Outcome measure

The main outcome measure of this study, psychological distress, was derived from the 10-item Kessler psychological distress scale (K-10) (Kessler et al. 2002). The scale measures current nonspecific psychological distress and has been validated in the South African context (Andersen et al. 2011). The scale was dichotomised into two categories with a total score < 20 for minimal psychological distress (coded 0) and over 20 for mild to severe psychological distress (coded 1) (Andrews & Slade 2001). Cronbach’s alpha for the psychological distress scale used during this study is α = 0.94, indicating high inter-item reliability.