Disability assessment as an outcome measure: a comparative study of Nigerian outpatients with schizophrenia and healthy control.

BACKGROUND AND OBJECTIVE: Schizophrenia is a chronic mental disorder that leads to disability in several aspects of the individual's personal, social, and occupational functioning. This study assesses and compares the level of disability among Nigerian outpatients with schizophrenia and healthy controls (HC). METHODS: A comparative cross-sectional study among 100 schizophrenia outpatients with an ICD-10 diagnosis and 100 HC was conducted over a 4-month period. They completed a questionnaire containing the Zung's Self-Rating Depression Scale (SDS), the World Health Organization Disability Assessment Schedule-Second Version (WHODAS-II). Symptoms of schizophrenia were assessed with the Positive and Negative Syndrome Scale (PANSS). Student's t tests and Chi-square were used to compare patient with schizophrenia and healthy control. Pearson correlation and multiple linear regression analyses were used to assess the relationships of socio-demographic and clinical variable with disability. RESULTS: The patients with schizophrenia reported greater disability than the HC on most of the disability domains of WHODAS-II. They also reported significantly higher mean Zung's SDS scores than the HC. Depressive symptoms, negative symptoms, and PANSS total were significantly related to all the WHODAS-II domains. The disability summary score was significantly predicted by depressive symptoms, negative and positive symptoms of schizophrenia, number of active symptoms (relapse) of schizophrenia, and marital status [F (5, 94) = 23.90, p < 0.001]. CONCLUSION: Schizophrenia is a disabling disorder that affects different aspects of a patient's life. Treatment strategies that target these different aspects may help in reducing disability.

Morbidity profile of first-degree relatives of probands with schizophrenia: a comparison with mood disorder and healthy control.

PURPOSE: There is a paucity of data on heritability of psychotic disorders in Africa. The study aimed to investigate morbid risk of schizophrenia and mood disorder among first-degree relatives of schizophrenia probands, compared with mood disorder and healthy controls. METHODS: The study examined 330 first-degree relatives of probands with schizophrenia (n = 50), 350 first-degree relatives of probands with mood disorder (n = 50) and 387 first-degree relatives of healthy control (n = 50). The Schedules for Clinical Assessment in Neuropsychiatry, SCAN was used to ascertain diagnosis in ill subjects. To each subject, a socio-demographic questionnaire was administered. Family history was obtained using the Family History Schedule. Morbid risk estimates were calculated using the Weinberg shorter method. RESULTS: There was a significant difference between the mean age of relatives of schizophrenia probands compared to mood disorder (p = 0.01, 95 % CI 1.34-9.61) and healthy control (p < 0.01, 95 % CI 1.53-9.84). There were also significant differences between the number of children of schizophrenia probands and the number of children of normal control (p < 0.01, 95 % CI -2.0 to -3.9), as well as the number of deceased first-degree relatives of schizophrenia probands compared to normal control (p = 0.04, 95 % CI 0.01-0.94). Finally, there was a significant difference between the number of first-degree relatives of schizophrenia probands compared to the number of first-degree relatives of healthy control who were below the age of risk for schizophrenia (p = 0.01, 95 % CI -0.12 to -1.27). Morbid risks of 4.38 and 0.39 were obtained for schizophrenia among first-degree relatives of probands with schizophrenia and mood disorder, while first-degree relatives of probands with schizophrenia, mood disorder and healthy control had morbid risks for mood disorder of 0.42, 3.82 and 0.35, respectively. CONCLUSION: The study revealed excess mortality among first-degree relatives of schizophrenia patients. First-degree relatives of probands with schizophrenia and mood disorder also had higher morbid risks for these psychotic conditions than healthy control with some measure of overlap between the two diagnostic categories.

Subjective life satisfaction and objective living conditions of patients with schizophrenia in Nigeria.

OBJECTIVE: This study explored life satisfaction among patients with schizophrenia in Nigeria and its relationship with objective living situation. METHODS: Adult outpatients (N=99) were assessed with the brief version of the World Health Organization Quality of Life Scale. They also rated aspects of their objective living situation corresponding to the satisfaction items. RESULTS: In contrast to their poor living conditions, most patients expressed a high level of life satisfaction. Items with the highest scores included satisfaction with self, "life meaningful," "enjoying life," and overall quality of life; items with the lowest scores included personal relationships, transport, money, and capacity to work. Of 12 satisfaction items, only four (sleep, daily living, relationships with individuals of the same gender, and condition of living place) were significantly correlated with objective measures. CONCLUSIONS: The correlation between subjective life satisfaction and objective living conditions of Nigerian patients with schizophrenia was poor. Efforts to enhance their quality of life should focus on improving work opportunities and transportation options.

Social distance towards people with mental illness in southwestern Nigeria.

OBJECTIVE: Recent research findings have challenged earlier claims that stigmatizing attitudes towards the mentally ill are less evident in non-Western cultures. A knowledge base of the attitude of the community towards the mentally ill is needed before embarking on an active anti-stigma programme in sub-Saharan Africa. The aim of the present study was to assess the lay public's attitude (social distance) towards people with mental illness in southwestern Nigeria and examine the factors correlating with such an attitude. METHOD: A cross-sectional survey was carried out in which respondents (n=2078) selected from three different communities in southwestern Nigeria completed questionnaires detailing sociodemographic variables, familiarity with mental illness, perceived causation of mental illness, perceived personal attributes of mental illness and perceived prognosis of mental illness. Their preferred social distance towards people with mental illness was measured with a modified version of the Bogardus Social Distance Scale. RESULTS: The level of desired social distance towards the mentally ill was seen to increase with the level of intimacy required in the relationship, with 14.5% of the participants categorized as having low social distance, 24.6% as having moderate social distance and 60.9% as having high social distance towards the mentally ill. The independent correlates of high social distance towards the mentally ill included having never cared for the mentally ill (odds ratio (OR)=3.31, 95% confidence interval (CI)=2.14-5.21), age over 50 years (OR=1.93, 95%CI=1.59-2.33), perceived supernatural causation of mental illness (OR=1.82, 95%CI=1.51-2.18) and perceived 'dangerousness' stereotype of the mentally ill (OR=1.54, 95%CI=1.28-1.85). CONCLUSIONS: There is emerging evidence of a high level of social distance and stigmatization of mental illness in sub-Saharan Africa. There is need to incorporate anti-stigma educational programmes into the mental health policies of countries in sub-Saharan Africa. Such policy should include community education regarding the causation, manifestation, treatment and prognosis of mental illness.

Lay beliefs regarding causes of mental illness in Nigeria: pattern and correlates.

BACKGROUND: Although studies have shown that views about causation are strongly associated with stigmatising attitudes to mental illness, none have examined the correlates of such causal views in order to identify the population needed to be targeted for education. OBJECTIVES: To evaluate the pattern and correlates of lay beliefs regarding the causes of mental illness in south-western Nigeria. METHOD: A cross-sectional survey in which respondents (n = 2,078) were administered questionnaire detailing sociodemographic variables and perceived causation of mental illness. RESULTS: Beliefs in supernatural factors and the misuse of psychoactive substances were the most prevalent. While urban dwelling, higher educational status and familiarity with mental illness correlated with belief in biological and psychosicial causation, older age, rural dwelling, and lack of familiarity correlated with a belief in supernatural causation. Educational status had no effect on the belief in supernatural causation. CONCLUSION: Anti-stigma programmes need to incorporate these factors in order to identify the population at risk, who will actually benefit from targeted education regarding the causes of mental illness.

Social distance towards people with mental illness amongst Nigerian university students.

BACKGROUND: It had been claimed that stigma and social distance are less severe in African countries, although not enough research had been done to confirm this. Most of the studies had focussed on the general community, and specific population groups had been neglected. AIMS: The aims of this study are to examine the level of social distance of students in a Nigerian university towards people with mental illness and to assess the possible socio-demographic variables involved. This is to enable the development of appropriate mental health educational and stigma-reducing programmes. METHODS: A modified version of Bogardus Social Distance Scale was used to assess the desire for social distance towards people with mental illness amongst 1,668 students of a Nigerian federal university. Socio-demographic details were also obtained. RESULTS: The social distances increased with the level of intimacy required in the relationship and were higher than those from the western culture, with 65.1% of the respondents categorised as having high social distance towards the mentally ill people. The predictors of high social distance towards the mentally ill include female gender [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.69-2.60], studying a non-medical course (OR 4.65, 95% CI 3.01-7.19) and not having a family member with mental illness (OR 6.73, 95% CI 4.34-10.44). CONCLUSION: Social distance towards the mentally ill is higher amongst Nigerian university students than expected. This challenges the notion that stigma and negative attitude towards the mentally ill are less severe in Africa than in western cultures. There are needs for intensive public awareness, effective stigma-reducing educational programmes and more research in this area.