By September 2014, an outbreak of Ebola Viral Disease (EVD) in West African countries of Guinea, Liberia, Sierra Leone, Senegal and Nigeria, had recorded over 4500 and 2200 probable or confirmed ...cases and deaths respectively. EVD, an emerging infectious disease, can create fear and panic among patients, contacts and relatives, which could be a risk factor for psychological distress. Psychological distress among this subgroup could have public health implication for control of EVD, because of potential effects on patient management and contact tracing. We determined the Prevalence, pattern and factors associated with psychological distress among survivors and contacts of EVD and their relatives.
In a descriptive cross sectional study, we used General Health Questionnaire to assess psychological distress and Oslo Social Support Scale to assess social support among 117 participants who survived EVD, listed as EVD contacts or their relatives at Ebola Emergency Operation Center in Lagos, Nigeria. Factors associated with psychological distress were determined using chi square/odds ratio and adjusted odds ratio.
The mean age and standard deviation of participants was 34 +/ - 9.6 years. Of 117 participants, 78 (66.7%) were females, 77 (65.8%) had a tertiary education and 45 (38.5%) were health workers. Most frequently occurring psychological distress were inability to concentrate (37.6%) and loss of sleep over worry (33.3%). Losing a relation to EVD outbreak (OR = 6.0, 95% CI, 1.2-32.9) was significantly associated with feeling unhappy or depressed while being a health worker was protective (OR = 0.4, 95% CI, 0.2-0.9). Adjusted Odds Ratio (AOR) showed losing a relation (AOR = 5.7, 95% CI, 1.2-28.0) was a predictor of "feeling unhappy or depressed", loss of a relation (AOR = 10.1, 95% CI, 1.7-60.7) was a predictor of inability to concentrate.
Survivors and contacts of EVD and their relations develop psychological distress. Development of psychological distress could be predicted by loss of family member. It is recommended that psychiatrists and other mental health specialists be part of case management teams. The clinical teams managing EVD patients should be trained on recognition of common psychological distress among patients. A mental health specialist should review contacts being monitored for EVD for psychological distress or disorders.
Abstract Background In April 2011, a post-election violent conflict in northern Nigeria led to resettlement of internally displaced persons (IDPs) in a camp in Kaduna, the worst affected state. We ...set out to determine the prevalence of depression among the IDPs. We also determined socio-demographic and other correlates of depression among the IDPs. Methods Cross-sectional systematic random sampling was used to select 258 adults IDPs. We used the Hopkins symptom checklist to diagnose probable depression, composite international diagnostic interview for diagnosis of definite depression and communal trauma event inventory to determine exposure to psycho-trauma. We assessed social adjustment using social provision scale and Harvard trauma questionnaire to diagnose “symptomatic PTSD”. Multiple logistic regression was used to determine independent predictors of depression. Results Of the 258 IDPs, 154 (59.7%) had probable depression, and 42 (16.3%) had definite depression. Females were more likely to have probable depression (1.68, 95% CI 1.02–2.78; p =0.04) and definite depression (2.69, 1.31–5.54; p = 0.006). IDPs with co-morbid PTSD were more likely to have probable depression (16.9, 8.15–35.13; p <0.000) and definite depression (3.79,1.86–7.71; p <0.000). A comorbid CIDI diagnosis of PTSD (AOR 16.6, 7.2–38.6; p <0.000) and psycho-trauma of getting beaten (AOR 2.7, 1.1–6.7; p =0.004) remained as independent predictors of probable depression among the IDPs. The male gender remained a protective factor against probable depression (AOR 0.3, 0.1–0.7; p = 0.006). Limitations This study was conducted 2 years post-conflict and only IDPs living in the camps were studied. Conclusion IDPs living in Hajj camp in Kaduna, northern Nigeria developed post-conflict probable depression and definite depression. Female gender, experienced beating and comorbid diagnosis of PTSD were independent predictors of probable depression among the IDPs, while IDPs that were unemployed or retired had more of definitive depression.
Objectives
Despite the importance of a satisfying sexual life, most patients with schizophrenia spectrum disorders do not discuss sexual issue with their clinicians. The current study seeks to ...determine the prevalence and socio-clinical correlates of sexual dysfunction among patients with schizophrenia spectrum disorders receiving typical and atypical antipsychotic medications. The second objective is to determine the frequency and correlates of specific sexual dysfunction (desire, arousal, erection/lubrication and orgasm) by gender and drug type using the Arizona Sexual Experience Scale.
Methodology
This cross-sectional study used standardized structured interviewer based survey to assess sexual dysfunction among patients with schizophrenia that are both sexually active and inactive at a tertiary hospital in Maiduguri from December 2020 to April 2021. Participants were also assayed for prolactin using ELISA Kit for a possible association with sexual dysfunction.
Results
The overall prevalence of sexual dysfunction among patients with schizophrenia spectrum disorder receiving antipsychotics was 34% with patients on typical and atypical antipsychotics reporting rates of 36.8% and 24.6%, respectively. Among the typical and atypical antipsychotics, patients receiving haloperidol (40.3%) and risperidone (37.5%) reported a relatively higher frequency of sexual dysfunction compared to those receiving clozapine (18.2%). Independent correlates of sexual dysfunction were: female gender (OR = 1.89, 95% CI = 1.17-3.06; P = .010), being unmarried (OR = 1.51, 95% CI = 1.17-1.96; P = .001), pseudoparkinsonism (OR = 1.66, 95% CI = 1.02-2.69; P = .008), prolactin (OR = 2.15, 95% CI = 1.34-3.43; P = .001) and severity of illness (OR = 1.34, 95% CI = 1.03-1.75; P = .030).
Conclusion
Sexual dysfunction is prevalent among patients with schizophrenia spectrum disorder receiving either typical or atypical antipsychotics.
Purpose of Review
The goal of this paper was to review recent literature and provide recommendations regarding the use of telemental health, with a focus on tele-consultation and tele-supervision in ...post-disaster and low-resource settings, including the impact of COVID-19.
Recent Findings
The latest research on mental health needs in low-resource settings has identified a high need for mental health services for difficult-to-reach and underserved populations. Research on tele-consultation and tele-supervision was reviewed and found that tele-consultation and tele-supervision to be an effective modality for insuring quality mental health care delivery in low-resource settings. Additionally, two case studies were included which illustrate the use of both tele-consultation and tele-supervision in low-resource low- and middle-income settings.
Summary
The paper concludes that tele-consultation and tele-supervision hold the promise to narrow the gap in quality mental health services in low-resource settings so often impacted by disaster and conflict. The authors recommend that telemental health training be developed that specifically enhances consultants’ and supervisors’ skills in tele-consultation and tele-supervision.
Suicide is a primary emergency for mental health professionals, a major public health problem and the most common mode of death in prisons. Although juvenile crime rates appear to have fallen since ...the mid-1990s, this decrease has not reduced the concern particularly in the sub-Saharan Africa where the population is predominantly youth who are also increasingly prone to vices that may lead to incarceration. To determine the spectrum and predictors of suicide risk among incarcerated youth. This cross-sectional study was conducted at the Borstal Training Institution in Kaduna, North-western Nigeria between March 2018 and June, 2018. We recorded the participants' socio-demographic details using a data collection sheet while the Adverse Childhood Experiences (ACE) Questionnaire was used to assess all the categories of adverse childhood experiences. We used the Mini International Neuropsychiatric Interview to assess for depression and suicidality in the participants. The 262 youth aged 18 years to 35 years were all males with mean age of 22.34 years (SD ±3.68). The prevalence of 40.1% (105) was obtained for suicide risk; majority were low risk (37.1%). Six (2.3%) participants had made suicidal attempts while 21 (8.0%) had lifetime attempt. Participants that were likely to make an attempt in the future were 2.7% (7) and twenty participants (7.6%) had suicidal behavior disorder. However, no current depression (OR = 3.248; P value = 0.021; 95% CI = 1.196-8.826), previous remands (OR = 0.523; P value = 0.043; 95% CI = 0.280-0.979), increasing age (OR = 1.099; P value = 0.020; 95% CI = 1.015-1.019) and having mothers with high-level jobs (OR = 0.417; P value = 0.002; 95% CI = 0.238-0.731) were the only predictors of suicide risk. Suicide risk is prevalent among incarcerated youth and proven suicide prevention strategies should be incorporated into their management.
In April 2011, a post election violent conflict in Northern Nigeria led to resettlement of internally displaced persons (IDPs) in a camp in Kaduna, the worst affected state. We set out to determine ...prevalence and socio-demographic factors associated with post-traumatic stress disorder (PTSD) among IDPs. We also determined types of psycho-trauma experienced by the IDPs and their psychosocial adjustment.
Cross-sectional systematic random sampling was used to select 258 adults IDPs. We used Harvard trauma questionnaire to diagnose "symptomatic PTSD," composite international diagnostic interview (CIDI) for diagnosis of depression, and communal trauma event inventory to determine exposure to psycho-trauma. We assessed social adjustment using social provision scale. Multiple logistic regression analysis was used to determine independent predictors of PTSD.
Of the 258 IDPs, 109 (42.2%) had a diagnosis of PTSD, 204 (79.1%) had poor living conditions, and only 12 (4.7%) had poor social provision. The most frequent psycho-traumas were destruction of personal property (96.1%), been evacuated from their town (96%) and witnessing violence (88%). More than half (58%) of IDPs had experienced 11-15 of the 19 traumatic events. Independent predictors of PTSD among respondents were having a CIDI diagnosis of depression (adjusted odds ratios 3.5, 95% confidence interval 1.7-7.5; p = 0.001) and witnessing death of a family member (3.7, 1.2-11.5; p = 0.0259).
We concluded that exposure to psycho-trauma among IDPs in Kaduna led to post conflict PTSD. Death of a family member and co-morbid depression were independent predictors of PTSD among IDPs. Though their living condition was poor, the IDPs had good psychosocial adjustment. We recommended a structured psychosocial intervention among the IDP targeted at improving living condition and dealing with the psychological consequences of psycho-trauma.
The treatment gap for mental illness in Nigeria, as in other sub-Saharan countries, is estimated to be around 85%. There is need to prioritise mental health care in low and middle income countries by ...providing a strong body of evidence for effective services, particularly with a view to increasing international and government confidence in investment in scaling up appropriate services. This paper lays out the processes by which a programme to integrate evidence-based mental health care into primary care services in Nigeria was designed, including a research framework to provide evidence from a robust evaluation.
This paper forms the first step in the overall process evaluation of the mhSUN intervention, where standard research practice indicates that the intervention, and its development, is clearly documented prior to subsequent evaluation. The report covers the period of programme development and evaluation design, and study site and design was chosen to allow generalisability and practical conclusions to be drawn for service development in Nigeria. In order to design an intervention that was informed by evidence and took into account local context and input of stakeholders, a structured process was followed, including: (1) Engagement of relevant stakeholders for information gathering and buy-in; (2) Literature review and gathering of pertinent evidence; (3) Situation analysis at a national and local level; (4) Model development (using Theory of Change); (5) Ongoing consultation, recognising the iterative nature of Theory of Change, and need for ongoing refinement of complex interventions.
The different sections of the structured approach resulted in outputs that built the necessary components (literature review, situation analysis) for informing the Theory of Change. A Theory of Change map is presented, which includes transparent documentation of the assumptions and logic behind the activities to drive the desired change. In addition, it documents the indicators necessary to measure fidelity and draw conclusions as to hypothesised effects of different mechanisms of action in subsequent evaluation.
In addition to the details of ensuring robust evaluation design, there are a number of considerations that are particular to the context that must be taken into account in programme development, including the relationships between ultimate beneficiaries, implementers, host government and institutions, donors, and programme evaluators. Structured methods from existing frameworks can be drawn upon to use and collate relevant information to maximise the local applicability of a generic evidence base. Theory of Change, with its documented assumptions can form the basis of subsequent evaluation and iterative programme refinement, contributing to a more scientifically valid means of developing mental health programmes for scale up.
Current international recommendations to address the large treatment gap for mental healthcare in low- and middle-income countries are to scale up integration of mental health into primary care. ...There are good outcome studies to support this, but less robust evidence for effectively carrying out integration and scale-up of such services, or for understanding how to address contextual issues that routinely arise.
This protocol is for a process evaluation of a programme called Mental Health Scale Up Nigeria. The study aims are to determine the extent to which the intervention was carried out according to the plans developed (fidelity), to examine the effect of postulated moderating factors and local context, and the perception of the programme by primary care staff and implementers.
We use a theoretical framework for process evaluation based on the Medical Research Council's Guidelines on Process Evaluation. A Theory of Change workshop was carried out in programme development, to highlight relevant factors influencing the process, ensure good adaptation of global normative guidelines and gain buy-in from local stakeholders. We will use mixed methods to examine programme implementation and outcomes, and influence of moderating factors.
Data sources will include the routine health information system, facility records (for staff, medication and infrastructure), log books of intervention activities, supervision records, patient questionnaires and qualitative interviews.
Evidence from this process evaluation will help guide implementers aiming to scale up mental health services in primary care in low- and middle-income countries.
Background: Antipsychotic medication for the treatment of schizophrenia spectrum disorders are associated with adverse effects with extrapyramidal side effects constituting one of the most notable ...effects associated with poor medication adherence and poor quality of life. Aims: The study aims to compare the prevalence of extrapyramidal side effects (EPSE), among patients with schizophrenia spectrum disorders on typical and atypical antipsychotic medications. The secondary aim is to determine the association of extra-pyramidal side effects with socio-clinical variables. Methodology: A cross-sectional hospital-based study with systematic random sampling recruitment of 340 participants and 303 completed the study. Variables with significant association on chi square analysis were subjected to logistic regression analysis. Results: The overall prevalence of extrapyramidal side effects among patients with schizophrenia spectrum disorder on antipsychotic medication was 42.6 %. The prevalence of tardive dyskinesia, parkinsonism and akathisia were 7.9 %, 38.6 and 3.6 %, respectively. The prevalence of extra-pyramidal side effects due to use of typical, atypical and combination drug was 44.4 %, 51.2 % and 34.5 %, respectively with haloperidol (59.4 %) and risperidone (71.4 %) having the greatest effect. Being elderly was associated with tardive dyskinesia, duration of treatment, severity of illness and type of illness with parkinsonism and severity of illness with akathisia. Conclusion: The findings of this study support the high prevalence of extrapyramidal side effects from either using typical and atypical antipsychotic medications. Therefore, Clinicians should discuss on these side effects and proffer possible solutions with their patients prior to commencement of antipsychotic medications in order to promote medication adherence.
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