Psychometric evaluation of the affiliate stigma scale for caregivers of people with mental illness in Uganda.

BACKGROUND: Affiliate stigma is common among caregivers of people with mental illness and impacts negatively on the caregivers' quality of life and their ability to care for the patients. Although there is evidence of affiliate stigma in sub-Saharan Africa, the psychometric properties of commonly used tools are not available in the African context. The aim of this analysis was to evaluate the factor structure of the affiliate stigma scale among caregivers of people with mental illness in southwestern Uganda. Having a validated method to assess affiliate stigma in the Ugandan setting helps to appropriately evaluate affiliate stigma among caregivers of people with mental illnesses, which could inform the development of interventions to support such caregivers. METHOD: A total of 385 caregivers of people with mental illness attending outpatient psychiatry clinics in selected tertiary hospitals in southwestern Uganda were enrolled in the study. The affiliate stigma and depression were assessed using the affiliate stigma scale and the patient health questionnaire (PHQ-9) respectively. We conducted exploratory and confirmatory factor analysis to determine the factor structure, reliability and validity of the affiliate stigma scale. We also evaluated the convergent validity of the affiliate stigma scale by determining the correlation between affiliate stigma scale scores and the PHQ-9. RESULT: More than half of participants were male (55.06%) and majority of caregivers were living in rural areas (80.26%). The sample size was adequate, as evidenced by the KMO of 0.91 and the inter-correlation was sufficient to conduct the factor analysis, according to the Bartlett test. Confirmatory factor analysis revealed four factors and all 22 items were retained as all of them had a factor loading > 0.4. The internal consistency of the total scale was excellent (alpha = 0.92). The affiliate stigma score correlated with depression which has been hypothesized to be associated with the stigma of mental illness. CONCLUSION: The study findings show the affiliate stigma scale as a valid measure of affiliate stigma among the caregivers of patients with mental illness in southwestern Uganda. Therefore, this scale provides an opportunity to mental health care providers to assess affiliate stigma and develop interventions aimed at prevention stigma among caregivers and improve outcomes among people with mental illness.

Psychological distress among healthcare professionals in Mbarara, following the 2022 Ebola Virus Disease outbreak in Uganda: a mixed methods study.

BACKGROUND: The 2022 Ebola Virus Disease (EVD) outbreak occurred at a time when Uganda was still battling the social and psychological challenges of the COVID-19 pandemic; placing health care professionals (HCPs) at a much higher risk of developing psychological distress. Psychological distress among HCPs can cause decreased workplace productivity and ineffective management of their patients. The current study aimed to investigate and understand psychological distress among HCPS in Mbarara city in Southwestern Uganda following the 2022 EVD outbreak. METHOD: We enrolled 200 HCPs through convenient sampling from one private and one public health facility in Mbarara city in Southwestern Uganda, in a cross-sectional convergent parallel mixed method approach where qualitative and quantitative data were collected concurrently. Quantitative data, utilizing the Kessler Psychological Distress (K10) Scale, provided us with a quantitative measure of the prevalence of psychological distress among HCPs, and were analyzed using STATA version 16. Qualitative data, on the other hand, offered deeper insights into the nature, perceptions, and contextual factors influencing this distress, and were analyzed using emergent theme analysis. RESULTS: The prevalence of psychological distress was 59.5% and it was higher among females (63.9%) compared to males (36.1%). HCPs vividly expressed distress and anxiety, with heightened suspicion that every patient might be an EVD carrier, creating a pervasive sense of unsafety in the workplace. However, the outbreak had an educational affect where concerns about the announcement of another EVD outbreak were diverse, with HCPs expressing anxiety, despair, and dissatisfaction with the country's management of potential outbreaks. CONCLUSION: High levels of psychological distress were experienced by HCPs in Southwestern Uganda as a result of the 2022 EVD pandemic. HCPs express a wide range of feelings, such as dread, anxiety, despair, pessimism, and discontent with the way the outbreaks are handled throughout the nation. We recommend implementation of comprehensive psychosocial support programs tailored to the unique needs of HCPs, including counseling services, stress management workshops, and peer support networks.

Primary Healthcare Workers' Awareness of Acute Rheumatic Fever & Rheumatic Heart Disease: A Study in Public Health Facilities in South Western Uganda.

Introduction: Timely identification and treatment of a streptococcal throat infection prevents acute rheumatic fever (ARF) and its progression to Rheumatic Heart Disease (RHD). However, children in developing countries still present with established RHD, due to either missed, untreated or sub-optimally treated sore throats and ARF. We aimed to determine the level of knowledge, skills, and practices of primary health workers in South Western Uganda in providing care such children. Methods: We conducted a comparative quantitative cross-sectional study to assess knowledge, practices, and skills regarding the care of a child with a sore throat, ARF, and RHD. The responses were scored against a structured guide. The Fisher's exact test and the chi-squared test with level of significance set at 0.05 were utilized to compare differences in knowledge, skills, and practices among health workers in private and public health facilities about ARF and RHD. Results: Eighty health workers from health facilities were interviewed in Mbarara district with a median age of 29.5 years (IQR 27.34) and median duration in practice of 5 years (IQR: 2, 10). On average, there were at least 3 children with sore throats weekly. At least 95% (CI: 87.25%-98.80%) of the health worker had awareness about ARF and RHD. Only 43.75% (95% CI: 33.18%-54.91%) had good knowledge about ARF and RHD. Majority, 61.25% (95% CI: 50.03%-71.39%) did not know the proper prophylaxis and investigations for a child with ARF. There were no statistically significant differences but a clinically meaningful differentials in the level of knowledge among health workers in public and private facilities. Conclusion: The knowledge and skill level of health workers in primary healthcare facilities about ARF and RHD in South Western Uganda remains low, with no difference between practitioners in public and private facilities.

Body image, eating distress and emotional-behavioral difficulties among adolescents in Mbarara, Southwestern Uganda.

BACKGROUND: Adolescents frequently have emotional and behavioral difficulties as they struggle with the challenges of transition from childhood to adulthood. Many struggle with issues of body image and eating distress as they deal with the difficult and frequently perplexing changes that occur with puberty. Yet there is surprisingly little research on the emotional and behavioral challenges, as well as body image and eating distress among this sizable population in Uganda. This study sought to assess attitudes and behaviors related to body image and eating distress, as well as emotional and behavioral difficulties among adolescents in Mbarara, Southwestern Uganda. METHODS: This was a cross-sectional study among 788 adolescents aged 13 to 19 years in secondary schools in Mbarara city and Mbarara district in south-western Uganda. The study employed the Body Image and Eating Distress scale to assess attitudes and behaviors about dieting and body shape and the extended version of the Strengths and Difficulties Questionnaire (SDQ) to assess for perceived emotional and behavioral difficulties. Logistic regression was used to identify the association between body image and eating distress and perceived difficulties. RESULTS: The prevalence of high body image and eating distress was 10.8% while that of perceived emotional and behavioral difficulties was 45.8%. Some of the adolescents (16.1%) were dissatisfied with their body shape, 24.6% exercised a lot to avoid gaining weight, 15.0% were terrified to gain even a little weight, and 12.1% could not control their eating. More males reported eating large amounts of food at one time (p = < 0.001). Having emotional and behavioral difficulties (aOR: 1.89; 95% CI: 1.18 - 3.02; p = 0.019) and coming from a two-parent household (aOR: 1.79; 95% CI: 1.10 - 2.92; p = 0.019) increased the odds of high body image and eating distress. CONCLUSION: High levels of body image and eating distress are linked to behavioral and emotional problems and adolescent's family structure. Clinicians who treat adolescents should use a holistic care strategy and be aware of the high prevalence and close association between emotional and behavioral difficulties, concerns about weight, and dieting. It is important to encourage parental involvement and support in providing information about mental health issues among adolescents.

Dual harm among patients attending a mental health unit in Uganda: a hospital based retrospective study.

BACKGROUND: Dual harm encompasses the complex interplay of the co-occurrence of self-harm and aggression. Individuals with dual harm may display a more hazardous pattern of harmful behaviors like homicide-suicide compared to people with sole harm. This study aimed to examine the presence of dual harm among general psychiatry inpatients in a mental health unit in Uganda. METHODS: A retrospective chart review of 3098 inpatients from January 2018 to December 2021. Dual harm reported experience at admission was based on experiences of self-harm with harm to people or property or both. Logistic regression assessed the association between dual harm and sociodemographics and clinical characteristics. RESULTS: A total of 29 (1%) patients experienced dual harm, with five having experienced self-harm with both harm to others and property, 23 with harm to people, and one with harm to property. Dual harm was statistically significantly associated with the male gender at bivariate analysis. However, there were no statistically significant factors associated with dual harm at multivariate analysis or sensitivity analysis with the specific types of dual harm. CONCLUSION: General psychiatry inpatients in Uganda experience dual harm before admission at lower prevalence than in previous literature. However, no investigated sociodemographic and clinical factors could explain these experiences. Further studies looking at dual harm are warranted to understand these unfortunate experiences with serious consequences among patients in Uganda.

Level of Knowledge on Sexual and Reproductive Health Rights Among the Teenage Mothers and Their Parents in Rwanda: A Comparative Cross-Sectional Study.

Background: Parents are the primary caregivers and influential figures in adolescents' lives. They play a crucial role in shaping their children's attitudes, beliefs, and behaviors regarding sexual reproductive health. A vast difference in knowledge between adolescents and their parents indicates failure in knowledge translation and is associated with sexual and reproductive consequences, such as teenage pregnancies. Methods: In this cross-sectional study between December 2020 and December 2021, 834 teenage mothers and their parents/guardians (n = 861) were enrolled from all five provinces of Rwanda. Knowledge of sexual reproductive health (SRH) rights was assessed, and the differences between the understanding of parents and their children were analyzed using Chi-square tests. Results: There were statistically significant differences for all the assessed aspects of SRH knowledge rights between parents and their teenagers (ie, on the age of consent, safe abortion, right to education for teenage mothers, understanding of financial responsibilities, and perceptions of legal consequences). Conclusion: There is a significant knowledge difference between the two generations regarding their understanding of SRH rights. It is recommended that future programming should devise innovative ways that bring together parents and their children to discuss sexual reproductive health rights, which will result in empowered children and teenagers in Rwanda. Also, awareness programs are needed to improve the knowledge gaps regarding SRH in the public by policymakers, NGOs, and educators.

Readmission and associated clinical factors among individuals admitted with bipolar affective disorder at a psychiatry facility in Uganda.

BACKGROUND: Bipolar affective disorder (BAD) is a common severe mental health condition with a relapsing course that may include periods of hospital re-admissions. With recurrent relapses and admissions, the course, prognosis, and patient's overall quality of life can be affected negatively. This study aims to explore the rates and clinical factors associated with re-admission among individuals with BAD. METHOD: This study used data from a retrospective chart review of all records of patients with BAD admitted in 2018 and followed up their hospital records for four years till 2021 at a large psychiatric unit in Uganda. Cox regression analysis was used to determine the clinical characteristics associated with readmission among patients diagnosed with BAD. RESULTS: A total of 206 patients living with BAD were admitted in 2018 and followed up for four years. The average number of months to readmission was 9.4 (standard deviation = 8.6). The incidence of readmission was 23.8% (n = 49/206). Of those readmitted during the study period, 46.9% (n = 23/49) and 28.6% (n = 14/49) individuals were readmitted twice and three times or more, respectively. The readmission rate in the first 12 months following discharge was 69.4% (n = 34/49) at first readmission, 78.3% (n = 18/23) at second readmission, and 87.5% (n = 12/14) at third or more times. For the next 12 months, the readmission rate was 22.5% (n = 11/49) for the first, 21.7% (n = 5/23) for the second, and 7.1% (n = 1/14) for more than two readmissions. Between 25 and 36 months, the readmission rate was 4.1% (n = 2/49) for the first readmission and 7.1% (n = 1/14) for the third or more times. Between 37 and 48 months, the readmission rate was 4.1% (n = 2/49) for those readmitted the first time. Patients who presented with poor appetite and undressed in public before admission were at increased risk of being readmitted with time. However, the following symptoms/clinical presentations, were protective against having a readmission with time, increased number of days with symptoms before admission, mood lability, and high energy levels. CONCLUSION: The incidence of readmission among individuals living with BAD is high, and readmission was associated with patients' symptoms presentation on previous admission. Future studies looking at BAD using a prospective design, standardized scales, and robust explanatory model are warranted to understand causal factors for hospital re-admission and inform management strategies.

Suicidal behavior among inpatients with severe mental conditions in a public mental health hospital in Uganda.

BACKGROUND: Suicidal behaviors are prevalent among inpatients with severe mental conditions and may result in many dying by suicide. Few studies have focused on the burden of suicidal behaviors among these inpatients in low-income settings, despite suicide being consistently higher in lower-income countries such as Uganda. This study, therefore, provides the prevalence and associated factors of suicidal behaviors and suicide attempts among inpatients with severe mental conditions in Uganda. METHOD: This was a retrospective chart review of all individuals admitted with severe mental conditions to a large psychiatry inpatient unit in Uganda for four years (2018-2021). Two separate logistic regressions were conducted to determine the factors associated with suicidal behaviors or suicidal attempts among the admitted individuals. RESULTS: The prevalence of suicidal behavior and suicidal attempts among 3104 (mean age = 33, Standard deviation [SD] = 14.0; 56% were males) were 6.12% and 3.45%, respectively. Having a diagnosis of depression increased the likelihood of both suicidal behaviors (adjusted odds ratio [aOR]: 5.36; 95% confidence interval [CI]: 2.14-13.37; p =0.001) and attempts (aOR: 10.73; 95% CI: 3.44-33.50; p < 0.001). However, a diagnosis of substance-related disorder increased the likelihood of having attempted suicide (aOR: 4.14; 95% CI: 1.21-14.15; p = 0.023). The likelihood of having suicidal behavior decreased as one increased in age (aOR: 0.97; 95% CI: 0.94-0.99; p = 0.006) and increased among individuals reporting stress from financial constraints (aOR: 2.26; 95% CI: 1.05-4.86; p = 0.036). CONCLUSION: Suicidal behaviors are common among inpatients managed for severe mental health conditions in Uganda, especially those with substance use and depressive disorders. In addition, financial stressors are a main predictor in this low-income country. Therefore, regular screening for suicide behaviors is warranted, especially among individuals with depression, and substance use, among those who are young, and among those reporting financial constraints/stress.

Absconding among admitted patients with bipolar affective disorder diagnosis in Uganda.

BACKGROUND: Hospitalization is often necessary for individuals with Bipolar affective Disorder (BAD) during severe manic or depressive episodes, as well as for stabilizing treatment regimens. However, a significant proportion of patients admitted for treatment of BAD abscond or leave the hospital without permission during their stay. In addition, patients managed for BAD may have unique characteristics that might force them into absconding. For example, the high prevalence of co-morbid substance use disorder - craving to use substances, suicidal behaviors - attempts to die by suicide, and cluster B personality disorders - characterized by impulsive acts. It is, therefore, essential to understand the factors contributing to absconding among patients with BAD, to facilitate designing strategies for preventing and managing this behavior. METHOD: This study was based on a retrospective chart review of the inpatients diagnosed with BAD at a tertiary psychiatry facility in Uganda from January 2018 to December 2021. RESULTS: Approximately 7.8% of those with BAD absconded from the hospital. The likelihood of absconding among those with BAD increased with the use of cannabis [adjusted odds ratio (aOR) = 4.00, 95% confidence interval (CI) = 1.22-13.09, p-value = 0.022] and having mood lability [aOR = 2.15, 95% CI = 1.10-4.21, p-value = 0.025]. However, receiving psychotherapy during the admission (aOR = 0.44, 95 CI = 0.26-0.74, p-value = 0.002) and treatment with haloperidol (aOR = 0.39, 95% CI = 0.18-0.83, p-value = 0.014) reduced the likelihood of absconding. CONCLUSION: Absconding among patients with BAD is common in Uganda. Those with symptoms of affective lability and those with comorbid cannabis use tend to abscond more, while those who receive haloperidol and psychotherapy are less likely to abscond.

Intrapersonal predictors of internalized stigma among school going adolescents living with HIV in southwestern Uganda.

We assessed the association between internalized HIV stigma, resilience, health locus of control, coping self-efficacy and empowerment among adolescents living with HIV in Uganda. We conducted a cross-sectional study between August and October 2020 among 173 adolescents aged 13-18 years attending Mbarara Regional Referral Hospital's HIV clinic. We used linear regression to determine the association between HIV stigma and intrapersonal factors adjusting for sociodemographic characteristics. The median age of the participants was 16 (IQR 3) years. There was a negative correlation between HIV stigma and resilience (ß= -0.03, p < 0.001), internal health locus of control (ß= -0.095, p < 0.001) and coping self-efficacy (ß= -0.02, p < 0.001), while empowerment was positively correlated (ß = 0.07, p < 0.001) with HIV stigma. After adjusting for the intrapersonal factors (resilience, health locus of control, coping self-efficacy and empowerment) and socio-demographic characteristics (education level and boarding school), only internal health locus of control (ß=-0.044, p = 0.016) and coping self-efficacy (ß=-0.015, p < 0.001) remained significantly correlated with HIV stigma. The findings suggest that interventions focusing on intrapersonal factors such as internal locus of control, empowerment and resilience may contribute towards reduction of HIV stigma among adolescents in boarding schools.

Substance use disorder among adolescents before and during the COVID-19 pandemic in Uganda: Retrospective findings from a psychiatric ward registry.

It has been reported that the COVID-19 pandemic has predisposed adolescents to risky behaviors such as substance use and subsequent substance use disorder (SUD). However, it is unknown how the pandemic has changed the prevalence of SUD among adolescents in Uganda. We aimed to determine the prevalence of SUD and associated factors among adolescents in southwestern Uganda. Retrospectively, psychiatry ward records from November 2018 to July 2021 were collected from the largest tertiary hospital in southwestern Uganda. A total of 441 adolescent records were included in the analysis, with a mean age was 17±1.88 years, and the majority were males (50.34%). The overall prevalence of SUD was 7.26% (5.90% and 9.80% before and during the pandemic). Despite a little rise in SUD (3.9% increment) during the COVID-19 pandemic, there was no statistical difference compared to before the pandemic. The likelihood of being diagnosed with SUD was more among older adolescents at any period. In addition, having a diagnosis of bipolar mood disorder reduced the likelihood of SUD during the pandemic. This study indicated no statistical change in the diagnosis of SUD among adolescents before and during the COVID-19 pandemic. As older-male adolescents (17 to 19 years) were at higher risk of SUD, there is a need for early intervention for this group.

Gambling-related suicide in East African Community countries: evidence from press media reports.

BACKGROUND: Gambling activities and associated mental health problems have become a topic of increased concern globally. Many individuals with a severe gambling disorder have gambling-related suicidality. However, no study has explored gambling-related suicide in East African Community (EAC) countries. The present study investigated the press media reporting of gambling-related suicide cases from EAC countries. METHODS: As there is no established suicide database in that region, media reports were utilized to collect gambling-related suicide data. Gambling-related suicide case reports were searched for in EAC countries' press media websites using Google. After removing duplicates, a total of 18 suicides were found. RESULTS: The victims were all males aged 16 to 40 years. The most prevalent reason for the death was university students who had used their university tuition fees for gambling and losing the money (n = 4/17). All the suicide deaths were in Kenya (10/18), Uganda (7/18), and Tanzania (1/18). Betting on soccer was the most common type of gambling reported (n = 11/15), and hanging was the most used mode of suicide (n = 10/16). CONCLUSIONS: Based on the press media reports, 18 males were identified as having carried out gambling-related suicides. The countries with the most widespread opportunities to gamble had more gambling-related suicides, although the number of suicides was very small.

Excessive eating and weight gain:A rare post-acute COVID-19 syndrome.

The coronavirus disease - 2019 (COVID-19) is a multisystem illness associated with several metabolic derangements. Studies report that post-acute COVID-19 syndromes (PACs) continue to evolve, however, polyphagia is not uncommon. Herein, we report a rare occurrence of polyphagia in a patient following acute COVID-19 illness. A-41-year-old Ugandan female with a negative past medical history presented with complains of excessive appetite, eating large amounts of food, inability to feel satisfied, failure to control desire to eat, and weight gain 6 months following recovery from a mild episode of acute COVID-19 pneumonia. Her body mass index rose to 30 Kg/m2 from 22 Kg/m2 prior to suffering from COVID-19. There was no history of polyuria, polydipsia, pruritus, or prior eating disorder or related history. Investigation found that brain computed tomography scan was normal, fasting blood sugar to be 5.6 mmol/L (normal range, 3.9-7.0 mmol/L), adrenocorticotropin hormone level to be 8.763 pg/mL (normal range, 6-40 pg/mL), erythrocyte sedimentation rate to be 12 mm/hour (0-30 mm/hour), but there was an elevation in glycosylated hemoglobin level (HbA1c, 7.7%). She was commenced on psychotherapy and behavioral changes with good outcomes. Polyphagia may be one of the rare PACs, requiring further research.