assess suicide risk may result in morbidity or mortality, and has the added complication of leaving the clinician to face negative emotional, personal, professional, and legal consequences. This article illustrates how research findings and empirical studies have been utilised to formulate a Suicide Risk Assessment Interview Schedule (SRAIS) designed to assist the clinician to make a thorough assessment of suicide risk by avoiding errors of omission. Two case vignettes are included to illustrate how the SRAIS has been used to guide the process of risk assessment and management.

“There is soccer but we have to watch”: the embodied consequences of rhetorics of inclusion for South African children with cerebral palsy

Twenty years after the advent of democracy in South Africa (SA), there have been some successes in the achievement of greater equality, access and inclusion for many persons with disabilities. The move towards inclusive education may, however, have had unanticipated embodied consequences for people positioned discursively as included, but who in fact may in some respects be further marginalised than they had been under apartheid. We describe ethnographic research conducted in a special needs school in SA to explore the lived experiences of children with cerebral palsy and their involvement in physical activity. Our study shows how inclusive educational practices in SA have impeded involvement in sport for some children with motor impairments because of resource limitations and other historic reasons. This paper raises important questions about the role of community psychology in recognising, naming and contributing to action around injustices, which may be hard to see but which can have profound effects on the lives and bodies of those who experience exclusion.

'This place is making me more depressed': the organisation of care for suicide attempters in a South African hospital

People who attend hospital following a suicide attempt represent a well-delineated high-risk group of patients who may be amenable to targeted interventions to reduce the risk of suicidal behaviour. Little is, however, known about how hospitals in South Africa respond to suicide attempters, what quality of care these patients receive or what possibilities exist for hospital-based suicide prevention interventions. We describe an ethnographic study conducted at a large hospital in South Africa to investigate the impact of current procedures and practices on the care received by those who attempt suicide. Findings suggest that the organisation of care within the hospital is a significant barrier to patients receiving optimal care and represents a lost opportunity for suicide prevention. Findings highlight the mismatch between the needs of suicide attempters and current services and call attention to the need for greater psychological input as well as hospital-based suicide prevention interventions that can be offered to patients without necessitating admissions.

I Would Rather Just Go Through With It Than Be Called a Wussy: An Exploration of How a Group of Young South African Men Think and Talk About Suicide

Worldwide suicide is a deeply gendered phenomenon. In South Africa, approximately 80% of suicide completers are male. This study aimed to investigate how a group of young South African men understand and think about suicidal behavior. In-depth semistructured interviews and thematic analysis using a grounded theory approach revealed that this group of young South African men had permissive attitudes to suicide and viewed suicide as a morally defensible alternative in specific situations. They spoke of suicide as a goal-directed behavior that provides a means of regaining control, asserting power, communicating, and rendering oneself visible. From this perspective, suicide was understood as a brave act requiring strength and determination. These data have congruence with the Theory of Gender and Health, which proposes that constructions of masculinity may be implicated in the attitudes and beliefs young men in South Africa hold toward suicide.

Symptoms of posttraumatic stress, depression, and anxiety as predictors of suicidal ideation among South African university students.

ABSTRACT Objective: To investigate the 2-week prevalence of suicidal ideations and their associations to symptoms of posttraumatic stress, depression, and anxiety among South African university students. Participants: Data were collected from 1,337 students between May and August 2013. Methods: Hierarchical regression analysis was used to investigate the relationship between suicidal ideation and symptoms of posttraumatic stress, depression, and anxiety. Results: Rates of suicidal ideation are higher among university students in South Africa than among the general population of the country and student populations in other parts of the world. Symptoms of depression and exposure to trauma predict suicidal ideation Conclusions: Findings bring into focus the high rates of suicidal ideation among a sample of university students in South African and the need for more research to investigate the psychosocial correlates of this phenomena within the cultural context of the country, especially given the correlation between suicidal ideation and other poor health outcomes.

Counselling Psychology in South Africa.

The origin and development of counselling psychology in South Africa has been profoundly influenced by the country’s sociopolitical history and the impact of apartheid. As a result of this, counselling psychologists in the country face a number of challenges and opportunities for the future. In this paper we provide a portrait of counselling psychology in South Africa by describing the current character of the specialty and the context in which South African psychologists work. We critically discuss the challenges that the specialty faces to meet the country’s mental health care needs, contest the current Scope of Practice; affirm multiculturalism without essentialising or reifying race and ethnicity, and build an evidence base for community interventions in the country. We also consider how, in the future, counselling psychologists in South Africa may make a more meaningful contribution within public health and the country’s health care and education systems.