Anxiety disorders in breast cancer: Prevalence, types, and determinants.

The coexistence of anxiety disorders among women with breast cancer has been linked with delay in diagnosis, treatment abandonment, and poor quality of life. This study investigated anxiety disorders with their determinants among 200 participants with histological diagnosis of breast cancer. A questionnaire was designed to elicit sociodemographic and clinical factors, while the schedule for clinical assessment in neuropsychiatry (SCAN) was used to ascertain the presence of anxiety disorders. The mean age of participants was 49.6 years (SD = 11.2) and more than half (54%) presented with advanced cancers (stages 3 and 4). Anxiety disorder was observed in 38 (19%) of the participants. Low income, absence of previous history of breast cancer, and early stage of breast cancer were the significant determinants of anxiety disorders (p < 0.05). However, only absence of previous history of breast cancer (odds ratio [OR] = 3.460, 95% confidence interval [CI] = 1.200-6.960) and early stage of breast cancer (OR = 1.560, 95% CI = 1.120-2.174) were the determinants of anxiety disorders following logistic regression. We advocate for public awareness to promote early screening. Similarly, there is need to improve access to care and integrate culturally appropriate psychosocial intervention into breast cancer care using the available knowledge on vulnerability factors. Further study on anxiety disorders in breast cancer is indicated.

Toward the integration of comprehensive mental health services in HIV care: an assessment of psychiatric morbidity among HIV-positive individuals in sub-Saharan Africa.

Existing evidence from research supports the desirability of integration of mental health services into HIV care in order to mitigate the grave consequences of unattended mental health morbidity among People Living with HIV/AIDS (PLWHA). This study aims to find out the burden and pattern of psychiatric disorders that is prevalent among HIV-positive individuals attending a Nigerian-based HIV clinic. The study participants, consisting of 295 HIV-positive adults were recruited using systematic random sampling method. The participants were subjected to questionnaire to elicit demographic profile and General Health Questionnaire (GHQ-28) to screen for probable psychiatric disorders. This was followed by Structured Clinical Interview for DSM-IV Non patient (SCID-NP) to diagnose the presence of psychiatric morbidity in any of the participant with a GHQ-28 score ≥5 and 10% of those with GHQ-28 score <5. Data were analyzed with SPSS 17. Of the 295 participants interviewed, approximately one-quarter (25.1%) of the participants had diagnosable psychiatric illness based on SCID-NP. Depression was the commonest mental disorder detected as 44 (14.9%) met the DSM-IV Axis 1 diagnosis of major depressive disorders. Anxiety disorders, concurrent Nicotine with Alcohol dependence and cannabis abuse were elicited in 24 (8.1%), 4 (1.3%), and 2 (0.7%) participants, respectively. This study finds a higher burden of psychiatric disorders in PLWHA in comparison to what is obtainable in the general population based on previous research works in similar context. Thus further underscores the need for integration of comprehensive psychiatric services into HIV care. We advocate the support and commitment of key stakeholders in HIV care to the translation of this research-based evidence into practice among PLWHA.

Psychopathology and subjective burden amongst primary caregivers of people with mental illness in South-Western Nigeria.

BACKGROUND: Most mentally ill persons reside with family members in sub-Saharan Africa with the primary caregiver having to cater for the patients' needs. The burden of this care giving may be associated with psychopathology in the carer. AIMS: To examine the rate and correlates of psychopathology and subjective burden amongst primary caregivers of people with mental illness in South-Western Nigeria. METHOD: Adult psychiatric outpatients (n = 338) from three centres were assessed for clinical and functioning status, while their adult primary caregivers (n = 338) were assessed for psychopathology (using the General Health Questionnaire-GHQ-12) and level of burden (using the Zarit's caregiver burden scale-ZCBS). RESULTS: The mean caregivers' GHQ-12 score was 3.11 (SD 2.57) and mean ZBCS score was 42.85 (SD = 19.31) with a significant correlation between the two (r = 0.638, P < 0.001). 118 (34.9%) caregivers had significant psychopathology and 205 (60.7%) had significant (moderate/severe) burden. The independent associate of psychopathology was poor patient functioning either measured objectively (OR 6.43, 95% CI 3.12-13.29) or subjectively perceived by the carers (OR 6.28, 95% CI 2.46-17.94). Caregivers burden was independently associated with patients' poor functioning (OR 5.97, 95% CI 2.56-15.45), caregivers' being employed (OR 5.40, 95% CI 3.02-9.64) and being male (OR 2.62, 95% CI 1.50-4.59). CONCLUSION: With the high level of psychopathology and burden amongst caregivers in this region, clinicians should be sensitive and review them periodically and to pick up signs of psychopathology which may necessitate attention. Caregivers should be encouraged to meet regularly to share their experiences and ventilate their emotions.

Detection of mental disorders with the Patient Health Questionnaire in primary care settings in Nigeria.

Mental disorders lead to difficulties in social, occupational and marital relations. Failure to detect mental disorder denies patients potentially effective treatment. This study aimed to assess the prevalence and nature of mental disorders at the primary care settings and the recognition of these disorders by the attending physicians. Over a period of eight weeks, consecutive and consenting patients who attended three randomly selected primary health care facilities in Sagamu Local Government Area of Ogun state were recruited and administered a questionnaire that included a socio-demographic section and Patient Health Questionnaire (PHQ). A total of 412 subjects took part in the study. Subject age ranged from 18-90 years with a mean age of 52.50±21.08 years. One hundred and seventy-six (42.7%) of the subjects were males. A total of 120 (29.1%) of the subjects had depressive disorder, 100 (24.3%) had anxiety disorder, 196 (47.6%) somatoform disorder and 104 (25.2%) met the criteria for an alcohol related problem. The PHC physicians were only able to diagnose disorders relating to mental health in 52 (12.6%) of the subjects. Health and work situations accounted for more than three-quarters of the causes of stress experienced by the subjects. We conclude that there is a high prevalence of mental disorders among patients seen in primary care settings and that a significant proportion of them are not recognized by the primary care physicians. Stress relating to health, work and financial problems is common among primary health care attendees. Physicians in primary health care should be alert to the possibility and the impact of undetected psychiatric morbidity.

A case control study of psychiatric morbidities among subjects with leprosy in Lagos, Nigeria.

OBJECTIVES: To determine the pattern of psychiatric morbidity prevalent among leprosy patients and to compare it with two control groups; those suffering from Tinea vesicolor and Normal subjects. DESIGN: Eighty-eight leprosy patients were matched for age and sex with those suffering from Tinea vesicolor as well as normal subjects. The subjects were assessed for psychiatric morbidity through a clinical interview with PSE-9. RESULTS: The prevalence of psychiatric morbidity among leprosy patients (580/1000) was significantly more than those with tinea vesicolor patients (182/1000) and normal subjects (148/1000) (p < 0.05). Depressive illness was the most common diagnosis in the three groups. CONCLUSIONS: Leprosy patients are more likely to manifest with psychiatric illness than those suffering from Tinea vesicolor and normal subjects.

Prevalence and correlates of poor medication adherence amongst psychiatric outpatients in southwestern Nigeria.

OBJECTIVE: The aim of this study was to assess the rate of adherence to medications amongst psychiatric outpatients in Nigeria and examine factors associated with medication nonadherence amongst this group. METHOD: Psychiatric outpatients (n=342) from three centres were assessed for medication adherence using the Morisky Medication Adherence Questionnaire. Details regarding sociodemographic variables (age, sex, education, religion, marital status, employment, income, medication cost), illness related variables (diagnosis, duration, number of episodes/admissions, insight, severity of symptoms, mental state, functional status), medication related variables (type, mode of administration, side effect, attitude to medication) and perception related variables (self-stigma, perceived causation and prognosis) were also obtained. RESULTS: There were 76 participants (22.2%) with good medication adherence, 102 (29.8%) with moderate adherence and 164 (48.0%) with poor adherence. The significant independent correlates of poor medication adherence included being employed [odds ratio (OR) 3.42, 95% confidence interval (95% CI) 2.17-5.39], poor social support (OR 5.86, 95% CI 2.87-12.17), high self-stigma (OR 4.70, 95% CI 2.24-9.96) and perceived spiritual causation of mental illness (OR 3.74, 95% CI 1.87-7.74). CONCLUSIONS: The majority of psychiatric outpatients in southwestern Nigeria had poor medication adherence. Our findings stressed the importance of patients' perception and social environment in determining treatment adherence and the necessity of educating the patient. Clinicians' attention to psychological barriers early in treatment may improve medication adherence and ultimately affect the course of illness.