The gender straightjacket: a qualitative investigation of a group of South African adolescent males' cognitive schemata for masculinity and gender roles

A surge of "masculinity in crisis" discourse suggests that men are primarily responsible for lawlessness, social mayhem, violence and other forms of psycho- and socio-pathology. This crisis is attributed, in part, to hegemonic models of masculinity which restrict men to certain modes of behaviour and specific roles in society. This study investigates the content of a group of South African adolescent males' cognitive schemata for masculinity and gender roles. A qualitative mode of enquiry was used to identify the beliefs held by participants about manhood and gender roles. The findings of this study affirm that a hegemonic model of masculinity exists is the sub-culture of South African society represented by the participants and suggests that hegemonic masculinity in South African is both restrictive and damaging to men and society.PsychologyM. A. (Psychology

Are suicide and poverty associated in low and middle income countries?

Over 800 000 people die by suicide every year – approximately one person every 40 seconds. Three out of four suicides take place in low and middle income countries where the majority of the world’s population live and where poverty is concentrated. Evidence supports a positive association between suicide and poverty in low-income and middle-income countries at the individual level. As a result of limited data it is not possible to draw firm conclusions about the association between poverty and suicide at the national level. These are the findings from our recent systematic review. The review was conducted by LSE in collaboration with the University of Cape Town and Stellenbosch University

I’m not afraid of dying because I’ve got nothing to lose : young men in South Africa talk about nonfatal suicidal behavior

CITATION: Bantjes, J. & Mapaling, C. 2021. I’m not afraid of dying because I’ve got nothing to lose : young men in South Africa talk about nonfatal suicidal behavior. American Journal of Men's Health, 15(2):1-11, doi:10.1177/1557988321996154.The original publication is available at https://journals.sagepub.comFirst-person narratives of suicidal behavior may provide novel insights into how individuals with lived experience of suicide understand and narrate their behavior. Our aim was to explore the narratives of young men hospitalized following nonfatal suicidal behavior (NFSB), in order to understand how young suicidal men construct and understand their actions. Data were collected via narrative interviews with 14 men (aged 18–34 years) admitted to hospital following an act of NFSB in Cape Town, South Africa. Narrative analysis was used to analyze the data. Two dominant narratives emerged in which participants drew on tropes of the “great escape” and “heroic resistance,” performing elements of hegemonic masculinity in the way they narrated their experiences. Participants position themselves as rational heroic agents and present their suicidal behavior as goal-directed action to solve problems, assert control, and enact resistance. This dominant narrative is incongruent with the mainstream biomedical account of suicide as a symptom of psychopathology. The young men also articulated two counter-narratives, in which they deny responsibility for their actions and position themselves as defeated, overpowered, wary, and unheroic. The findings lend support to the idea that there is not only one narrative of young men’s suicide, and that competing and contradictory narratives can be found even within a dominant hyper-masculine account of suicidal behavior. Gender-sensitive suicide prevention strategies should not assume that all men share a common understanding of suicide. Suicide can be enacted as both a performance of masculinity and as a resistance to hegemonic gender roles.https://journals.sagepub.com/doi/10.1177/1557988321996154Publisher's versio

Perinatal suicidal ideation and behaviour: psychiatry and adversity

Pregnant women are at increased risk for suicidal ideation and behaviours (SIB) compared to the general population. To date, studies have focused on the psychiatric correlates of SIB with lesser attention given to the associated contextual risk factors, particularly in low- and middle-income countries. We investigated the prevalence and associated psychiatric and socio-economic contextual factors for SIB among pregnant women living in low resource communities in South Africa. Three hundred seventy-six pregnant women were evaluated using a range of tools to collect data on socio-economic and demographic factors, social support, life events, interpersonal violence and mental health diagnoses. We examined the significant risk factors for SIB using univariate, bivariate and logistic regression analyses (p ≤ 0.05). The 1-month prevalence of SIB was 18%. SIB was associated with psychiatric illness, notably major depressive episode (MDE) and any anxiety disorder. However, 67% of pregnant women with SIB had no MDE diagnosis, and 65% had no anxiety disorder, while 54% had neither MDE nor anxiety disorder diagnoses. Factors associated with SIB included lower socio-economic status, food insecurity, interpersonal violence, multiparousity, and lifetime suicide attempt. These findings focus attention on the importance of socio-economic and contextual factors in the aetiology of SIB and lend support to the idea that suicide risk should be assessed independently of depression and anxiety among pregnant women

Chronic substance use and self-harm in a primary health care setting

Background: Chronic substance use (CSU) is associated with health problems, including selfharm, placing a significant burden on health care resources and emergency departments (EDs). This is problematic in low- and middle-income countries like South Africa (SA), where primary care facilitates and emergency departments (EDs) are often poorly resourced. Aim: To investigate the epidemiology of CSU and self-harm and to consider the implications for primary health care service delivery and suicide prevention in SA. Methods: Data were collected from 238 consecutive self-harm patients treated at the emergency department (ED) of an urban hospital in SA. The data were analysed using bivariate and multivariate analyses. Results: Approximately 37% of self-harm patients reported CSU. The patients in the CSU subgroup, compared to other self-harm patients, were more likely to be men (odds ratio[OR] = 8.33, 95% confidence interval [CI] = 3.19–20.9, p < 0.001), to have self-harmed by inflicting damage to their body tissue OR = 4.45, 95% CI = 1.77–11.2, p < 0.01) and to have a history of self-harm (OR = 3.71, 95% CI = 1.44–9.54, p = 0.007). A significantly smaller proportion of CSU patients, compared to other self-harm patients, were referred for psychiatric assessment (OR = 8.05, 95% CI = 4.16–15.7, p < 0.001). Conclusion: The findings of this study confirm that CSU is associated with greater service utilisation and repetition of self-harm among patients in primary health care settings. Treating self-harm as the presenting problem within primary care settings does not necessarily ensure that patients receive the care that they need. It might be helpful to include psychiatric assessments and screening for CSU as an integral component of care for self-harm patients who present in primary health care settings

Substance use and self-harm: a cross-sectional study of the prevalence, correlates and patterns of medical service utilisation among patients admitted to a South African hospital

Abstract Background Substance use is a potentially modifiable risk factor for suicidal behaviour. Little is known about the epidemiology of substance use among self-harm patients in South Africa. This study set out to collect epidemiological data about the prevalence, correlates, and patterns of medical service utilisation among self-harm patients who used substances at the time of self-injury. Methods Data from 238 consecutive self-harm patients treated at an urban hospital in South Africa were analysed using bivariate and multivariate statistics. Results Approximately 20% of patients reported substance use at the time of self-harm. When compared to other self-harm patients, higher rates of patients who had used substances: had depressed levels of consciousness on admission; utilised more medical resources and required longer hospital admissions; cited relationship difficulties and financial concerns as reasons for their self-harm; reported a previous episode of self-harm; and intended to die as a result of their injuries. Although the observed differences were not statistically significant (p > 0.05), the proportional differences were congruent with international literature. Conclusion Acute use of substances among self-harm patients warrants more focused research and clinical attention particularly in the context of reducing utilisation of scarce medical resources

Community context and individual factors associated with arrests among young men in a South African township.

BackgroundIn high-income countries, individual- and community-level factors are associated with increased contact with the criminal justice system. However, little is known about how these factors contribute to the risk of arrest in South Africa, which has one of the highest rates of arrests globally. We examine both individual- and community-level factors associated with arrests among young men living in the townships of Cape Town.MethodsData were collected from a stratified community sample of 906 young men aged 18-29 years old living in 18 township neighborhoods. Communities with high and low rates of arrest were identified. Logistic regression models were used to assess which individual-level (such as substance use and mental health status) and community-level (such as infrastructure and presence of bars and gangs) factors predict arrests.ResultsSignificant predictors of arrests were substance use, gang activity, being older, more stressed, and less educated. Living in communities with better infrastructure and in more recently established communities populated by recent immigrants was associated with having a history of arrests.ConclusionsWhen considering both individual- and community-level factors, substance use and gang violence are the strongest predictors of arrests among young men in South Africa. Unexpectedly, communities with better infrastructure have higher arrest rates. Community programs are needed to combat substance use and gang activity as a pathway out of risk among South African young men.Trial registrationClinicalTrials.gov registration #NCT02358226, registered Nov 24, 2014

Suicide and poverty in low-income and middle-income countries: a systematic review

Suicide is the 15th leading cause of death worldwide, with over 75% of suicides occurring in low- and middle-income countries where most of the world’s poor live. Nonetheless, evidence on the relationship between suicide and poverty in low- and middle-income countries is limited. We conducted a systematic review to understand the relationship between suicidal ideations and behaviours (SIB) and economic poverty in low- and middle-income countries. We identified 37 studies meeting inclusion criteria. In 18 studies reporting the relationship between completed suicide and poverty, 31 relationships were explored. The majority reported a positive association. Of the 20 studies reporting on the relationship between non-fatal SIB and poverty, 36 relationships were explored. Again, the majority of studies reported a positive relationship. However, when considering each poverty dimension separately, we found substantial variations. Findings suggest a relatively consistent trend at the individual level indicating that poverty, particularly in the form of worse economic status, diminished wealth and unemployment is associated with SIB. At the country level, there are insufficient data to draw clear conclusions. Available evidence suggests potential benefits in addressing economic poverty within suicide prevention strategies, with attention to both chronic poverty and acute economic events

South African university students’ experiences of online group cognitive behavioural therapy: Implications for delivering digital mental health interventions to young people

Mental disorders are common among university students. In the face of a large treatment gap, resource constraints and low uptake of traditional in-person psychotherapy services by students, there has been interest in the role that digital mental health solutions could play in meeting students’ mental health needs. This study is a cross-sectional, qualitative inquiry into university students’ experiences of an online group cognitive behavioural therapy (GCBT) intervention. A total of 125 respondents who had participated in an online GCBT intervention completed a qualitative questionnaire, and 12 participated in in-depth interviews. The findings provide insights into how the context in which the intervention took place, students’ need for and expectations about the intervention; and the online format impacted their engagement and perception of its utility. The findings of this study also suggest that, while online GCBT can capitalise on some of the strengths of both digital and in-person approaches to mental health programming, it also suffers from some of the weaknesses of both digital delivery and those associated with in-person therapies