3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Factors associated with postnatal depression at Levai Mbatha Community Healthcare Centre Evaton, Sedibeng District(2019) Phukuta, NyunduIntroduction Depression is a significant cause of disability globally, and approximately one in five women will experience an episode of depression during pregnancy and/or the postnatal period. Despite it being a common postnatal psychiatric condition with an important impact on not only the mother and child but also the family, postnatal depression (PND) has received only little attention in developing countries. This study aimed to determine the point prevalence and factors associated with PND among postnatal mothers attending Levai Mbatha clinic, in Gauteng South Africa. Method This cross-sectional study was conducted among 227 consecutively recruited mothers who attended the postnatal clinic. A researcher-administrated Edinburg Postnatal Depression Scale (EPDS) questionnaire was used to collect information on mothers’ mental state. In addition, socio-demographic and clinical information was also obtained. Analysis was done using descriptive statistics, chi square test and logistic regression. A score of more than 13 on the EPDS was considered positive for PND. Results Participants’ mean age was 27 years. More than half (52.4%) did not complete secondary school education, were single (55.5%), and employed or had an employed partner (60%). Using the EPDS, the point prevalence of PND was 38.8%. Most participants had no medical illness (67%) or previous PND (97%), were breastfeeding (88%), and had an unplanned pregnancy (58%). More than a third had a negative view of pregnancy or the sex of the child (37% and 34%, respectively). Most participants reported having had a favorable delivery (93%), were in a monogamous relationship (85%), and were financially supported by their partner or family (85%). Mothers who only completed primary school were significantly more likely to have PND (OR: 9.11; 95% CI: 1.03-80.22) than others. Mothers who used contraceptive methods prior falling pregnant were twice more likely to have PND compared to those who did not (OR: 2.05; 95% CI 1.12-3.72; p= 0.019). The likelihood of having PND was significantly lower for the mothers who iv had a relationship with the father of the index child compared to mothers who did not have relationship with the father of the index child (OR: 0.42; 95% CI 0.18-0.94; p= 0.037). Mothers who had ever thought of harming themselves or the baby were 22 times more likely to have PND. Conclusion This study found that PND is highly prevalent in the study setting. While this underscores the need for routine screening for PND in the parturient in the postpartum period, interventions aimed at addressing PND need to be cognizant of the influence of unstable relationship between the mother and the father, low level of education, contraception failure and thoughts of self-harm on the development, assessment and management of PND.Item Antenatal depression screening and perintal depression among women at Rahima Moosa Hospital(2018) Marsay, CarinaIn South Africa, 30-40% of women suffer from perinatal depression. This has devastating consequences for both mother and infant, as depressed mothers are at higher obstetric risk and have diminished capacity to care for the physical and emotional needs of their infants. Without adequate screening, approximately 75% of women with perinatal depression will remain undiagnosed and only 10% of these women will receive treatment. Studies conducted in low, middle and high income settings have shown that it is feasible and acceptable to incorporate mental health screening and depression assessment, with referral, into antenatal clinics. The study reported in this dissertation aimed to investigate whether women attending the antenatal clinic at Rahima Moosa Hospital would benefit from antenatal screening for perinatal depression. This would be achieved by determining whether antenatal screening for depression lead to reduced symptoms of depression. In addition, the study was designed to compare the specificity and sensitivity of the Whooley screening questions with the Edinburgh Postnatal Depression Scale (EPDS) in detecting major depression during pregnancy. Lastly, the study aimed to explore the lived experiences, and barriers to care, of women identified as suffering from perinatal depression who were referred for further management. A mixed-method, explanatory design, involving three phases, was used. In the first phase, data were collected using quantitative measures, including a standardised biographical interview, the EPDS, the Whooley screening questions and the Structured Clinical Interview of DSM5. During the second and third phases, quantitative measures were used again to identify changes from phase one. Data were also collected using qualitative indepth interviews to explain results in greater depth. Perinatal depression is a significant public health problem that needs to be addressed in order to improve maternal and child health. Only by listening to the needs of women experiencing perinatal depression can mental health care be improved within obstetric services. Welldesigned research studies which use an explanatory, transformative design can be used to guide effective screening programmes, improve treatment and inform national policy.Item Religious coping mechanism in reducing depression in PLWHA: comparison of generalized structural equation modelling and logistic regression modellin(2017) Chidumwa, GloryBackground People living with HIV/AIDS (PLWHA) are at higher risk of depression compared to HIV uninfected individuals. In addition to pharmacological treatments for depression among PLWHA, psychosocial interventions may facilitate coping with depression. Religious coping is one example of a psychosocial intervention that may help PLWHA confront both health problems and life stressors. The association between religious coping and depression among PLWHA has been examined in higher income countries using regression analyses. To my knowledge, few studies have been conducted on the African continent examining the relationship between religious coping and depression in PLWHA. Further, no study has utilized the generalized structural equation modelling (GSEM) technique to examine the above relationship. Yet literature suggests that this technique is useful in its potential to explore potential mediators and latent confounders as well to quantify each of the factors’ contribution to the covariance structure. This study contributes to the biostatistics literature and aims at addressing this gap. The study compares the GSEM approach to that of the logistic regression approach in exploring the relationship between religious coping and depression. Methods and material A secondary data analysis of a longitudinal study carried out at two specialized HIV clinics in Uganda was conducted. Data from the two sites were combined for analysis. To assess the factors associated with major depressive disorder, multivariable logistic regression and GSEM were utilized in Stata/IC version 14.1. Results Results of the logistic regression procedures suggested that stigma score (aOR = 1.08 95% CI (1.03-1.14) P = 0.002), childhood traumatic experience (aOR = 1.02 95% CI (1.00-1.05) P = 0.017), study site (aOR = 2.17 95% CI (1.48-4.98) P = 0.001), negative life events (aOR = 1.12 95% CI (0.99-1.28) P = 0.083), resilience score (aOR = 0.97 95% CI (0.95-0.99) P = 0.001), coping score (aOR = 1.04 95% CI (1.01-1.08) P = 0.003) and education (aOR = 0.69 95% CI (0.47-1.01) P = 0.054) were significantly associated with depression. However, when controlling for potential confounding factors, no significant association was found between depression and negative and positive religious coping among PLWHA (aOR = 1.12 95% CI (0.91-1.36) P = 0.282 and aOR = 1.01 95% CI (0.92-1.11) P = 0.784, respectively).On the other hand, results from fitting GSEMs showed that stigma score (aOR = 1.15 95% CI (1.10-1.20) P <0.001), childhood trauma score (aOR= 7.87 CI (3.88-15.95) P <0.001), study site, marital status, negative life events, social support score (aOR = 0.32 95% CI (0.21-0.48) P <0.001) and socio-economic status (aOR = 0.72 95% CI (0.50-1.04) P = 0.079) were significant in predicting depression. In addition, there was some evidence that negative religious coping was associated with depression among PLWHA (aOR = 1.18 95% CI (0.99-1.40) P = 0.061). Both modelling procedures thus suggest that stigma score, childhood trauma score, study site and negative life events were predictive of depression. Discussion and conclusion On comparing GSEM and logistic regression, the results obtained in this study suggest that the approaches differ only slightly. The GSEM approach found that negative religious coping was marginally significantly associated with depression. These findings, however, do not suggest superiority of either technique, but instead suggest that researchers should consider utilizing GSEM in analyzing mental health data. While some of the factors associated with depression differed between the two techniques both approaches suggested consistently that stigma score, childhood trauma score, study site, marital status and negative life events are associated with depression.Item A pilot study evaluating depression in mothers with children diagnosed with Down syndrome in state healthcare(2017) Swanepoel, MelissaParenting a child who has an intellectual disability has been shown to increase the risk for developing depression. The purpose of this study was to screen for depression in mothers with a child diagnosed with Down syndrome in state health care in Johannesburg, and to identify associated sociodemographic variables. The Edinburgh Postnatal Depression Scale (EPDS) was used to assess depression in participants along with a 10-item sociodemographic questionnaire, administered to 30 biological mothers of children postnatally diagnosed with Down syndrome. Eight mothers (26.7%) screened positive for depression with an EPDS score of 13 or greater. A statistically significant association was found between an HIV positive status and mothers who had an EPDS score of 13 or greater (p = 0.01). No significant association between a positive screening score for depression and various other sociodemographic factors were identified. Mothers with children diagnosed with Down syndrome, may be vulnerable towards developing depression.Item A randomised double-blind, multicentre parallel group study to compare the tolerability and efficacy of moclobemide administered in three different dosage regimens in depressed outpatients in psychiatric practice(1995) Dr Vukovic, Karen Margaret-AnnMoclobemide is a reversible monoamine oxidase inhibitor. It is a short acting antidepressant, and previously studies were done comparing 300 to 600 mg dosages administered three times daily. Data on a twice daily dosage schedule is limited. This study compares the efficacy and tolerability of Moclobemide 150 mg twice daily as compared to two different three times a day schedules with total daily dosages of 300 to 450 mg respectively. Thirty one adult outpatients with major depressive disorder (as defined by DSM-IIIR) were included in this trial. It was controlled in a randomised double-blind manner. All treatments were found to be effective and no clinically significant differences between treatments could be demonstrated in this respect. Group 3 (150 mg b.d.) was found to be slightly more effective than the other two groups. Moclobemide was found to be effective at all dosage regimens with respect to treating co-morbid symptoms of anxiety and agitation. There were no differences between the groups with respect to type and frequency of adverse events. Overall tolerability was found to be good in all the treatment groups. Since the twice daily dosage is more convenient, it has been suggested that compliance will be enhanced on this regimen. The treatment response rates obtained confirm this conclusion.Item Depressive symptoms in South African black patients with Rheumatoid Arthritis(2012-08) Pillay, AnershaBackground: Rheumatoid Arthritis (RA) is a chronic auto-immune musculoskeletal disorder of unknown aetiology that can result in physical disability, chronic pain and impaired quality of life. RA is associated with an increased prevalence of depression. The presence of depression in RA is reported to be associated with pain, functional disability, high disease activity and mortality. This study aims to determine the prevalence of depressive symptoms in a cohort of Black South African patients attending a Rheumatology outpatient clinic at a public health center. It also aims to determine the association and correlation between the presence of depressive symptoms and the sociodemographic profile and RA clinical characteristics of the study population. Methodology: The study was conducted in a Rheumatology out patient clinic. The study sample consisted of 100 systematically selected participants of Black race. The participants completed the disability questionnaire (HAQ-DI), Visual Analogue Scales (VAS) for pain, fatigue and disease activity; and the depression and tension subscales of the Arthritis Impact Measurement Scale (AIMS). The MADRS was then administered to assess depressive symptoms. Study participants were clinically assessed for disability, joint status and disease activity. Data was analyzed using the SAS version 9.1 statistical program. Results: The majority of the sample was female (85%) and unmarried (66%). The prevalence of current depression was 13.2%, although a further 22.2% of the sample was already stable on antidepressant treatment. The mean RA disease duration was 12.5 ± 9.2 years. No significant associations were found between the presence of depression and the sociodemographic variables. MADRS scores were significantly associated and correlated with disability (p = 0.002, r = 0.30); fatigue (p = <0.001, r = 0.43); disease activity (p = 0.001, r = 0.32); AIMS-D (p < 0.001, r = 0.40) and AIMS-T (p < 0.001, r = 0.35). Upon adjusting for age and clinical status, significant associations remained with MADRS scores and all five above-mentioned RA variables although correlations weakened slightly. Conclusions: Co morbid depression is prevalent in South African Black patients with RA. In order to improve clinical outcomes in RA, depression must be actively sought and effectively managed.Item Exploring the lived experiences and meanings of the body during depression.(2009-09-03T09:23:27Z) Sherry, AltheaDepression is predicted to be one of the largest global health burdens in the future. As such, it is important to expand the current understanding of this disorder, so as to develop more effective treatments. While somatic symptoms are being increasingly recognised as important, one area that has received little attention, is that of the lived somatic experiences in depression and the psychological meanings behind these. This study aimed to contribute to this by utilising a qualitative approach. Interviews were conducted with individuals who had recovered from depression. These interviews focused on experiences at the time of depression, with an emphasis on day-to-day physical aspects. Thematic content analysis of participants' narratives revealed central themes of disconnection from the body, and a sense of lack and deprivation in relation to the body. These themes were evident in both emotional and physical experiences of depression, indicating a link between these two aspects of self. The psychological meanings behind physical experiences were explored utilising psychodynamic etiological theories of depression. These theories included Freud's theory of object loss, the theory of unmet oral dependency needs, as well as Winnicott's understanding of psyche-soma indwelling. Finally, the possibility of the body as symbolic of etiological processes in depression, was discussed in relation to existing psychodynamic literature on the mind-body relationship. The results of this research imply that there may be a relevant relationship between the experiences of the mind and the body in depression, and that physical experiences during depression may potentially be understood as symbolic of underlying etiological processes.