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Iheanacho T, Chu C, Aguocha CM, Nwefoh E, Dike C. Integrating mental health into primary care in Nigeria: Implementation outcomes and clinical impact of the HAPPINESS intervention. Glob Ment Health (Camb) 2024; 11:e9. [PMID: 38390244 PMCID: PMC10882178 DOI: 10.1017/gmh.2024.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 02/24/2024] Open
Abstract
Background The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) intervention is a multicomponent, community-based, mobile technology-supported intervention that integrates mental health into primary health care centers in Nigeria using the World Health Organization's Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG). This study evaluates its implementation and patient-level clinical impact using a quasi-experimental design (single cohort with pre- and post-measures). Findings The HAPPINESS intervention implementation demonstrated high feasibility with 84% adoption rate (% of participating primary health centers that completed its roll out) and 81% fidelity (% of clinicians who completed required intervention components according to the protocol). Retention rate in care at 12 months was 86%. Among patients with complete clinical records analyzed (n = 178), there was a statistically significant reduction in 9-item Patient Health Questionnaire scores from baseline (Md = 9.5) to 6 months (Md = 3.0) post-intervention (z = 80.5, p < 0.001), with a large effect size (r = 0.8) and statistically significant reduction in Brief Psychiatric Rating Scale scores from baseline (Md = 36.0) to 6 months (Md = 17.0) post-intervention (z = 128.5, p < 0.001), with a large effect size (r = 0.9). Implications Mobile technology-enhanced, mhGAP-IG-based efforts to scale-up mental health services in Nigeria are feasible and effective.
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Affiliation(s)
| | - Casey Chu
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | | | - Emeka Nwefoh
- Department of Medicine, Imo State University, Owerri, Nigeria
- CBM International, Abuja, Nigeria
| | - Charles Dike
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Isiguzo GC, Stefanovics E, Unamba NN, Mbam TT, Anyaehie UG, Chukwu CC, Anyaehie UB, Osy-Eneze C, Ibezim EO, Okoro UG, Njoku PO, Adimekwe AI, Ibediro K, Stefanovics G, Iheanacho T. Perceptions of the COVID-19 Vaccine and Willingness to Receive Vaccination among Health Workers in Nigeria: A Cross-sectional Study. Niger J Clin Pract 2024; 27:102-108. [PMID: 38317042 DOI: 10.4103/njcp.njcp_537_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 12/01/2023] [Indexed: 02/07/2024]
Abstract
BACKGROUND COVID-19 vaccine hesitancy is a major barrier to vaccine uptake, and the achievement of herd immunity is required to reduce morbidity and mortality and protect the most vulnerable populations. In Nigeria, COVID-19 vaccine hesitancy has been high, and uptake remains very low. Healthcare workers (HCWs) in Nigeria can help support public health efforts to increase vaccine uptake. AIM This study evaluates Nigerian HCWs' acceptance and intent to recommend the COVID-19 vaccine. SUBJECTS AND METHODS Cross-sectional survey among 1,852 HCWs in primary, secondary, and tertiary care settings across Nigeria. Respondents included doctors, nurses, pharmacy workers, and clinical laboratory professionals who have direct clinical contact with patients in various healthcare settings. A 33-item questionnaire was used in the study, with two of the questions focused on the COVID-19 vaccine. The responses to the two questions were analyzed using Chi-square (c2) tests and independent t-tests to determine the acceptance of the vaccine. RESULTS The majority of respondents were younger than 34 years (n = 1,227; 69.2%) and primarily worked in hospitals (n = 1,278; 72.0%). Among the respondents, 79.2% (n = 1,467) endorsed the COVID-19 vaccine as a critical tool in reducing the impact of the disease, and 76.2% (n = 1,412) will accept and recommend the vaccine to their patients. The younger HCWs were more likely to endorse and recommend the vaccine to their patients. CONCLUSION There is a moderately high COVID-19 vaccine acceptance rate among HCWs surveyed in our study. The confidence of HCWs in its use and their willingness to recommend it to their patients can provide a potentially useful element in increasing acceptance by the larger population in Nigeria.
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Affiliation(s)
- G C Isiguzo
- Department of Medicine, Alex Ekwueme Federal University Teaching Hospital/Ebonyi State University Abakaliki, Ebonyi State, Nigeria
| | - E Stefanovics
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs New England Mental Illness Research and Education Clinical Center, West Haven, CT, USA
| | - N N Unamba
- Division of Cardiology, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - T T Mbam
- Department of Otorhinolaryngology, Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - U G Anyaehie
- National Orthopedic Hospital Enugu, Enugu State, Nigeria
| | - C C Chukwu
- Department of Radiology, University of Calabar Teaching Hospital, Calabar, Cross River, Nigeria
| | - U B Anyaehie
- Department of Physiology, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - C Osy-Eneze
- Colchester GP Vocational Training Scheme, NHS, England, UK
| | - E O Ibezim
- College of Medicine, Imo State University, Owerri, Imo State, Nigeria
| | - U G Okoro
- Family Practice Department, Franciscan Physician Network, Crown Point, Indiana, United States
| | - P O Njoku
- Department of Internal Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - A I Adimekwe
- Northallerton GP Vocational Training Scheme, NHS, England, UK
| | - K Ibediro
- Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - G Stefanovics
- U.S. Department of Veterans Affairs New England Mental Illness Research and Education Clinical Center, West Haven, CT, USA
| | - T Iheanacho
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- U.S. Department of Veterans Affairs New England Mental Illness Research and Education Clinical Center, West Haven, CT, USA
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Nwanaji-Enwerem U, Redeker NS, O'Connell M, Barry D, Iheanacho T, Knobf TM, Scheinost D, Wang K, Yaggi K, Sadler LS. Experiences of Stigma and Discrimination Compounded by Intersecting Identities among Individuals Receiving Medication for Opioid Use Disorder. J Health Care Poor Underserved 2024; 35:94-115. [PMID: 38661862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Stigma and discrimination create barriers to care among people receiving medication for opioid use disorder (MOUD). We report qualitative findings from a mixed methods study guided by three aims: to explore (1) intersecting identities of people receiving MOUD (2) how individuals experience stigma and discrimination and (3) helpful resources in addressing cumulative experiences of multiple forms of disadvantage. We conducted interviews with 25 individuals in three treatment centers in the Northeast United States and identified six themes: (1) Living with multiple socially marginalized identities and addiction; (2) Loss; (3) "It's everywhere": Discrimination and stigma; (4) A "damaged" identity, (5) Positive responses to negative experiences: Facing reality and becoming accountable, and (6) Experiencing treatment and identifying supportive interventions. Findings highlight the complexity of intersecting, marginalized social positions. Future work should look beyond one-size-fits-all approaches to care and recognize individual vulnerabilities and strengths for improving outcomes among those experiencing OUD.
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Chukwuorji JC, Ezeonu NA, Ude N, Itanyi IU, Eboreime E, Kung JY, Dennett L, Olawepo JO, Iheanacho T, Ogidi AG, Rositch AF, Nonyane BAS, Bass J, Ojo TM, Ikpeazu A, Ezeanolue EE. Addressing the unmet mental health needs of people living with HIV: a scoping review of interventions in sub-Saharan Africa. AIDS Care 2023; 35:1677-1690. [PMID: 36803172 DOI: 10.1080/09540121.2023.2176428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 01/24/2023] [Indexed: 02/22/2023]
Abstract
Some mental health interventions have addressed mental health among people living with HIV (PLWH) using a variety of approaches, but little is known about the details of such interventions in sub-Saharan Africa (SSA), a region that bears the largest burden of HIV in the world. The present study describes mental health interventions for PLWH in SSA regardless of the date and language of publication. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) reporting guidelines, we identified 54 peer-reviewed articles on interventions addressing adverse mental health conditions among PLWH in SSA. The studies were conducted in 11 different countries, with the highest number of studies in South Africa (33.3%), Uganda (18.5%), Kenya (9.26%), and Nigeria (7.41%). While only one study was conducted before the year 2000, there was a gradual increase in the number of studies in the subsequent years. The studies were mostly conducted in hospital settings (55.5%), were non-pharmacologic (88.9%), and interventions were mostly cognitive behavioural therapy (CBT) and counselling. Task shifting was the primary implementation strategy used in four studies. Interventions addressing the mental health needs of PLWH that incorporates the unique challenges and opportunities in SSA is highly recommended.
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Affiliation(s)
- JohnBosco Chika Chukwuorji
- Department of Psychology, University of Nigeria, Nsukka, Enugu, Nigeria
- Center for Translation and Implementation Research (CTAIR), College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Nwamaka Alexandra Ezeonu
- Center for Translation and Implementation Research (CTAIR), College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Nnamdi Ude
- Center for Translation and Implementation Research (CTAIR), College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research (CTAIR), College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ejemai Eboreime
- Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Janice Y Kung
- J. W. Scott Library, University of Alberta, Edmonton, Canada
| | - Liz Dennett
- J. W. Scott Library, University of Alberta, Edmonton, Canada
| | | | - Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Amaka G Ogidi
- Center for Translation and Implementation Research (CTAIR), College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bareng Aletta Sanny Nonyane
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Judy Bass
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tunde Masseyferguson Ojo
- Department of Psychiatry, University of Abuja, Abuja, Nigeria
- Department of Mental Health, University of Abuja Teaching Hospital, FCT Abuja, Nigeria
- National Mental Health Programme, Department of Public Health, Federal Ministry of Health, Abuja, Nigeria
| | - Akudo Ikpeazu
- National AIDS, Viral Hepatitis and STIs Control Programme (NASCP), Abuja, Nigeria
| | - Echezona E Ezeanolue
- Center for Translation and Implementation Research (CTAIR), College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Healthy Sunrise Foundation, Las Vegas, Nevada, USA
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Lee YJ, Rauben K, Liu C, Kim R, van der Velde N, Taylor C, Walsh A, Asasira M, Katongole I, Hatfield-King J, Blackwell S, Iheanacho T, Christ R, Ssekalo I. Evaluation of a pilot, community-led mental illness de-stigmatization theater intervention in rural uganda. BMC Psychiatry 2022; 22:794. [PMID: 36526984 PMCID: PMC9756628 DOI: 10.1186/s12888-022-04441-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND In rural areas of low- and middle- income countries, mental health care is often unavailable and inaccessible, and stigma is a major barrier to treatment. Destigmatization can increase treatment-seeking attitudes, community support, and acceptance of individuals suffering from mental illness. This study's primary objective was to evaluate the impact of a community-led, theater-based destigmatization campaign for mental illness conducted in the Busoga region of Eastern Uganda. METHODS One hundred residents of the Busoga region were randomly selected via cluster sampling to complete a structured questionnaire assessing mental health stigma. Four focus groups were conducted for qualitative data on mental health stigma. Common misconceptions and specific points of stigma were identified from these responses, and local village health team personnel developed and performed a culturally-adapted theatrical performance addressing these points. Changes in perceptions of mental illness were measured among 57 attendees using two measures, the Broad Acceptance Scale (designed to reflect factors that contribute to structural stigma) and Personal Acceptance Scale (designed to reflect factors that contribute to interpersonal, or public stigma), before and after the performance. RESULTS There was a significant increase in acceptance according to the Broad Acceptance Scale (p < .001) and Personal Acceptance Scale (p < .001). Qualitative responses from play attendees also indicated a decrease in stigma and an increased sense of the importance of seeking treatment for mentally ill patients. CONCLUSION This study shows community-led, theater intervention may be an effective tool for the destigmatization of mental illness in rural areas of Uganda. Larger studies are needed to further test the efficacy of this approach and potential for longer-term scalabilityand sustainability.
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Affiliation(s)
| | | | - Curtis Liu
- grid.268275.c0000 0001 2284 9898Williams College, Williamstown, USA
| | - Rebecca Kim
- grid.268275.c0000 0001 2284 9898Williams College, Williamstown, USA
| | | | - Chelsea Taylor
- grid.268275.c0000 0001 2284 9898Williams College, Williamstown, USA
| | - Alyssa Walsh
- grid.261331.40000 0001 2285 7943The Ohio State University, Columbus, USA
| | - Mildred Asasira
- grid.442658.90000 0004 4687 3018Uganda Christian University, Mukono, Uganda
| | - Ivan Katongole
- grid.442658.90000 0004 4687 3018Uganda Christian University, Mukono, Uganda
| | | | | | | | - Ryan Christ
- grid.47100.320000000419368710Yale University, New Haven, USA
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Iheanacho T, Maciejewski KR, Ogudebe F, Chumo F, Slade T, Leff R, Ngaruiya C. Prevalence and correlates of depression and substance use disorders in emergency department populations: A cross-sectional study at East Africa's largest public hospital. Afr J Emerg Med 2022; 12:307-314. [PMID: 35892005 PMCID: PMC9307521 DOI: 10.1016/j.afjem.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/25/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022] Open
Abstract
Introduction There are persistent gaps in screening, identification, and access to care for common mental disorders in Low- and Middle-Income Countries. An initial step towards reducing this gap is identifying the prevalence, co-morbidities, and context of these disorders in different clinical settings and exploring opportunities for intervention. This study evaluates the prevalence and correlates of depression and substance use disorders among adults presenting to the Emergency Department (ED) of a major national hospital in East Africa. Methods This study utilized the World Health Organization's STEPwise Approach to Surveillance (WHO-STEPS) tool and the Patient Health Questionnaire (PHQ-9) to conduct a cross-sectional survey capturing socio-demographic data, tobacco, and alcohol use and rates of depression in a sample of adults presenting to the ED. Bivariate and multivariate analyses were conducted for each outcome of interest and socio-demographics. Results Of 734 respondents, 298 (40.6%) had a PHQ-9 score in the "moderate" to "severe" range indicative of major depressive disorder. About 17% of respondents endorsed current tobacco use while about 30% reported being daily alcohol users. Those with high PHQ-9 score had higher odds of reporting current tobacco use ("severe range" = adjusted odds ratio (aOR) 1.85, 95% CI 1.05, 3.26). Those with a "severe" PHQ-9 scores were 9 times (aOR 2.3-35.3) more likely to be daily drinkers. Conclusions Screening and identification of people with depression and substance use disorders in the ED of a large national hospital in Kenya is feasible. This offers an opportunity for brief intervention and referral to further treatment.
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Affiliation(s)
- Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Corresponding author.
| | - Kaitlin R. Maciejewski
- Yale Center for Analytical Sciences, Yale University School of Public Health, New Haven, CT, USA
| | | | - Faith Chumo
- Department of History of Science, Medicine and Public Health, Yale College, New Haven, CT, USA
| | - Tracie Slade
- Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA
| | - Rebecca Leff
- Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christine Ngaruiya
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
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Tsai J, Szymkowiak D, Iheanacho T. Psychopharmacoepidemiology of antidepressant medications among homeless and unstably housed service users in the Veterans Affairs healthcare system. Hum Psychopharmacol 2022; 37:e2829. [PMID: 34799872 DOI: 10.1002/hup.2829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 09/07/2021] [Accepted: 11/11/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study conducted a pharmacoepidemiologic examination of antidepressant prescription patterns in homeless and unstably housed (HUH) populations. METHODS Data were analyzed on over 2.6 million veterans from the U.S. Department of Veterans Affairs (VA), the largest provider of healthcare for HUH veterans and a system that does not require healthcare insurance. RESULTS Multivariable analyses revealed that HUH veterans with depression and PTSD were less likely to receive an antidepressant Rx compared to their stably housed (SH) counterparts with these conditions (OR = 0.77, 99% CI = 0.74-0.79; and OR = 0.87, 99% CI = 0.84-0.90, respectively). Antidepressants were mostly prescribed in specialty mental health care settings, but HUH veterans were less likely to be prescribed antidepressants in primary care settings than SH veterans. In the total sample, the 40-49 age group, female sex, VA service-connected disability, outpatient mental health visits, and emergency department visits were positively associated with any antidepressant Rx. Nearly all psychiatric diagnoses were more associated with prescription of selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors (SSRIs/SNRIs) than tricyclic antidepressants. CONCLUSION These findings highlight socioeconomic disparities in antidepressant Rx in a healthcare system that does not rely on insurance and suggest clinical challenges with antidepressant prescriptions in HUH populations.
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Affiliation(s)
- Jack Tsai
- Homeless Program Office, U.S. Department of Veterans Affairs, National Center on Homelessness Among Veterans, Tampa, Florida, USA.,School of Public Health, University of Texas Health Science Center at Houston, San Antonio, Texas, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Dorota Szymkowiak
- Homeless Program Office, U.S. Department of Veterans Affairs, National Center on Homelessness Among Veterans, Tampa, Florida, USA
| | - Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Nwanaji-Enwerem U, Condon EM, Conley S, Wang K, Iheanacho T, Redeker NS. Adapting the Health Stigma and Discrimination Framework to understand the association between stigma and sleep deficiency: A systematic review. Sleep Health 2022; 8:334-345. [PMID: 35504839 PMCID: PMC9233012 DOI: 10.1016/j.sleh.2022.03.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 02/11/2022] [Accepted: 03/08/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Sleep deficiency and sleep disorders disproportionally affect socially disadvantaged and marginalized individuals and groups. Recent evidence suggests that stigma, a social process characterized by labeling, stereotyping, and prejudice, is associated with sleep characteristics. PURPOSE Guided by the Health Stigma and Discrimination Framework, the purpose of this systematic review is to describe associations between dimensions of stigma and sleep deficiency and to identify future directions for research. METHODS We searched the OVIDPsycINFO, OVIDEMASE, OVIDMEDLINE, and CINAHL databases for empirical research studies that reported relationships between the 3 dimensions of stigma-internalized, perceived, and anticipated-and characteristics of sleep deficiency-duration, continuity/efficiency, timing, alertness/sleepiness, quality, and disorders. RESULTS Of 1717 articles, 15 met our inclusion criteria. The most frequently assessed dimensions of stigma were internalized and perceived stigma. Characteristics of sleep deficiency were measured by self-report and included sleep quality, duration, trouble sleeping, and insomnia symptoms. We found consistent evidence that stigma, whether internalized, perceived, or anticipated, is associated with self-reported characteristics of sleep deficiency. CONCLUSIONS This evidence base can be further strengthened with prospective studies that incorporate both multidimensional measures of stigma and objective measures of sleep characteristics. We outline research implications that can clarify underlying mechanisms and more precisely define the relationships between stigma and sleep and inform interventions to address stigma, improve sleep, and reduce the health inequities that disproportionately affect individuals from socially disadvantaged and marginalized groups.
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Affiliation(s)
| | - Eileen M Condon
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
| | | | - Katie Wang
- Yale School of Public Health, New Haven, Connecticut, USA
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Chu C, Roxas N, Aguocha CM, Nwefoh E, Wang K, Dike C, Iheanacho T. Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project. BMC Health Serv Res 2022; 22:333. [PMID: 35279154 PMCID: PMC8917687 DOI: 10.1186/s12913-022-07703-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) project trains non-specialist and primary health care workers in Imo State, Nigeria. This project adapted the World Health Organization’s Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG), emphasizing stigma reduction among trainees. This convergent mixed-methods proof-of-concept study evaluates the HAPPINESS pilot project mhGAP-IG training’s impact on mental illness stigma among trainees and barriers, facilitators, and opportunities to consider for project improvement. Methods Trainees (n = 13) completed a 43-item questionnaire before and after their 5-day training to assess perceptions of mental disorders and attitudes towards people with mental illness. These responses were analyzed using paired-sample t-tests for four subscales of the questionnaire: acceptance of socializing with people with mental illness, normalizing activities and relationships with people with mental illness, supernatural causation of mental illness, and endorsement of a biopsychosocial approach to mental illness. Semi-structured key informant interviews (n = 11) with trainees, trainers, and local health officials who participated in or supported the HAPPINESS project were thematically analyzed to understand their experiences and perspectives of the project’s barriers, facilitators, and opportunities. Results Trainees showed significant improvements on socializing, normalizing, and supernatural causation subscales of the stigma questionnaire (p < 0.05). No significant effect was seen on the biopsychosocial subscale; however, evidence of biopsychosocial beliefs was found in interview responses. Key informant interviews revealed that the HAPPINESS project enhanced trainees’ diagnostic and treatment abilities, mental health awareness, and empathy towards patients. Misinformation, stigma, inadequate funding, and lack of road access to clinics were identified as barriers to mental health care integration into general care in Imo State. Respondents also suggested ways that the HAPPINESS project could be improved and expanded in the future. Conclusions This study adds to the limited evidence on the implementation of mhGAP-IG in Nigeria. Using mixed methods, it evaluates how mhGAP-IG can impact perceptions and knowledge of stigma among primary care trainees. It also highlights barriers, facilitators, and opportunities to consider for project growth. Future efforts should focus on clinical support, supervision, health outcomes, as well as scaling up and assessing the cost-effectiveness of the HAPPINESS project intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07703-1.
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Haeny AM, Oluwoye O, Cruz R, Iheanacho T, Jackson AB, Fisher S, Crouch M, O'Malley S. Drug and alcohol treatment utilization and barriers among Black, American Indian/Alaskan Native, Latine, Asian/Pacific Islander/Native Hawaiian, and White adults: Findings from NESARC-III. J Subst Abuse Treat 2021; 131:108569. [PMID: 34393011 PMCID: PMC9084614 DOI: 10.1016/j.jsat.2021.108569] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/24/2021] [Accepted: 07/14/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Existing epidemiological data suggest differences across racial/ethnic groups in drug and alcohol treatment utilization and barriers to treatment and typically include only Black, Latine, and White adults. The objective of this study was to examine whether disparities remain for DSM-5 lifetime alcohol use disorder (AUD) and drug use disorder (DUD) treatment utilization and barriers across Black, American Indian/Alaska Native (AI/AN), Latine, Asian/Pacific Islander/Native Hawaiian (Asian/PI/NH), and White adults. METHODS The current study conducted secondary analyses on data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC-III). Regression analyses, followed by pairwise comparisons, investigated differences across racial/ethnic groups. RESULTS Analyses indicated differences across racial/ethnic groups in AUD treatment utilization. White and AI/AN adults were more likely to utilize a health care professional than were Black adults. Asian/PI/NH and Latine adults were more likely to endorse language as a barrier to AUD treatment than were White adults. Black adults were more likely to use 12-step programs for DUD treatment utilization than were White and Latine adults, and Black and White adults were more likely to use outpatient programs than were Latine adults. Further, Black adults were more likely than Asian/PI/NH and Latine adults to use specialty DUD treatment. AI/AN, Asian/PI/NH, and White adults were more likely to endorse fear of what others would think as a barrier to DUD treatment relative to Black adults. AI/AN adults were more likely to endorse fear of being hospitalized relative to Black, Latine, and White adults. Asian/PI/NH and Latine adults were more likely to indicate that the hours were inconvenient relative to Black and White adults. White adults were more likely to endorse a family member objected relative to Black adults. AI/AN and White adults were more likely to endorse they stopped on their own relative to Black, Asian/PI/NH, and Latine adults. Further, AI/AN and White adults reported the greatest number of barriers to DUD treatment. CONCLUSIONS Differences remain across racial/ethnic group in drug and alcohol treatment utilization and barriers to treatment. Future research aimed at increasing treatment utilization across racial/ethnic groups should focus on social determinants of health.
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Affiliation(s)
- Angela M Haeny
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States.
| | | | - Rick Cruz
- Utah State University, United States
| | - Theddeus Iheanacho
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | - Asti B Jackson
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
| | | | - Maria Crouch
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States; University of Alaska Anchorage, United States
| | - Stephanie O'Malley
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06511, United States
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Iheanacho T, Stefanovics E, Okoro UG, Anyaehie UE, Njoku PO, Adimekwe AI, Ibediro K, Stefanovics GA, Haeny A, Jackson A, Unamba NN, Isiguzo G, Chukwu CC, Anyaehie UB, Mbam TT, Osy-Eneze C, Ibezim EO. Assessing knowledge, attitude, practice and training related to COVID-19: a cross-sectional survey of frontline healthcare workers in Nigeria. BMJ Open 2021; 11:e050138. [PMID: 34580097 PMCID: PMC8478584 DOI: 10.1136/bmjopen-2021-050138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Healthcare workers (HCWs) are at the frontline of efforts to treat those affected by COVID-19 and prevent its continued spread. This study seeks to assess knowledge, attitude and practice (KAP) as well as training needs and preferences related to COVID-19 among frontline HCWs in Nigeria. SETTING A cross-sectional survey was carried out among 1852 HCWs in primary, secondary and tertiary care settings across Nigeria using a 33-item questionnaire. PARTICIPANTS Respondents included doctors, nurses, pharmacy and clinical laboratory professionals who have direct clinical contact with patients at the various healthcare settings. ANALYSIS Exploratory factor analysis (EFA) was used to establish independent factors related to COVID-19 KAP. Analysis of variance was used to identify any differences in the factors among different categories of HCWs. RESULTS EFA identified four factors: safety and prevention (factor 1), practice and knowledge (factor 2), control and mitigation (factor 3) and national perceptions (factor 4). Significant group differences were found on three factors: Factor 1 (F(1,1655)=5.79, p=0.0006), factor 3 (F(1,1633)=12.9, p<0.0.0001) and factor 4 (F(1,1655)=7.31, p<0.0001) with doctors scoring higher on these three factors when compared with nurses, pharmaceutical workers and medical laboratory scientist. The most endorsed training need was how to reorganise the workplace to prevent spread of COVID-19. This was chosen by 61.8% of medical laboratory professionals, 55.6% of doctors, 51.7% of nurses and 51.6% of pharmaceutical health workers. The most preferred modes of training were webinars and conferences. CONCLUSION There were substantial differences in KAP regarding the COVID-19 pandemic among various categories of frontline HCWs surveyed. There were also group differences on COVID-19 training needs and preferences. Tailored health education and training aimed at enhancing and updating COVID-19 KAP are needed, particularly among non-physician HCWs.
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Affiliation(s)
- Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elina Stefanovics
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | - Udo Ego Anyaehie
- Department of Orthopaedics, National Orthopaedic Hospital Enugu, Enugu, Nigeria
| | - Paschal Okuchi Njoku
- Department of Internal Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Anthony Ikenna Adimekwe
- Department of Family Medicine, Catterick and Colburn Medical Group, Richmondshire, NHS North Yorkshire, Yorkshire and Humber, England, UK
| | - Kingsley Ibediro
- Department of Family Medicine, Meadow Primary Health Care Center, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Glenn A Stefanovics
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Angela Haeny
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Asti Jackson
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Norbert Ndubuisi Unamba
- Department of Cardiology, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Godsent Isiguzo
- Department of Medicine, Alex Ekwueme Federal Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | | | | | - Thomas Terence Mbam
- Department of Otorhinolaryngology, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Ebonyi, Nigeria
| | - Chinyere Osy-Eneze
- Department of Medicine, Abbeyfields Medical Center, Colchester, East England, UK
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12
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Iheanacho T, Nduanya UC, Slinkard S, Ogidi AG, Patel D, Itanyi IU, Naeem F, Spiegelman D, Ezeanolue EE. Utilizing a church-based platform for mental health interventions: exploring the role of the clergy and the treatment preference of women with depression. Glob Ment Health (Camb) 2021; 8:e5. [PMID: 34026236 PMCID: PMC8127631 DOI: 10.1017/gmh.2021.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/28/2020] [Accepted: 01/17/2021] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Training lay people to deliver mental health interventions in the community can be an effective strategy to mitigate mental health manpower shortages in low- and middle-income countries. The healthy beginning initiative (HBI) is a congregation-based platform that uses this approach to train church-based lay health advisors to conduct mental health screening in community churches and link people to care. This paper explores the potential for a clergy-delivered therapy for mental disorders on the HBI platform and identifies the treatment preferences of women diagnosed with depression. METHODS We conducted focus group discussion and free-listing exercise with 13 catholic clergy in churches that participated in HBI in Enugu, Nigeria. These exercises, guided by the positive, existential, or negative (PEN-3) cultural model, explored their role in HBI, their beliefs about mental disorders, and their willingness to be trained to deliver therapy for mental disorders. We surveyed women diagnosed with depression in the same environment to understand their health-seeking behavior and treatment preferences. The development of the survey was guided by the health belief model. RESULTS The clergy valued their role in HBI, expressed understanding of the bio-psycho-socio-spiritual model of mental disorders, and were willing to be trained to provide therapy for depression. Majority of the women surveyed preferred to receive therapy from trained clergy (92.9%), followed by a psychiatrist (89.3%), and psychologist (85.7%). CONCLUSION These findings support a potential clergy-focused, faith-informed adaptation of therapy for common mental disorders anchored in community churches to increase access to treatment in a resource-limited setting.
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Affiliation(s)
| | - Ujunwa Callista Nduanya
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Psychiatry, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | | | - Amaka Grace Ogidi
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Dina Patel
- Healthy Sunrise Foundation, Las Vegas, NV, USA
| | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | | | | | - Echezona E. Ezeanolue
- Center for Translation and Implementation Research, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Healthy Sunrise Foundation, Las Vegas, NV, USA
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13
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Iheanacho T, Bommersbach T, Fuehrlein B, Arnaout B, Dike C. Brief Training on Medication-Assisted Treatment Improves Community Mental Health Clinicians' Confidence and Readiness to Address Substance Use Disorders. Community Ment Health J 2020; 56:1429-1435. [PMID: 32062717 PMCID: PMC7429311 DOI: 10.1007/s10597-020-00586-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/12/2020] [Indexed: 11/25/2022]
Abstract
Despite the availability and effectiveness of medication-assisted treatment (MAT) for substance use disorders (SUDs), utilization of these medications remains suboptimal, especially in public sector settings. A key limitation is clinicians' reluctance to include MAT in their routine practice due, in part, to low confidence about managing SUDs and limited awareness of the disease model of addiction. This study evaluates the impact of a 1-day MAT training for community mental health clinicians using a 30-item pre- and post-training questionnaire. Of the 109 clinicians who attended the training, 107 completed the pre- and post-training questionnaires. Factor analysis of the questionnaire identified two domains: readiness to address SUDs among patients (factor 1) and understanding SUDs as diseases (factor 2). Post training, there was a significant change in both factor 1 (p = .00001) and factor 2 (p = .00003), indicating that a brief MAT training can increase clinicians' confidence and readiness to address SUDs and improve their understanding of the disease model of addiction.
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Affiliation(s)
- Theddeus Iheanacho
- Yale University School of Medicine, New Haven, CT, USA.
- VA Connecticut Healthcare System, West Haven, CT, USA.
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT, 06511, USA.
| | | | - Brian Fuehrlein
- Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Bachaar Arnaout
- Yale University School of Medicine, New Haven, CT, USA
- VA Connecticut Healthcare System, West Haven, CT, USA
| | - Charles Dike
- Yale University School of Medicine, New Haven, CT, USA
- Connecticut's Department of Mental Health and Addiction Services, Hartford, CT, USA
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14
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Ezeanolue EE, Iheanacho T, Adedeji IA, Itanyi IU, Olakunde B, Patel D, Dakum P, Okonkwo P, Akinmurele T, Obiefune M, Khamofu H, Oyeledun B, Aina M, Eyo A, Oleribe O, Oko J, Olutola A, Gobir I, Aliyu MH, Aliyu G, Woelk G, Aarons G, Siberry G, Sturke R. Opportunities and challenges to integrating mental health into HIV programs in a low- and middle-income country: insights from the Nigeria implementation science Alliance. BMC Health Serv Res 2020; 20:904. [PMID: 32993621 PMCID: PMC7526407 DOI: 10.1186/s12913-020-05750-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background In Nigeria, there is an estimated 1.9 million people living with HIV (PLHIV), 53% of whom utilize HIV care and services. With decreasing HIV-related deaths and increasing new infections, HIV with its associated comorbidities continue to be a key public health challenge in Nigeria. Untreated, comorbid mental disorders are a critical but potentially modifiable determinant of optimal HIV treatment outcomes. This study aimed to identify the challenges and opportunities related to integrating mental health care into existing HIV programs in Nigeria. Method Attendees at the Nigeria Implementation Science Alliance (NISA)‘s 2019 conference participated in nominal group technique (NGT) exercise informed by the “Exploration, Preparation, Implementation, and Sustainment (EPIS)” framework. The NGT process was conducted among the nominal groups in two major sessions of 30-min phases followed by a 30-min plenary session. Data analysis proceeded in four steps: transcription, collation, theming and content analysis. Results The two major theoretical themes from the study were – opportunities and challenges of integrating mental health treatment into HIV services. Three sub-themes emerged on opportunities: building on health care facilities for HIV services (screening, counseling, task-sharing monitoring and evaluation frameworks), utilizing existing human resources or workforce in HIV programs (in-service training and including mental health in education curriculum) and the role of social and cultural structures (leveraging existing community, traditional and faith-based infrastructures). Four sub-themes emerged for challenges: double burden of stigma and the problems of early detection (HIV and mental health stigma, lack of awareness), existing policy gaps and structural challenges (fragmented health system), limited human resources for mental health care in Nigeria (knowledge gap and burnout) and dearth of data/evidence for planning and action (research gaps). Conclusions Potential for integrating treatments for mental disorders into HIV programs and services exist in Nigeria. These include opportunities for clinicians’ training and capacity building as well as community partnerships. Multiple barriers and challenges such as stigma, policy and research gaps would need to be addressed to leverage these opportunities. Our findings serve as a useful guide for government agencies, policy makers and research organizations to address co-morbid mental disorders among PLHIV in Nigeria.
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Affiliation(s)
- Echezona E Ezeanolue
- Center for Translation and Implementation Research, Institute of Maternal and Child health, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.,Healthy Sunrise Foundation, Las Vegas, NV, USA
| | - Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, Yale University, 300 George Street, New Haven, CT, 06511, USA.
| | | | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, Institute of Maternal and Child health, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.,Department of Community Medicine, University of Nigeria, Enugu, Nigeria
| | - Babayemi Olakunde
- Center for Translation and Implementation Research, Institute of Maternal and Child health, University of Nigeria Nsukka, Enugu Campus, Enugu, Nigeria.,National Agency for Control of AIDS, Abuja, Nigeria
| | - Dina Patel
- Healthy Sunrise Foundation, Las Vegas, NV, USA
| | - Patrick Dakum
- Institute of Human Virology, University of Maryland, Baltimore, MD, USA.,Institute of Human Virology, Abuja, Nigeria
| | | | | | | | | | | | | | - Andy Eyo
- Excellence Community Education Welfare Scheme, Abuja, Nigeria
| | - Obinna Oleribe
- Excellence and Friends Management Consult, Abuja, Nigeria
| | - John Oko
- Catholic Caritas Foundation Nigeria, Abuja, Nigeria
| | | | - Ibrahim Gobir
- Center for Global Health Practice and Impact, Georgetown University, Washington, USA
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Gambo Aliyu
- National Agency for Control of AIDS, Abuja, Nigeria
| | - Godfrey Woelk
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, USA
| | | | - George Siberry
- United States Agency for International Development, Washington, USA
| | - Rachel Sturke
- Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
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15
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Moore KE, Iheanacho T, Pittman BP, McKee SA, Dike C. Immigration, Criminal Involvement, and Violence in the U.S.: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Deviant Behav 2020; 42:1525-1531. [PMID: 35001991 PMCID: PMC8734575 DOI: 10.1080/01639625.2020.1758371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/26/2020] [Indexed: 06/14/2023]
Abstract
Topics of immigration and crime often receive national attention, despite evidence of the "immigrant paradox," in which immigrants have lower than expected crime and violence given their extreme social disadvantage. Research examining the immigrant paradox using an expanded set of crime outcomes and the latest available population data is needed. Using the National Epidemiologic Survey on Alcohol and Related Conditions Wave III data (2012-2013; n = 36,309), we analyzed the association between first-generation immigrant status alongside violence (i.e., other-directed, self-directed, victimization) and criminal involvement (i.e., crime, legal problems, incarceration) outcomes. Immigrants self-reported lower rates of all outcomes compared to U.S.-born adults, providing continued support for the immigrant paradox. Future research considering later generations of immigrants, as well as differential mechanisms through which immigrants and U.S.-born adults engage in violence and crime, is needed.
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Affiliation(s)
- Kelly E. Moore
- Department of Psychology, East Tennessee State University, Johnson City, TN, US
| | - Theddeus Iheanacho
- Division of Law and Psychiatry, Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, US
| | - Brian P. Pittman
- Division of Law and Psychiatry, Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, US
| | - Sherry A. McKee
- Division of Law and Psychiatry, Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, US
| | - Charles Dike
- Division of Law and Psychiatry, Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT, US
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16
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Iheanacho T, Payne K, Tsai J. Mobile, Community‐Based Buprenorphine Treatment for Veterans Experiencing Homelessness With Opioid Use Disorder: A Pilot, Feasibility Study. Am J Addict 2020; 29:485-491. [PMID: 32367557 DOI: 10.1111/ajad.13055] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/17/2020] [Accepted: 04/23/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Theddeus Iheanacho
- Yale University School of Medicine New Haven Connecticut
- VA Connecticut Healthcare System West Haven Connecticut
| | - Kevin Payne
- VA Connecticut Healthcare System West Haven Connecticut
| | - Jack Tsai
- Yale University School of Medicine New Haven Connecticut
- VA Connecticut Healthcare System West Haven Connecticut
- VA National Center on Homelessness Among Veterans West Haven Connecticut
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17
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Corey Williams J, Lo E, Iheanacho T. A Novel Resident Experience in a Veteran's Homeless Center. Acad Psychiatry 2018; 42:538-541. [PMID: 29094290 DOI: 10.1007/s40596-017-0842-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 10/15/2017] [Indexed: 06/07/2023]
Affiliation(s)
| | - Emma Lo
- Yale University, New Haven, CT, USA
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18
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Iheanacho T, Stefanovics E, Ezeanolue EE. Clergy's Beliefs About Mental Illness and Their Perception of Its Treatability: Experience from a Church-Based Prevention of Mother-to-Child HIV Transmission (PMTCT) Trial in Nigeria. J Relig Health 2018; 57:1483-1496. [PMID: 29335920 DOI: 10.1007/s10943-017-0545-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Clergy participating in the Healthy Beginning Initiative (N = 45), a program utilizing church workers to integrate packages of care into church activities, completed a 43-item self-administered questionnaire assessing their attitudes and beliefs about mental disorders and perception of their treatability. A majority believed that drug/alcohol use, stress and genetic inheritance could cause mental illness and that society needed to adopt more tolerant attitude toward people with mental disorders. Clergy with contact with people with mental disorders were more likely to perceive depression as treatable. In conclusion, participants had positive attitudes toward mental disorders with some believing that they are treatable.
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Affiliation(s)
- Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA.
| | - Elina Stefanovics
- Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite 901, New Haven, CT, 06511, USA
| | - Echezona E Ezeanolue
- HealthySunrise Foundation, 8752 Castle Ridge Ave, Las Vegas, NV, 89129, USA
- University of Nevada School of Medicine, 2040 W. Charleston Blvd. Suite 402, Las Vegas, NV, 89102, USA
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19
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Iheanacho T, Ablondi K, Stefanovics E, Rosen M, Rosenheck R. Screening homeless Veterans for a voluntary money management skills training program. American Journal of Psychiatric Rehabilitation 2018. [DOI: 10.1080/15487768.2017.1408504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, Yale University, West Haven, Connecticut, USA
| | - Karen Ablondi
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, Yale University, West Haven, Connecticut, USA
| | - Elina Stefanovics
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, Yale University, West Haven, Connecticut, USA
| | - Marc Rosen
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, Yale University, West Haven, Connecticut, USA
| | - Robert Rosenheck
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VA Connecticut Healthcare System, Yale University, West Haven, Connecticut, USA
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20
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Iheanacho T, Stefanovics E, Makanjuola V, Marienfeld C, Rosenheck R. Medical and nursing students' attitudes to people with mental illness in Nigeria: a tale of two teaching hospitals. Int Psychiatry 2018. [DOI: 10.1192/s1749367600004380] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This study compared beliefs about and attitudes to mental illness among medical and nursing students at two teaching hospitals in Nigeria with very different levels of psychiatric instructional capacity. Factor analysis of responses to a 43-item self-report questionnaire identified three domains: social acceptance of people with mental illness; belief in non-superstitious causation of mental illness; and stress, trauma and poverty as external causes of mental illness, with entitlement to employment rights. Students at the hospital with a larger, functioning psychiatry department had significantly higher scores on all three factors. Culturally enshrined beliefs and attitudes about mental illness are not uncommon among medical trainees. The availability of psychiatric education and services may have a positive effect on beliefs and attitudes.
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Iheanacho T, Stefanovics E, Rosenheck R. Opioid use disorder and homelessness in the Veterans Health Administration: The challenge of multimorbidity. J Opioid Manag 2018; 14:171-182. [PMID: 30044482 DOI: 10.5055/jom.2018.0447] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The aim of this study is to estimate the prevalence and sociodemographic and clinical correlates of opioid use disorder (OUD), a major cause of morbidity and mortality in the United States, among homeless veterans nationally in the Veterans Health Administration (VHA). DESIGN Administrative data on 256,404 veterans who were homeless and/or had OUD in fiscal year 2012 were analyzed to evaluate OUD as a risk factor for homelessness along with associated characteristics, comorbidities, and patterns of service use. Bivariate analyses and logistic regression were used to compare homeless veterans with OUD to veterans with OUD but no homelessness and homeless veterans with no OUD. RESULTS Altogether 17.9 percent of homeless VHA users were diagnosed with OUD and 34.6 percent of veterans with OUD were homeless. The risk ratio (RR) for homelessness among veterans with OUD was 28.7. Homeless veterans with OUD, compared to nonhomeless veterans with OUD showed extensive multimorbidity with greater risk for HIV (RR = 1.57), schizophrenia (RR = 1.62), alcohol use disorder (RR = 1.67), and others. Homeless veterans with OUD also showed more multimorbidity and used more services than homeless veterans without OUD. Homeless and nonhomeless OUD veterans used opiate agonist therapy at similar, but very low rates (13 and 15 percent). CONCLUSIONS OUD is a major risk factor for homelessness. Homeless veterans with OUD have high levels of multimorbidity and greater service use than veterans with either condition alone. Tailored, facilitated access to opioid agonist therapy may improve outcomes for these vulnerable veterans.
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Affiliation(s)
- Theddeus Iheanacho
- Assistant Professor, Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Elina Stefanovics
- Associate Research Scientist, Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Robert Rosenheck
- Professor, Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut
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Ehiri JE, Iwelunmor J, Iheanacho T, Blackstone S, Obiefune MC, Ogidi AG, Ahunanya FU, Nnadi D, Patel D, Hunt AT, Ezeanolue EE. Using a Cultural Framework to Understand Factors Influencing HIV Testing in Nigeria. Int Q Community Health Educ 2016; 37:33-42. [PMID: 28030987 PMCID: PMC5645216 DOI: 10.1177/0272684x16685258] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
With support from the U.S. President's Emergency Plan for AIDS Relief and the global fund for HIV, tuberculosis, and malaria, Nigeria offers free services for prevention of mother-to-child transmission of HIV. However, uptake of these services is low, and pediatric transmission of HIV remains a significant public health challenge. Using the PEN-3 cultural model as the theoretical framework, we examined social, cultural, and contextual factors that influenced uptake of HIV counseling and testing among pregnant women and their male partners. This was a qualitative study of participants in the Healthy Beginning Initiative (HBI), a congregation-based program to prevent mother-to-child transmission of HIV in Enugu, southeast Nigeria. We conducted eight focus group discussion sessions with 83 pregnant women and their male partners. Participants' perspectives on why they did or did not test for HIV were obtained. The most cited reasons for getting tested for HIV included the following: "the need to know one's status", "the role of prenatal testing" (positive perceptions); "the role of the church", "personal rapport with healthcare worker" (positive enablers); and the "influence of marriage" (positive nurturer). The most cited reason for not testing were: "fear of HIV test", "shame associated with HIV+ test results", "conspiratorial beliefs about HIV testing" (negative perceptions); "lack of confidentiality with HIV testing", (negative enabler); and "HIV-related stigma from family and community systems" (negative nurturer). Overall, numerous facilitators and barriers influence uptake of HIV testing in the study setting. Public health practitioners and policymakers need to consider how sociocultural and religious factors unique to specific local contexts may promote or hinder uptake of available HIV/AIDS prevention and care interventions.
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Affiliation(s)
- John E. Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Juliet Iwelunmor
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, IL, USA
| | - Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah Blackstone
- Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbana-Champaign, IL, USA
| | - Michael C. Obiefune
- Prevention, Education, Treatment, Training and Research-Global Solutions, Enugu State, Nigeria
| | - Amaka G. Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions, Enugu State, Nigeria
| | - Frances U. Ahunanya
- Prevention, Education, Treatment, Training and Research-Global Solutions, Enugu State, Nigeria
| | - Donatus Nnadi
- Prevention, Education, Treatment, Training and Research-Global Solutions, Enugu State, Nigeria
| | - Dina Patel
- Global Health and Implementation Research Initiatives, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Aaron T. Hunt
- Global Health and Implementation Research Initiatives, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
| | - Echezona E. Ezeanolue
- Global Health and Implementation Research Initiatives, School of Community Health Sciences, University of Nevada, Las Vegas, NV, USA
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Iheanacho T, Kapadia D, Ezeanolue CO, Osuji AA, Ogidi AG, Ike A, Patel D, Stefanovics E, Rosenheck R, Obiefune M, Ezeanolue EE. Attitudes and beliefs about mental illness among church-based lay health workers: experience from a prevention of mother-to-child HIV transmission trial in Nigeria. ACTA ACUST UNITED AC 2015; 9:1-13. [PMID: 26807146 PMCID: PMC4706033 DOI: 10.1080/17542863.2015.1074260] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/15/2015] [Indexed: 12/02/2022]
Abstract
Common mental disorders are prevalent in Nigeria. Due to stigma and a limited number of trained specialists, only 10% of adults with mental illness in Nigeria receive any care. The Healthy Beginning Initiative is a community-based maternal/child health program that includes screening for perinatal depression and was implemented by lay, volunteer, church-based health advisors (CHAs). The aim of the study was to assess the beliefs and attitudes about mental illness among the CHAs. The study used a cross-sectional survey of 57 CHAs, who completed a 43-item, self-administered questionnaire that assessed their beliefs and attitudes about mental illness. The response rate was 71%. Respondents were mostly female (79%), married (83%) and aged 40–49 years (M = 41.16 SD = 10.48). Most endorsed possession by evil spirits (84%), traumatic events (81%) and witchcraft (60%) as causes of mental illness. A majority (69%) believed that people with mental illness were a nuisance, and less than half (46%) believed that mental disorders were illnesses like any other illness. It is concluded that stigmatizing attitudes and beliefs about mental illness are common among the CHAs. Training for lay health workers in Nigeria should include education on the known bio-psycho-social basis of mental disorders and the role of social inclusion in recovery.
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Affiliation(s)
- Theddeus Iheanacho
- Department of Psychiatry, Yale University School of Medicine , New Haven , USA
| | | | | | - Alice A Osuji
- Prevention, Education, Treatment, Training and Research Global Solutions , Enugu , Nigeria
| | - Amaka G Ogidi
- Prevention, Education, Treatment, Training and Research Global Solutions , Enugu , Nigeria
| | - Anulika Ike
- Prevention, Education, Treatment, Training and Research Global Solutions , Enugu , Nigeria
| | - Dina Patel
- HealthySunrise Foundation, Las Vegas, USA; University of Nevada School of Medicine, Las Vegas, USA
| | - Elina Stefanovics
- Department of Psychiatry, Yale University School of Medicine , New Haven , USA
| | - Robert Rosenheck
- Department of Psychiatry, Yale University School of Medicine , New Haven , USA
| | - Michael Obiefune
- HealthySunrise Foundation, Las Vegas, USA; Prevention, Education, Treatment, Training and Research Global Solutions, Enugu, Nigeria
| | - Echezona E Ezeanolue
- HealthySunrise Foundation, Las Vegas, USA; University of Nevada School of Medicine, Las Vegas, USA
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Iheanacho T, Obiefune M, Ezeanolue CO, Ogedegbe G, Nwanyanwu OC, Ehiri JE, Ohaeri J, Ezeanolue EE. Integrating mental health screening into routine community maternal and child health activity: experience from Prevention of Mother-to-child HIV transmission (PMTCT) trial in Nigeria. Soc Psychiatry Psychiatr Epidemiol 2015; 50:489-95. [PMID: 25201181 PMCID: PMC4322219 DOI: 10.1007/s00127-014-0952-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 08/28/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE Although the prevalence of mental health disorders in Nigeria is comparable to most developed countries, access to mental health care in Nigeria is limited. Improving access to care requires innovative approaches that deliver mental health interventions at the community level. The aim of this study was to determine the feasibility and acceptability of integrating mental health screening into an existing community-based program for prevention of mother-to-child transmission of HIV targeted at pregnant women and their male partners. METHODS Pregnant women and their male partners from 117 churches enrolled in the healthy beginning initiative (HBI) in southeast Nigeria participated in the mental health screening project. Two members from each church were trained as church-based health advisors to administer the 12-item general health questionnaire. RESULTS Ninety-three percent of the pregnant women and their male partners agreed to participate and fully completed the questionnaire. Overall, 21.7 % of the respondents scored above the threshold of 11 indicating significant psychological distress, with women having significantly higher scores than men. CONCLUSION Mental health screening is feasible and well accepted among a cohort of pregnant women and their male partners. Church members can be trained as health advisors to administer mental health screening. Mental health interventions can be developed on the framework of the HBI.
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Affiliation(s)
- Theddeus Iheanacho
- Department of Psychiatry, Yale Univeristy School of Medicine, 300 George Street, New Haven, CT, 06519, USA,
| | - Michael Obiefune
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, 7 Link Road Independence Layout Enugu, 400001 Enugu State Enugu, Nigeria
| | | | - Gbenga Ogedegbe
- School of Medicine, New York University, 550 1st Ave, New York, NY USA
| | - Okey C. Nwanyanwu
- United States Center for Diseases Control and Prevention, Country Office, Abuja, Nigeria
| | - John E. Ehiri
- Division of Health Promotion Sciences/Global Health Institute, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave., Tucson, AZ 85724 USA
| | - Jude Ohaeri
- Department of Psychological Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria
| | - Echezona E. Ezeanolue
- Sunrise Foundation, Plot 358 New GRA, Enugu, Nigeria ,Department of Pediatrics, University of Nevada School of Medicine, 2040 West Charleston Boulevard, Las Vegas, NV USA
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Iheanacho T, Marienfeld C, Stefanovics E, Rosenheck RA. Attitudes toward mental illness and changes associated with a brief educational intervention for medical and nursing students in Nigeria. Acad Psychiatry 2014; 38:320-324. [PMID: 24643398 DOI: 10.1007/s40596-014-0073-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 06/10/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE This study assessed beliefs about mental disorders and changes in those beliefs following an educational intervention for a convenience sample of Nigerian medical and nursing students. METHODS A 43-item questionnaire was used to assess perceptions regarding mental disorders and attitudes toward people with mental illness before and after a 4-day educational intervention. RESULTS Factor analysis identified four domains: (1) socializing with people with mental illness, (2) belief in witchcraft or curses as causes of mental illness, (3) favorable attitudes toward normalization of the lives of people with mental illness, and (4) biopsychosocial approaches to mental illness. The greatest changes were in attitudes favoring normalization of the lives of people with mental illness (p = 0.0002), socializing with the mentally ill (p = 0.01), and biopsychosocial perspectives on mental illness (p = 0.01). CONCLUSION Brief educational interventions may alter some stigmatizing negative attitudes toward mental illness in healthcare trainees in low- and middle-income countries.
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Iheanacho T, Issa M, Marienfeld C, Rosenheck R. Use of naltrexone for alcohol use disorders in the Veterans' Health Administration: a national study. Drug Alcohol Depend 2013; 132:122-6. [PMID: 23434041 DOI: 10.1016/j.drugalcdep.2013.01.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/13/2013] [Accepted: 01/20/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study aimed to determine the proportion of patients with alcohol use disorders who were prescribed naltrexone in Veterans Administration (VA) Healthcare system for fiscal year (FY) 2010 and socio-demographic and clinical factors associated with its use. METHODS VA national administrative data were used to identify all veterans who had an alcohol use disorder diagnosis (ICD-9-CM codes 303.9x or305.0x) in fiscal year (FY 2010) and were not prescribed any opioids (n=224,319). Patients in this group who filled a naltrexone prescription during this period were identified. Bivariate analysis was used to evaluate differences between veterans who received naltrexone prescription and those who did not on baseline characteristics and diagnoses. Multivariate logistic regression analysis identified measures that were independently related to receipt of naltrexone. RESULTS 6172 (2.75%) of the 224,319 patients with a diagnosis of alcohol use disorder who did not receive a prescription for opioid medications received naltrexone prescription. Bivariate analyses showed that patients taking naltrexone were 69 times more likely to have a co-morbid axis I diagnosis. Multivariate logistic regression analysis showed that a history of any substance abuse outpatient visit, any psychiatric outpatient visit or any mental health inpatient hospitalization, were significantly related to filling a prescription for naltrexone. CONCLUSIONS The rate of use of naltrexone by clinicians and patients remains low and having a co-morbid axis I diagnosis and receiving specialty mental health care were strong predictors of receiving a naltrexone prescription. Understanding the reasons for these findings may further naltrexone's clinical usefulness.
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