Suicidal behaviour among patients with congestive cardiac failure in a Nigerian teaching hospital.

Background: Suicidal behaviour is an established psychiatric complication of congestive cardiac failure (CCF), contributing significantly to morbidity and death by suicide. The magnitude and risk factors for suicidal behaviour among patients with CCF are yet to be unpacked, especially in developing nations such as Nigeria. Aim: To determine the prevalence of suicidal behaviour and the risk factors associated with suicidal behaviour, among patients with CCF in Nigeria. Setting: Cardiology outpatient clinic of Lagos State University Teaching Hospital, Lagos, Nigeria. Methods: A cross-sectional study was conducted among 98 randomly selected patients with a diagnosis of CCF. Participants were assessed with a socio-demographic and clinical factors questionnaire and Beck Scale of Suicidal Ideation. Chi-square test, t-test and logistic regression were used to analyse data. Results: The prevalence of suicidal ideation and suicidal attempt among patients with CCF was 52% and 1%, respectively. No socio-demographic factor was significantly associated with suicidal ideation. Clinical factors associated with suicidal ideation were age at diagnosis (p = 0.042), aetiology of CCF (p = 0.001) and severity of CCF (p = 0.032). Only the severity of CCF (odds ratio [OR] = 20.557, p = 0.014) predicted suicidal ideation among patients with CCF. Conclusion: Suicidal behaviour constitutes a huge burden among the outpatient CCF population. The identification of clinical risk factors for suicidal ideation (age at diagnosis, aetiology and severity of CCF) further illuminates a pathway to mortality among patients with CCF. Contribution: The findings lend a voice to the need for screening for suicidal behaviour, suicide prevention programmes, surveillance systems and government policies that support mental health for patients with CCF.

Clinicopathological determinants of suicidal thoughts and behavior in patients with post-stroke depression in South-West Nigeria.

OBJECTIVE: To evaluate the clinico-pathological determinants of suicidal thoughts and behavior in patients with post-stroke depression (PSD) in a teaching hospital in south-west Nigeria. METHOD: A cross-sectional study was carried out in Lagos State University Teaching Hospital and it involved 89 consecutively selected outpatients with post-stroke depression (diagnosed using the depression module of Mini International Neuropsychiatric Inventory). Socio-demographic and clinical factors questionnaire, Mini-Mental State Examination, National Institute of Health Stroke Scale, and Beck Scale of Suicidal Ideation (BSSI) were administered to the participants. BSSI total score was used as a measure of suicidal thoughts. Ethical approval was obtained from the ethics and research committee of Lagos State University Teaching Hospital. RESULT: Time since stroke (the time since onset of the most recent stroke) had a significant negative correlation with suicidal thoughts (r = -0.263, p = 0.013). In the same vein, the probability of attempting suicide significantly reduces with time since stroke, Odds Ratio = 0.925, p = 0.047. CONCLUSION: Suicidal thoughts and behavior occur early in patients with post-stroke depression. The identification of shorter time since stroke as a correlate of suicidal thoughts and behavior among this patient population underscores the need for performing early assessment and prompt intervention for the at-risk individuals.

Editorial: Equity, diversity and inclusion in child and adolescent mental health - equality of opportunities should be every child's right and every society's obligation.

Socio-ecological factors are major determinants of poor mental health across the life span. These factors can lead to health inequalities, which refer to differences in the health of individuals or groups (Kirkbride et al., 2024). Health inequity "is a specific type of health inequality that denotes an unjust, avoidable, systematic and unnecessary difference in health" (Arcaya, Arcaya, & Subramanian, 2015). Among several intersecting social adversities, inequity is one of the most pervasive contributors to poor mental health across all regions (Venkatapuram & Marmot, 2023). Structural inequity creates institutional power structures that marginalise large sections of the population and concentrate resources in the hands of a small minority (Shim, Kho, & Murray-García, 2018). The world is now more prosperous than it has ever been, yet the world is witnessing more within country inequality with the vast majority of the world's resources in the hands of a small minority of individuals or regions (United Nations, 2020).

Assessing psychometric properties and measurement invariance of the Sleep Quality Questionnaire among healthcare students.

OBJECTIVE: The sleep of healthcare students is worth discovering. Mental health and self-rated health are thought to be associated with sleep quality. As such, valid instruments to assess sleep quality in healthcare students are crucial and irreplaceable. This study aimed to investigate the measurement properties of the Sleep Quality Questionnaire (SQQ) for Chinese healthcare students. METHODS: Two longitudinal assessments were undertaken among healthcare students, with a total of 595, between December 2020 and January 2021. Measures include the Chinese version of the SQQ, Patient Health Questionnaire-4 (PHQ-4), Self-Rated Health Questionnaire (SRHQ), and sociodemographic questionnaire. Structural validity through confirmatory factor analysis (CFA) was conducted to examine factor structure of the SQQ. T-tests and ANOVAs were used to examine sociodemographic differences in sleep quality scores. Multi Group CFA and longitudinal CFA were respectively used to assess cross-sectional invariance and longitudinal invariance across two-time interval, i.e., cross-cultural validity. Construct validity, internal consistency, and test-retest reliability were correspondingly examined via Spearman correlation, Cronbach's alpha and McDonald's omega, and intraclass correlation coefficient. Multiple linear regression analysis was performed to examine incremental validity of the SQQ based on the PHQ-4 and SRHQ as indicators of the criterion variables. RESULTS: CFA results suggested that the two-factor model of the SQQ-9 (item 2 excluded) had the best fit. The SQQ-9 scores differed significantly by age, grade, academic stage, hobby, stress coping strategy, anxiety, depression, and self-rated health subgroups. Measurement invariance was supported in terms of aforesaid subgroups and across two time intervals. In correlation and regression analyses, anxiety, depression, and self-rated health were moderately strong predictors of sleep quality. The SQQ-9 had good internal consistency and test-retest reliability. CONCLUSION: Good measurement properties suggest that the SQQ is a promising and practical measurement instrument for assessing sleep quality of Chinese healthcare students.

Depression and Anxiety Mediate the Association between Sleep Quality and Self-Rated Health in Healthcare Students.

OBJECTIVES: This study aimed to investigate factors associated with sleep quality in healthcare students and to determine whether depressive and anxiety symptoms may explain some of the associations between sleep quality and self-rated health. STUDY DESIGN: This is a cross-sectional study at wave one. METHODS: A total of 637 healthcare students were recruited via a stratified random sampling method in Hangzhou, China. The Sleep Quality Questionnaire (SQQ) and the four-item Patient Health Questionnaire (PHQ-4) were used to assess sleep quality and depressive and anxiety symptoms, respectively. Self-rated health was assessed via a self-developed questionnaire of both physical and psychological health. Structural equation modeling was used to examine the direct and indirect effects of sleep quality on self-rated health through depressive and anxiety symptoms. RESULTS: Students engaged in part-time employment (p = 0.022), with poor perceived employment prospects (p = 0.009), and who did not participate in recreational sports (p = 0.008) had worse sleep quality. Structural equation modeling revealed a significant total effect of sleep quality on self-rated health (b = 0.592, p < 0.001), a significant direct effect of both sleep quality and depressive and anxiety symptoms on self-rated health (b = 0.277, 95% CI: 0.032-0.522), and a significant indirect effect of sleep quality on self-rated health through depressive and anxiety symptoms (b = 0.315, 95% CI: 0.174-0.457). CONCLUSIONS: Depressive and anxiety symptoms partially explain the association between sleep quality and self-rated health. Intervening upon sleep quality, depressive, and anxiety symptoms may bolster the self-rated health of healthcare students.

Editorial: Going through the slippery landscape of conduct disorder, oppositional defiant disorder and help for children in humanitarian crises.

This editorial presents the contentious debate among authors from different disciplines on the problems of psychiatric diagnoses with conduct disorder, and opposition-defiant disorder as case illustrations. Furthermore, it provides an overview of opinions of experts on mental health interventions for adolescent refugees.

Trends and patterns of suicidal behaviour in Nigeria: Mixed-methods analysis of media reports from 2016 to 2019.

BACKGROUND: Media coverage of suicides in Nigeria appears to be explicitly descriptive and deviates from the recommended best practice. Despite these shortcomings, verifiable information provided by these media outlets could arguably, at the minimum, mirror the reality of the trends and patterns of suicidal behaviour in Nigeria. AIM: This study aimed to analyse the trends and patterns of suicidal behaviour in Nigeria using media reports from 2016 to 2019. We examined the effect of gender and age groups on these trends and patterns of suicidal behaviour. SETTING: The study was carried out in Nigeria. METHODS: Qualitative content analysis was used to assess the content of each verifiable suicide event. In total, 336 verified suicide-related events were selected from 4365 media reports. Quantitative data were collected on age, gender, type of suicidal behaviour, method, place and motivation for suicidal behaviour. Data were analysed using the Statistical Package for the Social Sciences software. Fisher's exact test was used to examine the association between gender, age groups and other variables. p-value was set at ≤ 0.05. RESULTS: Completed suicide was the most common reported suicidal behaviour. Hanging was the dominant reported method, followed by poisoning. Significant gender differences were observed between age groups (p < 0.001) and methods of suicidal behaviour (p < 0.001). Also, significant age differences were observed between the methods of suicidal behaviour (p < 0.001), places (p < 0.001) and motivations for suicidal behaviour (p < 0.001). CONCLUSION: The study confirms that there are gender and age differences in the trends and patterns of suicidal behaviour in Nigeria.

Psychiatric morbidity among adolescents and youth involved with the juvenile justice system in sub-Saharan Africa: Systematic scoping review of current studies and research gaps.

The current body of knowledge on the prevalence rate of psychiatric morbidity among adolescents and youth within the juvenile justice system in sub-Saharan Africa is yet to be systematically synthesized.. Consequently, African literature in the field has remained obscure, out of consideration in global discourses around the subject.; and incoherent to policy-makers. The situation has also hampered the identification of and filling of regional research-gaps in the field. The aim of this study, therefore, was to conduct a systematic scoping review of available data on psychiatric morbidity among adolescents and youth within the juvenile justice system in sub-Saharan Africa. The search was conducted using PubMed/MEDLINE, Science Direct, EMBASE, CINAHL and Psych Info. Additional searches were done in Google Scholar and African Journal Online (AJOL) databases. Twenty-six studies from 21 different research projects were identified. More than two-thirds were conducted in Nigeria and published within the last decade. Similar to what has been established around the world, the prevalence rate of psychiatric disorder was often very high, with a range of 59.7% - 63.0% among respondents. Key strengths of identified studies included use of standardized clinician-administered instruments for assessment and exploration of a wide range of psychiatric disorders. The main weaknesses in the studies included male gender-bias, lack of normative comparison groups, emphasis on custodial settings with little data on non-custodial systems, and considerable length of time-lag between the points of incarceration and psychiatric evaluation among the samples studied.. The study concluded that a modest number of studies have been conducted on psychiatric morbidity among justice-involved adolescents in sub-Saharan Africa, but there are still significant research gaps which could be bridged in order to aid context-appropriate interventions.

Shisha smoking in selected nightclubs in Nigeria.

INTRODUCTION: Shisha consumption is a growing public health issue all over the globe and public health awareness about its deleterious health consequences is still not sufficiently raised. METHODS: In this location-based study of nightclubs in Ibadan, Nigeria, 633 patrons of selected nightclubs were interviewed in order to obtain information on prevalence, correlates and predictors of shisha smoking. RESULTS: The overall prevalence of shisha smoking was 7.1%. The age of initiation into shisha smoking was lower among women, p = 0.03, but men were significantly more likely to be more frequent users, daily or weekly users, p < 0.001 and also to be current cigarette smokers, p = 0.03. There was no significant gender variability in the stage of readiness to quit. Regression analysis showed that after adjusting for age, the predictors of shisha smoking were: cigarette smoking, OR = 4.83, 95% CI (1.49-15.70) and more than 12 years of education, OR = 7.55, 95% CI (1.88 - 30.37), while being a rural dweller was a protective factor, OR = 0.05, 95% CI (0.01-0.20). CONCLUSION: Shisha smoking has emerged as a prevalent public health issue in Nigeria. There is a need for an immediate response from policy providers towards shisha smoking intervention in Nigeria.

A stepped care intervention for non-specialist health workers' management of depression in the Mental Health in Primary Care (MeHPriC) project, Lagos, Nigeria: A cluster randomised controlled trial.

BACKGROUND: The study aimed to evaluate the clinical effectiveness of a developed stepped care intervention for management of depression in primary care. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Prevalence and correlates of depression among Nigerian stroke survivors.

BACKGROUND: There is mixed evidence for the hypothesis that the risk of depression after stroke is influenced by the location of lesions in the hemispheres, demographic and clinical factors, and disability of stroke survivors. AIM: The current study determined the prevalence of depression and its socio-demographic and clinico-pathological correlates among stroke survivors in a tertiary hospital in Lagos, Nigeria. METHOD: The cross-sectional study was carried out among 112 adult patients with a clinical history of stroke confirmed by neuroimaging. Depression was diagnosed using Mini International Neuropsychiatric Interview. The socio-demographic profile was obtained, and cognitive impairment was assessed using the Mini-Mental State Examination. Stroke severity was assessed retrospectively using the National Institute of Health Stroke Scale and current disability was measured using the Modified Rankin Scale. RESULTS: There were 48 (42.9%) stroke survivors with a clinical diagnosis of depression. Using binary logistic regression, the independent determinants of depression were younger age, unemployment, perceived poor social support, increasing number of previous admissions because of stroke, cognitive impairment, severity of stroke and current disability status. However, there was no significant association between depression and lesion location. CONCLUSION: Depression is a common associate of stroke, and there is a need for sustained focus on young stroke survivors with severe stroke, especially those who do not have social support and have low socio-economic status, who may have a higher risk of developing depression following stroke.

Prevalence and correlates of depression among Nigerian stroke survivors

Background: There is mixed evidence for the hypothesis that the risk of depression after stroke is influenced by the location of lesions in the hemispheres, demographic and clinical factors, and disability of stroke survivors. Aim: The current study determined the prevalence of depression and its socio-demographic and clinico-pathological correlates among stroke survivors in a tertiary hospital in Lagos, Nigeria. Method: The cross-sectional study was carried out among 112 adult patients with a clinical history of stroke confirmed by neuroimaging. Depression was diagnosed using Mini International Neuropsychiatric Interview. The socio-demographic profile was obtained, and cognitive impairment was assessed using the Mini-Mental State Examination. Stroke severity was assessed retrospectively using the National Institute of Health Stroke Scale and current disability was measured using the Modified Rankin Scale. Results: There were 48 (42.9%) stroke survivors with a clinical diagnosis of depression. Using binary logistic regression, the independent determinants of depression were younger age, unemployment, perceived poor social support, increasing number of previous admissions because of stroke, cognitive impairment, severity of stroke and current disability status. However, there was no significant association between depression and lesion location. Conclusion: Depression is a common associate of stroke, and there is a need for sustained focus on young stroke survivors with severe stroke, especially those who do not have social support and have low socio-economic status, who may have a higher risk of developing depression following stroke

Gender difference in the point prevalence, symptoms, comorbidity, and correlates of depression: findings from the Lagos State Mental Health Survey (LSMHS), Nigeria.

It is still unclear whether the gender difference in the rate of depression cuts across cultures or is specific to some depressive symptoms. This study evaluated the gender difference in current prevalence, symptoms, comorbidity, and correlates of depression in Lagos, Nigeria. A total of 11,246 adult participants (6525 females and 4712 males) in a face-to-face household survey were assessed for symptoms of depression. They were also assessed for symptoms of anxiety, somatic symptoms, alcohol and substance use disorders, and disability. The difference between the point prevalence for symptoms of depression in females (6.3%, s.e 0.3) and males (4.4%, s.e 0.3) was significant (OR 1.28, 95% CI 1.14-1.59). Compared to males, females had significantly higher rates for anhedonia (OR 1.20), hypersomnia (OR 2.15), fatigue (OR 1.49), guilt/worthless feeling (OR 1.41), poor concentration (OR 1.32), psychomotor retardation (OR 1.51), and suicidal ideation (OR 1.32). However, poor appetite (OR 0.69) and comorbidity with alcohol use (OR 0.25) was significantly lower in females compared to males. The significantly higher rates for depression in females were only restricted to below 45 years and higher socioeconomic status. Our study further contributed to the growing literature suggesting that the gender differences in rates of depression not only cut across many cultures, but most pronounced with atypical symptoms, not affected by recall bias and seems to disappear with increasing age. These need to be considered when formulating mental health policies for equitable and acceptable health services.

Correlations between psychopathology and self-reported quality of life among adolescents in youth correctional facilities in Lagos, Nigeria: A short report.

BACKGROUND: The relationship between psychopathology and quality of life (QoL) and well-being among young incarcerated offenders has hardly been explored. AIMS: Our aim was to test the hypothesis that higher self-rated psychopathology would be associated with lower QoL among adolescents resident within youth correctional facilities in Lagos. METHODS: Psychopathology was assessed using the Strength and Difficulty Questionnaire (SDQ), while QoL was measured by using the Paediatric Quality of Life. RESULTS: One hundred and sixty-five adolescents completed the study, mostly boys (n = 124; 75%) with a mean age of 14.3 ± 2.1 years. Nearly, a fifth (30, 18%) of respondents had abnormal total SDQ scores (≥17), suggestive of definite psychiatric disorder, while another 44 (27%) had highly probable psychopathology (total SDQ scores 15-16). There was strong negative correlation (r = -0.51, p < 0.001) between total SDQ scores and overall self-reported QoL among respondents. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Although we were unable to infer direction of relationship between psychopathology and QoL among these adolescents, it is plausible to suppose that treatment of mental health problems could have a positive impact on rehabilitation and reintegration. Given the rate of likely psychopathology, mental health screening within young offender institutions should be routine, and followed, as necessary with full assessment and resultant treatment. Copyright © 2017 John Wiley & Sons, Ltd.

Current prevalence, comorbidity and associated factors for symptoms of depression and generalised anxiety in the Lagos State Mental Health Survey (LSMHS), Nigeria.

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Validation of CRAFFT for Use in Youth Correctional Institutions in Lagos, Nigeria.

Substance-related disorders (SRD) are common psychiatric morbidities among adolescents within youth correctional systems. Identification and treatment of SRDs is critical for successful reformation and reintegration. Lack of simple, structured, valid, brief screening instruments that can be easily administered and scored by lay workers militates against screening for SRDs. We present the results of the reliability and concurrent validity of the CRAFFT (acronym for Car, Relax, Alone, Forget, Friends, and Trouble) substance abuse screening instrument among residents of youth correctional facilities in Lagos, Nigeria. Adolescents who screened positive on CRAFFT were further assessed with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) to determine whether they met diagnostic criteria for SRDs. The mean CRAFFT scores for all the adolescents (n = 178) was 0.66 (SD ± 1.45). A total of 23 (12.9%) had CRAFFT scores of >1.00. The CRAFFT instrument has good internal consistency (Cronbach's α = 0.85) and 2-week test reliability (Spearman correlation = 0.979; p < .001). At a cutoff point of >1.00, CRAFFT had the best sensitivity and specificity (area under the curve = 0.889; 95% confidence interval 0.765-1.000) among the participants. As validated, the CRAFFT is a reliable instrument for screening for SRDs in incarcerated youth.

Primary health care workers' knowledge and attitudes towards depression and its management in the MeHPric-P project, Lagos, Nigeria.

OBJECTIVE: This study aimed to evaluate the knowledge, perceived challenges and attitude of primary health care (PHC) workers in Lagos to depression and its management in the PHC. METHODS: Health workers (n=607) from 49 "flagship" PHCs in Lagos were evaluated for their level of knowledge, experience, competence, attitude and perceived challenges to managing depression in the primary care using a case vignette. RESULTS: More than half (56.2%) of the health workers correctly diagnosed depression. The most endorsed causative factors were "Psycho-social" (77.3%), but "spiritual factors" were endorsed by 36.2%. While only 39.4% agreed that the depressed patient is best managed in a PHC, 86.2% would support treating the patient in their PHC if their capacity is enhanced. Top identified challenges were "heavy work schedule" (68.5%) and "lack of competence of the PHC staff" (67.5%). Over 42% had poor attitude towards depressed patient. Having a mental health training was the major factor that predicted good knowledge (OR 4.52, 95%CI 2.96-7.00) and good attitude (OR 2.17, 95% CI 1.48-3.17). CONCLUSIONS: For successful scale up of mental health services in LMICs, the design of mental health training curriculum for PHC workers should consider their knowledge, experience, competence level, perception and attitudes.

Status of mental-health services for adolescents with psychiatric morbidity in youth correctional institutions in Lagos.

BACKGROUND: High prevalence rates of psychiatric morbidity have been documented among adolescents within youth correctional institutions in Nigeria. However, there has not been prior investigation to determine the capacity for and nature of mental health services being provided in these institutions. OBJECTIVES: To assess psychiatric morbidity among adolescents within youth correctional institutions in Lagos, while simultaneously examining the capacity for and the scope of mental health services. METHODS: Psychiatric morbidity and alcohol/substance use disorder were assessed among 165 respondents using the Strengths and Difficulties Questionnaire, and the CRAFFT screening tool for adolescent substance use disorder. Availability of mental-health services in the institutions was examined using an 'audit protocol'. RESULTS: We found prevalence rates of 18.2% and 15.8% of general psychiatric morbidity and alcohol/ substance use disorder, respectively, among the adolescents. Only about a third (34.3%; n = 20) of the operational staff at the institutions had educational backgrounds relevant to psycho-social services for children/adolescents, while less than a quarter (22.4%, n = 13) has ever received any training in child mental health services. There was no evidence of mental health screening and intervention in the service framework within the institutions. CONCLUSIONS: We concluded that there was evidence for significant mental health service gaps within the youth correctional services in Lagos.