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Hunduma G, Dessie Y, Geda B, Assebe Yadeta T, Deyessa N. Mental health dynamics of adolescents: A one-year longitudinal study in Harari, eastern Ethiopia. PLoS One 2024; 19:e0300752. [PMID: 38635790 PMCID: PMC11025968 DOI: 10.1371/journal.pone.0300752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/04/2024] [Indexed: 04/20/2024] Open
Abstract
AIMS This study aims to assess the dynamics of in-school adolescents' mental health problems in Harari regional state, eastern Ethiopia for a year. MATERIALS AND METHODS Using multistage sampling technique, we conducted a year-long longitudinal study at three public high schools between March 2020 and 2021. Three hundred fifty-eight in-school adolescents were chosen by systematic random sampling for the baseline assessment, and 328 completed the follow-up assessment. We used self-administered, adolescent version of SDQ-25 Questionnaire to collect the data. Wilcoxon matched-pairs signed-rank test and McNemara's Chi-squared tests were used to examine the median difference and distribution of mental health problems between times one and two. Random-effects logistic regressions on panel data was used to identify factors associated with mental health problems. A p-value < 0.05 was considered as statistically significant. RESULTS The magnitude of overall mental health problems at baseline assessment was 20.11% (95% CI: 16-25), with internalizing problems accounting for 27.14% (95% CI: 23-32) and externalizing problems accounting for 7.01% (95% CI: 4.6-10.3). At the follow-up assessment, these proportions rose to 22.56% (95% CI, 18-27) for overall problems and 10.3% (95% CI, 7.7-14.45) for externalizing problems. On other hand, internalizing problems decreased unexpectedly to 22.86% (95% CI, 18.6-27.7) at follow-up assessment. Internalizing problem scores at time two were significantly lower than baseline among older adolescents, girls and those with average wealth index in our study cohort. CONCLUSIONS The prevalence of mental health problems were high among the study cohort. The proportion of overall problems and externalizing problems has increased over time, indicating a deterioration in the mental health of the study cohort. However, the decrease in internalizing problems among older adolescents, girls, and those with an average wealth index is a positive sign. The findings highlight that tailored interventions are required to reduce externalizing problems and maintain the decrease in internalizing problems. These interventions should target middle-aged and male adolescents from low-income families.
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Affiliation(s)
- Gari Hunduma
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Biftu Geda
- Department of Nursing, College of Health Sciences, Madda Walabu University, Shashamene Campus, Shashamene, Ethiopia
| | - Tesfaye Assebe Yadeta
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Negussie Deyessa
- Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Kisaakye P, Kafuko A, Bukuluki P. Lifetime violence and suicidal ideation among young women (18-24 years) in Uganda: Results from a population-based survey. Front Glob Womens Health 2023; 4:1063846. [PMID: 37139174 PMCID: PMC10150090 DOI: 10.3389/fgwh.2023.1063846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Violence is a major global public health issue that threatens the physical and mental health of victims. Of particular concern is the increasing evidence which suggests that violence is strongly associated with suicidal behavior including ideation. Methods This study uses data from the 2015 Violence Against Children Survey (VACS). This study seeks to highlight the relationship between lifetime violence and suicidal ideation using a nationally representative sample of 1,795 young women (18-24 years) in Uganda. Results Results indicate that respondents who experienced lifetime sexual violence (aOR = 1.726; 95%CI = 1.304-2.287), physical violence (aOR = 1.930; 95%CI = 1.293-2.882) or emotional violence (aOR = 2.623; 95%CI = 1.988-3.459) were more likely to experience suicidal ideation. Respondents who were not married (aOR = 1.607; 95%CI = 1.040-2.484), not having too much trust with community members (aOR = 1.542; 95%CI = 1.024-2.320) or not having a close relationship with biological parents (aOR = 1.614; 95%CI = 1.230-2.119) were more likely to experience suicidal ideation. Respondents who did not engage in work in the past 12 months prior to the survey (aOR = 0.629; 95%CI = 0.433-0.913) were less likely to experience suicidal ideation. Conclusion The results can be used to inform policy and programming and for integration of mental health and psychosocial support in programming for prevention and response to violence against young women.
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Affiliation(s)
- Peter Kisaakye
- Department of Population Studies, School of Statistics and Planning, Makerere University, Kampala, Uganda
| | - Agatha Kafuko
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
| | - Paul Bukuluki
- Department of Social Work and Social Administration, School of Social Sciences, Makerere University, Kampala, Uganda
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Aoki A, Togoobaatar G, Tseveenjav A, Nyam N, Zuunnast K, Lkhagvasuren G, Shagdar BE, Mori R, Kikuchi A, Soya H, Kasai K, Takehara K. Socioeconomic and lifestyle factors associated with mental health problems among Mongolian elementary school children. Soc Psychiatry Psychiatr Epidemiol 2022; 57:791-803. [PMID: 34595562 PMCID: PMC8483169 DOI: 10.1007/s00127-021-02178-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/22/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Lifestyle factors of children and adolescents' mental health problems are an emerging health issue in low- and middle-income countries (LMICs). However, there is a lack of studies on lifestyle factors in LMICs. This study examined the socioeconomic and lifestyle factors associated with mental health problems among school-age children in Mongolia. METHODS A population-based cross-sectional survey was conducted among 4th-year students at public elementary schools in one district in Ulaanbaatar. The Strengths and Difficulties Questionnaire (SDQ) and a self-administrated socioeconomic and lifestyle questionnaire were completed by participants' guardians. A multivariate logistic regression analysis was performed. RESULTS Of the 2301 children surveyed, 1694 without missing responses were included in the analysis. The multivariate logistic regression analysis showed that male gender [adjusted odds ratio (AOR) 1.64 (1.29-2.10)], low maternal education [AOR 1.89 (1.16-3.05)], short sleep [AOR 1.41 (1.10-1.80)], no physical activity [AOR 1.31 (1.03-1.67)], and long screen time (AOR 1.53 (1.20-1.94)) were associated with high risk of mental health problems. Low maternal education, low household income, no physical activity habit, and long screen time were associated with internalising problems. Meanwhile, male gender, low maternal education, and long screen time were associated with externalising problems. CONCLUSION The results are consistent with previous studies in high-income countries, indicating that there are globally common socioeconomic and lifestyle risk factors. The findings of this study may help develop a targeted preventive intervention for high-risk groups, such as socioeconomically disadvantaged groups, as well as a universal preventive intervention to foster a healthy lifestyle in Mongolia.
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Affiliation(s)
- Ai Aoki
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo, Japan. .,Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.
| | - Ganchimeg Togoobaatar
- Faculty of Medicine, Global Health Nursing, University of Tsukuba, Tsukuba, Ibaraki Japan
| | - Anudari Tseveenjav
- School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia ,Global Leadership University, Ulaanbaatar, Mongolia
| | - Naranbaatar Nyam
- School of Nursing, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Khishigsuren Zuunnast
- Department of Mental Health, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | | | - Bat-Erdene Shagdar
- Mongolian National Institute of Physical Education, Ulaanbaatar, Mongolia
| | - Rintaro Mori
- Graduate School of Medicine, Kyoto University, Sakyoku, Kyoto, Japan
| | - Akihito Kikuchi
- Advanced Research Initiative for Human High Performance, Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan
| | - Hideaki Soya
- Advanced Research Initiative for Human High Performance, Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan ,Laboratory of Exercise Biochemistry and Neuroendocrinology, Faculty of Health and Sport Sciences, University of Tsukuba, Ibaraki, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Kenji Takehara
- Department of Health Policy, National Center for Child Health and Development, 2-10-1 Okura, Setagaya, Tokyo, Japan
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Oppong Asante K, Quarshie ENB, Onyeaka HK. Epidemiology of suicidal behaviours amongst school-going adolescents in post-conflict Sierra Leone. J Affect Disord 2021; 295:989-996. [PMID: 34706473 DOI: 10.1016/j.jad.2021.08.147] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/17/2021] [Accepted: 08/27/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Children and young people living in post-conflict contexts are at an increased risk of suicidal behaviours (ideations and attempts). Not much is known about the extent of suicidal behaviours amongst adolescents in most notable post-conflict countries in sub-Saharan Africa, including Sierra Leone. METHODS We performed a secondary analysis of data from the 2017 Sierra Leone World Health Organisation Global School-based Student Health Survey conducted amongst students in secondary schools nationwide. We estimated the 12-month prevalence and performed bivariable and multivariable analyses to assess the correlates of suicidal behaviours. RESULTS Of the 2,798 analytic sample, 14.6% (males = 15.1%, females = 14.0%) reported suicidal ideation, and the 12-month prevalence estimate of suicide attempt was 19.6% (male = 20.9%, females =17.8%). The factors associated with suicidal behaviours were multi-layered. While no statistically significant gender association with suicide ideation or attempt was observed at the personal level, being aged 18 or older, loneliness, and health risk behaviours (cannabis use, and leisure time sedentary behaviour) were associated with increased odds of suicidal behaviours. Within the family context, parental monitoring was associated with increased odds of suicidal ideation, but parental supervision was associated with reduced odds of suicide ideation. LIMITATIONS The cross-sectional nature of the data did not support causal inferences. CONCLUSIONS Taken together, professional mental healthcare would be helpful in treating adolescent emotional problems (e.g., depression and loneliness) related to suicidal behaviours; but prevention and intervention programmes targeted at addressing adolescent health risk behaviours, and familial and interpersonal problems may yield more favourable outcomes.
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Affiliation(s)
- Kwaku Oppong Asante
- Department of Psychology, University of Ghana, Legon, Accra, Ghana; Department of Psychology, University of the Free State, Bloemfontein, South Africa
| | - Emmanuel Nii-Boye Quarshie
- School of Psychology, University of Leeds, Lifton Place, Leeds LS2 9JT, UK; Department of Psychology, University of Ghana, Legon, Accra, Ghana.
| | - Henry K Onyeaka
- Department of Psychiatry, Massachusetts General Hospital/Mclean Hospital, Boston, USA; Harvard Medical School, Boston, USA
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Nsereko JR, Garman EC, Roomaney R. Depressive symptoms and socio-demographic correlates among adolescents in Kampala: a cross-sectional study. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2021. [DOI: 10.1177/00812463211049886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate the prevalence of depressive symptoms in secondary school students in Kampala, Uganda, and assess associations with demographic characteristics and living arrangements. In this cross-sectional study, 14- to 17-year-olds were recruited from six randomly selected schools in Kampala. Participants completed a questionnaire, covering demographic questions and the affective problems subscale of the Youth Self-Report (YSR) – a depression screening tool for minors. Scores range from 0 to 26; a minimum score of 9 and 8 for female and male participants, respectively, suggests depressive symptoms in the clinical range, according to standard (non-local) norms. Unadjusted logistic regressions were used to assess demographic (e.g., age, gender, religion, parental education) and family-related characteristics (e.g., living arrangements, household size) associated with symptoms of depression in the clinical range. In total, 503 participants were recruited, of which 26.6% had depressive symptoms in the clinical range (female: 32.5%, male: 18.1%; risk ratio [RR] = 1.79, 95% confidence interval [CI] [1.28, 2.51]). Those who reported living with only one parent (RR = 1.62, 95% CI [1.14, 2.30]) or another family member/friend (RR = 1.98, 95% CI [1.14, 2.30]) were at increased risk of depressive symptoms above clinical threshold compared with participants living with both parents. A quarter of urban low-risk school-going adolescents had depressive symptoms in the clinical range in Kampala; girls and adolescents not living with their parents were particularly vulnerable. It recommended that school staff be equipped with skills to identify students who may be at risk for depression and make appropriate referrals.
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Affiliation(s)
| | - Emily Claire Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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The prevalence of mental health problems in sub-Saharan adolescents: A systematic review. PLoS One 2021; 16:e0251689. [PMID: 33989357 PMCID: PMC8121357 DOI: 10.1371/journal.pone.0251689] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 05/01/2021] [Indexed: 12/11/2022] Open
Abstract
Background and purpose Most research regarding child and adolescent mental health prevention and promotion in low-and middle-income countries is undertaken in high-income countries. This systematic review set out to synthesise findings from epidemiological studies, published between 2008 and 2020, documenting the prevalence of mental health problems in adolescents from across sub-Saharan Africa. Methods A systematic search of multiple databases (MEDLINE, PsycINFO, Scopus) and Google Scholar was conducted guided by the Joanna Briggs Institute (JBI) Reviewer’s manual for systematic reviews of observational epidemiological studies. Studies included reported prevalence outcomes for adolescents aged 10–19 using either clinical interviews or standardized questionnaires to assess psychopathology. Clinical samples were excluded. Results The search yielded 1 549 records of which 316 studies were assessed for eligibility and 51 met the inclusion criteria. We present a qualitative synthesis of 37 of these 51 included articles. The other 14 studies reporting prevalence rates for adolescents living with HIV are published elsewhere. The prevalence of depression, anxiety disorders, emotional and behavioural difficulties, posttraumatic stress and suicidal behaviour in the general adolescent population and selected at-risk groups in 16 sub-Saharan countries (with a total population of 97 616 adolescents) are reported.
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Suicidal ideation and associated factors among school-going adolescents in rural Ghana. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01378-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AbstractSuicidal ideation is a critical risk for attempted suicide and eventual suicide. Little is known about suicidal ideation among rural adolescents in most sub-Saharan African countries. We aimed to estimate the 12-month prevalence of suicidal ideation and to describe some of the common and gender-specific associated factors among in-school adolescents in rural Ghana. We conducted a cross-sectional survey involving a random sample of 1101 in-school adolescents aged 10–19 years in a rural district in Eastern Ghana. The Suicidal Behavior Questionnaire-Revised was used to assess suicidal ideation. Overall, 25.1% participants (95% CI = 22.5–27.7), representing 28.3% females (95% CI = 24.7–32.2) and 21.5% males (95% CI = 18.0–25.2) reported suicidal ideation during the previous 12 months. Females who experienced personal and interpersonal adversities mainly outside the family context were likely to report suicidal ideation, while suicidal ideation among males was associated with conflict with parents. Regardless of gender, adolescents who reported exposure to a friend’s attempted suicide were about two times more likely to report suicidal ideation. The prevalence of suicidal ideation among adolescents in rural Ghana compares with in-school estimates from other countries within sub-Saharan Africa, but also underscores the need for targeted and universal prevention programmes and intervention efforts to mitigate the potential transition from suicidal ideations to suicidal attempts and eventual deaths by suicide among rural adolescents.
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Quarshie ENB, Onyeaka HK, Oppong Asante K. Suicidal behaviours among adolescents in Liberia. BMC Psychiatry 2020; 20:572. [PMID: 33256674 PMCID: PMC7706245 DOI: 10.1186/s12888-020-02985-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/23/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Whereas suicide remains in the top 12 leading causes of death among young people aged 10-24 in sub-Saharan Africa, little is known about suicidal behaviours among adolescents in Liberia. We aimed to estimate the 12-month prevalence and describe some of the correlates of suicide behaviours (ideation, planning, and attempt) among school-going adolescents in Liberia. METHODS We analysed data from the 2017 Liberia Global School-based Student Health Survey conducted nationwide among secondary school students. We performed bivariate and multivariable analyses to assess the correlates of suicidal ideation, planning, and attempt in the previous 12 months. RESULTS Of the 2744 students, 26.8% reported suicidal ideation, 36.5% made a specific plan to attempt suicide and 33.7% attempted suicide during the 12 months preceding the survey. In the final adjusted logistic models, bullying victimisation and food insecurity were associated with increased odds of ideation, planning, and attempt. Whereas no factor was uniquely associated with suicidal ideation, having many close friends, and parental monitoring were associated with the increased odds of suicidal planning only. Leisure-time sedentary behaviour was associated with increased odds of suicidal planning and attempt. Cannabis use, alcohol drunkenness, being physically attacked, and parental supervision were uniquely associated with increased odds of suicidal attempt, while parental understanding and having a smaller number of close friends were uniquely associated with reduced odds of suicidal attempt. CONCLUSIONS The relatively high prevalence estimates of suicide behaviours and the multi-contextual nature of the associated factors warrant the need for the design and implementation of universal and multi-level, collaborative targeted intervention efforts towards the prevention of the onset of ideation, planning, and attempt, and the possible transition to deaths by suicide among school-going adolescents in Liberia.
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Affiliation(s)
- Emmanuel Nii-Boye Quarshie
- Department of Psychology, University of Ghana, P.O. Box LG 84, Accra, Ghana. .,School of Psychology, University of Leeds, Leeds, UK.
| | - Henry K. Onyeaka
- Department of Psychiatry, Massachusetts General Hospital/Mclean Hospital, Boston, USA ,grid.38142.3c000000041936754XHarvard Medical School, Boston, USA
| | - Kwaku Oppong Asante
- grid.8652.90000 0004 1937 1485Department of Psychology, University of Ghana, P.O. Box LG 84, Accra, Ghana ,grid.412219.d0000 0001 2284 638XDepartment of Psychology, University of the Free State, Bloemfontein, South Africa
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Self-harm with suicidal and non-suicidal intent in young people in sub-Saharan Africa: a systematic review. BMC Psychiatry 2020; 20:234. [PMID: 32408896 PMCID: PMC7222461 DOI: 10.1186/s12888-020-02587-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/05/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Self-harm, whether attributed to suicidal or non-suicidal motives, is associated with several poor outcomes in young people, including eventual suicide. Much of our understanding of self-harm in young people is based on literature from Europe (particularly, the UK), North America, and Australia. We aimed to synthesise the available evidence on prevalence, the commonly reported self-harm methods, correlates, risk and protective factors, and reasons for self-harm, in adolescents (aged 10-25 years) in sub-Saharan Africa. METHOD We searched MEDLINE, PsycINFO, PubMed, African Journals OnLine, and African Index Medicus for records from 1950 through August 2019, without language restrictions. We supplemented the database searches by searching relevant portals for postgraduate theses, reference harvesting, contacting authors for unpublished studies, and hand searching relevant print sources. We applied narrative synthesis to the evidence. RESULTS Seventy-four studies from 18 sub-Saharan African countries met the inclusion criteria. The median lifetime prevalence estimate was 10·3% (interquartile range [IQR] 4·6% - 16·1%); median 12-month prevalence estimate was 16·9% (IQR: 11·5% - 25·5%); median 6-month prevalence estimate was 18·2% (IQR: 12·7% - 21·8%); and the median 1-month prevalence estimate was 3·2% (IQR: 2·5-14·8%). Studies from Western sub-Saharan Africa reported the highest 12-month prevalence estimates (median = 24·3%; IQR = 16·9% - 27·9%). Clinical samples commonly reported overdose, whereas self-cutting was most commonly reported in non-clinical samples. Academic failure, sexual, emotional, and physical abuse, romantic relationship problems, family conflict, depression, and previous self-harm were identified as key correlates of self-harm. No study reported protective factors against self-harm. CONCLUSION Variation in estimates was explained by small sample sizes and variation in definitions and measures used. Exploration of associations, risks and protective factors was based upon concepts and measures derived from high income countries. More detailed and culturally sensitive research is needed to understand the context-specific risks and protective factors for self-harm in adolescents in sub-Saharan Africa.
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Berhane Y, Canavan CR, Darling AM, Sudfeld CR, Vuai S, Adanu R, Bärnighausen T, Dessie Y, Bukenya JN, Guwatudde D, Killewo J, Sando MM, Sie A, Oduola AMJ, Fawzi WW. The age of opportunity: prevalence of key risk factors among adolescents 10-19 years of age in nine communities in sub-Saharan Africa. Trop Med Int Health 2019; 25:15-32. [PMID: 31698531 DOI: 10.1111/tmi.13339] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To measure health-related behaviours and risk factors among sub-Saharan African adolescents. METHODS Cross-sectional study in nine communities in Burkina Faso, Ethiopia, Eswatini, Ghana, Nigeria, Tanzania and Uganda between 2015 and 2017. Community-representative samples of males and females 10-19 years of age were selected. All communities used a uniform questionnaire that was adapted from the WHO Global School-based Student Health Survey. Weighted prevalence estimates and 95% confidence intervals were calculated for each indicator and stratified by age and sex using SAS version 9.4. All prevalence estimates were pooled across communities through random-effects meta-analyses in Stata version 14. RESULTS A total of 8075 adolescents participated in the study. We observed a high prevalence of inadequate fruit consumption (57-63%) and low physical activity (82-90%); a moderate prevalence of inadequate vegetable consumption (21-31%), unprotected last sex (38-45%), age at first sex <15 years (21-28%) and bullying and physical fighting (12-35%); and a low prevalence of mental health risk factors (1-11%) and alcohol and substance use risk factors (0-6%). We observed a moderate to high prevalence of daily soft drink consumption (21-31%) for all adolescents. Among sexually active adolescents 15-19 years, 37% of females reported ever being pregnant and 8% of males reported to have ever made someone pregnant. Bullying (23%) and physical fighting (35%) were more common among younger male adolescents . The prevalence of low mood was generally higher among older (15-19 years) than younger adolescents (10-14 years). The proportion of adolescents reporting alcohol, drug or cigarette use was very small, with the exception of khat use in Ethiopia. CONCLUSION Overall, diet and physical activity, violence, sexual and reproductive health, and depression are important risk factors for these sub-Saharan African communities. These findings suggest that more evidence is needed including novel efforts for the collection of sensitive information, as well as a need to move towards community-tailored interventions to reach adolescent populations with varying needs.
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Affiliation(s)
- Yemane Berhane
- Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
| | - Chelsey R Canavan
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Anne Marie Darling
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Said Vuai
- College of Natural and Mathematical Sciences, University of Dodoma, Dodoma, Tanzania
| | - Richard Adanu
- Department of Population, Family and Reproductive Health, University of Ghana School of Public Health, Accra, Ghana
| | - Till Bärnighausen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany.,Africa Health Research Institute, Somkhele, KwaZulu-Natal, South Africa
| | - Yadeta Dessie
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Justine Nnakate Bukenya
- Department of Community Health and Behavioural Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - David Guwatudde
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mary M Sando
- Africa Academy for Public Health, Dar es Salaam, Tanzania
| | - Ali Sie
- Nouna Health Research Center, Nouna, Burkina Faso
| | - Ayoade M J Oduola
- University of Ibadan Research Foundation, University of Ibadan, Ibadan, Nigeria
| | - Wafaie W Fawzi
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Thornton VJ, Asanbe CB, Denton EGD. Clinical risk factors among youth at high risk for suicide in South Africa and Guyana. Depress Anxiety 2019; 36:423-432. [PMID: 30900366 DOI: 10.1002/da.22889] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 12/21/2018] [Accepted: 02/25/2019] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Suicide is the second leading cause of death among youth worldwide, but low- and middle-income countries (LMICs) account for 78% of all suicides. The LMICs South Africa and Guyana rank high in the global suicide rates. To better understand and prevent suicide among the youth, the present study targets youths at high risk for suicide, in an LMIC, to contextually and representatively identify clinical risk factors for suicide. METHODS One hundred-ninety youths, aged 11-21, separated from biological parents at the time of assessment, in South Africa and Guyana, were administered the Child Behavior Checklist and Behavior Assessment System for Children to assess clinical symptoms. The youths were asked about current suicide ideation and previous attempt(s). Self-report responses to clinical items yielded scale scores for depression, social stress, atypicality, somatization, anxiety, and ADHD. Using an integrative data analytic technique, clinical scale scores were standardized and used to predict suicidal behaviors in a binary logistic regression analysis. RESULTS Approximately 22% of Black South African youths and 60% of Guyanese youths endorsed suicide ideation and attempt or suicide attempt only. In fully adjusted analyses, the odds of atypicality and somatization were 1.96 and 1.67 times greater among the youths who endorsed suicidal ideation when compared with those who did not (p < .04). Youth social stress was significantly associated with the suicide attempt, controlling for model covariates (odds ratio [OR], 1.88, p = .05). Gender moderated the effect of somatization on youth suicide. CONCLUSION Our results contextualize how social stress, atypicality, and somatization relate to LMIC youth suicide. Further study on high-risk samples will contribute to generalizable suicide-prevention models.
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Affiliation(s)
- Veronica J Thornton
- Department of Human Development and Family Studies, The University of North Carolina at Greensboro, Greensboro, North Carolina
| | - Comfort B Asanbe
- Department of Psychology, City University of New York College of Staten Island, Staten Island, New York
| | - Ellen-Ge D Denton
- Department of Psychology, City University of New York College of Staten Island, Staten Island, New York
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Darré T, Consuela KAC, Saka B, Djiwa T, Ekouévi KD, Napo-Koura G. Suicidal ideation and suicide attempts in subjects aged 15-19 in Lomé (Togo). BMC Res Notes 2019; 12:187. [PMID: 30925944 PMCID: PMC6441225 DOI: 10.1186/s13104-019-4233-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 03/26/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The purpose of this study was to study the epidemiological and clinical profile of adolescents with suicidal thoughts, with or without suicide attempts, and to identify associated factors. RESULTS A total of 155 (16.5%) of the 941 adolescents interviewed had suicidal thoughts. The average age of the respondents was 18 ± 2.1 years. The sex ratio (m/f) was 1.4. With regard to marital status, 70.2% were single and 29.8% were in a relationship with a cohabiting partner. Family history of suicide was reported in 40%. In their personal history, eight were infected with HIV, three were chronic ethylic and two were diabetics. Forty-six (29.7%) of the 155 adolescents who had suicidal ideation had ever had a suicide attempt. Teens affected by suicide lived in a boarding school in 25.8%, with one parent in 23.9% and 50.3% with both parents. Factors associated with suicide attempts were female sex (p = 0.0107), age over 18 years (p = 0.0177), living in a couple (p = 0.0316), underlying immunodepression (HIV infection, p = 0.0059, sickle cell disease, p = 0.0043) and having a family history of suicides (p = 0.0461).
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Affiliation(s)
- Tchin Darré
- Department of Pathology, University of Lomé, B.P. 1515, Lome, Togo.
| | | | - Bayaki Saka
- Department of Dermatology, University of Lomé, Lome, Togo
| | - Toukilnan Djiwa
- Department of Pathology, University of Lomé, B.P. 1515, Lome, Togo
| | | | - Gado Napo-Koura
- Department of Pathology, University of Lomé, B.P. 1515, Lome, Togo
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Akol A, Nalugya J, Nshemereirwe S, Babirye JN, Engebretsen IMS. Does child and adolescent mental health in-service training result in equivalent knowledge gain among cadres of non-specialist health workers in Uganda? A pre-test post-test study. Int J Ment Health Syst 2017; 11:50. [PMID: 28855962 PMCID: PMC5571627 DOI: 10.1186/s13033-017-0158-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 08/20/2017] [Indexed: 12/16/2022] Open
Abstract
Background Early identification and management of child and adolescent mental health (CAMH) disorders helps to avert mental illness in adulthood but a CAMH treatment gap exists in Uganda. CAMH integration into primary health care (PHC) through in-service training of non-specialist health workers (NSHW) using the World Health Organisation (WHO) Mental Health Gap Action Programme (mhGAP) Intervention Guide (IG) is a strategy to address this gap. However, results of such training are not supported by information on training development or delivery; and are undifferentiated by NSHW cadre. We aim to describe an in-service CAMH training for NSHW in Uganda and assess cadre-differentiated learning outcomes. Methods Thirty-six clinical officers, nurses and midwives from 18 randomly selected PHC clinics in eastern Uganda were trained for 5 days on CAMH screening and referral using a curriculum based on the mhGAP-IG version 1.0 and PowerPoint slides from the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP). The residential training was evaluated through pre- and post- training tests of CAMH knowledge and attitudes using the participants’ post-test scores; and the difference between pre-test and post-test scores. Two-tailed t-tests assessed differences in mean pre-test and post-test scores between the cadres; hierarchical linear regression tested the association between cadre and post test scores; and logistic regression evaluated the relationship between cadre and knowledge gain at three pre-determined cut off points. Results Thirty-three participants completed both pre-and post-tests. Improved mean scores from pre- to post-test were observed for both clinical officers (20% change) and nurse/midwives (18% change). Clinical officers had significantly higher mean test scores than nurses and midwives (p < 0.05) but cadre was not significantly associated with improvement in CAMH knowledge at the 10% (AOR 0.08; 95 CI [0.01, 1.19]; p = 0.066), 15% (AOR 0.16; 95% CI [0.01, 2.21]; p = 0.170), or 25% (AOR 0.13; 95% CI [0.01, 1.74]; p = 0.122) levels. Conclusion We aimed to examine CAMH learning outcomes by NSHW cadre. NSHW cadre does not influence knowledge gain from in-service CAMH training. Thus, an option for integrating CAMH into PHC in Uganda using the mhGAP-IG and IACAPAP PowerPoint slides is to proceed without cadre differentiation. Electronic supplementary material The online version of this article (doi:10.1186/s13033-017-0158-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Angela Akol
- The Global Mental Health Research Group, Center for International Health, University of Bergen, Postboks 7804, N-5009 Bergen, Norway.,Makerere University School of Public Health, Kampala, Uganda
| | - Joyce Nalugya
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
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Nalugya-Sserunjogi J, Rukundo GZ, Ovuga E, Kiwuwa SM, Musisi S, Nakimuli-Mpungu E. Prevalence and factors associated with depression symptoms among school-going adolescents in Central Uganda. Child Adolesc Psychiatry Ment Health 2016; 10:39. [PMID: 27800012 PMCID: PMC5081935 DOI: 10.1186/s13034-016-0133-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 10/17/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Depression in adolescents constitutes a global public health concern. However, data on its prevalence and associated factors are limited in low income countries like Uganda. METHODS Using a cross-sectional descriptive study design, 519 adolescent students in 4 secondary schools in Mukono district, Uganda, were randomly selected after meeting study criteria. The 4 school types were: boarding mixed (boys and girls) school; day mixed school; girls' only boarding school; and, boys' only boarding school. The 519 participants filled out standardized questionnaires regarding their socio-demographic characteristics and health history. They were then screened for depression using the Children Depression Inventory (CDI) and those with a cut-off of 19 were administered the Mini International Neuro-Psychiatric Interview for Children and Adolescents 2.0 (MINI-KID), to ascertain the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM IV) diagnostic types of depression and any co morbidity. Logistic regression analyses were used to assess factors associated with significant depression symptoms (a score of 19 or more on the CDI). RESULTS There were 301 (58 %) boys and 218 (42 %) girls with age range 14-16 years and a mean age of 16 years (SD 2.18). Of 519 participants screened with the CDI, 109 (21 %) had significant depression symptoms. Of the 109 participants with significant depression symptoms, only 74 were evaluated with the MINI-KID and of these, 8 (11 %) met criteria for major depression and 6 (8 %) met criteria for dysthymia. Therefore, among participants that were assessed with both the CDI and the MINI-KID (n = 484), the prevalence of depressive disorders was 2.9 %. In this sample, 15 (3.1 %) reported current suicidal ideation. In the logistic regression analyses, significant depression symptoms were associated with single-sex schools, loss of parents and alcohol consumption. LIMITATIONS This is a cross-sectional study therefore, causal relationships are difficult to establish. Limited resources and the lack of collateral information precluded the assessment of a number of potential factors that could be associated with adolescent depression. The MINI-KID was administered to only 74 out of 109 students who scored ≥19 on the CDI since 35 students could not be traced again due to limited resources at the time. CONCLUSIONS Significant depression symptoms are prevalent among school-going adolescents and may progress to full-blown depressive disorders. Culturally sensitive psychological interventions to prevent and treat depression among school-going adolescents are urgently needed.
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Affiliation(s)
- Joyce Nalugya-Sserunjogi
- Department of Psychiatry, Makerere University, College of Health Sciences, Kampala, Uganda ,Mulago National Referral and Teaching Hospital, Ministry of Health, Kampala, Uganda
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Emilio Ovuga
- Department of Psychiatry, Gulu University, Gulu, Uganda
| | - Steven M. Kiwuwa
- Department of Child Health and Development, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Seggane Musisi
- Department of Psychiatry, Makerere University, College of Health Sciences, Kampala, Uganda
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Iemmi V, Bantjes J, Coast E, Channer K, Leone T, McDaid D, Palfreyman A, Stephens B, Lund C. Suicide and poverty in low-income and middle-income countries: a systematic review. Lancet Psychiatry 2016; 3:774-783. [PMID: 27475770 DOI: 10.1016/s2215-0366(16)30066-9] [Citation(s) in RCA: 148] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 12/12/2022]
Abstract
Suicide is the 15th leading cause of death worldwide, with over 75% of suicides occurring in low-income and middle-income countries. Nonetheless, evidence on the association between suicide and poverty in low-income and middle-income countries is scarce. We did a systematic review to understand the association between suicidal ideations and behaviours and economic poverty in low-income and middle-income countries. We included studies testing the association between suicidal ideations and behaviours and economic poverty in low-income and middle-income countries using bivariate or multivariate analysis and published in English between January, 2004, and April, 2014. We identified 37 studies meeting these inclusion criteria. In 18 studies reporting the association between completed suicide and poverty, 31 associations were explored. The majority reported a positive association. Of the 20 studies reporting on the relationship between non-fatal suicidal ideations and behaviours and poverty, 36 associations were explored. Again, almost all studies reported a positive association. However, when considering each poverty dimension separately, we found substantial variations. These findings show a consistent trend at the individual level indicating that poverty, particularly in the form of worse economic status, diminished wealth, and unemployment is associated with suicidal ideations and behaviours. At the country level, there are insufficient data to draw clear conclusions. Available data show a potential benefit in addressing economic poverty within suicide prevention strategies, with particular attention to both chronic poverty and acute economic events.
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Affiliation(s)
- Valentina Iemmi
- London School of Economics and Political Science, London, UK.
| | | | - Ernestina Coast
- London School of Economics and Political Science, London, UK
| | | | - Tiziana Leone
- London School of Economics and Political Science, London, UK
| | - David McDaid
- London School of Economics and Political Science, London, UK
| | | | | | - Crick Lund
- University of Cape Town, Cape Town, South Africa
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Poverty and suicide research in low- and middle-income countries: systematic mapping of literature published in English and a proposed research agenda. Glob Ment Health (Camb) 2016; 3:e32. [PMID: 28596900 PMCID: PMC5454768 DOI: 10.1017/gmh.2016.27] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 10/03/2016] [Accepted: 10/14/2016] [Indexed: 11/06/2022] Open
Abstract
Approximately 75% of suicides occur in low- and middle-income countries (LMICs) where rates of poverty are high. Evidence suggests a relationship between economic variables and suicidal behaviour. To plan effective suicide prevention interventions in LMICs we need to understand the relationship between poverty and suicidal behaviour and how contextual factors may mediate this relationship. We conducted a systematic mapping of the English literature on poverty and suicidal behaviour in LMICs, to provide an overview of what is known about this topic, highlight gaps in literature, and consider the implications of current knowledge for research and policy. Eleven databases were searched using a combination of key words for suicidal ideation and behaviours, poverty and LMICs to identify articles published in English between January 2004 and April 2014. Narrative analysis was performed for the 84 studies meeting inclusion criteria. Most English studies in this area come from South Asia and Middle, East and North Africa, with a relative dearth of studies from countries in Sub-Saharan Africa. Most of the available evidence comes from upper middle-income countries; only 6% of studies come from low-income countries. Most studies focused on poverty measures such as unemployment and economic status, while neglecting dimensions such as debt, relative and absolute poverty, and support from welfare systems. Most studies are conducted within a risk-factor paradigm and employ descriptive statistics thus providing little insight into the nature of the relationship. More robust evidence is needed in this area, with theory-driven studies focussing on a wider range of poverty dimensions, and employing more sophisticated statistical methods.
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Straight B, Pike I, Hilton C, Oesterle M. Suicide in Three East African Pastoralist Communities and the Role of Researcher Outsiders for Positive Transformation: A Case Study. Cult Med Psychiatry 2015; 39:557-78. [PMID: 25381581 DOI: 10.1007/s11013-014-9417-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We examine cultural understandings and practices surrounding suicide in Pokot, Samburu, and Turkana pastoralists in north-central Kenya--three geographically overlapping and mutually interacting pastoralist communities. We collected our data in the context of a study of poverty, violence, and distress. In all three communities, stigma associated with suicide circumscribed individual responses to the World Health Organization's Self-Report Questionnaire, which led to an ethnographic sub-study of suicide building upon our long-standing research in East Africa on distress, violence, and death. As is true for most of sub-Saharan Africa, reliable statistical data are non-existent for these communities. Thus, we deliberately avoid making assertions about generalizable statistical trends. Rather, we take the position that ethnographically nuanced studies like the one we offer here provide a necessary basis for the respectful collection of accurate quantitative data on this important and troubling practice. Moreover, our central point in this paper is that positive transformational work relating to suicide is most likely when researcher outsiders practice 'deep engagement' while respectfully restricting their role to (1) iterative, community-driven approaches that contextualize suicide; and (2) sharing contextualized analyses with other practitioners. We contend that situating suicide within a broader cultural framework that includes attitudes and practices surrounding other forms of death is essential to both aspects of anthropological-outsiders' role.
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Affiliation(s)
- Bilinda Straight
- Department of Anthropology, Western Michigan University, 1020 Moore Hall, Kalamazoo, MI, 49008, USA,
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Mutumba M, Resnicow K, Bauermeister JA, Harper GW, Musiime V, Snow RC, Lepkowski JM. Development of a psychosocial distress measure for Ugandan adolescents living with HIV. AIDS Behav 2015; 19:380-92. [PMID: 25577026 DOI: 10.1007/s10461-014-0973-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Psychological distress among adolescents living with HIV (ALH) has been associated with risky behaviors including non-adherence to anti-retroviral therapy, leading to increased risk for AIDS morbidity and mortality. Efforts to establish the nature, prevalence, and impact of psychological distress among ALH in Uganda are hindered by the lack of culturally relevant assessment tools. The purpose of this study was to develop and test a measure for psychological distress for Ugandan ALH aged 12-19 years (N = 508; 53.1 % female). Using a mixed method approach, we developed and tested a 25-item checklist with six subscales-anhedonia, depressive-anxiety, isolation, suicidal ideation, sleep problems, and somatization. We found adequate reliability for the scale (α = 0.89), and a satisfactory measurement structure in our confirmatory factor analyses (RMSEA <1.0, and CFI and TLI >0.90). We discuss the potential use of this culturally sensitive scale to examine psychological distress among ALH in Uganda.
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Kinyanda E, Weiss HA, Mungherera M, Onyango-Mangen P, Ngabirano E, Kajungu R, Kagugube J, Muhwezi W, Muron J, Patel V. Prevalence and risk factors of attempted suicide in adult war-affected population of eastern Uganda. CRISIS 2014; 34:314-23. [PMID: 23608229 DOI: 10.1027/0227-5910/a000196] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is conflicting evidence on the relationship between war trauma and suicidal behavior. Some studies point to an increased risk of suicidal behavior while others do not, with a paucity of such data from sub-Saharan Africa. AIMS To investigate the prevalence and risk factors of attempted suicide in war-affected Eastern Uganda. METHOD A cross-sectional survey was carried out in two districts of Eastern Uganda where 1,560 respondents (15 years and older) were interviewed. Multivariable logistic regression was used to assess risk factors of attempted suicide in this population. RESULTS Lifetime attempted suicide was 9.2% (n = 142; 95% CI, 7.8%-10.8%), and 12-month attempted suicide was 2.6% (n = 41; 95% CI, 1.9-3.5%). Lifetime attempted suicide was significantly higher among females 101 (11.1%) than among males 43 (6.5%; OR = 1.80, 95% CI 1.21-2.65). Factors independently associated with lifetime rate of attempted suicide among females were subcounty, being a victim of intimate partner violence, having reproductive health complaints, and having major depressive disorder. Among males these were belonging to a war-vulnerable group, having a surgical complaint, and having a major depressive disorder. CONCLUSIONS In both sexes, the lifetime rate of attempted suicide was not independently directly related to experiences of war trauma. It was, however, indirectly related to war trauma through its association with psychological, somatic, and psychosocial sequelae of war.
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Affiliation(s)
- Eugene Kinyanda
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda/Senior EDCTP Fellowship, Cape Town, South Africa.
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Mamah D, Striley CW, Ndetei DM, Mbwayo AW, Mutiso VN, Khasakhala LI, Cottler LB. Knowledge of psychiatric terms and concepts among Kenyan youth: analysis of focus group discussions. Transcult Psychiatry 2013; 50:515-31. [PMID: 24005094 DOI: 10.1177/1363461513499809] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Psychiatric disorders and symptoms are common worldwide. However, cultural differences in symptom manifestation and knowledge of psychiatric terms and concepts represent a challenge to accurate clinical assessment. Our previous youth surveys revealed higher rates of psychotic experiences in Kenya compared to several other countries, suggesting culture may influence psychosis risk assessment survey results. The goal of the present investigation is to evaluate understanding of general mental health related terms and concepts and specific items from the Structured Interview for Psychosis-Risk Symptoms (SIPS), a commonly used psychosis risk assessment instrument. Six focus groups were conducted in Nairobi, Kenya and surrounding areas with young adults from the community, university and secondary school students, and mental health professionals. Analysis of the information obtained from participants indicated that adolescents and young adults in Kenya were aware of mental illness in their communities, but had very limited knowledge of the meaning of specific psychiatric disorders and symptoms. Many believed that the cause of mental illness was spiritual in nature. These results suggest that in order to obtain accurate reported rates of psychiatric symptoms, assessment of Kenyan adolescents and young adults requires elaboration of assessment questions and use of simplified terms.
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Abbo C, Kinyanda E, Kizza RB, Levin J, Ndyanabangi S, Stein DJ. Prevalence, comorbidity and predictors of anxiety disorders in children and adolescents in rural north-eastern Uganda. Child Adolesc Psychiatry Ment Health 2013; 7:21. [PMID: 23841918 PMCID: PMC3710504 DOI: 10.1186/1753-2000-7-21] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Accepted: 07/08/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Child and adolescent anxiety disorders are the most prevalent form of childhood psychopathology. Research on child and adolescent anxiety disorders has predominantly been done in westernized societies. There is a paucity of data on the prevalence, comorbidity, and predictors of anxiety disorders in children and adolescents in non-western societies including those in sub-Saharan Africa. This paper investigates the prevalence, comorbidity, and predictors of anxiety disorders in children and adolescents in north-eastern Uganda. OBJECTIVE To determine the prevalence of DSM-IV anxiety disorders, as well as comorbidity patterns and predictors in children and adolescents aged 3 to 19 years in north-eastern Uganda. METHODS Four districts (Lira, Tororo, Kaberamaido and Gulu) in rural north-eastern Uganda participated in this study. Using a multi-stage sampling procedure, a sample of 420 households with children aged 3-19 years from each district was enrolled into the study. The MINI International Neuropsychiatric Interview for children and adolescents (MINI KID) was used to assess for psychiatric disorders in 1587 of 1680 respondents. RESULTS The prevalence of anxiety disorders was 26.6%, with rates higher in females (29.7%) than in males (23.1%). The most common disorders in both males and females were specific phobia (15.8%), posttraumatic stress disorder (PTSD) (6.6%) and separation anxiety disorder (5.8%). Children below 5 years of age were significantly more likely to have separation anxiety disorder and specific phobias, while those aged between 14-19 were significantly more likely to have PTSD. Anxiety disorders were more prevalent among respondents with other psychiatric disorders; in respondents with two or more co-morbid psychiatric disorders the prevalence of anxiety disorders was 62.1%. Predictors of anxiety disorders were experience of war trauma (OR = 1.93, p < 0.001) and a higher score on the emotional symptom scale of the SDQ (OR = 2.58, p < 0.001). Significant socio-demograghic associations of anxiety disorders were found for female gender, guardian unemployment, living in permanent housing, living without parents, and having parents without education. CONCLUSION The prevalence of anxiety disorders in children and adolescents in rural north-eastern Uganda is high, but consistent in terms of gender ratio and progression over time with a range of prior work in other contexts. Patterns of comorbidity and predictors of anxiety disorders in this setting are also broadly consistent with previous findings from western community studies. Both psychosocial stressors and exposure to war trauma are significant predictors of anxiety disorders.Prevention and treatment strategies need to be put in place to address the high prevalence rates of anxiety disorders in children and adolescents in Uganda.
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Affiliation(s)
- Catherine Abbo
- Department of Psychiatry, College of Health Sciences, Makerere University, P.O.BOX 7072, Kampala, Uganda
- Division of Child and Adolescent Psychiatry, Red Cross War Memorial Hospital and University of Cape Town, 7700 Rondebosch, Cape Town, South Africa
| | - Eugene Kinyanda
- MRC/UVRI Uganda Reseach Unit on AIDS, P.O.BOX 49, Entebbe, Uganda
| | - Ruth B Kizza
- North Stockholm’s Psychiatric Clinic, Stockholm, Sweden
| | - Jonathan Levin
- MRC/UVRI Uganda Reseach Unit on AIDS, P.O.BOX 49, Entebbe, Uganda
| | | | - Dan J Stein
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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Kinyanda E, Kizza R, Abbo C, Ndyanabangi S, Levin J. Prevalence and risk factors of depression in childhood and adolescence as seen in four districts of North-Eastern Uganda. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2013; 13:19. [PMID: 23561039 PMCID: PMC3626891 DOI: 10.1186/1472-698x-13-19] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 03/15/2013] [Indexed: 11/10/2022]
Abstract
Background Millions of African children are having to grow up under harsh and adverse psychosocial conditions but it’s not fully understood how this negative psychosocial environment is affecting their mental health. This paper examines the prevalence and risk factors of depression in childhood and adolescence as seen in a community sample derived from four disadvantaged districts in north-eastern Uganda. Methods 1587 children were assessed using a structured instrument administered by trained psychiatric nurses to collect data on psychiatric disorders (DSM IV criteria), adverse psychosocial factors and socio-demographic factors. Results The point prevalence of depressive disorder syndromes (DDS) in this study was 8.6% (95% CI 7.2%–10.1%) with a point prevalence for major depressive episode of 7.6% (95% CI 6.3%–9.0%) and dysthymia of 2.1% (95% CI 1.5%–3.0%). At multiple logistic regression, the factors that were independently significantly associated with DDS were: district (representing ecological factors), nature of living arrangements, domestic violence and psychiatric co-morbidities/psychiatric problems of emotional distress (assessed by the SDQ), suicidality and marginally, anxiety disorder syndromes, eating disorder syndromes, motor disorder syndromes and behavioral and developmental disorder syndromes (the later being protective against depression). Conclusion Disadvantaged north-eastern Uganda had a high prevalence of childhood depressive disorders. Ecological factors, markers of the quality of the child-principal caregiver relationship (nature of living arrangements and domestic violence) and the presence of psychiatric co-morbidities/psychiatric problems were the important independent determinants of childhood depression in this study.
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Affiliation(s)
- Eugene Kinyanda
- MRC/UVRI Uganda Research Unit on AIDS, Senior EDCTP Fellowship, P.O. Box 49, Entebbe/Cape Town, Uganda, South Africa.
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