Gender difference in the point prevalence, symptoms, comorbidity, and correlates of depression: findings from the Lagos State Mental Health Survey (LSMHS), Nigeria.

It is still unclear whether the gender difference in the rate of depression cuts across cultures or is specific to some depressive symptoms. This study evaluated the gender difference in current prevalence, symptoms, comorbidity, and correlates of depression in Lagos, Nigeria. A total of 11,246 adult participants (6525 females and 4712 males) in a face-to-face household survey were assessed for symptoms of depression. They were also assessed for symptoms of anxiety, somatic symptoms, alcohol and substance use disorders, and disability. The difference between the point prevalence for symptoms of depression in females (6.3%, s.e 0.3) and males (4.4%, s.e 0.3) was significant (OR 1.28, 95% CI 1.14-1.59). Compared to males, females had significantly higher rates for anhedonia (OR 1.20), hypersomnia (OR 2.15), fatigue (OR 1.49), guilt/worthless feeling (OR 1.41), poor concentration (OR 1.32), psychomotor retardation (OR 1.51), and suicidal ideation (OR 1.32). However, poor appetite (OR 0.69) and comorbidity with alcohol use (OR 0.25) was significantly lower in females compared to males. The significantly higher rates for depression in females were only restricted to below 45 years and higher socioeconomic status. Our study further contributed to the growing literature suggesting that the gender differences in rates of depression not only cut across many cultures, but most pronounced with atypical symptoms, not affected by recall bias and seems to disappear with increasing age. These need to be considered when formulating mental health policies for equitable and acceptable health services.

Current prevalence, comorbidity and associated factors for symptoms of depression and generalised anxiety in the Lagos State Mental Health Survey (LSMHS), Nigeria.

BACKGROUND: Depression and anxiety are very prevalent, highly co-morbid, burdensome with huge treatment gaps in low and middle-income countries (LMICs). This study aimed to estimate the current prevalence of symptoms of depression and generalised anxiety, examine co-morbid conditions and associated sociodemographic factors in Lagos state, Nigeria. METHODS: A face to face household survey completed by 11,246 adult participants (age 18-75years). Clinically significant symptoms of depression, generalised anxiety and somatic symptoms were assessed using the specific modules of the Patient Health Questionnaire (PHQ) respectively. Alcohol use, substance use and disability were assessed with the Alcohol Use Disorders Identification Test-short form (AUDIT-C), the Mini International Neuropsychiatric Interview (M.I.N.I) and the WHO Disability Assessment Schedule (WHODAS 2.0) respectively. RESULTS: The mean age was 36.75 (sd 12.3) years and there were 6525 (58.0%) females. The weighted current prevalence of symptoms of depression, generalised anxiety and combined depression/generalised anxiety were 5.5% (se 0.3), 3.5% (se 0.2) and 1.2% (se 0.1) respectively. About 20.9% of all cases of depressive symptoms have co-morbidity with symptoms of generalised anxiety. Symptoms of depression and generalised anxiety had high co-morbidity with somatic symptoms, alcohol use problems and disability but not substance use disorders. Being female, not married (especially separated/divorced or widowed) and unemployment were significantly associated with presence of either symptoms of depression or generalised anxiety. CONCLUSION: Our findings suggest that despite the popularity of cross-national surveys, there is need for individual countries and states to generate complimentary local data to plan effective local response to close the huge treatment gap for common mental disorders.

Effect of 2 Models of Care and Factors Predicting Patients' Adherence to Doctor's Appointment Attendance in Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria.

BACKGROUND: Provision of antiretroviral therapy in resource limited settings has put pressure on the available infrastructure. OBJECTIVES: The study examined patients' adherence to Doctor's appointment attendance after an intervention changing the model of care and factors that predicted adherence. METHODS: Observational study was carried out over four years. The model of care was changed in the last year and the effect assessed. SPSS version 15.0 was used for analysis. Predictors of adherence were determined using logistic regression model. RESULTS: Over half 148 (59.7%) of the patients were females, with a mean age of 40.4±8.8 years and baseline CD4 cells of 143.5±92.7cells/microliters. "Adherence" rates were 51.3% in 2007, 35.9% in 2008 and 14.9% in 2009 giving patients' average adherence to Doctor's appointment attendance of 34.03%. Intervention changing the model of care in 2010 recorded an adherence rate of 93.1%. CONCLUSIONS: The change in model of care greatly improved patients' "adherence". Patients' knowledge of management, adherence, and smoking and drinking habits were identified as statistically significant predictors of adherence.

Prevalence and associated factors for suicidal ideation in the Lagos State Mental Health Survey, Nigeria.

BACKGROUND: To combat the increasing rate of suicide, basic data on suicidal behaviours reflecting the uniqueness of the locality are needed in sub-Saharan Africa. AIMS: To assess the prevalence of suicidal ideation and associated factors. METHOD: Adults (n=11 246) from the five administrative divisions of Lagos State completed questionnaires detailing suicidal ideation, socio-demographic details, common mental disorders (depression, anxiety and somatic symptoms), alcohol and psychoactive substance use disorders and disability. RESULTS: The weighted prevalence of current suicidal ideation was 7.28% (s.e. 0.27). Independently associated factors were older age, being female, not married, low occupational group, depression, anxiety, somatic symptoms and disability. CONCLUSIONS: Despite the validity of cross-national surveys, there is need for individual countries to generate complementary local data to explain variability in rates and risk factors in order to plan for suicide prevention or develop timely and effective response. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.