Doctoral Degrees (Psychiatry)

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Browsing Doctoral Degrees (Psychiatry) by Subject "Alcoholism -- South Africa -- Wellington"

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    Trauma and Post-Traumatic Stress Disorder (PTSD) in women with alcohol abuse and dependence in a community sample in the Western Cape Province, South Africa
    (Stellenbosch : Stellenbosch University, 2014-04) Pithey, Alitha; Seedat, Soraya; May, Phillip A.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
    ENGLISH ABSTRACT: Women in the communities of the Western Cape Province of South Africa are confronted with high levels of trauma exposure and acute stressful life events. Many live in rural communities where violence, rape, murder and substance abuse are prevalent. These women are also confronted with poor education, lack of support, poor health, are under-privileged and often live in overcrowded conditions (Riley et al., 2003). The consumption of alcohol during pregnancy is problematic – resulting in one of the highest provincial rates of Fetal Alcohol Syndrome (May et al., 2000). One of the major contributing factors is arguably untreated trauma and PTSD. However, rates of trauma exposure and PTSD have not previously been systematically documented. This study aimed to (i) determine the prevalence of trauma and post-traumatic stress disorder (PTSD) in women with alcohol use disorders (AUDs) in a community sample relative to women without alcohol abuse/dependence, and to establish the relationship between trauma exposure, onset of PTSD and the severity and course of AUDs and other psychopathologies (e.g. depression, other anxiety symptoms, other substance misuse); (ii) further determine if the development of an AUD is secondary to the onset of PTSD and to assess if there are differences in the type and severity of exposure to traumatic and stressful life events in alcohol abusing/dependent women with and without PTSD; (iii) assess the relationship of co-morbid PTSD to drinking outcomes in women with AUDs who enter case management; and (iv) to assess the diagnostic difference between women who have a child with FASD (Fetal Alcohol Syndrome Disorder), and women who do not. This study was nested within a National Institute on Alcohol Abuse and Alcoholism (NIAAA)-funded Fetal Alcohol Syndrome (FAS) Prevention Study that commenced in May 2008. The communities of Wellington, as well as the Bonnievale, Robertson, Ashton and Montagu (BRAM) communities in the Western Cape Province were included. Interviews, questionnaires and case note reviews were used to assess the relationship between trauma, PTSD, and alcohol use disorders in these communities and to establish the relationship of trauma and PTSD to drinking outcomes in a sub-sample of women who enter case management. In each area 99 randomly selected community members completed a community survey to determine the community profile and to establish community-specific challenges and stressors. The community survey sample included 79 males and 119 females in total. The maternal questionnaire component consisted of 100 mothers of FAS and Partial Fetal Alcohol Syndrome (PFAS) children, who were selected based on their children’s diagnosis in the in-school screening phase. The first 100 mothers with a child with FAS or PFAS were classified as cases for this study. Some 400 controls were randomly selected in each study community (200 BRAM and 200 Wellington) and comprised mothers of children sampled in the in-school screening phase who did not have a diagnosis of FAS of PFAS. Thus, in total, 500 mothers completed maternal questionnaires. The case-management component involved 50 women in Wellington who were identified as being at high risk for a child with FASD. Assessments included interviews at intake, 6 months follow-up, 12 months follow-up, and 18 months follow-up. The main findings of the study were as follows: In terms of the prevalence of trauma and PTSD in women with and without alcohol abuse/dependence, the maternal study indicated that significantly more women with alcohol dependence and alcohol abuse had a diagnosis of PTSD(x2 =7.95, p=0.00). The mean age that women with an alcohol use disorder and a diagnosis of PTSD started drinking alcohol regularly was 19.42 years (SD=3.8), and the mean age that women with an alcohol use disorder without a diagnosis of PTSD started drinking alcohol regularly was 17.81 years (SD=2.6), with a statistically significant group difference (t(320) = -1.87, p=0.05). The results suggest that in women with an alcohol use disorder in whom a diagnosis of PTSD is also present, initiation of regular drinking occurs later in adulthood. In terms of intimate partner violence, early life trauma and everyday stressful life events in women with alcohol abuse/dependence and PTSD, the following findings were evident: Women with an AUD and PTSD were significantly more exposed to intimate partner violence compared to women with an AUD without PTSD (x2 =7.42, p=0.00) .There were no significant group differences in childhood trauma exposure. Women with an AUD and PTSD also reported significantly more stressful life events than women with an AUD without PTSD (p=0.00). In addition, women with a FASD child had higher rates of PTSD, alcohol use disorder, depression and intimate partner violence compared to women without a FASD child with significant differences (p=0.00). The results indicated a positive association between the severity of alcohol abuse/dependence and the presence and severity of depressive symptoms (x2 =15.0, p=0.00). Women with an AUD and PTSD were expected to have worse drinking outcomes than those without a diagnosis of PTSD. The Davidson Trauma Scale and the PTSD module of the MINI were used to diagnose PTSD. The AUDIT was administered at intake, 6, 12 and 18 months follow-up to determine if there was a difference in drinking outcomes between women with and without PTSD. Women with PTSD had higher AUDIT scores at intake, 6 months follow-up and 12 months follow-up, but lower at 18 months follow-up, compared to women without PTSD. Women with PTSD, therefore, appear to have a more unfavourable drinking course than women without PTSD. However, the hypothesis that women with PTSD would have worse drinking outcomes (Schumacher et al., 2006) at 6 months follow-up and at 12 months follow-up could not be evaluated given the small sample of women evaluated in case management, and in particular the finding that only two women met criteria for PTSD. As such the sample did not provide adequate power to detect group differences. May et al. (2007) also recommended case management in a rural community in South Africa with high risk women. The results highlight the importance of screening for psychopathology and appropriate intervention in women with and without AUDs. From the study it is evident that women who have AUDs are at high risk for depression, intimate partner violence and PTSD. In addition, women who experience trauma, depression and intimate partner violence require timeous interventions to prevent later development of alcohol abuse/dependence. More research on the effectiveness of case management for women with PTSD and alcohol dependence is required.