Towards a youth mental health paradigm: a perspective and roadmap.

Most mental disorders have a typical onset between 12 and 25 years of age, highlighting the importance of this period for the pathogenesis, diagnosis, and treatment of mental ill-health. This perspective addresses interactions between risk and protective factors and brain development as key pillars accounting for the emergence of psychopathology in youth. Moreover, we propose that novel approaches towards early diagnosis and interventions are required that reflect the evolution of emerging psychopathology, the importance of novel service models, and knowledge exchange between science and practitioners. Taken together, we propose a transformative early intervention paradigm for research and clinical care that could significantly enhance mental health in young people and initiate a shift towards the prevention of severe mental disorders.

Identifying potential catalysts to accelerate the achievement of Sustainable Development Goals (SDGs) among adolescents living in Nigeria.

Investing in adolescents in Africa holds great promise for the development of the continent. The steps involved in identifying factors linked to interventions that may accelerate the attainment of multiple SDGs for adolescents in Nigeria are described. Data from a survey to investigate the well-being of 1800 adolescents aged 10-19 years in Southwest Nigeria was analysed. A four-step process was employed: 1) Mapping of variables deemed as suitable proxies for SDG targets; 2) Mapping hypothesised protective factors (accelerators) from the study instruments. Consequently, SDG targets related to elimination of hunger, good health, gender equality and peace; and seven accelerators (safe schools, parenting support, good mental health, no survival work, food security, stable childhood, and regular physical activity) were identified; 3) evaluating associations using bivariate analysis and multivariable logistic regression, 4) calculating adjusted probabilities. The mean age of the adolescents was 15.02 ± 2.27 years (48.6% female). Good mental health, not doing survival work, safe schools, stable childhood and parental support were significantly associated with at least two SDG targets. For example, food security was significantly associated with the highest number of SDG outcomes: one SDG target related to child survival (no substance use: x2 = 3.39, p = <0.001); three SDG targets related to educational outcomes (school progression: x2 = 5.68, p = 0.017, ability to concentrate in school: x2 = 26.92, p = <0.001, and school attendance: x2 = 25.89, p = <0.001); and four SDG targets related to child protection (no risky sexual behaviours: x2 = 16.14, p = <0.001, no perpetration of violence: x2 = 15.74, p = <0.001, no community violence: x2 = 39.06, p =<0.001, and no sexual abuse: x2 = 7.66, p = 0.006). Interventions centred around good mental health, not doing survival work, safe schools, small family size, stable childhood and parental support are potential accelerators for the attainment of SDG outcomes by adolescents living in Nigeria.

Lessons of Hope and Resilience: A Co-Produced Qualitative Study of the Experiences of Youth Living with Psychosis During the COVID-19 Pandemic in Nigeria.

Much of the emerging evidence on the impact of COVID-19 on people with psychosocial disabilities comes from high-income countries. This study sought to explore the perceptions and experiences of youths living with psychosis during the COVID-19 pandemic in Nigeria. Using a co-produced research process, a facility-based study was conducted among youth with confirmed diagnosis of a psychotic disorder. In-depth interviews were conducted with 20 participants. Data was transcribed, double-coded and analysed with Atlas.ti using a thematic analysis approach. We found that participants were aware of good evidence-based information on the nature of the disease and the pandemic. Many of them described worsening mental health and disruptions to daily routines. Opportunities for deepening family relationships, skill building, helping others, and extended time for previously neglected self-development activities were described. This study benefitted from co-production with persons with lived experience, which could be harnessed for future research on psychosis.

Psychiatric morbidity among pregnant and non pregnant women in Ibadan, Nigeria.

A comparative cross-sectional study was conducted among 991 pregnant and 674 non-pregnant women of reproductive age attending healthcare facilities in Ibadan, Nigeria using the General Health Questionnaire-12 (GHQ), and WHO self-reporting questionnaire (SRQ). Logistic regression analysis was conducted to identify predictors of psychiatric morbidity at p < 0.05. A significantly higher proportion of pregnant women experienced psychological distress on the GHQ (51.8%) and psychiatric morbidity on SRQ (33.3%) compared with 28.6% and 18.2% of non-pregnant women, respectively. Predictors of psychiatric morbidity among pregnant women were the type of facility, poor satisfaction and communication with partners, the experience of violence in the home, previous abortions, and previous history of depression. Psychiatric morbidity among non-pregnant women was predicted by younger age, previous history of depression, poor satisfaction and communication with partners. There is a need for early identification of psychiatric morbidity among women of reproductive age, to ensure early interventions and prevent long-term disability.Impact statementWhat is already known on this subject? Psychiatric morbidity has immense effects on a woman's quality of life, social functioning, obstetric outcome, and economic productivity.What do the results of this study add? Psychiatric morbidity among women of reproductive age is high. Pregnant women when compared to non-pregnant women had significantly higher rates of psychiatric morbidity. This high prevalence of psychiatric morbidity in both groups was predicted by poor satisfaction and communication with partners, and a previous history of depression.What are the implications of these findings for clinical practice and/or further research? Simple screening for women of reproductive age attending healthcare facilities may help with the early identification of psychiatric morbidity leading to prompt interventions, and preventing long-term disability.

Escaping social rejection, gaining total capital: the complex psychological experience of female genital mutilation/cutting (FGM/C) among the Izzi in Southeast Nigeria.

BACKGROUND: While the deleterious effects of FGM/C on physical health are well documented, the psychological experience of this harmful practice is a neglected area of research, which limits global mental health actions. As FGM/C was a traditional practice in some areas of Nigeria, the study aimed to understand the psychological experience of FGM/C in context. METHODS: This qualitative study was completed in urban and rural Izzi communities in Southeast Nigeria where FGM/C was widely practiced. In-depth interviews were completed with 38 women of the same ethnicity using the McGill Illness Narrative Interview (MINI) to explore the collective psychological experience of FGM/C before, during and after the procedure. The MINI was successfully adapted to explore the meaning and experience of FGM/C. We completed thematic content analysis and used the concepts of total capital and habitus by Bourdieu to interpret the data. RESULTS: During the period of adolescence, Izzi young women who had not yet undergone FGM/C reported retrospectively being subjected to intense stigma, humiliation and rejection by their cut peers. Alongside the social benefits from FGM/C the ongoing psychological suffering led many to accept or request to be cut, to end their psychological torture. Virtually all women reported symptoms of severe distress before, during and after the procedure. Some expressed the emotion of relief from knowing their psychological torture would end and that they would gain social acceptance and total capital from being cut. Newly cut young women also expressed that they looked forward to harassing and stigmatizing uncut ones, therein engaging in a complex habitus that underscores their severe trauma as well as their newly acquired enhanced social status. CONCLUSION: FGM/C is profoundly embedded in the local culture, prevention strategies need to involve the whole community to develop preventive pathways in a participatory way that empowers girls and women while preventing the deleterious psychological effects of FGM/C and corresponding stigma. Results suggest the need to provide psychological support for girls and women of practicing Izzi communities of Southeast Nigeria.

Accelerating progress towards the sustainable development goals for adolescents in Ghana: a cross-sectional study.

Since the adoption of the sustainable development goals (SDGs) by the United Nations (UN), the search has been on to identify interventions that have effects on multiple SDG-targets simultaneously. Like other developing countries, Ghana has a youthful population and would require creative, urgent, youth-focused interventions to be able to attain the SDGs by 2030. This paper describes the application of the accelerator model on data from a sample of Ghanaian adolescents to identify potential accelerators towards selected SDG targets involving youth. The data for 944 adolescents, 10-19 years (mean age 12.31 ± 3.51 years), extracted from two cross-sectional surveys on children and adolescents aged 6-19 years in Kumasi, Ghana, were analysed in this paper. Variables considered suitable proxies for SDG targets and potential accelerators were identified from the study instruments. Consequently, four aligned SDG targets (good mental health, access to ICT, school completion and no open defaecation) and five accelerators (cognitive stimulation, no relative poverty, low student-teacher ratio, high caregiver education and safe water) were extracted. Associations between accelerators and SDG targets were assessed using multivariable logistic regression adjusting for sociodemographic covariates and multiple testing. Cumulative effects were tested by marginal effects modelling. The three hypothesised accelerators identified were cognitive stimulation, low student-teacher ratio, and no relative poverty. A combination of all three accelerators was associated with a higher likelihood of adolescents having access to Information and Communication Technology (ICT) by +73% (CI 0.72-0.74), no open defecation by +44% (CI 0.43-0.46), school completion by +27% (CI 0.26-0.27) and good mental health by +9% (CI 0.08-0.10). Three hypothesized accelerators showed association across all four SDG aligned targets. The accelerator model has been further validated in this dataset from Ghana. Robust interventions designed around these accelerators may represent an opportunity for achieving the SDGs in Ghana.

Effect of a Brief Supportive and Educational Intervention on the Psychological Well-Being of Mothers with Babies in Neonatal Wards of a Tertiary Hospital in Ibadan, Nigeria.

OBJECTIVE: To assess the effect of a supportive educational intervention on the psychological wellbeing of mothers whose babies were admitted to Neonatal Care Unit (NCU) in Nigeria. METHODS: Controlled trial involving 41 mothers whose babies were consecutively admitted into two NCUs (21 in the intervention group and 19 controls). The intervention group received two group-based sessions which included psychological coping strategies, and familiarity with NCU environment, equipment, personnel and procedures. The control group received usual care. Outcome measures were depressive symptoms (Edinburg Postnatal Depression Scale-EPDS), stress-related to NCU (Parental Stressor Scale: Neonatal Intensive Care Unit-PSS: NICU) and post-traumatic symptoms (Impact Event Scale-Revised-IES-R). RESULTS: Difference-in-Differences (DiD) analysis showed a difference of -4.70 in PSS: NICU score in favour of the intervention group which was statistically significant [F(3, 75) = 9.47, p < 0.0001, R2 = 0.28]. The differences in EPDS (0.91) and IES-R (2.55) were not statistically significant [F(3, 75) = 10.10, p = 0.74] and [F(3, 75) = 10.13, p = 0.73], respectively. All the mothers in the treatment group expressed satisfaction with the intervention. CONCLUSION: This brief group-based supportive educational intervention for mothers with babies in NCU was feasible, acceptable and helpful in reducing stress related to NCU. Larger controlled trials are recommended to establish the generalizability of these findings in this region. LAY SUMMARY: Babies born too early and or with complications require admission to special hospital called Neonatal Care Unit (NCU) to help them to survive. However, parents whose babies are admitted to NCU can find the experience frightening. We examined how to reduce the fear and stress mothers in Nigeria experience when their babies are admitted to NCU.We had two groups of mothers. The first group made up of 21 mothers was taught how to cope with the stress of having a baby in NCU. They were also shown how the various equipment in the NCU work, what the staff in NCU do and what types of things need to be done to help their babies. The second group of 19 mothers received usual care but did not have the extra teaching the first group received. After 2 weeks, we checked the level of depression and stress the mothers in both groups had compared with the level before the first group received the extra teaching.We found that mothers in the first group who received the extra teaching were less stressed about having their babies in the NCU compared with the mothers that did not receive the teaching.

Effects of psycho-education plus basic cognitive behavioural therapy strategies on medication-treated adolescents with depressive disorder in Nigeria.

OBJECTIVE: Limited data exists on psychological interventions for adolescent depression in African countries such as Nigeria. This study therefore investigates the effects of a psychological intervention that includes psycho-education and basic elements of cognitive behavioural therapy (CBT) on depressed medication-treated adolescents in Nigeria. METHODOLOGY: This was a pre-post one-group intervention study of 18 adolescents aged 13-18 years with clinically diagnosed depressive disorder, attending a specialist psychiatric hospital. They had been on antidepressants for 3 months or longer. Depressive symptoms, knowledge of depression, hope, and attitudes towards treatment adherence were measured at baseline and repeated at 1 and 4 weeks post-intervention. The adolescents received four sessions of a group-based manualised intervention focused on psycho-education and basic CBT strategies. RESULTS: Statistically significant reductions in depressive symptoms were recorded, as were improvements in the adolescents' knowledge of depression, hope, and attitude towards treatment adherence one week after the intervention (all p = 0.001). All differences were sustained at 4 weeks post-intervention. Participants' satisfaction with the intervention was high. CONCLUSION: This study suggests that adding psycho-education with elements of CBT to antidepressant treatment is feasible, acceptable and can produce further benefits to depressed adolescents in this region.

Effectiveness of brief school-based, group cognitive behavioural therapy for depressed adolescents in south west Nigeria.

BACKGROUND: There is paucity of evidence-based psychological interventions for depressive disorders in Africa, more so among depressed children and adolescents. This study aimed to determine the effects of a school-based cognitive behavioural therapy programme (CBT) on depressed adolescents in South West Nigeria. METHODS: Forty students who scored 18 or above on the Beck Depression Inventory (BDI) were recruited from two schools (20 from each school). One school was designated intervention and the other a wait-list control school. Five weekly sessions of group CBT programme were conducted in the intervention school. Primary outcome measure was the Beck Depression Inventory, and secondary outcome measures were the Short Mood and Feelings Questionnaire and the Impact Supplement of the Strengths and Difficulties Questionnaire. RESULTS: Controlling for baseline scores and other confounders, the intervention group had significantly lower depressive symptoms scores on the BDI and SMFQ 1 week post intervention with large effect sizes. The intervention group maintained the treatment effect with significantly lower depression scores 16 weeks post intervention compared with their baseline scores. The effect sizes remained large. The intervention and control groups did not differ in their SDQ impact supplement scores post intervention, but the intervention group improved significantly on this measure at 16 weeks. CONCLUSIONS: To our knowledge, this is the first study of a school-based group CBT programme for depressed adolescents in Africa. The programme showed good feasibility and promising effectiveness.

The impact of a mental health teaching programme on rural and urban secondary school students' perceptions of mental illness in southwest Nigeria.

OBJECTIVE: Available evidence suggests that children hold negative views about mental illness. Studies show that it is possible for schools and mental health services to jointly undertake child and adolescent mental health promotion. This study aimed to assess the impact of a school based mental health awareness programme aimed at increasing mental health literacy and reducing negative views about persons with mental illness. METHODS: A total of 154 secondary school students in Ibadan, southwest Nigeria, were allocated into an intervention and a control group. Students in the intervention group received a three-hour mental health awareness session. All students completed a pre-, immediate post, and six month post-intervention questionnaire on their views about mental health and illness. RESULTS: There was a significant difference in the mean knowledge scores between the intervention and the control group post-intervention, but no significant differences in attitude and social distance scores. CONCLUSION: Brief training workshops appear able to produce small but positive changes in the mental health knowledge of young Nigerians.

Brief training in child and adolescent mental health: Impact on the knowledge and attitudes of pediatric nurses in Nigeria.

PROBLEM: Poor knowledge and stigmatizing attitudes of healthcare professionals constitute a significant barrier to child and adolescent mental health care worldwide. This study aimed to determine the effect of a training intervention on the knowledge and attitudes of pediatric nurses to child mental health problems at a Nigerian tertiary hospital. METHODS: A two group pretest-posttest study design was undertaken. A total of 156 pediatric nurses were recruited, and participants in the intervention group received a brief child mental health training based on the World Health Organization's mhGAP training manual. Knowledge and attitudes to child mental health problems were obtained at baseline, and post intervention. FINDINGS: There were no differences in knowledge or attitudes across the two groups at baseline. Post intervention, there was a significant increase in the mean post knowledge scores of the intervention group compared with the control group (t = 3.8, p < .001). The effect size of the intervention was 0.62. There were no significant differences in mean post attitude scores across groups. CONCLUSION: Incorporating children and adolescents mental health competencies into the training of nurses had a modest effect on their knowledge, but limited effect on their attitudes.

A controlled trial of Cognitive Behavioural Therapy-based strategies for insomnia among in-school adolescents in southern Nigeria.

BACKGROUND: Sleep difficulties are highly prevalent among adolescents, and are associated with significant impairments. The effectiveness and acceptability of Cognitive Behavioural Therapy-based (CBT-based) treatment for insomnia in adolescents is established for High Income Countries, but unknown for African settings. Thus, the aim of this study was to assess the effect of CBT-based intervention among in-school adolescents with sleep difficulties in Southern Nigeria. METHODS: This was a pilot controlled trial involving 50 adolescents with highest ranked scores on the Insomnia Severity Index (ISI) recruited from four schools (two government and two privately owned). Balloting was used to assign two schools (public and private) with 25 participants to the intervention group, and the other two schools (public and private) with 25 participants as waiting-list controls. The two groups were dyad-matched for baseline ISI scores, gender, and type of school to reduce baseline differences. The treatment group received weekly group-based manualised CBT-based intervention over 5 weeks. Primary outcome was ISI score at 6th week. Secondary outcomes were sleep onset latency (SOL), Total sleep duration (TSD), depressive symptoms, sleep hygiene, and knowledge about sleep. RESULTS: Participants were aged 13-17 years (M = 14.9, SD = 1.16) and consisted of 18 males and 32 females. Controlling for baseline scores, the intervention group showed significantly lower post-intervention insomnia scores compared with the control group {F (1, 34) = 1.10, p = 0.0001, (ηp2 = 0.59}, shorter SOL {F (1, 33) = 1.41, p = 0.0001, ηp2 = 0.39}, longer TSD {F (1, 33) = 1.03, p = 0.0001, ηp2 = 0.47}, lower depressive symptoms {F (1, 31) = 1.32, p = 0.002 (ηp2 = 0.34}, higher knowledge of sleep {F (1, 34) = 1.02, p = 0.001, ηp2 = 0.36}, but no significant change in sleep hygiene {F (1, 32) = 1.08, p = 0.08, ηp2 = 0.15}. All participants in the intervention group rated the programme as good or excellent. CONCLUSION: This pilot CBT-based intervention for adolescents with insomnia was feasible, well received and showed promising efficacy in this setting. Larger controlled trials are recommended to establish the generalisability of these findings in this region. Trial registration Pan African Clinical Trial Registry (Registration Number PACTR202001710494962).

If we build it, they will come: Caregiver decision to use an accessible outpatient psychiatric service for children and adolescents in Nigeria.

OBJECTIVE: If child and adolescent psychiatric (CAP) services were accessible in lower-middle-income countries (LMIC) such as Nigeria, what individual and socio-cultural factors would influence caregivers' willingness to use these services when they are needed? METHODS: To address this question, we conducted structured interviews with a stratified random sampling of 442 adult caregivers of children aged 5 to 19-years who lived within 10 km of an established CAP outpatient service in Ibadan, Nigeria. RESULTS: Based on structural equation modeling, our cross-sectional findings indicated that caregivers were generally willing to use the accessible outpatient CAP service for a narrow range of overtly disruptive and developmentally atypical child behavior. However, their decisions were not influenced by their recognition of child and adolescent mental health (CAMH) conditions, competing life stressors, caregiver wellness, nor stigma as we had initially hypothesized. Rather caregivers pragmatically considered a range of approaches to address CAMH concerns. Post-hoc hypotheses confirmed that caregivers' beliefs about etiology and treatment effectiveness for CAMH conditions shaped their help-seeking decisions and stigmatization of CAP services. Specifically, caregivers who attributed CAMH conditions to physical causes regarded biomedical interventions as the most effective treatment while spiritual interventions were deemed to be the least effective. CONCLUSIONS: Taken together our results suggested that caregivers were receptive and willing to use outpatient psychiatric services for their children. However, their beliefs about the etiology and treatment effectiveness of CAMH conditions shaped how they intended to engage the services. These findings underscored the importance of scaling up a broader spectrum of accessible complementary CAMH intervention and prevention services in Nigeria that extend beyond indigenous or biomedical models. In doing so caregivers will come.

Perceptions of the psychological experiences surrounding female genital mutilation/cutting (FGM/C) among the Izzi in Southeast Nigeria.

Evidence about psychological experiences surrounding female genital mutilation/cutting (FGM/C) remains weak and inconclusive. This article is the first of a series that deploys qualitative methods to ascertain the psychological experiences associated with FGM/C through the lifecycle of women. Using the free listing method, 103 girls and women, aged 12 to 68 years from rural and urban Izzi communities in Southeastern Nigeria, produced narratives to articulate their perceptions of FGM/C. Sixty-one of them had undergone FGM/C while 42 had not. Data was analysed using thematic analysis and the emerging themes were related to experiences and disabilities in the psychological, physical, and social health domains. While physical experiences were mostly negative, psychological experiences emerged as both positive and negative. Positive experiences such as happiness, hopefulness, and improved self-esteem were commonly described in response to a rise in social status following FGM/C and relief from the stigma of not having undergone FGM/C. Less commonly reported were negative psychological experiences, e.g., shame when not cut, anxiety in anticipation of the procedure, and regret, sadness, and anger when complications arose from FGM/C. Some participants listed disruption of daily activities, chronic pain, and sleep and sexual difficulties occurring in the aftermath of FGM/C. Most participants did not list FGM/C as having a significant effect on their daily living activities. In light of the association of FGM/C with both positive and negative psychological experiences in the Izzi community, more in-depth study is required to enable policy makers and those campaigning for its complete eradication to rethink strategies and improve interventions.

Who seeks child and adolescent mental health care in Kenya? A descriptive clinic profile at a tertiary referral facility.

BACKGROUND: The presence of psychiatric morbidity in the child and adolescent age group is demonstrable in various studies conducted in various settings in Kenya. This study set out to determine the psychiatric morbidity and socio-demographic profile of patients who eventually present for care at a tertiary specialist child and adolescent mental health clinic in Kenya. Knowledge of the patterns of presentation of disorders is crucial for planning of service scale up as well as serving as a useful training guide. METHODS: This was a cross sectional descriptive study of 166 patients and their guardians presenting to the child and adolescent mental health clinics at a tertiary referral hospital in Nairobi, Kenya. Data was collected using a researcher designed socio-demographic questionnaire and the Kiddie-schedule for affective disorders and schizophrenia-present and lifetime (KSADS-PL 2009 Working Draft) and analysed using Statistical Package for Social Scientists. RESULTS: There were more males (56%) than females in this study and the participant's mean age was 13.6 years. Substance abuse disorders were the most prevalent presentation (30.1%) followed by depressive disorders (13.9%), with most referrals to the clinic coming from medical practitioners and teachers. The mean time to accessing care at the clinic after the onset of symptoms was 16.6 months, with the longest time taken to specialist care being 183 months. CONCLUSIONS: The findings from this study will go a long way to support the establishment of programs that improve timely child and adolescent mental health service delivery. The involvement of various stakeholders such as the education sector and the community is key in the development of these programs.

Maternal depression and child psychopathology among Attendees at a Child Neuropsychiatric Clinic in Abeokuta, Nigeria: a cross sectional study.

BACKGROUND: Children with recognized, diagnosable mental and neurological disorders are in addition prone to emotional and behavioral problems which transcend their specific diagnostic labels. In accessing care, these children are almost invariably accompanied by caregivers (usually mothers) who may also have mental health problems, notably depression. The relationship between child and maternal psychopathology has however not been sufficiently researched especially in low and middle income countries. METHODS: Mothers (n = 100) of children receiving care at the Child and Adolescent Clinic of a Neuropsychiatric Hospital in Abeokuta, Nigeria took part in the study. To each consenting mother was administered a sociodemographic questionnaire and the Patient Health Questionnaire, while information regarding their children (n = 100) was obtained using the Strengths and Difficulties Questionnaire. Data analysis was done with the Statistical Package for Social Sciences (SPSS) version 16. RESULTS: The mean ages of the mothers and children were 40.4 years (SD 4.7) and 11.6 years (SD 4.1), respectively. Among the children, 63 % had a main diagnosis of seizure disorder. Regardless of main diagnosis, 40 % of all the children had a comorbid diagnosis. Among the mothers, 23 % had major depressive disorder. A quarter (25 %) of the children had abnormal total SDQ scores. A diagnosis of major depressive disorder in mothers was associated with poor total SDQ scores and poor scores in all SDQ domains except the emotional domain for the children. Major depressive disorder among the mothers was associated with not being married (p = 0.004; OR = 0.142, 95 % CI 0.037-0.546) and longer duration of the child's illness (p = 0.039, OR = 1.165, 95 % CI 1.007-1.346). CONCLUSION: The study showed notable rates of depressive illness among mothers of children with neuropsychiatric disorders. Marked rates of emotional and behavioral disorders were also found among the children. Associations were found between maternal and child psychopathology. Mothers of children with neuropsychiatric disorders should be screened for depressive illness.

Lifetime exposure to traumatic events among adolescents in contact with the Nigerian juvenile justice systems compared with a comparison group of secondary school students.

BACKGROUND: There are some knowledge gaps in what is known about pre-contact exposure to traumatic events among adolescents within the juvenile justice system. Data often focus on psychological sequelae without describing the traumatic events. In addition, there are few data from sub-Saharan Africa where juvenile justice inmates are often minor offenders and may themselves have been victims of abuse and neglect. OBJECTIVE: To present detailed data on the lifetime prevalence rate and pattern of traumatic events among a cohort of adolescents in juvenile justice custody in Nigeria and to compare inmates who are 'offenders' with those who are 'victims'. METHODS: Inmates of a borstal and a remand home comprised the study group and age- and gender-matched adolescents from two government schools were the secondary comparison group. The trauma-checklist of the Current and Lifetime Version of the Kiddies Schedule for Affective Disorders and Schizophrenia was used as a guide in assessing traumatic events. RESULTS: Of a total of 408 adolescents, 204 were recruited from the two juvenile justice institutions and 204 from secondary schools. Ninety per cent of participants were male and the mean (SD) age was 15·9 (2·8) years. The prevalence rate of lifetime exposure to traumatic events among the juvenile justice offenders was 88·7% compared with 48·5% of the comparison group (P = 0·001). The most commonly reported specific lifetime traumatic event was physical abuse (52·8%). The institutionalised adolescents were significantly more likely to report lifetime exposure to almost all the traumatic events assessed. Apart from the perpetrators of violent crime, there was no statistically significant difference in the prevalence and pattern of lifetime exposure to traumatic events between the offenders and the victims. CONCLUSIONS: This study provides further evidence that exposure to traumatic events is a fact of life for inmates of juvenile institutions, irrespective of whether they are offenders or victims. The implications for reform of the Nigerian juvenile justice system are discussed.

Post-traumatic stress symptoms among juvenile offenders in nigeria: implications for holistic service provisioning in juvenile justice administration.

BACKGROUND: There is hardly any study examining exposure to traumatic events and post-traumatic stress disorder (PTSD) among juvenile justice populations in Nigeria or any part of sub-Saharan Africa. METHOD: We examined the prevalence and trauma determinants of PTSD among a cohort of juvenile justice inmates in Nigeria, compared with a cohort of school-going adolescents. RESULTS: Ninety percent (90%) of the juvenile justice inmates reported exposure to at least one lifetime traumatic event with higher mean incident events, compared with 60% among the comparison group (p=.001). Juvenile justice inmates had significantly higher prevalence rate of current and lifetime PTSD than the comparison group (current: 5.8% vs. 1.4%; lifetime: 9.7% vs. 2.8%, p<.05). Mean incident traumatic event was statistically significantly higher among juvenile justice inmates who had PTSD. CONCLUSION: Posttraumatic stress symptoms are common among adolescents coming in contact with the juvenile justice system. Implications for holistic service provisioning in juvenile justice administration are discussed.

The 'beyond parental control' label in Nigeria.

Recent reports in Nigeria indicate a geometric rise in incarcerated adolescents, with an overwhelming majority of this increase being attributed to adolescents being declared 'beyond parental control'. There is a nagging suspicion that the Nigerian juvenile justice system has over criminalised adolescents by declaring them 'beyond control' when behavioural problems have actually resulted from child abuse/neglect and family disruption. A study was undertaken in a juvenile justice institution in Nigeria to assess the adequacy of pre-incarceration parental care among adolescents that had been declared as 'beyond parental control'. The study included 75 adolescent boys that had been declared as 'beyond parental control' and a comparison group of 144 matched school going boys. It examined self-reports received from the adolescent boys regarding their pre-incarceration family life and social circumstances, as well as the behavioural problems they had experienced. The findings indicate that adolescent boys who were declared as 'beyond parental control' had a significantly higher lifetime history of behavioural problems than the comparison group, and they also had significantly higher indicators of pre-incarceration child abuse/neglect and problems with stability and consistency of primary support. These findings pose questions regarding the presumption of adequate parental care prior to the declaration of 'beyond parental control'. It also raises questions about child rights protection and juvenile justice reform in Nigeria.