The effect of psychological distress on medication adherence in persons with HIV infection in Nigeria.

BACKGROUND: A high level of adherence to prescribed antiretroviral (ARV) regimens is required to achieve and maintain suppression of human immunodeficiency virus (HIV) replication and prevent drug resistance. OBJECTIVE: This study aimed to determine the possible relationship between psychopathology and ARV medication adherence in Nigeria. METHOD: Persons with HIV infection (N=182) completed various questionnaires on sociodemographic and clinical details, general psychopathology, self-esteem, and medication adherence. RESULTS: Low medication adherence was reported in 26.9% of the participants; significant correlates included presence of psychopathology and perceived poor social support. CONCLUSION: The success of any intervention policy for HIV-infected persons in sub-Saharan Africa must consider both low level of medication adherence and its associated factors.

Post-traumatic stress disorder (PTSD) after stigma related events in HIV infected individuals in Nigeria.

BACKGROUND: One of the most distressing concerns of many people living with HIV in sub-Saharan Africa is the stigma. Intense stigma may be traumatic. This study aimed to investigate the probability and correlates of Posttraumatic stress disorder (PTSD) following intense stigmatizing events and situations in HIV infected individuals in Nigeria. METHODS: Adult sero-positive attendees of an HIV care centre (N = 190) completed questionnaires regarding sociodemographic and clinical details; the 12-item General Health Questionnaire (GHQ-12) and the Rosenberg's Self-Esteem Scale. The clients were then interviewed for the presence of stigma related PTSD with a modified version of the mini international neuropsychiatry interview (MINI). RESULTS: About 2/3 of the participants had experienced at least an intense HIV-related stigmatizing event or situation. The rate of HIV-stigma related PTSD was 27.4%. Independent predictors of HIV stigma-related PTSD included past history of traumatic events (Single event, OR 2.28, 95% CI 1.08-4.73; Multiple events, OR 9.47, 95% CI 2.97-32.20), low self esteem (OR 6.52, 95% CI 2.59-16.55), poor level of social support (OR 3.33, 95% CI 1.24-9.79) and presence of general psychopathology (OR 2.18, 95% CI 1.07-4.44). CONCLUSION: PTSD may not be specific to traumatic events alone. There is a possibility of PTSD after an intense stigmatizing event or situation. While the validity for the validity of HIV-stigma related PTSD warrants further investigation, stigma needs to be considered when planning rehabilitation strategies for HIV infected individuals in sub-Saharan Africa. A closer attention to self esteem, level of social support and presence of psychopathology is needed in these individuals.

Relationship between depression and quality of life in persons with HIV infection in Nigeria.

OBJECTIVE: Despite the fact that two-thirds of all the people with HIV live in sub-Saharan Africa, little is known about the emotional state and quality of life (QOL) of subjects with HIV in this region. The objective of this study was to evaluate the association between clinical depression and quality of life in a group of HIV sero-positive subjects in Nigeria. METHODS: Subjects with HIV infection (n = 87) completed a questionnaire detailing sociodemographic and HIV related variables. The subjects were assessed for the diagnosis of depression using the Mini International Neuropsychiatric Interview (MINI) and their subjective health related quality of life (QOL) was assessed using the short version of the WHO quality of life scale (WHOQOL-BREF). RESULTS: There were 25 (28.7%) subjects with diagnosis of depression. Lower educational level correlated with poorer QOL in all the domains of WHOQOL-BREF except the "social relationship" domain. Also, poor social support correlated with poorer QOL scores on domains of "physical health" and "social relationship" and presence of medical problems was significantly associated with poorer scores on domains of "physical health" and "psychological health." Diagnosis of depression was significantly correlated with poorer QOL in all domains except the "social relationship" domain. CONCLUSION: Poorer health related QOL in Nigerian subjects with HIV was associated with depression, lower educational and socioeconomic levels, and poor social support. Early identification and referral of patients with depression needs to be incorporated into intervention programs designed for HIV infected individuals in this region.

The 12-month prevalence of DSM-IV anxiety disorders among Nigerian secondary school adolescents aged 13-18 years.

AIMS: To estimate the 12-month prevalence of DSM-IV-specific anxiety disorders among Nigerian secondary school adolescents aged 13-18 years. METHOD: A representative sample of adolescents (n=1090) from senior secondary schools in a semi-urban town in Nigeria was assessed for the 12-month prevalence of DSM-IV-specific anxiety. RESULTS: The 12-month prevalence for all anxiety disorders was 15.0% (females=19.6%; males=11.4%). There were significant gender differences in the prevalence for all anxiety disorders (P<0.001; OR 1.96, 95% CI 1.35-2.65) and social anxiety disorder (P=0.035; OR 1.82, 95% CI 1.03-3.19) and significant age difference in the prevalence of separation anxiety disorder (P=0.045; OR 2.43, 95% CI 0.99-5.96). CONCLUSION: The prevalence of anxiety disorders in Nigerian secondary school adolescents was comparable to the rates found in the western world. Health policies must integrate adolescents' anxiety as a disorder of public health significance. Further studies are needed to evaluate the factors associated with anxiety disorders amongst adolescents in this region.

Psychiatric disorders among the HIV-positive population in Nigeria: a control study.

OBJECTIVE: This article estimates the point prevalence of psychiatric disorders in a sample of HIV-positive subjects in Nigeria in comparison with normal HIV-negative controls and evaluates the possible sociodemographic and clinical correlates of psychiatric disorders in HIV-positive subjects. METHODS: HIV-positive subjects (n=88) and HIV-negative healthy controls (n=87) were assessed for their current diagnosis of DSM-IV psychiatric disorders via the Mini International Neuropsychiatric Interview. Sociodemographic and clinical details were also obtained. RESULTS: The rate of psychiatric disorders in subjects with HIV was 59.1% compared to 19.5% in subjects without HIV infection [odds ratio (OR)=5.95, 95% confidence interval (CI)=3.02-11.75]. The subjects with HIV had significantly higher rates of affective disorders (OR=3.58, 95% CI=1.44-8.94), anxiety disorders (OR=3.57, 95% CI=1.65-7.72), and psychotic disorders (OR=1.10, 95% CI=1.01-1.12) than healthy controls. The factors significantly associated with psychiatric disorders include poor level of social support and stage of the disease. CONCLUSION: Psychiatric disorders are common in our Nigerian subjects with HIV, and the rates are significantly higher when compared to the healthy general population. Proactive identification and treatment of mental disorders should be integrated into HIV intervention policies in this region.

Prevalence of major depressive disorders and a validation of the Beck Depression Inventory among Nigerian adolescents.

AIM: The aims of this study are to estimate the prevalence of major depressive disorder (MDD) in a representative sample of Nigerian adolescents, and to assess the validity of Beck Depression Inventory (BDI) in screening for depressive symptoms among adolescent population in Nigeria. METHOD: A total of 1095 adolescents aged 13-18 years attending senior secondary schools completed the BDI. The presence of MDD in the adolescents was assessed using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Epidemiological Version 5 (K-SADS-E). RESULT: The prevalence of MDD was 6.9%. (male = 5.5%, female = 8.9%). The difference between the rates for MDD in males and females was statistically significant (P = 0.028), but no age or age-gender-interaction difference was found. The BDI has good psychometric properties in screening for depression in adolescents. At a cut off score of 18 and above, the BID has a sensitivity of 0.91, specificity of 0.97, positive predictive value (PPV) of 0.88 and negative predictive value (NPV) of 0.98. CONCLUSION: The prevalence of MDD in Nigerian adolescents is comparable to those found in western culture and the BDI is a valid instrument for screening for MDD among Nigerian adolescents. Health policies in developing countries must integrate adolescents' depression as a disorder of public health significance.

Validity of the Pittsburgh Sleep Quality Index (PSQI) among Nigerian university students.

OBJECTIVES: Sleep-related problems and detection of them remain largely an unidentified public health issue, especially among university students. This study aims to assess the validity of the Pittsburgh Sleep Quality Index (PSQI) among Nigerian university students. METHODS: Five hundred and twenty students completed the PSQI, the 12-item General Health Questionnaire (GHQ-12) and questionnaires pertaining to socio-demographic details. The students were then interviewed for the diagnosis of insomnia according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth edition (DSM-IV) and the International Classification of Sleep Disorders, revised criteria (ICSD-R). RESULTS: The PSQI was of moderate value in screening for insomnia, with the best cut-off score at 5 (sensitivity 0.720, specificity 0.545, overall correct classification rate 0.554). The correlation between the PSQI and the GHQ-12 was 0.252 (p<0.001). A 3-factor model was generated by principal component analysis. CONCLUSION: The psychometric value of PSQI in screening for insomnia among Nigerian students was moderate compared to what has been obtained in Western cultures. Nonetheless, it is still a useful instrument in the detection of sleep problems in this population.

Prevalence and correlates of depression in late pregnancy among Nigerian women.

The objectives of this study were to estimate the prevalence of depressive disorder in late pregnancy in a group of Nigerian women and to examine the associated factors. One hundred and eighty women in late pregnancy completed a questionnaire on sociodemographic and obstetrical details. They also completed the Edinburgh Postnatal Depression Scale (EPDS). A proportion of them were then assessed for the DSM-IV diagnosis of depressive disorder. Fifteen (8.3%) women met the current (2 weeks) DSM-IV diagnosis of depressive disorder. The factors independently associated with depression included being single [odds ratio (OR)=16.67, 95% confidence interval (CI)=3.17-87.76], divorced/separated (OR=11.11, 95% CI=1.55-19.65), polygamous (OR=3.92, 95% CI=0.94-16.33), and having a previous history of stillbirth (OR=8.00, 95% CI=1.70-37.57) and perceived lack of social support (OR=6.08, 95% CI=1.42-26.04). Depression is common in late pregnancy among Nigerian women, with the significant correlates including mainly social and family factors. Such factors should be considered when planning health care services or formulating a predictive model. Interventions aimed at reducing the occurrence of antenatal depression need further research.

Relationship between depression and quality of life in Nigerian outpatients with heart failure.

OBJECTIVE: Our objective was to evaluate the relationship between depression and health-related quality of life (QoL) in Nigerian outpatients with heart failure (HF). METHODS: We used a cross-sectional study in which outpatients with HF (n=100) completed the WHO Quality of Life Scale-Brief Version to assess their subjective QoL. The patients were also assessed for the diagnosis of major depressive disorder (MDD) in accordance with the Diagnostic and Statistical Manual of Mental Health Disorders, Fourth Edition. RESULTS: The factors independently associated with poor QoL include disability due to illness, presence of MDD, younger age, and longer duration of illness. Patients with MDD had worse QoL than patients without MDD on dimensions of physical health, psychological health, and environment. CONCLUSION: Depression adversely affects the QoL of patients with HF. Programs designed to improve the QoL of patients with HF need to incorporate the early identification and treatment of depression. Future studies are warranted to investigate the impact of improved depression management on QoL in patients with HF.

Prevalence and correlates of major depressive disorder in Nigerian outpatients with heart failure.

This study aims to estimate the prevalence and correlates of major depressive disorder (MDD) in Nigerian outpatients with heart failure. Authors assessed patients with heart failure (N = 102) for DSM-IV diagnosis of MDD and obtained sociodemographic and clinical data. MDD was found in 28 (27.5%) of the patients. The significant correlates predicting MDD included unemployment and disability due to the illness, more severe illness (NYHA class), age younger than 60 years, and not being married. These factors should be considered in planning further studies and in screening and intervention programs for patients with heart failure.

Validity of the patient health questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students.

BACKGROUND: The common self-rated depression scales are lengthy, old and do not reflect the current diagnostic classifications criteria of depressive disorders. This study aimed to validate the Patient Health Questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students. METHODS: A representative sample of university students (n=512) completed the PHQ-9 and the Beck's Depressive Inventory (BDI). They were also interviewed for clinical diagnoses of depressive disorders using the Mini International Neuropsychiatric Interview (MINI). RESULTS: The internal consistency of questions within the PHQ-9 was 0.85. The PHQ-9 had good concurrent validity with the BDI (r=0.67, P<0.001). It also had a good (r=0.894, P<0.001) one month test-retest reliability. Using the Receiver Operating Characteristic (ROC) curve, the optimal cut-off score for minor depressive disorder is 5 (sensitivity 0.897, specificity 0.989, Positive Predictive Value - PPV 0.875, Negative Predictive Value - NPV 0.981 and Overall Correct Classification - OCC rate 0.973) while for major depressive disorder only is 10 (sensitivity 0.846, specificity 0.994, PPV 0.750, NPV 0.996 and OCC rate 0.992). LIMITATIONS: The study limitations include use of a specific group in community, moderate sample size and screening for only minor and major depressive disorders while neglecting other depressive disorders. CONCLUSIONS: The PHQ-9 has good psychometric properties amongst Nigerian university students. Because of its validity, reliability, brevity and ease of administration, the PHQ-9 will be a valuable tool for estimating depression amongst college students in Nigerian community. More studies are needed to test the usefulness of the translated local language versions of this instrument amongst the community in sub-Saharan Africa.

Gender differences in the relationship between alcohol use and anxiety symptoms among Nigerian college students.

Few studies have addressed the effect of gender on the relationship between alcohol and anxiety. Students in a Nigerian university, grouped into five separate categories of alcohol use completed the Zung's Self Rating Anxiety Scale. Although a non-linear "J shaped" relationship was found between alcohol use and anxiety symptoms among males, a linear relationship was found among females. Women tend not to share the positive effect moderate alcohol use confers on anxiety status. This gender difference may be an important consideration when planning preventive strategies for alcohol related problems in Nigerian youths.

Depression amongst Nigerian university students. Prevalence and sociodemographic correlates.

BACKGROUND: This study aimed to estimate the prevalence and examine the socio-demographic correlates of depressive disorder among university students in Western Nigeria. METHODS: A representative sample of students living in the halls of residence of a federal university (n = 1,206) completed sets of questionnaires on socio-demographic details, problems encountered in the university, alcohol use and smoking. Depressive disorder was assessed using the Mini International Neuropsychiatric Interview (MINI). RESULTS: A total of 101 (8.3%) students met the criteria for depressive disorder with 68 (5.6%) having minor depressive disorder and 33 (2.7%) having major depressive disorder. The factors that were significantly associated with depressive disorders in the students include problems with accommodation (OR 2.72, 95% CI 1.79-4.16), very large family size (OR 2.8, 95% CI 1.42-5.73), female gender (OR 2.21, 95% CI 1.46-3.35), heavy cigarette smoking (OR 3.67, 95% CI 2.23-6.05) and high level of alcohol consumption (OR 9.44, 95% CI 3.32-26.89). CONCLUSIONS: Depression is common among Nigerian university students and significantly associated with sociodemographic factors. An effective model for the prediction of the development of depression in university students need to be developed and evaluated and interventions aimed at reducing the incidence of depression among this population need further research.

Validation of the Edinburgh Postnatal Depression Scale as a screening tool for depression in late pregnancy among Nigerian women.

This study aimed to examine the validity of the Edinburgh Postnatal Depression Scale (EPDS) as a screening tool for depression in late pregnancy among Nigerian women. A total of 182 women in late pregnancy (32-36 weeks) completed either the English or the translated Yoruba language version of the EPDS and a proportion of them were then assessed for the presence of DSM-IV major and minor depressive disorders using the MINI International Neuropsychiatric Interview. A cut-off score of 10 on the EPDS was found to be the best for screening for both major and minor depression (sensitivity = 0.867, specificity = 0.915, Diagnostic Likelihood Ratio for a positive result = 10.200). When screening for major depression only, a cut-off of 12 was found to the most appropriate (sensitivity = 1.000, specificity = 0.961, Diagnostic Likelihood Ratio for a positive result = 25.641). The EPDS is a valid and useful instrument in screening for depression in late pregnancy among Nigerian women.

Quality of life and associated factors among adults with epilepsy in Nigeria.

OBJECTIVE: Epilepsy is a common condition worldwide and has been observed to affect quality of life (QOL). Though, much has been written on this subject among western populations, little research has been done in developing countries of Africa including Nigeria. The study aims to identify factors associated with quality of life among adult epilepsy patients in this environment. METHOD: Respondents were evaluated using the 10-item Quality of Life in Epilepsy Inventory (QOLIE-10), the 30-item General Health Questionnaire (GHQ-30), the modified Mini Mental State Examination (mMMSE),and the Hospital Anxiety and Depression Scale (HADS). Diagnosis of epilepsy was based on clinical and electroencephalographic findings. RESULTS: The mean age of the 51 respondents was 27.7 years (SD = 9.7). Thirteen (25.5%) had an average of 2 seizure episodes in the month preceding the interview, while 37 (72.5%) have had the condition for more than 5 years. Factors that were significantly associated with overall quality of life included being female (p < 0.05), seizure frequency (p < 0.01), using more than 1 anti-epileptic drugs (AEDs) (p < 0.01), GHQ-30 score (p < 0.01), high anxiety score (p < 0.001), and high depression score (p < 0.01). Multiple regression analysis showed that depressive symptoms were the single most important factor explaining low QOL. Other factors were GHQ-30 score, seizure frequency, and being a woman. CONCLUSION: Controlling seizures and paying attention to the psychological needs of adult epileptics will have a positive effect on the QOL among Nigerian epileptics.

Sociodemographic and obstetric risk factors for postpartum depressive symptoms in Nigerian women.

OBJECTIVE: Studies from the Western culture have emphasized psychosocial risk factors for the development of postnatal depression (PND). In Africa, poor obstetrics practice and sociodemographic factors may contribute significantly to the risk of PND. The goal of this study was to examine sociodemographic and obstetric risk factors for postnatal depressive symptoms in a Nigerian community. METHODS: 876 women recruited at 6 weeks postpartum from the postnatal and infant immunization clinics of 5 participating health centers were screened with the Edinburgh Postnatal Depression Scale (EPDS). Sociodemographic and obstetric information were also obtained through a structured questionnaire. RESULTS: The mean EPDS score was 5.66 (SD = 4.20). Depression was diagnosed in 128 (14.6 %) of the postpartum women. The predictors of PND include hospital admissions during the pregnancy (OR 3.95, CI 2.57-6.07), female sex of the baby (OR 2.74, CI 1.87-4.03), preterm delivery (OR 4.21, CI 2.78-6.39), instrumental delivery (OR 3.32, CI 1.79-6.16), Cesarean section (OR 3.58, CI 1.72-7.48), and being single (OR 3.44, CI 2.15-5.53). CONCLUSION: Although the prevalence of PND symptoms seems to be the same across cultures, risk factors differ significantly. This study identified certain sociodemographic and obstetric risk factors for postnatal depressive symptoms in an underdeveloped community. These factors must be taken into consideration when planning intervention and preventive strategies for these women.

Prevalence of and risk factors for anxiety and depressive disorders in Nigerian adolescents with epilepsy.

The emotional response of adolescents to a chronic illness like epilepsy may differ across cultures. This study was aimed at investigating the prevalence of and risk factors for anxiety and depressive disorders in a group of Nigerian adolescents with epilepsy. Adolescents with epilepsy (n=102) aged between 12 and 18 were assessed for anxiety and depressive disorders with the Diagnostic Interview Schedule for Children Version IV (DISC-IV). An anxiety disorder was diagnosed in 32 (31.37%) of the adolescents and a depressive disorder was reported in 29 (28.43%). Predictors of anxiety and depressive disorders by regression analysis include uncontrolled seizures, polytherapy, and felt stigma. Family factors such as parents' psychopathology and family stress are also moderately significant. Results show that emotional disorders in adolescents with epilepsy cut across cultures. Adequate monitoring, education targeted at reducing felt stigma, and family intervention programs are needed for early intervention.