Experiences of schizophrenia patients with treatment buddy support during the COVID-19 pandemic

Background: Schizophrenia is a major psychiatric disorder affecting physical, psychosocial, and cognitive functioning. Treatment includes pharmacological and psychotherapeutic interventions. Adherence to prescribed medication is critical but reportedly low, because of side effects, failure to understand instructions, a lack of insight about the condition, cognitive deficits, and financial difficulties. Interventions to promote adherence to medication are required. This study introduced a treatment buddy to provide the patient with virtual support in adherence to medication. Aim: The aim of this study was to explore the participants' lived experiences of a treatment buddy support. Setting: A specialised psychiatric clinic in a resource-constrained district of KwaZulu-Natal, South Africa. Methods: A qualitative study design, using semi-structured one-on-one interviews, was used to collect in-depth data from 24 participants, suffering from schizophrenia and who had been offered virtual treatment buddy support for 6 months. Data were analysed using thematic analysis. Results: The intervention improved adherence to medication. Participants indicated that the text messages served as reminders to take their medication daily. An alleviation of associated problems such as sleeping difficulties was observed. Participants were willing to encourage other patients suffering from schizophrenia to join 'treatment buddy services'. Conclusion: The virtual treatment buddy support increased awareness of the importance to adhere to antipsychotic medications among patients suffering from schizophrenia and helped to resolve other schizophrenia-related problems experienced by the participants. Contribution: The study has provided a supportive intervention that can be utilised by mental health institutions to address poor adherence to medication by patients suffering from schizophrenia.

Psychological impact of the COVID-19 pandemic on anaesthetists in an academic institution in South Africa

Background: Anaesthesiology is considered to be a medical speciality that can result in high levels of stress. The COVID-19 pandemic required anaesthetists to rapidly adopt additional challenging roles. This study describes the psychological impact of the pandemic on anaesthetists and identified and compared factors associated with depression, anxiety, stress, and post-traumatic stress disorder (PTSD). Methods: A cross-sectional study design was used. An anonymous questionnaire was used to collect data utilising convenience sampling and results were reported using descriptive statistics and logistic regression analysis. The order of importance for the sources of stress and organisational support was determined by calculating the median rank. Results: The majority of the participants were between ages 31­40 (62.6%), male (59.8%), registrars (47.6%), had no comorbidities (73.8%), and had no known mental illness (79.9%). Having a previous diagnosis of a mental health illness was linked with greater levels of depression (OR [95% CI] = 4.50 [2.02­10.24], p < 0.001), anxiety(OR [95% CI] = 3.9 [1.7­9.0], p = 0.001), stress (OR [95% CI] = 3.8 [1.6­9.2], p = 0.002), and PTSD (OR [95% CI] = 5.4 [2.2­13.5], p < 0.001). Sources of stress identified included: insecure access to appropriate personal protective equipment, being exposed to COVID-19 at work, and taking the infection home to family. Conclusion: Participants with a history of mental illness were predisposed to developing negative psychological symptoms as a result of the pandemic. The main source of stress identified was insecure access to appropriate personal protective equipment.

Psychosocial factors associated with psychiatric morbidity in higher institution students in Nigeria

Introduction: Mental health disorders in undergraduates are often undetected and may predispose to other academic and social complications. The objective of the study is to determine the prevalence of probable psychiatric morbidity among students of University of Ilorin, Nigeria and the psycho-social factors that are associated with psychiatric morbidity in them. Methods: Socio-demographic questionnaire and the 12-item General health questionnaire (GHQ-12) were administered to 3,300 undergraduate students to assess psychosocial variables and psychiatric morbidity respectively. Results: About 23.5% of respondents scored >3 using the GHQ-12 questionnaire, signifying a likehood of psychiatric morbidity. Students from polygamous families were 1.3 times more likely to have GHQ scores of >3 than those from monogamous (OR=1.276, P=0.026). Those who had unemployed fathers were twice more likely to have a GHQ > 3 than those with employed fathers. (OR=2.084, P=0.005).Those who lived in houses with shared toilet facilities were 1.3 times more likely to have GHQ >3 (OR=1.310, P=0.028) Conclusion: This study calls for a careful consideration and modification of the various psychosocial factors associated with pschiatric morbidity in order to ensure a mentally healthy and vibrant student community

Major cardiovascular risk factors and serious mental disorders, a double-edged sword: literature review

Background. The burden of mental disorders continues to grow with significant impacts on health. Their prevalence is higher in patients presenting cardiovascular risk factors.This review takes stock of the frequency, the mechanisms, and the implications of major cardiovascular risk factors in patients with serious mental disorders. Methods. A literature search was done in PubMed from 1980 to 2021 using various combinations of Mesh termslike tobacco, diabetes mellitus, hypertension, dyslipidemia, major depressive disorder, bipolar disorder, schizophrenia. Results. People with serious mental disordershave a greater prevalence of major cardiovascular risk factors compared to the general population. Conversely, people with cardiovascular diseases more frequently suffer from serious mental disorders. More specifically, we note that 45 to 88% of patients suffering from schizophrenia are tobacco users, Depression is reported to be 3 times higher in hypertensives than in non-hypertensives while around 19% of type 2 diabetic patients suffer from major depressive disorderwhich is 3 times greater than in the general population, and the prevalence of dyslipidemia among persons with severe and persistent mental illness is higher than the prevalence in the general population and ranges from 25% to 70%. The concomitant presence of these different pathologies can be explained either by their intertwined pathophysiological mechanisms, or by the side effects of the various medications taken in the context of these chronic diseases. Conclusion. The predisposing factors for the coexistence of mental illnesses and cardiovascular diseases are often entangled. It would be interesting to carry out more studies to elucidate precisely the different pathophysiological mechanisms of these diseases.

Contexte. La prévalence des maladies mentales est plus élevée chez les patients présentant des facteurs de risque cardiovasculaire. Cette revue fait le point sur la fréquence, les mécanismes et les implications des facteurs de risque cardiovasculaire majeurs chez les patients atteints de pathologies psychiatriques graves. Méthodologie. Une recherche documentaire a été effectuée dans PubMed de 1980 à 2021 en utilisant diverses combinaisons de termes MeSH comme tabac, diabète, hypertension, dyslipidémie, trouble dépressif majeur, trouble bipolaire, schizophrénie. Résultats. Les personnes atteintes de maladie mentales graves ont une plus grande prévalence de facteurs de risque cardiovasculaire majeurs comparé à la population générale. A l'inverse, les personnes atteintes de maladies cardiovasculaires souffrent plus fréquemment de troubles mentaux graves. Plus précisément, on note que 45 à 88% des patients souffrant de schizophrénie consomment du tabac. La dépression serait 3 fois plus élevée chez les hypertendus que chez les non hypertendus. Par ailleurs, environ 19% des patients diabétiques de type 2 souffrent d'un trouble dépressif majeur ce qui est 3 fois plus élevée que dans la population générale. La prévalence des dyslipidémies chez les personnes atteintes d'une maladie mentale grave est supérieure à la prévalence dans la population générale et varie de 25 % à 70 %. La présence concomitante de ces différentes pathologies s'explique soit par leurs mécanismes physiopathologiques imbriqués, soit par les effets secondaires des différents médicaments pris dans le cadre de ces maladies chroniques. Conclusion. Les facteurs prédisposant à la coexistence des maladies mentales et des maladies cardiovasculaires sont souvent intriqués. Il serait intéressant de mener plus d'études pour élucider précisément les différents mécanismes physiopathologiques de ces maladies.

The impacts of COVID-19 pandemic on mental health: A scoping review

Background: This scoping review assessed the COVID-19 impacts on mental health and associated risk factors. Methods: A literature search for relevant articles published between March 2020 and July 2022, was conducted in the APA PsychInfo, JBI Evidence Synthesis, Epistemonikos, PubMed, and Cochrane databases. Results: The article inclusion criteria were met by 72 studies. The commonly used mental health assessment tools were the Patient Health Questionnaire (41.7%), Generalized Anxiety Disorder Scale (36%), 21-item Depression, Anxiety, and Stress (13.9%), Impact of Event Scale (12.5%), Pittsburgh Sleep Quality Index (9.7%), Symptom Checklist and the General Health Questionnaire (6.9% each). The prevalence rate of depression ranged from 5-76.5%, 5.6-80.5% for anxiety, 9.1- 65% for Post-Traumatic Stress Disorder, 8.3-61.7% for sleep disorders, 4.9-70.1% for stress, 7-71.5% for psychological distress, and 21.4-69.3% for general mental health conditions. The risks included female gender, healthcare related/frontline jobs, isolation/quarantine, poverty, lower education, COVID-19 risk, age, commodities, mental illness history, negative psychology, and higher social media exposure. The incidence of mental disorders increased along with the increasing cases of COVID-19 and the corresponding government restrictions. Conclusion: Standard mental health assessment tools were used in these studies conducted during COVID-19. Mental health disorders like depression, anxiety, and stress increased during the COVID-19 pandemic and lockdowns. Various factors impacted the prevalence of mental health disorders. Policymakers need to provide social protective measures to improve coping in critical health events. Further studies should investigate the effectiveness of interventions for reducing the prevalence and risk factors for mental health conditions during a public health emergency.

Prevalence and correlates of common mental disorders among children and adolescents in Blantyre-Urban, Malawi

The high global prevalence of mental disorders justifies the need to quantify their burden in the sub-Saharan Africa where there is a dearth of information. These mental disorders are linked to different socio-demographic factors. Objective To determine the prevalence of, and factors associated with mental disorders among children and adolescents in Blantyre City, Malawi. Methods: Children and adolescents aged 6 to 17 years were interviewed to determine their socio-demographic characteristics and assess their mental health status using the Strengths and Difficulties Questionnaire (SDQ) and Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Associations between mental disorders and socio-demographic characteristics were tested using Chi-square and logistic regression analysis. Results The prevalence of symptoms of psychopathology on the SDQ was 7.3% (95%CI 4.8-10.5%) while for the K-SADS was 5.9% (95% CI 3.7%-8.9%). The prevalence of mental disorders across the age ranges of 6 to 12 years and 13 to 17 years was 5.4% and 7.9 % respectively. Males had a higher prevalence (7.1%) compared to females (4.7%). Conduct disorder was most prevalent (3.4%), followed by either type of ADHD- Attention Deficit Hyperactive Disorders (2.0%). Having a single parent (p<0.001), staying with a nonbiological guardian (p<0.030), engaging in paid work (p<0.039), not attending school (p<0.019) and having teacher difficulties(p<0.028) were positively associated with a mental disorder. Conclusion The socio-demographic factors associated with the risk of developing mental disorders may be important targets for mental health intervention programs

Insights into the clinical profile and comorbidities of factitious disorder in a multispeciality setting in southwest Nigeria: A cases series and review

Background: Factitious disorder (FD) is an under-recognized and under-diagnosed mental condition. Healthcare professionals often have challenges to diagnose and treating the disorder. As a result, needless and endless medical resources are recommended to assess and evaluate those affected. FD may present as a physical condition, a psychological disorder, or maybe both depending on the prominent symptoms. However, there is a strong correlation between having FD and psychiatric symptoms. Main Text: FD occurs in early adulthood, with a mean age of onset of 25 years in both genders, although with differing demographic features. The lifetime prevalence of FD imposed on oneself in clinical settings is 1.0%, 0.1% in the overall population (ranging between 0.007% and 8.0%) and occurs more in female health care professionals. FD may make up 0.6%­3.0% of psychiatric referrals, and it accounts for 3-5% of doctor-patient contacts. In actuality, 1-2% of hospital admissions and an average of 6-8% of all psychiatric admissions have been underreported. The study aimed to highlight the signs and symptoms of FD identified in a psychiatry department of a multispecialty center and to increase the awareness of health practitioners. A critical review of the literature was done with an emphasis on psychological symptoms. PubMed, Mendeley, and Google Scholar were thoroughly searched and full-text publications of journals from 2010-2021 were included. Conclusion: FD is a diagnostic puzzle that necessitates adequate, prompt medical attention as well as social support because of the potentially fatal consequence. A stronger patient-therapist relationship can strengthen the patient's conscious self-control to minimize the symptoms; therefore the healthcare provider has to be openminded. For the diagnostic enigma to be removed and for ease of treatment, additional research, increasing awareness among medical professionals and the general public, accurate evaluation, diagnosis, and psychotherapy should be encouraged. These case studies will contribute to the knowledge base of FD and improve the quality of care.

Risk factors for cardiovascular disease among people with mental illness in Namibia

Objectives: To determine the prevalence of risk factors for cardiovascular disease (CVD) among people with mental illness attending the Mental Health Care Centre, Windhoek, Namibia Design: Observational, cross-sectional study. Setting: Mental health Care Centre, Windhoek Central Hospital. Namibia Participants: Adult patients with a mental illness attending the Mental Health Care Centre, Windhoek. Data collection: Within a systematic random sampling method, 385 adult patients with mental illness were recruited between May and December 2017. Statistical analysis: Validated assessment tools were used. Descriptive summary statistics and Chi-squared tests of association were conducted. Results: One-third (31.7%) of participants used alcohol, 21% used nicotine, 21.3% had hypertension, 55% were overweight or obese, 59.2% of females and 11.5% of males had abdominal obesity. About twenty per cent (19.9%) of participants did meet the World Health Organisation recommended level of activity, while more than two-thirds of participants did not participate in moderate or vigorous physical activities. The patient's psychiatric condition was significantly associated with alcohol use (Chi-square=20.450, p=0.002) and physical activity (Chi-square=20.989, p=0.002). The psychiatric condition was not associated with the waist circumference and gender of the participant. Conclusions: The increased prevalence of CVD risk factors in people with mental illness calls for mental health practitioners to screen, monitor and manage these risk factors regularly. Systematically screening and monitoring for cardiovascular risk factors is likely to contribute to National targets and significantly impact cardiovascular morbidity and mortality in people with mental illness

HIV knowledge, attitudes and practices amongst patients with severe mental illnesses and chronic medical illnesses in Durban, South Africa

Background: Studies exploring HIV knowledge, attitudes and practices (KAP) of individuals with severe mental illness (SMI) have suggested their poorer knowledge about HIV. In KwaZulu-Natal (KZN) province, South Africa (SA), the epicentre of the country's HIV epidemic, improving KAP is essential for reduce its incidence amongst individuals with SMI. Comparing the KAP related to HIV between those with SMI and chronic medical illnesses (CMI) such as hypertension and diabetes may expose gaps in KAP related to HIV in the mentally ill who are more vulnerable to HIV. Aim: This study aimed to compare the KAP related to HIV between people living with SMI and CMI. Setting: Outpatient clinics in Durban, SA. Methods: A cross-sectional structured questionnaire survey was conducted amongst 214 adult outpatients with SMI and CMI attending two general public sector hospitals in Durban, KZN. The KAP questionnaire consisted of three sections: general information, prevention and transmission of HIV. Results: Interviews were conducted with 124 patients with SMI and 90 with CMI. Most were female (69.5%), single (57.5%) and unemployed (59.4%). The diagnosis of SMI was associated with poorer general information of HIV (p = 0.02), but not with its prevention and transmission compared with those with CMI. Educational level was associated with poorer performance in all three domains: general information of HIV (p = 0.01), prevention (p = 0.01) and transmission (p = 0.02) amongst all the participants. Conclusion: Gaps in the KAP of HIV amongst individuals with SMI compared with those with CMI suggested a need to provide focused health promotion regarding sexual health and HIV to the mentally ill at psychiatric facilities

Intervention on depression and insomnia symptoms during the COVID-19 pandemic

Objectives: The COVID-19 pandemic has created significant psychological challenges globally. Evidence has been mounting of greater emotional distress and possible worsening of underlying psychiatric disorders, due to repercussions of COVID-19. In addition, the pandemic has created barriers to access for help, due to social distancing and travel restrictions. Thus, creating a major need for effective interventions that can be accessed safely from home and provide coping tools which can be learned and practiced while in isolation. An App based Yoga of Immortals (YOI) program is one such strategy to help cope with stressful situations. The objective of this study was to investigate if the YOI program can provide significant benefit for depressive and insomnia symptoms. Material and Methods: Participants in this study were asked to complete two brief online but well validated mental health screening tools before intervention. This was followed by a 7-week long YOI intervention. Following the intervention, participants were once again asked to complete the online validated questionnaires. The survey questionnaires included baseline demographic data and validated scales for measuring insomnia severity Insomnia severity Index (ISI) and levels of depression symptoms patient health questionnaire-8, (PHQ-8). All statistical analysis was performed using the Statistical Package for the Social Science. Results: SY YOI intervention of 7 weeks significantly improved the ISI scores as well as PHQ-8 scores in the study population (P < 0.0001 in all comparisons). Conclusion: YOI intervention is an effective intervention strategy for decreasing insomnia and depression symptoms, even during the pandemic

Research Knowledge of health practitioners regarding mental health integration into human immunodeficiency virus management into primary healthcare level

Background: Mental disorders are common among people living with human immunodeficiency virus (HIV). Human immunodeficiency virus infection is associated with neurological complications, which may negatively affect HIV, leading to virologic as well as immunologic failure. The integration of mental healthcare services into HIV services at a primary healthcare level is vital, as this is the first contact point for most patients accessing healthcare services.Objectives: The aim of this study was to determine the knowledge of healthcare professionals about the integration of mental healthcare services into HIV services at a primary healthcare level.Method: This study was a quantitative descriptive study, designed to determine the knowledge of healthcare professionals towards integrating mental healthcare services into routine services at primary healthcare centres. The purposive sampling method was employed to select the 200 healthcare professionals who participated in this study.Results: The majority of the healthcare professionals (91%) who participated in this study had limited knowledge regarding the integration of mental healthcare services into HIV services at a primary healthcare level. Very few (9%, n = 18) had adequate knowledge about the integration of mental healthcare services into HIV services.Conclusion: Most of the participants had limited knowledge about the subject matter. This, therefore, shows that all stakeholders involved need to implement initiatives to address this knowledge gap

A task-sharing intervention for prepartum common mental disorders: Feasibility, acceptability and responses in a South African sample

Background: Peripartum common mental disorders (CMD) are highly prevalent in low- and middle-income countries (LMIC) such as South Africa. With limited public mental health resources, task sharing approaches to treatment are showing promise. However, little is known about the feasibility and acceptability of, as well as responses associated with problem-solving therapy (PST) for the treatment of prepartum CMD symptoms in South African public health settings. Aim: To investigate participants' preliminary responses to a task sharing PST intervention, and to evaluate the feasibility and acceptability of the intervention. Setting: A Midwife and Obstetrics Unit attached to a Community Health Centre in a Western Cape district. Methods: Using mixed methods, 38 participants' responses to a PST intervention, and their perceptions of its feasibility and acceptability, were explored. Primary outcomes included psychological distress (Self Reporting Questionnaire; SRQ-20) and depression symptoms (Edinborough Postnatal Depression Scale; EPDS). Semi-structured interviews were conducted three after the last session. Six stakeholders were also interviewed. Results: Significant reductions were seen on EPDS (Cohen's d = 0.61; Hedges g = 0.60) and SRQ-20 (Cohen's d = 0.68; Hedges g = 0.67) scores. The intervention's acceptability lay in the opportunity for confidential disclosure of problems; and in relieving staff of the burden of managing of patients' distress. Barriers included lack of transport and work commitments. Conclusion: Results support task sharing PST to Registered Counsellors to treat antenatal CMDs in perinatal primary health care settings. Research is needed on how such programmes might be integrated into public health settings, incorporating other non-specialists

COVID-19: Mental health and clinical equipoise in the face of moral injury

The COVID-19 pandemic may result in 'moral injury' and mental illness to health care workers (HCWs). Resources may at some point run out and situations may arise where difficult ethical decisions need to be made. Properly preparing staff for the job and the associated challenges reduces the risk of moral injury and mental health problems. Under conditions of information overload and uncertainty-related anxiety such as with the COVID-19 pandemic, doctors may stop acting with clinical equipoise and make cognitive errors. These circumstances require doctors to be the voice of reason and lead by example. Doctors must reason critically, be aware of the biases that may influence thinking processes and critically appraise evidence in deciding how to treat patients. Health care systems must address the stress of HCW's by continuously monitoring reactions and and creating mechanisms to offer psychosocial support

Experiences of family caregivers of persons living with mental illness: A meta-synthesis

Background: Meta-synthesis is used to generate and understand new insights from a qualitative perspective. Caregiving is associated with a range of physical and psychological symptoms. Caregivers bear the brunt of caregiving and this has become worse since the inception of de-institutionalisation, as more patients are discharged into the community under the care of their families.Objectives: The purpose of this study was to synthesise phenomenological qualitative studies and create a comprehensive chronicle of phenomena of family caregivers' experiences of caring for relatives living with mental illness.Method: Google Scholar and different electronic databases, which included CINAHL, MEDLINE, EBSCO and PubMed, were searched using keywords for relevant studies published from 1994 to 2014. To obtain an in-depth view of caregivers' lived experiences, a qualitative meta-synthesis was employed to review the findings of 10 studies.Results: A total of 10 studies were included in the meta-synthesis. The family caregivers described their caregiving experiences under four themes: perceived responsibility of caregiving, experiences of emotional effect, experiences of support needs and experiences of changed perspective.Conclusion: The meta-synthesis revealed a lack of emotional coping among the family caregivers. This calls for robust family caregiver interventions to facilitate their mental health

Lived experiences of couples in a relationship where one partner is diagnosed with a mental illness

Background: A partner with mental illness can be challenging in a couple's relationship. Mental illness brings about disintegration in the relationship because the partner without mental illness takes on more responsibilities than before. The partner without mental illness can be subjected to multiple risks, including stress and burden of care. The lived experiences of couples in a relationship where one partner is diagnosed with a mental illness is an under-researched area of mental health.Objectives: To explore and describe the lived experiences of couples in a relationship where one partner is diagnosed with a mental illness.Method: A qualitative, descriptive, exploratory and contextual research design was utilised. A purposive sampling method was used to sample participants for this study. Five couples, where one partner was diagnosed with a mental illness, participated in the study. Ten in-depth, individual, phenomenological interviews were conducted to provide rich descriptions of the couples' experiences. Data were analysed using thematic analysis. An independent coder assisted with the data analysis. A consensus discussion was held between the independent coder and the interviewing researcher to agree on the identified themes.Results: Four themes with categories emerged from the data analysis: couples experienced changed social roles in their relationship, emotional upheaval was experienced by the individual partners in the couple relationship, interpersonal distance was experienced in the couple's relationship and a changed relationship with the self was experienced by the individual partners in the couple relationship.Conclusion: The results concluded that couples experienced that the presence of mental illness in their relationship adversely affects the relationship, thus emphasising the need to empower the couples dealing with challenges of being in a relationship where one partner is diagnosed with a mental illness

The prevalence and factors associated with mental distress among college students in Southern Ethiopia: a cross-sectional study

BACKGROUND: Although mental health problems affect the general population, students are highly vulnerable to psychological disorders. Mental distress among students is a cause of concern as it may impair their behavior and diminish learning, which could negatively affect their academic performance. Therefore, the objective of this study was to assess the prevalence and the factors associated with mental distress among college students in Southern Ethiopia. METHODS: Institution based cross-sectional study was conducted among 280 regular students of Hawassa College of Health Sciences. Mental distress was measured using a Self-Reporting Questionnaire (SRQ-20). The data were entered into Epi-Info version 3.5.4 and analyzed using Statistical Package for Social Science (SPSS) version 20. Multivariable logistic analysis was performed following bivariate analysis to adjust for the effect of confounders. RESULT: The prevalence of mental distress among the study subjects was found to be 59 (22.30%). Female students were 2.08 times more likely to have mental distress as compared to male students (AOR =2.08 [95% CI: 1.14-3.82]). The odds of mental distress among third-year students was 60% lower compared to second-year students [AOR = 0.40; 95 % CI, (0.19, 0.87)]. Students who were from Amhara ethnic group were 3.37 times more likely to have mental distress as compared to students from Sidama ethnic group [AOR=3.37;95%CI (1.13-10.09)]. Moreover, students who had Grade Point Average of below 60% were 4.69 times more likely to be mentally distressed as compared to those students who scored Grade Point Average of greater or equal to 60% (AOR= 4.69; 95% CI,[ 2.46, 8.96). CONCLUSION: The finding suggests the importance of providing mental health counseling support for students as part of the teaching and learning process. More research to further explore the multiple factors influencing students' mental health condition should also be conducted

Mental health care - a public health priority in South Africa

Mental health is an integral part of health and it includes an individual's emotional, psychological and social well-being. Mental illness remains underreported and underdiagnosed, particularly in low- and middle-income countries, including South Africa. South Africa carries a huge burden of mental illnesses with the most prevalent being anxiety disorders, substance abuse disorders, mood disorders and depression. People with mental health conditions often face neglect in the health system as well as stigma and discrimination. This has resulted in poor health outcomes, isolation and high suicide rates, including amongst adolescents. The South African National Mental Health Policy Framework and Strategic Plan (2013­2020) aims to integrate mental health into the health system to provide quality mental health services that are accessible, equitable and comprehensive, particularly for community-based mental health. This article provides an overview of mental health care in South Africa, highlighting its public health importance

Social anxiety disorder and childhood trauma in the context of anxiety (behavioural inhibition), impulsivity (behavioural activation) and quality of life

Background: Social anxiety disorder (SAD) is one of the most prevalent psychiatric disorders in South Africa. Previous studies have linked childhood trauma with the development of SAD. The behavioural inhibition system (BIS) and the behavioural activation system (BAS), two dimensions of personality related to anxiety and impulsivity, respectively, are said to influence the development of psychopathology, including SAD. Both SAD and childhood trauma have an impact on quality of life. This study investigated the relationship between BIS, BAS and quality of life in patients with SAD with and without exposure to childhood trauma, compared to healthy controls. Method: Data were collected for 102 adults. A total of 76 participants met SAD criteria, of which 51 were exposed to childhood trauma and 25 were not. The remaining 26 participants were demographically matched healthy controls. Measures of anxiety, impulsivity and quality of life were obtained by administering Carver and White's BIS/BAS scales and the Quality of Life Enjoyment and Satisfaction Questionnaire ­ Self Report. Results: A positive correlation was found between the severity of SAD symptoms and the amount of childhood trauma exposure. No significant differences in impulsivity were found across the three groups. Healthy controls reported significantly lower anxiety and a better quality of life than both groups with SAD, while no differences were found between patients with SAD and childhood trauma and those without childhood trauma. Conclusion: More childhood trauma exposure appears to be associated with greater SAD severity. The lack of differences in BIS, BAS and quality of life in patients with SAD with or without childhood trauma requires further investigation

Patients' opinions about referral from a tertiary specialist psychiatric hospital to primary healthcare

Background: Referral of patients from tertiary specialist psychiatric hospitals to primary healthcare settings is a worldwide goal. This is of particular importance in South Africa with its considerable burden of mental disorders and limited resources. However, patients are often reluctant to be referred and studies have shown that patients may prefer a dedicated psychiatric service over an integrated primary healthcare service. Aim: This study explored the opinions of patients receiving care at a tertiary psychiatric hospital's outpatient department (OPD) about referral to a primary healthcare clinic (PHCC). Setting: The study was conducted at Weskoppies Psychiatric Hospital OPD. Methods: This was a qualitative study based on grounded theory. Participants were recruited through purposive-theoretical sampling. Data were collected by means of individual interviews and mini-essays. Results: From the 80 participants, 18 had individual interviews and 62 wrote mini-essays. Thirty-nine participants had previously attended a PHCC, while 41 had not. Perceived advantages of referral to PHCCs included: close proximity to participants' homes, resulting in saving on travelling time and transport costs, as well as the convenience of receiving psychiatric and other medical treatment at the same healthcare facility. Perceived disadvantages of PHCCs included: unavailability of treatment; lack of doctor-based care; lack of specialised care; loss of established relationships with hospital healthcare workers; mistreatment by PHCC nursing staff; longer waiting times; more stigmatisation. Conclusion: The perceived disadvantages of referral from a tertiary psychiatric hospital to a PHCC outweighed the perceived advantages. Nonetheless, participants expressed willingness for such a referral if their concerns were addressed

Knowledge and perception of mental disorders among relatives of mentally ill persons in a rural community in South-South Nigeria

Background: In Nigeria, mental disorders (MDs) are prevalent in the population and compounding the problem is the misconceptions and poor perceptions associated with these conditions. Consequently, the study was designed to assess the knowledge and perception of mental disorders among relatives of mentally ill persons in Amai community, Ukwuani Local Government Area, Delta State Nigeria. Methods: This was a descriptive study utilising qualitative method of data collection. An in-depth interview was conducted among 20 relatives of mentally ill people selected purposively from four quarters in Amai community. An in-depth interview guide was used to collect the data and was analysed manually for themes and content. Results: The age range of the participants was 25-75 years, comprising 11 females and nine males. The participants demonstrated some form of knowledge of the critical element of MDs, but showed misconceptions on the causes of MDs. Most of the participants preferred traditional (unorthodox) medicine for the treatment of MDs. Furthermore, despite their affirmative perception of MDs as a serious illness, the majority exhibited negative perception towards people with MDs.Conclusion: Misconceptions and myths about the causes of mental disorder are very prevalent among rural dwellers. Poor perception towards mentally challenged persons among relatives of mentally challenged persons was also common. Therefore, these misconceptions and myths should be corrected through organized strategic awareness campaigns among rural dwellers aimed at eliminating these misconceptions and myths, thereby improving the quality of life of persons suffering from MDs