Background: The challenges of research in economically stunted countries’ settings remains a profound concern and is linked to socioeconomic development of these countries. More research is needed regarding psychiatric morbidity in rural areas of the developing and poverty stricken countries. The present studies were undertaken within the framework of a broader ongoing community-based project on the course and outcome of major psychiatric disorders in the rural Butajira district located in Ethiopia. This thesis treats the course and outcome of bipolar I disorder in the district. Objectives: Through appraising mental health and population based research in a rural Ethiopian district, to evaluate the utility of modern research instruments, and to obtain baseline information relating to bipolar I disorder in the poverty stricken rural Butajira district of Ethiopia. The specific objectives were: 1. Evaluating and comparing two different screening methods of case detection and identification for schizophrenia and bipolar I disorder in the adult population of Butajira district. 2. Assesing the prevalence and clinical characteristics of of bipolar I disorder in Butajira at the community level. 3. Evaluating short-term outcome at follow-up of bipolar I disorder in the Butajira district. 4. Determining Neurological Soft Signs in community-identified cases of bipolar I disorder in Butajira district in comparison with healthy controls. 5. Assessing the burden of care among caregivers of those affected by bipolar I disorder identified in the Butajira Study. Methods: The district’s entire adult population aged 15-49 was identified through a double-sampling design. In the first stage of screening, door-to-door interviews were conducted by lay trained high school completed individuals who knew the culture of the people. Females interviewed females whereas males interviewed males. Additionally, the key-informants method was used to identify cases that would be missed by the CIDI or otherwise. The final confirmatory diagnostic interview was conducted by clinicians using the SCAN on door-to-door basis as well. The probable cases that fulfilled the lifetime DSM-IV diagnosis of bipolar I disorder were assigned for assessment by other baseline research instruments such as Neurological Evaluation vii Scale (NES), Young Mania Rating Scale, Hamilton Rating Scale for Depression, LCSS, PANS and SANS, BISS, BII, FIS and so on. Cases so identified with bipolar I disorder were subject to a follow-up for upto 2.5 years on the average (range 1 to 4 years). Two of the main clinical outcomes assessed were relapse to a mood episode, and remission from a mood episode. Outcomes were assessed annually by the instruments, and were further assessed monthly by trained psychiatric nurses. We also did a cross-sectional study of caregivers of bipolar I disorder cases, and assessed objective burden on the caregivers as considered from social, family strain, occupational and financial domains. Results: Information provided by the key informants was better at detecting schizophrenia or chronic psychiatric disease, whereas the CIDI was better at detecting affective disorders. Of the around 100 000 adults living in Butajira, 83.3% were found by the project’s census, of which 82% (68,378 subjects) were successfully screened by the CIDI, yielding 2,161 CIDI positive. These, together with 719 cases identified by the key informants, were invited for the SCAN interview, of which 74.7% agreed. This yielded 315 SCAN positive cases for bipolar I disorder, and complete information could be collected on 295 of these. Lifetime prevalence was estimated as 0.6% for males and 0.3% for females. The mean age of onset of the manic phase was 22.0 years and that of the depressive phase was 23.4 years. For 22.7% of the cases the illness started with a depressive episode and for the remaining 77.3% it started with a manic episode. Over half of the cases (55.9%) had never sought help from modern health care sector, and only 13.2% had ever been admitted to psychiatric hospital. At follow-up, 65.9% had exprerienced a relapse and 31.1% had persistent illness, while only 5% of the patients were in remission for most of the follow-up time. The bipolar I cases, as compared with healthy controls, performed worse on several items of NES, thus having more neurological dysfunction compared to controls. Caregives were largely (80.3%) first-degree relatives and spouses. Overall, 84% of the caregivers reported difficulties in at least one of the domains of family burden. Of these, 58.7% reported a severe degree of difficulties. Caregivers reported a high level of difficulties in intrafamilial relationships and social restrictions, disruption in earning a livelihood, and financial difficulties. Conclusions: The prevalence of bipolar I disorder is comparable to the prevalences reported from other countries, and our findings support the cross-cultural validity of the concept of bipolar I disorder. Majority of the cases are not treated in contrast to that in the developed countries. The burden of care for the caregivers is substantial in the population studied.

The purpose of this study was to evaluate the burden of care (BOC) of two presurgical infant orthopedic (PSIO) protocols used for complete unilateral cleft lip and palate (CUCLP), and to compare aesthetic outcomes with centres not utilizing PSIO. Four samples were collected. Two from the same centre that underwent either traditional infant orthopedics (TIO) or nasoalveolar molding (NAM) and two from centres not employing PSIO. BOC data were collected for the PSIO groups and photos at age 5 were collected for ratings of nasolabial aesthetics. The BOC of NAM was found to be significantly greater than IO for number of visits (9.9 vs. 6.6, (p<0.001)) and days wearing the appliance (127 vs. 112, (p<0.05)). Significant differences in aesthetic ratings were noted amongst the three centres but not between the NAM and TIO groups. Overall, an increased burden of NAM over TIO was detected, without an observable aesthetic improvement.

The purpose of this study was to evaluate the burden of care (BOC) of two presurgical infant orthopedic (PSIO) protocols used for complete unilateral cleft lip and palate (CUCLP), and to compare aesthetic outcomes with centres not utilizing PSIO. Four samples were collected. Two from the same centre that underwent either traditional infant orthopedics (TIO) or nasoalveolar molding (NAM) and two from centres not employing PSIO. BOC data were collected for the PSIO groups and photos at age 5 were collected for ratings of nasolabial aesthetics. The BOC of NAM was found to be significantly greater than IO for number of visits (9.9 vs. 6.6, (p<0.001)) and days wearing the appliance (127 vs. 112, (p<0.05)). Significant differences in aesthetic ratings were noted amongst the three centres but not between the NAM and TIO groups. Overall, an increased burden of NAM over TIO was detected, without an observable aesthetic improvement.

Broadly, the purpose of this study was to address the gaps in the knowledge base of caregiver strain through an examination of this and other theoretically related constructs in a sample of parents of high-risk youth. In the last two decades, a growing body of research has pointed to the significance of strain that can result from this caregiving experience, particularly as it relates to patterns of mental health services utilization. Despite the fact that the majority of children who receive mental health receive them from the school, few studies have examined caregiver strain in the context of school-based mental health services or with caregivers of youth in special education for Emotional Disturbance (ED). Additionally, while the Modified Double ABCX Model of family stress and coping has been identified as a useful model to understand caregiver strain and its related constructs, questions remain about how all of the components of this model work together to influence caregiver strain and the mechanism by which caregiver strain influences youth mental health service use and parent engagement in services. The specific aims of this study were to: (1) explore the construct of caregiver strain and its relationship with theoretically related constructs in caregivers of youth in special education for ED, and (2) examine the factors, including caregiver strain, that predict school-based mental health services utilization and parent engagement in services. Secondary analyses were conducted using data collected as part of a randomized controlled trial of a parent support intervention for caregivers of youth in special education for ED. Participants included 112 caregivers and you their youth recruited from 22 schools and special education centers. Data were provided by caregivers and school-based mental health service providers. Caregivers completed phone interviews conducted upon entry into the study and again approximately nine months later. These semi-structured interviews included measures of youth functioning, caregiver strain, and caregivers’ perceptions related to their child’s problems and engagement in services. School-based mental health service providers supplied data related to the amount of school-based mental health counseling services received by youth and whether caregivers consulted with service providers during the study period. Data were analyzed using a variety of quantitative methods, including descriptive statistics, dependent samples t-tests, one-way ANOVA, Structural Equation Modeling (SEM), multiple linear regression, and multiple logistic regression. Results revealed that caregivers reported the highest levels of subjective-internalizing strain, and that the level of three types of caregiver strain decreased from time 1 to time 2. Additionally, caregivers of males tended to report higher levels of strain than caregivers of females, and parents tended to report higher levels of strain than other caregivers. Consistent with previous studies, non-Hispanic Black caregivers tended to report the lowest levels of caregiver strain compared to all other racial/ethnic groups. Findings from SEM analyses revealed that following slight modifications to the originally hypothesized model, the model tested fit the data well and all of the paths included in the model (other than those related to race/ethnicity) had statistically significant parameter estimates. Findings from the multiple linear regression analyses revealed that collectively the predictors included in the model accounted for only a small percentage of the variance in the outcome (11.9%), and none of the predictors included in the regression model significantly predicted the amount of school-based counseling received by students. Results from the multiple logistic regression analyses revealed that only youth gender and youth conduct problems were significant predictors of the outcome; caregivers of male youth and caregivers of youth with more conduct problems were less likely than caregivers of female youth and caregivers of youth with fewer conduct problems, respectively, to have consulted with their child’s school-based mental health services provider during the school year. Collectively, findings from this study demonstrate that caregivers of youth in special education for ED experience caregiver strain to a similar degree as caregivers of youth receiving services through mental health systems. Further, findings provide evidence for the usefulness of the Modified Double ABCX Model in studying and understanding caregiver strain in this population. While findings from this study provide support for the relationships among the constructs of this model, findings from this study also suggest that this model may not hold up in terms of predicting the amount of school-based services received by youth or the likelihood of parent engagement with their child’s school-based mental health service provider. Additional research is needed that includes a more complete representation of the constructs of this model to determine if this model holds for school-based service use and engagement.

Inledning: Personer i det utökade privata nätverket (PUPN) bjuds in till nätverksmöten runt en individ eller familj i syfte att vara till hjälp i en svår situation. Studier som undersöker hur PUPN själva påverkas av deltagande i nätverksmöten saknas i hög grad. Frågeställningar: Hur upplever PUPN att de har påverkats av deltagande i närståendes nätverksmöten? Hur upplever PUPN att deltagande i nätverksmöten påverkar möjligheten att vara till hjälp för närstående? Hur upplever PUPN sig som belastade av huvudpersonens/ernas problematik? Metod: Studien har gjorts med kvalitativ undersökningsmetod. Intervjuer med 6 PUPN har genomförts. Resultat: Resultaten visar att PUPN fungerar som både praktiskt och känslomässigt stöd till närstående. Samtidigt upplever de sig själva som känslomässigt belastade av närståendes problematik. Deltagande i närståendes nätverksmöten har lett till minskad känslomässig belastning för egen del, men det förekommer också till viss del oförändrad och delvis ökad belastning. I några fall har deltagande i nätverksmöten gett effekter mer fristående från de närståendes problem i form av känsla av ökad status, ökad självkänsla och förändrad upplevelse av relationen till den närstående. Det finns upplevelser hos intervjupersonerna av att ha kunnat vara till bättre hjälp för sina närstående efter deltagande i nätverksmöten. Några olika typer av hjälparidentitet har kunnat urskiljas bland intervjupersonerna. De mest kontrasterande typerna skiljer sig markant åt vad gäller upplevelse av egen belastning, möjlighet att vara till stöd och hjälp och inställning till nätverksmöten. Diskussion: PUPN med position mellan direkt berörda och yrkeshjälpare diskuteras som möjlig brobyggare mellan mikronivåer runt nätverksmötets huvudperson. Att nätverksmöten kan ge minskad belastning hos PUPN lyfts fram som en positiv bieffekt av arbete med nätverksmöten. / Introduction: Members of the extended private network (MEPNs) are invited to network meetings around an individual or a family in order to help in a difficult situation. There are very few studies that investigates how MEPN themselves are affected by their participation in network meetings. Research questions: How does participation in a closely related person’s (CRP’s) network meetings affect the MEPN? How does participation in network meetings influence how the MEPN can be of help for the CRP? In what ways do the MEPN experience burden of care related to the CRP’s problematic situation? Method: A qualitative research method has been used, and the study is based on interviews with 6 MEPNs. Results: The results shows that MEPNs give both practical and emotional support to their CRPs. At the same time MEPNs experience emotional burden related to the problematic situation of their friend or relative. Participation in the CRP’s network meetings has led to emotional relief, but there are also examples of partly unchanged or partly increased burden. In some cases participation in network meetings has given effects not directly related to the CRP’s problems, in the forms of feelings of increased social status, increased self confidence and changed relations to the CRP. There are experiences among the interviewed persons that they can be of better help for their friends and relatives after participation in network meetings. Different types of helpers have been identified among the interview persons. The most contrasting ones show differences in terms of experienced burden, ability to be of help and support and attitude towards network meetings. Discussion: The MEPN’s position between the suffering person/family and the professional network is discussed as possible bridges between microlevels around the CRP. The potential to bring relief to the MEPN is considered as a positive side effect of participation in network meetings.

In an attempt to replicate and extend previous research, the present study conducted a brief psychoeducational intervention through community organisations designed to overcome methodological shortcomings of past studies. The two session intervention (one session with follow-up phone call) sought to establish if a brief community intervention was effective in both improving family members’ knowledge about schizophrenia and various other indicators linked to improved client functioning. People with schizophrenia and their family members (N = 50) were recruited into a controlled trial of a brief educational intervention. Clients and their corresponding key family members were randomly allocated to a treatment group or a wait-list control group. Measures included those reflecting knowledge about schizophrenia, expressed emotion, perceived coping ability, burden of care and distress. Analyses showed that knowledge increased significantly after the intervention and not after the control condition and was maintained at a nine-month follow-up. Family members’ and clients’ expressed emotion ratings significantly decreased from pre- to post-test with changes in total expressed emotion scores improving across treatment by over twice the magnitude compared to the control condition. All gains were maintained at the nine-month follow-up, with continuing improvement seen in family members’ intrusiveness ratings. A similar pattern of findings was reflected on other indices, with significant improvements in burden of care, coping and distress that were more a function of intervention than the control condition. All gains were maintained at the nine-month follow-up. Additionally, assessment of relapse rates at this follow-up interval indicated that no client had relapsed. Overall the results suggested that although knowledge increased as a result of education, the improvements in all indicators other than knowledge appeared to be due to education combined with some non-specific factors. These non-specific factors may have included expectancy effects, setting effects, sampling bias and other possibilities. These issues are considered in terms of implementation of brief programs in supportive community settings and in terms of future research.

The worldwide ageing of the population, with an increase in associated chronic diseases, will inevitably escalate the demand for social work services at individual, group and community level. Alzheimer’s disease is one of the conditions associated with a population that is growing older. The disease was first described by Alois Alzheimer in 1906 and is characterised by progressive declines in cognitive and body functions, eventually resulting in death. It is estimated that 25 to 30 million people worldwide suffer from Alzheimer’s disease and that in 2050, 106.2 million people will be living with the disease, causing a looming global epidemic of Alzheimer’s disease (Brookmeyer, Johnson, Ziegler-Graham & Arrighi, 2007:186). At some stage in the disease’s process, most, if not all people with Alzheimer’s, require some form of care. This care is generally provided by informal (family) caregivers in the community. Providing care to an older person with Alzheimer’s disease present multiple challenges with many factors influencing the caregiving experience. When the needs of caregivers are not met, caregiver burden may result. For the many families living in rural and impoverished areas, this additional responsibility may come as an extraordinary burden and cause unwarranted stress. The goal of the study was to explore the needs and experiences of caregivers of persons with Alzheimer’s disease living in black rural communities in Mpumalanga. The guiding research question was: What are the needs and experiences of caregivers of persons with Alzheimer’s disease living in black rural communities in Mpumalanga? A qualitative research approach was followed with a collective case study research design. The population for this study was caregivers providing care to persons diagnosed with Alzheimer’s disease living within the Ehlanzeni and Nkangala Rural Districts Municipalities of Mpumalanga. Non-probability purposive sampling was utilised to generate a sample. Eleven participants who were caregivers of persons with Alzheimer’s disease living in communities within the above-mentioned municipalities were selected. Semi-structured individual interviews were conducted with participants. Interviews were voice recorded with the permission of the participants, and were transcribed by a contracted transcriber. The data gathered were analysed by the researcher and themes and sub-themes were identified. The research findings were presented by providing a profile of research participants followed by a thematic analysis of the themes and sub-themes from the transcriptions. Literature control and verbatim quotes were used to support the findings. The themes include the following: Theme One – The Alzheimer’s disease caregiver; Theme Two – Indigenous issues with regards to Alzheimer’s disease; Theme Three – Caregivers’ understanding of Alzheimer’s disease; Theme Four – The impact of Alzheimer’s disease on the caregiver and Theme Five – Support services in the community. The conclusions of this study reflect that caregivers in black rural communities in Mpumalanga have a number of needs and challenges in providing care to a person with Alzheimer’s disease. Some of the challenges include the absence of caregiving training, stigmatisation due to indigenous beliefs, traditional healers’ diagnosis and treatment of Alzheimer’s disease, limited knowledge of caregivers about Alzheimer’s disease, adverse physical, social and psychological outcomes associated with caregiving, negative experiences with the public health care system, and the limited availability and accessibility of support services in the community. The recommendations offered by this study can be used by professionals working in the field of gerontology to understand the needs and experiences of Alzheimer’s caregivers. Social workers can use the recommendations to find ways to make their services known to the communities, and improve their intervention and support to these caregivers. / Dissertation (MSW)--University of Pretoria, 2015. / Social Work and Criminology / Unrestricted

Contexte: L’anxiété alimente l’évitement des traitements dentaires et occasionne une négligence de la santé bucco-dentaire. Cet évitement est amplifié par des inquiétudes liées à la douleur et l’insatisfaction potentielles à la suite d’une rencontre chez le dentiste. L’anxiété, la douleur et l’insatisfaction ne sont donc pas mutuellement exclusives et peuvent être regroupée sous une mesure composite appelée le fardeau de soins. Une intervention d’écoute musicale pourrait s’avérer efficace pour réduire le fardeau de soins des patients tel qu’observé dans la littérature pour divers contextes chirurgicaux. Cependant, les évidences appuyant les bienfaits d’une intervention musicale sur le fardeau de soins au cours de chirurgies dentaires sont limitées et les résultats sont hétérogènes en raison d’un manque de consistance sur le plan méthodologique. Objectif: L’objectif de cette étude était d’explorer les effets d’une intervention d’écoute musicale personnalisée sur le fardeau de soins associé à une greffe gingivale en comparaison à l’écoute de livres audios (contrôle). Méthodologie: Deux groupes de patients ont reçu la greffe gingivale autogène accompagnée de l’intervention musicale personnalisée (n= 25) ou d’un livre audio (n= 22). Les patients ont été attribués aléatoirement aux groupes en double aveugle (le chirurgien ignorait la stimulation auditive et les participants ignoraient la condition contrôle). Des mesures auto-rapportées d’anxiété, de douleur, d’insatisfaction et d’état émotionnel ont été prises avant et après la chirurgie. Les mesures postopératoires d’anxiété, de douleur et d’insatisfaction ont été combinées en une mesure composite du fardeau de soins. Les participants ont également complété les jugements émotionnels de leur stimulation auditive respective après la chirurgie. Résultats: Aucune différence significative n’a été observée entre les stimulations auditives pour le fardeau de soins et ses composantes. Les résultats illustrent une fluctuation des niveaux d’anxiété et de douleur à travers les temps de mesures pour les deux groupes. La musique a été perçue comme plus relaxante que le livre audio (U = 144.00, p =.005, η2=.17). Les participants, ayant rapporté plus d’émotions négatives avant (r =0.44, p =.002, R2 =.19) et après (r =0.42, p =.004, R2 =.17) la chirurgie, ont illustré un fardeau de soins plus important. Il n’y avait pas de différences significatives entre les groupes pour l’état émotionnel des participants. Conclusion: Il est possible que les deux stimulations auditives (musique et livre audio) soient efficaces pour réduire le fardeau de soins (et ses composantes séparément). Des évidences additionnelles sont nécessaires afin de confirmer les bienfaits d’une intervention musicale durant une chirurgie de greffe gingivale. Les recherches futures devraient inclure un troisième groupe recevant le traitement habituel afin d’évaluer l’effet des deux stimulations auditives sur le fardeau de soins. / Background: Anxiety feeds the avoidance of dental treatments which leads to the neglect of general oral health. This avoidance is often amplified by the fear of potential pain and dissatisfaction. Anxiety, pain and dissatisfaction are not mutually exclusive and can be combined into a composite measure called burden of care. A musical intervention could be beneficial to reduce this burden of care as shown in many surgical settings in the literature. However, there is limited evidence of the benefits of music listening during dental surgeries and results are heterogenous due to a lack of consistency in the methodology. Objective: The aim of this study was to explore the effects of a personalized musical intervention on the burden of care during autogenous gingival grafts in adults while comparing it to an active control (audiobook). Method: Two groups of patients received the autogenous gingival graft along with the personalized musical intervention (n=25) or an audiobook of choice (n=22). Participants were distributed randomly between groups in a double-blind design (surgeons were unaware of the assigned auditory stimuli and participants were unaware of the control condition). Self-reported measures of anxiety, pain, dissatisfaction, and emotional state were taken preoperatively and postoperatively. Postoperative measures of anxiety, pain and dissatisfaction were combined into a burden of care composite measure. Emotional ratings of the auditory stimuli were evaluated after the surgery. Results: There were no significant differences between the auditory stimuli on the burden of care and its separated components. Results show a fluctuation of anxiety and pain levels through time for both groups. Music was perceived as more relaxing than the audiobook (U = 144.00, p =.005, η2=.17). Participants, who felt more negative emotions before (r =0.44, p =.002, R2 =.19) and after the surgery (r =0.42, p =.004, R2 =.17), had a larger burden of care. There were no significant differences in the emotional states of the participants between the two groups. Conclusion: It is possible that both auditory stimuli (music or audiobook) are effective in the reduction of the burden of care (and its components separately). Further evidence is needed to verify the benefits of a personalized musical intervention during autogenous gingival grafts. Future research should add a third group of standard care to facilitate the evaluation of both auditory stimuli’s effects on the burden of care.

No description available.