Introduction: Rasmussen’s encephalitis (RE) is a rare, progressive inflammatory neurological disorder characterized by treatment-resistant epilepsy, progressive hemiplegia, and cognitive decline. Although its pathogenesis remains incompletely understood, immune-mediated mechanisms are thought to play a central role. RE predominantly affects children, with only approximately 10% of cases occurring in adults. Diagnosis relies on the combination of clinical features, serial neuroimaging, and electroencephalographic findings. Early recognition is essential, as treatment options are limited and outcomes are improved with timely intervention. Atypical adult-onset presentations are particularly uncommon and may present significant diagnostic challenges. Patient presentation: We report a case that presented with atypical, adult-onset RE with major neurocognitive disorder. Management and outcome: The patient’s diagnosis was made with neuroimaging 10 years following seizure onset. Findings indicated moderate generalised atrophy, with asymmetric involvement of the left cerebral hemisphere. Interventions required a multidisciplinary team, and pharmacological management included sodium valproate and lamotrigine for seizure control, as well as quetiapine and fluoxetine for behavioural disturbances. The patient’s prognosis remains poor because of generalised brain atrophy limiting treatment options. Conclusion: There is a need to raise awareness of RE to assist with early detection and treatment. Late diagnosis may have contributed to the patient’s poor prognosis. Contribution: Despite the need for further research, early neuroimaging of patients with new adult-onset seizures may help decrease morbidity associated with RE.
Background: Aggression and violence remain persistent challenges in healthcare settings, particularly in psychiatric and emergency units. Security personnel serve as frontline responders but frequently lack structured training in de-escalation techniques, increasing the risk of harm. Aim: This study aimed to assess and improve security personnel’s attitudes towards the causes and management of aggression through a structured de-escalation training programme. Setting: The study was conducted at Cecilia Makiwane Hospital, a regional academic facility in the Eastern Cape province of South Africa, housing the only public-sector mental health unit in Buffalo City Municipality. Methods: A quasi-experimental single-group pre-test–post-test design was used. Security personnel completed an interactive educational programme incorporating discussions, role-play, and scenario-based exercises. The Management of Aggression and Violence Attitude Scale (MAVAS) was administered before and after the intervention. Data were analysed using paired-samples t-tests and multiple regression at a 5% significance level. Results: Baseline MAVAS domain scores indicated moderate agreement with all four domains. Following the intervention, significant improvements were observed across all MAVAS domains (p ≤ 0.01), reflecting more positive attitudes towards aggression management. Female participants showed greater changes in environmental and interpersonal causes of aggression (B = −0.259, p = 0.003), while longer work experience predicted increased recognition of patient-related causes. Job rank and age were not significant predictors. Conclusion: Structured de-escalation training effectively improved security personnel’s attitudes towards managing aggression and violence in a hospital setting. Contribution: This study provides empirical evidence that context-specific de-escalation training for security personnel may support workplace safety and strengthen multidisciplinary collaboration in the South African setting.
Background: Inpatient psychiatric services in South Africa are faced with challenges such as high demand for beds, rapid discharges, limited community services upon discharge and high readmission rates. Aim: To provide a profile of the demographic and clinical characteristics of the mental health users of inpatient male acute psychiatric services. Setting: The male acute unit at Stikland Hospital. Methods: A retrospective folder review of all patients discharged (n = 693) from the male acute psychiatric unit at Stikland Hospital between 01 February 2022 and 31 January 2023, and followed up for 1 year post-discharge. Results: Most of the admissions were young males (29 [23–35] years), single (89%) and unemployed (80.8%), with no secondary-level education (65.4%). Thirty per cent of admissions were admitted directly to the unit, and most patients presented with a diagnosis of schizophrenia (42.1%). Almost half (47.8%) of all admissions were patients previously admitted to Stikland Hospital, and more than one quarter (27.6%) were readmitted within 1 year following discharge. Most admissions had a short length of stay (36 [27–53] days) and were crisis-discharged (63.5%). The use of long-acting injectables (LAI) was highly prevalent (73.4%). Conclusion: Current inpatient psychiatric services are functioning as crisis intervention units. The study provides a foundation for developing context-specific, tailored strategies to be integrated into the discharge planning processes within the existing healthcare system. Contribution: Current system-related factors, such as bed shortages, lead to short length-of-stays (LOS) and crisis discharges, which likely contribute to a higher rate of readmissions.
Background: Childbirth has been associated with post-traumatic stress disorder (PTSD) in women, affecting mother–child bonding, foetal growth, cognitive development and marital relationships. However, there is a dearth of literature on postpartum PTSD in Africa. Aim: The study aimed to investigate the occurrence of postpartum PTSD among women. Setting: The study was conducted within Johannesburg metropolitan clinics. Methods: The study included 88 women attending postnatal clinics in the metropolitan area. A questionnaire was used to collect data on their characteristics, obstetric and neonatal factors and perceived social support. The City Birth Trauma Scale was used to screen for postpartum PTSD symptoms. Data were analysed using R software with a significance level of 0.05. Results: Almost half of the participants (48.9%) perceived their most recent childbirth as a traumatic event. One participant (1.1%; 95% CI: 0.0003–0.06) endorsed all symptoms required to diagnose PTSD. Endorsing childbirth as a traumatic event was significantly associated with reporting intrusion and/or re-experiencing symptoms (OR = 3.7) and avoidance symptoms (OR = 3.3). There was no association between the mode of childbirth and PTSD symptom scores. There is no association between the presence or absence of neonatal complications and PTSD symptom scores. Conclusion: Although the occurrence was relatively low, our findings highlight the importance of routine screening and early intervention in maternal health services. Contribution: There is need for further research to inform culturally relevant prevention and treatment strategies.
Background: Mental healthcare service provision is challenging and becomes more complex when users are students. Students are more vulnerable to experiencing mental health challenges. Therefore, higher education institutions (HEIs) must offer effective mental healthcare services to meet the mental health needs of students. Aim: To understand the experiences of mental health practitioners (MHPs) who work for a HEI providing mental healthcare services. Setting: The study was conducted in South Africa within the context of higher education. Methods: A qualitative, exploratory, descriptive and contextual research design, incorporating the Appreciative Inquiry 5D Model, was used. This method allowed for the exploration and description of the experiences of MHPs working in a higher education setting who are tasked with providing mental healthcare services to students. Results: Five themes emerged from the analysis of data: (1) mental healthcare services are viewed as a source of holistic support, (2) mental healthcare provision is experienced as fulfilling and challenging, (3) mental healthcare services should be student-centred and engaging, (4) services should be available, accessible and responsive to address students’ needs, (5) mental healthcare services should integrate monitoring and evaluation strategies. Conclusion: Resource challenges and the rising demand for mental healthcare services by students remain an enormous burden on the already-burdened healthcare system. Higher education institutions must commit to funding these services, and then MHPs will be able to provide effective mental healthcare services to the students. Contribution: Strategies to guide the facilitation of students’ mental health were developed.
Background:Lactate dehydrogenase (LDH) plays a crucial role in glucose metabolism by catalysing the conversion of pyruvate to lactate and facilitating lactate utilisation. Given LDH's central role in energy metabolism, it may serve as a promising biomarker for anxiety disorders. Aim:This study aimed to compare serum LDH levels between patients with generalised anxiety disorder (GAD) and healthy controls (HC) and to examine the associations between LDH levels and clinical features. Setting:Bursa City Hospital: A tertiary hospital in Bursa, Turkey. Methods:This study included 113 participants with GAD and 90 HC. Group comparisons were conducted using an independent samples t-test. Correlations between LDH levels and clinical variables were assessed using the Pearson rank correlation coefficient. To control for the impacts of possible confounding factors on LDH levels, an analysis of covariance (ANCOVA) was conducted. Results:Serum LDH levels were significantly lower in the GAD compared to the HC (157.7 ± 18.7 vs. 173.2 ± 23.3; p: <0.001, t: -5.249, d Cohen: 0.733). The ANCOVA analysis revealed that there was a statistically significant difference in adjusted LDH levels between the control and GAD groups (p < 0.001; mean difference: -15.607; 95% confidence interval [CI]: -21.180 to -9.975). Additionally, LDH levels were negatively and significantly correlated with HAM-A scores (r = -0.218, p = 0.021) and psychic subscale scores (r = -0.250, p = 0.008). Conclusion:These findings support the hypothesis that LDH may represent a potential biomarker and therapeutic target in the clinical management of anxiety. Contribution:This study is the first to report significantly reduced LDH levels in individuals with GAD, highlighting a potential link between altered lactate metabolism and anxiety pathogenesis.
Background: Childhood traumatic experiences are known to have profound and lasting effects on mental health; however, there are limited data on the relationship between types of childhood trauma and social anxiety in non-clinical populations. Aim: This study aimed to explore the associations between types of childhood trauma and social anxiety symptoms in non-clinical young adults. Setting: The study was conducted at the Faculty of Health Sciences of a university in Istanbul, Turkey. Methods: This cross-sectional study included 486 university students. Sample size was determined via G*Power analysis to ensure statistical power. Participants completed the Liebowitz Social Anxiety Scale (LSAS) and the Childhood Trauma Questionnaire (CTQ) to assess childhood trauma types and social anxiety symptoms. Data were analysed using stepwise multiple regression. Results: The mean age of the participants was 21.8 ± 4.0 years, and 81% were female, with emotional abuse and neglect scoring highest in both genders. The sample’s LSAS total mean score was 63.87 ± 11.68. When the subscales were compared by gender, females had significantly higher mean fear and avoidance scores than males (p < 0.05). The results show that childhood abuse and neglect were significant predictors of social anxiety and explained 23% of the social anxiety variance. Conclusion: Childhood abuse and neglect are clearly associated with social anxiety symptoms. Interventions and treatments for individuals with social anxiety should incorporate a detailed assessment of childhood trauma history, with a particular focus on emotional abuse and neglect. Contribution: This study contributes to the literature by clarifying the associations between specific types of childhood trauma and social anxiety symptoms in a non-clinical young adult population.
Background: Anaesthesia trainees are at increased risk of burnout and depression – with occupational stress recognised as a trigger for both. Previous South African single-site studies have assessed these outcomes separately, but not within the same study. Aim: This study aimed to describe a composite mental well-being profile of South African anaesthesia trainees, focusing on burnout, depression screening, occupational stress and associated risk factors. Setting: The study was conducted among South African anaesthesia trainees from nine university-affiliated public teaching hospitals. Methods: Participants were recruited via convenience sampling through engagement with study representatives. Burnout, depression screening and occupational stress were measured using the abridged Maslach Burnout Inventory-Human Services Survey for Medical Personnel, the Harvard Department of Psychiatry National Depression Screening Day Scale and the Effort–Reward Imbalance questionnaire. The response rate was 37%. Results: Of the 194 trainees, 54 (28%) met burnout criteria, 88 (45%) screened positive for depression and 144 (74%) demonstrated chronic occupational stress. Forty-one (21%) trainees simultaneously met criteria for all three study outcomes, representing a distinctly vulnerable subcohort. Risk factors included: previous and/or current treatment for psychiatric illness, registrars in their second year of training and self-prescribing anxiolytics and antidepressants. Conclusion: Burnout rates in this population closely approximate international estimates; however, both depressive symptoms and occupational stress prevalence exceed international figures. Contribution: This first-of-its-kind study provided a composite insight into the mental well-being profile of South African anaesthesia trainees, identifying a bigger cohort at risk of burnout and/or depression in the near future.
Background: The increasing prevalence of autism spectrum disorder (ASD) highlights the importance of understanding caregivers’ experiences in accessing mental healthcare for their children, particularly given the demanding nature of supporting children with ASD in resource-constrained settings. Aim: This study aimed to explore the experiences of caregivers of children with ASD when accessing mental healthcare services in South Africa. Setting: This qualitative study was conducted at the Child and Adolescent Psychiatric Unit at Weskoppies Hospital, a tertiary-level hospital in Pretoria West, Gauteng province, South Africa. Methods: This qualitative case study purposively sampled 15 caregivers of children with ASD at a tertiary psychiatric facility in South Africa. Data were gathered through in-depth interviews and analysed using a Grounded Theory-informed thematic analysis approach. Results: Five main themes emerged: (1) challenges in accessing mental health care services, (2) delays in screening and early diagnosis, (3) limited ongoing education and knowledge-sharing, (4) the need for emotional support and counselling, and (5) facilitating referrals to specialised schools and allied health care services. Conclusion: The study identified significant barriers to mental health service utilisation, underscoring the urgent need for improved service accessibility, caregiver support and increased public awareness. Contribution: The findings advocate for strengthened mental healthcare access and targeted caregiver support for families of children with ASD in South Africa.
Background: Women in Khyber Pakhtunkhwa face several barriers, including poverty, cultural stigma, intense social pressure and a lack of accessible services, which prevent them from addressing drug use and mental health issues. Aim: The study aimed to explore the impact of socio-economic and psychological factors on substance use among women aged 25–34. Setting: This study was conducted at community centres and private schools across several cities in Khyber Pakhtunkhwa, Pakistan, including Peshawar, Charsadda, Nowshera, Swabi and Mardan. Methods: A mixed-methods approach was employed, combining quantitative surveys from 120 participants to analyse drug use patterns and qualitative interviews with 20 participants to investigate personal and social challenges through in-depth interviews. Results: Quantitative data indicated that unemployment, financial hardship and low education significantly predicted drug use, whereas moderate depression, anxiety and stress exacerbated it. Perceived stigma serves as a protective role in this study. Qualitative findings highlight themes such as socioeconomic challenges, mental health issues, cultural pressures and barriers to treatment that exacerbate these problems. Conclusion: This study highlights the importance of rehabilitation centres and community counselling services tailored to women’s specific needs, along with legislative measures to address gaps in support and resources for women facing drug use issues. Contribution: This study contributes to the understanding of the complex relationships between mental health, socioeconomic status and cultural factors influencing drug use among women and aims to inform public health policy and strategy.
Background: Colorectal cancer is one of the most common types of cancer worldwide, including in Indonesia, and has a significant impact on patients’ quality of life. In addition to the physical burden it causes, colorectal cancer patients often experience psychological disorders such as depression and anxiety, which worsen their quality of life. Aim: Although many studies have assessed the physical impact of cancer, the relationship between psychological disorders and quality of life still requires further attention. Setting: This study was conducted at H. Adam Malik General Hospital in Medan, Sumatra. Methods: This study used a correlative analytical design with a cross-sectional approach, involving 300 colorectal cancer patients. Data were collected using the Patient Health Questionnaire-9 (PHQ-9), Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A) and World Health Organization Quality of Life-Brief (WHOQOL-BREF) questionnaires to evaluate depression syndrome, anxiety levels and quality of life. Spearman’s test, logistic regression and linear regression model were used in this study. Results: The results of the study show that 41% of patients experienced severe depression, while 58% of patients experienced severe anxiety. There was a strong negative correlation between symptoms of depression (PHQ-9) and anxiety (HADS-A) and quality of life (WHOQOL-BREF), with a p-value < 0.001 for both. Clinical factors such as stage IV and metastasis, as well as socioeconomic status such as employment and education, were also found to have a significant association. Conclusion: Psychological disorders, particularly depression and anxiety, significantly affect the quality of life of colorectal cancer patients. Psychological interventions, such as cognitive behavioural therapy (CBT), are essential to reduce symptoms of depression and anxiety and improve patients’ quality of life. Contribution: Strong social support has also been shown to play an important role in improving patients’ psychological well-being and treatment outcomes.
Background:Bipolar disorder (BD) is associated with unfavourable reproductive health outcomes. Evidence-based treatment guidelines advocate for reproductive safe prescribing, including family planning, avoidance of teratogenic medication and documentation of risk acknowledgement. However, there is poor adherence to the prescribed guidelines in clinical practice. Aim:To describe the range of psychotropic medications prescribed to women of reproductive age (WRA) with BD at a tertiary psychiatric unit. Setting:Helen Joseph Hospital, Johannesburg, South Africa. Methods:A retrospective record review of females aged 18-49 years treated for BD between January 2016 and December 2023 was conducted. A convenience sample of 141 files was reviewed. Data were collected from the latest clinical notes and prescription charts. Results:A combination of mood stabilisers (MS) and atypical antipsychotics was predominantly prescribed (81.6%). Of the MS, valproate use was most common (50.6%), followed by lithium (29.3%). Risperidone was the most prescribed antipsychotic (39.0%), followed by olanzapine (24.7%) and quetiapine (20.5%). Antidepressants were combined with MS or antipsychotics in 10.6% of cases. Documented contraception counselling (5%) and contraception use (9.2%) were low. None of the records had documented risk acknowledgement for valproate use (100%). Conclusion:Prescribing guidelines for teratogenic MS were not consistently followed. Therefore, WRA diagnosed with BD may be at an increased risk of teratogenic drug exposure in pregnancy. Contribution:This study highlights the need for improved documentation of medication risk discussions, family planning and informed consent at every visit.
Background: Harmful substance use (HSU) poses a significant global health challenge, impacting social, economic, and healthcare systems. Low- and middle-income countries (LMICs) are particularly burdened as a result of limited infrastructure for managing substance-related issues. While evidence-based brief interventions like motivational interviewing (MI) are widely used in high-income countries, research on their effectiveness in LMICs is limited. Aim: This systematic review aims to evaluate studies employing MI as part of interventions for adults with HSU in LMIC settings. Setting: This review focused on studies within low- and middle-income countries which include settings characterised by constrained mental health resources, high treatment gaps for substance use disorders (SUDs), and diverse service delivery contexts. Methods: Following Cochrane and PRISMA guidelines, we searched PubMed, EBSCOhost, Web of Science, Cochrane Library, clinicaltrials.gov and GSK Clinical Study Register for publications from 2010 to 2022. A narrative analysis was conducted, and the Joanna Briggs Institute Critical Appraisal Tools assessed study quality. Results: Out of 518 publications, 11 studies from five countries met our inclusion criteria. Most were randomised controlled trials, with some using qualitative or mixed methods. The interventions targeted alcohol, opioids, and other drugs. Different strategies were used, including MI-blended with other interventions (such as cognitive-behavioural therapy, behavioural activation, and imaginal desensitisation) or using MI-informed approaches. Conclusion: Overall, MI-informed interventions were shown to improve substance use outcomes in six of the 11 studies, with a significant reduction in substance use. However, further high-quality research with larger samples and rigorous designs is needed to strengthen the evidence base and address potential sources of bias. Contribution: Findings suggest that MI-informed approaches, as a brief intervention, can improve substance use outcomes in resource-constrained environments within LMICs.
Background: South Africa is considered as the epicentre of rape. Despite the establishment of hospital-based post-rape centres, uptake remains limited. Within the context of medical pluralism, many individuals utilise both biomedical and traditional healing systems, which are often perceived as culturally congruent and accessible. This study explored post-rape care services provided by traditional health practitioners (THPs) when survivors seek care outside the formal healthcare system. Aim: The study aimed to demystify traditional healing methods used in post-rape care by describing treatment approaches and formulations. Setting: The study was conducted in KwaZulu-Natal, South Africa, which is a province with high rates of gender-based violence and rape. Methods: A qualitative descriptive design was used. Fifteen THPs, including faith healers, diviners, and herbalists, participated in one-on-one interviews conducted in isiZulu and translated into English. Data were analysed using thematic analysis and the healthworlds framework. Results: Findings indicated that rape was often understood as spiritual contamination affecting both survivors and their bloodline. Healing practices therefore focused on addressing this perceived spiritual transgression. Conclusion: The results of this study highlight the importance of culture and spirituality in shaping understandings of rape, treatment formulation, and holistic post-rape care. Contribution: The study demonstrates the significance of traditional healing methods in providing holistic post-rape care.
Background: Despite advances in diagnostics and pharmacological interventions, adults with attention-deficit/hyperactivity disorder (ADHD) experience poor mental health outcomes in South Africa. Patient involvement in psychiatric care remains inconsistent, and co-production has yet to be explored for improved continuity, adherence, and satisfaction. Aim: This study explored how adults with ADHD perceive their involvement in psychiatric care to inform co-production practices for clinicians. Setting: Participants were recruited via the South African Society of Psychiatrists (SASOP) ADHD Special Interest Group (SIG). Methods: This qualitative study explored how adults with ADHD perceive their involvement in psychiatric care. Thirteen adults formally diagnosed with ADHD were purposively sampled. Semi-structured interviews, guided by the SERVPERF model, were conducted online and analysed thematically using ATLAS.ti (version 24.2.1 [32295]; ATLAS.ti Scientific Software Development GmbH, Berlin, Germany). Results: The proposed patient-centred care framework is based on four identified themes: (1) patient agency enhances engagement when decision-making is shared and treatment options are clearly explained; (2) trust in provider expertise and empathy influence adherence and comfort with treatment plans; (3) satisfaction increases with personalised, responsive care, particularly during medication adjustments and follow-up; and (4) continuity of care and timely access foster sustained engagement, while inconsistent communication leads to frustration and dropout. Together, these dynamics form a relational framework for the co-production of care. Conclusion: Patient involvement in ADHD care is relational and influenced by trust, effective communication, and continuity of care. Where co-production was present, patients experienced improved outcomes. Contribution: This study emphasises integrating co-production into psychiatric practice through structured involvement strategies, improved continuity, and relational training for healthcare providers.
Background: Chronic low-grade systemic inflammation is implicated in the pathophysiology of schizophrenia, particularly in its early stages. Pro-inflammatory and anti-inflammatory cytokines have been implicated, particularly interleukin (IL) 6, 8 and 10. Aim: To investigate the association between serum inflammatory cytokines (IL-6, IL-8 and IL-10) and first-episode psychosis (FEP). Setting: The study was at five clinical sites in KwaZulu-Natal, South Africa. Methods: This study was an observational, cross-sectional sub-analysis of data derived from a larger longitudinal cohort study of individuals with FEP. In this analysis, we included HIV-negative participants who were 18 years to 45 years old and had less than 6 weeks of antipsychotic exposure. Measures included socio-demographics (age, sex), body mass index (BMI), psychiatric diagnosis (Mini International Neuropsychiatric Interview, MINI), psychosis severity (Positive and Negative Syndrome Scale, PANSS), depressive symptoms (Patient Health Questionnaire-9, PHQ-9), substance use (WHO Alcohol, Smoking and Substance Involvement Screening Test, WHO-ASSIST), childhood trauma (Childhood Trauma Questionnaire, CTQ), and serum cytokines (Multiplex ELISA). Results: The sample comprised 58 participants, predominantly men (83%), with high rates of lifetime alcohol use (88%) and at least one type of childhood trauma (66%). There was a statistically significantly higher cytokine expression with current alcohol use: IL-6 (p = 0.04), IL-8 (p = 0.01) and IL-10 (p = 0.03). There was also a statistically significant association between lifetime alcohol and tobacco use and elevated IL-10 (p = 0.00 and p = 0.04, respectively). There was no statistically significant association between PANSS, PHQ-9, CTQ, BMI or cannabis and interleukins. Conclusion: The study concludes that there is some evidence of immunological dysfunction at baseline in treatment-naïve persons diagnosed with FEP. Contribution: This study contributes novel data on inflammatory cytokine profiles in individuals with FEP in a South African context, an under-represented population in psychoneuro-immunology research.
Background: Inpatient care is a key driver of mental healthcare costs in South Africa (SA). Schizophrenia is a common psychiatric diagnosis amongst hospitalised patients in the public sector of SA. Determining the length of stay (LOS) and associated factors in patients with schizophrenia could assist in effective utilisation of the mental healthcare budget. Aim: To determine the LOS and any associated socio-demographic and clinical factors in patients with schizophrenia. Setting: A psychiatric unit in a central public hospital, Chris Hani Baragwanath Academic Hospital (CHBAH) and a specialised psychiatric hospital, Tara H Moross (TARA) in Gauteng, SA. Methods: A quantitative retrospective review of the records of patients with schizophrenia admitted to CHBAH and discharged from CHBAH and TARA hospital over the study period was conducted. Information on the LOS, socio-demographic and clinical factors was collected upon discharge. Results: The median LOS for the 132 patients with schizophrenia was 42 days, with a mean of 55 days. In bivariate analysis, statistically significant factors associated with LOS were living arrangements (p = 0.036), number of previous admissions (first admission) (p = 0.009) and being on clozapine (p 0.001). However, in regression analyses, only living alone remained statistically significant and associated with a shorter LOS (p = 0.004). Conclusion: Prolonged LOS indicates ongoing reliance on inpatient care due to service level constraints, including poorly resourced community psychiatric services and individual contextual factors. Both socio-demographic and clinical factors influenced LOS. Associated factors such as living alone and early clozapine initiation provide targets from which to start addressing modifiable contributors that may reduce LOS. Contribution: This study contributes to the limited data on the LOS for patients with schizophrenia in SA.
Background: Adjustment disorder (AjD) is a significant yet often underdiagnosed condition in workplace mental health. The International Adjustment Disorder Questionnaire (IADQ) has shown promise as a screening tool, but its clinical utility within South African (SA) occupational settings remains unexplored. Aim: To assess the psychometric validity and clinical utility of the IADQ in an educated SA workplace population. Setting: The research was conducted across various occupational sectors in South Africa. Methods: A cross-sectional survey included the IADQ alongside validated measures of depression, anxiety, post-traumatic stress disorder and psychological resilience. Confirmatory factor analysis assessed structural validity, while performance of the IADQ algorithm was evaluated against clinical interviews. A grey zone approach was considered to refine screening thresholds. Results: Adjustment disorder point prevalence was 4.3% in this sample. Confirmatory factor analysis supported the two-factor model of AjD symptoms, with measurement invariance observed across gender and language groups. The IADQ algorithm demonstrated good diagnostic accuracy for screening purposes, with sensitivity and specificity values exceeding 0.95. Psychological resilience was associated with lower odds of AjD. Conclusion: The IADQ demonstrated good psychometric properties and clinical utility for comparable workplace mental health screening. The grey zone approach may offer a practical framework for graduated triage in resource-limited settings. Contribution: Our study supported the global applicability of the two-factor AjD symptom model, provided updated AjD prevalence rates for a SA workplace sample, and considered a refined screening method for use in occupational mental health services.
