Wylene Saal

The applicability of the Theory of Planned Behaviour in predicting adherence to ART among a South African sample

We sought to determine the extent to which the Theory of Planned Behaviour (TPB) was applicable in predicting medication adherence among South Africans receiving antiretroviral therapy (ART). Regression analyses revealed that the linear combination of attitudes towards adherence, perceived behavioural control and perceived group norms explained 12 percent of the variance in intentions to adhere to ART. We also found a non-significant relationship between intentions to adhere to treatment and self-reported adherence. The results call into question the extent to which TPB is helpful in understanding a health-promoting behaviour such as medication adherence among South Africans receiving ART.

Relationship between depressive symptoms, alcohol use, and antiretroviral therapy adherence among HIV-infected, clinic-attending patients in South Africa

Despite the prevalence of depression and alcohol use among HIV-infected individuals, few studies have examined their association together in relation to nonadherence to antiretroviral therapy in sub-Saharan Africa. This study examined depressive symptoms, alcohol use, and other psychosocial factors (stigma, demographic characteristics) in relation to nonadherence to antiretroviral therapy among clinic-attending, HIV-infected individuals in South Africa (n = 101). Nonadherence was assessed using event-level measurement (missed doses over the past weekend). Multivariable logistic regression analyses revealed that only alcohol use, over and above depressive symptoms and education level, was associated with antiretroviral therapy nonadherence(AOR = 1.15; 95%CI = 1.02–1.29; p < .05). Findings point to the independent association of alcohol use and nonadherence to antiretroviral therapy above and beyond depressive symptoms.

Distress, depression and anxiety among persons seeking HIV testing

ABSTRACT We investigated psychological distress and symptoms of depression and anxiety among 485 South Africans seeking HIV testing. The mean scores of the sample were 45.78 (SD = 16.81) on the Hopkins Symptom Checklist; 15.8 (SD = 12.4) on the Beck Depression Inventory and 12.44 (SD = 13.00) on the Beck Anxiety Inventory, which fell in the elevated, mild and low ranges on these instruments, respectively. For more than a third of participants, symptoms of depression and clinically significant distress were at least moderate and in some cases severe, indicating that they may have benefitted from psychological help. We make the case that symptoms of depression and distress are common among persons seeking HIV testing and are therefore not a consequence of an HIV-positive test result.

The relationship between symptoms of common mental disorders and drug and alcohol misuse among persons seeking an HIV test

ABSTRACT We studied 500 South Africans who sought an HIV test in a community outreach setting. On average, both men and women in the sample indicated hazardous and harmful alcohol use, as well as possible alcohol dependence. Men but not women among the sample experienced drug-related problems. Men were 1.64 times more likely than females to report problematic alcohol use and 4.88 times more likely than females to report drug use. Symptoms of posttraumatic stress, anxiety, and depression significantly explained 16.5% of the variance in alcohol misuse. Symptoms of posttraumatic stress significantly explained 23.5% of the variance in drug use. Implications are explored in the context of HIV testing.

Prevalence of Traumatic Events and Symptoms of PTSD Among South Africans Receiving an HIV Test

We studied posttraumatic stress disorder (PTSD) among a community sample of 500 persons seeking an HIV test. The majority of participants (62.2%) indicated that they had experienced at least one index event that qualified for PTSD, even though a small proportion (5%) actually met the diagnostic criteria for the disorder. Of those who reported an index event, 25 (8.04%) met the diagnostic criteria for PTSD while 286 (91.96%) did not. On average about one-third of participants who did not meet the criteria for PTSD endorsed PTSD symptoms whereas more than three quarters of those who met the full criteria did so. No demographic factors were associated with PTSD caseness, except number of traumatic events. These results are discussed in the context of the need to address traumatic events and PTSD among persons who undergo HIV testing.

Utility of the Posttraumatic Stress Scale–Self-report version in screening for posttraumatic stress disorder among persons seeking HIV testing

The literature on the utility of self-report instruments in determining caseness for posttraumatic stress disorder in South Africa is sparse. We administered the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders–Research Version and the Posttraumatic Stress Scale–Self-report version to a sample of 500 South African community members seeking HIV testing. Of our original sample of 500, 306 (61.2%) reported an index event for posttraumatic stress disorder and 25 (5.0%) met the criteria for this diagnosis. The Posttraumatic Stress Scale–Self-report displayed internal consistency of .95 as measured by Cronbach’s alpha. Using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders as a gold standard, we conducted receiver operating curve analysis among the 306 participants who reported an index traumatic event to determine the extent to which the Posttraumatic Stress Scale–Self-report as a screening instrument successfully discriminated between participants who did and did not meet the diagnostic criteria for posttraumatic stress disorder. The Posttraumatic Stress Scale–Self-report yielded sensitivity of .76 and specificity of .78, with an area under the curve of .837. Positive and negative predictive values were .24 and .97, respectively. Our findings suggest that the Posttraumatic Stress Scale–Self-report may be effectively used to screen for posttraumatic stress disorder among community samples, including persons seeking HIV testing.

Utility of the Beck Depression Inventory in measuring major depression among individuals seeking HIV testing in the Western Cape, South Africa

ABSTRACT The Beck Depression Inventory (BDI) is often used to screen individuals for symptoms of major depressive disorder (MDD). Yet, its effectiveness in correctly discriminating between MDD cases and non-cases among individuals seeking HIV testing has not been investigated. We report on the effectiveness of the BDI-I in predicting caseness for MDD with the Structured Clinical Interview for the DSM (SCID) as a gold standard. A total of 500 HIV test-seekers were recruited at five non-medical testing sites in the Western Cape, South Africa. Receiver operating characteristic curve analysis was used to determine the extent to which the screening instrument was able to discriminate between MDD caseness or non-caseness. The SCID-based prevalence of MDD was 14.4%. The BDI-I predicted MDD with 67% sensitivity and 67% specificity, with an area under the curve (AUC) of 77%. The positive and negative predictive values were 0.25 and 0.92, respectively. Even though the BDI-I is often used to screen large numbers of people for depression, especially in psychiatric and medical settings, its ability to predict MDD is limited. Persons screening positive for MDD may still require evaluation with a clinical interview by a trained professional to be diagnosed with depression.

Suicidal ideation and behaviour among persons seeking HIV testing in peri-urban areas of Cape Town, South Africa: a lost opportunity for suicide prevention

ABSTRACT Suicidal ideation and behaviour (SIB) are among the psychiatric sequela of HIV/AIDS. Few studies have however examined the prevalence and correlates of SIB among persons seeking HIV testing. We set out to document the prevalence and correlates of SIB among people seeking HIV testing in peri-urban areas of Cape Town, South Africa (SA). A cross-sectional research design was used to recruit a sample (n = 500) of individuals seeking HIV testing. Self-report measures were used to assess two-week prevalence of SIB as well as life-time prevalence of suicide attempt. A structured clinical interview was used to assess common mental disorders (CMDs). Regression analysis was used to determine if CMD and socio-demographic variables predicted suicidal ideation. The mean age of the sample was 36 years, 51.6% were female and 46.6% were unemployed. The two-week prevalence of suicidal ideation was 24.27% while the two-week prevalence of suicide attempt and suicide plans was 2.8%. Suicidal ideation was not associated with age, gender, employment status, family income or household food insecurity. CMDs were significantly associated with suicidal ideation; individuals with depressive disorders were approximately 5.5 times more likely to report suicidal ideation, while those with generalised anxiety disorder, trauma-related disorders and alcohol use disorder were approximately 7, 4.7 and 2.8 times more likely to report suicidal ideation, respectively. Results suggest that persons seeking HIV testing may be a well-delineated group of persons at risk of suicide in this region of SA. Contact with the health care system during HIV testing provides an opportunity for targeted suicide prevention interventions in what appears to be a high risk group.

Using the Beck Anxiety Inventory Among South Africans Living With HIV Exploratory and Higher Order Factor Analyses

We administered the Beck Anxiety Inventory (BAI) to 101 adults receiving HIV treatment. Exploratory factor analysis yielded a single anxiety factor that accounted for 68.7% of the variance in the data. A single score may be used to indicate the overall level of anxiety of individuals receiving HIV treatment in South Africa.