Psychopatholgy, fundamental assumptions and CD-4 T lymphocyte counts in HIV-positive patients

Objective: We investigated whether psychopathology in HIV-positive patients was associated with more negative fundamental assumptions than in healthy controls. In addition; we explored whether psychopathology and negative fundamental assumptions in HIV-positive patients were associated with lower CD4 T-lymphocyte counts. Method: Self-rating questionnaires to assess depressive symptoms; posttraumatic stress symptoms; alcohol abuse; general psychopathology and fundamental assumptions; were completed by 123 HIV-positive patients and 84 uninfected clinic attendees at three primary health care clinics in the Western Cape; South Africa. CD4 T-lymphocyte counts were obtained from chart records. Results: HIV-positive patients reported more depressive and posttraumatic symptoms than uninfected individuals. However when controlling for socio-economic status; the number of traumatic events experienced and other potential confounds; no differences remained. Fundamental assumptions (FA) were mainly positive in both HIV-positive patients and controls and no correlations were found between fundamental assumptions; psychiatric symptoms and CD4 levels. However; in infected patients FA and psychopathology were negatively associated with all participants scoring in the positive range of the FA scale. Conclusion: The positive scores on the FA scale indicate that positive assumptions are related to less psychopathology. Longitudinal studies investigating the association between the valence of fundamental assumptions and HIV morbidity are needed

Childhood trauma in adults with social anxiety disorder and panic disorder: a cross-national study

Objectives: The influence of childhood trauma as a specific environmental factor on the development of adult psychopathology is far from being elucidated. As part of a collaborative project between research groups from South Africa (SA) and Sweden focusing on genetic and environmental factors contributing to anxiety disorders; this study specifically investigated rates of childhood trauma in South African and Swedish patients respectively; and whether; in the sample as a whole; different traumatic experiences in childhood are predictive of social anxiety (SAD) or panic disorder (PD) in adulthood. Method: Participants with SAD or PD (85 from SA; 135 from Sweden) completed the Childhood Trauma Questionnaire (CTQ). Logistic regression was performed with data from the two countries separately; and from the sample as a whole; with primary diagnoses as dependent variables; gender; age; and country as covariates; and the CTQ subscale totals as independent variables. The study also investigated the internal consistency (Cronbach alpha) of the CTQ subscales. Results: SA patients showed higher levels of childhood trauma than Swedish patients. When data from both countries were combined; SAD patients reported higher rates of childhood emotional abuse compared to those with PD. Moreover; emotional abuse in childhood was found to play a predictive role in SAD/PD in adulthood in the Swedish and the combined samples; and the same trend was found in the SA sample. The psychometric qualities of the CTQ subscales were adequate; with the exception of the physical neglect subscale. Conclusion: Our findings suggest that anxiety disorder patients may differ across countries in terms of childhood trauma. Certain forms of childhood abuse may contribute specific vulnerability to different types of psychopathology. Longitudinal studies should focus on the potential sequential development of SAD/PD among individuals with childhood emotional abuse

The Prevalence of Anxiety and Depression Symptoms and Syndromes in Kenyan Children and Adolescents

Background: Community studies on children and adolescents in Western settings suggest prevalence rates of anxiety and depressive symptoms that require intervention. Aim: To establish equivalent prevalence rates in a Kenyan (developing country) situation. Method: Self-administered questionnaires for socio-demographic data; three Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV)-based instruments for anxiety symptoms and syndromes in children; one instrument for depression and one culture sensitive instrument for depression and anxiety were administered in three different sets to 3 775 randomly sampled students drawn from a stratified sample of 34.7of all public secondary schools in Nairobi; Kenya. Results: The prevalence rates of anxiety and depression symptoms and syndromes varied widely depending on sex and age and also on the emphasis of the different instruments used; and also according to the cut-off points for the various syndromes and instruments. Clinical diagnostic scores for depression were recorded in 43.7of all the students. Using the cut-off points for the Multidimensional Anxiety Scale for Children (MASC); anxiety was recorded in 12.9of all students. Nearly half (40.7) of the respondents who completed the Short Leyton Obsessional Inventory for Children and Adolescents had positive scores for obsessive disorder; 81.1were positive for compulsive disorder and an average of 69.1had positive scores for both obsessive and compulsive disorders combined. Amongst those who completed the Ndetei-Othieno-Kathuku (NOK) scale for Depression and Anxiety; 49.3had positive scores for moderate to severe anxiety with or without depression. The Screen for Child Anxiety Related Disorders - Revised (SCARED-R) yielded high levels (50-100) for the different syndromes; with obsessive-compulsive disorder at 99.3; just below separation anxiety and school phobia at 100. Suicidal thoughts and plans were prevalent at 4.9-5.5. Conclusion: Anxiety and depression were found at prevalence rates no less than is found in the West. This calls for appropriate clinical practices and policies

The Prevalence of Anxiety and Depression Symptoms and Syndromes in Kenyan Children and Adolescents

Background: Community studies on children and adolescents in Western settings suggest prevalence rates of anxiety and depressive symptoms that require intervention. Aim: To establish equivalent prevalence rates in a Kenyan (developing country) situation Method: Self-administered questionnaires for socio-demographic data; three Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV)-based instruments for anxiety symptoms and syndromes in children; one instrument for depression and one culture sensitive instrument for depression and anxiety were administered in three different sets to 3 775 randomly sampled students drawn from a stratified sample of 34.7of all public secondary schools in Nairobi; Kenya. Results: The prevalence rates of anxiety and depression symptoms and syndromes varied widely depending on sex and age and also on the emphasis of the different instruments used; and also according to the cut-off points for the various syndromes and instruments. Clinical diagnostic scores for depression were recorded in 43.7of all the students. Using the cut-off points for the Multidimensional Anxiety Scale for Children (MASC); anxiety was recorded in 12.9of all students. Nearly half (40.7) of the respondents who completed the Short Leyton Obsessional Inventory for Children and Adolescents had positive scores for obsessive disorder; 81.1were positive for compulsive disorder and an average of 69.1had positive scores for both obsessive and compulsive disorders combined. Amongst those who completed the Ndetei-Othieno-Kathuku (NOK) scale for Depression and Anxiety; 49.3had positive scores for moderate to severe anxiety with or without depression. The Screen for Child Anxiety Related Disorders - Revised (SCARED-R) yielded high levels (50-100) for the different syndromes; with obsessive-compulsive disorder at 99.3; just below separation anxiety and school phobia at 100. Suicidal thoughts and plans were prevalent at 4.9-5.5.Conclusion: Anxiety and depression were found at prevalence rates no less than is found in the West.This calls for appropriate clinical practices and policies

The Prevalence of Anxiety and Depression Symptoms and Syndromes in Kenyan Children and Adolescents

Background: Community studies on children and adolescents in Western settings suggest prevalence rates of anxiety and depressive symptoms that require intervention. Aim: To establish equivalent prevalence rates in a Kenyan (developing country) situation Method: Self-administered questionnaires for socio-demographic data; three Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV)-based instruments for anxiety symptoms and syndromes in children; one instrument for depression and one culture sensitive instrument for depression and anxiety were administered in three different sets to 3 775 randomly sampled students drawn from a stratified sample of 34.7of all public secondary schools in Nairobi; Kenya. Results: The prevalence rates of anxiety and depression symptoms and syndromes varied widely depending on sex and age and also on the emphasis of the different instruments used; and also according to the cut-off points for the various syndromes and instruments. Clinical diagnostic scores for depression were recorded in 43.7of all the students. Using the cut-off points for the Multidimensional Anxiety Scale for Children (MASC); anxiety was recorded in 12.9of all students. Nearly half (40.7) of the respondents who completed the Short Leyton Obsessional Inventory for Children and Adolescents had positive scores for obsessive disorder; 81.1were positive for compulsive disorder and an average of 69.1had positive scores for both obsessive and compulsive disorders combined. Amongst those who completed the Ndetei-Othieno-Kathuku (NOK) scale for Depression and Anxiety; 49.3had positive scores for moderate to severe anxiety with or without depression. The Screen for Child Anxiety Related Disorders - Revised (SCARED-R) yielded high levels (50-100) for the different syndromes; with obsessive-compulsive disorder at 99.3; just below separation anxiety and school phobia at 100. Suicidal thoughts and plans were prevalent at 4.9-5.5.Conclusion: Anxiety and depression were found at prevalence rates no less than is found in the West.This calls for appropriate clinical practices and policies

Psychometric Properties of the Multidimensional Anxiety Scale for Children (MASC) amongst Nairobi Public Secondary School Children; Kenya

Background: There are few psychometric instruments whose properties have been studied in a developing country's context. Aim: To determine the psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) in Nairobi public secondary school children; Kenya. Method: Concurrent self-administration of the MASC and Children's Depression Inventory (CDI) to students in Nairobi public secondary schools. Results: The MASC had a high overall internal consistency alpha co-efficient (0.85) in the Kenyan sample; which is similar to Western findings; and is hence a reliable tool for measuring anxiety in the study population. It was also similar to the findings from two Western studies in the anxiety domains of physical symptoms; social anxiety; separation anxiety and harm avoidance. The correlation co-efficient with CDI was similar to Scandinavian findings. Conclusion: The MASC can be used in Kenyan children and; by extension; other Africa children

Psychometric Properties of the Multidimensional Anxiety Scale for Children (MASC) amongst Nairobi Public Secondary School Children; Kenya

Background:There are few psychometric instruments whose properties have been studied in a developing country's context.Aim: To determine the psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) in Nairobi public secondary school children; Kenya.Method: Concurrent self-administration of the MASC and Children's Depression Inventory (CDI) to students in Nairobi public secondary schools.Results: The MASC had a high overall internal consistency alpha co-efficient (0.85) in the Kenyan sample; which is similar to Western findings; and is hence a reliable tool for measuring anxiety in the study population.It was also similar to the findings from two Western studies in the anxiety domains of physical symptoms; social anxiety; separation anxiety and harm avoidance.The correlation co-efficient with CDI was similar to Scandinavian findings.Conclusion: The MASC can be used in Kenyan children and; by extension; other Africa children

Psychometric Properties of the Multidimensional Anxiety Scale for Children (MASC) amongst Nairobi Public Secondary School Children; Kenya

Background:There are few psychometric instruments whose properties have been studied in a developing country's context.Aim: To determine the psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) in Nairobi public secondary school children; Kenya.Method: Concurrent self-administration of the MASC and Children's Depression Inventory (CDI) to students in Nairobi public secondary schools.Results: The MASC had a high overall internal consistency alpha co-efficient (0.85) in the Kenyan sample; which is similar to Western findings; and is hence a reliable tool for measuring anxiety in the study population.It was also similar to the findings from two Western studies in the anxiety domains of physical symptoms; social anxiety; separation anxiety and harm avoidance.The correlation co-efficient with CDI was similar to Scandinavian findings.Conclusion: The MASC can be used in Kenyan children and; by extension; other Africa children

Mental health literacy: focus on developing countries

Mental health literacy refers to knowledge and beliefs about mental disorders which aid their recognition, management and prevention. This is a non-systematic review of published articles on mental health literacy in the general population and among primary healthcare workers, in particular, in developing countries, sourced from Medline, PsychInfo and African Healthline databases (1990-2006). Our review of the literature suggests that public knowledge about mental disorders as medical conditions, and their evidence based treatment strategies, in developing countries may be generally poorly or inaccurately understood. The review also reveals that improving the mental health literacy among primary health care professionals is imperative. Poor mental health literacy can be an obstacle to providing treatment for those in need; and is of particular concern in low and middle-income countries where mental health services are already scarce. It is likely that strategies for improvement will need to be comprehensive and innovative, taking advantage of opportunities and meeting challenges faced in the developing world

Post traumatic stress disorder: undiagnosed cases in a tertiary inpatient setting

Objective : Post traumatic stress disorder (PTSD) is a common; debilitating anxiety disorder characterized by emotional and physical symptoms that may occur after exposure to a severely traumatic event. Since it occurs commonly as a comorbid diagnosis with other mood- and anxiety disorders; we postulated that this disorder may be under-diagnosed in therapeutic wards where anxiety and mood disorders are treated. The study thus sought to determine the prevalence of undiagnosed PTSD in an inpatient population; and to compare the demographic details and comorbid diagnoses of subjects with and without PTSD. Method : The Clinician-administered PTSD Scale for DSM-IV (CAPS) was administered to 40 subjects who were inpatients in a therapeutic ward of a large psychiatric hospital and who had never had a diagnosis of PTSD before. Results :16 (40) subjects met the DSM-IV criteria for PTSD. We did not find significant clinical differentiating factors between subjects with and without PTSD; however subjects with PTSD were more likely to use cannabis. Conclusions : PTSD remains undiagnosed in many patients admitted to therapeutic units

Emergency Care Provision for; and Psychological Distress in; Survivors of Domestic Violence

"Background : This study aimed (i) to ascertain the number of treatment referrals and information about protection orders given to survivors of domestic violence presenting for emergency trauma care; as reported at the one-month visit; (ii) to obtain a profile of violent incidents and injuries; and (iii) to assess self-esteem and posttraumatic and depressive symptomatology in the aftermath of injury.Methods : A survey of 62 participants presenting in the acute aftermath of domestic violence (as defined by the Domestic Violence Act of 1998) was conducted over 12 weeks at the Trauma and Resuscitation Unit of a Level One trauma centre in an urban public hospital in South Africa.1 Following informed consent; face-to-face structured interviews were conducted during admission and a month later. The following instruments were administered at baseline: a Demographic and Injury Questionnaire; the Beck Depression and Rosenberg Self-Esteem Inventories; and the Davidson Trauma Scale. A psychosocial questionnaire was administered at the one-month follow-up. Results : Fifty-eight per cent of the participants were female and 42 were male. Seventy-four per cent of the perpetrators were male. Ninety-five per cent of the participants said that no health professional had informed them about where or how they could find help. Although all were seriously injured; 76 of the participants said only the researcher had asked about their experience. Sixty-six per cent of the cases of domestic violence were related to intimate partner violence. Overall; subjects displayed high levels of depressive and post-traumatic stress symptomatology that had neither been treated nor adequately referred. Conclusion Even though domestic violence poses significant health threats and costs to the health system; it appears to be a neglected area of South African health care. Health professionals should at least be able to identify and intervene within the ""open window"" period when psychosocial opportunities are pivotal."