Mental illness attitudes, service provision interest and further training preferences of clinical associates.

BACKGROUND:  Non-specialist health professionals are required to provide mental health services given the burden of disease due to mental illness. The study aimed to explore the attitudes of clinical associates towards those with mental illness as well as their interest in mental health work and additional mental health training. METHODS:  A cross-sectional study design was utilised. The study population consisted of clinical associates based in South Africa. An electronic questionnaire was developed that incorporated the 16-item Mental Illness Clinicians' Attitudes version 4 scale (MICA-4), which is scored out of 96 with higher scores indicating more stigmatising attitudes. Multivariate linear regression was used to determine factors associated with the MICA-4 score. RESULTS:  The mean MICA-4 score for the 166 participants who completed all 16 questions was 37.55 (standard deviation 7.33). In multivariate analysis, the factors associated with significantly lower MICA-4 scores were falling in the 25- to 29-year-old age category and indicating that a mental health rotation formed part of the undergraduate degree. More than 80% of the participants (140/167, 83.8%) indicated an interest in mental health work. Two-thirds of the participants (111/167, 66.5%) indicated an interest in a specialisation in mental health. CONCLUSION:  The mean MICA-4 score recorded for clinical associates indicates low stigma levels towards those with mental illness. Additionally, there is significant interest in working and training in mental health.Contribution: Training programmes should take note of the contribution of a mental health rotation to a positive attitude to mental health patients. Clinical associates' attitudes towards mental illness together with their interest in working and training in mental health suggest that they could be more widely utilised in mental health service provision.

Knowledge, confidence, and practices of clinical associates in the management of mental illness.

Background: Additional human resources are needed to provide mental health services in underserved areas in South Africa (SA). Clinical associates, the mid-level medical worker cadre in SA, could potentially be used to deliver these services. Aim: The study explored the self-reported knowledge, confidence, and current practices of clinical associates related to mental health assessment and management. Setting: South Africa. Methods: A cross-sectional study was conducted. The link to the electronic questionnaire was distributed to clinical associates via databases and social media. Data were analysed with Stata v17. Results: Of the 209 participants, 205 (98.1%) indicated they had training on management of patients with mental illness during their undergraduate degree and 192 (91.9%) had a mental health rotation. Few (10.7%) had any additional mental health training. Most participants rated their knowledge of priority mental disorders as 'good' or 'excellent'. Only 43.2% of the participants felt quite or very confident to perform a mental health examination. Participants who felt quite or very confident to manage patients presenting with suicide risk, aggression, and confusion were 44.9%, 46.9% and 53.1%, respectively. Factors associated with a confidence score of 75% and higher were male gendered, working in Gauteng or Northern Cape provinces, and in a rural area. The majority of participants were already involved in mental health assessment and management in their current work. Conclusion: Clinical associates have a contribution to make in mental health service provision, but this may need to be supplemented by additional practical training. Contribution: Potential gaps in training have been identified.

Readmission of adolescent psychiatric patients to a specialised unit in Gauteng, South Africa.

Background: Readmission rates to child and adolescent psychiatric units among the youth have been reported to be increasing. Aim: The study aimed to determine the readmission rate and factors associated with readmission of adolescent psychiatric patients at a child and adolescent psychiatric unit. Setting: A specialised psychiatric hospital in Gauteng province, South Africa. Methods: This retrospective cohort study utilised data from the records of patients admitted to the adolescent inpatient unit over a period of five years. The cumulative incidence and incidence rate of readmission within one year of discharge from the index admission was calculated using survival analysis methods. Characteristics significantly associated with readmission were determined by applying the multivariable Cox proportional hazards regression model. Results: Among the 189 patients included in the analysis, the cumulative incidence of readmission within one year of discharge was 17.5%. The incidence rate was 5.31 readmissions per 10 000 person-days. The final multivariable model showed that a diagnosis of schizophrenia (p = 0.015), a diagnosis of attention deficit hyperactivity disorder (p = 0.039), and coming from a child and youth care centre or temporary safe care (p = 0.018) increased the risk of readmission while having a medical condition (p = 0.008) reduced the risk. Conclusion: Psychiatric diagnosis and residential care could be potential risk markers for readmission. Improving the collaboration between health and social services in residential care would be beneficial. Contribution: Identifying factors that predispose adolescent psychiatric patients to readmission can inform and improve management and risk assessments.

Perceptions and attitudes of black men in a rural district of South Africa towards depression and its treatment.

BACKGROUND: Depression is a major contributor to the overall global burden of disease, impacting social life, family life and occupational functioning if left untreated. Despite its high prevalence and morbidity, the evidence suggests that men are hesitant to seek help, with a large percentage remaining undiagnosed. This study aimed to determine the attitudes and perceptions related to depression and its treatment amongst black men in a rural district of South Africa. METHODS: The design used was an exploratory descriptive qualitative design. Participants were selected by purposive sampling. Individual semistructured interviews were conducted, which were audio-recorded and transcribed verbatim. The data were subsequently analysed thematically to develop themes and subthemes. RESULTS: Participants described depression as a psychological problem associated with lack of sleep, loneliness, feeling unwanted, increased stress, deep sadness, weight loss, forgetfulness, crying over small things and lack of concentration. Collectively, the interviews with participants showed a good understanding of the psychosocial determinants of depression but exposed a lack of awareness of its biological determinants. A large proportion (n = 13; 68.4%) of participants reported not having knowledge of available services in their area for people seeking treatment for depression. Barriers to help-seeking behaviours were fear of social stigma, fear of expressing their feelings, gender norms and stereotypes and lack of trust in others. CONCLUSION: Interventions such as support groups and mental health awareness programmes to counteract personal perceptions may help to improve and expand the effectiveness of depression treatment. The results highlight the future need to raise awareness of depressive symptoms and expand health outreach programmes.

Screening for depression at the primary care level: Evidence for policy decision-making from a facility in Pretoria, South Africa.

BACKGROUND: Depression is a serious public health issue that has clinical, social and economic implications. Adult patients attending a primary healthcare (PHC) facility were screened in order to estimate the prevalence of depressive features and identify potential risk factors for screening positive. METHODS: This was an analytical cross-sectional study conducted at a clinic in Pretoria, South Africa. A self-administered questionnaire, which included the Patient Health Questionnaire-9 (PHQ-9) screening tool, was completed by patients attending the clinic. A PHQ-9 score of less than five was deemed as a negative screen for depressive features; with a score of five or more being considered a positive screen. A multivariate logistic regression model was developed to identify factors associated with a positive screen for depressive features. RESULTS: A total of 199 patients participated and the proportion screened positive for depressive features using the PHQ-9 tool was 46.23% (n = 92). Employed participants had significantly lower odds (odds ratio [OR] = 0.48; 95% confidence interval [CI]: 0.25 - 0.94) of screening positive, whilst the participants with significantly higher odds were those with co-morbidities (OR = 2.12; 95% CI: 1.08 - 4.17) and a history of stressful life events (OR = 3.21; 95% CI: 1.64 - 6.28). CONCLUSION: Depression appears to be a significant problem in PHC settings in South Africa. Screening for depressive features at primary level, targeting those with chronic medical conditions, history of recent stressful life events and other known risk factors may improve detection rates, lead to earlier diagnosis and improved health outcomes.

Trends in practice intentions and preferences of clinical associate students: Implications for training and health services in South Africa.

BACKGROUND: The University of Pretoria (UP) had its first intake of Bachelor of Clinical Medical Practice (BCMP) students in 2009. The objectives of this study were to examine the trends in geographical practice intentions and preferences of the first nine cohorts of BCMP students. We also assessed sector and level of care preferences of six BCMP cohorts. METHODS: Cross-sectional studies were conducted 2011, 2014 and 2017. First-, second- and third-year UP BCMP students were invited to complete a electronic questionnaire. Our analyses consisted of calculating proportions for the practice intentions and preferences for each surveys, and performing multiple logistic regression on the aggregated date to determine their associations with sociodemographic and training characteristics. RESULTS: The proportion of participants intending to practise as a clinical associate in a rural area in South Africa directly after graduating was 62.5% in the 2014 survey and 69.7% in the 2017 survey, compared to 59.6% in the 2011 survey. The majority in all three surveys (53.4% in 2011, 56.6% in 2014 and 59.8% in 2017) indicated a preference for rural practice. Both rural practice intention and rural practice preference were found to be significantly associated with respondent's self-description of having lived most of her/his life in a rural area, and rural district hospital exposure during training. In 2014 and 2017, approximately two-thirds of the participants selected a public sector option as their most preferred work setting. District hospitals were the most preferred setting of 30.3% participants in 2014 and 32.0% in 2017. CONCLUSION: Most participants across the three surveys intended to work in rural settings. Considering that this could provide a sustainable solution to the shortage of health care workforce in rural areas, policy makers in both higher education and health need to promote and ensure the viability of the training of this category of health care providers.