Prevalence of alcohol use in a rural South African community

Among a community sample of 801 rural South Africans, 22.2% of men and 5.0% of women were classified as high-risk drinkers and 3.3% as with probable alcohol dependence.     

Screening and brief intervention of alcohol problems in primary care in South Africa: A brief report

The aim of this randomised controlled trial was to provide screening and brief intervention for alcohol problems in a primary care setting in South Africa. Outpatients were screened for hazardous or harmful alcohol use and were randomised into an experimental (one brief counselling session) or control group (received an alcohol health education leaflet). The study population of hazardous or harmful drinkers (N=140) consisted of 105 male and 35 female women, with a mean age of 30.4 years (SD=6.6). Among the 128 (91.4%) primary care outpatients who also attended the 6-month follow-up session, the time effects on the AUDIT scores were significant but the intervention effect on the AUDIT score was statistically not significant. It would seem that alcohol screening and the provision of an alcohol health education leaflet may in itself cause reduction in drinking.     

Pathways to mental health care by members of a rural community in South Africa

This study explored mental health help seeking pathways followed by Black South African rural community dwellers in the Limpopo province of South Africa. Ten participants (5 females and 5 males) aged between 18 and 59 years receiving services from a rural mental health care facility in the Limpopo province were the informants. They presented with psychotic disorders?=?50%, substance-use mental disorders?=?20%, mood disorders?=?20% and epilepsy?=?10%. They completed a semi-structured one-to-one interview on their pathways to mental health care services. Data were content analysed. The results showed that help seeking pathways for mental health involve several entry points. These include the utilisation of western medicine when experiencing acute symptoms, and a preference for traditional medicine when faced with chronic but manageable symptoms. The findings suggest that families and significant others are important facilitators for individuals navigating the mental health care pathways.     

Substance use among urban and rural secondary school pupils in South Africa

This study investigated the prevalence and frequency of substance use among a sample of 209 urban and 191 rural school pupils in South Africa. The three most predominantly used substances were alcohol, tobacco, and cannabis. Urban and rural differences in substances used were found.     

Prevalence and social and health correlates of insomnia symptoms among middle-and older-age persons in rural South Africa

This study investigated the prevalence and social and health correlates of insomnia symptoms among middle-and older-adults in rural South Africa. We analysed baseline survey data from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH community in South Africa (HAALSI) (N = 5 059; females = 53.6%; largely African Shangaan/Tsonga-speaking). In all, 8.0% of the adults had three insomnia symptoms, 8.9% of participants had difficulty initiating sleep, 13.6% had difficulty in sleep maintenance, and 6.5% had poor sleep quality. In adjusted logistic regression, lower education, perceived unsafe neighbourhood, poorer self-rated health status, vision difficulty, pain, depressive symptoms, and posttraumatic stress disorder (PTSD) symptoms increased the odds of having insomnia symptoms. Insomnia symptoms are common in middle-and older-age adults in rural South Africa, and various risk factors were identified. This can help in improving insomnia prevention treatment in this population.     

Correspondence: Mental health care in South Africa

Shame has been an insufficiently studied emotion in psycho-analytic literature until recently, mainly because it tended to be ‘absorbed’ under the concept of guilt. Now it is recognized as a powerful affect of pregenital origin, linked with narcissism and the ego ideal. Shame can be a motivation for achievements and social adaptation, it can protect an individual's integrity and can be a modulator of interpersonal relatedness; it can also function as a defence or initiate psychopathological states, such as depression, self-alienation, identity confusion or acting out. In adolescence shame is a ubiquitous phenomenon, as this developmental stage consists of all the parameters that can trigger feelings of shame. The emotional regression connected with the emergence of primitive impulses, conflicts and defences; the grandiose phantasies and the increased narcissism; the preoccupation with bodily functions and body image; the tendency to idealization and the need for social acceptance constitute the matrix within which shame and shame-derived feelings can develop. Shame is discussed as it is experienced by young patients and often by the therapist. Shame in the countertransference and during supervision is also considered. Stress is put on the importance of taking shame into account as a fundamental factor in psychotherapy with adolescents, particularly in relation to the establishment of the therapeutic relationship, understanding and interpretations. The thesis is illustrated with clinical vignettes.     

Posttraumatic stress symptoms in a population of rural children in South Africa

The purpose of the study was to identify exposure to experiences such as violence and the consequences for health in children in a rural South African community. The stratified random sample included 148 children below 17 yr., which comprised 68 (46%) boys and 80 (54%) girls in the age range of 6 to 16 years (M = 12.1 yr., SD = 3.1). Their ethnicity was Northern Sotho. The interviews included the Children's Posttraumatic Stress Disorder Inventory and the Reporting Questionnaire for Children. The experiences could be grouped into either traumatic or other events. 99 (67%) had directly or vicariously experienced a traumatic event which included witnessing someone killed or seriously injured, serious accident, violent or very unexpected death or suicide of loved one, sexual abuse or rape of relative or friend, violent crime, child abuse, and other life-threatening situations. Scores on the Children's Posttraumatic Stress Disorder Inventory of 17 (8.4%) fulfilled the criterion for posttraumatic stress disorder. 71% had more than one score and 53% had more than four scores on the Reporting Questionnaire for Children. Posttraumatic stress symptoms were significantly related to age and experiences such as those mentioned above.     

Patterns of alcohol use among rural and small-town adolescents

Much research has indicated that age, gender, grade in school, religiosity, socioeconomic status, and involvement in extracurricular activities are all related to adolescent alcohol use. However, most of such research focuses on urban youth. The present study examines patterns of rural adolescent alcohol use and factors associated with such use. The Student Alcohol Inventory was administered to 650 students in grades 7-12 in a small, middle-Atlantic town and surrounding county. The survey contained sections addressing demographic data, attitudes regarding students' alcohol use, and their parents' use. Along with standard SES measures, items were included on unemployment and receipt of government assistance. The dependent variables included age at first drink, frequency of drinking, amount of drinking, and a composite heavy-drinking index. Eighty-three percent of the respondents indicated that they had drunk alcohol and 57% had had their first drink by age 12. Gender and grade in school were significant predictors of alcohol use for all four dependent variables. Time spent in social activities was significant in predicting all but age at first drink. Religiosity was a significant predictor for only one dependent variable--age at first drink. The SES measures were also weak predictors of drinking behavior. Policy implications and directions for future research are discussed.     

Descriptive profile of sex and psychiatric diagnosis among rural and peri-urban clinic attenders in South Africa

Of 1,232 patients receiving psychiatric medication in outlying areas of South Africa more than half had diagnoses of schizophrenia. Significantly more men than women had substance-induced psychosis, while significantly more women had depressive and anxiety disorders.     

Affect and alcohol use: an ecological momentary assessment study of outpatients with borderline personality disorder

Alcohol use may be viewed as an attempt (albeit maladaptive) to regulate negative emotional states. We examined associations between both negative and positive affects and alcohol use in outpatient women diagnosed with borderline personality disorder (BPD; n=74), a prototype of emotional dysregulation, as well as a psychiatric control group of women with current depressive disorder (major depressive disorder/dysthymic disorder [MDD\DYS]; n=50). Participants completed randomly prompted reports of mood and alcohol use up to six times a day over a 28-day period using electronic diaries. Mean levels of either positive or negative affects did not distinguish between drinkers and nondrinkers in either diagnostic group. However, levels of both negative and positive affects were positively associated with alcohol use at the momentary level in BPD drinkers. More robust findings were obtained with respect to within-person affective variability, which was related to alcohol use in multiple ways. BPD drinkers showed higher within-person variability for most negative affects than BPD nondrinkers; MDD\DYS drinkers in general showed less within-person variability than MDD\DYS nondrinkers for negative affects. Multilevel lagged analyses for BPD drinkers indicated that alcohol use was positively related to variability in all affects, concurrently, but fewer significant effects of affect variability on the next day's drinking or significant effects of alcohol use on the next day's affect variability were observed. Among MDD\DYS drinkers, we observed more significant associations between affect variability on next day's alcohol use and of alcohol use on next day's affect variability. We discuss theoretical and methodological issues relevant to these findings as well as implications for future research.     

Correlations for perceived family environmental factors with substance use among adolescents in South Africa

Perceived family environmental factors were used to predict self-reported use of substances (drugs or alcohol) among adolescents in South Africa. 435 high school students (ages 15 to 19 years, M=17.2 yr., SD=1.34) answered a questionnaire which included questions on demographic variables, the Family Environmental Scale, and questions on substances used (drugs or alcohol). Logistic regression analysis indicated that scores on family conflict and low family moral-religious emphasis were significantly associated with drug use (57.9% of the variance was accounted for) and use of alcohol (62.3% of the variance was accounted for). Programmes for the reduction of substance use among adolescents should include activities designed to reduce family conflict and strengthen family moral-religious emphasis.     

Effects of tobacco use on non-adherence to antiretroviral therapy among HIV-positive patients in South Africa

This study aimed to estimate the relationship between tobacco use and non-adherence to antiretroviral therapy (ART) in a South African sample. Participants were 1 963 HIV patients who attended a primary care clinic in Pretoria (female = 68.5%; black African = 99.5%; median age = 37.0 years; tobacco users only = 8.6%, problem drinkers only = 14.9%, and tobacco users and problem drinkers = 10.5%). In adjusted logistic regression analysis, tobacco use only was not significantly associated with non-adherence to ART. Alcohol use only (OR: 1.72; CI: 1.26, 2.36) and tobacco use and problem drinking (OR: 2.31; CI: 1.60, 3.33) were highly associated with non-adherence to ART.     

Assessment Center Practices in South Africa

Despite the popularity of assessment centers (AC) in South Africa, no recent study exists that describes AC practices in that region. Given this research gap, we conducted a survey study that analyzes the development, execution, and evaluation of ACs in N=43 South African organizations. We report findings regarding AC design, job analysis and job requirements assessed, target groups and positions of the participants after the AC, number and kind of exercises used, additional diagnostic methods used, assessors and characteristics considered in constitution of the assessor pool, observational systems and rotation plan, characteristics, contents, and methods of assessor training, types of information provided to participants, data integration process, use of self‐ and peer‐rating, characteristics of the feedback process, and features after the AC. Finally, we compare the results with professional suggestions to identify pros and cons in current South African AC practices and offer suggestions for improvement.     

The Flynn effect in South Africa

This is a study of secular score gains in South Africa. The findings are based on representative samples from datasets utilized in norm studies of popular mainstream intelligence batteries such as the WAIS as well as widely used test batteries which were locally developed and normed in South Africa. Flynn effects were computed in three ways. First, studies where two different groups take the same test, with several years in between, using representative or comparable samples were used. Second, studies where the same group takes two different test batteries at a specific time were used. Third, the score differences between English- and Afrikaans-speaking Whites in South Africa in the 20th century were compared. The Flynn effect in White groups in South Africa is somewhat smaller than the Flynn effect in Western, industrialized countries (total N = 6534), and the Flynn effect in Indian groups is substantially smaller (total N = 682). Non-verbal IQ scores surpassed increases in verbal IQ scores. The findings from English- and Afrikaans-speaking Whites evidence a leveling out of differences in score gains over the 20th century (total N = 79,310). A meta-regression analysis showed no clear support for the moderators a) method used for computing the Flynn effect gain, b) type of test battery, c) time span, d) quality of the sample, and e) average age of sample.     

Opinion on AIDS prevention and education among rural secondary school pupils in the northern province of South Africa

The study investigated perceptions of AIDS prevention and education among 308 Grade 11 pupils (132 boys and 176 girls), secondary school pupils (mainly Northern Sotho and Tsonga) in the Northern Province of South Africa. They were chosen randomly from three rural schools in Mankweng district and were ages 17 to 25 years (M age = 19.1 yr., SD = 2.8). Analysis of ratings given on items of a questionnaire on AIDS prevention and education indicated that 'Isolating people who are HIV positive' and 'How to protect yourself from getting HIV/AIDS' received the highest ratings. Factor analysis extracted three factors on AIDS education explaining 48% of the variance. The items loading strongly on the first factor were use of condoms (.54), giving information (.53), finding a cure (.52), and no sex outside marriage (.42). On AIDS education two factors were extracted accounting for 52% of the variance. The first factor had significant item loadings for 'sexual behaviour and HIV/AIDS' (.75), 'knowledge of self-protection' (.68), 'how AIDS/HIV affects the body' (.66), and 'alcohol and sexual behaviour'. These findings should contribute to the development of health promotion initiatives directed at AIDS/HIV.