Descriptive Characterization of Psycho-Trauma, Psychological Distress, and Post-traumatic Stress Disorder among Children and Adolescent Internally Displaced Persons in Kaduna, Nigeria.

BACKGROUND: A postelection violent conflict in Kaduna resulted in 800 deaths and 65,000 displaced people leading to setting up of camp for internally displaced persons (IDPs). We set out to determine the prevalence and pattern of psycho-traumatic stressful life events, psychological distress, and post-traumatic stress disorder (PTSD) among child/adolescents IDPs. METHODS: A descriptive cross-sectional study of 73 child/adolescent IDPs were selected by total sampling. Stressful life event checklist measured conflict-related trauma and reaction of adolescents to traumatic stress (RATS) measured post-trauma reaction of children/adolescents. Hopkins Symptoms Checklist 37 for Adolescents measured psychological distress associated with trauma. Diagnostic Interview Schedule for Children was used for diagnosis of PTSD. RESULTS: Of 73 respondents, 3 (4.1%) had probable PTSD, 2 (2.7%) had definitive PTSD, and mean score of the child/adolescent IDPs on HSCL-37A and RATS was 44.7 (SD = 6.3) and 31.9 (SD = 5.7), respectively. Most frequently occurring psychological distress among female participants was suddenly scared for no reason 7 (19.5%) and becoming angry easily and feeling fearful 5 (13.9%). The average score for female participants were higher than that for males on depressive and anxiety subscale of HSCL-37A. CONCLUSION: We concluded that children/adolescent IDPs were exposed to psycho-trauma following postelection violent conflict and developed psychological distress. However, the low prevalence of psychological distress and PTSD suggested that living with parents and psychosocial intervention provided could have led to much lower morbidity.

Strong family history and early onset of schizophrenia: about 2 families in Northern Nigeria.

Schizophrenia is a highly heritable psychotic disorder and high genetic loading is associated with early onset of the disease. The outcome of schizophrenia has also been linked with the age of onset as well as the presence of family history of the disease. Therefore families with patients with early onset Schizophrenia are subpopulations for genetic studies. We present 2 families with heavy genetic loading who have adolescents with schizophrenia.

Childhood epilepsy in a tropical child psychiatric unit: challenges of providing care in a resource-constrained environment.

BACKGROUND: Epilepsy is an important cause of childhood morbidity and its care is fraught with challenges. Itinerant search for remedy and manifestation as or with psychiatric disorders could result in presentation in a psychiatric unit. Identification of these challenges is essential to providing optimal care. The objective was to identify caregiver challenges in the provision of care to children with epilepsy presenting in a psychiatric unit. MATERIALS AND METHOD: Administration of a structured questionnaire to caregivers of children with epilepsy presenting, between September and December 2011, in the newly constituted Child and Adolescent Mental Health(CAMH) Unit of the Federal NeuroPsychiatric Hospital, Kaduna Nigeria. RESULTS: A total of 84 caregivers were interviewed. The age range of the caregivers was 23 to 62 years (mean 38 ± 9.2 years) and a female preponderance (50, 59.5%). Most of the caregivers were in the upper social classes (I-III, 79.8%). A high number of challenges were indicated by majority 65, 77.4%) of the caregivers. The recurrence of seizures (84,100%) was the commonest challenge while the experience of discrimination (17, 20.2%) was the least. All caregivers had sought remedy from multiple health care options. Challenges were significantly (P < 0.05) associated with the female caregiver, age < 40 years, generalized type of epilepsy and residing outside Kaduna. CONCLUSION: The study identified multi dimensional caregiver challenges and highlighted the need for provision of comprehensive health and social services to children with epilepsy and their families.

Suicide risk among adults with epilepsy in Kaduna, Nigeria.

OBJECTIVE: There is paucity of information on epilepsy and suicide in Nigeria. The objective of this study therefore was to assess the prevalence and determinants of suicide risk among adults with epilepsy (AWE) in Kaduna, Nigeria. METHOD: We administered the suicidality module of the Mini International Neuropsychiatric Interview, the three-item Oslo Social Support Scale and the Hospital Anxiety and Depression Scale to 170 consecutive AWE attending the outpatient clinic of Federal Neuropsychiatric Hospital, Kaduna, between January and June 2011 to determine the prevalence of suicide risk, the level of social support and the psychological symptoms, respectively. We also recorded the sociodemographic and clinical characteristics of the subjects. RESULTS: There are 99 males and 71 females. The subject's mean age was 28.7±12.1 years. The prevalence of suicide risk was 20.0%. Short seizure-free periods (χ2=4.658, P=.031), previous suicide attempts (χ2=12.216, P<.001), anxiety symptoms (χ2=5.075, P=.024) and depressive symptoms (χ2=5.093, P=.016) were significantly associated with suicidal tendencies. However, after a logistic regression analysis, none of the above variables predicted suicide risk. CONCLUSION: Suicide risk is common among AWE. Poor seizure control, previous suicidal attempts and emotional distress are associated factors.

Quality of life of people with cancers in Ibadan, Nigeria.

BACKGROUND: Cancer is associated with psychological and physical morbidities. The presence of such comorbidities has been reported to worsen the overall outcome and quality of life (QOL) of affected people. AIMS: To assess the QOL and its determinants among participants with cancer. METHODS: We administered the short version of the World Health Organization Quality of Life-BREF instrument, socio-demographic/clinical data collection sheet and structured clinical interview for Diagnostic and Statistical Manual Fourth Edition (DSM-IV) diagnosis to 210 consecutively admitted participants with cancer at the University College Hospital Ibadan to determine the diagnosis of major depression. RESULTS: The sample consisted of 63 men and 147 women; 68 participants had cancer of the breast, while 59, 40 and 43 had cancers of the cervix, colon/rectum and prostate, respectively. The QOL of most of the participants was fair. Approximately 30% of the participants were depressed, 75.7% had pains while 49.5% of them had advanced cancer. Male sex, older age, depression, pains and advanced stage cancers were significantly associated with poor QOL. CONCLUSION: The QOL of participants is negatively affected by male sex, older age, depression, advanced stage of cancer and pains.

Sleep quality among primary care attendees in Kaduna, Northern Nigeria: a case-control study.

OBJECTIVE: To assess sleep quality and its determinants among primary care patients in a Northern Nigerian setting. METHODS: We administered the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale to 217 consecutive patients attending the General Outpatient Clinic of Barau Dikko Specialist Hospital, Kaduna, and PSQI to 223 age-matched controls to evaluate their sleep quality and levels of anxiety and depression. A data collection sheet was used to record the sociodemographic characteristics of patients and controls, and the clinical characteristics of the patients. RESULTS: The mean ages of all the subjects, patients, and controls were 33.7 (SD 10.6), 33.5 (SD 10.6), and 34.0 (SD 10.5) years respectively; 54.4% of the patients were females, 54.8% were Muslims, 56.2% admitted they had pain, 60.8% and 46.5% had anxiety and depressive symptoms respectively, while 68.7% had poor sleep quality. The mean global score of sleep quality for patients was 9.2 (SD 3.6) while that of the control was 3.8 (SD 1.4). The difference was statistically significant (t = 20.834, P value < 0.001, 95% CI 4.891-5.910). Islamic religious faith, presence of pain, anxiety symptoms, and depressive symptoms were significantly associated with poor quality of sleep (P value < 0.05). Multiple regression analysis identified being a Muslim (OR 6.422, P value 0.027, 95% CI 0.196-0.907), pain (OR 8.038, P value < 0.001, 95% CI 0.016-0.091), and anxiety symptoms (OR 5.253, P value < 0.001, 95% CI 0.136-0.473) as predictors of poor sleep quality among the patients. CONCLUSION: Poor quality of sleep is common in primary care patients. Efforts should be made to improve its recognition, identify associated factors, and consider a holistic approach to patients' care.

Factors associated with emotional distress among caregivers of patients with schizophrenia in Katsina, Nigeria.

BACKGROUND: Caregivers play an important role in the management of chronic mental illness in the community. Caring for patients with chronic mental illness like schizophrenia can cause emotional distress in the caregivers. However, the magnitude of the problem remains largely unknown in Sub-Saharan Africa and other developing countries. METHOD: A total of 129 caregivers of patients with schizophrenia attending the outpatient clinic of Katsina State Psychiatric Hospital were enrolled for the study. They were interviewed using socio-demographic data collecting sheet and Hospital Anxiety and Depression Scale. The data obtained were analysed using the Statistical Package for Social Science version 13. Statistical significance was set at 5% level of probability. RESULTS: The caregivers consisted of 87 (67.4%) females and 42 (32.6%) males. The mean age of the subjects was 45.07 ± 8.91 years. Siblings constituted majority of the caregivers. Emotional distress was found in 79.84% of the caregivers (95% CI 72.82-86.86). Factors associated with emotional distress in the caregivers were family size, education, financial support, patient gender and relationship with the patient. CONCLUSION: Emotional distress is common among caregivers of patients with schizophrenia and the risk factors were similar in most communities.

Caregiver burden among poor caregivers of patients with cancer in an urban African setting.

OBJECTIVES: The nature and magnitude of the problems facing caregivers remain largely unknown in developing countries of the world. This study addresses these issues in a group of caregivers of patients with cancer in Zaria, Nigeria. METHOD: One hundred and three patients attending an oncology outpatient clinic at the Ahmadu Bello University Teaching Hospital were enrolled in the study with their caregivers. The caregivers were interviewed using the Socio-demographic data sheet, General Health Questionnaire-30 (GHQ-30) and Zarith Burden Interview (ZBI). A score of 4 or more in GHQ and scores above the median score of the sample in ZBI were considered a clinically significant level of psychological morbidity and a high level of burden, respectively. Data obtained were analyzed using the Statistical Package for Social Sciences Version 13 for Windows. All statistical tests of significance were carried out at 5% level of probability. RESULTS: The patients were 60 women whose mean age was 57. Of the 103 caregivers, 60 (58%) were men and 43 (42%) were women. Their mean age was 37. Their mean ZBI and GHQ-30 scores were 29.16±12.8 (median = 25) and 3.67±3.01, respectively. A high level of burden was found in 49.5% (95% CI 39.9-59.1%) and psychological morbidity was found in 46.6% (95% CI 37.0-56.2%) of the caregivers. High levels of burden and psychological morbidity were significantly associated with absence of financial support. CONCLUSION: The study demonstrated a high level of caregiver burden, psychological morbidity and financial strain in family caregivers coming to the clinic with a relative who has cancer in an urban Nigerian setting.