Scholarly works in Psychiatry

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Clinical correlates of schizophrenia: a study at the University College Hospital, Ibadan
(2002) Morakinyo, J. J.; Oladeji, B.; Odejide, A. O.
Reasons for consultation in the psychiatric out-patient clinic of a university teaching hospital in Nigeria: is this optimal use of psychiatrists’ time and expertise?
(Cambridge University Press & Assessment, 2003) Omigbodun, O.O.; Esan, O.B.
AIMS AND METHOD To identify activities that can be modified in the psychiatry out-patient clinic in order to improve the quality of services rendered. Consulting doctors obtained information on the reason for consultation and time spent by each patient over a one-month period. RESULTS Half of all the patients (50.5%) came for are peat prescription, and19.3% came for are peat prescription and counselling. The mean times spent on these two activities were 5.13 (s.d.=2.5) and 7.81 (s.d.=7.51) minutes, respectively. The time spent on these activities by doctors was 47%of the total clinic time. CLINICAL IMPLICATIONS Clinic services should be reorganised so that doctors can use their skills in more efficient and creative ways.
Prevalence and correlates of suicidal behaviour among adolescents in southwest Nigeria
(Nigerian Medical Association, 2008) Omigbodun, O.; Dogra, N.; Esan, O.B.; Adedokun, B.
Background: Despite being recognized by the World Health Organization as a significant social and health concern, information on suicidal behaviours in Nigerian adolescents is unknown. Aims: To establish the prevalence and associated psychosocial correlates of suicidal ideation and attempts in Nigerian youth. Methods: Stratified sampling was used to identify youth aged 10–17 years who completed the Nigeria version of the Global School Health Questionnaire (GSHQ) and the Diagnostic Predictive Scale (DPS) for youths (suicidal behaviour questions) in a classroom setting. Results: A total of 1429 youth completed the instruments. Over 20% reported suicidal ideation and approximately 12% reported that they had attempted suicide in the last year. Adolescents living in urban areas, from polygamous or disrupted families, had higher rates of suicidal behaviour. Multiple psychosocial factors such as sexual abuse, physical attack and involvement in physical fights were significant predictors of suicidal behaviour. Conclusion: Factors associated with suicidal ideation and behaviours are similar to those found in other studies but the rates of both suicidal ideation and attempts are towards the upper limit of rates for youth. This study suggests that there is an urgent need for Nigerian policymakers and health providers to review and address this issue.
Mental Health: morbidity and impact
(San Diego Elsevier Academic Press, 2008) Gureje, O.; Oladeji, B.
Women, depression, and mental-physical comorbidity: chronic pain as a mediating factor
(Cambridge University Press, 2009) Gureje, O.; Oladeji B.
Gender and rural-urban differences in the nutritional status of in-school adolescents in south-western Nigeria
(Cambridge University Press, 2010) Omigbodun, O.O.; Adediran, K.I.; Akinyemi, J.O.; Omigbodun, A.O.; Adedokun, B.O.; Esan, O.B.
This study assessed gender and rural/urban differences in height and weight, and the prevalence of stunting, underweight and overweight of school-going adolescents in south-west Nigeria, using 2007 WHO reference values for comparison. The influence of sexual maturity and the socio demographic correlates of growth performance were also examined. In this cross-sectional study, 924 male (51.4%) and 875 female (48.6%) students (1799 in total) aged 10–19 years from eighteen schools in Ibadan (five rural, nine urban public and four urban private) were interviewed and examined. Although males were significantly taller than females (p<0.05) stunting was more pronounced for males, who were 7.5 cm shorter than the 2007 WHO reference, compared with females who were 3.5 cm shorter. Body mass index (BMI) for girls was also greater than for boys (p<0.05) Rural adolescents had lower heights and BMIs compared with those in urban areas. The mean height of male adolescents in rural schools fell below 2 SDs of the 2007 WHO reference between 14 and 17 years, while heights of males and females in private schools were similar to the median 2007 WHO standard. Low height-for-age was observed in 282 adolescents (15.7%), which, after multivariate analysis, was significantly associated with school type, gender, number of mother’s children and puberty onset. Adolescents in rural schools were much more likely to be stunted than those in urban private schools (AOR 13.1; 95% CI 5.2–33.2) and males were three times more likely to be stunted compared with females (AOR 3.3; 95% CI 2.4–1.4). Low BMI-for-age was observed in 240 adolescents (18.9%), with correlates similar to stunting. Adolescents at the pre-puberty stage were twice as likely to have low BMI-for-age (OR 2.0; 95% CI 1.6–2.5) than those with signs of puberty. There were 2.3% overweight adolescents, who were significantly more likely to be female, in private school and post-pubertal. Innovative interventions for Nigerian adolescents, especially rural inhabitants and males, are needed to reduce the prevalence of stunting and underweight
Depression in adult Nigerians: results from the Nigerian Survey of Mental Health and Well-being
(Cambridge University Press & Assessment, 2010) Gureje, O.; Uwakwe, R.; Oladeji, B.; Makanjuola, V.O.; Esan, O.B.
Background: Community-based studies of the rates and profile of depression among Africans are still sparse. Methods: As part of the World Mental Health Surveys initiative, a clustered multi-stage sampling of households in 21 of Nigeria's 36 states (representing 57% of the national population) was implemented to select adults aged 18 years and over(N=6752)for face-to-face interviews using the Composite International Diagnostic Interview (CIDI 3.0). Diagnosis of major depressive episode (MDE) was based on the criteria of the Diagnostic and Statistical Manual, 4th edition. Results: Lifetime and 12 monthestimatesofMDEwere3.1%(standarderror0.3) and1.1% (s.e.0.1), receptively. Increasing age was associated with higher estimates of positive responses to stem (screen)questions for depression and of lifetime disorders among stem-positive respondents. The mean age of onset was about 29.2 years. The median (inter quantile range, IQR) duration of an episode among lifetime cases was 1.0 (2.0–2.4) year and the median (IQR) number of lifetime episodes was 1.5 (2.0–2.8). MDE was highly comorbid with anxiety disorders, musculoskeletal conditions, chronic pain and ulcer. The odds ratio of lifetime suicide attempt among persons with lifetime MDEwas11.6(95%confidenceinterval,3.9–34.9).Over25%of12-monthcaseswererated as severely disabled in the performance of usual roles. Only 16.9%(i.e. 5.0) of 12-monthcases had received any treatment. Limitations: All data were based on self-reports. Conclusion: MDE, defined according to DSM-IV, is a risk factor for mental and physical comorbidity as well as disability in Nigerians. Age-related telescoping or denial may partly explain the low rates in this young population
The gateway hypothesis of substance abuse: an examination of its applicability in Nigeria general population
(Informa Healthcare USA, Inc., 2010) Makanjuola, V. A.; Oladeji, B. D.; Gureje, O.
The study aims to estimate the prevalence and predictors of not following the gateway theory. Respondents were selected from a multistage stratified clustered sampling of households in five of Nigeria’s six geopolitical regions. Interviews were conducted between February 2002 and May 2003 using the CIDI-version.3 with a total sample size (N) of 2,143. Cumulative incidence proportions of not following a gateway pattern were estimated with SUDAAN. Predictors of this were estimated using multivariate logistic regression models. The deviation from the normative sequence of drug use occurs albeit infrequently. The public health implications of this are discussed as well as the limitations of the findings.
Family related adverse childhood experiences as risk factors for psychiatric disorders in Nigeria
(Cambridge University Press, 2010) Oladeji, B. D.; Makanjuola, V. A.; Gureje, O.
"Adverse childhood experiences have been associated with a variety of mental health problems in adult life. Aims To examine whether this reported link between childhood experiences and mental health disorders in adult life applies in a Sub-Saharan African setting where cultural and family attributes may be different. Method A multistage random sampling was used in the Nigerian Survey of Mental Health and Well-Being (NSMHW) to select respondents for face-to-face interviews. Assessments of family-related adverse childhood experiences and lifetime mental health disorders were conducted with the Composite International Diagnostic Interview (CIDI 3.0). Results Almost half of the respondents had experienced an adverse childhood experience within the context of the family before they were 16 years of age. Associations between adverse childhood experiences and adult mental health disorders were few and were attenuated when clustering of adverse childhood experience and disorder comorbidities were accounted for. There was an elevated likelihood of adult substance use disorders among individuals who had experienced family violence and neglect or abuse. Parental psychopathology was associated with a significantly increased risk for developing mood disorders. Conclusions Adverse childhood experiences reflecting violence in the family, parental criminality and parental mental illness and substance misuse were more likely to have significant mental health consequences in adulthood"
The gateway hypothesis of substance abuse: an examination of its applicability in Nigeria general population
(Informa Healthcare USA, Inc., 2010) Makanjuola, V. A.; Oladeji, B. D.; Gureje, O.
The study aims to estimate the prevalence and predictors of not following the gateway theory. Respondents were selected from a multistage stratified clustered sampling of households in five of Nigeria’s six geopolitical regions. Interviews were conducted between February 2002 and May 2003 using the CIDI-version.3 with a total sample size (N) of 2,143. Cumulative incidence proportions of not following a gateway pattern were estimated with SUDAAN. Predictors of this were estimated using multivariate logistic regression models. The deviation from the normative sequence of drug use occurs albeit infrequently. The public health implications of this are discussed as well as the limitations of the findings.
Chronic pain conditions and depression in the Ibadan Study of Ageing
(Elsevier Inc, 2011) Oladeji, B.D.; Makanjuola, V.A.; Esan, O.B.; Gureje, O.
"Background—Chronic pain is quite common in the elderly and is often associated with co morbid depression, limitation of functioning and reduced quality of life. The aim of this study was to ascertain whether there is a differential risk of depression among persons with pain in different anatomical sites and to determine which pain conditions are independent risk factors for depression. Methods—Data is from the Ibadan Study of Ageing (ISA), a community based longitudinal survey of persons aged 65 years and older from eight contiguous Yoruba Speaking states in Nigeria (n = 2152). Data was collected in face-to-face interviews; depression was assessed using the World Mental Health initiative version of the Composite International Diagnostic Interview (CIDI) while chronic pain was assessed by self-report (response rate = 74%). Results—Estimates of persistent pain (lasting more than 6 months), in different anatomical sites range from 1.3% to 12.8%, with the commonest being joint pains (12.8%), neck or back (spinal) pain (7.6%) and chest pain (3.0%). Significantly more pain conditions were reported by females and by respondents who were aged over 80 years. The risk for depression was higher in respondents with spinal, joint and chest pain. However, only chest pain was independently associated with depression after adjustments were made for pains at other sites and for functional disability. Conclusion—Our data suggests that, among elderly persons, there is a differential association of depression with chronic pain that is related to the anatomical site of the pain."
The natural history of insomnia in the Ibadan study of ageing
(Oxford University Press, 2011) Gureje, O.; Oladeji, B.D.; Abiona, T.; Makanjuola, V.; Esan, O.B.
"Study Objectives: To determine the incidence and risk factors for insomnia among an under-studied population of elderly persons in Sub-Saharan Africa. Setting: Eight contiguous predominantly Yoruba-speaking states in south-west and north-central Nigeria representing about 22% of the national population. Participants: 1307 elderly community-dwelling persons, aged 65 years and older. Measurements: Face-to-face assessment with the Composite International Diagnostic Interview, version 3 (CIDI.3) in 2007 and 12 months later in 2008 to determine the occurrence and risk factors of incident and persistent insomnia, defined as syndrome or symptom. Results: The incidence of insomnia syndrome in 2008 at 12 months was 7.97% (95% CI, 6.60–9.60), while that of insomnia symptom was 25.68% (22.68-28.66). Females were at elevated risk for both syndrome and symptom. Among persons with insomnia symptom or syndrome at the base line, 47.36% (95% CI 43.07–51.68) continued to have it one year later. Decreasing economic status was associated with increasing incidence of insomnia. Persons with chronic medical conditions at baseline were at increased risk for new onset of insomnia. Compared to persons with the lowest body mass index (BMI) (< 18.5), those with higher BMI were at elevated risk for persistence of their insomnia, with those in the obese range (≥ 30) having a 4-fold risk. Conclusions: There is a high incidence and chronicity of insomnia in this elderly population. Persons with chronic health conditions are particularly at risk of new onset as well as persistence of insomnia. "
Parental psychopathology and the risk of suicidal behavior in their offspring: results from the world mental health surveys
(Macmillan Publishers Limited, 2011) Gureje, O.; Oladeji, B.; Hwang, I.; Chiu, W. T.; Kessler, R. C.; Sampson, N. A.; Alonso, J.; Andrade, L. H.; Beautrais, A.; Borges, G.; Bromet, E.; Bruffaerts, R.; de Girolamo, G.; de Graaf, R.; Gal, G.; He, Y.; Hu, C.; Iwata, N.; Karam, E. G.; Kovess-Masféty, V.; Matschinger, H.; Moldovan, M. V.; Posada-Villa, J.; Sagar, R.; Scocco, P.; Seedat, S.; Tomov, T.; Nock, M. K.
Previous research suggests that parental psychopathology predicts suicidal behavior among offspring; however, the more fine-grained associations between specific parental disorders and distinct stages of the pathway to suicide are not well understood. We set out to test the hypothesis that parental disorders associated with negative mood would predict offspring suicide ideation, whereas disorders characterized by impulsive aggression (for example, antisocial personality) and anxiety/agitation (for example, panic disorder) would predict which offspring act on their suicide ideation and make a suicide attempt. Data were collected during face-to-face interviews conducted on nationally representative samples (N= 55 299; age 18þ) from 21 countries around the world. We tested the associations between a range of parental disorders and the onset and persistence over time (that is, time since most recent episode controlling for age of onset and time since onset) of subsequent suicidal behavior (suicide ideation, plans and attempts) among offspring. Analyses tested bivariate and multivariate associations between each parental disorder and distinct forms of suicidal behavior. Results revealed that each parental disorder examined increased the risk of suicide ideation among offspring, parental generalized anxiety and depression emerged as the only predictors of the onset and persistence (respectively) of suicide plans among offspring with ideation, whereas parental antisocial personality and anxiety disorders emerged as the only predictors of the onset and persistence of suicide attempts among ideators. A dose-response relation between parental disorders and respondent risk of suicide ideation and attempt was also found. Parental death by suicide was a particularly strong predictor of persistence of suicide attempts among offspring. These associations remained significant after controlling for comorbidity of parental disorders and for the presence of mental disorders among offspring. These findings should inform future explorations of the mechanisms of intergenerational transmission of suicidal behavior.
Childhood stress: neurobiology and association with adult physical and mental disorders
(2011) Oladeji, B.
Many people experience significant stressful or traumatic events in childhood. These events often leave a scar that may manifest in the form of adult psychopathology and chronic physical conditions. The neurobiological basis of the link between these childhood experiences and adult health problems is increasingly being studied and understood. The advantage of this understanding is that even if the exposure to traumatic and stressful events in childhood cannot be entirely prevented, the consequences of such exposure may be ameliorated by the institution of early intervention to persons at greatest risk.
Traumatic events and posttraumatic stress symptoms among adolescents in Ibadan
(College of Medicine, University of Ibadan, Nigeria, 2011) Oladeji, B. D.; Morakinyo, J. J.; Gureje, O.
Little empirical data exist on the rates of exposure to traumatic events and its sequelae especially in adolescents. This study was designed to determine the lifetime prevalence of exposure to traumatic events and posttraumatic stress symptoms among adolescents in Ibadan, Nigeria. A sample of 786 boys and girls from 10 senior secondary schools located within Ibadan were interviewed using an adapted version of the Schedule for Affective Disorders and Schizophrenia (KSADS) to ascertain the prevalence of exposure to traumatic events and posttraumatic stress symptoms. Irrespective of gender, more than 40% reported lifetime exposure to at least one traumatic event. Commonly reported events were: receiving news of sudden injury, death or illness in a close family member or friend, being a victim or witness to a violent crime and physical abuse. About 2.4% of the sample met diagnostic criteria for posttraumatic stress disorder (PTSD). Female sex, exposure to more than one traumatic event, and sexual abuse were associated with increased risk for PTSD. The results of this study highlights the substantial risk for experiencing serious traumatic events by adolescents within the community, and a need for professionals involved in the care of adolescents to be more vigilant in screening for trauma related distress.
Incidence and risk factors of late life depression in the Ibadan study of ageing
(Cambridge University Press, 2011) Gureje, O.; Oladeji, B. D.; Abiona, T.
Background. We present the incidence and risk factors for major depressive disorder (MDD) among community dwelling elderly Nigerians. Method. A cohort study of persons aged o65 years residing in eight contiguous Yoruba-speaking states in southwest and north-central Nigeria was conducted between November 2003 and December 2007. Of the 2149 baseline sample, 1408 (66%) were successfully followed up after approximately 39 months. Face-to-face in-home assessments were conducted with the World Health Organization (WHO) Composite International Diagnostic Interview, version 3 (CIDI.3) and diagnosis was based on the DSM-IV. Incident MDD was determined in the group with no prior lifetime history of MDD at baseline and who were free of dementia at follow-up (n=892). Results. During the follow-up period, 308 persons had developed incident MDD, representing a rate of 104.3 [95% confidence interval (CI) 93.3–116.6] per 1000 person-years. Compared to males, the age-adjusted hazard for females was 1.63 (95% CI 1.30–2.06). Lifetime or current subsyndromal symptoms of depression at baseline did not increase the risk of incident MDD. Among females, but not males, rural residence and poor social network were risk factors for incident MDD. Physical health status at baseline did not predict new onset of MDD. Conclusions. The finding of a high incidence of MDD among elderly Nigerians complements earlier reports of a high prevalence of the disorder in this understudied population. Social factors, in particular those relating to social isolation, constitute a risk for incident MDD.
Epidemiology of schizophrenia-- an update with a focus on developing countries
(Taylor & Francis, 2012) Esan, O.B.; Ojagbemi, A.; Gureje, O.
Developments over the past few decades in analytical epidemiological research in schizophrenia have challenged some long-held views about the disorder. For example, the conventional view that schizophrenia may have a favourable outcome in developing countries is currently being challenged by emerging empirical data. However, quality research from develop ing countries is still relatively scarce. In this article we review some major epidemiological fi ndings of schizophrenia with a focus on data from the developing world and within the context of the methodological issues and challenges associ ated with such studies.
Mental disorders and earnings: results from the Nigerian National Survey of Mental Health and Well-Being (NSMHW)
(International Center of Mental Health Policy and Economics, 2012) Esan, O. B.; Kola, L.; Gureje, O.
Background: Mental disorders are associated with a loss in earnings both at the individual and societal level. Very few studies have addressed the issue of the cost of mental illness in Sub-Saharan Africa. These studies have been largely hospital based, localized, and have addressed only a few mental disorders using very small sample sizes. Aims of the Study: To examine the impact of mental disorders on earnings of affected persons. Methods: Mental disorders on and personal earnings were assessed in a representative sample of 1,889 Nigerians aged 18-64 years in an epidemiological survey. Version 3.0 of the World Health Organization Composite International Diagnostic Interview (WHO CIDI) was used to assess mental disorders. Respondents were also asked to report their personal earnings before tax in the past 12 months, while authors predicted personal earnings in the same period from information about 12 month and life time DSM IV mental disorders among respondents. Results: A 12-month prevalence of Serious Mental Illness (SMI) was found in 0.5% of the sample while other 12-month disorders had a prevalence of 4.83%. The prevalence of other lifetime disorders was 4.14%. The mean annual impact of serious mental illness was 60,126 Naira (US$ 463). At the level of the society the annual impact was 21.6 billion Naira (US$ 166.2 million). Discussion: Mental disorders have an enormous individual and societal financial burden. This impact appears more severe in males. Implications for Health Care Provision and Use: Mental disorders have enormous negative impacts on earnings both at the individual and societal level. This analysis highlights the financial value of lost earnings in the absence of such disorders. Implications for Health Policies: An increase in spending on mental health based on proportionate economic burden of mental disorders may substantially reduce financial losses due to mental disorders. Implications for Further Research: In the present study, only the indirect health care costs have been assessed. Future research should consider direct costs.
Mental health and HIV in Africa
(Jones and Bartlett Learning, 2012) Oladeji, B. D.; Gureje, O.
Determinants of transition across the spectrum of alcohol use and misuse in Nigeria
(Elsevier Inc, 2013) Esan, O.B.; Makanjuola, V.; Oladeji, B.; Gureje, O.
Many studies have examined the risk factors associated with alcohol use disorders. No information is available from developing countries about the factors that may determine the transitions across different levels of use and misuse. Alcohol use and its misuse were assessed in a cohort of 2143 Nigerians using Version 3.0 of the World Health Organization Composite International Diagnostic Interview (WHO-CIDI). This generated six levels of alcohol use and related disorders. Using age of onset variables created for the purpose, analysis was done to determine rates of and risk factor for transition between the levels. Lifetime prevalence estimates were 57.8% for alcohol use, 27.6% for regular use, 2.9% for abuse, and 0.3% for dependence. Whereas 47.8% transited to regular use from lifetime ever use, only 10.5% transited to abuse from regular use and 9.5% from abuse to dependence. Male sex, age 18e49 years and being never married predicted onset of alcohol use. Transition to regular use was predicted only by male sex while transition to abuse was predicted by male sex and age 35e49 years. Factors associated with recovery from abuse were female sex and a student status. Higher rates of transition occurred in the stages preceding the onset of alcohol use disorders. Sex and age were the main determinants of transition, with male gender and middle age being risk factors for transition to problematic use of alcohol.