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Collings SJ, Valjee SR. A Multi-Mediation Analysis of the Association between Adverse Childhood Experiences and Non-Suicidal Self-Injury among South African Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1221. [PMID: 39338104 PMCID: PMC11431216 DOI: 10.3390/ijerph21091221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 09/06/2024] [Accepted: 09/15/2024] [Indexed: 09/30/2024]
Abstract
The available research findings suggest that non-suicidal self-injury (NSSI) constitutes an important public health issue, with identified risk factors for NSSI having been found to include exposure to adverse childhood experiences (ACEs) and comorbidity with various mental disorders. However, the available findings have, for the most part, been based on the experiences of individuals living in predominantly high-income countries located in the Global North, and it is not clear whether these findings can be confidently generalised to individuals living in low-resourced countries. As such, this cross-sectional study assessed risk factors for NSSI in a non-clinical sample of 636 South African adolescents (12-18 years old), with the data being analysed using a multi-mediation analysis. ACEs were assessed using a revised version of the ACEs Questionnaire, and NSSI was assessed using items adapted from the Self-Harm subscale of the Risk-Taking and Self-Harm Inventory for Adolescents, with emotion dysregulation, depression, and PTSD being considered as possible mediators. High prevalence rates for NSSI and exposure to five or more ACEs were reported by the participants, with the mediation analysis indicating that significant direct effects of adverse childhood experiences on NSSI were partially mediated by emotion dysregulation. These findings are discussed with respect to their implications for primary, secondary, and tertiary prevention.
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Affiliation(s)
- Steven J. Collings
- School of Applied Human Sciences, University of KwaZulu-Natal, Mazisi Kunene Road, Glenwood, Durban 4041, South Africa;
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2
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Somefun O, Theron L, Ungar M. The association between family adversity and youth mental health outcomes. J Adolesc 2023; 95:1333-1347. [PMID: 37335052 DOI: 10.1002/jad.12205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/02/2023] [Accepted: 06/03/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND The association between family adversity and young people's mental health outcomes in communities that experience economic instability has not been well explored in the South African context. Furthermore, the overtime interaction between resilience factors, family adversity, and young people's psychological functioning in African settings, like South Africa, is under-investigated. PURPOSE This study investigates the relationship between family adversity and conduct problems and depression at two-time points in a sample of youths in two South African communities stressed by their dependency on economically volatile oil and gas industries. METHOD This article draws on longitudinal data generated by the Resilient Youth in Stressed Environments (RYSE) study in South Africa, which included 914 and 528 (wave 1 and 3) adolescents and emerging adults (14-27-year-olds; M age = 18.36 years) living in Secunda/eMbalenhle and Sasolburg/Zamdela. Participants were sampled at baseline (wave 1) and 18-24 months later (wave 3). They self-reported experience of community violence, family adversity, resilience-enabling resources, conduct difficulties, and depression symptoms. Regression analyses were used to examine the unadjusted and adjusted association of family adversity on conduct problem and depression. RESULTS About 60% of participants reported high family adversity. Regressions, however, revealed no association between family adversity and conduct problems and depression cross-sectionally and over time. Individual resilience, biological sex, and experience of victimization in the community, however, were associated with conduct difficulty while all three resilience factors were associated with decreased depression among participants. CONCLUSION Our study sheds light on the risk and protective factors for mental health outcomes of adolescents and youths who reside in volatile, turbulent communities and experience ongoing familial challenges. To effectively support the mental well-being of young individuals in such contexts, interventions must consider the potential ambivalence of the resilience factors they aim to strengthen.
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Affiliation(s)
- Oluwaseyi Somefun
- Department of Educational Psychology, University of Pretoria, Pretoria, South Africa
| | - Linda Theron
- Department of Educational Psychology, University of Pretoria, Pretoria, South Africa
| | - Michael Ungar
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
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3
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Kleintjes S, Schneider M. History and politics of mental health policy and care in South Africa. SSM - MENTAL HEALTH 2023. [DOI: 10.1016/j.ssmmh.2023.100206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
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4
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Leshem B, Kashy-Rosenbaum G, Schiff M, Benbenishty R, Pat-Horenczyk R. Continuous Exposure to Terrorism during the COVID-19 Pandemic: A Moderated Mediation Model in the Israeli Context. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2799. [PMID: 36833494 PMCID: PMC9956153 DOI: 10.3390/ijerph20042799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
This study tested the role of perceived social support as a moderating factor in the mediation of COVID-19-related concerns in the association between continuous traumatic stress (CTS) and depression. The study participants were 499 college students who responded to an anonymous online questionnaire. Measures included the assessment of prior continuous exposure to threats of terrorism, COVID-19-related distress, perceived social support and depressive symptoms. The results demonstrated that COVID-19-related concerns mediated the relationship between continuous exposure to threats of terrorism and depression symptoms, and that perceived social support moderated the association between COVID-19-related concerns and depression. The implications of the study highlight the role of prior exposure to traumatic stress as a risk factor for depression and the role of social support as a protective factor. These results point to the need to develop accessible and non-stigmatic mental health services for populations exposed to other types of continuous traumatic stress.
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Affiliation(s)
- Becky Leshem
- Department of Education, Achva Academic College, Beer Tuvia, Arugot 7980400, Israel
| | | | - Miriam Schiff
- Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem 9190501, Israel
| | - Rami Benbenishty
- Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem 9190501, Israel
- Department of Education, Universidad Andres Bello, Santiago 7591538, Chile
| | - Ruth Pat-Horenczyk
- Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem 9190501, Israel
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Levy I. Stress, anxiety, and depression in times of COVID-19: Gender, individual quarantine, pandemic duration and employment. Front Public Health 2022; 10:999795. [PMID: 36408032 PMCID: PMC9670105 DOI: 10.3389/fpubh.2022.999795] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives This study explores the inter-relationship between emotional distress in adults and gender, quarantine experiences, pandemic duration, and employment. Methods An online cross-sectional online survey comprised 943 Israelis. The link to the survey was distributed via different personal and academic social networking sites (e.g., Facebook, WhatsApp, and Twitter). The survey was administered using the online survey portal Google Forms. Participants addressed questions about their socio-demographic characteristics (e.g., gender, age, family status, employment, and quarantine experiences) and ranked their levels of stress, anxiety, and depression using the Hebrew version of the Depression, Anxiety and Stress Scale-DASS-21. Results The majority of the respondents (72%) were women, 39% experienced quarantine, and 55% were unemployed. About 42% experienced a short-term pandemic (one lockdown), and the rest experienced a continuous pandemic (two lockdowns). The MANCOVA results, controlling for family status, indicated that women and unemployed participants reported higher stress, anxiety, and depression levels than men and employed participants. Participants who experienced individual quarantine reported higher anxiety and depression. Furthermore, there was a significant interaction between gender, employment, and pandemic duration. The experience of individual quarantine intensified the stress, anxiety, and depression for both employed and unemployed women. Conversely, the quarantine intensified stress, anxiety, and depression only for unemployed men, whereas the quarantine did not affect stress, anxiety, and depression among employed men. Conclusions Employment is a critical factor regarding men's emotional state during such stressful situations as the COVID-19 pandemic. Furthermore, individual quarantine and long-term pandemics are associated with opposite outcomes regarding individual mental health. The individual quarantine is associated with increased anxiety and depression, while a long-term, continuous pandemic is associated with decreased stress.
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Affiliation(s)
- Inna Levy
- Department of Criminology, Ariel University, Ariel, Israel
- Department of Interdisciplinary Studies, Zefat Academic College, Zefat, Israel
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Amone-P'Olak K, Omech B, Kakinda AI, Kibedi H. Echoes of the past: prevalence and correlates of PTSD among formerly abducted youths in northern Uganda: findings from the WAYS study. Gen Psychiatr 2022; 35:e100840. [DOI: 10.1136/gpsych-2022-100840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
BackgroundPost-traumatic stress disorder (PTSD) has considerable and persistent effects on survivors of war, particularly in postconflict areas. Yet, evidence on what keeps survivors on the path of PTSD remains scarce.AimsThe current study aimed to assess the prevalence and correlates of PTSD symptoms among the war-affected population in northern Uganda.MethodsData from 476 war-affected youths (aged 20–27 years) who had participated in a longitudinal cohort study were analysed to describe the enduring associations of background and postwar environmental risk factors with PTSD symptoms. The Impact of Event Scale-Revised was used to evaluate symptoms of PTSD. Descriptive statistics were used to compute background and postwar environmental correlates. Binary logistic regression analyses were fitted to assess the magnitude of the effects of the correlates on PTSD symptoms.ResultsBackground and postwar environmental factors (eg, sexual abuse and injury in captivity) were significantly associated with PTSD symptoms. Postwar environmental factors associated with PTSD symptoms included postwar hardships, stigma/discrimination, chronic illness, community relations, family acceptance and general functioning, among others. The odds ratios (ORs) for post-war hardships were 2.41 (95% confidence interval (CI): 1.63 to 3.56) and 2.90 (95% CI: 2.03 to 4.14) for high and severe PTSD, respectively. For stigma/discrimination, compared with higher scores, the ORs were 3.38 (95% CI: 2.22 to 5.17) and 4.12 (95% CI: 2.69 to 6.30) for high and severe PTSD symptoms, respectively.ConclusionsBackground and postwar environmental stressors exacerbate the severity of PTSD symptoms in survivors of war and should form the basis for interventions to alleviate the toxic effects of war on survivors.
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Wa Mwenda Jonas KA, Kisungu Basile K, Jean Baptiste KN, Alyousef HA, Meng H. Associations between posttraumatic stress symptoms and abuse experiences in child and adolescent girls from a Central African country. J Trauma Stress 2022; 35:1432-1444. [PMID: 35642389 DOI: 10.1002/jts.22843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 03/18/2022] [Accepted: 03/19/2022] [Indexed: 11/11/2022]
Abstract
Posttraumatic stress disorder (PTSD) is frequently reported among survivors of abuse. However, there is a paucity of research examining the association between PTSD and abuse, including polyvictimization, in nonconflict areas of the Democratic Republic of Congo (DRC). We aimed to investigate the prevalence and correlates of PTSD among girls in nonconflict zones who experienced at least one type of abuse. Participants in this cross-sectional study were 3,011 middle-school girls, aged 11-18 years, who attended randomly selected schools and completed questionnaires. The probable PTSD prevalence was 67.5%. The rate of probable PTSD increased with the number of experienced abuse types over a 12-month period. The findings demonstrated associations between probable PTSD and exposure to five (86.9%), four (63.9%), and three types of abuse (60.1%). The strongest association was observed between probable PTSD and experiencing five types of abuse, OR = 26.806, 95% CI [19.303, 37.225]; associations were also found between PTSD and abuse with a weapon, OR = 4.341, 95% CI [3.519, 5.354]; rape with penetration, OR = 4.728, 95% CI [3.447, 6.484]; and experiencing three, OR = 6.625, 95% CI [4.325, 10.148], or four types of abuse, OR = 7.114, 95% CI [5.025,10.070]. The findings of this study underscore the importance of the need for psychological and physical health care for girls who have been exposed to abuse, regardless of the number of abuse experiences or abuse types she has experienced.
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Affiliation(s)
| | - Kalema Kisungu Basile
- Department of School and Professional Orientation, National Pedagogical University, Kinshasa, Congo
| | | | - Hala Ayaman Alyousef
- Department of Nutrition and Food Hygiene, School of Public Health, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Heng Meng
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Maercker A, Cloitre M, Bachem R, Schlumpf YR, Khoury B, Hitchcock C, Bohus M. Complex post-traumatic stress disorder. Lancet 2022; 400:60-72. [PMID: 35780794 DOI: 10.1016/s0140-6736(22)00821-2] [Citation(s) in RCA: 100] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 04/19/2022] [Accepted: 04/27/2022] [Indexed: 12/21/2022]
Abstract
Complex post-traumatic stress disorder (complex PTSD) is a severe mental disorder that emerges in response to traumatic life events. Complex PTSD is characterised by three core post-traumatic symptom clusters, along with chronic and pervasive disturbances in emotion regulation, identity, and relationships. Complex PTSD has been adopted as a new diagnosis in the ICD-11. Individuals with complex PTSD typically have sustained or multiple exposures to trauma, such as childhood abuse and domestic or community violence. The disorder has a 1-8% population prevalence and up to 50% prevalence in mental health facilities. Progress in diagnostics, assessment, and differentiation from post-traumatic stress disorder and borderline personality disorder is reported, along with assessment and treatment of children and adolescents. Studies recommend multicomponent therapies starting with a focus on safety, psychoeducation, and patient-provider collaboration, and treatment components that include self-regulatory strategies and trauma-focused interventions.
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Affiliation(s)
- Andreas Maercker
- Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland.
| | - Marylene Cloitre
- National Center for PTSD Division of Dissemination and Training and Department of Psychiatry and Behavioural Sciences, Stanford University, CA, USA
| | - Rahel Bachem
- Division of Psychopathology and Clinical Intervention, University of Zurich, Zurich, Switzerland
| | | | | | - Caitlin Hitchcock
- MRC Cognition and Brain Science Unit, University of Cambridge, Cambridge, UK; Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Martin Bohus
- Heidelberg University, Heidelberg Germany and Ruhr University, Bochum, Germany
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“In the Middle, between Anxiety Victims and PTSD, There Are People That Have Some Kind of a Disorder That Has No Name Yet” Insights about the Traumatic Stress Consequences of Exposure to Ongoing Threat. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2020015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Current diagnostic criteria for post-traumatic stress disorder (PTSD) do not include symptoms resulting from exposure to ongoing traumatic stress. Thus, existing assessment tools do not fully capture stress symptoms associated with exposure to threats that extend over months or years. We aimed to enumerate the symptoms associated with ongoing exposure to stress and to evaluate the need for a new comprehensive tool designed to assess traumatic stress in these situations. Study methods included focus group sessions, interviews, and a content expert’s workshop. Thematic analysis yielded three main themes: 1. PTSD in its current definition does not capture the whole “traumatic picture” observed in ongoing exposure to threat, 2. Some DSM-5 criteria are not applicable in ongoing exposure to threat, 3. The need for a new tool or modifications of commonly used assessment tools. This study supports the notion that PTSD assessment practices are lacking when assessing traumatic stress in ongoing exposure to threat and highlights the need for a new tool specifically designed for these situations.
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Womersley JS, Xulu KR, Sommer J, Hinsberger M, Kidd M, Elbert T, Weierstall R, Kaminer D, Malan-Müller S, Seedat S, M J Hemmings S. Associations between telomere length and symptoms of posttraumatic stress disorder and appetitive aggression in trauma-exposed men. Neurosci Lett 2021; 769:136388. [PMID: 34890718 DOI: 10.1016/j.neulet.2021.136388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/19/2022]
Abstract
Exposure to community violence is common in South Africa and negatively impacts on biopsychosocial health. Posttraumatic stress disorder (PTSD) is characterised by symptoms of intrusion, avoidance, hypervigilance and negative alterations in cognition and mood, and can develop consequent to trauma exposure. Individuals who repeatedly experience and witness violence may also come to view it as appealing and rewarding. This appetitive aggression (AA) increases the likelihood of perpetrating violence. Telomeres are repetitive nucleotide sequences that protect the ends of chromosomes. Telomere length (TL) attrition is a stress-sensitive marker of biological aging that has been associated with a range of psychiatric disorders. This study investigated the cross-sectional relationship between TL and symptoms of PTSD and AA in South African men residing in areas with high community violence. PTSD and AA symptom severity was assessed in 290 men using the Posttraumatic Stress Disorder Symptom Scale - Interview (PSS-I) and Appetitive Aggression Scale (AAS), respectively. Quantitative polymerase chain reaction was performed on DNA extracted from saliva and used to calculate relative TL (rTL). Regression models were used to assess the relationships between rTL and PSS-I and AAS scores. Network analyses using EBIC glasso methods were performed using rTL and items from each of the AAS and PSS-I measures. Both PSS-I (p = 0.023) and AAS (p = 0.016) scores were positively associated with rTL. Network analyses indicated that rTL was weakly related to two PSS-I and five AAS items but performed poorly on indicators of centrality and was not strongly associated with measure items either directly or indirectly. The positive association between rTL and measures of AA and PTSD may be due to the induction of protective homeostatic mechanisms, which reduce TL attrition, following early life trauma exposure.
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Affiliation(s)
- Jacqueline S Womersley
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Khethelo R Xulu
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Jessica Sommer
- Department of Psychology, University of Konstanz, Konstanz, Germany.
| | | | - Martin Kidd
- Centre for Statistical Consultation, Department of Statistics & Actuarial Sciences, Stellenbosch University, Stellenbosch, South Africa.
| | - Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Germany.
| | - Roland Weierstall
- Department of Psychology, University of Konstanz, Konstanz, Germany; Clinical Psychology & Psychotherapy, Medical School Hamburg, Hamburg, Germany; Oberberg Clinics, Berlin, Germany.
| | - Debbie Kaminer
- Department of Psychology, University of Cape Town, Cape Town, South Africa.
| | - Stefanie Malan-Müller
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Sian M J Hemmings
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Potluri S, R Patel A. Using a Continuous Traumatic Stress Framework to Examine Ongoing Adversity Among Indian Women from Slums: A Mixed-Methods Exploration. J Trauma Stress 2021; 34:917-928. [PMID: 34462969 DOI: 10.1002/jts.22699] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 04/10/2021] [Accepted: 04/20/2021] [Indexed: 01/22/2023]
Abstract
Gender-based violence (GBV) is pervasive among Indian women. Although posttraumatic stress disorder (PTSD) is a psychological outcome of GBV, it might not accurately capture the experiences of Indian women from slums, who face continued stressors (i.e., ongoing adversity). Continuous traumatic stress (CTS) is a framework used to characterize experiences of ongoing adversity. This mixed-method study investigated the applicability of the CTS framework for characterizing ongoing adversity and the psychological impacts of ongoing adversity among GBV-exposed Indian women from slums. Indian women from slums (N = 100) completed all study measures; a subset (n = 47) completed qualitative interviews analyzed using deductive coding and thematic analysis to identify core CTS characteristics. To examine the impact of ongoing adversity on participants' psychological symptom severity in the full sample, we performed an ANCOVA on PTSD symptom severity and an ANOVA on anxiety and depression symptom severity. Interviewed participants described the context of stressor conditions as pervasive, reported stressor conditions existed in the present or future rather than the past, had difficulty discriminating between real versus imagined threat, and demonstrated absent external protective systems. Results indicated that ongoing adversity was associated with significantly more severe PTSD, F(1, 96) = 9.86, p < .001; anxiety, F(1, 98) = 20.31, p < .001; and depression, F(1, 98) = 25.24, p < .001. The CTS framework is valuable for characterizing ongoing adversity and its related mental health impacts among GBV-exposed Indian women from slums. Assessment and intervention in slum communities must account for ongoing adversity.
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Affiliation(s)
- Sriramya Potluri
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Anushka R Patel
- Department of Psychology, The University of Tulsa, Tulsa, Oklahoma, USA.,Trauma Recovery Center, University of California San Francisco, San Francisco, California, USA
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Harper GW, Lewis KA, Norwitz GA, Odhiambo EO, Jadwin-Cakmak L, Okutah F, Lauber K, Aloo T, Collins B, Gumbe E, Amico KR, Olango K, Odero W, Graham SM. “God Didn’t Make a Mistake in Creating Me”: Intrapersonal Resilience Processes among Gay and Bisexual Male Youth in Kenya. ADOLESCENTS 2021; 1:267-282. [PMID: 35665057 PMCID: PMC9161601 DOI: 10.3390/adolescents1030020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gay and bisexual male youth in Kenya experience human rights violations, including pervasive stigma and discrimination, and these oppressive forces are associated with elevated rates of mental health concerns. Despite these challenges, many gay and bisexual male youth in Kenya are thriving during this critical developmental period. This study explored intrapersonal processes that gay and bisexual male youth in Kisumu, Kenya, highlight as important to developing, and demonstrating resilience in the face of adversity. We conducted qualitative in-depth interviews (IDIs) with 40 gay and bisexual male youth, ages 20–30 (mean = 26.4), and an additional 20 IDIs with gay and bisexual men, ages 22–45 (mean = 26.6), who were working as peer educators (total n = 60), all in Kisumu, Kenya. A total of nine primary themes emerged which describe various intrapersonal resilience processes enacted by gay and bisexual male youth, including sexual identity acceptance, self-confidence, self-love, religious/spiritual affirmation, adaptive coping, successful navigation, legal rights awareness, economic stability, and advocacy satisfaction. These data demonstrate the range of positive personal processes that promote mental health and wellbeing among gay and bisexual male youth in Kenya. We discuss implications of these findings for community-based interventions, and call for a research paradigm shift away from deficits and toward resilience.
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Affiliation(s)
- Gary W. Harper
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I, Ann Arbor, MI 48109, USA
- Correspondence:
| | - Katherine A. Lewis
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I, Ann Arbor, MI 48109, USA
| | - Gabriella A. Norwitz
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St., New York, NY 10032, USA
| | | | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I, Ann Arbor, MI 48109, USA
| | - Felix Okutah
- Anza Mapema Tom Mboya Center, Nyanza Reproductive Health Society, Kisumu 40100, Kenya
| | - Kendall Lauber
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I, Ann Arbor, MI 48109, USA
| | - Teddy Aloo
- Anza Mapema Tom Mboya Center, Nyanza Reproductive Health Society, Kisumu 40100, Kenya
| | - Ben Collins
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I, Ann Arbor, MI 48109, USA
| | - Edwin Gumbe
- Anza Mapema Tom Mboya Center, Nyanza Reproductive Health Society, Kisumu 40100, Kenya
| | - K Rivet Amico
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, SPH I, Ann Arbor, MI 48109, USA
| | - Kennedy Olango
- Men Against AIDS Youth Group (MAAYGO), Milimani Box 1174, Kisumu 40100, Kenya
| | - Wilson Odero
- Department of Family Medicine and Community Health, School of Medicine, Maseno University, Private Bag, Maseno 40105, Kenya
| | - Susan M. Graham
- Departments of Global Health and Medicine, University of Washington, Box 359909, 325 Ninth Avenue, Seattle, WA 98104, USA
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Living Near an Immigration Detention Center: Impact on Latinas' Health. J Immigr Minor Health 2021; 24:626-638. [PMID: 34097163 PMCID: PMC8181535 DOI: 10.1007/s10903-021-01219-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 11/29/2022]
Abstract
There is ample evidence that exposure to Immigration and Customs Enforcement (ICE) activities could widen Latinas’ health disparities. Whether or not residing near an ICE detention center (IDC) further impacts their health is unknown. During nationwide increased ICE activities Latinas (N=45) attended an intervention at two separate sites: one near and another one far from an IDC. A focus group discussion and an interview were conducted using a grounded theory approach. Quantitative data were collected and analyzed. Participants residing near an IDC benefited less from the intervention and reported changes in anxiety levels and in mobility, and a sense of powerlessness. They also requested resources to respond to ICE overreach and broadcasting of their reality. Our results suggest that proximity to IDCs impacts immigrant communities and public health programming, which is inevitably embedded in political realities. These need to be addressed when providing much needed interventions.
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Goral A, Feder-Bubis P, Lahad M, Galea S, O’Rourke N, Aharonson-Daniel L. Development and validation of the Continuous Traumatic Stress Response scale (CTSR) among adults exposed to ongoing security threats. PLoS One 2021; 16:e0251724. [PMID: 34043646 PMCID: PMC8158953 DOI: 10.1371/journal.pone.0251724] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Current diagnostic criteria for posttraumatic stress disorder (PTSD) do not include symptoms resulting from exposure to continuous or ongoing traumatic stress. Thus existing assessment tools do not fully capture stress symptoms associated with exposure to threats that extend over months or years. To address this void, we enumerated the symptoms associate with ongoing exposure to stress including those that are distinct from existing PTSD diagnostic criteria. OBJECTIVES To develop the Continuous Traumatic Stress Response Scale (CTSR) and assess its psychometric properties. METHOD We sampled 313 adults exposed and unexposed to ongoing security threat between December 2016 and February 2017. Respondents lived in communities bordering the Gaza Strip in southern Israel where they are exposed to frequent rocket attacks, requiring they locate and find shelter in 30 seconds or less. We assessed the concurrent validity of CTSR relative to the Posttraumatic Diagnostic Scale (PDS). RESULTS On the basis of exploratory factor analysis (EFA), we retained 11 of 25 items measuring three distinct factors: exhaustion/detachment, rage/betrayal, and fear/helplessness. We found moderate concurrence between the scales; that is, the CTSR appears to measure a construct related to, but distinct from PTSD. This conclusion is supported by confirmatory factor analysis (CFA) indicating that each factor significantly contributes to measurement of a higher-order, continuous traumatic stress latent construct. CONCLUSIONS These results support the psychometric properties of CTSR. Future research is required to confirm these findings in other countries and cultures and among individuals exposed to other forms of continuous traumatic stress.
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Affiliation(s)
- Aviva Goral
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Paula Feder-Bubis
- PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- Department of Health Systems Management, School of Public Health, Faculty of Health Sciences and Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Mooli Lahad
- PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- Department of Psychology, Tel-Hai College, Upper Galilee, Israel
- The Community Stress Prevention Centre (CSPC), Kiryat-Shmona, Israel
| | - Sandro Galea
- School of Public Health, Boston University, Boston, MA, United States of America
| | - Norm O’Rourke
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
| | - Limor Aharonson-Daniel
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be’er Sheva, Israel
- PREPARED Center for Emergency Response Research, Ben-Gurion University of the Negev, Be’er Sheva, Israel
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15
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The case for mindfulness interventions for traumatic stress in high violence, low resource settings. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-019-00177-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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16
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Harper GW, Crawford J, Lewis K, Mwochi CR, Johnson G, Okoth C, Jadwin-Cakmak L, Onyango DP, Kumar M, Wilson BD. Mental Health Challenges and Needs among Sexual and Gender Minority People in Western Kenya. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031311. [PMID: 33535647 PMCID: PMC7908383 DOI: 10.3390/ijerph18031311] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 02/07/2023]
Abstract
Background: Sexual and gender minority (SGM) people in Kenya face pervasive socio-cultural and structural discrimination. Persistent stress stemming from anti-SGM stigma and prejudice may place SGM individuals at increased risk for negative mental health outcomes. This study explored experiences with violence (intimate partner violence and SGM-based violence), mental health outcomes (psychological distress, PTSD symptoms, and depressive symptoms), alcohol and other substance use, and prioritization of community needs among SGM adults in Western Kenya. Methods: This study was conducted by members of a collaborative research partnership between a U.S. academic institution and a Kenyan LGBTQ civil society organization (CSO). A convenience sample of 527 SGM adults (92.7% ages 18-34) was recruited from community venues to complete a cross-sectional survey either on paper or through an online secure platform. Results: For comparative analytic purposes, three sexual orientation and gender identity (SOGI) groups were created: (1) cisgender sexual minority women (SMW; 24.9%), (2) cisgender sexual minority men (SMM; 63.8%), and (3) gender minority individuals (GMI; 11.4%). Overall, 11.7% of participants reported clinically significant levels of psychological distress, 53.2% reported clinically significant levels of post-traumatic stress disorder (PTSD) symptoms, and 26.1% reported clinically significant levels of depressive symptoms. No statistically significant differences in clinical levels of these mental health concerns were detected across SOGI groups. Overall, 76.2% of participants reported ever using alcohol, 45.6% home brew, 43.5% tobacco, 39.1% marijuana, and 27.7% miraa or khat. Statistically significant SOGI group differences on potentially problematic substance use revealed that GMI participants were less likely to use alcohol and tobacco daily; and SMM participants were more likely to use marijuana daily. Lifetime intimate partner violence (IPV) was reported by 42.5% of participants, and lifetime SGM-based violence (SGMV) was reported by 43.4%. GMI participants were more likely than other SOGI groups to have experienced both IPV and SGMV. Participants who experienced SGMV had significantly higher rates of clinically significant depressive and PTSD symptoms. Conclusions: Despite current resilience demonstrated by SGM adults in Kenya, there is an urgent need to develop and deliver culturally appropriate mental health services for this population. Given the pervasiveness of anti-SGM violence, services should be provided using trauma-informed principles, and be sensitive to the lived experiences of SGM adults in Kenya. Community and policy levels interventions are needed to decrease SGM-based stigma and violence, increase SGM visibility and acceptance, and create safe and affirming venues for mental health care. Political prioritization of SGM mental health is needed for sustainable change.
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Affiliation(s)
- Gary W. Harper
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (J.C.); (K.L.); (G.J.); (L.J.-C.)
- Correspondence:
| | - Jessica Crawford
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (J.C.); (K.L.); (G.J.); (L.J.-C.)
| | - Katherine Lewis
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (J.C.); (K.L.); (G.J.); (L.J.-C.)
| | | | - Gabriel Johnson
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (J.C.); (K.L.); (G.J.); (L.J.-C.)
| | - Cecil Okoth
- Nyanza Rift Valley and Western Kenya (NYARWEK) LGBTI Coalition, Kisumu 40100, Kenya; (C.O.); (D.P.O.)
| | - Laura Jadwin-Cakmak
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA; (J.C.); (K.L.); (G.J.); (L.J.-C.)
| | - Daniel Peter Onyango
- Nyanza Rift Valley and Western Kenya (NYARWEK) LGBTI Coalition, Kisumu 40100, Kenya; (C.O.); (D.P.O.)
| | - Manasi Kumar
- Department of Psychiatry, School of Medicine, University of Nairobi, Nairobi 00100, Kenya;
| | - Bianca D.M. Wilson
- The Williams Institute, School of Law, University of California Los Angeles, Los Angeles, CA 90095, USA;
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Xulu KR, Womersley JS, Sommer J, Hinsberger M, Elbert T, Weierstall R, Kaminer D, Malan-Müller S, Seedat S, Hemmings SMJ. DNA methylation and psychotherapy response in trauma-exposed men with appetitive aggression. Psychiatry Res 2021; 295:113608. [PMID: 33290938 DOI: 10.1016/j.psychres.2020.113608] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
Exposure to violence can lead to appetitive aggression (AA), the positive feeling and fascination associated with violence, and posttraumatic stress disorder (PTSD), characterised by hyperarousal, reexperience and feelings of ongoing threat. Psychotherapeutic interventions may act via DNA methylation, an environmentally sensitive epigenetic mechanism that can influence gene expression. We investigated epigenetic signatures of psychotherapy for PTSD and AA symptoms in South African men with chronic trauma exposure. Participants were assigned to one of three groups: narrative exposure therapy for forensic offender rehabilitation (FORNET), cognitive behavioural therapy or waiting list control (n = 9-10/group). Participants provided saliva and completed the Appetitive Aggression Scale and PTSD Symptom Severity Index at baseline, 8-month and 16-month follow-up. The relationship, over time, between methylation in 22 gene promoter region sites, symptom scores, and treatment was assessed using linear mixed models. Compared to baseline, PTSD and AA symptom severity were significantly reduced at 8 and 16 months, respectively, in the FORNET group. Increased methylation of genes implicated in dopaminergic neurotransmission (NR4A2) and synaptic plasticity (AUTS2) was associated with reduced PTSD symptom severity in participants receiving FORNET. Analyses across participants revealed a proportional relationship between AA and methylation of TFAM, a gene involved in mitochondrial biosynthesis.
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Affiliation(s)
- Khethelo R Xulu
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Jacqueline S Womersley
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Jessica Sommer
- Department of Psychology, University of Konstanz, Konstanz, Germany.
| | | | - Thomas Elbert
- Department of Psychology, University of Konstanz, Konstanz, Germany.
| | - Roland Weierstall
- Department of Psychology, University of Konstanz, Konstanz, Germany; Clinical Psychology & Psychotherapy, Medical School Hamburg, Hamburg, Germany.
| | - Debbie Kaminer
- Department of Psychology, University of Cape Town, Cape Town, South Africa.
| | - Stefanie Malan-Müller
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Sian M J Hemmings
- Department of Psychiatry, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa; South African Medical Research Council / Stellenbosch University Genomics of Brain Disorders Research Unit, Faculty of Medicine & Health Sciences, Stellenbosch University, Cape Town, South Africa.
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18
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Fouché A, Fouché DF, Theron LC. Child protection and resilience in the face of COVID-19 in South Africa: A rapid review of C-19 legislation. CHILD ABUSE & NEGLECT 2020; 110:104710. [PMID: 32938531 PMCID: PMC7473143 DOI: 10.1016/j.chiabu.2020.104710] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/25/2020] [Accepted: 08/27/2020] [Indexed: 05/18/2023]
Abstract
BACKGROUND & PURPOSE In response to the COVID-19 (C-19) pandemic, the South African government instituted strict lockdown and related legislation. Although this response was well intended, many believed it advanced children's vulnerability to abuse and neglect. This article interrogates these concerns. It investigates how C-19 legislation enabled, or constrained, South African children's protection from abuse and neglect and appraises the findings from a social-ecological resilience perspective with the aim of advancing child protection in times of emergency. METHOD The authors conducted a rapid review of the legislation, directives and regulations pertaining to South Africa's strict lockdown (15 March to 31 May 2020). They searched two databases (SA Government platform and LexisNexus) and identified 140 documents for potential inclusion. Following full-text screening, 17 documents were reviewed. Document analysis was used to extract relevant themes. FINDINGS The regulations and directives that informed South Africa's strict lockdown offered three protective pathways. They (i) limited C-19 contagion and championed physical health; (ii) ensured uninterrupted protection (legal and statutory) for children at risk of abuse; and (iii) advanced social protection measures available to disadvantaged households. CONCLUSION C-19 legislation has potential to advance children's protection from abuse and neglect during emergency times. However, this potential will be curtailed if C-19 legislation is inadequately operationalised and/or prioritises physical health to the detriment of children's intellectual, emotional, social and security needs. To overcome such risks, social ecologies must work with legislators to co-design and co-operationalise C-19 legislation that will not only protect children, but advance their resilience.
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Affiliation(s)
- Ansie Fouché
- School of Psychosocial Health, North-West University, Optentia, Private Bag x1174, Vanderbijlpark, South Africa.
| | - Daniël F Fouché
- School of Legal Sciences, Vaal University of Technology, Vanderbilpark, South Africa.
| | - Linda C Theron
- Department of Educational Psychology, University of Pretoria, South Africa.
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Rink J, Lipinska G. Evidence of distinct profiles of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD in a South African sample. Eur J Psychotraumatol 2020; 11:1818965. [PMID: 33282146 PMCID: PMC7685205 DOI: 10.1080/20008198.2020.1818965] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Both post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD) have been included in the 11th edition of the International Classification of Diseases (ICD-11). Although the validity of CPTSD has been controversial, a growing number of studies support the distinction between PTSD and CPTSD. However, the majority of this research has originated in high-income countries (HICs), whereas the prevalence of trauma experience associated with PTSD/CPTSD diagnosis is significantly higher in low- and middle-income countries (LMICs). Objective: This study assessed whether a sample from an LMIC setting produced distinct classes that reflect ICD-11 criteria for PTSD and CPTSD. Furthermore, this study investigated whether childhood trauma distinguished between PTSD and CPTSD. Method: International Trauma Questionnaire responses from a sample of South African university undergraduates were used as indicator variables in a latent class analysis (LCA). Chi-squared tests of independence and Kruskal-Wallis H tests were used to assess between-class differences. Results: The LCA identified four distinct classes: a PTSD class with elevated symptoms of PTSD, but low endorsement of disturbances in self-organization (DSO; symptoms that are specific to CPTSD); a CPTSD class with elevated symptoms of PTSD and DSO; a DSO class with low symptoms of PTSD, but elevated symptoms of DSO; and a Low class with low endorsements on all symptoms. Regarding childhood trauma, participants in the CPTSD class had more severe childhood abuse and neglect, specifically emotional abuse and neglect, than participants in the PTSD class. Conclusions: Findings were consistent with the distinction between PTSD and CPTSD symptom profiles in the ICD-11. Our findings support a similar qualitative distinction between PTSD and CPTSD in our LMIC context, as previously reported in HICs. This distinction is especially relevant in LMICs because of the significant number of individuals vulnerable to these disorders.
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Affiliation(s)
- James Rink
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Gosia Lipinska
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, Cape Town, South Africa
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20
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Kadish Y, Smith C. Psychoanalysis and psychoanalytic psychotherapy in the South African context. PSYCHOANALYTIC PSYCHOTHERAPY 2020. [DOI: 10.1080/02668734.2020.1827286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Yael Kadish
- Department of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa
| | - Cora Smith
- Department of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa
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21
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Kleintjes S, den Hollander DH, Pillay SR, Kramers-Olen A. Strengthening the National Health Insurance Bill for mental health needs: response from the Psychological Society of South Africa. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1177/0081246320954317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article summarizes the findings of a consultation process initiated at the 25th congress of the Psychological Society of South Africa in September 2019 to submit a response to the national public participation process on the National Health Insurance Bill, 2019. While the Psychological Society of South Africa supports the overall purpose of the Bill, to provide universal health coverage in South Africa, this article critically discusses eight core concerns related to the Bill, including the need to: (1) integrate mental health more effectively into the National Health Insurance Bill; (2) ensure equitable access to health services for all people; (3) improve human resources for mental health; (4) clarify accreditation standards and contractual conditions for service providers; (5) improve utilization of private practitioners within an integrated health system; (6) include mental health expertise in the advisory structures of the National Health Insurance Bill; (7) set out a robust accountability framework within the National Health Insurance Bill; and (8) include mental health indicators in the National Health Insurance information system. Taken together, this article contributes to the ongoing deliberations about strengthening the National Health Insurance system to ensure that it is responsive to mental health care needs.
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Affiliation(s)
- Sharon Kleintjes
- Division of Intellectual Disability, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | | | - Suntosh R Pillay
- King Dinuzulu Hospital Complex, South Africa
- Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Anne Kramers-Olen
- Fort Napier Hospital, South Africa
- Department of Behavioural Medicine, Nelson R Mandela School of Medicine, South Africa
- University of KwaZulu-Natal, South Africa
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22
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Woollett N, Bandeira M, Hatcher A. Trauma-informed art and play therapy: Pilot study outcomes for children and mothers in domestic violence shelters in the United States and South Africa. CHILD ABUSE & NEGLECT 2020; 107:104564. [PMID: 32512265 PMCID: PMC7494566 DOI: 10.1016/j.chiabu.2020.104564] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 05/13/2020] [Accepted: 05/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND While intimate partner violence (IPV) has well documented impact on women and children, few interventions have been tested for mothers and children in the domestic violence shelter system. OBJECTIVE We used mixed methods to explore effects of a pilot intervention combining trauma focused cognitive behavior therapy (TF-CBT) (verbal therapy method) with art and play therapy (non-verbal therapy methods) in New York City and Johannesburg, to compare efficacy between high and low-middle income contexts. PARTICIPANTS AND SETTING School-aged children and their mothers from one domestic violence shelter in each city were invited to participate. METHODS Children were screened for depression and post-traumatic stress disorder (PTSD). Children participated in a weekly group session lasting 1-2 hours over 12 weeks and mothers received 3 group sessions. Quantitative data comprised pre-and post-intervention child self-reports (n = 21) and mother's report (n = 16) of child depressive and PTSD symptoms. Qualitative in-depth interviews were conducted with children (n = 11) and mothers (n = 8) who completed the intervention. RESULTS At baseline, children showed high rates of symptoms of probable depression and probable PTSD (33 % and 66 % respectively). By endline, depressive symptoms significantly reduced (mean of 13.7-8.3,p = 0.01) and there was a non-significant trend towards PTSD improvement (40.0-34.4, p = 0.21). Children revealed the art helped them express difficult emotions and experiences with their mothers. Multiple children felt it assisted in managing challenging behaviours. CONCLUSION This pilot trauma-informed art and play therapy group intervention holds promise in mitigating the effects of IPV for children and mothers in domestic violence shelters.
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Affiliation(s)
- Nataly Woollett
- Wits School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 60 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Monica Bandeira
- Regional Psychosocial Support Initiative (REPSSI), P.O. Box 23076, Randburg, 2167, South Africa.
| | - Abigail Hatcher
- Wits School of Public Health, Faculty of Health Sciences, University of Witwatersrand, 60 York Road, Parktown, Johannesburg, 2193, South Africa; Bixby Center for Global Reproductive Health, University of California San Francisco, 50 Beale Street, San Francisco, 94105, USA.
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23
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Pat-Horenczyk R, Schiff M. Continuous Traumatic Stress and the Life Cycle: Exposure to Repeated Political Violence in Israel. Curr Psychiatry Rep 2019; 21:71. [PMID: 31264027 DOI: 10.1007/s11920-019-1060-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW Millions of individuals and families live under continual exposure to threat such as protracted socio-political conflict or community violence facing current and future danger. The construct of continuous traumatic stress (CTS) was suggested as a supplement perspective for the understanding of the specific impact of living under both current and realistic future threat. Yet, the unique parameters, utility, and validity of the construct CTS are underexplored. RECENT FINDINGS Currently, CTS describes both the exposure and the unique clinical conglomerate of distress. In this paper, we first elaborate on the rationale for the construct of CTS. Then, we present evidence on the consequences of exposure to CTS in the Israeli context of continual ongoing and prolonged political violence. Research on CTS is presented across the life cycle with an emphasis on risk and protective factors from a developmental perspective. We conclude with implications for research, assessment, and interventions.
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Affiliation(s)
- Ruth Pat-Horenczyk
- Paul Baerwald School of Social work and Social Welfare, The Hebrew University of Jerusalem, Mount Scopus, 91905, Jerusalem, Israel.
| | - Miriam Schiff
- Paul Baerwald School of Social work and Social Welfare, The Hebrew University of Jerusalem, Mount Scopus, 91905, Jerusalem, Israel
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Pentecost M, Gerber B, Wainwright M, Cousins T. Critical orientations for humanising health sciences education in South Africa. MEDICAL HUMANITIES 2018; 44:221-229. [PMID: 30482814 PMCID: PMC6288686 DOI: 10.1136/medhum-2018-011472] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 05/25/2023]
Abstract
In this article, the authors make a case for the 'humanisation' and 'decolonisation' of health sciences curricula in South Africa, using integration as a guiding framework. Integration refers to an education that is built on a consolidated conceptual framework that includes and equally values the natural or biomedical sciences as well as the humanities, arts and social sciences, respecting that all of this knowledge has value for the practice of healthcare. An integrated curriculum goes beyond add-on or elective courses in the humanities and social sciences. It is a curriculum that includes previously marginalised sources of knowledge (challenging knowledge hierarchies and decolonising curricula); addresses an appropriate intellectual self-image in health sciences education (challenging the image of the health professional); promotes understanding of history and social context, centring issues of inclusion, access and social justice (cultivating a social ethic) and finally, focuses on care and relatedness as an essential aspect of clinical work (embedding relatedness in practice) The article offers a brief historical overview of challenges in health and health sciences education in South Africa since 1994, followed by a discussion of contemporary developments in critical health sciences pedagogies and the medical and health humanities in South Africa. It then draws on examples from South Africa to outline how these four critical orientations or competencies might be applied in practice, to educate health professionals that can meet the challenges of health and healthcare in contemporary South Africa.
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Affiliation(s)
- Michelle Pentecost
- Department of Global Health and Social Medicine, King’s College London, London, UK
- School of African and Gender Studies, Anthropology and Linguistics, University of Cape Town, Cape Town, South Africa
| | - Berna Gerber
- Division of Speech, Language and Hearing Therapy, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa
| | - Megan Wainwright
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Thomas Cousins
- Institute of Social and Cultural Anthropology, University of Oxford, Oxford, UK
- Department of Sociology and Anthropology, University of Stellenbosch, Stellenbosch, South Africa
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Frenkel L, Swartz L. Chronic pain as a human rights issue: setting an agenda for preventative action. Glob Health Action 2018; 10:1348691. [PMID: 28766405 PMCID: PMC5645677 DOI: 10.1080/16549716.2017.1348691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Historically, chronic pain has been viewed primarily as a medical issue, and research has been focused on the individual and predominantly on pain sufferers in high-income countries. Objectives: This article argues the need for a broader understanding of the context of chronic pain and its complex aetiologies and maintenance. It is suggested that the interaction between chronic pain and social context has been inadequately explored. Methods: A single case study is used of a man living in a violent urban environment in South Africa accessing a pain clinic at a tertiary hospital. Following the case-study approach, as used in the chronic traumatic stress field by Kaminer et al., the case material is utilised to develop an argument for a new research agenda. Results: Analysis of the case material demonstrates the complex interplay between bodily and psychological experiences, with chronic pain being contextually maintained and exacerbated by very difficult life circumstances, ongoing violence, and marginalisation. Conclusions: It is suggested that a research agenda be developed which explores the links between chronic pain and ongoing chronic traumatisation in contexts of continuous violence, oppression, and disempowerment – common features of much of the contemporary majority world.
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Affiliation(s)
- Louise Frenkel
- a Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - Leslie Swartz
- b Department of Psychology , Stellenbosch University , Stellenbosch , South Africa
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26
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Frenkel L, Swartz L, Bantjes J. Chronic traumatic stress and chronic pain in the majority world: notes towards an integrative approach. CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2017.1308467] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Louise Frenkel
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Leslie Swartz
- Department of Psychology, Alan J Flisher Centre for Public Mental Health, Stellenbosch University, Stellenbosch, South Africa
| | - Jason Bantjes
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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