FACULTY OF CLINICAL SCIENCES
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Item Suicidal behavior and associations with quality of life among HIV/AIDS patients in Ibadan, Nigeria(SAGE, 2015) Oladeji, B. D.; Taiwo, B.; Mosuro, O.; Fayemiwo, S. A.; Abiona, T.; Fought, A. J.; Robertson, K.; Ogunniyi, A.; Adewole, I. F.Background: Suicidality has rarely been studied in HIV-infected patients in sub-Saharan Africa. This study explored suicidal behavior in a clinic sample of people living with HIV, in Nigeria. Methods: Consecutive patients were interviewed using the Composite International Diagnostic Interview (CIDI-10.0) and the World Health Organization Quality of Life (WHO-QOLHIV-BREF). Associations of suicidal behavior were explored using logistic regression models. Results: In this sample of 828 patients (71% female, mean age 41.3 + 10 years), prevalence of suicidal behaviors were 15.1%, 5.8%, and 3.9% for suicidal ideation, plans, and attempts, respectively. Women were more likely than men to report suicidal ideation (odds ratio 1.7; 95% confidence interval 1.05-2.64). Depression and/or anxiety disorder was associated with increased odds of all suicidal behaviors. Suicidal behavior was associated with significantly lower overall and domain scores on the WHO-QOL. Conclusion: Suicidal behaviors were common and significantly associated with the presence of mental disorders and lower quality of life.Item A pilot randomized controlled trial of a stepped care intervention package for depression in primary care in Nigeria(2015) Oladeji, B. D.; Kola, L.; Abiona, T.; Montgomery, A. A.; Araya, R.; Gureje, O.Background: Depression is common in primary care and is often unrecognized and untreated. Studies are needed to demonstrate the feasibility of implementing evidence-based depression care provided by primary health care workers (PHCWs) in sub-Saharan Africa. We carried out a pilot two-parallel arm cluster randomized controlled trial of a package of care for depression in primary care. Methods: Six primary health care centers (PHCC) in two Local Government Areas of Oyo State, South West Nigeria were randomized into 3 intervention and 3 control clinics. Three PHCWs were selected for training from each of the participating clinics. The PHCWs from the intervention clinics were trained to deliver a manualized multicomponent stepped care intervention package for depression consisting of psychoeducation, activity scheduling, problem solving treatment and medication for severe depression. Providers from the control clinics delivered care as usual, enhanced by a refresher training on depression diagnosis and management. Outcome measures Patient’s Health Questionnaire (PHQ-9), WHO quality of Life instrument (WHOQOL-Bref) and the WHO disability assessment schedule (WHODAS) were administered in the participants’ home at baseline, 3 and 6 months. Results: About 98% of the consecutive attendees to the clinics agreed to have the screening interview. Of those screened, 284 (22.7%) were positive (PHQ-9 score ≥ 8) and 234 gave consent for inclusion in the study: 165 from intervention and 69 from control clinics. The rates of eligible and consenting participants were similar in the control and intervention arms. In all 85.9% (92.8% in intervention and 83% in control) of the participants were successfully administered outcome assessments at 6 months. The PHCWs had little difficulty in delivering the intervention package. At 6 months follow up, depression symptoms had improved in 73.0% from the intervention arm compared to 1.6% control. Compared to the mean scores at baseline, there was improvement in the mean scores on all outcome measures in both arms at six months. Conclusion: The results provide support for the feasibility of conducting a fully-powered randomized study in this setting and suggest that the instruments used may have the potential to detect differences between the arms.Item 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.Item Association between depression and hypertension in the Ibadan Study of Ageing. African(2020) Ajayi, S.O.; Oladeji, B.; Abiona, T.; Gureje, O.Introduction: The elderly population is growing all over the world with attendant increase in occurrence of comorbid conditions. Using data from a longitudinal study of community-dwelling elderly persons in Nigeria, we explored the prevalence and corelates of hypertension and depression as well as the factors associated with the comorbidity of these two conditions. Methods: The Ibadan Study of Ageing, a longitudinal community-based cohort study conducted between 2003 and 2009 on the profile and determinants of successful ageing. A multistage cluster random sampling was used to select a cohort of elderly participants from across eight contiguous Yoruba speaking states in Nigeria- Ekiti, Kogi, Kwara, Lagos, Ogun, Ondo, Osun, and Oyo. Participants (non-institutionalized elderly, aged 65 years or over) were assessed at 4 time points: baseline(2003/2004) and annually from 2007 (wave 1), 2008 (wave 2 and 2009 (wave 3). 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), social engagement was assessed using an adapted World Health Organization Disability Assessment Schedule WHODAS) and functional disability using activities of daily living (ADL) and instrumental activities of daily living (IADL). Hypertension was defined according to the Joint National Committee-7(JNC7) recommendations as systolic blood pressure of 140 mmHg and above, diastolic blood pressure of 90mmHg. This current study is based on cross-sectional data from the wave 1(2007) assessment. Results: Of the 1597 participants, 58% were females and 42% were 70 years and older. The mean age was 74.2 years (SD ±7.8). Nine hundred and ninety-eight (62.5%) participants had hypertension while 177 (10.6%) met the criteria for major depression while comorbid depression and hypertension was present in 122 (7.1%). The comorbidity of hypertension and depression was significantly associated with gender (higher in women) (p=0.001), insomnia (p=0.001), lack of family participation (p=0.001), lack of community participation (p=0.002), and experiencing a negative life event in the past year (p=0.003). In a multivariate analysis, lack of participation in family activities was associated with an increased risk of co-morbidity between hypertension and depression (OR 4.51, p=0.000, CI 2.14-9.50). Conclusions: These findings suggest that the comorbidity of depression and hypertension could potentially be minimized by modifying social risk factors such as keeping the elderly involved in family and community life participation by promoting their involvement in recreational and volunteer activities as well as social gatherings.