Z Zingela

When this article was published in Psychological Medicine, it omitted to capitalise ‘Mini International Neuropsychiatric Interview’in its title. This has now been updated online. The author apologises for this error.

The Kessler Psychological Distress Scale (K10) has been widely used to screen psychological distress across many countries. However, its performance has not been extensively studied in Africa. The present study sought to evaluate and compare measurement properties of the K10 across four African countries: Ethiopia, Kenya, Uganda, and South Africa. Our hypothesis is that the measure will show equivalence across all.Data are drawn from a neuropsychiatric genetic study among adult participants (N = 9179) from general medical settings in Ethiopia (n = 1928), Kenya (n = 2556), Uganda (n = 2104), and South Africa (n = 2591). A unidimensional model with correlated errors was tested for equivalence across study countries using confirmatory factor analyses and the alignment optimization method. Results displayed 30 % noninvariance (i.e., variation) for both intercepts and factor loadings across all countries …

This editorial addresses catatonia, a complex neuropsychiatric syndrome characterised by a spectrum of psychomotor disturbances. The editorial seeks to clarify the ambiguous aspects of catatonia, integrating recent research findings, including global studies and diagnostic advancements. It discusses catatonia’s clinical manifestations, prevalence, and associated psychiatric and medical conditions, with particular emphasis on its frequent co-occurrence with schizophrenia and mood disorders. The prevalence of catatonia, which varies across psychiatric populations, is illustrated by a significant study conducted in Nelson Mandela Bay, South Africa. This study provides valuable insights into the effectiveness of the Bush-Francis Screening Instrument compared to the Diagnostic and Statistical Manual 5 criteria in diagnosing catatonia. The editorial evaluates treatment approaches, primarily focusing on …

Background The global ubiquity of smartphone use among young people makes them excellent candidates for collecting data about individuals’ lived experiences and their relationships to mental health. However, to-date most app-based studies have been conducted in North America and Europe. Understanding young people’s willingness to participate in app-based research and share information about their mental health is key to understanding the feasibility of broad-scale research using these approaches. We aimed to understand the recruitment and engagement approaches influencing young peoples’ (aged 16-24) participation in app-based studies of mental health. We hypothesised that providing a choice of study topics will improve engagement. Methods We developed a 12-week pilot study of mental health implemented in the MindKind app, designed to assess participants’ willingness to engage in remote mental health research, both actively and passively. Enrollees were randomised to one of two different engagement arms, either selecting their study topics of interest or receiving a fixed assignment of study topics, in order to understand the role of choice in study engagement. This pilot study was conducted in India, South Africa, and the United Kingdom. Different recruitment strategies were employed in each location. Results The MindKind Study recruited 1,034 (India), 932 (South Africa) and 1,609 (UK) participants. Engagement differed by country with median days of activity = 2, 6, and 11 for India, South Africa, and UK, respectively. Most surprisingly, participants given a choice of study topics showed lower engagement relative to …

Background: There is a deficit of psychiatrists in South Africa, and to our knowledge, there is no situational analysis of training posts for psychiatrists in the country.Aim: To compare the number of specialists and subspecialists in training and training posts available in 2008 and 2018.Setting: South African medical schools with departments of psychiatry.Methods: A situational analysis involving data collection through a survey completed by eight heads of academic psychiatric departments followed by a comparative analysis of the two aforementioned years.Results: Data shows an 11% increase in funded and unfunded posts combined and a 9.3% increase in funded posts. The occupancy of funded posts decreased (92% in 2008 to 82% in 2018). When considering both funded and unfunded posts, only three more psychiatrists were being trained in 2018. Supernumeraries appointed in unfunded posts can be expected to return to their countries of origin. As such, a decrease in filled funded posts likely reflects a decrease in training psychiatrists destined to work in South Africa. While child and adolescent psychiatry was the only subspeciality with accredited training posts in 2008, all sub-specialities included on the questionnaire had accredited training posts in 2018, and the number of accredited training posts in child and adolescent psychiatry doubled. That said, many of the posts were unfunded and vacant.Conclusion: While there was an increase in posts from 2008 to 2018, many posts remained unfilled. As such, not only are additional funded training posts required but also strategies to increase post-occupancy and successful completion of …

Background: Trauma exposure is widespread and linked to chronic physical and mental health conditions including posttraumatic stress disorder. However, there are major gaps in our knowledge of trauma exposure in Africa and on the validity of instruments to assess potentially life-threatening trauma exposure.Objective: The Life Events Checklist for the DSM-5 (LEC-5) is a free, widely used questionnaire to assess traumatic events that can be associated with psychopathology. As part of a case–control study on risk factors for psychosis spectrum disorders, we used the LEC-5 to examine the frequency of traumatic events and to assess the questionnaire’s factor structure in South Africa (N = 6,765).Method: The prevalence of traumatic events was measured by individual items on the LEC-5 across the study sample, by case–control status, and by sex. Cumulative trauma burden was calculated by grouping items …

In this paper we begin by highlighting the large treatment gap in South Africa for mental health conditions. We then describe the mental health services available, including the provision of evidence-based treatments in South Africa at each level of care, using the WHO's optimal mix of mental healthcare services as a framework. The optimal mix of services pyramid includes the following domains: informal services, which comprise self-care and informal community mental health care (including religious and traditional healers), primary care mental health services, psychiatric services provided at general hospitals, community mental health services, specialist services and long-stay facilities. In South Africa, mental healthcare services are concentrated at the apex of the pyramid within secondary hospital and specialist services, with fewer resources available at other levels of care, particularly at the community level …

Ethical challenges of genetic counselling for schizophrenia include effective communication of critical scientific information in an easily understood manner by patients and relatives, and the ability to ensure communication is unencumbered by medical jargon. Levels of literacy in the target population may limit this process, making it difficult for patients to attain the desired levels of informed consent to make crucial decisions during genetic counselling. Multilingualism in target communities may further complicate such communication. This paper outlines the ethical principles, challenges and opportunities facing clinicians when conducting genetic counselling for schizophrenia and how these might be met, drawing on lessons from South African studies. The paper draws on reflections of clinician and researcher experiences gained from clinical practice or research on the genetics of schizophrenia and psychotic disorders in South Africa. The context of genetic studies in schizophrenia is used to illustrate the ethical challenges in genetic counselling for schizophrenia, both in clinical and research settings. Attention is also drawn to multicultural and multilingual populations, particularly where the preferred language lacks a well-developed scientific language of communication for some of the genetic concepts that have to be presented during the genetic counselling process. The authors describe the ethical challenges and how to address these to empower patients and relatives to make well-informed decisions despite these obstacles. Principles applied by clinicians and researchers during the genetic counselling are described. Potential solutions …

BackgroundAmong people with psychotic disorders, substance use (SU) and substance use disorders (SUD) are highly prevalent. Studies suggest that the high rates of substance use are moderated by demographic characteristics such as sex, age, marital status and location; however, there is limited data on substance use among people with psychosis in Africa. We described patterns of substance use across South Africa, Ethiopia, Kenya and Uganda for four major classes of drugs (alcohol, tobacco, cannabis and khat) across three primary diagnostic categories: bipolar disorder (BD), schizophrenia (SCZ) and schizoaffective disorder (SAD).MethodsWe utilized data from the Neuropsychiatric Genetics of African Populations-Psychosis project, a large case-control study which will soon have genetic data on over 42,000 participants, half with psychosis. Substance abuse information was collected using the Alcohol …

Mobile devices offer a scalable opportunity to collect longitudinal data that facilitate advances in mental health treatment to address the burden of mental health conditions in young people. Sharing these data with the research community is critical to gaining maximal value from rich data of this nature. However, the highly personal nature of the data necessitates understanding the conditions under which young people are willing to share them. To answer this question, we developed the MindKind Study, a multinational, mixed methods study that solicits young people’s preferences for how their data are governed and quantifies potential participants’ willingness to join under different conditions. We employed a community-based participatory approach, involving young people as stakeholders and co-researchers. At sites in India, South Africa, and the UK, we enrolled 3575 participants ages 16–24 in the mobile app-mediated quantitative study and 143 participants in the public deliberation-based qualitative study. We found that while youth participants have strong preferences for data governance, these preferences did not translate into (un)willingness to join the smartphone-based study. Participants grappled with the risks and benefits of participation as well as their desire that the “right people” access their data. Throughout the study, we recognized young people’s commitment to finding solutions and co-producing research architectures to allow for more open sharing of mental health data to accelerate and derive maximal benefit from research.

BackgroundVoluntary informed consent in research participation is essential in ethical research practice and is challenging to assess in vulnerable populations, such as psychiatric patients. The University of California, San Diego Brief Assessment of Capacity to Consent (UBACC) is a tool used to assess the capacity of participants to consent in psychiatric research globally, but very little is known about its use in low and middle-income countries especially in the context of genetics studies. This study aimed to examine the psychometric properties of the UBACC in a sample of 16,467 individuals with psychosis and 15,741 controls across four countries in Africa.MethodsWe examined the reliability, latent factor structure, and item difficulty of the UBACC items in the full sample and stratified by country, diagnostic status, sex, and language group.ResultsAcross all groups, the internal consistency of the UBACC was low …

Menopause is characterised by the ending of the menstrual cycle as part of a natural process. However, menopause can also be caused by other health conditions, such as premature ovarian failure or cancers that may have led to an oophorectomy or a radical hysterectomy. The physiological and psychological mechanisms linked to menopause across all age groups, races and ethnicities are not well understood. The paucity of data could reduce the advancement of optimal clinical practice, leading to reduced quality of life for women. To better explore and assess menopause, we have designed the MenopAuse mental hEalth Rating (MARiE) tool. We will conduct a prospective mixed methods study using two work streams of WP2a and WP2b among in women 18 years and above that are experiencing perimenopause, menopause or post-menopause among an array of ethnicities and races. WP2a will involve a number of validated clinical assessments of Hospital Anxiety and Depression Scale, Insomnia Severity Index Scale, Menopause Rating Scale, Greene Climacteric Scale, Health Related Quality of Life, Quebec Pain Disability Scale, and Burnout Assessment Tool will be administered digitally using the Qualtrex platform. WP2b will assess the feasibility of using a novel tool called MARiE to report face validity and efficacy. Research Ethics approval reference for this study in the UK is 22/EE/0159. As required, country-specific approvals have been obtained and continue to be secured. The study findings will be made available using a peer review publication journal, workshops and conferences.

Individual AbstractGenomic studies have yet to adequately represent the entirety of the global population. While there have been improvements over the last decade, primarily driven by increased data from Asian populations, less than 3% of data currently included in genetic studies are from African populations. Increasing data collection in previously underrepresented areas of the world through collaborative efforts is the best solution to this issue. However, to do this, we must overcome the legacy of abuse and distrust from potential partners driven by centuries of “safari research” and colonialism. Building trust and equitable partnerships takes time and a commitment to a shared goal that includes success of both the research and the researchers. Investing in the next generation, students and early-career researchers, is an ideal way to reach that goal. Unfortunately relying on traditional models, such as lab …

Background: Early detection of psychosis improves treatment outcomes, but there is limited research evaluating the validity of psychosis screening instruments, particularly in lowresourced countries.Aim: This study aims to assess the construct validity and psychometric properties of the psychosis screening questionnaire (PSQ) in South Africa.Setting: This study was conducted at several health centres in the Western and Eastern Cape provinces in South Africa.Methods: The sample consisted of 2591 South African adults participating as controls in a multi-country case-control study of psychiatric genetics. Using confirmatory factor analysis and item response theory, we evaluated the psychometric properties of the PSQ.Results: Approximately 11% of the participants endorsed at least one psychotic experience on the PSQ, and almost half of them (49%) occurred within the last 12 months. A unidimensional model demonstrated good fit (root mean square error of approximation [RMSEA]= 0.023, comparative fit index [CFI]= 0.977 and Tucker–Lewis Index [TLI]= 0.954). The mania item had the weakest association with a single latent factor (standardised factor loading= 0.14). Model fit improved after removing the mania item (RMSEA= 0.025, CFI= 0.991 and TLI= 0.972). With item response theory analysis, the PSQ provided more information at higher latent trait levels.Conclusion: Consistent with prior literature, the PSQ demonstrated a unidimensional factor structure among South Africans. In our study, the PSQ in screening for psychosis performed better without the mania item, but future criterion validity studies are warranted.Contribution: This study …

BackgroundThe coronavirus disease 2019 (COVID-19) outbreak caused worldwide disruptions to healthcare systems. The emerging evidence indicates that mental health problems have consequently become an occupational hazard in frontline healthcare workers.AimWe aimed to develop a psychological preparedness training (PPT) programme to support frontline health workers in three resource-limited hospitals in South Africa dealing with the COVID-19 outbreak and to evaluate its effectiveness using an audit tool. We established a theoretical framework and goals for a psychological preparedness programme to support healthcare workers at the study sites.SettingData were collected at the Dora Nginza Hospital, Nelson Mandela Academic Hospital and Elizabeth Donkin Hospital.MethodsWe employed an observational, descriptive, and cross-sectional design. A group psychological intervention was developed …

BackgroundCatatonia is a severe psychomotor disorder that presents as abnormality of movement which may also be excessive or severely slowed. It often inhibits communication when protracted or severe. In this study we investigated the emotive and cognitive experience of patients with catatonia during a prevalence study in an acute mental health unit from August 2020 to September 2021. The value of this study is the addition of the inner and often unexplored cognitive and emotive experience of patients in the description of the catatonic state, which lends an additional dimension to complement the medical and psychopathological descriptors that have been the focus of most studies on catatonia.MethodsEthical approval was received from the Nelson Mandela University Human Research Committee and convenience sampling was undertaken to recruit participants admitted into an acute mental health unit with …

Catatonia is a psychomotor abnormality caused by neurological, medical or severe psychiatric disorders and substances. Its prevalence ranges from less than 10% to just above 60%. Diagnosis may be influenced by the screening tools used. Screening of new admissions to a mental health unit for catatonia was undertaken using three instruments to determine prevalence of catatonia. Participants ranged from age 16 years and over. Recruitment took place from September 2020 to August 2021. The setting was a mental health unit within a general hospital in Nelson Mandela Metro, South Africa. Five assessors were trained by the principal investigator to apply the Bush Francis Screening Instrument (BFCSI), the Bush Francis Catatonia Rating Scale (BFCRS), and the Diagnostic and Statistical Manual 5 (DSM-5), to assess participants. Clinical and demographic data were collected using a specially designed datasheet. Data analysis was performed to identify significant associations between presence or absence of catatonia and clinical and demographic data. Up to 241 participants were screened and 44 (18.3%) had catatonia. All 44 cases were identified through the BFCSI while the DSM-5 identified only 16 (6.6%%) of the 44 cases even though the remaining 28 (63.6%) participants still required treatment for catatonic symptoms. The DSM-5 diagnostic criteria excluded staring, which was the commonest sign of catatonia identified through the BFCSI [n = 33 (75%)]. Close to half (21; 47.7%) of those with catatonia on the BFCSI had schizophrenia. The rest had bipolar disorder (12; 27.3%), substance-induced psychotic disorder (7; 15.9%) and no …

ObjectivesRapid intervention for catatonia with benzodiazepines and electroconvulsive therapy can prevent fatal complications. We describe the management and treatment response of 44 patients with catatonia in a psychiatric unit in urban South Africa. The objective was to screen admissions for catatonia and investigate management, treatment response, and treatment outcomes.MethodWe used a prospective, descriptive, observational study design and collected data using a data collection sheet, the Bush Francis Catatonia Screening Instrument, the Bush Francis Catatonia Rating Scale, and the Diagnostic Statistical Manual-5 to assess catatonia in new admissions from September 2020 to August 2021.ResultsOf the 241 participants screened on admission, 44 (18.3% of 241) screened positive for catatonia on the Bush Francis Catatonia Screening Instrument, while 197 (81.7% of 241) did not. Thirty-eight (86.4 …

ObjectivesTuberculosis (TB) remains prevalent despite the availability of effective anti-TB medications, and accumulating evidence suggests a high rate of mental disorders in people with TB. This is because TB and psychiatric disorders share several risk factors, such as poverty, homelessness and substance use disorder. Moreover, psychiatric comorbidities in patients with TB are associated with poor treatment outcomes. This study explored the psychiatric comorbidity and clinical correlates in individuals receiving TB treatment.DesignA cross-sectional survey over 10 months.SettingTwo primary care clinics at King Sabata Dalindyebo district, Mthatha, Eastern Cape, South Africa.ParticipantPatients receiving TB treatment in the two clinics.InterventionThe Mini-International Neuropsychiatric Interview was used to screen for psychiatric disorders.Primary and secondary outcome measuresRates of mental disorders in …

Description Catatonia is a psychomotor abnormality that may be caused by severe physical or mental illness or by substances. It has a wide-ranging prevalence from less than 10% to just over 60%, worldwide. This thesis investigated multiple aspects of catatonia in an acute mental health unit setting. Critical aspects examined include the psychological experience of catatonia and assessment, prevalence, presentation, management, and treatment outcomes of catatonia. The research design was a prospective descriptive triangulation study that used a mixed quantitative and qualitative approach. The theoretical framework applied in this thesis was a positivist paradigm approach to explore the quantitative data collected, with application of deductive reasoning, supported by statistical analysis to detect correlations between catatonia and demographic and clinical data. The research explored the experience of a …