"So, you must understand that that group changed everything": perspectives on a telehealth group intervention for individuals with chronic pain.

BACKGROUND: The Patient Education Empowerment Programme (PEEP) is an interdisciplinary group intervention for people living with chronic pain. As a result of the COVID-19 pandemic, lockdown and restrictions on in-person group-based health care delivery in South Africa, PEEP was modified to a telehealth electronic format (ePEEP) and offered to patients on a waiting list at two interdisciplinary chronic pain clinics in Cape Town, South Africa. The purpose of this study was to explore the feasibility and acceptability of ePEEP through the perspectives of individuals with chronic pain who participated in ePEEP.  METHODS: A qualitative, exploratory descriptive study was conducted. One month after completion of the 6-week ePEEP programme, individuals who participated, were recruited for the study. Data were collected through semi-structured interviews. Data analysis followed an iterative process of inductive content analysis.  RESULTS: Six individuals, all women, consented and participated in the study. Three main themes emerged from the data. Theme one focussed on how ePEEP initiated a journey of personal development and discovery within the participants. In theme two, participants reflected on the importance and value of building peer and therapeutic relationships as part of ePEEP. In theme 3, participants shared that the online learning environment had features which influenced learning about pain in different ways. CONCLUSION: ePEEP was found to be acceptable, feasible and valuable for the participants. ePEEP facilitated self-discovery, empowerment, relationship building and transformation in the participants, through experiential learning. Although barriers and facilitators to learning were present, both enhanced the learning experience. The positive reception of this telehealth initiative indicates potential for enhanced access to chronic pain management services in the South African setting.

'They Sent Me Out to School, and I Came Back with a Baby': Perinatal Women's Experiences of Biographical Disruption and Nonfatal Suicidal Behaviour.

Exploring perinatal women's experience of nonfatal suicidal behaviour (NFSB) could help illuminate the contexts in which perinatal suicide occurs and new ways to conceptualise maternal suicide prevention. Our aim was to explore perinatal women's subjective experience of NFSB in South Africa. Data were collected via in-depth interviews with seven perinatal women hospitalised following NFSB. Thematic analysis showed how poverty and gender norms shape experiences of pregnancy and highlighted the need for eco-systemic interventions for perinatal women in resource scarce environments to increase social support, assist with childcare, improve educational retention, challenge gender norms and increase paternal involvement. Pregnancy can precipitate biographical disruption by disturbing women's view of themselves and their futures. An inability to reconstruct a coherent narrative and re-imagine the future impedes the transition to motherhood and provides a context for suicide. Using the concept of biographical disruption to frame perinatal suicide, could identify novel approaches to suicide prevention.

Depressive symptoms and quality of life prior to metabolic surgery in Cape Town, South Africa.

Background: Depression has been shown to have a negative impact on the outcomes of metabolic surgery and quality of life (QOL). Currently, there are limited data on mental distress and QOL in metabolic surgery candidates in South Africa. Aim: This study aimed to determine the prevalence of depressive symptoms at the time of presurgical assessment in participants undergoing metabolic surgery. Setting: The Obesity and Metabolic Surgery Initiative at Tygerberg Hospital. Methods: We conducted pre-operatively a retrospective cross-sectional study on patients who underwent metabolic surgery from September 2017 to September 2019. Participants were profiled in terms of metabolic parameters, depressive symptoms and QOL. Results: Of the 157 participants assessed, 88% were female with a body mass index in the super obese range. Twenty-two percent of participants had depressive symptoms. Metabolic surgery candidates with depressive symptoms had a significantly poorer overall QOL score compared with those without depressive symptoms. When controlling for all other variables, an increase in QOL score was shown to decrease the odds of current depressive symptoms, whilst back pain on non-narcotic medication and having had a stroke were found to increase the odds of current depressive symptoms. Conclusion: This study highlights the complex interplay between metabolic, clinical and psychiatric factors in patients undergoing metabolic surgery. The study highlights the vital role of a psychiatrist as part of a multidisciplinary team pre- and post-operatively in the early identification of depressive symptoms. Psychiatrists may have an important role to play as part of the multidisciplinary team in metabolic surgery, including screening for mental health problems pre- and post-operatively, providing psychoeducation and relevant pharmacological treatment and psychotherapy where needed. Contribution: This study expands our limited knowledge of psychiatric comorbidity (in particular depressive symptoms and associated factors) in people undergoing metabolic surgery in low- and middle-income countries.

Methods of deliberate self-harm in a tertiary hospital in South Africa.

BACKGROUND: Little is known about the methods of deliberate self-harm (DSH) in South Africa (SA), despite the importance of means restriction as a public health strategy to reduce the morbidity and mortality associated with self-harm. AIM: The aim of this study was to investigate the range of methods used in DSH and identify the socio-demographic and clinical factors associated with violent and non-violent methods of DSH among patients treated at a tertiary hospital in SA. SETTING: The study was conducted at an urban, tertiary level emergency department at Groote Schuur hospital in Cape Town, South Africa. METHOD: Data were collected from 238 consecutive DSH patients who presented for emergency department treatment at the hospital. Logistic regression models were used to explore the factors associated with violent and non-violent methods of DSH. RESULTS: Self-poisoning was the most common method of self-harm (80.3%). Prescription medication was the most common form of self-poison (57.6%), while a large number of patients used non-prescription paracetamol (40.9%). In the regression analysis, male gender, stating that the reason for DSH was to escape a situation and history of substance use were associated with violent method of DSH. CONCLUSION: Improved monitoring of prescription medications commonly used in DSH is integral to public health suicide prevention strategies in SA. This study underscores the need for substance use interventions in the healthcare setting.

Correlates of emotional and behavioural problems in children with perinatally acquired HIV in Cape Town, South Africa.

In the antiretroviral era, youth perinatally infected with HIV (PHIV+) are surviving into adulthood and are at risk for emotional and behavioural problems. Few studies of these problems have been conducted in low- and middle-income countries and even fewer in sub-Saharan Africa. The aims of this study were to provide a quantitative description of emotional and behavioural problems in a group of PHIV+ youth (n = 78) in South Africa compared with a group of demographically matched HIV-negative controls (n = 30) and to identify correlates of emotional and behavioural problems. A cross-sectional study was conducted employing participants from community and hospital-based clinics. Emotional and behavioural problems were assessed using the Child Behaviour Checklist (CBCL). Several measures were used to assess demographic, biological, cognitive and contextual correlates of problem behaviours. Youth were compared by HIV status on demographic, cognitive and contextual variables as well as the Total Problems and subscale scores of the CBCL. Multivariate comparisons of the influence of contextual and cognitive variables on CBCL Total Problems scores were performed using a stepwise linear regression analytic procedure. In this study, there were no significant differences in between-group comparisons for the prevalence of Internalizing, Externalizing and Total Problems in the PHIV+ youth and control group at the clinical and borderline cut-off ranges of the CBCL. Caregiver depression was the only significant predictor of greater Total Problems scores in the full model, after controlling for age and gender (F = 8.57, df = 5.102, P < .01). An interaction between HIV status and caregiver depression was observed (t = -2.20, P = .03), with follow-up within-group analyses confirming that caregiver depression predicted greater Total Problems scores both in HIV-negative youth (ß = 0.61, P < .001), and to a lesser extent, in HIV-positive youth (ß = 0.25, P < .001). This study highlights the need for adequate screening of depression in the caregivers of HIV-infected youth.

Prevalence and patterns of medication use in children and adolescents with autism spectrum disorders in the Western Cape, South Africa.

OBJECTIVE: This study was conducted to investigate the prevalence and patterns of medication use amongst a sample of school going children and adolescents with autism spectrum disorders (ASD) in the Western Cape, South Africa. METHOD: This was a descriptive, quantitative, analytic study. A survey questionnaire and the Nisonger Child Behaviour Rating Form (NCBRF) were administered to parents of children and adolescents recruited from two schools for children with ASD in Cape Town and from the Autism Action database. RESULTS: A total of 24.6% of the 65 children used psychotropic medications. Antipsychotics were the most common reportedly used psychotropics followed by stimulants, antidepressants and mood stabilisers. Complementary and alternative medications were also commonly used with 40% of children using over the counter medications (OTC) and 15.4% being on a special diet for autism. Children of black African or coloured ethnicity were less likely to use OTC medication than children in the white/ Asian ethnic group. CONCLUSIONS: In keeping with international studies this sample of children with ASD was a highly medicated group. The findings of this pilot study were limited by the response rates and sample size, but provide valuable insight into medication use in the South African ASD population.

Substance use in pregnancy: The medical challenge.

Substance use contributes significantly to the global burden of disease. Growing numbers of women use nicotine, alcohol, and illicit substances. Women are the most vulnerable to problematic substance use in their reproductive years. The first 1000 days of life, starting at conception, have been established as a critical window of time for long-term health and development. Substance use in pregnancy is associated with negative pregnancy and child health outcomes. The impact of antenatal substance use on these outcomes needs to be considered within a challenging and complex context. This review provides an overview of the current literature on the impact of substances on pregnancy and child outcomes as well as the evidence and guidelines on screening and interventions for women using substances during pregnancy.

'This place is making me more depressed': The organisation of care for suicide attempters in a South African hospital.

People who attend hospital following a suicide attempt represent a well-delineated high-risk group of patients who may be amenable to targeted interventions to reduce the risk of suicidal behaviour. Little is, however, known about how hospitals in South Africa respond to suicide attempters, what quality of care these patients receive or what possibilities exist for hospital-based suicide prevention interventions. We describe an ethnographic study conducted at a large hospital in South Africa to investigate the impact of current procedures and practices on the care received by those who attempt suicide. Findings suggest that the organisation of care within the hospital is a significant barrier to patients receiving optimal care and represents a lost opportunity for suicide prevention. Findings highlight the mismatch between the needs of suicide attempters and current services and call attention to the need for greater psychological input as well as hospital-based suicide prevention interventions that can be offered to patients without necessitating admissions.