The Impact of Online Schooling due to the Covid-19 Pandemic on the Mental and Socioeconomic Well-being of Parents and Guardians of Primary School Students

• COVID-19 caused extensive economic recession and Trinidad is no exception. Whilst lockdown slowed the spread of COVID-19, it also resulted in the closure of schools and retrenchment of workers. • Therefore, it was imperative that the parental population be investigated to determine the impact of this pandemic on their livelihood, since challenges they encountered impacted the quality of education received by their children. • Many families faced financial constraints in purchasing electronic devices and internet connectivity to facilitate their children's online learning. This overwhelming stress coupled with lack of technological competence had the possibility of increasing the prevalence of psychiatric disorders such as generalized anxiety and depression

Depression and diabetic control amongst a chronic disease clinic in Trinidad

Objectives: The goals of this study were to evaluate the relationship between two outcomes; depression and uncontrolled diabetes as well as to determine the prevalence and associated factors of these two main outcomes amongst diabetics attending a chronic disease clinic in Trinidad. Research Design and Methods: A cross-sectional study utilizing a researcher-administered questionnaire with a sample of 239 diabetic patients from the St Joseph Enhanced Health Centre. The Patient Health Questionnaire was used to determine the presence of depression whilst history from patients and laboratory data from the files were used to determine the HbA1C and other factors. Results: Depressed patients had increased odds for uncontrolled diabetes (OR 8.24 95%CI 3.37-20.17 p <0.000). Mann-Whitney U testing showed significant differences between the median and variance of the HbA1C between the depressed and non-depressed group, with the depressed group having a median HbA1C 9.0% and the non-depressed group a median of 7.1%. Prevalence of depression was 23.4% in this population and 59.4% of patients had HbA1C >7.0%. Factors associated with increased odds for depression were females, unemployment, no exercise and treatment with insulin. Decreased odds for depression was associated with religious participation, frequent exercise, compliance with medication and Afro-Trinidadian ethnicity. With respect to uncontrolled diabetes, housewives and those on insulin had increased odds whilst single persons and those who comply with medications had decreased odds for uncontrolled diabetes. Conclusions: The presence of depression is associated with 8x increased odds of uncontrolled diabetes, with depressed persons having higher average HbA1Cs than non-depressed. Persons treated with insulin had increased odds of both depression and uncontrolled diabetes whilst those compliant with medication had lowered odds for both.

Depression among tertiary education students in a developing country

OBJECTIVE: To determine the prevalence of depression among students at The University of the West Indies, St Augustine campus over the period 2014–2015. SUBJECTS AND METHOD: A cross-sectional study utilizing convenience sampling was executed between January and May 2015. A self-administered questionnaire based on the Centre for Epidemiological Studies Depression Scale-Revised (CESD-R) was formulated by the addition of demographic and other variables and was distributed to a total of 1020 undergraduate students at The University of the West Indies, St Augustine. The acquired data were analysed using Statistical Package for Social Sciences (SPSS) for Windows 8. RESULTS: With a response rate of 95.2%, the study revealed the overall prevalence of depression to be 39.8%, with 39.3% of non-medical students and 40.2% of medical students being depressed (95%CI). The factors statistically associated with depression were religion (p = 0.013), smoking (p < 0.001), alcohol consumption (p < 0.001), illicit drug use (p = 0.008) and being previously treated for depression (p < 0.001). More than two-thirds (69.5%) of respondents thought that they could recognize the symptoms of personal depression; however, 53.5% of them misdiagnosed themselves as not being depressed (95%CI). A quarter (24.9%) of respondents believed there is a stigma attached to seeking help for depression while 37.8% of them were unaware of the available counseling resources (95%CI). CONCLUSION: The overall prevalence of depression at The University of the West Indies, St Augustine campus during the 2014–2015 period was found to be 39.8%. The factors associated with depression were alcohol consumption, illicit drug use, smoking, religion and a previous diagnosis of depression.

High prevalence of diabetes mellitus in a cohort of Trinidadian patients with chronic obstructive pulmonary disease

OBJECTIVE: To define the prevalence of diabetes mellitus (DM) in a cohort of Trinidadian chronic obstructive pulmonary disease (COPD) patients, and investigate its relationship to lung function, quality of life, and depression. DESIGN AND METHODS: Anthropometric and spirometric data were obtained from 108 COPD (91 males) patients from Trinidad chest clinics, who also had HbA1c test results. Questionnaires on quality of life St. George’s Respiratory questionnaire ({SGRQ} and COPD Assessment Test {CAT}) and depression (Center for Epidemiologic Studies Depression Scale {CES-D & CESD-R}) were administered, and an interview conducted. RESULTS: Mean (SD) age: 67.4 (11.0) years. Median (IQR) HbA1c: 6.1 (5.7, 6.7) %. HbA1c values were obtained for 105 patients of whom 40% had diabetes, and 40% pre-diabetes. Diabetics had a greater (p=0.001) median (IQR) BMI [27.3 (24.1, 30.4)] than non-diabetics [24.2 (21.2, 27.2)]. Patients with at least one chest infection/exacerbation in the past year had increasing CAT & SGRQ Total (p<0.001), and CES-D & CESD-R (p≤0.013) scores. CAT and SGRQ total scores were negatively related to lung function and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages (p<0.001). All lung function parameters, except Forced expiratory volume/Forced vital capacity (FEV1/FVC), decreased with increasing CES-D and CESD-R scores (p<0.05). CAT & SGRQ correlated well with CES-D & CESD-R scores (p<0.001). Intravenous corticosteroid use was positively associated with HbA1c (p=0.043). Dosage of inhaled corticosteroids was associated with lower FEV1 (p=0.034) and higher SGRQ & CAT (p≤0.048). FVC % predicted was negatively related to HbA1c (p=0.033). CONCLUSION: The prevalence of DM in the COPD patients was 40%; however no significant correlations of DM to outcome measures were observed. Patients with worse quality of life due poor lung function were more depressed.

The prevalence of depression and the quality of life in hemodialysis patients and patients with chronic medical illnesses (CMIs) in the Bahamas

OBJECTIVE: To determine the prevalence of depression and the quality of life in hemodialysis patients and patients with chronic medical illnesses (CMIs) in the Bahamas. DESIGN AND METHODS: This study used a cross-sectional design with consecutive sampling. Data about sociodemographic characteristics, depression, and quality of life were collected using a sociodemographic questionnaire, the Beck Depression Inventory BDI-II, and the Short Form36 (SF 36) respectively. Data were analyzed using the Statistical Package for Social Sciences (SPSS). RESULT: 305 individuals (CMI: 106; Dialysis: 199) participated, 22 refused; 50.2% were males, 49.8% were female; mean age was 53.44 (ñ14.44); 45.9% were married; and 32.8% were unemployed for more than 2 years. The prevalence of depression was 43.7% for dialysis patients and 36.8% for CMI patients. Age of patients was associated with marital status, occupational status, ethnicity, and educational level. Hemodialysis patients were shown to have a lower quality of life than CMI patients. Linear regression analysis found that eight quality of life items were statistically significant predictor factors of the Beck score for the CMI and dialysis groups, and accounted for 45.5% of the variance. CONCLUSION: Although, these results did not necessarily demonstrate causality, patients receiving hemodialysis were as likely to be depressed as patients with chronic medical illness. Having to be on hemodialysis detracts significantly from patients’ quality of life.

The prevalence of depression and its associated factors among elderly patients attending health centres in Trinidad

BACKGROUND: Depression is the most common mood disorder in the elderly. Internationally, most studies have found the prevalence of depression in the elderly population to range from appoximately 13% to 18%. In 2010 it is estimated that persons over 60 years of age made up 10% of the population of Trinidad and Tobago. The ageing population faces many complex issues such as chronic illness, disability, loneliness, isolation and adverse socio-economic circumstances that may contribute to depression. Locally, no studies have been done that investigate the depression specifically in the elderly. This study aims to establish preliminary data on this topic for the elderly population of Trinidad. METHODS This was a cross sectional descriptive study of patients over age 60, attending four health centres in Trinidad (Arima, St. Joseph, Freeport and Couva). Convenience sampling was used and participants completed a demographic questionaire and the Zung self rating depression scale. Data was analyzed using SPSS for Windows version 10.0 and the Chi-square test was used to determine statistically significant associations. RESULTS: There were 348 participants consisting of 200 females (57.4%) and 148 males (42.6%). Those 60-79 years made up 90.8%, while the remaining 9.1% were 80 years or older. Indo-Trinidadians made up 60.1%, Afro-Trinidadians 31.2% and mixed or others made up 8.7%. The prevalence of depression in this elderly population was found to be 17.2%. Depression was found to be associated with level of education (p=0.016). No association was found between gender (p=0.470), marital status (p=0.066), ethnicity (p=0.742)....... CONCLUSION: The prevalence of depression found in this population (17.2%), its association with level of education is comparable to that found in other elderly population internationally. Depression is intertwined with social and economic well being and self-perceived health and is an important consideration when caring for the elderly in Trinidad.

Obesity stress and depression

Obesity may lead to chronic non-communicable diseases (NCDs). Unlike influenza, these NCDs cannot be passed on from one person to another ("non-communicable"), and they are "chronic", that is, once these diseases develop, they would not go away but would require lifestyle treatment. But obesity is also linked to stress and depression.

Somatization disorders among Indians in Jamaica and Trinidad and its association with social and psychological factors

Data on presence of somatization disorder, depression, anxiety, distress, stigma associated with having somatic symptoms, having a female somatizing relative, a history of domestic violence, sexual abuse and the presence of an alcoholic spouse was collected from Indo Trinidadians and Indo Jamaicans. Within the entire sample elevated somatization was reported by 27.5% of the sample. Thirty percent (30%) had elevated scores of distress, 26% for depression, 10.5% for anxiety and 15.5% gave history of domestic violence, 7.5% reported stigma and 9% had a history of sexual abuse. Chi-square analyses revealed a significant moderate relationship exists between depression and somatization, there was a P value of .000 (Chi-square (1) = 45.580. p<0.05). There was also a significant relationship between somatization disorder and anxiety for the entire sample ( Chi-square (1) = 22.710, p<0.00). A moderate relationship existed between somatization disorder and distress (chi-square (1) = 28.691, p<0.00). A statistically significant relationship was found between persons feeling that they are weak or worth less than others if they have somatic symptoms and the presence of somatization disorder (Chi-square (1) = 8.591, p=0.03).

Depression and psychosis associated with cannabis abuse in a developing country

Notwithstanding the increase use of cannabis among adolescents in both developing and developed countries, few studies have looked at cannabis use and mood disorders. In a series of case studies, this research project seeks to investigate patterns of clinical presentations seen among cannabis users in psychiatric outpatients in Trinidad. Five clinical patterns of presentations are identified among cannabis users and abusers based on variables of dosing, age of initial use, duration of use, tolerance and reverse tolerance and poly-drug abuse. All patients in these case studies were standardized for method of use and potency of cannabis used. Patients were screened by urine tests to determine co-morbid use of other substances. Other variables such as environmental factors and genetic vulnerability were reviewed as far as possible from historical accounts of family members. The five patterns described are low, controlled use with mild euphoria and heightened awareness, moderate use with mixed depressive symptoms and suicidal behavior, heavy, short term use with manic symptoms, long term incremental use with psychotic symptoms due to the trumping of depressive symptoms and cannabis mixed with other substances resulting in florid psychosis. Mood disorders appear to be a common finding among adolescents using cannabis. Sensitization to symptomatic presentation and early detection of cannabis use in young adolescents are necessary. Further research is needed on the effect of cannabinoids on emotions, behavior and thinking and its relationship to mental disorders. This study is useful as a guideline for the implementation of public health strategies and legislation concerning the use of cannabis in youths.

Depression in Trinidad and Tobago: incidence and social trends

Depression is a major problem worldwide and ranks within the first five common burden of disease affecting mankind. Raising rates of depression among youths and its association with the use of intoxicants present a major challenge to health care policy planner and governments alike. This chapter reviews major trends in adolescent depression in secondary schools in the Republic of Trinidad and Tobago and independently in the sister isle of Tobago. Incidence rates of 14% were found in Trinidad and Tobago and 10.1% in Tobago indicative of differences in population composition and social trends in both islands. Social parameters of gender differences, age cohort, attendance to religious institutions, prayer with the family, family use of alcohol, type of school attended, ethnicity and family structures were investigated. These variables were found to be significant contributory factors to adolescent depression in the Republic. An understanding of early depression in diverse communities will be helpful in reducing the global burden of common diseases.

Letter to the editor: prevention is better than cure: a reply to McKenzie, March et al. and Selten & Cantor-Graae

We are grateful to the commentators for their constructive observations on our review. We agree with Kwame McKenzie (2009) that consensus needs to be built ; the key point we attempted to make is that, to gain such a consensus, the problem of high rates of psychosis in migrant and minority ethnic populations needs to be de-coupled from the no less important issue of service provision for minority ethnic patients. In the same way that improving customer services for insurance claimants following an accident is irrelevant to reducing the rate at which such accidents occur, so reforming mental health services (important as this no doubt is) will have no impact on population rates of disorder.

Depression and the nature of Trinidadian family practice: a cross-sectional study.

BACKGROUND: Depression is the most common mental disorder; in an ambulatory-care setting 5 to 10 per cent of patients meet the criteria for major depression. Despite extensive documentation in primary care internationally, Trinidadian studies published on depression have been primarily hospital-based and focussed on suicide. The objectives of this study were to determine the prevalence of depression, the variables associated with depression and the commonest reason for the encounter (RFE) among adult patients attending Trinidadian fee-for-service family practice? METHODS: This was a cross-sectional descriptive survey of consecutive patients taken from a stratified random sample of family practices in the north-west region of Trinidad. To measure depression the Zung scale was modified for use as a brief diagnostic tool. This modified Zung scale, when tested against a psychiatric interview, revealed that at a cut off point of 60, the scale had a specificity of 94 per cent (95 per cent CI 87-100), a sensitivity of 60 per cent (95 per cent CI 45-75), and a likelihood ratio for a positive test result of 10 (95 per cent CI 6-42). RESULTS: 508 patients from 28 practices participated; a response rate of 85 per cent. Participants were primarily younger 18-49 years (66.7 per cent), female (69.5 per cent), and educated, with 72.8 per cent having received a secondary school, technical school or university education. Sixty-five (12.8 per cent) of the respondents (95 per cent CI 9.9-15.7) were determined to be depressed. Chi-square analysis revealed no statistically significant association between depression and age, ethnicity, education levels, occupation or marital status (p > 0.05).

Adolescent depression in Trinidad and Tobago

This study investigates depression in adolescents in Trinidad and Tobago and identifies any significant trends associated with its occurrence. A stratified random sample of 1.845 adolescent students from 24 schools was administered a questionnaire requesting demographic information and responses to the Reynolds Adolescent Depression Scale. In all, 14 per cent of the sample was depressed. Depression was 2.18 times more likely to occur in females than males (17.9 per cent vs. 8.2 per cent). The peak age was 16 years with a rate of 15.9 per cent. Both attendance at a religious institution and prayer with the family resulted in lower depression rates. Intact families had the lowest rate (11.7 per cent),while the reconstituted family had the highest rate (25.7 per cent). Individuals who had alcohol abuse in their family were 1.8 times more likely to be depressed than those without abuse. Adolescents from non-prestige schools were more likely to be depressed than those from prestige schools (p < 0.01). There were no ethnic differences in depression. The findings of this study are comparable to those of developed countries and provide guidelines for the planning and development of strategies for fighting depression in developing countries.

Mental disorders in female victims of intimate partner violence in Trinidad

The study examines the prevalence of major depression, posttraumatic stress disorder, alcohol and substance abuse disorders in a sample of 21 women between the ages of 18 and 57 who had experienced intimate partner violence within the previous year. The findings are compared to those in a control sample of 60 women who had never experienced physical abuse. The prevalence of major depression in the battered sample was 71 percent compared to 10 percent in the control sample. Posttraumatic stress disorder was found in 62 percent of the battered sample compared to 2 percent of the control sample. Both findings were statistically significant. Alcohol and substance abuse disorders were found in 14 percent of battered subjects as compared to 2 percent in the control group. This finding was not statistically significant. The findings are consistent with the hypothesis that intimate partner violence increases risk for mental health problems (AU)

Validation of the Zung depression scale in a Jamaican population [abstract]

OBJECTIVE: To validate the Zung depression scale in a Jamaican population in order to incorporate its use in primary health care facilities. METHODS: The Zung depression scale is a 20-item questionnaire used in the evaluation and detection of depression in individuals. Four mental health officers administered the scale to a cohort of 584 persons at the Maxfield Park Health Centre. RESULTS: Approximately 17 percent of the sample fell in the category of moderate depression and 5 percent in the category of severe depression. These results are consistent with other international studies. Wide variations were seen in the age bands designated adolescent, young adult, adult and elderly. The results showed good internal consistency with Cronbach ‘ of 0.813. Factor analysis using principle component analysis and varimax rotation identified three factors: positive outlook, physical activity and psychological symptoms. CONCLUSION: Overall, items were highly predictive of depression. (AU)

The important concepts in the management of microbial keratitis

Eye practitioners in the Caribbean must be aware of the issues involved in the management of microbial keratitis. A comprehensive literature review is presented in order to outline appropriate management strategies and to identify when referral may be indicated. (AU)

Cultural diversity, stress, and depression: working women in the Americas

Social support lengthens life, and stressors induce morbidity early in life and death later. Social supports and stressors, however, particularly those embedded in daily social interactions, exhibit important forms of cultural variation not yet incorporated into stress measurements. This article reports a clinically useful measure of stress applicable to culturally diverse populations. Ninety working women with a wide range of ages, educational attainments, class backgrounds, and historical origins (Africa, northwest Europe, Hispanic, and Native Americans) provided cultural data on the meaning of stress. Consensus analysis, principal components analysis and Cronbach's alpha, and logistic regression document content validity of the stress scale. The meaning of social supports (words or acts that imply respect, equality, or help or otherwise lead one to feel special and important) and stressors (words or acts that demean, imply inferiority, impede achievement, or otherwise lead one to feel bad about oneself) experienced a risk of depressive symptoms 85 times higher than informants without such a history. Standardized cultural research methods yield an instrument based on potential cultural universals that can facilitate clinical assessment and management of stress and health outcomes, such as depression, in culturally diverse populations.(Au)

The effects of witnessing domestic violence on behavioural problems and depressive symptomatology. A community sample of pupils from St. Lucia

Behavioural problems and depressive symptomatology were evaluated in a sample of 60 St. Lucian pupils who came from homes where parents were either in violent or non-violent marital relationships. Teachers rated pupils using the Revised Behaviour Problem Checklist (RBPC) while self rating scores were obtained from pupils using either the Reynolds Child Depression Scale (RCDS) or the Reynolds Adolescent Depression Scale (RADS), depending on the age of the pupil. The results indicated that those pupils whose parents were experiencing violent marital discord showed significantly higher levels of both depression and behavioural problems than those pupils not exposed to domestic violence. In addition, exposed children exhibited more behavioural problems but less depressive symptomatology than adolescents. The results from this study are consistent with those of more developed countries. The theoretical implications of these findings are discussed and methodological refinements are suggested for further research.(AU)

Occupational mental health: a study of work-related depression among nurses in the Caribbean

This study addresses issues of occupational mental health among nurses in the Caribbean. A linear model linking role, work and social factors, stress, burnout, depression, absenteeism and turnover intention guides the research. Data were collected from 119 nurses working for major hospitals located in St. Vincent and Trinidad & Tobago using a field survey. Psychometrically sound instruments with provencross-cultural validity were utilized in the questionnaire. Descriptive statistics, correlations, and path analysis were used to analyze the data. The results indicated fairly strong support for proposed model which is tested for the first time among a Caribbean population. Role conflict, role overload and social support predicted stress, which along with social support predicted burnout. Burnout was the sole predictor of depression which in turn predicted both absenteeism and turnover intention. Implications of these findings for research and practice are discussed.(AU)

Suicide rate in Jamaica in 1998 and the prevalence of mental disordes and stressful life events in suicide victims in Kingston, St Andrew and St. Catherine in 1998

The suicide rate of Jamaica was reviewed using available police records. The prevalence of mental disorders and stressful life events in 1998 suicide victims in two parishes in Jamaica was investigated. A psychological autopsy interview method was used to interview relatives and acquaintances of 32 suicide victims over a 4 month period. Hospital records and telephone interviews supplemented information. The DSM IV criteria and a stressful life event categorisation was used to diagnose mental disorders and assess year long exposure to stressful events. It was confirmed that Jamaica's suicide rate (2.8 per 100,000) had increased but remained one of the lowest in the Caribbean. Young men and older men were most at risk. At least 90 percent of the victims were diagnosed as having a mental disorder at the time of suicide. The most common diagnosis was depression, followed by schizophrenia, alcoholism and personality disorder. There was significant comorbidity with substance abuse disorders - marijuana and alcohol abuse. There was a significant level of stressful life events in the suicide victims. The category of interpersonal losses and problems was the most common, followed by health related injuries and living conditions. The category of financial, job related and legal issues was least prominent. The author recognises limitations in time, methodology and analysis. The findings of the prevalence of mental disorders were similar to other psychological autopsy findings. Case controlled studies and regression analysis could give further insight on the role that mental disorders and stressful events play in suicide. Recommendations are made for prevention and control of suicide in Jamaica.(AU)