Sexual Risk Behavior, Sexual Violence, and HIV in Persons With Severe Mental Illness in Uganda: Hospital-Based Cross-Sectional Study and National Comparison Data

Physical and psychiatric comorbidities among patients with severe mental illness as seen in Uganda

While psychiatric and physical comorbidities in severe mental illness (SMI) have been associated with increased mortality and poor clinical outcomes, problem has received little attention in low- and middle-income countries (LMICs). This study established the prevalence of psychiatric (schizophrenia, bipolar affective disorder, and recurrent major depressive disorder) and physical (HIV/AIDS, syphilis, hypertension and obesity) comorbidities and associated factors among 1201 out-patients with SMI (schizophrenia, depression and bipolar affective disorder) attending care at two hospitals in Uganda. Participants completed an assessment battery including structured, standardised and locally translated instruments. SMIs were established using the MINI International Neuropsychiatric Interview version 7.2. We used logistic regression to determine the association between physical and psychiatric comorbidities and potential risk factors. Bipolar affective disorder was the most prevalent (66.4%) psychiatric diagnoses followed by schizophrenia (26.6%) and recurrent major depressive disorder (7.0%). Prevalence of psychiatric comorbidity was 9.1%, while physical disorder comorbidity was 42.6%. Specific comorbid physical disorders were hypertension (27.1%), obesity (13.8%), HIV/AIDS (8.2%) and syphilis (4.8%). Potentially modifiable factors independently significantly associated with psychiatric and physical comorbidities were: use of alcohol for both syphilis and hypertension comorbidities; and use of a mood stabilisers and khat in comorbidity with obesity. Only psychiatric comorbidity was positively associated with the negative outcomes of suicidality and risky sexual behaviour. The healthcare models for psychiatric care in LMICs such as Uganda should be optimised to address the high burden of psychiatric and physical comorbidities.

A qualitative exploration of Ugandan mental health care workers’ perspectives and experiences on sexual and reproductive health of people living with mental illness in Uganda

Background

People with Mental Illness experience vast sexual and reproductive health challenges due to the affected mental health. Globally, prevalence of mental illness is on the rise with subsequent increase in the number of people with sexual and reproductive challenges warranting urgent public health intervention. However, information on the perceptions and experiences of mental health workers, the key health care providers for this population is generally lacking yet it’s essential for formulation of appropriate policies and public health interventions.

Aim

To explore Ugandan mental health care worker’s perspectives and experiences on the sexual and reproductive health of people living with mental illness in Uganda in order to generate recommendations to the ministry of health on how it can be improved.

Materials and methods

Qualitative study design was employed with utilization of phone call semi-structured in-depth interviews to collect data from 14 mental health workers from Uganda’s National mental referral hospital, Butabika. Purposive sampling and convenience recruitment was done and the collected data was analyzed using Thematic content analysis.

Results

Four themes were generated which included people with Mental illness having normal sexual needs, mental illness effect on sexuality and relationships, practices for safeguarding sexuality of people with mental illness and the barriers encountered in the provision of sexual and reproductive health services at a mental hospital.

Conclusion

People with mental illness experience a multitude of sexual and reproductive health challenges that need public health interventions. However, the integration of sexual and reproductive health services in a mental hospital are not yet successful making people with mental illness to remain with unaddressed health challenges. Policies should therefore be developed and implemented to ensure successful integration of sexual and reproductive health at all mental health service care provision points.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14128-2.

Sexual and reproductive health knowledge and practices among youth with and without mental illness in Uganda: a comparative study

BACKGROUND

Sexual and reproductive health challenges among youth in low-income countries have persistently remained a public health challenge. In addition to these challenges, approximately 25% of youth experience a mental health illness, a situation anticipated to steeply increase especially in sub-Saharan Africa. However, there is still a scarcity of knowledge on the sexual and reproductive health of youth with mental illness in comparison to youth without mental illness in low-income countries. In this paper, the objective was to compare the sexual and reproductive health knowledge and practices among youth with mental illness and without mental illness at Mbarara Regional Referral Hospital (MRRH), South Western Uganda.

METHODS

Using a cross-sectional comparative study design, 104 youth with mental illness and 101 youth without mental illness were recruited as they sought medical health care services at MRRH. Structured interviews were conducted and they covered sexual and reproductive health knowledge and sexual practices.

RESULTS

205 youth were interviewed and of these 53 males and 51 females had mental illness while 49 males and 52 females did not have a mental illness. More youth without mental illness (61.7%) had more knowledge of sexual and reproductive health compared to youth with mental illness (38.3%) with a prevalence odds ratio of 0.29 (CI 0.16-0.52) and p value of 0.001. All youth were knowledgeable about contraceptive methods. Youth with MI engaged more in risky sexual practices though the difference wasn't statistically significant.

CONCLUSIONS

Youth generally have low sexual and reproductive health knowledge and this was found to be significantly lower in youth with mental illness compared to those without mental illness and they generally tend to engage in risky sexual behavior. It is recommended to incorporate SRH services among the mainstream general youth health care and mental health care services is critical to reducing sexual and reproductive health challenges among youth.

Risk factors for violence against women in high-prevalence settings: a mixed-methods systematic review and meta-synthesis

INTRODUCTION

Violence against women (VAW) affects one in three women globally. In some countries, women are at much higher risk. We examined risk factors for VAW in countries with the highest 12-month prevalence estimates of intimate partner violence (IPV) to develop understanding of this increased risk.

METHODS

For this systematic review, we searched PUBMED, CINAHL, PROQUEST (Middle East and North Africa; Latin America and Iberia; East and South Asia), Web of Science, EMBASE and PsycINFO (Ovid) for records published between 1 January 2000 and 1 January 2021 in English, French and Spanish. Included records used quantitative, qualitative, or mixed-methods, reported original data, had VAW as the main outcome, and focused on at least one of 23 countries in the highest quintile of prevalence figures for women's self-reported experiences of physical and/or sexual violence in the past 12 months. We used critical interpretive synthesis to develop a conceptual model for associations between identified risk factors and VAW.

RESULTS

Our search identified 12 044 records, of which 241 were included for analysis (2 80 360 women, 40 276 men, 274 key informants). Most studies were from Bangladesh (74), Uganda (72) and Tanzania (43). Several quantitative studies explored community-level/region-level socioeconomic status and education as risk factors, but associations with VAW were mixed. Although fewer in number and representing just one country, studies reported more consistent effects for community-level childhood exposure to violence and urban residence. Theoretical explanations for a country's high prevalence point to the importance of exposure to other forms of violence (armed conflict, witnessing parental violence, child abuse) and patriarchal social norms.

CONCLUSION

Available evidence suggests that heightened prevalence of VAW is not attributable to a single risk factor. Multilayered and area-level risk analyses are needed to ensure funding is appropriately targeted for countries where VAW is most pervasive.

PROSPERO REGISTRATION NUMBER

The review is registered with PROSPERO (CRD42020190147).

A scoping review of measurement of violence against women and disability

INTRODUCTION

Existing evidence indicates that prevalence of violence against women with disability is elevated compared to women without disability. We conducted a scoping review with a focus on measurement to assess the forms of measurement and study design utilized to explore the intersection of violence against women with disabilities, and to identify strengths and limitations in current approaches to measuring violence against women with disabilities. This scoping review is designed to inform current debates and discussions regarding how to generate evidence concerning violence against women with disabilities.

METHODS AND RESULTS

We conducted systematic searches of the following databases: PubMed, PsycINFO, Embase, CINAHL, PILOTS, ERIC, Social Work Abstracts, International Bibliography of the Social Sciences, Social Services Abstracts, ProQuest Criminal Justice, and Dissertations & Theses Global, and conducted structured searches of national statistics and surveys and grey literature available on-line. We identified 174 manuscripts or reports for inclusion. n = 113 manuscripts or reports utilized acts-specific measurement of violence. In terms of measurement of disability, we found that amongst the included manuscripts and reports, n = 75 utilized measures of functioning limitations (n = 20 of these were Washington Group questions), n = 15 utilized a single question approach and n = 67 defined participants in the research as having a disability based on a diagnosis or self-report of a health condition or impairment.

DISCUSSION

This scoping review provides a comprehensive overview of measurement of violence against women with disabilities and measurement of violence within disability-focused research. We identified several important gaps in the evidence, including lack of sex and disability disaggregation, limited evidence concerning adaptation of data collection methods to ensure accessibility of research activities for women with disabilities, and limited evidence concerning differential relationships between types of disability and violence exposure. This scoping review provides directions for sub-analyses of the included studies and further research to address gaps in evidence.

Self-Reported Prevalence of HIV Infection, Sexually Transmitted Infections and Risky Sexual Behavior among Mental Health Care Users Accessing Healthcare Services in Tshwane District, South Africa

The rate of HIV and sexually transmitted infections among mental patients is higher than that of the general population worldwide. Many risky sexual behaviors are associated with mental illness. However, mental health care users (MHCUs) are not specifically targeted for HIV preventative care, and routine HIV testing is not done among this population. Limited studies have investigated self-reported HIV and STI prevalence and associated risky sexual behavior in persons with mental illnesses accessing health care services in South Africa in particular. This study set out to determine both the Sexually Transmitted Infections (STI) and human immunodeficiency virus (HIV) self-reported prevalence and sexual practices of MHCUs. A descriptive cross-sectional survey using purposive sampling was used to select 107 MHCUs across five clinics within Gauteng Province of South Africa who were above the age of 18, had a mental illness, and were currently stable and receiving chronic medication. Descriptive statistics were performed using Stata IC version 16. The chi square test was used to indicate statistical significance (p < 0.05) of differences in frequency distributions. More males (52.5%) than females were currently in a sexual relationship (50.0%), having multiple sexual partners (n = 4.13%), and having alcohol-driven sex (n = 4.19%). The majority of MHCUs (n = 82.77%) had an STI in the past six months, and a quarter (n = 21.25%) were HIV-positive with over two-thirds of MHCU (n = 69.70%) perceiving themselves not at risk for HIV. MHCUs engaged in risky behaviors had a low perception of the risks of contracting HIV. Bivariate analysis of gender by sexual behavior revealed that female MHCUs are more at risk of being forced to have sex compared to males (p = 0.006). Integrated interventions should be put in place to ensure that MHCUs' sexual and reproductive health are not left behind and issues such as sexual education, safe sex, and sexually transmitted infections should form part of the care of MHCUs.

Cango Lyec (Healing the Elephant): Gender Differences in HIV Infection in Post-conflict Northern Uganda

Background:

As previously encamped resettle, potential for rapid HIV transmission in post-conflict Northern Uganda is concerning. Women in particular may be experiencing heightened vulnerability resulting from war-related sexual violence.

Setting:

Cango Lyec (Healing the Elephant) Project is a cohort involving conflict-affected people in 3 districts in Northern Uganda.

Methods:

Eight randomly selected communities were mapped, and a census was conducted. Participants aged 13–49 years completed questionnaires in Luo on war-related experiences, mental health, sexual vulnerabilities, and sociodemographics. Blood samples were tested for HIV and syphilis. Baseline data from all sexually active participants was used to determine gender differences in HIV prevalence. Multivariate modeling determined correlates of HIV by gender.

Results:

Among 2008 participants, HIV prevalence was higher among women [17.2; 95% confidence interval (CI): 14.7 to 19.7] compared to men (10.6; 95% CI: 8.0 to 13.2, <0.001). Among women, correlates of HIV included: war-related sexual assault [adjusted odds ratio (AOR): 1.95; 95% CI: 1.16 to 3.26]; probable depression (AOR: 2.22; 95% CI: 1.46 to 3.37); probable post-traumatic stress disorder (AOR: 2.03; 95% CI: 1.45 to 2.84); experiencing ≥12 traumatic events (AOR: 2.04; 95% CI: 1.31 to 3.18); suicide ideation (AOR: 1.67; 95% CI: 1.22 to 2.28); living in a female-headed household (AOR: 2.76; 95% CI: 1.70 to 4.49); first sexual partner ≥10 years older (AOR: 1.69; 95% CI: 1.07 to 2.67); sex for exchange (AOR: 5.51; 95% CI: 1.76 to 17.31); having 2 (AOR: 2.54; 95% CI: 1.23 to 5.23) or 3+ (AOR: 4.65; 95% CI: 2.65 to 8.18) sexual partners; inconsistent condom use (AOR: 0.40; 95% CI: 0.29 to 0.57); genital ulcers (AOR: 3.08; 95% CI: 2.16 to 4.38); active syphilis (AOR: 4.33; 95% CI: 1.22 to 15.40); and ill health without medical care (AOR: 2.02; 95% CI: 1.22 to 3.34). Among men, correlates of HIV included no condom at sexual debut (AOR: 1.92; 95% CI: 1.30 to 2.83) and genital ulcers (AOR: 4.40; 95% CI: 1.35 to 14.40).

Conclusion:

Women are disproportionately impacted by HIV, trauma, and depression in this conflict-affected population. Trauma-informed HIV prevention and culturally safe mental health initiatives are urgently required.

Indicators of Complex Care During the Consultation-Liaison Psychiatry Activity at the Transplant Center of the Policlinico Hospital, Modena

OBJECTIVE

The objective of this study was to identify possible biopsychosocial predictors of organizational complexity in patients referred to the consultant psychiatrist for assessment before liver transplantation.

METHODS

This was a case-control study. All psychiatric consultations performed before and after liver transplantation from January 1, 2008 to December 31, 2013 were included. Complexity was operationalized as "undergoing two or more psychiatric consultations". Controls were defined as patients who were assessed only once by the consultant. Cases were represented by patients who underwent two or more consultations. Statistical analysis was performed with STATA 13.1, using logistic regressions.

RESULTS

In this study, 515 consultations were requested for 309 patients potentially eligible for liver transplantation. Controls were 209 (67.6%); cases were 100 (32.4%). Positive psychiatric history (odds ratio [OR] = 2.44; 95% confidence interval [CI], 1.43-4.16), viral or toxic (alcohol- or drug-related) liver disease (OR = 1.93; 95% CI, 1.09-3.42), use of psychotropic medications at the baseline (OR = 2.15; 95% CI, 1.14-4.07), and female gender (OR = 1.77; 95% CI, 1.01-3.11) were significantly associated with an increased probability of being cases.

CONCLUSIONS

Positive psychiatric history, viral or toxic liver disease, use of psychotropic medications at the index referral, and female gender are possible biopsychosocial predictors of complexity in patients eligible for liver transplantation.