Mental disorders are among the most poorly treated illnesses in sub-Saharan Africa. It is estimated that 70%-80% of South Africans consult traditional health practitioners for the treatment of psychological ailments. As traditional health practitioners maintain a strong role in assessing and treating patients with mental illness in this context, this study contributes to the burgeoning research literature on the topic. Semi-structured in-depth interviews were conducted with 18 traditional health practitioners in Johannesburg, South Africa, between January and May 2022. Interviews were transcribed and translated into English. The data were managed using NVivo 12 software and thematically analysed. Traditional health practitioners interviewed generally perceived mental illness to be of supernatural causation, either as a result of bewitchment, a calling for patients to become THPs themselves, due to displeased ancestors, or due to natural causes. Traditional health practitioners identified eight primary treatments that they use for treating mental illness. Among these were throwing of bones () to start communicating with ancestors, steaming () to start a cleansing process, sneezing () to forcefully dispel the spirit causing the illness, induced vomiting (), and the administration of laxatives () to remove the spirits poisoning the body as well as animal sacrifice to purge spirits and communicate with ancestors. This is all followed by cutting (), which is the final part of the treatment and ensures that the evil spirit cannot return. Due to the ubiquity of traditional health practitioner usage for mental illness in sub-Saharan Africa, it is essential to understand what conceptions traditional health practitioners have of the aetiology of these disorders as well as their modalities for administering treatment.

Adolescence is characterized as a period of great physical, psychological, social, and behavioral challenges which often impacts on the mental health of adolescents. Prior research has demonstrated the mental health of adolescents to be further complicated by the COVID-19 pandemic which resulted in isolation during the strictest lockdown period. As such, the primary purpose of this study was to identify the difficulties of South African adolescents during the COVID-19 pandemic. Data were collected through a questionnaire completed by 4230 grade 4 to 12 learners from two provinces in South Africa (Mpumalanga, North-West) and analyzed with chi-square, Cramer's , Bayesian, and the odds ratio tests. Participants self-reported on the difficulties they experienced during the strictest part of the COVID-19 lockdown period which could possibly impact on their mental health. The results indicate that fear was the most prominent difficulty experienced, but it must be viewed as a comorbidity with anxiety, stress, and depression. A significant finding was that the difficulties experienced were gender, age, and school level specific. The results indicate that mental health practitioners working with adolescents who experienced such difficulties should adopt a multilevel systems approach in supporting the mental health of adolescents during crisis situations like the lockdown during the COVID-19 pandemic. More importantly, early mental health interventions should take gender, age, and primary and secondary school levels into consideration for effectiveness since the difficulties highlighted in this study are likely to impact on the mental health of learners.

Despite the societal increase in mental health disorders during the initial stages of the COVID-19 pandemic, many individuals were able to cope effectively with new mental health challenges. The heterogeneity in responses to adversity underscores the influence of protective factors in promoting coping behaviour. The current study investigates fortitude as a potential protective resource by examining the potential direct, mediating, and moderating roles of fortitude in the relationship between perceived vulnerability to disease, fear of COVID-19, and indices of psychological well-being. Participants ( = 355) were schoolteachers who completed the Perceived Vulnerability to Disease Questionnaire, Fear of COVID-19 Scale, Fortitude Questionnaire, UCLA Loneliness Scale, trait scale of the State-Trait Anxiety Inventory, Beck Hopelessness Scale, and the Center for Epidemiological Studies Depression Scale. Path analysis indicated that fortitude had a health-sustaining effect that was evident in its association with all indices of psychological well-being. Fortitude also mediated the relationship between perceived vulnerability to disease and depression, anxiety, and loneliness. In addition, fortitude moderated the relationship between fear of COVID-19 and depression. The significant moderating and mediating effects of fortitude on psychological outcomes support its potential for counterbalancing the negative mental health impacts of COVID-19. Interventions aimed at enhancing fortigenic appraisals of self and others may prove beneficial in promoting psychological well-being.

COVID-19 has impacted negatively on the lives and academic activities of university students. This has contributed to increasing levels of psychological distress among this population group. Intrinsic and contextual factors can mediate the psychological impact of the pandemic. The study focuses on sense of coherence and ego-resilience as potential protective factors on indices of psychological distress and life satisfaction. Participants were undergraduate students ( = 337) at a South African university who completed six self-report questionnaires, namely, the Beck Hopelessness Scale, the University of California Los Angeles Loneliness Scale, the Center for Epidemiological Studies Depression Scale, the Sense of Coherence Scale, the Ego-Resilience Scale, and the Satisfaction with Life Scale. To examine the direct and mediating effects of sense of coherence and ego-resilience on psychological distress, structural equation modeling was used. Compared to previous research, greater psychological distress was found in the current sample. Moreover, while the hopelessness-life satisfaction relationship was only partially mediated by protective factors, the depression-life satisfaction relationship was fully mediated by sense of coherence and ego-resilience. The direct association between ego-resilience as well as sense of coherence and life satisfaction was significant, suggesting that these factors have a health-sustaining role.

The aim of this study was to assess the association between five health risk behaviours and persistent and incident depressive symptoms in a longitudinal study in South Africa. The sample included 5059 men and women (≥40 years) in 2014/2015, and 4176 in 2018/2019 of the 'Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community in South Africa'. Depressive symptoms were assessed with the Centre for Epidemiologic Studies Depression scale. Multivariable logistic regression analysis was conducted to assess the associations between five health risk behaviours and persistent and incident depressive symptoms. Results indicate that 5.0% of participants had depressive symptoms at both wave 1 and 2 (persistent depressive symptoms), and 27.9% had incident depressive symptoms in wave 2. Higher education and moderate baseline physical activity were negatively associated and those with cardiovascular disease were positively associated with persistent depressive symptoms. Middle wealth index was negative, and being HIV positive and baseline tobacco use were positively associated with incident depressive symptoms. In conclusion, of five health risk behaviours assessed (inadequate fruit/vegetable intake, alcohol dependence, tobacco use, physical activity, and sedentary behaviour), only moderate physical activity was protective against persistent depressive symptoms, and tobacco use was associated with incident depressive symptoms.

There are an estimated 32,000 incident cases of multidrug-resistant tuberculosis in children globally each year. Extended hospitalisation is often required to ensure optimal adherence to the complex multidrug-resistant tuberculosis treatment regimen. Hospitalisation usually results in caregiver-child separation which is known to cause psychological difficulties in children. We explored caregivers' and health workers' perceptions of the effects of caregiver-child separation during hospitalisation for tuberculosis in the Western Cape. We conducted semi-structured interviews with health workers ( = 7) and caregivers ( = 14) of children who were receiving multidrug-resistant tuberculosis treatment. All interviews were audio-recorded, transcribed, and translated. We used thematic analysis to organise and interpret the data. We identified three themes: (1) multidrug-resistant tuberculosis treatment was a distressing experience for children, caregivers, and health workers; (2) children's behavioural states during and post-hospitalisation (e.g., crying, aggression, hyperactivity, and withdrawal) were suggestive of their distress; and (3) caregivers and health workers used strategies, such as deception, threat, and the prioritisation of biomedical health over psychological health as a means to manage their own as well as the children's distress. This article presents novel research on the dynamics involved in caregiver-child separation as a result of multidrug-resistant tuberculosis treatment in South Africa. We highlight that the challenges of caregiver-child separation intersected with predisposing factors related to the social adversity that families affected by childhood tuberculosis experience. Delivery models that facilitate outpatient community-based care should be prioritised and a more structured form of psychological support should be implemented for those who still require hospitalisation.

The COVID-19 pandemic changed how we view the world, human behaviour, and societal structures and institutions. The emerging subdiscipline of psychological anthropology is well placed to provide a perspective on the way individuals and communities are affected by and respond to the pandemic, as well as the fallout from government responses and prevention strategies. Moreover, this viewpoint enables insights into the workings of societal structures and agents of power in the context of a health crisis that is worsened by poverty, inequality, and structural violence. How communities respond and adapt to the 'new normal' are critical to holding governing structures accountable in situations where poor leadership, mismanagement, and unethical behaviour have been evident.

The COVID-19 pandemic and ensuing lockdown had a profound effect on human life. This research explores the influence of COVID-19-related experiences on the emotional wellbeing and mental health of South African university students 3 months into the pandemic. Research data were obtained from an online survey completed by 5074 students. Students reported difficulties in coping with psychological challenges during the lockdown: 45.6% and 35.0% reported subjective experiences of anxiety and depression, respectively. Students scored low on the mental health continuum. Hierarchical stepwise multiple regression analyses showed that some different dimensions predicted emotional difficulties or wellbeing and mental health - confirming the two continuum theory of Keyes. Students' serious discomfort during lockdown, difficulty adjusting academically and feeling socially isolated contributed most to emotional difficulties. Females, students in their early years of study and students residing in informal settlements were most at risk of experiencing emotional difficulties. Mental health was most predicted by students' hopefulness. Social, academic, spiritual and physical wellbeing and positive coping strategies influenced both emotional difficulties and mental health. The research serves to alert university authorities to students' emotional wellbeing, especially of first-year students and students with limited resources. The results could assist university psychological services to provide appropriate support services to enhance students' adjustment and promote their mental health amid a public health crisis.

COVID-19, the disease caused by severe acute respiratory syndrome coronavirus 2, has affected most parts of the globe since its first appearance in the city of Wuhan, China, in December 2019. As a result, the World Health Organization declared the virus a global public health crisis and a pandemic within 2 weeks, after the virus had spread to 114 countries with 118 000 recorded cases and 4291 deaths due to the virus and related complications. The World Health Organization declaration is indicative of the enormous impact of the pandemic on human life globally. South Africa has not been exempted from that impact. While the pandemic has affected all South Africans in various ways, the poor have been most affected due to structural inequality, poverty, unemployment, and lack of access to quality health care and other services. Furthermore, public mental health has also been negatively affected by the pandemic, and this comes against a backdrop of an ailing mental health care system. We argue that the psychology profession, as a mental health profession and behavioural science, working as part of a multidisciplinary team, ought to play a significant role in addressing the mental health ramifications of the pandemic. In so doing, lessons can be drawn from other countries while establishing contextual immediate and long-term interventions.

As a result of a long colonial history and subsequent developmental and economic challenges, many African countries have struggled to put in place adequate policies, systems, and associated infrastructures to address the health and social needs of their citizens. With the COVID-19 pandemic threatening human lives and livelihoods, concerns are raised about the preparedness and readiness of health policies and systems in African countries to deal with these kinds of health calamities. More particularly, questions can be asked about the preparedness or even existence of mental health policies and associated systems to help individuals and communities in Africa to deal with the consequences of COVID-19 and other health emergencies. In this article, we analyse the existing mental health policies of four African countries paying attention to the capacity of these legislative provisions to enable psychology professionals to deal with psychosocial problems brought about by COVID-19. We use Walt and Gilson's Policy Triangle Framework to frame our analysis of the existing mental health policies. In line with this conceptual framework, we review the role played by the different factors in shaping and influencing these mental health policies. We further explore the challenges and opportunities associated with existing legislation and mental health policies. We also reflect on the reports obtained from each of the four countries about the role that psychologists are playing to deal with the associated psychosocial problems. Based on our policy analysis and country reports, we highlight strengths and gaps in these policies and give recommendations on how mental health policies in these countries can be strengthened to respond to COVID-19 and future health emergencies.

This study examined experiences with sexual violence among Black African gay, bisexual, and other men who have sex with men (GBMSM) and transgender women (TGW) in townships surrounding Pretoria, South Africa. Of 81 GBMSM and TGWs interviewed, 17 reported to have experienced sexual violence perpetrated by other men. Qualitative analysis of interviews revealed the social and relational context of these experiences as well as their psychological and health consequences. The described context included single- and multiple-perpetrator attacks in private and public spaces, bias-motivated attacks, and violence from known partners. Several participants reported refusing propositions for sex as a reason for being victimized. HIV-positive individuals were overrepresented among survivors compared to the sample as a whole. Following victimization, participants described feelings of pain, fear, anger and self-blame. The results demonstrate the need for interventions designed to (a) prevent sexual violence against GBMSM and TGW in this population, and (b) reduce the negative psychological and health outcomes of sexual victimization. The discussion also highlights the need to examine more closely the link between experiences of sexual violence and risk for HIV infection.

Burgeoning research on the well-being of young people in recent years has made it difficult to identify conceptual gaps in the literature. We conducted a review of South African research in this area to better understand the use and measurement of the construct, as well as factors associated with it. The search of multiple databases identified 28 studies published in academic journals between 2000 and 2016. Within this period, studies that referred to well-being and its related subjective components varied significantly in terms of how they defined and operationalised these constructs, resulting in a fragmented body of work. The review highlights the need for a coherent research agenda in this area given the centrality of well-being research in promoting optimal outcomes in young people. Recommendations for strengthening South African research in this area are provided.

Associations between community violence exposure, family management practices, and substance use were compared in a sample of early adolescents in low-income communities from the United States ( = 151; age = 12.71 years, standard deviation = 0.65; 50.3% female) and South Africa ( = 175; age = 12.55 years, standard deviation = 0.85; 64.6% female) using home interviews with youth and their maternal caregivers. Past year victimization was associated with recent youth substance use. The moderating role of family management practices varied by type of practice (e.g., parental knowledge, control, solicitation, or child disclosure), reporter, and country. High parental knowledge reported by caregiver was protective against substance use only for South African youth. In youth reports, parental knowledge was protective across the United States and South Africa. Youth reports of their disclosure to parents were negatively associated with substance use in the United States but not South Africa. These data highlight the importance of considering both ecological context and reporter in the links between violence exposure, parenting, and substance use in youth.

Compared to patients not receiving treatment, antiretroviral therapy (ART) users may experience a lower viral load, an increased CD4 count, slower disease progression, fewer opportunistic infections, and more rapid recovery time from HIV-related illnesses. As such, health related quality of life (HR-QOL) is likely to be considerably greater for ART users than patients not receiving treatment. The dearth of QOL research in sub-Saharan Africa brings into focus the need for and importance of documenting the various dimensions of well-being among persons living with HIV in this region of the world. We thus sought to report on the performance of South African patients enrolled in a public government funded antiretroviral therapy (ART) program. We administered the Functional Assessment of HIV Infection (FAHI) to a convenience sample of patients receiving ART in the Western Cape in South Africa. We used confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) to determine the factor structure of the FAHI amongst South African ART users. The CFA revealed a poor model fit of the data. However the EFA factor structure closely approximated the subscales of the measure, indicating the dimensions of physical, emotional, functional, and social well-being and cognitive functioning. We identified problematic items contributing to the poor model fit and contribute to the knowledge base on QOL amongst ART users in South Africa.

A Girls Empowerment Programme held in 2010 in Lesotho, Sub-Saharan Africa, focused on HIV/AIDS risk reduction and prevention, life skills and entrepreneurial training (income-generating activities). Entrepreneurial training was a crucial part of equipping the camp attendees with basic skills to help them develop sustainable livelihoods. Such skills and financial independence are essential to enable rural girls to complete their secondary schooling (in a fee-based educational system) and to pursue a career, as well as to further help them be less susceptible to transactional sex and its significant risks. The results of a brief process evaluation with some nested supporting data showed considerable improvement in the girls' knowledge about income-generating activities. In addition, almost half of the camp attendees participated in further entrepreneurial training and about half of these girls went on to develop small businesses. Replication of this model of camp training is recommended and being explored in other African countries.