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Assessing the cultural benefits provided by non-market ecosystem services can contribute previously unknown information to supplement conservation decision-making. The concept of sense of place embeds all dimensions of peoples’ perceptions and interpretations of the environment, such as attachment, identity or symbolic meaning, and has the potential to link social and ecological issues. This review contains: (1) an evaluation of the importance of sense of place as an ecosystem service; and (2) comprehensive discussion as to how incorporating sense of place in an evaluation can uncover potential benefits for both biodiversity conservation and human well-being. Sense of place provides physical and psychological benefits to people, and has neglected economic value. The biodiversity-related experiences are essential components of the service that need to be further explored. A conceptual framework was used to explore how the existing knowledge on sense of place derived from other fields can be used to inform conservation decision-making, but further research is needed to fill existing gaps in knowledge. This review contributes to a better understanding of the role biodiversity plays in human well-being, and should inform the Intergovernmental Platform on Biodiversity and Ecosystem Services (IPBES).

There is a surge of cardiovascular disease (CVD) in Africa. CVD is the leading cause of mortality among patients with severe mental illness (SMI) in developed countries, with little evidence from the African context. To determine the prevalence and risk factors for MetS among South African patients with SMI. In a cross sectional study, individuals with SMI treated with antipsychotics and a control group without a mental illness, matched for age, gender and ethnicity were evaluated for MetS using the 2009 Joint Interim statement (JIS) criteria. Of the 276 study group subjects, 65.9% were male, 84.1% black African, 9.1% white, 5.4% of Indian descent and 1.5% coloured (mixed race) with a mean age of 34.7 years (±12.5). Schizophrenia was the most common diagnosis (73.2%) and 40% were taking first generation antipsychotics. The prevalence of MetS was 23.2% (M: 15.4%, F: 38.3%) in the study group and 19.9% (M: 11.9%, F: 36.3%) in the control group (p = 0.4). MetS prevalence was significantly higher in study subjects over 55 years compared to controls (p = 0.03). Increased waist circumference (p< 0.001) and low high density lipoprotein (HDL) cholesterol (p = 0.003) were significantly more prevalent in study subjects compared to controls. In study subjects, risk factors associated with MetS included age (OR: 1.09, 95% CI 1.06-1.12, p < 0.001), female gender (OR: 2.19, 95% CI 1.06-4.55, p = 0.035) and Indian descent (OR: 5.84, 95% CI 1.66-20.52, p = 0.006) but not class of antipsychotic (p = 0.26). The overall MetS prevalence was not increased in patients with SMI compared to controls; however, the higher prevalence of the individual components (HDL cholesterol and waist circumference) suggests an increased risk for CVD, especially in patients over 55 years.

Purpose In resource-limited contexts in low- and middle-income countries (LMICs), a considerable proportion of individuals seeking care for mental disorders consult traditional and religious healers in their pathway to mental health care. Reports from Africa suggest that early involvement of healers may result in delays in the care pathway; a potential barrier to early identification and intervention. Methods A systematic review was conducted to evaluate the proportion of patients attending formal health services after making first contact for treatment of mental disorders with traditional or religious healers or other informal and formal care providers within published research in Africa. Electronic databases were searched for the period from January 1990 to February 2014. Quality assessment of included studies was conducted the SAQOR tool. Results Fourteen papers were identified with data on category of first care provider. Utilizing random effects modelling with inverse variance method, the pooled proportion of participants making first contact for treatment of mental disorders with two broadly categorised providers (informal and formal) was 48.1 % (95 % CI 36.4–60.0 %) and 49.2 % (95 % CI 38.0–60.4 %), respectively. The pooled proportion of participants making first contact with specific providers was: traditional healers (17.0 %, 95 % CI 10.9–24.1 %); religious healers (26.2 %, 95 % CI 18.1–35.1 %); general health services (24.3 %, 95 % CI 16.9–32.5 %); and mental health services (13.0 %, 95 % CI 5.1–23.5 %). Substantial regional variation in patterns of first provider choice was evident. Conclusions Conclusions of this review must be qualified in the light of several limitations. Approximately half of individuals seeking formal health care for mental disorders in Africa, choose traditional and religious healers as their first care provider. Previous reports suggest that this choice is associated with delays in accessing formal mental health services. Strategies to improve pathways to mental health care in Africa must include innovative programmes aimed at fostering collaboration between biomedical mental health services and these key community-based providers.

Strengthening social protection through cash transfers has proven effective in reducing common mental disorders such as anxiety and depression. However, the acceptability of unconditional cash transfer (UCT) interventions, also known as Basic Income Support (BIS) in certain regions, for socially vulnerable young adults who have experienced first-episode psychosis (FEP) in sub-Saharan Africa, including South Africa, remains unknown. This qualitative inquiry explored the experience and acceptability of an unconditional cash transfer (UCT) intervention among patients with FEP and their caregivers. The study was conducted at government hospitals in KwaZulu-Natal Province, South Africa. In this descriptive phenomenological qualitative study, we aimed to interview 15 recipients of a UCT intervention with their caregivers based on convenience sampling. An interview guide was designed to explore recipients' experiences with money utilization and budget decisions, as well as their views on preferred recipients, the effects of UCT, and their recommendations on how much money is needed to cater to their needs. Information saturation was achieved after interviewing ten FEP recipients and their caregivers. NVIVO 14 was used to analyze the data using interpretive phenomenology. The UCT intervention was well accepted, with funds used for transportation to the hospital and purchasing groceries and food. Indirectly, UCT enhances family relationships and medication adherence and reduces patient and caregiver stress. The UCT intervention was acceptable and positively experienced by patients with FEP. This study highlights the need to enhance social protection mechanisms to support engagement in mental health treatment for FEP.

IntroductionAccess to mental health services is a challenge, especially for young people who are over-represented in the unemployment and poverty index in South Africa. Therefore, continuing care is a problem after hospital discharge for young people with first-episode psychosis (FEP) due to a lack of clinical engagement and follow-up, for which they need support, including financial, to improve their outcomes. This pilot randomised control trial (RCT) aims to assess the feasibility and acceptability of financial support, in the form of an unconditional cash transfer (UCT), among young patients with FEP to prevent relapse.Methods and analysisThis study will use a 1:1 ratio two-arm open-label pilot RCT of 60 young participants (18–29 years) with FEP in remission, who will be recruited from specialised psychiatric facilities in KwaZulu-Natal Province, South Africa. This study will implement an UCT and assess its feasibility, acceptability and preliminary clinical outcomes (ie, medication adherence, relapse, quality of life, personal and social function). The follow-up time will be 3 months, the outcomes being measured at baseline, months 1 and 3. Descriptive and conventional content analysis will be done for quantitative and qualitative data, respectively.Ethics and disseminationThe study obtained provisional approval from the Biomedical Research Ethics Committee at the University of KwaZulu-Natal(#BREC/00004117/2022). Also is registered on the South African National clinical trial registry (#DOH-27-092022-5894) and approved by the KwaZulu-Natal department of health (#NHRD Ref: KZ_2002209_033). The results from this investigation will be actively disseminated through peer-reviewed journal publications, conference presentations and stakeholder engagement.Trial registration numberDOH-27-092022-5894.

Sub-Saharan Africa faces unprecedented disasters, with climate change expected to exacerbate the frequency and severity of unpredictable and stressful catastrophic events. Unlike developed nations, reconstruction in developing nations is hindered by resource constraints, with certain communities potentially experiencing multiple and enduring effects of disasters. Despite the potential danger of such cumulative community disaster exposure on mental health (e.g. depression), large-scale population-level evidence for the region is limited. We investigated the association between exposure to cumulative disaster and the first onset of depression in a nationally representative survey in South Africa. We used panel data from the South African National Income Dynamics Study (SA-NIDS) from 2008–2017, consisting of 17,255 adult study participants who were depression free at baseline. Risk of first depression onset between individuals exposed and unexposed to community disaster was measured, accounting for multiple disaster exposure over time by fitting generalized estimating equation (GEE) regression models. Data on the geographic location of disasters were obtained from the South African government gazette, and mapped with the government delineated SA-NIDS households’ locations. Of the sampled individuals, 2,986 were exposed to disaster during the study duration (17.3%). Increased cumulative community disaster was significantly associated with the likelihood of depression onset (adjusted relative risk [aRR] = 1.20, p<0.01, 95% CI: 1.09–1.33), even after controlling for socio-demographic factors. In sub-group analyses, greater likelihood of depression onset was found among females [but not in men] (aRR = 1.23, p<0.01, 95% CI: 1.09–1.38), Black African [but not in other population group] (aRR = 1.21, p<0.01, 95% CI: 1.09–1.36), lower education attainment group [but not in tertiary and above educational attainment group] (aRR = 1.20, p<0.01, 95% CI: 1.08–1.33), and lower income attainment group [but not in the top income quartile group] (aRR = 1.24, p<0.01, 95% CI: 1.11–1.38), due to cumulative community disaster. Although cumulative community disaster exposure was significantly associated with the first onset of depression, its negative impact may be more pronounced among individuals considered chronically socially vulnerable (i.e. the groups above) in South Africa. Given that many individuals in South Africa rely on social, food parcel relief, and health services from government/public sector, timely access to community-based supportive intervention is needed for disaster survivors, prioritizing socially vulnerable groups to help mitigate problems associated with mental health challenges.

Purpose Household food insecurity in South Africa is a pervasive public health challenge. Although its link to chronic health conditions is well established, its relationship to mental illness, particularly major depression, is not well-understood. Despite KwaZulu-Natal Province being the epicenter of the drug-resistant tuberculosis (MDR-TB) epidemic, and having the largest share of poverty in South Africa, this relationship remains unexamined. This study investigated the association between major depressive episode (MDE) and household food insecurity among individuals with MDR-TB. Methods We enrolled and interviewed 141 newly admitted microbiologically confirmed MDR-TB inpatients at a specialized TB hospital in KwaZulu-Natal Province, South Africa. Logistic regression models were fitted to assess the relationship between MDE and household food insecurity, while accounting for socio-demographic status (e.g., age, gender, education, marital status, social grant status, income, and preference for living in one’s community). Results The prevalence of MDE and household food insecurity was 11.35% and 21.01%, respectively. MDE was significantly associated with household food insecurity (aOR 4.63, 95% CI 1.17–18.38). Individuals who are female (aOR 6.29, 95% CI 1.13–35.03), young (aOR 8.86, 95% CI 1.69–46.34), have low educational attainment (aOR 6.19, 95% CI 1.70–22.59) and receive social grants (aOR 7.60, 95% CI 2.36–24.48) were most at risk of household food insecurity. Conclusions MDE in individuals with MDR-TB was significantly associated with household food insecurity, independent of socio-economic status. Although MDR-TB is not exclusively a disease of the poor, individuals from socio-economically disadvantaged backgrounds (e.g., female, young adults, low education, and social grant recipients) were more likely to experience household food insecurity. Our study underscores the need to address the co-occurring cycles of food insecurity and untreated MDE in South Africa.

South Africa’s refugee population has grown considerably over the last decade. Both food insecurity and mental illness are common in developing countries, but this relationship remains unexamined in an African refugee population. 335 adult refugees in Durban, South Africa were interviewed using a self-report of food insecurity and the Hopkins Symptom Checklist-25. The proportion of those who responded ‘often true’ to not having enough food and eating less was 23.1 and 54.3 %, respectively. The proportion of individuals with a significant level of anxiety and depressive symptomatology was 49.4 and 54.6 %, respectively. The adjusted logistic regression indicated that not eating enough was significantly associated with anxiety (aOR = 4.52, 95 % CI: 2.09–9.80) and depression (aOR = 4.51, 95 % CI: 2.01–10.09). Similarly, eating less was significantly associated with anxiety (aOR = 2.88, 95 % CI: 1.56–5.31) and depression (aOR = 2.88, 95 % CI: 1.54–5.39). The high prevalence of food insecurity, and its relationship to mental illness, highlight the importance of addressing basic needs among this population.

Background The INTREPID programme of research aims to establish comparable studies of incident psychosis in a number of low- and middle-income countries (LMICs). Discussion The importance of this cannot be under-estimated, as this will enable the testing of existing findings and evidence across differing environmental contexts; and will permit the identification of new and unique evidence that is only apparent within specific contexts. The epidemiological, aetiological and phenomenological insights derived from this programme are likely to inform major research advances of the next decades. Of equal importance, by adopting novel methods for detecting psychosis ‘cases’ in low-resourced settings, the researchers will be able to test two key hypotheses that could revolutionize clinical research and service provision within LMIC settings: (1) that informal providers can be incorporated successfully into an adequate (and perhaps even superior) case-detection system that is community and population-based (rather than hospital-based); and (2) that informal providers can be integrated meaningfully into the pathway to care (and perhaps even long-term management) of patients with incident psychosis living in low-resourced settings.

Wider recognition of the mental health burden of disease has increased its importance as a global public health concern. However, the spatial heterogeneity of mental disorders at large geographical scales is still not well understood. Herein, we investigate the spatial distribution of incident depression in South Africa. We assess depressive symptomatology from a large longitudinal panel survey of a nationally representative sample of households, the South African National Income Dynamics Study. We identified spatial clusters of incident depression using spatial scan statistical analysis. Logistic regression was fitted to establish the relationship between clustering of depression and socio-economic, behavioral and disease risk factors, such as tuberculosis. There was substantial geographical clustering of depression in South Africa, with the excessive numbers of new cases concentrated in the eastern part of the country. These clusters overlapped with those of self-reported tuberculosis in the same region, as well as with poorer, less educated people living in traditional rural communities. Herein, we demonstrate, for the first time, spatial structuring of depression at a national scale, with clear geographical ‘hotspots’ of concentration of individuals reporting new depressive symptoms. Such geographical clustering could reflect differences in exposure to various risk factors, including socio-economic and epidemiological factors, driving or reinforcing the spatial structure of depression. Identification of the geographical location of clusters of depression should inform policy decisions.