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Getachew B, Mulu A. Prevalence and associated factors of post-stroke depression in Africa: a systematic review and meta-analysis. BMC Neurol 2024; 24:360. [PMID: 39342116 PMCID: PMC11438399 DOI: 10.1186/s12883-024-03867-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 09/17/2024] [Indexed: 10/01/2024] Open
Abstract
BACKGROUND Depressive disorder is considered the most frequent and burdensome mental health complication after stroke. Post-stroke depression is under-recognized in Africa and data remain scarce. These systematic reviews and meta-analyses were, therefore conducted to fill the gap. METHODS An inclusive review of both published and unpublished articles was conducted. An initial search was conducted in PubMed, African Journal Online, EMBASE, SCOPUS and Google Scholar. Data were extracted using an Excel data format and the analysis was done using STATA version 14 statistical software. The heterogeneity of studies was determined using the Cochrane Q test statistic and I2 test statistics with forest plots. A random effects model was used to examine the pooled prevalence of post-stroke depression and subgroup analysis was conducted for those having significant heterogeneity. Sensitivity analysis and publication bias were also assessed. Pooled odds ratios (ORs) with a 95% confidence interval (CI) were calculated. Results were presented in narratives, tables and forest plots. RESULT A total of 25 Articles with 3098 stroke patients from African countries were included to pool the prevalence of post-stroke depression in the meta-analysis. The pooled prevalence of post-stroke depression in Africa at any time was 38.35% [95% CI, 34.07-42.63%]. The pooled estimate for post-stroke depression using clinical diagnostic tools was [38.53%, 95%CI: 34.07-42.63] and (36.81% [32.09-41.52%]) by rating scale. Subgroup analysis by region showed that Central Africa [50.92%, 95% CI: 45.94-55.90] had the highest pooled estimate of depression among stroke survivors with high heterogeneity (92.5%). Female gender, cognitive dysfunction and younger age were found associated in the primary studies but their pooled Odds ratio and overall effect were not significant in the meta-analysis. The pooled estimate of the Odds ratio of physical disability in Africa was 2.02[95% CI, 1.04-3.94] with no heterogeneity but the overall effect was significant (p = 0.038). CONCLUSION Post-stroke depression was relatively higher in Africa. Central Africa had the highest burden of post-stroke depression followed by West Africa. Physical disability was significantly associated with post-stroke depression in the current meta-analysis.
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Affiliation(s)
- Bekalu Getachew
- Institute of Health, Department of Biomedical science, Jimma university, Jimma, Ethiopia.
| | - Abay Mulu
- Department of Anatomy, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Zhou P, Wang S, Yan Y, Lu Q, Pei J, Guo W, Yang X, Li Y. Association between chronic diseases and depression in the middle-aged and older adult Chinese population-a seven-year follow-up study based on CHARLS. Front Public Health 2023; 11:1176669. [PMID: 37546300 PMCID: PMC10403076 DOI: 10.3389/fpubh.2023.1176669] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background With the aging of the Chinese population, the prevalence of depression and chronic diseases is continually growing among middle-aged and older adult people. This study aimed to investigate the association between chronic diseases and depression in this population. Methods Data from the China Health and Retirement Longitudinal Study (CHARLS) 2011-2018 longitudinal survey, a 7-years follow-up of 7,163 participants over 45 years old, with no depression at baseline (2011). The chronic disease status in our study was based on the self-report of the participants, and depression was defined by the 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10). The relationship between baseline chronic disease and depression was assessed by the Kaplan-Meier method and Cox proportional hazards regression models. Results After 7-years follow-up, 41.2% (2,951/7163, 95% CI:40.1, 42.3%) of the participants reported depression. The analysis showed that participants with chronic diseases at baseline had a higher risk of depression and that such risk increased significantly with the number of chronic diseases suffered (1 chronic disease: HR = 1.197; 2 chronic diseases: HR = 1.310; 3 and more chronic diseases: HR = 1.397). Diabetes or high blood sugar (HR = 1.185), kidney disease (HR = 1.252), stomach or other digestive diseases (HR = 1.128), and arthritis or rheumatism (HR = 1.221) all significantly increased the risk of depression in middle-aged and older adult Chinese. Conclusion The present study found that suffering from different degrees of chronic diseases increased the risk of depression in middle-aged and older adult people, and these findings may benefit preventing depression and improving the quality of mental health in this group.
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Affiliation(s)
- Pengfei Zhou
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
- School of Public Health, Southwest Medical University, Luzhou, Sichuan, China
| | - Shuai Wang
- Department of Outpatient, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Ya Yan
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Qiang Lu
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Jiaxing Pei
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
- School of Public Health, Southwest Medical University, Luzhou, Sichuan, China
| | - Wang Guo
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
- Department of Statistics, College of Mathematics, Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Xiaoguang Yang
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
| | - Yunming Li
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, Chengdu, Sichuan, China
- School of Public Health, Southwest Medical University, Luzhou, Sichuan, China
- Department of Statistics, College of Mathematics, Southwest Jiaotong University, Chengdu, Sichuan, China
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Stieglitz LM, Adams LB, Bärnighausen T, Berghöfer A, Kazonda P, Killewo J, Leyna GH, Lohmann J, Rohr JK, Kohler S. Depressive symptoms and their association with age, chronic conditions and health status among middle-aged and elderly people in peri-urban Tanzania. Glob Ment Health (Camb) 2023; 10:e27. [PMID: 37854410 PMCID: PMC10579685 DOI: 10.1017/gmh.2023.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 02/28/2023] [Accepted: 04/25/2023] [Indexed: 10/20/2023] Open
Abstract
Background Depression is a global mental health challenge. We assessed the prevalence of depressive symptoms and their association with age, chronic conditions, and health status among middle-aged and elderly people in peri-urban Dar es Salaam, Tanzania. Methods Depressive symptoms were measured in 2,220 adults aged over 40 years from two wards of Dar es Salaam using the ten-item version of the Center of Epidemiologic Studies Depression Scale (CES-D-10) and a cut-off score of 10 or higher. The associations of depressive symptoms with age, 13 common chronic conditions, multimorbidity, self-rated health and any limitation in six activities of daily living were examined in univariable and multivariable logistic regressions. Results The estimated prevalence of depressive symptoms was 30.7% (95% CI 28.5-32.9). In univariable regressions, belonging to age groups 45-49 years (OR 1.35 [95% CI 1.04-1.75]) and over 70 years (OR 2.35 [95% CI 1.66-3.33]), chronic conditions, including ischemic heart disease (OR 3.43 [95% CI 2.64-4.46]), tuberculosis (OR 2.42 [95% CI 1.64-3.57]), signs of cognitive problems (OR 1.90 [95% CI 1.35-2.67]), stroke (OR 1.56 [95% CI 1.05-2.32]) and anemia (OR 1.32 [95% CI 1.01-1.71]) and limitations in activities of daily living (OR 1.35 [95% CI 1.07-1.70]) increased the odds of depressive symptoms. Reporting good or very good health was associated with lower odds of depressive symptoms (OR 0.48 [95% CI 0.35-0.66]). Ischemic heart disease and tuberculosis remained independent predictors of depressive symptoms in multivariable regressions. Conclusion Depressive symptoms affected almost one in three people aged over 40 years. Their prevalence differed across age groups and was moderated by chronic conditions, health status and socioeconomic factors.
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Affiliation(s)
- Laura-Marie Stieglitz
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Leslie B Adams
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Anne Berghöfer
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Japhet Killewo
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Germana H Leyna
- Department of Epidemiology and Biostatistics, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julia Lohmann
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Julia K Rohr
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, MA, USA
| | - Stefan Kohler
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
- Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Pengpid S, Peltzer K. Prevalence and correlates of major depressive disorder among a national sample of middle-aged and older adults in India. Aging Ment Health 2023; 27:81-86. [PMID: 35037808 DOI: 10.1080/13607863.2021.2024796] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives: This study aimed to assess the prevalence and correlates of major depressive disorder (MDD) among middle-age and older adults in India.Methods: The cross-sectional sample consisted of 72,262 persons (45 years and older) from the 2017 to 2018 Longitudinal Ageing Study in India (LASI) Wave 1. MDD is defined using DSM-5 criteria and measured with the CIDI-SF. Logistic regression was used to evaluate the associations with MDD.Results: The prevalence of past 12-month MDD was 7.6%, 8.1% among women and 7.0% among men, and 8.2% in persons 60 years and older. In the final adjusted model, food insecurity, having 3-6 discrimination experiences, ill-treatment, victim of violent crime, disaster exposure, unsafe home/neighbourhood, poor childhood health, hypertension, stroke, tobacco use, and physical pain were positively associated with MDD. Being male, married, high socioeconomic status, living in urban areas, high spirituality/religiosity, health insurance and medium social network were negatively associated with MDD.Conclusion: Almost one in ten middle-aged and older adults in India had MDD and several associated factors were identified.
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Affiliation(s)
- Supa Pengpid
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, Thailand.,Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa
| | - Karl Peltzer
- Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa.,Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
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Determinants of post-stroke depression among stroke survivors at University of Gondar Hospital, Northwest Ethiopia: a case-control study. BMC Neurol 2022; 22:446. [PMID: 36456908 PMCID: PMC9714110 DOI: 10.1186/s12883-022-02982-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 11/17/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Stroke is one of the most common causes of disability among adults. Post-stroke depression (PSD) is a frequent neuropsychiatric complication in stroke patients. Despite the increasing prevalence of stroke, there is a paucity of data on PSD and its determinants among stroke survivors in developing countries like Ethiopia. We aim to assess the factors associated with PSD in survivors of stroke. METHOD A hospital-based unmatched case-control study was conducted during the period of February to July 2020 at University of Gondar Hospital among stroke survivors. Study subjects were recruited consecutively. Socio-demographic and clinical data were obtained from patients' interviews and medical record reviews. A diagnosis of PSD was made using the Patient Health Questionnaire (PHQ-9). EpiData version 3.1 was used to enter data, and SPSS version 26 was used to analyze it. Bivariate and multivariate logistic regressions were fitted to identify associated variables. The adjusted odds ratio (AOR) with 95% confidence interval (CI) and p-value 0.05 were used to determine the significance of the association. RESULT A total of 240 stroke survivors were included in the study (80 cases and 160 controls). The mean age was 60.8 years (SD ± 14.3) with an equal sex distribution. Variables statistically associated with PSD were male gender (AOR = 3.5, 95% CI: 1.64-7.46 C, P-value = 0.001), subcortical location of the largest lesion (AOR = 2.42, 95% CI: 1.06-5.56, p-value = 0.036), severity of the stroke (AOR = 52.34, 95% CI:10.64-256.87, p-value = 0.000), physical disability (AOR = 5.85. 95% CI:1.94-17.65, p-value = 0.002), previous history of stroke or transient ischemic attack (AOR = 5.90, 95% CI:2.04-17.10, p-value = 0.001) and ischemic heart disease (AOR = 9.97, 95% CI:3.4-29.22, p-value = 0.000). CONCLUSION Important factors in the occurrence of PSD in this study include prior history of stroke, physical disability, severity of the stroke, subcortical location of the lesion, male gender, and ischemic heart disease. Stroke patients with such factors need routine screening for PSD, particularly in LMICs where there is uncoordinated post-stroke care, a shortage of neurologists and mental health practitioners.
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Predictors of Post-Stroke Depression: A Retrospective Cohort Study. Brain Sci 2022; 12:brainsci12080993. [PMID: 35892434 PMCID: PMC9332855 DOI: 10.3390/brainsci12080993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 07/16/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
Despite reports of a high incidence and various predictors of post-stroke depression (PSD), the underdiagnosis and undertreatment rates of PSD are still high. This study aimed to examine the incidence of depression in stroke patients and identify factors associated with PSD. This was a retrospective cohort study on ischemic stroke patients from the Geisinger Neuroscience Ischemic Stroke (GNSIS) registry. The following statistical analyses were performed to predict PSD in the studied population: a Kaplan−Meier estimator and a Cox proportional hazards model. A total of 5882 patients were included in the study. The median age at the time of an ischemic stroke was 72 years and 56% were males. A total of 294 patients were diagnosed with PSD within one year of a stroke. The cumulative incidence of depression was found to be 6.4% (95% CI 5.7−7.1%) at one year for the entire cohort. Women were found to have a higher risk of PSD than men (HR for women = 1.47, 95% CI 1.18−1.85, p = 0.001). A history of prior stroke (HR = 1.58, 95% CI 1.18−2.11, p = 0.002) and myocardial infarction (HR = 1.47, 95% CI 1.05−2.06, p = 0.025) were associated with PSD. Medicaid patients had a higher risk for PSD (HR = 2.16, 95% CI 1.5−3.12, p < 0.001) than those with commercial insurance or health maintenance organization plans. Our findings showed that women, patients with a history of prior stroke or myocardial infarction, and with Medicaid insurance were more likely to develop PSD. Through an observational study on the EHR data, we confirmed that chronic stress, including financial and health-related stress, irrespective of age, significantly increased the risk for PSD.
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Cuesta-Lozano D, Lopez-Alcalde J, Castro Molina FJ, García Sastre M, Maravilla Herrera P, Muriel A, Asenjo-Esteve ÁL, Alvarez-Diaz N, Monge Martín D, Carralero-Montero A. Psychoeducation for the parents of people with severe mental illness. Hippokratia 2022. [DOI: 10.1002/14651858.cd014532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Jesús Lopez-Alcalde
- Faculty of Medicine; Universidad Francisco de Vitoria; Pozuelo de Alarcón Spain
- Clinical Biostatistics Unit; Hospital Universitario Ramón y Cajal (IRYCIS). CIBER Epidemiology and Public Health (CIBERESP); Madrid Spain
- Institute for Complementary and Integrative Medicine; University Hospital Zurich and University of Zurich; Zurich Switzerland
| | | | | | | | - Alfonso Muriel
- Department of Nursing and Physiotherapy; Universidad de Alcalá; Madrid Spain
- Clinical Biostatistics Unit; Hospital Universitario Ramón y Cajal (IRYCIS). CIBER Epidemiology and Public Health (CIBERESP); Madrid Spain
| | | | | | - Diana Monge Martín
- Faculty of Medicine; Universidad Francisco de Vitoria; Pozuelo de Alarcón Spain
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Gbadamosi IT, Henneh IT, Aluko OM, Yawson EO, Fokoua AR, Koomson A, Torbi J, Olorunnado SE, Lewu FS, Yusha'u Y, Keji-Taofik ST, Biney RP, Tagoe TA. Depression in Sub-Saharan Africa. IBRO Neurosci Rep 2022; 12:309-322. [PMID: 35746974 PMCID: PMC9210463 DOI: 10.1016/j.ibneur.2022.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 03/14/2022] [Indexed: 12/23/2022] Open
Abstract
Mood disorders can be considered among the most common and debilitating mental disorders. Major depression, as an example of mood disorders, is known to severely reduce the quality of life as well as psychosocial functioning of those affected. Its impact on the burden of disease worldwide has been enormous, with the World Health Organisation projecting depression to be the leading cause of mental illness by 2030. Despite several studies on the subject, little has been done to contextualise the condition in Africa, coupled with the fact that there is still much to be understood on the subject. This review attempts to shed more light on the prevalence of depression in Sub-Saharan Africa (SSA), its pathophysiology, risk factors, diagnosis and the experimental models available to study depression within the sub-region. It also evaluates the contribution of the sub-region to the global research output of depression as well as bottlenecks associated with full exploitation of the sub region's resources to manage the disorder.
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Affiliation(s)
- Ismail Temitayo Gbadamosi
- Department of Anatomy, University of Ilorin, Nigeria
- Laboratory for Translational Research in Neuropsychiatric Disorders, BRAINCITY Nencki-EMBL Center of Excellence for Neural Plasticty and Brain Disorders, Warsaw, Poland
| | - Isaac Tabiri Henneh
- Department of Pharmacotherapeutics and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Ghana
| | - Oritoke Modupe Aluko
- Department of Physiology, School of Basic Medical Sciences, Federal University of Technology, Akure, Nigeria
| | | | | | - Awo Koomson
- Department of Pharmacology and Toxicology University of Ghana, Ghana
| | - Joseph Torbi
- Department of Pharmacology and Toxicology University of Ghana, Ghana
| | | | | | - Yusuf Yusha'u
- Department of Human Physiology Ahmadu Bello University, Zaria, Nigeria
| | | | - Robert Peter Biney
- Department of Pharmacotherapeutics and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Ghana
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Oyelade OO, Nkosi-Mafutha NG. Psychosocial rehabilitation of individuals with schizophrenia: a scoping review protocol. Syst Rev 2022; 11:32. [PMID: 35183253 PMCID: PMC8858536 DOI: 10.1186/s13643-022-01901-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 02/07/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The psychosocial rehabilitation of an individual with mental illness is an evidence-based approach to reducing the burden of the illness and the associated stigma globally. Specifically, in Africa, it has promising scope for African life and the African economy. Psychosocial rehabilitation is described as a set of approaches that aim to assist an individual in achieving restoration from a state of dependency caused by schizophrenia to a state of being an independent decision-maker. However, there seems to be a dearth of literature and implementation of psychosocial rehabilitation in Africa. Therefore, it is necessary to map studies on how psychosocial rehabilitation is conducted for people living in Africa with the most chronic form of mental illness, schizophrenia. METHODS This study will adopt the Arksey and O'Malley scoping review framework to search and compile relevant studies. This process will involve three steps: title screening, to be performed solely by the principal investigator, followed by abstract and full-text screening, to be performed independently by two reviewers (the principal investigator and co-investigator). Rayyan QCRI, a systematic reviews web app, will be used for tracking the screening records, and data charting form will be used to extract basic data of included studies. The risk of bias in the articles identified for screening will be assessed by the Mixed Method Appraisal Tool (MMAT). Finally, the content analysis of the screened studies will be performed with NVivo. EXPECTED OUTCOME This study has the likelihood of revealing a research gap in psychosocial rehabilitation approaches and methods. The review results will constitute part of the available evidence that the researchers aim to adopt in the broader part of the project, which aims to develop implementation strategies for the psychosocial rehabilitation of chronic mental illnesses, specifically schizophrenia, in Sub-Sahara Africa. The implementation process also encompasses disseminating the findings of this review to stakeholders, which will enhance their knowledge of the current state of Sub-Saharan Africa and may stimulate support for the implementation of rehabilitation strategies.
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Affiliation(s)
- Oyeyemi Olajumoke Oyelade
- Department of Nursing Education, School of Therapeutic Sciences, University of the Witwatersrand, Park Town, Johannesburg, South Africa.
- Department of Nursing Science, Faculty of Basic Medical Sciences, Obafemi Awolowo University, Ile-Ife, Osun-State, Nigeria.
| | - Nokuthula Gloria Nkosi-Mafutha
- Department of Nursing Education, School of Therapeutic Sciences, University of the Witwatersrand, Park Town, Johannesburg, South Africa
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Prevalence and Associated Factors of Poststroke Depression among Outpatient Stroke Patients Who Have a Follow-Up at the Outpatient Neurology Clinic of Zewditu Memorial Hospital in Addis Ababa, Ethiopia. DEPRESSION RESEARCH AND TREATMENT 2022; 2022:9750035. [PMID: 35359498 PMCID: PMC8964203 DOI: 10.1155/2022/9750035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 03/05/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Poststroke depression is the most common and burdensome poststroke psychiatric complication. Studies showed discrepancies in reporting frequencies and risk factors for poststroke depression. Updated local data are relevant for efficient strategies of poststroke depression screening and prevention. OBJECTIVES To determine the prevalence and associated factors of poststroke depression among outpatient stroke patients from the outpatient neurology clinic of Zewditu Memorial Hospital in Addis Ababa, Ethiopia. METHODS An institution-based cross-sectional study was conducted on 249 stroke patients. Data was collected through structured questionnaire using interviews and a review of medical charts. PHQ-9 depression questionnaire was used to diagnose poststroke depression. Descriptive analysis was used to see the nature of the characteristics of interests. Bivariate analysis was used to sort out variables at p values less than 0.05 for multivariate logistic regression. Significance level was obtained using an odds ratio with 95% CI and p value < 0.05. RESULTS Point prevalence for poststroke depression was 27.5 percent. Female gender, unemployment, low social support level, diabetes mellitus, and poststroke period under 2 years were statistically significant and independent predictors for poststroke depression. CONCLUSIONS The point prevalence estimate of poststroke depression was comparable with other studies. Low social support levels increased the odds for poststroke depression by more than eight folds. It appeared that external factors are more important in the pathogenesis of poststroke depression in the African population. Detection and prevention programs should consider disparities of poststroke depression incidence and risk factors.
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Rice DR, Okeng'o K, Massawe E, Ismail S, Mworia NA, Chiwanga F, Kapina B, Wasserman M, Mateen FJ. Efficacy of Fluoxetine for Post-Ischemic Stroke Depression in Tanzania. J Stroke Cerebrovasc Dis 2022; 31:106181. [PMID: 34740138 PMCID: PMC8766895 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/14/2021] [Accepted: 10/17/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE Post-stroke fluoxetine trials are primarily conducted in high-income countries. We characterize post-ischemic stroke depression in fluoxetine-treated and -untreated study participants in urban Tanzania. METHODS Adults (>18 years old) within 14 days of CT-confirmed acute ischemic stroke onset were enrolled at Muhimbili National Hospital, Tanzania. The fluoxetine-treated group took 20mg fluoxetine daily for 90 days in a phase II trial and were compared to fluoxetine-untreated historical controls. The primary outcome was depression at 90 days, measured by the Patient Health Questionnaire-9 (PHQ-9). PHQ-9 scores were compared between fluoxetine-treated and -untreated groups. A score >=9 points was considered to reflect depression. A multivariable linear regression model assessed associations with post-stroke PHQ-9 scores. RESULTS Of the fluoxetine-treated (n=27) and -untreated (n=32) participants, the average age was 56.8 years old (39% women, 100% Black/African). The average presentation NIHSS score was 12.1 points and modified Rankin Scale (mRS) score was 3.5. The average mRS score at 90-day follow-up was 2.3. There was no significant difference between 90-day PHQ-9 scores in the fluoxetine-treated (mean=4.1 points, standard deviation=3.2; 11% depression) and untreated (mean=4.4, standard deviation=4.8; 19% depression) groups, p=.69. In the multivariable analysis, older age (β=0.08, p=.03) and higher NIHSS score (β=0.15, p=.04), but neither fluoxetine (β=0.57, p=.59) nor sex (β=-0.51, p=.63), were significantly associated with more depressive symptoms. CONCLUSIONS Our findings parallel results from trials from higher income settings that fluoxetine does not significantly improve post-ischemic stroke depression, although our sample size was small. More work is needed to depict the longitudinal nature and treatment of post-stroke depression in Sub-Saharan Africa.
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Affiliation(s)
- Dylan R Rice
- Massachusetts General Hospital, Boston, MA, United States
| | | | | | - Seif Ismail
- Muhimbili National Hospital, Dar es Salaam, Tanzania
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Remes O, Mendes JF, Templeton P. Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature. Brain Sci 2021; 11:1633. [PMID: 34942936 PMCID: PMC8699555 DOI: 10.3390/brainsci11121633] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 12/15/2022] Open
Abstract
Depression is one of the leading causes of disability, and, if left unmanaged, it can increase the risk for suicide. The evidence base on the determinants of depression is fragmented, which makes the interpretation of the results across studies difficult. The objective of this study is to conduct a thorough synthesis of the literature assessing the biological, psychological, and social determinants of depression in order to piece together the puzzle of the key factors that are related to this condition. Titles and abstracts published between 2017 and 2020 were identified in PubMed, as well as Medline, Scopus, and PsycInfo. Key words relating to biological, social, and psychological determinants as well as depression were applied to the databases, and the screening and data charting of the documents took place. We included 470 documents in this literature review. The findings showed that there are a plethora of risk and protective factors (relating to biological, psychological, and social determinants) that are related to depression; these determinants are interlinked and influence depression outcomes through a web of causation. In this paper, we describe and present the vast, fragmented, and complex literature related to this topic. This review may be used to guide practice, public health efforts, policy, and research related to mental health and, specifically, depression.
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Affiliation(s)
- Olivia Remes
- Institute for Manufacturing, University of Cambridge, Cambridge CB3 0FS, UK
| | | | - Peter Templeton
- IfM Engage Limited, Institute for Manufacturing, University of Cambridge, Cambridge CB3 0FS, UK;
- The William Templeton Foundation for Young People’s Mental Health (YPMH), Cambridge CB2 0AH, UK
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Chun HYY, Ford A, Kutlubaev MA, Almeida OP, Mead GE. Depression, Anxiety, and Suicide After Stroke: A Narrative Review of the Best Available Evidence. Stroke 2021; 53:1402-1410. [PMID: 34865508 DOI: 10.1161/strokeaha.121.035499] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Depression and anxiety each affect around 1 in 3 people during the first year after a stroke. Suicide causes the death of about 3 to 4/1000 stroke survivors during the first 5 years. This narrative review describes the best available evidence for the epidemiology of depression, anxiety, and suicide; their prevention; and the treatment of anxiety and depression. We conclude with directions for future research.
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Affiliation(s)
| | - Andrew Ford
- University of Western Australia, Australia (A.F., O.P.A.)
| | | | | | - Gillian E Mead
- University of Edinburgh, United Kingdom (H.-Y.Y.C., G.E.M.)
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Yao YY, Wei ZJ, Zhang YC, Li X, Gong L, Zhou JW, Wang Y, Zhang YY, Wang RP. Functional Disability After Ischemic Stroke: A Community-Based Cross-Sectional Study in Shanghai, China. Front Neurol 2021; 12:649088. [PMID: 34512499 PMCID: PMC8427524 DOI: 10.3389/fneur.2021.649088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 07/13/2021] [Indexed: 01/03/2023] Open
Abstract
Objective: This study aimed to understand the demographics, functional disabilities, cognitive impairment, and depressive mood among stroke patients and to explore the correlation between functional disability and the other health conditions so as to provide some data for community rehabilitation among stroke patients. Methods: A cross-sectional study was conducted to investigate the functional status of ischemic stroke patients with stroke history between 1 month and 2 years by applying the modified Rankin Scale (mRS). Data were collected during October 2016 and January 2017 from 11 communities in two districts of Shanghai, China. We used face-to-face questionnaire interviews to collect information on sociodemographics, vascular risks associated with stroke, cognitive function [Mini-Mental State Examination (MMSE)], and depression [Patient Health Questionnaire-9 (PHQ-9)]; and we applied SPSS 24.0 for data analysis. Results: In this study, 305 patients with ischemic stroke were finally recruited, including 189 (61.97%) men, with an average age of 67 years. According to the mRS score, ischemic stroke patients were divided into patients without symptoms (controls, mRS = 0), patients without obvious disability (mRS = 1), and patients with mild to severe disability (mRS = 2-5). Ischemic stroke patients with different mRS levels demonstrated significant differences in age, tobacco smoke exposure, previous stroke history, cognitive function, and depression status. Compared with patients without symptoms (mRS = 0), patients with mRS = 1 had a lower MMSE score [odds ratio (OR): 0.48, 95% confidence interval (CI): 0.26-0.90]; and patients with mRS = 2-5 had a lower MMSE score [OR = 0.16, 95% CI: 0.08-0.33], had a higher PHQ-9 score [OR = 5.36, 95% CI: 2.19-13.11], and were more likely to have previous stroke history [OR = 2.18, 95% CI: 1.01-4.79]. Conclusion: Lower degrees of functional independence are related to cognitive impairment, as well as the previous stroke history and depression status.
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Affiliation(s)
- Ying-Ye Yao
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Zi-Jun Wei
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yue-Chan Zhang
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiang Li
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Liu Gong
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.,Department of Neurology, Shanghai Baoshan Integrated Traditional Chinese and Western Medicine Hospital, Shanghai, China
| | - Jia-Wei Zhou
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yu Wang
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yun-Yun Zhang
- Department of Neurology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Rui-Ping Wang
- Clinical Research Center, Shanghai Skin Diseases Hospital, Tongji University, Shanghai, China
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Abstract
Stroke is a leading cause of disability, dementia and death worldwide. Approximately 70% of deaths from stroke and 87% of stroke-related disability occur in low-income and middle-income countries. At the turn of the century, the most common diseases in Africa were communicable diseases, whereas non-communicable diseases, including stroke, were considered rare, particularly in sub-Saharan Africa. However, evidence indicates that, today, Africa could have up to 2-3-fold greater rates of stroke incidence and higher stroke prevalence than western Europe and the USA. In Africa, data published within the past decade show that stroke has an annual incidence rate of up to 316 per 100,000, a prevalence of up to 1,460 per 100,000 and a 3-year fatality rate greater than 80%. Moreover, many Africans have a stroke within the fourth to sixth decades of life, with serious implications for the individual, their family and society. This age profile is particularly important as strokes in younger people tend to result in a greater loss of self-worth and socioeconomic productivity than in older individuals. Emerging insights from research into stroke epidemiology, genetics, prevention, care and outcomes offer great prospects for tackling the growing burden of stroke on the continent. In this article, we review the unique profile of stroke in Africa and summarize current knowledge on stroke epidemiology, genetics, prevention, acute care, rehabilitation, outcomes, cost of care and awareness. We also discuss knowledge gaps, emerging priorities and future directions of stroke medicine for the more than 1 billion people who live in Africa.
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Ogunlade AO, Williams SK, Joseph J, Onakomaiya DO, Eimicke JP, Teresi JA, Williams O, Ogedegbe G, Spruill TM. Prevalence and correlates of depression among black and Latino stroke survivors with uncontrolled hypertension: a cross-sectional study. BMJ Open 2020; 10:e040461. [PMID: 33293392 PMCID: PMC7725089 DOI: 10.1136/bmjopen-2020-040461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To examine the prevalence and correlates of depression in a cohort of black and Hispanic stroke survivors with uncontrolled hypertension. SETTING Baseline survey data from 10 stroke centres across New York City. PARTICIPANTS Black and Hispanic stroke survivors with uncontrolled hypertension (n=450). OUTCOME MEASURES Depressive symptoms were assessed with the 8-item Patient Reported Outcomes Measurement Information System (PROMIS) measure. Depression was defined as a PROMIS score ≥55. Other data collected included clinical factors, health-related quality of life (EuroQoL five dimensions (EQ-5D)), functional independence (Barthel Index, BI), stroke-related disability (Modified Rankin Score), physical function (PROMIS Physical Function) and executive functioning (Frontal Assessment Battery). RESULTS The mean age was 61.7±11.1 years, 44% of participants were women and 51% were black. Poststroke depression was noted in 32% of the cohort. Examining bivariate relationships, patients with depression were observed to have poorer function and quality of life as evidenced by significantly lower PROMIS physical function scores (36.9±8.32 vs 43.4±10.19, p<0.001); BI scores (79.9±19.2 vs 88.1±15.1, p<0.001); EQ-5D scores (0.66±0.24 vs 0.83±0.17, p<0.001) and higher Rankin scores (2.10±1.00 vs 1.46±1.01, p<0.001) compared with those without depression. Multivariate (model adjusted) significant correlates of depression included lower self-reported quality of life (OR=0.02 (CI 0.004 to 0.12) being younger (OR=0.94; 95% CI 0.91 to 0.97); not married (OR=0.46; CI 0.24 to 0.89)); and foreign-born (OR=3.34, 95% CI 1.4 to 7.97). There was a trend for higher comorbidity to be uniquely associated with depression (≥3 comorbid conditions, OR=1.49, 95% CI 1.00 to 2.23). CONCLUSIONS Poststroke depression is common among black and Hispanic stroke survivors with higher rates noted among foreign-born patients and those with high comorbidity. These findings highlight the importance of screening for depression in minority stroke survivors. TRIAL REGISTRATION NUMBER http://www.clinicaltrials.gov. Unique identifier: NCT01070056.
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Affiliation(s)
- Adebayo O Ogunlade
- Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Stephen K Williams
- Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Jennifer Joseph
- Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Deborah O Onakomaiya
- Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Joseph P Eimicke
- Research Division, Hebrew Home at Riverdale, Bronx, New York, USA
| | - Jeanne A Teresi
- Research Division, Hebrew Home at Riverdale, Bronx, New York, USA
- Columbia University Stroud Center, New York State Psychiatric Institute, New York, New York, USA
| | | | - Gbenga Ogedegbe
- Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Tanya M Spruill
- Center for Healthful Behavior Change, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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A meta-analysis of poststroke depression risk factors comparing depressive-related factors versus others. Int Psychogeriatr 2020; 32:1331-1344. [PMID: 32014074 DOI: 10.1017/s1041610219002187] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Poststroke depression (PSD) is a public health issue, affecting one-third of stroke survivors, and is associated with multiple negative consequences. Reviews tried to identify PSD risk factors with discrepant results, highlighting the lack of comparability of the analyzed studies. We carried out a meta-analysis in order to identify clinical risk factors that can predict PSD. DESIGN PubMed and Web of Science were searched for papers. Only papers with a strictly defined Diagnostic and Statistical Manual of Mental Disorders depression assessment, at least 2 weeks after stroke, were selected. Two authors independently evaluated potentially eligible studies that were identified by our search and independently extracted data using standardized spreadsheets. Analyses were performed using MetaWin®, the role of each variable being given as a risk ratio (RR). RESULTS Eighteen studies were included in the meta-analysis. Identified risk factors for PSD with RR significantly above 1 were previous history of depression (RR 2.19, confidence interval (CI) 1.52-3.15), disability (RR 2.00, CI 1.58-2.52), previous history of stroke (RR 1.68, CI 1.06-2.66), aphasia (RR 1.47, CI 1.13-1.91), and female gender (RR 1.35, CI 1.14-1.61). Fixed effects model leads to identification of two more risk factors: early depressive symptoms with an RR of 2.32 (CI 1.43-3.79) and tobacco consumption (RR 1.40, CI 1.09-1.81). Time bias was found for alcohol consumption. Sample size was significantly involved to explain the role of "alcohol consumption" and "cognitive impairment." CONCLUSION Five items were significantly predictive of PSD. It might be of clinical interest that depressive-related risk factors (such as past depressive episodes) were having the largest impact.
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Ojagbemi A, Akinyemi J, Owolabi M, Akinyemi R, Arulogun O, Gebregziabher M, Akpa O, Olaniyan O, Salako B, Ovbiagele B. Predictors and prognoses of new onset post-stroke anxiety at one year in black Africans. J Stroke Cerebrovasc Dis 2020; 29:105082. [PMID: 32807479 PMCID: PMC7673258 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/09/2020] [Accepted: 06/19/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is relatively limited information on the risk factors and outcome of new onset Poststroke Anxiety (PSA) in Low- and Middle-Income Countries. We estimated incidence, cumulative incidence, risk factors and outcome of new onset anxiety in the first year of stroke among African stroke survivors. METHODS We analyzed the dataset of a completed clinical trial comprising patients enrolled to test an intervention designed to improve one-year blood pressure control among recent (≤ one month) stroke survivors in Nigeria. Anxiety was measured using the Hospital Anxiety and Depression Scale. Outcomes were assessed using the modified Rankin Scale (mRS), Community screening instrument for dementia (CSID) and Health Related Quality of Life in Stroke Patients (HRQOLISP-26). RESULTS Among 322 stroke survivors who were free of anxiety at baseline, we found a one-year cumulative incidence of 34% (95% CI = 28.6-39.3). Rates were 36.2% (95% CI =29.6-42.7) for men and 29.2% (95% CI =19.9-38.3) for women. In multivariate Cox regression analyses, haemorrhagic stroke type was associated with higher risk of new onset PSA (Hazard Ratio=1.52, 95% CI =1.01-2.29). New onset PSA was independently associated with cognitive [(mean difference (MD) in CSID scores=1.1, 95% C.I=0.2, 1.9)] and motor decline (MD in mRS scores= -0.2, 95% C.I= -0.4, -0.02), as well as poorer quality of life overtime (MD in total HRQOLISP-26 scores=3.6, 95% C.I=1.0, 6.2). CONCLUSION One in 3 stroke survivors in Nigeria had PSA at one year. Clinicians in SSA should pay special attention to survivors of haemorrhagic stroke as they are at higher risk of incident anxiety and therefore its consequences.
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Affiliation(s)
- Akin Ojagbemi
- Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria.
| | - Joshua Akinyemi
- Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Mayowa Owolabi
- Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Rufus Akinyemi
- Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | - Oyedunni Arulogun
- Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | | | - Onoja Akpa
- Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
| | | | - Babatunde Salako
- Department of Psychiatry, College of Medicine, University of Ibadan, Nigeria
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Mirolovics Á, Bokor M, Dobi B, Zsuga J, Bereczki D. Socioeconomic Factors Predicting Depression Differ in the Acute Stage and at 1 year After Ischemic Stroke or TIA. J Stroke Cerebrovasc Dis 2020; 29:105241. [PMID: 33066950 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/04/2020] [Accepted: 08/06/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Considerable depressive symptoms follow stroke in about one third of patients. Initial depressive symptoms may wane after the acute phase of stroke, but persisting depressive symptoms adversely affect rehabilitation and quality of life. We set forth to evaluate predictors of depressive symptoms with a focus on socioeconomic factors. METHODS We evaluated clinical features and socioeconomic characteristics in 233 consecutive patients with acute ischemic stroke or TIA. Depressive symptoms could be evaluated in 168 subjects in the acute phase with a repeated testing after a mean of 14.7 months via telephone interview in 116 patients. Survival status, scores on the Center for Epidemiologic Studies-Depression Scale (CES-D), Beck Depression Inventory (BDI) and disability (modified Rankin scale, mRS) were recorded. RESULTS In the acute phase, employment status (p = 0.037) and level of education (p = 0.048) whereas one year later dependency (mRS≥3, p = 0.002) and income (p = 0.012) were the significant predictors of the severity of depressive symptoms. A change from independent (mRS≤2) to dependent living predicted worsening depressive symptoms (p = 0.008), whereas improving to functional independence from an initially dependent condition was associated with diminishing depressive symptoms (p = 0.077 for CES-D and p = 0.044 for BDI) in the first year after an acute ischemic cerebrovascular event. CONCLUSIONS Predictors of the severity of depressive symptoms differed in the acute phase and at follow-up. In addition to disability, education and employment status in the acute phase and income in the late phase predict the severity of depressive symptoms after ischemic stroke or TIA.
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Affiliation(s)
- Ágnes Mirolovics
- János Szentágothai Doctoral School of Neurosciences, Semmelweis University, Budapest, Hungary; Departmet of Neurology, National Institute of Psychiatry and Addictions Nyírő Gyula, Budapest, Hungary
| | - Magdolna Bokor
- Departmet of Neurology, National Institute of Psychiatry and Addictions Nyírő Gyula, Budapest, Hungary
| | - Balázs Dobi
- Department of Probability Theory and Statistics, Eötvös Loránd University, Budapest, Hungary
| | - Judit Zsuga
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Dániel Bereczki
- Department of Neurology, Semmelweis University, Budapest, Hungary; MTA-SE Neuroepidemiological Research Group, Budapest, Hungary.
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Wallace S, Mactaggart I, Banks LM, Polack S, Kuper H. Association of anxiety and depression with physical and sensory functional difficulties in adults in five population-based surveys in low and middle-income countries. PLoS One 2020; 15:e0231563. [PMID: 32589635 PMCID: PMC7319598 DOI: 10.1371/journal.pone.0231563] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 03/26/2020] [Indexed: 12/13/2022] Open
Abstract
Background The aim of this study was to assess the association between anxiety and depression with physical and sensory functional difficulties, among adults living in five low and middle-income countries (LMICs). Methods and findings A secondary data analysis was undertaken using population-based disability survey data from five LMICs, including two national surveys (Guatemala, Maldives) and 3 regional/district surveys (Nepal, India, Cameroon). 19,337 participants were sampled in total (range 1,617–7,604 in individual studies). Anxiety, depression, and physical and sensory functional difficulties were assessed using the Washington Group Extended Question Set on Functioning. Age-sex adjusted logistic regression analyses were undertaken to assess the association of anxiety and depression with hearing, visual or mobility functional difficulties. The findings demonstrated an increased adjusted odds of severe depression and severe anxiety among adults with mobility, hearing and visual functional difficulties in all settings (with ORs ranging from 2.0 to 14.2) except for in relation to hearing loss in India, the Maldives and Cameroon, where no clear association was found. For all settings and types of functional difficulties, there was a stronger association with severe anxiety and depression than with moderate. Both India and Cameroon had higher reported prevalences of physical and sensory functional difficulties compared with Nepal and Guatemala, and weaker associations with anxiety and depression. Conclusion People with physical and sensory functional difficulties are more likely to report experiencing depression and anxiety. This evidence supports the need for ensuring a good awareness of mental health among those working with individuals with physical and sensory functional difficulties in LMICs. This implies that these practitioners must have the skills to identify anxiety and depression. Furthermore, mental health services must be available and accessible to patients with these conditions, which will likely require further programmatic scale-up in these LMIC settings.
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Affiliation(s)
- Sarah Wallace
- Public Health Training Scheme, London Deanery, London, United Kingdom
| | - Islay Mactaggart
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sarah Polack
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
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21
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Moon KJ, Chung ML, Hwang SY. The Perceived Marital Intimacy of Spouses Directly Influences the Rehabilitation Motivation of Hospitalized Stroke Survivors. Clin Nurs Res 2020; 30:502-510. [PMID: 32441122 DOI: 10.1177/1054773820924573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Spousal support is likely to influence the rehabilitation motivation of stroke survivors who require long-term rehabilitation. This study was conducted to examine the reciprocal effects of the depressive symptoms and marital intimacy of stroke survivors and their spouses, and identify the factors that influence the rehabilitation motivation of stroke survivors. For this cross-sectional descriptive study, 72 stroke survivor-spouse couples were recruited from four rehabilitation hospitals in South Korea in 2017. The collected data were analyzed using path analyses with SPSS 20.0 and the R package. There were significant differences in the actor effects of stroke survivors' and spouses' depressive symptoms on the marital intimacy of the survivors and their spouses. The perceived marital intimacy of spouses was significantly associated with the rehabilitation motivation of stroke survivors. In order to enhance their rehabilitation motivation, it is necessary to periodically assess the depressive symptoms and perceived marital intimacy of their spouses.
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Affiliation(s)
- Kil Je Moon
- Department of Nursing, Dongnam Health University, Suwon, South Korea
| | - Misook L Chung
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Seon Young Hwang
- School of Nursing, Hanyang University, Seongdong-gu, Seoul, South Korea
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Prynn JE, Kuper H. Perspectives on Disability and Non-Communicable Diseases in Low- and Middle-Income Countries, with a Focus on Stroke and Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3488. [PMID: 31546803 PMCID: PMC6766001 DOI: 10.3390/ijerph16183488] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/04/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022]
Abstract
Non-communicable diseases (NCD) and disability are both common, and increasing in magnitude, as a result of population ageing and a shift in disease burden towards chronic conditions. Moreover, disability and NCDs are strongly linked in a two-way association. People living with NCDs may develop impairments, which can cause activity limitations and participation restriction in the absence of supportive personal and environmental factors. In other words, NCDs may lead to disabilities. At the same time, people with disabilities are more vulnerable to NCDs, because of their underlying health condition, and vulnerability to poverty and exclusion from healthcare services. NCD programmes must expand their focus beyond prevention and treatment to incorporate rehabilitation for people living with NCDs, in order to maximize their functioning and well-being. Additionally, access to healthcare needs to be improved for people with disabilities so that they can secure their right to preventive, curative and rehabilitation services. These changes may require new innovations to overcome existing gaps in healthcare capacity, such as an increasing role for mobile technology and task-sharing. This perspective paper discusses these issues, using a particular focus on stroke and dementia in order to clarify these relationships.
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Affiliation(s)
- Josephine E Prynn
- Faculty of Population Health, University College London, 62 Huntley Street, London WC1E 6DD, UK.
| | - Hannah Kuper
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Kuringe E, Materu J, Nyato D, Majani E, Ngeni F, Shao A, Mjungu D, Mtenga B, Nnko S, Kipingili T, Mongi A, Nyanda P, Changalucha J, Wambura M. Prevalence and correlates of depression and anxiety symptoms among out-of-school adolescent girls and young women in Tanzania: A cross-sectional study. PLoS One 2019; 14:e0221053. [PMID: 31419238 PMCID: PMC6697336 DOI: 10.1371/journal.pone.0221053] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/29/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, adolescent girls and young women (AGYW) who are out of school are at higher risk of depressive and anxiety disorders compared to their school attending peers. However, little is known about the prevalence and risk factors for these conditions among out-of-school AGYW. This study examines the prevalence of depression and anxiety and associated factors in a community sample of out-of-school AGYW in Tanzania. METHODS A cross-sectional analysis of baseline data from an on-going cluster randomized controlled trial in North-West Tanzania was conducted. A total of 3013 out-of-school AGYW aged 15 to 23 years from 30 clusters were included. Anxiety and depression were assessed using the Patient Health Questionnaire (PHQ-4), a tool comprising of PHQ-2 and Generalized Anxiety Disorders (GAD-2) screeners. Data were collected using Audio Computer-Assisted Self-Interview (ACASI). A random-effects logistic regression was fitted for binary outcomes and an ordinal logistic regression model with robust variance was used to adjust for clustering at the village level. Logistic regression and ordinal logistic regression were used to explore the associations between mental disorders symptoms and other factors. RESULTS The prevalence of depressive (PHQ-2 ≥ 3) and anxiety (GAD-2 ≥ 3) symptoms among out-of-school AGYW were 36% (95% CI 33.8%-37.3%) and 31% (95% CI 29.0%-32.3%) respectively. Further, using the PHQ-4 tool, 33% (95% CI 30.8%-34.2%) had mild, 20% (95% CI 18.3%-21.1%) moderate and 6% (95% CI 5.5%-7.2%) had severe symptoms of anxiety and depression. After adjusting for other covariates, two factors most strongly associated with having anxiety symptoms were violence experience from sexual partners (AOR = 1.63, 95% CI: 1.36-1.96) and HIV positive status (AOR = 1.54, 95% CI: 1.03-2.31). Likewise, living alone, with younger siblings or others (AOR = 2.51, 95% CI: 1.47-4.29) and violence experience from sexual partners (AOR = 1.90, 95% CI: 1.59-2.27) were strongly associated with depression symptoms. Having savings (AOR = 0.81, 95% CI: 0.70-0.95) and emotional support (AOR = 0.82, 95% CI: 0.67-0.99) were protective against depression and anxiety, respectively. CONCLUSION Depressive and anxiety symptoms are prevalent among out-of-school AGYW in Tanzania. The findings emphasize the need to strengthen preventive interventions and scale-up mental health disorder screening, referral for diagnosis and management.
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Affiliation(s)
- Evodius Kuringe
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Jacqueline Materu
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Daniel Nyato
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Esther Majani
- Sauti Project, Jhpiego Tanzania—an affiliate of Johns Hopkins University, Dar es Salaam, Tanzania
| | - Flaviana Ngeni
- Sauti Project, Jhpiego Tanzania—an affiliate of Johns Hopkins University, Dar es Salaam, Tanzania
| | - Amani Shao
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Deusdedit Mjungu
- Sauti Project, Jhpiego Tanzania—an affiliate of Johns Hopkins University, Dar es Salaam, Tanzania
| | - Baltazar Mtenga
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Soori Nnko
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | | | - Aminiel Mongi
- Sauti Project, Jhpiego Tanzania—an affiliate of Johns Hopkins University, Dar es Salaam, Tanzania
| | - Peter Nyanda
- Sauti Project, Jhpiego Tanzania—an affiliate of Johns Hopkins University, Dar es Salaam, Tanzania
| | - John Changalucha
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
| | - Mwita Wambura
- Department of Sexual and Reproductive Health, National Institute for Medical Research, Mwanza, Tanzania
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Ojagbemi A, Bello T. Tedium vitae in stroke survivors: a comparative cross-sectional study. Top Stroke Rehabil 2019; 26:195-200. [PMID: 30890043 DOI: 10.1080/10749357.2019.1590971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Suicide is best studied by deconstructing the psychological experiences preceding suicidal death. We assessed the characteristics of tedium vitae (feeling tired of life) after first ever stroke in Nigerian survivors. METHODS Using the Schedule for Clinical Assessment in Neuropsychiatry, tedium vitae was assessed in 130 stroke survivors attending rehabilitation in a large Nigerian university hospital. Global cognitive and executive dysfunctions were evaluated, respectively, using the Mini Mental State Examination and the modified Indiana University Token test. All participants had their index stroke 3 to 24 months before recruitment into the study. We also examined a comparative group of 130 age, gender, and education matched apparently normal persons who were unrelated to the stroke survivors. Associations were explored using univariate and multivariate logistic regression analyses. RESULTS Tedium vitae was experienced by 16 (12.3%) stroke survivors compared with 5 (3.9%) in the comparative group (O. R = 3.5, 95% C. I = 1.3-9.9, p = 0.018). Among stroke survivors, those who were retired were more likely to experience tedium vitae (56.2%, p = 0.045). In analyses adjusting for the effect of systemic hypertension, cognitive dysfunction, retirement and marital separation, there was a 3.5-fold increase in the odds of experiencing tedium vitae after surviving a stroke (O. R = 3.5, 95% C. I = 1.1-11.6, p = 0.042). CONCLUSIONS Tedium vitae is a common suicidal experience after stroke and may be among the earliest perceptible pointer to impending poststroke suicide. It is easy to assess and may be less costly to obtain an adequate sample size in studies aiming to understand the phenomenon of suicide in the stroke population.
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Affiliation(s)
- Akin Ojagbemi
- a World Health Organization (WHO) Collaborating Centre for Research and Training in Mental health, Neuroscience, and Substance abuse, Department of Psychiatry, College of Medicine , University of Ibadan , Ibadan , Nigeria
| | - Toyin Bello
- a World Health Organization (WHO) Collaborating Centre for Research and Training in Mental health, Neuroscience, and Substance abuse, Department of Psychiatry, College of Medicine , University of Ibadan , Ibadan , Nigeria
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Grochans E, Szkup M, Kotwas A, Kopeć J, Karakiewicz B, Jurczak A. Analysis of Sociodemographic, Psychological, and Genetic Factors Contributing to Depressive symptoms in Pre-, Peri- and Postmenopausal Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040712. [PMID: 29642625 PMCID: PMC5923754 DOI: 10.3390/ijerph15040712] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/05/2018] [Accepted: 04/07/2018] [Indexed: 12/13/2022]
Abstract
Depressive symptoms that are faced by women in the pre-, peri-, and postmenopausal periods are determined by a wide array of sociodemographic, psychological, and biological variables. The aim of our study was to identify factors that contribute to depressive problems at this stage of life. The study included 815 healthy Polish women aged 45–60 years. The survey part was conducted using the Beck Depression Inventory (BDI), the State–Trait Anxiety Inventory (STAI), the Neuroticism–Extroversion–Openness Five Factor Inventory (NEO-FFI), and a self-developed questionnaire. Genetic analysis was also performed. Depressive symptoms were observed in 25.5% of participants. 70% of the women were postmenopausal. No statistically significant differences in the severity of depressive symptoms were demonstrated with regard to genetic variables (p > 0.05). Reproductive capacity (p < 0.001), employment (p < 0.001), and being married (p < 0.018) were found to reduce the incidence of depressive symptoms. The contribution of personality and anxiety as a trait to depressive symptoms varied. Conclusions: The factors predisposing pre-, peri-, and postmenopausal women to depressive symptoms include lower education, lack of a life partner, unemployment, high anxiety, and neurotic personality. No evidence was found for the contribution of genetic factors to depressive symptoms in the examined women.
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Affiliation(s)
- Elżbieta Grochans
- Department of Nursing, Pomeranian Medical University in Szczecin, ul. Żołnierska 48, 71-210 Szczecin, Poland.
| | - Małgorzata Szkup
- Department of Nursing, Pomeranian Medical University in Szczecin, ul. Żołnierska 48, 71-210 Szczecin, Poland.
| | - Artur Kotwas
- Department of Public Health, Pomeranian Medical University in Szczecin, ul. Żołnierska 48, 71-210 Szczecin, Poland.
| | - Jacek Kopeć
- Faculty of Medicine, School of Population and Public Health, The University of British Columbia, 2206 East Mall Vancouver, BC V6T 1Z3, Canada.
| | - Beata Karakiewicz
- Department of Public Health, Pomeranian Medical University in Szczecin, ul. Żołnierska 48, 71-210 Szczecin, Poland.
| | - Anna Jurczak
- Department of Clinical Nursing, Pomeranian Medical University in Szczecin, ul. Żołnierska 48, 71-210 Szczecin, Poland.
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