Mental health status of doctors and nurses in a Nigerian tertiary hospital: A COVID-19 experience.

Background: Healthcare professionals (HCPs) working to save lives during the coronavirus disease 2019 (COVID-19) pandemic are under tremendous physical and psychological pressure, therefore facing the risk of developing challenges with mental health. Aim: This study aimed primarily to determine the prevalence and factors associated with depression, anxiety and stress among HCPs in a tertiary hospital in Lagos State during the COVID-19 pandemic. Setting: Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria. Methods: This was a descriptive cross-sectional study conducted between June and July 2021 among 1452 doctors and nurses in LASUTH, Ikeja, Lagos, Nigeria, selected by the multistage sampling method. Depression, anxiety and stress were assessed using the Patient Health Questionnaire, Generalised Anxiety Disorder and Perceived Stress Scale, respectively. Results: The majority of respondents were female (72.5%), with two-thirds being nurses. The prevalence of depression, anxiety and stress was 9.8%, 5.0% and 62.4%, respectively. Nurses showed a higher prevalence of these mental health conditions as compared with doctors. Younger HCPs, nurses, those that lost a colleague to COVID-19, and those whose family members were infected with COVID-19 were more likely to be depressed. Nurses and those afraid of being infected were more likely to experience anxiety. Younger HCPs, nurses, history of anxiety and/or depression and previous COVID-19 infection were identified as factors associated with stress. Conclusion: Stress was the most prevalent mental health condition with nurses being the most affected of the HCPs and at a greater risk of developing challenges with mental health. Psychosocial interventions and stress management techniques are recommended to minimise the risks. Contribution: This study adds to the few studies on the mental health of HCPs during COVID-19 and calls for in-depth surveys to understand psychosocial challenges among HCPs in Nigeria.

Prevalence and correlates of depression among Nigerian stroke survivors.

BACKGROUND: There is mixed evidence for the hypothesis that the risk of depression after stroke is influenced by the location of lesions in the hemispheres, demographic and clinical factors, and disability of stroke survivors. AIM: The current study determined the prevalence of depression and its socio-demographic and clinico-pathological correlates among stroke survivors in a tertiary hospital in Lagos, Nigeria. METHOD: The cross-sectional study was carried out among 112 adult patients with a clinical history of stroke confirmed by neuroimaging. Depression was diagnosed using Mini International Neuropsychiatric Interview. The socio-demographic profile was obtained, and cognitive impairment was assessed using the Mini-Mental State Examination. Stroke severity was assessed retrospectively using the National Institute of Health Stroke Scale and current disability was measured using the Modified Rankin Scale. RESULTS: There were 48 (42.9%) stroke survivors with a clinical diagnosis of depression. Using binary logistic regression, the independent determinants of depression were younger age, unemployment, perceived poor social support, increasing number of previous admissions because of stroke, cognitive impairment, severity of stroke and current disability status. However, there was no significant association between depression and lesion location. CONCLUSION: Depression is a common associate of stroke, and there is a need for sustained focus on young stroke survivors with severe stroke, especially those who do not have social support and have low socio-economic status, who may have a higher risk of developing depression following stroke.

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.

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.

Correlations between psychopathology and self-reported quality of life among adolescents in youth correctional facilities in Lagos, Nigeria: A short report.

BACKGROUND: The relationship between psychopathology and quality of life (QoL) and well-being among young incarcerated offenders has hardly been explored. AIMS: Our aim was to test the hypothesis that higher self-rated psychopathology would be associated with lower QoL among adolescents resident within youth correctional facilities in Lagos. METHODS: Psychopathology was assessed using the Strength and Difficulty Questionnaire (SDQ), while QoL was measured by using the Paediatric Quality of Life. RESULTS: One hundred and sixty-five adolescents completed the study, mostly boys (n = 124; 75%) with a mean age of 14.3 ± 2.1 years. Nearly, a fifth (30, 18%) of respondents had abnormal total SDQ scores (≥17), suggestive of definite psychiatric disorder, while another 44 (27%) had highly probable psychopathology (total SDQ scores 15-16). There was strong negative correlation (r = -0.51, p < 0.001) between total SDQ scores and overall self-reported QoL among respondents. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Although we were unable to infer direction of relationship between psychopathology and QoL among these adolescents, it is plausible to suppose that treatment of mental health problems could have a positive impact on rehabilitation and reintegration. Given the rate of likely psychopathology, mental health screening within young offender institutions should be routine, and followed, as necessary with full assessment and resultant treatment. Copyright © 2017 John Wiley & Sons, Ltd.

Child mental-health policy development in sub-Saharan Africa: broadening the perspectives using Bronfenbrenner's ecological model.

Despite socio-economic, demographic and epidemiological facts and realities that point to a potential risk for explosion in the prevalence of childhood mental health problems in sub-Saharan Africa, there is still a severe dearth of child and adolescent mental health (CAMH) policy or strategy to respond to the situation in the region. Unfortunately, current attempts at suggesting courses of action in this regard appear to be focused on narrow reactionary approaches. There is a need for theoretical frameworks to capture the full ramification of childhood in sub-Saharan Africa, from which multi-level, context-appropriate and holistic CAMH policy directions can be understood. In this commentary, we propose an amended version of the Bronfenbrenner's ecological model of childhood as such framework that captures proximal, intermediate and distal factors that influence the care environment of children. We then used the insights provided by the model to identify and prioritize intervention points and appropriate intervention strategies in charting a tentative course for CAMH policy development in the region. Though the ecological model provides a distinct perspective to the structure and dynamics of the care environment of children, the proposed framework using the model is still largely theoretical and need to be further integrated into future studies on CAMH policy development in the region.

Status of mental-health services for adolescents with psychiatric morbidity in youth correctional institutions in Lagos.

BACKGROUND: High prevalence rates of psychiatric morbidity have been documented among adolescents within youth correctional institutions in Nigeria. However, there has not been prior investigation to determine the capacity for and nature of mental health services being provided in these institutions. OBJECTIVES: To assess psychiatric morbidity among adolescents within youth correctional institutions in Lagos, while simultaneously examining the capacity for and the scope of mental health services. METHODS: Psychiatric morbidity and alcohol/substance use disorder were assessed among 165 respondents using the Strengths and Difficulties Questionnaire, and the CRAFFT screening tool for adolescent substance use disorder. Availability of mental-health services in the institutions was examined using an 'audit protocol'. RESULTS: We found prevalence rates of 18.2% and 15.8% of general psychiatric morbidity and alcohol/ substance use disorder, respectively, among the adolescents. Only about a third (34.3%; n = 20) of the operational staff at the institutions had educational backgrounds relevant to psycho-social services for children/adolescents, while less than a quarter (22.4%, n = 13) has ever received any training in child mental health services. There was no evidence of mental health screening and intervention in the service framework within the institutions. CONCLUSIONS: We concluded that there was evidence for significant mental health service gaps within the youth correctional services in Lagos.

Cross-Cultural Measurement Invariance of Adolescent Self-Report on the Pediatric Quality of Life Inventory™ 4.0.

This study evaluated the cross-cultural measurement invariance of the Pediatric Quality of Life Inventory version 4.0 (PedsQL™) among adolescents sampled from Bulgaria, Croatia, India, Indonesia, Nigeria, Serbia, and Turkey. The multiple-indicator multiple-cause (MIMIC) model was used, which allowed controlling of demographic variables (i.e., age, gender, and socioeconomic status). Significant effects of country on scores within the PedsQL™ domains were observed, with up to 17 items showing differential item functioning (DIF) across the countries. We did not find support for cross-cultural measurement invariance hypotheses for scores on the PedsQL™ adolescent self-report in this study. Researchers should use caution in making cross-cultural quality of life comparisons while using the PedsQL.

Towards school mental health programmes in Nigeria: systematic review revealed the need for contextualised and culturally-nuanced research.

BACKGROUND: School-based mental health programmes, a potential avenue to reach many children and youth, are not yet developed in Nigeria. In view of the importance of cultural nuances in mental health issues, initial groundwork towards the establishment of these programmes in Nigeria must be cognizant of cultural peculiarities at the outset. OBJECTIVES: The objective of the study was to critically examine, through the lens of transcultural psychiatry, all the currently available epidemiological studies and needs assessments relevant to school-based mental health programmes in Nigeria. METHODS: The study was a systematic review of relevant studies available from MEDLINE, Science Direct, PsychInfo, Google Scholar, and AJOL databases. RESULTS: This review shows that there is an ongoing effort at documenting the burden of mental health problems and risks, resource needs, and the available resource and capacity for school-based mental health programmes in Nigeria. However, generally speaking these epidemiological data and needs assessments are significantly limited in epistemological philosophy and cultural contextualisation. This was evidenced by a preponderance of non-representative data, quantitative assessments, and decontextualised interpretation of results and conclusions. CONCLUSIONS: Going forward, recommendations are offered for culturally-nuanced epidemiology and the direction is set for context-appropriate needs assessments for school-based mental health programmes in Nigeria.

Level of community mental health literacy in sub-Saharan Africa: current studies are limited in number, scope, spread, and cognizance of cultural nuances.

BACKGROUND: The combination of high prevalence of mental disorders and the scarcity of resources to care for them in sub-Saharan Africa underscores the need for good mental health literacy as a potential mental health resource. AIM: To conduct a systematic review of the findings of studies that have examined aspects of mental health literacy among community dwellers in sub-Saharan Africa. METHODS: A search was conducted using local and international indexes like MEDLINE, EMBASE and PsychInfo. RESULTS: Only 19 studies from eight different countries met inclusion criteria. Key aspects of the functional mental health literacy that has been examined include recognition of mental disorders, knowledge about causation, and treatment preferences. The modes of seeking mental health information are yet to be examined. Some studies utilized a methodology that allowed for respondents to use local labels to describe their understanding of various mental disorders. Otherwise, respondents were largely unable to label orthodox psychiatry syndromes correctly. Supernatural and ultra-human views were rampant, and alternative mental health services were mostly preferred. Quantitative modes of assessment were the most common, and authors-especially those that adopted this mode of assessment-did not take full cognizance of socio-cultural underpinnings of the concept of mental health literacy in their conclusion and recommendations. CONCLUSION: There is need for more studies to adopt more comprehensive approaches to the assessment of mental health literacy. The outcomes of such studies will provide the right context for making profound statements on the level of knowledge and skills for mental health promotion in sub-Saharan Africa.

Problematic Internet Use and Its Correlates Among Students from Three Medical Schools Across Three Countries.

OBJECTIVE: The authors aimed to assess and compare problematic internet use among medical students enrolled in a graduate degree course in one school each from Croatia, India, and Nigeria and to assess correlates of problematic use among these students. METHODS: The questionnaire included a sociodemographic profile of participants and Young's Internet Addiction Test. RESULTS: The final analysis included 842 subjects. Overall, 38.7 and 10.5 % of respondents scored in the mild and moderate categories. Only a small fraction (0.5 %) of students scored in the severe category. Being male and spending more time on the internet were correlated with problematic internet use. Moreover, a significantly higher proportion of participants who scored above the cutoff used the Internet for browsing, social networking, chatting, gaming, shopping, and viewing pornography. However, there was no difference between the two groups with regard to using the internet for e-mailing or academic activities. CONCLUSIONS: It is important to address problematic internet use among medical students. The correlates can help identify those at increased risk.

Nigerian resident doctors on strike: insights from and policy implications of job satisfaction among resident doctors in a Nigerian teaching hospital.

OBJECTIVES: The Nigerian health system has been engulfed in a crisis occasioned by a deluge of strike actions by resident doctors in recent times. Dissatisfaction with conditions of service has been cited as the bone of contention. Job satisfaction studies among doctors have provided insights into the contributory factors to recurrent industrial disputes in other climes. This study aims to determine the predictors of job satisfaction among resident doctors in a tertiary healthcare centre in Nigeria. This is with a view to gain some insights into the possible contributory factors to industrial disputes and to discuss the policy implications of such findings. METHODS: A semi-structured questionnaire was used to obtain socio-demographic characteristics and job-related determinants of job satisfaction among resident doctors. Logistic regression analysis was carried out to determine predictors of job satisfaction. FINDINGS: A total of 163 resident doctors completed the study. Overall, 90 (55.2%) of the resident doctors were satisfied with their jobs. Lower age, career advancement opportunities, autonomy of practice, alignment of job with core personal and professional values, and working environment predicted job satisfaction. CONCLUSIONS: To restore satisfaction and possibly stem industrial disputes by resident doctors, government of Nigeria needs to sustain current wages while introducing non-financial benefits. There is a need to adopt policies geared towards increasing government spending on health especially in the area of human capacity and infrastructural development, so as to afford resident doctors opportunities for skill acquisition and career development.

Different points of a continuum? Cross sectional comparison of the current and pre-contact psychosocial problems among the different categories of adolescents in institutional care in Nigeria.

BACKGROUND: The combination of adverse social indicators and a predominantly youthful population puts Nigeria, and indeed many countries of sub-Sahara Africa, at the risk of explosion in the number of youth coming in contact with the juvenile justice system. Despite this risk, custodial childcare systems in the region are still poorly developed with both juvenile offenders and neglected adolescents coming in contact with the systems being kept in the same incarcerating facility. The needs of these different groups of adolescents may be different. Knowing their common and unique needs can inform common prevention strategies and ensure that specific service-needs of different categories of adolescents in institutional custody are met. METHODS: Data on the family background, pre-contact social circumstance, neurological and anthropometric profiles, and certain aspects of mental health of adolescents drawn from two juvenile justice institutions in Nigeria were obtained. The results for the adolescents on 'criminal code' and those admitted as a case of child neglect were compared using chi-square and odd ratios. RESULTS: Participants were 211 adolescents comprising of 158 on 'criminal code' and 53 declared as 'neglected'. A lot of similarities were found. For instance, the prevalence of parental separation, family transition, experience of street-life and lifetime exposure to traumatic events and posttraumatic stress was equally high among the two groups of adolescents. The adolescents on 'criminal code' however had significantly higher prevalence of conduct and alcohol/substance use disorders while the child neglect group had poorer anthropometric profiles and higher prevalence of neurological disorders. CONCLUSIONS: Child neglect and juvenile delinquency in Nigeria may truly be different points of a continuum. There are however fundamental differences that can warrant specific prevention strategies and tailor-made service provision while in custodial care.

Towards school-based mental health programs in Nigeria: the immediate impact of a depression-literacy program among school-going adolescents and their teachers.

BACKGROUND: Depression-literacy, which is the foundational requirement for symptom recognition, positive attitude and help-seeking, is poor among adolescents in Nigeria. This study, therefore, aims to determine the impact of a school-based training program on depression-literacy among a cohort of high-school students and their teachers in South-West Nigeria. METHODS: An adapted version of the Break Free from Depression, a 4-module depression awareness curriculum for staff and students, was implemented among students and their teachers. Paired-sample T-test was used to assess the domain-specific (knowledge, attitude, and confidence) impact of the training by comparing the baseline and immediate (within the week of the training) post-scores. RESULTS: A total of 3098 students and 294 teachers from 21 schools across three states in South-West Nigeria successfully completed the training. There was a significant positive difference (p < 0.05), at post-test, in the knowledge, attitude, and confidence among the students. The same was observed among teachers except for attitude where positive change did not reach significant level (p = 0.06). When statistically significant, the calculated effect size (eta squared) was highest for knowledge (students: 0.07, p = 0.001; teachers: 0.08, p < 0.000) and least for attitude (students: 0.003, p = 0.002 teachers: 0.085, p = 0.06). Multiple regression analyses result showed that the level of pre-scores predicted the magnitude of change in all domains of depression-literacy (p < 0.05) after controlling for age, gender, and type of school among the students, but not for teachers. CONCLUSIONS: School-based depression-literacy programs can lead to significant positive change in knowledge, attitude, and confidence of students and teachers.

Factors Driving the Acquisition of University Postgraduate Degrees among Resident Doctors in Nigeria.

The study examined the characteristics and factors driving the acquisition of postgraduate academic degrees among resident doctors in Nigeria. About 10% of the respondents had a form of university postgraduate degree with majority being master's degree. Having more than seven years of professional practice was the only factor predicting the acquisition of postgraduate academic degrees amongst the respondents [AOR: 0.243 (95% CI: 0.069,0.856; p = 0.028)]. The acquisition of postgraduate degree is not common among the surveyed resident doctors; and those that will acquire it do so in the later part of their career.

Impact of Covid-19 on Residency Training in Tertiary Health Institutions in Nigeria: A National Survey.

Background: The emergence of COVID-19 had a massive impact on the health system globally. While there are many kinds of literature reporting the impact on postgraduate medical training in other parts of the world, this cannot be said about Nigeria. Methodology: This was a national cross-sectional study among Resident doctors via an online google form survey for 8-months. Stratified cluster design where the entire country was stratified into the six geopolitical zones, and Tertiary Health Institutions (THI) were randomly selected from each of these zones. Data from the 47-item google form were analysed with Statistical Package for Social Science (SPSS) version 23, and internal consistency reliability was measured by Cronbach's alpha coefficient. Categorical variables were compared using chi-square, and the p-value was <0.05. Results: A total of 239 residents from THI in all six geopolitical zones completed the survey. The mean± standard deviation of the age of respondents, years in practice, and years in residency were 36.3±4.4); 10.2±7.6 years, and 4.2±2.6 years, respectively. The Cronbach's alpha coefficient was 0.95. Less than half had delayed the progression of residency (44.4%). The least strongly positive impacts were related to recruitments (4.2%), laboratory testing (4.2%), and ward rounds (4.2%); and the more strongly positive disruptive impact was on postgraduate seminars (9.2%), research (8.4%), professional examinations (8.0%) and residents' clinical schedules (8.0%). Conclusion: COVID-19 has caused a considerable delay in residents' training programs, and resident doctors have great concerns regarding the pandemic. This impact is perceived by them in almost all aspects of the training.

Changes in rates of psychiatric beds and prison populations in sub-Saharan Africa from 1990 to 2020.

Background: Psychiatric bed numbers (general, forensic, and residential) and prison populations have been considered indicators of institutionalization. The present study aimed to assess changes of those indicators across sub-Saharan Africa (SSA) from 1990 to 2020. Methods: We retrospectively obtained data on psychiatric bed numbers and prison populations from 46 countries in SSA between 1990 and 2020. Mean and median rates, as well as percentage changes between first and last data points were calculated for all of SSA and for groups of countries based on income levels. Results: Primary data were retrieved from 17 out of 48 countries. Data from secondary sources were used for 29 countries. From two countries, data were unavailable. The median rate of psychiatric beds decreased from 3.0 to 2.2 per 100 000 population (median percentage change = -16.1%) between 1990 and 2020. Beds in forensic and residential facilities were nonexistent in most countries of SSA in 2020, and no trend for building those capacities was detected. The median prison population rate also decreased from 77.8 to 71.0 per 100 000 population (-7.8%). There were lower rates of psychiatric beds and prison populations in low-income and lower-middle income countries compared with upper-middle income countries. Conclusions: SSA countries showed, on average, a reduction of psychiatric bed rates from already very low levels, which may correspond to a crisis in acute psychiatric care. Psychiatric bed rates were, on average, about one twenty-fifth of countries in the Organization for Economic Co-operation and Development (OECD), while prison population rates were similar. The heterogeneity of trends among SSA countries over the last three decades indicates that developments in the region may not have been based on coordinated policies and reflects unique circumstances faced by the individual countries.

Mental Disorders Among Detained Youth: The Hidden Nature and Peculiarities of African Literature.

Beaudry et al.1 published the results of a global systematic review of studies that have assessed prevalence rates of common mental disorders (CMD) among detained adolescents. The eligibility criteria were as follows: studies conducted in a general population of detained adolescents (10-19 years of age); studies that assessed prevalence rates of any of current depression, psychotic disorders, attention-deficit/hyperactivity disorder (ADHD), posttraumatic stress disorder (PTSD), or lifetime conduct disorder; studies with diagnoses made using clinical examination or semi-structured diagnostic instruments; and studies with results disaggregated by sex, unless >90% of respondents were of same sex. A total of 45 studies from 19 countries across continental America, Europe, Asia, and Australia met eligibility criteria. However, no study from Africa was adjudged to be eligible. Careful re-review of the literature, using Africa-specific research databases and contextualizing the search terms for Africa, revealed that few eligible studies from the region were omitted, and that the age cut-off point used in defining youth correctional populations was biased against the reality in Africa.

External locus-of-control partially mediates the association between cumulative trauma exposure and posttraumatic stress symptoms among adolescents from diverse background.

Locus of control (LOC) is a modifiable mediator of symptoms of posttraumatic stress disorder (PTSD) among traumatized individuals and a potential target of intervention. Compared with studies involving adults, the potential mediation effect of LOC on PTSD symptoms among trauma-exposed children and adolescents is relatively under-explored. This study, therefore, assessed the mediation effects of LOC on the association between lifetime cumulative trauma and PTSD symptoms among a large cohort of adolescents from different cultural background.Cross-sectional study.LOC was determined using the Multi-Dimension Locus of Control Scale; Posttraumatic stress symptoms using the UCLA PTSD Reaction Index; and other significant negative life events using the Life Events Checklist.Among 3826 adolescents who completed the study, external LOC explained 24% of variance (R2 = .24; F2,3823 = 619.01; p < .01) in PTSD symptoms and had significant indirect effect on the relationship between self-reported cumulative traumatic event exposure and PTSD symptoms (ß = .14; 95% BC CI [.10, .20]). Moderated mediation results showed significant potentiation of the moderation effects among older adolescents; boys; and those from more affluent families.The study further strengthened the hitherto limited evidence that external LOC partially mediate the relationship between cumulative trauma exposure and PTSD symptoms among adolescents.

Posttraumatic stress disorder symptoms among trauma-exposed adolescents from low- and middle-income countries.

BACKGROUND: Exposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the types of traumatic events experienced and the presence and predictors of PTSD symptoms among adolescents from the general population from ten low- and middle-income countries (LMICs). METHODS: Data were simultaneously collected from 3370 trauma-exposed adolescents (mean age = 15.41 [SD = 1.65] years, range 12-18; 1465 (43.5%) males and 1905 (56.5%) females) in Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, the Palestinian Territories, the Philippines, Romania, and Serbia, with Portugal, a high-income country, as a reference point. The UCLA PTSD Reaction Index for the DSM-5 (PTSD-RI-5) was used for the assessment of traumatic events and PTSD symptoms. RESULTS: The most frequently reported traumatic events were death of a close person (69.7%), witnessing violence other than domestic (40.5%), being in a natural disaster (34.4%) and witnessing violent death or serious injury of a close person (33.9%). In total, 28.5% adolescents endorsed two to three DSM-5 PTSD criteria symptoms. The rates of adolescents with symptoms from all four DSM-5 criteria for PTSD were 6.2-8.1% in Indonesia, Serbia, Bulgaria, and Montenegro, and 9.2-10.5% in Philippines, Croatia and Brazil. From Portugal, 10.7% adolescents fall into this category, while 13.2% and 15.3% for the Palestinian Territories and Nigeria, respectively. A logistic regression model showed that younger age, experiencing war, being forced to have sex, and greater severity of symptoms (persistent avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity) were significant predictors of fulfilling full PTSD criteria. CONCLUSIONS: Nearly every third adolescent living in LMICs might have some PTSD symptoms after experiencing a traumatic event, while nearly one in ten might have sufficient symptoms for full DSM-5 PTSD diagnosis. The findings can inform the generation of PTSD burden estimates, allocation of health resources, and designing and implementing psychosocial interventions for PTSD in LMICs.