Perceived discrimination and mental health disorders: The South African Stress and Health study

Objectives. To describe the demographic correlates of perceived discrimination and explore the association between perceived discrimination and psychiatric disorders.Design. A national household survey was conducted between 2002 and 2004 using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate diagnoses of psychiatric disorders. Additional instruments provided data on perceived discrimination and related variables.Setting. A nationally representative sample of adults in SouthAfrica.Subjects. 4 351 individuals aged 18 years and older.Outcomes. 12-month and lifetime mood, anxiety and substanceuse disorders.Results. In the multivariate analyses, acute and chronic racial discrimination were associated with an elevated risk of any 12-month DSM-IV disorder when adjusted for socio-demographic factors, but this association was no longer statistically significant when adjusted for other sources of social stress. In fully adjusted models, acuteracial discrimination was associated with an elevated risk of lifetime substance use disorders. Acute and chronic nonracial discrimination were associated with an elevated risk of 12-month and lifetime rates of any disorder, even after adjustment for other stressors and potentially confounding psychological factors. The association of chronic non-racial discrimination and 12-month and lifetime disorder wasevident across mood, anxiety, and substance use disorders inthe fully adjusted models.Conclusion. The risk of psychiatric disorders is elevated among persons who report experiences of discrimination. These associations are more robust for chronic than for acute discrimination and for non-racial than for racial discrimination. Perceived discrimination constitutes an important stressor that should be taken into account in the aetiology of psychiatric disorders

Explanatory case studies: Implications and applications for clinical research

Explanatory case study methodology has been used to research complex systems in the fields of business, public policy and urban planning, to name a few. While it has been suggested by some that this might be a useful way to progress complex research issues in health science research, to date, there has been little evidence of this happening. The purpose of this paper is to review the explanatory case study method and present a framework for understanding how it differs from other case study methods. A review of the literature is undertaken to ascertain to what extent this method is currently being used in health science research. Finally, a model for guiding the implementation of the explanatory case study method is proposed in order to promote quality, rigour and applicability of this approach within clinical settings

13th National Congress of the South African Society of Psychiatrists, 20-23 September 2004

List of abstacts and authors: 1. Integrating the art and science of psychiatry Eugene Allers 2. Chronic pain as a predictor of outcome in an inpatient Psychiatric population Eugene Allers and Gerhard Grundling 3. Recent advances in social phobia Christer Allgulander 4. Clinical management of patients with anxiety disorders Christer Allgulander 5. Do elephants suffer from Schizophrenia? (Or do the Schizophrenias represent a disorder of self consciousness?) A Southern African perspective Sean Exner Baumann 6. Long term maintenance treatment of Bipolar Disorder: Preventing relapse Charles L. Bowden 7. Predictors of response to treatments for Bipolar Disorder Charles L. Bowden 8. Aids/HIV knowledge and high risk behaviour: A Geo-graphical comparison in a schizophrenia population P Buckley, S van Vuuren, L Koen, J E Muller, C Seller, H Lategan, D J H Niehaus 9. Does Marijuana make you go mad? David J Castle 10. Understanding and management of Treatment Resistant Schizophrenia David J Castle 11. Workshop on research and publishing David J Castle 12. From victim to victor: Without a self-help book Beatrix Jacqueline Coetzee 13. The evaluation of the Gender Dysphoric patient Franco Colin 14. Dissociation: A South African model A M Dikobe, C K Mataboge, L M Motlana, B F Sokudela, C Kruger 15. Designated smoking rooms...and other "Secret sins" of psychiatry: Tobacco cessation approaches in the severely mentally ill Charl Els 16. Dual diagnosis: Implications for treatment and prognosis Charl Els 17. Body weight, glucose metabolism and the new generation antipsychotics Robin Emsley 18. Neurological abnormalities in first episode Schizophrenia: Temporal stability and clinical and outcome correlates Robin Emsley, H Jadri Turner, Piet P Oosthuizen, Jonathan Carr 19. Mythology of depressive illnesses among Africans Senathi Fisha 20. Substance use and High school dropout Alan J. Flisher, Lorraine Townsend, Perpetual Chikobvu, Carl Lombard, Gary King 21. Psychosis and Psychotic disorders A E Gangat 22. Vulnerability of individuals in a family system to develop a psychiatric disorder Gerhard Grundling and Eugene Allers 23. What does it Uberhaupt mean to "Integrate"? Jürgen Harms 24. Research issues in South African child and adolescent psychiatry S M Hawkridge 25. New religious movements and psychiatry: The Good News V H Hitzeroth 26. The pregnant heroin addict: Integrating theory and practice in the development and provision of a service for this client group V H Hitzeroth, L Kramer 27. Autism spectrum disorder Erick Hollander 28. Recent advances and management in treatment resistance Eric Hollander 29. Bipolar mixed states M. Leigh Janet 30. Profile of acute psychiatric inpatients tested for HIV - Helen Jospeh Hospital, Johannesburg A B R Janse van Rensburg 31. ADHD - Using the art of film-making as an education medium Shabeer Ahmed Jeeva 32. Treatment of adult ADHD co-morbidities Shabeer Ahmed Jeeva 33. Needs and services at ward one, Valkenberg Hospital Dr J. A. Joska, Prof. A.J. Flisher 34. Unanswered questions in the adequate treatment of depression Moderator: Dr Andre F Joubert Expert: Prof. Tony Hale 35. Unanswered questions in treatment resistant depression Moderator: Dr Andre F Joubert Expert: Prof. Sidney Kennedy 36. Are mentally ill people dangerous? Sen Z Kaliski 37. The child custody circus Sean Z. Kaliski 38. The appropriatenes of certification of patients to psychiatric hospitals V. N. Khanyile 39. HIV/Aids Psychosocial responses and ethical dilemmas Fred Kigozi 40. Sex and Psychiatry B Levinson 41. Violence and abuse in psychiatric in-patient institutions: A South African perspective Marilyn Lucas, John Weinkoove, Dean Stevenson 42. Public health sector expenditure for mental health - A baseline study for South Africa E N Madela-Mntla 43. HIV in South Africa: Depression and CD4 count M Y H Moosa, F Y Jeenah 44. Clinical strategies in dealing with treatment resistant schizophrenia Piet Oosthuizen, Dana Niehaus, Liezl Koen 45. Buprenorphine/Naloxone maintenance in office practice: 18 months and 170 patients after the American release Ted Parran Jr, Chris Adelman 46. Integration of Pharmacotherapy for Opioid dependence into general psychiatric practice: Naltrexone, Methadone and Buprenorphine/ Naloxone Ted Parran 47. Our African understanding of individulalism and communitarianism Willie Pienaar 48. Healthy ageing and the prevention of Dementia Felix Potocnik, Susan van Rensburg, Christianne Bouwens 49. Indigenous plants and methods used by traditional African healers for treatinf psychiatric patients in the Soutpansberg Area (Research was done in 1998) Ramovha Muvhango Rachel 50. Symptom pattern & associated psychiatric disorders in subjects with possible & confirmed 22Q11 deletional syndrome J.L. Roos, H.W. Pretorius, M. Karayiorgou 51. Duration of antidepressant treatment: How long is long enough? How long is too long Steven P Roose 52. A comparison study of early non-psychotic deviant behaviour in the first ten years of life, in Afrikaner patients with Schizophrenia, Schizo-affective disorder and Bipolar disorder Martin Scholtz, Melissa Janse van Rensburg, J. Louw Roos 53. Treatment, treatment issues, and prevention of PTSD in women: An update Soraya Seedat 54. Fron neural networks to clinical practice M Spitzer 55. Opening keynote presentation: The art and science of Psychiatry M Spitzer 56. The future of Pharmacotherapy for anxiety disorders Dan J. Stein 57. Neuropsychological deficits pre and post Electro Convulsive Therapy (ECT) thrice a week: A report of four cases Ugash Subramaney, Yusuf Moosa 58. Prevalence of and risk factors for Tradive Dyskinesia in a Xhosa population in the Eastern Cape Dave Singler, Betty D. Patterson, Sandi Willows 59. Eating disorders: Addictive disorders? Christopher Paul Szabo 60. Ethical challenges and dilemmas of research in third world countries Godfrey B. Tangwa 61. The interface between Neurology and Psychiatry with specific focus on Somatoform dissociative disorders Michael Trimble 62. Prevalence and correlates of depression and anxiety in doctors and teachers H Van der Bijl, P Oosthuizen 63. Ingrid Jonker: A psychological analysis L. M. van der Merwe 64. The strange world we live in, and the nature of the human subject Vasi van Deventer 65. Art in psychiatry: Appendix or brain stem? C W van Staden 66. Medical students on what "Soft skills" are about before and after curriculum reform C W van Staden, P M Joubert, A-M Bergh, G E Pickworth, W J Schurink, R R du Preez, J L Roos, C Kruger, S V Grey, B G Lindeque 67. Attention deficit hyperactivity disorder (ADHD) - Medical management. Methylphenidate (Ritalin) or Atomoxetine (Strattera) Andre Venter 68. A comprehensive guide to the treatment of adults with ADHD W J C Verbeeck 69. Treatment of Insomnia: Stasis of the Art? G C Verster 70. Are prisoners vulnerable research participants? Merryll Vorster 71. Psychiatric disorders in the gym Merryl Vorster 72. Ciprales: Effects on anxiety symptoms in Major Depressive Disorder Bruce Lydiar