Relationship between depressive symptoms and quality of life in Nigerian patients with schizophrenia.

PURPOSE: Quality of life (QOL) in patients with schizophrenia is influenced by various factors such as depressive symptoms. This study assessed the relationship between depressive symptoms and QOL in outpatients with schizophrenia in Nigeria and evaluated the associated socio-demographic and clinical factors. METHODS: One hundred patients with 10th edition of the International Classification of Diseases diagnosis of schizophrenia participated in this study. Socio-demographic and clinical factors such as depression were assessed with Zung Self-rating Depression Scale and symptoms of schizophrenia with the Positive and Negative Syndrome Scale of schizophrenia (PANSS). The level of functioning was assessed with the Global Assessment of Functioning Scale. QOL was assessed using the brief version of the World Health Organisation Quality of Life Scale. RESULTS: There were 27 (27.0 %) patients with depression. The depressed patients reported significant lower scores in all QOL domains when compared with the non-depressed group. All QOL domains were significantly negatively correlated with the total PANSS and all its subscales (except for psychological domain with total PANSS and social relationship and environmental domains with PANSS positive). Severity of depressive symptoms was significantly negatively correlated with all QOL domains. Functioning was significantly positively correlated with all QOL domains except in the environmental domain. Multiple regression analysis showed that depressive symptoms predicted all QOL domains except the social relationship domain while negative symptoms predicted social relationship and environmental domains. CONCLUSION: Depression is a common occurrence during the course of schizophrenia. Depressive and negative symptoms have a significant impact on the QOL of patients with schizophrenia.

Aggressive behaviour and mental illness: a study of in-patients at Aro Neuropsychiatric Hospital, Abeokuta.

OBJECTIVES: To determine the magnitude and pattern of aggressive behaviour among psychiatric in-patients and identity associated socio-demographic and clinical factors. METHOD: The study was cross-sectional in design. Among patients admitted to the Neuro-psychiatric Hospital, Aro (and its Lantoro annex), Abeokuta between January 1 to December 31, 2005, those who manifested aggressive behaviour were identified. Each was evaluated by the medical team, and a questionnaire detailing socio-demographic and clinic variables was administered on them. RESULTS: A total of 305 patients comprising 213 (69.8%) males and 92 (30.2%) females were managed as inpatients during the period of the survey. Out of these, 43 patients manifested aggressive behaviour representing a rate of 13.8%. The aggressive patients consisted of 26 males and 17 females, representing rates of 12.2 and 18.5 percent for the sexes respectively. Of the 11 diagnoses entered for all the patients, only 3 were associated with aggressive behaviour. These included schizophrenia, 21 patients (48.8%); bipolar manic illness, 12 patients (27.9%) and co-morbid substance use (mainly cannabis) and mental disorder, 10 patients (22.3%). Nursing personnel constituted the majority of target of aggression. Unemployment was the only socio demographic variable observed with significant positive relationship with aggressive behaviour. In addition, the commonest probable precipitants of aggressive behaviour included hallucinations, clamouring for discharge and attempting to abscond, reaction to confrontational interview, impulsivity and reaction to unmet demands. CONCLUSION: Mental health practitioners (especially nurses) should be equipped with necessary skills in managing aggressive and potentially aggressive patients. The present observations may be useful in raising the suspicion of care providers on potentially aggressive patients for preventive purpose.

Psychological profile of spouses of women with infertility in Nigeria.

Ninety five men who accompanied their wives to the fertility clinic of a Nigerian teaching hospital (index group) were compared with 95 matched controls using the Hospital Anxiety and Depression Scale (HADS). Their rates of significant anxiety symptoms (24.2%) and depressive symptoms (20.0%) were higher than the corresponding rates of 13.7% and 9.5% for the controls. The higher rate of significant depressive symptoms in the infertility group was significant (p < 0.05). Their mean scores on the two subscales of HADS (anxiety and depressive subscales) were also significantly higher (p < 0.001). Results of multiple regression analysis indicated that lower anxiety symptoms were predicted by age group among subjects in the index group, indicating that belonging to higher age groups was associated with lower anxiety symptoms. In addition, lower anxiety symptoms were predicted by 'being very religious'. However, higher anxiety symptoms were predicted by previous exposure to couple counselling. On the predictors of depressive symptoms, lower symptoms were predicted by age group and religiosity while higher symptoms were predicted by respondents' previous exposure to couple counselling and higher number of wives. Other factors investigated such as level of education, duration of infertility, attitude towards child adoption, pressure from extended family members on account of infertility, expectation of the respondents on the possible outcome of treatment and the result of semen analysis were not observed as predictors of anxiety and/or depressive symptoms. The observations on emotional distress among these men, together with previous observations that counselling/support received from gynecological consultations is usually inadequate indicates that the quality of psychological support that is available to them needs to be improved and modified. Involvement of mental health professionals (psychiatrists and clinical psychologists) in the provision of psychological couple counselling for infertility-related emotional distress could improve the quality of support provided. The establishment of special counselling units in hospitals providing treatment for infertility is advocated.

Stimulant use among secondary school students in Osogbo, Nigeria.

OBJECTIVES: The objectives of this study were to determine the prevalence and pattern of stimulant use and its association with 'brain fag syndrome' among secondary school students in Osogbo, Osun State. The study also aimed to determine the association of socio-demographic variables (of the students and their parents) with stimulant use. MATERIALS AND METHODS: A questionnaire consisting of sociodemographic variables, the stimulant use section of the WHO Student Drug Use Questionnaire and the Brain Fag Syndrome Scale (BFSS) was administered on randomly selected students of the two Local Government Areas of Osogbo. The prevalence rates of stimulant use were calculated and the association of stimulant use with Brain Fag Syndrome (BFS) and socio-demographic variables was determined. RESULTS: The 30-day prevalence rate of stimulant use was 20.3%. Users engaged more in the use of common and cheap stimulants (coffee and kola nut). Majority of users started at age 13 years or below. There was a very high relationship between stimulant use and the symptoms of the BFS (p<0.001). Stimulant use was associated with lower age group, poor school attendance, polygamous background, low education of mother, high education of father and the description of mother as being too permissive. CONCLUSION: The findings suggest the need to increase the awareness of the dangers of stimulant use among students. Control programmes are urgently needed to prevent student wastage.

Factors associated with psychoactive substance use among a sample of prison inmates in Ilesa, Nigeria.

OBJECTIVES: To determine the rates of psychoactive substance use before and during imprisonment among a sample of prisoners and the factors that are associated with current drug use among them. METHODS: All the inmates of Ilesa medium security prison, who gave informed consent to participate, were interviewed with a questionnaire detailing socio-demographic, drug-use and imprisonment-related information. RESULTS: Majority of the prisoners were young adults. The current (one month) use rates of the substances were: tobacco, 13.7%; hypnosedatives, 11.4%; alcohol, 10.7%; stimulants, 9.6%; cannabis, 7.0%; pethidine/morphine, 2.3%; inhalants, 2.3%; cocaine, 2.3%; heroin, 1.3% and LSD, 0.0%. These rates were just slightly lower than rates of use before imprisonment for hypnosedatives, stimulants, cannabis, pethidine/ morphine and inhalants. Majority of current users of cannabis (71.4%) and tobacco (68.3%) were engaged in 'heavy use' of these substances. Analyses of factors that were significantly associated with the five commonly used substances (tobacco, hypnosedatives, alcohol, stimulants and cannabis) indicated that current tobacco use was associated with unemployment before imprisonment, being a sentenced prisoner, previous mental disorder and previous arrest(s) for drug offense. Current hypnosedatives use was associated with being a sentenced prisoner, previous arrest(s) for drug offense and being held for a major offense. Current stimulants use was associated with unemployment, previous arrest(s) for drug offense, previous imprisonment and longer duration of imprisonment. Current cannabis use was associated with higher age groups and being a sentenced prisoner. Cannabis use was also associated with previous arrest(s) for drug offense, previous imprisonment and being held for a major offense, a pattern which suggests that cannabis use may be associated with criminality than the other substances. The observation on pethidire/morphine does not conform to previous observation of non-use by prisoners in Nigeria. CONCLUSION: The rates of drug use are lower than figures reported from samples in western countries but similar to previous reports from Nigeria. The present observation on pethidine suggests that injecting drugs may be an emerging behaviour among prisoners in Nigeria. The prevalence rates of the substances and the similarity in the prisoners' access to drug before and during imprisonment call for drug prevention and treatment programmes within the criminal justice system in Nigeria.

Unfulfilled desire for pregnancy: gender and family differences in emotional burden among a Nigerian sample.

The aims of this study were to compare anxiety and depressive symptoms between a sample of Nigerian women and their husbands on treatment for infertility, and to identify factors, which are associated with emotional burden in their families. In total, 82 women and their spouses completed the two subscales of the Hospital Anxiety and Depression Scale (HADS) at the gynaecology clinics of a Nigerian teaching hospital. The women had a significantly higher mean anxiety score (p<0.001) and higher mean depression score (p <0,001) than their husbands. On both anxiety and depression subscales of the HADS, the scores of the women were positively correlated with their husbands' scores (p<00.1). Emotional burden in the family was significantly associated with low religious inclination of husband and wife; strained relationship of couple; extended family pressure on husband; husbands' negative attitude towards child adoption; and lower age group of wife. Women with infertility in this subregion experience higher emotional burden than their husbands. Psychological couple counselling is required to ameliorate the emotional burden of infertility imposed by these factors.

Complete recovery of renal allograft function after sixty days of delay following living related transplantation.

Delayed graft function (DGF), a term employed when a newly transplanted organ does not function efficiently is commonly observed following cadaveric renal transplantation but is very rare after living related transplants. We present a 31-year-old female recipient of a related donor kidney (mother) who had DGF following trans-plantation due to acute tubular necrosis, probably caused by partial allograft arterial thrombosis, which recovered function after 60 days. Appropriate use of allograft biopsy should be encouraged even in resource-limited settings lest the allograft be assumed to have failed irreversibly.

Substance use Among University Undergraduates: A Study of Pattern and Beliefs in Ile-Ife.

OBJECTIVES: To determine the prevalence of substance use and to investigate the relationship between psychosocial variables and current use of psychoactive substances among university undergraduates. METHODS: A cross-sectional survey of randomly selected undergraduates of the Obafemi Awolowo University, Ile Ife was carried out using the WHO drug use questionnaire. RESULTS: Alcohol, stimulants, hypnosedatives, tobacco and cannabis with current use prevalence rates of 20.2 %, 17.7%, 9.8%, 9.0% and 8.2 % respectively were the most commonly used substances. Inhalants/organic solvents, cocaine, heroin, hallucinogens and pethidine/morphine with current use rates of 3.2%, 2.6%, 2.2%, 1.0% and 0.5% respectively belonged to the 'low - use' category. However, these rates were marginally higher than most previous findings. Five variables (sex, polygamy, living outside the university campus, poor mental health and study difficulty), were significantly associated with the use of many of the substances. Also, perceived harmfulness was observed to be a possible deterrent to substance use and most users were engaged in the use of cheap and easily available substances. CONCLUSION: The observations are largely similar to those from other locations in Nigeria and may therefore be useful in preventive programmes.

Emotional Burden of Infertility : a Controlled Study of Women Managed at a Nigerian Teaching Hospital

The purpose of this study was to determine the relationship between socio-cultural factors and infertility-related stress among a sample of Nigerian women. The subscales of the Hospital Anxiety and Depression Scale and a schedule detailing socio-demographic and infertility-related variables were administered on women with infertility and a matched control group. The rates of significant anxiety symptoms (39.4) and depressive symptoms (40.4) among the women with infertility were higher than the corresponding rates of 11.1 and 10.1 in the control group. Their mean anxiety and depression scores were also higher (P0.001). Low religiosity; friction with husband's family; polygamous relationship and family pressure on husband predicted symptoms among the women with infertility. Public campaign to improve attitude towards women with infertility is advocated. Therapeutic mental health services are important for these women

Emotional distress and self-reported quality of life among primary caregivers of stroke survivors in Nigeria.

OBJECTIVES: To investigate emotional symptoms and domain quality of life (QOL) among primary caregivers of stroke survivors and to determine survivor-related and caregiver-related predictors of these variables. DESIGN: A cross-sectional study. SETTING: Medical units of the two major hospitals of the Obafemi Awolowo University Teaching Hospitals Complex, ile-Ife, Nigeria. SUBJECTS: One hundred and three matched-pairs of caregivers of stroke survivors and caregivers of mild hypertensive patients, and 103 stroke survivors. RESULTS: Twenty three (22.3%) and 25(24.3%) stroke caregivers were observed with clinically significant anxiety and depressive symptoms respectively compared with 12(11.7%) and 14(13.6%) subjects in the control group. Stroke caregivers were observed with significantly higher mean anxiety and depressions scores, and also, with significantly lower mean scores on the four QOL domains (physical health, psychological health, social relationships and environment). By multiple linear regression analysis, anxiety symptoms in stroke caregivers were predicted by high socioeconomic status of survivors and paresis in them. Depressive symptoms were predicted by high caregivers' age and depression in the patients. Higher QOL on one or more WHOQOL-Bref domains was predicted by intimate relationship with survivor, female gender of caregiver, longer duration of caring, higher education of survivor and higher age of survivor. Low QOL on one or more domain(s) was predicted by higher caregivers' age, carers' perception of survivor as cooperative, female gender of survivor, depression in survivor, paresis and cognitive impairment in survivor. CONCLUSION: Caregiving imposes high burden on stroke carers. Attention should be paid to their psychological needs and services should be designed for them to ameliorate the burden.

Difficult delivery and some selected factors as predictors of early postpartum psychological symptoms among Nigerian women.

OBJECTIVES: The objectives of this study were to compare depressive and anxiety symptoms between Nigerian women with a difficult delivery (cesarean or instrumental) and those with an unassisted vaginal delivery during the puerperium and to highlight other factors of predictive value for symptoms. METHODS: Women (n=83) who had a difficult delivery (index group) were compared with matched control subjects (n=83) who had an unassisted vaginal delivery. They were all evaluated using the State-Trait Anxiety Inventory (state form) and Zung's Self-Rating Depression Scale. Information was also collected on their sociodemographic characteristics, obstetric factors, and general health problems. RESULTS: After delivery, 19 subjects from the index group (22.9%) obtained scores higher than the threshold for significant depressive symptoms, as compared with 13 subjects from the control group (15.7%). Six weeks later, the rates were 10 (12.0%) and 8 (9.6%), respectively. The mean anxiety and depressive symptom scores for the difficulty delivery group were significantly higher at birth. Although both groups improved over time, the differences were still significant after 6 weeks. Using stepwise regression analysis, we observed cesarean delivery and polygamy to predict depressive symptoms after birth but not after 6 weeks. Previous induced abortions were also observed to predict anxiety and depressive symptoms throughout. Depressive symptoms at 6 weeks were predicted by depressive symptoms at birth and by anxiety symptoms at 6 weeks. The same pattern was observed for anxiety symptoms. CONCLUSION: Although difficult delivery was associated with higher levels of symptoms, it was not predictive of postpartum depressive and anxiety symptoms at 6 weeks. Also, of other possible risk factors studied, only illegal abortions were observed to be important in the study population during the puerperium.

Attitude towards antipsychotics among out-patients with schizophrenia in Nigeria.

OBJECTIVE: The study aim to assess the attitude of patients with schizophrenia attending out-patient clinics in Nigeria towards antipsychotic medication and examine the factors associated with such attitude. METHOD: Out-patients with schizophrenia (n = 312) completed the 10-item Drug Attitude Inventory. They were also evaluated for sociodemographic details, illness-related and drug-related variables. RESULTS: Overall, the patients had a good attitude towards antipsychotic medication. The factors significantly associated with poor attitude towards medication include presence of symptoms, presence of side-effects like dyskinesia and sedation, lack of insight into the illness, and being employed. CONCLUSION: Special attention should be paid to patients with these factors while designing programmes to improve overall compliance in patients with schizophrenia.

Pattern of alcohol consumption among commercial road transport workers in a semi-urban community in south western Nigeria.

OBJECTIVES: To determine prevalence and pattern of alcohol use, evaluate the level of awareness of the harmful consequences of drinking, and determine the relationship between alcohol use and some selected factors among commercial road transport workers. DESIGN: Cross-sectional survey. SETTING: All the five motor parks spread over Ile-Ife, a semi-urban community in south western Nigeria. RESULTS: out of the 403 transport workers, 400 (99.3%) agreed to participate in the study. The questionnaire of one respondent was rejected. The current prevalence rate of alcohol use was 67.2%. Forty seven percent were 'heavy' users; 15.3% 'moderate' users and 37.7% were occasional or 'mild' users. All the users were engaged in the use of commonly available alcoholic beverages in the vicinity of the motor parks. Majority of the respondents (74.5%) reported drinking after work; 13.5% in the mornings; 10.1% when off-duty and 1.9%, during work. Frustrations that are associated with their work topped the list of reasons adduced for drinking. Belonging to lower age groups was significantly associated with current drinking (chi2 = 17.46, df = 3, p < 0.001). The proportions of respondents with unsatisfactory level of awareness regarding the association of current drinking with road traffic accidents, and with physical complications were high. CONCLUSION: Current alcohol use and use in a hazardous manner is an important public health problem among commercial road transport workers in Nigeria. There is an urgent need to modify existing legislations or enact new laws on 'driving under the influence' of alcohol, and enforce them.

Psychological characteristics as correlates of emotional burden in incarcerated offenders in Nigeria.

OBJECTIVES: To evaluate the demographic and psychosocial characteristics of incarcerated offenders in a Nigerian prison and investigate their relationship with psychiatric morbidity. DESIGN: A cross-sectional study employing the 30 - item version of the General Health Questionnaire (GHQ-30) and the depression sub-scale of the Hospital Anxiety and Depression scale (HADS-Depression). SETTING: A medium security prison located in Ilesa, a semi-urban community in Southwestern Nigeria. SUBJECTS: Three hundred and three prison inmates. RESULTS: Out of the 352 inmates, 49 (13.9%) refused to participate in the study. There was a preponderance of male offenders (96.4%), and majority (59.3%) was awaiting trial. Thirteen inmates (4.3%) had been imprisoned before (i.e., before current imprisonment). Less than half (34%) reported enjoying good mental health in prison while 11 (3.7%) gave history of previous mental disorder before imprisonment. Majority reported the level of visitation and financial assistance by relatives and friends as poor. Also, majority reported prison accommodation and feeding as poor while less than a half of the sample were satisfied with the level of available health care. Majority of the inmates scored above the cut-off points on the measures of psychopathology. These were 87.8% and 85.3% on the GHQ - 30 and the HADS - Depression Sub-scale respectively. Significant relationship was observed between GHQ-30 'caseness' and awaiting trial status, and also with reporting current mental health; prison accommodation and prison feeding as poor. In addition, significant depressive symptoms were associated with being a Muslim or traditional religion worshipper; lower education; single, divorced or separated marital status, and appraisal of current mental health as poor. CONCLUSION: The results are largely similar to findings from the developed world. Improving living condition and provision of basic needs of the prisoners appear essential for the promotion of their mental health.

Kidney transplantation in a developing economy: challenges and initial report of three cases at Ile Ife.

BACKGROUND: Kidney transplantation (KT) is globally adjudged the best alternative treatment for end stage renal disease (ESRD) in preference to life-long dialysis. This form of therapy was hitherto unavailable in Nigeria until our hospital and a private hospital embarked on a KT programme despite our depressed economy, and inadequate facilities. We present the initial report of KT performed in our hospital and the challenges of KT in our developing society. CASE REPORTS: Three patients with ESRD had living related KT between June 2002 and April 2003. The first patient died with functioning graft six and a half months post transplantation from complications of Diabetes mellitus and sepsis, while the remaining two still enjoy a good quality of life 35 months post transplantation. There were problems with procurement and monitoring of immunosuppressive drugs in the three patients. This report also illustrates the common causes of ESRD in Nigeria and some of the complications of KT. To our knowledge, these are the first reported cases of KT in Nigeria. CONCLUSION: Kidney transplantation is cost effective and offers a good quality of life for ESRD patients. Poverty, inadequate facilities and lack of donors are major problems facing KT in our society. Although KT requires high technical and material resources, with proper training, commitment and adequate funding, it is feasible, safe and cheaper on a long term basis for the management of patients with ESRD in a developing economy like ours. There is a need for government funding of KT programmes in developing countries.

Emotional distress and its correlates among Nigerian women in late pregnancy.

A cross-sectional study was carried out in a Teaching Hospital to compare women in late pregnancy and matched controls for emotional distress. Each of the 156 pregnant women was matched with a control and studied to determine the relationship of some obstetric and sociodemographic factors with anxiety and depression. All the subjects were evaluated using the state form of the State-Trait Anxiety Inventory (STAI-state) and the Zung's Self-Rating Depression Scale (SDS), which are standardised instruments for assessing depression and anxiety, respectively. The pregnant women had significantly higher levels of anxiety and higher levels of depression than their non-pregnant controls. Four of the factors evaluated (age, level of education, socio-economic status and parity) were not found to be significantly related to anxiety or depression among the pregnant women. However, four other factors, i.e. polygamy, previous abortions, mode of previous delivery (caesarean section and instrumentally-assisted delivery) and previous puerperal complications had positive and significant associations with anxiety and depression. The implications of these findings are discussed.

Psychopathology among senior secondary school students in Ilesa, south western Nigeria.

The prevalence rate of psychopathology and the relationship between psychopathology and some socio-demographic variables and consolidated current drug use were studied in 600 randomly selected senior secondary school students in Ilesa, south-western Nigeria. The 30-item version of the General Health Questionnaire and the WHO student drug use questionnaire were administered for the study. The findings revealed that the prevalence of psychopathology among the study population was 39.5%. There were significant positive associations between psychopathology and belonging to low socio-economic status, coming from a polygamous family and self-rated poor academic performance. The results also showed that although psychopathology was commoner amongst respondents who were engaged in current use of psychoactive substances than those who were not, the difference was not significant. The implications of these findings within the context of the limitations of the study and the importance of effective preventive and therapeutic student mental health services are discussed.

Post partum emotional distress in mothers of preterm infants: a controlled study.

OBJECTIVE: To investigate whether mothers of preterm infants experience more psychological distress than mothers of normal full term infants in the immediate postpartum period. DESIGN: Cross sectional prospective study of postpartal women using the Beck Depression Inventory (BDI) and the GHQ-30. SETTING: Neonatal intensive care units and the obstetric units of Wesley Guild Hospital, Ilesa and Multipurpose Health Centre, Ilesa (These are component Units of Obafemi Awolowo University Teaching Hospitals Complex, Osun State Nigeria). RESULTS: Of the 60 postnatal women recruited into the study, 33 mothers of preterm neonates formed the index group and 27 mothers of full term normal infants constituted the control group. More mothers of preterm neonates (27.3%) had GHQ-30 scores which categorised them as having significant emotional distress than mothers of full term normal infants (3.7%). Similarly more mothers of preterm neonates (15.1%) were more depressed than mothers of full term normal infants (3.7%). These differences were found to be statistically significant when the mean scores of the two groups on the instruments swere compared. CONCLUSION: These problems are not usually detected nor appropriately referred by the paediatrician/obstetrician to the psychiatrist. This has a number of implications for preventive psychiatry. A multidisciplinary approach is therefore essential in the detection and management of these problems.

Psychosocial correlates of substance use amongst secondary school students in south western Nigeria.

OBJECTIVE: To determine the psychosocial correlates of substance use among secondary school students in rural and urban communities in south western Nigeria. DESIGN: A cross-sectional survey of secondary school students using questionnaire eliciting substance use by students (WHO drug use questionnaire) and a well designed questionnaire on psychosocial variables. SETTING: Six secondary schools selected from two local government areas in Ilesa, Osun State, South Western Nigeria. SUBJECTS: The study population comprised 600 randomly selected senior secondary school students from six schools. RESULTS: A total of 562 questionnaires were analysed. Current stimulant use was significantly associated with lower socio-economic status, coming from a polygamous family and self-rated poor academic performance. Current alcohol use was associated with being a male, polygamous family background, living alone or with friends, not being religious and self-rated poor academic performance. Current hypnosedatives use was commoner in students living alone or with friends and in those with self-rated poor academic performance. There was also significant positive relationship between current tobacco use and the male sex, not being religious and self-rated poor academic perfomance. Lifetime use of these substances had similar association with the psychosocial variables with slight differences. CONCLUSION: The similarity between the psychosocial correlates highlighted in this study and those reported in previous studies from other parts of Nigeria makes these observations useful enough for the planning of preventive strategies.