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.

Assessment of the alcohol consumption among outdoor bar drinkers in Nigeria by qualitative methods.

BACKGROUND: There are indications that drinking in outdoor bars, such as at motor-parks, by the roadsides or street corners have become popular in Nigeria. METHOD: Three sets of qualitative assessments were carried out from three outdoor bars, randomly selected from 22 of such in Ibadan, Nigeria. The main sources of data were by direct observation and focus group discussion (FGD), conducted by a non-probabilistic sample of outdoor bar drinkers, alcohol vendors and from community members. The qualitative assessments were recorded, followed by a thematic analysis of the contents of the qualitative assessments. RESULTS: Widespread use of alcohol was reported. Patrons of outdoor bars reported that their context of drinking was pleasurable to them. Use of local beverages usually called 'sepe' is increasing. The majority of them do not have adequate health information about the harmful consequences of alcohol. Alcohol and other substances of abuse were openly displayed, sold and consumed at the study sites. There were poor law provision and enforcement of laws prohibiting open display of alcohol and other substances. CONCLUSION: A high proportion of social drinkers in outdoor bars require intervention for their drinking behaviour. This is important because they have little or no information about the health hazards associated with excessive drinking. Presentation of these findings should contribute to increased awareness and improved response from the policy makers.

Prevalence of alcohol consumption and alcohol use disorders among outdoor drinkers in public open places in Nigeria.

BACKGROUND: There is a rapid shift in the social context of drinking, with a large proportion of regular drinkers favouring outdoor-open space drinking, such as motor-parks, by the road sides, the majority of which are unlicensed premises for drinking. METHOD: This study determined the prevalence and determinants of harmful or hazardous alcohol use and possible dependence, defined as a "likely alcohol use disorder" (AUD) in a community sample of 1119 patrons of open space drinking places in Ibadan, Nigeria, using the AUDIT. Scores of 8 and above signified a likely AUD. The associations between a likely AUD and demographic characteristics were sought using Chi square statistics and binary regression analysis was used to determine the effects of multiple confounding variables on a likely AUD using the SPSS version 20.0 software. RESULTS: Of the entire population, the prevalence of likely AUD was 39.5%, and 44.4% out of the drinking population Multivariate analysis showed that Islamic religion was a negative predictor for likely AUD, OR = 0.13, 95% CI (0.06-0.26), while rural residence, OR = 1.84, 95% CI (1.34-2.53) and cigarette smoking OR = 1.81, 95% CI (1.37-2.40) were predictive of likely AUD. CONCLUSION: Outdoor-open space drinkers are likely to have AUD compared with the general population. Open space drinking has a huge public health implication because of the associated health risks and injuries.

Lifetime and 12 Months Prevalence of Alcohol Use and Alcohol Use Disorders Among Soldiers Residing in a Military Community in Ibadan.

OBJECTIVE: Aims of the study were to determine lifetime and 12 months prevalence of alcohol use and alcohol use disorders and the profile of problems associated with the diagnoses of alcohol use disorders among a military population in Nigeria. METHOD: In this descriptive cross-sectional study, 223 military officers were interviewed by multistage stratified systematic sampling method. The Composite International Diagnostic Interview (CIDI) version 7.0 was used to generate data on prevalence of lifetime and current alcohol use, alcohol use disorders, and associated profile of problems. Chi square statistics, Wilcoxon-signed rank test, and binary regression analysis were used to explore the correlates of alcohol use and alcohol use disorder. All analyses were carried using SPSS Version 17.0. RESULTS: Prevalence of lifetime alcohol use was 76.0%, 12 months prevalence was 53.9%, and frequent binge drinking was reported in 6.7% of respondents. Predictors of lifetime alcohol use were: Hausa/Fulani ethnicity OR = 1.51, 95% CI (1.11-8.71), Igbo ethnicity OR = 1.46, 95% CI (1.09-7.01), involvement in combat OR = 1.41, 95% CI (1.01-6.16). Predictors of 12 months alcohol use were: Hausa/Fulani ethnicity OR = 1.98, 95% CI (1.25-8.71), involvement in combat OR = 1.39 95% CI (1.01-5.28) and junior rank soldier OR = 2.08, 95% CI (1.47-8.99) while predictors of lifetime alcohol use disorders were: Hausa/Fulani ethnicity OR = 2.22, 95% CI (1.03-6.99) and involvement in combat OR = 2.04 95% CI (1.12-6.81). CONCLUSION: Alcohol misuse is highly prevalent in the Nigerian military and its associated factors exemplify the common "military drinking culture."

Burnout and quality of life among nurses working in selected mental health institutions in South West Nigeria.

BACKGROUND: Burnout remains a huge public health problem among nurses. METHODS: A cross-sectional descriptive study assessed 259 nurses from two Neuropsychiatric hospitals in Nigeria. Data was collected using a sociodemographic/ job related questionnaire, the Maslach Burnout Inventory (MBI), and the Short-Form health survey (SF-12). The associations between sociodemographic characteristic and burnout was anaysed using Chi square test, between burnout and quality of life using Spearman correlation statistics. Predictors of burnout were determined using binary regression analysis. RESULTS: Prevalence of emotional exhaustion (EE) was 44.4%, depersonalization (DEP) 31.7% and reduced personal accomplishment was 98.8%. Predictors of EE were: poor funding from management, OR = 0.38 (95% CI 0.15-0.95) and role conflict, OR = 2.44 (95% CI 1.03-5.78), while the predictors of DEP, were age group, 31-40 years, OR = 0.37 (95% CI 0.18-0.77), male gender, OR = 2.55 (95% CI 1.40-4.65), role conflict, OR = 6.53 (95% CI 0.88-7.81) and working at more urban city, OR = 3.07 (95% CI 1.54-6.16). The mean total Quality of life (QOL) scores were significantly higher among respondents who had no EE and DEP p < 0.001. CONCLUSION: Burnout is high among mental health nurses and is associated with poor quality of life.

Factors associated with paternal perinatal depression in fathers of newborns in Nigeria.

INTRODUCTION: There is a lack of information on paternal postnatal depression in developing countries such as Nigeria. METHODS: This study aims to assess the prevalence of depression in fathers at the birth of their infants and the incidence of paternal postnatal depression at 6 weeks postpartum. We also examined the correlation between paternal postpartum depression (PPD) at 6 weeks and maternal PPD as well as the sociodemographic and other correlates of paternal PPD at 6 weeks. RESULTS: All the 331 fathers recruited at baseline completed the study. Prevalence of depression in fathers at birth of their babies was 10 (3%). After excluding the 3%, the incidence of PPD in fathers (N = 321) at 6 weeks was 19 (5.9%). In all, 29 (8.8%) fathers had PPD. The prevalence of depression in mothers at 6 weeks postpartum was 57 (17.8%). The prevalence of depression in mothers at 6 weeks was significantly higher than the incidence of depression in fathers at 6 weeks (X2 = 26.2, p < .001). There was no significant correlation between maternal PPD and paternal PPD. At baseline, prevalence of PPD among the unemployed fathers was higher than in the employed, 3 (21.4%) versus 7 (2.2%), this was significant (FE p < .01). There was no significant correlate of paternal PPD at 6 weeks. DISCUSSION: Postpartum mental health services should be extended to fathers of newborns especially those who are unemployed. Our findings have implications for family health.

Social network as a determinant of pathway to mental health service utilization among psychotic patients in a Nigerian hospital.

OBJECTIVE: The main objectives of the study were to determine the relationship between social network and pathway to service utilization among psychotic patients. MATERIALS AND METHODS: This descriptive study was carried out in a psychiatric unit in a general hospital in South West Nigeria. Using structured questionnaires, primary data were collected from 652 psychotic patients on their social network, health behaviors and pathway to current service use. Logistic regression analysis was used to assess the effect of social network on patients' use of services, controlling for sociodemographics, health and functional status. RESULTS: Mean age of the respondents was 29.0 ± 7.5 years, range 14-58 years, males constituted 52.6%. Regarding pathway to services, alternative sources of care such as priests, spiritualists, natural therapists, herbalists, was the first port of call for 78.9% of respondents. Family dominated the social network in 51.1% of patients. The presence of some social network and social support structures were significantly associated with the use of general medical and specialty psychiatric services for patients with schizophrenia (P = 0.03), schizoaffective disorder (P = 0.02), bipolar I disorder (P = 0.01), but not with major depression and symptoms of psychological distress. CONCLUSIONS: Findings indicate that social support and social network enhanced utilization of mental health services for psychiatric patients except for those with psychotic depression or those with symptoms of psychological distress. In addition, alternative sources of care are still relevant in mental health service delivery in South West Nigeria.

Expert panel's modification and concurrent validity of the Teacher Stress Inventory among selected secondary school teachers in Nigeria

Background: The Teacher Stress Inventory (TSI) is an instrument used for assessing occupational stress among teachers but has not been adapted or validated for use in Nigeria. Objective: This study aimed to modify and adapt the TSI for use in Nigeria and also assess its reliability and validity. An expert panel was constituted to modify the original version of the TSI. Thereafter, both the original and the modified versions were applied to 471 teachers from 15 schools in Oyo State, Nigeria. Result: Of all the respondents, 227 (48.2 %) were men and 244 (51.8 %) were women. Mean age was 36.55 ± 8.80 years. Cronbach α for all items of the modified version was .943, and item mean score was 2.60 (1.86­3.56). Concurrent validity of the modified TSI demonstrated significant correlations p< 0.001 with the corresponding items of the original version. Test-retest reliability of the modified version was .988. There were significant inter-item correlations for all the items of the modified version of the TSI. Conclusion: The modified version of the TSI is a valid and reliable instrument in the Nigerian population to assess teachers' stress. (AU)

Use of mental health services in a developing country. Results from the Nigerian survey of mental health and well-being.

BACKGROUND: Evidence from developed industrialized countries suggests poor uptake of mental health services. No data exist in developing resource-constrained countries about met and unmet need for mental health service in the community. METHOD: A four-stage stratified probability sample of households was studied in the Yoruba-speaking part of Nigeria (population, approximately 25 million people or 22% of the Nigerian national population). Face-to-face interviews were conducted with persons 18 years old and above (n=4,984) using the World Mental Health version of the Composite International Diagnostic Interview. We determined the proportions of respondents with 12-month Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) anxiety, mood, or substance use disorder who had received any mental health treatment and the correlates of treatment receipt. RESULTS: Only 9.0% of those with any 12-month DSM-IV disorder had received treatment. While 11% of those with a mood disorder had received some treatment, none of those with substance use disorders had used a mental health service. Most treatments were received from general medical settings, with only about 1% of those with DSM-IV disorders receiving specialist mental health service. Surprisingly, complementary or alternative health providers were also consulted by only about 4% of those with mental disorders, although a much higher proportion of 57% of those with no DSM-IV disorders but who nevertheless received mental health treatment did so from such providers. Irrespective of the disorders or the sector where treatment was received, virtually no treatment was adjudged minimally adequate. CONCLUSION: There is a striking level of unmet need for mental health service in the community in this developing country setting. While inadequacy of the formal public health sector may be partly responsible for this observation, there is the likelihood that receipt of treatment for mental health problems may also be hampered by the public's poor knowledge of the nature of the disorders and by stigma.

Lifetime and 12-month prevalence of mental disorders in the Nigerian Survey of Mental Health and Well-Being.

BACKGROUND: Large-scale community studies of the prevalence of mental disorders using standardised assessment tools are rare in sub-Saharan Africa. AIMS: To conduct such a study. METHOD: Multistage stratified clustered sampling of households in the Yoruba-speaking parts of Nigeria. Face-to-face interviews used the World Mental Health version of the Composite International Diagnostic Interview (WMH-CIDI). RESULTS: Of the 4984 people interviewed (response rate 79.9%), 12.1% had a lifetime rate of at least one DSM-IV disorder and 5.8% had 12-month disorders. Anxiety disorders were the most common (5.7% lifetime, 4.1% 12-month rates) but virtually no generalised anxiety or post-traumatic stress disorder were identified. Of the 23% who had seriously disabling disorders, only about 8% had received treatment in the preceding 12 months. Treatment was mostly provided by general medical practitioners; only a few were treated by alternative practitioners such as traditional healers. CONCLUSIONS: The observed low rates seem to reflect demographic and ascertainment factors. There was a large burden of unmet need for care among people with serious disorders.

Community study of knowledge of and attitude to mental illness in Nigeria.

BACKGROUND: The improvement of community tolerance of people with mental illness is important for their integration. Little is known about the knowledge of and attitude to mental illness in sub-Saharan Africa. AIMS: To determine the knowledge and attitudes of a representative community sample in Nigeria. METHOD: A multistage, clustered sample of household respondents was studied in three states in the Yoruba-speaking parts of Nigeria (representing 22% of the national population). A total of 2040 individuals participated (responserate 74.2%). RESULTS: Poor knowledge of causation was common. Negative views of mental illness were widespread, with as many as 96.5% (s.d.=0.5) believing that people with mental illness are dangerous because of their violent behaviour. Most would not tolerate even basic social contacts with a mentally ill person: 82.7% (s.e.=1.3) would be afraid to have a conversation with a mentally ill person and only 16.9% (s.e.=0.9) would consider marrying one. Socio-demographic predictors of both poor knowledge and intolerant attitude were generally very few. CONCLUSIONS: There is widespread stigmatisation of mental illness in the Nigerian community. Negative attitudes to mental illness may be fuelled by notions of causation that suggest that affected people are in some way responsible for their illness, and by fear.