Umbrella Review of the Global Prevalence of Conduct Disorder in Children and Adolescents.

With the ever-increasing prevalence of mental health issues worldwide, a robust synthesis of existing epidemiological data on the prevalence of Conduct disorder (CD) in children and adolescents is needed to strengthen the knowledge base. This quantitative umbrella review aims to provide a robust synthesis of evidence on the prevalence of CD children and adolescents from meta-analytic systematic reviews. We searched PubMed, Web of Science, PsychINFO, and Scopus to identify relevant articles. The study protocol has been registered with PROSPERO (CRD42023447620). The methodological quality of the studies was evaluated by using a Measurement Tool to Assess Systematic Reviews (AMSTAR). Invariance variance weighted random-effect meta-analysis was performed to pool prevalence estimates from the included articles. Seven meta-analyses, encompassing 138 primary studies and slightly over 48 million CD cases were included in this umbrella review. The quantitative analysis of these studies found a pooled prevalence of CD 3.0% (95%CI 2.0-5%) in children and adolescents, based on random effect meta-analyses. In a stratified analysis, the prevalence estimate of CD was 2.6 times higher in boys compared to girls. Evidence from our quantitative umbrella review showed that the prevalence of CD is relatively high in children and adolescents with boys 2.6 times more likely to experience the disorders when compared to girls. Our findings underlie that attention should be given to preventing, identifying, and treating CD in children and adolescents.

Prevalence of attention deficit hyperactivity disorder in adults: Umbrella review of evidence generated across the globe.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a class of neurodevelopmental disorders which is commonly diagnosed in school-age children, but it can occur in any age group. To provide a robust synthesis of published evidence on the prevalence of ADHD in adults, we conducted an umbrella review of systematic reviews and meta-analyses. METHODS: The review was guided by preferred reporting items for systematic review and meta-analysis (PRISMA). We searched PsychINFO, Web of Science, PubMed, and Scopus to retrieve pertinent studies. The review protocol was registered with PROSPERO (CRD42023389704). A Measurement Tool to Assess Systematic Reviews (AMSTAR) was used to assess the quality of the included studies. A random-effects model was used to perform a meta-analysis. RESULTS: Five systematic reviews and meta-analyses (57 unique primary studies) with data on 21,142,129 adult participants were eligible for inclusion in this umbrella review. Inverse variance weighted random effect meta-analysis of these studies indicated that the pooled prevalence of ADHD in adults was 3.10% (95%CI 2.60-3.60%). ADHD-I (the inattentive type of ADHD) remained the commonest type of ADHD, followed by ADHD-HI (the hyperactive type) and ADHD-C (the combined type). CONCLUSION: The results indicate that ADHD is relatively high in adults, with ADHD-I remaining the most common subtype. Attention should be given to preventing, reducing, identifying, and managing ADHD in adults.

The global prevalence of attention deficit hyperactivity disorder in children and adolescents: An umbrella review of meta-analyses.

BACKGROUND: Emerging epidemiological data suggest that hundreds of primary studies have examined the prevalence of ADHD in children and adolescents and dozens of systematic view and meta-analyses studies have been conducted on the subject. The purpose of this umbrella review is to provide a robust synthesis of evidence from these systematic reviews and meta-analyses. METHODS: We systematically searched PubMed, Web of Science, PsychINFO, and Scopus to find pertinent studies. The study was preregistered with PROSPERO (CRD42023389704). The quality of the studies was assessed using a Measurement Tool to Assess Systematic Reviews (AMSTAR). Prevalence estimates from the included studies were pooled using invariance variance weighted random-effect meta-analysis. RESULTS: Thirteen meta-analytic systematic reviews (588 primary studies) with 3,277,590 participants were included in the final analysis. A random effect meta-analysis of these studies showed that the global prevalence of ADHD in children and adolescents was 8.0 % (95%CI 6.0-10 %). The prevalence estimate was twice higher in boys (10 %) compared to girls (5 %). Of the three subtypes of ADHD, the inattentive type of ADHD (ADHD-I) was found to be the most common type of ADHD followed by the hyperactive (ADHD-HI) and the combined types (ADHD-C). CONCLUSION: Findings from our compressive umbrella review suggest that ADHD is highly prevalent in children and adolescents with boys twice more likely to experience the disorder than girls. Our results underpin that priority should be given to preventing, early identifying, and treating ADHD in children and adolescents.

Maternal psychological distress and associated factors among pregnant women attending antenatal care at public hospitals, Ethiopia.

OBJECTIVE: Mothers who have endured psychological distress during pregnancy are more likely to have cognitive and behavioral issues for their baby, and are at greater risk for subsequent mental health problems for themselves. The aim of this study is to evaluate the prevalence of psychological distress during pregnancy in women attending antenatal clinics in Addis Ababa public hospitals and to find out if there are any associated factors. METHODS: Hospital based cross sectional study was employed from May 7 to June 6, 2019 at public hospitals. A total of 810 pregnant women participated in the study selected through systematic random sampling technique. Kessler psychological distress Scale (K10) was used to measure psychological distress during pregnancy. Frequency tables and graphs were used to describe the study variable. The association between variables analyzed with bi-variable and multivariable binary logistic regression. A statistical significance was declared at p value < 0.05 with 95% confidence interval. RESULT: A total of 810 participants were included in the study with the response rate of 92%. The Prevalence of psychological distress among pregnant women was found to be 174(21.5%) with (95% CI, 18.6, 24.6). decreasing age [AOR = 3.61, 95%CI, 1.00, 13.01], no formal education [AOR = 3.57, 95%CI, 2.06, 6.19], having an abortion history [AOR = 2.23, 95%CI, 1.29, 3.87], having intimate partner violence [AOR = 4.06, 95%CI, 2.37, 6.94] and poor social support[AOR = 3.33, 95%CI, 1.95, 5.70] were statistically associated with psychological distress during pregnancy. CONCLUSION: This research found high prevalence of psychological distress during pregnancy compared with majorities of preceding studies. In this study we identified factors that are associated with psychological distress in pregnancy. This includes, decreasing age, no formal education, having an abortion history, having intimate partner violence and poor social support. Psychological distress screening and potential risk factors for mental illness evaluations should be carried out during pregnancy for early diagnosis and intervention.

The prevalence of depression among adolescent with HIV/AIDS: a systematic review and meta-analysis.

BACKGROUND: Depression is particularly common among adolescents with HIV/AIDS and has been associated with disruption of the important developmental process, subsequently leading to a wide range of negative mental, physical and psychosocial consequences, as well as poor quality of life in those population groups. Nevertheless, to the best of our knowledge, there are no prior systematic reviews and meta-analytic studies that determined the prevalence of depression among adolescents with HIV/AIDS. METHOD: We systematically searched PubMed, Scopus and Web of Science for relevant literature until May 2020. A random-effect meta-analysis was used to pool prevalence rates from individual studies. Sensitivity and subgroup analyses were performed to identify the source of heterogeneities and to compare the prevalence estimates across the groups. The Joanna Briggs Institute's quality assessment checklist was used to evaluate the quality of the included studies. Cochran's Q and the I2 tests were used to assess heterogeneity between the studies. RESULTS: A total of ten studies were included for the final analysis, with 2642 adolescents living with HIV/AIDS. Our final meta-analysis showed that more than a quarter of adolescents with HIV had depression [26.07% (95% CI 18.92-34.78)]. The prevalence was highest amongst female adolescents (32.15%) than males (25.07%) as well as amongst the older adolescents aged 15-19 years (37.09%) than younger adolescents aged 10-14 years (29.82%). CONCLUSION: Our study shows that a significant proportion of adolescents with HIV had depression, indicating the imperativeness of intervention strategies to alleviate the suffering and possibly reduce the probable negative ramifications.

Systematic review and meta-analysis of the prevalence of depressive symptoms, dysthymia and major depressive disorders among homeless people.

OBJECTIVES: To assess the global prevalence estimates of depressive symptoms, dysthymia and major depressive disorders (MDDs) among homeless people. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Databases including PubMed, Scopus and Web of Science were systematically searched up to February 2020 to identify relevant studies that have reported data on the prevalence of depressive symptoms, dysthymia and MDDs among homeless people. ELIGIBILITY CRITERIA: Original epidemiological studies written in English that addressed the prevalence of depressive problems among homeless people. DATA EXTRACTION AND SYNTHESIS: A random-effect meta-analysis was performed to pool the prevalence estimated from individual studies. Subgroup and sensitivity analyses were employed to compare the prevalence across the groups as well as to identify the source of heterogeneities. The Joanna Briggs Institute's quality assessment checklist was used to measure the study quality. Cochran's Q and the I2 test were used to assess heterogeneity between the studies. RESULTS: Forty publications, including 17 215 participants, were included in the final analysis. This meta-analysis demonstrated considerably higher prevalence rates of depressive symptoms 46.72% (95% CI 37.77% to 55.90%), dysthymia 8.25% (95% CI 4.79% to 11.86%), as well as MDDs 26.24% (95% CI 21.02% to 32.22%) among homeless people. Our subgroup analysis showed that the prevalence of depressive symptoms was high among younger homeless people (<25 years of age), whereas the prevalence of MDD was high among older homeless people (>50 years of age) when compared with adults (25-50 years). CONCLUSION: This review showed that nearly half, one-fourth and one-tenth of homeless people are suffering from depressive symptoms, dysthymia and MDDs, respectively, which are notably higher than the reported prevalence rates in the general population. The findings suggest the need for appropriate mental health prevention and treatment strategies for this population group.

Misdiagnosis, detection rate, and associated factors of severe psychiatric disorders in specialized psychiatry centers in Ethiopia.

BACKGROUND: There are limited studies on the prevalence of misdiagnosis as well as detection rates of severe psychiatric disorders in specialized and non-specialized healthcare settings. To the best of our knowledge, this is the first study to determine the prevalence of misdiagnosis and detection rates of severe psychiatric disorders including schizophrenia, schizoaffective, bipolar, and depressive disorders in a specialized psychiatric setting. METHOD: In this cross-sectional study, a random sample of 309 patients with severe psychiatric disorders was selected by systematic sampling technique. Severe psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV (SCID). The potential determinates of misdiagnosis were explored using univariable and multivariable logistic regression models, adjusting for the potential confounding factors. RESULT: This study revealed that more than a third of patients with severe psychiatric disorders were misdiagnosed (39.16%). The commonly misdiagnosed disorder was found to be a schizoaffective disorder (75%) followed by major depressive disorder (54.72%), schizophrenia (23.71%), and bipolar disorder (17.78%). Among the patients detected with the interview by SCID criteria, the highest level of the correct diagnosis was recorded in the medical record for schizophrenia (76.29%) followed by bipolar (72.22%), depressive (42.40%), and schizoaffective (25%) disorders with detection rate (sensitivity) of 0.76 (95% CI 0.69-0.84), 0.42 (95% CI 0.32-0.53), 0.72 (95% CI 0.60-0.84), and 0.25 (95% CI 0.09-0.41), respectively for schizophrenia, depressive, bipolar, and schizoaffective disorders. Patients with bipolar disorder were more likely to be misdiagnosed as having schizophrenia (60%), whereas schizophrenic patients were more likely to be misdiagnosed as having bipolar disorder (56.25%) and patients with depressive disorders were more likely to be misdiagnosed as having schizophrenia (54.72%). Having a diagnosis of schizoaffective and depressive disorders, as well as suicidal ideation, was found to be significant predictors of misdiagnosis. CONCLUSION: This study showed that roughly four out of ten patients with severe psychiatric disorders had been misdiagnosed in a specialized psychiatric setting in Ethiopia. The highest rate of misdiagnosis was observed for schizoaffective disorder (3 out of 4), followed by major depressive disorder (1 out of 2), schizophrenia (1 out of 4), and bipolar disorders (1 in 5). The detection rates were highest for schizophrenia, followed by bipolar, depressive, and schizoaffective disorders. Having a diagnosis of schizoaffective and depressive disorders as well as suicidal ideation was found to be significant predictors of misdiagnosis.

The Prevalence and Associated Factors of Suicidal Attempt Among Medical Students in Addis Ababa Ethiopia.

Although suicidal attempt is common among medical students, little is known about the prevalence estimates and the potential determining factors in low and middle-income countries including Ethiopia. To the best of our knowledge, this is the first study to estimate the prevalence and associated factors of suicidal attempts among medical students in Ethiopia. Institutional based cross-sectional study was conducted among 423 medical students selected by using a stratified random sampling technique. The World Health Organization Composite International Diagnostic Interview (CIDI) was used to assess suicidal attempts among the study participants. Binary and multivariable logistic regression analysis was performed to identify the potential determinants of suicidal attempt. Odds ratios (OR) with the corresponding 95% confidence interval (95%CI) were calculated to assess the strength of association. In this study, the prevalence of suicidal attempt among medical students was found to be 8.2% (95% CI 5.7, 11.4%). In the adjusted model, the variables associated with suicidal attempt were female sex, history of chronic medical illness, excessive course load, psychological distress, poor social support, and daily internet use for more than 3 h. In the present study, the prevalence of suicide attempts was relatively high (8.2%). Early screening is necessary to identify suicidal attempt and the potential determining factors to prevent death as well as adverse educational outcomes during the medical education program.

Prevalence and correlates of diagnosed and undiagnosed epilepsy and migraine headache among people with severe psychiatric disorders in Ethiopia.

BACKGROUND: There is a paucity of research on the prevalence of diagnosed as well as undiagnosed neurological disorders with episodic manifestations such as epilepsy and migraine headaches in people with severe psychiatric disorders (SPD). To the best of our knowledge, this is the first study analyzing and comparing the prevalence of diagnosed and undiagnosed chronic neurological disorders with episodic manifestations including epilepsy and migraine headache in people with SPD. METHOD: This quantitative cross-sectional survey was undertaken among 309 patients with SPD selected by a systematic random sampling technique. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) was used to confirm SPD among the participants. The International Classification of Headache Disorders (ICHD-3) and International League Against Epilepsy (ILAE) were used to define migraine headache and epilepsy, respectively]. Risk factors for chronic neurologic disorders were explored by using logistic regression models. RESULT: In this study, the prevalence of overall neurological disorders, epilepsy, and migraine headache among people with SPD were found to be 5.2% (95%CI 3.2-8.3), 1.6% (95%CI 0.7-3.9), and 3.9% (95%CI 2.2-6.7), respectively. We found that a considerably higher proportion of people with SPD had undiagnosed overall neurological disorder (87.5%; 14/16), epilepsy (60%; 3/5), as well as migraine headaches (100%; 12/12). On the other hand, in this study, 12.5%, 40%, and 0% of patients with overall neurologic disorder, epilepsy, and migraine headaches respectively were diagnosed by the professionals. Higher disability score (WHODAS score) was associated with increased odds of having neurological disorders compared with the lower WHODAS score [OR = 1.30 (95% CI 1.02-1.66)]. CONCLUSION: Whilst the prevalence estimates of neurological disorders with episodic manifestations including epilepsy and migraine headache was high among people with SPD, the vast majority of them remained undiagnosed. The diagnosis rates of those disorders were significantly low, perhaps surprisingly zero for migraine headache. High WHODAS score was associated with increased odds of having neurological disorders. Routine screening and management of epilepsy and migraine headache are imperative among people with SPD.

The Prevalence of Suicidal Ideation and Attempt Among Young People with HIV/AIDS: a Systematic Review and Meta-Analysis.

Studies have suggested that suicidal ideation and attempt are highly prevalent among young people with HIV/AIDS and have been linked with increased risk of complete suicide. However, thus far, there are no worldwide systematic reviews and meta-analysis of the prevalence of suicidal ideation and attempt among young people with HIV/AIDS. A systematic search of PubMed, Scopus, and Web was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prevalence rates from individual studies were pooled by using a random-effect meta-analysis. The quality of included studies was assessed by the Joanna Briggs Institute's quality assessment checklist. We used the Cochran's Q and the I2 tests to measure heterogeneity across the studies. In total, 14 studies involving 4842 young people with HIV/AIDS were included in this meta-analysis. Our random effect meta-analysis indicated that roughly a quarter of young people with HIV/AIDS had lifetime suicidal ideations [24.38% (95% CI; 18.49-31.44)], and more than one in ten had current [10.33% (95% CI; 6.13-16.88)], and 6 month [13.03% (95% CI; 4.71-31.24)] suicidal ideations. Likewise, a significant proportion of young people with HIV/AIDS had current [3.75% (95% CI; 2.30-6.06)], 6 month [15.33% (95% CI; 10.00-22.78)], and lifetime [13.05% (95% CI; 7.55-21.61)] suicidal attempts. The pooled prevalence estimate of both suicidal ideation and attempts varied according to the sample size of the participants. This study found that a considerable proportion of young people with HIV/AIDS had suicidal ideation and attempt, suggesting the urgent needs of intervention strategies to relieve the suffering and possibly prevent death due to suicide.

The Global Prevalence of Suicidal Attempt among Medical Students: a Systematic Review and Meta-Analysis.

Even though suicidal attempt among medical students is a major public health concern, there are no prior studies that reported its consolidated magnitude worldwide. To the best of our knowledge, this systematic review is the first to quantitatively analyze the prevalence of suicidal attempts among medical students. We systematically searched PubMed, Embase, and Scopus for English language articles that assessed the prevalence of suicide attempts among medical students. A random-effect meta-analysis was used to combine data from individual studies. The heterogeneity across the studies was evaluated using Cochran's Q- and the I2 test. We assessed publication bias using Egger's test and visual inspection of the symmetry in funnel plots. A total of 14 articles were selected for meta-analysis according to the PRISMA guideline. The pooled lifetime prevalence of suicidal attempt was found to be 2.19% (95% CI; 1.17-4.07). The pooled one-year prevalence was estimated to be 1.64 (95% CI; 0.60-4.45). The estimated prevalence of suicidal attempt was considerably high among medical studies in low and middle-income countries than medical studies in high-income countries. The estimated prevalence of suicidal attempt also varies by gender of participants Given the high prevalence estimate of suicidal attempt among medical students and its potential in resulting death by suicide, early identification, and interventions should be considered among medical students.

A systematic review and meta-analysis of the prevalence of bipolar disorder among homeless people.

BACKGROUND: Bipolar disorder (BD) is a common severe mental disorder among homeless people and is associated with an increased risk of disability and mortality from suicide, medical causes (including HIV/AIDS, hepatitis infection, hypertension, and tuberculosis), as well as substance use disorders. However, a systematic synthesis of the existing evidence on the subject is lacking. To fill this gap in the literature, this study aimed to carry out systematic review and meta-analysis to determine the consolidated prevalence of BD among homeless people. METHODS: In this systematic review and meta-analysis, we searched Embase, PubMed, and Scopus to identify pertinent studies that reported the prevalence of BD among homeless people in March 2019. Random effect meta-analysis was employed to pool data from the eligible studies. Subgroup and sensitivity analysis was conducted and Cochran's Q- and the I2 test were utilized to quantify heterogeneity. Publication bias was assessed by using Egger's test and visual inspection of the symmetry in funnel plots. RESULTS: Of 3236 studies identified, 10 studies with 4300 homeless individuals were included in the final analysis. Among the 10 studies, five studies used the Diagnostic Statistical Manual of Mental disorders (DSM), three studies used Mini-International Neuropsychiatric Interview (MINI), one study used Schedule for Clinical Assessment of Neuropsychiatry (SCAN), and one study used Composite International Neuropsychiatric Interview (CIDI) to assess BD among homeless individuals. Based on the results of the random effect model, the prevalence of BD among homeless people was 11.4% (95% CI; 7.5-16.9). The prevalence of BD was 10.0% (95% CI; 3.1-27.9) in Europe and it was 13.2% (95% CI; 8.9-19.3) in other countries. Moreover, the prevalence of BD was 11.5% (95% CI; 5.5-22.3) for studies that used DSM to assess BD and it was 11.0% (95% CI; 6.1-19.2) for studies that used other instruments (MINI, SCAN, and CIDI). CONCLUSION: Our meta-analysis demonstrated that BD is highly prevalent among homeless individuals, underlying the importance of early screening and targeted interventions for BD among homeless individuals.

Food insecurity and the risk of depression in people living with HIV/AIDS: a systematic review and meta-analysis.

BACKGROUND: The link between food insecurity and depression in people living with HIV/AIDS (PLWHA) has been explored in numerous studies; however, the existing evidence is inconclusive due to inconsistent results. Therefore, the objective of this systematic review and meta-analysis is to examine the relationship between food insecurity and depression in PLWHA. METHODS: We systematically searched PubMed, EMBASE, and Scopus to identify relevant studies. A random-effect model was used for conducting the meta-analysis. We assessed the risk of publication bias by funnel plot and Egger's regression asymmetry test. RESULTS: In this review, seven studies were included in the final analysis. Our meta-analysis revealed that food insecurity significantly increased the risk of depression in PLWHA [RR 2.28 (95% CI 1.56-3.32)]. This association remained significant after adjusting for the confounding effects of drug use [RR 1.63 (95% CI 1.27-2.10)], social support [RR 2.21 (95% CI 1.18-4.16)] as well as ART drugs [RR 1.96 (95% CI 1.17-3.28)]. Our subgroup and sensitivity confirmed the robustness of the main analysis. CONCLUSION: This systematic review and meta-analysis suggest a significant association between food insecurity and increased risk of depression PLWHA. Therefore, early screening and management of food insecurity in PLWHA seem to be necessary.

A Systematic Review and Meta-Analysis of the Prevalence of Post-Traumatic Stress Disorder among Homeless People.

Post-traumatic stress disorder (PTSD) is common among homeless people and is associated with an increased risk of mortality from suicide, medical causes, and drug-related problems. However, there are no previous systematic review and meta-analysis studies that reported the consolidated magnitude of PTSD among homeless people. A literature search was conducted on PubMed, Embase, and Scopus to discover pertinent studies that determined the prevalence of PTSD among the homeless. Articles were evaluated by titles, abstracts, and full-text. Comprehensive meta-analysis software was used to conduct the meta-analysis. Subgroup and sensitivity analysis were performed and Cochran's Q- and the I2 test were used to assess heterogeneity. The evidence of publication bias was evaluated by using Egger's test and visual inspection of the symmetry in funnel plots. From the total, 19 studies with 20,364 participants across seven countries were included in the final analysis. Our meta-analysis revealed that the pooled prevalence of PTSD among homeless people was 27.38% (95% CI; 21.95-33.57). In our subgroup analysis, we found that the prevalence of PTSD was considerably high as measured by the screening instrument (35.93%) than the diagnostic instrument (23.57% %). The prevalence of PTSD among homeless showed a significant variation by the location of the studies, the instruments used to measure PTSD as well as the quality of the included studies. This review showed that the pooled prevalence estimate of PTSD among homeless peoples was remarkably high (27.38%). Early screening and treatment of PTSD among homeless peoples are warranted to alleviate suffering.

Prevalence and determinants of test anxiety among medical students in Addis Ababa Ethiopia.

BACKGROUND: Worldwide, problematic test anxiety is a common health problem among medical students. The magnitude of problematic test anxiety ranges from 25 to 40% in undergraduate medical students and has a detrimental effect on academic achievement and success of students. However, data on the prevalence of test anxiety among medical students is limited. Thus, the study aimed to assess the prevalence and associated factors of test anxiety among medical students. METHODS: In this cross-sectional study, a stratified random sampling technique was used to select the participants. The level of test anxiety was determined by the Westside Test Anxiety Inventory (WTAI). We utilized logistic regression to explore the association between test anxiety and the potential sociodemographic/student-related characteristics among medical students. RESULTS: The study included 423 medical students. Our study resulted the prevalence of problematic test anxiety among medical students to be 52.30% (95% CI 47.40-57.30). The prevalence of test anxiety was remarkably higher in women (79.75%) than in men (33.62%) students. Female sex [AOR = 3.25, 95% CI: (1.54, 6.89)], having low grade [AOR = 0.11,95% CI: (0.044,0.288)], being first year [AOR = 10.55,95% CI: (1.4,76.7)], excessive course load [AOR = 6.128,95% CI: (2.675,14.039)], and taking oral examination [AOR = 2.89,95% CI: (1.42,5.84)] were determined as some of the predicting factors of test anxiety among medical students. Additionally, lack of systemic study plan [AOR = 2.4, 95% CI: (1.25, 4.59)], poor social support [AOR = 3.6, 95% CI: (1.56, 8.29)], moderate social support [AOR = 3.39, 95% CI: (1.56, 7.4)], psychologically distressed [AOR = 2.68, 95% CI: (1.37, 5.27)] independently predicts test anxiety among medical students. CONCLUSION: Findings suggest that a substantial percentage of medical students had problematic test anxiety in Ethiopia (52.30%). This study also showed a significant association between test anxiety and female sex, having poor grade point average, being the first year, excessive course load, oral examination, lack of study plan, poor social support, moderate social support, and having psychological distress. Problematic test anxiety, which is found to be common among medical students, deserves more attention.

Suicidal Ideation and Attempt among Homeless People: a Systematic Review and Meta-Analysis.

Globally, suicide is a major public health problem among homeless people. Suicidal ideation and attempt are remarkably higher among homeless people as compared to the general population and they are linked with greater risk of complete suicide. However, no systematic review and meta-analysis has been conducted to report the consolidated magnitude of suicidal ideation and attempt among homeless people. We searched PubMed, Embase, and Scopus to identify pertinent studies on suicidal ideation and attempt among homeless people. A meta-analysis of the studies was conducted using a random effect model. We also conducted a sensitivity analysis and Cochran's Q- and the I2 test was employed to evaluate heterogeneity. Publication bias was assessed by Egger's test and visual inspection of the symmetry in funnel plots. In total, 20 eligible studies with 27,497 homeless people matched the inclusion criteria. Nineteen studies assessed suicidal attempt and thirteen studies assessed suicidal ideation among homeless people. The pooled current and lifetime prevalence of suicidal ideation was 17.83% (95% CI;10.73-28.14) and 41.60% (95% CI; 28.55-55.95), respectively whereas the pooled current and lifetime prevalence of suicidal attempt was 9.16% (95% CI;4.10-19.20) and 28.80% (95% CI; 21.66-37.18), respectively. We found a considerable heterogeneity between the studies, but we found no significant publication bias. The current review revealed a remarkably higher magnitude of suicidal ideation and attempt among homeless people as compared to the estimated prevalence in the general population. The concerned stakeholders need to give attention to address this problem emphasizing more on prevention and treatment strategies as well as utilizing holistic approaches to address the potential predictors of suicide among homeless people including physical, mental, and substance use problems.