Post-traumatic stress disorder as a public health concern in South Africa
Abstract
This article briefly surveys the extent to which traumatic events are a feature of life all over Africa and provides a comprehensive review of research that documents the pervasiveness of traumatic events in South Africa and the prevalence of PTSD symptoms. The material reviewed includes statistics on crime, violence and accidents, research from clinical settings, and surveys. Several provide evidence for the causal link between traumatic events and the development of PTSD. These studies show that PTSD has been and continues to be a significant problem for public health in South Africa, affecting individuals in all sectors of society and as much a concern with respect to children as to adults.
... The literature suggests that more psychological treatment should be rendered to survivors of traumatic events (Edwards 2005;2009;Leibowitz-Levy 2005). However, in this study, survivors of traumatic events verbalised that they were only given treatment for their physical symptoms. ...
... However, in this study, survivors of traumatic events verbalised that they were only given treatment for their physical symptoms. The tendency to prioritise physical medical treatments by mine hospital doctors may have resulted from limited research that addresses the extent to which findings of studies conducted in Europe and in the United State of America could be applied to the South African cultural context (Edwards 2005). As a result, Edwards (2005) is concerned about the transferability of international interventions on the basis that some South African medical practitioners may feel improperly trained to render them to their patients. ...
... The tendency to prioritise physical medical treatments by mine hospital doctors may have resulted from limited research that addresses the extent to which findings of studies conducted in Europe and in the United State of America could be applied to the South African cultural context (Edwards 2005). As a result, Edwards (2005) is concerned about the transferability of international interventions on the basis that some South African medical practitioners may feel improperly trained to render them to their patients. Mavundla (2000), in a study that investigated the nurses' perceptions of nursing mentally ill people in general hospital settings, found that general hospital nurses were not equipped with communication skills to engage patients who suffer from mental disorders in their care. ...
Deep-shaft mining is regarded as a high-risk occupation with an increasing number of traumatic accidents. Though there are strategies for the management of post-traumatic stress disorder (PTSD), little has been done to document the male survivors’ perceptions of PTSD management strategies in the South African mining sector. An exploratory, descriptive and contextual study was conducted within the South African mining sector to explore and describe the survivors’ perceptions of PTSD management strategies. The population comprised all men who were suffering from PTSD as a result of accidents in the mines. A purposive sample of 29 men was selected to participate in the study and data saturation was achieved. Unstructured individual interviews and field notes were used as methods of data collection. One question was asked during the interviews: “What do think helped you recover from PTSD?” Communication skills were employed to facilitate the participation of the men during the interviews. Data were collected using a voice recorder and were then transcribed verbatim and analysed using Tesch’s descriptive method of data analysis. Measures for ensuring trustworthiness were applied to verify the findings. Three themes emerged during data analysis: (1) perceived emphasis on physical versus psychological treatments, (2) perceived coping strategies used to deal with the trauma, and lastly, (3) the perceived effect of social support networks during trauma. Based on the perceptions of the participants, it became evident that PTSD management did not meet expectations. An integrated approach is recommended for the future treatment of psychological and physical trauma among survivors of traumatic events in the mining sector.
... For example, South African reports often highlight the high prevalence of community-level traumatic exposures and associated PTSD, independent of occupational status. [21][22][23] There is currently no clear contemporary picture of CMDs in the South African occupational context. The SASH data, based on the DSM-IV diagnostic system, are becoming dated, having been collected in 2003-2004, and some of the other studies cited above had small sample sizes and/or used measures that were not validated locally. ...
... 20 Older, and more experienced HCWs have been shown to be prone to sickness absence or long-term sickness. 21 ...
... Many young activists burn out, particularly in contexts such as South Africa where there is such a large gap between the inclusive and liberal vision embodied in the Constitution, and the reality of society. When the liberal vision is not enacted in the political sphere, or through effective law enforcement, it is easy for activists and human service professionals to get overwhelmed at the vastness of the task ahead, and give up when facing obstacles (Edwards, 2005;van der Kolk, 2004). Contemporary mindfulness research has revealed that resilience can be learnt through practices that invite the activist to return, again and again, to the present moment, in order to address issues as they arise, without layering multiple disappointments, one on top of another. ...
This chapter highlights the potential benefits of a contemplative,
compassionate approach to the process of Critical Reflexive Praxis. It
reviews recent findings from contemplative neuroscience that highlight a
need to feel safe and experience self-compassion in order to turn a critically
reflexive focus onto the self. Different contemplative practices are discussed,
and their benefits for emotion regulation, developing warmth and
connection, and transforming habitual reactivity into skilful responses and
wise action. The need for the sustainability of activists working in difficult
environments is also explored, and contemplative practices offer practical
skills to develop resilience, while maintaining empathy and enhancing
compassion.
... Suicide is an occupational risk for social workers and psycho-counselors (Edwards, 2005). All professionals who interact with people with suicidal behavior face psychological distress when learning of the death by suicide of a consultant. ...
... Nevertheless, "trauma research on this population has focused primarily on maltreatment rather than the full spectrum of trauma experiences identified within the [Diagnostic and Statistical Manual] DSM-IV (4th ed.; DSM-IV; American Psychiatric Association, 1994; Salazar et al., 2013, p. 545)." Therefore, whereas PTSD is acknowledged as a major public health problem both in the United States (Gabbay et al., 2004) and around the globe (Edwards, 2005), more research is needed to better understand the manifestation of this phenomena among youth who are transitioning out of care. ...
Network analysis is increasingly being used to explore interrelationships between symptoms of post-traumatic stress (PTS); nevertheless, no study to date has applied network theory to explore PTS in youth who are transitioning from foster care to independence. The present study estimated Adaptive LASSO and relative importance networks of PTS symptoms using the CIDI-PTSD Short Form (CIDI-SF) index from the Multi-Site Evaluation of Foster Youth Programs Study (2001-2010). Graph-theoretic algorithms including community detection and minimum spanning tree (MST; a unique, acyclic subnetwork with a fixed number of connections) were implemented to identify interconnected network symptom clusters. Two symptoms of emotional numbing (restricted affect and feeling detached) and two symptoms of intrusive reexperiencing (flashbacks, distressing dreams) emerged as the most important items in the network. The MST algorithm further revealed a backbone structure of PTSD that was centered on negative evaluations of the future. Feedback loops within the network were identified as well as symptoms that were highly predictive and potentially causal. Results strongly suggest that emotional numbing is a central aspect of psychopathology following experiences of complex trauma and home removal that merits special consideration in the diagnostic and treatment evaluation process of youth involved in the foster care system.
... Broader socio-political contexts also matter, in that non-work experiences also impact on workers. For instance, South Africans face high prevalence of community level traumatic exposures and associated prevalence of PTSD, independent of occupational experience (Edwards, 2005;Kaminer and Eagle, 2010;Peltzer and Pengpid, 2019). ...
Mental health in the workplace is becoming of ever greater importance. General occupational health surveillance programmes are already in widespread use, with established referral systems for treatment and rehabilitation, and the same mechanisms could be expanded to include mental health screening and intervention. This study aimed to develop a concise composite mental health screening tool, based on analysis of existing data, for application in routine occupational health surveillance in South Africa. Data from workplace occupational health surveillance programs from 2,303 participants were analysed. Participants completed a number of questions/scaled items collated into a survey format, and partook in an interview with a psychologist. The data was analysed using frequency of positive self-reports, Chi square to calculate associations with outcomes, Receiver Operator Characteristic curve analysis to explore predictive ability, and binomial logistic regression to calculate the relative contribution of markers to outcomes. An exploratory factor analysis was further conducted on identified items. A general workplace model with 14 markers (and a maritime workplace model with 17 markers) were identified. The factor analysis suggested their organisation into five domains (similar for both models), namely neurocognitive health, common mental disorders, history of adaptation in occupational specific contexts, family-work interface, and stress overload. The study’s data-driven approach proposed a concise composite screener with less than 50 items, comprising five domains. This tool appears useful in identifying employees at risk for workplace injuries or poor mental health outcomes, and could be applied to related workplace settings in South Africa.
... El suicidio es un riesgo ocupacional para trabajadores sociales y psico-orientadores (Edwards, 2005). Todos los profesionales que interactúan con personas con comportamientos suicidas afrontan un distrés psicológico al conocer la muerte por suicidio de un consultante. ...
Este libro actualiza el conocimiento sobre los comportamientos autolesivos con fines suicidas, en relación con la frecuencia, las posibles causas biológicas, psicológicas, sociales, culturales y políticas; es decir, aborda el suicidio desde una visión amplia, no reduccionista, y considera la complejidad del fenómeno. La fuente de la información son las investigaciones científicas más recientes —preferiblemente, revisiones sistemáticas y metaanálisis—, ante el acervo de datos disponibles en relación con el tema del suicidio. Incluye temas novedosos como los comportamientos autolesivos no suicidas y los comportamientos suicidas en grupos socialmente excluidos por etnia, orientación sexual e inmigrantes. Asimismo, presenta una visión integral de las estrategias de prevención de los comportamientos suicidas. Se puso especial atención en la revisión e inclusión de las investigaciones realizadas en Colombia y otros países latinoamericanos, dado que los estudios publicados en español excepcionalmente son considerados en las revisiones en inglés especialmente. Cada capítulo está ampliamente referenciado para que los lectores puedan profundizar en los detalles de cada tema, cuando lo estimen conveniente. Es necesario continuar la revisión de evidencias para reducir los comportamientos suicidas mediante la implementación de programas preventivos en los grupos sociales más vulnerables.
... In a country with highly reported community level traumatic exposures and associated prevalence of PTSD (Edwards, 2005;Kaminer & Eagle, 2010;Peltzer & Pengpid, 2019), a screener as brief is this one may be particularly valuable. However, given that the interview-determined PTSD prevalence was only 0.8%, follow-up studies will be required to confirm the diagnostic accuracy of the PC-PTSD-5 in samples with higher prevalence of traumatic exposure or diagnosed PTSD. ...
Orientation: South Africa carries a high burden of mental ill-health. Screening to identify individuals for further referral is emerging as one pathway to promote access to mental health interventions. Existing occupational health surveillance infrastructure may be a useful mechanism for clinical mental health screening.
Research purpose: This study explored the clinical validity of a range of brief mental health measures in the context of occupational health surveillance.
Motivation for the study: To meaningfully screen for mental health as part of occupational health surveillance, tools are required that are empirically validated, clinically useful, locally available and practical to administer.
Research approach/design and method: Workers (n = 1816), recruited through workplace occupational health surveillance programmes, completed the Patient Health Questionnaire-9, Brief Symptom Inventory 18-somatisation subscale, Generalised Anxiety Disorder scale-7, Primary Care Post-Traumatic Stress Disorder Screen, Intense (panic-like) anxiety scale and CAGE scale and partook in a diagnostic interview with a clinical psychologist.
Main findings: Basic psychometric characteristics were reported, including confirmatory factor analyses, measurement invariance, internal consistencies and socio-demographic effects. Clinical utility was explored through receiver operating/operator characteristics curve analyses, and calculations of positive and negative predictive values, as well as sensitivity and specificity. These indicators provided evidence of clinical validity in the study context.
Practical/managerial implications: The findings support the use of psychological screening as a brief, practicable and easily accessible mode of occupational mental health support.
Contribution/value-add: This article presented evidence of structural and criterion validity for these scales and described their clinical application for practical use in occupational mental health surveillance.
This article presents findings from a teacher education study, exploring the implications of mindfulness training on student teachers in the context of a transitional society, South Africa. Western secular mindfulness has been expanding to new continents, from its origins in the East, and can now benefit from being contextualised. Recent critiques of the contemporary mindfulness movement identify elements that are missing from much secular mindfulness training, such as ethics, compassion, and social engagement. As part of a mixed methods research study, in-depth interviews were carried out with fourteen student teachers in Gauteng, aiming to understand the level and causes of their stress, and evaluate whether a mindfulness-based intervention (MBI) was beneficial. The study's findings extended the current literature, highlighting the benefits of including compassion practices in MBIs, particularly in stressful contexts. Compassion-based mindfulness has the potential as a practice that not only improves the resilience of individuals, but also becomes a means of enhancing social engagement. For student teachers in the global south, mindfulness balanced with compassion impacted on their experience of self-compassion, empathy and compassion for others and altruistic behaviour. Explicit compassion training could, therefore, address some of the current critiques of MBIs.
This paper documents the approach and experience of Traumaclinic, a Cape Town based organisation offering a trauma support service. The controversy over single session debriefing interventions is examined and it is concluded that interventions that invite intense emotional expression should not be offered indiscriminately or forced on those who do not want them. When they do occur, they need to be carefully managed and take place over several sessions. A review of contemporary approaches to intervention following trauma highlights their comprehensive and flexible nature and the inclusion of multiple components that are introduced in a manner responsive to the needs of the situation. This is the basis of the current model used by Traumaclinic. The principles of that model are summarised and examples given of the application of the approach to specific cases.
This article introduces a special issue of the Journal of Psychology in Africa on post-traumatic stress disorder (PTSD) in Africa and particularly in South Africa and examines the critical debate that has surrounded PTSD research. It begins with an examination of the meaning of the term trauma, and of its specialised use within the clinical context and with respect to the concept of PTSD. The diagnostic approach to the detection of PTSD is presented, criteria in the DSM-IV-TR and the ICD-10 are summarised and differences between the two manuals are discussed. Arguments presented by critics of the concept of PTSD are presented and discussed. These concern the historical evolution of the concept, concerns about the universality of PTSD cross-culturally, and problems arising from understanding human suffering from a narrow medical perspective. It is concluded that while there are dangers in thinking of the sequelae of trauma as a medical/psychiatric problem, and while the alarming rate of traumatic events needs to be addressed at the political, economic and societal level, there is an important place for the provision of assessment and treatment of PTSD within a psychiatric/psychological clinical setting.
This study aimed to establish prevalence of adolescents' exposure to violence and related symptoms in the South African context and to explore relationships between exposure and symptoms.
Four high schools in Cape Town, South Africa.
Self report questionnaires were administered to 104 students. Types of violence explored included: witnessing or being a victim of violence perpetrated by someone known to the child or in the home and witnessing or being a victim of violence perpetrated by a stranger. The Harvard Trauma Scale, Beck Depression Inventory, and Zung Self-Rating Anxiety Scale were used to assess potentially related symptoms.
The majority of children had been exposed to at least one type of violence, and exposure to the one type of violence was related to the other type. Symptoms of post-traumatic stress disorder and depression appear to be related to most types of exposure to violence, but anxiety symptoms only to exposure to violence perpetrated by someone known to the child or in the home.
Rates of exposure to violence, and related symptoms, were unacceptably high. Symptoms were associated with exposure to violence.
There is a lack of comparative data on the prevalence and effects of exposure to violence in African youth.
We assessed trauma exposure, post-traumatic stress symptoms and gender differences in adolescents from two African countries.
A sample of 2041 boys and girls from 18 schools in CapeTown and Nairobi completed anonymous self-report questionnaires.
More than 80% reported exposure to severe trauma, either as victims or witnesses. Kenyan adolescents, compared with South African, had significantly higher rates of exposure to witnessing violence (69% v. 58%), physical assault by a family member (27% v. 14%) and sexual assault (18% v. 14%). But rates of current full-symptom post-traumatic stress disorder (PTSD) (22.2% v. 5%) and current partial-symptom PTSD (12% v. 8%) were significantly higher in the South African sample. Boys were as likely as girls to meet PTSD symptom criteria.
Although the lifetime exposure to trauma was comparable across both settings, Kenyan adolescents had much lower rates of PTSD. This difference may be attributable to cultural and other trauma-related variables. High rates of sexual assault and PTSD, traditionally documented in girls, may also occur in boys and warrant further study.
The prevalence of traumatic event exposure and post-traumatic stress disorder (PTSD) were surveyed in a cohort of 198 full-time operational members of the South African National Defence Force stationed in their "home" unit between deployments. Approximately 90% of members reported having experienced or witnessed trauma in their lifetime (mean number of traumatic events = 4.3 +/- 3.2), whereas 51% reported having inflicted trauma. Twenty-six percent met diagnostic criteria for PTSD on self-report with approximately 29% with PTSD also meeting diagnostic criteria for depression. Few members, however, sought help. PTSD symptom severity was best predicted by trauma type (exposure to physical assault and infliction of life-threatening injury). These findings highlight the high rates of exposure to multiple, noncombat-related trauma in military personnel, the potentially high rates of PTSD, and the role of inflicted trauma as an additional risk factor for PTSD.
Investigated the psychosocial impact of a deliberately set fire, which destroyed a shantytown in South Africa, on 98 male and 109 female children (aged 2–17 yrs). Ss came from 71 families who had managed to rebuild their homes. 40% of Ss had symptoms of posttraumatic stress disorder (PTSD). Problems increased when mothers were severely affected. In the youngest age group, boys were more symptomatic, but by adolescence this tendency was reversed. Ss demonstrated clear patterns of liking and disliking those responsible for the tragedy. Implications are offered for apartheid and for refugee assistance. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The purpose of the study was to identify exposure to experiences such as violence and the consequences for health in children in a rural South African community. The stratified random sample included 148 children below 17 yr., which comprised 68 (46%) boys and 80 (54%) girls in the age range of 6 to 16 years (M = 12.1 yr., SD = 3.1). Their ethnicity was Northern Sotho. The interviews included the Children's Posttraumatic Stress Disorder Inventory and the Reporting Questionnaire for Children. The experiences could be grouped into either traumatic or other events. 99 (67%) had directly or vicariously experienced a traumatic event which included witnessing someone killed or seriously injured, serious accident, violent or very unexpected death or suicide of loved one, sexual abuse or rape of relative or friend, violent crime, child abuse, and other life-threatening situations. Scores on the Children's Posttraumatic Stress Disorder Inventory of 17 (8.4%) fulfilled the criterion for posttraumatic stress disorder. 71% had more than one score and 53% had more than four scores on the Reporting Questionnaire for Children. Posttraumatic stress symptoms were significantly related to age and experiences such as those mentioned above.
Through a detailed analysis of a dream shared by three adolescent girls suffering from PTSD, this paper has outlined many similarities between an African and a Western understanding of their symptoms. It has shown how both systems would acknowledge these symptoms to be a function of: (a) the breaching of stimulus boundaries; (b) the existence of survivor guilt; (c) the phenomenon of frozen mourning. It has illustrated further how many factors considered to be part of Western psychotherapy, e.g., (a) catharsis following an emotional reliving of the traumatic event; (b) re-ordering of perceptions following insight; (c) fostering hope for the future following a re-establishment of continuity with the past, may be promoted while interpreting dreams within the traditional meanings ascribed to them by an African healing framework. That is, it has been shown how these elements may be fostered while working within the African belief that dreams are not the manifestation of intrapsychic conflict but communications from ancestral spirits concerning interpersonal duties that need to be fulfilled. Finally this paper has illustrated the importance of therapists developing a general appreciation of myths and metaphors.
The paper presents a 3-year follow-up of a prospective longitudinal study of posttraumatic stress disorder (PTSD) after motor vehicle accidents (J. Abnormal Psychol., 107 (1998) 508). Participants were 546 patients who had been assessed when attending an emergency clinic shortly after a motor vehicle accident, and at 3 months and 1 year afterwards. The prevalence of posttraumatic stress disorder PTSD at 3 years was 11%. Maintaining psychological factors, i.e. negative interpretation of intrusions, rumination, thought suppression and anger cognitions, were important in predicting the persistence of PTSD at 3 years, as were persistent health and financial problems after the accident. Other predictors were female sex, hospital admission for injuries, perceived threat and dissociation during the accident, and litigation.