Substance use and self-harm at an urban South African hospital: implications for suicide prevention, service delivery and future research
| dc.contributor.advisor | Bantjes, Jason | en_ZA |
| dc.contributor.author | Breet, Elsie | en_ZA |
| dc.contributor.other | Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology. | en_ZA |
| dc.date.accessioned | 2018-02-08T12:37:24Z | |
| dc.date.accessioned | 2018-04-09T06:53:35Z | |
| dc.date.available | 2018-02-08T12:37:24Z | |
| dc.date.available | 2018-04-09T06:53:35Z | |
| dc.date.issued | 2018-03 | |
| dc.description | Thesis (PhD)--Stellenbosch University, 2018. | en_ZA |
| dc.description.abstract | ENGLISH SUMMARY: Self-harm is a form of suicidal behaviour which constitutes a serious public health problem in low-income and middle-income countries (LMICs). The World Health Organization identifies substance use as a potentially modifiable risk factor for suicidal behaviour, including self-harm. Little is known about the prevalence, correlates, nature, and context of substance use among self-harm patients in South Africa. In this thesis, I explored the relationship between substance use and self-harm among patients who presented for treatment at an urban hospital in the Western Cape, South Africa. I employed a mixed methods research design and present my findings in the form of four journal articles. In the first article, I report on the results of a systematic review to investigate what is known, and what remains unknown, about the relationship between substance use and suicidal behaviour in LMICs. From the review results, I argue that: (1) the assessment and management of substance use should be integral to the care of at-risk patients; (2) suicide prevention research in LMICs should focus on reducing hazardous use of alcohol, tobacco, cannabis, opioids, sedatives, stimulants and non-medical use of medications; and (3) more research is required to understand the nature of the relationship between substance use and suicidal behaviour. In articles two and three, I report on two quantitative studies, consisting of a retrospective review of patient files to establish the demographic characteristics, patterns of medical service utilisation, and sociocultural differences between self-harm patients who report substance use and other self-harm patients (i.e. those who reported no substance use) among 238 self-harm patients. I focused on acute use of substances (i.e. substance intoxication) (AUS) in article two and chronic substance use (i.e. recurrent substance use over an extended period) (CSU) in article three. In article two, bivariate and multivariate statistical analysis showed that one in five selfharm patients reported AUS. Compared to other self-harm patients, the AUS sub-group were more inclined to: have depressed levels of consciousness on admission; utilise more medical resources; report previous acts of self-harm; and state an intention to die as a result of their injuries. In article three, 37% of self-harm patients reported CSU. Compared to other self-harm patients, the CSU sub-group were more likely to be male; to inflict damage to their body tissue; and to have a history of self-harm. A significantly smaller proportion of CSU patients, compared to other self-harm patients, were referred for psychiatric assessment (p<0.001). For article four, I conducted a qualitative study by analysing semi-structured interviews of 80 self-harm patients who were admitted to the hospital. I made use of a multiple-case study methodology and identified seven ways in which patients understood their substance use was implicated in their self-harm: impulsivity, poor judgment, and aggression; auditory hallucinations or paranoia related to substance use; substance use to facilitate self-harm; substance use as a method of self-harm; unsuccessful treatment for substance use disorder; the breakdown of substance use as a means of coping; and third-party substance use. I conclude this thesis by, reflecting on the broad aim and offering recommendations for future research and suicide prevention at the hospital where data were collected. | en_ZA |
| dc.description.abstract | AFRIKAANSE OPSOMMING: Selfbeskadiging is ‘n vorm van selfmoordgedrag wat 'n ernstige openbare gesondheidsprobleem is in lae-inkomste- en middelinkomste-lande (LMIL). Die Wêreldgesondheidsorganisasie (WGO) identifiseer substansgebruik as 'n potensieel veranderbare risikofaktor vir sekere uitkomste onder individue wat selfbeskadig. Min is bekend oor die voorkoms en korrelate, aard, en konteks van substansgebruik onder selfbeskadigingpasiënte in Suid-Afrika. In hierdie proefskrif, ondersoek ek die verhouding tussen substansgebruik en selfbeskadiging, asook die sosiokulturele konteks waarin hierdie gedrag plaasgevind het, onder pasiënte wat behandeling ontvang in 'n stedelike hospitaal in die Wes-Kaap, Suid-Afrika. Ek het 'n gemengde metode navorsingsontwerp onderneem en my gevolgtrekkings in vier tydskrif artikels aangebied. In die eerste artikel rapporteer ek die resultate van 'n sistematieseoorsig om ondersoek in te stel oor wat bekend is, en wat nog onbekend is, van die verhouding tussen substansgebruik en selfmoordgedrag in LMIL. Vanuit die resultate argumenteer ek dat: (1) die assessering en bestuur van substansgebruik ʼn integrale deel moet wees van die versorging van risiko-pasiënte; (2) selfmoordvoorkomingsnavorsing in LMIL moet fokus op die vermindering van die gevaarlike gebruik van alkohol, tabak, cannabis, opioïede, kalmeermiddels, stimulante en die nie-mediese gebruik van medisyne; en (3) meer navorsing benodig word om die aard van die verhouding tussen substansgebruik en selfmoordgedrag te verstaan. In artikels twee en drie, rapporteer ek oor twee kwantitatiewe studies wat behels die retrospektiewe hersiening van pasiëntlêers om die demografiese eienskappe, patrone van mediese diensbenutting en sosiokulturele verskille te identifiseer tussen selfbeskadigingpasiënte wat substansgebruik rapporteer en ander selfbeskadigingpasiënte (diegene wat geen substansgebruik rapporteer het nie) onder 'n kohort van 238 selfbeskadigingpasiënte. In artikel twee het ek gefokus op die akute gebruik van substanse (d.w.s. substansinname) (AGS) terwyl ek in artikel drie gefokus het op chroniese substansgebruik (d.w.s. herhalende substansgebruik oor 'n verlengde tydperk) (CSG). In artikel twee het bivariate en multivariate statistiese analise getoon dat een uit vyf selfbeskadigingpasiënte AGS gerapporteer het. In vergelyking met ander selfbeskadigingpasiënte was die AGS-subgroep meer geneig om depressiewe vlakke van bewussyn te toon by opname in die hospitaal; gebruik te maak van meer mediesehulpbronne; langer hospitaalopnames te vereis; vorige selfbeskadigings dade te noem; en te beoog om te sterf as gevolg van hul beserings. In artikel drie het 37% van die selfbeskadigingpasiënte CSG geraporteer. In vergelyking met ander selfbeskadigingpasiënte was die CSG-subgroep meer geneig om manlik te wees; skade aan hul liggaamsweefsel te veroorsaak; en 'n geskiedenis van selfbeskadiging te hê. 'n Statistiesebeduidende kleiner persentasie CSG-pasiënte, in vergelyking met ander selfbeskadigingpasiënte, is verwys vir psigiatriese assessering (p<0.001). In artikel vier het ek 'n kwalitatiewe studie gedoen deur semi-gestruktureerde onderhoude te analiseer van 80 selfbeskadigingpasiënte wat in die hospitaal opgeneem is. Ek het gebruik gemaak van 'n meervoudige gevallestudie-metodologie en het sewe maniere geïdentifiseer waarop pasiënte verstaan hulle substansgebruik betrokke was in hul selfbeskadiging: impulsiwiteit, swak oordeel, en aggressie; ouditiewe hallusinasies of paranoia wat verband hou met substansgebruik; substansgebruik om selfbeskadiging te fasiliteer; substansgebruik as 'n metode van selfbeskadiging; onsuksesvolle behandeling vir substansgebruiksversteuring; die ineenstorting van substansgebruik as 'n manier om moeilikhede te hanteer; en derdepartysubstansgebruik. | af_ZA |
| dc.format.extent | xxi, 148 pages | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/10019.1/103345 | |
| dc.language.iso | en_ZA | en_ZA |
| dc.publisher | Stellenbosch : Stellenbosch University | en_ZA |
| dc.rights.holder | Stellenbosch University | en_ZA |
| dc.subject | Substance abuse -- Patients | en_ZA |
| dc.subject | Self-destructive behavior | en_ZA |
| dc.subject | Suicide -- Prevention | en_ZA |
| dc.subject | Suicidal behavior | en_ZA |
| dc.subject | Parasuicide | en_ZA |
| dc.subject | UCTD | |
| dc.title | Substance use and self-harm at an urban South African hospital: implications for suicide prevention, service delivery and future research | en_ZA |
| dc.type | Thesis | en_ZA |