South African families raising children with autism spectrum disorders: relationship between family routines, cognitive appraisal and family quality of life.

BACKGROUND: The purpose of this study was to investigate the relationship between family routines, cognitive appraisal of the impact of autism spectrum disorders (ASD) on the family and family quality of life (FQOL) in families raising children with ASD in South Africa. METHODS: A sample of 180 families of young children with ASD who were receiving disability-related services in the Gauteng province of South Africa completed a self-administered survey. Structural equation modelling was used to examine the direct relationship between the regularity of family routines and FQOL, and the mediating effect of cognitive appraisal on this relationship. RESULTS: The results suggested a direct, positive relationship between the regularity of family routines and families' satisfaction with their FQOL. Furthermore, cognitive appraisal of the impact of ASD on the family mediated this relationship in a partial manner. CONCLUSION: A higher frequency of regular family routines was strongly associated with a higher satisfaction level of FQOL. Also, cognitive appraisal of the impact of ASD acted as a mechanism through which the regularity of family routines influenced FQOL. We discuss the research and clinical implications of these findings.

Elevated Risk of Suicidal Ideation in HIV-Positive Persons.

Globally, suicide and HIV/AIDS remain two of the greatest healthcare issues, particularly in low- and middle-income countries. Several studies have observed a relationship between suicidal behaviour and HIV/AIDS. Materials and Methods. The main objective of this research was to determine the prevalence of elevated risk of suicidal ideation in HIV-positive persons immediately following voluntary HIV counselling and testing (VCT). The study sample consisted of adult volunteers attending the VCT clinic at a university-affiliated, general state hospital. Participants completed a sociodemographic questionnaire, Beck's Hopeless Scale, and Beck's Depression Inventory. Results. A significantly elevated risk of suicidal ideation was found in 83.1% of the patients who tested seropositive. Despite a wide age range in the cohort studied, the majority of patients with suicidal ideation were males in the younger age group (age < 30 years), consistent with the age-related spread of the disease and an increase in suicidal behaviour in younger people. Relevant associated variables are discussed. Conclusion. The results serve as important markers that could alert healthcare professionals to underlying suicide risks in HIV-positive patients. It is recommended that screening for elevated risk of suicidal ideation and prevention of suicidal behaviour should form a routine aspect of comprehensive patient care at VCT clinics.

Characteristics and post-hospital perceptions of patients refusing inpatient treatment in a South African general hospital psychiatric unit.

This paper explores characteristics and post-hospital perceptions of patients who refused general hospital psychiatric inpatient treatment in a relatively young unit. It was found that after an initial significant increase of up to 9.6% per year in these patients, the average for the 6-year period studied was 6.2% of all admissions. Most of the patients were single or divorced, not gainfully employed, refused hospital inpatient treatment within the first day after admission and were significantly younger than the controls. Substance use, adjustment and personality disorders predominated, and most of the patients were dissatisfied with some aspect of their treatment. Less than half the patients had a positive attitude towards at least one staff member. Results are discussed within the context of understanding the decision of such patients, in an attempt to deal with the problem and with reference to a consultation-liaison approach.

Hopelessness and low-intent in parasuicide.

Parasuicide is usually associated with low suicidal intent and research data show that rising rates remain a challenging clinical and research problem. Hopelessness, a core characteristic of depression, appears to be the link between depression and suicidal behavior in high-risk patients. Previous research in this regard focused largely on hopelessness as a correlate of suicide, attempted suicide, serious suicidal intent, and as a predictor of eventual suicide among serious suicidal ideators in the absence of a recent suicide attempt. The present study was designed to investigate the relationship between hopelessness and low suicidal intent in a cohort of 337 hospitalized adult parasuicide patients referred to a general hospital psychiatric unit. Within 24-48 hours after admission, all patients, once alert, underwent an individual detailed clinical interview and one of three assessments, viz., they were rated on the Beck Hopelessness Scale, The Zung Self-Rating Depression Scale or, DSM III criteria for depression. Results support the positive relationship between hopelessness and suicidal behavior in low-intent patients, previously demonstrated in high-intent patients. The need to also address hopelessness in low-intent patients as part of an effective therapeutic intervention strategy is discussed.

Admissions to a South African general hospital psychiatric unit.

In a study of admissions to the psychiatric unit of a general hospital from December 1, 1977, to November 30, 1978, data obtained from all 478 admitted patients were analyzed; the most prevalent condition was found to be neuroses, followed by organic brain syndromes. Most patients admitted fell into the 19--39 age groups, with a preponderance of male admissions between the ages of 6--39, but more admissions of females above 40. A significant difference in the occurrence of conditions between the sexes was noted: the most prevalent condition for males between the ages of 6--39 years was schizophrenia, while more females suffered from the neuroses. Males 40 years and older presented predominantly with organic brain syndromes; females in that age group presented predominantly with affective psychoses. The average length of stay for both sexes was eight days. Schizophrenia required the longest hospital stay, an average of 11 days. Seventy-eight patients (16.3%) were admitted more than once during the period of study. Conditions commonly associated with readmission were affective psychoses and schizophrenia. The role of the general hospital psychiatric unit and its advantages and shortcomings are discussed.

A psychophysiological hypothesis on the aetiology of duodenal ulceration.

A previously undescribed explanation for the development of duodenal ulcer is advanced. Stressful situations and avoidance-avoidance conflicts in individuals with a dependant compliant personality incapable of appropriate "stimulus-seeking behaviour" lead to an immobilised state. This predicament is denied. Helplessness develops. This state is associated with an autonomic imbalance in which a central monoamine depletion results in uncompensated parasympathetic overactivity which facilitates the development of duodenal ulceration. Denial often invalidates superficial psychological investigations into the aetiology of duodenal ulceration and may explain the contradictory findings in the literature.

Suicidal behavior in patients diagnosed with cancer of the cervix.

There is a paucity of literature on suicide and cancer, especially cancer of the cervix. This study reports on suicidal behavior in these patients. The sample consisted of adult, black, Zulu-speaking women from palliative and radical oncology treatment groups who volunteered for the study. There were more patients in the palliative group who were younger, and had a more significant delay between cancer symptom presentation and seeking oncology treatment. Patients experienced: significant depression, anxiety, stress, hopelessness/helplessness, anxious preoccupation about their disease, poor current or delayed social support, feelings of being a burden to their significant others, beliefs that they would be better off dead, perceptions that they were stigmatized by society or that their communities suspected them of being HIV-AIDS positive, and suppressed anger. More patients in the palliative, compared to the radical treatment, group were inclined toward suicidal ideation with serious intent. Overall, most patients coped inadequately with their disease and its management. These patients are a high risk group for suicidal behavior and should be identified in time for appropriate psychological intervention.

Stress, social support and biopsychosocial dynamics in HIV-AIDS.

PIP: Early research on HIV/AIDS had a mainly biomedical orientation. From 1984, however, consideration has also been given to the psychosocial aspects of HIV/AIDS. A more integrated view of the biological, psychological, and social aspects of HIV/AIDS has been increasingly evident in research agendas. The argument that HIV is a necessary, but insufficient cause of symptomatic disease development has led to extensive commentary upon the possible etiological significance of cofactors. This paper reviews research trends in the psychosocial aspects of HIV-AIDS and explores the role of psychosocial cofactors in disease progression. This is done with a biopsychosocial model with recognition of the role of psychosocial stress, social support, and emotional adjustment. Research data from a study of biopsychosocial interrelationships in a sample of HIV-positive patients show a significant correlation between social support and emotional adjustment and that social support exerts a mediatory, stress-buffering effect in these patients. Observations are made upon aspects of the social conditions of South Africans with HIV/AIDS.^ieng

Health care professionals' knowledge about AIDS, prejudice and attitudes towards AIDS.

PIP: The study was conducted in a large university-affiliated teaching general hospital, drawing upon the professional health care staff as subjects. 80 subjects were issued questionnaires, 74 (92.5%) of whom returned completed questionnaires. Of these 43 (58.1%) were nursing sisters and 31 (41.9%) were medical doctors; 48 (64.9%) were female and 26 (35.1%) were male; 61 (82.4%) were White, 7 (9.5%) were Colored, 4 (5.4%) were Indian, and 2 (2.7%) were Black. The age range was 22-64 years (X = 38 years). The questionnaire intended to measure: knowledge about AIDS; attitudes toward AIDS; attitudes toward homosexuality; and attitudes toward the sexuality of Black people. The final knowledge scale required respondents to choose between options of right/wrong or true/false. The attitudes were assessed on a 5-point Likert Scale (1 = strongly disagree; 5 = strongly agree). The range of scores obtained in the knowledge section was from 22% to 100% correct (the mean was 77%). The results indicated a high level of knowledge of AIDS within the group. Items answered with the lowest degree of accuracy included dates, statistics, and specific technical aspects. Some respondents apparently failed to differentiate between HIV infection and full-blown AIDS. Negative attitudes (especially with regard to AIDS patients' rights) were evident. 50.0% of subjects felt that homosexuality is a psychological disorder, and 52.7% agreed that it is immoral. Attitudes to homosexuality reflected general reluctance to comprehend the normality of these people as well as an ambivalence about their life-styles. In response to statements directly relating homosexuality to AIDS, certain respondents did believe in such a direct causal link. Regarding attitudes to the sexuality of Blacks, certain statements measured the degree of blame attached to Black people for the spread of HIV disease. Knowledge about AIDS correlated significantly with attitudes towards the disease, but this correlation was the weakest significant correlation elicited (p 0.05).^ieng

Suicide prevention: a proposed national strategy for South Africa.

Suicidal behaviour is an important public health problem globally and in Africa. A brief overview of the nature and severity of the problem is provided, but the primary aim of this paper is to identify priorities and prevention strategies for reducing suicidal behaviour in South Africa by discussing a framework for a proposed national prevention programme. South African suicide rates range from 11.5 per 100 000 to as high as 25 per 100 000 of the population, depending on sampling procedures and research methods. About 11% of all non-natural deaths are suicide related. On average 9.5% of non-natural deaths in young people are due to suicide. It is a complex phenomenon and risk factors are, therefore, multifactorial and multidimensional. Some of the most important ones are identified and several priorities and prevention possibilities for reducing suicidal behaviour are recommended. The outline and structure for such a national suicide prevention programme is underpinned by research undertaken locally and internationally. It requires a comprehensive multi-sectoral approach that involves both health care and non-health care sectors and action at various levels utilising a framework based on a set of guiding principles and a range of strategies with specific objectives as a national priority within an interdisciplinary context.

Suicidal ideation in seropositive patients seen at a South African HIV voluntary counselling and testing clinic.

OBJECTIVE: Suicidal behaviour and HIV/AIDS are significant public health concerns. The aim of this study was to investigate suicidal ideation in patients who were referred to a voluntary HIV counselling and testing (VCT) clinic and who were found to be seropositive. This in order to improve suicide prevention and intervention strategies amongst such patients. METHOD: The sample studied consisted of volunteer adult patients referred over a three-month period to a HIVVCT clinic based at a university-affiliated general state hospital. Patients completed a questionnaire on sociodemographic data. Suicidal ideation was measured using the Beck Hopelessness Scale and the Beck Depression Inventory (BDI), at two time points (within 72 hours after notification and again at a 6 week follow-up). All patients received extensive pre-and post-test counselling. RESULTS: HIV-test results were available for 189 (99.5%) of the original sample of 190 patients studied, with 157 (83.1%) testing positive. More females tested positive as did unemployed and single/divorced patients. The mean age for HIV-positive patients was 33.49 (SD = 9.449), and for HIV-negative patients it was 37.94 (SD = 15.238). Age was a significant factor in that for each year increase in age, the risk of testing HIV-positive decreased by 4.1%. Lower education and traditional beliefs were also significantly associated with testing HIV-positive. At 72 hours suicidal ideation was present in 17.1% (95% confidence interval 12.16% to 23.45%), and at 6 weeks in 24.1% (95% confidence interval 17.26% to 32.39%) of the seropositive patients. Their average BDI scores were 15.20 and 14.23 respectively at the two time points. CONCLUSION: Suicidal ideation was present in a significant number of the seropositive cohort studied and increased over a six week period among these patients. The average BDI scores at both time points imply a clinical depression. The findings also suggest an association between positive HIV-test results and certain socio-demographic variables that can act as indicators for suicidal ideation in HIV-infected persons, although this requires further research. Although the relationship between suicidal ideation and HIV-infection is complex, it is an important consideration when assessing patient suicide vulnerability at HIV VCT clinics and when implementing suicide prevention and management strategies.

HIV-infection as a self-reported risk factor for attempted suicide in South Africa.

OBJECTIVE: The aim of this study was to examine variables associated with recently diagnosed HIV-infection as a self-reported attempted suicide risk factor. METHOD: The study cohort consisted of 112 general hospital in-patients who attempted suicide because of HIV-infection. All the patients were subject to a comprehensive mental state examination and administration of a semi-structured questionnaire to obtain biographical, sociodemographic and other relevant information. Pearson uncorrected Chi-square (X(2)) or Fisher's Exact Probability Test were used to analyze data utilising Epicalc 2000, version 1.02. RESULTS: Most patients expressed a heterosexual preference. The average age was 34.9 years. Females predominated and in both genders depression and substance abuse (mainly alcohol-related) accounted for the most common psychiatric diagnoses. Less than half of the patients were married. Partner relational problems was a statistically significant variable. The most prevalent co-morbid stressors were poor social support, fear of disclosure/stigmatization and socio-economic pressures. Cognitive deficits included problems with cognitive flexibility, concentration and memory. Based on estimated national suicidal behaviour prevalence rates, a descriptive HIV-related attempted suicide rate of 67.2 per 100 000 and an increased risk for attempted suicide of 13.33% to 18.87% were calculated. CONCLUSION: HIV-infection can be an underestimated suicide risk factor. Effective management and prevention programmes should include as imperatives early diagnosis of HIV-related suicidal behaviour, recognition of underlying psychopathology, neurocognitive deficits, associated stressors, the dynamics of partner relationship problems, as well as cultural awareness and sensitivity. Potential neurocognitive complications that can act as additional risk factors require further research.

HIV-infection as a self-reported risk factor for attempted suicide in South Africa

Objective: The aim of this study was to examine variables associated with recently diagnosed HIV-infection as a self-reported attempted suicide risk factor. Method: The study cohort consisted of 112 general hospital in-patients who attempted suicide because of HIV-infection. All the patients were subject to a comprehensive mental state examination and administration of a semi-structured questionnaire to obtain biographical; sociodemographic and other relevant information. Pearson uncorrected Chi-square (X2) or Fisher's Exact Probability Test were used to analyze data utilising Epicalc 2000; version 1.02. Results: Most patients expressed a heterosexual preference. The average age was 34.9 years. Females predominated and in both genders depression and substance abuse (mainly alcohol-related) accounted for the most common psychiatric diagnoses. Less than half of the patients were married. Partner relational problems was a statistically significant variable. The most prevalent co-morbid stressors were poor social support; fear of disclosure/stigmatization and socio-economic pressures. Cognitive deficits included problems with cognitive flexibility; concentration and memory. Based on estimated national suicidal behaviour prevalence rates; a descriptive HIV-related attempted suicide rate of 67.2 per 100 000 and an increased risk for attempted suicide of 13.33to 18.87were calculated. Conclusion: HIVinfection can be an underestimated suicide risk factor. Effective management and prevention programmes should include as imperatives early diagnosis of HIV-related suicidal behaviour; recognition of underlying psychopathology; neurocognitive deficits; associated stressors; the dynamics of partner relationship problems; as well as cultural awareness and sensitivity. Potential neurocognitive complications that can act as additional risk factors require further research

Short-term precipitants of parasuicide in adolescents.

Despite extensive research, our knowledge about adolescent parasuicide, why its incidence is currently so high and how to predict it remains incomplete. In the past research often focused on aetiological factors and long-range prediction. In this article short-term aetiological variables relating to both immediate precipitants and psychiatric diagnoses in a sample of 159 adolescents who attempted suicide are explored. The findings should contribute to a clearer understanding of the build-up to the parasuicidal crisis, the consequent level of disturbance and its treatment.

Self-destructive behaviour in adolescents.

Parasuicides continue to be an important public health responsibility. The consensus of opinion of most research workers is that the previously observed high rates are increasing on an international scale. Generally tabulated figures are minimal, representing an underestimation of actual rates, and exclude an unknown proportion of events classed incorrectly, although such studies nevertheless give some comprehension of the nature and severity of the problem. A 1978 study of parasuicides in young patients seen in the Department of Psychiatry, Addington Hospital, Durban, is updated for the period 1 January - 31 December 1983. The overall patient attendance figure for this period was 10 984, while a total of 3 200 requests for consultations were received. Of these 567 were for patients referred because of parasuicides--17,7% of all consultations referred. Nearly one-third (29%) of the parasuicides were in young patients, i.e. of 19 years old and younger, which represents a notable increase for the next 5 years when compared with the 1978 study in which 25% of parasuicides were in patients in this age range. There were more girls than boys. Peak months were October and November. A number of patients had a history of earlier parasuicides, suicidal thoughts and psychological treatment or came from a family with a history of mental disorder or previous parasuicides. Ten per cent of patients had a history of alcohol or drug abuse. Self-poisoning with analgesics, benzodiazepines and antidepressants was the most common method used. Results are discussed within the context of a service in medical psychology in a general hospital.

The diagnosis and treatment of conduct disorders in young people.

Conduct disorders are among the most prevalent psychiatric disorders currently encountered in young people. The condition 'conduct disorder' is, however, an 'umbrella concept' which affects divergent personality subtypes. Treatment in the past, based on such an 'umbrella concept', has often proved itself prognostically dubious. This article stresses the need for the direction of management towards differential diagnosis and treatment of the various conduct disorder subtypes.

Consultation-liaison clinical psychology in modern general hospital practice.

The past few decades have witnessed rapid international development of the interface between psychiatry and the mainstream of medicine. This development, which is a characteristic of general hospital psychiatric units, has become known as consultation-liaison psychiatry and has evolved as a clinical and teaching activity dealing with psychosomatic medicine. Problems of health and illness are inextricably related to physical as well as behavioural and environmental factors, each contributing to problems encountered in the medical management of patients. Therefore as a corollary to the developments mentioned above, a new role has emerged for clinical psychology within the general hospital and has become known as 'medical psychology'. By this term is meant all the medical applications of normal and abnormal psychology. A clinical psychology consultation-liaison service in a general hospital is discussed and an analysis of 1 092 consultations and 4 193 outpatient attendances at a psychiatric unit of a general hospital between 1 January and 30 June 1982 is presented. A rationale for the role of the clinical psychologist as a consultant within the medical setting is suggested.

Negative bodily experience and prevalence of depression in patients who request augmentation mammoplasty.

Increasing numbers of women seek to improve their physical appearance through augmentation mammoplasty (AM), often as a result of underlying psychological problems. Because of methodological problems in many studies, the reported prevalence of psychopathology in these patients varies widely. This study was designed to ascertain the presence of negative bodily experience and depression in patients requesting AM. The study cohort of 30 patients (mean age 30,4 years) was matched and compared with a hospital control group (mean age 30,8 years) who had never requested AM and had been admitted for minor surgery. The two groups were sociodemographically equivalent, the typical patient being a relatively well-educated white housewife. Each patient underwent individual psychological assessment, which included a semistructured interview, mental status examination and administration of the Beck Depression Inventory. Apart from several psychological problems related to a negative bodily experience, results indicated that varying degrees of depression were present to a significant extent in most patients seeking AM, emphasising the need for careful pre-operative psychological assessment and treatment of those patients who may require it.

Long-term psychological sequelae of augmentation mammoplasty.

A request for elective surgery for augmentation mammoplasty (AM) is often associated with underlying psychopathology and high expectations of a positive psychological outcome. This study was designed to ascertain the long-term psychological sequelae of AM in a group of patients who were reassessed 3 years or more after surgery. The postoperative study cohort of 20 patients constituted 67% of the original sample that was psychologically assessed pre-operatively. The results show that the majority of patients benefited psychologically from the AM and had experienced an improvement in psychosexual functioning and a reduction of high pre-operative levels of negative body image, anxiety and depression. Although not all expectations had been met and basic personalities remained unchanged, most women had no regrets and would recommend AM to other women in similar circumstances. They had not, however, seriously considered the possibility of unsatisfactory postoperative outcome. The value of close liaison between mental health specialists and plastic surgeons is emphasised.