Olayinka Atilola

Self-reported mental health problems among adolescents in developing countries: results from an international pilot sample.

Objective: To evaluate the prevalence, pattern, and sociodemographic correlates of self-reported mental health problems among a pilot sample of adolescents from 5 developing countries and to speculate the methodology and design of a larger scale study. Methods: The sociodemographic questionnaire was developed based on extant literature on the sociodemographic correlates of mental health problems among adolescents. Additional information about the socioeconomic status of parents/caregivers of the participants was obtained using the Family Affluence Scale (FAS). Mental health problems were evaluated using the Strength and Difficulty Questionnaire (SDQ). Logistic regression analysis was done to determine independent sociodemographic correlates of mental health problems. Results: A total of 1894 adolescents sampled from 5 countries completed the study. The prevalence of self-reported mental health problems was 10.5% (range, 5.8–15) with conduct and emotional problems being the most prevalent. When the raw total-SDQ scores were adjusted for age, gender, and FAS scores, there was a statistically significant difference in the mean scores among the adolescents from different countries (F = 17.23, p < .001). After controlling for all potential sociodemographic confounders, living with single parents or other nonparent care givers, having a chronic disabling physical condition, lower maternal education, and coming from a family in the lower FAS-score category were all independently associated with higher odds of mental health problems. Conclusions: Study has added to the currently limited data on prevalence of mental health problems among adolescents in developing countries. It further established that socioeconomic and family factors still play a major role in the mental health of children irrespective of region of the world. Significant but surmountable methodological issues for a larger scale study were raised.

Does the Strengths and Difficulties Questionnaire - self report yield invariant measurements across different nations? Data from the International Child Mental Health Study Group

AIMS This study evaluated the measurement invariance of the strengths and difficulties questionnaire (SDQ) self-report among adolescents from seven different nations. METHODS Data for 2367 adolescents, aged 13-18 years, from India, Indonesia, Nigeria, Serbia, Turkey, Bulgaria and Croatia were available for a series of factor analyses. RESULTS The five-factor model including original SDQ scales emotional symptoms, conduct problems, hyperactivity-inattention problems, peer problems and prosocial behaviour generated inadequate fit degree in all countries. A bifactor model with three factors (i.e., externalising, internalising and prosocial) and one general problem factor yielded adequate degree of fit in India, Nigeria, Turkey and Croatia. The prosocial behaviour, emotional symptoms and conduct problems factor were found to be common for all nations. However, originally proposed items loaded saliently on other factors besides the proposed ones or only some of them corresponded to proposed factors in all seven countries. CONCLUSIONS Due to the lack of a common acceptable model across all countries, namely the same numbers of factors (i.e., dimensional invariance), it was not possible to perform the metric and scalar invariance test, what indicates that the SDQ self-report models tested lack appropriate measurement invariance across adolescents from these seven nations and it needs to be revised for cross-country comparisons.

Role of personal and family factors in alcohol and substance use among adolescents: an international study with focus on developing countries

Most studies examining adolescent alcohol and substance use or abuse hardly include samples from developing countries. To bridge some gap, the prevalence and associated social correlates of alcohol and substance use and abuse was examined among a cohort of school-going adolescents sampled from seven developing countries. Alcohol and substance abuse was measured using the CRAFFT instrument, independent socio-demographic correlates were determined using regression models. A total of 2454 adolescents completed the study, among which 40.9% reported using either alcohol or at least one other substance during the previous 12 months. This was mostly alcohol (37.8%), followed by marijuana/hashish (8.6%) and other substances (8.1%). Among the adolescents who reported using at least one substance, 45% (18.3% of total sample) had CRAFFT scores indicative of problematic or hazardous substance use. Several personal and family factors were independently associated with use/abuse, and the modifiable nature of these factors calls for appropriate intervention strategies.

Level of community mental health literacy in sub-Saharan Africa: Current studies are limited in number, scope, spread, and cognizance of cultural nuances

Abstract Background: The combination of high prevalence of mental disorders and the scarcity of resources to care for them in sub-Saharan Africa underscores the need for good mental health literacy as a potential mental health resource. Aim: To conduct a systematic review of the findings of studies that have examined aspects of mental health literacy among community dwellers in sub-Saharan Africa. Methods: A search was conducted using local and international indexes like MEDLINE, EMBASE and PsychInfo. Results: Only 19 studies from eight different countries met inclusion criteria. Key aspects of the functional mental health literacy that has been examined include recognition of mental disorders, knowledge about causation, and treatment preferences. The modes of seeking mental health information are yet to be examined. Some studies utilized a methodology that allowed for respondents to use local labels to describe their understanding of various mental disorders. Otherwise, respondents were largely unable to label orthodox psychiatry syndromes correctly. Supernatural and ultra-human views were rampant, and alternative mental health services were mostly preferred. Quantitative modes of assessment were the most common, and authors—especially those that adopted this mode of assessment—did not take full cognizance of socio-cultural underpinnings of the concept of mental health literacy in their conclusion and recommendations. Conclusion: There is need for more studies to adopt more comprehensive approaches to the assessment of mental health literacy. The outcomes of such studies will provide the right context for making profound statements on the level of knowledge and skills for mental health promotion in sub-Saharan Africa.

Cross-cultural measurement invariance of the Revised Child Anxiety and Depression Scale across 11 world-wide societies

BACKGROUND In order to compare estimates by one assessment scale across various cultures/ethnic groups, an important aspect that needs to be demonstrated is that its construct across these groups is invariant when measured using a similar and simultaneous approach (i.e., demonstrated cross-cultural measurement invariance). One of the methods for evaluating measurement invariance is testing for differential item functioning (DIF), which assesses whether different groups respond differently to particular items. The aim of this study was to evaluate the cross-cultural measurement invariance of the Revised Child Anxiety and Depression Scale (RCADS) in societies with different socioeconomic, cultural, and religious backgrounds. METHODS The study was organised by the International Child Mental Health Study Group. Self-reported data were collected from adolescents residing in 11 countries: Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, Palestinian Territories, the Philippines, Portugal, Romania and Serbia. The multiple-indicators multiple-causes model was used to test the RCADS items for DIF across the countries. RESULTS Ten items exhibited DIF considering all cross-country comparisons. Only one or two items were flagged with DIF in the head-to-head comparisons, while there were three to five items flagged with DIF, when one country was compared with the others. Even with all cross-culturally non-invariant items removed from nine language versions tested, the original factor model representing six anxiety and depressive symptoms subscales was not significantly violated. CONCLUSIONS There is clear evidence that relatively small number of the RCADS items is non-invariant, especially when comparing two different cultural/ethnic groups, which indicates on its sound cross-cultural validity and suitability for cross-cultural comparisons in adolescent anxiety and depressive symptoms.

Knowledge and Beliefs of Breast Self-Examination and Breast Cancer among Market Women in Ibadan, South West, Nigeria.

Background In most resource constrained settings like Nigeria, breast self-examination self-breast examination (BSE) is culturally acceptable, religious friendly and attracts no cost. Womens knowledge and beliefs about breast cancer and its management may contribute significantly to medical help-seeking behaviours. This study aimed to assess knowledge and beliefs of BSE among market women. Methods A descriptive cross-sectional study was conducted among 603 market women in Ibadan, Nigeria. Data was collected using semi-structured interviews and analyzed using descriptive and analytic statistical methods. Results The mean age of the respondents was 34.6±9.3 years with 40% of the women aged between 30-39years. The proportion of married women was 339 (68.5%) with 425 (70.8%) respondents reporting that they do not know how to perform BSE. However, 372 (61.7%) women strongly agreed that BSE is a method of screening for breast cancer. Highest proportion 219 (36.3%) reported that the best time for a woman to perform BSE was ‘anytime’. Most of the respondents believed breast cancer is a dangerous disease that kills fast and requires a lot of money for treatment. Conclusion More efforts are needed in creating awareness and advocacy campaigns in the grassroots in order to detect early breast cancer and enhance prevention strategies that would reduce the burden of breast cancer in Nigeria.

Child mental-health policy development in sub-Saharan Africa: broadening the perspectives using Bronfenbrenner's ecological model

Despite socio-economic, demographic and epidemiological facts and realities that point to a potential risk for explosion in the prevalence of childhood mental health problems in sub-Saharan Africa, there is still a severe dearth of child and adolescent mental health (CAMH) policy or strategy to respond to the situation in the region. Unfortunately, current attempts at suggesting courses of action in this regard appear to be focused on narrow reactionary approaches. There is a need for theoretical frameworks to capture the full ramification of childhood in sub-Saharan Africa, from which multi-level, context-appropriate and holistic CAMH policy directions can be understood. In this commentary, we propose an amended version of the Bronfenbrenners ecological model of childhood as such framework that captures proximal, intermediate and distal factors that influence the care environment of children. We then used the insights provided by the model to identify and prioritize intervention points and appropriate intervention strategies in charting a tentative course for CAMH policy development in the region. Though the ecological model provides a distinct perspective to the structure and dynamics of the care environment of children, the proposed framework using the model is still largely theoretical and need to be further integrated into future studies on CAMH policy development in the region.

The suicide of Ṣàngó through the prism of Integrated Motivational–Volitional model of suicide: implications for culturally sensitive public education among the Yorùbá

Recent studies have continued to recommend community-based public enlightenment and education as a key suicide-prevention strategy in sub-Saharan Africa. The role of socio-cultural factors in suicidal behaviours and the relevance of cultural factors in better understanding of and formulating more effective prevention strategies for suicidal behaviours are gaining wider acceptance. Therefore, in a multi-ethnic and multicultural region like sub-Saharan Africa, successful public enlightenment campaign has to be cognisant of specific cultural and historical nuances of suicidal behaviours in different ethnic groups. Understanding cultural contexts requires a foray into the history, cultural beliefs and the worldview of a people. We present a brief narrative of the cultural and historical perspectives of the Yorùbá people of sub-Saharan Africa about suicide. We then further situate the suicide of Ṣàngó – a well-known historical icon among the Yorùbá – within the framework of the Integrated Motivational–Volitional model of suicide. The outcome is a culturally and historically nuanced and a theoretically sound public enlightenment tool that can be used among the Yorùbá. Broader lessons for successful public enlightenment about suicide in Yorùbá communities – and indeed the sub-Saharan Africa region – were also drawn.

Lifetime exposure to traumatic events among adolescents in contact with the Nigerian juvenile justice systems compared with a comparison group of secondary school students

Abstract Background: There are some knowledge gaps in what is known about pre-contact exposure to traumatic events among adolescents within the juvenile justice system. Data often focus on psychological sequelae without describing the traumatic events. In addition, there are few data from sub-Saharan Africa where juvenile justice inmates are often minor offenders and may themselves have been victims of abuse and neglect. Objective: To present detailed data on the lifetime prevalence rate and pattern of traumatic events among a cohort of adolescents in juvenile justice custody in Nigeria and to compare inmates who are ‘offenders’ with those who are ‘victims’. Methods: Inmates of a borstal and a remand home comprised the study group and age- and gender-matched adolescents from two government schools were the secondary comparison group. The trauma-checklist of the Current and Lifetime Version of the Kiddies Schedule for Affective Disorders and Schizophrenia was used as a guide in assessing traumatic events. Results: Of a total of 408 adolescents, 204 were recruited from the two juvenile justice institutions and 204 from secondary schools. Ninety per cent of participants were male and the mean (SD) age was 15·9 (2·8) years. The prevalence rate of lifetime exposure to traumatic events among the juvenile justice offenders was 88·7% compared with 48·5% of the comparison group (P = 0·001). The most commonly reported specific lifetime traumatic event was physical abuse (52·8%). The institutionalised adolescents were significantly more likely to report lifetime exposure to almost all the traumatic events assessed. Apart from the perpetrators of violent crime, there was no statistically significant difference in the prevalence and pattern of lifetime exposure to traumatic events between the offenders and the victims. Conclusions: This study provides further evidence that exposure to traumatic events is a fact of life for inmates of juvenile institutions, irrespective of whether they are offenders or victims. The implications for reform of the Nigerian juvenile justice system are discussed.

Can we really use available scales for child and adolescent psychopathology across cultures? A systematic review of cross-cultural measurement invariance data:

In this systematic review, we assessed available evidence for cross-cultural measurement invariance of assessment scales for child and adolescent psychopathology as an indicator of cross-cultural validity. A literature search was conducted using the Medline, PsychInfo, Scopus, Web of Science, and Google Scholar databases. Cross-cultural measurement invariance data was available for 26 scales. Based on the aggregation of the evidence from the studies under review, none of the evaluated scales have strong evidence for cross-cultural validity and suitability for cross-cultural comparison. A few of the studies showed a moderate level of measurement invariance for some scales (such as the Fear Survey Schedule for Children-Revised, Multidimensional Anxiety Scale for Children, Revised Child Anxiety and Depression Scale, Revised Childrens Manifest Anxiety Scale, Mood and Feelings Questionnaire, and Disruptive Behavior Rating Scale), which may make them suitable in cross-cultural comparative studies. The remainder of the scales either showed weak or outright lack of measurement invariance. This review showed only limited testing for measurement invariance across cultural groups of scales for pediatric psychopathology, with evidence of cross-cultural validity for only a few scales. This study also revealed a need to improve practices of statistical analysis reporting in testing measurement invariance. Implications for future research are discussed.