Symptomatic and functional outcome of bipolar disorder in Butajira, Ethiopia.

BACKGROUND: Limited information is available on the outcome of bipolar disorder in developing countries. OBJECTIVE: To describe the symptomatic and functional outcome of bipolar disorder. METHODS: The psychoses and affective disorder modules of the CIDI were used to screen 68,378 individuals by a door-to-door survey of a defined district in Ethiopia. In addition, key informants were used to identify individuals with probable major mental illnesses. SCAN interviews were completed at the second stage to confirm the diagnosis. A total of 315 cases of bipolar disorder were identified, of which 264 (69 recent-onset and 195 prevalent cases) were prospectively followed for a mean of 2.5 (range 1-4) years by baseline and annual clinical assessments using symptom rating scales. Functional dimensions of the SF-36 scale were used to describe functional outcome. Random coefficient analyses were used to evaluate potential correlates of outcome. RESULTS: The magnitudes of mania and depression symptoms were elevated at baseline but improved with follow-up, although the improvement was less marked for depression. Sociodemographic or clinical variables were not associated with the improvements in symptomatic outcome. Between 35% and 47% of the recent-onset cases had functional role restrictions, while 42-52% of long-standing cases had such restrictions during the follow-up years. Similarly, social and physical functioning deficits were also present in 52-86% and 35-47% of recent-onset and long-standing cases, respectively. The magnitude of depression and mania symptoms was associated with poor functional outcome, while male sex, rural residence and being married were associated with better functional outcome. CONCLUSION: Although there were improvements in function with follow-up, between one-third and one-half of cases continued to have functional deficits.

The distribution of mental disorders among an isolated island community in southern Ethiopia.

BACKGROUND: It is now recognized that surveys of unique communities are important to better understand the epidemiology of mental disorders. The Zeway islanders are completely different from the surrounding cultural groups, in the midst of whom they have been living in isolation for over three centuries. OBJECTIVES: To describe the prevalence and sociodemographic correlates of major mental disorders in this community. METHODS: Trained and supervised field workers were employed to conduct a door-to-door survey of the entire adult population of the islands using the Amharic CIDI (Composite International Diagnostic Interview). RESULTS: A total of 18.3% of the study subjects were classified as having ICD-10 diagnoses, excluding substance use disorders. The most prevalent CIDI/ICD-10 disorder in the study were neurotic and somatoform disorders (17%). Affective disorders were present in 2.2% while no cases of psychoses were found. The prevalence of tobacco use and alcohol dependence was 0.4% and 1.5%, respectively, with all cases being males. CONCLUSION: The pattern of occurrence of mental disorders in this isolated community is different from other populations in Ethiopia and elsewhere with no reported case of psychoses.

Mental disorders among the Borana semi-nomadic community in Southern Ethiopia.

This study aimed to estimate the lifetime prevalence and socio-demographic correlates of psychiatric disorders among the Borana semi-nomadic community of the Oromia region of Ethiopia. 1854 people of both sexes, aged 15 years and above, were interviewed during the survey. The households were selected by using a cluster sampling method proportionate to population size. The interviews were conducted by trained high school graduates using the Oromiffa version of the Composite International Diagnostic Interview (CIDI). The lifetime prevalence of ICD-10 mental disorders, including substance abuse, was 21.6%. Affective disorders were found in 1.7% of the study population, whereas neurotic and somatoform disorders constituted 14%. No cases of schizophrenia were detected. The prevalence of substance use was 10.1%. Studies using other methods, including interview by clinicians, might shed more light on the nature of mental illness in this unique community.