MENTAL HEALTH IN KENYAN SCHOOLS: TEACHERS' PERSPECTIVES.

INTRODUCTION: This qualitative study, conducted in public primary and secondary schools, sought teachers' perceptions of mental health concerns that are relevant in school settings. Based on the phenomenological theory, the study aimed to understand the teachers experiences of mental health problems in the schools and how they handled them. METHOD: The schools sampled represented rural, suburban and urban sections of Kiambu County in Kenya. Data were collected through Focus Group Discussions (FGDs). The researcher made summary notes from both audio taped interviews and notes made by the research assistants and summarized the major themes. RESULTS: Teachers reported that they were aware that students suffered from mental health problems. They recognized learning difficulties, externalizing problems, internalizing problems, bizarre behavior, and problem substance use among students. Teachers reported that lack of skills and time were challenges in dealing with student mental health problems. CONCLUSION: Teachers perceive presence of mental health problems among the students. There is need for in- service training for identification and referral and that school psychologists be employed to deal with student mental health problems.

Traditional healers and provision of mental health services in cosmopolitan informal settlements in Nairobi, Kenya.

OBJECTIVE: The study aimed to investigate the types of mental illnesses treated by traditional healers, and their methods of identifying and treating mental illnesses in their patients. METHOD: In urban informal settlements of Kibera, Kangemi and Kawangware in Nairobi, Kenya, we used opportunistic sampling until the required number of traditional healers was reached, trying as much as possible to represent the different communities of Kenya. Focus group discussions were held with traditional healers in each site and later an in-depth interview was conducted with each traditional healer. An in-depth interview with each patient of the traditional healer was conducted and thereafter the MINIPLUS was administered to check the mental illness diagnoses arrived at or missed by the traditional healers. Quantitative analysis was performed using SPSS while focus group discussions and in-depth interviews were analysed for emerging themes. RESULTS: Traditional healers are consulted for mental disorders by members of the community. They are able to recognize some mental disorders, particularly those relating to psychosis. However, they are limited especially for common mental disorders. CONCLUSION: There is a need to educate healers on how to recognize different types of mental disorders and make referrals when patients are not responding to their treatments.

The prevalence of depressive symptoms among adolescents in Nairobi public secondary schools: association with perceived maladaptive parental behaviour.

OBJECTIVE: Depression in adolescents is a matter of concern because of its high prevalence, potential recurrence and impairment of functioning in the affected individual. The study sought to determine the prevalence of depressive symptoms among adolescents in Nairobi (Kenya) public secondary schools; make a comparison between day and boarding students; and identify associated factors in this population. METHOD: A random sample of school going adolescents was taken from a stratified sample of 17 secondary schools out of the 49 public secondary schools in Nairobi province. The sample was stratified to take into account geographical distribution, day and boarding schools, boys only, girls only and mixed (co-education) schools in the capital city of Kenya. Self administered instruments (EMBU and CDI) were used to measure perceived parental behaviour and levels of depression in a total of 1,276 students excluding those who had no living parent. RESULTS: The prevalence of clinically significant depressive symptoms was 26.4%. The occurrence was higher in girls than it was in boys p<0.001. Students in boarding schools had more clinically significant depressive symptoms compared to day students (p=0.01). More girls exhibited suicidal behaviour than boys (p<0.001). There was a significant correlation between depressive symptoms and suicidal behaviour (p<0.001). CDI scores correlated positively with age (p<0.001) with an increase in CDI score with unit increase in age among students 14-17 years old, perceived rejecting maternal parenting behaviour (p<0.001), perceived no emotional attachment paternal behaviour (p<0.001), perceived no emotional attachment maternal behaviour (p<0.001), and perceived under protective paternal behaviour (p=0.005). CONCLUSION: Perceived maladaptive parental behaviours are substantially associated with the development of depressive symptoms and suicidal behaviour in children.

Knowledge, attitude and practice (KAP) of mental illness among staff in general medical facilities in Kenya: practice and policy implications.

OBJECTIVE: To determine the knowledge, attitudes and beliefs about mental illness among staff in general hospitals. METHOD: A descriptive cross-sectional study conducted on staff in ten medical facilities in Kenya on their socio-demographic characteristics, professional qualifications and knowledge, attitudes and practice (KAP) toward mental illness. RESULTS: A total of 684 general hospital staff: nurses (47.8%); doctors (18.1%); registered clinical officers (5.1%); students (9.5%) and support staff (19.5%) were recruited. About three quarters were under 40 years of age; most thought mental illness could be managed in general hospital facilities; the older the doctors were (age 40 years and older) the more they were aware of and positive towards mental illness. Most of the workers did not suspect any psychiatric symptoms among the patients they treated resulting in low referral rates for psychiatric services. CONCLUSION: There are gaps in knowledge on mental illness which could be constructively filled with Continued Medical Education (CME).

Perceived economic and behavioural effects of the mentally ill on their relatives in Kenya: a case study of the Mathari Hospital.

OBJECTIVE: There is no documented evidence in Kenya on relatives' perceptions of economic and behavioural effects of the mentally ill patients and their coping mechanisms. To document what relatives of mentally ill patients perceive to be the economic effects of the patients on the family and how they are affected by and cope with the disturbed behaviours of the patients. METHOD: This was a cross-sectional descriptive study conducted at the Mathari Psychiatric Hospital. Informed consent was obtained from both the relatives and the patients admitted at the hospital. Data on socio-demographic and economic profiles were obtained from the patients and their relatives. The relatives were interviewed using a structured questionnaire to determine what they perceived to be the economic effects of the mental illness, how the various disturbed behaviours of the mentally ill affected them, and how they coped. The data were analysed using SPSS version 11.5 and results are presented in narratives and tables. RESULTS: One hundred and seventy-five relatives and 107 patients were recruited and interviewed. The patients were younger and better educated but economically less well off than their relatives. The relatives perceived that the mentally ill patients caused financial constraints and that various disturbed behaviours, particularly, verbal and physical aggression and refusal of the patient to take medicine or go to hospital, affected the family in different ways. Different coping mechanisms were used, depending on whether or not the behaviours were intrusive. CONCLUSION: Mentally ill patients adversely affect their families in diverse ways. There is need for appropriate policy to address the needs of families with mentally ill patients at the family and community levels. However, these must be evidence-based and this calls for further research.

Obsessive-compulsive (oc) symptoms in psychiatric in-patients at Mathari hospital, Kenya.

OBJECTIVE: To document the prevalence of obsessive-compulsive disorders (OCD) among patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya. METHOD: This was a descriptive cross-sectional study conducted at the Mathari Hospital. RESULTS: Out of 691 patients interviewed, 84 (12.2%) had symptoms which met the Diagnostic and Statistical Manual of Mental Disorders (DSMIV) criteria for OCD, which started early in life. The clinicians had not recognized the OC symptoms/disorder. There were high co-morbidities between OCD and other Structured Clinical Interview for DSM-IV (SCID) core syndromes as well as psychotic symptoms often associated with schizophrenia. CONCLUSION: OC symptoms are common in psychiatric patients admitted at Mathari Hospital although such symptoms were clinically undetected and therefore not managed. The high co-morbidities between OCD, other psychiatric disorders and other psychiatric symptoms pose clinical challenges in differentiating between psychotic symptoms perceived by the patients to have an external locus and OC symptoms perceived to have an internal locus. A more systematic clinical procedure for assessing all DSM-IV symptoms should be adapted as standard quality control practice in all patients, particularly those with psychotic symptoms.

Burnout in staff working at the Mathari psychiatric hospital.

OBJECTIVE: As there are no data on burnout in staff in Kenyan psychiatric hospitals, this study sought to document the level of burnout among the staff at the Mathari Psychiatric Hospital. METHOD: This was a cross sectional descriptive study of staff working at Mathari Psychiatric Hospital. The hospital staff completed self-administered questionnaires on socio-demographic characteristics and work environment and the Maslach Burnout Inventory - Human Services and General Survey. Analysis of the data was undertaken using the Statistical Package for the Social Sciences (SPSS) version 11.5. RESULTS: Ninety-five percent of the respondents reported low to high emotional exhaustion while 87.8% reported depersonalization. Low accomplishment was reported by only 38.6% while 61.4% reported average to high personal accomplishment. Several work- and non-work-related factors including young age, number of own children, number of years worked, heavy workload and low morale were positively associated with various syndromes of burnout. Relationships at work, with family and society were generally rated as average. The staff made recommendations on how to improve the social support system and work performance. CONCLUSION: High levels of burnout were reported. These should be addressed at individual, collective and institutional levels.

Psychometric Properties of the Multidimensional Anxiety Scale for Children (MASC) amongst Nairobi Public Secondary School Children; Kenya

Background: There are few psychometric instruments whose properties have been studied in a developing country's context. Aim: To determine the psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) in Nairobi public secondary school children; Kenya. Method: Concurrent self-administration of the MASC and Children's Depression Inventory (CDI) to students in Nairobi public secondary schools. Results: The MASC had a high overall internal consistency alpha co-efficient (0.85) in the Kenyan sample; which is similar to Western findings; and is hence a reliable tool for measuring anxiety in the study population. It was also similar to the findings from two Western studies in the anxiety domains of physical symptoms; social anxiety; separation anxiety and harm avoidance. The correlation co-efficient with CDI was similar to Scandinavian findings. Conclusion: The MASC can be used in Kenyan children and; by extension; other Africa children

Psychometric Properties of the Multidimensional Anxiety Scale for Children (MASC) amongst Nairobi Public Secondary School Children; Kenya

Background:There are few psychometric instruments whose properties have been studied in a developing country's context.Aim: To determine the psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) in Nairobi public secondary school children; Kenya.Method: Concurrent self-administration of the MASC and Children's Depression Inventory (CDI) to students in Nairobi public secondary schools.Results: The MASC had a high overall internal consistency alpha co-efficient (0.85) in the Kenyan sample; which is similar to Western findings; and is hence a reliable tool for measuring anxiety in the study population.It was also similar to the findings from two Western studies in the anxiety domains of physical symptoms; social anxiety; separation anxiety and harm avoidance.The correlation co-efficient with CDI was similar to Scandinavian findings.Conclusion: The MASC can be used in Kenyan children and; by extension; other Africa children

Psychometric Properties of the Multidimensional Anxiety Scale for Children (MASC) amongst Nairobi Public Secondary School Children; Kenya

Background:There are few psychometric instruments whose properties have been studied in a developing country's context.Aim: To determine the psychometric properties of the Multidimensional Anxiety Scale for Children (MASC) in Nairobi public secondary school children; Kenya.Method: Concurrent self-administration of the MASC and Children's Depression Inventory (CDI) to students in Nairobi public secondary schools.Results: The MASC had a high overall internal consistency alpha co-efficient (0.85) in the Kenyan sample; which is similar to Western findings; and is hence a reliable tool for measuring anxiety in the study population.It was also similar to the findings from two Western studies in the anxiety domains of physical symptoms; social anxiety; separation anxiety and harm avoidance.The correlation co-efficient with CDI was similar to Scandinavian findings.Conclusion: The MASC can be used in Kenyan children and; by extension; other Africa children

"Outcome of a Working Diagnosis of ""Psychosis"" in Relation to DSM-IV Diagnostic Criteria in a Kenyan In-Patient Cohort at Mathari Hospital; Nairobi"

"Background: When a patient presents with mental illness and displays psychotic symptoms which are not clearly delineated; a clinical diagnosis of psychosis is usually enter-tained. Aim: To determine the underlying Diagnostic and Statistical Manual of Mental Disorders-Fourth edition (DSM-IV) disorders in clinical entities admitted with a working diagnosis of ""psychosis"" at Mathari Psychiatric Hospital; Nairobi; Kenya. Study Design: Descriptive cross-sectional quantitative study Method: A total of 138 patients with a working diagnosis of ""psychosis"" on admission at Mathari Hospital during the period of this study were recruited over a one-month period. Their DSM-IV diagnoses were made using the Structured Clinical Interview for DSM-IV (SCID). Analysis of the results was done using SPSS version 11.5. Results: Nearly three quarters (72.5) of the patients were male; 68.5were aged between 20 and 34 years and 63.7reported that they were single. Nearly half (49.2) had attained up to 12 years of formal education and 90were dependants of a member of the family. The most common DSM-IV diagnoses were schizophrenia; bipolar disorder; substance abuse; depression and anxiety disorders. Co-morbidity was recorded with an average of three DSM-IV disorders. Conclusion: ""Psychosis"" as a working diagnosis was reported in relatively young adults. The patients whose working clinical diagnosis was ""psychosis"" met the criteria for an average of three DSM-IV diagnoses. There is need for a proactive policy in clinical practice so that definitive diagnoses rather than just ""psychosis"" are made and appropriate management initiated as early as possible."