Common mental and substance use disorders among people seeking HIV testing

Saal, Wylene Leandri (2017-03)

Thesis (D.Phil)--Stellenbosch University, 2017.

Thesis

ENGLISH SUMMARY: The baseline prevalence of common mental disorders (CMDs) and symptoms of distress, depression, anxiety and hazardous alcohol use prior to the receipt of a HIV diagnosis is unknown. The primary aim of this research was to determine the prevalence of CMDs, such as major depression, persistent depressive disorder, generalized anxiety, and alcohol use disorders among a sample of people seeking HIV testing. The second aim was to determine the extent of general distress among the sample of HIV test seekers. The third aim of the study was to determine the ability of the Hopkins Symptom Checklist (HSCL), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and the Alcohol Use Disorder Identification Test (AUDIT) to discriminate between CMD caseness and non-caseness. Utilizing a cross-sectional design, 500 participants were recruited while seeking HIV testing at five non-medical testing sites in the Western Cape, South Africa. The research version of the Structured Clinical Interview for the DSM-5 (SCID-RV) was administered to assess the CMDs. Furthermore, the extent of distress, depression, anxiety and hazardous alcohol use was assessed using the HSCL-25, BDI, BAI, and AUDIT, respectively. Descriptive statistics were used to evaluate the prevalence of CMDs and receiver operating characteristic (ROC) curve analysis was used to determine the effectiveness of the screening instruments in predicting CMD caseness against the SCID as gold standard. The results demonstrated that 28.4% (95% CI [24.45, 32.35]) of the sample had at least one common mental disorder. Elevated prevalence rates for major depression (14.4%; 95% CI [11.32, 17.48]), persistent depressive disorder (7.2%; 95% CI [4.93, 9.47]), generalized anxiety disorder (3.4%; 95% CI [1.81%, 4.99%]) and alcohol use disorder (19.6%; 95% CI [16.12, 23.08]) were reported. The results further showed that the HSCL-25, BDI, BAI, and the AUDIT were effective in identifying CMD caseness. Even the subscales of the HSCL-25 were successful in detecting most of the cases of depression (MDD, and PDD) and generalized anxiety. Of the sample, 41.2% were psychologically distressed, while 21% had moderate depression, 13.6% had moderate anxiety and 34.6% reported hazardous alcohol use. The findings of the research indicated that it is important to screen people for CMDs and distress prior to communicating an HIV diagnosis as these disorders may have a negative impact on quality of life and adherence to ART. A further contribution of the study is that the screening instruments may be used as proxies in identifying people seeking HIV testing with a CMD. Given that HIV testing and mental health services are available independently, fragmented services are provided in public health facilities in South Africa. Future research may need to focus on the integration of referral trajectories with routine screening and HIV testing.

AFRIKAANS OPSOMMING: Die basislynvoorkoms van algemene geessteurings en simptome van depressie, angs en gevaarlike alkoholgebruik voor die ontvangs van ’n MIV-positiewe diagnose is nie bekend nie. Die primêre doelstelling van hierdie navorsing was om die voorkoms van algemene geessteurings te bepaal onder 'n steekproef van mense wat MIV-toetsing aanvra met insluiting van depressiewe versteuring, aanhoudende depressiewe versteuring, algemene angsversteuring, en alkoholgebruikversteuring. Die tweede doelstelling was om die vlakke van sielkundige nood onder mense wat ’n MIV-toets aanvra, te bepaal. Die derde doelstelling van die studie was om die effektiwiteit van die ‘Hopkins Symptom Checklist (HSCL)‘, ‘Beck Depression Inventory (BDI)’, ‘Beck Anxiety Inventory (BAI)’ en die ‘Alcohol Use Disorder Identification Test (AUDIT)’ in die bepaling van algemene geestesiekte ‘gevalmatigheid’ en ‘nie-gevalmatigheid’ te ondersoek. Die navorsing het ’n deursneenavorsingsontwerp gebruik. Vyfhonderd deelnemers is gewerf ten tyde van aanmeliding vir MIV-toetsing by vyf nie-mediese toetsplekke in die Wes-Kaap, Suid Afrika. Die navorsingsweergawe van die gestruktureerde kliniese onderhoud vir die DSM-5 (SCID 5), is gebruik om algemene geestessteurings te assesseer. Verder is die vlakke van sielkundige nood, depressie, angs en gevaarlike alkoholgebruik bepaal met behulp van onderskeidelik die HSCL-25, BDI, BAI en AUDIT. Beskrywende statistiek is gebruik om die voorkoms van algemene geessteurings te bepaal en ‘Ontvanger bedryfseienskapkurwe’ (OBE – ROC) analise is gebruik om die doeltreffendheid van die self-rapporteringsinstrumente te bepaal in die voorspelling van algemene geessteuring ‘caseness’ teen die SCID as goudstandaard. Die resultate het getoon dat ten minste 28.4% (95% vertrouensinterval (VI) [24.45, 32.35]) van die steekproef ’n algemene geessteuring het. ’n Verhoogde voorkoms van depressie (14.4%; 95% VI [11.32, 17.48]), aanhoudende depressie (7.2%; 95% VI [4.93, 9.47]), algemene angsversteuring (3.4%; 95% VI [1.81%, 4.99%]) en alkoholgebruikversteuring (19.6%; 95% VI [16.12, 23.08]) is aangemeld. Die resultate het verder getoon dat die HSCL-25, BDI, BAI, en die AUDIT effektief was vir die identifisering van gemeenskaplike geessteuring ‘caseness’. Selfs die subskale van die HSCL-25 was suksesvol met die opsporing van depressie (MDD en PDD), en algemene angs. Van die steekproef het 41.2% van die deelnemers sielkundige nood gehad, terwyl 21% matige depressie, 13.6% matige angs en 34.6% gevaarlike alkoholgebruik gehad het. Die bevindinge van die navorsing het aangedui dat dit belangrik is om mense vir algemene geessteurings en sielkundige nood te toets voor die bekendmaking van hulle MIV-diagnose, aangesien hierdie versteurings ’n negatiewe invloed op lewensgehalte en die nakoming van ARB kan hê. ’n Verdere bydrae van die studie is dat die graderingsinstrumente gebruik mag word vir die identifisering van mense met ’n hoe risiko vir algemene geessteurings wat MIV-toetsing ondergaan. Gegewe dat MIV-toetsing en geestesgesondheidsdienste onafhanklik is van mekaar, verskaf openbare gesondheidsfasiliteite in Suid-Afrika gefragmenteerde dienste. Toekomstige navorsing mag nodig wees om te fokus op die integrasie van verwysingstrajekte met roetine sifting en MIV toetsing.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/101213
This item appears in the following collections: