Psychotherapy training in postgraduate psychiatry training in Nigeria - Are we doing enough?

Introduction: Nigeria, with an estimated 40 million people living with mental disorders, faces a critical shortage of psychiatrists to address the significant burden. Despite psychotherapy being integral to psychiatric training, it lacks structure, consistency and adequate supervision. This is alarming, particularly given the substantial demand for specialized psychotherapeutic support among those with mental illness. Methodology: A cross-sectional study utilised an online survey targeting early career psychiatrists recruited from the Early Career Psychiatrists section of the Association of Psychiatrists in Nigeria. Results: The questionnaire was distributed to 252 early career psychiatrists across Nigeria, with a 42.9% response rate, of which 50% were male, with 73.2% trainees and 26.8% early career psychiatrists. While 52.8% had received some psychotherapy training, only 2.8% were qualified psychotherapists. Notably, only 27.6% of those with psychotherapy training had over 100 hours of training. Factors such as receiving psychotherapy training during postgraduate training and having supervised psychotherapy training were found significant for having independent psychotherapy training. Conclusions: There is little emphasis on psychotherapy training in the postgraduate training in Nigeria. Those who had full training in psychotherapy were self-sponsored. Structured, supervised and mandatory psychotherapy within psychiatry training curriculum is recommended.

Workforce migration and brain drain - A nationwide cross-sectional survey of early career psychiatrists in Nigeria.

Background: Nigeria's shortage of psychiatrists is exacerbated due to health worker migration. Aim: This study explores migration experiences and tendencies among early-career psychiatrists in Nigeria. Methods: We conducted a cross-sectional survey covering Nigeria's six geopolitical zones, using a 61-item online questionnaire assessing short-term mobility, long-term migration experiences and migration attitudes. Data was analysed using IBM SPSS version 29. Results: Of 228 early-career psychiatrists surveyed, 9.7% had short-term mobility and 8.0% had long-term migration experiences. However, 85.8% had 'ever' considered migration, 69.2% were planning to leave 'now', and 52.9% had taken 'practical migration steps'. Over half (52.7%) said they would be working abroad in 5 years, with 25.2% indicating they would migrate within a year. The top reasons to leave were financial and academic, while personal and cultural factors were the key reasons to stay. Income dissatisfaction (OR = 2.27, 95%, CI = 1.05-4.88) predicted planning to leave 'now', while being in a relationship (OR = 3.46, 95%CI = 1.06-11.30) predicted taking 'practical migration steps'. Attractive job features were good welfare (85.4%) and high salaries (80.3%). Improvements in finances (90.8%) and work conditions (86.8%) were requested. Conclusions: Systemic changes to address psychiatrists' migration from Nigeria are needed.

Burnout: A predictor of oral health impact profile among Nigerian early career doctors.

There have been reported association of oral health disorders with burnout, stress, and mental health. Arguably, with these reported associations, and the current prevalence of burnout amongst Nigerian doctors, exploring the role of burnout on oral health amongst Nigerian doctors is timely. This study aims to determine the relationship between burnout and oral health-related quality of life amongst Early Career Doctors (ECDs) in Nigeria, while also identifying the role other possible predictors plays in this relationship. This was a cross-sectional study conducted amongst Nigerian ECDs as part of Challenges of Residency Training in Nigeria (CHARTING) II project. A total of 632 ECDs were recruited across thirty-one tertiary hospitals in the 6 geopolitical zones of the country using a multistage cluster sampling technique. A self-administered paper-based semi-structured questionnaire was given to each participant that consented. The tools used to assess burnout and Oral health-related quality of life (OHRQoL) were Copenhagen Burnout Inventory (CBI) and Oral Health Impact Profile (OHIP-14) respectively. Independent samples T-test, ANOVA and Multiple linear regression were used to draw inferences from the data collected. Overall mean OHIP-14 score of all participants was 11.12 (±9.23). The scores for the 3 dimensions of burnout were below 50% with CBI-Personal Burnout having the highest score of 49.96 (±19.15). Significant positive correlations (p < 0.001) were found between OHIP-14 and all the dimensions of burnout, as the burnout scores were increasing, there was a corresponding increase in the OHIP scores thus poorer OHRQoL. The regression model shows that the predictors of OHIP were CBI-PB (p = 0.003), use of fluoride paste (p = 0.039), use of tobacco (p = 0.005) and being a denture user (p = 0.047). This study shows a positive correlation between burnout and OHIP of ECDs. We found that as burnout was increasing, OHIP increased thus implying poorer oral health related quality of life amongst ECDs. The use of fluoride toothpaste, tobacco and denture are other factors we found that could affect the OHIP of ECDs.

Health, well-being, and burnout amongst Early Career Doctors in Nigeria.

BACKGROUND: Early Career Doctors (ECDs) in Nigeria are faced with many individual and systemic problems, which consequently adversely affect their health, well-being, patient care and safety. OBJECTIVE: This study, the second phase of the Challenges of Residency Training and Early Career Doctors in Nigeria (CHARTING II) Study, sought to examine the risk factors and contributors to the health, well-being and burnout amongst Nigerian ECDs. METHODS: This was a study of health, well-being and burnout amongst Nigerian ECDs. Outcome variables included burnout, depression, and anxiety, which were respectively assessed using the Copenhagen Burnout Inventory (CBI) and Oldenburg Burnout Inventory (OLBI), Patient Health Questionnaire (PHQ-9) depression scale, and Generalized Anxiety Disorder (GAD-7) scale. The quantitative data obtained was analysed using the IBM SPSS, version 24. Associations between categorical outcome and independent variables were assessed using chi square, with level of significance set at < 0.05. RESULTS: The mean body mass index (BMI), durations of smoking and alcohol consumption of the ECDs were 25.64 ± 4.43 kg/m2 (overweight range), 5.33 ± 5.65 years and 8.44 ± 6.43 years respectively. Less than a third (157, 26.9%) of the ECDs exercised regularly. The most common disease conditions affecting the ECDs were musculoskeletal (65/470, 13.8%) and cardiovascular diseases (39/548, 7.1%). Almost a third (192, 30.6%) of the ECDs reported experiencing anxiety. Male and lower cadre ECDs were more likely than female and higher cadre ECDs to report anxiety, burnout and depression. CONCLUSION: There is an urgent need to prioritize the health and well-being of Nigerian ECDs, so as to optimize patient care and improve Nigeria's healthcare indices.