Roger C. Gibson

Parenting and depressive symptoms among adolescents in four Caribbean societies

BackgroundThe strategies that parents use to guide and discipline their children may influence their emotional health. Relatively little research has been conducted examining the association of parenting practices to depressive symptoms among Caribbean adolescents. This project examines the association of parenting styles to levels of depressive symptoms among adolescents in Jamaica, the Bahamas, St. Kitts and Nevis, and St. Vincent.MethodsAdolescents attending grade ten of academic year 2006/2007 in Jamaica, the Bahamas, St. Vincent, and St. Kitts and Nevis were administered the Parenting Practices Scale along with the BDI-II. Authoritative, Authoritarian, Permissive and Neglectful parenting styles were created using a median split procedure of the monitoring and nurturance subscales of the Parenting Practices Scale. Multiple regression analyses were used to examine the relationships of parenting styles to depressive symptoms.ResultsA wide cross-section of tenth grade students in each nation was sampled (n = 1955; 278 from Jamaica, 217 from the Bahamas, 737 St. Kitts and Nevis, 716 from St. Vincent; 52.1% females, 45.6% males and 2.3% no gender reported; age 12 to 19 years, mean = 15.3 yrs, sd = .95 yrs). Nearly half (52.1%) of all adolescents reported mild to severe symptoms of depression with 29.1% reporting moderate to severe symptoms of depression. In general, authoritative and permissive parenting styles were both associated with lower levels of depressive symptoms in adolescents. However, the relationship of parenting styles to depression scores was not consistent across countries (p < .05). In contrast to previous research on Caribbean parenting, caregivers in this study used a mixture of different parenting styles with the two most popular styles being authoritative and neglectful parenting.ConclusionsThere appears to be an association between parenting styles and depressive symptoms that is differentially manifested across the islands of Jamaica, the Bahamas, St. Kitts and Nevis and St. Vincent.

Depression in adolescence: new developments

Depression in adolescence is under-recognized although its associated burden of illness is very high. Some frequent associations with depression in this age group are under-achievement, poor lifestyle choices including substance abuse, and a high risk of the persistence of the illness into adulthood There is also an increased risk of mortality related to suicide and harmful lifestyles. For depression in adolescents to be reduced, there needs to be strong collaboration among health professions, adolescents and their caregivers. Non-mental health clinicians must expand their role and become better prepared to recognize, prevent and treat depression in this age-group. Greater public awareness must also be achieved so that adolescents and their caregivers can seek help early.

Internalizing stigma associated with mental illness: findings from a general population survey in Jamaica

OBJECTIVES The culture of stigma associated with mental illness is particularly intense when persons who are normally victims of that stigmatization (mentally ill persons and their family members) themselves act negatively toward others whom they associate with mental illness. We attempt to determine the extent of this internalization and assimilation of stigmatizing attitudes, cognitions, and behaviors in persons who are at risk for such stigmatization in Jamaica. METHODS Data from a 2006 national survey on mental health were analyzed. Demographic variables, the presence or absence of mental illness in respondents and in their family members, and responses pertaining to behaviors and attitudes toward mentally ill persons were examined. Subsamples (respondents with mental illness, respondents with a family member with mental illness, respondents with neither) were compared using the chi-square test. RESULTS Respondents with family members with mental illness were less likely to demonstrate a number of different manifestations of stigmatization than others (P=0.009-0.019). Respondents with mental illness showed no difference in the demonstration of a number of different manifestations of stigmatization from other respondents (P=0.069-0.515). CONCLUSIONS The small number of mentally ill respondents resulted in low statistical power for demonstrating differences between that subgroup and other respondents. The significantly more positive attitudes and behavior of respondents with family members with mental illness suggest that some benefit may be gained by creating more opportunities for the general public to interact with persons with mental illness.

Locus of control, depression and quality of life among persons with sickle cell disease in Jamaica

This study explored how locus of control (LOC), depression and quality of life (QOL) interplay in patients with sickle cell disease. One hundred and forty-three sickle cell clinic patients with consecutive clinic consultations completed the Multidimensional Health Locus of Control and Short Factor 36 (SF-36) scales as well as the Beck Depression Inventory. Participants in this study had higher scores on the “chance”, “other people” and “internal” domains of LOC than persons with a number of other chronic illnesses in a previous study. Hierarchical regression analyses showed that high scores on the “internal” domain of LOC were associated with better QOL and fewer symptoms of depression. Depressive symptoms were greater in persons with high scores on the “other people” LOC domain and in younger persons. These findings would suggest that it is possible that interventions which enhance internal LOC and discourage “other people” orientations might improve QOL and ameliorate depression among persons with sickle cell disease.

Depression: a major public healthproblem facing the Caribbean

Epidemiological studies indicate that depression is a common disorder worldwide (1, 2). Estimates of the lifetime prevalence for this disorder range from 5–17% of the population in the USA (3–4). However a MEDLINE trawl of two hundred and seventy-five publications on mental health issues in Caribbean people revealed a paucity of written material on depression in the region. In the Global Burden of Disease Report, it is estimated that depression was the fourth leading cause of burden among all diseases and that it accounted for 4.4% of the Total Disability Adjusted Life Years (5). An important characteristic feature of the longitudinal course of major depression is the frequent co-occurrence with other illnesses. Numerous studies have examined the prevalence of co-morbid depression. Robin et al (3) and Wittchen et al (6) have shown that there is high co-morbidity between major depression and other psychiatric disorders. Much has been written on the risk factors; Blazer et al have shown that there was a stronger correlation with younger age, lower level of education and lower income in co-morbid depression in contrast to pure depression in which the major potential risk for pure depression was non-black race/ ethnicity (7). Studies have shown that in persons diagnosed with diabetes mellitus the prevalence of depression range from 6.1% – 60.7% (8). In a meta-analysis of 42 studies on co-morbid depression in adults with diabetes, Anderson et al concluded that the presence of diabetes increases the risk of depression they also concluded that the variation in prevalence estimates was due to clinical and methodological factors (9). A number of epidemiological studies have established a clear relationship between depression and cardiovascular diseases (10–13) with the prevalence of major depression in post myocardial infarction ranging from 15%–20% (14, 15). Depression, coexisting with other medical conditions, has poorer outcome in terms of quality of life and social and physical functioning (16, 17) and it is associated with increased morbidity and mortality (18, 19). In a study of patients with myocardial infarction, Frasure-Smith et al showed that 17% of patients had died by six months compared with 3% for non-depressed patients (14). In patients with breast cancer depression is associated with a reduced 5-year survival (19). Major criticisms on studies of co-morbid depression have identified methodological problems, inadequate control of confounding variables and weak or inappropriate comparison groups as major limitations. In a recent study by Scott et al, adjustments were …

Current research on transcultural psychiatry in the Anglophone Caribbean: Epistemological, public policy, and epidemiological challenges

In this article, we review recent research on mental health in the Caribbean. Three major themes emerge: (a) the effects of colonialism on the Caribbean psyche; (b) decolonization of psychiatric public policy, including innovative treatment approaches, deinstitutionalization, and community and policy responses to mental health issues; and (c) the nature and epidemiology of psychiatric pathology among contemporary Caribbean people, with particular focus on migration, genetic versus social causation of psychosis and personality disorders, and mechanisms of resilience and social capital. Caribbean transcultural psychiatry illustrates the principles of equipoise unique to developing countries that protect the wellness and continued survival of postcolonial Caribbean people.

Education and employment levels among Jamaican patients newly diagnosed with schizophrenia and bipolar disorder

Background: Comparisons between persons with bipolar disorder and those with schizophrenia are not well researched in the Caribbean. Aims: To compare the educational and occupational attainments in Jamaicans diagnosed with these two disorders. Methods: Data on diagnosis, educational level, type of employment and other basic socio-demographic variables were collected from Jamaican hospital patients who were newly diagnosed with schizophrenia or bipolar disorder. Fisher’s exact and χ2 tests, as well as binary logistic regression, were used to explore how these characteristics varied according to diagnosis. Statistical significance was taken at p < .05. Results: Schizophrenia was associated with significantly lower educational attainment than bipolar disorder (p = .022 for educational level attained; p = .026 for completion of secondary school). The majority (87.1%) of the 93 patients included in the analysis had no specific marketable job skills. However, the proportion of persons with bipolar disorder who had such skills was three times the corresponding proportion of persons with schizophrenia. Conclusions: The low educational achievement among persons with schizophrenia makes education a potentially important area for interventions targeted at this group. Because gross deficiencies in job skills were common to both patient groups, improvement in job skill levels is an important goal for persons with either of these disorders.

Associations amongst disease severity, religious coping and depression in a cohort of Jamaicans with sickle-cell disease

The purpose of this study was to investigate the relationship between disease severity (sickle-cell type and hospital, emergency room and clinic emergency visits (CEU)), religious coping (positive and negative) and depression. This was accomplished through secondary analysis of a data set based on a Comprehensive Sickle Cell Standardized Questionnaire compiled by a multidisciplinary team of professionals from Duke University Medical Centre, and administered to persons with sickle-cell disease being treated at the Sickle Cell Unit on the University of the West Indies Campus between November 2008 and January 2009. Disease severity was not a good predictor of depression within the population. On the other hand, depression was found to correlate with positive and negative religious coping, such that increases in the former were associated with decreases in depression scores; while the reverse was noted for the latter (negative religious coping). The results shed light on issues that could possibly impact the treatment plan for such individuals.

The prevalence and associated demographic factors of dementia from a cross-sectional community survey in Kingston, Jamaica

Using a cross‐sectional community survey, the authors aimed to estimate the prevalence of dementia among a sample of older Jamaicans and to identify associated demographic factors.

Changing the research culture at the Section of Psychiatry, The University of the West Indies, Mona

OBJECTIVE To compare the medical research output of the Section of Psychiatry, The University of the West Indies (UWI), Mona, before and after the implementation of strategies aimed at stimulating research. METHOD Specific strategies such as weekly research and journal club meetings, with an emphasis on team activities and the establishment of bi-annual targets for submission of research papers were instituted in 2000. All research outputs from the Section of Psychiatry over the period 1995 to 2005 were identified from the Departmental Reports of the University of the West Indies and the published abstracts of the UWI Faculty of Medical Sciences and the Caribbean Health Research Council annual research conferences. A number of variables were extracted from each paper and comparisons made between the five-year period before and the five-year period after the implementation of the research enhancing strategies. Statistical analyses were performed with the Statistical Package for the Social Sciences (SPSS; version 11.5) and included chi-squared and Mann Whitney U tests. RESULTS One-hundred and sixty-two items of research output were identified for the entire period under study. In the period after the implementation of the research enhancing strategies, there were significant increases in the total research output (p = 0.008) and refereed publications (p = 0.016). CONCLUSIONS There were considerable increases in the overall research output of the department as well as in many sub-categories of output. These strategies are presented as a model to other departments seeking to augment their output of research.