Hostname: page-component-7c8c6479df-p566r Total loading time: 0 Render date: 2024-03-28T12:10:46.691Z Has data issue: false hasContentIssue false

Prevalence of psychiatric morbidity in the adult population of a rural South African village

Published online by Cambridge University Press:  09 July 2009

S. Rumble
Affiliation:
Child Guidance Clinic, University of Cape Town, the Urbanization and Health Programme, Medical Research Council, Tygerberg and Health Systems Research Division, Medical Research Council, Tygerberg, South Africa
L. Swartz*
Affiliation:
Child Guidance Clinic, University of Cape Town, the Urbanization and Health Programme, Medical Research Council, Tygerberg and Health Systems Research Division, Medical Research Council, Tygerberg, South Africa
M. Zwarenstein
Affiliation:
Child Guidance Clinic, University of Cape Town, the Urbanization and Health Programme, Medical Research Council, Tygerberg and Health Systems Research Division, Medical Research Council, Tygerberg, South Africa
*
1Address for correspondence: Dr Leslie Swartz Child Guidance Clinic. University of Cape TownChapel RoadRosebank7700South Africa.

Synopsis

We report on the first South African two-stage community prevalence study of psychiatric morbidity, conducted in Mamre, a rural ‘coloured’2 village, 50 km from Cape Town. Randomly selected adults (N = 481) were assessed using the Self-Reporting Questionnaire (SRQ) as a first-stage screen and the Present State Examination (PSE-9) was administered to a proportion of the sample (N = 121) as the second-stage criterion. Demographic, health care utilization, and substance abuse data were also collected. Using the PSE-9 CATEGO Index of Definition of 5, the weighted prevalence of psychiatric morbidity was 27·1 % (confidence interval of 19·5−34·7 %), the majority of cases being given a tentative diagnosis of depressive or anxiety disorder. The CATEGO algorithm may not be fully appropriate in this cultural context as there was an apparent overdiagnosis of paranoid states. The SRQ's weighted sensitivity and specificity were 0·49 and 0·82 respectively. Overall, the SRQ correctly identified 67% of cases and non-cases. No demographic variables predicted psychiatric morbidity, but there was an indirect link between morbidity and primary care utilization. Further South African studies of the validity of both the SRQ and of criterion instruments are needed. These may contribute to knowledge regarding cultural factors affecting psychiatric diagnosis.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bebbington, P., Hurry, J., Tennant, C. & Sturt, E. (1981). Epidemiology of mental disorders in Camberwell. Psychological Medicine 11, 561581.CrossRefGoogle ScholarPubMed
Bebbington, P., Dean, C., Der, G., Hurry, J. & Tennant, C. (1991). Gender, parity and the prevalence of minor affective disorder. British Journal of Psychiatry 158, 4045.CrossRefGoogle ScholarPubMed
Ben-Arie, O., Swartz, L., Teggin, A. & Elk, R. (1983). The coloured elderly in Cape Town – a psychological, psychiatric and medical community survey: Part II. Prevalence of psychiatric disorders. South African Medical Journal 64, 10561061.Google Scholar
Benjamin, S., Decalmer, P. & Haran, D. (1982). Community screening for mental illness: A validity study of the GHQ. British Journal of Psychiatry 140, 174180.CrossRefGoogle Scholar
Bester, F., Weich, D. & Gagiano, C. (1991). Mental disorders of elderly blacks in the Orange Free State. The Journal of Age Related Disorders 3, 1316.Google Scholar
Brislin, R. (1986). The wording and translation of research instruments. In Field-methods in Cross-cultural Research (ed. Lonner, W. J. and Berry, J. W.), pp. 139164. Sage Publications: Berkeley.Google Scholar
Chan, D. & Chan, L. (1983). Reliability, validity and the structure of the GHQ in a Chinese context. Psychological Medicine 13, 363371.CrossRefGoogle Scholar
Cheng, T. A. (1988). A community study of minor psychiatric morbidity in Taiwan. Psychological Medicine 18, 953968.CrossRefGoogle ScholarPubMed
De Beer, C. (1984). The South African Disease: Apartheid, Health and Health Services. South African Research Service: Johannesburg.Google Scholar
De Jong, J., De Klein, G. & Ten Horn, S. (1986). A baseline study on mental disorders in Guinea-Bissau. British Journal of Psychiatry 148, 2732.CrossRefGoogle Scholar
Dhadphale, M. & Ellison, R. (1982). Frequency of mental disorder among outpatients at a rural district hospital in Kenya. Central African Journal of Medicine 28, 8589.Google Scholar
Dohrenwend, B. (1990). Problems of validity in field studies revisited. Psychological Medicine 20, 195208.CrossRefGoogle ScholarPubMed
Dube, K. (1970). A study of prevalence and biosocial variables in mental illness in a rural and an urban community in Uttat Pradesh – India. Acta Psychiatrica Scandinavia 46, 327359.CrossRefGoogle Scholar
Duncan-Jones, P. & Henderson, P. (1978). The use of a two-stage design in a prevalence survey. Social Psychiatry 13, 231237.CrossRefGoogle Scholar
Fabrega, H. (1989). Cultural relativism and psychiatric illness. Journal of Nervous and Mental Disease 177, 415425.CrossRefGoogle ScholarPubMed
Finlay-Jones, R. & Murphy, E. (1979). Severity of psychiatric disorders and the 30-item General Health Questionnaire. British Journal of Psychiatry 134, 609616.CrossRefGoogle ScholarPubMed
Freeman, M. (1990). The Need for Improved Mental Health Care in South Africa. Centre for the Study of Health Policy. University of Witwatersrand: Johannesburg.Google Scholar
Freeman, M. (1991). An Evaluation of Mental Health Services in the South Eastern Transvaal. Centre for the Study of Health Policy. University of Witwatersrand: Johannesburg.Google Scholar
Freeman, M. (1992). Providing Mental Health Care for All in South Africa – Structure and Strategy. Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa.Google Scholar
Gillis, L., Elk, R., Ben-Arie, O. & Teggin, A. (1982). The present state examination: Experiences with Xhosa speaking psychiatric patients. British Journal of Psychiatry 141, 143147.CrossRefGoogle ScholarPubMed
Gillis, L., Lewis, J. & Slabbert, M. (1968). Psychiatric disorder amongst the coloured people of the Cape Peninsula. British Journal of Psychiatry 114, 15751587.CrossRefGoogle ScholarPubMed
Gillis, L. S. (1991). Depression in elderly black persons.Paper presented at the 10th Epidemiological Conference.Cape Town, South Africa.Google Scholar
Goldberg, D. & Huxley, P. (1980). Mental Illness in the Community. Tavistock Publications: London.Google Scholar
Goldberg, D. & Huxley, P. (1992). Common Mental Disorders. A Biosocial Model. Tavistock/Routledge: London.Google Scholar
Goldberg, D. & Williams, P. (1988). A User's Guide to the General Health Questionnaire. NFER-Nelson: Windsor.Google Scholar
Good, B. & Good, M., DelVecchio, (1982). Toward a meaning-centered analysis of popular illness categories. In Cultural Concepts of Mental Health and Therapy (ed. Marsella, A. and White, G.), pp. 141146. Reidel: Dordrecht.CrossRefGoogle Scholar
Harding, T., De Arango, M., Baltazar, J., Climent, C., Ibrahim, H., Ladrido-lgnacio, L., Murthy, R. & Wig, N. (1980). Mental disorders in primary health care: a study of their frequency and diagnosis in four developing countries. Psychological Medicine 10, 231241.CrossRefGoogle ScholarPubMed
Hodiamont, P., Peer, N. & Syben, N. (1987). Epidemiological aspects of psychiatric disorder in a Dutch health centre. Psychological Medicine 17, 495505.CrossRefGoogle Scholar
Hoeper, E., Nycz, G., Cleary, P., Regier, D. & Goldberg, D. (1979). Estimating prevalence of RDC mental disorders in primary medical care. International Journal of Mental Health 8, 615.CrossRefGoogle Scholar
Hollifield, M., Katon, W., Spain, D. & Pule, L. (1990). Anxiety and depression in a village in Lesotho, Africa: a comparison with the United States. British Journal of Psychiatry 156, 343350.CrossRefGoogle Scholar
Katzenellenbogen, J., Pick, W., Hoffman, M. & Weir, G. (1988). Community participation in the Mamre community health project. South African Medical Journal 74, 335338.Google ScholarPubMed
Kortmann, F. (1990). Psychiatric case finding in Ethiopia: shortcomings of the Self-Report Questionnaire. Culture, Medicine and Psychiatry 14, 381391.CrossRefGoogle Scholar
Kortmann, F. & Ten Horn, S. (1988). Comprehension and motivation in response to a psychiatric screening instrument: Validity of the SRQ in Ethiopia. British Journal of Psychiatry 153, 95101.CrossRefGoogle ScholarPubMed
Lobo, A., Pérez Echeverria, M. & Artal, J. (1986). Validity of the scaled version of GHQ-28 in a Spanish population. Psychological Medicine 16, 135140.CrossRefGoogle Scholar
Mari, J. & Williams, P. (1986). A validity study of a psychiatric screening questionnaire (SRQ-20) in primary care in the city of Sao Paulo. British Journal of Psychiatry 148, 2326.CrossRefGoogle ScholarPubMed
Metz, C. (1978). Basic principles of ROC analysis. Seminars in Nuclear Medicine 8, 283298.CrossRefGoogle ScholarPubMed
Miller, T. (1989). Unpublished data.Google Scholar
Miller, T., Swartz, L. & Rumble, S. (1991). Psychological issues in primary health care in Mamre: an exploratory study.Paper presented at the 10th Epidemiological Conference.Cape Town, South Africa.Google Scholar
Orley, J. & Wing, J. (1979). Psychiatric disorder in two African villages. Archives of General Psychiatry 36, 513520.CrossRefGoogle ScholarPubMed
Parry, C. (1992). Psychiatric epidemiology in Africa: methodological considerations.Paper presented at the 11th annual conference of the Epidemiological Association of Southern Africa:Johannesburg.Google Scholar
Parry, C. (1996). A Review of Psychiatric Epidemiology in Africa: strategies for increasing validity when using instruments transculturally. Transcullural Psychiatric Research Review (in the press).CrossRefGoogle Scholar
Reeler, A. (1987). Psychological disorders in Africa. III. Service delivery. Central African Journal of Medicine 33, 3741.Google ScholarPubMed
Reiger, D., Boyd, J., Burke, J., Rae, D., Myers, J., Kramer, M., Robins, L., George, L., Karno, M. & Locke, B. (1988). One-month prevalence of mental disorders in the United States. Archives of General Psychiatry 45, 985997.Google Scholar
Robins, L. (1985). Epidemiology: reflections on testing the validity of psychiatric interviews. Archives of General Psychiatry 42, 918924.CrossRefGoogle ScholarPubMed
Rumble, S. (1994). Prevalence of psychiatric Morbidity in the Adult Population of Mamre: An Empirical and Methodological Investigation. Unpublished M. Sc. thesis, University of Cape Town.Google Scholar
Sashidharan, P. (1985). Definitions of psychiatric syndromes – a comparison in hospital and general population. British Journal of Psychiatry 147, 547557.CrossRefGoogle ScholarPubMed
Sashidharan, S., Surtees, P., Kreitman, N., Ingham, J. & Miller, P. (1988). Hospital-treated and general population morbidity from affective disorders. British Journal of Psychiatry 152, 499505.CrossRefGoogle ScholarPubMed
Sen, B., Wilkinson, G. & Mari, J. (1987). Psychiatric morbidity in primary health care. A two-stage screening procedure in developing countries: choice of instruments and cost-effectiveness. British Journal of Psychiatry 151, 3338.CrossRefGoogle ScholarPubMed
Shrout, P. (1990). Statistical design of screening procedures. In Screening for Depression in Primary Care: Screening and Detection (ed. Attkisson, C. and Zich, J.), pp. 8497. Routledge, Chapman & Hall, Inc.: New York.Google Scholar
Surtees, P. & Sashidharan, S. (1986). Psychiatric morbidity in two matched community samples: a comparison of rates and risks in Edinburgh and St. Louis. Journal of Affective Disorders 10, 101113.CrossRefGoogle ScholarPubMed
Swartz, L. (1987 a). Transcultural psychiatry in South Africa. I. Transcultural Psychiatric Research Review 23, 273303.CrossRefGoogle Scholar
Swartz, L. (1987 b). Transcultural psychiatry in South Africa. II. Cross-cultural issues in mental health practice. Transcultural Psychiatric Research Review 24, 530.CrossRefGoogle Scholar
Swartz, L. (1992). Professional ethnopsychiatry in South Africa: the question of relativism. In Ethnopsychiatry: the Cultural Construction of Professional and Folk Psychiatries (ed. Gaines, A. D.), pp. 225249. SUNY Press: New York.Google Scholar
Swartz, L., Ben-Arie, O. & Teggin, A. F. (1985). Subcultural delusions and hallucinations: comments on the Present State Examination in a multi-cultural context. British Journal of Psychiatry 146, 391394.CrossRefGoogle Scholar
Tenenbein, A. (1970). A double sampling scheme for estimating from binomial data with misclassification. Journal of the American Statistical Association 65, 331, 13501361.CrossRefGoogle Scholar
Thorn, R., Zwi, R. & Reinach, S. (1993). The prevalence of psychiatric disorders at a primary care clinic in Soweto, Johannesburg. South African Medical Journal 83, 653655.Google Scholar
Turton, R. W. & Chalmers, B. (1990). Apartheid, stress and illness: the demographic context of distress reported by South African Africans. Social Science & Medicine 31, 11911200.CrossRefGoogle ScholarPubMed
Vázquez-Barquero, J. & Díez-Manrique, J. (1986). Two stage design in a community survey. British Journal of Psychiatry 149, 8897.CrossRefGoogle Scholar
Vázquez-Barquero, J., Díez-Manrique, J., Pérna, C., Aldama, J., Samaniego-Rodriguez, C., Mendez Arango, J. & Mirapeix, C. (1987). A community mental health survey in Cantabria: a general description of morbidity. Psychological Medicine 17, 207242.CrossRefGoogle ScholarPubMed
Vázquez-Barquero, J., Munoz, P. & Jauregui, V. (1981). The interaction between physical illness and neurotic morbidity in the community. British Journal of Psychiatry 139, 328335.CrossRefGoogle ScholarPubMed
Vázquez-Barquero, J., Wilkinson, G., Williams, P., Díz-Manrique, J. & Péna, C. (1990). Mental health and medical consultation in primary care settings. Psychological Medicine 20, 681694.CrossRefGoogle ScholarPubMed
Weissman, M., Myers, J. & Harding, P. (1978). Psychiatric disorders in a US urban community: 1975/1976. American Journal of Psychiatry 135, 459462.Google Scholar
Wing, J., Cooper, J. & Sartorius, N. (1974). The Measurement and Classification of Psychiatric Symptoms. Cambridge University Press: Cambridge.Google Scholar
Wing, J., Henderson, A. & Winckle, M. (1977). The rating of symptoms by a psychiatrist and a non-psychiatrist: a study of patients referred from general practice. Psychological Medicine 7, 713715.CrossRefGoogle Scholar