Changing patterns of mental health knowledge in rural Kenya after intervention using the WHO mhGAP-Intervention Guide.

BACKGROUND: Despite the high prevalence of mental disorders, mental health literacy has been comparatively neglected. People's symptom-management strategies will be influenced by their mental health literacy. This study sought to determine the feasibility of using the World Health Organization mhGAP-Intervention Guide (IG) as an educational tool for one-on-one contact in a clinical setting to increase literacy on the specified mental disorders. METHODS: This study was conducted in 20 health facilities in Makueni County, southeast Kenya which has one of the poorest economies in Kenya. It has no psychiatrist or clinical psychologist. We recruited 3267 participants from a community that had already been exposed to community mental health services. We used Mental Health Knowledge Schedule to measure the changing patterns of mental health knowledge after a period of 3 months, following a training intervention using the WHO mhGAP-IG. RESULTS: Overall, there was a significant increase in mental health related knowledge [mean range 22.4-23.5 for both post-test and pre-test scores (p < 0.001)]. This increase varied with various socio-demographic characteristics such as sex, marital status, level of education, employment status and wealth index. CONCLUSIONS: mhGAP-IG is a feasible tool to increase mental health literacy in low-resource settings where there are no mental health specialists. Our study lends evidence that the WHO Mental Health Action Plan 2013-2020 and reduction of the treatment gap may be accelerated by the use of mhGAP-IG through improving knowledge about mental illness and potentially subsequent help seeking for early diagnosis and treatment.

[Psychiatric care of refugees in Africa and the Middle East : Challenges and solutions]. / Psychiatrische Versorgung von Flüchtlingen in Afrika und dem Nahen Osten : Herausforderungen und Lösungsansätze.

Violence, flight, famine, and natural disasters as well as the absence of a psychosocial healthcare system are major psychological burdens for refugees. The level of provision of mental healthcare is particularly low in developing countries. Internally displaced people and refugees place high demands on the healthcare system because they often suffer from psychiatric disorders, such as depression, posttraumatic stress disorder, and substance use disorders. We present first initiatives to improve psychiatric care in refugee camps in Ethiopia, Kenya, and Sudan. Moreover, we provide first insights into a project based in Northern Iraq and Germany aimed at the treatment of people who were severely traumatized by the terror regime of the so-called Islamic State (IS).

External built residential environment characteristics that affect mental health of adults.

External built residential environment characteristics include aspects of building design such as types of walls, doors and windows, green spaces, density of houses per unit area, and waste disposal facilities. Neighborhoods that are characterized by poor quality external built environment can contribute to psychosocial stress and increase the likelihood of mental health disorders. This study investigated the relationship between characteristics of external built residential environment and mental health disorders in selected residences of Nakuru Municipality, Kenya. External built residential environment characteristics were investigated for 544 residents living in different residential areas that were categorized by their socioeconomic status. Medically validated interview schedules were used to determine mental health of residents in the respective neighborhoods. The relationship between characteristics of the external built residential environment and mental health of residents was determined by multivariable logistic regression analyses and chi-square tests. The results show that walling materials used on buildings, density of dwelling units, state of street lighting, types of doors, states of roofs, and states of windows are some built external residential environment characteristics that affect mental health of adult males and females. Urban residential areas that are characterized by poor quality external built environment substantially expose the population to daily stressors and inconveniences that increase the likelihood of developing mental health disorders.

Feasibility of WHO mhGAP-intervention guide in reducing experienced discrimination in people with mental disorders: a pilot study in a rural Kenyan setting.

AimsStigma can have a negative impact on help-seeking behaviour, treatment adherence and recovery of people with mental disorders. This study aimed to determine the feasibility of the WHO Mental Health Treatment Gap Interventions Guidelines (mhGAP-IG) to reduce stigma in face-to-face contacts during interventions for specific DSM-IV/ICD 10 diagnoses over a 6-month period. METHODS: This study was conducted in 20 health facilities across Makueni County in southeast Kenya which has one of the poorest economies in the country and has no psychiatrist or clinical psychologist. We recruited 2305 participants from the health facilities catchment areas that had already been exposed to community mental health services. We measured stigma using DISC-12 at baseline, followed by training to the health professionals on intervention using the WHO mhGAP-IG and then conducted a follow-up DISC-12 assessment after 6 months. Proper management of the patients by the trained professionals would contribute to the reduction of stigma in the patients. RESULTS: There was 59.5% follow-up at 6 months. Overall, there was a significant decline in 'reported/experienced discrimination' following the interventions. A multivariate linear mixed model regression indicated that better outcomes of 'unfair treatment' scores were associated with: being married, low education, being young, being self-employed, higher wealth index and being diagnosed with depression. For 'stopping self' domain, better outcomes were associated with being female, married, employed, young, lower wealth index and a depression diagnosis. In regards to 'overcoming stigma' domain; being male, being educated, employed, higher wealth index and being diagnosed with depression was associated with better outcomes. CONCLUSIONS: The statistically significant (p < 0.05) reduction of discrimination following the interventions by trained health professionals suggest that the mhGAP-IG may be a useful tool for reduction of discrimination in rural settings in low-income countries.

Feasibility and effectiveness of nurses and clinical officers in implementing the WHO mhGAP intervention guide: Pilot study in Makueni County, Kenya.

OBJECTIVES: (1) To determine the feasibility and effectiveness of nurses and clinical officers in using the mental health Global Action Programme Intervention Guide (mhGAP-IG) as an intervention tool in reducing disability, improving quality of life in the clinical outcomes in patients with the mhGAP-IG priority mental disorders in a Kenyan rural setting. (2) To identify any gaps that can be contributed towards future research. METHODS: This study was conducted in 20 healthcare facilities across Makueni County in the South East of Kenya. This county had a population of approximately one million people, with no psychiatrist or clinical psychologist. We recruited 2306 participants from the healthcare facilities in the catchment areas that had previously been exposed to the community mental health awareness campaigns, while being subjected to screening for the mhGAP-IG disorders. We used the Mini-International Neuropsychiatric Interview for adults (MINI-Plus) for DSM-IV confirmatory diagnosis on those who screened positive on the mhGAP-IG. We measured disability using WHO-Disability Assessment Schedule II (DAS II), Quality of Life (QoL) using the WHO QoL-BREF, depression using Patient Health Questionnaire (PHQ-9), suicidality using The Beck Suicide Scale (BSS), psychosis using the Washington Early Recognition Center Affectivity and Psychosis (WERCAP), epilepsy using a seizure questionnaire and alcohol and substance abuse using The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). These measurements were at the baseline, followed by the training for the health professionals on using the WHO mhGAP-IG as an interventional tool. The measurements were repeated at 3 and 6 months post-intervention. RESULTS: Of the 2306 participants enrolled in the study, we followed 1718 at 3 months and 1371 at 6 months a follow-up rate of 74.5% and 59.4% respectively. All participants received psycho-education and most depending on condition also received medication. Overall, there was significant decline in disabilities, improvement in seizure control and improvement in clinical outcomes on the identified mental disorders. CONCLUSIONS: Trained, supervised and supported nurses and clinical officers can produce good outcomes using the mhGAP-IG for mental health.

Psychiatric morbidity among sexually abused children and adolescents.

OBJECTIVES: To describe the social demographic profile and identify psychiatric morbidity in sexually abused children and adolescents. DESIGN: A Cross-sectional descriptive survey. SETTING: Nairobi Women's Hospital (NWH) Gender Violence Recovery Centre (GVRC), Hurlingham, Nairobi-Kenya. SUBJECTS: A sample of 61 sexually abused children and adolescents aged 7-17 years. RESULTS: Eighty two percent of the survivors were sexually abused by acquaintances such as neighbours, caregivers and parents. Ninety percent of the sampled group were females. Abuse occurred in both single and both parent families and regardless of the guardian/parental economic status. Sixty six percent of the survivors' parents were abusing psychoactive substances. Sexual abuse variables and most of the social demographic variables did not predict either presence or absence of psychiatric morbidity. Only 66% of the abuse came to the notice of the child's caregiver within the first 48 hours. On the socio demographic profile, the only factor that showed a statistical significant difference in predicting presence or absence of psychiatric morbidity was the family's way of sorting out their disagreements (p = 0.045). The prevalence of psychiatric morbidity among the subjects studied as measured by the Diagnostic Statistical Manual Text Revision (DSM IV-TR) was found to be 69%. Eight different types of DSM IV-TR diagnoses were made. Twenty nine percent of the AXIS-I DSMIV-TR diagnoses were co-morbidities (Multiple DSM IV-TR diagnoses). CONCLUSIONS: The psychiatric morbidity prevalence is comparable to that found in other studies. Sexual abuse occurred regardless of the social demographic variables. Family's way of sorting out disagreement predicted presence or absence of psychiatric morbidity among the study subjects. Majority (82%) of the sexual abusers were acquaintances to the study subjects. RECOMMENDATIONS: It is recommended that all children and adolescents who have been sexually abused be evaluated for psychiatric morbidity regardless of their social demographic and abuse profiles and that all parents and care givers, be sensitised on childhood sexual abuse and the fact that majority of the perpetrators are acquaintances to the subjects. Families need to be sensitised on their role on prevention and reduction of psychiatric morbidity among children and adolescents in general.

A comparative study of psychotic and affective symptoms in Rwandan and Kenyan students.

AIMS: War and conflict are known to adversely affect mental health, although their effects on risk symptoms for psychosis development in youth in various parts of the world are unclear. The Rwandan genocide of 1994 and Civil War had widespread effects on the population. Despite this, there has been no significant research on psychosis risk in Rwanda. Our goal in the present study was to investigate the potential effects of genocide and war in two ways: by comparing Rwandan youth born before and after the genocide; and by comparing Rwandan and Kenyan adolescents of similar age. METHODS: A total of 2255 Rwandan students and 2800 Kenyan students were administered the Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen. Prevalence, frequency and functional impairment related to affective and psychosis-risk symptoms were compared across groups using univariate and multivariate statistics. RESULTS: Rwandan students born before the end of the genocide and war in 1994 experienced higher psychotic and affective symptom load (p's < 0.001) with more functional impairment compared with younger Rwandans. 5.35% of older Rwandan students met threshold for clinical high-risk of psychosis by the WERCAP Screen compared with 3.19% of younger Rwandans (χ 2 = 5.36; p = 0.02). Symptom severity comparisons showed significant (p < 0.001) group effects between Rwandan and Kenyan secondary school students on affective and psychotic symptom domains with Rwandans having higher symptom burden compared with Kenyans. Rwandan female students also had higher rates of psychotic symptoms compared with their male counterparts - a unique finding not observed in the Kenyan sample. CONCLUSIONS: These results suggest extreme conflict and disruption to country from genocide and war can influence the presence and severity of psychopathology in youth decades after initial traumatic events.

Psychiatric morbidity among convicted male sex offenders at Kamiti Prison, Kenya.

OBJECTIVES: To determine the prevalence and distribution of psychiatric morbidity among convicted male sex offenders and to establish factors associated with sexual offending. DESIGN: A Cross-sectional descriptive survey. SETTING: Kamiti Maximum Security Prison, Nairobi, Kenya. SUBJECTS: Seventy six male convicts. RESULTS: Forty seven (61.8%) had defilement-related convictions, 23 (30.3%) had rape-related, while six (7.9%) had other convictions. Twenty seven (35.5%) out of 76 had a DSM-IV Axis I disorder, majority of whom (71.1%) were dependent on or abused substances, and 26 (34.2%) had an Axis II disorder, most of whom had antisocial and impulsive personality disorders (46.2%). Of these 12 (15.8%) had an Axis I diagnosis alone, 11 (14.5%) had an Axis II diagnosis alone while 15 (19.7%) had both Axis I and II diagnoses, that is, co-morbidity. Exposure to erotica was statistically associated with both Axis I and II (p = 0.02 and p = 0.0003 respectively) and pre-occupation with thoughts about sex was associated with Axis II disorders (p = 0.01). CONCLUSIONS: Most of those with psychiatric morbidity targeted children and had antisocial or impulsive personality disorder. Awareness campaigns to enlighten the public of the fact that children are the most common victims and research to determine ways of treating and rehabilitating sexual offenders could reduce the vice.

Body dysmorphic disorder: case report.

The desire for self-mutilation in the absence of any discernible psychopathology is relatively rare. Self-mutilation is most commonly a manifestation of an underlying psychopathology such as depression, schizophrenia, personality disorder, transexuality, body dysmorphic disorder and factitious disorder. In this article, a case in which a 29-year-old single Kenyan lady of African origin demanded a surgical operation to modify and reduce the size of her external genitalia is presented. Although female genital mutilation is still widespread in the country, this case is of interest in that the woman did not seek the usual circumcision but sought to specifically reduce the size of her labia minora so that she could feel like a normal woman. The unique challenges in her management are discussed. Possible aetiological factors in patients who demand surgical removal or modification of parts of their bodies without an obvious cause is discussed.

Post traumatic stress disorder among Mau Mau concentration camp survivors in Kenya.

BACKGROUND: A decade before Kenya's independence in 1963 thousands of 'Mau Mau' fighters were arrested and incarcerated in concentration camps where many underwent torture and inhuman treatment. No studies have been done to establish the presence of post traumatic stress disorder (PTSD) and other psychiatric morbidity among the survivors of those concentration camps. OBJECTIVES: To establish the prevalence of PTSD and other psychiatric morbidity and associated factors among the Mau Mau Concentration Camp survivors. DESIGN: A cross-sectional, descriptive study of all consecutive concentration camp survivors included in the study. SETTING: Mau Mau War Veterans' Association (MMWVA) headquarters at Mwea House, Nairobi, Kenya Human Rights Commission headquarters in Nairobi, Tumaini House (Venue of MMWVA elections, 2005) and the MMWVA branch office in Kajiado District, Rift Valley Province, Kenya. SUBJECTS: One hundred and eighty one Mau Mau Concentration Camp Survivors who gave consent to participate in the study. MAIN OUTCOME MEASURES: Lifetime and Current PTSD, IES-R score and other Psychiatric Morbidity as measured using the SCID and the IES-R. RESULTS: A DSM-IV-TR diagnosis of current PTSD was made in 65.7% of the survivors. Current PTSD was associated with higher IES-R scores and older age, lower income, non-Catholic religion, larger household size, older age at incarceration, greater length of incarceration, incarceration in two or more camps, experiencing other traumatic events, family history of mental illness and having other psychiatric illness. CONCLUSIONS: Similar to other former Prisoners of War (POWs) elsewhere, these survivors suffer high PTSD prevalence rates and a special veterans' service is recommended to address this problem and its associated factors among these and other veterans in Kenya.

Psychometric properties of an African symptoms check list scale: the Ndetei-Othieno-Kathuku scale.

OBJECTIVES: To profile and quantify the psychometric properties of the NOK (Ndetei-Othieno-Kathuku) scale against internationally used Gold-standards and benchmarks for mild psychiatric disorders and post-traumatic stress disorders and to provide a potential easy to administer culture sensitive instrument for screening and assessing those with possible psychiatric disorders for the Kenyan and similar social-cultural situations. DESIGN: Cross-Sectional quantitative study. SETTING: A psychiatric clinical consultation setting and Kyanguli Secondary School psychotrauma counselling clinical set-up. SUBJECTS: Survivors of the Nairobi USA Embassy bombing who were referred for psychiatric treatment and survivors of a fire disaster from a rural Kenyan school (Kyanguli School fire disaster) including students, parents of the diseased children and staff members. RESULTS: Positive correlation was found between the NOK and all the instruments. The highest correlations were between the NOK and the BDI and SCL-90 (r = 0.557 to 0.786). The differences between the NOK scores among the different groups were statistically significant (F ratio = 13.54 to 160.34, p < 0.01). The reliability coefficient (internal consistency) of the scale, alpha = 0.9733. Other item statistics and correlations of the scale are discussed. CONCLUSION: It is concluded that the NOK has high concurrent and discriminant validity as well as a high internal consistency and that it can be used for the rapid assessment of psychotrauma victims of all age groups; and stress in general in similar age groups in the local setting. It is culture appropriate and sensitive.

Substance use among children and young persons appearing in the Nairobi Juvenile Court, Kenya.

OBJECTIVE: To estimate the prevalence and pattern of substance use among children and young persons appearing in the Nairobi Juvenile Court, Kenya. DESIGN: A point prevalence survey. SETTING: The Nairobi Juvenile Court, Kenya. SUBJECTS: Ninety (sixty four males and twenty six females) children and young persons aged 8 to 18 years classified as criminal offenders, group I (60) and those for protection and discipline, group II (30), were selected. METHOD: Socio-demographic and substance use questionnaires were administered to the subject. International classification of diseases, 10th Edition (ICD-10) diagnostic criteria were used. RESULTS: Crude rate for substance use in this study was found to be 39 out of the total sample of 90(43.3%), children and young persons. Of these thirty nine, 33 (85.8%) were males and six(14.2%) were females. Twenty nine (32.2%) used nicotine, 19(21.1%) used volatile hydrocarbons, 8(8.9%) used cannabis six (6.7%) used alcohol, five (5.6%) used khat and three (3.3%) used sedatives. Multiple substance use was also evident. CONCLUSION: This study has shown a high presence of substance use in children and young persons appearing in the Nairobi Juvenile Court.

Substance abuse in outpatients attending rural and urban health centres in Kenya.

OBJECTIVES: To estimate the prevalence and pattern of substance use among patients attending primary health centres in urban and rural areas of Kenya. DESIGN: A descriptive cross-sectional prevalence survey. SETTING: Urban health centres of Jericho and Kenyatta University (KU) and rural health centres in Muranga district. SUBJECTS: One hundred and fifty adult patients (seventy eight males and seventy two females) were included in the study. INTERVENTION: Semi-structured questionnaires and the DSM IV diagnostic criteria were used to record the socio-demographic data and to determine substance dependence or abuse. RESULTS: The substances commonly used in descending order of frequency were alcohol, tobacco, khat and cannabis. Only alcohol and tobacco were extensively used. Lifetime prevalence rates of alcohol use for the two urban health centres were 54% and 62% compared to 54% for the rural health centres. For tobacco the lifetime prevalence rates were 30% for Jericho, 28% for KU and 38% for Muranga. The differences between the rural and urban samples were not statistically significant. More males than females had used alcohol (average lifetime use 80.8% for males compared to 30.6% for females: p<0.05) and tobacco (average lifetime use 56.4% for males compared to 5.6% for females p<0.05). CONCLUSION: The rates of substance abuse were generally low with the exception of alcohol and tobacco. Socio-cultural factors might be responsible for the differences noted. It is suggested that preventive measures and education should be emphasised at the primary care level.

Psychiatric morbidity among children and young persons appearing in the Nairobi Juvenile Court, Kenya.

OBJECTIVES: To estimate the prevalence and pattern of psychiatric disorders among children and young persons appearing in the Nairobi juvenile court, Kenya. DESIGN: A point prevalence survey. SETTING: The Nairobi Juvenile Court, Kenya. SUBJECTS: Ninety (sixty-four males and twenty-six females) children and young persons aged 8 to 18 years classified as criminal offenders, group I (60), and those for protection and discipline, group II (30), were selected. METHOD: A socio-demographic questionnaire, reporting questionnaire for children (RQC), follow-up interview for children (FIC), present state examination (PSE) and clinical interview were administered to the subjects. International Classification of Diseases, 10th Edition (ICD-10) diagnostic criteria were used. RESULTS: The crude psychiatric morbidity (CPM) rate was 44.4%. ICD-10 documented psychiatric disorders detected in those with CPM were conduct disorders 45%, mixed disorders of conduct and emotion 20%, emotional disorders with onset specific to childhood 20%, mood disorders 12.5% and hyperkinetic disorders 2.5%. CONCLUSION: This study has shown a high presence of psychiatric morbidity in children and young persons appearing in the Nairobi Juvenile Court. These juveniles need and would benefit from mental treatment as recommended in section 18 of Cap 141 of the laws of Kenya; The Children's and Young Persons Act.

Study of psychiatric consequences of closed head injury at the Kenyatta National Hospital.

This was a study to compare the psychiatric consequences of closed head injury (CHI) in 37 patients with 39 demographically similar patients with fractured lower limb injury (FLLI), aged 16-55 years. The outcome measures were the Clinical Interview Schedule-Revised, the Bender Gestalt Test and the WHO AUDIT Core for alcohol abuse. The final diagnoses were made according to DSM-III-R diagnostic criteria. The findings indicated that CHI patients suffered more psychiatric consequences than FLLI controls (OR = 4.07; 95% CI = 1.30:13.14; p = 0.013). Depression and anxiety disorders were the most common problems encountered in these subjects.

Post traumatic stress disorder among motor vehicle accident survivors attending the orthopaedic and trauma clinic at Kenyatta National Hospital, Nairobi.

OBJECTIVES: To determine the prevalence rate of post traumatic stress disorder (PTSD) and associated risk factors among motor vehicle accident (MVA) survivors attending the orthopaedic and trauma clinic at Kenyatta National Hospital, Nairobi. DESIGN: A cross-sectional study. SETTING: Kenyatta National Hospital, Nairobi. SUBJECTS: One hundred and ninety seven adult males and sixty seven female patients. METHOD: The 264 patients were interviewed using a questionnaire to collect the socio-demographic data, the Self Rating Questionnaire (SRQ) and the Impact of Event Scale-Revised (IES-R). Diagnosis was made using the Diagnostic and Statistical Manual (DSM-IV). RESULTS: The mean age was 34.63+/-12.71 years (range 18-65). Overall, the prevalence rate of PTSD was 13.3%. None of the cases had been previously diagnosed as having PTSD. Females had a higher rate of 17.9% (n = 67), compared to the males 11.7% (n=197). The majority of those with PTSD (42.9%) were young, 20 - 29 years. Other risk factors were having post-primary education (62.9%), experiencing the first motor vehicle accident (14.1%), previous psychiatric illness, and other medical illnesses. The type of accident, role/status and immediate reactions to the accident were not significant. CONCLUSIONS: PTSD following motor vehicle accidents is common. Although the MVA survivors do develop significant rates of PTSD, it is not easy to identify those at risk but some of the parameters documented in this study may help. A multi disciplinary approach is therefore essential in the management of the RTA survivors at the orthopaedic and trauma clinics if their physical and psychological needs are to be adequately addressed

The relationship between schizoaffective, schizophrenic and mood disorders in patients admitted at Mathari Psychiatric Hospital, Nairobi, Kenya.

OBJECTIVE: The prevalence of schizoaffective disorder (SAD) and the relationship between schizophrenia (SCZ), SAD and mood disorders (MD) in non-Western countries is unknown. To determine the prevalence of SAD and the relationship between SCZ, SAD and MD in relation to socio-demographic, clinical and therapeutic variables in 691 patients admitted at Mathari Psychiatric Hospital, Kenya. METHOD: A cross-sectional comparative study using both clinician and SCID-1 for DSM-IV diagnoses. RESULTS: Approximately twenty three percent (n=160) met DSM-IV criteria for SAD using SCID-1. There were significant differences between SCZ, SAD and MD regarding: affective and core symptoms of schizophrenia (with the exception of core symptoms of schizophrenia between SCZ and SAD); presence of past trauma; a past suicide attempt; and comorbidity with alcohol and drug abuse disorders. SAD and MD patients took significantly more mood stabilizers than SCZ patients. There were no significant differences between the three groups regarding socio-demographic variables, brief psychiatric rating scale scores, cognitive performance, anxiety and depressive symptoms, presence of obsessions, and usage of both antipsychotics and antidepressants. CONCLUSION: There is no distinct demarcation between the three disorders. This lends support to recent evidence suggesting that SAD might constitute a heterogeneous group composed of both SCZ and MD patients or a middle point of a continuum between SCZ and MD.

Traditional healers and provision of mental health services in cosmopolitan informal settlements in Nairobi, Kenya.

OBJECTIVE: The study aimed to investigate the types of mental illnesses treated by traditional healers, and their methods of identifying and treating mental illnesses in their patients. METHOD: In urban informal settlements of Kibera, Kangemi and Kawangware in Nairobi, Kenya, we used opportunistic sampling until the required number of traditional healers was reached, trying as much as possible to represent the different communities of Kenya. Focus group discussions were held with traditional healers in each site and later an in-depth interview was conducted with each traditional healer. An in-depth interview with each patient of the traditional healer was conducted and thereafter the MINIPLUS was administered to check the mental illness diagnoses arrived at or missed by the traditional healers. Quantitative analysis was performed using SPSS while focus group discussions and in-depth interviews were analysed for emerging themes. RESULTS: Traditional healers are consulted for mental disorders by members of the community. They are able to recognize some mental disorders, particularly those relating to psychosis. However, they are limited especially for common mental disorders. CONCLUSION: There is a need to educate healers on how to recognize different types of mental disorders and make referrals when patients are not responding to their treatments.

The prevalence of depressive symptoms among adolescents in Nairobi public secondary schools: association with perceived maladaptive parental behaviour.

OBJECTIVE: Depression in adolescents is a matter of concern because of its high prevalence, potential recurrence and impairment of functioning in the affected individual. The study sought to determine the prevalence of depressive symptoms among adolescents in Nairobi (Kenya) public secondary schools; make a comparison between day and boarding students; and identify associated factors in this population. METHOD: A random sample of school going adolescents was taken from a stratified sample of 17 secondary schools out of the 49 public secondary schools in Nairobi province. The sample was stratified to take into account geographical distribution, day and boarding schools, boys only, girls only and mixed (co-education) schools in the capital city of Kenya. Self administered instruments (EMBU and CDI) were used to measure perceived parental behaviour and levels of depression in a total of 1,276 students excluding those who had no living parent. RESULTS: The prevalence of clinically significant depressive symptoms was 26.4%. The occurrence was higher in girls than it was in boys p<0.001. Students in boarding schools had more clinically significant depressive symptoms compared to day students (p=0.01). More girls exhibited suicidal behaviour than boys (p<0.001). There was a significant correlation between depressive symptoms and suicidal behaviour (p<0.001). CDI scores correlated positively with age (p<0.001) with an increase in CDI score with unit increase in age among students 14-17 years old, perceived rejecting maternal parenting behaviour (p<0.001), perceived no emotional attachment paternal behaviour (p<0.001), perceived no emotional attachment maternal behaviour (p<0.001), and perceived under protective paternal behaviour (p=0.005). CONCLUSION: Perceived maladaptive parental behaviours are substantially associated with the development of depressive symptoms and suicidal behaviour in children.

Knowledge, attitude and practice (KAP) of mental illness among staff in general medical facilities in Kenya: practice and policy implications.

OBJECTIVE: To determine the knowledge, attitudes and beliefs about mental illness among staff in general hospitals. METHOD: A descriptive cross-sectional study conducted on staff in ten medical facilities in Kenya on their socio-demographic characteristics, professional qualifications and knowledge, attitudes and practice (KAP) toward mental illness. RESULTS: A total of 684 general hospital staff: nurses (47.8%); doctors (18.1%); registered clinical officers (5.1%); students (9.5%) and support staff (19.5%) were recruited. About three quarters were under 40 years of age; most thought mental illness could be managed in general hospital facilities; the older the doctors were (age 40 years and older) the more they were aware of and positive towards mental illness. Most of the workers did not suspect any psychiatric symptoms among the patients they treated resulting in low referral rates for psychiatric services. CONCLUSION: There are gaps in knowledge on mental illness which could be constructively filled with Continued Medical Education (CME).