Misdiagnosis, detection rate, and associated factors of severe psychiatric disorders in specialized psychiatry centers in Ethiopia.

BACKGROUND: There are limited studies on the prevalence of misdiagnosis as well as detection rates of severe psychiatric disorders in specialized and non-specialized healthcare settings. To the best of our knowledge, this is the first study to determine the prevalence of misdiagnosis and detection rates of severe psychiatric disorders including schizophrenia, schizoaffective, bipolar, and depressive disorders in a specialized psychiatric setting. METHOD: In this cross-sectional study, a random sample of 309 patients with severe psychiatric disorders was selected by systematic sampling technique. Severe psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV (SCID). The potential determinates of misdiagnosis were explored using univariable and multivariable logistic regression models, adjusting for the potential confounding factors. RESULT: This study revealed that more than a third of patients with severe psychiatric disorders were misdiagnosed (39.16%). The commonly misdiagnosed disorder was found to be a schizoaffective disorder (75%) followed by major depressive disorder (54.72%), schizophrenia (23.71%), and bipolar disorder (17.78%). Among the patients detected with the interview by SCID criteria, the highest level of the correct diagnosis was recorded in the medical record for schizophrenia (76.29%) followed by bipolar (72.22%), depressive (42.40%), and schizoaffective (25%) disorders with detection rate (sensitivity) of 0.76 (95% CI 0.69-0.84), 0.42 (95% CI 0.32-0.53), 0.72 (95% CI 0.60-0.84), and 0.25 (95% CI 0.09-0.41), respectively for schizophrenia, depressive, bipolar, and schizoaffective disorders. Patients with bipolar disorder were more likely to be misdiagnosed as having schizophrenia (60%), whereas schizophrenic patients were more likely to be misdiagnosed as having bipolar disorder (56.25%) and patients with depressive disorders were more likely to be misdiagnosed as having schizophrenia (54.72%). Having a diagnosis of schizoaffective and depressive disorders, as well as suicidal ideation, was found to be significant predictors of misdiagnosis. CONCLUSION: This study showed that roughly four out of ten patients with severe psychiatric disorders had been misdiagnosed in a specialized psychiatric setting in Ethiopia. The highest rate of misdiagnosis was observed for schizoaffective disorder (3 out of 4), followed by major depressive disorder (1 out of 2), schizophrenia (1 out of 4), and bipolar disorders (1 in 5). The detection rates were highest for schizophrenia, followed by bipolar, depressive, and schizoaffective disorders. Having a diagnosis of schizoaffective and depressive disorders as well as suicidal ideation was found to be significant predictors of misdiagnosis.

Prevalence and associated factors of post-traumatic stress disorder among emergency responders of Addis Ababa Fire and Emergency Control and Prevention Service Authority, Ethiopia: institution-based, cross-sectional study.

OBJECTIVE: To assess the prevalence and associated factors of post-traumatic stress disorder (PTSD) among emergency responders at Addis Ababa Fire and Emergency Control and Prevention Service Authority, Ethiopia. DESIGN: Institution-based, cross-sectional design. SETTING: The study was conducted at the Fire and Emergency Control and Prevention Service Authority, Addis Ababa, Ethiopia. PARTICIPANTS: 603 emergency responders who worked in the Fire and Emergency Control and Prevention Authority during the study period. MEASUREMENT: Data were collected using a self-administered questionnaire: an adaptation of the standardised PTSD Checklist-Civilian Version. The questionnaire was administered to subjects on duty. Social support was measured using the Oslo 3-Item Social Support Scale, while other stressful life events were measured using the List of Threatening Experiences, that is, experiencing one or more stressful life events in the last 6 months. Reliability and construct validity were verified. To be diagnosed with PTSD, a subject must display at least three different types of symptoms at once. Coded variables were entered into Epi Info V.3.5.1 and then exported to SPSS V.20 for analysis. Descriptive and bivariate and multivariate logistic regressions and 95% CI were employed to establish and test statistically significant associations. RESULTS: A total of 603 subjects participated in the study, with 19.9% prevalence rate of PTSD (95% CI 16.9 to 23.1). The study found family history of mental illness (adjusted OR (AOR)=2.82; 95% CI 1.65 to 4.84), longer years of service (AOR=2.67; 95% CI 1.54 to 4.63), as well as prolonged exposure to emergency situations (AOR=0.44; 95% CI 0.24 to 0.84) and road traffic accidents (AOR=2.71; 95% CI 1.67 to 4.42) as significant predictors of PTSD among emergency responders. CONCLUSION: The prevalence of PTSD was high among the study population. Family history of mental illness, length of service, duration of exposure and type of exposure were found to be associated with PTSD. Mental health education and linking emergency responders with available mental health services/facilities should be prioritised to mitigate the problem.

A systematic review and meta-analysis of gender difference in epidemiology of HIV, hepatitis B, and hepatitis C infections in people with severe mental illness.

BACKGROUND: People with severe mental disorders (SMDs) are associated with increased risk of infectious disease including human immunodeficiency virus infection (HIV) and hepatitis viruses, such as hepatitis B virus (HBV), hepatitis C virus (HCV), and other types of hepatitis viruses because of high-risk behaviors compared to the general population. The prevalence of HIV in people with SMDs is higher in females than in males. Unlike HIV, the prevalence of HBV and HCV is higher in males than in females. This study aimed to carry out a systematic review and meta-analysis to determine the prevalence and estimated gender difference in the risk of HIV, HBV, and HCV in people with SMD. METHODS: Literature search was performed using the electronic databases PubMed, EMBASE, and Scopus. Publications were screened according to predefined inclusion criteria. A qualitative and quantitative analysis was undertaken for this systematic review. Eighteen materials published from 1993 to 2017 were included in the qualitative and quantitative analysis. Random-effect model was used to calculate weighted prevalence, odds ratio (OR), and corresponding 95% confidence interval (CI). RESULTS: 12,290 citations were identified and 18 articles including 11,175 participants were included. The results of our meta-analysis show that the prevalence of HIV, HBV, and HCV in people with SMD was 7.59% (95% CI 4.82-11.75), 15.63% (95% CI 7.19-30.69), and 7.21% (95% CI 4.44-11.50), respectively. The prevalence of HIV was higher in women (8.25%) than men (7.04%), but the prevalence of HBV and HCV was higher in men than women (18.91% versus 12.02% and 9.16% versus 5.43% for HBV and HCV in men versus women, respectively). A meta-analysis of included studies demonstrated a significantly increased risk of HBV (OR 1.72; 95% CI 1.17-2.53) and HCV (OR 2.01; 95% CI 1.16-3.20) infections in men compared to women in people with SMD. However, no significant association was observed between gender and HIV. The funnel plot and Egger's regression tests provided no evidence of substantial publication bias in the prevalence and gender difference in association for HIV, HBV, and HCV in people with SMD. CONCLUSIONS: In our review, the prevalence of HIV, HBV, and HCV was high. The prevalence of HBV is significantly higher than HIV and HCV. There was a significantly increased risk of HBV and HCV infections in men compared to women. No significant association was observed between gender and HIV. People with SMDs warrant greater emphasis in efforts to identify and treat HIV, HBV and HCV.