DEPRESSION AND MEDICATION ADHERENCE AMONG ALDER ADULTS WITH SELECTED CHRONIC MEDICAL CONDITIONS IN MAIDUGURI, NIGERIA.

Introduction: Older adults constitute a rapidly growing population whose healthcare needs are unique, with a higher prevalence of physical and psychiatric morbidities. A knowledge gap exists regarding the association of chronic medical conditions with Depression and how they affect medication adherence. This may be linked to their chronic nature and impacts on the mood of older adults. This study assessed Depression among older adults with Hypertension, Diabetes Mellitus, and Arthritis; and compared its relationship with medication adherence in the speciality clinics of UMTH, Maiduguri. Methods: A comparative cross-sectional analytic study was employed to recruit 327 older adults aged≥60years for six months. They were proportionally distributed into groups of Hypertension only (140), Diabetes only (85), Arthritis only (43), hypertension and diabetes (59). The socio- clinical proforma, Geriatric Depression Scale (GDS-30), and Morisky Medication Adherence Scale (MMAS-8) were administered. Data were analysed using SPSS version 26.0. The mean adherence scores for those with depression were compared with the mean scores of those without depression using a t-test. Results: The study found that the mean medication adherence score was lower in those with depression than those without depression. The difference is significant among the group with arthritis only (t = 1.943 and p-value = 0.049) where those with depression had an adherence score (2.299 ± 0.500) while those without depression scored (3.177 ± 1.267); and also, among the group with HTN + DM (t = 2.769, p-value = 0.006) where those with depression had an adherence score (2.000 ± 0.001) while those without depression scored (4.299 ±2.026). Conclusion: Depression is associated with low medication adherence in older adults with chronic medical conditions. This underscores the need for consultation-liaison practice and proactivity in assessing for depression in older adults with chronic conditions to improve their adherence.

A comparative cross-cultural study of the prevalence of late life depression in low and middle income countries.

BACKGROUND: Current estimates of the prevalence of depression in later life mostly arise from studies carried out in Europe, North America and Asia. In this study we aimed to measure the prevalence of depression using a standardised method in a number of low and middle income countries (LMIC). METHODS: A one-phase cross-sectional survey involving over 17,000 participants aged 65 years and over living in urban and rural catchment areas in 13 sites from 9 countries (Cuba, Dominican Republic, Puerto Rico, Mexico, Venezuela, Peru, China, India and Nigeria). Depression was assessed and compared using ICD-10 and EURO-D criteria. RESULTS: Depression prevalence varied across sites according to diagnostic criteria. The lowest prevalence was observed for ICD-10 depressive episode (0.3 to 13.8%). When using the EURO-D depression scale, the prevalence was higher and ranged from 1.0% to 38.6%. The crude prevalence was particularly high in the Dominican Republic and in rural India. ICD-10 depression was also associated with increased age and being female. LIMITATIONS: Generalisability of findings outside of catchment areas is difficult to assess. CONCLUSIONS: Late life depression is burdensome, and common in LMIC. However its prevalence varies from culture to culture; its diagnosis poses a significant challenge and requires proper recognition of its expression.

Sociodemographic correlates of continuing tobacco use - a descriptive report from the Nigerian Survey of Mental Health and Wellbeing.

OBJECTIVE: To investigate whether sociodemographic factors were associated with continuing tobacco use in a nationwide Nigerian sample. METHOD: The World Mental Health Survey Schedule was used to interview 6752 Community dwelling participants 18 years and over, selected in a complex multistage sampling from the six geopolitical zones of Nigeria. Ever and current smokers were identified with their sociodemographic characteristics. RESULTS: About 17% (1137/6752) of the participants were ever smokers, 24.8% of whom were current smokers. Participants who completed primary school, had some College education, were never married, or students were more likely to continue using smoke once they commenced its use. Being in the older age group or having had graduate college education was associated with much less likelihood of continuing to use tobacco among ever smokers. CONCLUSION: In general, tobacco smoking rate in Nigeria is lower compared to most developed countries. Younger participants, having some education, those who were never married were more likely to continue tobacco smoking. Determinants of factors associated with continuing tobacco use should be adequately investigated to permit appropriate interventions.

Religion, coping and outcome in out-patients with depression or diabetes mellitus.

OBJECTIVE: The study assesses the association between religiosity and coping style with the outcome of depression and diabetes. METHOD: Using a simple random sampling, we recruited 112 participants with diabetes and an equal number with depression consecutively, matching for gender. Religiosity was determined using Religious Orientation Scale (revised) (ROS-R), coping styles with Brief Religious Coping (Brief RCOPE) scale and Mental Adjustment to Cancer (MAC) scale (adapted). Primary and secondary outcomes were evaluated using Sheehan's Disability Scale (SDS) and Becks Depression Inventory-II (BDI-II) respectively. RESULTS: Among participants with diabetes, BDI-II total scores correlated negatively with ROS-R Extrinsic Social (r = -0.2, P < 0.05) and Fighting Spirit (r = -0.3, P < 0.05) but correlated positively with Helplessness/Hopelessness (r = 0.3, P < 0.05) and Brief RCOPE Negative (r = 0.4, P < 0.05). SDS global scores correlated positively with Helplessness/Hopelessness (r = 0.3, P < 0.05) and Brief RCOPE Negative (r = 0.4, P < 0.05). Among participants with depression, BDI-II total scores correlated negatively with Intrinsic religiosity (r = -0.2, P < 0.05) and Fighting Spirit (r = -0.4, P < 0.05) but correlated positively with Helplessness/Hopelessness (r = 0.6, P < 0.05) and Brief RCOPE Negative (r = 0.7, P < 0.05). SDS global scores correlated negatively with Intrinsic religiosity (r = -0.2, P < 0.05) and Fighting Spirit (r = -0.3, P < 0.05) but correlated positively with Helplessness/Hopelessness (r = 0.5, P < 0.05) and Brief RCOPE Negative (r = 0.4, P < 0.05). CONCLUSION: High intrinsic and extrinsic religiosities are likely to be associated with positive coping skills and better treatment outcome in patients with depression or diabetes.

Psychiatric Morbidity among Subjects with Leprosy and Albinism in South East Nigeria: A Comparative Study.

BACKGROUND: Skin, which is the largest organ in the body, carries immense psychological significance. Disfiguring skin disorders may impact negatively on the mental health of individuals. AIM: This study compared the psychiatric morbidity of subjects with leprosy and albinism. SUBJECTS AND METHODS: One hundred subjects with leprosy and 100 with albinism were interviewed. Sociodemographic questionnaire and General Health Questionnaire (GHQ-28) assessed the sociodemographic characteristics and psychiatric morbidity, respectively. GHQ positive cases and 10% of noncases for each group were interviewed with Mini International Neuropsychiatric Inventory for specific ICD-10 diagnoses. RESULTS: Fifty-five percent (55/100) subjects with leprosy were GHQ positive cases while 41% (41/100) with albinism were GHQ positive cases. The risk of developing psychiatric morbidity was significantly higher in subjects with leprosy than in subjects with albinism (OR = 1.76, CI = 1.00 - 3.08, P = 0.04). The prevalence of specific psychiatric disorders among subjects with leprosy were depression 49% (49/100), generalized anxiety disorder (GAD) 18% (18/100), alcohol/drug abuse 16% (16/100), whereas in albinism depression was 51% (51/100), GAD 27% (27/100), and alcohol/drug abuse 7% (7/100). Male, married and uneducated subjects with leprosy had significantly higher psychiatric morbidity than the male, married and uneducated subjects with albinism, respectively. CONCLUSION: Psychiatric morbidity was higher in subjects with leprosy than in subjects with albinism. Male, married and uneducated subjects with leprosy significantly had higher morbidity than male, married and uneducated subjects with albinism respectively.

Prevalence and correlates of cigarette smoking among patients with schizophrenia in southeast Nigeria.

OBJECTIVE: To determine the prevalence of cigarette smoking among patients with schizophrenia and to explore their sociodemographic and clinical characteristics. METHOD: A cross-sectional descriptive study of 367 patients with schizophrenia. Instruments administered included sociodemographic questionnaire, Present State Examination: schizophrenia section to confirm schizophrenia diagnosis and Present State Examination: tobacco section to those that smoked. RESULTS: A total of 189 females (51.5%) and 178 (48.5%) males were studied. The mean age of the participants was 34.1 ± 9.94 years. Two hundred and forty-one (65.7%) had never being married. Two hundred and three (55.3%) had secondary school education. A lifetime prevalence of 25.9% and a current smoking rate of 20.4% were reported. Ninety five (53.4%) of the males had smoked at least once in their lifetime. None of the females smoked. Among those that smoked, being unmarried (Ï°² = 6.51, P < 0.01) and unemployed (Ï°² = 5.11, P < 0.02) were associated with prescription of high doses of antipsychotics. Of those that smoked, the managing psychiatrist identified or documented only twenty-five (26.3%) of them (kappa = 0.80, P < 0.00). CONCLUSION: The rate of smoking in Nigerian patients with schizophrenia is considerably less than is reported for their Western counterparts.

Factors associated with depression and suicide among patients with diabetes mellitus and essential hypertension in a Nigerian teaching hospital.

BACKGROUND: Diabetes mellitus (DM) and essential hypertension are chronic medical conditions that place a lot of burden on patients. The presence of depression and suicidal behaviour may worsen the prognosis. OBJECTIVE: To assess the prevalence of depression and suicidal behaviour in subjects with diabetes mellitus and essential hypertension and also determine the socio-demographic correlates. METHODS: Major depressive episode and suicidality modules of Mini-International Neuropsychiatric Interview were used to assess depression and suicidal behaviour respectively. RESULTS: The prevalence of depression for the subjects with DM was 27.8% and 26.7% for essential hypertension. The subjects with DM had prevalence of 6.3% for suicidal behaviour while essential hypertension had 7.8%. Depression was higher in subjects with DM if they were not married or had no education while the subjects with essential hypertension were more likely to have depression if they were not married, had no education or not employed. Suicidal behaviour was higher in subjects with DM if they had no education while in essential hypertension suicidal behaviour was higher in females, those not married and those not educated. CONCLUSION: Depression and suicidal behaviour occur with DM and essential hypertension.

Traumatic events and suicidal behaviour in the Nigerian Survey of Mental Health and Well-Being.

OBJECTIVE: Not much is known about the role of different traumatic events in predicting suicidal outcomes. We investigated the association of specific traumatic events with different suicidal outcomes. METHOD: Data are from the Nigerian Survey of Mental Health and Well-Being, a multistage probability household survey of persons aged 18 years and over. Information on traumatic events and suicidal behaviours (ideation, plan and attempts) was collected in face-to-face interviews using the Composite International Diagnostic Interview (CIDI.3) from a subsample of the respondents (N = 2143). RESULTS: At least one traumatic event was reported by 63% of the sample. Traumatic events were more likely to have been experienced by individuals with different suicidal outcomes, with a dose-response relationship between the number of traumatic events and suicide ideation. The risks of suicidal ideation were elevated among persons with a history of combat experience (OR 6.3 95% CI 1.8-21.8) and those with exposure to war (OR 4.2; 95% CI 1.6-10.6), while that of suicidal attempt was increased among persons with experience of interpersonal violence (OR 4.3; 95% CI 1.4-13.0). CONCLUSION: Traumatic events are common in the general population. This report highlights the role of traumatic events (especially those related to violence) in predicting suicidal behaviour.

Common psychiatric disorders over a lifetime: age of onset, risk and treatment contact in the Nigerian survey of mental health and wellbeing.

The study is to estimate prevalence, risk, and contact with services of mental health problems in the Nigerian community. Face-to-face interviews with a representative sample of persons aged 18 years and over (n = 6752) using the World Health Organization's Composite International Diagnostic Interview, Version 3. Lifetime DSM-IV prevalence estimates were 6.5% for anxiety disorders, 3.3% for mood disorders, 3.7% for substance use disorders, and 12.0% for any disorder. The median age of onset (represented by the 50th percentile age of onset) is 25 years for any disorder but ranged from 11 years for anxiety disorder to 42 years for mood disorder. The projected lifetime risks at age 75 years were considerably higher than prevalence estimates. For mood disorders, lifetime risk was 170% higher than the prevalence estimate. Ascertainment bottlenecks seem to account for some low prevalence estimates. In general, only a minority of persons with mental disorders made any treatment contact. The median delay in duration before seeking care ranged between 6 years for mood disorders and 16 years for anxiety disorders. Projected lifetime risks of mood disorders and possible false negatives for some disorders suggest that the societal burden of mental disorders is considerably higher than the prevalence estimates indicate. Nevertheless, even for identified cases, current treatment coverage falls far short of need.

The views of some selected Nigerians about mental disorders.

AIM: To determine the views of sampled subjects about mental disorders and their treatment recommendations of such disorders. METHODS: This is a cross sectional descriptive study. The subjects were asked to list the causes of mental disorders they know, explain what they think the role of evil spirits in mental disorders is, if any, and to name the treatment options available for these disorders. Medical students who participated in the survey were also re-administered the study questionnaire following their completion of four week's rotation in Mental Health. RESULTS: Medical students (30), nurses (20), medical records officers (20) and 64 others including 10 religious ministers participated in the study. Thirty-eight- (28.4%) respondents thought that evil spirits cause mental disorders, and 88 (65.7%) would recommend prayer houses for the treatment of mental disorders. Medical students, even after their 4 weeks of rotation in mental health, did not differ in their beliefs from the rest of the groups. CONCLUSION: The knowledge of most interviewees about mental disorders is based on religious beliefs without scientific foundation. Adequate training in psychiatry for medical students, interaction of psychiatrists with their non-psychiatrist counterparts, public enlightenment about mental disorders may be necessary to raise the level of awareness/general knowledge of, and reduce superstitious beliefs about psychiatric disorders.

Disability and care-giving in old age in a Nigerian community.

AIM: To describe the pattern of disability and care for older community residents in a selected Nigerian location. METHOD: Older persons living at home in Okporo Community were first identified through the traditional ruler and his assistant. The socio demographic profiles and any present diseases of these older subjects were obtained through a face- to face interview and they were subsequently assessed with the modified World Health Organization Disability Assessment Schedule Short version (WHO DAS-S). The primary care givers of the older subjects were interviewed to obtain their actual care giving role. A summarized Zarit Burden Interview and the twelve item General Health Questionnaire (GHQ-12) were used to measure the emotional impact on the caregivers. RESULTS: A total of 102 older subjects were recruited, with about 47% having some form of disability. Many comorbid physical diseases were reported. Most of the older subjects' children had left the community and females were the main care providers. Help with self-care was the greatest problem reported by the carers and care giving was regarded as very heavy burden associated with high emotional distress. CONCLUSION: Disability is high in community elderly subjects. Care giving is proving a great challenge in the face of children disserting their parents, and increasing harsh economy. There is need for a systematic, realistic plan to implement qualitative care policy for older Nigerians.

Medical and Mental Disorders in Ederly Patients seen at the Outpatients' Clinic of a Teaching Hospital in Eastern Nigeria - Prevalence and Sociodemographic Characteristics

Aim: To describe the medical and mental disorders in elderly patients seen at the medical outpatients' clinic of Nnamdi Azikiwe University Teaching Hospital Nnewi. Method: Records of all elderly patients aged 60 years and above that were seen for the first time at the (internal) medical outpatient clinic between February 1997 and February 1999 were examined. Sociodemographic and diagnostic characteristics of the patients were obtained. Results: elderly patients constituted 11.2of all the 7892 patients seen in the clinic during the study period. The male: female ratio was 1.5:1. Forty-one patients had more than one disease occurring in an individual. Cardiovascular diseases were the commonest occurring medical problems; degenerative; neoplastic and infectious diseases were also common. Mental disorders were diagnosed in only 2of the patients with one case of Alzheimer's disease. No patient with mental disorder was given any second medical diagnosis nor referred for psychiatric opinion. Conclusion: Elderly Nigerians probably have high rates of old age associated diseases (degenerative and neoplastic) with tropical infections. Recorded (diagnosed) mental disorders were low; reflecting possible under-diagnosis/under-recognition. Medical and mental health of the elderly must be properly integrated

The use of herbal products in dementia: experience of Kippo in four Nigerians.

Modern neuroimaging and other investigative techniques have provided a lot of new information on the neurobiology of the dementias. Unfortunately no permanent cure has been found for this debilitating disease, giving rise to continuing trial of various products. Alternative and herbal medicine has become popular in neuropsychiatric disorders including dementia. In this report, we present our experience with Kippo - a Japanese herbal product - in 4 Nigerians with dementia. Two of the patients fully completed the study. The ten word list learning test, community screening interview for dementia (CSI -D), structured dementia interview (SIDAM) and the Geriatric Mental State schedule (GMS) were used to identify dementia according to ICD -- 10 diagnostic criteria. Dementia behaviour disturbance scale (DBD) and modified 22 - item mini - mental state examination (MMSE) were used to evaluate the product efficacy over 8 weeks. One patient showed some initial improvement on the DBD without effect on the MMSE and the other patient showed some initial improvement on the MMSE without effect on the DBD. Both patients had worsening on the clinical Global Impression Scale (CGI) within the study period. There were no demonstrable adverse effects as shown by physical examinations and laboratory tests. No definite conclusion could be drawn on the efficacy and safety of Kippo in dementia in this short study. We recommend a well controlled larger scale investigation of the effect of Kippo on well defined different subtypes of dementia.

Sources of sexual information and its relevance to sexual behaviour in Nigeria.

A study was carried out to identify the various sources of sexual information by adolescents in Nigeria and their influence on the sexual behaviours of the subjects, using: a) coitus prior to marriage b) expectation with first coitus c) freeness to discuss with spouse or anybody as parameters. The study was carried between 1997 and 1998 using subjects randomly selected from three Nigerian communities, viz: Enugu, Benin and Nnewi. Coitus before marriage was significantly higher in those who got their first ever information from peers than those who got it from other sources (P < 0.01). Fulfillment of expectation with first coitus was also significantly higher among those who were taught by parents, peers and teachers than those who sought their information on their own from books, magazines and films (p < 0.05). However, in considering their ability to discuss with anybody, this was found to be significantly higher in those who sought information on their own than those who got their first information by personal contact with parents, peers and teachers (p < 0.05). The latter was found to be more inhibited from discussing sexuality with their spouse or anybody than those who got their information from books/magazines and films. Sex education of adolescents should, therefore, be provided in a cultural, community-based setting of which the guardian programme should be only one component. It may be counter-productive in Nigeria if the adolescents continue to learn about sexuality on their own from books, magazines and films.

Psychiatric morbidity in elderly patients admitted to non-psychiatric wards in a general/teaching hospital in Nigeria.

OBJECTIVE: To determine the mental morbidity rate and types of disorders in elderly patients admitted to non-psychiatric wards of a teaching hospital in Nigeria; the ability of the non-psychiatrists to recognise the mental disorders was also assessed. METHOD: All subjects aged 60 years and above who were admitted into the medical, surgical and gynaecological wards were assessed with the Self-Reporting Questionnaire, Mini Mental State Examination and the Geriatric Mental State Schedule. Diagnoses of mental disorders were made with the ICD-10 Diagnostic Criteria for Research. The patients' case records were then examined to determine the medical and any mental disorder diagnoses made by the attending physicians. The data were analysed by the SPSS/PC(+) computer package. RESULTS: The mental morbidity rate was 45.3% with depression being the commonest disorder, followed by organic disorders (delirium and dementia), adjustment disorder and generalised anxiety disorder. There were also cases of alcohol and drug abuse. The physicians recognised only 2.8% of the mental disorders and referred one dementia patient to the mental health team. The negative predictive value for the physicians was poor. CONCLUSION: Non-psychiatrist medical practitioners in Nigeria need adequate training in mental health to enhance their ability to recognise psychiatric disorders.

The pattern of psychiatric disorders among the aged in a selected community in Nigeria.

OBJECTIVE: To describe the common mental disorders in elderly Nigerians living at home. METHOD: A house-to-house survey of a rural community was conducted to identify subjects who were aged 60 years and above. The subjects were interviewed with the Self-Reporting Questionnaire (SRQ-24) and the Geriatric Mental State Schedule (GMS). Psychiatric syndromal diagnoses were made with the Clinical and Research ICD-10 manuals (ICD-10/ICD-10, DCR). RESULTS: The overall rate of major mental disorders was 23.1%, with depression constituting 79% of all the diagnoses. Specific dementia disorders were not found in any of the subjects (N=164), but 20.7% complained of forgetfulness. Use of tobacco (snuff), (local) alcohol, and other substances were common. No subject with any identified disorder was receiving any medical attention. CONCLUSION: The study reveals the same range of mental disorders as in studies carried out elsewhere. This suggests that if similar methodologies are used, the mental morbidity rates among the elderly in different parts of the world may be about the same. There is a need for adequate planning to accommodate the social security and mental health needs of old Nigerians.

Communication and sexuality in a Nigerian community.

The traditional lack of interest in discussing sexuality creates a problem in doctor-patient communication, and this can affect patient management adversely. The dearth, ease or comfort in discussing sex was examined by a self-administered questionnaire to respondents, mainly medical students, nurses and paramedics, 20-70 years of age, who were not seeking treatment for sexual problems. The respondents were mainly of Igbo extraction from Eastern Nigeria. Factors considered include age, sex, religion, marital status, and education. The results show that 71.9% of all the respondents indicated that they would like to be able to discuss freely whereas 28.1% never really bothered; 40.9% of all the respondents could discuss sex with anybody whereas 59.1% could not; 75% in the married group discussed sex freely with their spouses or friends and 25% were unable to do so. Education showed a very significant influence on the ability to discuss sex freely. It is suggested that a systematic approach to education, especially sexual health education, may be a major way to combat the prevailing cultural inhibition.