Alan J Flisher’s research while affiliated with Stellenbosch University and other places

Intimate partner violence (IPV) during pregnancy is prevalent across the world, but more so in low- and middle-income countries. It is associated with adverse outcomes for mothers and infants. This study sought to determine the prevalence and predictors of IPV among pregnant women attending one midwife and obstetrics unit (MOU) in the Western Cape, South Africa. A convenience sample of 150 pregnant women was recruited. Data were collected using several self-report measures concerning the history of childhood trauma, exposure to community violence, depression and alcohol use. Multivariable logistic models were developed, the first model was based on whether any IPV occurred, the remaining models investigated for physical-, sexual- and emotional abuse. Lifetime and 12 month prevalence rates for any IPV were 44%. The 12 month IPV rates were 32% for emotional and controlling behaviours, 29% physical and 20% sexual abuse. The adjusted model predicting physical IPV found women who were at risk for depression were more likely to experience physical IPV [odds ratios (ORs) 4.42, 95% confidence intervals (CIs) 1.88–10.41], and the model predicting sexual IPV found that women who reported experiencing community violence were more likely to report 12 month sexual IPV (OR 3.85, CI 1.14 to 13.08). This is the first study, which illustrates high prevalence rates of IPV among pregnant woman at Mitchells Plain MOU. A significant association was found between 12 month IPV and unintended pregnancy. Further prospective studies in different centres are needed to address generalisability and the effect of IPV on maternal and child outcomes.

In contemporary South African academia, “community engagement” is a valued commodity. My work as a nondisabled white man with disability activists and as editor of the African Journal of Disability is viewed as good for my career, and as an appropriate form of engagement and empowerment. In this article, I engage critically with the question of the extent to which capacity building is simply about increasing capacity. I ask whether capacity building inevitably involves elements of disavowal of the experience and competencies of less powerful people. I compare capacity building to the enforcement of normalcy, a process which disability scholars criticise with justification. I ask whether it is possible in very unequal social contexts to engage with the politics of voice without imposing a hegemonic narrative on non-dominant voices. I suggest links between the politics of engaged scholarship and processes of domestication of troubling bodies and minds.

& link to free access e-print: http://www.tandfonline.com/eprint/UMdi8jaYAWm2Y3CPe3I3/full This study aimed to investigate contextual influences on condom use by South African university students. Twenty one-to-one, semi-structured interviews were conducted with male and female South African undergraduates. The data were thematically analysed. Results revealed that condom use was transient and often unrelated to disease prevention. Condom use was impeded by closer perceived intimacy, gender dynamics, and social stigma against proposing use of condoms in a presumably committed relationship. Public health policies regarding condom, pill and injection pricing / promotion, and religious toleration also hampered condom use, by encouraging a preference over hormonal contraception or proscribing contraceptive measures altogether. The results provide a basis for considering the impact of immediate and wider social contexts on condom use, as proposed by socio-ecological models of HIV risk behaviour.

Evidence suggests that comorbid psychopathology can negatively affect treatment outcomes in substance users. In South Africa, limited information exists regarding the prevalence, nature and role of psychiatric comorbidity in substance users. This study examined psychiatric comorbidity and its association with specific substance use, and young adult substance users in treatment for substance use. Male and female inpatient substance users (n=95; ages 17-30 years) were sampled consecutively in order of admission from three clinics in Cape Town. An interview schedule was administered to elicit patients' sociodemographic and substance use history details. The computer-assisted Diagnostic Interview Schedule DSM IV (C-DIS IV) was administered to screen patients for current psychiatric disorders. The sample was largely male, Coloured, Muslim and single. Cannabis (51.6%) and crystal methamphetamine (17.9%) were the most common first substances of use. Heroin (53.7%) and crystal methamphetamine (33.7%) were the most common substances for which treatment was sought (primary substances). The most common comorbid psychopathologies were anti-social personality disorder (ASPD 87.4%) and conduct disorder (CD 67.4%). Regression analyses showed a marginally significant association between specific phobia and first use of cannabis, but indicated no statistically significant associations between psychopathology and substance use. The results demonstrated a high proportion of previously unidentified comorbid psychopathology in inpatient substance users. Further research is needed to investigate psychiatric comorbidity in inpatient substance users.

Although substance use is commonly associated with mental disorders, limited data on this association are available from low and middle income countries such as South Africa. The aims of the study were i) to determine patterns of substance use in young adults, ii) to identify trends of common psychiatric disorders in relation to use of specific substances, and iii) to determine whether specific psychiatric disorders were associated with use of specific substances in the South African population. Data were drawn from the South African Stress and Health (SASH) study, a nationally-representative, cross-sectional survey of South African households that forms part of a World Health Organisation (WHO) World Mental Health (WMH) initiative to standardise information on the global burden of mental illness and its correlates. Data from a subset (n = 1766; aged 18 to 30 years) of the SASH sample of 4351 individuals were analysed. The Composite International Diagnostic Interview Version 3 (CIDI 3.0) was used to elicit basic demographic details and information regarding mental illness and substance use. Multiple regression analyses, adjusted for age and gender, were used to identify associations between mental disorders and substance use. Significant associations were found between substance use and mood and anxiety disorders, with a particularly strong relationship between cannabis use and mental disorder. The results are consistent with those from previous studies, and reinforce the argument that comorbid substance use and mental disorders constitute a major public health burden.

Introduction: Although substance use is commonly associated with mental disorders, limited data on this association are available from low and middle income countries such as South Africa. The aims of the study were i) to determine patterns of substance use in young adults, ii) to identify trends of common psychiatric disorders in relation to use of specific substances, and iii) to determine whether specific psychiatric disorders were associated with use of specific substances in the South African population. Methods: Data were drawn from the South African Stress and Health (SASH) study, a nationally-representative, cross-sectional survey of South African households that forms part of a World Health Organisation (WHO) World Mental Health (WMH) initiative to standardise information on the global burden of mental illness and its correlates. Data from a subset (n=1766; aged 18 to 30 years) of the SASH sample of 4351 individuals were analysed. The Composite International Diagnostic Interview Version 3 (CIDI 3.0) was used to elicit basic demographic details and information regarding mental illness and substance use. Multiple regression analyses, adjusted for age and gender, were used to identify associations between mental disorders and substance use. Results: Significant associations were found between substance use and mood and anxiety disorders, with a particularly strong relationship between cannabis use and mental disorder. Conclusion: The results are consistent with those from previous studies, and reinforce the argument that comorbid substance use and mental disorders constitute a major public health burden.

Introduction: Evidence suggests that comorbid psychopathology can negatively affect treatment outcomes in substance users. In South Africa, limited information exists regarding the prevalence, nature and role of psychiatric comorbidity in substance users. This study examined psychiatric comorbidity and its association with specific substance use, and young adult substance users in treatment for substance use. Methods: Male and female inpatient substance users (n=95; ages 17-30 years) were sampled consecutively in order of admission from three clinics in Cape Town. An interview schedule was administered to elicit patients' sociodemographic and substance use history details. The computer-assisted Diagnostic Interview Schedule DSM IV (C-DIS IV) was administered to screen patients for current psychiatric disorders. Results: The sample was largely male, Coloured, Muslim and single. Cannabis (51.6%) and crystal methamphetamine (17.9%) were the most common first substances of use. Heroin (53.7%) and crystal methamphetamine (33.7%) were the most common substances for which treatment was sought (primary substances). The most common comorbid psychopathologies were anti-social personality disorder (ASPD 87.4%) and conduct disorder (CD 67.4%). Regression analyses showed a marginally significant association between specific phobia and first use of cannabis, but indicated no statistically significant associations between psychopathology and substance use. Conclusion: The results demonstrated a high proportion of previously unidentified comorbid psychopathology in inpatient substance users. Further research is needed to investigate psychiatric comorbidity in inpatient substance users.

The South African Society of Psychiatrists (SASOP) Treatment Guidelines for Psychiatric Disorders have been developed in order to address the local need for guidelines in our unique clinical setting.