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    Perceptions of mental health care users diagnosed with major depressive disorder of factors that lead to readmission
    (2018) Roestorff-Hambrock, Nadia
    Major Depressive Disorder tends to have a chronic course and Mental Health Care Users with this diagnosis experience challenges after discharge that impact recovery. A qualitative approach and descriptive design were used to explore these challenges and the perceived value that mental health care users attach to support group attendance after discharge. Data were gathered through semi-structured interviews with eleven participants. The transcribed interviews were analysed thematically. Data analysis generated four themes: “Inability to fully benefit from hospitalisation”, “Life was not what I expected it to be after discharge”, “I did not feel supported after discharge” and “Support groups could be valuable”. This study showed that learning is compromised during the acute phase of the disorder affecting the implementation of coping skills after discharge, that recovery is a journey that extends beyond hospitalisation, that the experience of isolation after discharge is detrimental to recovery and that support groups could compensate for some unmet treatment needs at discharge. Keywords: Major Depressive Disorder, challenges, readmission, occupational therapy
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    A description of the mental health outcomes of HIV positive adolescents accessing care in Johannesburg
    (2017) Woollett, Nataly Caren
    Background: Adolescents living with HIV are an emerging group in the global HIV/AIDS epidemic. Mental health in this population impacts HIV care, treatment, consequential morbidity and secondary transmission. Perinatally infected HIV positive adolescents (PIA) have high prevalence of mental health disorders; loss and bereavement are particularly pervasive in their lives, however little is known about the mental health of PIA retained in care in South Africa. How PIA beliefs concerning their HIV infection are affected by the cumulative effect of bereavement (particularly of parents), the failure to disclose to them the cause of death and the manner in which they learn their own HIV positive status, is a subject understudied. Similarly, there is a paucity of research on effective ways to manage such bereavement. Resilience, or positive adaptation to challenging situations, may be particularly important for PIA, who are exposed to significant stigma, risks and stressors. However, there is limited research regarding adolescents in South Africa, partly because section 71 of the National Health Act (NHA) requires parental or guardian's consent. This presents a significant barrier to research on HIV infected adolescents aged under 18 years. The aim of this research is to describe the mental health of HIV positive adolescents (13-19 years) accessing care and treatment in Johannesburg and generate evidence to inform mental health policy for this population in South Africa. The study describes the mental health outcomes of this population with a focus on how bereavement and disclosure impacts on mental health, as well as how resilience is manifest in this group. Methods: Prior to commencement of the research, an order was obtained from the High Court in Johannesburg as upper guardian of minor children for the statutory parental or guardian’s consent. For the thesis, data from three studies are presented in five published papers. These studies were conducted using a combination of qualitative and quantitative techniques resulting in a mixed methods study design. For the quantitative study, HIV positive adolescents aged 13-19 years (n=343) accessing five pediatric antiretroviral clinics in Johannesburg were assessed using standardized measures for depression (Children’s Depression Inventory), anxiety (Children’s Manifext Anxiety Scale), post traumatic stress disorder (PTSD) (Child PTSD Checklist) and suicidality (MINI International Psychiatric Interview). In addition to mental health, the survey captured information regarding HIV, sexual reproductive health and coping. Descriptive and bivariate analyses were conducted on all variables using Statistica v13. Two qualitative studies were conducted. The first purposively selected 25 participants from the larger study. The aim was to identify elements of resilience through in-depth interviews in this group of PIA. The second identified the most and least symptomatic participants (n=26) from the larger cohort on scores for mental health (depression, anxiety, post traumatic stress disorder, suicidality). Drawings and written accounts of the loss of a significant attachment figure of participants were assessed and compared by professionals (art therapists, psychologists, social workers and counsellors) in three focus group discussions. The goal of this study was to understand the influence of bereavement on mental health and the use of drawing and writing in expressing the experience of loss. Data were analysed in NVIVO 10 using a thematic approach to coding. The final paper details the process of obtaining ethical approval for research with adolescents in public health facilities through a case study (this PhD). Results: Of the enrolled 343 participants, 27% were symptomatic for depression, anxiety or PTSD; 24% reported suicidality. Results indicated high rates of comorbidity amongst depression, anxiety and PTSD. Females scored significantly higher for depression (p<.001), anxiety (p<.01), and PTSD (p<.001) than males. Those reporting suicidality also reported significantly higher on all three mental health scales suggesting that suicidal individuals are more likely to present with higher levels of depression (p<.001), anxiety (p<.001) and PTSD (p<.001). Almost 90% did not feel that they belonged in the family with which they lived. Peer violence was significantly correlated to all mental health problems, also hunger, being inappropriately touched, being hit and being female. High exposure to violence was evident and not feeling safe at home or in community increased risk for all mental health disorders. Knowing one’s HIV status, however, was protective as was having dreams for the future. The qualitative studies highlighted that despite marked stressors in the lives of these adolescents, a high degree of resilience was described. Characteristics of resilience in this group included a pertinent set of beliefs, including a belief in fate and recognition of personal strength as a consequence of managing adversity. Character traits such as a pragmatic acceptance about one’s life, actively taking responsibility, and a robust self-esteem were evident. Social behaviours included the ability to pursue and access adults and healthcare to meet developmental needs, having a desire to support and help others and challenging HIV related stigma. These characteristics were underscored by the capacity for self-reflection. The studies also revealed that PIA have limited understanding of how they became infected, vertical transmission and potential benefits of PMTCT to their future reproductive needs, despite disclosure. Most participants were experiencing complicated grieving which was impacting negatively on their mental health, ability to accept their HIV status and adhere to treatment. The drawings and written accounts of the qualitative study accentuated contextual deprivation, including high exposure to multiple and consistent losses of significant attachment figures. They also pointed to emotional deprivation and impoverishment, including unresolved complicated grieving. Views from participants emphasized missed opportunities, including failure to address the mental health concerns of this population at risk. The case study suggested that without court intervention, most of the participants, being orphans without guardians, could not have participated in the research because the statutory consent was otherwise impossible. This case study argues for exceptions to the parental consent requirement, by reason of the exclusion of Orphaned and Vulnerable Children and Youth (OVCY) from research. Inconsistent and confusing legal policy that inadvertently silences voices that most need to be heard, as well as law that is inconsistent with principles of justice, inclusiveness and autonomy, are put forward to argue for a change to the National Health Act. Conclusion: HIV positive adolescents accessing care demonstrate high levels of mental health problems that are largely unrecognized and could potentially be addressed within health systems. Recognition of mental health challenges in PIA is crucial to effective HIV care and treatment and providers need to be sufficiently sensitized to this reality. PIA need improved communication regarding vertical transmission and PMTCT to properly understand their HIV status and engage effectively in management. Honest communication about how relatives died and disclosure of HIV status is necessary to reduced stigma, complicated grieving and improve mental health. The impact of unprocessed loss early in life has long-term negative consequences for PIA. Innovative methods are required to address unmet mental health needs of this patient population. The use of non-verbal methods (drawing and writing) by healthcare professionals could be especially valuable to both patient and provider, particularly in the case of managing bereavement. PIA, who face high levels of hardship and change, nevertheless exhibit strong resiliency beliefs, traits, and behaviours. Healthcare environments have the potential to be utilized as powerful resources in fostering resilience in PIA, if characteristics of adolescent resilience are integrated into prevention and intervention programming. Finally, a balance is required between protecting adolescents from exploitation and permitting access to benefits of research. Mandating parental consent for all research does not necessarily give effect to policy. For the vast majority of South African HIV infected adolescents parental consent is not possible. Adolescents are understudied and poorly understood and although these laws are there to protect this vulnerable group, it also makes them and their problems less visible. In order to scale up interventions, careful consideration needs to be placed on how the laws can help researchers benefit adolescents. Section 71 of the National Health Act ought to be amended to facilitate valuable and necessary research concerning HIV infected orphan children and adolescents. Keywords: perinatal HIV infection, HIV positive adolescents, vulnerable youth, mental health, healthcare system, disclosure, violence, orphan, bereavement, complicated grief, drawing, resilience, research, National Health Act
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    Routine measurement of outcomes for mental health care users attending occupational therapy
    (2016) Silaule, Olindah
    Introduction: The lack of accurate routinely collected data regarding mental health services is one of the several ongoing challenges facing healthcare services in South Africa. The increasing emphasis on routine outcome measurement within the field of mental health has urged occupational therapists to demonstrate the impact of their intervention on mental health care users. Therefore, the aim of this study was to implement routine outcomes measurement in the occupational therapy department in order to describe and document changes in activity participation in MHCUs at Tintswalo Hospital situated within a rural site of Mpumalanga province. Methodology: Quantitative methods were employed in this study with a sample size of 64 MHCUs. One group pre/post- test design was used in order to collect data using an Activity Participation Outcome Measure (APOM). Results: The key findings demonstrated that the majority of participants improved significantly across all of the APOM domains during hospitalisation. A decline in the APOM domains was noted in the follow-up stages yielding insignificant results as demonstrated by the value of the effect sizes. Conclusion: Results of this study demonstrate the relevance of routinely measuring outcomes in mental health. The study generated evidence of change in activity participation during hospitalisation and follow-up and emphasised the need for future research in this regard.
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    Mental health promotion needs assessment of factory workers at a sugar mill company in Swaziland
    (2017) Manana, Sifiso
    Background: Work is both an important resource for mental health, yet it also presents psychosocial risks for mental health. The workplace has been identified as a potential setting for both mental health promotion and mental illness prevention. It is well documented in the literature that mental (emotional) health needs of employees should be addressed and a mental health promotion programme that addresses diverse mental health aspects should be included in comprehensive workplace health promotion programmes. The selected sugar mill company in Swaziland does not address mental health or mental illness issues through a dedicated programme as part of the comprehensive workplace health promotion programme. Employees/workers with mental health and personal problems are referred to the Employee Assistance Programme (EAP) for assistance and help. Purpose and objectives of the study: The overall purpose of this study was to investigate and describe the mental health promotion needs and mental health concerns of factory workers at a Sugar Mill Company in Swaziland. Research design and method: This study used a qualitative approach, descriptive in nature. In-depth face to face interviews using an interview guide was used to determine the mental health promotion needs of sugar factory workers. Through purposive sampled 20 workers participated in the study. Data analysis: Audio-taped interviews were transcribed verbatim and data were then analysed by means of themes, categories, and sub-categories using Tesch’s method. Main findings: Factors that influenced mental health negatively (stressors) were related to workplace factors (money, workload and long hours) and family factors (family needs money). The mental health promotion needs identified in relation to the workplace consisted of more opportunities for employees’ development, salary increase and enhanced management and communication skills of supervisors and managers. In addition, health and life skills education, as well as more counseling services were identified as mental health needs. Conclusions: The identified mental health needs can be addressed through the Sugar Mill’s existing workplace health promotion programme. Key words: Mental health promotion, mental health, needs, factory workers.
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    Glossolalia
    (1960) Van Eetveldt Vivier, Lincoln Morse
    The introduction to the problem covers mainly three sections, namely. Biblical, Historical and Psychological. Various tests are then named and described. This is followed by the section dealing with the Test Results, statistical methods used and finally a summary and conclusion. The summary and conclusion are of necessity brief, and cannot be expected to cover the whole field. Special mention must here be made of & B. Cutten whose book Speaking with Tongues is considered by the present writer to be the most scholarly and extensive account of the historical aspect of GLOSSOLALIA yet systematised. Portions relevant to the present investigation were either quoted in toto or epitomised because the writer felt they could not be improved upon. An intimate knowledge of the historical instances quoted by Cutten is essential to a complete understanding of the scope of the present work. The only originality claimed lies in the selection and presentation of the material to be found in Cutten's invaluable work. Extensive references and/or quotations have also been taken from the works of A. Schweitzer - Mysticism of St. Paul the Apostle and E.B. Tylor - Primitive Culturo, both of whom are regarded as being leaders of thought in their respective fields.
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    Occupational stress in a South African workforce: instrument testing, prevalence measurement and risk factor analysis
    (2015-03-27) Volmink, Heinrich Cyril
    Background Occupational stress represents a substantial public health challenge. Although there has been an extensive focus on this form of stress within the international setting, there appears to be a paucity of relevant evidence within South Africa. Specifically, within the local context, there are relatively few: (1) reliability testing studies of screening and assessment instruments, (2) prevalence analyses of occupational stress and (3) work-related stress management intervention designs. Methods A cross-sectional descriptive and analytical study was undertaken in a large tertiary hospital in Johannesburg. Primary data were collected between February 2013 and September 2013 using the Copenhagen Psychosocial Questionnaire (COPSOQ). A sample (n=166) of administrative staff was selected, stratified into front line staff (n=54), back office staff (n=90) and managers (n=22). Data analysis included reliability testing of the COPSOQ using the Cronbach‘s alpha statistic. Prevalence measurement was also undertaken to describe the distribution of stress and other variables across the study sample. Finally, logistic regression was used to estimate associations between the exposure variables and the stress outcome (at the p < 0.05 level of significance). Results The Cronbach‘s alpha range for the COPSOQ was 0.31 to 0.85. Two out of 24 scales of the instrument fell below the unacceptability threshold of 0.5. In terms of prevalence, the stress mean for the study sample (on a scale from 0 to 100) was 38.8 (SD 19.8). Furthermore, 68.1% (n=113) of the study sample had a stress value above the reference mean. There were also significant differences in the stress values by job category, with managers having the highest mean at 51.2 (SD 24.2). Adjusting for job category, risk factors significantly associated with occupational stress in the main logistic model were offensive behaviour (OR 3.38, 95% CI: 1.54 – 7.43), quantitative demands (OR 2.83, 95% CI: 1.35 – 5.92) and emotional demands (OR 2.32, 95% CI: 1.08 – 4.96), while quality of leadership (OR 0.32, 95% CI: 0.15 – 0.67) was a protective factor. Further analysis showed that the most harmful risk factor for females was work-family conflict (OR 4.03; 95% CI: 1.45 - 11.21), and for males was exposure to offensive behaviour (OR 4.63; 95% CI: 1.15 - 18.63). Finally, ordinal regression found offensive behaviour (OR 3.60; 95% CI: 1.92 - 6.75) and quantitative demands (OR: 2.38; 95% CI: 1.27 - 4.46) to be significant risks for moving from low stress to high stress, while a commitment to workplace (OR 0.46; 95% CI: 0.24 - 0.86) could help to prevent this. Conclusions The level of occupational stress in the study sample was high relative to reference values. An occupational stress intervention is recommended, which should include primary, secondary and tertiary prevention strategies (according to identified risks). Further development of the instrument is also recommended, so as to improve its reliability in the local context. Finally, future research into occupational stress should explore the impact of factors such as resource constraints and HIV/AIDS, and should include an expansion into other settings and occupational categories. Key words Occupational stress, questionnaire reliability, psychosocial risks, intervention design.
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    Identifying the understanding of mental illness of mental health care users of mixed ancestry group attending a community mental health clinic
    (2013-04-24) Ramanlal, Arunaben
    The purpose of this study was to elicit how mental health care users from a mixed ancestry group, otherwise called “Coloureds” at a Mental Health Clinic in an urban South African context, understood mental illness. “Coloured” peoples perceptions about mental illness in not well documented as few studies have addressed the needs of this population group in South Africa. The purpose was addressed within a closed questionnaire schedule using the Illness Perception Questionnaire - Mental Health, which was administered over a two month period, from 3rd June 2011 to 29th July 2011, using a non experimental, prospective, descriptive research design survey method. Data were collected by means of a self administered questionnaire and analysed by means of descriptive statistics. According to the statistician no confidence level was necessary as the instrument used was already tested to be valid and reliable. Since the study was descriptive, no comparative statistics were necessary.The analysed data revealed evidence of poor identification of mental illnesses. This could be a contributory factor to the inadequate adherence to treatment strategies and high re-hospitalization rates in this community. There was also a lack of collaboration between health workers and mental health care users and inadequate imparting of mental illness information by the mental health care practitioners. The positive results that have become evident in this study of good community support, good personal control of illness, a belief in the importance of taking medication and low stress levels, may be utilized effectively to empower this community with knowledge about mental illness. This may allow this community to assume responsibility and be supportive in the efforts to destigmatise mental illness and to ensure that community mental health care services move efficiently and effectively.