Prevalence and correlates of common mental disorders among participants of the Uganda Genome Resource: Opportunities for psychiatric genetics research.

Genetics research has potential to alleviate the burden of mental disorders in low- and middle-income-countries through identification of new mechanistic pathways which can lead to efficacious drugs or new drug targets. However, there is currently limited genetics data from Africa. The Uganda Genome Resource provides opportunity for psychiatric genetics research among underrepresented people from Africa. We aimed at determining the prevalence and correlates of major depressive disorder (MDD), suicidality, post-traumatic stress disorder (PTSD), alcohol abuse, generalised anxiety disorder (GAD) and probable attention-deficit hyperactivity disorder (ADHD) among participants of the Uganda Genome Resource. Standardised tools assessed for each mental disorder. Prevalence of each disorder was calculated with 95% confidence intervals. Multivariate logistic regression models evaluated the association between each mental disorder and associated demographic and clinical factors. Among 985 participants, prevalence of the disorders were: current MDD 19.3%, life-time MDD 23.3%, suicidality 10.6%, PTSD 3.1%, alcohol abuse 5.7%, GAD 12.9% and probable ADHD 9.2%. This is the first study to determine the prevalence of probable ADHD among adult Ugandans from a general population. We found significant association between sex and alcohol abuse (adjusted odds ratio [AOR] = 0.26 [0.14,0.45], p < 0.001) and GAD (AOR = 1.78 [1.09,2.49], p = 0.019) respectively. We also found significant association between body mass index and suicidality (AOR = 0.85 [0.73,0.99], p = 0.041), alcohol abuse (AOR = 0.86 [0.78,0.94], p = 0.003) and GAD (AOR = 0.93 [0.87,0.98], p = 0.008) respectively. We also found a significant association between high blood pressure and life-time MDD (AOR = 2.87 [1.08,7.66], p = 0.035) and probable ADHD (AOR = 1.99 [1.00,3.97], p = 0.050) respectively. We also found a statistically significant association between tobacco smoking and alcohol abuse (AOR = 3.2 [1.56,6.67], p = 0.002). We also found ever been married to be a risk factor for probable ADHD (AOR = 2.12 [0.88,5.14], p = 0.049). The Uganda Genome Resource presents opportunity for psychiatric genetics research among underrepresented people from Africa.

Victimisation in the life of persons with severe mental illness in Uganda: a pluralistic qualitative study.

INTRODUCTION: Victimisation of persons with severe mental illness is recognised as an urgent global concern, with literature pointing to higher rates of violent victimisation of persons with severe mental illness than those of the general population. Yet, for low income countries, there is a huge gap in the literature on the risk, character and victims' in-depth experiences of victimisation of persons with severe mental illness. We explore the lived experiences and meanings of victimisation of persons with severe mental illness in Uganda, and discuss their implications for care of the mentally ill. METHODS: A pluralistic qualitative study was undertaken to explore victimisation among patients with severe mental illness. Patients who had suffered victimisation were purposively sampled from Butabika National Referral Mental Clinic and Masaka Regional Referral Hospital, following confirmation of symptom remission. In-depth interviews were held with 18 participants, comprising 13 females and 5 males from low to moderate socioeconomic status. Interpretative phenomenological analysis and thematic content analysis were conducted. RESULTS: Victimisation was exhibited in three main forms: (a) psychological, expressed in attitudes towards mentally ill family members as valueless and dispensable, and stigmatisation, (b) physical, as manifested in beatings, indoor confinement and tethering mostly by family members and (c) sexual victimisation, particularly rape. Also observed were victim's various responses that pointed to the negative impact of victimisation, including a heightened risk of suicide, social withdrawal, a sense of hatefulness and a predisposition to more victimisation. CONCLUSION: The family environment plays a predominant role in perpetrating victimisation of the mentally ill in some sub-Saharan African contexts such as Uganda. We propose a holistic framework for mental health interventions, incorporating biomedical but notably also social determinants of mental health, and targeted at improving familial relationships, social support and a sense of belongingness both within the family and the broader community.

Physical and psychiatric comorbidities among patients with severe mental illness as seen in Uganda.

While psychiatric and physical comorbidities in severe mental illness (SMI) have been associated with increased mortality and poor clinical outcomes, problem has received little attention in low- and middle-income countries (LMICs). This study established the prevalence of psychiatric (schizophrenia, bipolar affective disorder, and recurrent major depressive disorder) and physical (HIV/AIDS, syphilis, hypertension and obesity) comorbidities and associated factors among 1201 out-patients with SMI (schizophrenia, depression and bipolar affective disorder) attending care at two hospitals in Uganda. Participants completed an assessment battery including structured, standardised and locally translated instruments. SMIs were established using the MINI International Neuropsychiatric Interview version 7.2. We used logistic regression to determine the association between physical and psychiatric comorbidities and potential risk factors. Bipolar affective disorder was the most prevalent (66.4%) psychiatric diagnoses followed by schizophrenia (26.6%) and recurrent major depressive disorder (7.0%). Prevalence of psychiatric comorbidity was 9.1%, while physical disorder comorbidity was 42.6%. Specific comorbid physical disorders were hypertension (27.1%), obesity (13.8%), HIV/AIDS (8.2%) and syphilis (4.8%). Potentially modifiable factors independently significantly associated with psychiatric and physical comorbidities were: use of alcohol for both syphilis and hypertension comorbidities; and use of a mood stabilisers and khat in comorbidity with obesity. Only psychiatric comorbidity was positively associated with the negative outcomes of suicidality and risky sexual behaviour. The healthcare models for psychiatric care in LMICs such as Uganda should be optimised to address the high burden of psychiatric and physical comorbidities.

Prevalence and factors associated with post traumatic stress disorder among field police patrol officers serving in Kampala Metropolitan region.

BACKGROUND: Occupation groups like police officers and fire fighters are exposed to a number of traumatic events which put them at a risk of developing post-traumatic stress disorder (PTSD). Previous studies have found the prevalence of PTSD in police officers to vary between 7 and 19%. However, most of these studies have been undertaken in western setting with little research having been undertaken in sub-Saharan Africa including Uganda. OBJECTIVE: To determine the prevalence and factors associated with post-traumatic stress disorder among field police patrol officers serving in Kampala Metropolitan Police (KMP) North Region. METHODS: This was a cross sectional study that was conducted on 392 field police patrol officers serving in KMP North Region. Diagnosis of PTSD was undertaken using the Clinician Administered PTSD Scale for DSM-5. In order to assess for psychiatric comorbidities, the study used the Mini International Neuropsychiatric Interview (M.I.N.I.) RESULTS: In this study, the prevalence of PTSD was 7.4%. An additional 62.5% had sub-threshold PTSD, which was defined as, the presence of at least one PTSD symptom but not meeting full criteria for PTSD diagnosis. The factors found to be significantly associated with PTSD were all related to the presence of psychiatric comorbidities, namely the presence of: a current major depressive episode (aOR = 4.7; 95% CI: 1.5- 14.8; p = .009); an alcohol use disorder (aOR = 5.1; 95% CI: 2.0-13.0; p = .001); and presence of dissociation symptoms (aOR = 6.7; 95% CI: 2.0-22.2; p = .002). CONCLUSION: PTSD is one of the common psychiatric disorders experienced by serving police officers in Uganda. The tendency of PTSD in this group to co-occur with other psychiatric disorders means that any treatment program to address it should be part of a comprehensive multi-disorder mental health treatment programme in the police office.

The efficacy of a lay health workers - led physical activity counselling program in patients with HIV and mental health problems: a real-world intervention from Uganda.

ABSTRACTThis study explored the efficacy of a lay health worker (LHW)-led physical activity (PA) counselling program for inactive patients with HIV/AIDS and mental health problems living in a Ugandan farming community. In total 49 (35 women) community patients (40.0 ± 11.2 years) followed an 8-week once weekly LHW-led PA counselling program based on a self-determination theory and motivational interviewing framework. Participants completed the Simple Physical Activity Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, HIV/AIDS Stress Scale and World Health Organization Disability Assessment Schedule 2 (WHODAS 2) pre- and immediately post-intervention. Small, significant (P < 0.05) effect sizes were found for reductions in HIV/AIDS-related stress (Cohen's d = 0.26) and in global disability (Cohen's d = 0.46). Large effect sizes were observed for reductions in time spent sedentary (Cohen's d = 1.97) and reductions in depressive (Cohen's d = 2.04) and anxiety (Cohen's d = 1.47) symptoms and increases in time spent active (Cohen's d = 1.98). Greater decrease in sedentary time was associated with greater anxiety symptoms reduction (r = 0.32, P = 0.021). In physically inactive patients with HIV/AIDS and mental health problems, an LHW-led PA counselling program reduced stress, anxiety, depression and disability. Randomized controlled trials are needed to confirm these preliminary positive findings.

Internalised HIV-related stigma associated with physical inactivity in people with HIV and AIDS: A cross-sectional study from Uganda.

Aim: The aim of the current study was to explore correlations between continuous physical activity (PA) levels and HIV-related stigma and differences in HIV-related stigma between those who meet versus those who do not meet the international PA recommendation of 150 min of PA per week at moderate intensity.Methods: 295 people living with HIV (PLHIV) (median [interquartile range] age = 37.0 [16.0]; 67.8% [n = 200] female) from central Uganda completed the Internalised AIDS-Related Stigma Scale (IA-RSS), Generalised Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Alcohol Use Disorders Identification Test (AUDIT) and the Physical Activity Vital Sign (PAVS).Results: There was a significant correlation between the PAVS and IA-RSS scores correcting for GAD-7, PHQ-9 and AUDIT scores (r = -0.15, p = 0.009). The IA-RSS score was also significantly different between those meeting versus not meeting PA guidelines.Conclusions: Our data demonstrate that higher internalised HIV-related stigma is associated with lower levels of physical activity. The current evidence demonstrates the need to explore whether HIV stigma-reduction interventions could improve physical activity participation and consequently physical and mental health outcomes in PLHIV.

Major Depressive Disorder Among HIV Infected Youth in Uganda: Incidence, Persistence and Their Predictors.

Incidence and persistence of major depressive disorder (MDD) in children and adolescents with HIV (CA-HIV) in Uganda is described. 1339 CA-HIV attending care were enrolled and followed up for 12 months. MDD was assessed using the DSM-5 referenced Child and Adolescent Symptom Inventory-5 (CASI-5), with a prevalence for MDD at baseline of 5% (95% CI 3.3-7.3). Kaplan-Meir method was used to estimate incidence of MDD and Cox models were fitted to investigate predictors of incident MDD. Cumulative incidence of MDD over 12 months was 7.6 per 100 person-years 95% CI (6.2-9.4) and a rate of persistent MDD of 10/105 (9.5% CI 3.9-15.1). Significant independent predictors of incident MDD were: highest educational level of CA-HIV (protective), increasing depressive scores and decreasing CD4 Nadir. These finding have implications for what should constitute components of a mental health integration model in HIV youth services and for the future development of individualised mental health care.

Clinical correlates and adverse outcomes of ADHD, disruptive behavior disorder and their co-occurrence among children and adolescents with HIV in Uganda.

Attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are important mental health concerns among children and adolescents living with HIV (CA-HIV). This study examines clinical correlates and adverse outcomes associated with ADHD, ODD/CD and ADHD + ODD/CD among (N = 1,336) CA-HIV living in Uganda. Being male, higher socio-economic status, emotional disorder, greater caregiver distress and youth-caregiver conflict were associated with a greater risk of behavioral disorders, particularly ADHD + ODD/CD. This group was also five-times more likely to have engaged in sex than their peers and report greater disciplinary problems at school than those without a behavioral disorder. These findings highlight the distinct clinical presentation and adverse outcomes associated with ADHD + ODD/CD among CA-HIV. As more CA-HIV are surviving into adulthood, screening and treatment of mental disorders is needed to ensure they are given the chance to thrive. In addition to youth, interventions should target caregivers due to their impact on youth outcomes.

The efficacy of physical activity counseling in Ugandan patients with HIV and a co-morbid mental disorder: a pilot study.

This study explored the efficacy of physical activity (PA) counseling in inactive patients with HIV/AIDS and a co-morbid mental health disorder living in a Ugandan fishing community. We investigated associations between changes in PA, sedentary behavior, mental health burden and quality of life (QoL) following an 8-week once per week PA counseling program using the self-determination theory and motivational interviewing framework. In total 41 (33 women) patients (39.8 ± 10.9years) completed the Simple Physical Activity Questionnaire, Patient Health Questionnaire, Alcohol Use Disorder Identification Test and World Health Organization Quality of Life Questionnaire pre- and post-intervention. Large effect sizes were found for reductions in time spent sedentary (Cohen's d = 2.85) and reductions in depressive symptoms (Cohen's d = 1.47). We also found large effect sizes for increases in time spent walking (Cohen's d = 1.38), in incidental PA such as household chores (Cohen's d = 1.69), and physical health (Cohen's d = 1.38), psychological health (Cohen's d = 0.95), and social relationships. (Cohen's d = 1.39). The more time spent sedentary decreased, the more the psychological health increased (r = -0.33, P = 0.037). In sedentary patients with HIV/AIDS and a co-morbid mental disorder, the mental health burden reduces and QoL improves following PA counseling. Controlled studies are however needed to confirm our findings.

Prevalence, correlates for early neurological disorders and association with functioning among children and adolescents with HIV/AIDS in Uganda.

BACKGROUND: The aim of this study was to determine the prevalence of neurological disorders and their associated correlates and relations with clinical and behavioural problems among children and adolescents with HIV/AIDS (CA-HIV). METHODS: This study involved a sample of 1070 CA-HIV/caregiver dyads who were evaluated at their 6-month follow-up visit as part of their participation in the longitudinal study, 'Mental health among HIV infected CHildren and Adolescents in KAmpala and Masaka, Uganda (the CHAKA study)'. Participants completed an extensive battery of measures that included a standardized DSM-5- referenced rating scale, the parent version (5-18 years) of the Child and Adolescent Symptom Inventory-5 (CASI-5). Using logistic regression, we estimated the prevalence of neurological disorders and characterised their associations with negative clinical and behavioural factors. RESULTS: The overall prevalence of at least one neurological disorders was 18.5% (n = 198; 95% CI, 16.2-20.8). Enuresis / encopresis was the most common (10%), followed by motor/vocal tics (5.3%); probable epilepsy was the least prevalent (4%). Correlates associated with neurological disorders were in two domains: socio-demographic factors (age, ethnicity and staying in rural areas) and HIV-related factors (baseline viral load suppression). Enuresis/encopresis was associated with psychiatric comorbidity. Neurological disorders were associated with earlier onset of sexual intercourse (adjusted OR 4.06, 95% CI 1.26-13.1, P = 0.02). CONCLUSIONS: Neurological disorders impact lives of many children and adolescents with HIV/AIDS. There is an urgent need to integrate the delivery of mental and neurological health services into routine clinical care for children and adolescents with HIV/AIDS in sub-Saharan Africa.

Rates, types and co-occurrence of emotional and behavioural disorders among perinatally HIV-infected youth in Uganda: the CHAKA study.

PURPOSE: To describe the rates, types and comorbidity of emotional and behavioural disorders among perinatally HIV-infected children and adolescents attending care at five HIV youth clinics in Central and Southwestern Uganda. METHODS: 1339 CA-HIV attending care at HIV youth clinics in Uganda were interviewed using the DSM-5-based Child and Adolescent Symptom Inventory-5 (CASI-5; caregiver reported) and the Youth Inventory-4R (YI-4R; youth reported). Prevalence, risk factors and comorbidity for psychiatric disorders were estimated using logistic regression models. RESULTS: According to caregiver or youth report, the prevalence of 'any DSM-5 psychiatric disorder' was 17.4% (95% CI 15.4-19.5%), while that of 'any behavioural disorder' was 9.6% (95% CI 8.1-11.2%) and that of 'any emotional disorder' was 11.5% (95% CI 9.9-13.3%). The most prevalent behavioural disorder was attention deficit hyperactivity disorder (5.3%), while the most prevalent emotional disorder was separation anxiety disorder (4.6%). The statistically significant risk factors were: for behavioural disorders, sex (more among males than females) and age group (more among adolescents than among children); for emotional disorders, age group (more among adolescents than among children) and the caregiver's highest educational attainment (more among CA-HIV with caregivers with secondary education and higher, than among CA-HIV with caregivers with no formal education or only primary level education). About a quarter (24.5%) of CA-HIV with at least one emotional disorder and about a third (33.5%) of the CA-HIV with at least one behavioural disorder had a comorbid psychiatric disorder. CONCLUSION: There was a considerable burden of psychiatric disorders among CA-HIV that spanned a broad spectrum and showed considerable comorbidity.

Association between major depressive disorder and pro-inflammatory cytokines and acute phase proteins among HIV-1 positive patients in Uganda.

BACKGROUND: Major depressive disorder (MDD) is a common psychiatric complication of HIV/AIDS. While considerable research has been undertaken to understand the psychosocial risk factors of MDD, there is a paucity of data on its biological risk factors including immunological factors. To address this we undertook a study to investigate the association between MDD and pro-inflammatory cytokines and acute phase proteins among persons living with HIV/AIDS (PLWHA) in Uganda. We collected clinical and laboratory data on 201 PLWHA attending two HIV clinics in central and southwestern Uganda. Clinical data included DSM-IV based MDD diagnosis, while laboratory data included the concentrations of IL-6, TNF-α and CRP measured using ELISA. Multiple logistic linear regression analysis was used to determine which proteins were independently significantly associated with MDD controlling for study site, sex, age and highest educational attainment. RESULTS: The prevalence of MDD was 62/201 (30.8%). Adjusting for confounders, the odds of MDD increased with increasing levels of IL-6 [each unit increase in IL-6 titres was associated with an aOR = 0.98 (95% CI, 0.97-0.99); p < 0.001]. Participants with low levels of TNF-α were at reduced risk of MDD compared to participants with no TNF-α [those with a TNF-α of 1- <50 pg/ml titres had an aOR = 0.35(95% CI,0.10-1.16)], but as the level of TNF-α increased, the risk of MDD increased, and in particular participants with high levels of TNF-α (of 500 or above) were at a significantly increased risk of MDD [e.g. those with a TNF-α of 500- < 1000 pg/ml titres had an aOR = 3.98 (95% CI,1.29-12.33)] compared to participants with no TNF-α. There was no evidence that MDD was associated with the level of CRP titres [aOR = 0.95 (0.78-1.15); p = 0.60)]. CONCLUSION: In this study, the pro-inflammatory proteins IL-6 and TNF-α were significantly associated with MDD, while CRP was not.

Association between serotonin transporter gene polymorphisms and increased suicidal risk among HIV positive patients in Uganda.

BACKGROUND: Persons living with HIV/AIDS (PLWHA) are at an increased risk of suicide. Increased suicidal risk is a predictor of future attempted and completed suicides and has been associated with poor quality of life and poor adherence with antiretroviral therapy. Clinical risk factors have low predictive value for suicide, hence the interest in potential neurobiological correlates and specific heritable markers of suicide vulnerability. The serotonin transporter gene has previously been implicated in the aetiology of increased suicidal risk in non-HIV infected study populations and its variations may provide a platform for identifying genetic risk for suicidality among PLWHA. The present cross-sectional study aimed at identifying two common genetic variants of the serotonin transporter gene and their association with increased suicidal risk among human immunodeficiency virus (HIV)-positive adults in Uganda. RESULTS: The prevalence of increased suicidal risk (defined as moderate to high risk suicidality on the suicidality module of the Mini Neuropsychiatric Interview (M.I.N.I) was 3.3% (95% CI, 2.0-5.3). The 5-HTTLPR was found to be associated with increased suicidal risk before Bonferroni correction (p-value = 0.0174). A protective effect on increased suicidal risk was found for the 5-HTTLPR/rs25531 S A allele (p-value = 0.0046)- which directs reduced expression of the serotonin transporter gene (5-HTT). CONCLUSION: The S A allele at the 5-HTTLPR/rs25531 locus is associated with increased suicidal risk among Ugandan PLWHA. Further studies are needed to validate this finding in Ugandan and other sub-Saharan samples.

Incidence and Persistence of Major Depressive Disorder Among People Living with HIV in Uganda.

Data on the course of major depressive disorder (MDD) among people living with HIV (PLWH) are needed to inform refinement of screening and interventions for MDD. This paper describes the incidence and persistence rate of MDD in PLWH in Uganda. 1099 ART-naïve PLWH attending HIV clinics in Uganda were followed up for 12 months. MDD was assessed using the DSM IV based Mini-International Neuropsychiatric Interview with a prevalence for MDD at baseline of 14.0 % (95 % CI 11.7-16.3 %) reported. Multivariable logistic regression was used to determine predictors of incident and persistent MDD. Cumulative incidence of MDD was 6.1 per 100 person-years (95 % CI 4.6-7.8) with significant independent predictors of study site, higher baseline depression scores and increased stress. Persistence of MDD was 24.6 % (95 % CI 17.9-32.5 %) with independent significant predictors of study site, higher baseline depression scores, and increased weight. Risks of incident and persistent MDD observed in this study were high. Potentially modifiable factors of elevated baseline depressive scores and stress (only for incident MDD) were important predictors of incident and persistent MDD.

Prevalence and correlates for ADHD and relation with social and academic functioning among children and adolescents with HIV/AIDS in Uganda.

BACKGROUND: Aim of this study was to determine the prevalence of attention-deficit/hyperactivity disorder (ADHD), its associated correlates and relations with clinical and behavioural problems among children and adolescents with HIV/AIDS (CA-HIV) attending five HIV clinics in central and South Western Uganda. METHODS: This study used a quantitative design that involved a random sample of 1339 children and adolescents with HIV and their caregivers. The Participants completed an extensive battery of measures including a standardized DSM-5 referenced rating scale, the parent version (5-18 years) of the Child and Adolescent Symptom Inventory-5 (CASI-5). Using logistic regression, we estimated the prevalence of ADHD and presentations, correlates and its impact on negative clinical and behavioural factors. RESULTS: The overall prevalence of ADHD was 6% (n = 81; 95%CI, 4.8-7.5%). The predominantly inattentive presentation was the most common (3.7%) whereas the combined presentation was the least prevalent (0.7%). Several correlates were associated with ADHD: socio-demographic (age, sex and socio-economic status); caregiver (caregiver psychological distress and marginally, caregiver educational attainment); child's psychosocial environment (quality of child-caregiver relationship, history of physical abuse and marginally, orphanhood); and HIV illness parameters (marginally, CD4 counts). ADHD was associated with poor academic performance, school disciplinary problems and early onset of sexual intercourse. CONCLUSIONS: ADHD impacts the lives of many CA-HIV and is associated with poorer academic performance and earlier onset of sexual intercourse. There is an urgent need to integrate the delivery of mental health services into routine clinical care for CA-HIV in Sub-Saharan Africa.

The experiences of caregivers of children living with HIV and AIDS in Uganda: a qualitative study.

BACKGROUND: Home-based care for HIV patients is popular in contexts severely affected by the epidemic and exacts a heavy toll on caregivers. This study aimed at understanding the experiences of caregivers and their survival strategies. METHODS: A total of 18 caregivers (3 males and 15 females) were interviewed using a semi-structured interview guide, and thematic analysis was used to analyse the data. RESULTS: Analysis suggests that the caregivers are burdened with insecure provisions for food and difficulties in accessing health care. They however survived these strains through managing their relationships, sharing burden with care-recipients, social networks and instrumental spirituality. These findings are discussed under two major themes: 1). Labour of caregiving and 2). Survivalism. CONCLUSIONS: Home-based care presents huge opportunities for community response to the HIV/AIDS epidemic in African settings. It is however burdensome and thus should not be left for families alone to shoulder. There is therefore an urgent need for protecting home-based care for HIV children in Uganda. Implications for improving and strengthening social interventions in home-based care of HIV/AIDS in the Ugandan context are addressed.

Risk of major depressive disorder among older persons living in HIV-endemic central and southwestern Uganda.

Major depressive disorder (MDD) is projected to become the second most common cause of disability by 2020 calling for a better understanding its antecedents across the lifespan and in diverse socio-cultural settings. In this paper we describe the risk factors of MDD among older people (50 years +) living in HIV-endemic central and southwestern Uganda. A cross-sectional study was undertaken among 471 respondents (50 years +) participating in the Wellbeing of Older People's Study cohort of the MRC/UVRI Uganda research Unit on AIDS in Uganda. Participants were from five strata: HIV negative, HIV positive on ART, HIV positive not on ART, having an adult child on ART, and having an adult child who died of HIV. Overall MDD prevalence was 9.2% (95% CI 6.7-12.2%) with a prevalence among males of 7.4% (95% CI 4.0-12.3%) and females of 10.3% (95% CI 7.0-14.3%). Factors significantly associated with MDD included: declining socio-economic status, increasing disability scores, decreasing mean grip strength, reported back pain, and not having hypertension. Marginally associated with MDD was being HIV infected and not on ART.

"The Cango Lyec Project - Healing the Elephant": HIV related vulnerabilities of post-conflict affected populations aged 13-49 years living in three Mid-Northern Uganda districts.

BACKGROUND: The protracted war between the Government of Uganda and the Lord's Resistance Army in Northern Uganda (1996-2006) resulted in widespread atrocities, destruction of health infrastructure and services, weakening the social and economic fabric of the affected populations, internal displacement and death. Despite grave concerns that increased spread of HIV/AIDS may be devastating to post conflict Northern Uganda, empirical epidemiological data describing the legacy of the war on HIV infection are scarce. METHODS: The 'Cango Lyec' Project is an open cohort study involving conflict-affected populations living in three districts of Gulu, Nwoya and Amuru in mid-northern Uganda. Between November 2011 and July 2012, 8 study communities randomly selected out of 32, were mapped and house-to-house census conducted to enumerate the entire community population. Consenting participants aged 13-49 years were enrolled and interviewer-administered data were collected on trauma, depression and socio-demographic-behavioural characteristics, in the local Luo language. Venous blood was taken for HIV and syphilis serology. Multivariable logistic regression was used to determine factors associated with HIV prevalence at baseline. RESULTS: A total of 2954 participants were eligible, of whom 2449 were enrolled. Among 2388 participants with known HIV status, HIV prevalence was 12.2% (95%CI: 10.8-13.8), higher in females (14.6%) than males (8.5%, p < 0.001), higher in Gulu (15.2%) than Nwoya (11.6%, p < 0.001) and Amuru (7.5%, p = 0.006) districts. In this post-conflict period, HIV infection was significantly associated with war trauma experiences (Adj. OR = 2.50; 95%CI: 1.31-4.79), the psychiatric problems of PTSD (Adj. OR = 1.44; 95%CI: 1.06-1.96), Major Depressive Disorder (Adj. OR = 1.89; 95%CI: 1.28-2.80) and suicidal ideation (Adj. OR = 1.87; 95%CI: 1.34-2.61). Other HIV related vulnerabilities included older age, being married, separated, divorced or widowed, residing in an urban district, ulcerative sexually transmitted infections, and staying in a female headed household. There was no evidence in this study to suggest that people with a history of abduction were more likely to be HIV positive. CONCLUSIONS: HIV prevalence in this post conflict-affected population is high and is significantly associated with age, trauma, depression, history of ulcerative STIs, and residing in more urban districts. Evidence-based HIV/STI prevention programs and culturally safe, gender and trauma-informed are urgently needed.

Intimate partner violence as seen in post-conflict eastern Uganda: prevalence, risk factors and mental health consequences.

BACKGROUND: Conflict and post-conflict communities in sub-Saharan Africa have a high under recognised problem of intimate partner violence (IPV). Part of the reason for this has been the limited data on IPV from conflict affected sub-Saharan Africa. This paper reports on the prevalence, risk factors and mental health consequences of IPV victimisation in both gender as seen in post-conflict eastern Uganda. METHODS: A cross-sectional survey was carried out in two districts of eastern Uganda. The primary outcome of IPV victimisation was assessed using a modified Intimate Partner Violence assessment questionnaire of the American Congress of Obstetricians and Gynaecologists. RESULTS: The prevalence of any form of IPV victimisation (physical and/or sexual and/or psychological IPV) in this study was 43.7 % [95 % CI, 40.1-47.4 %], with no statistically significant difference between the two gender. The factors significantly associated with IPV victimisation were: sub-county (representing ecological factors), poverty, use of alcohol, and physical and sexual war torture experiences. The mental health problems associated with IPV victimisation were probable problem alcohol drinking, attempted suicide and probable major depressive disorder. CONCLUSION: In post-conflict eastern Uganda, in both gender, war torture was a risk factor for IPV victimisation and IPV victimisation was associated with mental health problems.

Depressive symptoms and muscular fitness contribute independently to the ability to perform daily life activities in people with bipolar disorder.

BACKGROUND: Compared with healthy controls, people with bipolar disorder experience muscle weakness. The extent to which muscle weakness influences the performance of daily life activities such as walking in people with bipolar disorder requiring hospitalization is unclear. AIMS: The primary aim of the current study was to explore whether depressive symptoms and muscular fitness independently contribute to the walking capacity in people with bipolar disorder. A secondary aim was to identify variables that could explain the variability in muscular fitness. METHODS: Forty-two inpatients with bipolar disorder performed a standing broad jump test (SBJ), a measure of muscular performance, and the six minute walk test (6MWT) in addition to the International Physical Activity Questionnaire (IPAQ), the Depressive Symptomatology Self Report (QIDS) and a full-fasting metabolic screening. RESULTS: The correlation between the 6MWT (595.0 ± 127.3m) and SBJ (126.2 ± 48.6m) was high (r = 0.72, p < 0.001). In backward regression analyzes, 82.3% of the variance in 6MWT was explained by SJB, QIDS (7.6 ± 5.1) and the presence of metabolic syndrome (n = 16; 38%), while 83.0% of the variance in SBJ-score was explained by age, and the QIDS and IPAQ (1435.3 ± 1179.8 MET-min/week) scores. CONCLUSIONS: Depressive symptoms and muscular fitness contribute independently to daily life functioning in people with bipolar disorder. Thus, muscular rehabilitation strategies might offer a strategy for improving performance of daily life activities in this group.