Department of Psychiatry

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Browsing Department of Psychiatry by browse.metadata.advisor "Brakarsh, Jonathan"

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    Integrating a trauma-informed psychological intervention for PTSD among PLWH on the Friendship Bench in Zimbabwe : a mixed methods formative study
    (2018-12) Verhey, Ruth; Seedat, Soraya; Brakarsh, Jonathan; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
    ENGLISH SUMMARY : Introduction: Posttraumatic Stress Disorder (PTSD) and other Common Mental Disorders (CMD), such as depression and anxiety disorders, are highly prevalent in people living with HIV (PLWH). In Zimbabwe, an effective and culturally acceptable task-shifted psychological intervention for CMD, the Friendship Bench (FB), is offered in primary health care facilities (PHC). We found high levels of PTSD comorbidity among FB beneficiaries with CMD in preliminary studies and therefore sought to enhance the existing program by including a trauma-informed care component. Finding a strategy for such an inclusion has been the focus of this PhD thesis. Method: Formative work included a systematic literature review that was carried out first to establish knowledge about existing programs addressing PTSD in PLWH. Secondly, a qualitative study to explore the counseling experiences of clients and counselors with regards to PTSD-symptomatology was undertaken. It used a thematic content approach to analysing semi-structured interviews with beneficiaries (n=10) and lay health workers (LHWs) (n=5) that were conducted with an interview guide. Thirdly, the PTSD Checklist (PCL-5) was validated against the Clinician-Administered PTSD Scale (CAPS-5). Finally, we established prevalence and factors associated with PTSD in PHC clients (n=204) and LHWs (=183) through a cross-sectional study. Results: There is a dearth of evidence-based interventions in low- and middle-income countries (LMIC) with identified interventions being from high-income countries (HIC). The qualitative study identified the term kufungisisa kwenjodzi (excessive thinking due to trauma) as the local equivalent for PTSD/HIV-related PTSD. Traumatic events were defined as circumscribed incidents and ongoing pervasive experiences while LHWs recognized PTSD Symptoms. Clients described receiving psychological support as helpful. The PCL-5 cut-off of ≥33 yielded a sensitivity and specificity of 74.5% (95%CI: 60.4-85.7) and 70.6% (95%CI: 62.7-77.7), respectively, and good internal consistency (Cronbach’s alpha = 0.92). The prevalence of PTSD amongst PHC clients, of whom 91 (44.6%) were HIV-positive, using the PCL-5, was 40.7% (n=83), and of those 69.5% (n=57) had comorbid CMD as measured with the Shona Symptom Questionnaire (SSQ14>=9) (OR 6.48 (95%CI [3.35-12.54]). Results showed that PTSD was associated with recent negative life events (past six months) (OR 3.73 95%CI [1.49-9.34]) and chronic illness (OR 2.07 95%CI [1.15-3.72]). Amongst the FB counselors (n=182), the survey found a low prevalence of PTSD of 6% (n=11) and of CMD of 11% (n=17). Discussion: To our knowledge there are no task-shifted PTSD approaches for PLWH in LMICs. PTSD symptomatology and its conceptualization can be defined using cultural idioms of distress. The high prevalence of HIV-related PTSD and comorbidity with other CMD emphasizes the need for a trauma-informed intervention. Furthermore, the low rates of PTSD and CMD among LHWs suggests that it is feasible to train them to deliver trauma-informed care. This thesis recommends a trauma-informed approach that includes basic screening for trauma exposure, followed by questions about the main symptom clusters with incorporation of emotional regulation skills. It concludes with an algorithm for a trauma-informed FB component to address the needs of those suffering from PTSD and CMD and makes recommendations for future research.