Co-morbid mental health conditions in people with epilepsy and association with quality of life in low- and middle-income countries: a systematic review and meta-analysis.

BACKGROUND: Comorbid mental health conditions are common in people with epilepsy and have a significant negative impact on important epilepsy outcomes, although the evidence is mostly from high-income countries. This systematic review aimed to synthesise evidence on the association between comorbid mental health conditions and quality of life and functioning among people with epilepsy living in low- and middle income countries (LMICs). METHODS: We searched PubMed, EMBASE, CINAHL, Global Index medicus (GID) and PsycINFO databases from their dates of inception to January 2022. Only quantiative observational studies were included. Meta-analysis was conducted for studies that reported the same kind of quality of life and functioning outcome. Cohen's d was calculated from the mean difference in quality-of-life score between people with epilepsy who did and did not have a comorbid depression or anxiety condition. The protocol was registered with PROSPERO: CRD42020161487. RESULTS: The search strategy identified a total of 2,101 articles, from which 33 full text articles were included. Depression was the most common comorbid mental health condition (33 studies), followed by anxiety (16 studies). Meta-analysis was conducted on 19 studies reporting quality of life measured with the same instrument. A large standardized mean effect size (ES) in quality of life score was found (pooled ES = -1.16, 95% confidence interval (CI) - 1.70, - 0.63) between those participants with comorbid depression compared to non-depressed participants. There was significant heterogeneity between studies (I2 = 97.6%, p < 0.001). The median ES (IQR) was - 1.20 (- 1.40, (- 0.64)). An intermediate standard effect size for anxiety on quality of life was also observed (pooled ES = -0.64, 95% CI - 1.14, - 0.13). There was only one study reporting on functioning in relation to comorbid mental health conditions. CONCLUSION: Comorbid depression in people with epilepsy in LMICs is associated with poor quality of life although this evidence is based on highly heterogeneous studies. These findings support calls to integrate mental health care into services for people with epilepsy in LMICs. Future studies should use prospective designs in which the change in quality of life in relation to mental health or public health interventions across time can be measured.

Assessing cognition in people with severe mental disorders in low- and middle-income countries: a systematic review of assessment measures.

BACKGROUND: Cognitive difficulties are common in people with severe mental disorders (SMDs) and various measures of cognition are of proven validity. However, there is a lack of systematic evidence regarding the psychometric properties of these measures in low- and middle-income countries (LMICs). OBJECTIVE: To systematically review the psychometric properties of cognitive measures validated in people with SMDs in LMICs. METHODS: We conducted a systematic review of the literature by searching from four electronic databases. Two authors independently screened studies for their eligibility. Measurement properties of measures in all included studies were extracted. All eligible measures were assessed against criteria set for clinical and research recommendations. Results are summarized narratively and measures were grouped by measurement type and population. RESULTS: We identified 23 unique measures from 28 studies. None of these was from low-income settings. Seventeen of the measures were performance-based. The majority (n = 16/23) of the measures were validated in people with schizophrenia. The most commonly reported measurement properties were: known group, convergent, and divergent validity (n = 25/28). For most psychometric property, studies of methodological qualities were found to be doubtful. Among measures evaluated in people with schizophrenia, Brief Assessment of Cognition in Schizophrenia, Cognitive Assessment Interview, MATRICS Consensus Cognitive Battery, and CogState Schizophrenia Battery were with the highest scores for clinical and research recommendation. CONCLUSIONS: Studies included in our review provide only limited quality evidence and future studies should consider adapting and validating measures using stronger designs and methods. Nonetheless, validated assessments of cognition could help in the management and allocating therapy in people with SMDs in LMICs.

Impact of depression on self-efficacy, illness perceptions and self-management among people with type 2 diabetes: A systematic review of longitudinal studies.

BACKGROUND: Treating comorbid depression does not always improve outcomes for people with type 2 diabetes. Evidence is lacking on potential psychological and behavioural intermediaries of the impact of depression on diabetes outcomes. OBJECTIVE: To synthesise evidence on the impact of comorbid depression on self-efficacy, illness perceptions, and self-management in people with type 2 diabetes. DATA SOURCES: We searched PubMed, Embase, PsycINFO, and Global Health databases from inception up to 29th March 2023. STUDY ELIGIBILITY CRITERIA: Only prospective studies (cohort or intervention studies) were included, with no restrictions on language. The outcomes were self-efficacy, illness perceptions, and self-management. PARTICIPANTS: People with type 2 diabetes in community or health settings. EXPOSURE: Comorbid depression or depressive symptoms in people with type 2 diabetes. SYNTHESIS OF RESULTS: A narrative review of heterogeneous studies. RISK OF BIAS: The risk of bias was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies. RESULTS: Twenty-five studies were included, all from high-income countries. Depression was associated with lower self-efficacy (2 studies), poor illness perception (1 study), and poor self-management practices (17 studies) in people with type 2 diabetes. In 6/7 studies, depressive symptoms predicted less adherence to dietary recommendations, 8/10 studies found depressive symptoms were associated with poor medication adherence, 1/3 study found that depressive symptoms were associated with poor weight control, 3/4 with less physical exercise, and 2/3 with general self-care practices. LIMITATIONS: There were no studies from low- and middle-income countries and non-Western settings, and we cannot assume the mechanisms linking comorbid depression with diabetes outcomes are similar. CONCLUSIONS: Comorbid depression was associated with lower self-efficacy, poorer self-management, and less adaptive illness perceptions among people with diabetes.

Depressive Symptoms among Haramaya University Students in Ethiopia: A Cross-Sectional Study.

BACKGROUND: The prevalence of mental health problems including depression is increasing in severity and number among higher institution students, and it has a lot of negative consequences like poor academic performance and committing suicide. Identifying the prevalence and associated factors of mental illness among higher institution students is important in order to administer appropriate preventions and interventions. In Ethiopia, only a few studies tried to report associated factors of depression among university students. OBJECTIVE: The objective of this study was to determine the prevalence and factors associated with depressive symptoms among Haramaya University students, Ethiopia. METHODS: Institution-based, cross-sectional study design was conducted among 1040 students. A standard, self-administered questionnaire was used to get data from a sample of randomly selected 1040 undergraduate university students using a multistage systematic random sampling technique. The questionnaire used was the Beck Depression Inventory (BDI) scale which is a self-report 21-item scale that is used to assess the presence of depressive symptoms. All 21 items are rated on a three-point scale (0 to 3). Each question is scored on a 0 to 3 scale, and total scores range from 0 to 63, with higher scores reflecting greater levels of depressive symptoms. The questionnaire has been well validated as a measure of depressive symptomatology with scores 1-13 indicating minimal depressive symptoms, 14-19 showing mild depressive symptoms, 20-28 showing moderate depressive symptoms, and 29-63 indicating severe depressive symptoms. Logistic regression analysis was used to identify variables independently associated with depressive symptoms after we dichotomized the depressive symptoms screening tool to "yes/no" depressive symptoms. This means students who did not report any depressive symptoms were given "no" depressive symptoms and who reported at least one (≥1) depressive symptoms were given "yes" (depressive symptoms). RESULTS: A total of 1022 (98.3%) out of 1040 students participated in this study. The mean age of participants was 20.9 years (SD ± 2.17), and the majority of them (76.0%) were male students. Prevalence of depressive symptoms among undergraduate students was 26.8% (95% CI: 24.84, 28.76). Among those who had reported depressive symptoms: 10%, 12%, 4%, and 1% of students reported minimal, mild, moderate, and severe depressive symptoms, respectively. Multivariable logistic regression analysis in the final model revealed that being a first-year student (AOR 6.99, 95% CI: 2.31, 21.15, p value < 0.001), being a second-year student (AOR 6.25, 95% CI: 2.05, 19.07, p value < 0.001), being a second-year student (AOR 6.25, 95% CI: 2.05, 19.07, p value < 0.001), being a second-year student (AOR 6.25, 95% CI: 2.05, 19.07, p value < 0.001), being a second-year student (AOR 6.25, 95% CI: 2.05, 19.07, p value < 0.001), being a second-year student (AOR 6.25, 95% CI: 2.05, 19.07, p value < 0.001), being a second-year student (AOR 6.25, 95% CI: 2.05, 19.07, p value < 0.001), being a second-year student (AOR 6.25, 95% CI: 2.05, 19.07. CONCLUSIONS: The prevalence of depressive symptoms among university students in this study is high relative to the general population. Sociodemographic factors year of study and current substance use were identified as associated factors of depressive symptoms. Recommendations. This finding suggests the need for the provision of mental health services at the university, including screening, counseling, and effective treatment. Families need to closely follow their students' health status by having good communication with the universities, and they have to play their great role in preventing depression and providing appropriate treatment as needed. The governments and policy-makers should stand with universities by supporting and establishing matured policies which helps universities to have mental health service centers. Generally, the university and other stakeholders should consider these identified associated factors for prevention and control of mental health problems of university students.

Substance Use and Associated Factors among University Students in Ethiopia: A Cross-Sectional Study.

Studies indicate that substance use among Ethiopian adolescents is considerably rising; in particular college and university students are the most at risk of substance use. The aim of the study was to assess substance use and associated factors among university students. A cross-sectional survey was carried out among 1040 Haramaya University students using self-administered structured questionnaire. Multistage sampling technique was used to select students. Descriptive statistics, bivariate, and multivariate analysis were done. About two-thirds (62.4%) of the participants used at least one substance. The most commonly used substance was alcohol (50.2%). Being male had strong association with substance use (AOR (95% CI), 3.11 (2.20, 4.40)). The odds of substance use behaviour is higher among third year students (AOR (95% CI), 1.48 (1.01, 2.16)). Being a follower of Muslim (AOR (95% CI), 0.62 (0.44, 0.87)) and Protestant (AOR (95% CI), 0.25 (0.17, 0.36)) religions was shown to be protective of substance use. Married (AOR (95% CI), 1.92 (1.12, 3.30)) and depressed (AOR (95% CI), 3.30 (2.31, 4.72)) students were more likely to use substances than others. The magnitude of substance use was high. This demands special attention, emergency preventive measures, and targeted information, education and communication activity.