A Cross-Sectional Analysis of the Nicotine Metabolite Ratio and Its Association with Sociodemographic and Smoking Characteristics among People with HIV Who Smoke in South Africa.

The nicotine metabolite ratio (NMR) is associated with race/ethnicity but has not been evaluated among smokers in the African region. We conducted a cross-sectional analysis of baseline data from a large randomized, controlled trial for smoking cessation among people with HIV (PWH) in South Africa. Urine samples were analyzed for the NMR and evaluated as a binary variable using a cutoff value of the fourth quartile to determine the fastest metabolizers. The median NMR was 0.31 (IQR: 0.31, 0.32; range: 0.29, 0.57); the cut-point for fast metabolizers was ≥0.3174 ng/mL. A high NMR was not associated with the number of cigarettes per day (OR = 1.10, 95% CI: 0.71, 1.70, p = 0.66) but was associated with 40% lower odds of a quit attempt in the past year (OR = 0.69; 95% CI: 0.44, 1.07, p = 0.09) and alcohol use (OR = 0.59, 95% CI: 0.32, 1.06, p = 0.07). No association was seen with marijuana or HIV clinical characteristics. As we found only minimal variability in the NMR and minimal associations with intensity of smoking, NMR may be of limited clinical value in this population, although it may inform which individuals are less likely to make a quit attempt.

Evaluation of Modified Patient Health Questionnaire-9 Teen in South African Adolescents.

BACKGROUND: This report describes the findings of the survey conducted by South African Depression and Anxiety Group (SADAG) in a cohort of disadvantaged South African adolescent scholars in which PHQ-9 teen version was modified and adapted (PHQ-9M) to improve the response rate. METHOD: PHQ-9M was administered to 2025 secondary students of 35 schools over 2 years in Gauteng Province, South Africa. RESULTS: The mean age was 15.8 years. 23% of respondents scored 9 or above, 26.7% reported suicidal ideations in last month, 21.8% reported lifetime suicide attempts and 9.3% had severe functional impairment. PHQ-9M showed a fair internal consistency and face validity in this study. CONCLUSION: The PHQ-9M could be useful in conducting surveys in settings of low mental health literacy after further evaluation of its psychometric properties. The high rates of suicidal ideations, suicide attempts, and functional impairment in this population suggest the need for preventive interventions.

South African adolescents' beliefs about depression.

PURPOSE: This study explores the depression literacy in adolescents in South Africa. METHOD: A semi-structured questionnaire was administered to 2,050 students from disadvantaged secondary schools in Johannesburg region. RESULT: A total of 90.9% reported depression as an illness, and 41.4% considered it a sign of weakness. Parents and siblings followed by friends and teachers were the preferred support options. The indicators of depression identified were socialisation pattern changes (24.6%), sad mood (23.6%), sleeping and eating pattern changes (18.3%), irritable behaviour (12.5%) and other health risk behaviours (9.7%). CONCLUSION: The majority considered depression an illness. An improvement in adolescent mental health literacy will increase access to help when needed.

Communication and adherence of patients at a South African public sector specialist psychiatric out-patient clinic

BACKGROUND. The impact that communication has on adherence, considering outcomes such as patient satisfaction and recall of the content of encounters with health care providers, has been extensively reported on in the literature. The South African Depression and Anxiety Group (SADAG) developed a specific communication intervention program, which was implemented in a local public sector setting. OBJECTIVE. To investigate the attendance and medication adherence of patients at the specialist psychiatric outpatient clinic of the Helen Joseph Hospital in Johannesburg, before and after the pilot implementation of this program. METHODS. Included quantitative and qualitative methodologies. The retrospective component included a review of participants' demographic and clinical profile and medication adherence. The prospective, qualitative component included structured pre- and post-questionnaires. RESULTS. The typical participant was female (76%), older than 40 years (58.2%) and unemployed (74.2%). Comparing the study and control groups, the communication program resulted in a higher post-intervention booking ratio for the Study group, while the diagnostic category of participants were associated with their understanding of their medication. DISCUSSION. Being mindful of the noted limitations of this pilot project, the SADAG program or similar communication intervention strategy, should be a standard operational procedure in local South African state sector clinics.

The internalized stigma experienced by members of a mental health advocacy group in South Africa.

BACKGROUND: Although there is a growing literature on internalized stigma from the developed world, very little research has been conducted in developing countries such as South Africa. Therefore, the purpose of this study was to describe the internalized stigma experienced by members of a mental health advocacy group in South Africa and relationships between self-stigma and other constructs, namely, empowerment, perceived devaluation and discrimination. METHODS: Self-administered questionnaires measuring respondents reported levels of internalized stigma, empowerment and perceived devaluation and discrimination were distributed to all the members of the South African Depression & Anxiety Group (SADAG) by post and via email. Of the 850 members invited to participate, 142 members of SADAG completed the questionnaire. Pearson correlations were computed and multiple regression analyses were carried out to analyse the data. RESULTS: The highest reports of stigma were for stigma resistance (mean = 2.9), alienation (mean = 2.47) and perceived discrimination (mean = 2.24). Low levels of stereotype endorsement (mean = 1.77) and social withdrawal (mean = 1.22) were reported. Although respondents often felt that the public held negative attitudes towards individuals suffering with a mental illness (perceived devaluation and discrimination scale (PDD), mean = 2.95), a majority of respondents reported high levels of empowerment (mean = 3.0) and self-efficacy (mean = 2.47). After controlling for socio-demographic factors, higher scores on the PDD were associated with social withdrawal and having experienced discrimination. CONCLUSION: Internalization of stigma, disempowerment and loss of self-esteem are not inevitable consequences for all individuals with a mental illness. Nevertheless, perceived stigma is significantly associated with social withdrawal and experienced discrimination.