Mental healthcare-seeking behavior of women in Bangladesh: content analysis of a social media platform.

BACKGROUND: Mental health remains a highly stigmatized area of healthcare, and people often conceal their concerns rather than seek assistance or treatment. The Women Support Initiative Forum (WSIF) is a social media platform established in 2018 to provide expert and peer-led psychosocial support services to women of all ages in Bangladesh. The anonymous nature of the forum means that mental health concerns can be aired without fear of identification. METHOD: A content analysis was conducted on the anonymous posts retrieved from the WSIF platform between 8th March 2020 and 7th July 2022. Around 1457 posts were initially selected for analysis which was reduced to 1006 after removing duplicates and non-relevant posts, such as queries about the addresses of the doctors and other non-mental health-related issues. A thematic analysis of the data was conducted using an inductive approach. RESULT: The 1006 posts generated four themes and nine sub-themes. All the women mentioned mental health symptoms (n = 1006; 100%). Most also mentioned reasons for seeking mental healthcare (n = 818; 81.31%), healthcare-seeking behavior (n = 667; 66.30%), and barriers to seeking mental healthcare (n = 552; 54.87%). The majority of women described symptoms of stress, depression, and anxiety-like symptoms, which were aggregated under common mental health conditions. Mental health symptoms were ascribed to various external influences, including marital relationship, intrafamilial abuse, and insecurities related to the COVID-19 pandemic. A large proportion of posts were related to women seeking information about mental healthcare services and service providers (psychologists or psychiatrists). The analysis found that most women did not obtain mental healthcare services despite their externalized mental health symptoms. The posts identified clear barriers to women accessing mental health services, including low mental health literacy, the stigma associated with mental healthcare-seeking behavior, and the poor availability of mental health care services. CONCLUSION: The study revealed that raising mass awareness and designing culturally acceptable evidence-based interventions with multisectoral collaborations are crucial to ensuring better mental healthcare coverage for women in Bangladesh.

Associations between sexual identity, living with disability, bully victimisation, and HIV status and intimate partner violence among residents in Nigeria.

BACKGROUND: The aim of the study was to determine the associations between sexual identity, disability and HIV status and bullying victimisation, and a history of physical, emotional and sexual violence in Nigeria. METHODS: This was a secondary analysis of a primary dataset generated through an online survey conducted between February 7 and 19, 2021. The 3197 participants for the primary study were recruited through snowballing. The dependent variables were physical, emotional and sexual violence. The independent variables were sexual identity (heterosexual and sexual minority), HIV status (negative, positive and unknown), bullying victimisation (yes/no) and living with disability (yes/no). A multivariate logistic regression model was developed for each form of IPV. Each model was adjusted for age, sex assigned at birth, marital status and education level. RESULTS: Respondents living with HIV had higher odds for physical (AOR: 2.01; 95% CI: 1.46-2.76; p < 0.001), sexual (AOR: 2.17; 95%CI: 1.55-3.05; p < 0.001), and emotional (AOR: 1.59; 95%CI: 1.24-2.06; p < 0.001) violence. Also, those with history of bullying victimisation had higher odds for physical (AOR: 3.79; 95%CI: 2.86 - 5.68; p < 0.001), sexual (AOR: 3.05; 95%CI: 2.27 - 4.10; p < 0.001) and emotional (AOR: 2.66; 95%CI: 2.10 - 3.37; p < 0.001) violence. In addition, females had higher odds of physical (AOR: 1.52; 95%CI: 1.13-2.043; p < 0.001) and sexual (AOR: 1.83; 95%CI: 1.34 - 2.50; p < 0.001) violence; and respondents cohabiting (AOR: 1.95; 95%CI: 1.12 - 3.28; p = 0.012) had higher odds for emotional violence. Respondents who were married have significantly lower odds of experiencing physical (AOR: 0.66; 95%CI: 0.45 - 9.60; p = 0.029), sexual (AOR: 0.40; 95%CI: 0.26 - 0.62; p < 0.001) and emotional (AOR: 0.68; 95%CI: 0.50 - 0.93; p = 0.015) violence when compared to singles. Younger respondents also had lower odds of experiencing sexual violence (AOR: 0.97; 95%CI: 0.95-0.99; p = 0.016). CONCLUSION: HIV positive status and bullying victimisation seem to increase the risk for all forms of IPV while the experience of IPV did not differ by sexual identity and disability status. The associations between age, sex, marital status and IPV may suggest moderating roles of the factors taking cognisance of the cultural context of these relationships. Future relational analysis is necessary to further understand the pathways for the associations found between the variables in this study.

Whose rights are being violated when receiving HIV and sexual and reproductive health services in Nigeria?

BACKGROUND: In Nigeria, vulnerability status may increase the risk for the violation of human rights while receiving health care. The present study determined the proportion and profile of people who reported rights violation while accessing HIV and sexual and reproductive health (SRH) services. METHODS: This was a cross sectional study with data collected between February and March 2021. The dependent variables were patients' rights to autonomy: right to privacy and confidentiality of medical records; right to be treated with respect, regardless of gender, race, religion, ethnicity, allegations of crime, disability or economic circumstances; right to decline or consent to participation in medical research, experimental procedures or clinical trials; right to quality care in accordance to prevailing standards; and right to complain and express dissatisfaction regarding services received. The independent variables were sexual identity (heterosexual/straight, gay, lesbian, bisexual, queer), HIV status (positive, negative, do not know), living with disability (yes/no), and access point to HIV services (public or donor funded/private). Five multivariate regression models were developed to determine associations between the dependent and independent variable after adjusting for age, education level (no formal education, primary, secondary, tertiary), sex (male, female, intersex), marital status (single, married, separated/divorced, cohabiting) and gender identity (male, female, transgender). RESULTS: Complete data from 2119 study participants were analysed. Transgender individuals had significantly higher odds of experiencing violation of their rights to privacy and confidentiality of medical records (AOR:1.70), right to be treated with respect (AOR:1.71), right to complain and express dissatisfaction regarding services received (AOR:1.57) and right to decline consent to participate in medical research, experimental research, experimental procedures or clinical trials (AOR:1.81) compared to individuals who were males. CONCLUSION: A high proportion of recipients of HIV and SRH services in Nigeria reported rights violations. Transgender individuals appear to have higher risk and those in spousal relationships have lower risk for rights violations. Studies are needed to learn how to improve rights-based HIV and SRH service delivery in Nigeria especially for transgender individuals.

Associations between psychological wellbeing, depression, general anxiety, perceived social support, tooth brushing frequency and oral ulcers among adults resident in Nigeria during the first wave of the COVID-19 pandemic.

INTRODUCTION: The aims of this study were to determine the associations between psychological wellbeing, and the frequency of tooth brushing and presence of oral ulcers during the COVID-19 pandemic; and to identify the mediating roles of psychological distress (general anxiety and depression) and perceived social support in the paths of observed associations. METHODS: This cross-sectional study recruited 996 adults in Nigeria between June and August 2020. Data collected through an online survey included outcome variables (decreased frequency of tooth brushing and presence of oral ulcers), explanatory variable (psychological wellbeing), mediators (general anxiety symptoms, depression symptoms and perceived social support) and confounders (age, sex at birth, educational and employment status). Multivariate logistic regression was used to determine the risk indicators for the outcome variables. A path analysis was conducted to identify the indirect effect of mediators on the association between the outcome and explanatory variables. RESULTS: Of the 966 respondents, 96 (9.9%) reported decreased tooth-brushing frequency and 129 (13.4%) had oral ulcers during the pandemic. The odds of decreased tooth-brushing during the pandemic decreased as the psychological wellbeing increased (AOR: 0.87; 95% CI: 0.83-0.91; p < 0.001) and as generalized anxiety symptoms increased (AOR: 0.92; 95% CI: 0.86-0.98; p = 0.009). The odds of having an oral ulcer was higher as the generalized anxiety symptoms increased (AOR: 1.15; 95% CI: 01.08-1.21; p < 0.001). Only generalized anxiety (indirect effect: 0.02; 95% CI: 0.01-0.04; P = 0.014) significantly mediated the relationship between wellbeing and tooth-brushing accounting for approximately 12% of the total effect of wellbeing on decreased toothbrushing. Generalized anxiety (indirect effect 0.05; 95% CI: - 0.07-0.03; P < 0.001) also significantly mediated the relationship between wellbeing and presence of oral ulcer accounting for 70% of the total effect of wellbeing on presence of oral ulcer. Depressive symptoms and perceived social support did not significantly mediate the associations between psychological wellbeing, decreased frequency of tooth brushing and the presence of oral ulcers. CONCLUSION: Patients who come into the dental clinic with poor oral hygiene or oral ulcers during the COVID-19 pandemic may benefit from screening for generalized anxiety and psychological wellbeing to identify those who will benefit from interventions for mental health challenges.

Pregnancy-related anxiety symptoms and associated factors amongst pregnant women attending a tertiary hospital in south-west Nigeria.

BACKGROUND: Pregnancy can be associated with anxiety symptoms because of anticipated uncertainty. AIM: This study investigated pregnancy-related anxiety symptoms (PRASs) and their associated factors amongst pregnant women. SETTING: Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. METHODS: This cross-sectional survey involved 230 pregnant women attending antenatal clinic at a tertiary teaching hospital in Nigeria. Pregnancy-related anxiety symptoms, maternal worries, personality traits and social support were measured by using Perinatal Anxiety Screening Scale (PASS), Cambridge Worry Scale (CWS), Big Five Personality Inventory (BFI-10) and Maternal Social Support Scale (MSSS) respectively. Socio-demographic and obstetric details were also obtained. The Chi-square, t-test and logistic regression were used. RESULTS: Respondents' mean age was 28.2 ± 5.4 years, whilst 192 (83.5%) were of Yoruba ethnicity. Twenty-four respondents (10.4%) were in the first trimester, 85 (37.0%) in the second and 121 (52.6%) in the third trimester. Some 154 (67.0%) were parous. The prevalence of PRAS and major maternal worries were 43.5% and 55.7% respectively. The socio-demographic factors significantly associated with PRAS were age (p = 0.004), ethnicity (p = 0.001), educational level (p = 0.011) and living arrangement (p = 0.029). Associated obstetric factors include trimester (p = 0.01), hypertension (p = 0.006), past miscarriage(s) (p = 0.013) and past pregnancy complication (p = 0.030). Significant psychosocial factors were partner social support (p = 0.038), maternal worries (p < 0.001) and extraversion (p = 0.016). Factors that contributed significantly to regression models were older maternal age and socio-medical worries. CONCLUSION: High level of PRAS and major maternal worries were common amongst antenatal clinic attendees of a tertiary teaching hospital in Nigeria. Older maternal age and socio-medical maternal worries are important predictors of PRAS.

Disability assessment as an outcome measure: a comparative study of Nigerian outpatients with schizophrenia and healthy control.

BACKGROUND AND OBJECTIVE: Schizophrenia is a chronic mental disorder that leads to disability in several aspects of the individual's personal, social, and occupational functioning. This study assesses and compares the level of disability among Nigerian outpatients with schizophrenia and healthy controls (HC). METHODS: A comparative cross-sectional study among 100 schizophrenia outpatients with an ICD-10 diagnosis and 100 HC was conducted over a 4-month period. They completed a questionnaire containing the Zung's Self-Rating Depression Scale (SDS), the World Health Organization Disability Assessment Schedule-Second Version (WHODAS-II). Symptoms of schizophrenia were assessed with the Positive and Negative Syndrome Scale (PANSS). Student's t tests and Chi-square were used to compare patient with schizophrenia and healthy control. Pearson correlation and multiple linear regression analyses were used to assess the relationships of socio-demographic and clinical variable with disability. RESULTS: The patients with schizophrenia reported greater disability than the HC on most of the disability domains of WHODAS-II. They also reported significantly higher mean Zung's SDS scores than the HC. Depressive symptoms, negative symptoms, and PANSS total were significantly related to all the WHODAS-II domains. The disability summary score was significantly predicted by depressive symptoms, negative and positive symptoms of schizophrenia, number of active symptoms (relapse) of schizophrenia, and marital status [F (5, 94) = 23.90, p < 0.001]. CONCLUSION: Schizophrenia is a disabling disorder that affects different aspects of a patient's life. Treatment strategies that target these different aspects may help in reducing disability.

Prevalence and pattern of intimate partner violence during COVID-19 pandemic among Nigerian adults.

OBJECTIVES: Our objectives were to determine the prevalence, pattern, and associated sociodemographic, psychosocial, and COVID-19-related factors associated with intimate partner violence (IPV) during the COVID-19 pandemic among Nigerian adults. METHOD: We conducted an online survey among Nigerian adults (n = 994, aged 18-72 years) who completed the HARK questionnaire, Hospital Anxiety and Depression Scale, Perceived Social Support Scale, and factors associated with the COVID-19 pandemic. Logistic regression was carried out with presence or absence of IPV as the outcome variable. RESULTS: Prevalence of IPV among women was 57.5%, while it was 42.5% among men, during the COVID-19 pandemic. IPV was significantly associated with younger age; having no children; increased threat of income due to COVID-19; anxiety; depression; reduced frequency of accessing COVID-19 updates via TV, radio, and news outlet; self-isolation due to COVID-19 symptoms; and self-reported impact of COVID-19 on recreation. A high monthly income, presence of anxiety and depressive symptoms, threat of COVID-19 to income, and self-reported impact of COVID-19 on recreation increased the odds of experiencing IPV. CONCLUSION: Our findings indicate that the ongoing COVID-19 pandemic has had a significant impact on the experience of IPV among adult Nigerians. The implications of our findings are that both men and women were affected by IPV during the COVID-19 pandemic. Modalities for reducing IPV and its aftermath among this population should include online psychosocial support measures, which may offer anonymity and reduced stigma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychological Distress, Anxiety, Depression, and Associated Factors Among Nigerian Healthcare Workers During COVID-19 Pandemic: A Cross-Sectional Study.

Objectives: We determined the prevalence of psychological distress, and the associations between sociodemographic factors, anxiety, depression, COVID-19-related experiences, and psychological distress, among nurses and doctors in Nigeria. Methods: The study was a cross-sectional descriptive study, conducted over a month (1st of July-31st of July 2021) among 434 Health Care Workers (HCWs) [225 (51.8%) nurses and 209 (48.2%) doctors] from two tertiary health facilities in southwestern Nigeria. Binary logistic regression was carried out to determine the factors associated with psychological distress (dependent variable), while the independent variables were anxiety, depression, and COVID-19 experience-related factors. Results: The prevalence of moderate and severe psychological distress was 49.1% and 5.8%, respectively. Individuals who had the first degree had significantly lower odds (AOR: 0.43; p = 0.037) of experiencing psychological distress while being a nurse (AOR: 2.03; p = 0.014), higher levels of anxiety (1.28; p < 0.001), and depression (AOR: 1.17; p = 0.005) were associated with significantly higher odds of experiencing moderate to severe levels of psychological distress. Conclusion: There is a high level of psychological distress experienced by these health workers. Hence, they will benefit from strategies to reduce their distress.

Life events and psychosis: case-control study from India, Nigeria, and Trinidad and Tobago.

BACKGROUND: There is evidence of an association between life events and psychosis in Europe, North America and Australasia, but few studies have examined this association in the rest of the world. AIMS: To test the association between exposure to life events and psychosis in catchment areas in India, Nigeria, and Trinidad and Tobago. METHOD: We conducted a population-based, matched case-control study of 194 participants in India, Nigeria, and Trinidad and Tobago. Cases were recruited through comprehensive population-based, case-finding strategies. The Harvard Trauma Questionnaire was used to measure life events. The Screening Schedule for Psychosis was used to screen for psychotic symptoms. The association between psychosis and having experienced life events (experienced or witnessed) was estimated by conditional logistic regression. RESULTS: There was no overall evidence of an association between psychosis and having experienced or witnessed life events (adjusted odds ratio 1.19, 95% CI 0.62-2.28). We found evidence of effect modification by site (P = 0.002), with stronger evidence of an association in India (adjusted odds ratio 1.56, 95% CI 1.03-2.34), inconclusive evidence in Nigeria (adjusted odds ratio 1.17, 95% CI 0.95-1.45) and evidence of an inverse association in Trinidad and Tobago (adjusted odds ratio 0.66, 95% CI 0.44-0.97). CONCLUSIONS: This study found no overall evidence of an association between witnessing or experiencing life events and psychotic disorder across three culturally and economically diverse countries. There was preliminary evidence that the association varies between settings.

Developing an mHealth Intervention to Reduce COVID-19-Associated Psychological Distress Among Health Care Workers in Nigeria: Protocol for a Design and Feasibility Study.

BACKGROUND: Globally, COVID-19-related psychological distress is seriously eroding health care workers' mental health and well-being, especially in low-income countries like Nigeria. The use of mobile health (mHealth) interventions is now increasingly recognized as an innovative approach that may improve mental health and well-being. This project aims to develop an mHealth psychological intervention (mPsyI) to reduce COVID-19-related psychological distress among health care workers in Nigeria. OBJECTIVE: Our objective is to present a study protocol to determine the level of COVID-19-related psychological distress among health care workers in Nigeria; explore health care workers' experience of COVID-19-related psychological distress; develop and pilot test mPsyI to reduce this distress; and assess the feasibility of this intervention (such as usability, engagement, and satisfaction). METHODS: A mixed (quantitative and qualitative) methods approach is used in which health care workers will be recruited from 2 tertiary health care facilities in southwest Nigeria. The study is divided into 4 phases based on the study objectives. Phase 1 involves a quantitative survey to assess the type and levels of psychosocial distress. Phase 2 collects qualitative data on psychosocial distress among health care workers. Phase 3 involves development of the mHealth-based psychological intervention, and phase 4 is a mixed methods study to assess the feasibility and acceptability of the intervention. RESULTS: This study was funded in November 2020 by the Global Effort on COVID-19 Health Research, and collection of preliminary baseline data started in July 2021. CONCLUSIONS: This is the first study to report the development of an mHealth-based intervention to reduce COVID-19-related psychological distress among health care workers in Nigeria. Using a mixed methods design in this study can potentially facilitate the adaptation of an evidence-based treatment method that is culturally sensitive and cost-effective for the management of COVID-19-related psychological distress among health care workers in Nigeria. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/36174.

Depressive and anxiety symptoms and COVID-19-related factors among men and women in Nigeria.

Despite the greater adverse economic impacts in low and middle-income (LAMI) compared to high-income countries, fewer studies have investigated the associations between COVID-19-related stressor and mental health in LAMI countries. The objectives of this study were to determine the associations between COVID-19-related stressors and anxiety and depressive symptoms while controlling for known risk and protective factors and to investigate any sex differences. An online survey was carried out to assess sociodemographic, psychosocial (previous mental health conditions, sexual orientation, intimate partner violence and perceived social support) and COVID-19-related variables. Hierarchical linear regression was carried out with anxiety and depressive symptoms as separate outcomes. Of the COVID-19-related factors, testing positive for COVID-19 infection, having COVID-19 symptoms, having other medical conditions, self-isolating due to COVID-19 symptoms, worry about infection, perception of the pandemic as a threat to income and isolation during the lockdown were significantly associated with higher anxiety and depressive symptoms. Of these, worry about infection, isolation during lockdown and disruption due to the pandemic retained independent associations with both outcomes. The variance in anxiety and depressive symptoms explained by COVID-19-related factors was larger in women (11.8%) compared to men (6.1% and 0.8% respectively). COVID-19-related stressors are associated with higher anxiety and depressive symptoms, with these effects being larger in men compared to women. Enhancing social support can be an affordable strategy to mitigate this risk but this needs to be investigated using appropriate designs.

Internalized Homophobia, Coping, and Quality of Life Among Nigerian Gay and Bisexual Men.

Despite high levels of homophobia in Nigeria, no studies have investigated the quality of life (QOL) of Nigerian gay and bisexual (GB) men. The associations between QOL and minority stress may differ from those reported in developed countries and may indicate alternative interventions. This study investigated internalized homophobia (IH) and coping strategies among gay and bisexual men in Nigeria and the relationships with overall QOL. Eighty-nine GB men were recruited with a snowball sampling technique. QOL (outcome), IH (predictor) and coping strategies (covariates) were assessed using standardized questionnaires. Relationships were investigated using linear regression analyses. Participants used adaptive more frequently than maladaptive coping strategies. The relationship between IH and QOL was nonlinear (ß = -0.27, 95% CI = -0.48, -0.06), and the positive component was attenuated by adaptive coping strategies. Adaptive strategies can be reinforced as a therapeutic intervention to improve wellbeing among gay and bisexual men in Nigeria.

Economic Cost of Schizophrenia in a Nigerian Teaching Hospital.

OBJECTIVE: This study evaluated the economic cost of schizophrenia in Nigerian patients and identified factors that influence cost. METHODS: A total of 100 participants with schizophrenia were assessed using the modified economic cost questionnaire, the mini-international neuropsychiatric interview, the positive and negative syndrome scale, the Liverpool University Neuroleptic side-effect rating scale, and the global assessment of functioning scale. Associations between sociodemographic characteristics, illness-related variables and direct, indirect, and total costs of schizophrenia were assessed. RESULTS: The average annual total, direct, and indirect costs of the treatment were $818.48, $349.59, and $468.89, respectively, per patient. The direct cost constituted 42.7%, while the indirect cost was 57.3% of the total costs of treatment. Hospitalization was the leading contributor to the direct cost, while productivity loss was a major component of the indirect cost. CONCLUSION: Schizophrenia is an expensive disease in Nigeria, measures to reduce hospitalization could significantly reduce the cost of illness to the patient and their relatives.