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Browsing by Author "Bantjes, Jason"

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Common mental disorders and psychological adjustment among individuals seeking HIV testing : a study protocol to explore implications for mental health care systems
(BioMed Central, 2018-04-10) Bantjes, Jason; Kagee, Ashraf
Background: In an effort to promote greater access to voluntary counseling and testing for HIV, it has become practice in many countries, including South Africa, to establish non-medical testing sites and to de-couple HIV testing from other medical and mental health care services. While it is well established that HIV infection is associated with a range of psychopathology, much of the literature has assumed that it is receipt of an HIV positive diagnosis that causes people to become depressed, traumatized, or develop other psychiatric symptoms. Empirical data about the baseline psychiatric condition and mental health care needs of persons seeking HIV testing is scarce. Understanding the psychological health of persons seeking HIV testing and documenting how psychiatric symptoms develop over time following receipt of an HIV positive diagnosis, has important implications for mental health care systems. Methods: We describe a study protocol to investigate: (1) the level of psychological distress and the prevalence of common mental disorders among persons seeking HIV testing; (2) the longitudinal development of psychiatric symptoms among persons diagnosed with HIV; and (3) the recommendations that can be made for mental health care systems to support persons seeking HIV testing and those newly diagnosed with HIV. In this longitudinal study quantitative and qualitative data are collected to document participants’ psychiatric symptoms, to determine whether they meet diagnostic criteria for a common mental disorder, and to explore the lived experiences of persons receiving an HIV positive test result. Data are collected at three time points; before HIV testing, and then again at 6 and 12 months post-testing. Discussion: Documenting the prevalence of common mental disorders among persons seeking HIV testing, and tracking the psychosocial support needs, psychological adjustment and psychosocial experiences of persons newly diagnosed with HIV, has important implications for the delivery of mental health care services and the design of integrated mental health care systems.
Common mental disorders and psychological adjustment among individuals seeking HIV testing : a study protocol to explore implications for mental health care systems
(BMC (part of Springer Nature), 2018) Bantjes, Jason; Kagee, Ashraf
Background: In an effort to promote greater access to voluntary counseling and testing for HIV, it has become practice in many countries, including South Africa, to establish non-medical testing sites and to de-couple HIV testing from other medical and mental health care services. While it is well established that HIV infection is associated with a range of psychopathology, much of the literature has assumed that it is receipt of an HIV positive diagnosis that causes people to become depressed, traumatized, or develop other psychiatric symptoms. Empirical data about the baseline psychiatric condition and mental health care needs of persons seeking HIV testing is scarce. Understanding the psychological health of persons seeking HIV testing and documenting how psychiatric symptoms develop over time following receipt of an HIV positive diagnosis, has important implications for mental health care systems. Methods: We describe a study protocol to investigate: (1) the level of psychological distress and the prevalence of common mental disorders among persons seeking HIV testing; (2) the longitudinal development of psychiatric symptoms among persons diagnosed with HIV; and (3) the recommendations that can be made for mental health care systems to support persons seeking HIV testing and those newly diagnosed with HIV. In this longitudinal study quantitative and qualitative data are collected to document participants’ psychiatric symptoms, to determine whether they meet diagnostic criteria for a common mental disorder, and to explore the lived experiences of persons receiving an HIV positive test result. Data are collected at three time points; before HIV testing, and then again at 6 and 12 months post-testing. Discussion: Documenting the prevalence of common mental disorders among persons seeking HIV testing, and tracking the psychosocial support needs, psychological adjustment and psychosocial experiences of persons newly diagnosed with HIV, has important implications for the delivery of mental health care services and the design of integrated mental health care systems.
Community context and individual factors associated with arrests among young men in a South African township
(Public Library of Science, 2019) Christodoulou, Joan; Stokes, Lynissa R.; Bantjes, Jason; Tomlinson, Mark; Stewart, Jackie; Rabie, Stephan; Gordon, Sarah; Mayekiso, Andile; Rotheram-Borus, Mary Jane
Background: In high-income countries, individual- and community-level factors are associated with increased contact with the criminal justice system. However, little is known about how these factors contribute to the risk of arrest in South Africa, which has one of the highest rates of arrests globally. We examine both individual- and community-level factors associated with arrests among young men living in the townships of Cape Town. Methods: Data were collected from a stratified community sample of 906 young men aged 18–29 years old living in 18 township neighborhoods. Communities with high and low rates of arrest were identified. Logistic regression models were used to assess which individual-level (such as substance use and mental health status) and community-level (such as infrastructure and presence of bars and gangs) factors predict arrests. Results: Significant predictors of arrests were substance use, gang activity, being older, more stressed, and less educated. Living in communities with better infrastructure and in more recently established communities populated by recent immigrants was associated with having a history of arrests. Conclusions: When considering both individual- and community-level factors, substance use and gang violence are the strongest predictors of arrests among young men in South Africa. Unexpectedly, communities with better infrastructure have higher arrest rates. Community programs are needed to combat substance use and gang activity as a pathway out of risk among South African young men.
Disability : the forgotten side of race science
(African Sun Media, 2020) Swartz, Leslie; Bantjes, Jason; Lourens, Heidi; Watermeyer, Brian
The impetus for this book was an article, the first line of the abstract of which reads: “Colored women in South Africa have an increased risk for low cognitive functioning.”1 There is no question that the article reproduces racist ideas, and we are in agreement with the authors of the other chapters in this book. There is, however, another side to this article that has been less discussed. What does it mean to describe a group of people as having “increased risk for low cognitive functioning”? In much that has been written about the article, there has been almost no discussion of the social context in which the idea of somebody having, or being at risk of, “low cognitive functioning” is seen, automatically, as a form of insult.
Evaluation of the beck anxiety Inventory in predicting generalised anxiety disorder among individuals seeking HIV testing in the Western Cape province, South Africa
(AOSIS, 2019) Saal, Wylene L.; Kagee, Ashraf; Bantjes, Jason
Background: Routine anxiety screening is needed among HIV test seekers, given the lack of health-care professionals with the ability to identify individuals with generalised anxiety. Aim: The aim of this study was to determine the effectiveness of the Beck anxiety inventory (BAI) in predicting caseness for generalised anxiety disorder (GAD) among persons seeking HIV testing, using the structured clinical interview for the DSM-5 (SCID-5) as the gold standard. Setting: Five HIV testing sites in the Western Cape region of South Africa. Method: We recruited 500 persons seeking HIV testing from five non-medical testing sites in the Western Cape, South Africa. We used receiver operating curve analysis to determine the optimal cut-off point on the BAI to discriminate between GAD caseness and non-caseness. Results: 3.4% of the sample met the DSM-5 criteria for a diagnosis of GAD. Using an optimal cut-off point of 21.5, the sensitivity and specificity of the BAI were 82% and 80%, respectively. The positive predictive value was 13%, while the negative predictive value was 99%. Conclusion: Our data suggest that while the BAI may be used to screen for GAD, it is likely to yield a high number of false positives. A two-tiered method may be useful to mitigate against case over-identification. Thus, in a public health setting, persons screening positive on the BAI should receive a diagnostic interview to determine whether they are true cases for GAD. Within resource-constrained communities in South Africa, referral trajectories should be integrated with routine screening and HIV testing.
Gender-specific HIV and substance abuse prevention strategies for South African men : study protocol for a randomized controlled trial
(BioMed Central, 2018-08-03) Rotheram-Borus, Mary J.; Tomlinson, Mark; Mayekiso, Andile; Bantjes, Jason; Harris, Danielle M.; Stewart, Jacqueline; Weiss, Robert E.
Background: Young men in South Africa face concurrent epidemics of HIV, drug and alcohol abuse, and unemployment. Standard HIV prevention programs, located in healthcare settings and/or using counseling models, fail to engage men. Soccer and vocational training are examined as contexts to deliver male-specific, HIV prevention programs. Methods: Young men (n = 1200) are randomly assigned by neighborhood to one of three conditions: 1) soccer league (n = 400; eight neighborhoods); 2) soccer league plus vocational training (n = 400; eight neighborhoods); or 3) a control condition (n = 400; eight neighborhoods). Soccer practices and games occur three times per week and vocational training is delivered by Silulo Ulutho Technologies and Zenzele Training and Development. At baseline, 6 months, 12 months, and 24 months, the relative efficacy of these strategies to increase the number of significant outcomes (NSO) among 15 outcomes which occur (1) or not (0) are summed and compared using binomial logistic regressions. The summary primary outcome reflects recent HIV testing, substance abuse, employment, sexual risk, violence, arrests, and mental health status. Discussion: The failure of men to utilize HIV prevention programs highlights the need for gender-specific intervention strategies. However, men in groups can provoke and encourage greater risk-taking among themselves. The current protocol evaluates a male-specific strategy to influence men’s risk for HIV, as well as to improve their ability to contribute to family income and daily routines. Both interventions are expected to significantly benefit men compared with the control condition.
A group-analytic formulation of an incident of disruptive behaviour in a school
(SA ePublications, 2011-06) Bantjes, Jason; Nieuwoudt, Johan
One way of approaching disruptive behaviour in schools is to pathologise the miscreants. Working within this paradigm, schools seek to discourage misconduct via concrete mechanisms such as control, discipline and exclusions. While sometimes helpful, these strategies fail to consider other less obvious dynamics and group processes complicit in precipitating misbehaviour. Reconceptualising disruptive behaviour from a group analytic perspective can offer an alternative formulation and suggest alternative strategies for promoting cooperative behaviour. This article, structured around an incident of mayhem in a school, demonstrates how concepts borrowed from group analytic theory can illuminate other hitherto unconscious dynamics contributing to disruptive behaviour. The paper illustrates the utility of group analytic theory in educational settings and contributes to the ongoing debate about the legitimacy of applying psychoanalytic concepts to understand socio-cultural phenomena.
Health professionals talk about the challenges of suicide prevention in two correctional centres in South Africa
(SAGE Publications, 2019) Nieuwoudt, Pieter; Bantjes, Jason
ENGLISH ABSTRACT: Suicide is the leading cause of death among offenders in correctional facilities in many parts of the world. While epidemiological data have described the extent and scope of the problem, no research has documented the experiences and insights of health professionals who are tasked with providing care to suicidal offenders in South African correctional centres. It is within this context that we set out to document the experiences of a group of health professionals working in two correctional facilities in South Africa. We were interested in learning from them about their perceptions of the factors that contribute to suicidal behaviour among offenders and their suggestions for suicide prevention. In-depth semi-structured interviews were conducted with a group of health professionals (N = 10). Data were analysed using thematic analysis and an inductive approach was adopted for coding the data. The participants describe a number of structural and contextual factors which they believe make correctional centres in South Africa unsafe, thus increasing the risk of suicidal behaviour among offenders and hindering suicide prevention efforts within the two correctional centres where data were collected. These factors include high levels of psychopathology, trauma, substance abuse, violence, gangsterism, overcrowding, inadequate mental health care resources, and problems relating to stigma. These findings highlight human rights and mental health issues facing offenders and draw attention to conditions within correctional centres that need attention as part of any national suicide prevention strategy in South Africa.
Help-seeking intention in obsessive-compulsive disorder: predictors and barriers in South Africa
(Frontiers Media S.A., 2021-09) Hathorn, Sarah Kate; Lochner, Christine; Stein, Dan J.; Bantjes, Jason
Introduction: Many individuals with obsessive-compulsive disorder (OCD) delay seeking help, leading to greater illness severity, additional comorbidity, and increased functional impairment. Patterns of help-seeking for OCD have however not yet been described in South Africa, a low-and middle-income country with many health service challenges. Using the health belief model as a conceptual framework, study aims were to identify predictors of and barriers to help-seeking among South Africans with OCD. Methods: Fifty adults with OCD completed an online survey to assess (1) socio-demographic characteristics, (2) OCD symptom severity, (3) treatment barriers, (4) perceived treatment benefits, (5) self-efficacy, and (6) help-seeking intention. Multiple linear regression analysis was used to establish predictors of help-seeking intention. Descriptive statistics were used to determine the most endorsed help-seeking barriers. Results: 42.6% of the variance in help-seeking intention was explained by the investigated constructs (R2 = 0.426, F = 4.45 and p < 0.01). Perceived treatment benefits were the only significant predictor of help-seeking intention (B = 1.37, t = 5.16, and p < 0.01). More than a third (36%) of the sample endorsed wanting to handle the problem independently as a significant barrier, followed by treatment concerns (26%), affordability (22%), and shame (20%). Conclusion: An innovative analysis of help-seeking patterns suggested that perceived treatment benefits were the only significant predictor of help-seeking intention among South African adults with OCD. Psychoeducation and mental health literacy programmes may be useful in increasing public appreciation of the benefits of OCD treatment, and in mitigating key help-seeking barriers.
Human rights and mental health in post-apartheid South Africa : lessons from health care professionals working with suicidal inmates in the prison system
(BioMed Central, 2017-10-12) Bantjes, Jason; Swartz, Leslie; Niewoudt, Pieter
Background: During the era of apartheid in South Africa, a number of mental health professionals were vocal about the need for socio-economic and political reform. They described the deleterious psychological and social impact of the oppressive and discriminatory Nationalist state policies. However, they remained optimistic that democracy would usher in positive changes. In this article, we consider how mental health professionals working in post-apartheid South Africa experience their work. Methods: Our aim was to describe the experience of mental health professionals working in prisons who provide care to suicidal prisoners. Data were collected from in-depth semi-structured interviews and were analyzed using thematic content analysis. Results: Findings draw attention to the challenges mental health professionals in post-apartheid South Africa face when attempting to provide psychological care in settings where resources are scarce and where the environment is anti-therapeutic. Findings highlight the significant gap between current policies, which protect prisoners’ human rights, and every-day practices within prisons. Conclusions: The findings imply that there is still an urgent need for activism in South Africa, particularly in the context of providing mental health care services in settings which are anti-therapeutic and inadequately resourced, such as prisons.
“I was like intoxicated with this positivity”: the politics of hope amongst participants in a trial of a novel spinal cord injury rehabilitation technology in South Africa
(Taylor and Francis, 2020-09) Evans, Robert W.; Bantjes, Jason; Shackleton, Claire L.; West, Sacha; Derman, Wayne; Albertus, Yumna; Swartz, Leslie
Purpose: This study discussed the reports by participants in a randomised controlled trial of a novel intervention for spinal cord injury (SCI) rehabilitation in Cape Town, South Africa. Materials and methods: Sixteen participants were randomised to rehabilitation involving the use of robotic locomotor training, a novel technology, or to a group receiving an activity-based intervention. All participants were interviewed before the intervention and at six months follow-up. Results: In a context in which rehabilitation services for SCI are virtually non-existent, all participants approached the study with enthusiasm and expressed gratitude for participation. They had high hopes for what the programme could achieve, with many believing, perhaps incorrectly, that the programme would help them walk independently again. While hope and enthusiasm are useful for adherence to experimental intervention studies, there is a danger, especially in poorly resourced contexts, for participants to experience considerable disappointment following false hope not being realised. This raises important ethical issues for researchers interested in the potential of new technologies to promote health in poorly resourced contexts. Conclusions: For clinicians, the path between supporting positive emotions (which may lead to positive outcomes), and confronting unrealistic hope (which may lead to negative outcomes) may be difficult. Follow-up with participants after re-integration into their communities is important to determine long-term psychological impact. Pan African Clinical Trial Number: PACTR201608001647143 IMPLICATIONS FOR REHABILITATION: In low-resource contexts where there is a low level of access to rehabilitation services, such access in the context of a trial of a new intervention may engender hope in a group of people with spinal cord injury. This hope may increase when a new technology is used, as was the case in this study. Hope can be very helpful to people entering rehabilitation, but unrealistic hope and expectations may have negative implications in the longer term. In this study, expectations of participants centred, unrealistically, around regaining the ability to walk again, despite past experiences and medical advice suggesting otherwise. A thin line exists between supporting high expectations and confronting unrealistic hope. This conundrum is difficult for the clinician, as both inappropriate hope and undue pessimism about an intervention have the potential to cause harm. Participant follow-up after the end of any innovative trial is important, not just to monitor physical progress, but also, where necessary, to support participants through a potential period of disillusionment when they find their expectations have not been fully met.
Inequality and mental healthcare utilisation among first-year university students in South Africa
(BMC, 2020-01-25) Bantjes, Jason; Saal, Wylene; Lochner, Christine; Roos, Janine; Auerbach, Randy P.; Mortier, Philippe; Brufaerts, Ronny; Kessler, Ronald C.; Stein, Dan J.
Background: Addressing inequalities in mental healthcare utilisation among university students is important for socio-political transformation, particularly in countries with a history of educational exclusion. Methods: As part of the WHO World Mental Health International College Student Initiative, we investigated inequalities in mental healthcare utilisation among first-year students at two historically “White” universities in South Africa. Data were collected via a web-based survey from first-year university students (n=1402) to assess 12-month mental healthcare utilisation, common mental disorders, and suicidality. Multivariate logistic regression models were used to estimate associations between sociodemographic variables and mental healthcare utilisation, controlling for common mental disorders and suicidality. Results: A total of 18.1% of students utilised mental healthcare in the past 12 months, with only 28.9% of students with mental disorders receiving treatment (ranging from 28.1% for ADHD to 64.3% for bipolar spectrum disorder). Of those receiving treatment, 52.0% used psychotropic medication, 47.3% received psychotherapy, and 5.4% consulted a traditional healer. Treatment rates for suicidal ideation, plan and attempt were 25.4%, 41.6% and 52.9%, respectively. In multivariate regression models that control for the main effects of mental health variables and all possible joint effects of sociodemographic variables, the likelihood of treatment was lower among males (aOR=0.57) and Black students (aOR=0.52). An interaction was observed between sexual orientation and first generation status; among second-generation students, the odds of treatment were higher for students reporting an atypical sexual orientation (aOR=1.55), while among students with atypical sexual orientations, the likelihood of mental healthcare utilisation was lower for first-generation students (aOR=0.29). Odds of treatment were significantly elevated among students with major depressive disorder (aOR=1.88), generalised anxiety disorder (aOR=2.34), bipolar spectrum disorder (aOR=4.07), drug use disorder (aOR=3.45), suicidal ideation (without plan or attempt) (aOR=2.00), suicide plan (without attempt) (aOR=3.64) and suicide attempt (aOR=4.57). Likelihood of treatment increased with level of suicidality, but not number of mental disorders. Conclusion: We found very low mental healthcare treatment utilisation among first-year university students in South Africa, with enduring disparities among historically marginalised groups. Campus-based interventions are needed to promote mental healthcare utilisation by first-year students in South Africa, especially among male and Black students and first-generation students with atypical sexual orientations.
Inequality and mental healthcare utilisation among first-year university students in South Africa
(BMC (part of Springer Nature), 2020-01-25) Bantjes, Jason; Saal, Wylene; Lochner, Christine; Roos, Janine; Auerbach, Randy P.; Mortier, Philippe; Bruffaerts, Ronny; Kessler, Ronald C.; Stein, Dan J.
Background: Addressing inequalities in mental healthcare utilisation among university students is important for socio-political transformation, particularly in countries with a history of educational exclusion. Methods: As part of the WHO World Mental Health International College Student Initiative, we investigated inequalities in mental healthcare utilisation among first-year students at two historically “White” universities in South Africa. Data were collected via a web-based survey from first-year university students (n = 1402) to assess 12-month mental healthcare utilisation, common mental disorders, and suicidality. Multivariate logistic regression models were used to estimate associations between sociodemographic variables and mental healthcare utilisation, controlling for common mental disorders and suicidality. Results: A total of 18.1% of students utilised mental healthcare in the past 12 months, with only 28.9% of students with mental disorders receiving treatment (ranging from 28.1% for ADHD to 64.3% for bipolar spectrum disorder). Of those receiving treatment, 52.0% used psychotropic medication, 47.3% received psychotherapy, and 5.4% consulted a traditional healer. Treatment rates for suicidal ideation, plan and attempt were 25.4%, 41.6% and 52.9%, respectively. In multivariate regression models that control for the main effects of mental health variables and all possible joint effects of sociodemographic variables, the likelihood of treatment was lower among males (aOR = 0.57) and Black students (aOR = 0.52). An interaction was observed between sexual orientation and first generation status; among second-generation students, the odds of treatment were higher for students reporting an atypical sexual orientation (aOR = 1.55), while among students with atypical sexual orientations, the likelihood of mental healthcare utilisation was lower for first-generation students (aOR = 0.29). Odds of treatment were significantly elevated among students with major depressive disorder (aOR = 1.88), generalised anxiety disorder (aOR = 2.34), bipolar spectrum disorder (aOR = 4.07), drug use disorder (aOR = 3.45), suicidal ideation (without plan or attempt) (aOR = 2.00), suicide plan (without attempt) (aOR = 3.64) and suicide attempt (aOR = 4.57). Likelihood of treatment increased with level of suicidality, but not number of mental disorders. Conclusion: We found very low mental healthcare treatment utilisation among first-year university students in South Africa, with enduring disparities among historically marginalised groups. Campus-based interventions are needed to promote mental healthcare utilisation by first-year students in South Africa, especially among male and Black students and first-generation students with atypical sexual orientations.
Inequality and mental healthcare utilisation among first‑year university students in South Africa
(BMC (part of Springer Nature), 2020) Bantjes, Jason; Saal, Wylene; Lochner, Christine; Roos, Janine; Auerbach, Randy P.; Mortier, Philippe; Bruffaerts, Ronny; Kessler, Ronald C.; Stein, Dan J.
Background: Addressing inequalities in mental healthcare utilisation among university students is important for socio-political transformation, particularly in countries with a history of educational exclusion. Methods: As part of the WHO World Mental Health International College Student Initiative, we investigated inequalities in mental healthcare utilisation among first-year students at two historically “White” universities in South Africa. Data were collected via a web-based survey from first-year university students (n = 1402) to assess 12-month mental healthcare utilisation, common mental disorders, and suicidality. Multivariate logistic regression models were used to estimate associations between sociodemographic variables and mental healthcare utilisation, controlling for common mental disorders and suicidality. Results: A total of 18.1% of students utilised mental healthcare in the past 12 months, with only 28.9% of students with mental disorders receiving treatment (ranging from 28.1% for ADHD to 64.3% for bipolar spectrum disorder). Of those receiving treatment, 52.0% used psychotropic medication, 47.3% received psychotherapy, and 5.4% consulted a traditional healer. Treatment rates for suicidal ideation, plan and attempt were 25.4%, 41.6% and 52.9%, respectively. In multivariate regression models that control for the main effects of mental health variables and all possible joint effects of sociodemographic variables, the likelihood of treatment was lower among males (aOR = 0.57) and Black students (aOR = 0.52). An interaction was observed between sexual orientation and first generation status; among second-generation students, the odds of treatment were higher for students reporting an atypical sexual orientation (aOR = 1.55), while among students with atypical sexual orientations, the likelihood of mental healthcare utilisation was lower for first-generation students (aOR = 0.29). Odds of treatment were significantly elevated among students with major depressive disorder (aOR = 1.88), generalised anxiety disorder (aOR = 2.34), bipolar spectrum disorder (aOR = 4.07), drug use disorder (aOR = 3.45), suicidal ideation (without plan or attempt) (aOR = 2.00), suicide plan (without attempt) (aOR = 3.64) and suicide attempt (aOR = 4.57). Likelihood of treatment increased with level of suicidality, but not number of mental disorders. Conclusion: We found very low mental healthcare treatment utilisation among first-year university students in South Africa, with enduring disparities among historically marginalised groups. Campus-based interventions are needed to promote mental healthcare utilisation by first-year students in South Africa, especially among male and Black students and first-generation students with atypical sexual orientations.
I’m not afraid of dying because I’ve got nothing to lose : young men in South Africa talk about nonfatal suicidal behavior
(SAGE Publications, 2019) Bantjes, Jason; Mapaling, Curwyn
First-person narratives of suicidal behavior may provide novel insights into how individuals with lived experience of suicide understand and narrate their behavior. Our aim was to explore the narratives of young men hospitalized following nonfatal suicidal behavior (NFSB), in order to understand how young suicidal men construct and understand their actions. Data were collected via narrative interviews with 14 men (aged 18–34 years) admitted to hospital following an act of NFSB in Cape Town, South Africa. Narrative analysis was used to analyze the data. Two dominant narratives emerged in which participants drew on tropes of the “great escape” and “heroic resistance,” performing elements of hegemonic masculinity in the way they narrated their experiences. Participants position themselves as rational heroic agents and present their suicidal behavior as goal-directed action to solve problems, assert control, and enact resistance. This dominant narrative is incongruent with the mainstream biomedical account of suicide as a symptom of psychopathology. The young men also articulated two counter-narratives, in which they deny responsibility for their actions and position themselves as defeated, overpowered, wary, and unheroic. The findings lend support to the idea that there is not only one narrative of young men’s suicide, and that competing and contradictory narratives can be found even within a dominant hyper-masculine account of suicidal behavior. Gender-sensitive suicide prevention strategies should not assume that all men share a common understanding of suicide. Suicide can be enacted as both a performance of masculinity and as a resistance to hegemonic gender roles.
Mental health care providers' suggestions for suicide prevention among people with substance use disorders in South Africa : a qualitative study
(BMC (part of Springer Nature), 2018-12-07) Goldstone, Daniel; Bantjes, Jason; Dannatt, Lisa
Background: People with substance use disorders (PWSUDs) are a clearly delineated group at high risk for suicidal behaviour. Expert consensus is that suicide prevention strategies should be culturally sensitive and specific to particular populations and socio-cultural and economic contexts. The aim of this study was to explore mental health care providers' context- and population-specific suggestions for suicide prevention when providing services for PWSUDs in the Western Cape, South Africa. Methods: Qualitative data were collected via in-depth, semi-structured interviews with 18 mental health care providers providing services to PWSUDs in the public and private health care sectors of the Western Cape, South Africa. Data were analysed inductively using thematic analysis. Results: Participants highlighted the importance of providing effective mental health care, transforming the mental health care system, community interventions, and early intervention, in order to prevent suicide amongst PWSUDs. Many of their suggestions reflected basic principles of effective mental health care provision. However, participants also suggested further training in suicide prevention for mental health care providers, optimising the use of existing health care resources, expanding service provision for suicidal PWSUDs, improving policies and regulations for the treatment of substance use disorders, provision of integrated health care, and focusing on early intervention to prevent suicide. Conclusions: Training mental health care providers in suicide prevention must be augmented by addressing systemic problems in the provision of mental health care and contextual problems that make suicide prevention challenging. Many of the suggestions offered by these participants depart from individualist, biomedical approaches to suicide prevention to include a more contextual view of suicide prevention. A re-thinking of traditional biomedical approaches to suicide prevention may be warranted in order to reduce suicide among PWSUDs.
Mental health care providers’ perceptions of the barriers to suicide prevention amongst people with substance use disorders in South Africa : a qualitative study
(BioMed Central, 2016) Goldstone, Daniel; Bantjes, Jason
Background: Substance use is a well-established, and potentially modifiable, risk factor for suicide. Suicide preven- tion interventions are typically framed within the biomedical paradigm and focus on addressing individual risk factors, improving access to psychiatric care, and improving the skills of medical personnel to recognise at-risk individuals. Few studies have focused on contextual factors that hinder suicide prevention in people with substance use disor - ders, particularly in low-resource settings. The aim of this qualitative study was to explore mental health care providers’ perceptions of barriers to suicide prevention in people with substance use disorders in South Africa. Methods: Semi-structured interviews were conducted with 18 mental health care providers who worked with sui- cidal people with substance use disorders in Cape Town, South Africa. Data were analysed using thematic analysis and Atlas.ti software was used to code the data inductively. Results: Two superordinate themes were identified: structural issues in service provision and broad contextual issues that pose barriers to suicide prevention. Participants thought that inadequate resources and insufficient training hindered them from preventing suicide. Fragmented service provision was perceived to lead to patients not receiving the psychiatric, psychological, and social care that they needed. Contextual problems such as poverty and inequality, the breakdown of family, and stigma made participants think that preventing suicide in people with substance use disorders was almost impossible. Conclusions: These findings suggest that structural, social, and economic issues serve as barriers to suicide preven- tion. This challenges individual risk-factor models of suicide prevention and highlights the need to consider a broad range of contextual and socio-cultural factors when planning suicide prevention interventions. Findings suggest that the responsibility for suicide prevention may need to be distributed between multiple stakeholders, necessitating intersectoral collaboration, more integrated health services, cautious use of task shifting, and addressing contextual factors in order to effectively prevent suicide in people with substance use disorders.
Methods of deliberate self-harm in a tertiary hospital in South Africa
(AOSIS, 2020) Pieterse, Deirdre; Hoare, Jacqueline; Louw, Kerry-Ann; Breet, Elsie; Henry, Michelle; Lewis, Ian; Bantjes, Jason
Background: Little is known about the methods of deliberate self-harm (DSH) in South Africa (SA), despite the importance of means restriction as a public health strategy to reduce the morbidity and mortality associated with self-harm. Aim: The aim of this study was to investigate the range of methods used in DSH and identify the socio-demographic and clinical factors associated with violent and non-violent methods of DSH among patients treated at a tertiary hospital in SA. Setting: The study was conducted at an urban, tertiary level emergency department at Groote Schuur hospital in Cape Town, South Africa. Method: Data were collected from 238 consecutive DSH patients who presented for emergency department treatment at the hospital. Logistic regression models were used to explore the factors associated with violent and non-violent methods of DSH. Results: Self-poisoning was the most common method of self-harm (80.3%). Prescription medication was the most common form of self-poison (57.6%), while a large number of patients used non-prescription paracetamol (40.9%). In the regression analysis, male gender, stating that the reason for DSH was to escape a situation and history of substance use were associated with violent method of DSH. Conclusion: Improved monitoring of prescription medications commonly used in DSH is integral to public health suicide prevention strategies in SA. This study underscores the need for substance use interventions in the healthcare setting.
A more equitable society : the politics of global fairness in paralympic sport
(Public Library of Science, 2016) Swartz, Leslie; Bantjes, Jason; Rall, Divan; Ferreira, Suzanne; Blauwet, Cheri
The Paralympic Movement explicitly sets out to create a more equitable society and promote participation for all and fairness in disability sport. This is primarily achieved through the use of a range of interventions with less attention given to how economic factors may hinder access and achievement in Paralympic sport. We investigated how country-level economic variables influence the level of participation and achievement in the 2015 International Paralympic Committee (IPC) Athletics Championships held in Doha. We used multiple regression analysis to show how levels of participation and achievement in the Championships were significantly determined by economic factors independent of population size. Our data show that in spite of the ideals of inclusion and fairness within the Paralympic Movement and the considerable effort expended on the use of technologies to achieve this, economic factors continue to exert a statistically significant influence on both the level of participation and achievement of Paralympic athletes. LMICs participate at lower levels and achieve fewer medals when compared to HICs. These differences are particularly marked in events that have a high cost of participation. Our findings raise questions regarding the use of current technologies and the level to which they are able to truly disrupt the politics of global inequality in sport.
Prevalence and sociodemographic correlates of common mental disorders among first-year university students in post-apartheid South Africa : implications for a public mental health approach to student wellness
(BMC (part of Springer Nature), 2019-07-10) Bantjes, Jason; Lochner, Christine; Saal, Wylene; Roos, Janine; Taljaard, Lian; Page, Daniel; Auerbach, Randy P; Mortier, Philippe; Bruffaerts, Ronny; Kessler, Ronald C.; Stein, Dan J.
Background: There is growing awareness of the need for effective prevention, early detection, and novel treatment approaches for common mental disorders (CMDs) among university students. Reliable epidemiological data on prevalence and correlates are the cornerstones of planning and implementing effective health services and adopting a public health approach to student wellness. Yet, there is a comparative lack of sound psychiatric epidemiological studies on CMDs among university students in low- and middle-income countries, like South Africa (SA). It is also unclear if historically marginalised groups of students are at increased risk for mental health problems in post-apartheid SA. The objective of the study was to investigate the prevalence and sociodemographic correlates of lifetime and 12-month CMDs among university students in SA, with a particular focus on vulnerability among students in historically excluded and marginalised segments of the population. Methods: Data were collected via self-report measures in an online survey of first-year students registered at two large universities (n = 1402). CMDs were assessed with previously-validated screening scales. Data were weighted and analysed using multivariate statistical methods. Results: A total of 38.5% of respondents reported at least one lifetime CMD, the most common being major depressive disorder (24.7%). Twelve-month prevalence of any CMD was 31.5%, with generalised anxiety disorder being the most common (20.8%). The median age of onset for any disorder was 15 years. The median proportional annual persistence of any disorder was 80.0%. Female students, students who reported an atypical sexual orientation, and students with disabilities were at significantly higher risk of any lifetime or 12-month disorder. Female gender, atypical sexual orientation, and disability were associated with elevated risk of internalising disorders, whereas male gender, identifying as White, and reporting an atypical sexual orientation were associated with elevated risk of externalising disorders. Older age, atypical sexual orientation, and disability were associated with elevated risk of bipolar spectrum disorder. Conclusions: Despite advances to promote greater social inclusion in post-apartheid SA, students who identify as female, students with atypical sexual orientations, and students with disabilities are nonetheless at increased risk of CMDs, although students who identify as Black and first-generation students are not.

Browsing by Author "Bantjes, Jason"

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