If we build it, they will come: Caregiver decision to use an accessible outpatient psychiatric service for children and adolescents in Nigeria.

OBJECTIVE: If child and adolescent psychiatric (CAP) services were accessible in lower-middle-income countries (LMIC) such as Nigeria, what individual and socio-cultural factors would influence caregivers' willingness to use these services when they are needed? METHODS: To address this question, we conducted structured interviews with a stratified random sampling of 442 adult caregivers of children aged 5 to 19-years who lived within 10 km of an established CAP outpatient service in Ibadan, Nigeria. RESULTS: Based on structural equation modeling, our cross-sectional findings indicated that caregivers were generally willing to use the accessible outpatient CAP service for a narrow range of overtly disruptive and developmentally atypical child behavior. However, their decisions were not influenced by their recognition of child and adolescent mental health (CAMH) conditions, competing life stressors, caregiver wellness, nor stigma as we had initially hypothesized. Rather caregivers pragmatically considered a range of approaches to address CAMH concerns. Post-hoc hypotheses confirmed that caregivers' beliefs about etiology and treatment effectiveness for CAMH conditions shaped their help-seeking decisions and stigmatization of CAP services. Specifically, caregivers who attributed CAMH conditions to physical causes regarded biomedical interventions as the most effective treatment while spiritual interventions were deemed to be the least effective. CONCLUSIONS: Taken together our results suggested that caregivers were receptive and willing to use outpatient psychiatric services for their children. However, their beliefs about the etiology and treatment effectiveness of CAMH conditions shaped how they intended to engage the services. These findings underscored the importance of scaling up a broader spectrum of accessible complementary CAMH intervention and prevention services in Nigeria that extend beyond indigenous or biomedical models. In doing so caregivers will come.

Depression and suicidality among adolescents living with human immunodeficiency virus in Lagos, Nigeria.

BACKGROUND: Nigeria is considered to have the second highest number of people living with human immunodeficiency virus (HIV) worldwide with a national HIV infection prevalence of 5.2% in children and adolescents. Adolescents with HIV-infection have been reported to be more prone to developing comorbid emotional difficulties including depression and suicidality compared to those without HIV-infection. This study is aimed at determining the prevalence and correlates of depression and suicidality in adolescents living with HIV infection. METHODS: Through a consecutive sampling method, two hundred and one adolescents attending HIV outpatient clinics in two tertiary hospital (Lagos state University Teaching Hospital and Nigerian Institute of Medical Research) were recruited. Confidentiality was assured and maintained. Suicidality and Depression were assessed with their corresponding modules in Mini International Neuropsychiatric Interview for children and adolescents (MINI-Kid) by researcher, while the independent variables were assessed using self-administered questionnaires. Data was analyzed with Statistical Package for Social Science version 20. RESULT: The prevalence of current and lifetime major depressive episode, and suicidality were 16.9%, 44.8% and 35.3% respectively. Female gender, decreased cluster of differentiation 4 (CD4) count and high adverse childhood experience (ACE), were significantly associated with current depressive episode, while poor social support, high ACE, physical abuse, contacting HIV infection after birth and disclosure of status, were associated with lifetime major depressive episode. Factors associated with suicidality were high ACE score, physical abuse, and emotional abuse. After logistic regression analysis; gender, high ACE and CD4 level were independently associated with current major depression, while only poor social support and contracting HIV infection after birth, were independently associated with lifetime major depression. There was a positive correlation between suicidality and depression. CONCLUSION: The presence of high rate of depression and suicidality among adolescents living with HIV-infection in the current study clearly shows the need for regular psychological assessment in these group of adolescents, and thus a strong indication for a multidisciplinary management in them.

Parenting styles and socio-demographic dynamics associated with mental health of in-school adolescents in Ibadan, south-west Nigeria.

Background: Positive parenting and enabling socio-demography, engenders good conduct in adolescence. Balanced parental demandingness and emotional responsiveness, deployed by authoritative parents, supports adolescents' mental health. Parental emotional responsiveness deters peer-pressured risky behaviours; while parental negligence, permissiveness, or demandingness encourages mental health problems. This is especially in the context of unfavourable socio-demographic setting. Aim: We aimed to evaluate parenting styles and socio-demographic factors associated with adolescents' mental health. Method: A cross-sectional multistage study was conducted with 286 in-school adolescents in Ibadan, Nigeria. Data were collected with questionnaires. The questionnaires evaluated socio-demography, mental health, and perceived parenting styles using the Strength and Difficulty Questionnaire (SDQ) and Scale of Parenting Styles (SPS) questionnaires. Data analysis was conducted using SPSS 21. Results: Some of the adolescents in this study, experienced peer problems (4.9%), conduct problems (9.4%), hyperactivity problems (0.7%), emotional problems (14.3%), and they lacked pro-social behaviours (11.1%). In comparison to adolescents who perceived fathers as authoritative, adolescents who perceived fathers as less demanding experienced emotional (p = 0.01) and peer (p = 0.02) problems. Perceived maternal negligence and authoritarian parenting was associated with more peer problems (1.5±2.3 and 1.3±2.2) in comparison to perceived maternal authoritative style (0.6±1.5). Most adolescents from lower social class experienced conduct (88.8%; p = 0.07) and emotional problems (73.2%; p = 0.20). Conclusion: Competent parenting style and socio-economic resources supports resilience to mental health problems in adolescents.

Should Traffic Offenders Undergo Compulsory "Mental Test": A Study of Mental Health and Crash Involvement Among Commercial Motorcyclists in Ibadan, Nigeria?

Government policies on commercial motorcycle crash prevention are often not driven by data in terms of mental health risks. In this cross-sectional study, data was obtained from 508 commercial motorcyclists (CMs) in Ibadan, Nigeria on psychological distress, personality, suicidality, impulsivity, substance use and Intelligence Quotient, to determine the mental health correlates of road crash involvement. One-month and 12-month accident rates were 7.9 and 28.9% respectively. One-month crash involvement was independently associated with helmet non-use (OR 2.2, 95% CI 1.1-4.7, p = 0.03) and poor knowledge of road signs (OR 2.5, 95% CI 1.2-5.3, p = 0.02). The odds of 12-month crash involvement was increased among lifetime users of alcohol (OR 2.0, 95% CI 1.3-3.0, p = 0.001) and those with fewer than two children (OR 2.0, 95% CI 1.2-3.3, p = 0.006), but was reduced among riders with primary school education (OR 0.2, 95% CI 0.1-0.7, p = 0.007). Crash involvement rate in this population is high. Results from the study do not support routine psychiatric evaluation for traffic offenders, but are more in favour of safety education and traffic law enforcement.

Parenting styles and socio-demographic dynamics associated with mental health of in-school adolescents in Ibadan, south-west Nigeria

Background: Positive parenting and enabling socio-demography, engenders good conduct in adolescence. Balanced parental demandingness and emotional responsiveness, deployed by authoritative parents, supports adolescents' mental health. Parental emotional responsiveness deters peer-pressured risky behaviours; while parental negligence, permissiveness, or demandingness encourages mental health problems. This is especially in the context of unfavourable socio-demographic setting.Aim: We aimed to evaluate parenting styles and socio-demographic factors associated with adolescents' mental health.Method: A cross-sectional multistage study was conducted with 286 in-school adolescents in Ibadan, Nigeria. Data were collected with questionnaires. The questionnaires evaluated socio-demography, mental health, and perceived parenting styles using the Strength and Difficulty Questionnaire (SDQ) and Scale of Parenting Styles (SPS) questionnaires. Data analysis was conducted using SPSS 21.Results: Some of the adolescents in this study, experienced peer problems (4.9%), conduct problems (9.4%), hyperactivity problems (0.7%), emotional problems (14.3%), and they lacked pro-social behaviours (11.1%). In comparison to adolescents who perceived fathers as authoritative, adolescents who perceived fathers as less demanding experienced emotional (p = 0.01) and peer (p = 0.02) problems. Perceived maternal negligence and authoritarian parenting was associated with more peer problems (1.5±2.3 and 1.3±2.2) in comparison to perceived maternal authoritative style (0.6±1.5). Most adolescents from lower social class experienced conduct (88.8%; p = 0.07) and emotional problems (73.2%; p = 0.20).Conclusion: Competent parenting style and socio-economic resources supports resilience to mental health problems in adolescents

Perception of parenting styles by in-school adolescents in South-West Nigeria.

BACKGROUND: Parenting styles can be explained as behavioural strategies parents use to interact with their offspring. It is importance to understand the perception of parenting styles received by adolescents undergoing socio-cognitive development, however, there are few Nigerian studies exploring this topic. OBJECTIVE: To describe the perception of parenting styles received by in-school adolescents in South-West Nigeria. METHODS: A descriptive cross-sectional multistage study was conducted among students attending public and private schools in Ibadan, Nigeria. Data was collected by self-administered questionnaires, evaluating socio-demographic characteristics and perception of styles of parenting received by the adolescents. RESULT: The prevalent perceived parenting style was the authoritative style (73.1%) and the least perceived was the permissive (3.8%) style. Female adolescents perceived fathers as being more negligent (65.2%), permissive (66.7%) and authoritarian (56.0%) but less authoritative (40.4%) than male adolescents (p = 0.01). Adolescents in lower social class perceived their mothers as more authoritarian (78.6%) and negligent (72.7%) in contrast to adolescents in higher social class (p = 0.889). CONCLUSION: Perceived parenting style is the tendency of the adolescent to cognizance the behaviour of parents in a particular manner in all situations and develop a perception about their parents. The prevalent authoritative style is the ideal and most desirable style of parenting worldwide, as it describes parents who maintain a balance between high levels of demandingness and responsiveness, consistently supervising their adolescent's behaviour and practicing constructive criticism. Other styles of parenting can be perceived by adolescents and may prevail across socio-economic divide, as depicted by this study.

Psychiatric disorders and adherence to antiretroviral therapy among a population of HIV-infected adults in Nigeria.

Psychiatric disorders are common among people living with HIV in Nigeria. Adherence is necessary to optimise the outcome of antiretroviral therapy. In this study, we aimed to identify associations between antiretroviral adherence, measured by one-week and one-month self-reported missed doses, and psychiatric illness in a cohort previously assessed for psychiatric disorders using the Composite International Diagnostic Interview. The study participants comprised 151 adults with major depression, anxiety or suicidal symptoms, and 302 matched-control participants. Two controls were randomly selected for each case within the same gender and education level. We compared participants with psychiatric disorders (WPDs) and no psychiatric disorders (NPDs) on selected demographic and clinical variables, in addition to adherence. Participants with one or more missed doses in the preceding month had twice the odds of having a major depressive episode as those with no missed doses during this period (OR 2.22, 95% CI 1.03, 4.79). This association remained significant after adjusting for selected risk factors. There was no statistically significant difference between WPD and NPD groups on either one-week or one-month adherence, or on age, marital status, occupational class, HIV viral load at enrolment or current CD4 cell count. Among Nigerian adults with HIV, suboptimal antiretroviral adherence is associated with, and could be a sign of, depression. Routine self-report adherence assessments may potentially be utilised in identifying individuals at risk among this population.

Contemporary issues on the epidemiology and antiretroviral adherence of HIV-infected adolescents in sub-Saharan Africa: a narrative review.

INTRODUCTION: Adolescents are a unique and sometimes neglected group in the planning of healthcare services. This is the case in many parts of sub-Saharan Africa, where more than eight out of ten of the world's HIV-infected adolescents live. Although the last decade has seen a reduction in AIDS-related mortality worldwide, largely due to improved access to effective antiretroviral therapy (ART), AIDS remains a significant contributor to adolescent mortality in sub-Saharan Africa. Although inadequate access to ART in parts of the subcontinent may be implicated, research among youth with HIV elsewhere in the world suggests that suboptimal adherence to ART may play a significant role. In this article, we summarize the epidemiology of HIV among sub-Saharan African adolescents and review their adherence to ART, emphasizing the unique challenges and factors associated with adherence behaviour. METHODS: We conducted a comprehensive search of online databases for articles, relevant abstracts, and conference reports from meetings held between 2010 and 2014. Our search terms included "adherence," "compliance," "antiretroviral use" and "antiretroviral adherence," in combination with "adolescents," "youth," "HIV," "Africa," "interventions" and the MeSH term "Africa South of the Sahara." Of 19,537 articles and abstracts identified, 215 met inclusion criteria, and 148 were reviewed. DISCUSSION: Adolescents comprise a substantial portion of the population in many sub-Saharan African countries. They are at particular risk of HIV and may experience worse outcomes. Although demonstrated to have unique challenges, there is a dearth of comprehensive health services for adolescents, especially for those with HIV in sub-Saharan Africa. ART adherence is poorer among older adolescents than other age groups, and psychosocial, socio-economic, individual, and treatment-related factors influence adherence behaviour among adolescents in this region. With the exception of a few examples based on affective, cognitive, and behavioural strategies, most adherence interventions have been targeted at adults with HIV. CONCLUSIONS: Although higher levels of ART adherence have been reported in sub-Saharan Africa than in other well-resourced settings, adolescents in the region may have poorer adherence patterns. There is substantial need for interventions to improve adherence in this unique population.

Quality of life of people with cancers in Ibadan, Nigeria.

BACKGROUND: Cancer is associated with psychological and physical morbidities. The presence of such comorbidities has been reported to worsen the overall outcome and quality of life (QOL) of affected people. AIMS: To assess the QOL and its determinants among participants with cancer. METHODS: We administered the short version of the World Health Organization Quality of Life-BREF instrument, socio-demographic/clinical data collection sheet and structured clinical interview for Diagnostic and Statistical Manual Fourth Edition (DSM-IV) diagnosis to 210 consecutively admitted participants with cancer at the University College Hospital Ibadan to determine the diagnosis of major depression. RESULTS: The sample consisted of 63 men and 147 women; 68 participants had cancer of the breast, while 59, 40 and 43 had cancers of the cervix, colon/rectum and prostate, respectively. The QOL of most of the participants was fair. Approximately 30% of the participants were depressed, 75.7% had pains while 49.5% of them had advanced cancer. Male sex, older age, depression, pains and advanced stage cancers were significantly associated with poor QOL. CONCLUSION: The QOL of participants is negatively affected by male sex, older age, depression, advanced stage of cancer and pains.