Stacey L. Williams

Perceived Discrimination, Race and Health in South Africa

To assess the levels of perceived acute and chronic racial and non-racial discrimination in South Africa, their association with health, and the extent to which they contribute to racial differences in physical and mental health, data were used from a national probability sample of adults, the South African Stress and Health Study (SASH). All Black groups in South Africa (African, Coloured and Indian) were two to four times more likely than Whites to report acute and chronic experiences of racial discrimination. Africans and Coloureds report higher levels of ill health than Whites, but acute and chronic racial discrimination were unrelated to ill health and unimportant in accounting for racial differences in self-rated health. In contrast, all Black groups had higher levels of psychological distress than Whites, and perceived chronic discrimination was positively associated with distress. Moreover, these experiences accounted for some of the residual racial differences in distress after adjustment for socioeconomic status. Our main findings indicate that, in a historically racialized society, perceived chronic racial and especially non-racial discrimination acts independently of demographic factors, other stressors, psychological factors (social desirability, self-esteem and personal mastery), and multiple SES indicators to adversely affect mental health.

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.

Race and Psychological Distress: The South African Stress and Health Study

We analyze data from the South African Stress and Health Study, a nationally representative in-person psychiatric epidemiologic survey of 4,351 adults conducted as part of the World Mental Health Survey Initiative between January 2002 and June 2004. All blacks (Africans, Coloreds, and Indians) initially report higher levels of non-specific distress and anger/hostility than whites. Access to socioeconomic resources helps explain differences in non-specific distress between Coloreds and whites and Indians and whites. However, only when social stressors are considered do we find few differences in psychological distress (i.e., non-specific distress and anger/hostility) between Africans and whites. In addition, self-esteem and mastery have independent effects on non-specific distress and anger/hostility, but differences between Coloreds and whites in feelings of anger/hostility are not completely explained by self-esteem and mastery. The findings contribute to the international body of work on social stress theory, challenge underlying assumptions of the minority status perspective, and raise a series of questions regarding mental health disparities among South Africans.

Weight status misperception as related to selected health risk behaviors among middle school students.

BACKGROUND Weight misperception has been documented among children although the impact on health risk behaviors is less understood, particularly among middle school students. The goals of this study were to describe sociodemographic differences in actual and perceived weight, correspondence between actual and perceived weight, and weight-related health risk behaviors, as well as to examine weight misperception and interactions with sociodemographic variables in explaining weight-related health risk behaviors. METHODS Participants were recruited at 11 public school districts participating in the Tennessee Coordinated School Health (CSH) pilot program. A total of 10,273 middle school students completed the Centers for Disease Control and Preventions Youth Risk Behavior Survey administered by teachers in the school setting. RESULTS Findings revealed sociodemographic differences in actual and perceived weight as well as weight misperception. Although overestimating ones weight was significantly related to greater likelihood of weight-related health risk behaviors, significant interactions showed this relationship to be especially pronounced in females. Additional distinctions based on sociodemographic variables are indicated. CONCLUSIONS Results highlight the importance of screening for health risk behaviors including weight misperception among middle school students. The CSH program offers an opportunity to understand health risk behaviors among students while also informing and evaluating methods for intervention.

Perpetration of gross human rights violations in South Africa: Association with psychiatric disorders

BACKGROUND A nationally representative study of psychiatric disorders in South Africa provided an opportunity to study the association between perpetration of human rights violations (HRVs) during apartheid and psychiatric disorder. Prior work has suggested an association between perpetration and post-traumatic stress disorder (PTSD), but this remains controversial. METHODS Subjects reported on their perpetration of human rights violations, purposeful injury, accidental injury and domestic violence. Lifetime and 12-month prevalence of DSM-IV (Diagnostic and Statistical Manual, 4th edition) disorders were assessed with Version 3.0 of the World Health Organization Composite International Diagnostic Interview (CIDI 3.0). Socio-demographic characteristics of these groups were calculated. Odds ratios for the association between the major categories of psychiatric disorders and perpetration were assessed. RESULTS HRV perpetrators were more likely to be male, black and more educated, while perpetrators of domestic violence (DV) were more likely to be female, older, married, less educated and with lower income. HRV perpetration was associated with lifetime and 12-month anxiety and substance use disorders, particularly PTSD. Purposeful and DV perpetration were associated with lifetime and 12-month history of all categories of disorders, whereas accidental perpetration was associated most strongly with mood disorders. CONCLUSION Socio-demographic profiles of perpetrators of HRV and DV in South Africa differ. While the causal relationship between perpetration and psychiatric disorders deserves further study, it is possible that some HRV and DV perpetrators were themselves once victims. The association between accidental perpetration and mood disorder also deserves further attention.

Differential Contributions of Polycystic Ovary Syndrome (PCOS) Manifestations to Psychological Symptoms

The purpose of this study was to investigate the relative contributions of previously identified Polycystic ovary syndrome (PCOS) manifestations (infertility, hirsutism, obesity, menstrual problems) to multiple psychological symptoms. Participants were 126 female endocrinology patient volunteers diagnosed with PCOS who completed a cross-sectional study of PCOS manifestations and psychological symptoms. Participants had significantly elevated scores on nine subscales of psychological symptoms. Menstrual problems were significantly associated with all symptom subscales as well as the global indicator, while hirsutism and obesity were significantly related to five or more subscales. After controlling for demographic factors, menstrual problems were the strongest predictor of psychological symptoms. Findings suggest features of excess body hair, obesity, and menstrual abnormalities carry unique risks for adverse psychologic symptoms, but menstrual problems may be the most salient of these features and deserve particular attention as a marker for psychological risk among women with PCOS.

Internalised HIV-stigma, loneliness, depressive symptoms and sleep quality in people living with HIV

Objective: People living with HIV (PLWH) commonly report sleep disturbances which are associated with long-term health consequences, including disease progression. PLWH also experience internalised stigma as a result of their HIV status, which can be associated with increased loneliness and depression. Little attention focuses on the impact of these factors on sleep. Therefore, we examined whether internalised HIV-stigma was indirectly related to poorer sleep quality through higher levels of loneliness and depressive symptoms. Design: 181 PLWH from across the United States completed an online survey. Main Study Measures: Internalised HIV-stigma was assessed using the HIV-Stigma Scale, loneliness was assessed using the UCLA-Loneliness Scale-Short Form, depressive symptoms were assessed with the Center for Epidemiologic Studies–Depression Index, and Sleep Quality was assessed using the Pittsburgh Sleep Quality Index. Results: Internalised HIV-stigma was indirectly associated with poorer global sleep quality and daytime sleep dysfunction through both loneliness and depressive symptoms. Conclusions: PLWH who experience HIV-related stigma may experience greater feelings of loneliness, which are related to increased depressive symptoms and poorer sleep quality. Interventions focused on improving sleep in PLWH should focus on multiple factors that influence sleep, including psychosocial factors such as stigma, social isolation and depressive symptoms.

HIV-Stigma, Self-Compassion, and Psychological Well-Being Among Gay Men Living With HIV.

Gay men living with HIV (MLWH) are often adversely affected by stigma related to both their serostatus and their sexual orientation, and the experience of living with HIV appears to increase feelings of internalized homophobia (IH). Little research attention has focused, however, on factors that may buffer the impact of HIV-stigma and IH on well-being among men living with HIV. Self-compassion, which consists of self-kindness, common humanity, and mindfulness, has been associated with resilience against the negative effects of stigma on well-being. We hypothesized that HIV-stigma would be indirectly related to poorer psychological well-being through increased levels of IH. Moreover, we expected that self-compassion would attenuate the negative effects of HIV-stigma on well-being through IH. Our sample consisted of 90 ethnically diverse gay MLWH. Participants completed an online questionnaire that assessed levels of HIV-stigma, IH, self-compassion, depression, anxiety, and positive and negative affect. After controlling for a variety of sociodemographic, health, and social characteristics, results revealed that more HIV-stigma was indirectly related to more depressive symptoms and anxiety through higher IH. Moreover, self-compassion emerged as a moderator of the indirect association of HIV-stigma on higher negative affect through higher IH, such that this indirect effect was significant for those with low self-compassion, but not for those with high self-compassion. Compassion-focused practices should be explored as a means of increasing resilience among gay MLWH.

HIV-specific unsupportive social interactions, health, and ethnicity in men living with HIV

Individuals living with HIV experience higher rates of stigmatizing social interactions that may negatively impact psychological and physical health. We examined depressive symptoms as a mediator of the relationship between HIV-specific unsupportive social interactions (USIs) and health behaviors in 87 Black and White men living with HIV (MLWH). We also examined ethnicity as a moderator of this model. Depressive symptoms were an indirect mechanism through which HIV-specific USIs explained poorer health behaviors. The indirect effects between disconnecting USI, more depressive symptoms, and poorer health behaviors were significant for Black men but not for White men. Depressive symptoms may be one pathway through which USI are associated with physical health, and disconnecting USI may be particularly detrimental for Black MLWH.