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The global burden of disorders has shifted from infectious disease to non-communicable diseases, including neuropsychiatric disorders. Whereas infectious disease can sometimes be combated by targeting single causal mechanisms, such as prevention of contact-spread illness by handwashing, in the case of mental disorders multiple causal mechanisms are typically relevant. The emergent field of global mental health has emphasized the magnitude of the treatment gap, particularly in the low- and middle-income world and has paid particular attention to upstream causal factors, for example, poverty, inequality, and gender discrimination in the pathogenesis of mental disorders. However, this field has also been criticized for relying erroneously on Western paradigms of mental illness, which may not be relevant or appropriate to the low- and middle-income context. Here, it is important to steer a path between scientism and skepticism. Scientism regards mental disorders as essential categories, and takes a covering law approach to causality; skepticism regards mental disorders as merely social constructions and emphasizes the role of political power in causal relations. We propose an integrative model that emphasizes the contribution of a broad range of causal mechanisms operating at biological and societal levels to mental disorders and the consequent importance of broad spectrum and multipronged approaches to intervention.

The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a useful opportunity to revisit debates about the nature of psychiatric classification. An important debate concerns the involvement of mental health consumers in revisions of the classification. One perspective argues that psychiatric classification is a scientific process undertaken by scientific experts and that including consumers in the revision process is merely pandering to political correctness. A contrasting perspective is that psychiatric classification is a process driven by a range of different values and that the involvement of patients and patient advocates would enhance this process. Here we draw on our experiences with input from the public during the deliberations of the Obsessive Compulsive-Spectrum Disorders subworkgroup of DSM-5, to help make the argument that psychiatric classification does require reasoned debate on a range of different facts and values, and that it is appropriate for scientist experts to review their nosological recommendations in the light of rigorous consideration of patient experience and feedback.

The facts seem to indicate that South Africa is one of the more violent places on earth. We have been, and continue to be, a country with significant levels of political violence, criminal violence and domestic violence. And now, we are witnessing violence against fellow Africans. While many have termed this 'xenophobia', a more accurate term may well be 'Afrophobia'. For clinician-scientists, many questions arise. In this editorial, we briefly consider a few of the most pertinent.

IntroductionPain is one of the most commonly reported symptoms in people living with HIV/AIDS (PLWHA). However, wide ranges of pain prevalence have been reported, making it difficult to determine the relative impact of pain in PLWHA. A systematic review of the literature was conducted to establish the prevalence and characteristics of pain and to explore pain management in PLWHA.MethodsStudies that included cross‐sectional data were included in the search, which was conducted in April 2012. Databases searched using a time limit of March 1982 to March 2012 included PubMed, Scopus, Africa‐wide: NIPAD, CINAHL, PsychARTICLES, PSYCINFO, PSYCHIATRYONLINE, ScienceDirect and Web of Science. Search terms selected were "pain" and "HIV" or "acquired immune deficiency syndrome." Two reviewers independently screened all citation abstracts for inclusion. Methodological quality was evaluated using a standardized 11‐item critical appraisal tool.ResultsAfter full text review, 61 studies fulfilled the inclusion criteria. Prevalence of pain ranged from a point prevalence of 54% (95%CI 51.14–56.09) to 83% (95%CI 76–88) using a three‐month recall period. The reported pain was of moderate‐to‐severe intensity, and pain was reported in one to two and a half different anatomical sites. Moderate levels of pain interference with function were reported. All nine studies reporting on the adequacy of pain management recorded marked under‐treatment of pain.DiscussionThe studies reviewed reported that pain commonly presents at multiple pain sites with a range of severity suggesting that there are several differing pathological processes contributing to pain at one time. The interplay of variables associated with pain suggests that the biopsychosocial model of pain is an appropriate paradigm from which to view pain in PLWHA and from which to approach the problem, explore causes and establish effective treatment.ConclusionsThe results highlight that pain is common in PLWHA at all stages of the disease. The prevalence rates for pain in PLWHA do not appear to have diminished over the 30 years spanning the studies reviewed. The body of work available in the literature thus far, while emphasizing the problem of pain, has not had an impact on its management.

Drawing on data collected from 3 focus groups with 24 traditional healers, the aim of this qualitative study was to use the constructs of the Theory of Planned Behaviour (TPB) to gain an understanding of traditional healer referral practices of their patients with a mental illness. Results indicated that traditional healers possess a concept of mental illness, mainly referring to a patient behaving abnormally. They often report regularly treating patients with these behaviours. Traditional healer referral to Western care is considered a temporary measure or a last resort. A majority of healers feel that allopathic physicians do not treat them with the respect that they feel their contribution to the health of the community warrants. Recommendations include the need for traditional healers to be trained to identify potential cases of mental illness in their communities and for dialogue between traditional and allopathic physicians in regard to mental health care.

Global Mental Health and Psychotherapy: Adapting Psychotherapy for Middle- and Low-Income Countries takes a detailed look at how psychotherapies can be adapted and implemented in low- and middle-income countries, while also illuminating the challenges and how to overcome them. The book addresses the conceptual framework underlying global mental health and psychotherapy, focusing on the importance of task-shifting, a common-elements approach, rigorous supervision, and the scaling up of psychotherapies. Specific psychotherapies, such as cognitive-behavioral therapy, interpersonal therapy and collaborative care are given in-depth coverage, as is working with special populations, such as children and adolescents, pregnant women, refugees, and the elderly. In addition, treatment strategies for common disorders, such as depression, anxiety and stress, and substance abuse are covered, as are strategies for more severe mental disorders, such as schizophrenia

Background: Although there is a growing literature on internalized stigma from the developed world, very little research has been conducted in developing countries such as South Africa. Therefore, the purpose of this study was to describe the internalized stigma experienced by members of a mental health advocacy group in South Africa and relationships between self-stigma and other constructs, namely, empowerment, perceived devaluation and discrimination. Methods: Self-administered questionnaires measuring respondents reported levels of internalized stigma, empowerment and perceived devaluation and discrimination were distributed to all the members of the South African Depression & Anxiety Group (SADAG) by post and via email. Of the 850 members invited to participate, 142 members of SADAG completed the questionnaire. Pearson correlations were computed and multiple regression analyses were carried out to analyse the data. Results: The highest reports of stigma were for stigma resistance (mean = 2.9), alienation (mean = 2.47) and perceived discrimination (mean = 2.24). Low levels of stereotype endorsement (mean = 1.77) and social withdrawal (mean = 1.22) were reported. Although respondents often felt that the public held negative attitudes towards individuals suffering with a mental illness (perceived devaluation and discrimination scale (PDD), mean = 2.95), a majority of respondents reported high levels of empowerment (mean = 3.0) and self-efficacy (mean = 2.47). After controlling for socio-demographic factors, higher scores on the PDD were associated with social withdrawal and having experienced discrimination. Conclusion: Internalization of stigma, disempowerment and loss of self-esteem are not inevitable consequences for all individuals with a mental illness. Nevertheless, perceived stigma is significantly associated with social withdrawal and experienced discrimination.

"PTSD is a chronic, under-detected and under-treated psychiatric consequence of trauma that is often linked to new-onset medical and psychological conditions, impaired quality of life and long-term disability across the globe. This book is the first systematic analysis of the rates, risk factors, consequences and global burden of trauma and PTSD across a variety of wealthy and underdeveloped settings. An analysis of a global survey conducted by the World Health Organisation and featuring findings from over 70,000 participants around the world, this text demonstrates a unique perspective on the prevalence of exposure to trauma and PTSD and the impact it has on population health. The findings inside this text underscore the urgent need for policymakers and healthcare providers to prioritize interventions aimed at reducing the burden of trauma, PTSD and its consequences"--Provided by publisher

This unique book presents original research from the largest cross-national survey of the epidemiology of mental disorders ever conducted. It provides the latest findings from the WHO World Mental Health Surveys based on interviews of nearly 150,000 individuals in twenty-six countries on six continents. The book is ordered by specific disorder, with individual chapters dedicated to presenting detailed findings on the prevalence, onset timing, sociodemographic profile, comorbidity, associated impairment and treatment for eighteen mental disorders. There is also discussion of important cross-national consistencies in the epidemiology of mental disorders and highlighting of intriguing patterns of cross-national variation. This is one of the most comprehensive summaries of the epidemiology of mental disorders ever published, making this an invaluable resource for researchers, clinicians, students and policy-makers in the fields of mental and public health

Background: Our study explores perceptions of the caregiver support for mental health service users (MHSUs) in a low- to middle-income country setting. Materials: We conducted in-depth individual interviews with 16 MHSUs and their treatment partners/caregivers from a treatment partner and text-message intervention study. Discussion: Treatment partners/caregivers felt obligated to care for MHSUs, but had a limited understanding of mental illness. They found supporting adherence to treatment difficult due to a number of factors including violence, food insecurity and substance abuse. Conclusion: Socioeconomic and environmental factors affecting the lives of MHSUs have impact on caregiver relationships with MHSUs in their care.

As a response to the COVID-19 pandemic, many governments have introduced steps such as spatial distancing and "staying at home" to curb its spread and impact. The fear resulting from the disease, the lockdown' situation, high levels of uncertainty regarding the future, and financial insecurity raise the level of stress, anxiety, and depression experienced by people all around the world. Psychoactive substances and other reinforcing behaviors (e.g., gambling, video gaming, watching pornography) are often used to reduce stress and anxiety and/or to alleviate depressed mood. The tendency to use such substances and engage in such behaviors in an excessive manner as putative coping strategies in crises like the COVID-19 pandemic is considerable. Moreover, the importance of information and communications technology (ICT) is even higher in the present crisis than usual. ICT has been crudal in keeping parts of the economy going, allowing large groups of people to work and study from home, enhancing social connectedness, providing greatly needed entertainment, etc. Although for the vast majority ICT use is adaptive and should not be pathologized, a subgroup of vulnerable individuals are at risk of developing problematic usage patterns. The present consensus guidance discusses these risks and makes some practical recommendations that may help diminish them.

This study uses two national probability samples of adults, the National Survey of American Life (NSAL) and the South African Stress and Health Study (SASH) to systematically assess how the levels of perceived racial and non-racial discrimination and their effects on self-esteem and mastery in the U.S. compares to those in South Africa. Levels of perceived racial discrimination are higher in the U.S. than South Africa. In the U.S. both African Americans and Caribbean blacks have comparable or higher levels of self-esteem and mastery than whites. In contrast, South African Whites have higher levels of both self-esteem and mastery than blacks, Coloureds and Indians. Perceived discrimination, especially chronic everyday discrimination, is inversely related to self-esteem and mastery in both societies. In South Africa, stress and socioeconomic status (SES) but not discrimination are important determinants of racial differences in self-esteem and mastery. Our main findings indicate that in two racialized societies, perceived discrimination acts independent of demographic factors, other stressors, social desirability, racial identity and SES to negatively affect psychological functioning.