Jonathan Kenneth Burns

University of Exeter | UoE · Medical School

Background Older people admitted to hospital in an emergency often have prolonged inpatient stays that worsen their outcomes, increase health-care costs, and reduce bed availability. Growing evidence suggests that the biopsychosocial complexity of their problems, which include cognitive impairment, depression, anxiety, multiple medical illnesses, a...

We investigated the trajectory of depressive symptoms (“depression”) from the start of the COVID-19 pandemic in South Africa (March 2020) until 2021, between individuals with and without pre-pandemic depression, specifically regarding the role of food security. Our investigation used publicly available panel data (N = 6,930) from the South African...

Psychotic disorders, such as schizophrenia, can be devastating and long-lasting and are associated with significant individual, familial, and societal costs. Schizophrenia is one of the top ten leading causes of disability worldwide. The overwhelming majority of research on psychotic disorders is conducted in countries in North America, Europe, and...

Psychotic disorders, such as schizophrenia, can be devastating and long-lasting and are associated with significant individual, familial, and societal costs. Schizophrenia is one of the top ten leading causes of disability worldwide. The overwhelming majority of research on psychotic disorders is conducted in countries in North America, Europe, and...

Background: The COVID-19 pandemic and the lockdown experience may have not only precipitated or exacerbated mental illness but also influenced access to care and the nature and content of the psychotic symptomatology of people with psychosis. Aim: This study aimed to evaluate the association of the COVID-19 pandemic and lockdown experience on cl...

Background: Cannabis use has been linked to psychotic disorders but this association has been primarily observed in the Global North. This study investigates patterns of cannabis use and associations with psychoses in three Global South (regions within Latin America, Asia, Africa and Oceania) settings. Methods: Case-control study within the Inte...

Clean water and sanitation provisions are essential for good hygiene and health, with rural South Africa facing a simultaneous access crisis of both, the direct health effect of restricted access to both on mental health remaining scarce and largely overlooked. This study investigated the association between access to clean water and sanitation on...

Background: Extensive evidence indicates that rates of psychotic disorder are elevated in more urban compared with less urban areas, but this evidence largely originates from Northern Europe. It is unclear whether the same association holds globally. This study examined the association between urban residence and rates of psychotic disorder in cat...

Introduction Access to mental health services is a challenge, especially for young people who are over-represented in the unemployment and poverty index in South Africa. Therefore, continuing care is a problem after hospital discharge for young people with first-episode psychosis (FEP) due to a lack of clinical engagement and follow-up, for which t...

Importance Less than 10% of research on psychotic disorders has been conducted in settings in the Global South, which refers broadly to the regions of Latin America, Asia, Africa, and Oceania. There is a lack of basic epidemiological data on the distribution of and risks for psychoses that can inform the development of services in many parts of the...

Background There is an alarming trend in sub-Saharan Africa in the use of codeine-containing pharmaceuticals, but its risk of common comorbidities, such as mental health, remains unquantified at a national-level. We investigated the relationship between codeine use and onset of depression in South Africa at a population-level. Methods We used nati...

The scaling up of antiretroviral therapy services over the past decades has led to a remarkable reduction in HIV infections and HIV-related deaths in South Africa (SA). While this is a step in the right direction, it brings a new public health challenge into focus, namely psychological challenges associated with such chronic and often stigmatising...

Background Culture is inevitably linked with the experience, interpretation and course of what modern biomedicine understands to be psychotic symptoms. However, data on psychoses in low- and middle-income countries are sparse. Our previous study showed that psychotic and mood-related experiences, symptoms and disorders are common among individuals...

Sub-Saharan Africa faces unprecedented disasters, with climate change expected to exacerbate the frequency and severity of unpredictable and stressful catastrophic events. Unlike developed nations, reconstruction in developing nations is hindered by resource constraints, with certain communities potentially experiencing multiple and enduring effect...

Sociocultural context seems to influence the epidemiology, phenotype, treatment, and course of psychosis. However, data from low- and middle-income countries is sparse. This research is part of a multidisciplinary and multimethod study on possible mental disturbances, including hallucinations, among (apprentice) traditional health practitioners (TH...

While food insecurity is a persistent public health challenge, its long-term association with depression at a national level is unknown. We investigated the spatial heterogeneity of food insecurity and its association with depression in South Africa (SA), using nationally-representative panel data from the South African National Income Dynamics Stu...

Stigma is an important social determinant of health-seeking behavior; however, the nature and extent of its association with depression among people living with multidrug-resistant tuberculosis (MDR-TB) are not well-understood. We enrolled 200 microbiologically confirmed MDR-TB inpatients at a TB specialist hospital in KwaZulu-Natal Province, an ar...

Objectives Optimising medication adherence is one of the essential factors in reversing the tide of a TB‐HIV syndemic in sub‐Saharan Africa, especially South Africa. Impairment in key neurocognitive domains may impair patients’ ability to maintain adherence to treatment, but the level of cognition and its relationship to HIV status has not been exa...

Background: Rapid population growth, urbanisation, and economic development have led to an unprecedented number of waste sites in developing countries. This challenge has become a contentious international relations issue, with an unsustainable amount of waste and its health consequences often being borne by developing countries. However, little na...

This qualitative ethnographic study complements an epidemiological study on first episode psychosis in Vulindlela, a rural area in KwaZulu-Natal, South Africa. It focuses on two themes that emerged from our data: (1) the calling of the ancestors to become a traditional health practitioner and (2) ukuthwasa, the training to become a traditional heal...

Background: Few studies on quality of life (QoL) among people with mental illness have been conducted in South Africa, and none in community dwelling individuals. However, a greater understanding of subjective QoL may inform community-based medical, psychotherapeutic, or social interventions. This study examined the QoL, clinical and sociodemograp...

Although neurocognitive impairment (NCI) is a well-recognized challenge in human immunodeficiency virus (HIV), there is little evidence regarding it among individuals with multiple drug-resistant tuberculosis (MDR-TB) within HIV endemic sub-Saharan Africa. The extent of NCI risk, particularly HIV-associated neurocognitive disorders (HAND) risk, was...

Purpose There is considerable variation in epidemiology and clinical course of psychotic disorders across social and geographical contexts. To date, very little data are available from low- and middle-income countries. In sub-Saharan Africa, most people with psychoses remain undetected and untreated, partly due to lack of formal health care service...

Purpose Household food insecurity in South Africa is a pervasive public health challenge. Although its link to chronic health conditions is well established, its relationship to mental illness, particularly major depression, is not well-understood. Despite KwaZulu-Natal Province being the epicenter of the drug-resistant tuberculosis (MDR-TB) epidem...

This is a podcast produced by Bhekisisa in South Africa on our INCET study of psychosis in rural Vulindlela, KwaZulu-Natal, focusing on our collaboration with traditional health practitioners.

Wider recognition of the mental health burden of disease has increased its importance as a global public health concern. However, the spatial heterogeneity of mental disorders at large geographical scales is still not well understood. Herein, we investigate the spatial distribution of incident depression in south Africa. We assess depressive sympto...

Introduction: Few studies on quality of life (QoL) in the mentally ill population of South Africa have been conducted, but none in community-dwelling individuals. This study examined the QoL of psychiatric patients at community mental health clinics in Gauteng province of South Africa.Methods: A cross-sectional interview-based study was conducted o...

Background: While there is considerable research in developed countries on the nature and extent of post-traumatic stress among refugees and migrants, few report on female Africans migrating within Africa. Aim: The aim of this study was to investigate the association between exposure to traumatic life events and post-traumatic stress disorder ri...

Background While there is considerable research in developed countries on the nature and extent of post-traumatic stress among refugees and migrants, few report on female Africans migrating within Africa. Aim The aim of this study was to investigate the association between exposure to traumatic life events and post-traumatic stress disorder risk i...

Background: Sexual transmission of HIV frequently occurs in the context of a primary relationship between two partners; however, HIV prevention interventions generally focus on individuals at risk, rather than specifying couples as a unit of change and analysis, neglecting the crucial role that partners may play in sexual behaviour. This article re...

Background There is considerable variation in epidemiology and clinical course of psychotic disorders across social and geographical contexts. To date, very little data is available of low- and middle-income countries (LMICs). Obtaining valuable evidence from under-represented regions such as Sub-Saharan Africa holds the promise of advancing our kn...

Most countries have witnessed a dramatic increase of income inequality in the past three decades. This paper addresses the question of whether income inequality is associated with the population prevalence of depression and, if so, the potential mechanisms and pathways which may explain this association. Our systematic review included 26 studies, m...

There are few studies on the role of migration within sub-Saharan Africa and its relation to the development of mental illness. We investigated post-resettlement adaptation and mental health challenges of African refugees/migrants in Durban, South Africa. We interviewed 335 African help-seeking refugees/migrants for anxiety, depression (25-item Hop...

Purpose: This study investigated the epidemiological patterns of mental illness and stigma in community households in Kenya using a cross-sectional community household survey among 846 participants. Methods: A cross-sectional community household survey was conducted around urban slum (Kangemi) and rural (Kibwezi) selected health facilities in Ke...

Background: A family history of psychosis is associated with negative clinical characteristics of psychosis. Aim: We aimed to determine the relationship between a family history (in first-degree relatives) of psychosis (FHP) or of any mental illness (FHM), and the clinical features (including cannabis use) of first episode early onset psychosis...

Proximity to primary healthcare facilities may be a serious barrier to accessing mental health services in resource-limited settings. In this study, we examined whether the distance to the primary healthcare clinic (PHCC) was associated with risk of depression in KwaZulu-Natal Province, South Africa. Depressive symptoms and household coordinates da...

Coercion remains a dominant theme in mental healthcare and a source of major concern. While the presence of coercion is ubiquitous internationally, it varies significantly in nature and degree in different countries and is influenced by a variety of factors. Recent reports have raised concerns about physical restraint and the increasing use of legi...

Background: Unprecedented levels of habitat transformation and rapid urbanisation are changing the way individuals interrelate with the natural environment in developing countries with high economic disparities. Although the potential benefit of green environments for mental health has been recognised, population-level evidence to this effect is s...

Postnatal depression (PND) exerts a significant burden on the global public health system, globally affecting approximately 10 to 20% of women Despite the recently reported high prevalence of PND in Zimbabwe, it is rarely diagnosed or appropriately managed in primary care settings This review scopes evidence on PND from studies on screening for PND...

South Africa's refugee population has grown considerably over the last decade. Both food insecurity and mental illness are common in developing countries, but this relationship remains unexamined in an African refugee population. 335 adult refugees in Durban, South Africa were interviewed using a self-report of food insecurity and the Hopkins Sympt...

p> Background: The use of neuroimaging modalities in psychiatry has been evaluated in several studies. The vast majority seem to suggest that neuroimaging may be overutilised in psychiatry. There is a significant constraint on availability and cost related to neuroimaging of patients at general state medical facilities. The routine use of computeri...

Comorbid substance use in adolescents with mental illness is often an indicator of poor treatment outcome. This study aims to determine the prevalence of, and associated risk factors for, substance use in adolescents with mental illness attending a mental health service. Data was collected from hospital records of 162 adolescents, using a structure...

Aim: Income inequality (II) and poverty are major challenges in South Africa (SA) yet little is known about their interaction on population mental health. We explored relationships between district II, household income (HHI) and depressive symptoms in national panel data. Method: We used 3 waves (2008, 2010, 2012) of the SA National Income Dynam...

Objective: To develop a culture specific screening tool for trauma, and to determine whether it would significantly increase the probability of eliciting traumatic events and associated symptoms when added to a Western diagnostic tool for trauma. Method: A convenience sample of 1 hundred Zulu speaking volunteers was recruited in the North-Easter...

Provides an introduction to this special edition of Psychological Trauma. The papers included in this special section focus on aspects of trauma and the effects of trauma in a cultural context that pertains to the way of life in South Africa. These articles highlight the complexities of the effects of trauma and call for tailored interventions to a...

Millions of refugees are on the move globally, mostly settling in low- and middle-income (LMIC) "host" countries, where they often receive insufficient assistance and encounter a multitude of barriers. Despite a risk for developing mental illness, limited research exists on their struggles and coping strategies in these settings, especially outside...

Background: There is an increased prevalence of metabolic syndrome (MetS) in individuals with severe mental illness (SMI) globally. The prevalence of MetS is higher in black women compared to black men from South Africa. Aim: To compare the prevalence of MetS between black South African men and women with SMI taking antipsychotic medication. Furthe...

Background: To determine the prevalence and incidence of metabolic syndrome in individuals with a first episode of severe mental illness from South Africa. Methods: Antipsychotic naïve study subjects with a first episode of severe mental illness and control subjects were recruited at baseline for a prospective study. Individuals without metaboli...

Childhood trauma is a recognised risk factor for schizophrenia. It has been proposed that childhood trauma interferes with normal neurodevelopment, thereby establishing a biological vulnerability to schizophrenia. Poor premorbid adjustment is frequently a precursor to schizophrenia, and may be a manifestation of neurodevelopmental compromise. We in...

Background Growing interest in strategies regarding early intervention for psychosis has led to a parallel interest in understanding help-seeking behavior, especially in low- and middle-income countries (LMICs). Nevertheless, few LMIC studies have examined individuals with psychosis in non-urban, non-hospital settings. Using the perspective of form...

Purpose of review: This is the first review of studies on the epidemiology of eating disorders on the African continent. Recent findings: The majority of articles found through our search did not assess formal diagnoses, but only screened for eating attitudes and behaviors. Only four studies - including only one recent study - provided specific...

Background: Substance use and psychiatric disorders cause significant burden of disease in low- and middle-income countries. Co-morbid psychopathology and longer duration of untreated psychosis (DUP) can negatively affect treatment outcomes. Objectives: The study assessed substance use amongst adults with severe mental illness receiving services...

Background: Comorbid substance use, particularly cannabis among adolescents with mental illness, is a major public health concern in developing countries with limited mental health resources. Better understanding of the association between cannabis use and other polysubstance use and early mental illness will provide for more targeted early interv...

Background: The majority of studies on spirituality demonstrate its positive association with mental health. Despite the increasing number of studies, there remains a dearth of studies emanating from African countries looking at the relationship between mental illness, quality of life and measures of spirituality. The present study evaluates the ro...

Background: There is a surge of cardiovascular disease (CVD) in Africa. CVD is the leading cause of mortality among patients with severe mental illness (SMI) in developed countries, with little evidence from the African context. Objective: To determine the prevalence and risk factors for MetS among South African patients with SMI. Method: In a...

This study examined the quality of family relationships and its associations with the severity of unmet needs of individuals admitted to a tertiary psychiatric hospital in South Africa. The quality of family relations and perceived unmet needs were assessed using the Lehman Quality of Life Interview and Camberwell Assessment of Needs, respectively....

Introduction: Few studies in developing nations have assessed the use of short messaging services (SMS) to identify psychological challenges in refugee populations. This study aimed to assess the feasibility of SMS-based methods to screen for depression risk among refugees in South Africa attending mental health services, and to compare its reliab...

Assessing the cultural benefits provided by non-market ecosystem services can contribute previously unknown information to supplement conservation decision-making. The concept of sense of place embeds all dimensions of peoples’ perceptions and interpretations of the environment, such as attachment, identity or symbolic meaning, and has the potentia...

Background: The study of first episode early onset psychosis can yield many clues to understanding the early development of psychosis and guide interventions to decrease psychosis risk and improve outcome. The aim of the study was to investigate the socio-demographic profile and clinical correlates in early onset psychosis. Method: Forty-five ad...

The INTREPID programme of research aims to establish comparable studies of incident psychosis in a number of low- and middle-income countries (LMICs). The importance of this cannot be under-estimated, as this will enable the testing of existing findings and evidence across differing environmental contexts; and will permit the identification of new...

There is limited evidence on the acceptability, feasibility and cost-effectiveness of task-sharing interventions to narrow the treatment gap for mental disorders in sub-Saharan Africa. The purpose of this article is to describe the rationale, aims and methods of the Africa Focus on Intervention Research for Mental health (AFFIRM) collaborative rese...

The relationship between poverty and mental health is indisputable. However, to have an influence on the next set of sustainable global development goals, we need to understand the causal relationships between social determinants such as poverty, inequality, lack of education and unemployment; thereby clarifying which aspects of poverty are the key...

Considerable controversy surrounds the role of traditional health practitioners (THPs) as first-contact service providers and their influence on the duration of untreated psychosis (DUP) in sub-Saharan Africa. This study examined first-contact patterns and pathways to psychiatric care among individuals with severe mental illness in South Africa. A...

Despite improvements in service delivery and patient management, low birth weight among infants has been a persistent challenge in South Africa. The study aimed to explore the relationship between depression before pregnancy and the low birth weight (LBW) of infants in post-apartheid South Africa. This study utilized data from Waves 1 and 2 of the...

The apartheid regime that governed South Africa from 1948-1994 established spatial segregation that is understood to have contributed to the magnitude of neighborhood social disorder in the postapartheid era. Although a number of neighborhood social disorder characteristics, such as perceived violence and crime in the community, are prominent issue...

In resource-limited contexts in low- and middle-income countries (LMICs), a considerable proportion of individuals seeking care for mental disorders consult traditional and religious healers in their pathway to mental health care. Reports from Africa suggest that early involvement of healers may result in delays in the care pathway; a potential bar...

p>With the publication of the Diagnostic and Statistical Manual , 5th edition, and the ongoing revision of the International Classification of Diseases , currently 10th edition, it is timely to consider the wider societal implications of evolving psychiatric classification, especially within low- and middle-income countries (LMICs). The author re...