Abiodun O. Adewuya

Validation of the Edinburgh Postnatal Depression Scale as a screening tool for depression in late pregnancy among Nigerian women.

This study aimed to examine the validity of the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool for depression in late pregnancy among Nigerian women. A total of 182 women in late pregnancy (32–36 weeks) completed either the English or the translated Yoruba language version of the EPDS and a proportion of them were then assessed for the presence of DSM-IV major and minor depressive disorders using the MINI International Neuropsychiatric Interview. A cut-off score of 10 on the EPDS was found to be the best for screening for both major and minor depression (sensitivity = 0.867, specificity = 0.915, Diagnostic Likelihood Ratio for a positive result = 10.200). When screening for major depression only, a cut-off of 12 was found to the most appropriate (sensitivity = 1.000, specificity = 0.961, Diagnostic Likelihood Ratio for a positive result = 25.641). The EPDS is a valid and useful instrument in screening for depression in late pregnancy among Nigerian women.

Relationship between Depression and Quality of Life in Persons with Hiv Infection in Nigeria

Objective: Despite the fact that two-thirds of all the people with HIV live in sub-Saharan Africa, little is known about the emotional state and quality of life (QOL) of subjects with HIV in this region. The objective of this study was to evaluate the association between clinical depression and quality of life in a group of HIV sero-positive subjects in Nigeria. Methods: Subjects with HIV infection (n=87) completed a questionnaire detailing sociodemographic and HIV related variables. The subjects were assessed for the diagnosis of depression using the Mini International Neuropsychiatric Interview (MINI) and their subjective health related quality of life (QOL) was assessed using the short version of the WHO quality of life scale (WHOQOL-BREF). Results: There were 25 (28.7%) subjects with diagnosis of depression. Lower educational level correlated with poorer QOL in all the domains of WHOQOL-BREF except the “social relationship” domain. Also, poor social support correlated with poorer QOL scores on domains of “physical health” and “social relationship” and presence of medical problems was significantly associated with poorer scores on domains of “physical health” and “psychological health.” Diagnosis of depression was significantly correlated with poorer QOL in all domains except the “social relationship” domain. Conclusion: Poorer health related QOL in Nigerian subjects with HIV was associated with depression, lower educational and socioeconomic levels, and poor social support. Early identification and referral of patients with depression needs to be incorporated into intervention programs designed for HIV infected individuals in this region.

Sociodemographic and obstetric risk factors for postpartum depressive symptoms in Nigerian women.

Objective: Studies from the Western culture have emphasized psychosocial risk factors for the development of postnatal depression (PND). In Africa, poor obstetrics practice and sociodemographic factors may contribute significantly to the risk of PND. The goal of this study was to examine sociodemographic and obstetric risk factors for postnatal depressive symptoms in a Nigerian community. Methods: 876 women recruited at 6 weeks postpartum from the postnatal and infant immunization clinics of 5 participating health centers were screened with the Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic and obstetric information were also obtained through a structured questionnaire. Results: The mean EPDS score was 5.66 (SD = 4.20). Depression was diagnosed in 128 (14.6 %) of the postpartum women. The predictors of PND include hospital admissions during the pregnancy (OR 3.95, CI 2.57-6.07), female sex of the baby (OR 2.74, CI 1.87-4.03), preterm delivery (OR 4.21, CI 2.78-6.39), instrumental delivery (OR 3.32, CI 1.79-6.16), Cesarean section (OR 3.58, CI 1.72-7.48), and being single (OR 3.44, CI 2.15-5.53). Conclusion: Although the prevalence of PND symptoms seems to be the same across cultures, risk factors differ significantly. This study identified certain sociodemographic and obstetric risk factors for postnatal depressive symptoms in an underdeveloped community. These factors must be taken into consideration when planning intervention and preventive strategies for these women.

Social distance towards people with mental illness amongst Nigerian university students.

It had been claimed that stigma and social distance are less severe in African countries, although not enough research had been done to confirm this. Most of the studies had focussed on the general community, and specific population groups had been neglected. The aims of this study are to examine the level of social distance of students in a Nigerian university towards people with mental illness and to assess the possible socio-demographic variables involved. This is to enable the development of appropriate mental health educational and stigma-reducing programmes. A modified version of Bogardus Social Distance Scale was used to assess the desire for social distance towards people with mental illness amongst 1,668 students of a Nigerian federal university. Socio-demographic details were also obtained. The social distances increased with the level of intimacy required in the relationship and were higher than those from the western culture, with 65.1% of the respondents categorised as having high social distance towards the mentally ill people. The predictors of high social distance towards the mentally ill include female gender [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.69–2.60], studying a non-medical course (OR 4.65, 95% CI 3.01–7.19) and not having a family member with mental illness (OR 6.73, 95% CI 4.34–10.44). Social distance towards the mentally ill is higher amongst Nigerian university students than expected. This challenges the notion that stigma and negative attitude towards the mentally ill are less severe in Africa than in western cultures. There are needs for intensive public awareness, effective stigma-reducing educational programmes and more research in this area.

Social distance towards people with mental illness in southwestern Nigeria

Objective: Recent research findings have challenged earlier claims that stigmatizing attitudes towards the mentally ill are less evident in non-Western cultures. A knowledge base of the attitude of the community towards the mentally ill is needed before embarking on an active anti-stigma programme in sub-Saharan Africa. The aim of the present study was to assess the lay publics attitude (social distance) towards people with mental illness in southwestern Nigeria and examine the factors correlating with such an attitude. Method: A cross-sectional survey was carried out in which respondents (n=2078) selected from three different communities in southwestern Nigeria completed questionnaires detailing sociodemographic variables, familiarity with mental illness, perceived causation of mental illness, perceived personal attributes of mental illness and perceived prognosis of mental illness. Their preferred social distance towards people with mental illness was measured with a modified version of the Bogardus Social Distance Scale. Results: The level of desired social distance towards the mentally ill was seen to increase with the level of intimacy required in the relationship, with 14.5% of the participants categorized as having low social distance, 24.6% as having moderate social distance and 60.9% as having high social distance towards the mentally ill. The independent correlates of high social distance towards the mentally ill included having never cared for the mentally ill (odds ratio (OR)=3.31, 95% confidence interval (CI)=2.14–5.21), age over 50 years (OR=1.93, 95%CI=1.59–2.33), perceived supernatural causation of mental illness (OR=1.82, 95%CI=1.51–2.18) and perceived ‘dangerousness’ stereotype of the mentally ill (OR=1.54, 95%CI=1.28–1.85). Conclusions: There is emerging evidence of a high level of social distance and stigmatization of mental illness in sub-Saharan Africa. There is need to incorporate anti-stigma educational programmes into the mental health policies of countries in sub-Saharan Africa. Such policy should include community education regarding the causation, manifestation, treatment and prognosis of mental illness.

Anxiety disorders among Nigerian women in late pregnancy: a controlled study

SummaryThis study aimed to investigate the rate and type of anxiety disorders among Nigerian women in late pregnancy. Women in late pregnancy (n = 172) and a non-pregnant control group were assessed for DSM-IV anxiety disorders. The rate of any anxiety disorder in the pregnant women was 39.0% compared with 16.3% in the non-pregnant population (p < 0.001). Although all the anxiety disorders were more common, only the rate of social anxiety disorder was significantly higher among the pregnant than non-pregnant population. Correlates of anxiety disorder in the pregnant population include age less than 25 years (OR 4.62, 95% CI 2.39–8.92), primiparity (OR 3.90, 95% CI 2.00–7.59) and presence of medical conditions (OR 3.60, 95% CI 1.28–10.12). More research is needed in this field to ascertain the specific association between pregnancy and anxiety disorders.

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.

Lay beliefs regarding causes of mental illness in Nigeria: pattern and correlates.

BackgroundAlthough studies have shown that views about causation are strongly associated with stigmatising attitudes to mental illness, none have examined the correlates of such causal views in order to identify the population needed to be targeted for education.ObjectivesTo evaluate the pattern and correlates of lay beliefs regarding the causes of mental illness in south-western Nigeria.MethodA cross-sectional survey in which respondents (n = 2,078) were administered questionnaire detailing sociodemographic variables and perceived causation of mental illness.ResultsBeliefs in supernatural factors and the misuse of psychoactive substances were the most prevalent. While urban dwelling, higher educational status and familiarity with mental illness correlated with belief in biological and psychosicial causation, older age, rural dwelling, and lack of familiarity correlated with a belief in supernatural causation. Educational status had no effect on the belief in supernatural causation.ConclusionAnti-stigma programmes need to incorporate these factors in order to identify the population at risk, who will actually benefit from targeted education regarding the causes of mental illness.

Prevalence of postnatal depression in Western Nigerian women: a controlled study

Objective The objective of this study is to compare the prevalence of depression in postpartum women and that of non-postpartum women. Method A total of 876 women recruited at 6 weeks postpartum and 900 matched non-postpartum women were administered the Becks Depressive Inventory (BDI) and translated local version of the EPDS. Psychiatric diagnosis was made using the using the modified non-patient version of Structured Clinical Interview for DSM-III-R (SCID-NP). Results Depressive disorder was diagnosed in 128 (14.6%) of the postpartum women and in 55 (6.3%) of the non-postpartum women, and the difference was found to be significant (t=8.919, df=875, P<0.001). The postpartum women had higher EPDS and BDI scores than the non-postpartum women. The EPDS correlated well with the SCID-NP diagnosis with a Spearmans correlation of 0.600 (P<0.001) and with the BDI score with a Spearmans correlation of 0.461 (P<0.001). The sensitivity of the EPDS at cut-off score of 8/9 was 94% and specificity was 97%. Conclusion The prevalence of postnatal depression in Nigeria is comparable to that of the western world and the Yoruba version of EPDS is a valid instrument for screening postnatal women for depressive disorders in a Nigerian community.

CORRELATES OF SELF-STIGMA AMONG OUTPATIENTS WITH MENTAL ILLNESS IN LAGOS, NIGERIA

Background: Studies in this region have all been limited to public stigma whereas little is known about the extent of self-stigma. Aims: To assess the extent, domains and correlates of self-stigma among psychiatric outpatients in Lagos, Nigeria. Method: Psychiatric outpatients (n = 342) from three centres completed a modified version of the Internalized Stigma of Mental Illness scale (ISMI) as a measure of their self-stigma. They were also evaluated for various sociodemographic and clinical related variables. Results: A total of 74 (n = 21.6%) patients were classified as having ‘high selfstigma’. The correlates of high self-stigma included unemployment (OR 3.85, 95% CI 2.55—7.00), poor social support (OR 10.82, 95% CI 4.85—24.84), longer duration of illness (OR 10.35, 95% CI 4.36—25.78) and having full insight into the illness (OR 4.23, 95% CI 2.16—8.76). Conclusions: Self-stigma is a common phenomenon in psychiatric outpatients in this environment. The present anti-stigma programmes must extend to regions of sub-Saharan Africa and incorporate self-stigma as a matter of priority.