Risk factors for female and male homicidal strangulation in Johannesburg, South Africa

Background. There is a paucity of research on homicidal strangulation by gender.Objectives. A sex-disaggregated and comparative research approach was used to investigate individual-level risk factors for female and male homicidal strangulation in Johannesburg, South Africa (2001 - 2010).Methods. Data were drawn from the National Injury Mortality Surveillance System. Logistic regressions were used to examine associations between each of the independent variables and homicidal strangulation in females and males relative to all other female and male homicides, respectively.Results. The risk of fatal strangulation was high for both females and males aged ≥60 years, but markedly high only for male children and adolescents. Temporal risk for females was undifferentiated for day of the week, and the risk for males was high during weekdays. Females were more likely to be strangled in public places, and males in private locations.Conclusions. The study underlines the importance of disaggregating homicide by external cause and gender.

Occupational disability on psychiatric grounds in South African school-teachers

Objective: School-teachers are exposed to high levels of stress and have high rates of premature retirement on psychiatric grounds. This study investigated factors associated with occupational disability due to psychiatric disorders in teachers in South Africa. Method: This retrospective study investigated 81 school-teachers in the Cape Town area who had been declared permanently medically disabled as a consequence of psychiatric disorders. Results: Patients were relatively young (44±6.1 yrs), had experienced symptoms for 5.2±3.8 yrs, and had been treated for 4±3.5 yrs. Almost half had a family history of psychiatric disorder, and the majority (N = 66. 81%) cited work-related stress as a significant contributing factor. Major depressive disorder was the commonest diagnosis (83%), and 56% had co-morbid Axis-I diagnoses. Thirty percent had prominent underlying obsessive-compulsive personality traits, and 46% displayed classroom phobia. Conclusion: Work-related stress is a major factor in South African teachers with occupational disability on psychiatric grounds

Relationship between childhood abuse and substance misuse problems is mediated by substance use coping motives, in school attending South African adolescents

This is the author accepted manuscript. The final version is available from Elsevier via the DOI in this record.Background: In adults, it has been shown that the relationship between childhood abuse and substance misuse problems is mediated by the belief that substance use helps cope with negative affective states. By contrast, in adolescents, it is unknown whether drug use coping motives play this same mediating role. Methods: Secondary analysis of 1149 school attending adolescents in Cape Town South Africa (average age = 16.24 years, range = 13–23; 60% females). Questionnaire measures obtained during a single test session (among a larger battery) assessed childhood trauma (CTQ), alcohol (AUDIT) and drug problems (DUDIT), and coping orientation (A-COPE) which contained three items assessing drug use to cope with negative affect. Results: The three types of childhood abuse measured by the CTQ – emotional, physical and sexual – were positively associated with greater alcohol/drug problems, and drug use coping motives. Drug use coping motives mediated the relationships between childhood abuse types and alcohol/drug problems, and these mediational pathways remained significant when gender and other subscales of the A-COPE were included as covariates. Conclusions: These data are preliminary insofar as drug use coping motives were assessed with a non-validated subscale of the A-COPE. Nevertheless, drug use to cope with negative affect mediated the relationship between all three types of childhood abuse (emotional, physical, sexual) and alcohol/drug problems in school attending adolescents. The implication is that drug prevention programs for this age group should seek to mitigate drug use coping motives.The secondary analysis was supported by an MRC Confidence in Global Mental Health pump priming award (MC_PC_MR/R019991/1) to Hogarth and Seedat, and by an Alcohol Research UK grant (RS17/03) to Hogarth. The original study that collected the data was supported by the South African Research Chair in PTSD, hosted by Stellenbosch University, funded by the Department of Science and Technology, Republic of South Africa (Grant No. 64811) and administered by the National Research Foundation, to Seedat and Martin

9Th Injury Prevention and Safety Promotion Conference, Melbourne, Australia

No Abstract

Assessing post-traumatic stress disorder in South African adolescents: using the child and adolescent trauma survey (CATS) as a screening tool

BACKGROUND: Several studies have demonstrated that South African children and adolescents are exposed to high levels of violent trauma with a significant proportion developing PTSD, however, limited resources make it difficult to accurately identify traumatized children. METHODS: A clinical interview (K-SADS-PL, selected modules) and self-report scale (CATS) were compared to determine if these different methods of assessment elicit similar information with regards to trauma exposure and post-traumatic stress disorder (PTSD) in adolescents. Youth (n = 58) from 2 schools in Cape Town, South Africa participated. RESULTS: 91% of youth reported having been exposed to a traumatic event on self-report (CATS) and 38% reported symptoms severe enough to be classified as PTSD. On interview (K-SADS-PL), 86% reported exposure to a traumatic event and 19% were found to have PTSD. While there were significant differences in the rates of trauma exposure and PTSD on the K-SADS and CATS, a cut-off value of 15 on the CATS maximized both the number of true positives and true negatives with PTSD. The CATS also differentiated well between adolescents meeting DSM-IV PTSD symptom criteria from adolescents not meeting criteria. CONCLUSIONS: Our results indicate that trauma exposure and PTSD are prevalent in South African youth and if appropriate cut-offs are used, self-report scales may be useful screening tools for PTSD

Post traumatic stress disorder: undiagnosed cases in a tertiary inpatient setting

Objective: Post traumatic stress disorder (PTSD) is a common, debilitating anxiety disorder characterized by emotional and physical symptoms that may occur after exposure to a severely traumatic event. Since it occurs commonly as a comorbid diagnosis with other mood- and anxiety disorders, we postulated that this disorder may be under- diagnosed in therapeutic wards where anxiety and mood disorders are treated. The study thus sought to determine the prevalence of undiagnosed PTSD in an inpatient population, and to compare the demographic details and comorbid diagnoses of subjects with and without PTSD. Method: The Clinician-administered PTSD Scale for DSM-IV (CAPS) was administered to 40 subjects who were inpatients in a therapeutic ward of a large psychiatric hospital and who had never had a diagnosis of PTSD before. Results:16 (40%) subjects met the DSM-IV criteria for PTSD. We did not find significant clinical differentiating factors between subjects with and without PTSD; however subjects with PTSD were more likely to use cannabis. Conclusions: PTSD remains undiagnosed in many patients admitted to therapeutic units. Keywords: Stress Disorders, Post-Traumatic; Diagnosis; Inpatients;African Journal of Psychiatry Vol. 11 (2) 2008 pp. 119-12

A preliminary investigation of the AUDIT and DUDIT in comparison to biomarkers for alcohol and drug use among HIV-infected clinic attendees in Cape Town, South Africa

Objective: There is growing concern about the effect of substance use on HIV treatment outcomes. The study objectives included: (i) evaluating whether the use of validated questionnaires (AUDIT and DUDIT) provide useful and consistent information of alcohol and drug consumption when compared with the use of biomarkers of alcohol in (urine and hair) and drugs in (urine) and (ii) assessing the feasibility of using self-report measures compared with urine and hair tests.Method: Participants were HIV positive patients attending an HIV community health clinic in Kraaifontein, Cape Town. Hair and urine samples were collected and analysed for alcohol, in Fatty Acid Ethyl Esters (FAEE) and in Ethyl Glucuronide and (EtG), and drugs. Biological markers were compared with self-report measures of alcohol and drug consumption in terms of sensitivity, specificity. Forty-three participants completedthe self-report measures, while 30 provided hair and urine samples. Results: On the AUDIT, 18 (41.9%) participants screened positive for harmful and hazardous drinking and 13 (30.2%) participants on the DUDIT screened positive for having a drug-related problem. Two of 30 participants (7%) tested positive for alcohol abuse on FAEE analysis. For EtG, 6 of 24 (25%) participants tested positive for alcohol abuse. On hair drug analysis, all 30 participants tested negative for cannabis, amphetamines, opiates, cocaine, PCP and methaqualone. On the urinalysis, 1of 30 participants tested positive for cannabis and everyone tested negative for all otherdrugs included in the screening.Conclusion: Substance use among patients attending HIV clinics appears to be a problem, especially alcohol. Self-report measures seem to be a more cost effective option for screening of alcohol and drug abuse inresource poor settings

Intimate partner violence, health behaviours, and chronic physical illness among South African women

Objectives. An association between intimate partner violence and adverse physical health outcomes and health-risk behaviours among women has been established, most scientific research having been conducted in the USA and other developed countries. There have been few studies in developing countries, including South Africa, which has one of the highest rates of intimate partner violence in the world. We therefore sought to study the association between physical intimate partner violence and physical health outcomes and behaviours among South African women. Methods. Using data from the cross-sectional, nationally representative South African Stress and Health Study, we assessed exposure to intimate partner violence, health-risk behaviours, health-seeking behaviours and chronic physical illness among a sample of 1 229 married and cohabiting women. Results. The prevalence of reported violence was 31%. This correlated with several health-risk behaviours (smoking, alcohol consumption, and use of non-medical sedatives, analgesics and cannabis) and health-seeking behaviours (recent visits to a medical doctor or healer). Intimate partner violence was not significantly associated with chronic physical illness, although rates of headache, heart attack and high blood pressure reached near-significance. Conclusions. Partner violence against women is a significant public health problem in South Africa, associated with healthrisk behaviours and increased use of medical services. Public health programmes should incorporate interventions to mitigate the impact of violence on victims and reduce the risk of negative behavioural outcomes. Further investigation of the pathways between violence exposure and health behaviours is needed to inform the design of such programming