Pamela Braboy Jackson

Twelve-month mental disorders in South Africa: prevalence, service use and demographic correlates in the population-based South African Stress and Health Study

BACKGROUND South Africas history and current social conditions suggest that mental disorders are likely to be a major contributor to disease burden, but there has been no national study using standardized assessment tools. METHOD The South African Stress and Health Study was a nationally representative in-person psychiatric epidemiological survey of 4351 adults (aged 18 years) that was conducted as part of the WHO World Mental Health (WMH) Survey Initiative between January 2002 and June 2004. Twelve-month prevalence and severity of DSM-IV disorders, treatment, and sociodemographic correlates were assessed with Version 3.0 of the WHO Composite International Diagnostic Interview (CIDI 3.0). RESULTS The 12-month prevalence of any DSM-IV/CIDI disorder was 16.5%, with 26.2% of respondents with disorder classified as severe cases and an additional 31.1% as moderately severe cases. The most common disorders were agoraphobia (4.8%), major depressive disorder (4.9%) and alcohol abuse or dependence (4.5%). Twenty-eight percent of adults with a severe or moderately severe disorder received treatment compared to 24.4% of mild cases. Some 13.8% of persons with no disorder received treatment. Treatment was mostly provided by the general medical sector with few people receiving treatment from mental health providers. CONCLUSIONS Psychiatric disorders are much higher in South Africa than in Nigeria and there is a high level of unmet need among persons with severe and moderately severe disorders.

Race, Gender, and SES Disparities in Self-Assessed Health, 1974-2004

Despite improvements in the status of Blacks and women over the past 30 years, racial and gender disparities in mortality and morbidity persist. Using General Social Survey (GSS) data from 1974 to 2004, the authors explore the extent to which race, gender, and socioeconomic status converge to produce differences in self-assessed health. The intersectionality paradigm is used to guide this work on health disparities. The authors find that the gender gap in self-assessed health has narrowed significantly over this 30-year time period. This decreased gap is especially pronounced because of the marked improvement over time in Black womens reports of their health. However, Black women continue to report the lowest levels of self-assessed health even in 2004. In fact, Black women who hold a college degree report worse health than White men, White women, and Black men with a high school diploma.

Role occupancy and minority mental health

Most studies of the mental health consequences of role occupancy do not consider racial/ethnic variation. Using a national sample of adults (N = 13,017), this paper examines the relationship between three role characteristics (role accumulation, role status, and role combinations) and mental health for Blacks, Mexicans, and Puerto Ricans and explores the extent to which these patterns differ from those for non-Hispanic Whites. Blacks and Puerto Ricans do not benefit from role accumulation whereas Mexicans and Whites who report a high number of roles report better psychological health than those who report few roles. All ethnic groups benefit from the spousal role but there is no consistent effect of either employment or parenthood. Membership in organizational groups benefits non-Hispanic Whites only, whereas familial roles (especially having a sibling) are related to improved mental health among all ethnic groups, except Puerto Ricans. In terms of role combinations, the psychological benefits of occupying all three adult social roles is more evident among non-Hispanic Whites and Mexican Americans compared to Blacks and Puerto Ricans. These findings are discussed in the context of their implications for sociological research which assumes that social psychological processes operate in the same manner across racial/ethnic groups.

A Research Agenda for the Black Middle Class: Work Stress, Survival Strategies, and Mental Health*

In this article we discuss the social position of the black middle class and two forms of work stress that appear unique to this group: token stress and social rejection. We outline a research agenda for studying: (1) the relationship between these stressors and mental health in the context of the work environment, and (2) the type of strategies that appear especially efficacious (or problematic) with regard to these problems. We begin the paper with a contextual discussion of the black middle class. We then offer a set of theoretical predictions about the relationship between work stress and mental health among middle class African Americans. We conclude the article with recommendations for future research, and we identify the implications of the research agenda for social policy efforts to diversify the workplace.

Mental health service use among South Africans for mood, anxiety and substance use disorders

BACKGROUND Europe and North America have low rates of mental health service use despite high rates of mental disorder. Little is known about mental health service use among South Africans. DESIGN A nationally representative survey of 4351 adults. Twelve-month DSM-IV (Diagnostic and Statistical Manual, 4th edition) diagnoses, severity, and service utilisation were determined using the World Health Organization Composite International Diagnostic Interview (CIDI). Twelve-month treatment was categorised by sector and province. South Africans in households and hostel quarters were interviewed between 2002 and 2004 in all nine provinces. OUTCOME MEASURES 4 317 respondents 18 years and older were analysed. Bivariate logistic regression models predicted (i) 12-month treatment use of service sectors by gender, and (ii) 12-month treatment use by race by gender. RESULTS Of respondents with a mental disorder, 25.2% had sought treatment within the previous 12 months; 5.7% had used any formal mental health service. Mental health service use was highest for adults with mood and anxiety disorders, and among those with a mental disorder it varied by province, from 11.4% (Western Cape) to 2.2% (Mpumalanga). More women received treatment, and this was largely attributable to higher rates of treatment in women with mood disorders. Age, income, education and marital status were not significantly associated with mental health service use. Race was associated with the treatment sector accessed in those with a mental disorder. CONCLUSIONS There is a substantial burden of untreated mental disorders in the South African population, across all provinces and even in those with substantial impairment. Greater allocation of resources to mental health services and more community awareness initiatives are needed to address the unmet need.

Life stress and mental disorders in the South African Stress and Health study

BACKGROUND Although stressful life events (SLEs) are associated with psychopathology, the contribution from distal and proximal events and the specificity of their association with common mental disorders require further exploration. We examined the association of recent life events and past adversities to mood, anxiety, substance use and impulse control disorders in South Africa. METHODS Data were analysed from the South African Stress and Health study, a population-based study of mental disorders in a nationally representative sample of 4 351 adults. Psychiatric disorders were assessed with the Composite International Diagnostic Interview (CIDI). This included questions covering early and later SLEs (negative life events, relationship stress, partner violence, social strain and adverse events during childhood) and various sociodemographic variables. Logistic regression models were constructed for 3957 respondents (2371 female, 1586 male) with no missing covariate data, to assess life stress and sociodemographic predictors of 12-month and lifetime disorder. RESULTS Recent negative life events and relationship problems were significant predictors of any 12-month disorder and any lifetime disorder. Physical partner violence predicted any lifetime disorder. There was evidence of specificity for the prediction of mood versus anxiety disorders, with childhood adversity specifically associated with mood disorders but not anxiety disorders. Single marital status was the strongest socio-demographic predictor of any 12-month and any lifetime disorder. CONCLUSIONS Stressful life events, distal and proximal, contribute significantly and independently to the prediction of major psychiatric disorders among South Africans, underscoring the importance of screening adversities in adults with common mental disorders, and of providing appropriate adjunctive interventions.

Health Inequalities Among Minority Populations

There are several challenges facing scholars studying health inequalities among minority populations. Primary among these challenges are developing adequate measures of social inequality and introducing appropriate strategies for eliminating health disparities. More research is sorely needed on both of these fronts as evidenced by the health paradox facing black, middle class men and women. This effort, however, can best move the study of health inequalities forward when juxtaposed against theoretical paradigms that embrace the complexity of the intersection of race, class, and gender.

Role Sequencing: Does Order Matter for Mental Health?.

Role sequencing refers to the ordering of social roles. According to the normative order hypothesis, adults who follow a certain sequencing of their social roles will be better adjusted than their peers who follow other life course patterns. The normative order is defined as first entering the paid labor force, getting married, and later having children. This study tests this hypothesis by analyzing retrospective life history data from three subsamples of adults who completed the 1987–1988 National Survey of Families and Households: (1) married, working parents; (2) divorced, working parents; and (3) married, unemployed parents. The findings indicate significant race/ethnic (black/white), gender, and cohort differences in the type of role sequencing patterns that are conducive to positive mental health. For example, African Americans who work first, then have children, and later get married report better mental health than their peers who followed the normative order. White men and women seem to benefit from following the normative course of role transitions. Among women, however, the psychological benefits of following typical life course patterns are especially evident among those born during the baby boom.

Perceived discrimination and mental health disorders: the South African Stress and Health study.

OBJECTIVES To describe the demographic correlates of perceived discrimination and explore the association between perceived discrimination and psychiatric disorders. DESIGN A national household survey was conducted between 2002 and 2004 using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate diagnoses of psychiatric disorders. Additional instruments provided data on perceived discrimination and related variables. SETTING A nationally representative sample of adults in South Africa. SUBJECTS 4351 individuals aged 18 years and older. OUTCOMES 12-month and lifetime mood, anxiety and substance use disorders. RESULTS In the multivariate analyses, acute and chronic racial discrimination were associated with an elevated risk of any 12-month DSM-IV disorder when adjusted for socio-demographic factors, but this association was no longer statistically significant when adjusted for other sources of social stress. In fully adjusted models, acute racial discrimination was associated with an elevated risk of lifetime substance use disorders. Acute and chronic non-racial discrimination were associated with an elevated risk of 12-month and lifetime rates of any disorder, even after adjustment for other stressors and potentially confounding psychological factors. The association of chronic non-racial discrimination and 12-month and lifetime disorder was evident across mood, anxiety, and substance use disorders in the fully adjusted models. CONCLUSION The risk of psychiatric disorders is elevated among persons who report experiences of discrimination. These associations are more robust for chronic than for acute discrimination and for non-racial than for racial discrimination. Perceived discrimination constitutes an important stressor that should be taken into account in the aetiology of psychiatric disorders.

Conventions of Courtship: Gender and Race Differences in the Significance of Dating Rituals:

Dating rituals include dating—courtship methods that are regularly enacted. This study explores gender and race differences in the relative importance placed on certain symbolic activities previously identified by the dating literature as constituting such rituals. Using information collected from a racially diverse sample of college students (N = 680), it is found that some traditional gender differences persist, but that these are also cross-cut by racial contrasts. Men, overall, place more emphasis on gifting, as well as sexual activity. Gender differences, however, are significantly greater among African Americans as compared with Whites in the sample studied. African American respondents are also significantly more likely than White respondents to associate meeting the family with a more serious dating relationship. The findings highlight the need for greater efforts to uncover and account for racial differences in dating, relationships, and courtship.