No abstract

Objective: Non-fatal suicidal behaviour (NFSB) severely impacts on the health services and the resources of a country and should be prevented. The aim of this control study was to describe a group of patients with NFSB and to elicit, if any, the factors associated with this behaviour compared to a non-suicidal control group. Method: Interviews were conducted on patients with NFSB treated in the Johannesburg Hospital medical emergency rooms. The information was gathered by way of a questionnaire and included: patient demographics, past history of psychiatric and medical illness, family history, habits and social adjustment. Results: The study sample comprised forty-three patients with NFSB (mean age = 29.7 years) and control group of forty-five non-suicide attempters (mean age = 30.9 years). 26 (60.5%) of the patients and 33 (73.3%) of the controls were females. 10 (23.3%) of the patients had been treated for NFSB within the preceding 12 months. Patients with a past history of a psychiatric illness or of physical or sexual abuse were significantly more likely to exhibit NFSB compared to the control group (p < 0.05). Conclusions: Patients who threaten deliberate self-harm and who have a history of previous NFSB, past psychiatric illness and physical or sexual abuse, are at a higher risk of this behaviour as compared to the general population. If NFSB intentions are suspected in or voiced by an individual, then these risk factors should be assessed and appropriate preventative measures instituted.

Background: Persons with HIV and severe mental illness face numerous barriers in antiretroviral treatment adherence. More information is needed on reasons for loss of follow-up in this population. Methods: A retrospective analysis was conducted on adult HIV patients with a history of mental illness enrolled at an urban HIV clinic in Johannesburg, South Africa who discontinued care. Results: 24.8% of adult patients in the clinic discontinued follow-up during the study period. Of those discontinuing follow-up, 48 were successfully traced by home visits. Among this group, 21 (43.8%) were not engaged in care, 12 (25.0%) had transferred care, 9 (18.8%) were deceased, 3 (6.2%) had relocated, and 3 (6.2%) were missing. Transportation costs and distance, conflicts with work/school schedule, and confusion regarding when to return were the most frequently cited reasons for discontinuing follow-up. Conclusions: Although almost 25% of patients were lost to follow up, overall rates of retention in care for these patients were similar to those seen in other HIV-infected populations and higher than those seen among patients with psychiatric disease. Tracing patients through home visits proved to be an effective means to confirm the magnitude of patients lost to follow up, ascertain their outcomes, and elucidate the reasons for discontinuing care.

A retrospective cohort analysis was performed to describe outcomes and retention in care on antiretroviral therapy (ART) of 53 patients with severe mental illness (SMI). Diagnoses were psychosis secondary to HIV (24 patients), psychosis not otherwise specified (12), mania with or without psychosis (9), depression with psychotic features (4), and schizophrenia and bipolar mood disorder (2 each). The median baseline CD4 count was 66/mm(3) and viral load was 5.4 log10 copies/mL. Thirteen (25%) patients were lost to follow-up (10 within 6 months), 3 were transferred out, and 3 died. By week 96, 29 (85%) of 34 (64%) patients still in care had a viral load <400 copies/mL and 26 (76%) a viral load <25 copies/mL. Median CD4 count increased to 307/mm(3). Twenty-seven of 34 patients discontinued antipsychotic medication. Patients with SMI and advanced HIV infection responded well to ART. The first 6 months was important for retention in care.