[Show abstract][Hide abstract] ABSTRACT: Although studies have found associations between maternal distress/anxiety and alterations in blood flow, data across different trimesters are inconsistent. We, therefore, sought to determine the association between measures of distress and uterine blood flow in all three trimesters. Healthy women with low-risk singleton pregnancies were recruited from antenatal clinics. Women were assessed at 13-14 weeks (T1), 21-22 weeks (T2), and 32-33 weeks (T3) of gestation with measures of distress and anxiety (the K10, Perceived Stress Scale, and the State Subscale of the Spielberger State-Trait Anxiety Inventory [STAI]) and with uterine Doppler flow velocity studies. The Trait Subscale of the STAI was done either at T1 or T2. Thirty women were seen at T1, 79 women were seen at T2, and 59 women were seen at T3. No significant correlations were found between measures of distress and anxiety and umbilical artery pulsatility index (PI) or middle cerebral artery PI at any time-point. Small positive correlations between trait anxiety and uterine artery PI were found, but these were not significant after adjustment for alcohol and nicotine use (any use as well as problem drinking/nicotine dependence). At T3 but not T1 or T2, women scoring above 20 on the K10 (a standardized cutoff for the presence of axis I psychiatric disorders) had higher uterine artery PI than those scoring below 20.This was significant after adjusting for alcohol and nicotine use, as well as when nicotine dependence was considered. This work highlights the complexities of the relationship between increased measures of distress and anxiety and changes in the placental circulation. Further work in this area is needed to explore the underlying mechanisms which account for this relationship and to delineate fully the extent to which the relationship is determined by the presence of psychiatric and substance use disorders.
Archives of Women s Mental Health 08/2010; 13(4):359-64. · 2.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A psychometric scale assessing inhibitors and facilitators of willingness to participate (WTP) in an HIV vaccine trial has not yet been developed. This study aimed to construct and derive the exploratory factor structure of such a scale. The 35-item Inhibitors and Facilitators of Willingness to Participate Scale (WPS) was developed and administered to a convenience sample of 264 Black females between the ages of 16 and 49 years living in an urban-informal settlement near Cape Town. The subscales of the WPS demonstrated good internal consistency with Cronbach's alpha coefficients ranging between 0.69 and 0.82. A principal components exploratory factor analysis revealed the presence of five latent factors. The factors, which accounted for 45.93% of the variance in WTP, were (1) personal costs, (2) safety and convenience, (3) stigmatisation, (4) personal gains and (5) social approval and trust. Against the backdrop of the study limitations, these results provide initial support for the reliability and construct validity of the WPS among the most eligible trial participants in the Western Cape of South Africa.
AIDS Care 02/2010; 22(4):452-61. · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Currently available symptom severity measures for Generalized Anxiety Disorder (GAD) are not optimal. This study investigates the reliability and validity of a new measure for GAD. The Generalized Anxiety Disorder Severity Scale (DGSS), comprising 8 DSM-IV GAD symptoms assessed in terms of frequency and intensity, was used in a trial of agomelatine versus placebo for the treatment of GAD. Internal reliability, concurrent validity, responsiveness to change, most robust items, and factor structure were computed. The DGSS demonstrated good internal reliability, correlated significantly with the Hamilton Anxiety Scale and Clinical Global Impression severity scale, and demonstrated a clear change in response to agomelatine. The most robust DGSS items were derived, and an exploratory factor analysis yielded a 2-factor structure of the DGSS. The DGSS is potentially a useful scale for the assessment of GAD in clinical trials of this disorder.
The Journal of nervous and mental disease 07/2009; 197(6):391-4. · 1.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Human immunodeficiency virus-associated neurocognitive disorders (HAND) occurs globally and across different genetic clades of the virus. However, few studies have examined HAND in South Africa, despite the prevalence of HIV in this region of the world, and the predominance of clade C. The present study examined the relationship between a number of demographic and clinical variables in a sample of 536 patients attending HIV clinics in South Africa. HAND was present in 23.5% of the sample and was associated with older age, a low educational level among those with post-traumatic stress disorder (PTSD) and alcohol abuse among those with many months since diagnosis. These results suggest that HAND is common among patients in South Africa, and is associated with clinical variables such as PTSD and alcohol abuse. This underlines the impact of HIV on the nervous system and the importance of screening for co morbid mental health conditions.
AIDS and Behavior 04/2009; 14(2):371-8. · 3.49 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Poor urban children in South Africa are exposed to multiple community traumas, but AIDS-orphaned children are at particular risk for posttraumatic stress. This study examined the hypothesis that social support may moderate the relationship between trauma exposure and posttraumatic stress for this group. Four hundred twenty-five AIDS-orphaned children were interviewed using standardized measures of psychopathology. Compared to participants with low perceived social support, those with high perceived social support demonstrated significantly lower levels of PTSD symptoms after both low and high levels of trauma exposure. This suggests that strong perception of social support from carers, school staff, and friends may lessen deleterious effects of exposure to trauma, and could be a focus of intervention efforts to improve psychological outcomes for AIDS-orphaned children.
Journal of Traumatic Stress 04/2009; 22(2):106-12. · 2.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Recent literature has indicated that exposure to multiple traumatic events in adults is associated with high levels of posttraumatic stress disorder (PTSD), anxiety, and depression. Against the backdrop of stressful life events and childhood abuse and neglect, we investigated the cumulative effect of multiple trauma exposure on PTSD, anxiety, and depression in an adolescent sample.
One thousand one hundred forty 10th-grade learners from 9 Cape Town (South Africa) schools completed questionnaires on stressful life experiences; trauma exposure; and symptoms of anxiety, depression, and PTSD. Our population of interest for this study was adolescents between the ages of 14 and 18 years who had been exposed to serious, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, qualifying traumatic events. The final sample size was thus 922.
Rates of trauma exposure, PTSD, depression, and anxiety were high. Controlling for sex, stressful life experiences in the past year, and childhood adversity, we found an effect of cumulative trauma exposure effect on PTSD and depression, with an increase in the number of traumas linearly associated with an increase in symptoms of PTSD (F((4,912)) = 7.60, P < .001) and depression (F((4,912)) = 2.77, P < .05). We did not find a cumulative effect on anxiety.
Our findings indicate that adolescents exposed to multiple traumas are more likely to experience more severe symptoms of PTSD and depression than those who experience a single event, with this effect independent of childhood adversity and everyday stressful life experiences. Exposure to multiple trauma, however, does not seem to be associated with more severe anxiety symptoms.
[Show abstract][Hide abstract] ABSTRACT: The epidemiology of DSM-IV intermittent explosive disorder (IED) is not well characterized in developing country settings. In South Africa, given the high rates of violence and trauma, there is particular interest in traumatic exposures as potential risk factors for IED.
We examined the prevalence and predictors of IED in a nationally representative sample of 4,351 South African adults. IED and other diagnoses based on DSM-IV criteria were assessed using the World Health Organization Composite International Diagnostic Interview (CIDI). A 28-item scale was constructed to measure exposure to traumatic events.
Overall, 2.0% of participants (95% CI: 0-4.9%) fulfilled criteria for the narrow definition of IED, and 9.5% (95% CI: 6.6-12.3%) fulfilled criteria for the broad definition of IED. Individuals with IED experienced high rates of comorbid anxiety, mood and substance use disorders compared to non-IED participants. In multivariate analysis, a diagnosis of IED was associated with Caucasian and mixed-race ethnicity, psychiatric comorbidity and exposure to multiple traumatic events.
These data suggest a relatively high prevalence of IED in South Africa. By reducing violence and trauma, and by providing appropriate psychological support to trauma survivors, we may be able to reduce rates of IED.
[Show abstract][Hide abstract] ABSTRACT: Exposure to community violence and trauma, stress, and childhood abuse and neglect have been identified as risk factors for the development of posttraumatic stress disorder (PTSD) symptoms among adolescents. Although evidence suggests that resilience may moderate the relationship between some of these risk factors and PTSD symptoms, no studies to date have examined these risk factors collectively.
Our first aim was to examine the relationship between exposure to community violence, childhood abuse and neglect, perceived stress, and PTSD symptoms. Our second aim was to examine the extent to which resilience moderated the relationship between risk factors and PTSD symptoms.
A convenience sample of 787 participants was drawn from 5 public secondary schools in the Cape Town metropole of South Africa. The participants were invited to complete a battery of questionnaires on a single occasion.
Of the participants, 48.3% were Black, 58.6% were female, and 31.6% were in grade 8. After controlling for covariates, we found that exposure to community violence, perceived stress, and childhood abuse and neglect together accounted for 33.4% of the variance in PTSD symptoms (F(8,778) = 71.06, P < .001). Nevertheless, resilience moderated the relationship between childhood abuse and symptoms of PTSD (beta = .09, t(786) = 2.88, P < .001), where the independent effect of childhood abuse and neglect on PTSD symptoms was significantly reduced with increasing resilience. Resilience did not, however, interact with exposure to community violence or perceived levels of stress to influence PTSD symptoms.
High levels of exposure to community violence, perceived stress, and childhood abuse and neglect may contribute to the development of PTSD symptoms in South African adolescents. However, high levels of resilience may buffer the negative effects of childhood abuse and neglect.
[Show abstract][Hide abstract] ABSTRACT: This study examined the relationships between behavioural inhibition (BI), anxiety disorders, depression and CD4 counts in 456 HIV-infected adults attending primary healthcare HIV clinics in South Africa. Our first hypothesis was that BI would be positively correlated with anxiety disorders and with depression. Our second hypothesis was that BI, anxiety disorders and depression would be negatively correlated with CD4 counts. Participants completed the Retrospective Self-Report of Childhood Inhibition scale (RSRCI), the Center for Epidemiologic Studies Depression scale (CES-D) and the Mini-International Neuropsychiatric Interview (MINI). We found that BI was positively correlated with depression, agoraphobia, social phobia (social anxiety disorder) and posttraumatic stress disorder (PTSD). In addition, we found that BI, anxiety disorders and depression were not associated with CD4 counts. Finally, we found no gender effects for BI, depression, CD4 counts or any anxiety disorder diagnosis. While BI was linked to certain anxiety disorders, we found no evidence to suggest that BI, a diagnosis of an anxiety disorder, and/or depressive symptoms were associated with CD4 counts among HIV-positive adults.
AIDS Care 12/2008; 20(10):1279-83. · 1.60 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Mini Mental State Examination (MMSE) has been traditionally used to screen for cognitive impairment in a variety of dementing illnesses, including HIV associated dementia. More recently, the HIV Dementia Scale (HDS) was developed as a bedside evaluation test to differentiate patients with HIV-associated frank dementia from those who are cognitively normal.
This study assessed the sensitivity and specificity of the HDS (using the MMSE as the gold standard) in a sample of 474 patients attending anti-retroviral (ARV) services in the Cape Town metropole of South Africa. None of these patients had a pre-existing clinical diagnosis of dementia based on a review of the medical records.
The HDS and MMSE were significantly correlated and showed significant agreement. Nonetheless, the HDS identified more participants demonstrating cognitive impairment than the MMSE. An ROC curve analysis revealed that an HDS cut-off of < or =10 yielded a sensitivity of 80%, specificity of 80%, and discriminated between the presence and absence of cognitive impairment 90% of the time.
Our findings suggest that the HDS may be a more sensitive screening instrument for HIV associated dementia in patients attending ARV services.
Journal of the Neurological Sciences 07/2008; 269(1-2):62-4. · 2.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: There are no published data on the factor structure of the Multidimensional Anxiety Scale for Children (MASC) among adolescents in the Cape Town metropole of South Africa. The objectives of this study were (i) to establish the exploratory factor structure of the MASC using a principal components exploratory factor analysis (EFA); (ii) to confirm the derived factor structure using confirmatory factor analysis (CFA); and (iii) to examine gender, age, and race effects among adolescents in the Western Cape of South Africa. A convenience sample of 1,051 adolescents was selected from nine different schools in the Cape Town metropole of South Africa. An EFA yielded a four-factor structure congruent to the factor structure established previously in other samples. Furthermore, the CFA showed that the four-factor structure fit the data well. Black participants reported significantly higher levels of Harm Avoidance than other racial groups, and Black and Coloured (mixed race) participants reported significantly higher levels of Anxious Coping than White and Asian participants. Black and Coloured participants reported significantly higher levels of Separation/Panic than White participants, and Black participants reported higher levels than Asian and Coloured participants. Finally, there were no significant age effects, but females scored significantly higher overall and on all MASC subscales. The MASC seems to be a useful tool for assessing and distinguishing anxiety symptoms among adolescents in the Cape Town metropole of South Africa.
Depression and Anxiety 12/2007; 25(11):E147-53. · 4.61 Impact Factor