Prevalence of psychiatric disorders among sentenced prisoners in a medium security prison in Ghana: Implications for mental health assessment and service.

BACKGROUND: Extant literature has shown that there is a higher prevalence of mental disorders among prisoners compared to the general population. These findings have, however, mostly been from high-income and westernised cultures. In Ghana, little is known about the extent of psychiatric disorders among prisoners, as is consistent with the dearth of scholarly work in low and middle-income countries. AIMS: Our aim was to determine the prevalence of common mental disorders among sentenced prisoners in the second largest prison in Ghana. METHODS: A cross-sectional survey research design was used in one prison. The Mini International Neuro-Psychiatric Interview questionnaire was used to collect data from men and women serving prison sentences who volunteered for the study. Socio-demographic characteristics and criminal history data were collected using a questionnaire designed by the researchers. RESULTS: Five hundred prisoners participated. Nearly half (246, 49.8%) had at least one psychiatric disorder. The most prevalent disorders were major depression and a range of anxiety disorders (145, 29%, 132, 26% respectively). A smaller proportion recorded high scores on the antisocial personality disorder scale (13%); just 50 (10%) reported using substances in the 12 months before interview, but this is a minimum estimate of such problems as many were already in prison during that time. None of these prisoners, regardless of disorder, had been screened, diagnosed, or treated in prison. CONCLUSIONS: This study contributes to the gap in scholarly literature in low- and middle-income countries on psychiatric disorders in the prison population. It will be important to explore further the extent to which the internationally recognised screening tools used led to under-estimation of psychiatric disorders. The findings are of immediate practical importance nationally as they highlight the need to implement reforms anticipated by the new mental health legislation of 2012 and strategies for interagency working to improve health services and their uptake in the criminal justice system.

Exploring the role of religion in the recovery experiences of suicide attempt survivors in Ghana.

BACKGROUND: Religion performs a doubled edged role in a suicide crisis. On the one hand, it elicits empathic responses towards suicidal persons. On the other, it condemns and shames them. Although there is evidence that religion promotes better health and general wellbeing, little attention has been given to its role in recovery, especially after a suicide attempt. The current study explored how religion facilitated recovery among suicide attempt survivors. METHODS: Using a semi-structured interview guide, we interviewed suicide attempt survivors who had attended a psychiatric unit. Thematic analysis was used to analyse the data. RESULTS: Ten suicide attempters were interviewed, six females and four males. Three major themes were identified: Reasons in context, Religion in the recovery process and Renewed commitment to religious rituals/practices. CONCLUSIONS: The role of religion in suicide prevention as a resource, is a complex one. Suicide preventionists need to carefully guide and gauge their prevention efforts in context where religion is rife to provide suicide attempt survivors the most effective religious resource in their recovery trajectory.

Bullying Victimization and Suicidal Behavior among adolescents in 28 Countries and Territories: A Moderated Mediation Model.

BACKGROUND: Previous studies have increasingly shown the adverse effects of being bullied on suicidal behavior among young people, but the mechanisms underlying this association remain unclear. We examined the association between bullying and suicidal behavior among in-school adolescents. We further tested whether loneliness mediated the link between bullying and suicidal behavior and explored the moderated role of parental involvement in this association. METHODS: We used cross-sectional school-based data from the Global School-based Student Health Survey among 28 countries and territories. Adjusted, modified Poisson regressions with robust variance relative risks and moderation analyses were used to examine associations among bullying, suicidal behavior, and parental involvement. The mediating effect of loneliness on the bullying-suicidal behavior link was assessed using the generalized decomposition method. RESULTS: A total of 78,558 school-going adolescents participated in this study. Bullying was associated with a 44% increased risk of suicidal behavior after adjusting for potential confounders (relative risk = 1.44; 95% confidence interval = 1.39-1.48). Loneliness partially mediated the association between bullying and suicidal behavior, and parental involvement moderated the association. DISCUSSION: The findings suggest the need to recognize the dual burden of bullying and loneliness when addressing suicidal behavior and the importance of parental support in adolescents' mental health and well-being.

Substance use disorders among adults during imprisonment in a medium security prison: Prevalence and risk indicators.

BACKGROUND: Research shows that the prevalence of substance use disorders among the prison population is high globally. Although prisons are highly controlled environments, access to drugs and other substances in prison remains a major problem. Yet, previous research is focussed mainly on the Western context, with the studies generally reporting on lifetime prevalence without reference to whether the disorders are manifest even within the controlled environment. AIMS: To estimate the prevalence of substance use disorders evident while in prison in Ghana and associated risk indicators. For these purposes, substance use disorder was defined by any indication of dependency, or escalating use or socially problematic use during the 12 months of imprisonment prior to the interview. METHODS: The study involved 500 adults (443 men and 57 women) in a medium-security prison in Ghana who had served at least 1 year of a prison sentence. Participants' alcohol use disorder was assessed separately from other substance use disorders which included cannabis, cocaine and other stimulants using the Mini International Neuropsychiatric Interview (MINI); it is a structured interview and diagnostic tool for major psychiatric and substance use disorders in DSM-5 and ICD-10. RESULTS: Two percent of the 500 participants had used alcohol to the level of alcohol use disorder, and 6% had other substance use disorders in 12 months prior to interview and while in prison. Cannabis (4%) and stimulants (3%) were the most frequently reported substance use disorders. Logistic regression model estimates indicate that younger age, prior offending and alcohol use dependence were significantly associated with such disorders in prison. CONCLUSION: In spite of efforts to prevent substance use in prison, nearly one in 10 of these prisoners were using alcohol or illicit drugs to a level indicative of substance use disorders. Our findings suggest that prioritising brief assessment may help identify those in most need of clinical help to limit their alcohol and illicit substance use problems.

The Mental Health Outcomes of Food Insecurity and Insufficiency in West Africa: A Systematic Narrative Review.

(1) Background: Food insufficiency is a global pandemic affecting many people, especially those residing in developing countries. African countries have been affected by food insufficiency, which is mostly caused by drought or wars. Famine or food insufficiency has been reported to have an impact on the psychological health and quality of life of people affected. This review assessed the mental health outcomes of famine and food insufficiency in West Africa. (2) Methods: A search of the published literature was conducted using PubMed, PsycExtra, Medline, and PsycINFO databases. The search was limited to papers published in English between the years 2010 and 2020. Two reviewers independently screened the titles and abstracts of the retrieved papers using pre-defined inclusion and exclusion criteria and a third reviewer resolved conflicts. Data were extracted and appraised using a data extraction form and an appraisal checklist. (3) Results: A total of 81 papers were identified through the journal databases search. Out of the seven papers that met the inclusion criteria, six papers used cross-sectional designs and one paper used an experimental design. The six papers used quantitative approach for data collection, while the one paper used a qualitative technique. The evidence synthesized from this review indicated that exposure to food insecurity or insufficiency is associated with increased psychological distress including anxiety, sleeplessness, intellectual disability, general mental, and emotional instability. (4) Conclusions: This review strongly highlights the need for further research across the sub-region. It further suggests that famine and food insufficiency are associated with significant mental health problems in adults and impacts the cognitive and intellectual development of children. Although there is paucity of literature about famine and its impact on mental health in West Africa, these findings are important for developing social policy initiatives for increasing food supply and mental health interventions for all ages.

Psychiatric Disorders among the Military in West Africa: A Systematic Narrative Review.

(1) Background: Military combat impacts the mental health of veterans and active military personnel. Although various studies, the majority of which are from Westernized countries, have provided insight into how combat causes psychiatric disorders, such as post-traumatic stress disorder (PTSD), depression, and anxiety among veterans, there appears to be scant published literature on psychiatric disorders among military personnel in the West African region. It is important to contextually understand the psychiatric disorders among military personnel in this region who may be faced with similar vulnerabilities to their counterparts from Western cultures. (2) Methods: This study follows the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were published in English between January 2010 and January 2021 and assessed mental health problems or psychiatric disorders among soldiers in West Africa. (3) Results: All three included studies were from Nigeria. High prevalence rates of substance and alcohol use were reported. (4) Conclusions: This review highlights the need for more research in this population as well as identifying the intervention needs of the soldiers and their implications.

Mental health and mining: the Ghanaian gold mining story.

PURPOSE: There is limited empirical evidence regarding mental health in workplace settings in Africa. Gold mining is a major industry in Ghana, and this study investigated mental health-related symptoms and the factors contributing to such symptoms among employees in the Ghanaian. METHODS: A cross-sectional survey design study was used to collect data from employees working in the mining industry across five gold mines in Ghana. All mining employees were invited to participate in the survey. Sociodemographic and work characteristic data (including job content) was collected alongside measures of recent mental health-related symptoms (Kessler-10). Questionnaires were administered in English. Data were analysed using descriptive statistics and logistic regression models. RESULTS: Of 1165 participants (response rate: 78%), 87% were male and 13% were female. The majority of the participants were in the 25-34 age category. Psychological distress was categorized as low (62.6%), moderate (24.3%), high (10.0%) and very high (3.2%). Shift type (working 12 h or more), physical working conditions and financial factors were significantly associated with psychological distress. Job resources and job demands was not significantly associated with levels of psychological distress. CONCLUSION: This is the first study to explore mental health in the Ghanaian gold mining industry. The findings identify workplace factors associated with psychological distress in the mining industry in Ghana and support the importance of promoting mental health as part of workplace health and safety strategy to improve mental health across the mining population.

Consumption of carbonated soft drinks among Ghanaian adolescents: associations with socio-demographic factors, health risk factors and psychological distress.

BACKGROUND: Carbonated soft drinks consumption is associated with weight gain and other chronic diseases. AIM: To examine whether socio-demographic factors, health risk factors and psychological distress are associated with carbonated soft drink consumption among adolescents in selected senior high schools in Ghana. METHODS: Data were obtained from the 2012 Ghana Global School-based Student Health Survey (GSHS). Participants consisted of 1756 school-going adolescents sampled using a two-stage cluster sampling method. Binomial logistic regression was used to determine whether socio-demographic factors, health risk factors and psychological distress were associated with consumption of soft drinks. RESULTS: The prevalence of carbonated soft drinks consumption was 34.9%. Males (odds ratio (OR) = 0.73 (95% confidence intervals (CI) 0.59-0.92); p = 0.007), and participants with high socio-economic status (OR = 0.76 (95% CI 0.48-0.97); p = 0.033) had smaller odds for consumption of soft drinks. Also, adolescents in Senior High School (SHS) 3 (OR = 0.72 (95% CI 0.53-0.97); p = 0.034) and SHS 4 (OR = 0.63 (95% CI 0.43-0.91); p = 0.014) had smaller odds for soft drinks intake compared to those in SHS 1. Health risk factors associated with greater odds of high soft drink consumption were tobacco use (OR = 1.68, (95% CI 1.07-2.65); p = 0.025), fast food consumption (OR = 1.88, (95% CI 1.47-2.41); p = 0.011) and alcohol consumption (OR = 1.43, (95% CI 1.02-1.99); p = 0.039). Consuming adequate fruit (OR = 0.19 (95% CI 0.15-0.24); p = 0.000) and adequate vegetable (OR = 0.55 (95% CI 0.34-0.87); p = 0.011) were associated with lower odds for soft drink consumption. Adolescents who reported feeling anxious had smaller odds for soft drink intake (OR = 0.65, (95% CI 0.47-0.91); p = 0.011). CONCLUSIONS: The findings from this study show that socio-demographic characteristics, health risk factors and psychological distress are associated with the soft drink consumption among adolescents in Ghana. Interventions aimed at reducing soft drink consumption and other health risk factors are needed.

Online media reporting of suicidal behaviour in Ghana: Analysis of adherence to the WHO guidelines.

BACKGROUND: Irresponsible media reporting of suicide is a potential risk for copycat suicide. There is a paucity of studies from sub-Saharan Africa on the quality of media reporting of suicide. OBJECTIVES: We assessed the compliance of Ghanaian online media outlets with the World Health Organization (WHO) guidelines for media reporting of suicide. METHODS: We searched 10 local media outlets with strong online presence in Ghana, to identify suicide-related news reports from 2000 through 2019. We applied summative content analysis and chi-square (χ2) test to the data. RESULTS: We included 288 news reports, of which 261 (90.6%) were completed suicides, 7 (2.4%) were attempted suicides and 20 (6.9%) were homicide suicides. Most of the news reports failed to comply with the WHO guidelines: 92.7% mentioned the specific method of the suicide act, 82.6% included 'suicide' in the headline and 55.6% included photos of the victims. The χ2 tests indicated that privately owned media outlets were more likely than publicly owned to post a photo of the victim, χ2(1) = 17.37, p < .001, and report the incident location in the headline, χ2(1) = 15.00, p < .001. However, generally, there were no statistically significant relationships between the quality of reporting and media outlet ownership. Each of the 288 reports failed to mention any of the potentially helpful features recommended by the WHO guidelines. CONCLUSION: Regardless of the ownership of the media outlet (whether private or publicly owned), mostly, the online reportage of suicidal behaviour in Ghana deviates sharply from the international recommended best practice by the WHO.

Prevalence of suicidal behaviour among nursing and midwifery college students in Ghana.

AIM: To provide exploratory and descriptive evidence on the prevalence estimate and some demographic correlates of suicidal behaviour among nursing and midwifery college students in Ghana. DESIGN: We used a cross-sectional survey design. METHOD: An anonymous survey involving a randomly selected sample of 305 nursing and midwifery college students was conducted in March-May 2017. The Suicide Behavior Questionnaire-Revised was used to assess suicidal behaviour (i.e., ideation, planning, threat and attempt) and suicidal behaviour risk. RESULTS: The lifetime prevalence of suicide ideations (15.4%; 95% confidence interval [CI] = 0.11-0.20), plans (6.6%; 95% CI = 0.04-0.10), attempts (2.3%; 95% CI = 0.01-0.05), threats (13.4%; 95% CI = 0.10-0.18) and 12-month prevalence of ideations (21.3%; 95% CI = 0.17-0.26) are comparable to estimates found in both high-income and low- and middle-income countries. However, associations between the demographic variables studied and suicidal behaviour risk were not statistically significant.

Comparing the reasons for suicide from attempt survivors and their families in Ghana.

BACKGROUND: Family members are key in detecting early suicide warning signs. This study compared the reasons for suicidality as reported by attempt survivors with their family folks in Ghana. METHODS: A qualitative design was used to select a sample size of 20 (10 family members and 10 suicide attempt survivors). Thematic analysis was used to analyse the data. RESULTS: Analysis of the data showed two major themes: 1) Similar Reasons (where both families and attempt survivors consistently reported similar reasons for suicidality and 2) Different Reasons (where there were sharp divergences). CONCLUSIONS: Findings from this study help to understand the readiness of attempt survivor family members to intervene early during suicidal crisis.

The experiences of attempt survivor families and how they cope after a suicide attempt in Ghana: a qualitative study.

BACKGROUND: Ghana's socio-cultural landscape proscribes suicidal behaviour, and this has serious ramifications for attempt survivors and their families. The objective of this qualitative study was to understand the experiences of the families of attempt survivors and how they cope with the aftermath of the attempt. METHODS: Ten families with attempted suicides agreed to participate in the study, hence they were interviewed. The information gathered was manually analyzed according to Interpretative Phenomenological Analysis (IPA) resulting in three major thematic areas. RESULTS: Three major themes emerged two of which addressed negative experiences and reactions towards the attempts: Experiencing shame and stigma, and Reactive affect. The third theme addressed the coping resources of these informants under the theme: Surviving the stress of attempt. The specific coping resources included personalized spiritual coping, social support, and avoidance. CONCLUSIONS: Family systems theory is used to explain some of the findings of this study, and the implication for clinical practice and designing postvention programs for families after a suicide attempt are addressed.