ABSTRACT
Background: Older adults have a high prevalence of chronic conditions like arthritis with morbidities, especially depression ranging up to 40% - 70%. Therefore, it is important to explore depression in older adults with arthritis. Aim: This study aimed to determine if any demographic and clinical factors are associated with depression in older adults aged ≥ 60 years with arthritis attending a rheumatology clinic. Setting: This is a cross-sectional study conducted over 6 months among 127 older adults on follow-up care in a university teaching hospital in the North-Eastern region of Nigeria. Methods: A clinical proforma with information about the type of arthritis, duration of illness, hospitalisation, use of medications, co-morbidity was utilised for the data collection. The Geriatric Depression Scale (GDS-30), sociodemographic questionnaire and clinical proforma were administered. Data were analysed using Statistical Product and Service Solutions (SPSS) version 26.0 with the level of significance set as 0.05. Results: The mean age (± standard deviation [s.d.]) was 66.6 (± 5.5) years, with males constituting 57.5%. The prevalence of depression was 57.8%. Osteoarthritis 30.2%, while 69.8% had rheumatoid arthritis. Sociodemographic factors associated with depression include age (p = 0.049), marital status (p = 0.001), and level of education (p = 0.001). Duration of illness (p = 0.02), hospitalisation (p = 0.03), and number of medications (p = 0.01) were clinical factors associated with depression score. Conclusion: The prevalence of depression in older people with arthritis is high and was associated with females, the widowed, no formal education; and those with long duration of illness, those using multiple medications, and those with repeated hospitalisation. Contribution: This finding can enhance the suspicion index for depression to establish standard operating procedures, which will help to improve therapeutic practice for caring for the older adult age group.
ABSTRACT
The Nigerian Mental Health Law originated as a Lunacy ordinance in 1916 and matured into Lunacy Act CAP 524 of the law of Nigeria, 1964. This review of the National Mental Health Act (NMHA) 2021 of Nigeria examines the prospects, challenges, and possible ways forward. This act has a schedule, five parts, fifty-eight sections, and many subsections. It was compared with the WHO Checklist while the limitations were examined with a view to recommending solutions and identifying the tasks ahead. The NMHA 2021 provides for enhancing and regulating Mental Health Services through a Mental health Services Department. Also, a Mental Health Assessment committee is set up as a tribunal to protect the rights of persons with intellectual, cognitive and psychosocial disabilities, including the rights to a legal representative, employment, and housing. Persons with mental health conditions are to enjoy standard services and participate in formulating their medical plans devoid of coercion. The Presidential gazetting of the act is a good starting point in a positive direction. It should be adequately implemented with the coordinated efforts of all stakeholders and domesticated by the state governments. Finally, more advocacy by the Association of Psychiatrists in Nigeria and other key players. A key limitation is the access to the health care facility given the rural-urban access challenges and owing to the wide treatment gap and the low Doctor-patient ratio worsened by the brain drain.