Mental health stigma experiences among caregivers and service users in South Africa: a qualitative investigation

Participants' experiences of a counsellor-supported PTSD Coach intervention in a resource-constrained setting

We explored participants' experiences of a counsellor-supported PTSD Coach mobile application intervention (PTSD Coach-CS) in a randomised controlled trial. PTSD Coach-CS participants, who received the intervention and self-completed a custom-designed questionnaire at intervention completion were included (n = 25; female = 20; ages 19-59; isiXhosa = 22). This questionnaire comprised questions regarding the feasibility, acceptability and potential impact of the PTSD Coach-CS intervention, and general psychological support in our setting. Data were analysed using Braun and Clarke's thematic analysis. Three main themes emerged. (i) Participants' largely positive experiences of treatment procedures included the safe space created by the counsellor support in combination with the PTSD Coach application, allowing them to learn about and understand their lived experiences, and to accept their PTSD diagnoses. (ii) Positive perceptions of the PTSD Coach application, yet raising important concerns (e.g., lack of family involvement) for future consideration. (iii) Intervention-specific and systemic treatment barriers (e.g., stigma) providing important information to inform and increase the usefulness of the PTSD Coach-CS intervention. The findings suggest that the PTSD Coach-CS intervention may help address the need for access to suitable care for South African adults with PTSD. Some contextual barriers must be considered in further intervention implementation.

"If You Need a Psychiatrist, It's BAD": Stigma Associated with Seeking Mental Health Care Among Obstetric Providers in Ghana

Purpose

Globally, the COVID-19 pandemic has brought attention to the impact of negative patient outcomes on healthcare providers. In Ghana, obstetric providers regularly face maternal and neonatal mortality, yet limited research has focused on provision of mental health support for these providers. This study sought to understand how obstetric providers viewed seeking mental health support after poor clinical outcomes, with a focus on the role of mental health stigma.

Patients and Methods

Participants were 52 obstetric providers (20 obstetrician/gynecologists and 32 midwives) at two tertiary care hospitals in Ghana. Five focus groups, led by a trained facilitator and lasting approximately two hours, were conducted to explore provider experiences and perceptions of support following poor maternal and neonatal outcomes. Discussions were audiotaped and transcribed verbatim, then analyzed qualitatively using grounded theory methodology.

Results

Most participants (84.3%, N=43) were finished with training, and 46.2% (N=24) had been in practice more than 10 years. Emerging themes included pervasive stigma associated with seeking mental health care after experiencing poor clinical outcomes, which was derived from two overlapping dimensions. First, societal-level stigma resulted from a cultural norm to keep emotions hidden, and the perception that psychiatry is equated with severe mental illness. Second, provider-level stigma resulted from the belief that healthcare workers should not have mental health problems, a perception that mental health care is acceptable for patients but not for providers, and a fear about lack of confidentiality. Despite many providers acknowledging negative mental health impacts following poor clinical outcomes, these additive layers of stigma limited their willingness to engage in formal mental health care.

Conclusion

This study demonstrates that stigma creates significant barriers to acceptance of mental health support among obstetric providers. Interventions to support providers will need to respect provider concerns without reinforcing the stigma associated with seeking mental health care.

Factors associated with depression, anxiety, and satisfaction with life among Malaysian parental caregivers of adolescent psychiatric patients: A cross-sectional study

Depression and anxiety are prevalent mental health issues worldwide, especially among parental caregivers. By expanding the family stress model, this cross-sectional study investigated the relevant factors associated with depressive symptoms, anxiety symptoms, and satisfaction with life among Malaysian parental caregivers of adolescent psychiatric patients. Data were collected through questionnaires (N = 207) across five major public hospitals through convenience sampling. Participants answered questionnaires measuring financial strain, caregiver burden, relationship quality, belief in mental illness, perceived COVID-19 stress, satisfaction with health services, depressive symptoms, anxiety symptoms and life satisfaction. Findings revealed that relationship quality among spouses, COVID-19 stress and caregiver burden were significantly correlated with anxiety symptoms, depressive symptoms and satisfaction with life. The multiple regression model also suggested that depressive symptoms (β = .613, p < .001), anxiety symptoms (β= .657, p < .001) and relationship quality among spouses (β = .264, p < .001) were the most influential predictors of anxiety symptoms, depressive symptoms and satisfaction with life respectively. By addressing the mental health needs of parental caregivers, this study can contribute to improving the overall quality of care and support provided to adolescent patients and their caregivers in Malaysia and beyond.

A counsellor-supported 'PTSD Coach' intervention versus enhanced Treatment-as-Usual in a resource-constrained setting: A randomised controlled trial

To widen treatment access for posttraumatic stress disorder (PTSD) in resource-constrained South Africa, we evaluated the feasibility and effectiveness of a counsellor-supported PTSD Coach mobile application (app) (PTSD Coach-CS) intervention on PTSD and associated sequelae in a community sample. Participants (female = 89%; black = 77%; aged 19-61) with PTSD were randomised to PTSD Coach-CS (n = 32) or enhanced Treatment-as-Usual (n = 30), and assessed with the Clinician-Administered PTSD Scale (CAPS-5), PTSD Checklist (PCL-5) and Depression, Anxiety and Stress Scale-21 items, at pre- to post-treatment and follow-up (1 and 3 months). We also collected data on user experiences of the PTSD Coach app with self-administered surveys. We conducted an intent-to-treat analysis and linear mixed models. A significant (group × time) effect for the CAPS-5 (F3.136 = 3.33, p = 0.02) indicated a greater reduction in PTSD symptom severity over time for the intervention group with a significant between-group effect size detected at 3-month follow-up. Significant between-group effect sizes were detected in self-reported stress symptom reduction in the intervention group at post-treatment and 3-month follow-up. Participants perceived the app as helpful and were satisfied with the app. Findings suggest PTSD Coach-CS as a suitable low-cost intervention and potential treatment alternative for adults with PTSD in a resource-constrained country. Replication in larger samples is needed to fully support effectiveness. Pan African Trial Registry: PACTR202108755066871.

Identification of mental disorders in South Africa using complex probabilistic hesitant fuzzy N-soft aggregation information

This paper aims to address the challenges faced by medical professionals in identifying mental disorders. These mental health issues are an increasing public health concern, and middle-income nations like South Africa are negatively impacted. Mental health issues pose a substantial public health concern in South Africa, putting forth extensive impacts on both individuals and society broadly. Insufficient funding for mental health remains the greatest barrier in this country. In order to meet the diverse and complex requirements of patients effective decision making in the treatment of mental disorders is crucial. For this purpose, we introduced the novel concept of the complex probabilistic hesitant fuzzy N-soft set (CPHFNSS) for modeling the unpredictability and uncertainty effectively. Our approach improves the precision with which certain traits connected to different types of mental conditions are recognized by using the competence of experts. We developed the fundamental operations (like extended and restricted intersection, extended and restricted union, weak, top, and bottom weak complements) with examples. We also developed the aggregation operators and their many features, along with their proofs and theorems, for CPHFNSS. By implementing these operators in the aggregation process, one could choose a combination of characteristics. Further, we introduced the novel score function, which is used to determine the optimal choice among them. In addition, we created an algorithm with numerical illustrations for decision making in which physicians employ CPHFNS data to diagnose a specific condition. Finally, comparative analyses confirm the practicability and efficacy of the technique that arises from the model developed in this paper.

Effectiveness of Facebook Groups and Pages on Participant Recruitment Into a Randomized Controlled Trial During the COVID-19 Pandemic: Descriptive Study

BACKGROUND

In response to the unprecedented challenges posed by the COVID-19 pandemic, conventional recruitment approaches were halted, causing the suspension of numerous clinical trials. Previously, Facebook (Meta Platforms, Inc) has emerged as a promising tool for augmenting participant recruitment. While previous research has explored the use of Facebook for surveys and qualitative studies, its potential for recruiting participants into randomized controlled trials (RCTs) remains underexplored.

OBJECTIVE

This study aimed to comprehensively examine the effectiveness of using Facebook groups and pages to facilitate participant recruitment during the COVID-19 pandemic for an RCT on the effectiveness of a remote parenting program, 1-2-3 Magic, in families who have children with attention-deficit/hyperactivity disorder (ADHD) in the United Kingdom.

METHODS

We disseminated 5 Facebook posts with an attached digital flyer across 4 prominent ADHD UK support groups and pages run by the National Attention Deficit Disorder Information and Support Services, reaching an audience of around 16,000 individuals over 2 months (January 7 to March 4, 2022). Eligibility criteria mandated participants to be parents or caregivers of a child with diagnosed ADHD aged 12 years or younger, be residing in the United Kingdom, have access to stable internet, and have a device with the Zoom (Zoom Video Communications) app. Participants were required to have never attended 1-2-3 Magic training previously. Prospective participants expressed their interest through Microsoft Forms (Microsoft Corporation). The trial aimed to recruit 84 parents. It is important to note that the term "parent" or "caregiver" in the RCT and in this study within a trial refers to anybody who has legal responsibility for the child.

RESULTS

Overall, 478 individuals registered their interest through Microsoft Forms within the stipulated 2-month window. After the eligibility check, 135 participants were contacted for a baseline meeting through Zoom. The first 84 participants who attended a baseline meeting and returned a completed consent form were enrolled. Subsequently, another 16 participants were added, resulting in a final sample of 100 participants. This recruitment strategy incurred negligible expenses and demanded minimal human resources. The approach yielded favorable outcomes by efficiently attracting eligible participants in a condensed time frame, transcending geographical barriers throughout the United Kingdom, which would have been tedious to achieve through traditional recruitment methods.

CONCLUSIONS

Our experience demonstrated that digital flyers posted in the targeted Facebook groups were a cost-effective and quick method for recruiting for an RCT, which opened during the COVID-19 pandemic when lockdown restrictions were in place in the United Kingdom. Trialists should consider this low-cost recruitment intervention for trials going forward, and in the case of a global pandemic, this novel recruitment method enabled the trial to continue where many have failed.

TRIAL REGISTRATION

International Standard Randomized Controlled Trial Number (ISRCTN) 15281572; https://www.isrctn.com/ISRCTN15281572.

A Qualitative Exploration of Ontario Caregivers' Perspectives of Their Role in Navigating Mental Health and/or Addiction Services for Their Youth

Many youth experiencing mental health and/or addiction (MHA) concerns rely on their caregivers to find and access services. Considering that caregivers often play a significant role in their youth's treatment trajectory, a descriptive qualitative study was used to explore how caregivers (n = 26) in the Greater Toronto Area perceive their role in navigating MHA care for their youth (ages 13 to 26). The Person-Environment-Occupation model was used to guide the thematic analysis. The findings reveal three main themes (1) the internal experience of caregiving, which describes caregivers' emotions and thought processes; (2) the external factors impacting the caregiver's ability to find and access youth MHA services, which explores systemic and social factors that impact navigation; and (3) the demands of the caregiving role. The discussion highlights the importance of supporting the wellbeing of caregivers as they navigate youth MHA services and can provide useful information for healthcare professionals and policy-makers to increase equitable access to youth MHA services.

Psychometric properties of the Burnout Assessment Tool across four countries

BACKGROUND

The Burnout Assessment Tool (BAT) is a new burnout measure developed to replace the Maslach Burnout Inventory (MBI). Studies have supported the psychometric properties and cross-cultural measurement invariance of the BAT. However, some unresolved questions remain. These questions are the appropriate level of score interpretation, convergent validity with the MBI, and measurement invariance using sample groups from countries outside of Europe.

METHODS

We used a cross-sectional survey approach to obtain 794 participants from Australia (n = 200), the Netherlands (n = 199), South Africa (n = 197), and the United States (n = 198). In brief, we used bifactor modelling to investigate the appropriate score interpretation and convergent validity with the MBI. Hereafter, we used the Rasch model and ordinal logistic regression to investigate differential item functioning.

RESULTS

The bifactor model showed a large general factor and four small group factors, which suggests calculating and interpreting a general burnout score. This model further shows that the BAT and MBI measure the same burnout construct but that the BAT is a more comprehensive burnout measure. Most items fit the Rasch model, and few showed non-negligible differential item functioning.

CONCLUSIONS

Our results support the psychometric properties and cross-cultural measurement invariance of the BAT in Australia, the Netherlands, South Africa, and the United States. Furthermore, we provide some clarity on the three previously mentioned unresolved questions.

Perceived social support and family members of patients with mental disorders: A mixed method study

Introduction

Family members are the caregivers to patients with mental disorders at home, and the mental and spiritual pressures caused by this responsibility necessitate physical, mental, and perceived social support for these families. The present mixed method study is an attempt to elaborate on the perceived social support by Iranian families of patients with chronic mental disorders.

Materials and methods

Using a sequential mixed method explanatory study (quantitative and qualitative), 200 family members of patients with chronic mental disorders were selected through convenient sampling (quantitative phase). Data gathering was started using a demographics form and Stewart and Sherburne's perceived social support scale. The qualitative phase included 10 participants who obtained low scores in the quantitative phase and took part in private, face-to-face, in-depth, and semi-structured interviews. The data obtained in the quantitative phase were analyzed using statistical tests, and the interviews were analyzed using qualitative content analysis.

Findings

The perceived social support by the participants was at a moderate level in different fields of tangible support, information and emotional support, kindness, and positive social interactions. The results of the qualitative phase revealed social support status in 15 subcategories, 6 categories, and 2 themes of support and acceptance by family, relatives, and friends, with support and being understood by society. The results of the qualitative and quantitative sections emphasized the needs of the patient's family members (who acted as caregivers for patients) for support in family, social, and emotional areas.

Conclusion

The family members of patients with chronic mental disorders have different needs in the area of perceived social support. Such needs are more tangible in family members such as children with mentally ill parents or parents with mentally ill children. The results of this study can be used for educational and supportive planning for caregivers of patients, most of whom are family members.

Determinants of Burden in Family Caregivers of Individuals With Schizophrenia: A Systematic Review

The current systematic review was performed to determine the specific burdens placed on families of individuals with schizophrenia. Scopus, PubMed, and CINAHL databases were searched, resulting in 21 articles that met inclusion criteria. Results showed that treatment of individuals with schizophrenia poses a burden on families. Most caregivers experienced emotional and financial problems that affected their quality of life. Influencing factors in caregivers were age, sex, educational level, family status, income, time spent with the individual per day, knowledge regarding schizophrenia, attitude, and psychological stress. Influencing factors in individuals with schizophrenia were age, sex, severity of illness, social function, and treatment adherence. Environmental factors were stigma, social support, and professional support from health care providers. Family caregivers of individuals with schizophrenia need to be empowered to improve resilience and acceptance in caring for these individuals. [Journal of Psychosocial Nursing and Mental Health Services, 61(2), 38-43.].

Obstacles and facilitators to communicating with children about their parents' mental illness: a qualitative study in a sub-district of Mpumalanga, South Africa

BACKGROUND

Given that common mental disorders are one of the leading causes of disease burden worldwide, it is likely that many children are growing up with a parent or other adult within their family who has anxiety or depression. Parents with a mental illness may not consider it appropriate to discuss their illness with their child, and consequently an absence of communication may lead to stigmatization, shame, misunderstanding their parents' symptoms, and even blaming themselves. There is a scarcity of research exploring the experiences and perceptions of healthcare professionals about communication with children of parents with mental illness in low-resource and African contexts.

METHODS

A qualitative study using semi-structured interviews with healthcare professionals (n = 15) was conducted within the Bushbuckridge sub-district of Mpumalanga Province, South Africa. Data were analysed using Thematic Analysis.

RESULTS

Four themes were identified relating to the obstacles around communication with children. These included: (1) finding an appropriate language to describe mental illness, as well as the prevailing cultural explanations of mental illness (2) the stigma associated with mental illness (3) the perceived role of children in society and (4) mental health services and staff skills. Two themes that addressed facilitators of communication about parental mental illness were identified: (1) the potential to increase mental health awareness amongst the broader community through social media, the internet, and general psychoeducation (2) healthcare professionals' concerns for the wellbeing and future mental health of patients' children, as well as their hopes for increased mental health awareness amongst future generations.

CONCLUSIONS

This study provides insight into healthcare professionals' attitudes and perceptions about talking to patients and families within their community about mental illness. The results provide recommendations about possible ways to promote sharing information about a parent's mental illness with children at an individual and community level. Future research should focus on the collaborative creation of culturally sensitive psychoeducational resources and evidence-based guidelines. This must be supported by systemic and organisational change in order for professionals to successfully facilitate conversations with patients who are parents, and their children.

Feasibility and acceptability of a mental health stigma intervention for low-income South African caregivers: A qualitative investigation

Background

Common mental health illnesses such as depression and anxiety disorders are increasing globally. There remain significant gaps in health services provision and support for mental illness linked to stigma in developing countries.

Aim

Our study aimed to assess the feasibility and acceptability of a mental health intervention for caregivers of mental health service users.

Setting

Low-income South African communities.

Method

Our study qualitatively assessed the feasibility of an anti-stigma mental health intervention for family caregivers in low-income settings. The intervention was structured into five sessions delivered over three days. Caregivers attended all the sessions at a centralised community venue. Semi-structured qualitative interviews were held separately with caregivers (n = 10) and their service users (n = 9) eight weeks post-intervention. Interviews were translated verbatim from local languages to English prior to framework analysis.

Results

Post-intervention, service users reported improved family relations and understanding of mental illness among family members. The intervention was reported as acceptable and helpful by caregivers as it increased knowledge, fostering better relationships with service users. Group discussions were noted as a critical driver of intervention success. Widespread mental health stigma within communities remained a key concern for caregivers and service users.

Conclusion

With the government’s drive for deinstitutionalisation, the need to integrate anti-stigma interventions within community mental health services is vital, as is the need for population-wide anti-stigma interventions to support the integration of mental health service users within communities.

Measuring judiciarization of people with mental illnesses

The judiciarization of the psychiatric subject is a two-sided process. It could anti-discriminate people with mental illnesses but, at the same time, it could potentially provoke pathologization of mental illnesses. Current methodologies proposed to measure this important and complicated process for people with mental illnesses do not allow analysis on multiple levels (the macro, meso, and micro). In this article, to fill this gap we propose a methodological strategy that helps to investigate judiciarization of people with mental illnesses on multiple levels at once. This approach is based on critical discourse analysis of legal documents and court decisions that feature people with the poor mental health. Namely, we suggest how to measure the level or degree of judiciarization, its geographical evenness, actors in the legal process, its dimensions (the law branches of its occurrence), and linguistic content. We applied this methodology in examining 1,243 legal documents and 327,311 court decisions that were issued by agents of the Russian law system. The research findings show that judiciarization levels in Russia have been rising over the years, moving away from stigmatizing those with mental illnesses and towards anti-discrimination. Our paper could be of interest to socio-legal researchers and social policy practitioners.