Katherine Sorsdahl

Traditional healers in the treatment of common mental disorders in South Africa.

Abstract: There are few population-level insights into the use of traditional healers and other forms of alternative care for the treatment of common mental disorders in sub-Saharan Africa. We examined the extent to which alternative practitioners are consulted, and predictors of traditional healer visits. A national survey was conducted with 3651 adult South Africans between 2002 and 2004, using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate DSM-IV diagnoses for common mood, anxiety, and substance use disorders. A minority of participants with a lifetime DSM-IV diagnosis obtained treatment from Western (29%) or alternative (20%) practitioners. Traditional healers were consulted by 9% of the respondents and 11% consulted a religious or spiritual advisor. Use of traditional healers in the full sample was predicted by older age, black race, unemployment, lower education, and having an anxiety or a substance use disorder. Alternative practitioners, including traditional healers and religious advisors, appear to play a notable role in the delivery of mental health care in South Africa.

Household food insufficiency and mental health in South Africa

Background Both mental illness and food insufficiency are common in low and middle income countries. However, there are limited data on the relation between food insufficiency and mental disorders, despite the potential relevance of such data for the development of policy-level interventions. The relationship between food insufficiency and mental disorders within a nationally representative sample of South African adults was examined. Methods A national survey of 4185 South African adults was conducted using the WHO Composite International Diagnostic Interview to generate psychiatric diagnoses. The survey included a widely used single-item measure of household food insufficiency. The independent effects of food insufficiency and demographic characteristics on 12-month and lifetime DSM-IV diagnosis were assessed using logistic regression. Results 29% of respondents reported that their household ‘sometimes’ did not have enough to eat while 9% reported that they ‘often’ did not have enough to eat. After controlling for conventional socioeconomic and sociodemographic variables, food insufficiency was associated with having any 12-month (OR 1.44, 95% CI 1.1 to 1.9) and lifetime (OR 1.35, 95% CI 1.1 to 1.7) DSM-IV disorder. Conclusions In South Africa the prevalence of household food insufficiency is very high compared with studies conducted in the developed world, and is independently associated with having a 12-month and lifetime DSM-IV diagnosis. The relationship between food insufficiency and mental health has implications for reducing the burden of common mental disorders in South Africa since, unlike a number of major risk factors for mental illness, food insufficiency may be relatively amenable to intervention.

Knowledge of and stigma associated with mental disorders in a South african community sample.

The aim of this study was to assess the awareness of, attitudes toward, and stigma associated with psychiatric disorders among South Africans. A convenience sample of 1081 members of the general public participated in the study. One of 10 vignettes portraying different psychiatric disorders with subtle or obvious symptoms was presented to each respondent. Schizophrenia was reported as being the most representative of a psychiatric disorder and post-traumatic stress disorder as the least representative. Psychosocial stress was reported more frequently than medical etiologies as a possible cause of mental disorders. Seeking help from a health professional in the form of psychotherapy was often endorsed as an effective treatment option, whereas taking medication was rarely endorsed. Respondents held more stigmatizing attitudes toward patients with substance abuse and schizophrenia, whereas post-traumatic stress disorder was stigmatized significantly less than the other conditions. Further effort is required to educate the public about the psychobiological underpinnings of psychiatric disorders and about the value of effective treatments.

Negative attributions towards people with substance use disorders in South Africa: Variation across substances and by gender

BackgroundLittle research has examined attitudes towards people who use substances in low and middle income countries (LMIC). Therefore, the present study examined the attributions made by the general South African population about people who use substances and whether these attributions differ by the type of substance being used, the gender of the person using the substance, or the characteristics of the person making the attribution.MethodA convenience sample of 868 members of the general public was obtained through street-intercept methods. One of 8 vignettes portraying alcohol, cannabis, methamphetamine or heroin, with either a male or female as the protagonist was presented to each respondent. Respondents’ attitudes towards the specific cases were investigated.ResultsRespondents held equally negative views of the presented substances, with the exception of the cannabis vignette which was considered significantly less “dangerous” than the alcohol vignette. Respondents were more likely to offer “help” to women who use alcohol, but more likely to suggest “coercion into treatment” for men. Individuals who scored higher on the ASSIST were more likely to hold negative attitudes towards substance users and black African respondents were more likely to offer help to individuals who use substances.ConclusionThe stigma associated with substance use in South Africa is high and not necessarily dependent on the drug of choice. However, a range of factors, including gender of the substance user, and ethnicity of the rater, may impact on stigma. Interventions designed to strengthen mental health literacy and gender-focused anti-stigma campaigns may have the potential to increase treatment seeking behaviour.

Investigating the psychosocial determinants of child health in Africa: the Drakenstein Child Health Study

BACKGROUND Early life psychobiological and psychosocial factors play a key role in influencing child health outcomes. Longitudinal studies may help elucidate the relevant risk and resilience profiles, and the underlying mechanisms that impact on child health, but there is a paucity of birth cohort data from low and middle-income countries (LMIC). We describe the rationale for and present baseline findings from the psychosocial component of the Drakenstein Child Health Study (DCHS). METHODS We review the psychosocial measures used in the DCHS, a multidisciplinary birth cohort study in a peri-urban area in South Africa, and provide initial data on psychological distress, depression, substance use, and exposure to traumatic stressors and intimate partner violence (IPV). These and other measures will be assessed longitudinally in mothers in order to investigate associations with child neurodevelopmental and health outcomes. RESULTS Baseline psychosocial data is presented for mothers (n=634) and fathers (n=75) who have completed antenatal assessments to date. The sample of pregnant mothers is characterized by multiple psychosocial risk factors, including a high prevalence of psychological distress and depression, high levels of substance use, and high exposure to traumatic stressors and IPV. DISCUSSION These data are consistent with prior South African studies which have documented a high prevalence of a multitude of risk factors during pregnancy. Further longitudinal assessment of mothers and children may clarify the underlying psychobiological and psychosocial mechanisms which impact on child health, and so inform clinical and public health interventions appropriate to the South African and other LMIC contexts.

The prevalence and predictors of stigma amongst people living with HIV/AIDS in the Western Province

Abstract The aim of the present study was determine the extent to which internalized and enacted stigma is experienced by people living with HIV/AIDS and to establish correlates of such experiences. A convenience sample of 400 HIV-positive participants was selected from three health clinics in the Cape Town area. Respondents’ experiences of internalized and enacted stigma were investigated using the HIV/AIDS Stigma Instrument – PLWA (HASI-P). Overall, 28% of respondents endorsed more than one item addressing internalized stigma and 8% endorsed more than one item on any of the four subscales measuring enacted stigma. Male respondents (OR = 0.52, CI = 0.92–0.99), younger respondents (OR = 0.52, CI = 0.29–0.94), and those respondents who had been living with HIV longer were less likely to experience internalized stigma. More educated respondents (OR = 1.19, CI = 1.02–1.39) experienced more internalized stigma than those with less education No demographic characteristics predicted enacted stigma in this particular population. There are a number of possible reasons for low reports of HIV-related stigma, including having access to treatment and not disclosing HIV status.

I understand just a little... Perspectives of HIV/AIDS service providers in South Africa of providing mental health care for people living with HIV/AIDS.

Abstract Research conducted in South Africa and other parts of the world has revealed that people living with HIV/AIDS (PLWHA) are more at risk of developing a mental disorder than the general population. It makes sense to explore means of integrating HIV/AIDS and mental health care thereby facilitating access of PLWHA to prompt mental health care. We conducted qualitative interviews with 22 HIV/AIDS service providers of three occupational categories (10 nurses, six adherence counsellors and six patient advocates) at three primary health care clinics in the Western Cape, South Africa. We explored the issues of knowledge and practice in mental health care as well as the role of nurses and lay health workers in providing mental health care to PLWHA thereby attempting to integrate mental health and HIV/AIDS care. Although the majority of participants were in favour of mental health screening for PLWHA, they lacked confidence to conduct the screening themselves. Most participants displayed poor knowledge of mental disorders and reported that they referred to colleagues or to an external mental health service if they suspected a possible mental disorder in a patient. Integration of mental health and HIV/AIDS care has potential benefit to the public HIV/AIDS care system. Mental health training should be provided to HIV/AIDS service providers in this regard.

The internalized stigma experienced by members of a mental health advocacy group in South Africa

Background: Although there is a growing literature on internalized stigma from the developed world, very little research has been conducted in developing countries such as South Africa. Therefore, the purpose of this study was to describe the internalized stigma experienced by members of a mental health advocacy group in South Africa and relationships between self-stigma and other constructs, namely, empowerment, perceived devaluation and discrimination. Methods: Self-administered questionnaires measuring respondents reported levels of internalized stigma, empowerment and perceived devaluation and discrimination were distributed to all the members of the South African Depression & Anxiety Group (SADAG) by post and via email. Of the 850 members invited to participate, 142 members of SADAG completed the questionnaire. Pearson correlations were computed and multiple regression analyses were carried out to analyse the data. Results: The highest reports of stigma were for stigma resistance (mean = 2.9), alienation (mean = 2.47) and perceived discrimination (mean = 2.24). Low levels of stereotype endorsement (mean = 1.77) and social withdrawal (mean = 1.22) were reported. Although respondents often felt that the public held negative attitudes towards individuals suffering with a mental illness (perceived devaluation and discrimination scale (PDD), mean = 2.95), a majority of respondents reported high levels of empowerment (mean = 3.0) and self-efficacy (mean = 2.47). After controlling for socio-demographic factors, higher scores on the PDD were associated with social withdrawal and having experienced discrimination. Conclusion: Internalization of stigma, disempowerment and loss of self-esteem are not inevitable consequences for all individuals with a mental illness. Nevertheless, perceived stigma is significantly associated with social withdrawal and experienced discrimination.

White-Matter Damage in Clade C HIV-Positive Subjects: A Diffusion Tensor Imaging Study

The relationship between cognitive impairment and white-matter integrity in human immunodeficiency virus (HIV) remains poorly understood, particularly in clade C. The authors utilized diffusion tensor imaging (DTI) and a comprehensive neuropsychological evaluation to investigate the relationship between cognitive impairment and white-matter integrity in HIV-positive subjects with clade C HIV. Forty-four HIV-infected individuals and 10 seronegative subjects were compared, using a whole-brain, voxel-based approach to define fractional anisotropy (FA) and mean diffusion (MD). Compared with healthy-control subjects, the HIV-infected group exhibited decreased FA in the corpus callosum, superior longitudinal fasciculus, and cingulum and sagittal stratum. This study provides evidence that white-matter integrity is compromised in individuals infected with clade C HIV.

Traditional Healer Attitudes and Beliefs Regarding Referral of the Mentally Ill to Western Doctors in South Africa

Drawing on data collected from 3 focus groups with 24 traditional healers, the aim of this qualitative study was to use the constructs of the Theory of Planned Behaviour (TPB) to gain an understanding of traditional healer referral practices of their patients with a mental illness. Results indicated that traditional healers possess a concept of mental illness, mainly referring to a patient behaving abnormally. They often report regularly treating patients with these behaviours. Traditional healer referral to Western care is considered a temporary measure or a last resort. A majority of healers feel that allopathic physicians do not treat them with the respect that they feel their contribution to the health of the community warrants. Recommendations include the need for traditional healers to be trained to identify potential cases of mental illness in their communities and for dialogue between traditional and allopathic physicians in regard to mental health care.