Factors associated with depression among war-affected population in Northeast, Ethiopia.

BACKGROUND: Depression is the most common mental health outcome of exposure to war-related traumatic stressors. Due to inter-communal conflict, Dessie City residents have experienced prolonged armed conflict in 2021. This conflict leads to widespread violence, negative impact on mental health, and large-scale forced migration. However, the problem is not properly addressed in Ethiopia. Therefore, this study aimed to assess the prevalence and risk factors of depression in the war-affected area in Dessie City, Ethiopia. METHOD: A cross-sectional study design was conducted among 785 participants in 2022. The study subjects were selected using a multi-stage cluster sampling technique. The outcome measures used in the study were validated with the Patient Health Questionnaire (PHQ-9). Data was entered using Epi-data version 3.1 and SPSS version 25 was used to analyze data. Bivariate and multivariable logistic regressions were done to identify factors related to depression. In multivariable logistic regression variables with a p-value less than 0.05 were considered significant and, adjusted OR (AOR) with 95% CI was used to present the strength of the association. RESULT: The prevalence of depression among participants was found to be 24.5% (95% CI,21.7, 27.5). In multivariable analysis, post-traumatic stress disorder (AOR = 2.79, 95% CI 1.76-4.43), middle-perceived life threats (AOR = 8.25, 95% CI 2.47-17.49), low social support (AOR = 1.90, 95% CI 1.23-2.96) were variables significantly associated with depression. CONCLUSION: This study found a high prevalence of depression among Dessie City residents. post-traumatic stress disorder, middle-perceived life threats, and low social support were associated with depression. Interventional strategies should be implemented to promote healing, resilience, and the overall well-being of individuals and communities. However, the findings underscore the need to address the current lack of mental health care resources in post-conflict populations.

Umbrella Review of the Global Prevalence of Conduct Disorder in Children and Adolescents.

With the ever-increasing prevalence of mental health issues worldwide, a robust synthesis of existing epidemiological data on the prevalence of Conduct disorder (CD) in children and adolescents is needed to strengthen the knowledge base. This quantitative umbrella review aims to provide a robust synthesis of evidence on the prevalence of CD children and adolescents from meta-analytic systematic reviews. We searched PubMed, Web of Science, PsychINFO, and Scopus to identify relevant articles. The study protocol has been registered with PROSPERO (CRD42023447620). The methodological quality of the studies was evaluated by using a Measurement Tool to Assess Systematic Reviews (AMSTAR). Invariance variance weighted random-effect meta-analysis was performed to pool prevalence estimates from the included articles. Seven meta-analyses, encompassing 138 primary studies and slightly over 48 million CD cases were included in this umbrella review. The quantitative analysis of these studies found a pooled prevalence of CD 3.0% (95%CI 2.0-5%) in children and adolescents, based on random effect meta-analyses. In a stratified analysis, the prevalence estimate of CD was 2.6 times higher in boys compared to girls. Evidence from our quantitative umbrella review showed that the prevalence of CD is relatively high in children and adolescents with boys 2.6 times more likely to experience the disorders when compared to girls. Our findings underlie that attention should be given to preventing, identifying, and treating CD in children and adolescents.

The impact of parental mental health problems on the educational outcomes of their offspring: Findings from the Raine Study.

OBJECTIVES: There is limited evidence on the impact of parental mental health problems on offspring's educational outcomes. We investigated the impact of maternal anxiety and depressive symptoms, as well as paternal emotional problems on the educational outcomes of their adolescent and young adult offspring. METHODS: We used data from a longitudinal birth cohort recruited between 1989 and 1991 in Australia (the Raine Study). The Depression, Anxiety and Stress Scale was used to assess maternal depressive and anxiety symptoms, and a self-reported question was used to measure paternal mental health problems. Both were assessed when the offspring was aged 10 years. Outcomes included offspring's self-reported education attainment-not completing year 10 at age 17, not attending tertiary education at ages 17 and 22 and primary caregiver's reports of offspring's academic performance at age 17. RESULTS: A total of 1033, 1307 and 1364 parent-offspring pairs were included in the final analysis exploring the association between parental mental health problems and offspring's academic performance at school, completing year 10 and attending tertiary education, respectively. After adjusting for potential confounders, the offspring of mothers with anxiety symptoms were 3.42 times more likely than the offspring of mothers without anxiety symptoms to have poor or below-average academic performance (odds ratio = 3.42; 95% confidence interval = [1.31, 8.92]) and more than 2 times more likely to not attend tertiary education (odds ratio = 2.55; 95% confidence interval = [1.10, 5.5.88]) and not to have completed year 10 (odds ratio = 2.13; 95% confidence interval = [1.04, 4.33]). We found no significant associations between maternal depressive symptoms or paternal emotional problems and offspring educational attainment. CONCLUSION: Maternal anxiety symptoms, but not depression and paternal emotional problems, are associated with poor educational attainment and achievement in adolescent offspring. The findings highlight that efforts to improve the outcomes of offspring of mothers with anxiety could focus on educational attainment.

The Prevalence of Alcohol Consumption Among Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis.

BACKGROUND: Evidence indicates that a significant proportion of women drink alcohol during pregnancy. Studies have also suggested that prenatal alcohol consumption was associated with a wide range of adverse outcomes. To the best of our knowledge, this is the first systematic review and meta-analysis aimed to systematically summarize the available evidence on the epidemiology of alcohol consumption among pregnant women in Ethiopia and suggest evidence based recommendations for future clinical practice. METHODS: This systematic review and meta-analysis was followed the PRISMA guidelines. PubMed, SCOPUS and EMBASE databases were searched to identify relevant articles that assessed alcohol consumption among pregnant women in Ethiopia. The Comprehensive Meta-Analysis software version 3.0 was used to conduct a meta-analysis using the random-effect model. Cochran's Q- and I2-tests were used to assess the heterogeneity of the included studies. RESULTS: A total of 6361 pregnant women from fifteen primary studies were included in the final analysis. The pooled prevalence estimate of alcohol consumption among pregnant women in Ethiopia was found to be 14.1%. The pooled prevalence of alcohol consumption among pregnant women in Ethiopia was reported to be lower in the studies that used the standardized alcohol consumption assessment tools (9.4%) when compared to the studies that did not use standardized tools (17%). The pooled prevalence of alcohol consumption among pregnant women ranged between 12.8% and 15.5% in leave-one-out sensitivity analysis. CONCLUSION: A considerable number of women in Ethiopia consume alcohol during pregnancy. Therefore, early identification and intervention strategies are highly recommended.

The prevalence of depression among adolescent with HIV/AIDS: a systematic review and meta-analysis.

BACKGROUND: Depression is particularly common among adolescents with HIV/AIDS and has been associated with disruption of the important developmental process, subsequently leading to a wide range of negative mental, physical and psychosocial consequences, as well as poor quality of life in those population groups. Nevertheless, to the best of our knowledge, there are no prior systematic reviews and meta-analytic studies that determined the prevalence of depression among adolescents with HIV/AIDS. METHOD: We systematically searched PubMed, Scopus and Web of Science for relevant literature until May 2020. A random-effect meta-analysis was used to pool prevalence rates from individual studies. Sensitivity and subgroup analyses were performed to identify the source of heterogeneities and to compare the prevalence estimates across the groups. The Joanna Briggs Institute's quality assessment checklist was used to evaluate the quality of the included studies. Cochran's Q and the I2 tests were used to assess heterogeneity between the studies. RESULTS: A total of ten studies were included for the final analysis, with 2642 adolescents living with HIV/AIDS. Our final meta-analysis showed that more than a quarter of adolescents with HIV had depression [26.07% (95% CI 18.92-34.78)]. The prevalence was highest amongst female adolescents (32.15%) than males (25.07%) as well as amongst the older adolescents aged 15-19 years (37.09%) than younger adolescents aged 10-14 years (29.82%). CONCLUSION: Our study shows that a significant proportion of adolescents with HIV had depression, indicating the imperativeness of intervention strategies to alleviate the suffering and possibly reduce the probable negative ramifications.

Misdiagnosis, detection rate, and associated factors of severe psychiatric disorders in specialized psychiatry centers in Ethiopia.

BACKGROUND: There are limited studies on the prevalence of misdiagnosis as well as detection rates of severe psychiatric disorders in specialized and non-specialized healthcare settings. To the best of our knowledge, this is the first study to determine the prevalence of misdiagnosis and detection rates of severe psychiatric disorders including schizophrenia, schizoaffective, bipolar, and depressive disorders in a specialized psychiatric setting. METHOD: In this cross-sectional study, a random sample of 309 patients with severe psychiatric disorders was selected by systematic sampling technique. Severe psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV (SCID). The potential determinates of misdiagnosis were explored using univariable and multivariable logistic regression models, adjusting for the potential confounding factors. RESULT: This study revealed that more than a third of patients with severe psychiatric disorders were misdiagnosed (39.16%). The commonly misdiagnosed disorder was found to be a schizoaffective disorder (75%) followed by major depressive disorder (54.72%), schizophrenia (23.71%), and bipolar disorder (17.78%). Among the patients detected with the interview by SCID criteria, the highest level of the correct diagnosis was recorded in the medical record for schizophrenia (76.29%) followed by bipolar (72.22%), depressive (42.40%), and schizoaffective (25%) disorders with detection rate (sensitivity) of 0.76 (95% CI 0.69-0.84), 0.42 (95% CI 0.32-0.53), 0.72 (95% CI 0.60-0.84), and 0.25 (95% CI 0.09-0.41), respectively for schizophrenia, depressive, bipolar, and schizoaffective disorders. Patients with bipolar disorder were more likely to be misdiagnosed as having schizophrenia (60%), whereas schizophrenic patients were more likely to be misdiagnosed as having bipolar disorder (56.25%) and patients with depressive disorders were more likely to be misdiagnosed as having schizophrenia (54.72%). Having a diagnosis of schizoaffective and depressive disorders, as well as suicidal ideation, was found to be significant predictors of misdiagnosis. CONCLUSION: This study showed that roughly four out of ten patients with severe psychiatric disorders had been misdiagnosed in a specialized psychiatric setting in Ethiopia. The highest rate of misdiagnosis was observed for schizoaffective disorder (3 out of 4), followed by major depressive disorder (1 out of 2), schizophrenia (1 out of 4), and bipolar disorders (1 in 5). The detection rates were highest for schizophrenia, followed by bipolar, depressive, and schizoaffective disorders. Having a diagnosis of schizoaffective and depressive disorders as well as suicidal ideation was found to be significant predictors of misdiagnosis.

A Systematic Review and Meta-Analysis of the Risk of Disruptive Behavioral Disorders in the Offspring of Parents with Severe Psychiatric Disorders.

Inconsistent results of the association between severe psychiatric disorders (SPD) in parents and the risk of disruptive behavioral disorders (DBD) including conduct disorders (CD) and oppositional defiant disorders (ODD) in the offspring have been found by previous epidemiologic studies. PubMed, EMBASE, PsycINFO, and Scopus were searched for relevant studies. Fourteen studies met the predefined criteria for inclusion. A meta-analysis of the included studies revealed an elevated risk of DBD in the offspring of parents with SPD, bipolar, and depressive disorders. Our further analysis considering the specific DBD as an outcome showed that parents with SPD are at an increased risk of having a child with ODD as well as CD. Moreover, the current meta-analysis found that the children of parents with bipolar disorder were also at increased risk of ODD and CD. Parental schizophrenia and depressive disorders were not associated with higher risks of ODD and CD in the offspring.

The Prevalence and Associated Factors of Suicidal Attempt Among Medical Students in Addis Ababa Ethiopia.

Although suicidal attempt is common among medical students, little is known about the prevalence estimates and the potential determining factors in low and middle-income countries including Ethiopia. To the best of our knowledge, this is the first study to estimate the prevalence and associated factors of suicidal attempts among medical students in Ethiopia. Institutional based cross-sectional study was conducted among 423 medical students selected by using a stratified random sampling technique. The World Health Organization Composite International Diagnostic Interview (CIDI) was used to assess suicidal attempts among the study participants. Binary and multivariable logistic regression analysis was performed to identify the potential determinants of suicidal attempt. Odds ratios (OR) with the corresponding 95% confidence interval (95%CI) were calculated to assess the strength of association. In this study, the prevalence of suicidal attempt among medical students was found to be 8.2% (95% CI 5.7, 11.4%). In the adjusted model, the variables associated with suicidal attempt were female sex, history of chronic medical illness, excessive course load, psychological distress, poor social support, and daily internet use for more than 3 h. In the present study, the prevalence of suicide attempts was relatively high (8.2%). Early screening is necessary to identify suicidal attempt and the potential determining factors to prevent death as well as adverse educational outcomes during the medical education program.

Maternal and paternal mental health problems and the risk of offspring depression in late adolescence: findings from the Raine study.

BACKGROUND: There are limited studies on the risk of depressive symptoms in adolescent offspring exposed to parental mental health problems in middle childhood. AIM: We investigated the association between parental mental health problems, particularly paternal emotional problems and maternal symptoms of anxiety and depression, and the risk of depressive symptoms in adolescent offspring aged 17. METHODS: The study included 995 parent-offspring pairs from the 1989-91 birth cohort (the Raine Study) in Western Australia. Log-binomial regression was used to assess the associations. RESULTS: An increased risk of depression symptoms was observed in the adolescent offspring of mothers with depressive [RR 1.45, 95% CI 1.13-1.86] as well as anxiety symptoms [RR 1.43, 95% CI 1.09-1.87].Compared to those non-exposed, offspring whose mothers reported comorbid anxiety and depressive symptoms were more likely to have developed depressive symptoms by late adolescence [RR 1.63, 95%CI 1.11-2.38]. An increased risk of depressive symptoms was also seen in the offspring of fathers with emotional problems [RR 1.29, 95%CI 1.01-1.53]. CONCLUSION: Our findings suggest an increased risk of depressive symptoms in the adolescent offspring of parents with mental health problems, specifically paternal emotional problems (29%) and maternal anxiety (43%), depression (45%), as well as comorbid anxiety and depressive symptoms (63%).

Undiagnosed HIV, hepatitis B, and hepatitis C infections in people with severe psychiatric disorders in Ethiopia.

BACKGROUND: Worldwide, there is limited epidemiologic evidence on the seroprevalence of undiagnosed chronic viral infections including HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among patients with severe psychiatric disorders. To our knowledge, this is the first study to explore and compare undiagnosed seroprevalence rates of HIV, HBV, and HCV infections among patients with severe psychiatric disorders. METHOD: In this study, we included a random sample of 309 patients with severe psychiatric disorders selected by systematic sampling technique. We used a structured clinical interview for DSM-IV (SCID) to confirm the diagnosis of severe psychiatric disorders among the participants. Binary and multivariable logistic regression models, adjusting for the potential confounding factors was used to explore the potential determinants of chronic viral infections. RESULT: The prevalence estimates of HIV infection among patients with severe psychiatric disorders in this study (3.24%) was roughly 3 times the estimated population prevalence of HIV infection in Ethiopia (1.1%). This study showed that the prevalence rates of HBV and HCV infections among patients with severe psychiatric disorders were 4.85 and 1.29%, respectively. Our results also showed that among patients with chronic viral infections, HIV, HBV and HCV, 76.92, 60, 80, and 75% respectively were undiagnosed. Regarding associated factors, the presence of chronic viral infection was found to be significantly associated with the age of the participants (ranging between 30 and 40 years) after adjusting for the possible confounding factors [AOR = 3.95 (95%CI.18-13.17)]. CONCLUSION: Even though the prevalence estimates of HIV (3.24%), HBV (4.85%), and HCV (1.29%) infections were high among patients with severe psychiatric disorders, the majority of them remained undiagnosed. HBV was found to be the commonly undiagnosed infection (4 out of 5) followed by HCV (3 out of 4) and HIV (6 out of 10). The present study provided evidence of a significant association between the age of the participant (between 30 and 40 years) and chronic viral infections in patients with severe psychiatric disorders. Increasing the awareness of psychiatry professionals and early screening, as well as interventions of chronic viral infections among patients with severe psychiatric disorders are imperative.

The prevalence and associated factors of depression among patients with schizophrenia in Addis Ababa, Ethiopia, cross-sectional study.

BACKGROUND: Depression is common among people with schizophrenia and associated with severe positive and negative symptoms, higher rates of disability, treatment resistance and mortality related to suicide, physical and drug-related causes. However, to our knowledge, no study has been conducted to report the magnitude of depression among people with schizophrenia in Ethiopia. Therefore, this study aimed to determine the prevalence and associated factors of depression among people with schizophrenia. METHOD: A hospital-based cross-sectional study was conducted among 418 patients with schizophrenia selected by systematic sampling technique. Patient Health Questionnaire 9 (PHQ-9) was used to measure depression among the study participants. To identify the potential contributing factors, we performed binary and multivariable logistic regression analysis adjusting the model for the potential confounding factors. Odds ratios (OR) with the corresponding 95% confidence interval (95%CI)) was determined to evaluate the strength of association. RESULT: The prevalence estimate of depression among people with schizophrenia was found to be 18.0% [95% confidence interval: 14.50-22.30]. Our multivariable analysis revealed that current substance use (AOR 2.28, 95%CI (1.27, 4.09), suicide attempt (AOR 5.24, 95%CI (2.56, 10.72), duration of illness between 6 and 10 years (AOR 2.09, 95%CI (1.08, 4.04) and poor quality of life (AOR 3.13, 95%CI (1.79, 5.76) were found to be the factors associated with depression among people with schizophrenia. CONCLUSION: The current study revealed that comorbid depression was high among people with schizophrenia and associated with current substance use, suicide attempt, and long duration of the illness as well as poor quality of life. Attention needs to be given to address comorbid depression among people with schizophrenia.

A qualitative exploration of substance misuse among homeless women in Addis Ababa, Ethiopia.

BACKGROUND: Substance use among homeless people is higher compared to the general population. In some studies, reported rates of problematic drug use among the homeless vary, with estimates ranging from 25 to 70%. There is a common perception that substance abuse and homelessness are linked, but there is considerable debate about the direction of the relationship. Despite observations of high levels of substance use among the homeless population in Addis Ababa, there are limited studies to date conducted on the topic. This study aims to explore the factors associated with onset of substance use and its continued use, patterns of substance use and its social and health consequences among female residents of a shelter in Addis Ababa, Ethiopia. METHODS: A qualitative study was conducted in 2019. In-depth interviews were conducted on 14 study participants who were selected purposively. The qualitative data analysis software QDA Miner 5.0.30 was used for data processing and analysis. RESULTS: Four major thematic areas were identified and they comprised the categories under which sub-themes were identified and coded. The major segments or categories included the following: reasons for the onset of substance use after becoming homeless, experiences of substance use and reasons for continued use, the harms which resulted on them from substance use, and the means of obtaining supply of the substances. CONCLUSION: Factors related to life on streets were strong reasons for onset of substance use, as well as for its continued use. Homeless women suffered untimely death, addiction, and ill health from use of substances; however, they gave priority to obtaining substances than any other thing, and used every means to grab a supply of the substances.

Food insecurity and the risk of depression in people living with HIV/AIDS: a systematic review and meta-analysis.

BACKGROUND: The link between food insecurity and depression in people living with HIV/AIDS (PLWHA) has been explored in numerous studies; however, the existing evidence is inconclusive due to inconsistent results. Therefore, the objective of this systematic review and meta-analysis is to examine the relationship between food insecurity and depression in PLWHA. METHODS: We systematically searched PubMed, EMBASE, and Scopus to identify relevant studies. A random-effect model was used for conducting the meta-analysis. We assessed the risk of publication bias by funnel plot and Egger's regression asymmetry test. RESULTS: In this review, seven studies were included in the final analysis. Our meta-analysis revealed that food insecurity significantly increased the risk of depression in PLWHA [RR 2.28 (95% CI 1.56-3.32)]. This association remained significant after adjusting for the confounding effects of drug use [RR 1.63 (95% CI 1.27-2.10)], social support [RR 2.21 (95% CI 1.18-4.16)] as well as ART drugs [RR 1.96 (95% CI 1.17-3.28)]. Our subgroup and sensitivity confirmed the robustness of the main analysis. CONCLUSION: This systematic review and meta-analysis suggest a significant association between food insecurity and increased risk of depression PLWHA. Therefore, early screening and management of food insecurity in PLWHA seem to be necessary.

A systematic review and meta-analysis of the prevalence of bipolar disorder among homeless people.

BACKGROUND: Bipolar disorder (BD) is a common severe mental disorder among homeless people and is associated with an increased risk of disability and mortality from suicide, medical causes (including HIV/AIDS, hepatitis infection, hypertension, and tuberculosis), as well as substance use disorders. However, a systematic synthesis of the existing evidence on the subject is lacking. To fill this gap in the literature, this study aimed to carry out systematic review and meta-analysis to determine the consolidated prevalence of BD among homeless people. METHODS: In this systematic review and meta-analysis, we searched Embase, PubMed, and Scopus to identify pertinent studies that reported the prevalence of BD among homeless people in March 2019. Random effect meta-analysis was employed to pool data from the eligible studies. Subgroup and sensitivity analysis was conducted and Cochran's Q- and the I2 test were utilized to quantify heterogeneity. Publication bias was assessed by using Egger's test and visual inspection of the symmetry in funnel plots. RESULTS: Of 3236 studies identified, 10 studies with 4300 homeless individuals were included in the final analysis. Among the 10 studies, five studies used the Diagnostic Statistical Manual of Mental disorders (DSM), three studies used Mini-International Neuropsychiatric Interview (MINI), one study used Schedule for Clinical Assessment of Neuropsychiatry (SCAN), and one study used Composite International Neuropsychiatric Interview (CIDI) to assess BD among homeless individuals. Based on the results of the random effect model, the prevalence of BD among homeless people was 11.4% (95% CI; 7.5-16.9). The prevalence of BD was 10.0% (95% CI; 3.1-27.9) in Europe and it was 13.2% (95% CI; 8.9-19.3) in other countries. Moreover, the prevalence of BD was 11.5% (95% CI; 5.5-22.3) for studies that used DSM to assess BD and it was 11.0% (95% CI; 6.1-19.2) for studies that used other instruments (MINI, SCAN, and CIDI). CONCLUSION: Our meta-analysis demonstrated that BD is highly prevalent among homeless individuals, underlying the importance of early screening and targeted interventions for BD among homeless individuals.

Prevalence of depressive symptoms and associated factors among patients with tuberculosis attending public health institutions in Gede'o zone, South Ethiopia.

BACKGROUND: Depression is a common mental disorder among patients with tuberculosis and it is associated with a greater risk of suicide, multidrug-resistant tuberculosis, and poor quality of life. Evidence suggests the early identification of depression among patients with tuberculosis is important to decrease adverse outcomes. However, there are limited studies that examined the prevalence and determinants of depressive symptoms among patients with tuberculosis. This study aimed to assess the prevalence and associated factors of depressive symptoms among patients with tuberculosis attending public health institutions in Gede'o zone, South Ethiopia. METHODS: An institution-based a cross-sectional study was conducted from November 1 to December 30, 2018, among a randomly selected sample of 415 patients with tuberculosis attending public health institutions in Gede'o zone, South Ethiopia. Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms. Logistic regression was used to identify the potential risk factors of depressive symptoms. The strength of the association was presented by crude odds and adjusted odds ratio with their corresponding 95% CI. Finally, the statistical significance was set at p < 0.05. RESULTS: The prevalence of depressive symptoms was found to be 45.5% (95% CI; 41.1-50.1%) among patients with tuberculosis; 33.3% had moderate, 9.8% had moderately severe, and 2.4% had severe depression. After adjusting for the possible confounders, being on re-treatment for tuberculosis (AOR = 2.47, 95% CI: 1.17-5.22), aged ≥45 years (AOR = 2.41, 95% CI: 1.09-5.32), having poor social support (AOR = 4.21, 95% CI: 2.10-8.47), and Tuberculosis/Human Immunodeficiency Virus (TB/HIV) co-infection) (AOR = 3.96, 95% CI 2.0, 7.84) were significantly associated with depressive symptoms among patients with TB. CONCLUSIONS: This study suggests that a substantial percentage of patients with TB had depressive symptoms (45.5%). TB/HIV coinfection, being on re-treatment for tuberculosis, those having poor social support, patients aged 45 and above were factors associated with depressive symptoms. Routine screening of depression among patients with TB is warranted. Moreover, patients with TB falling into the risk categories should be more carefully monitored for depression and when possible referred to mental health professionals.

Prenatal tobacco use and the risk of mood disorders in offspring: a systematic review and meta-analysis.

PURPOSE: It is plausible that offspring born to mothers using tobacco during pregnancy may have increased risk of mood disorders (depression and bipolar disorders); however, mixed results have been reported. We conducted a systematic review and meta-analysis to investigate the magnitude and consistency of associations reported between prenatal tobacco use and mood disorders in offspring. METHODS: We systematically searched EMBASE, SCOPUS, PubMed and Psych-INFO for studies on mood disorders and prenatal tobacco use. Methodological quality of studies was assessed with the revised Newcastle-Ottawa Scale. We estimated pooled relative risk (RR) with inverse variance weighted random-effects meta-analysis. We performed leave-one-out analyses, and stratified analyses by a subgroup (depression and bipolar disorder). Potential publication bias was assessed by inspection of the funnel plot and Egger's test for regression asymmetry. This study protocol was prospectively registered in PROSPERO (CRD42017060037). RESULTS: Eight cohort and two case-control studies were included in the final meta-analysis. We found an increased pooled relative risk of mood disorders in offspring exposed to maternal prenatal tobacco use RRs 1.43 (95% CI 1.27-1.60) compared to no prenatal tobacco use. Similarly, the pooled relative risks of bipolar and depressive disorders in offspring were 1.44, (95% CI 1.15-1.80) and 1.44, (95% CI 1.21-1.71), respectively. Moreover, the pooled estimated risk of mood disorders was not significantly attenuated in the studies that reported sibling comparison results [RR = 1.21 (95% CI 1.04-1.41)]. CONCLUSION: Taken together, there was strong evidence for a small (RR < 2) association between prenatal tobacco use and mood disorders in offspring.

Epidemiology of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents in Africa: a systematic review and meta-analysis.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is the most common neurodevelopmental disorders in childhood and adolescence, affecting 2.2 to 17.8% of all school-aged children and adolescents. ADHD in children has been associated with a wide range of developmental deficits including limitations of learning or control of executive functions as well as global impairments of social skills. However, no review has been conducted to report the consolidated magnitude of ADHD in children and adolescents in Africa. Therefore, this systematic review and meta-analysis aimed to estimate the prevalence of ADHD in Africa. METHODS: Following the PRISMA guideline, we systematically reviewed and meta-analyzed studies that investigated the prevalence of ADHD in Africa from three electronic databases (PubMed, Embase, and Scopus). We also looked at the reference lists of included studies to include other relevant studies. Subgroup and sensitivity analysis was carried out based on the study setting, tools used to measure ADHD, sex of participants, and the subtype of ADHD. Heterogeneity across the studies was evaluated using Cochran's Q- and the I 2-test. We assessed potential publication bias using Egger's test and visual inspection of the symmetry in funnel plots. RESULTS: In the present meta-analysis, 7452 articles were initially identified and evaluated. Of these, 12 studies that met the inclusion criteria were included in the final analysis. The pooled prevalence of ADHD in children and adolescents in Africa was 7.47% (95% CI 60-9.26). The prevalence of ADHD was apparently greater in boys (10.60%) than in girls (5.28%) with a male:female ratio of 2.01:1. In our subgroup analysis, the predominantly inattentive type (ADHD-I) was found to be the most common subtype of ADHD, followed by hyperactive-impulsive type (ADHD-HI) and the combined type (ADHD-C) with the prevalence of 2.95%, 2.77%, and 2.44% respectively. The predominantly inattentive type (ADHD-I) was the most common type of ADHD in both boys (4.05%) and girls (2.21%). The funnel plot and Egger's regression tests provided no evidence of substantial publication bias in the prevalence of ADHD. CONCLUSION: Our systematic review suggested a higher prevalence of ADHD (7.47%) in children and adolescents in Africa, indicating that ADHD is a serious public health problem in children and adolescents in Africa. The prevalence of ADHD was considerably greater in males than in females. The predominantly inattentive type (ADHD-I) was the most common type of ADHD in both males and females. Greater attention needs to be paid to the prevention and treatment of ADHD.

The prevalence of depression among patients with tuberculosis: a systematic review and meta-analysis.

BACKGROUND: Evidence has shown that the prevalence of depression is much higher among patients with tuberculosis (TB) and this, in turn, may adversely impact compliance with anti-TB medications. Therefore, this systematic review and meta-analysis aimed to quantitatively summarize epidemiologic evidence on the prevalence of depression among patients with TB and formulate a recommendation for future clinical practice as well as research. METHODS: We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to conduct this review. We searched PubMed, EMBASE, SCOPUS and Psych INFO to identify relevant studies that investigated the prevalence of depression among TB patients. We also supplemented our electronic search with manual searching to include all pertinent studies in the analysis. We used a Comprehensive Meta-Analysis software version 3.0 (CMA 3.0) to conduct a meta-analysis. We conducted a subgroup and sensitivity analysis and Cochran's Q- and the I 2-statistics were used to assess heterogeneity. The evidence for the presence of publication bias was checked by using Egger's test and visual inspection of the symmetry in funnel plots. RESULTS: We identified a total of 25 studies that included 4903 participants across seven countries. In our analysis, the pooled estimated prevalence of depression among TB patients was found to be 45.19% (95% CI 38.04-52.55). The prevalence was higher in MDR-TB 52.34% (95% CI 38.09-66.22) than non-MDR-TB 43.47% (95% CI 35.88-51.37) patients. We also found that the pooled prevalence of depression was higher among females 51.54% (95% CI 40.34-62.60) when compared to males 45.25% (95% CI 35.19-55.71). The pooled prevalence of depression was 45.45% as measured by HRDS, and it was 55.62%, 45.52%, and 38.36% as measured by BDI, HADS and PHQ-9, respectively. CONCLUSION: Our finding suggested that the pooled estimated prevalence of depression among tuberculosis patients was relatively high. Screening and management of depression among TB patients were warranted to alleviate suffering. Moreover, the integration of tuberculosis program with regular psychiatry services may substantially reduce the burden.

The Prevalence of Suicidal Ideation and Attempt Among Young People with HIV/AIDS: a Systematic Review and Meta-Analysis.

Studies have suggested that suicidal ideation and attempt are highly prevalent among young people with HIV/AIDS and have been linked with increased risk of complete suicide. However, thus far, there are no worldwide systematic reviews and meta-analysis of the prevalence of suicidal ideation and attempt among young people with HIV/AIDS. A systematic search of PubMed, Scopus, and Web was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Prevalence rates from individual studies were pooled by using a random-effect meta-analysis. The quality of included studies was assessed by the Joanna Briggs Institute's quality assessment checklist. We used the Cochran's Q and the I2 tests to measure heterogeneity across the studies. In total, 14 studies involving 4842 young people with HIV/AIDS were included in this meta-analysis. Our random effect meta-analysis indicated that roughly a quarter of young people with HIV/AIDS had lifetime suicidal ideations [24.38% (95% CI; 18.49-31.44)], and more than one in ten had current [10.33% (95% CI; 6.13-16.88)], and 6 month [13.03% (95% CI; 4.71-31.24)] suicidal ideations. Likewise, a significant proportion of young people with HIV/AIDS had current [3.75% (95% CI; 2.30-6.06)], 6 month [15.33% (95% CI; 10.00-22.78)], and lifetime [13.05% (95% CI; 7.55-21.61)] suicidal attempts. The pooled prevalence estimate of both suicidal ideation and attempts varied according to the sample size of the participants. This study found that a considerable proportion of young people with HIV/AIDS had suicidal ideation and attempt, suggesting the urgent needs of intervention strategies to relieve the suffering and possibly prevent death due to suicide.

The Global Prevalence of Suicidal Attempt among Medical Students: a Systematic Review and Meta-Analysis.

Even though suicidal attempt among medical students is a major public health concern, there are no prior studies that reported its consolidated magnitude worldwide. To the best of our knowledge, this systematic review is the first to quantitatively analyze the prevalence of suicidal attempts among medical students. We systematically searched PubMed, Embase, and Scopus for English language articles that assessed the prevalence of suicide attempts among medical students. A random-effect meta-analysis was used to combine data from individual studies. The heterogeneity across the studies was evaluated using Cochran's Q- and the I2 test. We assessed publication bias using Egger's test and visual inspection of the symmetry in funnel plots. A total of 14 articles were selected for meta-analysis according to the PRISMA guideline. The pooled lifetime prevalence of suicidal attempt was found to be 2.19% (95% CI; 1.17-4.07). The pooled one-year prevalence was estimated to be 1.64 (95% CI; 0.60-4.45). The estimated prevalence of suicidal attempt was considerably high among medical studies in low and middle-income countries than medical studies in high-income countries. The estimated prevalence of suicidal attempt also varies by gender of participants Given the high prevalence estimate of suicidal attempt among medical students and its potential in resulting death by suicide, early identification, and interventions should be considered among medical students.