Hashim Moomal

Bio: Hashim Moomal is an academic researcher from University of the Witwatersrand. The author has contributed to research in topics: Mental health & Substance abuse. The author has an hindex of 14, co-authored 15 publications receiving 1776 citations. Previous affiliations of Hashim Moomal include University of South Africa.

The South African Stress and Health (SASH) study: 12-month and lifetime prevalence of common mental disorders.

Abstract: Background . The South African Stress and Health (SASH) study is the first large-scale population-based study of common mental disorders in the country. This paper provides data on the 12-month and lifetime prevalence of these conditions. Methods . Data from a nationally representative sample of 4 351 adults were analysed. Mental disorders were assessed with the Composite International Diagnostic Interview (CIDI). An extensive survey questionnaire detailed contextual and socio-demographic factors, onset and course of mental disorders, and risk factors. Simple weighted cross-tabulation methods were used to estimate prevalence, and logistic regression analysis was used to study correlates of 12-month and lifetime prevalence. Results . The lifetime prevalence for any disorder was 30.3%, and the most prevalent 12-month and lifetime disorders were the anxiety disorders. The Western Cape had the highest 12-month and lifetime prevalence rates, and the lowest rates were in the Northern Cape. Conclusions . The SASH study shows relatively high 12-month and lifetime prevalence rates. These findings have significant implications for planning mental health services.

Twelve-month mental disorders in South Africa: prevalence, service use and demographic correlates in the population-based South African Stress and Health Study.

Abstract: Background South Africa’s history and current social conditions suggest that mental disorders are likely to be a major contributor to disease burden, but there has been no national study using standardized assessment tools.

Lifetime prevalence of psychiatric disorders in South Africa.

Abstract: To date, no nationally representative data have been available on the prevalence of psychiatric disorders in South Africa. Such data are clearly important for rigorous local mental health service planning. Furthermore, given the particular circumstances of South Africa’s colonial and apartheid past, and its recent emergence as a democracy, such data are also relevant to understanding more global issues and processes including social disparities in health and mechanisms of vulnerability and resilience to psychopathology. The lack of epidemiological data on psychiatric disorders in South Africa is consistent with a relative lack of data from elsewhere in the continent. 12-month prevalence of any psychiatric disorder in the Yoruba-speaking part of Nigeria was recently reported as 4.7%, one of the lowest in 14 countries participating in the World Mental Health Surveys (Demyttenaere, Bruffaerts, Posada-Villa, et al, 2004). The precise reasons underlying the low estimated prevalence are unclear, but underreporting to lay interviewers, or the social capital held by African societies, may be relevant factors. There are several reasons to believe that the prevalence of psychiatric disorder in South Africa would be relatively high. Stressors such as racial discrimination and political violence have been perennial in the past, and high rates of gender inequality and criminal violence are reportedly a feature in the present (Dunkle, Jewkes, Brown, et al, 2004; Hirschowitz and Orkin, 1997). Poverty remains a significant problem, and is likely to contribute to vulnerability to common psychiatric disorders in developing countries (Patel and Kleinman, 2003). On the other hand, features of South African society may predict a more complex picture. The country’s socioeconomic history has resulted in different racial populations having distinct socioeconomic profiles, with whites advantaged, and blacks disadvantaged. Socioeconomic privilege might protect against stressors and reduce prevalence of psychiatric disorder. Alternatively, factors reducing prevalence of psychiatric disorder in Nigeria might also operate in some sectors of society. As a result, prevalence of psychiatric disorders in South Africa might be posited to lie between that reported in the developed world (Kessler, Berglund, Demler, et al, 2005; Wittchen and Jacobi, 2005) and in Nigeria.

Multiple Traumatic Events and Psychological Distress : The South Africa Stress and Health Study

Abstract: Using nationally representative data from South Africa, we examine lifetime prevalence of traumas and multiple traumas (number of events). Employing multiple regression analysis, the authors study the sociodemographic risk of trauma, and the association between trauma and distress. Results indicate most South Africans experience at least one traumatic event during their lives, with the majority reporting multiple. Consistent variation in risk is evident for gender and marital status, but not other sociodemographics. Trauma is positively related to high distress, and findings also support a cumulative effect of trauma exposure. Individuals with the most traumas (6+) appear at 5 times greater risk of high distress. This study highlights the importance of considering traumatic events in the context of other traumas in South Africa.

Discrimination and racial disparities in health: evidence and needed research

Abstract: This paper provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway and the paper reviews the published research on discrimination and health that appeared in PubMed between 2005 and 2007. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.

Association of Torture and Other Potentially Traumatic Events With Mental Health Outcomes Among Populations Exposed to Mass Conflict and Displacement: A Systematic Review and Meta-analysis

Abstract: Context Uncertainties continue about the roles that methodological factors and key risk factors, particularly torture and other potentially traumatic events (PTEs), play in the variation of reported prevalence rates of posttraumatic stress disorder (PTSD) and depression across epidemiologic surveys among postconflict populations worldwide. Objective To undertake a systematic review and meta-regression of the prevalence rates of PTSD and depression in the refugee and postconflict mental health field. Data Sources An initial pool of 5904 articles, identified through MEDLINE, PsycINFO and PILOTS, of surveys involving refugee, conflict-affected populations, or both, published in English-language journals between 1980 and May 2009. Study Selection Surveys were limited to those of adult populations (n ≥ 50) reporting PTSD prevalence, depression prevalence, or both. Excluded surveys comprised patients, war veterans, and civilian populations (nonrefugees/asylum seekers) from high-income countries exposed to terrorist attacks or involved in distal conflicts (≥25 years). Data Extraction Methodological factors (response rate, sample size and design, diagnostic method) and substantive factors (sociodemographics, place of survey, torture and other PTEs, Political Terror Scale score, residency status, time since conflict). Data Synthesis A total of 161 articles reporting results of 181 surveys comprising 81 866 refugees and other conflict-affected persons from 40 countries were identified. Rates of reported PTSD and depression showed large intersurvey variability (0%-99% and 3%-85.5%, respectively). The unadjusted weighted prevalence rate reported across all surveys for PTSD was 30.6% (95% CI, 26.3%-35.2%) and for depression was 30.8% (95% CI, 26.3%-35.6%). Methodological factors accounted for 12.9% and 27.7% PTSD and depression, respectively. Nonrandom sampling, small sample sizes, and self-report questionnaires were associated with higher rates of mental disorder. Adjusting for methodological factors, reported torture (Δ total R 2 between base methodological model and base model + substantive factor [ΔR 2 ] = 23.6%; OR, 2.01; 95% CI, 1.52-2.65) emerged as the strongest factor associated with PTSD, followed by cumulative exposure to PTEs (ΔR 2 = 10.8%; OR, 1.52; 95% CI, 1.21-1.91), time since conflict (ΔR 2 = 10%; OR, 0.77; 95% CI, 0.66-0.91), and assessed level of political terror (ΔR 2 = 3.5%; OR, 1.60; 95% CI, 1.03-2.50). For depression, significant factors were number of PTEs (ΔR 2 = 22.0%; OR, 1.64; 95% CI, 1.39-1.93), time since conflict (ΔR 2 = 21.9%; OR, 0.80; 95% CI, 0.69-0.93), reported torture (ΔR 2 = 11.4%; OR, 1.48; 95% CI, 1.07-2.04), and residency status (ΔR 2 = 5.0%; OR, 1.30; 95% CI, 1.07-1.57). Conclusion Methodological factors and substantive population risk factors, such as exposure to torture and other PTEs, after adjusting for methodological factors account for higher rates of reported prevalence of PTSD and depression.

The consequences of perceived discrimination for psychological well-being: A meta-analytic review.

Abstract: In 2 meta-analyses, we examined the relationship between perceived discrimination and psychological well-being and tested a number of moderators of that relationship. In Meta-Analysis 1 (328 independent effect sizes, N = 144,246), we examined correlational data measuring both perceived discrimination and psychological well-being (e.g., self-esteem, depression, anxiety, psychological distress, life satisfaction). Using a random-effects model, the mean weighted effect size was significantly negative, indicating harm (r = -.23). Effect sizes were larger for disadvantaged groups (r = -.24) compared to advantaged groups (r = -.10), larger for children compared to adults, larger for perceptions of personal discrimination compared to group discrimination, and weaker for racism and sexism compared to other stigmas. The negative relationship was significant across different operationalizations of well-being but was somewhat weaker for positive outcomes (e.g., self-esteem, positive affect) than for negative outcomes (e.g., depression, anxiety, negative affect). Importantly, the effect size was significantly negative even in longitudinal studies that controlled for prior levels of well-being (r = -.15). In Meta-Analysis 2 (54 independent effect sizes, N = 2,640), we examined experimental data from studies manipulating perceptions of discrimination and measuring well-being. We found that the effect of discrimination on well-being was significantly negative for studies that manipulated general perceptions of discrimination (d = -.25), but effects did not differ from 0 when attributions to discrimination for a specific negative event were compared to personal attributions (d = .06). Overall, results support the idea that the pervasiveness of perceived discrimination is fundamental to its harmful effects on psychological well-being.