Psychosocial factors predicting severity of depression among treatment-seeking HIV/AIDS patients: A multi-site Nigerian study.

BACKGROUND AND OBJECTIVES: Depression as major psychological sequelea of the HIV/AIDS infection has continued to attract investigation. With few studies in Nigeria, it is unclear whether levels of perceived stigma, sexual risk behaviors, and anticipated discrimination are differentially associated with severity of depression. MATERIALS AND METHODS: The present study using a multivariate design investigated the role of stigma, anticipated discrimination, self-esteem, HIV-related factors (e.g., drug use combination, knowledge of duration of HIV diagnosis) and socio demographic factors (e.g., multiple spouse, age, gender, and ethnicity) in depression among people living with HIV/AIDS (PLWHA) on follow-up management in three tertiary hospitals in Nigeria. Five hundred and two (187 [37.3%] males and 315 [62.7%] females) HIV/AIDS patients participated in the study. RESULTS: Mean age and mean time in months since diagnosis were 36.73 ± 9.38 and 19.42 ± 23.12, respectively. Three variables: Ethnicity, anticipated discrimination, and HIV-related stigma were related to severity of depression at (P < 0.05). Multinomial logistic regression analyses showed that being from Yoruba (odds ratio [OR] = 0.25; 95% confidence interval [CI] = 0.145-0.441), or Igbo extraction (OR = 0.43; 95% CI = 0.214-0.873) reduces the risk of reporting severity of depression by 25% and 43%, respectively. Moreover, low perceived HIV-related stigma (OR = 0.59; 95% CI = 0.355-0.966) and low anticipated discrimination (OR = 0.54; 95% CI = 0.319-0.914) reduced the risk of reporting symptoms of severe depression by 59% and 54%, respectively. CONCLUSION: Intervention to reduce the severity of depression should consider cultural specificity in its design and also evolve educational programs that incorporate discrimination and stigma in managing depression among PLWHAs.

HIV-related stigma and self-disclosure: the mediating and moderating role of anticipated discrimination among people living with HIV/AIDS in Akure Nigeria.

Although links between HIV-related stigma and self-disclosure of HIV status among people living with HIV have been well established, it is unclear whether levels of perceived discrimination are differentially associated with self-disclosure. The present study using a multi-factorial survey design investigated the role of stigma and other self-related factors (e.g., anticipated discrimination, self-esteem, HIV-related factors [e.g., drug use combination; knowledge of duration of HIV diagnosis] and socio-demographic factors [e.g., multiple spouse; age, gender, educational level] and psychological distress [depression]) in self-disclosure among People living with HIV/AIDs has been added (PLWHA) on follow-up management in State Specialist Hospital Akure, Nigeria. One hundred and thirty nine HIV/AIDS patients (49 males and 90 females) participated in the study. Mean age and mean time in months since diagnosis were 39.56 ± 10.26 and 37.78 ± 48.34, respectively. Four variables: multiple spouse, anticipated discrimination, HIV-related stigma and self-esteem were related to self-disclosure at (p < .05). Product-term regression analyses demonstrated that perceived discrimination mediated the relationship between self-esteem (Sobel test: z = 2.09, Aroian = 2.06, p < .001), perceived stigma (Sobel test: z = 2.78, Aroaian = 2.75 p < .01) and self-disclosure. Interaction term analysis between HIV-related stigma t (5, 137) = 1.69, p > .05, self-esteem t (5, 137) = .59, p > .05 and anticipated discrimination were non-significant, suggesting a non-moderation effect of discrimination and disclosure. The results indicate that anticipated discrimination may impact HIV-related stigma to reduce self-disclosure among the PLWHAs in Akure, Nigeria. Interventions should incorporate anticipated discrimination in educational programs of HIV stigma in encouraging self-disclosure among PLWHAs.

Determinants of quality of life of elderly Nigerians: results from the Ibadan study of ageing.

Little is known about factors that determine the QoL of elderly persons living in developing societies undergoing rapid social changes. A representative sample of elderly Nigerians, aged 65 years and over (n = 2152), was assessed for QoL using the World Health Organization Quality of Life instrument (WHOQoL-Bref). Other than sociodemographic factors, respondents were also evaluated for major depressive disorder, physical conditions as well as for social network, support and engagement. Using linear regression modeling, these factors were explored for their ability to predict the physical, psychological, social and environmental domains of QoL. Economic status was the most consistent predictor of the four domains of QoL, with the coefficients ranging between 1.0 and 1.68 (p < 0.001 in every instance). Among health variables, functional disability (range: 7.07-19.86) and self-rated overall health (range: 7.89-18. 42) were the most salient. Participation in community activities (range 7.74-17.48) was the most consistent social predictor. Even though health factors are important, social factors, in particular those relating to the quality of social support and participation, are the most important predictors of QoL.

Psychosocial determinants of HIV-related quality of life among HIV-positive military in Nigeria.

There is a paucity of research regarding the role played by psychosocial and HIV-related factors on quality of life (QoL) among military in developing countries. On presentation to a military hospital-based HIV clinic, 125 air-force personnel, 56 seropositive (none of whom had AIDS) and 69 seronegative were interviewed. At the interview, participants were assessed using the Medical Outcome QoL and other psychosocial measures. The overall QoL was less among seropositive compared with seronegative air-force personnel. Seropositive personnel also reported a greater number of negative life events and trauma symptoms (post-traumatic stress disorder, PTSD). Seronegative military personnel reported more sexual risk behaviours compared with seropositive personnel. Multivariate analysis showed that trauma symptoms (PTSD) were a significant contributor to QoL and explained of the variance in physical, mental, role and social functioning among HIV-infected air-force personnel. Other variables that predicted QoL, but to a lesser extent, included age, number of negative life events and increased symptomatology. These findings highlight the importance of evaluation of QoL in HIV-infected military personnel.

Child sexual abuse, harmful alcohol use and age as determinants of sexual risk behaviours among freshmen in a Nigerian university.

In Nigeria, freshmen constitute a risk group of adolescents and young adults capable of engaging in unsafe sexual practices. This study documents the associated factors to sexual risk behaviours practices of University of Ibadan, Nigeria freshmen. Eight hundred and forty one (841), freshmen who attended a routine orientation program were asked to respond to a questionnaire. Results showed that 30.8% were sexually active and 47% did not use condom in their last sexual episode. Associated with sexual risk behaviours include: being a male freshman increasing age; lower tendency for violence; increase sexual compulsivity; alcohol abuse; history of rape and a history of Child Sexual Abuse (CSA). Three variables: alcohol abuse; history of CSA and increasing age remained significant in a multiple regression analysis. The paper presents the first evidence of vulnerability of freshmen to sexual risk practices in a Nigerian University.

Child sexual abuse, harmful alcohol use and age as determinants of risky sexual behaviours among freshmen in a Nigerian University

In Nigeria, freshmen constitute a risk group of adolescents and young adults capable of engaging in unsafe sexual practices. This study documents the associated factors to sexual risk behaviours practices of University of Ibadan, Nigeria freshmen. Eight hundred and forty one (841), freshmen who attended a routine orientation program were asked to respond to a questionnaire. Results showed that 30.8% were sexually active and 47% did not use condom in their last sexual episode. Associated with sexual risk behaviours include: being a male freshman increasing age; lower tendency for violence; increase sexual compulsivity; alcohol abuse; history of rape and a history of Child Sexual Abuse (CSA). Three variables: alcohol abuse; history of CSA and increasing age remained significant in a multiple regression analysis. The paper presents the first evidence of vulnerability of freshmen to sexual risk practices in a Nigerian University. (Afr J Reprod Health 2008; 12[2]:75-88)

The role of support group and duration of infection in HIV/AIDS patients' knowledge and attitudes to their illness.

To assess the association between support group membership, socio-demographic and HIV related factors including knowledge and attitude of illness in people living with HIV/AIDS (PLWHAs). Seventy-six participants with HIV who were on follow-up management at three non-governmental care and treatment agencies in south western, Nigeria were asked to complete a questionnaire detailing their demographic characteristics, duration of awareness of HIV status, medication status, membership of a support group, HIV-related knowledge (including number of workshops/seminars attended, reading of literature), and attitude toward their illness and treatment. Compared to those who did not belong to a support group, (34, 45%), those who did (42, 55%) were significantly more knowledgeable about HIV-related (t=4.02, p=0.00) and also reported more favorable attitudes toward the illness and its treatment (t=3.38, p=0.005). A multiple regression analysis indicated that group membership and a longer period of awareness of HIV infection contributed significantly to illness knowledge and attitudes. Age, sex, years of education, medication status, and employment status did not contribute significantly to these outcome variables. Individuals living with HIV/AIDS who belonged to a support group and had availed themselves of relevant literature were more knowledgeable and positive about their illness than those who did not belong to support groups. HIV/AIDS support group membership is an important component of psycho-social care in HIV/AIDS patients in Nigeria and should be encouraged.

Improving well-being through psycho-education among voluntary counseling and testing seekers in Nigeria: a controlled outcome study.

The present study evaluated the efficacy of an individualized psycho-education (PE) program in reducing psychological distress and risky sexual behavior and enhancing self-disclosure associated with an HIV diagnosis among attendees of a walk-in non-governmental voluntary counseling and testing (VCT) center in Nigeria. Ninety-four consecutive individuals were asked to complete a pre-counseling, baseline questionnaire detailing their sociodemographic characteristics, psychopathology, sexual practices, self-disclosure intention and coping behaviors. They were screened for HIV and post-test counseled. Sixty-seven individuals (72.2%) who tested positive were consecutively randomly assigned to one of two groups: a PE program (four 60-minute weekly manual driven sessions) (N=34) and a wait-list (WL) control group (N=33). The major outcome measures used were the Crown Crisp Experiential Index (CCEI), the Beck Depression Inventory (BDI) (Beck et al., (1961), self-report sexual practices in past three months, self-disclosure intention and the brief COPE. At four weeks post-intervention, significant reductions on all measures as well as reduction in risky sexual practices were observed in the treatment group compared with the wait-list group. Treatment group members were also significantly more likely to disclose their serostatus and accept their HIV status as a way of coping, compared with the wait-list group. Overall, support was found for the efficacy of a manual-driven PE program for self-disclosure, reduction of depression and improvement in safe sexual practices.

Social and health behaviors in youth of the streets of Ibadan, Nigeria.

OBJECTIVES: This study documents the extent and impact of perceived patterns of behavior in a sample of youths of the streets of Ibadan, Nigeria, with the purpose of implementing a Life Skills Educational (LSE) intervention. METHOD: The study uses both qualitative and quantitative methods of data collection. Qualitatively, two Focus Group Discussions (FGD) and two in-depth interviews (IDI) with 20 boys and 2 community leaders were conducted on separate occasions for the purpose of eliciting commonly exhibited behaviors and patterns of street youth. Quantitatively, 169 youths (89.3% male) were consecutively interviewed from five subcultural areas in Ibadan, Nigeria. Street youths were accessed through a snowballing technique made possible by "Area boys" (AB, adults, who serve as a symbol of authority for street children). RESULTS: The mean age of participants was 18.4 years. The majority was on the street for financial reasons, had been on the street for more than 1 year, and had not completed their primary schooling. While youths of the street were economically viable, 69% had a history of alcohol abuse, 14% of drug abuse, and 24% operated as drug couriers; 46% reported school refusal, 27% school suspension, and 47% school truancy. Forty-nine percent admitted to being sex workers and 11% had been raped and were, therefore, at risk of contacting sexually transmitted diseases (STD). One-third of youths had been arrested for various offenses, including street fighting and drug use. While females were in the minority, they were more likely to engage in antisocial behaviors compared with boys. CONCLUSIONS: Although many youths of the street display antisocial behaviors, they also are an economically viable group. Some of their antisocial behaviors may have been exhibited within the context of economic survival. Implementing a life skill program to address these antisocial behaviors may help to increase the well being of street youths in developing countries in Africa.

Attitudes towards community based residential care for people living with HIV/AIDS in Nigeria.

Community based care and support are important aspects of HIV/AIDS management in resource-poor African countries in view of increasing incidence of the disease and absence of a cure. A representative community sample (n = 2040) selected using a clustered stratified selection procedure was studied in Ogun, Oyo, and Osun states. A single item question which formed part of a larger survey of the stigma of mental illness was used to elicit information about the opinion of respondents regarding provision of a group home in their neighborhood for the care of persons experiencing a range of medical and social conditions which include HIV/AIDS, mental handicap, previous jail term, physical disability, mental illness, and drug abuse. Of the respondents, 906 (44.4%) were males and 1134(55.65) were females. The mean age was 43.5 (SD 19.72). Over 71% of the respondents disagreed or strongly disagreed with the location of a residential care for persons living with HIV/AIDS (PLWHA) in their neighborhood. This level of rejection was only comparable to that for drug addicts and alcoholics. PLWHA's were more likely to be rejected than ex-convicts for whom about 55% expressed rejection. Decreasing education (X2 = 32.55, p < 0.003) lower income (X2 = 21.25, p < 0.01), urban residence of the respondents (X2 = 15.11, p < 0.05) and female gender (X2 = 9.25, p < 0.05) were associated with a negative attitude to such a residential care for PLWHA. These results suggest a deep-seated prejudice against the provision of a group home for the PLWHA. A community-based enlightenment program anchored on the nature and course of HIV/AIDS should be part of a holistic management approach to the disease.

Association between sexual violence and psychiatric morbidity among HIV positive women in South Africa.

This study examined the association between rape and psychiatric morbidity among recently diagnosed HIV-infected women in South-Africa. One hundred and five women attending an out-patient infectious disease clinic of the Department of Internal Medicine, Tygerberg Hospital, Cape Town, South-Africa participated in the study. Full medical as well as socio-demographic histories were obtained for each patient. Psychiatric morbidity was assessed with the MINI International Neuropsychiatric Interview (MINI). Life-time prevalence of rape among the women was 4.8%. A significant relationship was found between rape and (i) drug dependence (X2 = 40.77, P < 0.00), (ii) alcohol dependence (X2 = 14.37, P < 0.01), (iii) post traumatic stress disorder (X2 = 8.91, P < 0.02), and (iv) major depression (X2 = 4.57, P < 0.05). Women who were raped were more likely to be younger (t = 2.86, P < 0.05), Afrikaans-speaking (X2 = 7.39, P < 0.02), and unemployed (X2 = 6.42, P < 0.04). HIV positive women with a history of having been raped may experience a number of psychiatric disorders. As part of the comprehensive medical care of HIV, it is important that health workers assess past sexual abuse and current psychiatric symptoms.

Post-traumatic stress disorder among recently diagnosed patients with HIV/AIDS in South Africa.

This study examined the prevalence of and factors associated with post-traumatic stress disorder in recently diagnosed HIV/AIDS patients in South Africa. One hundred and forty-nine (44 male, 105 female) recently diagnosed HIV/AIDS patients (mean duration since diagnosis = 5.8 months, SD = 4.1) were evaluated. Subjects were assessed using the MINI International Neuropsychiatric Interview (MINI), the Carver Brief COPE coping scale and the Sheehan Disability Scale. In addition, previous exposures to trauma and past risk behaviours were assessed. Twenty-two patients (14.8%) met criteria for PTSD. Current psychiatric conditions more likely to be associated with PTSD included major depressive disorder (29% in PTSD patients versus 7% in non-PTSD patients, p = 0.004), suicidality (54% versus 11%, p = 0.001) and social anxiety disorder (40% versus 13%, p = 0.04). Further patients with PTSD reported significantly more work impairment and demonstrated a trend towards higher usage of alcohol as a means of coping. Discriminant function analysis indicated that female gender and a history of sexual violation in the past year were significantly associated with a diagnosis of PTSD. Patients whose PTSD was a direct result of an HIV/AIDS diagnosis (8/22) did not differ from other patients with PTSD on demographic or clinical features. In the South African context, PTSD is not an uncommon disorder in patients with HIV/AIDS. In some cases, PTSD is secondary to the diagnosis of HIV/AIDS but in most cases it is seen after other traumas, with sexual violation and intimate partner violence in women being particularly important.

Determinants of unprotected sex among HIV-positive patients in South Africa.

This study examined the prevalence of unprotected sex, other sexual risk behaviours, and factors associated with unprotected sex among men and women recently diagnosed with HIV in South Africa. One hundred and forty-nine outpatients (44 males and 105 females) were assessed, of whom 101 were sexually active at least 6 months prior to study entry. Subjects were asked about sexual risk behaviours with reference to their most recent sexual encounter. Logistic regression analysis was employed to determine the predictors of condom use, with independent variables selected from five general categories: (1) sociodemographic characteristics; (2) situational characteristics regarding sexual intercourse (i.e. alcohol or drugs used before intercourse); (3) clinical diagnoses; (4) negative life events; and (5) coping styles. Fifty-five patients (19 males and 36 females), representing 54.4% of those sexually active in the 6 months preceding the study, had not used a condom during the most recent intercourse. Compared with those who used condoms, participants who did not significantly reported shorter duration of HIV infection (t = -2.7, p < 0.001), have a current partner (chi2 = 3.98, p = 0.005), and lack knowledge of their partner's HIV status (chi2 = 4.78, p = 0.004). Also they were significantly more likely to engage in denial (t = 3.2, p < 0.002) and to use substances (t = 1.98, p < 0.05) as a means of coping. Logistic regression showed that shorter duration of illness (odds ratio (OR) = 1.2, 95% confidence interval (CI) = 1.01-1.41) and coping styles characterized by denial (OR = 0.6, 95% CI = 0.45-0.96) were significantly associated with unprotected sex. These data suggest the need for interventions to further reduce sexual risk behaviours in HIV-positive patients in South Africa.

Self-disclosure of HIV serostatus in recently diagnosed patients with HIV in South Africa.

Failure of people living with HIV/AIDS to disclose their HIV serostatus can place their sexual partners at risk. The current study examined HIV serostatus disclosure and its relationship to risky sexual behaviours in 69 sexually active, heterosexual, married (62%) or cohabiting (38%) patients recently diagnosed as HIV positive. Results show that 78% had not disclosed their HIV serostatus to their sexual partners and 46% had no knowledge of their sexual partner's serostatus. Compared to those who disclosed their serostatus, those who did not disclose were more likely to be male (chi2 = 7.02, p = 0.00), to have not used a condom during their last sexual encounter (chi2 = 29.64, p = 0.000), to have used alcohol heavily before sex (chi2 = 6.79, p = 0.00), to have multiple sexual partners (t = 3.01, p = 0.05), and to have engaged more frequently in sexual intercourse in the six months preceding the study (t = 8.21, p = 0.00). Logistic regression analysis show that being in a married relationship (OR = 0.86, 95% CI = 0.65, 1.15), being male (OR = 1.48, 95% CI = 0.24, 1.99), having more than two multiple partners (OR = 2.03, 95% CI = 1.11, 3.68) and non-use of condom at last sex (OR = 1.53, 95% CI = 0.83, 1.88) were significantly associated with non-disclosure of HIV serostatus. Preventive strategies among HIV-positive patients should place emphasis on the management of self-disclosure and its importance in safe sexual behaviour.

Psychosocial and seizure factors related to depression and neurotic-disorders among patients with chronic epilepsy in Nigeria.

To establish the effect of psychosocial and seizure factors on Depression and Neurotic Disorders among clinically diagnosed Nigerian patients, with epilepsy. This study utilized the multivariate statistical design to evaluate the associations between some psychosocial and seizure factors on increase depression and neurotic disorders. The Neurology outpatient clinics of two tertiary facilities in Nigeria: Aro Neuro-psychiatric Hospital/World Health Organization Collaborating Centre, Abeokuta and the University College Hospital Ibadan, were used for the study. Two hundred and sixty four (264) consecutive clinic attendees with a clinical diagnosis of epilepsy participated in the study. Perceived Stigma Scale (PSS); Washington Psychosocial Seizure Inventory (WPSI-Modified): Becks Depression Inventory (BDI) and Crown-Crisp Experiential Index (CCEI). Significant main effect for seizure control, stigma, emotional adjustment, vocational adjustment, interpersonal adjustment, adjustment to seizures but not for age at onset of epilepsy, financial adjustment and gender, were recorded on depression. Similarly significant main effect for seizure control, stigma, emotional adjustment, adjustment to seizures but not for age at onset of epilepsy, gender, vocational adjustment, financial adjustment and interpersonal adjustment were recorded for neurotic disorders. The study highlights some of the factors, which may contribute to the understanding of epilepsy-related psychopathologies and implication for psychotherapeutic intervention among individuals with epilepsy in Nigeria.

Predictors of major depression in recently diagnosed patients with HIV/AIDS in South Africa.

There is increasing evidence that major depression impacts the course of HIV infection, yet few studies have explored demographic and clinical predictors of depression in people who with HIV/AIDS. This study investigated predictors of depression (e.g., demographic and clinical variables, negative life events, and coping response) among outpatients with recently diagnosed HIV/AIDS patients in South Africa. One hundred forty-nine recently diagnosed HIV/AIDS patients (44 males and 105 females; mean time since diagnosis = 5.8, standard deviation [SD] 4.1) were evaluated. Subjects were assessed using the Mini International Neuropsychiatric Interview (MINI), the Carver Brief COPE coping scale, and the Sheehan Disability Scale. In addition, previous exposures to trauma and past risk behaviors were assessed. Three variables: gender (odd ratio [OR] = 1.23; 95% confidence interval [CI] 1.56, 1.93), impact of negative life events (OR = 1.13; CI, 1.03, 1.23), and disability (OR = 1.51, CI, 1.28, 1.80) predicted current major depression. It is well known from non-HIV populations that female gender and increased negative life events predict depression. These data also emphasize the importance of these links in HIV.

Predictors of hazardous and harmful alcohol use among Nigerian freshmen.

Problem drinking among young persons is a concern among contemporary researchers. The present study examines the prevalence and the predictors of hazardous and harmful alcohol use among a sample of freshmen at the University of Ibadan Nigeria. Five hundred and forty freshmen were surveyed, of which 289 used alcohol. The effect of eighteen psychosocial variables on Alcohol Use Disorder Identification Test (AUDIT) scores was investigated using regression analysis. The results showed that, being a male freshman (r = 0.78, p < 0.0005); coming from a polygamous home background (r = 0.59, p < 0.01); high levels of parents socio-economic status (r = -0.47, p < 0.0005); living with both parents (r = -0.24, p < 0.0005); mother working full time outside home (r = 0.39. p < 0.005); increasing number of siblings (r = 0.35, p < 0.0005); living in urban cities (r = 0.38, p < 0.005); belonging to a social club (r = -0.46, p < 0.01); increasing religious activities (r = -0.51, p < 0.005); increasing parent child interaction (r = 0.72, p < 0.01); and low need for affiliation (r = -0.49, p < 0.0005) were found to be associated with hazardous and harmful alcohol use among the freshmen. When these eleven variables were entered into a stepwise multiple regression analysis to determine their relative predictive power to hazardous and harmful alcohol use among the freshmen, three variables; being a male (p < 0.0005); polygyny polygamy (p < 0.0053) and low need for affiliation (p < 0.0053) remained significant. There is a need to consider psychosocial factors in designing health educational programs for students on alcohol consumption.

Gender differences in condom use behaviour among students in a Nigerian university.

Within a social cognitive framework, the present study evaluated condom use behaviour in a sample of students at the Faculties of Social Sciences and Arts, University of Ibadan, Nigeria. The study population comprised 262 (62.1%) males and 160 (37.9%) females with a mean age of 24.1 years (SD = 4.5) and mean educational level of 17.36 years (SD = 5.8). Results show that 422 students (representing 55.2%) were sexually active within three months before the study. Seventy seven per cent of students reported ever using a condom, 89% of females reported condom use by a partner, while 70% of males had used condoms during sex with a partner. Regarding the frequency of use, more males (30%) than females (11%) had never used condom. We conclude that the majority of sexually active university students in the study do not use condom. However, the females reported greater consistency of use of condom when compared to the males. Condom use behaviour in this sample did not differ markedly from other college student samples.

A comparative study of burnout syndrome among health professionals in a Nigerian teaching hospital.

Burnout as a measure of stress has generated research interest in the past two decades. However, there is a dearth of research on this interesting and important phenomenon in Nigeria. This study compared burnout and its associated factors in various health professionals working at the University College Hospital, Ibadan, Nigeria. Two hundred and sixty health care providers were sampled from 5 main units: Theatre/Intensive Care Unit (ICU), Accident and Emergency (A & E), Oncology, Dentistry and General Outpatients Department (GOP), among others. Included were 104 nurses (40%), 83 doctors (31.9%), 21 pharmacists/pharmacy technicians (8.0%), 10 medical social workers (3.8%) and 42 nursing assistants (16.1%). Outcome measures included the Maslach Burnout Inventory (MBI), the 30-item General Health Questionnaire (GHQ) and the Spielberger State Trait Anxiety Inventory (STAI). Core findings indicated that nurses consistently reported higher scores on all measures of burnout: exhaustion (F = 3.60, df = 258, P < .05); accomplishment (F = 3.94, df = 258, P < .05) and depersonalization (F = 4.58, df 258, P < .01) when compared with other health care providers. Significant differences were also noted between nurses and all other care providers in total scores on the General Health Questionnaire (F = 6.54, df 258, P < .01) and the State Trait Anxiety Inventory (F = 1.91, df 258, P < .05), respectively. These results are discussed in relation to the existing literature on burnout in Nigeria. Further empirical study is highly suggested in view of dearth of studies on the occupational health of health care providers in Nigeria.

Evaluation of the effect of cognitive therapy on perioperative anxiety and depression among Nigerian surgical patients.

STUDY OBJECTIVE: Surgical paients have been known to benefit immensely from psychological interventions. This study set out to assess the pre and postoperative anxiety levels and depression and the effect of cognitive therapy among Nigerian surgical patients. The effects of gender and educational status on perioperative anxiety and depression were also evaluated. STUDY DESIGN: The study utilized a controlled outcome design to evaluate the efficacy of self-instructional training (SIT) and rational emotive therapy (RET) in surgical patients. Preoperative anxiety and depression scores were used as co-variants. PATIENTS: Thirty-three (33) elective surgical patients were sampled randomly, divided into 3 groups of eleven (11) patients each. Eight (8) subjects underwent gynaecological procedures while the remaining 25 subjects had general surgical procedures. The mean age was 32.72 +/- 15.83 years (range = 17-16 years.) MEASUREMENTS: The major instruments used in the study were the State Anxiety Subscale of the Speilberger State Trait Anxiety Inventory (STAI) and Hospital Anxiety and Depression Inventory. MAIN RESULTS: SIT had the potential to reduce anxiety level among subjects postoperatively (t = 2.06; df = 10; p < 0.05). The use of RET reduced depression among surgical patients (t = 1.23; df = 10; p < 0.05). CONCLUSIONS: It was concluded that surgical patients manifest varying degrees of anxiety preoperatively and postoperatively. Patient's pre and postoperative anxiety and depression can be reduced by the introduction of SIT and RET.