Impact of depression on stroke outcomes among stroke survivors: Systematic review and meta-analysis.

BACKGROUND: Depression may negatively affect stroke outcomes and the progress of recovery. However, there is a lack of updated comprehensive evidence to inform clinical practice and directions of future studies. In this review, we report the multidimensional impact of depression on stroke outcomes. METHODS: Data sources. PubMed, PsycINFO, EMBASE, and Global Index Medicus were searched from the date of inception. Eligibility criteria. Prospective studies which investigated the impact of depression on stroke outcomes (cognition, returning to work, quality of life, functioning, and survival) were included. Data extraction. Two authors extracted data independently and solved the difference with a third reviewer using an extraction tool developed prior. The extraction tool included sample size, measurement, duration of follow-up, stroke outcomes, statistical analysis, and predictors outcomes. Risk of bias. We used Effective Public Health Practice Project (EPHPP) to assess the quality of the included studies. RESULTS: Eighty prospective studies were included in the review. These studies investigated the impact of depression on the ability to return to work (n = 4), quality of life (n = 12), cognitive impairment (n = 5), functioning (n = 43), and mortality (n = 24) where a study may report on more than one outcome. Though there were inconsistencies, the evidence reported that depression had negative consequences on returning to work, functioning, quality of life, and mortality rate. However, the impact on cognition was not conclusive. In the meta-analysis, depression was associated with premature mortality (HR: 1.61 (95% CI; 1.33, 1.96)), and worse functioning (OR: 1.64 (95% CI; 1.36, 1.99)). CONCLUSION: Depression affects many aspects of stroke outcomes including survival The evidence is not conclusive on cognition and there was a lack of evidence in low-income settings. The results showed the need for early diagnosis and intervention of depression after stroke. The protocol was pre-registered on the International Prospective Register of Systematic Review (PROSPERO) (CRD42021230579).

Evidence on the links between water insecurity, inadequate sanitation and mental health: A systematic review and meta-analysis.

BACKGROUND: Water insecurity and inadequate sanitation have adverse impacts on the mental health of individuals. OBJECTIVE: To review and synthesize evidence on the relationship between water insecurity, inadequate sanitation, and mental health globally. DATA SOURCES: Relevant studies were identified by searching PubMed, PsycINFO, and EMBASE databases from inception up to March 2023. STUDY ELIGIBILITY CRITERIA: Only quantitative studies were included. The exposure was water insecurity and or inadequate sanitation. The outcome was common mental disorders (CMD: depression or anxiety), mental distress, mental health or well-being. There was no restriction on geographical location. PARTICIPANTS: General population or people attending health facilities or other services. EXPOSURE: Water insecurity and/ or inadequate sanitation. RISK OF BIAS: The effective Public Health Practice Project (EPHPP) assessment tool was used to assess quality of selected studies. SYNTHESIS OF RESULTS: A meta-analysis was conducted using a random effects statistical model. RESULTS: Twenty-five studies were included, with 23,103 participants from 16 countries in three continents: Africa (Kenya, Ethiopia, Ghana, Uganda, South Africa, Malawi, Mozambique, and Lesotho), Asia (Nepal, Bangladesh, India, and Iran) and the Americas (Brazil, Haiti, Bolivia and Vietnam). There was a statistically significant association between water insecurity and CMD symptoms. Nine studies reported a continuous outcome (5,248 participants): overall standardized mean difference (SMD = 1.38; 95% CI = 0.88, 1.87). Five studies reported a binary outcome (5,776 participants): odds ratio 5.03; 95% CI = 2.26, 11.18. There was a statistically significant association between inadequate sanitation and CMD symptoms (7415 participants), overall SMD = 5.36; 95% CI = 2.51, 8.20. LIMITATIONS: Most of the included studies were cross-sectional which were unable to examine temporal relationships. CONCLUSIONS: Water insecurity and inadequate sanitation contribute to poorer mental health globally. IMPLICATIONS OF KEY FINDINGS: Interventions to provide basic water, sanitation and psychosocial support, could substantially contribute to reducing the burden of CMD alongside other health and social benefits. TRIAL REGISTRATION: PROSPERO registration number: CRD42022322528.

Consequences of COVID-19 on access and delivery of mental health care in two rural Ethiopian districts. A mixed method study

Introduction: The impact of COVID-19 on people with Severe Mental Health Conditions (SMHCs) has been neglected. We aimed to describe the effect and explore the consequences of COVID-19 on people with SMHCs and mental health services in rural districts of Ethiopia. Methods: We conducted a mixed-method study nested within well-characterized population cohorts in Butajira and Sodo districts. We sampled 336 people (168 people with SMHCs, 168 comparisons) in a cross-sectional survey. We conducted qualitative key informant interviews with psychiatric nurses (n=3), primary health care workers (n=3), service users (n=4), family members (n=6) and community members (n=2). We assessed wellbeing (WHO wellbeing index), social support (Oslo social support scale; OSS) and food security quantitatively and used thematic analysis to explore impacts. Results: People with SMHCs reported significantly lower wellbeing (WHO wellbeing score 52 vs. 72; p<0.001), less social support (OSS score 8.68 vs. 9.29; p<0.001), worse living standards (47.0% vs. 29.0%; p<0.001) and increased food insecurity (26.0% vs. 12.5%; p<0.001). Household economic status worsened for over one-third of participants. Participants reported increased relapse, exacerbated stigma due to perceived susceptibility of people with SMHCs to COVID-19, and increased restraint. In mental healthcare settings, there was decreased patient flow but an increase in new cases. Innovations included flexible dispensing of medicines, longer appointment intervals and establishing new treatment centers. Conclusions: COVID-19 had negative consequences on people with SMHCs and mental health services, which must be anticipated and prevented in any future humanitarian crisis. Adaptive responses used during COVID may increase health system resilience

Community's Perception and Attitude towards People with Epilepsy in Ethiopia.

INTRODUCTION: Most people with epilepsy suffer from a dual burden. In one hand, they struggle with the symptoms and disabilities on the other hand from misconceptions and stigma associated with it. But there are no recent studies which assess the community's perception and attitude. OBJECTIVE: To assess the perception and attitude of the community towards people with epilepsy and identify associated factors. METHODS: A community-based cross-sectional study was conducted in South Ethiopia from a total of 701 participants. Data were collected with face to face interview using a structured questionnaire developed based on the Health Belief Model (HBM). Data were presented with frequencies, tables, and figures. Univariate and multivariable logistic regression was done to identify significantly important variables. The presence of association was presented by odds ratio and 95% confidence interval. Ethical clearance was obtained from Wolaita Sodo University. RESULTS: The most frequently mentioned perceived causes for epilepsy were stress (91%), substance use (61.8%), and bad spirit (49.8%) while loss of consciousness and falling (80.7%) and sleep problems (78%) were considered symptoms of epilepsy. Only 13.1% of the participants think that they may be susceptible for epilepsy. Six hundred sixty (94.2%) participants will not employ a person with epilepsy while only 47 (6.7%) of the participants will allow a family member to marry a person with epilepsy. In multivariable analysis, understanding the illness as a medical problem was associated with perceived susceptibility and perceived benefit of modern treatment was significantly associated with having a current medical problem. CONCLUSIONS: The knowledge about the cause, possible susceptibility, better treatment options, and attitude of the participants were similar to other low-income settings. The negative attitude was high and multidimensional. All stakeholders must work to increase awareness about the cause, symptoms, and treatment options for epilepsy and to decrease the negative attitude of the community.