BACKGROUND: Europe and North America have low rates of mental health service use despite high rates of mental disorder. Little is known about mental health service use among South Africans. DESIGN: A nationally representative survey of 4 351 adults. Twelve-month DSM-IV (Diagnostic and Statistical Manual, 4th edition) diagnoses, severity, and service utilisation were determined using the World Health Organization Composite International Diagnostic Interview (CIDI). Twelve-month treatment was categorised by sector and province. South Africans in households and hostel quarters were interviewed between 2002 and 2004 in all nine provinces. OUTCOME MEASURES: 4 317 respondents 18 years and older were analysed. Bivariate logistic regression models predicted (i) 12-month treatment use of service sectors by gender, and (ii) 12-month treatment use by race by gender. RESULTS: Of respondents with a mental disorder, 25.2% had sought treatment within the previous 12 months; 5.7% had used any formal mental health service. Mental health service use was highest for adults with mood and anxiety disorders, and among those with a mental disorder it varied by province, from 11.4% (Western Cape) to 2.2% (Mpumalanga). More women received treatment, and this was largely attributable to higher rates of treatment in women with mood disorders. Age, income, education and marital status were not significantly associated with mental health service use. Race was associated with the treatment sector accessed in those with a mental disorder. CONCLUSIONS: There is a substantial burden of untreated mental disorders in the South African population, across all provinces and even in those with substantial impairment. Greater allocation of resources to mental health services and more community awareness initiatives are needed to address the unmet need.

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.

There are few data from South Africa and other low- and middle-income countries on how mental disorders in childhood and adolescence may influence different aspects of socio-economic position, including educational attainment. We examined the association between early-onset disorders and subsequent educational achievement in a nationally representative sample of 4 351 South African adults. After adjusting for participant demographic characteristics and traumatic life events, post-traumatic stress disorder, major depressive disorder and substance-related disorders were each associated with increased odds of failing to complete secondary education (odds ratios and 95% confidence intervals 2.3, 1.0 - 5.1; 1.7, 1.2 - 2.5, and 1.7, 1.2 - 2.5, respectively). These data point to the role that early-life mental disorders may play in educational achievement and subsequent socio-economic position over the life course.

Supercritical CO2 (SCO2) can be utilized to extract oils from a number of plant materials as a nontoxic alternative to hexane, and there is industrial interest in using SCO2 extraction to obtain high-quality oils for cosmetics and other high-value applications. A possible substrate is rosehip (Rosa aff. rubiginosa) seed. The scope of our work was to select SCO2 extraction conditions and to compare cold-pressed, hexane-extracted and SCO2-extracted rosehip oil. We used a fractional factorial experimental design with extraction temperature (T, 40-60 °C), extraction pressure (p, 300-500 bar) and dynamic extraction time (t, 90-270 min) as independent variables and yield and color as response variables. Samples of 100 g flaked rosehip seeds were extracted with 21 g CO2/min, following a static extraction (15 min adjustment) period. Resulting data were analyzed using response surface methodology. Extracted oil (4.7-7.1% in our experimental region) increased slightly with p and more pronouncedly with T and specially t. On the other hand, the photometric color index was independent of t but worsened (increased) as a result of an increase in either p or specially T. We extracted five batches of 250 g seeds with 21 g CO2/min at 40 °C and 300 bar for 270 min and compared the oil with samples obtained by solvent extraction (a batch of 2.5 kg of laminated seeds was treated with 10 L hexane and rotaevaporated until there was virtually no residual hexane) and cold pressing, by determining color, fatty acid composition, iodine index and saponification index. It was concluded that SCO2 allows an almost complete recovery of rosehip oil (6.5% yield), which is of a better quality than the oil extracted with hexane. Yield was higher than it was when using a cold-pressing process (5.0% yield).