MMed, Psychiatry, Faculty of Health Sciences, University of the Witwatersrand / Introduction: National and international child and adolescent mental healthcare policy and action advocate that the health and well-being of children in South Africa should be increasingly given greater attention. Child and adolescent services have recently been established at Rahima Moosa Hospital. The purpose of this study was to describe the scope, capacity and diagnostic profile of existing child and adolescent mental health and psychiatric services at Rahima Moosa Hospital within the context of the available infrastructure and service rendering and to describe the demographic and clinical profile of the users. Method: A descriptive, retrospective clinical audit study of the data from users‟ clinical files was performed. The study population comprised all users treated at the Rahima Moosa Hospital over a one-year period from January to December 2007. Descriptive statistical analyses of demographic and socio-economic variables were made and these variables were compared with the presenting clinical problems. P-values of less than 0.05 were regarded as significant. Odds ratios were also calculated for variables that showed a statistically significant association. Results: During this period a total of 303 users attended this clinic. Their age, gender, race and catchment area was reviewed. Socio-economic variables that were described included caregiver of user, placement, parents‟ well being and marital status, educational level of caregiver and household income. Most common disorders were Attention Deficit Hyperactivity Disorder (ADHD), Mood, Anxiety, Elimination, Attachment, Disruptive behaviour disorders and V-code diagnoses. Although not regarded as psychiatric diagnoses, V-codes are problems that are the focus of clinical attention. These include 5 sexual abuse, academic problems and parent-child relationship difficulties. Statistical comparisons between demographic data and disorders revealed that being male increased the likelihood of presenting with AHDH and disruptive behaviour disorders; being female increased the likelihood of being sexually abused. Race showed a significant association with parent-child relationship difficulties. Regarding socio-economic variables, the identity of the caregiver of the child influenced the risk of disruptive behaviour disorders, sexual abuse, neglect and academic problems. Placement was a risk factor for disruptive behaviour disorders, sexual abuse, neglect and academic problems. Whether the mother of a user was alive or deceased was related to ADHD and disruptive behaviour and whether the father of a user was alive or deceased was related to sexual abuse and academic problems. The education level of the caregiver showed a significant association with sexual abuse, neglect and academic problems; the marital status of the parents showed a significant association with bereavement. Household income was associated with sexual abuse, neglect and academic problems. Type of housing showed an association with the risk of sexual abuse. Discussion: This study clearly demonstrates the huge impact that socio-economic circumstances have on the prevalence of childhood disorders; hence the urgent need for government and social welfare departments to improve on the socio-economic status of communities. Job creation and employment will lead to better outcomes and help lower the incidences of childhood illnesses. The focus should be on preventative measures, that is, improving the social well-being of both children and their parents, which will result in lower prevalence of disease. Moreover, interventions in schools and children‟s homes should be 6 implemented. The provision of psycho-education for the group in the catchment with regard to identification of mental health problems can contribute to the early detection of mental illness and early intervention leading to a reduction in disease. Conclusion: In spite of government‟s initiative to prioritise child and adolescent mental health services in South Africa, further endeavours are required to improve psychiatric services among this section of the population, including more clinics and child psychiatry training posts and extended social work services. Socio-economic factors influence the prevalence of childhood disorders. Hence, modifying the environment to which these children are exposed is an integral part of the holistic treatment approach

Background: Self-compassion which may be shaped by early attachment experiences involves being kind to oneself at times of difficulty and is consistently linked to psychological well-being. Self-compassion may be particularly useful in adolescence during which, difficulties associated with physiological and psychosocial transitions can lead to psychological distress. Aims: The aims of this thesis were twofold. First: to review the literature exploring the relationship between self-compassion and psychological distress in adolescents. Second: a research study to investigate the emerging theory that self-compassion may offer a healthier self-relating construct than self-esteem. The study examined whether self-compassion or self-esteem mediated the relationship between attachment and depression and anxiety in adolescents attending child and adolescent mental health services (CAMHS). Method: A systematic search of articles related to the relationship between self-compassion and psychological distress in adolescents was conducted. The quality of included papers was assessed. In the research study, 53 adolescents (mean age 15.52 years; 75% female) attending CAMHS presenting with symptoms of anxiety and/or depression were asked to complete five self-report questionnaires measuring: self-compassion, self-esteem, quality of life, satisfaction with attachment relationship and current symptoms of depression and anxiety. Results: The systematic review revealed 25 studies for inclusion. Studies reported an inverse relationship between self-compassion and psychological distress in adolescents. Quality ratings illustrated variation in methodological quality of included studies. In the research study self-compassion and self-esteem were both negatively correlated with depression and anxiety. The mediating impact of self-compassion was only apparent in the relationship between attachment availability and depression, but not anxiety. Contrary to the hypothesis, self-esteem mediated the relationship between attachment security and depression and anxiety to a greater extent than self-compassion. Conclusions: Self-compassion may have clinical implications in improving psychological well-being among adolescents. Future studies with different measures of self-compassion; varying study designs and consideration of contextual factors would increase understanding of the relationship between self-compassion and psychological distress in adolescents.

Thesis (M.S.P.H.)--University of Michigan, 1933.

Thesis (M.S.P.H.)--University of Michigan, 1933.

In recent years, there has been an ever increasing emphasis placed on the collection and use of patient reported outcome measures (PROM) in mental health services. This emphasis stems from a culture of evidence based practice, wherein PROM are shown to improve therapeutic outcomes at the clinical level, as well as provide information for the appropriate development of services and commissioning at a national level. This study uses an online survey to explore the use of PROM by mental health staff (n=112) in various Child and Adolescent Mental Health Services across England. Attitudes toward routine outcome monitoring practices and perceived competency around PROM use were also measured. Results found that although significant numbers of staff were using PROM, the amount of data being collected falls short of policy targets. Staff’s attitudes towards the practice are shown to be ambivalent, whereas overall perceived levels of competency were reasonably good. The relationships between attitudes, competence and PROM usage are discussed and a prediction model for PROM usage is developed in light of existing psychological theory. Results showed that training played an important role in the uptake of PROM and implications for the dissemination of training programs are emphasised.

Introduction: Young people with high functioning autism spectrum disorders (HFASD) are particularly vulnerable to developing comorbid depression. It has been suggested that young people with HFASD and comorbid mental health difficulties are likely to experience difficulties during the transition to adulthood. This transition involves significant changes in both services and daily routine, something which people with HFASD often find difficult. Aims: This thesis includes two distinct pieces of work. A systematic review aiming to understand the prevalence of depression in children and young people with HFASD. A qualitative study aiming to explore transition to adulthood from the perspectives of young people with HFASD, who currently attend child and adolescent mental health services (CAMHS), and their families. Methods: For the systematic review, literature reporting the prevalence of depression in children and young people with HFASD was systematically searched and reviewed. For the qualitative study, data collection and analysis followed the principles of Interpretative Phenomenological Analysis (IPA). Four dyads of a young person with HFASD and a parent were interviewed. Results: The systematic review identified 18 studies which described results from 17 independent samples. The prevalence reported varied from 0% to 83%. This variation is most likely explained by methodological differences between studies. In the qualitative study, transition to adulthood was described as a process during which the young person is developing independence, while parents continue to have a role in providing support. Current and future support needs were perceived differently by the young people with HFASD than their parents, with the young people reporting less need for support. Conclusions: Further research is needed to better understand how to assess depression in this population, as well as the impact of age, gender, setting, medication use and other comorbidities. Transition is a time of uncertainty and change for young people, during which they become more independent of their families. Services need to consider the impact of these processes and young people’s perceptions about what it means to receive support.

Bakgrund: Psykisk ohälsa ökar bland barn och unga, medan väntetiderna på många enheter blir längre och längre. Psykisk ohälsa kan påverka barn och ungas välbefinnande samt hela barnets familj. Grundläggande omvårdnadsbehov kan bli lidande. Det satsas stora pengar inom området, men förändringarna har hittills uteblivit. Kan tidig intervention påverka barns psykiska ohälsa och därmed ge evidens för allvaret med de långa vårdköerna? Syfte: Att undersöka faktorer och dess påverkan på barn och unga samt deras föräldrar i samband med långa väntetider inom barn och ungdomspsykiatrin. Metod: Studien genomfördes genom en litteraturöversikt baserad på 15 vetenskapliga artiklar med båda kvalitativ och kvantitativ metod. Sökningarna genomfördes i databaserna Cinahl, PubMed och PsycINFO. Resultat: Resultat visar flera fördelar med tidig intervention i behandlingsresultatet av psykisk ohälsa hos barn och unga såsom minskad ångest/oro och depressiva symtom. Dessa fördelar har även visat sig hålla sig kvar under en längre tid efter avslutad behandling. Resultatet visar även på att väntetiderna har en betydande påverkan på föräldrarna till barn och unga med psykisk ohälsa. I resultatet framkommer det att korta behandlingstider med tidig intervention ger ett förbättrat mående.  Slutsats: Psykisk ohälsa innebär en utmaning för barn och unga. Det finns stora brister inom barn och ungdomspsykiatrin. Barn och ungas psykiska hälsa måste börja tas på allvar. Barn och unga är landets framtid och bygger en grund för en vidare fungerande samhällsstruktur. Barn och ungdomspsykiatrin är en viktig enhet för främjandet, utvecklandet och bibehållandet av barn och ungas psykiska hälsa. / Background: Mental illness increases among young people, while waiting times for treatments are getting longer. Mental illness can affect the well-being of young people and their family. Basic nursing needs can be suffering. The government is investing money, but so far has no changes been seen. Can early intervention affect children’s mental health and provide evidence for the seriousness with the long care queues? Aim: To investigate factors and their effect on children and adolescents and their parents in connection with long waiting times in child and adolescent psychiatry. Method: A literature review based on 15 scientific articles with qualitative and quantitative methods. The searches were performed in the databases Cinahl, PubMed and PsycINFO. Result: The results shows benefits of early intervention in the treatment outcome of mental illness in children and adolescents such as reduced anxiety and depressive symptoms. These benefits have also been shown to persist for an extended period after completion of treatment. Waiting times has a significant impact on the parents of children with mental illness. Short treatment times with early intervention in mental illness in children and adolescents provides an improved feeling. Conclusion: Mental illness is a challenge for young people. There are shortcomings in treatment for mental illnesses. Mental health of children and adolescents must begin to be taken seriously. Young people is the future of the country and build a foundation for a further functioning society. Psychiatry is an important unit for development and maintenance of young people’s mental health.