Browsing by Author "Breet, Elsie"

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    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.
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    Substance use and self-harm : a cross-sectional study of the prevalence, correlates and patterns of medical service utilisation among patients admitted to a South African hospital
    (BioMed Central, 2018-03-06) Breet, Elsie; Bantjes, Jason; Lewis, Ian
    Background: Substance use is a potentially modifiable risk factor for suicidal behaviour. Little is known about the epidemiology of substance use among self-harm patients in South Africa. This study set out to collect epidemiological data about the prevalence, correlates, and patterns of medical service utilisation among self-harm patients who used substances at the time of self-injury. Methods: Data from 238 consecutive self-harm patients treated at an urban hospital in South Africa were analysed using bivariate and multivariate statistics. Results Approximately 20% of patients reported substance use at the time of self-harm. When compared to other self-harm patients, higher rates of patients who had used substances: had depressed levels of consciousness on admission; utilised more medical resources and required longer hospital admissions; cited relationship difficulties and financial concerns as reasons for their self-harm; reported a previous episode of self-harm; and intended to die as a result of their injuries. Although the observed differences were not statistically significant (p > 0.05), the proportional differences were congruent with international literature. Conclusion: Acute use of substances among self-harm patients warrants more focused research and clinical attention particularly in the context of reducing utilisation of scarce medical resources.
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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.
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    Substance use and suicidal ideation and behaviour in low- and middle-income countries : a systematic review
    (BioMed Central, 2018-04-24) Breet, Elsie; Goldstone, Daniel; Bantjes, Jason
    Background: Understanding relationships between substance use and suicidal ideation and behaviour (SIB) has important public health implications for suicide prevention in low- and middle-income countries (LMICs), where 75% of suicides occur. This systematic review explored the associations between substance use and SIB in LMICs. Methods: We searched five databases using a combination of keywords for substance use, SIB and LMICs to identify English-written quantitative studies published between January 2006 and February 2016. Data were extracted to provide an overview of what is known about the topic, highlight gaps in the literature, and explore the implications of current knowledge for suicide prevention. Studies included in the review were assessed for methodological quality using the Scottish Intercollegiate Guidelines Network checklist. Results: Analysis of included studies (N = 108) demonstrated a consistent positive association between substance use and SIB across all substances (i.e. alcohol, tobacco, cannabis, illicit drugs, non-medical use of prescription drugs), all substance use dimensions (i.e. intoxication, use, and pathological use) and all SIB dimensions (i.e. suicidal ideation, nonfatal suicidal behaviour, and suicide). Most of the available research evidence comes from upper-middle-income countries, only 22% comes from lower-middle-income and low-income countries. Most studies focused on alcohol and tobacco, while neglecting substances such as cannabis, opioids, sedatives, stimulants, misuse of prescription medication, inhalants, and hallucinogens. Most of the studies employed a cross-sectional design, were conducted within a risk-factor paradigm, and provided little information about the potential interaction between variables. Conclusions: Public health suicide prevention policy and research in LMICs should take account of the fact that: substance use is a potentially modifiable risk factor; assessment and management of substance use is integral to the care of at-risk patients; reducing consumption and hazardous use of substances in LMICs is important for suicide prevention; and research needs to be expanded to include more theory driven research that focuses on all substance use dimensions and SIB dimensions, while employing more sophisticated statistical methods.
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    Symmetry symptoms in obsessive-compulsive disorder : clinical and genetic correlates
    (Associacao Brasileira de Psiquiatria, 2016) Lochner, Christine; McGregor, Nathaniel; Hemmings, Sian M. J.; Harvey, Brian H.; Breet, Elsie; Swanevelder, Sonja; Stein, Dan J.
    Objective: In obsessive-compulsive disorder (OCD), symmetry-related symptoms may be important. Although clinical correlates of symmetry-related symptoms have been identified in OCD, few data exist on genetic associations. Animal studies indicate involvement of dopamine in symmetry-related behavior, suggesting this may be relevant to analogous symptoms in OCD. Alterations in dopamine may also reflect environmental influences. However, the association of symmetry-related symptomatology, early adversity, and polymorphisms in dopaminergic genes has not been investigated in OCD. Methods: Clinical information and polymorphisms in key dopaminergic genes were compared between OCD patients with primary symmetry symptoms and those without. Results: OCD patients with primary symmetry symptoms comprised 46.6% (n=210) of the sample (n=451), and were older (p < 0.01), had longer illness duration (p < 0.01), higher OCD severity scores (p = 0.01), and greater comorbidity (p < 0.01) than those without. In Caucasians (n=343), genotype frequency differed significantly between groups for ANKK1 rs1800497, with more OCD patients with symmetry symptoms being homozygous for the A2 (CC) genotype (χ2 = 7.296; p = 0.026). Conclusion: Symmetry symptoms have some distinct clinical features and may represent a marker of severity in OCD. However, clinical associations, in combination with the association found with the ANKK1 rs1800497 A2 variant, suggest that primary symmetry symptoms may represent a distinctive clinical and psychobiological profile.
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    Systematic review and narrative synthesis of suicide prevention in high-schools and universities : a research agenda for evidence-based practice
    (BMC (part of Springer Nature), 2021-06-10) Breet, Elsie; Matooane, Matsie; Tomlinson, Mark; Bantjes, Jason
    Background: Youth suicide prevention in high-schools and universities is a public health priority. Our aim was to propose a research agenda to advance evidence-based suicide prevention in high-schools and universities by synthesizing and critically reviewing the research focus and methodologies used in existing intervention studies. Methods: Fourteen databases were systematically searched to identify studies which evaluate suicide prevention interventions delivered on high-school or university campuses, with before and after measures. Data from included studies (n = 43) were extracted to identify what, where, how and for whom interventions have been tested. Narrative synthesis was used to critically evaluate research focus and methodology. Study quality was assessed. Results: Research has focused primarily on selective interventions, with less attention on indicated and universal interventions. Most evidence comes from North America and high-income countries. The target of interventions has been: non-fatal suicidal behaviour; confidence and ability of staff/students to intervene in a suicidal crisis; suicide-related knowledge and attitudes; and suicide-related stigma. No studies included suicide deaths as an outcome, evaluated eco-systemic interventions, explored how context influences implementation, used multisite study designs, or focused explicitly on LGBTQ+ youth. Two studies evaluated digital interventions. Quality of the majority of studies was compromised by lack of methodological rigour, small samples, and moderate/high risk of bias. Interventions often assume the existence of an external well-functioning referral pathway, which may not be true in low-resource settings. Conclusion: To advance evidence-based suicide prevention in educational settings we need to: conduct more high-quality clinical and pragmatic trials; promote research in low- and middle-income countries; test targeted interventions for vulnerable populations (like LGBTQ+ youth), evaluate interventions where death by suicide is the primary outcome; include translational studies and use implementation science to promote intervention uptake; evaluate the potential use of digital and eco-systemic interventions; and conduct multisite studies in diverse cultural settings.