Life events in Xhosas in Cape Town

Trauma exposure and psychometric properties of the life events checklist among adults in South Africa

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 into 0, 1, 2, 3, and ≥4 traumatic event types. Psychometric properties of the LEC-5 were assessed through exploratory and confirmatory factor analyses.Results: More than 92% of the study sample reported experiencing ≥1 traumatic event; 38.7% reported experiencing ≥4 traumatic event types. The most endorsed item was physical assault (65.0%), followed by assault with a weapon (50.2%). Almost 94% of cases reported ≥1 traumatic event compared to 90.5% of controls (p < .001) and 94% of male participants reported ≥1 traumatic event compared to 89.5% of female participants (p < .001). Exploratory factor analysis revealed a 6-factor model. Confirmatory factor analyses of three models found that a 7-factor model based on the South African Stress and Health survey was the best fit (standardized root mean square residual of 0.024, root mean square error of approximation of 0.029, comparative fit index of 0.910).Conclusion: Participants reported very high exposure to traumatic events. The LEC-5 has good psychometric priorities and is adequate for capturing trauma exposure in South Africa.

Psychosocial determinants of HIV-related quality of life among HIV-positive military in Nigeria

Summary

There is a paucity of research regarding the role played by psychosocial and HIV-related factors on quality of life (QoL) among military in developing countries. On presentation to a military hospital-based HIV clinic, 125 air-force personnel, 56 seropositive (none of whom had AIDS) and 69 seronegative were interviewed. At the interview, participants were assessed using the Medical Outcome QoL and other psychosocial measures. The overall QoL was less among seropositive compared with seronegative air-force personnel. Seropositive personnel also reported a greater number of negative life events and trauma symptoms (post-traumatic stress disorder, PTSD). Seronegative military personnel reported more sexual risk behaviours compared with seropositive personnel. Multivariate analysis showed that trauma symptoms (PTSD) were a significant contributor to QoL and explained of the variance in physical, mental, role and social functioning among HIV-infected air-force personnel. Other variables that predicted QoL, but to a lesser extent, included age, number of negative life events and increased symptomatology. These findings highlight the importance of evaluation of QoL in HIV-infected military personnel.

Post-traumatic stress disorder among recently diagnosed patients with HIV/AIDS in South Africa

This study examined the prevalence of and factors associated with post-traumatic stress disorder in recently diagnosed HIV/AIDS patients in South Africa. One hundred and forty-nine (44 male, 105 female) recently diagnosed HIV/AIDS patients (mean duration since diagnosis = 5.8 months, SD = 4.1) were evaluated. Subjects were assessed using the MINI International Neuropsychiatric Interview (MINI), the Carver Brief COPE coping scale and the Sheehan Disability Scale. In addition, previous exposures to trauma and past risk behaviours were assessed. Twenty-two patients (14.8%) met criteria for PTSD. Current psychiatric conditions more likely to be associated with PTSD included major depressive disorder (29% in PTSD patients versus 7% in non-PTSD patients, p = 0.004), suicidality (54% versus 11%, p = 0.001) and social anxiety disorder (40% versus 13%, p = 0.04). Further patients with PTSD reported significantly more work impairment and demonstrated a trend towards higher usage of alcohol as a means of coping. Discriminant function analysis indicated that female gender and a history of sexual violation in the past year were significantly associated with a diagnosis of PTSD. Patients whose PTSD was a direct result of an HIV/AIDS diagnosis (8/22) did not differ from other patients with PTSD on demographic or clinical features. In the South African context, PTSD is not an uncommon disorder in patients with HIV/AIDS. In some cases, PTSD is secondary to the diagnosis of HIV/AIDS but in most cases it is seen after other traumas, with sexual violation and intimate partner violence in women being particularly important.

Determinants of unprotected sex among HIV-positive patients in South Africa

This study examined the prevalence of unprotected sex, other sexual risk behaviours, and factors associated with unprotected sex among men and women recently diagnosed with HIV in South Africa. One hundred and forty-nine outpatients (44 males and 105 females) were assessed, of whom 101 were sexually active at least 6 months prior to study entry. Subjects were asked about sexual risk behaviours with reference to their most recent sexual encounter. Logistic regression analysis was employed to determine the predictors of condom use, with independent variables selected from five general categories: (1) sociodemographic characteristics; (2) situational characteristics regarding sexual intercourse (i.e. alcohol or drugs used before intercourse); (3) clinical diagnoses; (4) negative life events; and (5) coping styles. Fifty-five patients (19 males and 36 females), representing 54.4% of those sexually active in the 6 months preceding the study, had not used a condom during the most recent intercourse. Compared with those who used condoms, participants who did not significantly reported shorter duration of HIV infection (t = -2.7, p < 0.001), have a current partner (chi2 = 3.98, p = 0.005), and lack knowledge of their partner's HIV status (chi2 = 4.78, p = 0.004). Also they were significantly more likely to engage in denial (t = 3.2, p < 0.002) and to use substances (t = 1.98, p < 0.05) as a means of coping. Logistic regression showed that shorter duration of illness (odds ratio (OR) = 1.2, 95% confidence interval (CI) = 1.01-1.41) and coping styles characterized by denial (OR = 0.6, 95% CI = 0.45-0.96) were significantly associated with unprotected sex. These data suggest the need for interventions to further reduce sexual risk behaviours in HIV-positive patients in South Africa.

Predictors of major depression in recently diagnosed patients with HIV/AIDS in South Africa

There is increasing evidence that major depression impacts the course of HIV infection, yet few studies have explored demographic and clinical predictors of depression in people who with HIV/AIDS. This study investigated predictors of depression (e.g., demographic and clinical variables, negative life events, and coping response) among outpatients with recently diagnosed HIV/AIDS patients in South Africa. One hundred forty-nine recently diagnosed HIV/AIDS patients (44 males and 105 females; mean time since diagnosis = 5.8, standard deviation [SD] 4.1) were evaluated. Subjects were assessed using the Mini International Neuropsychiatric Interview (MINI), the Carver Brief COPE coping scale, and the Sheehan Disability Scale. In addition, previous exposures to trauma and past risk behaviors were assessed. Three variables: gender (odd ratio [OR] = 1.23; 95% confidence interval [CI] 1.56, 1.93), impact of negative life events (OR = 1.13; CI, 1.03, 1.23), and disability (OR = 1.51, CI, 1.28, 1.80) predicted current major depression. It is well known from non-HIV populations that female gender and increased negative life events predict depression. These data also emphasize the importance of these links in HIV.

Measuring life events in a sample of South African students: comparison of the Life Experiences Survey and the Schedule of Recent Experiences

This study compared the Life Experiences Survey and the Schedule of Recent Experiences for a sample of 213 students. Scores on the Life Experiences Survey-Negative discriminated between rural and urban students and between African language speakers and Afrikaans/English speakers. A small but significant correlation between Life Experiences Survey-Negative and scores on the Center for Epidemiological Studies-Depression scale was found, while there was no correlation between scores on the Schedule of Recent Experiences with depression. The Life Experiences Survey-Negative was the only significant predictor of Depression scores. The Life Experiences Survey-Negative interacted significantly with all the measures of social support (Friends, Family, Satisfaction, and Number of Supports) in predicting depression, while the Schedule of Recent Experiences only interacted significantly with support from Family and Number of Supports. The study also provides support for clearly distinguishing between desirable and undesirable events, since positive events moderated the correlation of negative events with depression. The Life Experiences Survey is a more promising measure of life events than the Schedule of Recent Experiences in the South African context.

Stressful life events and psychological status in black South African women

The relationship between stressful life events and psychological status in Black South African women was explored, using a semistructured interview that consisted of a demographic questionnaire; the Xhosa Life Event Scale (XLES; Swartz, Elk, Teggin, & Gillis, 1983), which comprises mainly personal stressors; the Township Life Event Scale (TLES; Bluen & Odesnik, 1988), which comprises mainly sociopolitical stressors; and the General Health Questionnaire (GHQ, Goldberg, 1972, 1978). The participants were a random sample of 100 Black women living in a South African township. There were significant positive correlations between psychological distress and (a) undesirable life changes, (b) recurring stressful events of a sociopolitical nature (but not of a personal nature), and (c) continuous stressful events of a sociopolitical nature (but not of a personal nature). The results indicated that adverse sociopolitical conditions and the stress that accompanied them had a stronger negative effect than stressful events of a personal nature did on the women's mental health.

Problem-solving appraisal in the association of life stress and depression: a South African study

This study focuses on the role that appraisal of problem-solving skills plays in the relationship of stress to distress. 450 black South African university students completed the Life Experiences Survey, the Problem Solving Inventory, and the Centre for Epidemiological Studies Depression Scale. Multiple regression analysis indicated a direct effect for problem-solving appraisal on depression, but no support could be found for the stress-buffering effects of problem-solving appraisal.

Experiences of Violence in the Lives of Township Youths in ‘Unrest’ and ‘Normal’ Conditions

Political violence has attracted the attention of psychological researchers in South Africa. In comparison, the more habitual forms of violence occurring in townships have been neglected. In this study the authors investigate the experiences of violence of two cohorts of township youths; one which had recently experienced the violence of ‘unrest’ and one which had not. A comparison of the two cohorts revealed some differences, which are related to ‘unrest’. There are, however, many similarities which indicate consistencies in experiences of violence regardless of ‘unrest’. It is concluded that the more habitual forms of violence deserve more research attention.

Stress, locus of control, and psychological status in black South African migrants

The aim of this study was to investigate the specific impact of a major migration-related stressor on the psychological functioning of Black South African migrants who had been coerced to migrate from their indigenous residence to an area designated by the South African government. Scales measuring stress, locus of control, and psychological status were administered to a sample of 50 involuntary farm migrants, 50 "voluntary" farm migrants, 50 "black spot" migrants, and 50 non-migrants. Subjects were male and female adults aged between 35 and 45 years. Results indicated that migrants perceived more stress and were more psychologically distressed than nonmigrants. This distress was particularly associated with the stressor lose home. Farm migrants perceived more external control than black spot and nonmigrant groups.

Issues for cross-cultural psychiatric research in South Africa

South Africa's heterogenous society offers many opportunities for cross-cultural psychiatric research, but researchers in the country are subject to a number of restraints. Apart from legally enforced segregation, there are strict censorship laws and restricted access to certain types of information. The issues surrounding categorization of cultures and factors affecting publishing research from South Africa have important implications for the type of work that is done. It is a central argument of this article that the issues affecting research in South Africa are relevant to other countries as well, and parallels between the local and international context are drawn. The South African experience suggests that analysis of the research enterprise itself is a useful part of the business of cross-cultural psychiatric research.