Indigenous mental healthcare and human rights abuses in Nigeria: The role of cultural syntonicity and stigmatization.

Background: Indigenous mental healthcare using traditional non-western methods termed "unorthodox approaches" has been observed in Nigeria historically. This has been largely due to a cultural preference for spiritual or mystical rather than biomedical formulations of mental disorder. Yet, there have been recent concerns about human rights abuses within such treatment settings as well as their tendency to perpetuate stigmatization. Aim: The aim of this review was to examine the cultural framework for indigenous mental healthcare in Nigeria, the role of stigmatization in its utilization and interrogate the issues of human rights abuses within a public mental health context. Methods: This is a non-systematic narrative review of published literature on mental disorders, mental health service utilization, cultural issues, stigma, and indigenous mental healthcare. Media and advocacy reports related to human rights abuses in indigenous mental health treatment settings were also examined. International conventions on human rights and torture, national criminal legislation, constitutional provisions on fundamental rights and medical ethics guidelines relevant to patient care within the country were examined in order to highlight provisions regarding human rights abuses within the context of care. Results: Indigenous mental healthcare in Nigeria is culturally syntonic, has a complex interaction with stigmatization and is associated with incidents of human rights abuses especially torture of different variants. Three systemic responses to indigenous mental healthcare in Nigeria include: orthodox dichotomization, interactive dimensionalization, and collaborative shared care. Conclusions: Indigenous mental healthcare is endemic in Nigeria. Orthodox dichotomization is unlikely to produce a meaningful care response. Interactive dimensionalization provides a realistic psychosocial explanation for the utilization of indigenous mental healthcare. Collaborative shared care involving measured collaboration between orthodox mental health practitioners and indigenous mental health systems offers an effective as well as cost-effective intervention strategy. It reduces harmful effects of indigenous mental healthcare including human rights abuses and offers patients a culturally appropriate response to their problems.

Measuring discrimination experienced by people with a mental illness: replication of the short-form DISCUS in six world regions.

BACKGROUND: The Discrimination and Stigma Scale (DISC) is a patient-reported outcome measure which assesses experiences of discrimination among persons with a mental illness globally. METHODS: This study evaluated whether the psychometric properties of a short-form version, DISC-Ultra Short (DISCUS) (11-item), could be replicated in a sample of people with a wide range of mental disorders from 21 sites in 15 countries/territories, across six global regions. The frequency of experienced discrimination was reported. Scaling assumptions (confirmatory factor analysis, inter-item and item-total correlations), reliability (internal consistency) and validity (convergent validity, known groups method) were investigated in each region, and by diagnosis group. RESULTS: 1195 people participated. The most frequently reported experiences of discrimination were being shunned or avoided at work (48.7%) and discrimination in making or keeping friends (47.2%). Confirmatory factor analysis supported a unidimensional model across all six regions and five diagnosis groups. Convergent validity was confirmed in the total sample and within all regions [ Internalised Stigma of Mental Illness (ISMI-10): 0.28-0.67, stopping self: 0.54-0.72, stigma consciousness: -0.32-0.57], as was internal consistency reliability (α = 0.74-0.84). Known groups validity was established in the global sample with levels of experienced discrimination significantly higher for those experiencing higher depression [Patient Health Questionnaire (PHQ)-2: p < 0.001], lower mental wellbeing [Warwick-Edinburgh Well-being Scale (WEMWBS): p < 0.001], higher suicidal ideation [Beck Hopelessness Scale (BHS)-4: p < 0.001] and higher risk of suicidal behaviour [Suicidal Ideation Attributes Scale (SIDAS): p < 0.001]. CONCLUSIONS: The DISCUS is a reliable and valid unidimensional measure of experienced discrimination for use in global settings with similar properties to the longer DISC. It offers a brief assessment of experienced discrimination for use in clinical and research settings.

From ideation to attempt: A study of suicidality and its correlates amongst patients with schizophrenia in a resource-poor country.

BACKGROUND: There is increasing evidence that patients with schizophrenia have high tendency to commit suicide. However, such an act is usually preceded by suicidal behaviours (or suicidality) such as suicidal ideations, suicidal intent, suicidal plans and suicidal attempt. If any of this suicidal behaviour spectrum is missed, then suicide results. In spite of the relevance of such behaviours in the management and prognosis of schizophrenia, there is a paucity of research on the patterns and correlates of suicidal behaviours amongst this population group in sub-Saharan Africa. AIM: This study assessed the prevalence and pattern of suicidality and its relationship with certain sociodemographic and clinical variables. SETTING: The study was conducted at the outpatient psychiatric clinic of the Lagos University Teaching Hospital, Idi-Araba, Lagos State. METHODS: Suicidal behaviours were assessed amongst 160 randomly selected patients with schizophrenia over a six-month period. The prevalence, pattern and correlates of suicidal behaviour amongst them were also assessed. Data were collated and processed with the eighteenth version of Statistical Package for Social Sciences (SPSS 18). RESULTS: About 43.1% of the participants exhibited suicidal behaviour. Of these, 5.8% exhibited suicidal plans whilst 75.4% attempted suicide. In terms of severity, one tenth (10%) of those who expressed suicidal behaviour exhibited severe suicidal tendencies. Participants who earned lesser income were more likely to exhibit suicidal behaviour. The same pattern was observed for medication adherence viz a viz suicidal behaviour. CONCLUSIONS: The study brings to the fore the tendency of patients with schizophrenia to commit suicide, hence the need to screen for suicidal behaviour before suicide eventually occurs.

Psychosocial health effects of Covid-19 infection on persons in treatment centers in Lagos, Nigeria.

INTRODUCTION: Prior research has highlighted the psychosocial impact of infectious diseases on individuals and the community at large. However, little is known about the psychosocial implications of COVID-19. This study set out to determine the rate as well as correlates of anxiety and depressive symptoms among persons managed as in-patients for COVID-19 in Lagos, Nigeria. MATERIALS AND METHODS: We conducted an online survey between April to June ending 2020 using a consecutive sampling technique of persons positive for COVID-19 and who were managed as in-patients across five (5) treatment centres in Lagos, Nigeria. The survey collected information on demographic as well as clinical data including suicidality. Anxiety and depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). RESULTS: There were one hundred and sixty participants in total. The mean age of respondents was 36.4 (±9.7) years with a higher proportion (56.9%) being males. With regards to diagnosis, 28.1% and 27.5% of the respondents were categorised as probable cases of depression and anxiety respectively, while 3.8% respondents reported suicidal ideation. Majority of the respondents (61.9%) reported the fear of infecting their loved ones. The variables that showed association with psychiatric morbidity were a past history of an emotional concern, employment status, guilt about infecting others and boredom. CONCLUSION: This study revealed a high burden of psychological/psychiatric morbidity among persons treated for COVID-19, particularly persons who have had prior emotional concerns. The findings from this study reiterate the need to pay attention to the mental health of people during disease outbreaks and to incorporate psychosocial interventions as part of the management package.

Self-stigma and decision about medication use among a sample of Nigerian outpatients with schizophrenia.

OBJECTIVE: Self-stigma is a common barrier to maintenance therapy and recovery in schizophrenia. We investigated the prevalence of the decision not to use medication as prescribed and describe the multidimensional relationship of self-stigma with such a decision in 370 adults with schizophrenia. METHOD: A multivariate binary logistic regression model was used to examine the relationship between specific aspects of self-stigma (alienation, perceived discrimination, stigma resistance, stereotype endorsement and social withdrawal) and the decision not to take medication, while controlling for other clinical variables. RESULTS: Of the total study participants, 16.5% reported high self-stigma while 39.2% decided not to use their medications. The decision not to use medication was associated with a high self-stigma global score, alienation, perceived discrimination and stigma resistance. Stereotype endorsement and social withdrawal did not demonstrate a relationship with nonuse of medication. Following regression analysis, the decision not to use medication was associated with self-stigma, especially high alienation and perceived discrimination, and other factors including medication side effects, worse psychopathology, not living alone, poor 24-hr medication use recall, and absence of medical comorbidity. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Medication nonuse and self-stigma are prevalent and interrelated in patients on maintenance therapy for schizophrenia. Obtaining routine information during follow-up appointments about medication use including side effects, the symptom profile, and conducting a focused stigma screening can inform clinical discussions regarding medication use in a shared decision-making process. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

A longitudinal cohort study of symptoms and other concerns among Nigerian people with stages 3-5 chronic kidney diseases: study protocol.

BACKGROUND: The burden of symptoms and other concerns in chronic kidney disease (CKD) is known to be high, adversely affecting the quality of life of the growing number of those with this condition in developing countries. In this paper, we describe the protocol of a longitudinal observational study among people living with CKD. The study is developed to assess the bio-psychosocial factors associated with palliative care symptoms and concerns, and pattern of health services usage among Nigerians with stages 3-5 CKD. The overall objective is to establish the evidence-base for advocacy and policy formulation, treatment guidelines, care and services, and future clinical trial studies. METHODS: This is a multi-center study to investigate the longitudinal course of symptoms and other concerns among patients with stages 3-5 CKD in Nigeria. Interviewer administered and self-report measures at baseline (T0) and 3-month (T1) address socio-demographic characteristics, clinical-illness related information, palliative care-related symptoms and other concerns, pattern of formal or informal service usage, and bio psychosocial measures including estimated glomerular filtration rate (eGFR), anxiety, depression, quality of life, functioning, social support and spiritual wellbeing. DISCUSSION: This study represents the first longitudinal investigation of palliative care symptoms and concerns among people with CKD in Nigeria. It includes early stages of CKD in compliance with best practices, and a comprehensive range of bio-psychosocial outcomes to understand how these factors are associated with symptoms. This study will provide evidence for how best to integrate palliative care into management of CKD to improve care and quality of life of people with CKD. The study team welcomes collaborations with both national and international researchers.

Mental health services in Nigerian prisons: Lessons from a four-year review and the literature.

Forensic and correctional mental health services may constitute an important "safety net" for the mentally ill and can ensure a degree of public protection. The increasing prison populations and shift towards humane care of the mentally ill that encompasses promotion of human rights, community re-integration, utilitarian safety and operation of internationally comparable mental health legislations underscore the need to appraise correctional psychiatry services, especially in resource-restricted settings. We present findings from a review of the literature and from mental health services provided to 179 inmates in two Nigerian urban prisons. The mental health services spanned four years and allowed a focus on important issues deserving urgent attention. The mean age of participants was 33.10 years (SD = 9.91) and majority (86.6%) were males. The common clinical diagnoses among participants were schizophrenia (49.3%) and mood disorders (29.6%), while approximately half (46.5%) used psychoactive substances. About one-fifth was evaluated as having high risk for violence-dangerousness based solely on clinical evaluation. The majority (88.4%) presented with a first episode of mental illness, and 14% had a prior correctional history. Gender, marital status and hallucinatory experiences were associated with a high risk of dangerousness (p < 0.05), while gender, use of psychoactive substances, previous history of mental disorders and depot medication indexed participants more likely to have a previous forensic history (p < 0.05). Considering the current findings, we advocate for inclusion of validated tools in risk assessments, multipronged intervention strategy to address the unmet needs of prisoners and improved attention to forensic and correctional mental health in relevant policy-law, service-planning, research and training.

Disordered eating attitudes: demographic and clinico-anthropometric correlates among a sample of Nigerian students.

OBJECTIVES: We set out in this study to determine the demographic and clinico-anthropometric correlates of disordered eating attitudes among undergraduate students of two higher institutions in Lagos, Nigeria. METHODS: This cross-sectional descriptive study was conducted among 1,054 participants after written informed consent. A socio-demographic questionnaire, the Eating Attitude Test (EAT-26) and 12-item General Health Questionnaire (GHQ-12) were administered to the participants. In addition, their blood pressure, height and weight were measured, and body mass index (BMI) was calculated. RESULTS: The study participants comprised of 561(55.6%) males with median age of 21.4 years. The mean (±SD) score on EAT-26 was 11.52(±8.54), and 16% of all the respondents were categorized as having disordered eating attitude. A significant relationship was found between disordered eating attitude and age (p= 0.027), gender (p= <0.001), institution of study (p= 0.005), systolic blood pressure (p=0.019), BMI (p= 0.027) and psychological distress (p=0.005). CONCLUSION: Our study observed disordered eating attitude to be prevalent among young adults, and demographic along with clinico-anthropometric factors constituted associated factors. Our findings strengthen the basis to incorporate health awareness programs aimed at improving nutrition and eating behavior among the young adult population. Future research is needed.

Psychological Distress and Emotional Pain Among Adult Attendees of a Dental Clinic: A Case-Control Study.

We set out to carry out a case-control evaluation of psychological distress and emotional pain among adult attendees of a Nigerian dental clinic. A total of 201 subjects, made up of 101 dental patients (test group) matched with age and sex with 100 normal subjects (controls), was recruited into the study. All participants completed a designed socio-demographic questionnaire. General Health Question naire and Psyche ache Assessment Schedule were also administered to assess psychological distress based on cut-off scores ≥3 and emotional pain based on cut-off scores ≥28 respectively. The mean ages of study and control group were 33 (±12) and 36 (±13) years respectively, and both study and control groups were not significantly different in all the assessed socio-demographic parameters. Overall, 21.8% (n=22) of the subjects had psychological distress, while only 7% of the control group had psychological distress. This difference was statistically significant (P=0.003). Similarly, there was significant difference in the experience of psyche ache (unbearable psychological pain) as over a third of the dental patients (37.6%, n=38) had emotional pain, while only 13% of the controls experienced psych ache (P<0.001). In this study, the burden of psychological distress and emotional pain was many-fold in dental patients when compared with the controls.

A FOUR-YEAR REVIEW OF GERIATRIC MENTAL HEALTH SERVICES. IN A LAGOS BASED HOSPITAL, NIGERIA

Background: There is a growing global concern about the public health implications of the increasing population of the elderly. One main issue of concern is centered on how to address their mental health needs using homegrown interventions and services. We expect that important lessons on geriatric mental health issues would be brought to fore in this report. Methods: This is a four-year (2007-2011) retrospective report on the mental health services rendered to 938 clients aged 60 years and above at a Lagos based mental health treatment facility in Nigeria. Designed questionnaires were filled with socio-demographic and clinical data obtained from patients case notes based on the objectives of the study. Results: The mean (standard deviation) age of elders was (±7.93) 69.6 years, and 65.5% were females. Majority were married, self-employed and belonged to low socio-economic status (73.1%, 63.1% and 63.2%, respectively). Close to two-thirds (62.4%) commute for at least one hour to get treatment. The commonest diagnosis was psychotic disorders (34.8%), while 5.5% had Alzheimer's dementia. Some 96.5% of the elders were solely on medications. About a quarter had past history of mental illness and 48.5% reported co-morbid medical conditions, with cardiovascular problems (53.0%) being the commonest physical comorbidity. The middle old along with very old elders (aged≥70 years), and those with at least tertiary education, were more likely to present with dementia were more likely to present with index episode of mental illness and receive outpatient care Conclusion: The elders were managed for a wide range of treatable mental illnesses and other comorbidities and commute for hours to access care. Pharmacotherapy was the preponderant sole treatment modality. There is need for sustained development of expertise to enhance multimodal care and scaling up of comprehensive geriatric mental health services. Further research is needed on how to appropriately link and/or integrate geriatric care with services at all-tiers of health care delivery.

A four-year review of geriatric mental health services in a Lagos based hospital, Nigeria

Background: There is a growing global concern about the public health implications of the increasing population of the elderly. One main issue of concern is centered on how to address their mental health needs using home-grown interventions and services. We expect that important lessons on geriatric mental health issues would be brought to fore in this report.Methods: This is a four-year (2007-2011) retrospective report on the mental health services rendered to 938 clients aged 60 years and above at a Lagos based mental health treatment facility in Nigeria. Designed questionnaires were filled with socio-demographic and clinical data obtained from patients' case notes based on the objectives of the study.Results: The mean (standard deviation) age of elders was 69.6 (±7.93) years, and 65.5% were females. Majority were married, self-employed and belonged to low socio-economic status (73.1%, 63.1% and 63.2%, respectively). Close to two-thirds (62.4%) commute for at least one hour to get treatment. The commonest diagnosis was psychotic disorders (34.8%), while 5.5% had Alzheimer's dementia. Some 96.5% of the elders were solely on medications. About a quarter had past history of mental illness and 48.5% reported co-morbid medical conditions, with cardiovascular problems (53.0%) being the commonest physical comorbidity. The middle old along with very old elders (aged ≥70years), and those with at least tertiary education, were more likely to present with dementia. Elders with dementia were more likely to present with index episode of mental illness and receive outpatient care.Conclusion: The elders were managed for a wide range of treatable mental illnesses and other comorbidities and commute for hours to access care. Pharmacotherapy was the preponderant sole treatment modality. There is need for sustained development of expertise to enhance multimodal care and scaling up of comprehensive geriatric mental health services. Further research is needed on how to appropriately link and/or integrate geriatric care with services at all-tiers of health care delivery

Screening for depression with Centre for Epidemiological Studies Depression Scale Revised and its implication for consultation-liaison psychiatry practice among cancer subjects: a perspective from a developing country.

OBJECTIVE: Co-morbidity of depressive symptomatology is a common indication for use of mental health services in oncology. In this regard, screening instruments are useful for prompt identification of mental disorders in cancer. This study is set to evaluate the diagnostic validity of Centre for Epidemiological Studies Depression Scale Revised (CES-DR) for depression screening in cancer. METHODS: The CES-DR and the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) were administered by the researchers on 200 attendees of a Nigerian hospital with histological diagnoses of cancer. Subsequently, the diagnostic validity of CES-DR was compared with SCAN. RESULTS: Ninety-eight (49.0%) participants had significant depressive symptomatology (CES-DR scores of ≥ 16) as against the diagnosis of depression in 55 (27.5%) participants following SCAN interview. Furthermore, of these 55 (27.5%) depressed participants, two (3.6%) participants had CES-DR scores <16 (non-cases). The Cronbach's alpha reliability of CES-DR was 0.86, and sensitivity and specificity of CES-DR were 96.4% and 68.7%, respectively, whereas positive and negative predictive values of CES-DR were found to be 0.54 and 0.98, respectively, in this study. The average administration time of CES-DR was 6 (± 2) min, and an inter-rater reliability of 93.7% was observed. CONCLUSIONS: The CES-DR was found in this study to be a useful tool for screening for depression in cancer but with diagnostic limitation when compared with SCAN. The development as well as popularization of screening instrument(s) with improved diagnostic and administration property for prompt identification of mental disorders to improve consultation-liaison psychiatry services in cancer care is recommended. Furthermore, replication of similar research is warranted.