Mental health status of doctors and nurses in a Nigerian tertiary hospital: A COVID-19 experience.

Background: Healthcare professionals (HCPs) working to save lives during the coronavirus disease 2019 (COVID-19) pandemic are under tremendous physical and psychological pressure, therefore facing the risk of developing challenges with mental health. Aim: This study aimed primarily to determine the prevalence and factors associated with depression, anxiety and stress among HCPs in a tertiary hospital in Lagos State during the COVID-19 pandemic. Setting: Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria. Methods: This was a descriptive cross-sectional study conducted between June and July 2021 among 1452 doctors and nurses in LASUTH, Ikeja, Lagos, Nigeria, selected by the multistage sampling method. Depression, anxiety and stress were assessed using the Patient Health Questionnaire, Generalised Anxiety Disorder and Perceived Stress Scale, respectively. Results: The majority of respondents were female (72.5%), with two-thirds being nurses. The prevalence of depression, anxiety and stress was 9.8%, 5.0% and 62.4%, respectively. Nurses showed a higher prevalence of these mental health conditions as compared with doctors. Younger HCPs, nurses, those that lost a colleague to COVID-19, and those whose family members were infected with COVID-19 were more likely to be depressed. Nurses and those afraid of being infected were more likely to experience anxiety. Younger HCPs, nurses, history of anxiety and/or depression and previous COVID-19 infection were identified as factors associated with stress. Conclusion: Stress was the most prevalent mental health condition with nurses being the most affected of the HCPs and at a greater risk of developing challenges with mental health. Psychosocial interventions and stress management techniques are recommended to minimise the risks. Contribution: This study adds to the few studies on the mental health of HCPs during COVID-19 and calls for in-depth surveys to understand psychosocial challenges among HCPs in Nigeria.

Changes in rates of psychiatric beds and prison populations in sub-Saharan Africa from 1990 to 2020.

Background: Psychiatric bed numbers (general, forensic, and residential) and prison populations have been considered indicators of institutionalization. The present study aimed to assess changes of those indicators across sub-Saharan Africa (SSA) from 1990 to 2020. Methods: We retrospectively obtained data on psychiatric bed numbers and prison populations from 46 countries in SSA between 1990 and 2020. Mean and median rates, as well as percentage changes between first and last data points were calculated for all of SSA and for groups of countries based on income levels. Results: Primary data were retrieved from 17 out of 48 countries. Data from secondary sources were used for 29 countries. From two countries, data were unavailable. The median rate of psychiatric beds decreased from 3.0 to 2.2 per 100 000 population (median percentage change = -16.1%) between 1990 and 2020. Beds in forensic and residential facilities were nonexistent in most countries of SSA in 2020, and no trend for building those capacities was detected. The median prison population rate also decreased from 77.8 to 71.0 per 100 000 population (-7.8%). There were lower rates of psychiatric beds and prison populations in low-income and lower-middle income countries compared with upper-middle income countries. Conclusions: SSA countries showed, on average, a reduction of psychiatric bed rates from already very low levels, which may correspond to a crisis in acute psychiatric care. Psychiatric bed rates were, on average, about one twenty-fifth of countries in the Organization for Economic Co-operation and Development (OECD), while prison population rates were similar. The heterogeneity of trends among SSA countries over the last three decades indicates that developments in the region may not have been based on coordinated policies and reflects unique circumstances faced by the individual countries.

Towards school-based mental health programs in Nigeria: the immediate impact of a depression-literacy program among school-going adolescents and their teachers.

BACKGROUND: Depression-literacy, which is the foundational requirement for symptom recognition, positive attitude and help-seeking, is poor among adolescents in Nigeria. This study, therefore, aims to determine the impact of a school-based training program on depression-literacy among a cohort of high-school students and their teachers in South-West Nigeria. METHODS: An adapted version of the Break Free from Depression, a 4-module depression awareness curriculum for staff and students, was implemented among students and their teachers. Paired-sample T-test was used to assess the domain-specific (knowledge, attitude, and confidence) impact of the training by comparing the baseline and immediate (within the week of the training) post-scores. RESULTS: A total of 3098 students and 294 teachers from 21 schools across three states in South-West Nigeria successfully completed the training. There was a significant positive difference (p < 0.05), at post-test, in the knowledge, attitude, and confidence among the students. The same was observed among teachers except for attitude where positive change did not reach significant level (p = 0.06). When statistically significant, the calculated effect size (eta squared) was highest for knowledge (students: 0.07, p = 0.001; teachers: 0.08, p < 0.000) and least for attitude (students: 0.003, p = 0.002 teachers: 0.085, p = 0.06). Multiple regression analyses result showed that the level of pre-scores predicted the magnitude of change in all domains of depression-literacy (p < 0.05) after controlling for age, gender, and type of school among the students, but not for teachers. CONCLUSIONS: School-based depression-literacy programs can lead to significant positive change in knowledge, attitude, and confidence of students and teachers.

Factors Driving the Acquisition of University Postgraduate Degrees among Resident Doctors in Nigeria.

The study examined the characteristics and factors driving the acquisition of postgraduate academic degrees among resident doctors in Nigeria. About 10% of the respondents had a form of university postgraduate degree with majority being master's degree. Having more than seven years of professional practice was the only factor predicting the acquisition of postgraduate academic degrees amongst the respondents [AOR: 0.243 (95% CI: 0.069,0.856; p = 0.028)]. The acquisition of postgraduate degree is not common among the surveyed resident doctors; and those that will acquire it do so in the later part of their career.

Impact of Covid-19 on Residency Training in Tertiary Health Institutions in Nigeria: A National Survey.

Background: The emergence of COVID-19 had a massive impact on the health system globally. While there are many kinds of literature reporting the impact on postgraduate medical training in other parts of the world, this cannot be said about Nigeria. Methodology: This was a national cross-sectional study among Resident doctors via an online google form survey for 8-months. Stratified cluster design where the entire country was stratified into the six geopolitical zones, and Tertiary Health Institutions (THI) were randomly selected from each of these zones. Data from the 47-item google form were analysed with Statistical Package for Social Science (SPSS) version 23, and internal consistency reliability was measured by Cronbach's alpha coefficient. Categorical variables were compared using chi-square, and the p-value was <0.05. Results: A total of 239 residents from THI in all six geopolitical zones completed the survey. The mean± standard deviation of the age of respondents, years in practice, and years in residency were 36.3±4.4); 10.2±7.6 years, and 4.2±2.6 years, respectively. The Cronbach's alpha coefficient was 0.95. Less than half had delayed the progression of residency (44.4%). The least strongly positive impacts were related to recruitments (4.2%), laboratory testing (4.2%), and ward rounds (4.2%); and the more strongly positive disruptive impact was on postgraduate seminars (9.2%), research (8.4%), professional examinations (8.0%) and residents' clinical schedules (8.0%). Conclusion: COVID-19 has caused a considerable delay in residents' training programs, and resident doctors have great concerns regarding the pandemic. This impact is perceived by them in almost all aspects of the training.

Posttraumatic stress disorder symptoms among trauma-exposed adolescents from low- and middle-income countries.

BACKGROUND: Exposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the types of traumatic events experienced and the presence and predictors of PTSD symptoms among adolescents from the general population from ten low- and middle-income countries (LMICs). METHODS: Data were simultaneously collected from 3370 trauma-exposed adolescents (mean age = 15.41 [SD = 1.65] years, range 12-18; 1465 (43.5%) males and 1905 (56.5%) females) in Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, the Palestinian Territories, the Philippines, Romania, and Serbia, with Portugal, a high-income country, as a reference point. The UCLA PTSD Reaction Index for the DSM-5 (PTSD-RI-5) was used for the assessment of traumatic events and PTSD symptoms. RESULTS: The most frequently reported traumatic events were death of a close person (69.7%), witnessing violence other than domestic (40.5%), being in a natural disaster (34.4%) and witnessing violent death or serious injury of a close person (33.9%). In total, 28.5% adolescents endorsed two to three DSM-5 PTSD criteria symptoms. The rates of adolescents with symptoms from all four DSM-5 criteria for PTSD were 6.2-8.1% in Indonesia, Serbia, Bulgaria, and Montenegro, and 9.2-10.5% in Philippines, Croatia and Brazil. From Portugal, 10.7% adolescents fall into this category, while 13.2% and 15.3% for the Palestinian Territories and Nigeria, respectively. A logistic regression model showed that younger age, experiencing war, being forced to have sex, and greater severity of symptoms (persistent avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity) were significant predictors of fulfilling full PTSD criteria. CONCLUSIONS: Nearly every third adolescent living in LMICs might have some PTSD symptoms after experiencing a traumatic event, while nearly one in ten might have sufficient symptoms for full DSM-5 PTSD diagnosis. The findings can inform the generation of PTSD burden estimates, allocation of health resources, and designing and implementing psychosocial interventions for PTSD in LMICs.

External locus-of-control partially mediates the association between cumulative trauma exposure and posttraumatic stress symptoms among adolescents from diverse background.

Locus of control (LOC) is a modifiable mediator of symptoms of posttraumatic stress disorder (PTSD) among traumatized individuals and a potential target of intervention. Compared with studies involving adults, the potential mediation effect of LOC on PTSD symptoms among trauma-exposed children and adolescents is relatively under-explored. This study, therefore, assessed the mediation effects of LOC on the association between lifetime cumulative trauma and PTSD symptoms among a large cohort of adolescents from different cultural background.Cross-sectional study.LOC was determined using the Multi-Dimension Locus of Control Scale; Posttraumatic stress symptoms using the UCLA PTSD Reaction Index; and other significant negative life events using the Life Events Checklist.Among 3826 adolescents who completed the study, external LOC explained 24% of variance (R2 = .24; F2,3823 = 619.01; p < .01) in PTSD symptoms and had significant indirect effect on the relationship between self-reported cumulative traumatic event exposure and PTSD symptoms (ß = .14; 95% BC CI [.10, .20]). Moderated mediation results showed significant potentiation of the moderation effects among older adolescents; boys; and those from more affluent families.The study further strengthened the hitherto limited evidence that external LOC partially mediate the relationship between cumulative trauma exposure and PTSD symptoms among adolescents.

Mental Disorders Among Detained Youth: The Hidden Nature and Peculiarities of African Literature.

Beaudry et al.1 published the results of a global systematic review of studies that have assessed prevalence rates of common mental disorders (CMD) among detained adolescents. The eligibility criteria were as follows: studies conducted in a general population of detained adolescents (10-19 years of age); studies that assessed prevalence rates of any of current depression, psychotic disorders, attention-deficit/hyperactivity disorder (ADHD), posttraumatic stress disorder (PTSD), or lifetime conduct disorder; studies with diagnoses made using clinical examination or semi-structured diagnostic instruments; and studies with results disaggregated by sex, unless >90% of respondents were of same sex. A total of 45 studies from 19 countries across continental America, Europe, Asia, and Australia met eligibility criteria. However, no study from Africa was adjudged to be eligible. Careful re-review of the literature, using Africa-specific research databases and contextualizing the search terms for Africa, revealed that few eligible studies from the region were omitted, and that the age cut-off point used in defining youth correctional populations was biased against the reality in Africa.

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.

Evaluating the Relationship between Duty Hours and Quality of Life of Nigerian Early Career Doctors.

This study explored association between early career doctors (ECDs) duty hours and their quality of life (QoL). Information was collected on socio-demographics, duty hours and QoL of 391 Nigerian ECDs. Results showed median of 70 duty-hours weekly, 10 call-days monthly and 6 sleep-hours daily. Weekly duty-hours and daily sleep-hours were significantly negatively and positively correlated respectively with all four domains of WHOQoL. QoL potentially affects health of ECDs especially mental health. Policies targeted at improving ECDs workforce, working conditions should improve QoL and curtail the potential impact of brain drain and attrition among ECDs in Nigeria.

Health determinants of adolescent criminalisation.

Several conditions related to health and development in adolescence can increase the risk that a young person will be exposed to the criminal justice system. Such determinants include neurodevelopmental disability, poor mental health, trauma, and experiences of maltreatment. Furthermore, the risk of exposure to the criminal justice system seems to be amplified by social marginalisation and inequality, such that young people are made susceptible to criminal behaviour and criminalisation by a combination of health difficulties and social disadvantages. This Review presents evidence on the health determinants of criminalisation among adolescents, providing a persuasive case for policy and practice reform, including for investment in approaches to prevent criminalisation on the basis of health and developmental difficulties, and to better address related needs once within a criminal justice system.

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.

UCLA PTSD reaction index for DSM-5 (PTSD-RI-5): a psychometric study of adolescents sampled from communities in eleven countries.

Background: Children and adolescents are often exposed to traumatic events, which may lead to the development of posttraumatic stress disorder (PTSD). It is therefore important for clinicians to screen for potential symptoms that can be signs of PTSD onset. PTSD in youth is a worldwide problem, thus congruent screening tools in various languages are needed. Objective: The aim of this study was to test the general psychometric properties of the Traumatic Stress Disorder Reaction Index for children and adolescents (UCLA PTSD) Reaction Index for DSM-5 (PTSD-RI-5) in adolescents, a self-report instrument intended to screen for trauma exposure and assess PTSD symptoms. Method: Data was collected from 4201 adolescents in communities within eleven countries worldwide (i.e. Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, Palestine-Gaza, Philippines, Portugal, Romania, and Serbia). Internal consistency, discriminant validity, and a confirmatory factor analysis of a four-factor model representing the main DSM-5 symptoms of the PTSD-RI-5 were evaluated. Results: The PTSD-RI-5 total score for the entire sample shows very good reliability (α = .92) as well as across all countries included (α ranged from .90 to .94). The correlations between anxiety/depressive symptoms and the PTSD-RI-5 scores were below .70 indicating on good discriminant validity. The four-factor structure of the scale was confirmed for the total sample and data from six countries. The standardized regression weights for all items varied markedly across the countries. The lack of a common acceptable model across all countries prevented us from direct testing of cross-cultural measurement invariance. Conclusions: The four-factor structure of the PTSD-RI-5 likely represents the core PTSD symptoms as proposed by the DSM-5 criteria, but there could be items interpreted in a conceptually different manner by adolescents from different cultural/regional backgrounds and future cross-cultural evaluations need to consider this finding.

Antecedentes: Los niños y adolescentes a menudo están expuestos a eventos traumáticos, que pueden llevar al desarrollo de un trastorno de estrés postraumático (TEPT). Por lo tanto, es importante que los médicos examinen los posibles síntomas que pueden ser signos del inicio de un TEPT. Este trastorno en jóvenes es un problema global, por lo que se necesitan herramientas de detección congruentes en varios idiomas.Objetivo: El objetivo de este estudio fue probar en adolescentes las propiedades psicométricas generales del Índice de Reacción TEPT de la UCLA para el DSM-5 (PTSD-RI-5), que es un instrumento de auto-reporte destinado a evaluar la exposición al trauma y evaluar los síntomas de PTSD.Método: Los datos se recopilaron de 4201 adolescentes en comunidades dentro de once países alrededor del mundo (es decir, Brasil, Bulgaria, Croacia, Indonesia, Montenegro, Nigeria, Palestina-Gaza, Filipinas, Portugal, Rumania y Serbia). Se evaluó la consistencia interna, la validez discriminante y un análisis factorial confirmatorio de un modelo de cuatro factores que representa los principales síntomas del DSM-5 del PTSD-RI-5Resultados: La puntuación total de PTSD-RI-5 para toda la muestra reveló una muy buena confiabilidad (α = .92), así como en todos los países incluidos (α varió de .90 a .94). Las correlaciones entre los síntomas de ansiedad/depresión y las puntuaciones del PTSD-RI-5 fueron inferiores a .70, lo que indica una buena validez discriminante. La estructura de cuatro factores de la escala se confirmó para la muestra total y los datos de seis países. Las ponderaciones de regresión estandarizada variaron notablemente para todos los ítems en todos los países. La falta de un modelo aceptable común en todos los países nos impidió realizar pruebas directas de invariancia de medición intercultural.Conclusiones: La estructura de cuatro factores del PTSD-RI-5 probablemente representa los síntomas centrales del TEPT según lo propuesto por los criterios del DSM-5, pero podría haber elementos interpretados de manera conceptualmente diferente por adolescentes con diferentes orígenes culturales/regionales, y futuras evaluaciones interculturales deben considerar este hallazgo.

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.