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1.
AIDS Care ; : 1-5, 2021 Apr 23.
Artículo en Inglés | MEDLINE | ID: mdl-33888003

RESUMEN

Previous research has indicated that major depression is a chronic illness with people experiencing several depressive episodes over the course of their lifetime. To this extent people who currently report major depression are more likely to enter and exit future depressive episodes than those who do not. We studied 500 South Africans seeking an HIV test to determine whether past depressive disorders predicted present depression. Among our sample, 14.40% met the diagnostic criteria for current major depression and 10.42% reported past major depression. Using chi-square analysis we found that study participants with current major depression were 9.25 times more likely to have had past major depression than those without past major depression. These results have important implications for HIV care. Persons who test positive for HIV and who have major depression are less likely to accept and adhere to antiretroviral therapy. Thus identifying positive cases of depression and thus the risk of future depressive episodes among this population will enhance the likelihood of referral for mental health treatment which in turn is likely to yield improved HIV treatment outcomes.

2.
Public Health Nutr ; : 1-30, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33769239

RESUMEN

OBJECTIVE: Food insecurity is a structural barrier to HIV care in peri-urban areas in South Africa (SA), where approximately 80% of households are moderately or severely food insecure.(1) For people with HIV (PWH), food insecurity is associated with poor ART adherence and survival rates. Yet, measurement of food insecurity among PWH remains a challenge. DESIGN: This study examines the factor structure of the 9-item Household Food Insecurity Access Scale (HFIAS, isiXhosa-translated) among PWH in SA using a restrictive bifactor model. SETTING: Primary care clinics in Khayelitsha, a peri-urban settlement in Cape Town, SA. PARTICIPANTS: Participants (N=440) were PWH who received HIV care in Khayelitsha screening for a clinical trial. Most were categorized as severely (n=250, 56.82%) or moderately (n=107, 24.32%) food insecure in the past 30 days. RESULTS: Revised parallel analysis suggested a 3-factor structure, which was inadmissible. A 2-factor structure was examined but did not adequately fit the data. A 2-factor restrictive bifactor model was examined, such that all items loaded on a general factor (food insecurity) and all but two items loaded on one of two specific additional factors, which adequately fit the data (CFI=0.995, SRMR=0.019). The two specific factors identified were: anxiety/insufficient quality, and no food intake. Reliability was adequate (ω=.82). CONCLUSIONS: Results supported the use of a total score, and identified two specific factors of the HFIAS, which may be utilized in future research and intervention development. These findings help identify aspects of food insecurity that may drive relationships between the construct and important HIV-related variables.

3.
J Trauma Stress ; 2021 Feb 03.
Artículo en Inglés | MEDLINE | ID: mdl-33533528

RESUMEN

This study assessed the ability of the Posttraumatic Stress Disorder (PTSD) Checklist for the DSM-5 (PCL-5) to distinguish between caseness and noncaseness for PTSD among South Africans receiving care for HIV. The PCL-5 and the Structured Clinical Interview for DSM-5-Research Version (SCID-RV) module for PTSD were administered to 688 patients receiving antiretroviral therapy (ART) at two HIV care clinics in the greater Cape Town (South Africa) area. In total, nearly half of the sample (n = 324, 47.1%) reported experiencing an index traumatic event, and 101 participants (14.74%, 95% CI [12.17%, 17.62%]) met the diagnostic criteria for PTSD as measured using the SCID-RV. An ROC curve analysis suggested that a PCL-5 cutoff score of 32 yielded optimal sensitivity (0.88) and specificity (0.88), indicating that the measure was successful in determining caseness for PTSD 88% of the time and noncaseness 88% of the time. The AUC was 94.3%, 95% CI [92.6% to 96.1%], indicating high accuracy. The positive predictive value and negative predictive values were 56.3% and 97.7%, respectively, which suggests that the PCL-5 is an effective screening instrument to determine the presence of PTSD among South African ART users. Undetected and, thus, untreated PTSD may reduce quality of life, impede optimal adherence to ART, and increase the likelihood of risk behaviors among individuals living with HIV, contributing to further infections. The PCL-5 may be used for detection, referral, and treatment of PTSD as a way to enhance its management among individuals receiving HIV care.

4.
AIDS Behav ; 25(6): 1864-1872, 2021 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-33387136

RESUMEN

The aim was to establish the potential reduction in non-fatal suicidal behaviour (NFSB) that could be achieved by treating common mental disorders (CMDs) among persons receiving HIV treatment. Data were collected from antiretroviral therapy (ART) patients in South Africa (n = 688). Structured Clinical Interviews assessed CMDs and the Mini International Neuropsychiatric Interview assessed 1-month prevalence of NFSB and suicide risk. Population Attributable Risk (PAR) analysis established the potential reduction in prevalence of NFSB and suicide risk that could be achieved by treating CMDs, with the simplifying assumption of a causal relationship between psychopathology and suicidality. Treating CMDs could result in as much as a 63.9% proportional reduction in the prevalence of suicide ideation, 84.2% proportional reduction in the prevalence of suicide plan, and 63.4% proportional decrease in prevalence of suicide risk. There is potential to significantly reduce NFSB among ART patients. Pragmatic trials are needed to evaluate the effects of treating CMDs in HIV treatment centres.


Asunto(s)
Infecciones por VIH , Trastornos Mentales , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Trastornos Mentales/tratamiento farmacológico , Trastornos Mentales/epidemiología , Prevalencia , Medición de Riesgo , Factores de Riesgo , Sudáfrica/epidemiología , Ideación Suicida , Intento de Suicidio
5.
Gen Hosp Psychiatry ; 67: 70-76, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33059218

RESUMEN

Patients receiving HIV care at two public health facilities in South Africa were assessed using the Centres for Epidemiological Studies Depression Scale Revised (CESD-R) and the Structured Clinical Interview for DSM5 to assess major depressive disorder. Of the 688 study participants, 229 (33.3%; CI = 29.8%; 36.9%) scored in the elevated range on the CESD-R and 170 (24.7%; CI = 21.5% to 28.1%) met the diagnostic criteria for major depressive disorder (MDD). ROC curve analysis indicated that a CESD-R cut-point of 26.5 (rounded to 27) yielded optimal sensitivity (0.81) and specificity (0.82) in determining caseness for MDD. Positive and negative predictive values of the CESD-R were 60.26% and 92.98%, respectively. The AUC was 0.89 (89%) (95% CI = 0.86-0.92) indicating moderate to high accuracy. For the purpose of routine screening in the context of HIV care, the CESD-R appears to hold promise in identifying cases of MDD. Those who screen positive may then undergo a formal diagnostic interview to determine whether they are true cases for MDD, and referred for treatment.

6.
Curr HIV/AIDS Rep ; 17(5): 529-546, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32776179

RESUMEN

PURPOSE OF REVIEW: We reviewed interventions to improve uptake and adherence to antiretroviral therapy (ART) in African countries in the Treat All era. RECENT FINDINGS: ART initiation can be improved by facilitated rapid receipt of first prescription, including community-based linkage and point-of-care strategies, integration of HIV care into antenatal care and peer support for adolescents. For people living with HIV (PLHIV) on ART, scheduled SMS reminders, ongoing intensive counselling for those with viral non-suppression and economic incentives for the most deprived show promise. Adherence clubs should be promoted, being no less effective than facility-based care for stable patients. Tracing those lost to follow-up should be targeted to those who can be seen face-to-face by a peer worker. Investment is needed to promote linkage to initiating ART and for differentiated approaches to counselling for youth and for those with identified suboptimal adherence. More evidence from within Africa is needed on cost-effective strategies to identify and support PLHIV at an increased risk of non-adherence across the treatment cascade.

7.
BMC Palliat Care ; 19(1): 95, 2020 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-32611344

RESUMEN

BACKGROUND: Research on the patient experience of receiving palliative care across a number of settings is increasing, but the majority of these investigations are situated within the context of developed countries. There is limited research from resource-limited countries, especially with regard to patients with cancer who receive hospice care. The present study explored the lived experience of attending hospice care facilities in South Africa to develop a bottom-up understanding from the perspectives of patients themselves. METHODS: A qualitative cross-sectional study was designed to examine how patients experienced receiving hospice care We conducted in-depth, semi-structured interviews with thirteen, purposively selected patients living with terminal cancer and receiving in-patient or day care palliative services from a hospice organisation in South Africa. We used inductive thematic analysis to analyse the data. RESULTS: We identified three themes that reflected a process of transformation that was experienced by participants during their engagement with the hospice services. The first theme describes participants' initial reluctance to be linked to the hospice as a result of the stereotypic perceptions of hospice as being associated with death and dying. The second theme presents the perceived positive impact on patients' physical and psychosocial wellbeing which resulted from the highly valued interactions with staff and other patients as well as patients' engagement with creative activities. The final theme delineates the transformation of hospice into a second 'family' and 'home' and the restoration of an identity that expands beyond the 'sick' role. CONCLUSIONS: Receiving hospice care that sensitively attends to patients' psychosocial and physical needs helps people to re-create a sense of homeliness within the world, re-orient themselves toward a meaningful life and re-configure their relationship with self. Patient experience of receiving hospice care in South Africa does not appear dissimilar to that reported by patients in resource-rich countries, suggesting underlying commonalities. There is a need for raising awareness and educating the public about what palliative care can offer to those in need. Public health campaigns could help reduce the stigma attached to palliative care, deflect negative perceptions, and communicate the benefits for patients, families and communities in culturally sensitive ways.

8.
Glob Public Health ; 15(8): 1093-1102, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32524893

RESUMEN

In seeking to limit the number of new infections of COVID-19, governments around the world have implemented national lockdowns and guidelines about safe behaviours. Lockdown requires people to stay home and only leave when essential such as to purchase groceries and medication. In low- and middle-income countries, many of which have large proportions of the population living in precarity, lockdown forces millions of people to spend prolonged periods of time together in close proximity to one another and with limited resources. In many ways, efforts to contain the spread of COVID-19 in densely populated communities with limited access to food, water and sanitation may seem counter-intuitive and even impossible under conditions of precarity. In this paper, we explore the barriers to implementation of lockdown rules in conditions of precarity. We conceptualise the structural barriers by drawing on the Theoretical Domains Framework to explain how these barriers influence adherence to lockdown rules. We argue that without sufficient support or intervention to help poor communities mitigate these structural barriers, adhering to lockdown rules is difficult, resulting in continued COVID-19 infections.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Países en Desarrollo , Conductas Relacionadas con la Salud , Neumonía Viral/epidemiología , Cuarentena , Aislamiento Social , Betacoronavirus , Infecciones por Coronavirus/prevención & control , Humanos , Modelos Teóricos , Pandemias/prevención & control , Neumonía Viral/prevención & control
9.
Eur J Psychotraumatol ; 11(1): 1753941, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32537098

RESUMEN

There is a need in the global south to evaluate and implement empirically supported psychological interventions to ameliorate symptoms of posttraumatic stress disorder (PTSD). Empirically supported treatments (ESTs) have increasingly been developed and implemented, yet the majority people in the global south do not have access to these treatments for mental disorders such as PTSD. Prolonged exposure therapy has accrued substantial empirical evidence to show it as an effective treatment for PTSD. Research on the effectiveness and acceptability of prolonged exposure in a low- and middle-income countries (LMICs) are sparse. This brief report presents a review of prolonged exposure (PE) therapy and its feasibility as a trauma therapy for PTSD in LMICs. First, we present a brief overview of PE as a first-line treatment for PTSD. Second, using South Africa as a case example, we present a brief overview of traumatic stress in South Africa and how mental healthcare has developed since the abolishment of apartheid in 1994. Lastly, we discuss the challenges pertaining to the dissemination and implementation of PE in LMICs and propose future perspectives regarding the implementation of ESTs such as PE in LMICs.

10.
AIDS Behav ; 24(9): 2680-2690, 2020 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-32162093

RESUMEN

South Africa (SA) has the most people living with HIV/AIDS (PLWH) globally and prevalent alcohol use. Beliefs that mixing alcohol and antiretroviral therapy (ART) can lead to adverse reactions may promote ART nonadherence. Healthcare providers (n = 11) and patients (n = 19) recruited from primary HIV and substance use care in SA described their messages, beliefs, and behaviors around simultaneous use of alcohol and ART. Transcripts were analyzed using thematic analysis: (1) most providers indicated a message shift to reflect harm reduction principles: PLWH should manage alcohol use but not let it interfere with taking ART; however, (2) patients recalled conflicting messages from their providers and some displayed interactive toxicity beliefs and behaviors. Despite progress demonstrated by 2016 national adherence guidelines and shifted provider messaging, interactive toxicity beliefs remain a barrier to ART adherence. Results have implications for the adaptation of adherence counseling to minimize the impact of alcohol use on HIV treatment.


Asunto(s)
Consumo de Bebidas Alcohólicas/psicología , Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Personal de Salud/psicología , Cumplimiento de la Medicación/psicología , Adulto , Interacciones Farmacológicas , Femenino , Adhesión a Directriz , Infecciones por VIH/epidemiología , Infecciones por VIH/psicología , Reducción del Daño , Humanos , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Investigación Cualitativa , Sudáfrica , Encuestas y Cuestionarios
11.
Glob Public Health ; 15(6): 918-924, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32083988

RESUMEN

Many non-governmental organisations (NGOs) in resource-constrained communities who provide psychosocial services employ lay and paraprofessional counsellors to dispense these services to clients. Yet, selection criteria for such lay persons are highly variable. In the context of low levels of formal education in many communities, education-based criteria are not easily applied. The eligibility of individuals for counsellor training is a matter of considerable importance even though NGO staff may not differentiate between those volunteers or employees who are and are not eligible for training. Also, no screening instruments have been developed to reliably discriminate between individuals who do and do not become effective counsellors. Indeed, decisions about which applicants are and are not trainable are of considerable consequence in sustaining high quality work. A research programme is needed to identify attitudinal and personality markers that may predict success as lay counsellors. In this article specific suggestions are made, including suggestions for practice so that the administrative and human resource needs of NGO's can be balanced with the professional and ethical imperative of recruiting lay counsellors who are trainable and capable of performing counselling tasks with the highest level of professionalism possible despite their lay status.

12.
Glob Public Health ; 15(6): 818-827, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31994442

RESUMEN

In multilingual societies, where researchers and participants often do not speak the same language, research is a challenge as a mismatch of understanding between researchers, research instruments and participants often occurs. Reporting on the translation process is crucial because of the potential implications for the validity of the data that follow from it. We aimed to report on the complexities of such a translation process and many considerations that came to our attention. Methodologically, we used a detailed case study to demonstrate that the complexity of translation might be underestimated by researchers who may neglect to report on the challenges that they experience to benefit the wider research community. We emphasise that translating documents, particularly between languages that are not cognate, requires time and financial resources that researchers often do not anticipate or plan for. By discussing what happened to texts that were translated, and how we as researchers were challenged by considerations that were primarily linguistic but also straddled cultural and socio-political domains, we hope to encourage a deeper understanding of the translation task. We conclude that consideration of these complexities is necessary if the aim is the development of translated documents which complement the researchers' goals.

13.
Behav Res Ther ; 130: 103466, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-31733813

RESUMEN

The study's objective was to determine the effectiveness of a task-sharing psychological treatment for perinatal depression using non-specialist community health workers. A double-blind individual randomised controlled trial was conducted in two antenatal clinics in the peri-urban settlement of Khayelitsha, Cape Town. Adult pregnant women who scored 13 or above on the Edinburgh Postnatal Depression rating Scale (EPDS) were randomised into the intervention arm (structured six-session psychological treatment) or the control arm (routine antenatal health care and three monthly phone calls). The primary outcome was response on the Hamilton Depression Rating Scale (HDRS) at three months postpartum (minimum 40% score reduction from baseline) among participants who did not experience pregnancy or infant loss (modified intention-to-treat population) (registered on Clinical Trials: NCT01977326). Of 2187 eligible women approached, 425 (19.4%) screened positive on the EPDS and were randomised; 384 were included in the modified intention-to-treat analysis (control: n = 200; intervention: n = 184). There were no significant differences in response on the HDRS at three months postpartum between the intervention and control arm. A task-sharing psychological treatment was not effective in treating depression among women living in Khayelitsha, South Africa. The findings give cause for reflection on the strategy of task-sharing in low-resource settings.

14.
Psychotherapy (Chic) ; 57(1): 107-118, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31670529

RESUMEN

South Africa has the largest HIV/AIDS burden globally. In South Africa, substance use is prevalent and interferes with HIV treatment adherence and viral suppression, and yet it is not routinely treated in HIV care. More research is needed to adapt scalable, evidence-based therapies for substance use for integration into HIV care in South Africa. Behavioral activation (BA), originally developed as an efficacious therapy for depression, has been feasibly used to treat depression in low- and middle-income countries and substance use in high-income settings. Yet, to date, there is limited research on using BA for substance use in low- and middle-income countries. Guided by the ADAPT-ITT framework, this study sought to adapt BA therapy for substance use in HIV care in South Africa. We conducted semistructured individual interviews among patients (n = 19) with moderate/severe substance use and detectable viral load, and HIV care providers and substance use treatment therapists (n = 11) across roles and disciplines at 2 clinic sites in a peri-urban area of Cape Town. We assessed patient and provider/therapist views on the appropriateness of the BA therapy model and sought feedback on isiXhosa-translated BA therapy components. Participants identified the central role of boredom in contributing to substance use and saw the BA therapy model as highly appropriate. Participants identified church and religious practices, sports, and yard/housework as relevant substance-free activities. These findings will inform adaptations to BA therapy for substance use and HIV medication adherence in this setting. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

15.
Health Care Women Int ; 41(3): 308-329, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-31242076

RESUMEN

We examined biopsychosocial predictors of symptoms of depression in women with endometriosis. The sample consisted of 202 women with endometriosis who completed a battery of measures including a demographic questionnaire, Beck Depression Inventory, Stellenbosch Endometriosis Quality of life Menstrual characteristics subscale, Short form health survey Physical functioning subscale, and three modular components of the Endometriosis Health Profile 30, namely the Sexual Relationships, Feelings about the Medical Profession, and Feelings about Infertility modules. About 43.1% of the sample reported moderate to severe symptoms of depression. Physical functioning, feelings about the medical profession and sexual relationships were significant predictors of symptoms of depression. The identification of these predictors may enable researchers and practitioners to identify patients to be screened for depression, e.g., patients who report sub-optimal physical functioning, negative feelings about the medical profession and difficult sexual relationships.


Asunto(s)
Depresión/etiología , Endometriosis/diagnóstico , Endometriosis/psicología , Calidad de Vida/psicología , Estrés Psicológico/etiología , Adulto , Estudios Transversales , Depresión/psicología , Dispareunia , Endometriosis/epidemiología , Femenino , Humanos , Dolor , Satisfacción del Paciente , Escalas de Valoración Psiquiátrica , Estrés Psicológico/psicología , Encuestas y Cuestionarios
16.
Glob Public Health ; 15(1): 22-30, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31274374

RESUMEN

Community engagement in biomedical trials is to ensure ethical conduct in research, yet it has been criticised regarding power and exploitation of vulnerable communities where trials take place. This makes community engagement processes complex. We report on one example of how the global politics of biomedical research and local issues of contemporary politics and identities intertwine in a community engagement process. These issues emerged during observations in staff training at a biomedical HIV prevention trial centre in South Africa from September to November 2015. Within the practices of the training sessions, the sessions had an unintended and not explicitly discussed purpose, termed the hidden project of creating a safe space for participants to discuss issues of difference. Examples are culture and greeting practices, culture and respect and the politics of language. Creating a space during training sessions where issues of power may be discussed is a prime example of community engagement. Engagement includes creating the space to discuss differences and collaborative bases. Processes of meaningful community stakeholder engagement, as illustrated by the training sessions, may contribute to combination prevention of HIV by promoting the integration of behavioural, sociocultural and biomedical efforts, and by a more developed understanding of power.


Asunto(s)
Ensayos Clínicos como Asunto , Participación de la Comunidad , Infecciones por VIH/prevención & control , Factores Socioeconómicos , Participación de los Interesados , Investigación Biomédica , Diversidad Cultural , Salud Global , Humanos , Proyectos de Investigación , Sudáfrica
17.
J Health Psychol ; 25(1): 82-91, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-29243520

RESUMEN

HIV vaccine efficacy trials require the enrolment of large numbers of HIV-negative individuals and thus it is necessary to engage with communities where HIV incidence is high. We identify some of the caveats and pitfalls associated with researching community engagement in the context of HIV vaccine trials. These are as follows: the lack of consensus of what community engagement is and how it is practiced, the sometimes paradoxical role of community advisory boards as community representatives and challenges associated with information dissemination in communities. We identify a set of considerations for community engagement practitioners, trial investigators and social scientists when conducting community engagement.

18.
AIDS Behav ; 24(2): 629-636, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31041626

RESUMEN

There is a need for effective psychiatric screening of HIV test seekers, given the high rates of psychopathology in this population. We used receiver operating characteristic curve analysis to establish the utility of the short version of the Hopkins Symptom Checklist (HSCL-25) to correctly identify common mental disorders (CMDs) among persons seeking HIV testing. The HSCL-25 is moderately accurate in identifying CMDs (sensitivity = 69%, specificity = 71%). The HSCL-25 performed better than the Beck Depression Inventory at detecting depressive disorders, and was comparable to the Beck Anxiety Inventory and Posttraumatic Stress Scale-Self-report at detecting cases of generalised anxiety disorder and posttraumatic stress disorder, respectively. However, the instrument generates a high number of false positives and is poor at detecting cases of alcohol use disorder, which limits its utility as a trans-diagnostic screening tool in HIV testing sites.


Asunto(s)
Lista de Verificación , Infecciones por VIH/diagnóstico , Tamizaje Masivo/métodos , Trastornos Mentales/diagnóstico , Pruebas Serológicas/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Humanos , Masculino , Tamizaje Masivo/normas , Trastornos Mentales/psicología , Persona de Mediana Edad , Escalas de Valoración Psiquiátrica , Curva ROC , Sensibilidad y Especificidad
19.
S Afr J Psychiatr ; 25: 1336, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31824741

RESUMEN

Background: Routine anxiety screening is needed among HIV test seekers, given the lack of health-care professionals with the ability to identify individuals with generalised anxiety. Aim: The aim of this study was to determine the effectiveness of the Beck anxiety inventory (BAI) in predicting caseness for generalised anxiety disorder (GAD) among persons seeking HIV testing, using the structured clinical interview for the DSM-5 (SCID-5) as the gold standard. Setting: Five HIV testing sites in the Western Cape region of South Africa. Method: We recruited 500 persons seeking HIV testing from five non-medical testing sites in the Western Cape, South Africa. We used receiver operating curve analysis to determine the optimal cut-off point on the BAI to discriminate between GAD caseness and non-caseness. Results: 3.4% of the sample met the DSM-5 criteria for a diagnosis of GAD. Using an optimal cut-off point of 21.5, the sensitivity and specificity of the BAI were 82% and 80%, respectively. The positive predictive value was 13%, while the negative predictive value was 99%. Conclusion: Our data suggest that while the BAI may be used to screen for GAD, it is likely to yield a high number of false positives. A two-tiered method may be useful to mitigate against case over-identification. Thus, in a public health setting, persons screening positive on the BAI should receive a diagnostic interview to determine whether they are true cases for GAD. Within resource-constrained communities in South Africa, referral trajectories should be integrated with routine screening and HIV testing.

20.
J Child Adolesc Ment Health ; 31(1): 39-50, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30961448

RESUMEN

Objective: To explore the perceived barriers and facilitators for healthy behaviours among parents and caregivers of adolescents receiving mental health care in Cape Town, South Africa. Method: Thirty-five qualitative in-depth interviews were conducted with parents and caregivers of adolescents receiving mental health treatment by six facilitators matched for language. The data was analysed using thematic analysis. Results: The participants were predominantly female (n = 28, 80%) and parents (n = 29, 83%) of the adolescents. Personal barriers to good health included unhealthy eating, substance use and physical inactivity. Environmental barriers were inherited medical conditions, the easy availability of unhealthy foods and the absence of recreational facilities in communities. Perceived facilitators to good health were parental role modelling, planning and preparing healthy meals, exercise opportunities providing by walking long distances to work, and doing physically demanding jobs and household chores. Conclusion: Parents and caregivers are essential to adolescents' healthy development as they may influence adolescent health behaviours. It is likely that the promotion of positive health behaviours may be achieved though family-based interventions.


Asunto(s)
Actitud Frente a la Salud , Conductas Relacionadas con la Salud , Trastornos Mentales/terapia , Responsabilidad Parental/psicología , Padres/psicología , Adolescente , Adulto , Femenino , Hospitales Públicos , Humanos , Masculino , Servicios de Salud Mental , Investigación Cualitativa , Sudáfrica
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