Studies in behavioural epidemiology

Collection of papers submitted to the Faculty of Medicine, University of Cape Town, in fulfilment of the requirements of Part III of the Degree Master of Medicine in Psychiatry.The following five papers are included in this collection. Paper 1. Flisher AJ, Joubert G, Yach D. Mortality from external causes in South African adolescents, 1984 - 1986. South African Medical Journal 1992; 81: 77-80. Paper 2. Flisher AJ, Chalton DO. High school dropouts in a working-class South African community: selected characteristics and risk-taking behaviour. Journal of Adolescence (in press). Paper 3. Flisher AJ, Roberts MM, Blignaut RJ. Youth attending Cape Peninsula day hospitals. Sexual behaviour and missed opportunities for contraception counselling. South African Medical Journal 1992; 82: 104-106. Paper 4. Flisher AJ, Parry CDH. Suicide in South Africa. An analysis of nationally registered mortality data for 1984-1986. Acta Psychiatrica Scandinavica (in press). Paper 5. Flisher AJ, Parry CDH, Bradshaw D, Juritz J. Suicide in South Africa - seasonal variation. Acta Psychiatrica Scandinavica (to be submitted)

Selected results of the "methods for the epidemiology of child and adolescent mental disorders" study

Bibliography: leaves 68-75

Standards for the mental health care of people with severe psychiatric disorders in South Africa: Part 2. Methodology and results

Objective: Mental health care standards have been developed to describe what is an acceptable and adequate quality of mental health care for service users in South Africa. Part two describes the standards development methods, the range of standards developed and, as an example, the rights and protection standards domain. Methods: a systematic literature review and broad consultation to develop a set of normative- based standards. Consultation included widespread draft document distribution/feedback, in-depth provinical workshops, and focus groups. Structually, detailed criteria and sub-criteria were developed for measurability and adequate detail in key service areas. Results: Three types of standards were developed: core standards, standards for service delivery and for specific settings. Standards to ensure the rights and protection of varied service users within a range of contexts are described. Conclusion: A standards document is an essential component of a quality improvement process, within the context of a supportive legislative, political and managerial framework.Keywords: standards, mental health care, South Africa, methodology, results South African Psychiatry Review Vol. 8(4) 2005: 146-15

Conducting Epidemiological Research in South Africa: Challenges in the Data Collection Process

This article addresses the challenges faced by research supervisors and research assistants while collecting data to explore the prevalence of psychiatric disorders among children and adolescents in South Africa. The article focuses on budgetary constraints, interviewee expectations, moral issues, limited confidentiality, fatigue factors and racial issues that threatened the completion of the project. These challenges are examined from the emic-etic theoretical paradigm and the interactions between the research supervisors, the research assistants and the research participants are analyzed. The authors propose recommendations that can serve to prepare researchers who embark on conducting research in similar socio-cultural environments

Standards for the mental health care of people with severe psychiatric disorders in South Africa: Part 1. Conceptual issues

Part one describes conceptual issues underlying the development of South African standards for people with severe psychiatric disorders. Mental health care standards seek to describe what is an acceptable and adequate quality of mental health care for service users. A focus on service quality is especially crucial in resource constraint contexts. Standards are essential tools for quality assurance, advocacy and rights protection, capacity and management development and dialogue. They should be appropriate, useful and patient-centred, and operationalise local policy and legislation. Mental health standards are a challenge to define, and need to combine both a consumer and rights based approach. International and local standards and views were adapted and included in order to develop these standards which should be applicable, measurable and gradable across all South African contexts. Keywords: standards, mental health care, South Africa, conceptual South African Psychiatry Review Vol. 8(4) 2005: 140-14

Urbanisation and adolescent risk behaviour

Objective. To investigate whether there is an association between the length of time lived in an urban area and selected adolescent risk behaviours.Design. Cross-sectional survey in which students completed an anonymous, confidential questionnaire.Setting. Four high schools in black communities in the Cape Peninsula, South Africa.Participants. A sample of 1 296 students obtained by multistage cluster sampling.Main outcome measures. Selected risk behaviours.Results. There is a relationship between urbanisation and certain risk behaviours. The following risk behaviours were associated with urbanisation: use in the previous month of alcohol, cannabis, and cannabis mixed with Mandrax; being a victim of violence; perpetration of an act of violence; and suicidality. Conversely, participation in sexual intercourse and solvent sniffing in the previous month were not associated with urbanisation.Conclusion. Urbanisation is associated with an increase in the prevalence rates of some risk behaviours. Mental health promotion efforts may be informed by further research aimed at the identification of: (z) the characteristics of risk behaviour that determine whether it is associated with urbanisation; and (iz) where applicable, the specific aspects of the urbanisation process that contribute to an increase in risk

The development, implementation and evaluation of a training programme in rape crisis intervention for lay therapists : a community psychology approach

Bibliography: pages 234-253.A conceptual framework was developed in the context of community psychology for the development of a training programme in rape crisis intervention for lay therapists who were members of the Rape Crisis Organisation in Cape Town, South Africa. This framework was structured around the use of lay therapists, crisis intervention (including crisis intervention with rape victims) and consultation. The interrelationships of these three aspects were explored. The programme consisted of theoretical input and experiential exercises pertaining to rape crisis intervention and was held over two full days and one evening. The programme was evaluated by means of a modification of the instrument reported by Carkhuff (1969) to assess the levels of facilitativeness (FAC) and action orientedness (ACT) that therapists were able to offer. This instrument consists of 16 client stimulus expressions to which the therapists are required to provide responses which are rated. Besides the experimental group which consisted of the members of Rape Crisis who attended the programme (N=8), there were two control groups: control group A, consisting of members of Rape Crisis who did not attend the programme (N = 9) and control group B, consisting of people who were neither members of Rape Crisis nor who attended the programme (N = 8). The data were analysed by means of a 3 way AN OVA with repeated measures on two of the factors (the stage of assessment and the client stimulus expressions) and no repeated measures on the other factor (the groups). There were no differences in levels of FAC that subjects were able to offer within any of the groups for any of the client stimulus expressions. However, members of Rape Crisis offered significantly lower levels of FAC than subjects who were not members of Rape Crisis (overall the stage of assessment and the client stimulus expressions). The levels of ACT that subjects were able to offer increased in the case of the experimental group for all 16 client stimulus expressions, decreased in the case of control group A for 4 expressions and increased for one expression and decreased for one expression in the case of control group B. The theoretical and practical implications of these results were explored. In addition, this data was used in conjunction with information gathered from experiential reports that the members of the experimental group provided at the end of each component of the programme and from a questionnaire that they completed after the programme to yield a blueprint for future training programmes in rape crisis intervention. Finally, the training programme was discussed in relation to the conceptual framework that had been developed

The school as a setting for child and adolescent mental health interventions

How important are mental disorders in childhood and adolescence? One way of addressing this question is to examine prevalence rates for this age group. In South Africa, we do not yet have valid or reliable prevalence data from samples that are representative of any large populations. This is unfortunate, as such data are useful for service planning and for making the case that mental disorders are important. To fill this gap, an expert task team was convened in the Western Cape to compile estimates of prevalence rates of mental disorders for children, adolescents and adults in that province.1 Co-morbidity adjusted annual prevalence rates were derived by consensus. This process was informed by a systematic literature review, and estimates of rates were adjusted to take account of the extent to which risk factors for each disorder were assessed to be present in the province. The overall prevalence rate was assessed to be 17%. The rates for selected disorders were as follows: agoraphobia – 3%; attention deficit hyperactivity disorder – 5%; bipolar disorder – 1%; conduct disorder – 4%; enuresis – 5%; major depressive disorder and dysthymic disorder – 8%; oppositional defiant disorder – 6%; schizophrenia – 0.5%; separation anxiety disorder – 4%; and simple phobia – 3%. It should be borne in mind that these prevalence rates include only children and adolescents in whom the presence of the disorder was combined with functional disability to the extent that intervention was indicated