Satisfaction with psychiatric in-patient care as rated by patients at discharge from hospitals in 11 countries.

PURPOSE: There is disregard in the scientific literature for the evaluation of psychiatric in-patient care as rated directly by patients. In this context, we aimed to explore satisfaction of people treated in mental health in-patient facilities. The project was a part of the Young Psychiatrist Program by the Association for the Improvement of Mental Health Programmes. METHODS: This is an international multicentre cross-sectional study conducted in 25 hospitals across 11 countries. The research team at each study site approached a consecutive target sample of 30 discharged patients to measure their satisfaction using the five-item study-specific questionnaire. Individual and institution level correlates of 'low satisfaction' were examined by comparisons of binary and multivariate associations in multilevel regression models. RESULTS: A final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards the upper end of the scale, with a median total score of 44 (interquartile range 38-48) out of 50. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio. CONCLUSION: Further studies on patients' satisfaction should additionally pay attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients' disempowerment, and power imbalance.

Assessing psychometric properties and measurement invariance of the Sleep Quality Questionnaire among healthcare students.

OBJECTIVE: The sleep of healthcare students is worth discovering. Mental health and self-rated health are thought to be associated with sleep quality. As such, valid instruments to assess sleep quality in healthcare students are crucial and irreplaceable. This study aimed to investigate the measurement properties of the Sleep Quality Questionnaire (SQQ) for Chinese healthcare students. METHODS: Two longitudinal assessments were undertaken among healthcare students, with a total of 595, between December 2020 and January 2021. Measures include the Chinese version of the SQQ, Patient Health Questionnaire-4 (PHQ-4), Self-Rated Health Questionnaire (SRHQ), and sociodemographic questionnaire. Structural validity through confirmatory factor analysis (CFA) was conducted to examine factor structure of the SQQ. T-tests and ANOVAs were used to examine sociodemographic differences in sleep quality scores. Multi Group CFA and longitudinal CFA were respectively used to assess cross-sectional invariance and longitudinal invariance across two-time interval, i.e., cross-cultural validity. Construct validity, internal consistency, and test-retest reliability were correspondingly examined via Spearman correlation, Cronbach's alpha and McDonald's omega, and intraclass correlation coefficient. Multiple linear regression analysis was performed to examine incremental validity of the SQQ based on the PHQ-4 and SRHQ as indicators of the criterion variables. RESULTS: CFA results suggested that the two-factor model of the SQQ-9 (item 2 excluded) had the best fit. The SQQ-9 scores differed significantly by age, grade, academic stage, hobby, stress coping strategy, anxiety, depression, and self-rated health subgroups. Measurement invariance was supported in terms of aforesaid subgroups and across two time intervals. In correlation and regression analyses, anxiety, depression, and self-rated health were moderately strong predictors of sleep quality. The SQQ-9 had good internal consistency and test-retest reliability. CONCLUSION: Good measurement properties suggest that the SQQ is a promising and practical measurement instrument for assessing sleep quality of Chinese healthcare students.

Depression and Anxiety Mediate the Association between Sleep Quality and Self-Rated Health in Healthcare Students.

OBJECTIVES: This study aimed to investigate factors associated with sleep quality in healthcare students and to determine whether depressive and anxiety symptoms may explain some of the associations between sleep quality and self-rated health. STUDY DESIGN: This is a cross-sectional study at wave one. METHODS: A total of 637 healthcare students were recruited via a stratified random sampling method in Hangzhou, China. The Sleep Quality Questionnaire (SQQ) and the four-item Patient Health Questionnaire (PHQ-4) were used to assess sleep quality and depressive and anxiety symptoms, respectively. Self-rated health was assessed via a self-developed questionnaire of both physical and psychological health. Structural equation modeling was used to examine the direct and indirect effects of sleep quality on self-rated health through depressive and anxiety symptoms. RESULTS: Students engaged in part-time employment (p = 0.022), with poor perceived employment prospects (p = 0.009), and who did not participate in recreational sports (p = 0.008) had worse sleep quality. Structural equation modeling revealed a significant total effect of sleep quality on self-rated health (b = 0.592, p < 0.001), a significant direct effect of both sleep quality and depressive and anxiety symptoms on self-rated health (b = 0.277, 95% CI: 0.032-0.522), and a significant indirect effect of sleep quality on self-rated health through depressive and anxiety symptoms (b = 0.315, 95% CI: 0.174-0.457). CONCLUSIONS: Depressive and anxiety symptoms partially explain the association between sleep quality and self-rated health. Intervening upon sleep quality, depressive, and anxiety symptoms may bolster the self-rated health of healthcare students.

Shisha smoking in selected nightclubs in Nigeria.

INTRODUCTION: Shisha consumption is a growing public health issue all over the globe and public health awareness about its deleterious health consequences is still not sufficiently raised. METHODS: In this location-based study of nightclubs in Ibadan, Nigeria, 633 patrons of selected nightclubs were interviewed in order to obtain information on prevalence, correlates and predictors of shisha smoking. RESULTS: The overall prevalence of shisha smoking was 7.1%. The age of initiation into shisha smoking was lower among women, p = 0.03, but men were significantly more likely to be more frequent users, daily or weekly users, p < 0.001 and also to be current cigarette smokers, p = 0.03. There was no significant gender variability in the stage of readiness to quit. Regression analysis showed that after adjusting for age, the predictors of shisha smoking were: cigarette smoking, OR = 4.83, 95% CI (1.49-15.70) and more than 12 years of education, OR = 7.55, 95% CI (1.88 - 30.37), while being a rural dweller was a protective factor, OR = 0.05, 95% CI (0.01-0.20). CONCLUSION: Shisha smoking has emerged as a prevalent public health issue in Nigeria. There is a need for an immediate response from policy providers towards shisha smoking intervention in Nigeria.

Effectiveness of Alcohol, Smoking, and Substance Involvement Screening Test-Linked Brief Intervention on Harmful and Hazardous Alcohol Use in Nigerian Semirural Communities: A Non-Randomized Intervention Study.

OBJECTIVE: To determine the prevalence of alcohol consumption and the effectiveness of the alcohol, smoking, and substance involvement screening test (ASSIST)-linked brief intervention on hazardous and harmful alcohol use in semirural settings in Nigeria. METHODS: In this single arm non-randomized intervention study delivered by community health extension workers (CHEW), participants (N = 1,203), 15 years and older, recruited between October 2010 and April 2011 were assessed for prevalence of alcohol consumption and the associated level of risk. Scores of 0-10 were classified as lower risk scores, 11-26 as moderate risk, and 27+ as high risk. This was followed by a brief intervention. Prevalence of alcohol consumption and level of risk was assessed at 3 and 6 months postbrief intervention. Main outcome measure was the change in ASSIST scores at 3 and 6 months postintervention. RESULTS: There was a statistically significant difference in the prevalence of alcohol use at baseline compared with that at 6 months, χ2(2) = 4.2, p = 0.01. Among all respondents, a repeated measures ANOVA with a Greenhouse-Geisser correction showed that mean ASSIST score significantly reduced between time points [F(1.541, 34.092) = 53.241, p < 0.001]. Post hoc tests using the Bonferroni correction revealed that this difference was due to a significant reduction in the mean ASSIST scores at 3 months vs. baseline, p = 0.001, but not at 3 vs. 6 months, p = 0.09. CONCLUSION: There is a potential for CHEW-administered ASSIST-linked screening, brief intervention, and referral to treatment for unhealthy alcohol use in Nigerian semirural communities. This is feasible considering serious dearth of addiction specialists in the country.

Prevalence and Correlates of Alcohol Use among a Sample of Nigerian Semirural Community Dwellers in Nigeria.

Objective. To determine the prevalence and correlates of alcohol use among a sample of Nigerian semirural community dwellers in Nigeria. Methods. In a single arm nonrandomized intervention study, the assessment of baseline hazardous and harmful alcohol use and associated risk factors was conducted in two semirural local government areas of Oyo State, Nigeria, with the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Participants included 1203 subjects 15 years and older, recruited between October 2010 and April 2011. ASSIST score of 0-10 was classified as lower risk scores, 11-26 as moderate risk, and 27+ as high risk. Results. Prevalence of lifetime alcohol use was 57.9% and current alcohol use was 23.7%. Current alcohol use was more prevalent among the younger age group p = 0.02, male gender p = 0.003, unmarried p < 0.01, low educational level p = 0.003, low socioeconomic class p = 0.01, unemployed p < 0.001, and the Christians p < 0.01. Of the current drinkers, the majority (69.1%) were at either moderate or high health risk from alcohol use. Conclusion. Alcohol consumption is prevalent in semirural communities in Nigeria and the majority of these drinkers are at moderate or high health risk. Screening, brief intervention, and referral for treatment for unhealthy alcohol use should be integrated into community care services in Nigerian rural communities.

Community-Based Screening, Brief Intervention, and Referral for Treatment for Unhealthy Tobacco Use: Single Arm Study Experience and Implementation Success in Rural and Semi-Rural Settings, South-West Nigeria.

OBJECTIVE: To determine whether screening, brief intervention, and referral for treatment can reduce the prevalence of tobacco use in rural and semi-rural settings. DESIGN AND PARTICIPANTS: A non-randomized clinical trial with assessments at baseline and post-intervention assessments at 3 and 6 months was conducted in a rural and semi-rural district in South-West of Nigeria. A representative sample of 1203 persons consented to the study and had alcohol, smoking, and substance involvement screening test (ASSIST) administered to them by trained community health-care extension workers between October 2010 and April 2011. Follow-up participation was more than 99% at all points. INTERVENTION: Participants received a single ASSIST-linked brief intervention (BI) and referral for treatment (RT) at entry, and a booster ASSIST BI and RT at 3 months. MAIN OUTCOMES AND MEASURES: The primary outcome was self-reported scores on ASSIST. RESULTS: At baseline, out of 1203 respondents, lifetime prevalence and current prevalence of any tobacco products were 405 (33.7%) and 248 (20.6%), respectively. Of the current users, on the ASSIST, 79 (31.9%) scored 0-3 (low health risk), 130 (52.4%) scored 4-26 (moderate risk), and 39 (15.7%) scored 27+ (high risk). At 3 months, out of 1199 respondents, prevalence of current users was 199 (16.5%) and out of 1195 respondents, was 169 (14.1%) at 6 months. Prevalence of tobacco use reduced significantly at 3 months Z = -3.1, p = 0.01 and at 6 months when compared with baseline Z = 4.2, p = 0.001, but not at 6 months compared with at 3 months, Z = 2.1, p = 0.09. Multivariate analysis revealed that age at initiation of tobacco use, gender, marital status, setting of dwelling, and socioeconomic status were the only variables that were associated with current tobacco use at baseline, 3 and 6 months. CONCLUSION: A one-time BI with a booster at 3 months had a significant effect on tobacco use in persons living in community settings. This finding suggests a need for promoting the adoption of this intervention for tobacco use in rural and semi-rural community settings.

Incidence and correlates of delirium in a West African mental health clinic.

OBJECTIVE: To determine the incidence of delirium in those patients presenting to a psychiatric clinic in Nigeria and to examine if any demographic or clinical variables were correlated with this diagnosis. METHOD: A prospective survey design; 264 consecutive new referrals to a psychiatric clinic in Nigeria were assessed for the presence of delirium using a standardised diagnostic scale. Data was analysed for normality and appropriate statistical test employed to examine the relationships between the presence of delirium and demographic and clinical variables. RESULTS: Of individuals presenting to the mental health clinics, 18.2% had delirium. No demographic variable was significant regarding the presence or absence of delirium. With regard to clinical variables duration of current symptoms, referral source and the presence of comorbid physical illness were significantly associated with the presence of delirium. Most delirium was due to infections. Nearly all patients with delirium were prescribed psychotropic medication (95.2%), and most attributed their symptoms to a spiritual cause. CONCLUSION(S): Delirium presents more commonly to psychiatry services in the less developed world compared to the West. Development efforts should focus on recognition and management of delirium to improve outcomes and maximise resources.