Browsing by Author "Du Toit, Stefani"

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    Adolescent mental health in the context of adversity : evidence from a longitudinal intervention study in Khayelitsha, South Africa
    (Stellenbosch : Stellenbosch University, 2023-12) Du Toit, Stefani; Skeen, Sarah; Haag, Katharina; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Global Health. Health Systems and Public Health.
    ENGLISH SUMMARY: The World Health Organization defines adolescents as individuals between the ages of 10 and 19 years, undergoing transition from childhood to adulthood [1, 2]. Adolescence is a rapid developmental phase during which an individual undergoes major physical and psychological changes [1]. The changes that occur during this period create a vulnerability that is accentuated by exposure to risk factors such as poverty, community violence, and lack of access to basic services [1-5]. Mental health conditions most commonly appear during adolescence [1]. Experiencing mental health conditions during this period can have lasting effects on an individual's health, as it can increase the risk of substance use, violence victimisation and perpetration, and suicidal ideation [6-8]. There is a critical gap in the exploration of mental health conditions among adolescents in low- and middle-income countries, particularly in sub-Saharan African countries, where most adolescents live in the context of widespread poverty [9]. Most of the research on adolescent mental health is conducted in high-income countries, despite nearly 90% of the world's adolescent population living in low- and middle-income countries [9, 10]. There is an urgent need to assess potential risk and protective factors, as well as interventions, to address the mental health of adolescents in these contexts. To design effective preventative initiatives that aim to protect adolescents from the adverse consequences of mental health conditions, it is crucial to understand risk and protective factors at various stages throughout the life course. In addition, a comprehensive understanding of support structures and interventions that can aid in the prevention of mental health conditions and the promotion of positive mental health among adolescents is crucial. This thesis is based on research reported on four articles. The first two articles report on predictors of mental health problems, exploring both early childhood and current environmental factors. The second two articles in this thesis report on potential interventions for adolescent mental health.
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    Psychosocial interventions targeting mental health in pregnant adolescents and adolescent parents : a systematic review
    (BMC (part of Springer Nature), 2020-05-14) Laurenzi, Christina A.; Gordon, Sarah; Abrahams, Nina; Du Toit, Stefani; Bradshaw, Melissa; Brand, Amanda; Melendez-Torres, G. J.; Tomlinson, Mark; Ross, David A.; Servili, Chiara; Carvajal-Aguirre, Liliana; Lai, Joanna; Dua, Tarun; Fleischmann, Alexandra; Skeen, Sarah
    Background: Pregnancy and parenthood are known to be high-risk times for mental health. However, less is known about the mental health of pregnant adolescents or adolescent parents. Despite the substantial literature on the risks associated with adolescent pregnancy, there is limited evidence on best practices for preventing poor mental health in this vulnerable group. This systematic review therefore aimed to identify whether psychosocial interventions can effectively promote positive mental health and prevent mental health conditions in pregnant and parenting adolescents. Methods: We used the standardized systematic review methodology based on the process outlined in the World Health Organization’s Handbook for Guidelines Development. This review focused on randomized controlled trials of preventive psychosocial interventions to promote the mental health of pregnant and parenting adolescents, as compared to treatment as usual. We searched PubMed/Medline, PsycINFO, ERIC, EMBASE and ASSIA databases, as well as reference lists of relevant articles, grey literature, and consultation with experts in the field. GRADE was used to assess the quality of evidence. Results: We included 17 eligible studies (n = 3245 participants). Interventions had small to moderate, beneficial effects on positive mental health (SMD = 0.35, very low quality evidence), and moderate beneficial effects on school attendance (SMD = 0.64, high quality evidence). There was limited evidence for the effectiveness of psychosocial interventions on mental health disorders including depression and anxiety, substance use, risky sexual and reproductive health behaviors, adherence to antenatal and postnatal care, and parenting skills. There were no available data for outcomes on self-harm and suicide; aggressive, disruptive, and oppositional behaviors; or exposure to intimate partner violence. Only two studies included adolescent fathers. No studies were based in low- or middle-income countries. Conclusion: Despite the encouraging findings in terms of effects on positive mental health and school attendance outcomes, there is a critical evidence gap related to the effectiveness of psychosocial interventions for improving mental health, preventing disorders, self-harm, and other risk behaviors among pregnant and parenting adolescents. There is an urgent need to adapt and design new psychosocial interventions that can be pilot-tested and scaled with pregnant adolescents and adolescent parents and their extended networks, particularly in low-income settings. Keywords: Adolescent pregnancy, Adolescent parenthood, Mental health, Psychosocial interventions, Systematic review, Meta-analysis
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    Structural brain differences and motor functioning in prenatally Methamphetamine exposed children in Cape Town
    (Stellenbosch : Stellenbosch University, 2017-12) Du Toit, Stefani; Roos, Annerine; Coetzee, Bronwyne; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
    ENGLISH SUMMARY: Rates of methamphetamine use amongst pregnant women in South Africa is alarmingly high, rendering a large number of infants and children at risk for the adverse consequences of prenatal methamphetamine exposure (PME). Indeed, little is known about the effect of PME on brain and cognitive development in exposed children, especially in lowand middle-income settings like South Africa. The aim of the study was to contribute to the small, but growing, body of research that focuses on the brain development and motor performance of prenatally MA exposed children. The objectives were: (1) to examine the effect of PME on motor development in exposed children at the age of 8 years, compared to unexposed children of the same age; (2) to examine the effect of PME on structural brain volumes and cortical thicknesses of the brain in exposed children at the age of 8 years, compared to unexposed children; and (3) to investigate whether a correlation exists between altered brain development and motor function. Participants were 8 year old PME children (n = 17), and unexposed children (n=16) recruited from a local school and day care centre in the northern suburbs of Cape Town. PME children and unexposed controls completed two neurocognitive assessments (Beery Visual Motor Integration (VMI) test and Grooved Pegboard Test), assessing various aspects of motor function. Both groups also underwent magnetic resonance imaging (MRI). Independent sample t-tests showed that PME children scored significantly lower on measures of visual-motor integration, visual-motor coordination and fine motor development, when compared to unexposed children. Hierarchical regression analysis considering potential confounding anthropometric and socio-demographic variables and group effects, confirmed that poorer motor scores observed amongst PME children was as a result of PME. Analysis of variance (ANOVA) by group revealed that PME children had reduced cortical thickness in several brain areas that were associated with motor function.Overall, the findings of this study contribute to the growing body of literature available on the effect of PME on brain and motor development, especially in the South African context.