Lifetime mental disorders and suicidal behaviour in South Africa

There is relatively little data on the relationship between lifetime mental disorders and suicidal behaviour in low and middle income countries. This study examines the relationship between lifetime mental disorders; and subsequent suicide ideation; plans; and suicide attempts in South Africa. Method: A national survey of 4185 South African adults was conducted using the World Health Organization Composite International Diagnostic Interview (CIDI) to generate psychiatric diagnoses and suicidal behaviour. Bivariate; multivariate and discrete-time survival analyses were employed to investigate the associations between mental disorders and subsequent suicide ideation; plans; and attempts. Results: Sixty-one percent of people who seriously considered killing themselves at some point in their lifetime reported having a prior DSM-IV disorder. Mental disorders predict the onset of suicidal ideation; but have weaker effects in predicting suicide plans or attempts. After controlling for comorbid mental disorders; PTSD was the strongest predictor of suicidal ideation and attempts. There is a relationship between number of mental disorders and suicidal behaviour; with comorbidity having significantly sub-additive effects. Conclusion: Consistent with data from the developed world; mental disorders are strong predictors of suicidal behaviour; and these associations are more often explained by the prediction of ideation; rather than the prediction of attempts amongst ideators. This suggests some universality of the relevant mechanisms underlying the genesis of suicidal thoughts; and the progression to suicide attempts

The Prevalence of Anxiety and Depression Symptoms and Syndromes in Kenyan Children and Adolescents

Background: Community studies on children and adolescents in Western settings suggest prevalence rates of anxiety and depressive symptoms that require intervention. Aim: To establish equivalent prevalence rates in a Kenyan (developing country) situation Method: Self-administered questionnaires for socio-demographic data; three Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV)-based instruments for anxiety symptoms and syndromes in children; one instrument for depression and one culture sensitive instrument for depression and anxiety were administered in three different sets to 3 775 randomly sampled students drawn from a stratified sample of 34.7of all public secondary schools in Nairobi; Kenya. Results: The prevalence rates of anxiety and depression symptoms and syndromes varied widely depending on sex and age and also on the emphasis of the different instruments used; and also according to the cut-off points for the various syndromes and instruments. Clinical diagnostic scores for depression were recorded in 43.7of all the students. Using the cut-off points for the Multidimensional Anxiety Scale for Children (MASC); anxiety was recorded in 12.9of all students. Nearly half (40.7) of the respondents who completed the Short Leyton Obsessional Inventory for Children and Adolescents had positive scores for obsessive disorder; 81.1were positive for compulsive disorder and an average of 69.1had positive scores for both obsessive and compulsive disorders combined. Amongst those who completed the Ndetei-Othieno-Kathuku (NOK) scale for Depression and Anxiety; 49.3had positive scores for moderate to severe anxiety with or without depression. The Screen for Child Anxiety Related Disorders - Revised (SCARED-R) yielded high levels (50-100) for the different syndromes; with obsessive-compulsive disorder at 99.3; just below separation anxiety and school phobia at 100. Suicidal thoughts and plans were prevalent at 4.9-5.5.Conclusion: Anxiety and depression were found at prevalence rates no less than is found in the West.This calls for appropriate clinical practices and policies

The Prevalence of Anxiety and Depression Symptoms and Syndromes in Kenyan Children and Adolescents

Background: Community studies on children and adolescents in Western settings suggest prevalence rates of anxiety and depressive symptoms that require intervention. Aim: To establish equivalent prevalence rates in a Kenyan (developing country) situation Method: Self-administered questionnaires for socio-demographic data; three Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM-IV)-based instruments for anxiety symptoms and syndromes in children; one instrument for depression and one culture sensitive instrument for depression and anxiety were administered in three different sets to 3 775 randomly sampled students drawn from a stratified sample of 34.7of all public secondary schools in Nairobi; Kenya. Results: The prevalence rates of anxiety and depression symptoms and syndromes varied widely depending on sex and age and also on the emphasis of the different instruments used; and also according to the cut-off points for the various syndromes and instruments. Clinical diagnostic scores for depression were recorded in 43.7of all the students. Using the cut-off points for the Multidimensional Anxiety Scale for Children (MASC); anxiety was recorded in 12.9of all students. Nearly half (40.7) of the respondents who completed the Short Leyton Obsessional Inventory for Children and Adolescents had positive scores for obsessive disorder; 81.1were positive for compulsive disorder and an average of 69.1had positive scores for both obsessive and compulsive disorders combined. Amongst those who completed the Ndetei-Othieno-Kathuku (NOK) scale for Depression and Anxiety; 49.3had positive scores for moderate to severe anxiety with or without depression. The Screen for Child Anxiety Related Disorders - Revised (SCARED-R) yielded high levels (50-100) for the different syndromes; with obsessive-compulsive disorder at 99.3; just below separation anxiety and school phobia at 100. Suicidal thoughts and plans were prevalent at 4.9-5.5.Conclusion: Anxiety and depression were found at prevalence rates no less than is found in the West.This calls for appropriate clinical practices and policies

Psychometric Properties of the Multidimensional Anxiety Scale for Children (MASC) amongst Nairobi Public Secondary School Children; Kenya

Background: There are few psychometric instruments whose properties have been studied in a developing country's context. Aim: To determine the psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) in Nairobi public secondary school children; Kenya. Method: Concurrent self-administration of the MASC and Children's Depression Inventory (CDI) to students in Nairobi public secondary schools. Results: The MASC had a high overall internal consistency alpha co-efficient (0.85) in the Kenyan sample; which is similar to Western findings; and is hence a reliable tool for measuring anxiety in the study population. It was also similar to the findings from two Western studies in the anxiety domains of physical symptoms; social anxiety; separation anxiety and harm avoidance. The correlation co-efficient with CDI was similar to Scandinavian findings. Conclusion: The MASC can be used in Kenyan children and; by extension; other Africa children

Psychometric Properties of the Multidimensional Anxiety Scale for Children (MASC) amongst Nairobi Public Secondary School Children; Kenya

Background:There are few psychometric instruments whose properties have been studied in a developing country's context.Aim: To determine the psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) in Nairobi public secondary school children; Kenya.Method: Concurrent self-administration of the MASC and Children's Depression Inventory (CDI) to students in Nairobi public secondary schools.Results: The MASC had a high overall internal consistency alpha co-efficient (0.85) in the Kenyan sample; which is similar to Western findings; and is hence a reliable tool for measuring anxiety in the study population.It was also similar to the findings from two Western studies in the anxiety domains of physical symptoms; social anxiety; separation anxiety and harm avoidance.The correlation co-efficient with CDI was similar to Scandinavian findings.Conclusion: The MASC can be used in Kenyan children and; by extension; other Africa children

Psychometric Properties of the Multidimensional Anxiety Scale for Children (MASC) amongst Nairobi Public Secondary School Children; Kenya

Background:There are few psychometric instruments whose properties have been studied in a developing country's context.Aim: To determine the psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) in Nairobi public secondary school children; Kenya.Method: Concurrent self-administration of the MASC and Children's Depression Inventory (CDI) to students in Nairobi public secondary schools.Results: The MASC had a high overall internal consistency alpha co-efficient (0.85) in the Kenyan sample; which is similar to Western findings; and is hence a reliable tool for measuring anxiety in the study population.It was also similar to the findings from two Western studies in the anxiety domains of physical symptoms; social anxiety; separation anxiety and harm avoidance.The correlation co-efficient with CDI was similar to Scandinavian findings.Conclusion: The MASC can be used in Kenyan children and; by extension; other Africa children

Bullying in Public Secondary Schools in Nairobi; Kenya

Background: The prevalence and frequency of bullying in Nairobi public secondary schools in particular and in Kenyan schools in general is not known. Knowledge of the extent of the problem is essential in developing effective interventions. Aim: To study the prevalence and frequency of bullying in Nairobi public secondary schools; Kenya. Methods: A self-report sociodemographic questionnaire and the Olweus Bullying Questionnaire of 1991 were administered to 1 012 students from a stratified sample of public secondary schools in Nairobi. Results: Between 63.2(640) and 81.8(828) of students reported various types of bullying; both direct and indirect; with significant variations found for sex; age; class and year of study; whether in day or boarding school; and the place where bullied. Being bullied was significantly associated with becoming a bully; in turn. Discussion: Bullying is highly prevalent in Kenyan schools. Further studies are needed to characterise bullies and victims in terms of personality and environmental factors that may be associated with or conducive to bullying; as well as to determine the long-term prognosis for both bullies and victims. Further research is also required to determine the most appropriate intervention

Bullying in Public Secondary Schools in Nairobi; Kenya

Background: The prevalence and frequency of bullying in Nairobi public secondary schools in particular and in Kenyan schools in general is not known. Knowledge of the extent of the problem is essential in developing effective interventions. Aim: To study the prevalence and frequency of bullying in Nairobi public secondary schools; Kenya. Methods: A self-report sociodemographic questionnaire and the Olweus Bullying Questionnaire of 1991 were administered to 1 012 students from a stratified sample of public secondary schools in Nairobi. Results: Between 63.2(640) and 81.8(828) of students reported various types of bullying; both direct and indirect; with significant variations found for sex; age; class and year of study; whether in day or boarding school; and the place where bullied. Being bullied was significantly associated with becoming a bully; in turn. Discussion: Bullying is highly prevalent in Kenyan schools. Further studies are needed to characterise bullies and victims in terms of personality and environmental factors that may be associated with or conducive to bullying; as well as to determine the long-term prognosis for both bullies and victims. Further research is also required to determine the most appropriate intervention

Traumatic Experiences of Kenyan Secondary School Students

Background: There is no information on the socio-demographic variations and determinants of Trauma and Post-Traumatic Stress Disorder (PTSD) in Kenyan adolescents. Objectives: To describe the traumatic experiences of Kenyan high school students and to determine the levels of Post-traumatic Stress Disorder (PTSD) among them; and in relation to sociodemographic variables. Design: A cross-sectional study of 1 110 students (629 males and 481 females); aged 12 to 26 years; using self-administered questionnaires. Method: The students completed questionnaires on sociodemographic data followed by the Trauma Checklist and the Child PTSD Checklist. Results: Being confronted with bad news was the most common type of trauma encountered in 66.7of the subjects; followed by witnessing a violent crime and domestic violence; 23.2and 16.5of the subjects reported physical abuse and sexual abuse respectively. PTSD symptoms were common; avoidance and re-experiencing occurred in 75of the students and hyperarousal was reported by over 50. The number of traumatic events was positively correlated with the occurrence of PTSD. The prevalence of full PTSD was 50.5; while partial PTSD was 34.8. Male and female subjects were equally affected but the boarders were more affected (p 0.05) and the differences between the schools were statistically significant (p

Traumatic Experiences of Kenyan Secondary School Students

Background:There is no information on the socio-demographic variations and determinants of Trauma and Post-Traumatic Stress Disorder (PTSD) in Kenyan adolescents.Objectives: To describe the traumatic experiences of Kenyan high school students and to determine the levels of Post-traumatic Stress Disorder (PTSD) among them; and in relation to sociodemographic variables.Design: A cross-sectional study of 1 110 students (629 males and 481 females); aged 12 to 26 years; using self-administered questionnaires.Method: The students completed questionnaires on sociodemographic data followed by the Trauma Checklist and the Child PTSD Checklist.Results: Being confronted with bad news was the most common type of trauma encountered in 66.7of the subjects; followed by witnessing a violent crime and domestic violence; 23.2and 16.5of the subjects reported physical abuse and sexual abuse respectively. PTSD symptoms were common; avoidance and re-experiencing occurred in 75of the students and hyperarousal was reported by over 50. The number of traumatic events was positively correlated with the occurrence of PTSD. The prevalence of full PTSD was 50.5; while partial PTSD was 34.8. Male and female subjects were equally affected but the boarders were more affected (p 0.05) and the differences between the schools were statistically significant (p

Traumatic Experiences of Kenyan Secondary School Students

Background:There is no information on the socio-demographic variations and determinants of Trauma and Post-Traumatic Stress Disorder (PTSD) in Kenyan adolescents.Objectives: To describe the traumatic experiences of Kenyan high school students and to determine the levels of Post-traumatic Stress Disorder (PTSD) among them; and in relation to sociodemographic variables.Design: A cross-sectional study of 1 110 students (629 males and 481 females); aged 12 to 26 years; using self-administered questionnaires.Method: The students completed questionnaires on sociodemographic data followed by the Trauma Checklist and the Child PTSD Checklist.Results: Being confronted with bad news was the most common type of trauma encountered in 66.7of the subjects; followed by witnessing a violent crime and domestic violence; 23.2and 16.5of the subjects reported physical abuse and sexual abuse respectively. PTSD symptoms were common; avoidance and re-experiencing occurred in 75of the students and hyperarousal was reported by over 50. The number of traumatic events was positively correlated with the occurrence of PTSD. The prevalence of full PTSD was 50.5; while partial PTSD was 34.8. Male and female subjects were equally affected but the boarders were more affected (p 0.05) and the differences between the schools were statistically significant (p

"Outcome of a Working Diagnosis of ""Psychosis"" in Relation to DSM-IV Diagnostic Criteria in a Kenyan In-Patient Cohort at Mathari Hospital; Nairobi"

"Background: When a patient presents with mental illness and displays psychotic symptoms which are not clearly delineated; a clinical diagnosis of psychosis is usually enter-tained. Aim: To determine the underlying Diagnostic and Statistical Manual of Mental Disorders-Fourth edition (DSM-IV) disorders in clinical entities admitted with a working diagnosis of ""psychosis"" at Mathari Psychiatric Hospital; Nairobi; Kenya. Study Design: Descriptive cross-sectional quantitative study Method: A total of 138 patients with a working diagnosis of ""psychosis"" on admission at Mathari Hospital during the period of this study were recruited over a one-month period. Their DSM-IV diagnoses were made using the Structured Clinical Interview for DSM-IV (SCID). Analysis of the results was done using SPSS version 11.5. Results: Nearly three quarters (72.5) of the patients were male; 68.5were aged between 20 and 34 years and 63.7reported that they were single. Nearly half (49.2) had attained up to 12 years of formal education and 90were dependants of a member of the family. The most common DSM-IV diagnoses were schizophrenia; bipolar disorder; substance abuse; depression and anxiety disorders. Co-morbidity was recorded with an average of three DSM-IV disorders. Conclusion: ""Psychosis"" as a working diagnosis was reported in relatively young adults. The patients whose working clinical diagnosis was ""psychosis"" met the criteria for an average of three DSM-IV diagnoses. There is need for a proactive policy in clinical practice so that definitive diagnoses rather than just ""psychosis"" are made and appropriate management initiated as early as possible."