Lola Kola

The relation between multiple pains and mental disorders: Results from the World Mental Health Surveys

&NA; It is unclear whether differences exist in the prevalence of mood, anxiety and alcohol use disorders among persons with multiple pain conditions compared with those with single pain problems. We conducted population surveys in 17 countries in Europe, the Americas, the Middle East, Africa, Asia, and the South Pacific. Participants were community‐dwelling adults (N = 85,088). Mental disorders were assessed with the Composite International Diagnostic Interview. Pain was assessed by self‐report. Both multiple and single site pain problems were associated with mood and anxiety disorders, but not with alcohol abuse or dependence. In general, the prevalence of specific mood and anxiety disorders followed a linear pattern with the lowest rates found among persons with no pain, intermediate rates among those with one pain, and highest rates among those with multi‐site pain problems. Relative to persons not reporting pain, the pooled estimates of the age‐sex adjusted odds ratios were 1.8 (1.7–2.0) for mood disorders and 1.9 (1.8–2.1) for anxiety disorders for persons with single site pain; 3.7 (3.3–4.1) for mood disorders and 3.6 (3.3–4.0) for anxiety disorders among those with multi‐site pain. Our results indicate that the presence of multiple pain conditions was strongly and comparably associated with mood and anxiety disorders in diverse cultures. This consistent pattern of associations suggests that diffuse pain and psychiatric disorders are generally associated, rather than diffuse pain representing an idiom for expressing distress that is specific to particular cultural settings or diffuse pain solely representing a form of masked depression.

Epidemiology of major depressive disorder in elderly Nigerians in the Ibadan Study of Ageing: a community-based survey

BACKGROUND The growing populations of elderly people in sub-Saharan Africa are exposed to social changes with potential adverse effects on mental health. Our aim was to estimate the occurrence and effect of major depressive disorder in a large and representative community sample of elderly Africans. METHODS Face-to-face interviews with a representative sample of people aged 65 years and older (n=2152) were obtained by a multistage stratified sampling of households in the Yoruba-speaking areas of Nigeria (about 22% of the national population). Major depressive disorder was assessed with the WHO composite international diagnostic interview and diagnosed with the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. FINDINGS Lifetime and 12-month prevalence estimates of major depressive disorder were 26.2% (95% CI 24.3-28.2) and 7.1% (5.9-8.3) respectively. Female sex (odds ratio [OR] 1.9) and increasing levels of urbanisation of residence (OR 1.4) were associated with this disorder. People with major depressive disorder had impaired quality of life and functioning in home, work, and social roles. Independent ratings of symptom severity confirmed the presence of clinically significant depression in 96.9% of those with diagnosis, and increasing symptom severity was associated with greater disability and poorer quality of life. Only about 37% of lifetime cases had received any treatment, and there was a mean delay of 5 years from onset of depression to receipt of first treatment. Low economic status (0.3) and rural residence (1.0) predicted no treatment. INTERPRETATION Major depressive disorder is common in elderly Nigerians and its occurrence is related to urbanisation. This disorder is a seriously disabling illness in this group but only a few sufferers have ever received treatment. Health-care services need to invest in effective treatment programmes for major depressive disorder.

Functional disability in elderly Nigerians: Results from the Ibadan Study of Aging.

Functional disability is a common reason for loss of independence and need for informal care by elderly persons. There is little information on the profile of disability and the level of unmet need for care in elderly persons living in sub‐Saharan Africa. Using a multistage clustered sampling of households conducted in the Yoruba‐speaking area of Nigeria (representing 22% of the national population), persons aged 65 and older (N=2,152) were assessed for disability in activities of daily living and instrumental activities of daily living. Respondents were assessed for self‐reports of physical health, for major depressive disorder, and for availability of informal care. The prevalence of any functional disability (defined as inability to independently perform any function) was 9.2% (standard error 0.6). In logistic regression analysis, high risks of disability were associated with female sex, older age, and urban dwelling. Risks were also high for persons with chronic pain, those with poor self‐reported overall health, and those with evidence of undernutrition. Disabled persons had poorer quality of life and were more likely to suffer from major depressive disorder; 19.8% of disabled elderly persons lacked any informal care, and this unmet need for care increased the likelihood of having depression. The findings suggest a high burden of unmet need for care in a large section of disabled elderly persons in this African community undergoing demographic and social changes. Social factors relating to urbanization and poverty may be associated with the occurrence of disability and inability to access informal care.

Incidence of and Risk Factors for Dementia in the Ibadan Study of Aging

OBJECTIVES: To describe the incidence of dementia in a representative sample of elderly Yoruba Nigerians and provide information about the risk factors.

The profile and risks of suicidal behaviours in the Nigerian Survey of Mental Health and Well-Being.

BACKGROUND Suicide is a leading cause of death worldwide but information about it is sparse in Sub-Saharan Africa. Suicide-related behaviours can provide an insight into the extent of this compelling consequence of mental illness. METHOD Face-to-face interviews were conducted with a representative sample of persons aged 18 years and over (n=6752) in 21 of Nigerias 36 states (representing about 57% of the national population). Suicide-related outcomes, mental disorders, as well as history of childhood adversities were assessed using the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). RESULTS Lifetime prevalence estimates of suicide ideation, plan and attempts were 3.2% [95% confidence interval (CI) 1.4-6.5], 1.0% (95% CI 0.4-7.5) and 0.7% (95% CI 0.5-1.0) respectively. Almost two of every three ideators who made a plan went on to make an attempt. The highest risks for transition from ideation to plan and from plan to attempt were in the first year of having ideation or plan respectively. Mental disorders, especially mood disorders, were significant correlates of suicide-related outcomes. Childhood adversities of long separation from biological parents, being raised in a household with much conflict, being physically abused, or being brought up by a woman who had suffered from depression, anxiety disorder, or who had attempted suicide were risk factors for lifetime suicide attempt. CONCLUSIONS History of childhood adversities and of lifetime mental disorders identify persons at high-risk for suicide-related outcomes. Preventive measures are best delivered within the first year of suicide ideation being expressed.

Profile, comorbidity and impact of insomnia in the ibadan study of ageing

To provide information on the profile, comorbidity and impact of insomnia among an understudied group of elderly Africans.

Global Mental Health Reforms: Mental Health Care in Anglophone West Africa

This column describes the current state of resources and practice in mental health care in the Anglophone countries of West Africa: the Gambia, Sierra Leone, Ghana, Nigeria, and Liberia. Information was systematically gathered from the five countries by using a standard framework for country situation analysis. Mental health services, which are in various stages of development, are characterized by inadequate human resources and long policy neglect. Despite the low numbers of specialists, the region has made important contributions to community service development and global mental health research. Challenges include manpower development, policy and legislation updates, and increased attention to policy and budget. Although mental health service is still grossly inadequate in the context of human and material constraints, there are slowly evolving signs of positive modernization and service development.

Validation of short screening tools for common mental disorders in Nigerian general practices

OBJECTIVE The objective was to examine the psychometric properties of two brief screening questionnaires for common mental disorders in general practices in areas speaking the three main Nigerian languages. METHOD Consecutives attendees of selected general practices in Ibadan, Enugu and Kaduna were screened with the General Health Questionnaire 12-item version (GHQ12) and K6. We selected all cases and 50% of noncases for second-stage interview with the Composite International Diagnostic Interview. The receiver operating characteristic curves were generated for both questionnaires, and optimal cutoffs were determined. Exploratory factor analysis was done for both questionnaires. RESULTS The K6 had an area under the curve (AUC) of 0.62 for depression and 0.58 for anxiety disorder. The GHQ12 had an AUC of 0.74 for depression, while that for generalized anxiety disorder was 0.6. The GHQ12 was able to correctly classify 75% of the subjects with or without depression, while the K6 was able to correctly classify 56% of the subjects with or without depression. The optimal cutoff for both questionnaires was 4, selecting the point of best balance of sensitivity and specificity. CONCLUSION The findings suggest that the GHQ12 will be a useful tool in screening for common mental disorders in general practice in Nigeria.

The ICD-11 developmental field study of reliability of diagnoses of high-burden mental disorders: results among adult patients in mental health settings of 13 countries.

Reliable, clinically useful, and globally applicable diagnostic classification of mental disorders is an essential foundation for global mental health. The World Health Organization (WHO) is nearing completion of the 11th revision of the International Classification of Diseases and Related Health Problems (ICD‐11). The present study assessed inter‐diagnostician reliability of mental disorders accounting for the greatest proportion of global disease burden and the highest levels of service utilization – schizophrenia and other primary psychotic disorders, mood disorders, anxiety and fear‐related disorders, and disorders specifically associated with stress – among adult patients presenting for treatment at 28 participating centers in 13 countries. A concurrent joint‐rater design was used, focusing specifically on whether two clinicians, relying on the same clinical information, agreed on the diagnosis when separately applying the ICD‐11 diagnostic guidelines. A total of 1,806 patients were assessed by 339 clinicians in the local language. Intraclass kappa coefficients for diagnoses weighted by site and study prevalence ranged from 0.45 (dysthymic disorder) to 0.88 (social anxiety disorder) and would be considered moderate to almost perfect for all diagnoses. Overall, the reliability of the ICD‐11 diagnostic guidelines was superior to that previously reported for equivalent ICD‐10 guidelines. These data provide support for the suitability of the ICD‐11 diagnostic guidelines for implementation at a global level. The findings will inform further revision of the ICD‐11 diagnostic guidelines prior to their publication and the development of programs to support professional training and implementation of the ICD‐11 by WHO member states.

Perinatal depression in Nigeria: perspectives of women, family caregivers and health care providers

BackgroundPerinatal maternal depression is common and undertreated in many sub-Saharan African countries, including Nigeria. While culture shapes the social determinants and expression of depressive symptoms, there is a dearth of research investigating these processes in African contexts.MethodsTo address this gap, we conducted in-depth interviews with 14 women with perinatal depression, 14 of their family caregivers and 11 health providers, using the McGill Illness Narrative Interview as part of a larger trial of a stepped-care intervention. Interpretation of themes was guided by cultural constructivist and critical anthropological perspectives that situate perinatal depression in its complexity as a disorder that is embedded in webs of social relations and embodied practices.ResultsStudy respondents used idioms of distress that identified perinatal conditions that consist of somatic, affective, cognitive and behavior symptoms found in depressive disorders. Respondents viewed mental health problems in the perinatal period as tied to sociomoral concerns over gender roles and women’s position within the household. Conflict between women’s effort to be assertive to address interpersonal problems, while needing to be seen as non-aggressive contributed to their distress. Causal explanations for depression included husband’s lack of care, family problems, “spiritual attack”, having a female child when a male child was desired, and not resting sufficiently after childbirth. Guilt about breaching social norms for women’s conduct contributed to self blame, and feelings of shame.ConclusionsClinical assessment and interventions as well as public health prevention strategies for perinatal depression in global mental health need to consider local social contexts and meanings of depression, which can be explored with narrative-based methods.