Doctoral Degrees (Psychology)

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Browsing Doctoral Degrees (Psychology) by browse.metadata.advisor "Bantjes, Jason"

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    Attempted suicide among South African adolescents living in a low resource environment : contested meanings, lived experience, and expressed support needs
    (Stellenbosch : Stellenbosch University, 2020-12) Pasche, Sonja Christine; Bantjes, Jason; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
    ENGLISH ABSTRACT: Adolescent suicide is a serious public health concern, yet we do not understand the reasons South African adolescents give for their suicide attempts and the meanings they attach to their behaviour. Nor do we know how the adolescents’ caregivers and clinicians perceive their attempts, or how these experiences and understandings are framed by the socio-cultural context. The aim of this research was to provide a contextualised understanding of the phenomenon of suicide attempts by South African adolescents living in a low resource environment. I used a multiperspectival research design situated within a theoretical framework of hermeneutic phenomenology. All participants were recruited via the Child and Adolescent Mental Health unit of a large psychiatric hospital located in Cape Town. In-depth semi-structured interviews were conducted with 10 adolescents, their caregivers (n=10), and the clinicians who treated them (n=9). The adolescents also took photographs to illustrate their experience, and these were discussed during a second interview using the technique of photo-elicitation. I analysed data using Interpretative Phenomenological Analysis. All participants foregrounded the relational context of the adolescents’ suicide attempts, especially relationships with family members, which were described as both a mitigating and contributing factor to the suicide attempt. The adolescents explained how caregivers’ failure to acknowledge sexual and physical abuse, which they perceived as betrayal, led to emotional disconnection and subsequently, to precipitating a suicide attempt. In contrast, adolescents said that attachment to younger siblings and pets ameliorated their suicidality. The adolescents recounted how bonding with other suicidal peers reduced feelings of isolation, but that they also learned about suicidal behaviours from each other. Participants also spoke about how the adolescents’ suicide attempts were shaped by the socio-economic context, including exposure to poverty and high levels of violence. Both caregivers and clinicians described feelings of anxiety, powerlessness, and helplessness elicited by the adolescents’ suicidality, echoing the powerlessness reported by the adolescents. Participants did not endorse a purely psychiatric understanding of adolescent suicidal behaviour; instead they described the adolescents’ suicide attempts as an escape from pain, or an attempt to alleviate perceived economic burdensomeness. The adolescents experienced admission to a psychiatric hospital as providing safety, but also as exacerbating a loss of autonomy. Participants discussed how improved connectedness, belonging, communication, and validation of the adolescents’ experiences, to counter the adolescents’ sense of isolation and invisibility, were important for support after the attempt, and for the prevention of adolescent suicide. The participants’ accounts of the adolescents’ suicide attempts were incongruent with existing theories of suicidal behaviour, highlighting the need for adolescent specific, contextualised theories of suicidal behaviour. These findings also suggest that adolescent suicide prevention cannot solely be the responsibility of the mental health care sector, that the wellbeing of caregivers is essential for adolescent suicide prevention, and they emphasise the importance of adolescent-specific services that enhance feelings of autonomy. Potential areas for future research in the field of adolescent suicide prevention include the role of siblings, pets, and feelings of betrayal.
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    Substance use and self-harm at an urban South African hospital: implications for suicide prevention, service delivery and future research
    (Stellenbosch : Stellenbosch University, 2018-03) Breet, Elsie; Bantjes, Jason; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
    ENGLISH SUMMARY: Self-harm is a form of suicidal behaviour which constitutes a serious public health problem in low-income and middle-income countries (LMICs). The World Health Organization identifies substance use as a potentially modifiable risk factor for suicidal behaviour, including self-harm. Little is known about the prevalence, correlates, nature, and context of substance use among self-harm patients in South Africa. In this thesis, I explored the relationship between substance use and self-harm among patients who presented for treatment at an urban hospital in the Western Cape, South Africa. I employed a mixed methods research design and present my findings in the form of four journal articles. In the first article, I report on the results of a systematic review to investigate what is known, and what remains unknown, about the relationship between substance use and suicidal behaviour in LMICs. From the review results, I argue that: (1) the assessment and management of substance use should be integral to the care of at-risk patients; (2) suicide prevention research in LMICs should focus on reducing hazardous use of alcohol, tobacco, cannabis, opioids, sedatives, stimulants and non-medical use of medications; and (3) more research is required to understand the nature of the relationship between substance use and suicidal behaviour. In articles two and three, I report on two quantitative studies, consisting of a retrospective review of patient files to establish the demographic characteristics, patterns of medical service utilisation, and sociocultural differences between self-harm patients who report substance use and other self-harm patients (i.e. those who reported no substance use) among 238 self-harm patients. I focused on acute use of substances (i.e. substance intoxication) (AUS) in article two and chronic substance use (i.e. recurrent substance use over an extended period) (CSU) in article three. In article two, bivariate and multivariate statistical analysis showed that one in five selfharm patients reported AUS. Compared to other self-harm patients, the AUS sub-group were more inclined to: have depressed levels of consciousness on admission; utilise more medical resources; report previous acts of self-harm; and state an intention to die as a result of their injuries. In article three, 37% of self-harm patients reported CSU. Compared to other self-harm patients, the CSU sub-group were more likely to be male; to inflict damage to their body tissue; and to have a history of self-harm. A significantly smaller proportion of CSU patients, compared to other self-harm patients, were referred for psychiatric assessment (p<0.001). For article four, I conducted a qualitative study by analysing semi-structured interviews of 80 self-harm patients who were admitted to the hospital. I made use of a multiple-case study methodology and identified seven ways in which patients understood their substance use was implicated in their self-harm: impulsivity, poor judgment, and aggression; auditory hallucinations or paranoia related to substance use; substance use to facilitate self-harm; substance use as a method of self-harm; unsuccessful treatment for substance use disorder; the breakdown of substance use as a means of coping; and third-party substance use. I conclude this thesis by, reflecting on the broad aim and offering recommendations for future research and suicide prevention at the hospital where data were collected.