Akin Ojagbemi

Suicidal behaviour in old age - results from the Ibadan study of ageing

BackgroundAn important reason for the high risk of suicide in the elderly is the determination with which they act out their suicidal thoughts. Early identification of suicidal behaviours in the elderly is therefore important for suicide prevention efforts in this population.MethodData are from the Ibadan Study of Ageing (ISA), a household multi-stage probability sample of 2149 Yoruba Nigerians aged 65 years or older conducted between 2003 and 2004. We used the third version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) to explore suicidal experiences and behaviours. In this report, only those experiences or behaviours reported to have occurred after the age of 65 years are the focus of analysis. Derived weights were applied to the data in accordance with the study design and associations were explored using logistic regression. The results are presented as odds ratios (ORs) with 95% confidence intervals.ResultIn all, 4.0% (95% C.I= 3.1-4.2) of the subjects had suicidal ideation occurring after the age of 65 years, while 0.7% (95% C.I=0.4-1.3) and 0.2% (95% C.I= 0.1-0.4) reported suicidal plans and attempts, respectively. There was a significantly elevated likelihood of suicidal ideation among persons who had experienced spousal separation through death or divorce (O.R=4.9., 95% C.I= 1.5-15) or who were residing in rural settings (O.R=2.5, 95% C.I=1.3-4.8).ConclusionSuicidal ideation is common among the elderly. About 20% and 6% of those with ideation proceed to plans and attempts, respectively. Circumstances of social isolation and exclusion are important correlates of suicidal behaviour in the elderly.

Gait speed and cognitive decline over 2 years in the Ibadan study of aging.

Highlights • We studied the elderly in an area populated by a quarter of Nigerians.• Gait speed was associated with the average follow-up cognition.• Gait speed was associated with longitudinal changes in cognition.• Follow-up cognition score was associated with gait speed change over 2 years.

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

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.

Combining depot antipsychotic with an assertive monitoring programme for treating first-episode schizophrenia in a resource-constrained setting.

To assess the feasibility and effectiveness of depot antipsychotic (flupenthixol decanoate) combined with an assertive monitoring programme (AMP) in first‐episode schizophrenia.

Cognitive dysfunction and functional limitations are associated with major depression in stroke survivors attending rehabilitation in Nigeria

BACKGROUND The frequency and predictors of post-stroke depression diagnosed according to codified criteria remain unknown in Nigeria. OBJECTIVES We report on the predictors of post-stroke major depressive disorder (MDD) in Nigeria using standardized assessment methods. METHOD Using a case-control design, we consecutively recruited 260 participants. Among them were 130 stroke survivors attending rehabilitation. Along with historical details, an exploration for MDD meeting criteria in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders was carried out using a semi-structured interview. Cognition was assessed using both the Mini Mental State Examination and the modified Indiana University Token test, while disability was assessed using the modified Rankin Scale. Associations were explored using univariate and multivariate analyses. RESULTS The diagnosis of MDD was more frequently present in the stroke survivors (41.5%, p < 0.001). It was strongly associated with female gender (p < 0.001, O.R = 3.77, 95% C.I = 1.78-8.00), disability (p = 0.001, O.R = 3.27, 95% C.I = 1.57-6.83), and cognitive dysfunction (p < 0.001, O.R = 5.28, 95% C.I = 2.25-12.41). Female gender (p = 0.037, O.R = 2.65, 95% C.I = 1.06-6.62) and cognitive dysfunction (P = 0.03, O.R = 4.58, 95% C.I = 1.68-12.46) were independent predictors of post-stroke MDD. CONCLUSION Post stroke MDD is common in Nigerian survivors attending rehabilitation. The high rates reported in this population may be the result of factors affecting the efficient management of stroke in developing countries.

Predictors of Functional Dependency after Stroke in Nigeria

BACKGROUND The factors impacting poststroke functional dependency have not been adequately explored in sub-Saharan Africa. This study examined the risk factors for functional dependency in a group of Nigerian African stroke survivors. METHODS One hundred twenty-eight stroke survivors attending a tertiary general hospital in southwestern Nigeria were consecutively recruited and assessed for functional dependency using the modified Rankin Scale (mRS). Stroke was diagnosed according to the World Health Organization criteria. Candidate independent variables assessed included the demographic and clinical characteristics of survivors, cognitive dysfunction, and a diagnosis of major depressive disorder. Variables with significant relationship to functional dependency were entered into a logistic regression model to identify factors that were predictive of functional dependency among the stroke survivors. RESULTS In all, 60.9% of the stroke survivors were functionally dependent (mRS scores≥3), with mean±SD mRS scores of 2.71±1.01. Female sex (P=.003; odds ratio [OR] 3.08; 95% confidence interval [CI] 1.47-6.44), global cognitive dysfunction (P=.002; OR 5.04; 95% CI 1.79-14.16), and major depressive disorder (P<.0001; OR 3.06; 95% CI 1.92-4.87) were strongly associated with functional dependency in univariate analysis. Major depressive disorder was an independent predictor of functional dependency in multivariate analysis (P<.0001; OR 6.89; 95% CI 2.55-18.6; R2=0.19). CONCLUSIONS Depression, female sex, and cognitive dysfunction were strongly associated with poorer functioning after stroke. Interventions aimed at depression and cognitive dysfunction after stroke may improve functional independence in stroke survivors.

Trauma and psychotic experiences: transnational data from the World Mental Health Survey

BackgroundTraumatic events are associated with increased risk of psychotic experiences, but it is unclear whether this association is explained by mental disorders prior to psychotic experience onset.AimsTo investigate the associations between traumatic events and subsequent psychotic experience onset after adjusting for post-traumatic stress disorder and other mental disorders.MethodWe assessed 29 traumatic event types and psychotic experiences from the World Mental Health surveys and examined the associations of traumatic events with subsequent psychotic experience onset with and without adjustments for mental disorders.ResultsRespondents with any traumatic events had three times the odds of other respondents of subsequently developing psychotic experiences (OR = 3.1, 95% CI 2.7-3.7), with variability in strength of association across traumatic event types. These associations persisted after adjustment for mental disorders.ConclusionsExposure to traumatic events predicts subsequent onset of psychotic experiences even after adjusting for comorbid mental disorders.

Chronic Conditions, New Onset, and Persistent Disability in the Ibadan Study of Aging

Background. Information about the contribution of chronic conditions to disability in the sub-Saharan African older persons is derived from implicit data. We investigated the association of chronic conditions with incident and persistent disability among community-dwelling elderly Nigerians. Methods. We followed disability-free participants in a household cluster randomized sample of 2,149 Nigerians, aged 65 years or older, in three waves over 5 years (2003-2009). Disability was measured using culturally adapted tools. Dementia and depression were ascertained using validated interviewer-administered measures. The presence of pain in six sites, angina, systemic hypertension, diabetes, heart and respiratory disease, and vision and hearing impairment were assessed using standardized self-report of clinician diagnoses. Independent predictors of disability were investigated using separate multivariate binomial and multinomial regression models with Bonferroni corrections. Results. Among 1,887 disability-free participants, 457 (24.2%) had incident disability over 5 years; there were 234 (12.4%), 177 (9.4%), and 106 (5.6%) new cases in each of the waves. A total of 181 (10.0%) persons had disability persistently. Having a pain condition (relative risk ratio [RRR] = 4.7, 95% confidence interval [CI] = 2.0-11.0), especially when nonlocalizing (RRR = 1.5, 95% CI = 1.0-2.2), was the main predictor of incident disability in the study. Dementia was associated with cumulative deaths over 5 years (RRR = 3.5, 95% CI = 2.3-5.3). There were no significant associations between having a chronic condition and persistent disability following correction for false discovery rates. Conclusion. Using direct measurements, musculoskeletal pain appears to be the most disabling condition in this sub-Saharan African elderly cohort surviving for up to 5 years with chronic conditions. Dementia may be associated with early death.

Association Between Psychotic Experiences and Subsequent Suicidal Thoughts and Behaviors: A Cross-National Analysis From the World Health Organization World Mental Health Surveys

Importance Community-based studies have linked psychotic experiences (PEs) with increased risks of suicidal thoughts and behaviors (STBs). However, it is not known if these associations vary across the life course or if mental disorders contribute to these associations. Objective To examine the temporal association between PEs and subsequent STBs across the life span as well as the influence of mental disorders (antecedent to the STBs) on these associations. Design, Setting, and Participants A total of 33 370 adult respondents across 19 countries from the World Health Organization World Mental Health Surveys were assessed for PEs, STBs (ie, ideation, plans, and attempts), and 21 DSM-IV mental disorders. Discrete-time survival analysis was used to investigate the associations of PEs with subsequent onset of STBs. Main Outcomes and Measures Prevalence and frequency of STBs with PEs, and odds ratios and 95% CIs. Results Of 33 370 included participants, among those with PEs (n = 2488), the lifetime prevalence (SE) of suicidal ideation, plans, and attempts was 28.5% (1.3), 10.8% (0.7), and 10.2% (0.7), respectively. Respondents with 1 or more PEs had 2-fold increased odds of subsequent STBs after adjusting for antecedent or intervening mental disorders (suicidal ideation: odds ratio, 2.2; 95% CI, 1.8-2.6; suicide plans: odds ratio, 2.1; 95% CI, 1.7-2.6; and suicide attempts: odds ratio, 1.9; 95% CI, 1.5-2.5). There were significant dose-response relationships of number of PE types with subsequent STBs that persisted after adjustment for mental disorders. Although PEs were significant predictors of subsequent STB onset across all life stages, associations were strongest in individuals 12 years and younger. After adjustment for antecedent mental disorders, the overall population attributable risk proportions for lifetime suicidal ideation, plans, and attempts associated with temporally prior PEs were 5.3%, 5.7%, and 4.8%, respectively. Conclusions and Relevance Psychotic experiences are associated with elevated odds of subsequent STBs across the life course that cannot be explained by antecedent mental disorders. These results highlight the importance of including information about PEs in screening instruments designed to predict STBs.

Living Conditions, Low Socioeconomic Position, and Mortality in the Ibadan Study of Aging

Objectives Very little is known about socioeconomic differentials in mortality among persons surviving to old age in sub-Saharan Africa. We report on the impact of low socioeconomic position (SEP) on mortality over a 5-year observation period among community-dwelling older adults living in southwestern Nigeria. Method Data are from a household multistage probability sample of 2,149 Yoruba Nigerians aged 65 years or older. We collected information on indices related to health and well-being at baseline (2003/2004). Socioeconomic positions were estimated using asset-based measures relevant to low income settings. Information on mortality was obtained by research supervisors in multiple waves (2007, 2008, and 2009). Associations between baseline covariates and mortality were explored using discrete time survival models and life tables. Results We recorded 357 deaths over 5 years, or an annual mortality rate of 4.7% (95% CI = 4.2-5.2). Being 80 years or older (HR = 1.6, 95% CI = 1.1-2.5) and belonging to the lowest SEP (HR = 1.5, 95% CI = 1.1-2.1) were the main predictors of mortality. The significant effect of lowest SEP on mortality risk over the study period was independent of age, gender, education, rural or urban residence, weight, physical activity level, and social engagement. Conclusion In this sample of older persons living in an economically disadvantaged context, we found persistent socioeconomic differentials in mortality estimated, conservatively, over 5 years.