A major barrier to improving care effectiveness for mental health is a lack of consensus on outcomes measurement. The International Consortium for Health Outcomes Measurement (ICHOM) has already ...developed a consensus-based standard set of outcomes for anxiety and depression in adults (including the Patient Health Questionnaire-9, the Generalised Anxiety Disorder 7-item Scale, and the WHO Disability Schedule). This Position Paper reports on recommendations specifically for anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder in children and young people aged between 6 and 24 years. An international ICHOM working group of 27 clinical, research, and lived experience experts formed a consensus through teleconferences, an exercise using an adapted Delphi technique (a method for reaching group consensus), and iterative anonymous voting, supported by sequential research inputs. A systematic scoping review identified 70 possible outcomes and 107 relevant measurement instruments. Measures were appraised for their feasibility in routine practice (ie, brevity, free availability, validation in children and young people, and language translation) and psychometric performance (ie, validity, reliability, and sensitivity to change). The final standard set recommends tracking symptoms, suicidal thoughts and behaviour, and functioning as a minimum through seven primarily patient-reported outcome measures: the Revised Children's Anxiety and Depression Scale, the Obsessive Compulsive Inventory for Children, the Children's Revised Impact of Events Scale, the Columbia Suicide Severity Rating Scale, the KIDSCREEN-10, the Children's Global Assessment Scale, and the Child Anxiety Life Interference Scale. The set's recommendations were validated through a feedback survey involving 487 participants across 45 countries. The set should be used alongside the anxiety and depression standard set for adults with clinicians selecting age-appropriate measures.
This study aimed to assess the community knowledge, awareness, and attitude towards people living with epilepsy (PLWE) in Lagos, Nigeria. This was to provide background information for formulating ...evidence-based campaign and intervention to reduce stigma and improve health-related quality of life amongst PLWE and their families.
Adult respondents (n = 1614) selected via multistage probability sampling completed a set of questionnaires. A case vignette was used to depict epilepsy. The respondents' knowledge of, familiarity with, perceived cause, and preferred treatment option for epilepsy were assessed. Their attitude towards people's attitude was measured with Attitudes and Beliefs about Living with Epilepsy (ABLE) scale.
While a total of 1258 (67.6%) could correctly name the illness as epilepsy, only 945 (58.5%) had witnessed an epileptic seizure episode before. The most endorsed causes of epilepsy were brain injury/infection (75.8%), evil spirit/witchcraft (73.0%), God's will (70.0%), and infection by contact (64.9%). Only 67.6% believe that epilepsy is treatable, and 42.5% preferred treatment by spiritualist. Generally, there was a positive attitude to PLWE; however, there were serious risk and safety concerns. The factors associated with negative attitude towards PLWE include male gender (adjusted odds ratio AOR: 2.44, 95% confidence interval CI: 1.98–3.00), lower educational status (AOR: 1.69, 95% CI: 1.32–2.16), poor knowledge of epilepsy (AOR: 1.74, 95% CI: 1.36–2.22), poor familiarity with epilepsy (AOR: 1.65, 95% CI: 1.14–2.42), and endorsement of supernatural causes of epilepsy (AOR: 1.59, 95% CI: 1.28–1.97).
Closing the treatment gap for epilepsy in Nigeria and other sub-Saharan Africa countries will involve steps to change the misconception of the Nigerian populace as regards the causes of epilepsy and help seeking pathway. There is need for nationwide educational programs for epilepsy that consider cognitive and affective processes and also involve all the major stakeholders like primary care workers, community leaders, and spiritual and traditional leaders.
•Stigma and misconception are some of the important reasons for the huge treatment gap for epilepsy in sub-Saharan Africa•Belief in supernatural causation and the misconception that epilepsy is contagious is very common amongst lay public in Nigeria•Negative attitude towards PLWE is associated with male gender, low education and belief in supernatural causation of epilepsy•To maximise potential outreach, belief system based educational campaigns should be carried out in collaboration with stakeholders
To plan effective school-based adolescent suicide prevention strategies, there is need for valid epidemiology data. The aim of this study was to estimate the current (1 month) prevalence and ...associated factors of suicidal behaviours (ideation, planning, and attempt) amongst secondary school adolescents in Lagos, Nigeria. A total of 9441 adolescents (4684 males and 4757 females) with mean age 15.61 years (SD 1.49) recruited from 47 public senior secondary schools self-completed questionnaire consisting of sociodemographic, family, school, physical health, and mental health-related variables. Suicidal behaviours (ideation, planning, and attempt) in the past 1 month were also assessed. The weighted 1-month prevalence for suicidal ideation was 6.1% (95% CI 5.5–6.7), suicidal planning was 4.4% (95% CI 3.8–4.9), and suicidal attempt was 2.8% (95% CI 2.4–3.2). The factors significantly associated with suicidal behaviours included being female, not staying with the mother, maternal drinking, witnessing domestic violence, past and present academic difficulties, having no close friend in school and having problems relating with peers and teachers. Also, presence of chronic physical illnesses, depression, anxiety, behavioural disorders, and psychotic-like experiences were associated with adolescent suicidal behaviour. We have shown that a substantial percentage of adolescent have suicidal behaviours, and that there were demographic, family, school, physical health, and psychological health-related factors. We believe that our findings will be important when planning suicide prevention services that could be incorporated into the school mental health services
Aim
This study aimed to explore the presence of psychotic like experience (PLE) symptoms and evaluate for the possible socio‐demographic, family, school and mental health variables associated with ...clinically significant PLE symptoms in Nigeria school adolescent.
Methods
A total of 9441 adolescents from 47 secondary schools in Lagos Nigeria completed questionnaire detailing sociodemographic, family and school related variables. Mental health was assessed with the Mini International Diagnostic Interview for children and adolescents (MINI‐KID). PLE was assessed using the 16‐item version of Prodromal Questionnaire (PQ‐16).
Results
The mean age in years was 15.6 (SD 1.5) and 50.4% were females. The mean PQ‐16 score was 2.18 (SD 2.38) with 95% CI 2‐15‐2.21. A total of 2878 (30.5%) adolescents had no PLE symptoms while 990 (10.5%) had clinically significant PLE symptoms. The most experienced symptoms were “déjà vu” (35.5%) and loss of interest (29.6%). The variables independently associated with clinically significant PLE symptoms were “having no close friend in school” (OR 2.66, 95% CI 2.08‐3.41), “often beaten by parents” (OR 1.98, 95% CI 1.67‐2.34) “from a polygamous family” (OR 1.80, 95% CI 1.49‐2.18), and “diagnosis of depression” (OR 1.33, 95% CI 1.09‐1.63).
Conclusion
We have shown that PLE symptoms are relatively common in non‐help seeking Nigerian school adolescents and that personal and family factors are significantly associated. Longitudinal studies will be needed to chart the path of symptoms and determinants of distress, help seeking and development of psychosis.
Purpose
The study assessed the 3-year progression of clinically significant psychotic-like experience (CS-PLE) symptoms in an adult general population in terms of stability or remission of symptoms ...and transition to psychosis.
Methods
Participants (
n
= 1292) aged 18–65 years with CS-PLE were assessed at baseline for sociodemographic details, family history of mental illness, functioning status, common mental disorders, alcohol, and substance use disorders. Three years later they were reassessed for diagnosis of psychosis, presence or remission of PLE symptoms, and contact with mental health services.
Results
The mean age of the participants at baseline in years was 36.56 (SD = 11.66) and there were 855 (66.2%) females. By the 3rd year follow-up, 95 (7.3%) had transited to psychosis, while 850 (65.5%) had persistent CS-PLE symptoms and the rest 347 (27.2%) were in remission. Only history of mental illness in the immediate family (HR 4.81, 95% CI 1.40–16.47,
P
= 0.013) and regular use of cannabis at less than 18 years of age (HR 0.65, 95% CI 0.55–0.77,
P
< 0.001) were the independent predictors of conversion to psychosis at 3 years.
Conclusion
The rate of TTP in the non-clinical population with elevated risk may be lower than that earlier reported in the western literature. Interventions aimed at preventing transition to psychosis in high risk groups must pay attention to early onset users of cannabis and those with family history of mental illness.
The common self-rated depression scales are lengthy, old and do not reflect the current diagnostic classifications criteria of depressive disorders. This study aimed to validate the Patient Health ...Questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students.
A representative sample of university students (
n
=
512) completed the PHQ-9 and the Beck's Depressive Inventory (BDI). They were also interviewed for clinical diagnoses of depressive disorders using the Mini International Neuropsychiatric Interview (MINI).
The internal consistency of questions within the PHQ-9 was 0.85. The PHQ-9 had good concurrent validity with the BDI (
r
=
0.67,
P
<
0.001). It also had a good (
r
=
0.894,
P
<
0.001) one month test–retest reliability. Using the Receiver Operating Characteristic (ROC) curve, the optimal cut-off score for minor depressive disorder is 5 (sensitivity 0.897, specificity 0.989, Positive Predictive Value — PPV 0.875, Negative Predictive Value — NPV 0.981 and Overall Correct Classification — OCC rate 0.973) while for major depressive disorder only is 10 (sensitivity 0.846, specificity 0.994, PPV 0.750, NPV 0.996 and OCC rate 0.992).
The study limitations include use of a specific group in community, moderate sample size and screening for only minor and major depressive disorders while neglecting other depressive disorders.
The PHQ-9 has good psychometric properties amongst Nigerian university students. Because of its validity, reliability, brevity and ease of administration, the PHQ-9 will be a valuable tool for estimating depression amongst college students in Nigerian community. More studies are needed to test the usefulness of the translated local language versions of this instrument amongst the community in sub-Saharan Africa.
•Mobile telephony support improves adherence, clinical recovery and quality of life.•Mobile telephone support reduces the cost of improvement on the depression scale.•Mobile telephone support is ...acceptable to clients in primary care.
To evaluate the effectiveness and acceptability of adding a mobile telephone adherence support to a Collaborative Stepped Care (CSC) intervention for primary care management of depression.
A pilot cluster randomised controlled trial with 10 primary care centres in Lagos Nigeria, randomised into either the mobile telephone supported CSC (mCSC) group or the ordinary CSC (oCSC) group in ratio 1:1. The 5 mCSC clusters received in addition to the CSC intervention, a series of tailored informational text messages and reminders. Participants were adults (18–60 years) with depression. The primary outcome was the rate of adherence to intervention at 6th and 12th months follow up. Analysis was by intention to treat.
The mCSC group (n = 439 participants) had significantly better adherence rate compared to oCSC group (n = 456 participants) at 6th month (90.0% vs 67.8%, ARR 1.31, 95% CI 1.22–1.40) and at 12th month follow up (78.1% vs 59.2%, ARR 1.30, 95% CI 1.20–1.43). Compared to the oCSC group, the mCSC had significantly higher recovery rate, better quality of life, retention in treatment, was more cost effective and had high level of acceptance amongst clients
Self rating scales were not used for adherence score. We analysed according to Intention to Treat and we have not included mild depression
The addition of our mobile telephony support significantly improves adherence and clinical outcomes for CSC intervention and was cost effective and acceptable to clients. Mobile telephone technology can substantially aid the scale up of mental health services in developing countries.
•Pelotas model predicted depression among nigerian adolescents better than chance.•The model was able to discriminate adolescents with and without depression.•The model was not well-calibrated ...indicating poor overall performance.•Updating the model with context-specific factors may improve depression prediction.
Depression commonly emerges in adolescence and is a major public health issue in low- and middle-income countries where 90% of the world's adolescents live. Thus efforts to prevent depression onset are crucial in countries like Nigeria, where two-thirds of the population are aged under 24. Therefore, we tested the ability of a prediction model developed in Brazil to predict future depression in a Nigerian adolescent sample. Data were obtained from school students aged 14–16 years in Lagos, who were assessed in 2016 and 2019 for depression using a self-completed version of the Mini International Neuropsychiatric Interview for Children and Adolescents. Only the 1,928 students free of depression at baseline were included. Penalized logistic regression was used to predict individualized risk of developing depression at follow-up for each adolescent based on the 7 matching baseline sociodemographic predictors from the Brazilian model. Discrimination between adolescents who did and did not develop depression was better than chance (area under the curve = 0.62 (bootstrap-corrected 95% CI: 0.58–0.66). However, the model was not well-calibrated even after adjustment of the intercept, indicating poorer overall performance compared to the original Brazilian cohort. Updating the model with context-specific factors may improve prediction of depression in this setting.
The study aimed to evaluate the clinical effectiveness of a developed stepped care intervention for management of depression in primary care.
A cluster randomised controlled trial with primary care ...centres (PHCs) as unit of randomization. Five PHCs were randomised to stepped care intervention (SCI) group and another 5 PHCs were randomised to enhanced usual care (eUCA) control group. Participants were adults (18–60 years) with clinically significant depression symptoms. The primary outcome was clinical recovery at 12th months follow up. The outcome assessors were blinded to the cluster allocation.
There were 456 participants in SCI group and 451 in eUCA group. At 12 months, clinical recovery was significantly higher in the SCI group compared with the eUCA group (60.3% vs 18.2%, ARR 3.10, 95% CI 2.15–3.87). The SCI group also had significantly better quality of life and lesser rates of disability, death or deliberate self-harm compared to the eUCA group. Subgroup analysis within the SCI group showed no difference in clinical outcomes between participants receiving problem solving therapy (PST) and those receiving antidepressants.
Our study showed that stepped care intervention significantly improved clinical outcomes at 12 months. This lends support to growing evidence of clinically effective intervention for depression at primary care level in less resourced countries.
Trial Registration: http://www.isrctn.com/ISRCTN66243738.
Depression and anxiety are very prevalent, highly co-morbid, burdensome with huge treatment gaps in low and middle-income countries (LMICs). This study aimed to estimate the current prevalence of ...symptoms of depression and generalised anxiety, examine co-morbid conditions and associated sociodemographic factors in Lagos state, Nigeria.
A face to face household survey completed by 11,246 adult participants (age 18–75years). Clinically significant symptoms of depression, generalised anxiety and somatic symptoms were assessed using the specific modules of the Patient Health Questionnaire (PHQ) respectively. Alcohol use, substance use and disability were assessed with the Alcohol Use Disorders Identification Test-short form (AUDIT-C), the Mini International Neuropsychiatric Interview (M.I.N.I) and the WHO Disability Assessment Schedule (WHODAS 2.0) respectively.
The mean age was 36.75 (sd 12.3) years and there were 6525 (58.0%) females. The weighted current prevalence of symptoms of depression, generalised anxiety and combined depression/generalised anxiety were 5.5% (se 0.3), 3.5% (se 0.2) and 1.2% (se 0.1) respectively. About 20.9% of all cases of depressive symptoms have co-morbidity with symptoms of generalised anxiety. Symptoms of depression and generalised anxiety had high co-morbidity with somatic symptoms, alcohol use problems and disability but not substance use disorders. Being female, not married (especially separated/divorced or widowed) and unemployment were significantly associated with presence of either symptoms of depression or generalised anxiety.
Our findings suggest that despite the popularity of cross-national surveys, there is need for individual countries and states to generate complimentary local data to plan effective local response to close the huge treatment gap for common mental disorders.
•Current prevalence of depression and anxiety are 5.5% and 3.5% respectively.•Female, not married and unemployment were associated with depression and anxiety.•Locally generated data needed for effective local response to close treatment gap.
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