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 dueto 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

Computer Anxiety, Computer Self-efficacy and Attitudes towards the Internet of First Year Students at a South African University of Technology

Published ArticleNotwithstanding the benefits that information and communications technology (ICT) offers to learning processes, the majority of learners in rural and township areas in South Africa either do not have access to computers and the internet, or they lack sufficient skills to exploit the benefits of ICT. This lack of skills and access to computers may lead to computer anxiety and low computer self-efficacy among undergraduates entering higher education. Low computer anxiety and high computer self-efficacy levels are important factors in assisting students to be academically successful in the present technological era. This article reports on a study that assessed the computer anxiety, computer self-efficacy and attitude towards the internet among first year students at a South African university of technology. Data collection was done through a five section survey. The research revealed that students suffer from moderate computer anxiety; they have a moderate compute self-efficacy; and their attitude towards the internet is positive. The results, research contributions, and limitations are discussed, and implications for future studies are suggested

A suicide risk screening scale for HIVinfected persons in the immediate postdiagnosis period

Background. The risk of suicidal tendencies in HIV-infected persons appears high and may parallel the increasing prevalence of suicidal behaviour in South Africa. Objective. To construct a brief suicide risk  screening scale (SRSS) as a self-administered instrument to screen for suicidal ideation in recently diagnosed HIV-infected persons.Methods. An SRSS was developed, drawing 14 items from two established screening tests, and assessed using a sample of 150 HIV-infected consenting adults identified at a voluntary counselling and testing (VCT) clinic at an academic district level hospital in Durban, South Africa. Participants returned three weeks after their initial assessment for a re-assessment.Results. The internal consistency of the SRSS was good (Cronbach’s alpha, 0.87), and its sensitivity (81%) was higher than its specificity (47%). The findings suggest that, despite certain limitations, the SRSS may be a valuable screening tool for suicidal ideation at VCT clinics.Conclusion. Screening for suicide risk and possible suicidal behaviour in HIV-positive persons may form a routine aspect of comprehensive patient care at VCT clinics to assist with effective prevention and treatment

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 HIV VCT 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.Keywords: Suicidal ideation; HIV-infection; Voluntary counselling and testin

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

Objective:  Key Words: HIV-infection; Attempted suicide risk; Management; PreventionThe 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 13.33% to 18.87% were 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

Neuropsychological deficits associated with uraemic encephalopathy - A report of 5 patients

Although uraemic patients with end-stage renal disease (ESRD) often present with impaired cognitive functions, little information exists concerning the identification of some of the neuropsychological processes. underlying overt behaviour that affect adjustment to ESRD. The results of a neuropsychological investigation of a sample of adult patients with ESRD, before being accepted for dialysis, is documented in order to determine their altered neuropsychological status, since this may have a bearing on patient management and compliance. The patients were assessed by a single-case study methodology and the Luria-Nebraska Neuropsychological Battery in which parts requiring verbal patient response were taped for later detailed analysis. Neuropsychological complications occurred in conjunction with high urea levels in all patients, indicating varying degrees of impaired performance in motor, tactile, receptive language, arithmetic, and intellectual functions. A common underlying pattern of performance decrement revolved around disturbed spatial synthesis and orientation in relation to visual perception, activity, logicalgrammatical and arithmetical operations, and in intellectual tasks requiring identification of visual signs and spatial organisation. Further research is necessary to establish a possible correlation between physiological, biochemical and neuropsychological indices, and to compare neuropsychological differences between patients on different forms of treatment for ESRD

Sociodemographic and clinical profiles of suicidal patients requiring admission to hospitals south of Durban

Background: Suicidal behaviour has become a major public health concern worldwide. Non-fatal suicidal attempts outnumber fatal episodes by wide-ranging figures across, and within, many countries. Approximately 6 500 suicides and 130 000 suicide attempts occur annually in South Africa, with at least one suicide taking place every 40 seconds, compared to one suicide attempt every three seconds. It is more common for all forms of suicidal behaviour to occur in younger persons. This study aimed to analyse the characteristics of suicide attempters who were admitted to two community-based state hospitals in the south of Durban.Method: Adult patients presenting at two university-affiliated state  hospitals, following a suicide attempt during a two-year period, were invited to participate in the study. A World Health Organization standardised questionnaire was used to collect basic data relating to the suicide attempt. All participants provided informed consent. Data were analysed using SPSS® version 19.Results: The majority of the 688 participants were women who were young, single, unemployed, low-income earners, of Indian ethnicity, belonged to the Christian faith, and had a primary school education. Four hundred and thirty-eight participants (63.7%) suffered from varying levels of  depression. The majority of suicide attempts (97.2%) had taken placewithin the home environment of the attempters. Self-poisoning emerged as the dominant method that was used by 92.2% of all attempters.Conclusion: Disturbing levels of non-fatal suicidal behaviour were found in all the population groups. A number of modifiable factors were identified. These have implications for healthcare policy planners and prevention strategies

Anxiety and the patient with breast cancer: a review of current research and practice

Breast cancer is one of the most common cancers worldwide. Statistics reveal that the number of women diagnosed with breast cancer is increasing in South Africa. In particular, there appears to be a growing incidence in younger, black women in urban areas. Family practitioners and oncology healthcare professionals are going to be treating an increasing population of patients with breast cancer. Research has shown that in many instances, the psychological needs of patients with breast cancer are not adequately addressed, and that often the physical crisis is seen as more immediate. Also, healthcare professionals and oncologists may not be aware of the prevalence of co-morbid psychological distress, and thus do not focus on this aspect of the diagnosis. As a result, women who experience psychological distress during and after treatment may not be referred for psychological management. This may have a significant impact on their quality of life during this period and may even affect their compliance with treatment. This ultimately has implications for their ongoing health and survival. This review of the available literature aims to heighten awareness of healthcare professionals to the current situation, with a view of improving the mental health care of South African patients with breast cancer.Keywords: anxiety, breast cancer, depression, adjuvant treatment, psycho-oncolog

The genetic variation of lactase persistence alleles in northeast Africa

Lactase persistence (LP) is a well-studied example of a Mendelian trait under selection in some human groups due to gene-culture co-evolution. We investigated the frequencies of genetic variants linked to LP in Sudanese and South Sudanese populations. These populations have diverse subsistence patterns, and some are dependent on milk to various extents, not only from cows, but also from other livestock such as camels and goats. We sequenced a 316bp region involved in regulating the expression of the LCT gene on chromosome 2, which encompasses five polymorphisms that have been associated with LP. Pastoralist populations showed a higher frequency of LP-associated alleles compared to non-pastoralist groups, hinting at positive selection also in northeast African pastoralists. There was no incidence of the East African LP allele (−14010:C) in the Sudanese groups, and only one heterozygote individual for the European LP allele (−13910:T), suggesting limited recent admixture from these geographic regions. Among the LP variants, the −14009:G variant occurs at the highest frequency among the investigated populations, followed by the −13915:G variant, which is likely of Middle Eastern origin, consistent with Middle Eastern gene-flow to the Sudanese populations. The Beja population of the Beni Amer show three different LP-variants at substantial and similar levels, resulting in one of the greatest frequencies of LP-variants among all populations across the world.Competing Interest StatementThe authors have declared no competing interest.Introduction Results and Discussion - Allele frequencies - Haplotype Structure - Selection Scan Conclusion Materials and Methods - Phasing and imputation to analyze haplotype structure - Locus specific branch length (LSBL

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