The Ethiopian Cognitive Assessment battery in Schizophrenia (ECAS): a validation study.

Cognitive impairment is common in people with schizophrenia (PWS). To detect the presence and its consequences, cognitive measures with sound psychometric properties are needed. However, these are lacking especially in low-income countries. Hence, we developed the Ethiopian Cognitive Assessment battery in Schizophrenia (ECAS). In this study, we evaluated the psychometric properties of the ECAS in a cross-sectional study involving 350 PWS. Confirmatory factor analysis demonstrated a one-factor solution. ECAS score correlated significantly but weakly with a disability measure (r = -0.13, p = 0.02) and symptom dimensions of PANSS (r between -0.12 and -0.29, p < 0.05), except for positive symptoms (r = -0.10, p > 0.05). Years of education (ß = 0.12, 95% CI (0.09, 0.14), p < 0.001), male sex (ß = 0.22, 95% CI (0.05, 0.39)), age ß = -0.02, 95% CI (-0.03, -0.01), and medication side effects (ß = -0.03, 95% CI (-0.06, -0.01), p = 0.021) were significantly associated with the composite score of ECAS. The Item Response Theory analysis showed that the tool best functions among participants with moderate cognitive impairment (difficulty coefficient between -1.12 and 0.27). The Differential Item Functioning analyses showed that education had a positive contribution on Digit Symbol Substitution Test (MH OR = 2.64, 95% CI (1.34, 5.20)). The results showed that ECAS is valid in assessing cognition in PWS in low-resource settings.

Development and Evaluation of a Cognitive Battery for People With Schizophrenia in Ethiopia.

BACKGROUND AND HYPOTHESIS: Cognitive difficulties significantly burdened people with schizophrenia (PWS). However, cognitive assessment is often unavailable in low- and middle-income counties (LMICs) due to a lack of validated and culturally adapted cognitive assessment tools. In this study, we developed and evaluated a culturally sensitive cognitive battery for PWS in Ethiopia. STUDY DESIGN: This study was conducted in three phases. First, we selected appropriate tests through an instrument selection procedure and created a new battery. Then, we rigorously adapted the tests using culturally competent procedures, including cognitive interviewing and expert meetings. Finally, we tested the new battery in 208 PWS and 208 controls. We evaluated its psychometric properties using advanced statistical techniques, including Item Response Theory (IRT). STUDY RESULTS: The Ethiopian Cognitive Assessment battery for Schizophrenia (ECAS) was developed from three different batteries. Participants reported tests were easy to complete, and the raters found them easy to administer. All tests had good inter-rater reliability, and the composite score had very high test-retest reliability (ICC = 0.91). One-factor structure better represented the data with excellent internal consistency (α = .81). ECAS significantly differentiated PWS from controls with 77% sensitivity and 62% specificity at a Z-score ≤0.12 cut-off value. IRT analysis suggested that the battery functions best among moderately impaired participants (difficulty between -0.06 and 0.66). CONCLUSIONS: ECAS is a practical, tolerable, reliable, and valid assessment of cognition. ECAS can supplement current assessment tools in LAMICs for PWS and can be used to measure cognitive intervention outcomes.

Introducing an interview-based cognitive assessment tool for people with Schizophrenia in Ethiopia.

Assessment of cognitive impairment in people with schizophrenia (PWS) is limited in low and middle-income countries due to lack of context-appropriate measures. This study aimed to select, adapt, and evaluate an interview-based cognitive tool for PWS in Ethiopia. The study was carried out in three phases. In the first phase, we followed a rigorous instrument selection procedure to select a tool for adaptation. We then applied a rigorous instrument adaption procedure, including interviews with 24 participants. Finally, we evaluated the psychometric properties of the adapted tool with 208 PWS and 208 matched controls. The Cognitive Assessment Interview was selected as the appropriate tool for adaptation. This tool is practical and tolerable, with short time of administration. We reported high inter-rater reliability and test-retest reliability for the adapted scale. One-factor structure better represented the data with excellent internal consistency. Weak but significant correlation with a performance-based battery was reported. At a cut-off value of > 13, the tool significantly differentiated PWS from controls (62 % sensitivity and 82 % specificity). Item Response Theory-based analysis showed that the tool gives much information among severely impaired participants. The findings show that the tool is reliable, valid, and practical in resource-scarce settings.

Cognitive impairment in people with schizophrenia: an umbrella review.

Cognitive impairment is one of the core symptoms of schizophrenia. Quite a number of systematic reviews were published related to cognitive impairment in people with schizophrenia (PWS). This umbrella review, therefore, aimed at reviewing and synthesizing the findings of systematic reviews related to domains of cognition impaired and associated factors in PWS. We searched four electronic databases. Data related to domains, occurrence, and associated factors of cognitive impairment in PWS were extracted. The quality of all eligible systematic reviews was assessed using A MeaSurement Tool to Assess methodological quality of systematic Review (AMSTAR) tool. Results are summarized and presented in a narrative form. We identified 63 systematic reviews fulfilling the eligibility criteria. The included reviews showed that PWS had lower cognitive functioning compared to both healthy controls and people with affective disorders. Similar findings were reported among psychotropic free cases and people with first episode psychosis. Greater impairment of cognition was reported in processing speed, verbal memory, and working memory domains. Greater cognitive impairment was reported to be associated with worse functionality and poor insight. Cognitive impairment was also reported to be associated with childhood trauma and aggressive behaviour. According to our quality assessment, the majority of the reviews had moderate quality. We were able to find a good number of systematic reviews on cognitive impairment in PWS. The reviews showed that PWS had higher impairment in different cognitive domains compared to healthy controls and people with affective disorders. Impairment in domains of memory and processing speed were reported frequently.

Depressive symptoms and its associated factors among prisoners in Debre Berhan prison, Ethiopia.

BACKGROUND: Depression is a common mental disorder among prisoners characterized by a mood change involving a feeling of sadness, lack of interest, or hopelessness that lasts for weeks, months, or even longer. Besides imprisonment, depression is the primary factor leading to suicidal attempts. However, little is known about the depressive status of prisoners in Ethiopia. Therefore, this study aimed at assessing the magnitude and associated factors of depressive symptoms among prisoners of Debre Berhan prison. METHODS: We conducted an institution-based cross-sectional study. We collected data from 336 randomly selected prisoners using interviewer-administered Patient Health Questionnaire-9 (PHQ-9). We collected the data from May 3 to 28, 2015, and performed binary logistic regression to identify independent predictors of depressive disorder. RESULT: Out of the total of 336 prisoners, 98% (n = 330) were males. Using PHQ-9 at the cut-off point of ≥5, we found the prevalence of depression to be 44% (n = 148). Being widowed (AOR = 6.30; CI: 1.09-36.67), having a college or university level educational status (AOR = 5.34; CI:1.59-17.94), having a history of suicide attempt (AOR = 2.76 CI: 1.04-7.31), having faced severe stressful life events (AOR = 2.57; CI: 1.41-4.67), being sentenced for 5 to 10 years (AOR = 2.51; CI:1.32-4.79), and having a history of chronic medical illness (AOR = 3.32 CI: 1.26-8.75) were found to be independently associated with depressive symptoms. CONCLUSION: There is a high prevalence of depression among prisoners of Debre Berhan prison. Hence, designing strategies for early screening and treatment of depression at prisons is crucial.