A stepped care intervention for non-specialist health workers' management of depression in the Mental Health in Primary Care (MeHPriC) project, Lagos, Nigeria: A cluster randomised controlled trial.

BACKGROUND: The study aimed to evaluate the clinical effectiveness of a developed stepped care intervention for management of depression in primary care. METHODS: A cluster randomised controlled trial with primary care centres (PHCs) as unit of randomization. Five PHCs were randomised to stepped care intervention (SCI) group and another 5 PHCs were randomised to enhanced usual care (eUCA) control group. Participants were adults (18-60 years) with clinically significant depression symptoms. The primary outcome was clinical recovery at 12th months follow up. The outcome assessors were blinded to the cluster allocation. RESULTS: There were 456 participants in SCI group and 451 in eUCA group. At 12 months, clinical recovery was significantly higher in the SCI group compared with the eUCA group (60.3% vs 18.2%, ARR 3.10, 95% CI 2.15-3.87). The SCI group also had significantly better quality of life and lesser rates of disability, death or deliberate self-harm compared to the eUCA group. Subgroup analysis within the SCI group showed no difference in clinical outcomes between participants receiving problem solving therapy (PST) and those receiving antidepressants. CONCLUSIONS: Our study showed that stepped care intervention significantly improved clinical outcomes at 12 months. This lends support to growing evidence of clinically effective intervention for depression at primary care level in less resourced countries. TRIAL REGISTRATION: http://www.isrctn.com/ISRCTN66243738.

Gender difference in the point prevalence, symptoms, comorbidity, and correlates of depression: findings from the Lagos State Mental Health Survey (LSMHS), Nigeria.

It is still unclear whether the gender difference in the rate of depression cuts across cultures or is specific to some depressive symptoms. This study evaluated the gender difference in current prevalence, symptoms, comorbidity, and correlates of depression in Lagos, Nigeria. A total of 11,246 adult participants (6525 females and 4712 males) in a face-to-face household survey were assessed for symptoms of depression. They were also assessed for symptoms of anxiety, somatic symptoms, alcohol and substance use disorders, and disability. The difference between the point prevalence for symptoms of depression in females (6.3%, s.e 0.3) and males (4.4%, s.e 0.3) was significant (OR 1.28, 95% CI 1.14-1.59). Compared to males, females had significantly higher rates for anhedonia (OR 1.20), hypersomnia (OR 2.15), fatigue (OR 1.49), guilt/worthless feeling (OR 1.41), poor concentration (OR 1.32), psychomotor retardation (OR 1.51), and suicidal ideation (OR 1.32). However, poor appetite (OR 0.69) and comorbidity with alcohol use (OR 0.25) was significantly lower in females compared to males. The significantly higher rates for depression in females were only restricted to below 45 years and higher socioeconomic status. Our study further contributed to the growing literature suggesting that the gender differences in rates of depression not only cut across many cultures, but most pronounced with atypical symptoms, not affected by recall bias and seems to disappear with increasing age. These need to be considered when formulating mental health policies for equitable and acceptable health services.

Current prevalence, comorbidity and associated factors for symptoms of depression and generalised anxiety in the Lagos State Mental Health Survey (LSMHS), Nigeria.

BACKGROUND: Depression and anxiety are very prevalent, highly co-morbid, burdensome with huge treatment gaps in low and middle-income countries (LMICs). This study aimed to estimate the current prevalence of symptoms of depression and generalised anxiety, examine co-morbid conditions and associated sociodemographic factors in Lagos state, Nigeria. METHODS: A face to face household survey completed by 11,246 adult participants (age 18-75years). Clinically significant symptoms of depression, generalised anxiety and somatic symptoms were assessed using the specific modules of the Patient Health Questionnaire (PHQ) respectively. Alcohol use, substance use and disability were assessed with the Alcohol Use Disorders Identification Test-short form (AUDIT-C), the Mini International Neuropsychiatric Interview (M.I.N.I) and the WHO Disability Assessment Schedule (WHODAS 2.0) respectively. RESULTS: The mean age was 36.75 (sd 12.3) years and there were 6525 (58.0%) females. The weighted current prevalence of symptoms of depression, generalised anxiety and combined depression/generalised anxiety were 5.5% (se 0.3), 3.5% (se 0.2) and 1.2% (se 0.1) respectively. About 20.9% of all cases of depressive symptoms have co-morbidity with symptoms of generalised anxiety. Symptoms of depression and generalised anxiety had high co-morbidity with somatic symptoms, alcohol use problems and disability but not substance use disorders. Being female, not married (especially separated/divorced or widowed) and unemployment were significantly associated with presence of either symptoms of depression or generalised anxiety. CONCLUSION: Our findings suggest that despite the popularity of cross-national surveys, there is need for individual countries and states to generate complimentary local data to plan effective local response to close the huge treatment gap for common mental disorders.

Primary health care workers' knowledge and attitudes towards depression and its management in the MeHPric-P project, Lagos, Nigeria.

OBJECTIVE: This study aimed to evaluate the knowledge, perceived challenges and attitude of primary health care (PHC) workers in Lagos to depression and its management in the PHC. METHODS: Health workers (n=607) from 49 "flagship" PHCs in Lagos were evaluated for their level of knowledge, experience, competence, attitude and perceived challenges to managing depression in the primary care using a case vignette. RESULTS: More than half (56.2%) of the health workers correctly diagnosed depression. The most endorsed causative factors were "Psycho-social" (77.3%), but "spiritual factors" were endorsed by 36.2%. While only 39.4% agreed that the depressed patient is best managed in a PHC, 86.2% would support treating the patient in their PHC if their capacity is enhanced. Top identified challenges were "heavy work schedule" (68.5%) and "lack of competence of the PHC staff" (67.5%). Over 42% had poor attitude towards depressed patient. Having a mental health training was the major factor that predicted good knowledge (OR 4.52, 95%CI 2.96-7.00) and good attitude (OR 2.17, 95% CI 1.48-3.17). CONCLUSIONS: For successful scale up of mental health services in LMICs, the design of mental health training curriculum for PHC workers should consider their knowledge, experience, competence level, perception and attitudes.

Status of mental-health services for adolescents with psychiatric morbidity in youth correctional institutions in Lagos.

BACKGROUND: High prevalence rates of psychiatric morbidity have been documented among adolescents within youth correctional institutions in Nigeria. However, there has not been prior investigation to determine the capacity for and nature of mental health services being provided in these institutions. OBJECTIVES: To assess psychiatric morbidity among adolescents within youth correctional institutions in Lagos, while simultaneously examining the capacity for and the scope of mental health services. METHODS: Psychiatric morbidity and alcohol/substance use disorder were assessed among 165 respondents using the Strengths and Difficulties Questionnaire, and the CRAFFT screening tool for adolescent substance use disorder. Availability of mental-health services in the institutions was examined using an 'audit protocol'. RESULTS: We found prevalence rates of 18.2% and 15.8% of general psychiatric morbidity and alcohol/ substance use disorder, respectively, among the adolescents. Only about a third (34.3%; n = 20) of the operational staff at the institutions had educational backgrounds relevant to psycho-social services for children/adolescents, while less than a quarter (22.4%, n = 13) has ever received any training in child mental health services. There was no evidence of mental health screening and intervention in the service framework within the institutions. CONCLUSIONS: We concluded that there was evidence for significant mental health service gaps within the youth correctional services in Lagos.

Prevalence and associated factors for suicidal ideation in the Lagos State Mental Health Survey, Nigeria.

BACKGROUND: To combat the increasing rate of suicide, basic data on suicidal behaviours reflecting the uniqueness of the locality are needed in sub-Saharan Africa. AIMS: To assess the prevalence of suicidal ideation and associated factors. METHOD: Adults (n=11 246) from the five administrative divisions of Lagos State completed questionnaires detailing suicidal ideation, socio-demographic details, common mental disorders (depression, anxiety and somatic symptoms), alcohol and psychoactive substance use disorders and disability. RESULTS: The weighted prevalence of current suicidal ideation was 7.28% (s.e. 0.27). Independently associated factors were older age, being female, not married, low occupational group, depression, anxiety, somatic symptoms and disability. CONCLUSIONS: Despite the validity of cross-national surveys, there is need for individual countries to generate complementary local data to explain variability in rates and risk factors in order to plan for suicide prevention or develop timely and effective response. DECLARATION OF INTEREST: None. COPYRIGHT AND USAGE: © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Psychosocial effects of cleft lip and palate on Nigerians: the Ikeja-Lagos experience.

We studied 116 patients who presented with cleft lip and palate (CLP) and were seen during a state-wide screening exercise for people with orofacial deformities in Ikeja-Lagos, Nigeria between May 2006 and July 2007. Detailed histories were taken and physical examinations made. The following psychometric instruments: General Health Questionnaire 28 (GHQ28), State-Trait Anxiety Inventory Y1 (STAI-Y1), STAI-Y2, and Self rating Depression Scale (SDS) were given on the respondents by a clinical psychologist. The respondents comprised 57 men and 59 women with a male:female ratio of 1:1.04. There were 42 (36%) adults and 74 (64%) children. Fifty-four (47%) patients had cleft lip (CL), 27 (23%) had cleft lip and palate (CLP), and 35 (30%) had cleft palate alone. Forty-five (39%) of the respondents were parents and guardians who responded to the presence of the deformity on behalf of children who were less than 6 years old, and assessed the reactions of those who were aged 6-12 years old. Older patients replied directly to the psychometric instruments. The outcome of the assessment of the Mental Health Profile of the participants showed high incidence of anxiety, depression, and impairment of general wellbeing. The effects were most pronounced in the 6-12 year age group. We recommend that the psychosocial impacts of CLP on the patients, parents, and relations should be managed together with the reconstructive procedures.

Current pattern of cleft lip and palate deformities in Lagos, Nigeria.

OBJECTIVE: To evaluate the current pattern of cleft lip and/or palate deformities in Lagos, Nigeria. Design : Descriptive epidemiology. SETTING: Statewide survey of patients. PARTICIPANTS/METHODS: All patients with cleft lip and palate deformities that were seen during a screening program for individuals with orofacial deformities in Lagos, Nigeria, between June 2006 and May 2008 participated in this study. Demographic data were collected and physical examinations carried out. Cleft lip and/or palate deformities were classified using the Kernahan classification for common cases and the Tessier classification for the atypical cleft defects. RESULTS: A total of 225 patients were enrolled and completed the study. Cleft lip and palate was the most common presentation and was found in nearly 45% of the patients. Cleft lip was found in 61 (27%) patients. Twenty patients (8.89%) with different types of rare orofacial cleft deformities were seen. Cleft lip with or without cleft alveolus deformities occurred more commonly among males; whereas, cleft palate was more common among females. Cleft lip and/or palate occurred more frequently among males. Cleft lip with or without cleft alveolus was found predominantly on the left side. CONCLUSIONS: The pattern of cleft lip and/or palate deformities in Lagos, Nigeria, is different from those of other parts of Nigeria in some aspects. The proportion and varieties of atypical orofacial deformities in the study are striking. The prevalence of cleft lip and/or palate deformities in the study was 2.25 per 100,000. There may be an association between the prevalence of atypical deformities and the high level of environmental pollutants in the Lagos area.

Macrostomia: a study of 15 patients seen in Lagos, Nigeria and proposal for a classification of severity.

We made a descriptive epidemiological study of patients who presented with isolated macrostomia during a mass screening programme and repair of orofacial cleft deformities in Lagos, Nigeria. Detailed histories of environmental, gestational, and hereditary factors that may contribute to the malformation were taken, and physical examinations and specialist consultations to detect associated congenital malformations were made. Three patients had unilateral macrostomia and in 12 it was bilateral and symmetrical. The mean (SD) age was 8 (2) years, range 3 months to 32 years. There were 6 men and 9 women. Two women and one man had unilateral macrostomia; the two women presented with right sided involvement, while the man had left sided involvement. The commonest associated malformation was a low-set ear (n = 7). Other patients had combinations of congenital malformations. The mean (SD) age of the mothers at conception was 24 (1) years, range 18 to 32 years, while those of the fathers during the periods of conception were 35 (1) years, range 26 to 45. No gestational or environmental factors were detected in the history. One mother with unilateral presentation had a child with bilateral deformities.