Browsing by Author "Degenhardt, L."

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A descriptive epidemiology of substance use and substance use disorders in Nigeria during the early 21st century
(Elsevier Ltd., 2007) Gureje, O.; Degenhardt, L.; Olley, B; Uwakwe, R.; Udofia, O; Wakil, A; Adeyemi, O; Bohnert, K. M.; Anthony, J. C.
Background: Several studies have examined the use of psychoactive substances among selected groups in Nigeria. Here, we extend the description to include the features of substance dependence. Method: A stratified multi-stage random sampling of households was used to select respondents in 21 of Nigeria's 36 states (representing 57% of the national population). In-person interviews with 6752 adults were conducted using the World Health Organization Composite International Diagnostic Interview, Version 3. Lifetime history and recent (past year) use, as well as features of dependence on, alcohol, tobacco, cannabis, sedatives, stimulants, and other drugs were assessed. Results: Alcohol was the most commonly used substance, with 56% (95% confidence interval, CI = 54, 58%) ever users and 14% (95% CI = 13, 15%) recent (past year) users, Roughly 3% were recent smokers (3%, 95% CI = 2.6, 4.2%). Next most common were sedatives. 4% (95% CI = 2.3, 4.5%), and cannabis smokers, 0.4% (95% CI =0.1, 0.6%). Males were more likely than females to be users of every drug group investigated, with male preponderance being particularly marked for cannabis. Prevalence of both alcohol and tobacco use was highest among middle aged adults. Moslems were much less likely to use alcohol than persons of other faiths, but no such association was found for tobacco, non-prescription drug use, or illegal drug use. Features of abuse and dependence were more common at the population level for alcohol; but among users, these features were just as likely to be experienced by alcohol users as they were by other drug users. Conclusion: Alcohol is the most commonly used psychoactive drug' in Nigeria. Features associated with drug dependence and abuse arc less prevalent but may require attention by public health authorities.
Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys
(Elsevier Srl, 2022) Kessler, R. C.; Kazdin, A. E.; Aguilar-Gaxiola, S.; Al-Hamzawi, A.; Alonso, J.; Altwaijri, Y. A.; Andrade, L. H.; Benjet, C.; Bharat, C.; Borges, G.; Bruffaerts, R.; Bunting, B.; Caldas de Almeida, J. M.; Cardoso, G.; Chiu, W. T.; Cía, A.; Ciutan, M.; Degenhardt, L.; de Girolamo, G.; de Jonge, P.; de Vries, Y. A.; Florescu, S.; Gureje, O.; Haro, J. M.; Harris, M. G.,; Hu, C.; Karam, A. N.; Karam, E. G.; Karam, G.; Kawakami, N.; Kiejna, A.; Kovess-Masfety, V.; Lee, S.; Makanjuola, V.; McGrath, J. J.; Medina-Mora, M. E.; Moskalewicz, J.; Navarro-Mateu, F.; Nierenberg, A. A.; Nishi, D.; Ojagbemi, A.; Oladeji, B. D.; O’Neill, S.; Posada-Villa, J.; Puac-Polanco, V.; Rapsey, C.; Ruscio, A. M.; Sampson, N. A.; Scott, K. M.; Slade, T.; Stagnaro, J. C.; Stein, D. J.; Tachimori, H.; ten Have, M.; Torres, Y.; Viana, M. C.; Vigo, D. V.; Williams, D. R.; Wojtyniak, B.; Xavier, M.; Zarkov, Z.; Ziobrowski, H. N.; WHO WMH survey collaborators
Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys –17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) – carried out as part of the World Health Organization (WHO)’s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful.
The association between psychotic experiences and health-related quality of life. A cross-national analysis based on World Mental Health Surveys
(Elsevier, 2018) Alonso, J.; Saha, S.; Lim, C. C. W.; Aguilar-Gaxiola, S.; Al-Hamzawi, A.; Benjet, C.; Bromet, E. J.; Degenhardt, L.; de Girolamo, G.; Esan, O.B.; Florescu, S.; Gureje, O.; Haro, J. M.; Hu, C.; Karam, E. G.; Karam, G.; Kovess- Masfety, V.; Lepine, J. P.; Lee, S.; Mneimneh, Z.; WHO World Mental Health Survey Collaborators
Psychotic experiences (PEs)are associated with arrange of mental and physical disorders, and disability, but little is known about the association between PEs and aspects of health-related quality of life (HRQoL). We aimed to investigate the association between PEs and five HRQoL indicators with various adjustments. Using data from the WHO World Mental Health surveys (n = 33,370 adult respondents from 19 countries), we assessed for PEs and five HRQoL indicators (self-rated physical or mental health, perceived level of stigma (embarrassment and discrimination), and social network burden). Logistic regression models that adjusted for socio-demographic characteristics, 21 DSM-IV mental disorders, and 14 general medical conditions were used to investigate the associations between the variables of interest. We also investigated dose-response relationships between PE related metrics (number of types and frequency of episodes) and the HRQoL indicators. Those with a history of PEs had increased odds of poor perceived mental (OR = 1.5, 95% CI = 1.2–1.9) and physical health (OR = 1.3, 95% CI =1.0–1.7) after adjustment for the presence of any mental or general medical conditions. Higher levels of perceived stigma and social network burden were also associated with PEs in the adjusted models. Dose response associations between PE type and frequency metrics and subjective physical and mental health were non-significant, except those with more PE types had increased odds of reporting higher discrimination (OR=2.2,95%CI=1.3–3.5). Our findings provide novel insights into how those with PEs perceive their health status.