The Challenges and Opportunities for Mental Health Twin Research in Nigeria.

The recent interest in increasing diversity in genetic research can be useful in uncovering novel insights into the genetic architecture of mental health disorders - globally and in previously unexplored settings such as low- and middle-income settings like Nigeria. Genetic research into mental health is potentially promising in Nigeria and we reflect on the challenges and opportunities for twin research which may be particularly suited to Nigeria. The higher rates of twinning in Africa and Nigeria specifically, make the twin design an affordable and readily maintainable approach for genetic research in the country. Despite potential challenges with recruitment, data collection, data analysis and dissemination; the success of current efforts suggest that the twin design can tapped even further for greater impact in the country. We highlight some ways in which the scope of twin research can be increased and suggest some ways in which existing challenges can be overcome including recent Patient Participant Involve and Engagement activities.

Assessment of sleep knowledge among medical and dental students in a Nigerian tertiary institution: a cross-sectional study.

PURPOSE: Sleep medicine is a rapidly growing field of Medicine globally. However, studies are lacking on the knowledge of Nigerian medical and dental students on sleep and the different types of sleep disorders. Thus, we assessed the knowledge, interest and awareness of Nigerian medical and dental students about sleep medicine. We also determined the factors associated with sleep knowledge among the medical and dental students. METHODS: We conducted this cross-sectional study from June to September 2021, among medical students at the Obafemi Awolowo University, Ile-Ife, Nigeria. The students' knowledge of sleep was assessed with the Assessment of Sleep Knowledge in Medical Education (ASKME) survey. The participants were classified as having low or high scores based on the proportion who gave a correct answer to 60% of the questions. RESULTS: Among the 488 students who completed the questionnaire, there was a male preponderance (55%). About three-quarters of the respondents (376, 77%) had a low sleep knowledge score. Age, year of study, and awareness about sleep medicine were the predictors of sleep knowledge. CONCLUSION: A significant proportion of the medical students had poor sleep knowledge scores. There is a need to incorporate teaching sleep medicine in the curriculum of medical students early in their training.

Relationship Between Types of Information, Dental Anxiety, and Postoperative Pain Following Third Molar Surgery: A Randomized Study.

PURPOSE: Third molar (M3) extraction is an anxiety-provoking procedure. Information mode delivery may affect patients' anxiety level and postoperative sequelae. This study determined the relationship between information types, dental anxiety, and postoperative pain following mandibular M3 extraction. METHODS: Patients (aged 18 to 35 years) requiring M3 extraction under local anesthesia were recruited into this prospective randomized study conducted in Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. Patients were randomized to two groups; verbal or audiovisual depending on M3 extraction information received. Primary outcome variable (difference in anxiety between groups) was assessed with State-Trait Anxiety Inventory (STAI-S) and Modified Dental Anxiety Scale(MDAS). Pain recorded on postoperative days (PODs) 1, 3, and 7 using the Visual Analog Scale was the secondary outcome. Other covariables include biodata, impaction types, and difficulty indices. Data analysis was descriptive and bivariate using IBM/SPSS for Windows, version 23 (SPSS, Chicago, IL USA) with significance set at P < .05. RESULTS: Ninety patients referred for M3 extraction met the inclusion criteria, 45 patients in each group. The audiovisual group had significant increase in anxiety preoperatively measured by STAI-S (P = .002) and MDAS (P = .009) when compared with the verbal group. No significant differences in the STAI-S (P = .16) and MDAS (P = .216) scores were recorded at POD7. The progressive reduction in pain in both groups was not significant at POD7 (P = .746). CONCLUSIONS: Preoperative verbal information allayed anxiety compared to real life audiovisual information in M3 patients. These findings will provide a baseline reference data for subsequent research in our environment.

Depression and Associated Factors Among Gay and Heterosexual Male University Students in Nigeria.

Homosexuality is a recognized risk factor for depression in high-income countries; however, there is little research investigating the relationship between depression and sexual orientation in developing countries, especially in Africa. In this first study to investigate psychopathology in sexual minority men in Nigeria, the prevalence rates of depression in Nigerian gay and heterosexual individuals were compared as well as the explanatory power of risk and resilience factors in both groups. Eighty-one gay and 81 heterosexual male university students were, respectively, recruited from the Obafemi Awolowo University. Both groups were assessed for depression and other clinical factors, including alcohol and other substance use, suicidal ideation, and resilience. Gay students were further assessed for sexuality-related variables, including minority stress factors such as internalized homophobia and perceived stigma. The prevalence rates of depression among gay and heterosexual students were, respectively, 16 and 4.9% (OR 3.7; 95% CI 1.15-11.82), and this increased likelihood for depression was significantly attenuated by resilience. Clinical factors correlated significantly with depression in both groups, explaining 31% of the variance in depression in gay and heterosexual students, respectively. Sexuality-related variables including internalized homophobia and perceived stigma were further associated with depression in gay students-accounting for a further 14% of the variance of depression in gay students. The findings highlight the importance of minority stress factors in understanding depression among non-heterosexual individuals in a developing country, and the need for further research to investigate the mechanisms of these relationships in such settings.

Attitudes of Primary Care Health Workers Towards Mental Health Patients: A Cross-Sectional Study in Osun State, Nigeria.

World Health Organization (WHO) recommends integration of mental health services into primary health services; however attitude of primary health care workers is one barrier to this. A cross sectional survey using the Community Attitudes towards Mental Illness (CAMI) was done. One hundred and twenty primary care workers were randomly selected from three local government areas. Descriptive and inferential statistics were used in analyses. The results showed that most primary health care workers hold a benevolent (mean = 2.47, SD = 0.52) attitude towards the mentally ill. Workers with 10 years or more experience tend to have less authoritarian (t = 3.19, p = 0.01) and less social restrictive (t = 3.90, p = 0.01) attitudes towards the mentally ill. There were no significant differences in attitude by gender, marital status, or designation of health care workers. The study showed that primary care workers have attitudes similar to that seen in the general population.

The Yoruba version of the Beck Hopelessness Scale: psychometric characteristics and correlates of hopelessness in a sample of Nigerian psychiatric outpatients.

BACKGROUND: Previous studies from the developed western countries have repeatedly demonstrated that hopelessness positively correlates with an increased risk of suicide in the context of chronic mental disorders such as schizophrenia and affective disorders. Despite this persistently strong association, the construct of hopelessness in terms of its factorial structure and correlates has not been explored among Nigerian psychiatric outpatients. OBJECTIVE: The aim of this present study is to examine the psychometric characteristics of the Yoruba language culturally adapted version of the Beck Hopelessness Scale in a cross-sectional sample of psychiatric outpatients in South-western Nigeria. METHOD: The participants were 327 Nigerian adult outpatients receiving treatment for schizophrenia, bipolar and depressive disorders, consecutively recruited from the outpatient psychiatric clinics of a university teaching hospital in South-western Nigeria. The outpatients were recruited over a one year period. They completed the Yoruba translated version of the Beck Hopelessness Scale (BHS-Y), a sociodemographic and illness-related questionnaire, the Beck Depression Inventory-II (BDI-II). Their level of functioning was assessed with the Global Assessment of Functioning Scale (GAF), psychopathology was evaluated with the Positive and Negative Syndrome Scale (PANSS) and the level of disability measured with the World Health Organization Disability Assessment Schedule (WHODAS-II). Suicidality and confirmation of the diagnoses of schizophrenia, bipolar and depressive disorders were evaluated with the Mini International Neuropsychiatric Interview (MINI). The construct of hopelessness in terms of factorial structure, reliability, validity and correlates was explored. Exploratory Factor Analysis using Principal Component Analysis with Varimax rotation was used to examine the factorial structure of the BHS-Y. Internal consistency was examined with Cronbach's alpha, and the construct validity of the scale was assessed using correlational analyses with the MINI suicidality module, BDI-II, GAF and WHODAS-II domain scores. We also tested the hypothesis that a shortened version of the BHS-Y will possess psychometric properties similar to the 20 item version. RESULTS: Exploratory Factor Analysis using Principal Component Analysis with Varimax rotation showed that the construct of hopelessness among our outpatients was best explained by a 3 factor model. Reliability of the translated version of the scale was adequate as indicated by a Cronbach's alpha of 0.92. Construct validity was also satisfactory as reflected by the strong correlations with MINI suicidality, Beck Depression Inventory-II and Global Assessment of Functioning scores. The shortened 4 item single factor BHS-Y composed of items 8, 9, 13 and 15 demonstrated psychometric properties similar to those of the full item version. CONCLUSION: The Beck Hopelessness Scale (Yoruba Version) demonstrated satisfactory reliability and validity and therefore may be useful in measuring the construct of hopelessness and in clinical suicide risk assessments among Nigerian psychiatric outpatients. There is the need for more studies to further explore the psychometric features and correlates of this scale among other Nigerian ethnic groups in addition to other medical patients' populations.

Sleep quality and its relationship with school schedules and mental health of Nigerian secondary school adolescents.

STUDY OBJECTIVES: This study aimed to determine the sleep quality of in-school Nigerian adolescents and its association with their schooling and mental health outcomes. METHODS: The study was a descriptive cross-sectional study. It was conducted among adolescents attending public and private secondary schools within the Ife Central Local Government, Osun State, southwestern Nigeria. A multistage sampling technique was used to select study participants. The Pittsburgh Sleep Quality Index, 9-item Patient Health Questionnaire (PHQ-9), and 7-item General Anxiety Disorder questionnaires were used to determine sleep quality, depression, and anxiety, respectively. RESULTS: We studied 448 adolescents aged between 10 and 19 years with a mean age of 15.0 ± 1.8 years. The majority of our respondents (85.0%) had poor sleep quality. More than half of the respondents (55.1%) had insufficient sleep during weekdays, while only 34.8% had insufficient sleep during weekends. The school closing time and school type showed a statistically significant association with sleep quality (P = .039 and .005, respectively). The odds of having poor sleep quality increased by 2-fold among adolescents in private schools when compared with those in public schools (adjusted odds ratio = 1.97, 95% confidence interval = 1.069-3.627). Using multiple linear regression, only depression showed a statistically significant association with sleep quality at 95% confidence interval (CI = 0.073 to 0.219, P < .001), such that for every unit change in depression scores (PHQ-9), there will be a corresponding increase of 0.103 in sleep quality. CONCLUSIONS: Sleep quality is poor in adolescents and adversely associated with their mental health. This should also be addressed in the development of appropriate interventions. CITATION: Olorunmoteni OE, Fehintola FO, Seun-Fadipe C, Komolafe MA, Mosaku KS. Sleep quality and its relationship with school schedules and mental health of Nigerian secondary school adolescents. J Clin Sleep Med. 2023;19(11):1895-1904.

Sleep medicine in Africa: past, present, and future.

NONE: Interest in sleep and sleep disorders in Africa dates back thousands of years, influenced by various cultural and religious beliefs. However, the practice of sleep medicine as a specialty has been inadequate compared to other regions of the world. The objective of this study was to explore the current status of sleep medicine in Africa vis-à-vis education, professional societies, and facilities, and to identify challenges of the specialty in the region. A literature search of major electronic databases (PubMed, Google Scholar) was done. This revealed that there is a high prevalence of sleep disorders in Africa and a significant association with epilepsy, human African trypanosomiasis, human immunodeficiency virus, and other diseases. There are 6 sleep societies in Africa located in 4 countries. Forty-one sleep laboratories were identified located in 4 countries. The challenges hindering development of sleep medicine in Africa include lack of awareness, poor funding, lack of facilities, and inadequate training.

Depression, anxiety and quality of life among diabetic patients: a comparative study.

OBJECTIVE: The aim of this study was to compare psychiatric morbidity among diabetic patients, asthmatics and healthy individuals and also to assess the association of psychiatric morbidity and other variables with quality of life among diabetes patients. METHOD: For each respondent, the questionnaire on sociodemographic and clinical variables was completed. They also completed the Zung Self-Rating Depression Scale and the State Trait Anxiety Inventory (STAI 1). Diabetic patients also completed the Diabetic Well-Being Questionnaire. RESULTS: A total of 180 subjects were used for this study-80 diabetics (males=37, females=43) were compared with 50 asthmatics (males=22, females=28) and 50 healthy individuals (males=23, females=27). Depression was more prevalent among diabetic patients (20%) compared with asthmatics (12%) and healthy individuals (4%), while anxiety was more prevalent among asthmatics (34%) compared with diabetics (20%) and healthy individuals (8%). Predictors of depression include age of the patient, poor glycemic control and duration of diabetes mellitus. Factors that correlated significantly with diabetic general well-being include depression, anxiety and fasting blood glucose level. Depression and the presence of comorbid medical conditions significantly predicted a low quality of life. CONCLUSION: Psychiatric morbidity has significant effects on diabetic patients' quality of life.

Depressive symptoms in a sample of women following perinatal loss.

OBJECTIVE: The aim of the study is to identify variables associated with depressive symptoms among women shortly after perinatal loss. METHOD: Respondents who agreed to participate in the study were interviewed, and sociodemographic data were obtained from them. The Hospital Anxiety and Depression Scale and the Edinburgh Postnatal Depression Scale (EDPS) were thereafter administered on each respondent. RESULTS: Respondents with perinatal loss had high rate of depressive symptoms (52% on EDPS), the rate was significantly higher, when compared with the control group (chi2 = 10.16, P=0.001). Factors significantly associated with depressive symptoms included previous perinatal losses, poor support from husband and occurrence of antenatal complications. CONCLUSION: Depressive reaction following perinatal loss is very common. Programs need to be designed to help these women cope with their loss and to reduce subsequent psychological morbidity.

Sleep Hygiene Index: Psychometric Characteristics and Usefulness as a Screening Tool in a Sample of Nigerian Undergraduate Students.

STUDY OBJECTIVES: The objectives of this study were to investigate the psychometric properties of the Sleep Hygiene Index (SHI) and determine its capacity to screen for poor sleep quality in a nonclinical sample of Nigerian university students. METHODS: A total of 348 students appropriately completed the SHI, the Morningness-Eveningness Questionnaire (MEQ), the Pittsburgh Sleep Quality Index (PSQI), and the Epworth Sleepiness Scale (ESS). RESULTS: The internal consistency (Cronbach alpha) of the SHI was .64 and its construct validity was modestly satisfactory. It had a significant negative correlation with the MEQ (r = -.170, P < .001) and positive correlations with global PSQI (r = .289, P < .001) and ESS (r = .219, P < .001) scores. Prior to the factor analysis, our sample was randomly divided into two. In one half of the sample (sample 1), exploratory factor analysis of the SHI items yielded a three-factor model. Confirmatory factor analysis on the other half (sample 2) corroborated this model with satisfactory indices of fitness (c2 = 67.805; df = 55; c2/df = 1.233; P = .115; goodness of fit index = .943; Tucker-Lewis index = .958; incremental fit index = .972; comparative fit index = .970; root mean square error of approximation = .037). A cutoff total score of 16 on the SHI had the best sensitivity (77.0%) and specificity (47.5%) to identify students who were categorized as experiencing poor sleep quality, according to the PSQI (area under the curve = 0.65, 95% confidence interval = 0.59-0.71). CONCLUSIONS: The SHI exhibited satisfactory psychometric properties as a self-rated assessment instrument in the evaluation of sleep hygiene and as a screening instrument for poor sleep quality among Nigerian undergraduate students.

Sleep quality and psychological distress among undergraduate students of a Nigerian university.

OBJECTIVES: The objectives of the study were to assess the sleep quality of undergraduate students in a Nigerian University, to determine its association with psychological distress, and to evaluate some of the factors associated with poor sleep quality among the students. METHODS: It is a descriptive cross-sectional study conducted among the undergraduate students of Obafemi Awolowo University, Ile-Ife. The multistage sampling method was used to select 520 study participants, and a self-administered instrument including a questionnaire on sociodemographic characteristics, Pittsburgh Sleep Quality index, General Health Questionnaire, and Hospital Anxiety-Depression Scale was administered. RESULTS: Out of 520 students who gave consent to participate in the study, 505 students (97.1%) returned a fully-completed questionnaire. Half of the students (50.1%; 95% confidence interval [CI], 45.7-54.5%) had poor sleep quality, with a minority (5.7%) taking sleep medications at least once or twice a week. About one-fourth (24.4%; 95% CI, 21.7-27.1%)) had psychological distress. Among the demographic factors, the year of study (χ2=13.80 [P<.01]) had significant association with poor sleep quality. Presence of psychological distress and symptoms of depression and anxiety were also significantly associated with poor sleep quality. The year of study, psychological distress, and anxiety symptoms were significant predictors of poor sleep quality among the students. CONCLUSION: The strong association between psychological distress and quality of sleep further underscores the benefit of advocating for habits that can improve optimal mental health and sleep quality among the undergraduate students.

Psychopathology among a sample of hearing impaired adolescents.

Hearing impairment is a recognized cause of emotional and psychological disturbances worldwide, however little is known about this condition in Nigeria. The aim of this study is to compare the prevalence of psychopathology between hearing impaired adolescents and healthy adolescents. Students attending two special schools for the hearing impaired were assessed for psychopathology with the help of a trained signer and their teacher, using the International Classification of Diseases Diagnostic Criteria (ICD 10). Fifty two hearing impaired students and 52 age and sex matched controls from the same school were also interviewed using the same instrument. The mean age of the hearing impaired students was 16 (sd=3.8), while for the controls the mean age was 16 (sd=2.5). Psychopathology was present in 10 (19%) of the hearing impaired adolescents compared to 2 (4%) among the control group, this difference was statistically significant (χ(2)=4.62 p=0.03). The most common diagnosis was generalized anxiety disorder 4 (8%), followed by depression 2 (4%). Years spent in school (t=4.81, p=0.001), primary guardian (χ(2)=18.3, p=0.001) and mean income of guardian (t=7.10, p=0.001) were all significantly different between the two groups. Psychopathology is relatively common in this population. Proper assessment and treatment should be made available for this population group. A limitation to this study is communication difficulty which made only a third party assessment possible; this may affect the generalizability of the findings.

Caregiver burden in families of patients with depression attending Obafemi Awolowo University teaching hospitals complex Ile-Ife Nigeria.

OBJECTIVE: The objective of this study was to assess caregiver burden among relatives of patients on treatment for depressive disorder attending the psychiatry outpatient clinic of the Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria. METHODS: A cross sectional design was used. Hundred caregivers of patients with ICD-10 diagnosis of depression, on outpatient treatment for at least six months were recruited from the psychiatric outpatient clinic. Caregivers completed a semi-structured socio-demographic questionnaire, the Zarit Burden Interview and General Health Questionnaire (GHQ) 12. Descriptive statistics were used to describe socio-demographic variables; association between dependent and independent variables were assessed using Pearson's correlation, chi squared and t test as appropriate. RESULTS: The mean ZBI score was 41.32 (S.D. = 9.82), 45% of respondents reported moderate to severe burden, spouses constituted 57% of caregivers. Age at onset of depression (t = 2.46, P = .02) number of hospitalization,(χ(2) = 9.82, P = 0.001), and current active symptoms (χ(2) = 36.1, P = .001) were all significantly associated with burden score. Severity of symptoms (r = 0.48, P < .01) and age at onset of illness (r = -0.26, P < .01) both correlated significantly with burden scores, while GHQ score among caregivers also correlated significantly with burden scores (r = 0.52, P < .01). CONCLUSIONS: Caregivers of depressed patients experience moderate to severe burden. Caring for the depressed need to change from a patient focused approach to a combined patient and caregiver approach.

Psychological reactions to amputation in a sample of Nigerian amputees.

OBJECTIVE: The study compares psychological symptoms between amputees and other orthopedic patients. METHOD: Forty-two consecutive amputees were interviewed between 7 and 28 days after amputation, and an equal number of other orthopedic patients matched for age, sex, marital status, and occupation were used as controls. Each respondent completed a sociodemographic questionnaire, while clinical variables were obtained from the case notes. Respondents also completed the General Health Questionnaire, State Trait Anxiety Inventory, and the Zung Self-Rating Depression Inventory. RESULTS: The mean age of amputees in this study was 42.33 years (S.D.=15.89 years), and the average weekly income is #3500.00 ($29.00). Anxiety and depressive symptoms were high among amputees (64.3% and 59.5%, respectively) compared to other orthopedic patients (14.3% and 12.0%, respectively). Correlation analysis showed that there was significant correlation between anxiety and age (negative), marital status, and level of education, while depressive symptoms significantly correlated significantly with age (negative) and marital status. CONCLUSION: Psychological symptoms are high in this sample of amputees, indicating the importance of social and emotional support for these patients.

Interictal anxiety and depression symptoms in Nigerians with epilepsy: a controlled study.

The goals of this study were to compare symptoms of anxiety and depression between patients with epilepsy and a healthy control group, and to determine the possible factors associated with clinically significant anxiety and depression symptoms in patients with epilepsy. One hundred and four adult Nigerians (52 with epilepsy and 52 matched healthy controls) were assessed with the Hospital Anxiety and Depression Scale (HADS). The results obtained indicated a statistically significant difference in anxiety and depression symptoms between patients with epilepsy and controls. The association between anxiety symptoms and polytherapy was significant (P=0.008), as was the association between depression symptoms and duration of epilepsy longer than 10 years (P=0.04). Emotional problems are more common in patients with epilepsy than in the general population. Identifying and monitoring those with epilepsy of long duration and rational prescription of antiepileptic drugs are important in reducing the risk of affective problems.

Implications of psychosocial factors as precipitant of asthma attack among a sample of asthmatics.

OBJECTIVE: To explore the relationship between psychosocial factors and asthma. METHODS: One hundred consecutive asthmatics were screened using the 30-item version of the General Health Questionnaire (GHQ-30), Present state examination (PSE) and a socio-demographic schedule incorporating psychosocial variables. Chi-squared test, student "t" test and discriminant analysis were used in analysis. RESULTS: Among the asthmatics studied 36% had psychopathology. Psychosocial variables significantly associated with psychopathology include worrying, crying, fighting, anger, marital tension, and menstruation. The presence of multiple psychosocial variables was significantly associated with psychopathology. CONCLUSION: Psychosocial variables predict the presence of psychopathology.

Quality of life and associated factors among adults with epilepsy in Nigeria.

OBJECTIVE: Epilepsy is a common condition worldwide and has been observed to affect quality of life (QOL). Though, much has been written on this subject among western populations, little research has been done in developing countries of Africa including Nigeria. The study aims to identify factors associated with quality of life among adult epilepsy patients in this environment. METHOD: Respondents were evaluated using the 10-item Quality of Life in Epilepsy Inventory (QOLIE-10), the 30-item General Health Questionnaire (GHQ-30), the modified Mini Mental State Examination (mMMSE),and the Hospital Anxiety and Depression Scale (HADS). Diagnosis of epilepsy was based on clinical and electroencephalographic findings. RESULTS: The mean age of the 51 respondents was 27.7 years (SD = 9.7). Thirteen (25.5%) had an average of 2 seizure episodes in the month preceding the interview, while 37 (72.5%) have had the condition for more than 5 years. Factors that were significantly associated with overall quality of life included being female (p < 0.05), seizure frequency (p < 0.01), using more than 1 anti-epileptic drugs (AEDs) (p < 0.01), GHQ-30 score (p < 0.01), high anxiety score (p < 0.001), and high depression score (p < 0.01). Multiple regression analysis showed that depressive symptoms were the single most important factor explaining low QOL. Other factors were GHQ-30 score, seizure frequency, and being a woman. CONCLUSION: Controlling seizures and paying attention to the psychological needs of adult epileptics will have a positive effect on the QOL among Nigerian epileptics.