Nigerian secondary school children's knowledge of and attitudes to mental health and illness.

BACKGROUND: Children tend to lack knowledge of, and hold negative attitudes towards mental illness. However, most of the work undertaken in Nigeria has been done with adults. AIMS: To establish the views and knowledge about mental health and illness in pupils at four secondary schools in rural and urban Southwest Nigeria. METHODS: A cross-sectional survey based on a questionnaire previously used in the UK and adapted to Nigeria. RESULTS: Data from 145 Nigerian schoolchildren showed little knowledge of, negative attitudes and social distance towards persons with mental health problems. Urban participants and boys appeared less knowledgeable than rural children and girls. CONCLUSIONS: Nigerian schoolchildren, as with Nigerian adults and young people in Western countries, show stigma towards mental illness. This may be underpinned by a lack of knowledge regarding mental health problems. Educational interventions need to be appropriate to area, age and gender to effectively improve mental health literacy, which in turn will influence attitudes and social distance. However, the fact that the schoolchildren were optimistic about recovery is a strength that could be built upon.

Psychosocial functioning in offspring of parents with bipolar disorder.

BACKGROUND: Offspring of parents with bipolar disorder are at increased risk for a range of psychopathology, including bipolar disorder. It is not clear if they also have impairments in their psychosocial functioning. METHODS: We compared the psychosocial functioning of three groups of children enrolled in the Pittsburgh Bipolar Offspring Study (BIOS): offspring of probands with bipolar disorder (n=388), offspring of probands with other types of psychopathology (n=132), and offspring of healthy probands (n=118). Psychosocial functioning was assessed at study intake using the schedule of the Adolescent Longitudinal Interval Follow-Up Evaluation (A-LIFE), the Child Behavior Check List (CBCL) and the Children's Global Assessment Scale (CGAS). RESULTS: Offspring of probands with bipolar disorder exhibited impairments in various aspects of psychosocial functioning. On all measures, they had worse functioning in comparison with offspring of healthy probands. Offspring of probands with bipolar disorder generally exhibited more impairment than offspring of probands with nonbipolar psychopathology. After adjusting for proband parent functioning and the child's Axis I psychopathology, functioning of offspring of probands with bipolar disorder was similar to that of offspring of healthy probands. LIMITATIONS: Data are cross-sectional and therefore do not allow for causal conclusions about the association between parental psychopathology, child psychopathology and offspring psychosocial functioning. CONCLUSIONS: Offspring of parents with bipolar disorder exhibit impairments in psychosocial functioning which appear largely attributable to proband parent functional impairment and the child's own psychopathology. As such, interventions to improve parental functioning, as well as early interventions to treat the child's psychopathology may help reduce the risk for long-term functional impairment in offspring.

Stigmatization of mental illness among Nigerian schoolchildren.

BACKGROUND: Despite the fact that about 10% of children experience mental health problems, they tend to hold negative views about mental illness. The objective of this study was to investigate the views of Nigerian schoolchildren towards individuals with mental illness or mental health problems. METHODS: A cross-sectional design was used. Junior and senior secondary schoolchildren from rural and urban southwest Nigeria were asked: 'What sorts of words or phrases might you use to describe someone who experiences mental health problems?' The responses were tabulated, grouped and interpreted by qualitative thematic analysis. RESULTS: Of 164 students, 132 (80.5%) responded to the question. Six major themes emerged from the answers. The most popular descriptions were 'derogatory terms' (33%). This was followed by 'abnormal appearance and behaviour' (29.6%); 'don't know' answers (13.6%); 'physical illness and disability' (13.6%); 'negative emotional states' (6.8%); and 'language and communication difficulties' (3.4%). CONCLUSION: The results suggest that, similar to findings elsewhere, stigmatization of mental illness is highly prevalent among Nigerian children. This may be underpinned by lack of knowledge regarding mental health problems and/or fuelled by the media. Educational interventions and encouraging contact with mentally ill persons could play a role in reducing stigma among schoolchildren.

Social phobia in Nigerian university students: prevalence, correlates and co-morbidity.

BACKGROUND: Social phobia is considered to be among the most common anxiety disorders. Despite its early onset, chronic course, disability and co-morbidity there is virtually no information about this disorder in young people in sub-Saharan Africa. OBJECTIVES: The prevalence, correlates, and co-morbidity of social phobia in a Nigerian undergraduate university population were determined. METHODS: A cross-sectional survey of students at the University of Ibadan was carried out. Instruments used were the Composite International Diagnostic Interview (CIDI), the Alcohol Use Identification Test, the General Health Questionnaire and the WHO-Disability Assessment Schedule. RESULTS: The lifetime and 12-month prevalence of social phobia were 9.4 and 8.5% respectively. On bivariate analysis, social phobia was significantly associated with lifetime and 12-month depression, psychological distress and reporting poor overall health (P < 0.05). Lifetime depression, psychological distress and perceived poor overall health remained strongly and independently associated with social phobia after regression analysis. CONCLUSION: The prevalence of social phobia among Nigerian university students is similar to what has been found in other parts of the world. There is a need for increased awareness of this disorder and its association with depression so that sufferers can receive early treatment to prevent long-term disability.

Teachers' perspectives of mental health needs in Nigerian schools.

OBJECTIVE: This study assessed teachers' perspectives on children's mental health needs and the development of school-based mental health programmes in South-West Nigeria. METHOD: Focus group discussions were held with teachers from randomly selected urban and rural primary schools in Ibadan, Nigeria. Data were analysed using interpretative phenomenological analysis. RESULTS: Teachers identified significant mental health problems in school-age children and described a variety of bio-psychosocial contributing factors. These ranged from problems with primary support systems to poverty, spiritual factors, medical illnesses and genetic vulnerability. The school environment was recognised as an ideal place for dealing with child mental health issues despite deficiencies in teachers' knowledge, skills and resources. A school mental health programme that would provide training for teachers and awareness campaigns as well as human, material and financial resources was proposed. CONCLUSIONS: The findings from this study provide a background for understanding the current state of interventions to address child mental health problems in a resource poor country in sub- Saharan Africa and specific areas where future program development is most likely to have an impact.

Assessment of need for a school-based mental health programme in Nigeria: perspectives of school administrators.

The majority of children in Nigeria are unable to access mental health services. In this resource-poor setting, a school-based mental health service can be used to reach children who would otherwise not have access. An essential first step in the development of a school-based mental health programme is a needs assessment. Key informants (KIs) from southwest Nigeria were interviewed to identify their perspectives on child mental illness and needs for a school mental health programme. Data were analysed using interpretative phenomenological analysis. Although KIs sometimes used derogatory terms to describe mental illness, they were able to give full descriptions of different kinds of mental illnesses in children and a range of causes based on the bio-psychosocial model of disease. KIs acknowledged deficiencies in their training even though they currently use parent, child and environment-centred interventions to deal with mental health problems in school. KIs reported teachers as comfortable with handling mental health issues in children and suggested interventions that included development of basic and ongoing training. Barriers, such as poverty, ignorance and stigma need to be addressed, while government involvement and enlightenment campaigns are critical components of a successful programme.

Training Health Professionals for Child and Adolescent Mental Health Care in Nigeria: A Qualitative Analysis.

There is no organised training and service for CAMH in Nigeria. A 3-day course in child mental health aimed at multidisciplinary health professionals was developed and evaluated to inform future training. Developing the course involved multi-professional consultation. Course evaluation involved the completion of questionnaires by delegates (present from 5 of the 6 geopolitical zones of Nigeria) before and after the training. Training needs expressed include skills to manage CAMH problems in their own context, greater understanding of normal child development and strategies to train others. Most participants reported that their expectations were met and would affect their practice especially with regard to collaboration.

Stressors and psychological symptoms in students of medicine and allied health professions in Nigeria.

BACKGROUND: Studies suggest that high levels of stress and psychological morbidity occur in health care profession students. This study investigates stressors and psychological morbidity in students of medicine, dentistry, physiotherapy and nursing at the University of Ibadan. METHODS: The students completed a questionnaire about their socio-demographic characteristics, perceived stressors and the 12-item General Health Questionnaire. Qualitative methods were used initially to categorise stressors. Data was then analysed using univariate and logistic regression to determine odds ratios and 95% confidence intervals. RESULTS: Medical and dental students were more likely to cite as stressors, overcrowding, strikes, excessive school work and lack of holidays while physiotherapy and nursing students focused on noisy environments, security and transportation. Medical and dental students (1.66; SD: 2.22) had significantly higher GHQ scores than the physiotherapy and nursing students (1.22; SD: 1.87) (t = 2.3; P = 0.022). Socio-demographic factors associated with psychological morbidity after logistic regression include being in a transition year of study, reporting financial distress and not being a 'Pentecostal Christian'. Although males were more likely to perceive financial and lecturer problems as stressors and females to perceive faculty strikes and overcrowding as source of stress, gender did not have any significant effect on psychological morbidity. Stressors associated with psychological distress in the students include excessive school work, congested classrooms, strikes by faculty, lack of laboratory equipment, family problems, insecurity, financial and health problems. CONCLUSION: Several identified stressors such as financial problems, academic pressures and their consequent effect on social life have an adverse effect on the mental health of students in this environment especially for students of medicine and dentistry. While stressors outside the reach of the school authorities are difficult to control, academic support including providing a conducive learning environment, advice on means for sustenance, added support during periods of transition are key areas for interventions.