Psychiatry
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Item Effect of gender on the utilization of maternal and child health services among pastoralist caregivers in Somali region of Ethiopia(2021) Oladeji, O.; Oladeji, B.; Chamla, D.; Robins, A.; Belalahy, V.Ethiopia has made great effort in recent years to improve maternal and child health outcomes, however the uptake of services by women in the pastoralist communities of the country is still very low. This study was a cross-sectional study aimed to identify the effect of gender on the utilization of health services among pastoralists women. The study was conducted in Somali Region of Ethiopia between February and March 2020. A mix of qualitative and quantitative methods was used, and study population were married caregivers aged 15years and above. Bivariate analysis was done using t test and chi-square to test association among variables and p value was set at significant level of 5%. Husbands were reported as the main influence of the respondents’ decision about almost all the key households’ activities including health care seeking and financial decision making. Almost all caregivers (93.6%) who used the health facility took permission from their husbands and the test of association shows significant relationship between level of education and permission from respondents’ husbands which decreases with increasing level of education, p<0.05) but not affected by age. The care givers visited the health facilities because of their children more than themselves (58 per cent compared to 49.5 per cent for themselves) due to fear of being attended to by male health work. The study demonstrated the negative effect of gender inequities on health care seeking behaviours with women having limited control over family resources and decision-making over their health or that of their children.Item Prevalence and correlates of sexual dysfunction among patients with mental disorders in a tertiary hospital in Southwest Nigeria(2021) Adesola, A. O.; Oladeji, B.Background: Sexual dysfunction is more common among patients with mental disorders compared to the general population. Despite this high occurrence, information regarding sexual dysfunction as well as their correlates in patients receiving care for mental disorders in developing countries is still sparse. Aim: To determine the prevalence and correlates of sexual dysfunction among patients with mental disorders receiving care in a tertiary hospital in Southwest Nigeria. Setting: This study was performed at the psychiatric outpatient clinic at the University College Hospital, Ibadan, Southwest Nigeria. Methods: A cross-sectional study was conducted on a convenience sample of 238 adults aged 18–60 years. Socio-demographic and clinical information was obtained from all recruited patients. Sexual dysfunction was assessed using the International Index of Erectile Function questionnaire for men and the Female Sexual Function Index questionnaire for women. Questionnaires for measuring depression, medication adherence and autonomic medication side effects were also administered. Associations between sexual dysfunction and socio-demographic and clinical factors were explored. Results: The prevalence rates of sexual dysfunction among male and female participants were 84.7% and 95.7%, respectively. In the multivariate analysis, employment status and autonomic side effects of psychotropic medications significantly predicted male sexual dysfunction, while religion and employment status were predictors of female sexual dysfunction. Conclusion: Sexual dysfunction is very common among patients with mental disorders, with higher rates in female participants. There is a need for clinicians to consider routine screening for sexual dysfunction in psychiatric outpatients with a view of providing psychosocial interventions to improve patient’s quality of life.Item Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality(Cambridge University Press, 2020) Scott, K. M.; de Vries, Y. A.; Aguilar-Gaxiola, S.; Al-Hamzawi, A.; Alonso, J.; Bromet, E. J.; Bunting, B.; Caldas-de-Almeida, J. M.; Cía, A.; Florescu, S.; Gureje, O.; Hu, C. Y.; Karam, E. G.; Karam, A.; Kawakami, N.; Kessler, R. C.; Lee, S.; McGrath, J.; Oladeji, B.; Posada-Villa, J.; Stein, D. J.; Zarkov, Z.; de Jonge, P.Aims. Intermittent explosive disorder (IED) is characterised by impulsive anger attacks that vary greatly across individuals in severity and consequence. Understanding IED subtypes has been limited by lack of large, general population datasets including assessment of IED. Using the 17-country World Mental Health surveys dataset, this study examined whether behavioural subtypes of IED are associated with differing patterns of comorbidity, suicidality and functional impairment. Methods. IED was assessed using the Composite International Diagnostic Interview in the World Mental Health surveys (n = 45 266). Five behavioural subtypes were created based on type of anger attack. Logistic regression assessed association of these subtypes with lifetime comorbidity, lifetime suicidality and 12-month functional impairment. Results. The lifetime prevalence of IED in all countries was 0.8% (S.E.: 0.0). The two subtypes involving anger attacks that harmed people (‘hurt people only’ and ‘destroy property and hurt people’), collectively comprising 73% of those with IED, were characterised by high rates of externalising comorbid disorders. The remaining three subtypes involving anger attacks that destroyed property only, destroyed property and threatened people, and threatened people only, were characterized by higher rates of internalising than externalising comorbid disorders. Suicidal behaviour did not vary across the five behavioural subtypes but was higher among those with (v. those without) comorbid disorders, and among those who perpetrated more violent assaults. Conclusions. The most common IED behavioural subtypes in these general population samples are associated with high rates of externalising disorders. This contrasts with the findings from clinical studies of IED, which observe a preponderance of internalising disorder comorbidity. This disparity in findings across population and clinical studies, together with the marked heterogeneity that characterizes the diagnostic entity of IED, suggests that it is a disorder that requires much greater research.Item Comparative case studies in integrated care implementation from across the globe: a quest for action(Springer, 2019) Stadnick, N. A.; Sadler, E.; Sandall, J.; Turienzo, C. F.; Bennett, I. M.; Borkan, J.; Oladeji, B.; Gureje, O.; Aarons, G. A.; Sklar, M.Background: Integrated care is the coordination of general and behavioral health and is a highly promising and practical approach to improving healthcare delivery and patient outcomes. While there is growing interest and investment in integrated care implementation internationally, there are no formal guidelines for integrated care implementation applicable to diverse healthcare systems. Furthermore, there is a complex interplay of factors at multiple levels of influence that are necessary for successful implementation of integrated care in health systems. methods: Guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework (Aarons et al., 2011), a multiple case study design was used to address two research objectives: 1) To highlight current integrated care implementation efforts through seven international case studies that target a range of healthcare systems, patient populations and implementation strategies and outcomes, and 2) To synthesize the shared and unique challenges and successes across studies using the EPIS framework. Results: The seven reported case studies represent integrated care implementation efforts from five countries and continents (United States, United Kingdom, Vietnam, Israel, and Nigeria), target a range of clinical populations and care settings, and span all phases of the EPIS framework. Qualitative synthesis of these case studies illuminated common outer context, inner context, bridging and innovation factors that were key drivers of implementation. Conclusions: We propose an agenda that outlines priority goals and related strategies to advance integrated care implementation research. These goals relate to: 1) the role of funding at multiple levels of implementation, 2) meaningful collaboration with stakeholders across phases of implementation and 3) clear communication to stakeholders about integrated care implementation.Item A community-based intervention for improving utilization of medical services by rape survivors in refugee camps in Zambia(2019) Oladeji, O.; Owoaje, E.; Oladeji, B.; Fatiregun, A.Background: Rape is the most common form of violence in conflict and refugee situations but because of the associated stigma few cases are reported. This study assessed the outcome of an intervention targeted at women groups on the utilization of medical services by rape survivors in refugee camps in Zambia. Methods: A prospective quasi-experimental community-based intervention study was carried out in two refugee camps allocated into intervention and comparison areas. The intervention was participatory education sessions for women groups. Data was collected using the clinic records and the main outcome was the number of rape survivors who utilized and completed medical services provided at the camp clinics. Univariate, bivariate and multivariate analyses were carried out with level of significance set at 5%. Results: The proportion of the rape survivors who accessed medical care within 72 hours increased significantly from 41.2% to 84.8% in the intervention area but from 31.1% to 38.9% in the comparison area, (p=0.005). Those who completed their medical treatment and the follow-up visits increased significantly from 42.8% to 94.8% in intervention area but reduced from 38.5% to 21.4% in the comparison area, (p=0.002). Being resident in the intervention area predicted the utilization of medical services, [OR: 3.15; 95%CI: 1.955-5.681], p=0.002. Conclusion: Community-based intervention using participatory women’s group discussion had a significant impact on increasing the utilization of medical services by rape survivors and should be considered for scaling up as a key intervention for increasing utilization of medical services for rape survivors especially in refugee situations.Item Human Immunodeficiency Virus Type 1 and tuberculosis co-infection in multinational resource limited settings: increased neurological dysfunction(Oxford Academic, 2019) Robertson, K.; Oladeji, B.; Jiang, H.; Kumwenda, J.; Supparatpinyo, K.; Campbell, T.; Hakim, J.; Tripathy, S.; Hosseinipour, M.; Marra, C. M.; Kumarasamy, N.; Evans, S.; Vecchio, A.; La Rosa, A.; Santos, B.; Silva, M. T.; Montano, S.; Kanyama, C.; Firnhaber, C.; Price, R.; Marcus, C.; Berzins, B.; Masih, R.; Lalloo, U.; Sanne, I.; Yosief, S.; Walawander, A.; Nair, A.; Sacktor, N.; Hall, C.; AIDS Clinical Trials GroupBackground. AIDS Clinical Trial Group 5199 compared neurological and neuropsychological test performance of human immunodeficiency virus type 1 (HIV-1)–infected participants in resource-limited settings treated with 3 World Health Organization–recommended antiretroviral (ART) regimens. We investigated the impact of tuberculosis (TB) on neurological and neuropsychological outcomes. Methods. Standardized neurological and neuropsychological examinations were administered every 24 weeks. Generalized estimating equation models assessed the association between TB and neurological/neuropsychological performance. Results. Characteristics of the 860 participants at baseline were as follows: 53% female, 49% African; median age, 34 years; CD4 count, 173 cells/μL; and plasma HIV-1 RNA, 5.0 log copies/mL. At baseline, there were 36 cases of pulmonary, 9 cases of extrapulmonary, and 1 case of central nervous system (CNS) TB. Over the 192 weeks of follow-up, there were 55 observations of pulmonary TB in 52 persons, 26 observations of extrapulmonary TB in 25 persons, and 3 observations of CNS TB in 2 persons. Prevalence of TB decreased with ART initiation and follow-up. Those with TB coinfection had significantly poorer performance on grooved pegboard (P < .001) and finger tapping nondominant hand (P < .01). TB was associated with diffuse CNS disease (P < .05). Furthermore, those with TB had 9.27 times (P < .001) higher odds of reporting decreased quality of life, and had 8.02 times (P = .0005) higher odds of loss of productivity. Conclusions. TB coinfection was associated with poorer neuropsychological functioning, particularly the fine motor skills, and had a substantial impact on functional ability and quality of life.Item Effectiveness of traditional healers in treating mental disorders - a systematic review(Elsevier, 2016) Nortje, G.; Oladeji, B.; Gureje, O.; Seedat, S.Traditional healers form a major part of the mental health workforce worldwide. Despite this, little systematic examination has been done of their effectiveness in treating mental illness or alleviating psychological distress. In this Review, we aim to fill this gap, with a focus on quantitative outcomes. We searched four databases and reference lists for papers that explicitly measured the effectiveness of traditional healers on mental illness and psychological distress. Eligible papers were assessed for quality, and outcomes and other details were extracted with the use of a standardized template. 32 eligible papers from 20 countries were included. The published literature on this topic is heterogeneous and studies are generally of poor quality, although some findings emerge more consistently. Some evidence suggests that traditional healers can provide an effective psychosocial intervention. Their interventions might help to relieve distress and improve mild symptoms in common mental disorders such as depression and anxiety. However, little evidence exists to suggest that they change the course of severe mental illnesses such as bipolar and psychotic disorders. Nevertheless, qualitative changes that are captured poorly by conventional rating scales might be as important as the quantitative changes reviewed here. We conclude by outlining the challenges involved in assessing the effectiveness of traditional healers.Item Suicidal behaviour in old age - results from the Ibadan study of ageing(2013) Ojagbemi, A.; Oladeji, B.; Abiona, T.; Gureje, O.Background: An important reason for the high risk of suicide in the elderly is the determination with which they act out their suicidal thoughts. Early identification of suicidal behaviours in the elderly is therefore important for suicide prevention efforts in this population. Method: Data are from the Ibadan Study of Ageing (ISA), a household multi-stage probability sample of 2149 Yoruba Nigerians aged 65 years or older conducted between 2003 and 2004. We used the third version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) to explore suicidal experiences and behaviours. In this report, only those experiences or behaviours reported to have occurred after the age of 65 years are the focus of analysis. Derived weights were applied to the data in accordance with the study design and associations were explored using logistic regression. The results are presented as odds ratios (ORs) with 95% confidence intervals. Result: In all, 4.0% (95% C.I= 3.1-4.2) of the subjects had suicidal ideation occurring after the age of 65 years, while 0.7% (95% C.I=0.4-1.3) and 0.2% (95% C.I= 0.1-0.4) reported suicidal plans and attempts, respectively. There was a significantly elevated likelihood of suicidal ideation among persons who had experienced spousal separation through death or divorce (O.R=4.9., 95% C.I= 1.5-15) or who were residing in rural settings (O.R=2.5, 95% C.I=1.3-4.8). Conclusion: Suicidal ideation is common among the elderly. About 20% and 6% of those with ideation proceed to plans and attempts, respectively. Circumstances of social isolation and exclusion are important correlates of suicidal behaviour in the elderly.Item Determinants of transition across the spectrum of alcohol use and misuse in Nigeria(Elsevier, 2013) Esan, O.; 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.Item 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.