Psychosocial Factors Associated with Substance Use among Secondary School Students in Ilorin, Nigeria.

BACKGROUND: Adolescent substance use is a global concern. Identifying factors associated with it can help in preparing prevention programmes. OBJECTIVES: The objectives were to determine the sociodemographic factors associated with substance use and the prevalence of associated psychiatric morbidity among secondary school students in Ilorin. MATERIALS AND METHODS: Instruments used were a sociodemographic questionnaire, a modified WHO Students' Drug Use Survey Questionnaire, and the General Health Questionnaire-12 (GHQ-12) which was used to determine psychiatric morbidity, using a cut-off score of 3. RESULTS: Substance use was associated with older age groups, male gender, parental substance use and poor relationship with parents, and urban location of school. Reported religiosity did not confer protection against substance use. The overall prevalence of psychiatric morbidity was 22.1% (n= 442). Psychiatric morbidity was more common among users of opioids, organic solvents, cocaine and hallucinogens, with current opioid users having ten times the odds of psychiatric morbidity. CONCLUSION: Factors influencing adolescent substance use serve as a substrate for interventions. A good relationship with parents and teachers are protective factors, while parental substance use calls for holistic psychosocial support. The association of substance use with psychiatric morbidity highlights the need to incorporate behavioural treatment in substance use interventions.

CONTEXTE: La Consommation de Substances Psychoactives chez les Adolescents est une Préoccupation Mondiale. L'Identification des Facteurs qui y sont Associés Peut Aider à Préparer des Programmes de Prévention. OBJECTIFS: Déterminer les facteurs socio-démographiques associés à la consommation de substances psychoactives chez les élèves du secondaire à Ilorin. Déterminer la prévalence de la morbidité psychiatrique chez les étudiants et son association avec la consommation de substances. MATÉRIAUX ET MÉTHODES: Les instruments utilisés étaient un questionnaire sociodémographique, un questionnaire modifié de l'enquête de l'OMS sur la consommation de drogues par les étudiants, et le Questionnaire de santé générale-12 (GHQ-12) qui a été utilisé pour déterminer la morbidité psychiatrique, en utilisant un score seuil de 3. RÉSULTATS: La consommation de substances psychoactives était associée à des groupes d'âge plus élevés, au sexe masculin, à la consommation de substances psychoactives par les parents et à une mauvaise relation avec les parents, ainsi qu'à la localisation urbaine de l'école. La religiosité déclarée ne confère pas de protection contre la consommation de substances. La prévalence globale de la morbidité psychiatrique était de 22,1% (n= 442). La morbidité psychiatrique était plus fréquente chez les consommateurs d'opioïdes, de solvants organiques, de cocaïne et d'hallucinogènes, les consommateurs actuels d'opioïdes ayant dix fois plus de chances de souffrir de morbidité psychiatrique. CONCLUSION: Les facteurs qui influencent la consommation de substances psychoactives chez les adolescents servent de substrat aux interventions. Une bonne relation avec les parents et les enseignants sont des facteurs de protection, tandis que la consommation de substances par les parents nécessite un soutien psychosocial global. L'association entre la consommation de substances et la morbidité psychiatrique souligne la nécessité d'intégrer un traitement comportemental dans les interventions en matière de consommation de substances. Mots clés: Santé des adolescents, médecine des adolescents, services de santé mentale en milieu scolaire, consommation d'alcool avant l'âge légal, toxicomanie, oral, pédopsychiatrie. Traduit avec.

Knowledge and Attitude of Fathers towards Childhood Vaccination in Ogun State, Nigeria: A Comparative Study.

ACKGROUND/OBJECTIVES: Vaccine-preventable diseases (VPDs) have been shown to account for one-fifth of deaths among under-fives. Father's knowledge and attitude greatly influence the approval and uptake of childhood vaccination in patriarchal communities. This study aimed to assess and compare fathers' knowledge and attitude to childhood vaccination in urban and rural communities of Ogun State, Nigeria. METHODS: Four hundred and forty men each were interviewed in rural and urban areas. An interviewer-administered questionnaire was used to elicit data which were analyzed with IBM SPSS version 20. Mean ages of respondents were compared using T-test while chisquare was used in testing association between categorical variables. Results were presented in tables and P < 0.05 was considered statistically significant. RESULTS: There was no statistically significant difference in the mean ages of residents in the urban and rural areas (t = -1.82, p= 0.07). A greater proportion of rural participants (51.4%) had an overall good knowledge of childhood vaccination as against 45.2% of urban men but this difference was not statistically significant with p = 0.069. A greater percentage of participants in the urban area (58.0%) had an overall positive attitude to male participation in childhood vaccination compared to 54.1% of rural men. However, this difference was not statistically significant (p= 0.204). CONCLUSION/RECOMMENDATION: There was better knowledge of childhood vaccination among rural participants. In contrast, attitude towards childhood vaccination was better among urban residents. There is a need for educational interventions that may positively influence the attitude of men towards childhood vaccinations, particularly in rural areas to be conducted by the government, health workers, and other stakeholders through various communication media and adopting diverse health education methods.

CONTEXTE/OBJECTIFS: Il a été démontré que les maladies évitables par la vaccination (MEV) sont responsables d'un cinquième des décès chez les moins de cinq ans. Les connaissances et l'attitude du père influencent grandement l'approbation et l'adoption de la vaccination des enfants dans les communautés patriarcales. Cette étude visait à évaluer et à comparer les connaissances et l'attitude des pères vis-à-vis de la vaccination des enfants dans les communautés urbaines et rurales de l'État d'Ogun, au Nigeria. MÉTHODES: Quatre cent quarante hommes ont été interrogés dans les zones rurales et urbaines. Un questionnaire administré par un enquêteur a été utilisé pour obtenir des données qui ont été analysées avec IBM SPSS version 20. Les âges moyens des répondants ont été comparés à l'aide du test T, tandis que le test du carré a été utilisé pour tester l'association entre les variables catégorielles. Les résultats ont été présentés sous forme de tableaux et P < 0,05 a été considéré comme statistiquement significatif. RÉSULTATS: Il n'y a pas de différence statistiquement significative entre l'âge moyen des résidents des zones urbaines et rurales (t= -1,82, p= 0,07). Une plus grande proportion de participants ruraux (51,4 %) avait une bonne connaissance générale de la vaccination infantile contre 45,2 % des hommes urbains, mais cette différence n'était pas statistiquement significative avec p = 0,069. Un pourcentage plus élevé de participants de la zone urbaine (58,0 %) avait une attitude globalement positive à l'égard de la participation masculine à la vaccination des enfants, contre 54,1 % des hommes en milieu rural. Toutefois, cette différence n'était pas statistiquement significative (p = 0,204). CONCLUSION/RECOMMANDATION: Les participants rurauxavaient une meilleure connaissance de la vaccination des enfants. En revanche, l'attitude envers la vaccination des enfants était meilleure chez les citadins. Il est nécessaire que le gouvernement, les agents de santé et les autres parties prenantes mènent des interventions éducatives susceptibles d'influencer positivement l'attitude des hommes à l'égard des vaccinations infantiles, en particulier dans les zones rurales, par le biais de divers moyens de communication et en adoptant diverses méthodes d'éducation sanitaire. Mots clés: Connaissance, attitude, rural, urbain, vaccination des enfants, État d'Ogun.

A COMMUNITY-BASED PREVALENCE OF PRESBYOPIA AND SPECTACLE COVERAGE IN SOUTHWEST NIGERIA.

BACKGROUND: The use of population-based method to assess the prevalence of presbyopia and spectacle use is few even though it is more reliable compared to the commoner hospital based studies. This study was carried out to determine the need for spectacle services in our coverage area. AIM: To determine the prevalence of presbyopia among adults of 30 years old and above in Sagamu local government area of Ogun state, South-West, Nigeria. DESIGN: The study was a population based descriptive and cross-sectional design. SETTING: The study was carried out using a multistage cluster random sampling with probability proportional to size of regular adult residents of Sagamu Local Government area, Sagamu, Ogun state, Nigeria. MATERIALS AND METHODS: Examination of respondents included administration of semi-structured interviewer assisted questionnaire and distance visual acuity measurement with or without pinhole at 6 meters using the Snellen's charts. Automated refraction with subjective refraction was carried out in all participants with presenting visual acuity (PVA) worse than 6/9 but with an improvement with pinhole. Near assessment was done at 40cm with the distance correction in place if required. Ocular examination was also carried out in all participants that had refraction including pupillary dilatation when indicated. RESULTS: The prevalence of presbyopia was 80.9%. There was an increasing prevalence with age (p<0.001) with a 100% prevalence in the ≥80 years age group. The mean add requirement was +2.24DS. The met presbyopic need was 22.9% and the unmet need 58%. The presbyopic spectacle coverage was 28.4% which was positively associated with younger age (p=0.034), attaining at least secondary school education (p<0.001), and living in an urban area (p<0.001). CONCLUSION: The prevalence of presbyopia is high in this community and found in persons younger than 40 years and the spectacle coverage for the population is low with a high unmet spectacle need. There is a need to provide near vision spectacles to a large proportion of residents in the community.

Textural and sensory properties of trifoliate yam (Dioscorea dumetorum) flour and stiff dough 'amala'.

The use of trifoliate yam (Dioscorea dumetorum) flour for stiff dough 'amala' production is one of the ways to curb under-utilization of the tuber. The study evaluates the textural and sensory properties of trifoliate yam flour and stiff dough. Freshly harvested trifoliate yam tubers were peeled, washed, sliced and blanched (60 (°)C for 10 min). The sliced yam were soaked in water for 12 h, dried and milled into flour. Pasting viscosities, functional properties, brown index and sensory attributes of the flour and stiff dough were analyzed. Peak, holding strength and final viscosities ranged from 84.09 to 213.33 RVU, 81.25 to 157.00 RVU and 127.58 to 236.17 RVU respectively. White raw flour had higher viscosity than the yellow flours. The swelling index, water absorption capacity and bulk density ranged from 1.46 to 2.28, 2.11 to 2.92 ml H2O/g and 0.71 to 0.88 g/cm(3) respectively. Blanching method employed improved the swelling index and water absorption capacity of flour. The brown index values of flour and stiff dough ranged from 6.73 to 18.36 and 14.63-46.72 respectively. Sensory evaluation revealed significant differences in the colour, odour and general acceptability of the product when compared with the stiff dough from white yam.

Nutritional quality and essential oil compositions of Thaumatococcus danielli (Benn.) tissue and seed.

Nutritional quality and essential oil compositions of Thaumatococcus danielli (Benn.) tissue and seed were determined. Oil was extracted from the seed using standard methods while the fatty acids of the oil, chemical and anti-nutritional properties of defatted seed flour were determined. Total fat yield of the seed flour was 12.20%. Defatted seed flour had higher crude fibre (36.92%), carbohydrate (40.07%) and ash (8.17%) contents. Major mineral contents were potassium, calcium, sodium and magnesium. The tissue contain appreciable amount of vitamin C (8.10 mg/100 g). Oleic acid (42.59%) was the major fatty acid in the seed oil and the total unsaturated fatty acid was 62.38%. The seed oil had higher acid and saponification values and low iodine value. Oxalate (11.09 mg/100 g) content was the major anti-nutrient in the defatted seed flour. Defatted T. danielli seed flour serves as good source of dietary fibre and energy.

Effect of harvesting periods on the chemical and pasting properties of trifoliate yam flour.

The effects of delayed harvesting on the chemical and pasting properties of trifoliate yam flour were studied. The tubers were harvested at 7, 8, 9, 10 and 11months after maturity and were processed into flours. Chemical and pasting properties of the flours were determined. White trifoliate yam flour at 11months was significantly different (p<0.05) from other flours in dry matter and fibre contents but the lignin content (1.83%) was not significant different (p>0.05) from yellow trifoliate yam flour at 11months. Amylose and starch contents decreased while the sugar contents increased with harvesting periods. Yellow trifoliate yam flour had higher amylose at 10months while the white trifoliate yam flour had higher starch at 9months and sugar contents at 11months. Potassium and sodium were the major minerals found in the yam with higher values in yellow trifoliate yam flours. Peak viscosity and breakdown decreased while the holding strength and final viscosities increased with harvesting periods. Harvesting trifoliate yam tubers at 7-9months produced flour with high quality and prevents post harvest losses.

Psychiatric morbidity in stroke patients attending a neurology clinic in Nigeria.

BACK GROUND: Stroke produces a wide range of mental and emotional disorders. Neuropsychiatric complications associated with stroke may have negative effects on the social functioning, overall quality of life and the recovery of motor functioning of stroke survivors. OBJECTIVE: To determine the prevalence and nature of psychiatric morbidity among stroke patients attending neurology outpatient clinic of the University of Ilorin Teaching Hospital (UITH), Ilorin-Nigeria. METHODS: All patients with stroke aged 18 years and above at an outpatient neurology clinic in Ilorin, Nigeria were assessed for mental and emotional disorders using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) over one year (March 2009 to February 2010). RESULTS: Overall prevalence of psychiatric morbidity was 36.0% (30/83) among 83 patients who constituted the study population. Specific diagnoses recorded were depression (19.2%), generalised anxiety disorder (9.6%), harmful alcohol use (2.4%); dementia, somatoform disorder, phobia and delusional disorder each had a prevalence of 1.2%. Clinical and sociodemographic variables were not significantly associated with psychiatric morbidity. CONCLUSION: Psychiatric disorders are often associated with stroke. Identifying and treating stroke patients with these psychiatric co-morbidities could thus help to improve the overall quality of life of these patients.

Hazardous alcohol use among doctors in a Nigerian tertiary hospital.

BACKGROUND: There has been conflicting reports of the level of hazardous alcohol use among doctors despite the significant occurrences in the general population. Hence, the need to study the drinking habits of doctors, being supposedly role models in terms of behavior and lifestyle. METHODS: All the consenting doctors in the employ of University of Ilorin Teaching Hospital, Nigeria completed questionnaires detailing the socio-demographic (e.g., age, gender, marital status, professional qualifications), work-related (e.g., leisure, workload, job satisfaction), and clinical (e.g., prior treatment) variables. The participants also completed the 10-items Alcohol Use Disorders Identification Test (AUDIT) and the General Health Questionnaire-12 (GHQ-12). RESULTS: Of the 241 participants, 'lifetime abstainers' constituted 173 (71.8%) while 'lifetime (ever) alcohol use' was 68 (28.2%), 'past (time specified abstainers) alcohol use' was 29 (12.0%), and 'current users' were 39 (16.2%). Ten (4.1%) participants were 'hazardous users' while 29 (12.0%) were 'moderate users'. Of the 'hazardous users', 3 (30.0%) were interns, 5 (50.0%) were residents while 2 (20.0%) were consultants. They were found in five departments: Obstetrics & Gynaecology, 4 (40.0%); Laboratory Medicine, 3 (30.0%); and 1 (10.0%) each in Pediatrics, Surgery, and Internal Medicine. Heavy workload was significantly related to being a 'hazardous drinker' (x² = 5.92, p= 0.015) while 'abstinence' within the previous 6 months was related to GHQ-12 caseness (i.e., morbidity) (x² =11.78, p= 0.0006). CONCLUSION: There was a detectable level of hazardous drinking especially amongst the junior doctors. Efforts should be focused on younger doctors and their workload.

Predictive factors for psychiatric morbidity among women with infertility attending a gynaecology clinic in Nigeria.

OBJECTIVE: To determine the psychosocial and clinical factors that are associated with psychiatric morbidity among women with infertility attending a Nigerian gynaecology clinic. METHOD: Over a four month period, 320 respondents (160 in the study group and 160 in the control group) were interviewed using a proforma (designed by the authors) and a screening instrument, General Health Questionnaire version 30 (GHQ-30). All probable cases with a score of 5 or more on GHQ-30 were interviewed using the Present State Examination (PSE). Psychiatric diagnosis was made in accordance with the diagnostic criteria of the 10th edition of the International Classification of Diseases (ICD-10). RESULTS: The infertility rate among the study group was found to be 25.8% with primary and secondary infertility rates constituting 21.9% and 78.1% respectively. The prevalence of psychiatric morbidity among women with infertility (48.8%) was significantly more than that in the control group (11.2%) (chi(2) = 51.80, p < 0.0001). Lack of support from husband (chi(2) = 15.31, p < 0.001), lack of support from husband's relatives (chi(2) = 39.60, p < 0.0001), discrimination (chi(2) = 69.91, p < 0.0001) and history of induced abortion (chi(2) = 30.40, p < 0.0001) were found to be significantly associated with psychiatric morbidity among patients with infertility when compared with the fertile control population. There was no significant difference in the rate of psychiatric morbidity between women with primary infertility and those with secondary infertility (chi(2) = 0.03; p = 0.87). CONCLUSION: Psychiatric morbidity is significantly more common among patients with infertility as compared with those without. There was a significant association between psychiatric morbidity and absence of support from husband and his relations, presence of discrimination, and a history of induced abortion. We suggest more public enlightenment on the need for moral/psychosocial support to women with infertility. In addition, more efforts should be made towards early screening and identification of cases of psychiatric morbidity among patients with infertility.

Predictive factors for psychiatric morbidity among women with infertility attending a gynaecology clinic in Nigeria

Objective: To determine the psychosocial and clinical factors that are associated with psychiatric morbidity among women with infertility attending a Nigerian gynaecology clinic. Method: Over a four month period, 320 respondents (160 in the study group and 160 in the control group) were interviewed using a proforma (designed by the authors) and a screening instrument, General Health Questionnaire version 30 (GHQ-30). All probable cases with a score of 5 or more on GHQ-30 were interviewed using the Present State Examination (PSE). Psychiatric diagnosis was made in accordance with the diagnostic criteria of the 10th edition of the International Classification of Diseases (ICD-10). Results: The infertility rate among the study group was found to be 25.8% with primary and secondary infertility rates constituting 21.9% and 78.1% respectively. The prevalence of psychiatric morbidity among women with infertility (48.8%) was significantly more than that in the control group (11.2%) (c2 = 51.80, p < 0.0001). Lack of support from husband (c2 = 15.31, p < 0.001), lack of support from husband's relatives (c2 = 39.60, p < 0.0001), discrimination (c2 = 69.91, p < 0.0001) and history of induced abortion (c2 = 30.40, p < 0.0001) were found to be significantly associated with psychiatric morbidity among patients with infertility when compared with the fertile control population. There was no significant difference in the rate of psychiatric morbidity between women with primary infertility and those with secondary infertility (c2 =0.03; p = 0.87). Conclusion: Psychiatric morbidity is significantly more common among patients with infertility as compared with those without. There was a significant association between psychiatric morbidity and absence of support from husband and his relations, presence of discrimination, and a history of induced abortion. We suggest more public enlightenment on the need for moral/ psychosocial support to women with infertility. In addition, more efforts should be made towards early screening and identification of cases of psychiatric morbidity among patients with infertility

Postnatal depression in primary care populations in Nigeria.

OBJECTIVE: The purpose of this study is to determine the prevalence and associated factors for postnatal depression in primary health care (PHC) centers of a developing society. METHOD: A two-stage screening procedure involving the 10-item self-report Edinburgh Postnatal Depression Scale (EPDS) and the Present State Examination Schedule was employed. RESULTS: The prevalence of postnatal depression in the primary care populations studied was 18.6%. Postnatal depression was found on logistic regression to be independently predicted by younger age (OR, 5.42; 95% CI, 2.61-10.32; P<.05), by being primigravida (OR, 2.73; 95% CI, 1.44-4.24; P<.05), by not having the desired gender for their babies (OR, 2.86; 95% CI, 1.62-5.93; P<.05) and by in-law relationship problems (OR, 3.64; 95% CI, 1.84-7.22; P<.05). The EPDS was shown to be a feasible screening instrument for postnatal depression in the PHC centers (sensitivity, 88.1%; specificity, 84.3%; minimum misclassification rate, 15.0%). CONCLUSION: The EPDS should be incorporated into the maternal and child health care programs of PHC centers in developing countries in order to ensure early detection and appropriate therapeutic intervention in cases of postnatal depression.

Role of radiology in psychiatry: a review.

OBJECTIVE: To assess the contributions of radiological studies to current level of understanding of the pathophysiological mechanisms that underlie psychiatric symptoms/ disorders and their treatment. DATA SOURCES: Published articles in indexed journals. STUDY SELECTION: Radiological studies of psychiatric populations with emphasis on neuroimaging techniques. DATA EXTRACTION: Information concerning aetiological factors, pathophysiological mechanisms and treatment of psychiatric disorders were scrutinized. DATA SYNTHESIS: Structural changes on CT, in schizophrenia include enlargement of the ventricles, cerebral sulci and fissure. MRI studies in these patients confirm significant differences in ventricular volume and medial temporal structures. Functional changes on PET, SPECT and fMRI in depressed patients include altered cerebral blood flow and metabolism in the pre-frontal cortex, anterior cingulate, caudate nucleus, amygdala and thalamus, suggesting abnormal interactions in several brain regions. Drug distribution can be imaged by MRS and this has shown brain lithium level to be about half the plasma level. PET and SPET studies have demonstrated that unlike the classical antipsychotics (e.g. chlorpromazine), atypical antipsychotic drugs such as risperidone and clozapine have high cortical serotonin (5HT2) receptor occupancy (80-90%), thus challenging the theory of a simple relationship between dopamine (D2) receptor occupancy (blocked by classical antipsychotics) and clinical efficacy. CONCLUSION: Radiological studies of psychiatric populations add to available knowledge on the biological aspects of psychiatry. It is therefore essential to provide and update radiological facilities in mental health institutions in developing countries.

Physical morbidity in a psychiatric population in Nigeria.

The rate of physical morbidity amongst 191 psychiatric in-patients in a Nigerian general hospital was found to be 27.2%. Older psychiatric patients were observed to be significantly more likely to suffer from physical morbidity. Infective processes constituted 57.7% of the physical health problems identified in the study population. Organ systems most frequently involved were the central nervous system (mainly as acute organic brain syndrome from septicaemia) (28.9%), cardiovascular/haematological (19.2%), and gastrointestinal (17.3%). Over 70% of physical disorders remained undiagnosed by the referring sources. It is emphasized that adequate attention should be paid to the physical status of psychiatric patients (both new and old cases) at all levels of health care. Collaborative work between medicine and psychiatry should also be encouraged in developing countries, and this should extend beyond clinical services and training (undergraduate and postgraduate) into the areas of evaluative research.

Psychotropic drug use in primary health care units in Nigeria.

The rate of psychotropic drug use in primary care units in Nigeria was found to be 23.6%. The older age group, female sex, those with less education, those who were either separated, divorced or widowed and patients with mental morbidity on GHQ-12 were observed to be significantly more likely to have psychotropic drug prescription. It is suggested that part of efforts aimed at ensuring a more rational use of psychotropic drugs at primary health care (PHC) level of developing countries would need to include improving the ability of PHC workers to detect and manage common mental health problems in primary care.

Alcohol-related problems in primary care patients in Nigeria.

A total of 440 (50.1%) drinking patients were found in a study of 878 primary care patients in Nigeria, of whom 126 (28.6%) of drinking patients were observed to have alcohol-related problems. Those with alcohol-related problems were significantly more likely to be males, middle-aged and to belong to higher occupational groups. In addition, they were also more likely to be separated, divorced or widowed, made more frequent visits to health care facilities and were more likely to have associated mental morbidity. The primary health care (PHC) workers did not recognize these problem drinkers in their care. The need to improve the ability of PHC workers to detect and manage primary care patients with alcohol-related problems in developing countries through the use of reliable and valid short alcohol screening instruments (e.g. CAGE, AUDIT) and brief intervention techniques is emphasized. It is also suggested that, on a long-term basis, the training curricula for medical and paramedical primary care personnel in third world countries should include more hours on alcohol education.

Pathways to mental health care in Nigeria.

A total of 238 patients who attended a mental health service in Ilorin, Nigeria, over a one-month period were interviewed to assess the routes they took to psychiatric care. Ninety-five patients reported that they had first contacted traditional or religious healers when they became mentally ill. Patients who contacted such healers included significantly more males and Muslims and fewer patients with professional occupations. Family members played important roles in patients' decisions about the type of practitioner to consult. The author suggests that use of psychiatric care in developing countries could be improved by training primary health care workers to give mental health education to the communities they serve.

A validity study of the Hospital Anxiety and Depression Scale in general hospital units and a community sample in Nigeria.

BACKGROUND: The utility of the Hospital Anxiety and Depression Scale (HADS) as a screening instrument for anxiety and depressive disorders in non-psychiatric units (medical & surgical wards; gynaecology & antenatal clinics of a teaching hospital) and a community sample in Nigeria was investigated. METHOD: A two-stage screening procedure was employed. This involved the use of GHQ-12/GHQ-30 and HADS against the criteria of a standardised (PSE schedule) psychiatric interview, with psychiatric diagnosis assigned in accordance with ICD-9 criteria. RESULTS: Sensitivity for the anxiety sub-scale ranged from 85.0% in the medical and surgical wards to 92.9% in the ante-natal clinic, while sensitivity for the depression sub-scale ranged from 89.5% in the community sample to 92.1% in the gynaecology clinic. Specificity for the anxiety sub-scale ranged from 86.5% in the gynaecology clinic to 90.6% in the community sample, while specificity for the depression sub-scale ranged from 86.6% in the medical and surgical wards to 91.1% in the ante-natal clinic and community sample. Misclassification rates ranged from 9.9% in the community sample to 13.2% in the medical and surgical wards. Relative Operating Characteristic (ROC) analyses showed the HADS and the GHQ-12 to be quite similar in ability to discriminate between cases (anxiety and depression) and non-cases. CONCLUSIONS: The HADS is valid for use as a screening instrument in non-psychiatric units and although initially developed for use in hospital settings, it could be usefully employed in community settings of developing countries to screen for mental morbidity.

Psychosocial correlates of alcohol, tobacco and cannabis use amongst secondary school students in Ilorin, Nigeria.

The psychosocial correlates of alcohol, cigarette and cannabis use were examined in a population of secondary school students in Ilorin, Nigeria, using a 117-items substance use questionnaire. Current alcohol use was found to be significantly associated with urban location of schools, self-reported study difficulty, self-reported poor mental health and having fathers who are highly skilled professionals. Current cigarette use was found to be positively correlated with rural location of school, male sex, older age group and self-reported poor mental health. Lifetime cannabis use was found to be significantly associated with male sex, self-rated poor academic performance and self-reported poor mental health. Perceived availability of alcohol, cigarette and cannabis by the respondents was found to be related to the rate of use of these drugs while perceived harmfulness did not appear to serve as a sufficient deterrent against substance use in the student population. These findings indicate the need for preventive strategies that emphasize school based drug education programmes, parent and teacher education, and national health policies that control availability and accessibility to these substances by Nigerian youths.

Pattern of substance use amongst secondary school students in Ilorin, northern Nigeria.

One thousand and forty one Senior secondary School Students in Ilorin, Kwara State, Nigeria were surveyed using a 117-items self-administered substance use questionnaire in May 1988. Males constituted 56.6% and Females 43.5% of the study population. The mean age was 16.8 years (S.D. 1.84). The most currently used substances were found to include salicylate analgesics (56.2%), antibiotics (23.6%), stimulants (21.6%), alcohol (12.0%) and cigarette (4.4%). Current use of alcohol, antibiotics and salicylate analgesic was significantly more common in the rural school. Current use of cigarette and cannabis occurred significantly more in the male population while no significant sex differences were noted for the other drugs surveyed. For many students, initiation into substance use started at primary school level. The need to monitor the pattern of substance use at all levels of our educational system (primary, secondary and post-secondary) and to develop adequate preventive programmes for the student population was emphasized.

The role of psychosocial factors in the causation, course and outcome of physical disorders: a review.

Complex interactions occur between psychological and biological factors in health and disease. Stressful life events have been shown to be important in the initiation and exacerbation of both infectious and non-infectious diseases while personality factors may act to increase or reduce vulnerability to physical disorders. Some of the psychosocial complications of physical disorders include marital and financial difficulties, personality changes, affective disturbances, memory impairment and intellectual deterioration. Psychotic reactions may occur in some cases. These complications could worsen the overall outcome and increase family stress and burden. Psychosocial intervention techniques may be required in the management of psychosocial consequences of physical disorders and for some physical illnesses uncomplicated by psychological disorders (e.g. application of biofeedback and relaxation training in the management of hypertension). It is thus important to pay more attention to the behavioural, psychological and social aspects of medical care, particularly in developing countries where available resources are limited.