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Adaptation and validation of a computerized neurocognitive battery in the Xhosa of South Africa

  • Authors: Cobb, Scott J , Moore, Tyler M , Stein, Dan J , Pretorius, Adele , Zingela, Zukiswa , Nagdee, Mohammed , Ngqengelele, Linda , Campbell, Megan M , Sibeko, Goodman , King, Mary C , McClellan, Jon M , Port, Allison M , Jackson, Chad , Ruparel, Kosha , Susser, Ezra , Gur, Ruben C
  • Date: 2021
  • Subjects: To be catalogued
  • Language: English
  • Type: text , article
  • Identifier: http://hdl.handle.net/10962/302439 , vital:58196 , xlink:href="https://doi.org/10.1037/neu0000742"
  • Description: Objective: Large-scale studies have revolutionized biomedical research, and neurocognitive tests can help elucidate the biological basis of neuropsychiatric diseases. However, studies have predominantly been conducted in Western settings. We describe the development and validation of a computerized battery (PennCNB) with the Xhosa population of South Africa. Method: Individuals with schizophrenia (n = 525) and a normative comparison group (n = 744) were balanced on age, sex, education, and region. Participants provided blood samples, were assessed psychiatrically, and were administered a PennCNB translation to isiXhosa, including measures of executive functions, episodic memory, complex cognition, social cognition, and sensorimotor speed. Feasibility was examined with test completion rates and input from administrators, and psychometric structural validity and associations with clinical and demographic characteristics were examined. Results: Tests were well tolerated by participants, as >87% had one (or fewer) test missing. Results suggested a similar factor structure to prior PennCNB studies in Western contexts, and expected age and sex effects were apparent. Furthermore, a similar profile of schizophrenia was observed, with neurocognitive deficits most pronounced for executive functions, especially attention, as well as memory, social cognition, and motor speed relative to complex cognition and sensorimotor speed. Conclusions: Results support the feasibility of implementing a culturally adapted computerized neurocognitive battery in sub-Saharan African settings and provide evidence supporting the concurrent validity of the translated instrument. Thus, the PennCNB is implementable on a large scale in non-Western contexts, shows expected factor structure, and can detect cognitive deficits associated with neuropsychiatric disorders. Obtaining valid measures of cognition by nonspecialized proctors is especially suitable in resource-limited settings, where traditional testing is prohibitive. Future work should establish normative standards, test–retest reliability, and sensitivity to treatment.
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  • Date Issued: 2021

Prevalence and clinical correlates of substance use disorders in South African Xhosa patients with schizophrenia

  • Authors: Temmingh, Henk , Susser, Ezra , Mall, Sumaya , Campbell, Megan M , Sibeko, Goodman , Stein, Dan J
  • Date: 2021
  • Subjects: To be catalogued
  • Language: English
  • Type: text , article
  • Identifier: http://hdl.handle.net/10962/302509 , vital:58203 , xlink:href="https://doi.org/10.1007/s00127-020-01942-5"
  • Description: Purpose: To determine the prevalence of substance use disorders (SUDs) in patients with schizophrenia in a sample from South Africa and compare the clinical and demographic correlates in those with and without co-occurring SUDs. Methods: Patients with schizophrenia were interviewed using the Xhosa version SCID-I for DSM-IV. We used logistic regression to determine the predictors of SUDs. Results: In the total sample of 1420 participants, SUDs occurred in 47.8%, with the most prevalent SUD being cannabis use disorders (39.6%), followed by alcohol (20.5%), methaqualone (6.2%), methamphetamine (4.8%) and other SUDs (cocaine, ecstasy, opioids, 0.6%). Polydrug use occurred in 40%, abuse occurred in 13.5%, and 39.6% had at least one substance dependence diagnosis. Signifcant predictors of any SUD were younger age (41–55 vs. 21–30: OR=0.7, 95% CI=0.5–0.9), male sex (OR=8.6, 95% CI=5.1–14.6), inpatient status (OR=1.7, 95% CI=1.3–2.1), post-traumatic stress symptoms (OR=4.6, 95% CI=1.6–13.3), legal (OR=3.4, 95% CI=2.0–5.5) and economic problems (OR=1.4, 95% CI=1.0–2.0). Methamphetamine use disorders occurred signifcantly less often in the Eastern compared to the Western Cape provinces. Inpatient status and higher levels of prior admissions were signifcantly associated with cannabis and methamphetamine use disorders. Post-traumatic stress symptoms were signifcantly associated with alcohol use disorders. Anxiety disorders were associated with other SUDs. Conclusion: SUDs occurred in almost half of the sample. It is important for clinicians to identify the presence of SUDs as their presence is associated with characteristics, such as male sex, younger age, inpatient status, more prior hospitalisations, legal and economic problems, PTSD symptoms and anxiety.
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  • Date Issued: 2021

The relationship between childhood trauma and schizophrenia in the Genomics of Schizophrenia in the Xhosa people (SAX) study in South Africa

  • Authors: Mall, Sumaya , Platt, Jonathan M , Temmingh, Henk , Musenge, Eustasius , Campbell, Megan M , Susser, Ezra , Stein, Dan J
  • Date: 2020
  • Subjects: To be catalogued
  • Language: English
  • Type: text , article
  • Identifier: http://hdl.handle.net/10962/302567 , vital:58208 , xlink:href="https://doi.org/10.1017/S0033291719001703"
  • Description: Background. Evidence from high-income countries suggests that childhood trauma is associated with schizophrenia. Studies of childhood trauma and schizophrenia in low and middle income (LMIC) countries are limited. This study examined the prevalence of childhood traumatic experiences among cases and controls and the relationship between specific and cumulative childhood traumatic experiences and schizophrenia in a sample in South Africa. Methods. Data were from the Genomics of Schizophrenia in the South African Xhosa people study. Cases with schizophrenia and matched controls were recruited from provincial hospitals and clinics in the Western and Eastern Cape regions in South Africa. Childhood traumatic experiences were measured using the Childhood Trauma Questionnaire (CTQ). Adjusted logistic regression models estimated associations between individual and cumulative childhood traumatic experiences and schizophrenia. Results. Traumatic experiences were more prevalent among cases than controls. The odds of schizophrenia were 2.44 times higher among those who experienced any trauma than those who reported no traumatic experiences (95% CI 1.77–3.37). The odds of schizophrenia were elevated among those who experienced physical/emotional abuse (OR 1.59, CI 1.28–1.97), neglect (OR 1.39, CI 1.16–1.68), and sexual abuse (OR 1.22, CI 1.03–1.45) compared to those who did not. Cumulative physical/emotional abuse and neglect experiences increased the odds of schizophrenia as a dose–response relationship. Conclusion. Childhood trauma is common in this population. Among many other benefits, interventions to prevent childhood trauma may contribute to a decreasing occurrence of schizophrenia.
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  • Date Issued: 2020

Predictors of consent to cell line creation and immortalisation in a South African schizophrenia genomics study

Using iterative learning to improve understanding during the informed consent process in a South African psychiatric genomics study

  • Authors: Campbell, Megan M , Susser, Ezra , Mall, Sumaya , Mqulwana, Sibonile G , Mndini, Michael M , Ntola, Odwa A , Nagdee, Mohamed , Zingela, Zukiswa , Van Wyk, Stephanus , Stein, Dan J
  • Date: 2017
  • Subjects: Informed consent (Medical law) , Patient education
  • Language: English
  • Type: text , article
  • Identifier: http://hdl.handle.net/11260/6114 , vital:45124 , https://doi.org/10.1371/journal.pone.0188466
  • Description: Obtaining informed consent is a great challenge in global health research. There is a need for tools that can screen for and improve potential research participants’ understanding of the research study at the time of recruitment. Limited empirical research has been conducted in low and middle income countries, evaluating informed consent processes in genomics research. We sought to investigate the quality of informed consent obtained in a South African psychiatric genomics study. A Xhosa language version of the University of California, San Diego Brief Assessment of Capacity to Consent Questionnaire (UBACC) was used to screen for capacity to consent and improve understanding through iterative learning in a sample of 528 Xhosa people with schizophrenia and 528 controls. We address two questions: firstly, whether research participants’ understanding of the research study improved through iterative learning; and secondly, what were predictors for better understanding of the research study at the initial screening? During screening 290 (55%) cases and 172 (33%) controls scored below the 14.5 cut-off for acceptable understanding of the research study elements, however after iterative learning only 38 (7%) cases and 13 (2.5%) controls continued to score below this cut-off. Significant variables associated with increased understanding of the consent included the psychiatric nurse recruiter conducting the consent screening, higher participant level of education, and being a control. The UBACC proved an effective tool to improve understanding of research study elements during consent, for both cases and controls. The tool holds utility for complex studies such as those involving genomics, where iterative learning can be used to make significant improvements in understanding of research study elements. The UBACC may be particularly important in groups with severe mental illness and lower education levels. Study recruiters play a significant role in managing the quality of the informed consent process.
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  • Date Issued: 2017
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