Epidemiology of non-fatal suicidal behavior among first-year university students in South Africa.

Supplemental data for this article can be accessed on the publisher's website.We used a cross-sectional web-based survey and discrete-time survival analysis with person-year as unit of analysis and retrospective age-of-onset reports to estimate prevalence and predictors of suicidal ideation, plan, and attempt, and transitions from ideation to plan and attempt among South African university students (n = 1402). The lifetime prevalence of ideation, plan, and attempt were 46.4% (n = 650), 26.5% (n = 372), and 8.6% (n = 120), respectively. Multiple temporally primary mental disorders predicted subsequent onset of suicidality and transitions from ideation to plan and attempt. Results highlight the need for campus-based suicide prevention in South Africa, vulnerability of historically disadvantaged students, and the importance of promoting mental health in suicide prevention.

Prevalence and sociodemographic correlates of common mental disorders among first-year university students in post-apartheid South Africa: implications for a public mental health approach to student wellness.

BACKGROUND: There is growing awareness of the need for effective prevention, early detection, and novel treatment approaches for common mental disorders (CMDs) among university students. Reliable epidemiological data on prevalence and correlates are the cornerstones of planning and implementing effective health services and adopting a public health approach to student wellness. Yet, there is a comparative lack of sound psychiatric epidemiological studies on CMDs among university students in low- and middle-income countries, like South Africa (SA). It is also unclear if historically marginalised groups of students are at increased risk for mental health problems in post-apartheid SA. The objective of the study was to investigate the prevalence and sociodemographic correlates of lifetime and 12-month CMDs among university students in SA, with a particular focus on vulnerability among students in historically excluded and marginalised segments of the population. METHODS: Data were collected via self-report measures in an online survey of first-year students registered at two large universities (n = 1402). CMDs were assessed with previously-validated screening scales. Data were weighted and analysed using multivariate statistical methods. RESULTS: A total of 38.5% of respondents reported at least one lifetime CMD, the most common being major depressive disorder (24.7%). Twelve-month prevalence of any CMD was 31.5%, with generalised anxiety disorder being the most common (20.8%). The median age of onset for any disorder was 15 years. The median proportional annual persistence of any disorder was 80.0%. Female students, students who reported an atypical sexual orientation, and students with disabilities were at significantly higher risk of any lifetime or 12-month disorder. Female gender, atypical sexual orientation, and disability were associated with elevated risk of internalising disorders, whereas male gender, identifying as White, and reporting an atypical sexual orientation were associated with elevated risk of externalising disorders. Older age, atypical sexual orientation, and disability were associated with elevated risk of bipolar spectrum disorder. CONCLUSIONS: Despite advances to promote greater social inclusion in post-apartheid SA, students who identify as female, students with atypical sexual orientations, and students with disabilities are nonetheless at increased risk of CMDs, although students who identify as Black and first-generation students are not.

The relationship between childhood adversity, recent stressors, and depression in college students attending a South African university.

BACKGROUND: College students are at risk of depression. This risk may be increased by the experience of childhood adversity and/or recent stressors. This study examined the association between reported experiences of childhood adversity, recent stressors and depression during the last 12 months in a cohort of South African university students. METHODS: Six hundred and eighty-six first year students at Stellenbosch University in South Africa completed a health-focused e-survey that included items on childhood adversity, recent stressors and mood. Individual and population attributable risk proportions (PARP) between experiences of childhood adversity and 12-month stressful experiences and 12-month depression were estimated using multivariate binomial logistic regression analysis. RESULTS: About one in six students reported depression during the last 12 months. Being a victim of bullying and emotional abuse or emotional neglect during childhood were the strongest predictors of depression in the past year at both individual and population level. With regard to recent stressors, a romantic partner being unfaithful, serious ongoing arguments or break-ups with some other close friend or family member and a sexual or gender identity crisis were the strongest predictors of depression. The predictor effect of recent stressors was significantly reduced in the final model that adjusted for the type and number of childhood traumatic experiences. At a population level, academic stress, serious ongoing arguments or break-ups with a close friend or family member, and serious betrayal by someone close were the variables that yielded the highest PARP. CONCLUSIONS: Our findings suggest a significant relationship between early adversity, recent stressors, and depression here and throughout, consistent with the broader literature on predictors of depression. This study contributes to the limited data on college students' mental health in low and middle income countries including on the African continent. The findings provide information on the population level effect sizes of trauma as a risk factor for depression, as well as on the relationship between specific recent stressors and depression in college students.

Resting regional brain metabolism in social anxiety disorder and the effect of moclobemide therapy.

While there is mounting evidence of abnormal reactivity of several brain regions in social anxiety disorder, and disrupted functional connectivity between these regions at rest, relatively little is known regarding resting regional neural activity in these structures, or how such activity is affected by pharmacotherapy. Using 2-deoxy-2-(F-18)fluoro-D-glucose positron emission tomography, we compared resting regional brain metabolism between SAD and healthy control groups; and in SAD participants before and after moclobemide therapy. Voxel-based analyses were confined to a predefined search volume. A second, exploratory whole-brain analysis was conducted using a more liberal statistical threshold. Fifteen SAD participants and fifteen matched controls were included in the group comparison. A subgroup of SAD participants (n = 11) was included in the therapy effect comparison. No significant clusters were identified in the primary analysis. In the exploratory analysis, the SAD group exhibited increased metabolism in left fusiform gyrus and right temporal pole. After therapy, SAD participants exhibited reductions in regional metabolism in a medial dorsal prefrontal region and increases in right caudate, right insula and left postcentral gyrus. This study adds to the limited existing work on resting regional brain activity in SAD and the effects of therapy. The negative results of our primary analysis suggest that resting regional activity differences in the disorder, and moclobemide effects on regional metabolism, if present, are small. While the outcomes of our secondary analysis should be interpreted with caution, they may contribute to formulating future hypotheses or in pooled analyses.

The South African Depression and Anxiety Group and government hospital partners: Addressing the challenge of poor adherence in psychiatry.

The Helen Joseph Hospital, a government regional hospital in Johannesburg, South Africa, became aware of patient non-adherence issues at their specialist psychiatric outpatient department. In partnership with the South African Depression and Anxiety Group (SADAG), Africa's largest support network and advocacy group for people affected by mental health problems, and sponsored by Janssen Pharmaceuticals, they aimed to address the issue of non-adherence by developing and implementing a Reminder and Support Adherence Programme (RSAP). By providing a comprehensive service that regularly reminds patients to take their medication, attend their clinic appointments, offers free health information and psychosocial support, this has allowed many patients to benefit from the programme's ability to address the range of problems related to non-adherence.

White matter volume alterations in hair-pulling disorder (trichotillomania).

Trichotillomania (TTM) is a disorder characterized by repetitive hair-pulling resulting in hair loss. Key processes affected in TTM comprise affective, cognitive, and motor functions. Emerging evidence suggests that brain matter aberrations in fronto-striatal and fronto-limbic brain networks and the cerebellum may characterize the pathophysiology of TTM. The aim of the present voxel-based morphometry (VBM) study was to evaluate whole brain grey and white matter volume alteration in TTM and its correlation with hair-pulling severity. High-resolution magnetic resonance imaging (3 T) data were acquired from 29 TTM patients and 28 age-matched healthy controls (CTRLs). All TTM participants completed the Massachusetts General Hospital Hair-Pulling Scale (MGH-HPS) to assess illness/pulling severity. Using whole-brain VBM, between-group differences in regional brain volumes were measured. Additionally, within the TTM group, the relationship between MGH-HPS scores, illness duration and brain volumes were examined. All data were corrected for multiple comparisons using family-wise error (FWE) correction at p < 0.05. Patients with TTM showed larger white matter volumes in the parahippocampal gyrus and cerebellum compared to CTRLs. Estimated white matter volumes showed no significant association with illness duration or MGH-HPS total scores. No significant between-group differences were found for grey matter volumes. Our observations suggest regional alterations in cortico-limbic and cerebellar white matter in patients with TTM, which may underlie deficits in cognitive and affective processing. Such volumetric white matter changes may precipitate impaired cortico-cerebellar communication leading to a reduced ability to control hair pulling behavior.

The effects of acute serotonin challenge on executive planning in patients with obsessive-compulsive disorder (OCD), their first-degree relatives, and healthy controls.

RATIONALE: Obsessive-compulsive disorder (OCD) is characterized by executive function impairment and by clinical responsivity to selective serotonin reuptake inhibitors (SSRIs). Executive planning deficits constitute a candidate endophenotype for OCD. It is not known whether this endophenotype is responsive to acute serotonin manipulation. OBJECTIVE: The study aimed to investigate the effects of acute SSRI administration on executive function in patients with OCD, first-degree relatives of patients with OCD, and healthy controls. METHODS: A randomized double-blind cross-over study assessed the effects of single-dose escitalopram (20 mg) and placebo on executive planning in 24 patients with OCD, 13 clinically unaffected first-degree relatives of patients with OCD, and 28 healthy controls. Performance on a Tower of London task measuring executive planning was assessed 4 h after oral administration of the pharmacological challenge/placebo and compared across and within groups using a mixed model analysis of variance. RESULTS: On the outcome measure of interest, i.e., the mean number of choices to obtain the correct solution, there was a marginally significant effect of group (F(2, 59) = 3.1; p = 0.052), with patients (least square (LS) mean 1.43; standard error [SE] 0.06; 95% confidence interval (CI), 1.31-1.55) and their relatives (LS mean 1.46; SE 0.08; 95% CI, 1.30-1.62) performing worse than matched healthy controls (LS mean 1.26; SE 0.05; 95% CI, 1.15-1.37) on placebo. There was a trend towards a significant group × treatment interaction (F(2, 58) = 2.8, p = 0.069), with post hoc tests showing (i) patients (p = 0.009; LS mean difference 0.23; SE 0.08) and relatives (p = 0.03; LS mean difference 0.22; SE 0.10) were more impaired compared to controls and (ii) escitalopram was associated with improved executive planning in patients with OCD (p = 0.013; LS mean difference 0.1; SE 0.04), but not other groups (both p > 0.1; controls: LS mean difference - 0.03; SE 0.04; relatives: LS mean difference 0.02; SE 0.05). CONCLUSION: Our findings are consistent with a view that there is impaired executive planning in OCD and that this constitutes a behavioural endophenotype. In patients with OCD, but not in relatives, acute SSRI administration ameliorated this deficit. Further investigation is needed to understand common and differential involvement of neurochemical systems in patients with OCD and their relatives.

Reduction of PTSD in South African University Students Using Transcendental Meditation Practice.

A study was conducted on South African college students using the Transcendental Meditation technique to reduce posttraumatic stress disorder. Students meeting the criteria for possible posttraumatic stress disorder were included. Thirty-four students at the experimental university in South Africa clinically diagnosed with posttraumatic stress disorder were instructed in and practiced the Transcendental Meditation technique twice daily compared to 34 diagnosed posttraumatic stress disorder comparison students at the comparison university. The multivariate effect was significant for both the posttraumatic stress disorder symptomatology and depression. Results were significantly associated with regularity of practice. The study replicates recent findings and offers an alternative educational treatment for higher education.

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.