Factors associated with long hospitalisation for psychotic disorder patients in an acute ward: Tertiary care hospital.

Background: The average length of stay is often used to indicate health system efficiency; shorter stays are associated with reduced costs. In South Africa, mental healthcare expenditure is spent on inpatient care. Aim: To identify factors associated with a long stay in an acute psychiatric unit. Setting: A tertiary hospital. Methods: A case-control study review of inpatients diagnosed with psychotic symptoms was used. Sample was divided into two groups, length of stay (LOS) (LOS greater than 21 days, LOS less than 14 days). Total of 82 patients were divided into short stay group (SSG, n = 23) and long stay group (LSG) (n = 59). A comparison of demographic, clinical and system variables was conducted. Results: In demographics, LSG had fewer men compared to SSG (78.3%) and differed statistically from LSG with p = 0.05. Long stay groups were older in comparison to SSG with a p = 0.02. Illicit substance use in LSG was 44.1% and statistically less than SSG (73.91%; p = 0.02). A high proportion of LSG had medical or surgical and psychiatric comorbidities (67.8%) compared to SSG (43.5%) (p = 0.04). A total of 95% patients in SSG had family support. Conclusion: Longer stay was found to be associated with older females with primary psychotic disorders. Comorbidities with less availability of family support were associated with younger males presenting with psychotic symptoms that may be related to illicit substances that respond to rapid stabilisation. Contribution: Active surveillance of medical comorbidities amongst older female patients is necessary for early liaison services to reduce their length of stay.

Mental health symptoms among homeless shelter residents during COVID-19 lockdown in Tshwane, South Africa.

BACKGROUND: In order to contain the spread of COVID-19 in South Africa during the national state of emergency, the Gauteng Department of Social Development established temporary shelters and activated existing facilities to provide basic needs to street-homeless people in Tshwane, which facilitated primary health care service-delivery to this community. AIM: This study aimed to determine and analyse the prevalence of mental health symptoms and demographic characteristics among street-homeless people living in Tshwane's shelters during lockdown. SETTING: Homeless shelters set up in Tshwane during level 5 of the COVID-19 lockdown in South Africa. METHODS: A cross-sectional, analytical study was conducted using a Diagnostic and Statistical Manual of Mental Disorders (DSM-5)-based questionnaire that looked at 13 mental health symptom domains. RESULTS: Presence of moderate-to-severe symptoms were reported among the 295 participants as follows: substance use 202 (68%), anxiety 156 (53%), personality functioning 132 (44%), depression 85 (29%), sleep problems 77 (26%), somatic symptoms 69 (23%), anger 62 (21%), repetitive thoughts and behaviours 60 (20%), dissociation 55 (19%), mania 54 (18%), suicidal ideation 36 (12%), memory 33 (11%) and psychosis 23 (8%). CONCLUSION: A high burden of mental health symptoms was identified. Community-oriented and person-centred health services with clear care-coordination pathways are required to understand and overcome the barriers street-homeless people face in accessing health and social services.Contribution: This study determined the prevalence of mental health symptoms within the street-based population in Tshwane, which has not previously been studied.

Mental health literacy among primary healthcare workers in South Africa and Zambia.

BACKGROUND: In developing countries, mental health literacy (MHL) still needs to be improved due to the high prevalence of mental disorders. It is widely recognized that MHL can improve health outcomes for both individuals and populations. Healthcare professionals' development in MHL is crucial to the prevention of mental disorders. The aim of this study was to assess MHL of primary healthcare (PHC) workers in South Africa (SA) and Zambia and determinants thereof. Limited evidence is available on the levels of MHL among PHC workers in the sub-Saharan Africa region, which faces a large burden of mental disorders. METHODS: The study population for this cross-sectional survey comprised PHC workers (n = 250) in five provinces of SA and Zambia. MHL was measured with the Mental Health Literacy Scale (MHLS). We conducted a multivariate analysis to explore determinants of MHL. RESULTS: Results showed moderate MHL among PHC professionals, but with a wide range from low to high MHL. Knowledge-related items had a greater dispersion than other attributes of MHL. PHC workers with more education showed a greater ability to recognize mental health-related disorders. Those who had experience in the use of mental health-related assessment scales or screening tools reported a higher total MHL. The results confirmed strong internal consistency for the MHLS. CONCLUSION: The results highlighted varying mental health perceptions and knowledge in PHC. Implementation of specifically developed formal training programs and interventions to improve MHL in PHC workers to strengthen their competence may help bridge the treatment gap.

Development of a Mobile Application for Detection of Adolescent Mental Health Problems and Feasibility Assessment with Primary Health Care Workers.

Introduction: There has been a sharp increase in the use of digital health interventions in global health, particularly mobile health applications, in recent years. The extreme shortage of health care providers trained in mental health screening and intervention in low- and middle-income countries raises questions about the applicability of mobile applications to deliver these services due to their accessibility and availability. This exploratory paper describes the development and feasibility assessment of a mobile screening application for the detection of mental disorders among adolescents in Zambia and South Africa. Methods: Eighty-two health care workers (HCW) working in primary care evaluated the acceptability and practicality of the mobile screening application after receiving brief training. The evaluation included questions from the Mobile Application Rating Scale (MARS) as well as open-ended questions. Results: The acceptability of the screening app was high and study participants were positive about using the app in routine care. Problems with internet connectivity, and time and staff constraints were perceived as the main barriers to regular use. Conclusion: HCW in primary care were able and willing to use a mobile screening app for the detection of mental health problems among treatment-seeking adolescents. Implementation in clinical practice needs to be further evaluated.

Algorithmic Assessments in Deciding on Voluntary, Assisted or Involuntary Psychiatric Treatment.

The challenges in assessing whether psychiatric treatment should be provided on voluntary, assisted or involuntary legal bases prompted the development of an assessment algorithm that may aid clinicians. It comprises a part that assesses the incapacity to provide informed consent to treatment, care or rehabilitation. It also captures the patient's willingness to receive these treatments, the risk posed to the patient's health or safety, financial interests or reputation and risks of serious harm to self or others. By following various decision paths, the algorithm yields one of four legal states: a voluntary, assisted, or involuntary state or that the proposed intervention should be declined. This study examined the predictive validity and the reliability of this algorithm. It was applied 4052 times to 135 clinical case narratives by 294 research participants. The legal states yielded by the algorithm had high statistical significance when matched with the gold standard (Chi-squared = 6963; df = 12; p < 0.001). It was accurate in yielding the correct legal state for the voluntary, assisted, involuntary and decline categories in 94%, 92%, 88% and 86% of the clinical case narratives, respectively. For internal reliability, a correspondence model accounted for 99.8% of the variance by which the decision paths clustered together fittingly with each of the legal states. Inter-rater reliability testing showed a moderate degree of agreement among participants on the suitable legal state (Krippendorff's alpha = 0.66). These results suggest the algorithm is valid and reliable, which warrant a subsequent randomised controlled study to investigate whether it is more effective in clinical practice than standard assessments.

Validity of Categories Related to Gender Identity in ICD-11 and DSM-5 Among Transgender Individuals who Seek Gender-Affirming Medical Procedures.

BACKGROUND/OBJECTIVE: The most recent versions of the two main mental disorders classifications-the World Health Organization's ICD-11 and the American Psychiatric Association's DSM-5-differ substantially in their diagnostic categories related to transgender identity. ICD-11 gender incongruence (GI), in contrast to DSM-5 gender dysphoria (GD), is explicitly not a mental disorder; neither distress nor dysfunction is a required feature. The objective was compared ICD-11 and DSM-5 diagnostic requirements in terms of their sensitivity, specificity, discriminability and ability to predict the use of gender-affirming medical procedures. METHOD: A total of 649 of transgender adults in six countries completed a retrospective structured interview. RESULTS: Using ROC analysis, sensitivity of the diagnostic requirements was equivalent for both systems, but ICD-11 showed greater specificity than DSM-5. Regression analyses indicated that history of hormones and/or surgery was predicted by variables that are an intrinsic aspect of GI/GD more than by distress and dysfunction. IRT analyses showed that the ICD-11 diagnostic formulation was more parsimonious and contained more information about caseness than the DSM-5 model. CONCLUSIONS: This study supports the ICD-11 position that GI/GD is not a mental disorder; additional diagnostic requirements of distress and/or dysfunction in DSM-5 reduce the predictive power of the diagnostic model.

ANTECEDENTES/OBJETIVO: Las versiones más recientes de las clasificaciones de trastornos mentales ­CIE-11 de la Organización Mundial de la Salud y DSM­5 de la Asociación Psiquiátrica Americana­ difieren en sus categorías diagnósticas relacionadas con la identidad transgénero. La discordancia de género (DiscG) de la CIE-11, en contraste con la disforia de género (DisfG) del DSM-5, no es considerada un trastorno mental; el distrés y la disfunción no son características requeridas para el diagnóstico. El objetivo fue comparar los requisitos diagnósticos de la CIE-11 y el DSM-5 en términos de sensibilidad, especificidad y capacidad para discriminar casos y predecir el uso de procedimientos médicos de afirmación de género. MÉTODO: 649 adultos transgénero de seis países completaron una entrevista estructurada retrospectiva. RESULTADOS: De acuerdo con el análisis ROC, la sensibilidad de ambos sistemas fue equivalente, aunque la CIE-11 mostró mayor especificidad que el DSM-5. Los análisis de regresión indicaron que la historia de uso de hormonas o cirugía se predijo por variables intrínsecas a la DiscG/DisfG y no por el distrés o disfunción. Según los análisis de respuesta al ítem (TRi) la formación CIE-11 resulta más parsimoniosa y contiene mayor información sobre los casos. CONCLUSIONES: Se aporta evidencia a favor de que la DiscG/DisfG no es un trastorno mental; los criterios diagnósticos adicionales de distrés y/o disfunción del DSM-5 reducen su poder predictivo.

How can a 6-week training course shape mental healthcare professionals' understanding of mindfulness? Experiences at Weskoppies Psychiatric Hospital.

BACKGROUND: Mindfulness-based practice has gained increasing attention in the mental health community over the last four decades, and many studies have explored the evidence of its various benefits among healthcare users and providers alike. However, there remains limited research regarding the understanding of mindfulness among mental healthcare professionals. This poses the question: how much do mental healthcare professionals really know about mindfulness, and can self-practice increase the understanding of these providers? AIM: This descriptive or exploratory case study aimed to explore the understanding of mindfulness amongst 15 mental healthcare professionals. SETTING: The study took place at Weskoppies Psychiatric Hospital. METHOD: The study was conducted following a 6-week training course in which the participants were taught, and carried out mindfulness-based practices and techniques. The study also explored the following: (1) the healthcare workers' experiences, benefits and challenges regarding the consistent practice of mindfulness and (2) their confidence when explaining the concept of mindfulness, and the practices learned, to other colleagues and patients. Data were collected in the form of semi-structured interviews with the participants, 4-6 weeks after completion of the training course. RESULTS: Three main themes were identified: (1) understanding of mindfulness expanded with practice; (2) unexpected experiences during the mindfulness course; and (3) experience caused partial gains in confidence and skills. Overall, 15 subthemes were derived from the data collected. CONCLUSION: Self-practice of mindfulness can increase one's understanding of the concept and the confidence to teach informal techniques. More research is needed to determine how the design and duration of such training could impact this understanding and confidence.

Design and Development Process of a Youth Depression Screening m-Health Application for Primary Health Care Workers in South Africa and Zambia: An Overview of the MEGA Project.

Literature indicates a high prevalence and burden of mental illness in youths world-wide, which may be even higher in low- and middle-income countries (LMIC), such as South Africa and Zambia. Additionally, there is a lack of knowledge regarding youth depression amongst many primary health care (PHC) practitioners. The principal goal of the MEGA project is to provide youth with better access to mental health services and appropriate care, by developing a mental health screening mobile application tool to be used in PHC settings in South Africa and Zambia. In this study, we will use a mixed methods multi-center study design. In phase one, we will investigate the mental health literacy of PHC practitioners to identify areas in need of development. Based on the needs identified, we will develop and test a mobile health application to screen for common youth mental health problems in phase two. In phase three, we will implement and evaluate a tiered education and training program in the use of the m-health application. In the final phase, we will evaluate the acceptability and feasibility of the m-health application in PHC centres across South Africa and Zambia. Evidence suggests that PHC practitioners should routinely consider mental illness when assessing youth. However, common psychiatric disorders remain largely undetected and untreated in PHC settings. By identifying limitations in PHC workers knowledge with regard to youth mental health, we aspire to improve the depression care provided to youth in Southern Africa and Zambia by developing and implementing a locally relevant m-health application.

Content validation of Mental Health Literacy Scale (MHLS) for primary health care workers in South Africa and Zambia ─ a heterogeneous expert panel method.

Background: The lack of public knowledge and the burden caused by mental-health issues' effect on developing and implementing adequate mental-health care for young and adolescent in low- and middle-income countries (LMIC). Primary health care could be the key in facing the challenge, but it suffers from insufficient resources and poor mental health literacy. This study's aim was to adapt the content validity of the Mental Health Literacy Scale (MHLS) developed by O'Connor & Casey (2015) with researchers and primary health-care workers in low- and middle-income contexts in South Africa (SA) and in Zambia.Objectives: The study population comprised two expert panels (N = 21); Clinical Experts (CE) (n = 10) from Lusaka, Zambia and Professional Research Experts (PE) (n = 11) from the MEGA project management team were recruited to the study.Methods: MHLS was validated in a South African and a Zambian context using a heterogeneous expert-panel method. Participants were asked to rate the 35 MHLS items on a 4-point scale with 1 as not relevant and 4 as very relevant After the rating, all 35 MHLS items were carefully discussed by the expert panel and evaluated according their relevance. The data were analyzed using an item-level content validity index (I-CVI) and narrative and thematic analyses.Results: All 35 items ranked by the PREs met the cutoff criteria (≥0.8), and ten (n = 10) items were seen as relevant by CE when calculating I-CVIs. Based on the results of ratings and discussion, a group of sixteen (n = 16) of all items (n = 35) were retained as original without reviewing. A total of nineteen (n = 19) items were reviewed.Conclusion: This study found the MHLS to have sufficient validity in LMICs' context but also recognized a gap between professional researchers' and clinical workers' knowledge and attitudes related to mental health.

Experiences of gender incongruence and the relationship between social exclusion, psychological distress, and dysfunction among South African transgender adults: A field-study for ICD-11.

BACKGROUND: The classification of sexuality-related conditions and conditions relating to transgender identity has generated controversy. Growing evidence suggests that the distress and dysfunction reported by transgender individuals is more likely associated with social exclusion, stigmatization, and violence than as a result of gender incongruence per se. Our study aimed to explore the experiences of South African transgender individuals through: 1) their self-reported accounts of gender incongruence, and 2) associations between their experiences of social exclusion and violence, and their reports of psychological distress and dysfunction during adolescence. METHODS: Our sample of 57 South African transgender adults completed a structured interview, in English, including questions related to experiences of gender incongruence duration, distress, dysfunction, social exclusion, and violence. RESULTS: Many transgender individuals reported having experienced an intense desire to be a different gender, with all noting discomfort with several aspects of their bodies. Importantly, psychological distress and dysfunction were significantly associated with social exclusion (most commonly perpetuated by family and friends) and not with gender incongruence per se. CONCLUSIONS: This study adds to the growing evidence that experiences of social exclusion play a significant role in the psychological distress and dysfunction reported by transgender persons.

Priority areas for cannabis and cannabinoid product research in South Africa.

No abstract available.

The lifetime prevalence of psychiatric diagnoses in an academic gender reassignment service.

PURPOSE OF REVIEW: To review the literature regarding the prevalence of mental health concerns, including psychiatric diagnoses in the TGNC community. RECENT FINDINGS: Gender dysphoria is not the only mental health concern experienced by some members of TGNC people. Stigma and discrimination play a role in the development of mental health concerns. Even after reassignment surgery some members of the TGNC community is almost five times more likely to attempt suicide. Using a structured clinical psychiatric interview improves the likelihood of recognizing the presence of psychiatric diagnoses. Nonaffirming attitudes and behavior seem to predispose to psychiatric symptoms in some members of the TGNC community and impacts on family and peer relationships. Psychiatric symptoms are often hidden for fear of further discrimination. SUMMARY: A significant proportion of the TGNC community present with mental health concerns. Clinicians should screen appropriately for these concerns. Gender affirming interventions generally have an efficacious effect.