Thesis (MA)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: This study is aimed at exploring mental health services for low-income women in the West Coast I Winelands Region of South Africa. In order to understand the extent to which such services are empowering, the accessibility and theoretical underpinnings of these services are investigated. It was found that although services appear to be available, they are often not very accessible. They also often lack a specific gender focus. In certain instances, services need to increase their accessibility in order to accommodate the restrictive environments of women in this region. As such, it is believed that services require greater integration in their approach to intervention concerning both gender and the origins of mental health problems. Results of this study also highlight areas on which future research could focus. These areas include language of service provision, how organizations understand available theories surrounding service provision, and the service needs of women in this region themselves. / AFRIKAANSE OPSOMMING: Hierdie studie is gemik op die ondersoek van geestesgesondheidsdienste vir vroue van lae-inkomste groepe in die Weskus I wynverbouingstreek van Suid Afrika. Die toeganklikheid en teoretiese onderstuttngs van hierdie dienste word ondersoek in In poging om die graad waarin delke dienste bemagtigend is, te verstaan. Bevindinge toon dat dienste, albeit beskikbaar voorkom, dikwels nie baie toeganklik is nie. Dienste toon ook meestal 'n gebrekkige fokus ten opsigte van 'n spesifieke geslag. In sekere gevalle behoort die toeganklikheid van dienste verbeter te word in 'n poging om die beperkende omstandighede van vroue in hierdie streek tegemoet te kom. As sulks benodig dienste 'n hoër mate van integrasie in hul benadering tot intervensie, beide wat geslag en die oorsprong van geestesgesondheidsprobleme betref. Bevindinge lig ook areas uit waarop toekomstige navorsing kan fokus. Hierdie areas sluit die volgende in: die taal van diensvoorsiening, hoe organisasies beskikbare teorieë ten opsigte van diensvoorsiening verstaan, en die behoefts van die vroue in hierdie streek self ten opsigte van dienste.

This study used a multi-method approach to explore factors associated with high and low depression in a sample of rural mothers living in poverty. From a sample of 117 women with very high or very low CES-D depression scores, 40 cases were randomly selected for in-depth qualitative analysis. Qualitative comments about a variety of issues were explored including health, mental health, childcare, transportation, community, social support, and family of origin experiences. Quantitative data were then used in response to themes that emerged from the literature and the qualitative findings. All 117 eligible participants were used for quantitative analysis to increase power. Analysis of the qualitative data revealed several critical differences between the two groups. Low risk participants mentioned fewer health issues and less severe health problems as compared to their high risk counterparts. Mental health issues were reported more in the high risk group, with this group being more likely to have multiple family members experiencing symptoms. All participants reported receiving social support, however, the low risk group reported positive social support experiences, while the high risk group reported ambivalent relationships with the people who provided them with social support. Reported family of origin experiences were quite different between the two groups, with the low risk group reporting more positive past and current relationships. Quantitatively, several interesting results were revealed, many confirming the qualitative findings. Mothers showing higher levels of depression reported significantly more health problems for themselves, their partners, and their children. Additionally, participant's work status, income, perceived adequacy of income, childhood welfare use, and presence of partner were significantly related to depression. Low risk respondents were more likely to be working, perceive their income as adequate, and have a partner. They were also less likely to have received welfare as a child and had higher incomes. The findings offer important implications for future research and policy. Risk for depression seems to be related to a variety of factors, indicating that something should be done to minimize an individual's likelihood toward experiencing depression. This study ultimately provided a clearer picture of the existence of depressive symptoms among women with children living in rural poverty. / Graduation date: 2003

Thesis (DPhil (Psychology))—University of Stellenbosch, 2006. / Statistics show that young, heterosexual, low-income women are the fastest growing HIVinfected population in South Africa and in the rest of the world. Despite the rapidly growing numbers of women with HIV (human immunodeficiency virus) and AIDS (acquired immune deficiency syndrome), there is a scarcity of research that focuses primarily on how poor minority and disadvantaged women of colour experience being HIV-positive, how these women actually live and cope with their diagnosis. Furthermore, no research studies on minority groups, such as the Coloured women in the Western Cape, exploring these issues have been reported. Consequently, there is an urgent need for research studies in South Africa to explore the range of discourses revealed by low-income and minority women regarding their lives and experiences of HIV/AIDS, in order to generate understanding and knowledge which could contribute to possible interventions, support and care. The present study aimed to: 1) explore the psychosocial concerns and mental health needs of HIV-infected low-income Coloured mothers in everyday life; 2) construct a testable Grounded Theory regarding the illness experience of low-income Coloured mothers; and 3) recommend guidelines for health workers. The study was a systematic analysis and documentation of how the illness (HIV/AIDS) was constructed in narratives of one particular group of women in South Africa. Eleven suitable and willing HIV-infected Coloured mothers were recruited by means of convenience and theoretical sampling. The research study was conducted within a socialconstructionist framework where the focus was on how HIV-infected, low-income Coloured women make sense of their world and illness experience. Grounded Theory was applied within the framework of qualitative research to analyse the data and to explore the participants’ constructions of the illness. As qualitative measure, a semi-structured in-depth interview schedule was developed according to Grounded Theory protocol. To reach the aims of the present study, questions focused on specific behaviours, experiences, thoughts and feelings that related to living with a positive HIV-diagnosis. In the participants’ accounts of their illness experience, two dominant discourses were identified: a discourse of HIV/AIDS, within which the illness was constructed as an stigmatised, incurable and deadly illness; as a shameful illness that someone should be blamed for; and as being associated with secrecy, silence, separation, pain and suffering, loss, and loneliness, as well as a discourse of mothering, what it means to be a “good” woman/mother; constructed as someone that should primarily take care of her children and family, and not be separated from them, or neglect or abandon them through illness or death. It is suggested that the two dominant discourses found in the participants’ accounts of their illness experiences, namely the meaning of HIV/AIDS as an illness (a stigmatised, incurable, and deadly illness, a shameful and blameworthy illness, an illness of secrecy, silence, separation, pain and suffering, loss, and loneliness), and the imperatives of mothering, what it means to be a “good” woman/mother (the primary caregiver of children, someone who is connected, physically strong, healthy and productive, and someone who is able to cope with her caregiving responsibilities even when in distress herself) are irreconcilable. It seems that these distressing and disempowering experiences of being HIV-infected, while also being a primary caregiver and mother of children, caused the participants in the present study severe psychological distress and suffering. Given these discourses and the context of the participants’ lives within their specific socio-economic circumstances, namely their lack of emotional and social support from friends and family, abusive relationships, substance abuse, economic hardships, absence of treatment options, as well as their experience of an incapacitating, incurable, stigmatised illness causing them severe physical and psychological distress, it was argued that the majority of the participants in the present study were in some state of depression and were in need of psychosocial support and mental healthcare.

This study examined the distinct effects of partner violence and psychological abuse on women's mental health over time. Latent growth modeling was used to examine stability and change over time, evaluating the course and consequences of each form of abuse. The size of women's social support network was examined as a mediator. The sample consisted of 835 African American, Euro-American, and Mexican American low-income women. Participants who completed Waves 1, 2, 3, and 5 were included in the study (n = 585). In general, partner violence decreased over time for all groups, while psychological abuse decreased over time for only Euro-American women. Whereas initial and prolonged exposure to psychological abuse was related to and directly impacted women's mental health, partner violence was only related to initial levels of mental health. Surprisingly, social support was only related to initial violence and distress and had no impact on the rate of change over time. These results have important implications for researchers and health care professionals. First, differences in the pattern of results were found for each ethnic group, reaffirming the notion that counselors and researchers must be sensitive to multicultural concerns in both assessment and intervention. For example, psychological abuse had a greater impact on the mental health of African American and Mexican American women than it did for Euro-American women, suggesting a shift in focus depending on the ethnicity of the client may be warranted. Second, this longitudinal study highlights the importance of future research to considerer individual differences in treating and studying victimized women. Understanding factors that contribute to individual trajectories will help counselors gain insight into the problem and in devising plans to prevent or reduce the occurrence and negative health impact of partner abuse.