Access and Discontinuity of Care at an Outpatient Mental Health Service for Older People in South Western Nigeria.

We examined frequency and reasons for dropout from follow-up care at an outpatient mental health service for older people in South-Western Nigeria. This was a cross-sectional study. Administrative reviews of 201 case records of clinic attendees who received a psychiatric diagnosis that required follow-up consultations were conducted. Records were those of patients seen between January 2015 and December 2017. Chart extraction was followed by Key Informant Interview (KII) to explore the reasons for drop out and partial non-attendance. We identified 37(18.4%) regular clinic attendees, as well as 147(73.1%) and 17(8.5%) dropout and partially attending patients, respectively. Approximately 45.6% of the dropouts occurred after the first consultation. In KII, distance from the hospital, long waiting times and financial constraints were the common reasons for dropout. The findings of this study should inform the development of strategies to improve access to mental health services in Nigeria and other low- and middle-income countries.

Late-life depression in sub-Saharan Africa: lessons from the Ibadan Study of Ageing.

The population surviving to old age in sub-Saharan Africa (SSA) is increasing rapidly in consonance with the rest of the world. Nevertheless, the sub-region offers unique challenges to survival across the lifespan. The determinants of health and ageing in SSA are thus likely different from those in higher income countries. The need to explore pressing epidemiological and health service challenges of older people living in SSA in the context of multiple social changes and rapid ageing of the population provided the rationale for the Ibadan Study of Ageing (ISA). This article appraises ISA findings in relation to late-life depression. It concludes that healthcare policies in SSA need to deliberately prioritise the treatment of depression and other mental health problems in late-life in order to stem the neglect of older people's mental health in the region.

QUALITATIVE AND QUANTITATIVE METHODS OF SUICIDE RESEARCH IN OLD AGE.

This paper examines the merits of the qualitative and quantitative methods of suicide research in the elderly using two studies identified through a free search of the Pubmed database for articles that might have direct bearing on suicidality in the elderly. The studies have been purposively selected for critical appraisal because they meaningfully reflect the quantitative and qualitative divide as well as the social, economic, and cultural boundaries between the elderly living in sub-Saharan Africa and Europe. The paper concludes that an integration of both the qualitative and quantitative research approaches may provide a better platform for unraveling the complex phenomenon of suicide in the elderly.

The association between psychotic experiences and disability: results from the WHO World Mental Health Surveys.

OBJECTIVE: While psychotic experiences (PEs) are known to be associated with a range of mental and general medical disorders, little is known about the association between PEs and measures of disability. We aimed to investigate this question using the World Mental Health surveys. METHOD: Lifetime occurrences of six types of PEs were assessed along with 21 mental disorders and 14 general medical conditions. Disability was assessed with a modified version of the WHO Disability Assessment Schedule. Descriptive statistics and logistic regression models were used to investigate the association between PEs and high disability scores (top quartile) with various adjustments. RESULTS: Respondents with PEs were more likely to have top quartile scores on global disability than respondents without PEs (19.1% vs. 7.5%; χ2  = 190.1, P < 0.001) as well as greater likelihood of cognitive, social, and role impairment. Relationships persisted in each adjusted model. A significant dose-response relationship was also found for the PE type measures with most of these outcomes. CONCLUSIONS: Psychotic experiences are associated with disability measures with a dose-response relationship. These results are consistent with the view that PEs are associated with disability regardless of the presence of comorbid mental or general medical disorders.

Prevalence and predictors of anxiety in an African sample of recent stroke survivors.

OBJECTIVES: Studies considering emotional disturbances in the setting of stroke have primarily focused on depression and been conducted in high-income countries. Anxiety in stroke survivors, which may be associated with its own unique sets of risk factors and clinical parameters, has been rarely investigated in sub-Saharan Africa (SSA). We assess the characteristics of anxiety and anxiety-depression comorbidity in a SSA sample of recent stroke survivors. MATERIALS AND METHODS: We assessed baseline data being collected as part of an intervention to improve one-year blood pressure control among recent (≤1 month) stroke survivors in SSA. Anxiety in this patient population was measured using the Hospital Anxiety and Depression Scale (HADS), while the community screening instrument for dementia was used to evaluate cognitive functioning. Independent associations were assessed using logistic regression analysis. RESULTS: Among 391 participants, clinically significant anxiety (HADS anxiety score≥11) was found in 77 (19.7%). Anxiety was comorbid with depression in 55 (14.1%). Female stroke survivors were more likely than males to have anxiety (OR=2.4, 95% CI=1.5-4.0). Anxiety was significantly associated with the presence of cognitive impairment after adjusting for age, gender and education (OR=6.8, 95% CI=2.6-18.0). CONCLUSIONS: One in five recent stroke survivors in SSA has clinically significant anxiety, and well over 70% of those with anxiety also have depression. Future studies will need to determine what specific impact post-stroke anxiety may have on post-stroke clinical processes and outcomes.

Neuropsychiatric symptoms in Nigerian patients with Parkinson's disease.

BACKGROUND: Neuropsychiatric symptoms are common in Parkinson's disease and may precede onset of motor symptoms. They are also known to increase caregiver's burden. OBJECTIVE: The aim of this study was to assess neuropsychiatric symptoms in a cohort of Nigerian patients with idiopathic Parkinson's disease and compare with systemic hypertension. METHOD: Fifty patients with idiopathic Parkinson's disease were compared with fifty demographically matched controls with systemic hypertension. Diagnosis of Parkinson's disease was based on the United Kingdom Parkinson Disease Society (UKPDS) Brain Bank Clinical diagnostic Criteria. Diagnosis of hypertension was based on recorded blood pressure of ≥140/90 mmHg on two different occasions. The Neuropsychiatric Inventory (NPI) was applied to caregivers of both patients and controls. RESULTS: There were significant differences in frequency of neuropsychiatric symptoms in patients and controls (P < 0.05). Significant differences were found in mean distress scores for some neuropsychiatric symptoms and the total mean distress score. In all cases, patients with Parkinson's disease had higher scores when compared with controls. Severity of motor symptoms, as measured by the UKPDS, correlated with total NPI severity scores (P = 0.000). CONCLUSION: Neuropsychiatric symptoms occur more frequently in Parkinson's disease than matched controls, and the presence of these symptoms is associated with caregivers' distress. There is a need for early and adequate treatment for motor and behavioural symptoms of Parkinson's disease.

Stroke lesions and post-stroke depression among survivors in Ibadan, Nigeria.

BACKGROUND: We aimed to determine the association between the neuro-radiological characteristics of stroke lesions and post-stroke major depression among survivors in Ibadan, Nigeria. This is in the background of a paucity of information on the clinico-pathological correlation of post-stroke emotional responses among African Survivors. METHOD: We studied 30 stroke survivors receiving physiotherapy. The radiological characteristics of the stroke lesions were documented using computerized tomography or magnetic resonance imaging scans in the acute phase of the stroke. While the presence of major depressive disorder meeting criteria in the fourth edition of the Diagnostic and Statistical Manual was assessed using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN), between 3 months and 2 years after. The association between lesion characteristics and depression was explored using logistic regression analysis. RESULT: Nine (30.0%) stroke survivors met criteria for major depressive disorder. There were significant differences in their gender. The differences in the lesion types approached the set level of significance in survivors with or without major depressive disorder. There were however no differences when considering hemispheric lateralization or intra-hemispheric lesion location. Being female, but not the lesion characteristics was strongly associated with post-stroke major depressive disorder CONCLUSION: Lesion characteristics documented in the acute phase of stroke could not predict the occurrence of major depressive disorder during rehabilitation in this sample. The occurrence of depression among stroke survivors may ultimately be determined by a combination of factors.