The impact of attachment and depression symptoms on multiple risk behaviors in post-war adolescents in northern Uganda.

BACKGROUND: We have previously shown that depression symptoms are associated with multiple risk behaviors and that parental attachments are protective against depression symptoms in post-war adolescents. Accumulating literature indicates that low levels of attachment may sensitize individuals to increased multiple risk behaviors when depression symptoms exist. This investigation examined the interactive effects of attachment and depression symptoms on multiple risk behavior. METHODS: We conducted hierarchical logistic regression analyses to examine the impact of attachment and depression symptoms on multiple risk behavior in our post-war sample of 551 adolescents in Gulu district. RESULTS: Analyses revealed interactive effects for only maternal attachment-by-depression interaction. Interestingly, high levels of maternal attachment exacerbated the relationship between depression symptoms and multiple risk behaviors while low levels of maternal attachment attenuated this relationship. LIMITATIONS: It is possible that this analysis could be biased by a common underlying factor that influences self-reporting and therefore is correlated with each of self-reported attachment security, depressive symptoms, and multiple risk behaviors. CONCLUSIONS: These findings suggest that maternal attachment serves as a protective factor at low levels while serving as an additional risk factor at high levels. Findings support and expand current knowledge about the roles that attachment and depression symptoms play in the development of multiple risk behaviors and suggest a more complex etiology for post-war adolescents.

Neuropsychiatric perspectives on nodding syndrome in northern Uganda: a case series study and a review of the literature.

BACKGROUND: Nodding Syndrome (NS), previously called Nodding Disease, is a chronic and debilitating illness affecting thousands of children aged 3-18 years in post-conflict Northern Uganda and South Sudan. Characterised by malnutrition, stunted growth, mental retardation and seizures, some researchers have designated it as epilepsy. With reports appearing in Northern Uganda in1997, NS reached epidemic proportions around 2000-2003 when people were moved into Internally Displaced People's (IDP) camps. Investigations for infections (onchocerciasis) and toxins have been inconclusive as to cause, treatment or outcome. No study has addressed the possible relationship of NS to childhood war-trauma experiences. OBJECTIVE: To explore a possible relationship of exposure to prolonged war-trauma and the emergence of epidemic NS in Northern Uganda. METHOD: This study was a case-series descriptive psychiatric naturalistic field observations of NS cases from homesteads in Northern Uganda and psychiatric investigations and treatment of NS cases referred to Mulago National Referral and Teaching Hospital. RESULTS: Detailed Psychiatric clinical evaluations and field observations revealed that NS children had been exposed to severe war-related psychological and physical trauma as well as non-specific CNS insults including untreated CNS infections/infestations and malnutrition possibly causing seizures. Many children suffered post-traumatic stress disorder (PTSD) and depression. CONCLUSION: NS could present as an association of childhood complex PTSD, (called Developmental Trauma Disorder), occurring in the chronically war-traumatised children of Northern Uganda, complicated by severe prolonged depression with its characteristic symptoms of psychomotor retardation, anxiety, anhedonia and anorexia. This, coupled with food shortages, resulted in malnutrition, wasting and stunted growth with severe avitaminoses. Many children had seizures. All this calls for multi-disciplinary treatment approaches.

Prevalence and factors associated with depressive disorders in an HIV+ rural patient population in southern Uganda.

BACKGROUND: Depressive disorders are estimated to occur in nearly half of HIV-infected individuals worldwide. AIM: To examine the prevalence and cardinal demographic, psychosocial and clinical features associated with having any depressive disorder, sub-clinical depression, current and lifetime depressive disorders among patients with human immunodeficiency virus (HIV) in southern Uganda. METHODS: Five hundred HIV+ individuals were screened for depression using a 20 item self-reporting questionnaire (SRQ-20) and evaluated with the mini neuropsychiatric interview(MINI) that assessed current and lifetime depressive disorders. RESULTS: The prevalence estimates of any depressive disorder, subclinical depression, both current and lifetime major depression, and bipolar depression were 46.4%, 17.8%, 25% and 3.6% respectively. In comparison to non-depressed patients, those with sub-clinical depression were less likely to have high levels of self-efficacy, more likely to be using ART for less than one year, have advanced HIV disease and current alcohol use disorders (AUD's). Those with both current and lifetime depressive disorders were less likely to be 85% adherent to antiretroviral therapy (ART), have social support and high levels of self-efficacy, more likely to have tuberculosis and past manic episodes. Those with only lifetime depressive disorders were more likely to have current AUD's and past manic episodes. LIMITATIONS: Information concerning exposures and outcomes was collected simultaneously, thus causal relationships are difficult to establish. CONCLUSIONS: Sub-clinical depression, major depression and bipolar depression are widespread among HIV patients receiving ART. Integration of mental health services into HIV Care is desperately needed.

Effect of HIV infection on time to recovery from an acute manic episode.

INTRODUCTION: Understanding factors affecting the time to recovery from acute mania is critical in the management of manic syndromes. The aim of this study was to determine the effect of HIV infection on time to recovery from acute mania. METHODS: We performed a retrospective study in which medical charts of individuals who were treated for acute mania were reviewed. Survival analysis with Cox regression models were used to compare time to recovery from an acute manic episode between human immunodeficiency virus (HIV)-positive individuals and HIV-negative individuals. RESULTS: Median survival time was one week for HIV-positive individuals and more than four weeks for HIV-negative individuals (χ(2) = 18.4, P value = 0.000). HIV infection was the only marginally significant independent predictor of survival probability on the acute admission ward (hazards ratio 2.87, P = 0.06). CONCLUSION: Acute mania in HIV-infected persons responds faster to psychotropic drugs compared with that in HIV-negative persons.

Psychological Distress and Adherence to Highly Active Anti-Retroviral Therapy (HAART) in Uganda: a Pilot Study

Background: Mental health related risk factors for non-adherence to highly active anti-retroviral therapy (HAART) have not been investigated in Uganda and yet adherence is critical to the success of the current scale up in the provision of HAART to HIV positive individuals in rural areas of Uganda. Objective: To determine whether psychological distress is a risk factor for non-adherence to HAART among HIV positive individuals. Method: One hundred twenty-two HIV positive adult individuals receiving care from an Urban HIV clinic were enrolled in the study. Participants were screened for psychological distress with the Self Report Questionnaire (SRQ-20). Adherence was assessed using the self report method. Multivariate logistic regression analysis was used to determine whether psychological distress is a risk factor for non-adherence to HAART adjusting for various socio-demographic and clinical factors. Results: Psychological distress and living in isolation were significantly associated with non-adherence to HAART after adjusting for other demographic and clinical variables [OR=3.66; 95CI (1.39 - 9.78) and OR=9.80; 95CI (2.27 - 18.70)] respectively. Among HIV positive individuals who were receiving additional treatment for a mental disorder; psychological distress was not significantly associated with non-adherence to HAART [OR= 1.25; 95CI (0.30 - 5.20)] Conclusion: Regular screening and management of psychological distress may prevent further complications in HIV positive individuals in Uganda