Explanatory models, illness, and treatment experiences of patients with psychosis using the services of traditional and faith healers in three African countries: Similarities and discontinuities.

As part of formative studies to design a program of collaborative care for persons with psychosis, we explored personal experience and lay attributions of illness as well as treatment among persons who had recently received care at traditional and faith healers' (TFHs) facilities in three cultural groups in Sub-Saharan Africa. A purposive sample of 85 individuals in Ibadan (Nigeria), Kumasi (Ghana), and Nairobi (Kenya) were interviewed. Data was inductively explored for themes and analysis was informed by the Framework Method. Across the three sites, illness experiences featured suffering and disability in different life domains. Predominant causal attribution was supernatural, even when biological causation was also acknowledged. Prayer and rituals, steeped in traditional spiritual beliefs, were prominent both in traditional faith healing settings as well as those of Christianity and Islam. Concurrent or consecutive use of TFHs and conventional medical services was common. TFHs provided services that appear to meet the therapeutic goals of their patients even when harmful treatment practices were employed. Cultural and linguistic differences did not obscure the commonality of a core set of beliefs and practices across these three groups. This similarity of core worldviews across diverse cultural settings means that a collaborative approach designed in one cultural group would, with adaptations to reflect differences in context, be applicable in another cultural group. Studies of patients' experience of illness and care are useful in designing and implementing collaborations between biomedical and TFH services as a way of scaling up services and improving the outcome of psychosis.

Aftermath of anti-police protests in Nigeria: Burden and predictors of psychiatric morbidity among protesters and non-protesters.

OBJECTIVES: Anti-police (#EndSARS) protests took place in October 2020 across several Nigerian cities, resulting in deaths, injuries and loss of property, but the psychological sequelae of these protests have not been studied. METHOD: In a cross-sectional online survey, we collected data on psychiatric morbidity and potential risk factors from 426 Nigerian social media users, who self-identified as participants or non-participants in a recent anti-police protest. RESULTS: We found elevated rates of psychiatric morbidity, with worse outcomes for protesters compared to non-protesters (psychological distress [44.2% vs 29.8%], depression [26.0% vs 14.9%], anxiety [51.0% vs 29.8%], post-traumatic stress disorder [7.4% vs 1.8%], current substance use [11.2% vs 4.5%] and suicidal ideation [7.1% vs 4.4%], respectively). After adjusting for the effects of COVID-19 pandemic and previous mental health diagnosis, the predictors of poor mental health among non-protesters were being unmarried (odds ratio = 7.4, p = 0.01) and low resilience (odds ratio range = 4.1-5.4, p < 0.03) while for the protesters, the predictors were low resilience (odds ratio range = 2.9-4.7, p < 0.01), being from Northern Nigeria (odds ratio = 4.7, p < 0.01) or residing in Northern Nigeria (odds ratio = 2.8, p = 0.03), being under-/unemployed (odds ratio range = 2.1-2.5, p < 0.04), holding the view that the protest was caused by the state of the economy (odds ratio = 2.0, p = 0.01), belief that the protest had a direct negative impact on the protester (odds ratio = 2.3, p = 0.04) and willingness to participate in future protests (odds ratio = 4.13, p = 0.02). CONCLUSION: We conclude that participating in the #EndSARS protest was associated with significant psychiatric morbidity. There is need to recognise and address the mental health sequelae of collective actions, and invest in programmes that build resilience and address socio-political determinants of mental health, especially with a focus on youth.

A descriptive study of mental health and burnout among Nigerian medical students.

BACKGROUND: Increasing attention is being paid to medical students' mental wellbeing globally due in part to their exposure to stressors inherent in medical education and the numerous reports of elevated rates of mental health conditions in this population. AIMS: This study aimed to identify stressors and determine prevalence rates of psychiatric morbidity, substance use and burnout in a sample of Nigerian medical students. METHODS: In a cross-sectional online survey, 505 medical students from 25 Nigerian medical schools completed a socio-demographic questionnaire, short version of the General Health Questionnaire (GHQ-12), the CAGE questionnaire and the Oldenburg Burnout Inventory (OLBI). RESULT: The most commonly reported sources of stress were study (75.6%), money (52.3%) and relationships (30.1%). Nine students (1.8%) had received a mental health diagnosis prior to medical school but this number had increased to 29 (5.7%) whilst in medical school, with the majority being cases of anxiety and depressive disorders. The prevalence of psychological distress was 54.5%, but <5% of affected students had received any help for their mental health conditions. Twenty five students (5%) met criteria for problematic alcohol use and 6% had used cannabis. The proportions of students who met criteria for disengagement and exhaustion domains of the OLBI were 84.6% and 77.0% respectively. CONCLUSION: The prevalence of psychological distress and burnout is high among medical students. Interventions for medical students' well-being should be tailored to their needs and should target risk factors related to personal, organisational and medical school academic structure attributes.

Scaling up care for perinatal depression for improved maternal and infant health (SPECTRA): protocol of a hybrid implementation study of the impact of a cascade training of primary maternal care providers in Nigeria.

BACKGROUND: The large treatment gap for mental disorders in low- and middle-income countries (LMIC) necessitates task-sharing approaches in scaling up care for mental disorders. Previous work have shown that primary health care workers (PHCW) can be trained to recognize and respond to common mental disorders but there are lingering questions around sustainable implementation and scale-up in real world settings. METHOD: This project is a hybrid implementation-effectiveness study guided by the Replicating Effective Programmes Framework. It will be conducted in four overlapping phases in maternal care clinics (MCC) in 11 local government areas in and around Ibadan metropolis, Nigeria. In Phase I, engagement meetings with relevant stake holders will be held. In phase II, the organizational and clinical profiles of MCC to deliver chronic depression care will be assessed, using interviews and a standardized assessment tool administered to staff and managers of the clinics. To ascertain the current level of care, 167 consecutive women presenting for antenatal care for the first time and who screened positive for depression will be recruited and followed up till 12 months post-partum. In phase III, we will design and implement a cascade training programme for PHCW, to equip them to identify and treat perinatal depression. In phase IV, a second cohort of 334 antenatal women will be recruited and followed up as in Phase I, to ascertain post-training level of care. The primary implementation outcome is change in the identification and treatment of perinatal depression by the PHCW while the primary effectiveness outcome is recovery from depression among the women at 6 months post-partum. A range of mixed-method approaches will be used to explore secondary implementation outcomes, including fidelity and acceptability. Secondary effectiveness outcomes are measures of disability and of infant outcomes. DISCUSSION: This study represents an attempt to systematically assess and document an implementation strategy that could inform the scaling up of evidence based interventions for perinatal depression using the WHO mhGAP-IG in LMIC. Trial registration This study was registered on 03 December, 2019. https://doi.org/10.1186/ISRCTN94230307 .

Reducing anxiety and depression in infertility among Nigerian women: an exploratory psycho-educational intervention trial (RADIANT) study protocol.

RATIONALE: high premium is placed on infertility in Nigerian culture. Data is limited on its association with emotional problems in Nigeria. AIMS: to develop content for a culturally relevant and cost-effective psychoeducational intervention package and to evaluate its effectiveness for reducing symptoms of anxiety and depression. Sample size estimate: Methods and design: a multi-method study design including development and validation (which includes focus group discussions) of an audio-visual tool which will serve as the intervention in a randomized controlled trial. Data will be analyzed with interim and survival analyses. POPULATION STUDIED: one hundred and 138 (68 per group) infertile women attending infertility clinic in Ibadan. STUDY OUTCOMES: anxiety and depressions scores assessed with the hospital depression and anxiety scale (HADS) at 0, 3 and 6 weeks. DISCUSSION: it is hoped that the use of the audio-visual tool will improve participants depression and anxiety scores and that the tool will be used for education in routine clinic use and community awareness on psychosocial effects of infertility.

Family Burden in Caregivers of Schizophrenia Patients: Prevalence and Socio-demographic Correlates.

BACKGROUND: This study aims to determine the prevalence and socio-demographic correlates of caregiver's burden in schizophrenia. MATERIALS AND METHODS: A dyad of 368 schizophrenia patients and their caregivers were interviewed. Caregiver's burden was assessed using the Yoruba-version of the FBIS and GHQ-12. RESULTS: Mean age of patients was 29.7 SD (8.6) years. Of the 368 caregivers, 81.5% were parents, mean age was 58.1 years (SD 19.6). Total mean objective FBIS score was 22.69 (6.21), 324 (85.3%) reported total objective burden and 310 (84.2%), subjective burden. There were significant differential demographic associations with caregivers' burden. CONCLUSION: Caregivers of schizophrenia patients experience enormous burden and are potential "high risk group" for mental disorders. Thus, they require comprehensive intervention in order to reduce the growing incidence of chronic enduring diseases including mental disorders.