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BACKGROUND: Task shifting is a well-tested implementation strategy within low- and middle-income countries that addresses the shortage of trained mental health personnel. Task shifting can increase access to care for patients with mental illnesses. In Kenya, community health workers (CHWs) are a combination of community health assistants and community health volunteers and have played a crucial role on this front. In our study, we seek to assess the acceptability and feasibility of Group Interpersonal Psychotherapy (IPT-G) delivered by CHWs among depressed postpartum adolescents (PPAs) living with human immunodeficiency virus (HIV). METHOD: The study used theoretical framework of behaviour change including: Capability, Opportunity and Motivation (COM-B model) to help understand behavioural changes due to IPT-G intervention delivered by the CHWs. 24 PPAs were administered IPT-G by trained CHWs from two health centres. A two-arm study design (IPT-G intervention and treatment as usual) with an intent to treat was used to assess the acceptability and feasibility of IPT-G. With purposeful sampling, participants who scored > 10 on the Edinburgh postnatal depression scale and who were 6-12 weeks postpartum were eligible for the study. Participants were equally distributed into two groups: one group for intervention and another as a wait-listed group. This was achieved by randomly allocating numerical numbers and separating those with odd numbers (intervention group) and even numbers (wait-listed group). Focus group discussions and in-depth interviews ascertained the experiences and perceptions of the PPAs and the CHWs during IP-G delivery process. In addition to weekly face-to-face continuous supportive supervision for the CHWs, the researchers also utilized phone calls, short messages services and WhatsApp instant messaging services. RESULTS: The CHWs found the intervention useful for their own knowledge and skill-set. With regards to participation, 21 out of the 24 adolescents attended all sessions. Most of the adolescents reported an improvement in their interpersonal relationships with reduced distress and lessening of HIV-related stigma. Primary healthcare workers embraced the intervention by accommodating the sessions in their routine clinic activities. CONCLUSION: Our study demonstrates the possible benefits of task shifting in addressing mental health problems within low-resource settings in Kenya, and IPT-G is demonstrated to be both acceptable and feasible by health workers and adolescents receiving care.
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Mães Adolescentes , Infecções por HIV , Adolescente , Agentes Comunitários de Saúde , Feminino , HIV , Infecções por HIV/terapia , Humanos , QuêniaRESUMO
OBJECTIVE: The authors adopted a task-sharing strategy in which lay health workers delivered group interpersonal psychotherapy (IPT-G) in primary care clinics in Nairobi, Kenya, to young mothers with HIV and depression. The study examined the acceptability, feasibility, and effectiveness of IPT-G in improving depression and antiretroviral therapy adherence. METHODS: Twenty-four mothers (ages 18-24 years and 6-12 weeks postpartum) participated. The women were randomly assigned to IPT-G or to a waitlist. Eight lay providers administered the IPT-G sessions across 8 weeks. The primary outcome was pre- to postintervention change in depression scores as measured on the Edinburgh Postnatal Depression Scale. The secondary outcome was antiretroviral therapy adherence. All waitlist participants subsequently received the intervention, and a secondary outcome, within-group analysis, was conducted and included those participants. RESULTS: Participants' median age was 23.0 years, 17 (71%) lived with a partner, and 19 (79%) had fewer than two children. The intervention group had a mean±SD depression score of 15.9±4.3 at baseline and 6.8±7.0 postintervention. For the waitlist control group, the mean score was 17.3±5.9 at baseline and 13.2±6.6 at the first follow-up. Waitlist participants had significantly greater mean depression scores than did intervention group participants at the first follow-up (after the intervention group's 8-week IPT-G) (ß=6.42, 95% confidence interval=1.17 to 11.66, p=0.017). No difference was observed between groups in antiretroviral therapy adherence. CONCLUSIONS: This study provides preliminary evidence that IPT-G led by community health workers may have benefits for postpartum depression among young mothers with HIV.
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Psicoterapia Interpessoal , Adolescente , Adulto , Criança , Depressão/terapia , Feminino , Humanos , Quênia , Mães , Projetos Piloto , Psicoterapia , Resultado do Tratamento , Adulto JovemRESUMO
Introduction: adolescence is a transitory stage in the lives of young people. The transition from primary to secondary school among adolescents is associated with suicidal behavior but is not well characterized in the Kenyan context. This study sought to elucidate factors associated with the risk of suicidal behavior among adolescents aged 11-18 years in transition to secondary school. Methods: a cross-sectional design was employed in the study that was conducted among adolescents in 5 randomly selected secondary schools in Nairobi County. The study involved 539 students who had joined form 1 in January 2020. Data were collected using the suicide behavior questionnaire-revised (SBQ-R) in March 2020. Factors associated with suicidal behavior were assessed using a generalized linear model (GLM), using a poisson distribution with a log-link function to estimate adjusted prevalence ratios (aPR), and a significance level of p=.05. Results: one-fifth (20.04%) of adolescents with a median age of 14 years were at risk of suicidal behavior. Depression (aPR=3.16, C.I {1.85, 5.41}, p=0.001) and lifetime alcohol use (aPR=1.87, C.I {1.17, 2.97}, p=0.009) were found to be significant factors for suicidal behavior. Conclusion: depression and lifetime alcohol use are associated with the risk of suicidal behavior among adolescents transitioning from primary to secondary school. Interventions may need to be targeted at the pre-secondary or primary school level to prevent underage alcohol use and enhancement of social support to prevent depression in this demographic of the population.
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Consumo de Bebidas Alcoólicas , Ideação Suicida , Humanos , Adolescente , Estudos Transversais , Quênia/epidemiologia , Instituições AcadêmicasRESUMO
This paper describes a sustainable structure to deliver the World Health Organization (WHO) endorsed group Interpersonal Psychotherapy (IPT-G) for Postpartum Adolescent (PPA) mothers living with HIV in Nairobi. It documents the process of mobilizing, training, and engaging Community Health Workers (CHWs) and Key Informants (health facility staff) involved in the Prevention of Mother-To-Child Transmission (PMTCT) in two Primary Health Care (PHC) facilities from informal settlements of Nairobi County. Mainly reporting experiences from the training process utilizing focused group discussions and in-depth interviews involving participants, IPT-G therapists and supervisors we present process findings and acceptability of our IPT-G implementation.
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Infecções por HIV , Psicoterapia Interpessoal , Adolescente , Criança , Feminino , Infecções por HIV/terapia , Humanos , Transmissão Vertical de Doenças Infecciosas , Quênia , Mães , Atenção Primária à Saúde , Organização Mundial da SaúdeRESUMO
BACKGROUND: Children who experience sexual abuse undergo various negative psychosocial outcomes such as depressive symptoms. Unfortunately, not many studies have been conducted on the incidence of depressive symptoms among sexually abused children in Kenya. This study sought to ascertain the incidence of depressive symptoms among children who have experienced sexual abuse in Kenya. METHODS: This was a longitudinal study design. It was conducted at Kenyatta National Teaching and Referral Hospital and Nairobi Women's Hospitals in Kenya. One hundred and ninety-one children who had experienced sexual abuse and their parents/legal guardians were invited to participate in the study. The study administered the Becks Depression Inventory and the Child Depression Inventory to the children. RESULTS: The incidence of depressive symptoms after 1 month of sexual abuse revealed that amongst children who were below 16 years old, 14.6% had minimal-mild depressive symptoms while 85.4% had moderate-severe depressive symptoms. In comparison, children who were 16 years or older, 6.4% had minimal-mild depressive symptoms while 93.6% had moderate-severe depressive symptoms. Children below 16 years old whose parents were separated were found to have depressive symptoms (p < 0.001) as well as those who were presented early for medical care (p < 0.004), while children aged 16 years and above who were abused by strangers were more likely to have depressive symptoms (p < 0.024) and those who were not attending school (p < 0.002). CONCLUSION: Sexual abuse of children is world-wide and the Kenyan situation is comparable. Being the victim of sexual abuse as a child has major psychological and emotional sequlae which need to be addressed in Kenya. Children who experience sexual abuse have very high incidence of developing depressive symptoms. All the sexually abused children studied suffered from depressive symptoms and a large majority suffered from major depressive symptoms that should be promptly and effectively addressed to ameliorate psychological suffering among children.
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Data on youth emotional and behavioral problems from societies in Sub-Saharan Africa are lacking. This may be due to the fact that few youth mental health assessments have been tested for construct validity of syndrome structure across multicultural societies that include developing countries, and almost none have been tested in Sub-Saharan Africa. The Youth Self-Report (YSR), for example, has shown great consistency of its syndrome structure across many cultures, yet data from only one developing country in Sub-Saharan Africa have been included. In this study, we test the factor structure of YSR syndromes among Kenyan youth ages 11-18 years from an informal settlement in Nairobi, Kenya and examine sex-differences in levels of emotional and behavioral problems. We find the eight syndrome structure of the YSR to fit these data well (Root Mean Square Error of Approximation=.049). While Kenyan girls have significantly higher internalizing (Anxious/Depressed, Withdrawn/Depressed, Somatic) problem scores than boys, these differences are of similar magnitude to published multicultural findings. The results support the generalizability of the YSR syndrome structure to Kenyan youth and are in line with multicultural findings supporting the YSR as an assessment of emotional and behavioral problems in diverse societies.
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BACKGROUND: The PRIME screen is a self-administered questionnaire designed to quickly assess individuals at risk for developing a psychotic disorder. It is shorter in both length and administration time compared to the Structured Interview for Psychosis-Risk Syndromes (SIPS)-a standard instrument for psychosis prodromal risk assessment. Validation of the PRIME against the SIPS has not been reported in large non-clinical populations. METHODS: A culturally modified version of the PRIME screen (mPRIME) was administered to Kenyan youth between the ages of 14 and 29. 182 completed both the SIPS and mPRIME. Validation measures (sensitivity, specificity, positive predictive value, negative predictive value) were calculated and the study sample was then broken down into true positives, false positives, and false negatives for comparison on different quantitative measures. RESULTS: Using previously suggested thresholds for a positive screen, the mPRIME had a sensitivity of 40% and a specificity of 64.8% for our entire sample. Positive predictive value (PPV) and negative predictive value (NPV) were 12.3% and 89.7%, respectively. Breaking the sample down by questionnaire outcome showed that true-positive individuals scored higher on average rate and intensity of endorsement of mPRIME items compared to false-positive and false-negatives, while false-negatives on average registered disagreement on all mPRIME questionnaire items. CONCLUSIONS: The mPRIME does not appear to be an effective screener of at-risk individuals for psychosis in our non-clinical sample. Further validation efforts in other general populations are warranted.
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Escalas de Graduação Psiquiátrica/normas , Transtornos Psicóticos/diagnóstico , Adolescente , Adulto , Feminino , Humanos , Quênia , Masculino , Programas de Rastreamento , Valor Preditivo dos Testes , Psicometria/instrumentação , Risco , Sensibilidade e Especificidade , Adulto JovemRESUMO
PURPOSE: To estimate the prevalence, types and comorbidity of the most common mental disorders and the spread of suicide risk in a primary care practice in Kenya. METHODS: This was a cross-sectional descriptive study. A total of 300 adult outpatients were randomly selected while they were consulting their general practitioner. The M.I.N.I. Plus interview five was used to diagnose psychiatric disorders and suicide risk. RESULTS: Thus, 56.3 % of the sample (n = 169) presented one or more psychiatric disorders. The most prevalent disorders were Affective (39.0 %), Anxiety (31.3 %), and Somatoform (13.0 %). Regarding specific disorders, the most common were Major Depressive Disorder (26.3 %), Agoraphobia (16.7 %), Pain Disorder (12.5 %), Generalized Anxiety Disorder (9.3 %) and Bipolar Disorder (9 %). We found three cases of Bulimia Nervosa (1 %); 29.7 % had more than one current mental disorder. Suicide risk was present in 12.7 % of participants. No associations were identified between socio-demographic factors and the presence of mental disorder. Suicide risk was higher in women and in patients who came from slum areas. Gastric pain was positively associated with presence of mental disorder. CONCLUSION: High prevalence of mental disorders and suicide risk calls for integrating mental health services in primary health care; in particular, this study highlights the importance of differentiating between specific types of mental disorders (which require different therapeutic approaches), and of diagnosing comorbidities.
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Transtornos Mentais/epidemiologia , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Transtornos de Ansiedade/epidemiologia , Transtorno Bipolar/epidemiologia , Comorbidade , Estudos Transversais , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Quênia/epidemiologia , Masculino , Transtornos Mentais/classificação , Transtornos Mentais/diagnóstico , Pessoa de Meia-Idade , Prevalência , Fatores Socioeconômicos , Transtornos Somatoformes/epidemiologia , Inquéritos e Questionários , Adulto JovemRESUMO
Psychiatric disorders and symptoms are common worldwide. However, cultural differences in symptom manifestation and knowledge of psychiatric terms and concepts represent a challenge to accurate clinical assessment. Our previous youth surveys revealed higher rates of psychotic experiences in Kenya compared to several other countries, suggesting culture may influence psychosis risk assessment survey results. The goal of the present investigation is to evaluate understanding of general mental health related terms and concepts and specific items from the Structured Interview for Psychosis-Risk Symptoms (SIPS), a commonly used psychosis risk assessment instrument. Six focus groups were conducted in Nairobi, Kenya and surrounding areas with young adults from the community, university and secondary school students, and mental health professionals. Analysis of the information obtained from participants indicated that adolescents and young adults in Kenya were aware of mental illness in their communities, but had very limited knowledge of the meaning of specific psychiatric disorders and symptoms. Many believed that the cause of mental illness was spiritual in nature. These results suggest that in order to obtain accurate reported rates of psychiatric symptoms, assessment of Kenyan adolescents and young adults requires elaboration of assessment questions and use of simplified terms.
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Conhecimentos, Atitudes e Prática em Saúde , Psiquiatria , Adolescente , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Quênia , Masculino , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/etnologia , Terminologia como Assunto , Adulto JovemRESUMO
BACKGROUND: Studies on mental health problems during childhood and youth development phases have reported that families of children diagnosed with a depressive disorder tend to be dysfunctional. These dysfunctions have been shown to be mediating factors for children to develop psychiatric disorders in the future. OBJECTIVE: This study was designed to investigate whether perceived parenting behavior and parental psychiatric disorders have any relationship with youth presenting with major depressive disorder. METHODOLOGY: The study sample had a total number of 250 purposely selected youth attending the Youth Clinic at Kenyatta National Hospital in Nairobi. RESULTS: This study found associations between major depressive disorders (MDD) in the youth and co-morbid psychiatric disorders among the youth: conduct disorder (OR = 2.93, 95% CI 1.04 to 8.26, p = 0.035), any anxiety disorder (OR = 2.41, 95% CI 1.20 to 4.87, p = 0.012), drug abuse (OR = 3.40, 95% CI 2.01 to 5.76, p < 0.001), alcohol use (OR = 3.29, 95% CI 1.94 to 5.57, p < 0.001), and suicidal behavior (OR = 5.27, 95% CI 2.39 to 11.66, p < 0.001). The results also indicate that a higher proportion of youth between 16 and 18 years had major depressive disorder than the youth below 16 years or above 18 years of age (OR = 2.66, 95% CI 1.40 to 5.05, p = 0.003). Multivariate analysis shows that both rejecting maternal behavior (AOR = 2.165, 95% CI 1.060 to 4.422, p = 0.003) and maternal MDD (AOR = 5.27, 95% CI 1.10 to 14.76, p < 0.001) are associated with MDD in youth. CONCLUSION: Negative maternal parenting behavior and maternal depressive disorder are associated with major depressive disorder in children.
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BACKGROUND: Suicide is a major cause of death among youths particularly with psychiatric, alcohol abuse and substance abuse disorders. There are relatively few studies on the relationship between psychiatric and substance abuse disorders with suicidal behaviour from low-income countries. This study examines the relationship between suicidal behaviour and co-existing psychiatric or substance disorders among youths and depressive and alcohol use disorders in their parents. METHOD: The study sample had 678 respondents: 250 youths and 226 and 202 biological mothers and fathers, respectively. RESULTS: This study found a significant statistical association between depressive (p < 0.001), alcohol abuse (p <0.001) and substance abuse (p < 0.001) disorders and suicidal behaviour in youths. There was a significant relationship between maternal depressive disorder (p < 0.001) and perceived maternal rejecting parenting behaviour (p < 0.001) with suicidal behaviour in youths. There was a greater odds of a youth with two to three (odds ratio (OR) = 3.63; p = 0.009) and four or more (OR = 8.23; p < 0.001) co-existing psychiatric disorders to have suicidal behaviour than a youth with only one psychiatric disorder. The results also indicate that a higher proportion of youths between ages 16-18 years had suicidal behaviour than youths below 16 years or above 18 years of age (p = 0.004). CONCLUSION: These findings suggest that youths with psychiatric and substance abuse disorders have mothers living with a depressive disorder. Also, perceived maternal rejecting parenting behaviour contributes significantly to the development of suicidal behaviour later in adolescent years.
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Psychotic-like experiences (PLEs) have been observed worldwide in both adults and children outside the context of a clinical disorder. In the current study, we investigate the prevalence and patterns of PLEs among children and adolescents in Kenya. Among 1,971 students from primary and secondary schools around Nairobi (aged 8-19), 22.1 % reported a lifetime history of a psychotic experience, and 16.3 % reported this unrelated to sleep or drugs. Psychotic experiences were more common in males compared to females. LCA resulted in a three-class model comprised of a normative class (83.3 %), a predominately hallucinatory class (Type 1 psychosis: 9.6 %), and a pan-psychotic class (Type 2 psychosis: 7.2 %). These results indicate that PLEs are prevalent in children and adolescents, and the distributions of symptom clusters are similar to that found in adulthood. The relationship of specific PLEs to the future development of psychotic disorder, functional impairment or distress will require further study.
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Transtornos Psicóticos , Adolescente , Adulto , Criança , Feminino , Humanos , Quênia/epidemiologia , Masculino , Prevalência , Transtornos Psicóticos/classificação , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/epidemiologia , Fatores Sexuais , Adulto JovemRESUMO
Current evidence suggests that there may be significant differences in psychotic symptom prevalence in Africa compared with other cultures. However, there have been few studies evaluating these symptoms in the continent. We conducted a cross-sectional survey of psychotic-like experiences (PLEs) in 2963 Kenyan students from seven tertiary academic institutions spread across Kenya, using a self-administered psychosis questionnaire evaluating psychotic experiences and demographic variables. Logistic regression was used to evaluate relationship between PLEs and demographic variables. Latent class analysis (LCA) was used to determine specific classes of psychotic experiences. Twenty-three percent of respondents reported having at least one PLE, and 19% reported this unrelated to drug use or sleep. Compared to students identifying as Protestant Christians, Catholics had a lower likelihood of having any PLE or visual hallucinations. Other demographic variables were not significantly associated with PLEs. LCA of PLEs resulted in a three-class model that comprised 1) a non-psychotic class (83.8%), 2) a predominantly hallucinatory class ("type I PLE"; 12.7%), and 3) a multiple symptom class ("type II PLE"; 3.5%). Both psychotic classes had a predominance of male students. Further studies are required to clarify functionality and clinical progression associated with observed patterns of psychosis, as well as the generalizability of our findings.
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Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/fisiopatologia , Adolescente , Adulto , Teorema de Bayes , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Quênia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Transtornos Psicóticos/diagnóstico , Fatores Sexuais , Adulto JovemRESUMO
Research on posttraumatic stress disorder (PTSD) among youth has focused on specific subgroups from developed countries. Most of the world's youth and war-like violence, however, is concentrated in developing countries, yet there is limited mental health data within affected countries. This study focused on a random community-based sample of 552 impoverished youth ages 6-18 within an informal settlement in Nairobi, Kenya, which experienced war-like violence for a month following the contested presidential election of 2007. Six months after the violence ended, 99 (18%) had PTSD according to the UCLA PTSD Reaction Index (Steinberg, Brymer, Decker, & Pynoos, 2004), and an additional 18 (3%) were found to have partial PTSD due to high overall scores. Kenyan psychologists conducted diagnostic interviews and found the positive predictive value of the assessment tool to be 72% in this sample; the confirmed prevalence was 12%. Similar to other studies worldwide, Criterion C (avoidance) was the limiting factor for diagnosing PTSD according to the DSM-IV-TR, and parent-child agreement was at best fair. The number of traumatic experiences was strongly associated with PTSD outcomes. Differences due to age or sex were not found. The findings indicate the need for universal mental health services for trauma-exposed youth and their families in the impoverished informal settlements of Nairobi, Kenya.
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Traumatismo Múltiplo/psicologia , Pobreza , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Violência/psicologia , Adolescente , Criança , Bases de Dados Factuais , Feminino , Humanos , Entrevistas como Assunto , Quênia/epidemiologia , Masculino , GuerraRESUMO
The presence of depression in alcohol-dependent persons is likely to influence treatment process and outcomes. Identification of depression is important though not every depressed alcohol-dependent person requires treatment with antidepressants. Understanding the association between depression and alcohol dependence is essential for proper management of alcohol dependence. Objectives. To determine the prevalence of depression among alcohol-dependent persons before and after alcohol detoxification and rehabilitation. Design. Clinical trial with pre-/postmeasurements. Method. The CIDI and WHO-ASSIST were administered to 188 alcohol-dependent persons at intake and after six months. A researcher-designed sociodemographic questionnaire was also administered at intake. Results. The prevalence of depression among alcohol-dependent persons is high (63.8%) with a significant association between depression and the mean AUDIT score. At posttest, depressed participants had a statistically significant craving for alcohol. Conclusion. Alcohol dependence is associated with major depression.
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Defining the prepsychotic state in an effort to prevent illness progression and the development of disorders such as schizophrenia is a rapidly growing area of psychiatry. The presentation of psychotic symptoms can be influenced by culture; however, there has not been any previous assessment of psychosis risk symptoms in the continent of Africa. Our study aimed to measure the prevalence of psychosis risk in a community sample in Nairobi, Kenya, and to evaluate the effects of key demographic variables. A culturally modified version of the 12-item PRIME-Screen (mPRIME) was self-administered by 2758 youth (aged 14-29 years) recruited through house-to-house visits in Nairobi, Kenya. The prevalence and severity of psychosis risk items from the mPRIME and the effects of sex and age on symptoms were evaluated. k-Means cluster analysis was used to identify symptom groups. Depending on the mPRIME item, 1.8% to 19.5% of participants reported certainty of having had a psychosis risk symptom. Overall, 45.5% reported having had any psychosis risk symptom. Females had a significantly higher mean severity score on items evaluating persecutory ideation and auditory hallucinations. Symptom severity on 5 items showed a modest (R = 0.09-0.13) but significant correlation with age. Cluster analysis identified 4 groups of participants: normative (55%), high symptom (11%), intermediate symptom (19%), and grandiose symptom (15%). Psychosis risk symptoms appear to be highly prevalent in Kenyan youth. Longitudinal studies are needed to determine the correlation of identified symptoms with transition to psychotic illness, as well as the associated functionality and distress, to develop appropriate intervention strategies.
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Delusões/etnologia , Alucinações/etnologia , Transtornos Psicóticos/etnologia , Adolescente , Adulto , Distribuição por Idade , Análise por Conglomerados , Progressão da Doença , Feminino , Inquéritos Epidemiológicos , Humanos , Quênia/epidemiologia , Masculino , Prevalência , Medição de Risco , Distribuição por Sexo , Adulto JovemRESUMO
There are two medical schools training doctors in Kenya: the Moi University established in 1984 and the University of Nairobi established in 1967. The University of Nairobi has so far produced the majority of Kenyan doctors. Both are public universities with the Government being the main financier. The increased demand for university education and the inability to meet these demands has led to the introduction of a system of training self-sponsored medical students alongside Government-subsidised students. One other public university has started a medical school. The pressure to increase the number of schools and students in the absence of increased resources poses a particular challenge to the country.
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Educação Médica/organização & administração , Universidades , Atenção à Saúde/economia , Humanos , Quênia , Médicos/provisão & distribuiçãoRESUMO
Alcohol abuse and alcohol-related use problems among adolescents are highly prevalent and are a major concern worldwide. This study estimated the prevalence of drug abuse, knowledge about drug abuse and its effect on psychosocial well-being and induced behavioral problems among students of a public rural secondary school that admitted both girls and boys which offered both boarding and day school facilities. The students filled out a self-reporting substance use tool which measures the prevalence, frequency, and general patterns of substance use. Alcohol, tobacco, khat (catha edulis) and bhang (cannabis) were the most commonly reported substance of use, with user prevalence rates of 5.2%, 3.8%, 3.2%, and 1.7%, respectively. Tobacco use was initiated at 10 years, while cannabis, hard drugs, khat, and alcohol were initiated at 11, 12, 13, and 15 years of age, respectively. Among the students 71% were aware that their schoolmates were on drugs and it was known by 49.8%, 41.7%, 37.6%, 44.3%, and 32.4% of these students that using alcohol, tobacco, khat, cannabis, and hard drugs, respectively was a behavioral problem in the school. Three quarters of the students were aware that use of drugs was harmful to their health, with majority (78.6%) indicating that drug users need help to stop the drug use behavior. However most (73.6%) of the students suggested drug users in school should be punished. The drug use behavioral problems included school dropout, poor scholastic attainment, drunken driving, delinquency, and adolescence pregnancy which threaten the stability of the education system, family as an institution (family difficulties) and society at large. Therefore, teachers have an added burden of playing an active role in guidance and counselling the survivors of drug abuse, a pandemic facing teaching institutions apart from instilling knowledge.
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População Rural/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Comportamento do Adolescente/efeitos dos fármacos , Sintomas Comportamentais/induzido quimicamente , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Quênia/epidemiologia , Masculino , Prevalência , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto JovemRESUMO
The global burden of neuropsychiatry diseases and related mental health conditions is enormous, underappreciated and under resourced, particularly in the developing nations. The absence of adequate and quality mental health infrastructure and workforce is increasingly recognized. The ethical implications of inequalities in mental health for people and nations are profound and must be addressed in efforts to fulfil key bioethics principles of medicine and public health: respect for individuals, justice, beneficence, and non-malfeasance. Stigma and discrimination against people living with mental disorders affects their education, employment, access to care and hampers their capacity to contribute to society. Mental health well-being is closely associated to several Millennium Development Goals and economic development sectors including education, labour force participation, and productivity. Limited access to mental health care increases patient and family suffering. Unmet mental health needs have a negative effect on poverty reduction initiatives and economic development. Untreated mental conditions contribute to economic loss because they increase school and work absenteeism and dropout rates, healthcare expenditure, and unemployment. Addressing unmet mental health needs will require development of better mental health infrastructure and workforce and overall integration of mental and physical health services with primary care, especially in the developing nations.
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Encéfalo/fisiopatologia , Disparidades em Assistência à Saúde/ética , Transtornos Mentais/fisiopatologia , Transtornos Mentais/terapia , Serviços de Saúde Mental/ética , Serviços de Saúde Mental/provisão & distribuição , Psiquiatria/ética , Gastos em Saúde , Necessidades e Demandas de Serviços de Saúde , Disparidades em Assistência à Saúde/economia , Humanos , Transtornos Mentais/economia , Serviços de Saúde Mental/economia , Preconceito , Psiquiatria/economia , Fatores Socioeconômicos , Estereotipagem , Desemprego/estatística & dados numéricos , Estados Unidos/epidemiologiaRESUMO
AIM: To document Beck Depression Inventory (BDI) II suicidal symptoms among patients admitted to Kenyan non-psychiatric general medical facilities METHODS: All consenting adults admitted within a period of 4 weeks at 10 general medical facilities in Kenya were interviewed for suicidal symptoms and depression using the BDI-II. RESULTS: In all, 2,780 patients responded to item 9 (suicidal symptoms of the BDI-II). The prevalence of all BDI-II suicidal symptoms combined was 10.5%. Thoughts of 'killing oneself but have not carried them out' accounted for 9% of the suicidal symptoms. The younger age group had the highest prevalence of suicidal symptoms and the oldest age group had the least prevalence of suicidal symptoms. The more depressed the patients were on the overall BDI-II score, the higher the prevalence of suicidal symptoms. CONCLUSION: On average 1 out of 10 of the patients had suicidal symptoms, more so in younger than the older people and in the more depressed. These symptoms had not been clinically recognised and therefore not managed. This calls for clinical practice that routinely enquires for suicidal symptoms in general medical wards.