Status of mental-health services for adolescents with psychiatric morbidity in youth correctional institutions in Lagos

BACKGROUND

High prevalence rates of psychiatric morbidity have been documented among adolescents within youth correctional institutions in Nigeria. However, there has not been prior investigation to determine the capacity for and nature of mental health services being provided in these institutions.

OBJECTIVES

To assess psychiatric morbidity among adolescents within youth correctional institutions in Lagos, while simultaneously examining the capacity for and the scope of mental health services.

METHODS

Psychiatric morbidity and alcohol/substance use disorder were assessed among 165 respondents using the Strengths and Difficulties Questionnaire, and the CRAFFT screening tool for adolescent substance use disorder. Availability of mental-health services in the institutions was examined using an 'audit protocol'.

RESULTS

We found prevalence rates of 18.2% and 15.8% of general psychiatric morbidity and alcohol/ substance use disorder, respectively, among the adolescents. Only about a third (34.3%; n = 20) of the operational staff at the institutions had educational backgrounds relevant to psycho-social services for children/adolescents, while less than a quarter (22.4%, n = 13) has ever received any training in child mental health services. There was no evidence of mental health screening and intervention in the service framework within the institutions.

CONCLUSIONS

We concluded that there was evidence for significant mental health service gaps within the youth correctional services in Lagos.

Can we really use available scales for child and adolescent psychopathology across cultures? A systematic review of cross-cultural measurement invariance data

In this systematic review, we assessed available evidence for cross-cultural measurement invariance of assessment scales for child and adolescent psychopathology as an indicator of cross-cultural validity. A literature search was conducted using the Medline, PsychInfo, Scopus, Web of Science, and Google Scholar databases. Cross-cultural measurement invariance data was available for 26 scales. Based on the aggregation of the evidence from the studies under review, none of the evaluated scales have strong evidence for cross-cultural validity and suitability for cross-cultural comparison. A few of the studies showed a moderate level of measurement invariance for some scales (such as the Fear Survey Schedule for Children-Revised, Multidimensional Anxiety Scale for Children, Revised Child Anxiety and Depression Scale, Revised Children's Manifest Anxiety Scale, Mood and Feelings Questionnaire, and Disruptive Behavior Rating Scale), which may make them suitable in cross-cultural comparative studies. The remainder of the scales either showed weak or outright lack of measurement invariance. This review showed only limited testing for measurement invariance across cultural groups of scales for pediatric psychopathology, with evidence of cross-cultural validity for only a few scales. This study also revealed a need to improve practices of statistical analysis reporting in testing measurement invariance. Implications for future research are discussed.

Cross-Cultural Measurement Invariance of Adolescent Self-Report on the Pediatric Quality of Life Inventory™ 4.0

This study evaluated the cross-cultural measurement invariance of the Pediatric Quality of Life Inventory version 4.0 (PedsQL^™) among adolescents sampled from Bulgaria, Croatia, India, Indonesia, Nigeria, Serbia, and Turkey. The multiple-indicator multiple-cause (MIMIC) model was used, which allowed controlling of demographic variables (i.e., age, gender, and socioeconomic status). Significant effects of country on scores within the PedsQL^™ domains were observed, with up to 17 items showing differential item functioning (DIF) across the countries. We did not find support for cross-cultural measurement invariance hypotheses for scores on the PedsQL^™ adolescent self-report in this study. Researchers should use caution in making cross-cultural quality of life comparisons while using the PedsQL.

Prevalence and associated factors for suicidal ideation in the Lagos State Mental Health Survey, Nigeria

BACKGROUND

To combat the increasing rate of suicide, basic data on suicidal behaviours reflecting the uniqueness of the locality are needed in sub-Saharan Africa.

AIMS

To assess the prevalence of suicidal ideation and associated factors.

METHOD

Adults (n=11 246) from the five administrative divisions of Lagos State completed questionnaires detailing suicidal ideation, socio-demographic details, common mental disorders (depression, anxiety and somatic symptoms), alcohol and psychoactive substance use disorders and disability.

RESULTS

The weighted prevalence of current suicidal ideation was 7.28% (s.e. 0.27). Independently associated factors were older age, being female, not married, low occupational group, depression, anxiety, somatic symptoms and disability.

CONCLUSIONS

Despite the validity of cross-national surveys, there is need for individual countries to generate complementary local data to explain variability in rates and risk factors in order to plan for suicide prevention or develop timely and effective response.

DECLARATION OF INTEREST

None.

COPYRIGHT AND USAGE

© The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

Psychosocial wellbeing of patients with multidrug resistant tuberculosis voluntarily confined to long-term hospitalisation in Nigeria

Background and objective

Patient isolation, which is a widely successful treatment strategy for tuberculosis (TB), has been suspected to have effects on patient psychosocial wellbeing. We assessed the psychosocial wellbeing of multidrug resistant TB (MDR-TB) patients in voluntary and isolated long-term hospitalisation in Nigeria.

Methods

98 accessible and consenting patients in four drug-resistant treatment centres (University College Hospital and Government Chest Hospital, Ibadan; Mainland Hospital, Lagos, and Lawrence Henshaw Memorial Hospital, Calabar) were enrolled in this study. Data were collected using an 18-item psychosocial wellbeing questionnaire including sociodemographic characteristics. We used descriptive statistics to present demographic characteristics; the χ² test was used to assess associations between psychosocial wellbeing and independent variables and the relationship was modelled using logistic regression.

Results

The mean age of respondents was 36.1±11.9 years and 63% were males. Respondents had been in hospital an average of 4.5±1.9 months. Females had more psychosocial concerns compared with males. The most common concerns recorded among respondents were concern that people will get to know that the respondent had a bad type of TB (70%), discontent with being separated from and longing for the company of their marital partner (72%), concerns that they may have taken too many drugs (73%), and displeasure with being unable to continue to engage in their usual social and economic activities (75%). Respondents who were employed had eight times the odds of having more psychosocial concerns than the median number among respondents. Respondents who were supported by their own families during hospitalisation experienced a lower burden of psychosocial concerns compared with those who were supported by third parties.

Conclusions

Prolonged hospitalisation resulted in significant psychosocial burden for the MDR-TB patients in our study centres. There is a need to consider alternative approaches that place less psychosocial burden on patients without compromising quality of care.

Towards school mental health programmes in Nigeria: systematic review revealed the need for contextualised and culturally-nuanced research

BACKGROUND

School-based mental health programmes, a potential avenue to reach many children and youth, are not yet developed in Nigeria. In view of the importance of cultural nuances in mental health issues, initial groundwork towards the establishment of these programmes in Nigeria must be cognizant of cultural peculiarities at the outset.

OBJECTIVES

The objective of the study was to critically examine, through the lens of transcultural psychiatry, all the currently available epidemiological studies and needs assessments relevant to school-based mental health programmes in Nigeria.

METHODS

The study was a systematic review of relevant studies available from MEDLINE, Science Direct, PsychInfo, Google Scholar, and AJOL databases.

RESULTS

This review shows that there is an ongoing effort at documenting the burden of mental health problems and risks, resource needs, and the available resource and capacity for school-based mental health programmes in Nigeria. However, generally speaking these epidemiological data and needs assessments are significantly limited in epistemological philosophy and cultural contextualisation. This was evidenced by a preponderance of non-representative data, quantitative assessments, and decontextualised interpretation of results and conclusions.

CONCLUSIONS

Going forward, recommendations are offered for culturally-nuanced epidemiology and the direction is set for context-appropriate needs assessments for school-based mental health programmes in Nigeria.

Problematic Internet Use and Its Correlates Among Students from Three Medical Schools Across Three Countries

OBJECTIVE

The authors aimed to assess and compare problematic internet use among medical students enrolled in a graduate degree course in one school each from Croatia, India, and Nigeria and to assess correlates of problematic use among these students.

METHODS

The questionnaire included a sociodemographic profile of participants and Young's Internet Addiction Test.

RESULTS

The final analysis included 842 subjects. Overall, 38.7 and 10.5 % of respondents scored in the mild and moderate categories. Only a small fraction (0.5 %) of students scored in the severe category. Being male and spending more time on the internet were correlated with problematic internet use. Moreover, a significantly higher proportion of participants who scored above the cutoff used the Internet for browsing, social networking, chatting, gaming, shopping, and viewing pornography. However, there was no difference between the two groups with regard to using the internet for e-mailing or academic activities.

CONCLUSIONS

It is important to address problematic internet use among medical students. The correlates can help identify those at increased risk.

Suicidal ideation: Are refugees more at risk compared to host population? Findings from a preliminary assessment in a refugee community in Nigeria

Among the serious mental health problems that may be associated with being a refugee is suicidal behavior. This study aimed to assess the prevalence and correlates of suicidal ideation among African refugees in Oru-Ijebu Nigeria. Suicidal ideation was assessed using appropriate section in the Mini-International Neuropsychiatric Interview while the brief version of the WHO Quality of Life was used to assess quality of life as a clinical variable. Study involved 444 refugees and 527 non-refugee member of host community. Result showed that the prevalence of suicidal ideation was significantly higher among the refugees than the non-refugee comparison group (27.3% vs. 17.3%; p<0.001). Social status and quality of life was significantly poorer among the refugees compared with their non-refugee members of same community. Quality of life was the only factor independently associated with suicidal ideations among refugees. In conclusion, the study shows that the prevalence of suicidal ideation is significantly higher among the refugees than the non-refugee members of the host community and calls for innovative ways of extending mental health services to refugees at the study site.

Cross-cultural child and adolescent psychiatry research in developing countries

Mental disorders are currently a major source of morbidity among children and youth globally. The bulk of the epidemiological data about childhood mental health morbidity currently comes from the industrialized countries which paradoxically host a small (about 20%) proportion of global children and youth population. As the world seek to generate more data on the mental health of the teeming children and youth population in low- and middle-income countries (LMICs), cross-cultural issues need be considered. This consideration is imperative for reasons which include the high level of ethno-diversity in LMICs; the contextual issues in the conceptualization of normal (and abnormal) childhood across cultures, the cross-cultural nuances in risk and protective factors, and the plurality of nature and expression of childhood psychopathology. As much as it is imperative to do so, advancing cross-cultural child and adolescent research in LMICs will need to overcome challenges such as inclusive sampling and cultural validation of instruments developed in the industrialized countries of the West. Funding, technical resources, and publication bias are other potential challenges. These issues are appraised in this narrative review and some ways forward are proffered.

State of the Nigerian child - neglect of child and adolescent mental health: a review

BACKGROUND

As most child health initiatives in Nigeria lack a child and adolescent mental health (CAMH) strategy, CAMH issues have remained obscure to the country's policy-makers. The lack of current and representative epidemiological data on the mental health of Nigerian children continues to be a barrier to advocacy for CAMH policy initiatives. In view of the importance of CAMH to national development, there must be a continued search for ways of bringing the state of CAMH in Nigeria to the attention of policy-makers.

OBJECTIVES

To use information from UNICEF's State of the World's Children as proxy data to speculate on the state of child mental health in Nigeria.

METHODS

With a view to discussing its CAMH implications, social and health indicators in the Nigerian child were extracted from UNICEF's 2012 edition.

RESULTS

Most of the social and health indicators assessed reflect significant mental health risks. Up to 65% of households live on less than US$1·25 per day, child malnutrition is evident in up to 40% of children, and the primary and secondary school net enrolment ratios are only 63% and 25%, respectively. In addition, the rate of attendance for antenatal care was 45%, and only 39% of deliveries were supervised by skilled birth attendants. Child labour and under-age marriage is very common. A literature review demonstrates that children living in these circumstances are at significant risk of mental health problems.

CONCLUSION

Current data on the state of Nigerian children contain indices that can serve as proxy information for the state of CAMH in the country. Policy-makers need to invest more in pre-emptive child health initiatives as a way of preserving the physical and mental health of children.

Mental health service utilization in sub-Saharan Africa: is public mental health literacy the problem? Setting the perspectives right

The severely constrained resources for mental health service in less-developed regions like sub-Saharan Africa underscore the need for good public mental health literacy as a potential additional mental health resource. Several studies examining the level of public knowledge about the nature and dynamics of mental illness in sub-Saharan Africa in the last decade had concluded that such knowledge was poor and had called for further public enlightenment. What was thought to be mental health 'ignorance' has also been blamed for poor mainstream service utilization. These views however assume that non-alignment of the views of community dwellers in sub-Saharan Africa with the biomedical understanding of mental illness connotes 'ignorance', and that correcting such 'ignorance' will translate to improvements in service utilization. Within the framework of contemporary thinking in mental health literacy, this paper argues that such assumptions are not culturally nuanced and may have overrated the usefulness of de-contextualized public engagement in enhancing mental health service utilization in the region. The paper concludes with a discourse on how to contextualize public mental health enlightenment in the region and the wider policy initiatives that can improve mental health service utilization.

Level of community mental health literacy in sub-Saharan Africa: current studies are limited in number, scope, spread, and cognizance of cultural nuances

BACKGROUND

The combination of high prevalence of mental disorders and the scarcity of resources to care for them in sub-Saharan Africa underscores the need for good mental health literacy as a potential mental health resource.

AIM

To conduct a systematic review of the findings of studies that have examined aspects of mental health literacy among community dwellers in sub-Saharan Africa.

METHODS

A search was conducted using local and international indexes like MEDLINE, EMBASE and PsychInfo.

RESULTS

Only 19 studies from eight different countries met inclusion criteria. Key aspects of the functional mental health literacy that has been examined include recognition of mental disorders, knowledge about causation, and treatment preferences. The modes of seeking mental health information are yet to be examined. Some studies utilized a methodology that allowed for respondents to use local labels to describe their understanding of various mental disorders. Otherwise, respondents were largely unable to label orthodox psychiatry syndromes correctly. Supernatural and ultra-human views were rampant, and alternative mental health services were mostly preferred. Quantitative modes of assessment were the most common, and authors-especially those that adopted this mode of assessment-did not take full cognizance of socio-cultural underpinnings of the concept of mental health literacy in their conclusion and recommendations.

CONCLUSION

There is need for more studies to adopt more comprehensive approaches to the assessment of mental health literacy. The outcomes of such studies will provide the right context for making profound statements on the level of knowledge and skills for mental health promotion in sub-Saharan Africa.

Role of personal and family factors in alcohol and substance use among adolescents: an international study with focus on developing countries

Most studies examining adolescent alcohol and substance use or abuse hardly include samples from developing countries. To bridge some gap, the prevalence and associated social correlates of alcohol and substance use and abuse was examined among a cohort of school-going adolescents sampled from seven developing countries. Alcohol and substance abuse was measured using the CRAFFT instrument, independent socio-demographic correlates were determined using regression models. A total of 2454 adolescents completed the study, among which 40.9% reported using either alcohol or at least one other substance during the previous 12 months. This was mostly alcohol (37.8%), followed by marijuana/hashish (8.6%) and other substances (8.1%). Among the adolescents who reported using at least one substance, 45% (18.3% of total sample) had CRAFFT scores indicative of problematic or hazardous substance use. Several personal and family factors were independently associated with use/abuse, and the modifiable nature of these factors calls for appropriate intervention strategies.

Children within the juvenile justice system in Nigeria: psychopathology and psychosocial needs

Background:

Many children in Nigeria face a life of poverty, family instability, inadequate educational opportunities and poor physical and mental health which hinder their ability to develop into healthy adults, live an improved quality of life or fulfil their life aspirations. These factors have also been associated with juvenile delinquency and need for institutional care.

Objectives:

As a step toward providing comprehensive services for incarcerated children in Nigeria, this study aimed to identify the psychosocial needs as well as types of psychopathology among a group of incarcerated children at the Ibadan remand home.

Methods:

A cross-sectional survey of children and adolescents at the Ibadan remand home was carried out using a semi-structured questionnaire.

Results:

A total of 59 children were assessed over a one year period. Majority (90%) were in need of care and protection. All (100%) had significant psychosocial needs presenting as difficulty with their primary support, economic, social environment, or educational systems. Majority (97%) also demonstrated significant psychopathology and anxiety, suicidal and depressive symptoms were the most commonly elicited.

Conclusion:

Incarcerated children in this study showed significant mental health needs which need to be addressed as a matter of urgency. This should be carried out through the collaborative efforts of mental health professionals with various stakeholders in child care.

Lifetime exposure to traumatic events among adolescents in contact with the Nigerian juvenile justice systems compared with a comparison group of secondary school students

BACKGROUND

There are some knowledge gaps in what is known about pre-contact exposure to traumatic events among adolescents within the juvenile justice system. Data often focus on psychological sequelae without describing the traumatic events. In addition, there are few data from sub-Saharan Africa where juvenile justice inmates are often minor offenders and may themselves have been victims of abuse and neglect.

OBJECTIVE

To present detailed data on the lifetime prevalence rate and pattern of traumatic events among a cohort of adolescents in juvenile justice custody in Nigeria and to compare inmates who are 'offenders' with those who are 'victims'.

METHODS

Inmates of a borstal and a remand home comprised the study group and age- and gender-matched adolescents from two government schools were the secondary comparison group. The trauma-checklist of the Current and Lifetime Version of the Kiddies Schedule for Affective Disorders and Schizophrenia was used as a guide in assessing traumatic events.

RESULTS

Of a total of 408 adolescents, 204 were recruited from the two juvenile justice institutions and 204 from secondary schools. Ninety per cent of participants were male and the mean (SD) age was 15·9 (2·8) years. The prevalence rate of lifetime exposure to traumatic events among the juvenile justice offenders was 88·7% compared with 48·5% of the comparison group (P = 0·001). The most commonly reported specific lifetime traumatic event was physical abuse (52·8%). The institutionalised adolescents were significantly more likely to report lifetime exposure to almost all the traumatic events assessed. Apart from the perpetrators of violent crime, there was no statistically significant difference in the prevalence and pattern of lifetime exposure to traumatic events between the offenders and the victims.

CONCLUSIONS

This study provides further evidence that exposure to traumatic events is a fact of life for inmates of juvenile institutions, irrespective of whether they are offenders or victims. The implications for reform of the Nigerian juvenile justice system are discussed.

The 'beyond parental control' label in Nigeria

Recent reports in Nigeria indicate a geometric rise in incarcerated adolescents, with an overwhelming majority of this increase being attributed to adolescents being declared 'beyond parental control'. There is a nagging suspicion that the Nigerian juvenile justice system has over criminalised adolescents by declaring them 'beyond control' when behavioural problems have actually resulted from child abuse/neglect and family disruption. A study was undertaken in a juvenile justice institution in Nigeria to assess the adequacy of pre-incarceration parental care among adolescents that had been declared as 'beyond parental control'. The study included 75 adolescent boys that had been declared as 'beyond parental control' and a comparison group of 144 matched school going boys. It examined self-reports received from the adolescent boys regarding their pre-incarceration family life and social circumstances, as well as the behavioural problems they had experienced. The findings indicate that adolescent boys who were declared as 'beyond parental control' had a significantly higher lifetime history of behavioural problems than the comparison group, and they also had significantly higher indicators of pre-incarceration child abuse/neglect and problems with stability and consistency of primary support. These findings pose questions regarding the presumption of adequate parental care prior to the declaration of 'beyond parental control'. It also raises questions about child rights protection and juvenile justice reform in Nigeria.

Where lies the risk? An ecological approach to understanding child mental health risk and vulnerabilities in sub-saharan Africa

Efforts at improving child-health and development initiatives in sub-Saharan Africa had focused on the physical health of children due to the neglect of child and adolescent mental health (CAMH) policy initiatives. A thorough and broad-based understanding of the prevalent child mental-health risk and vulnerability factors is needed to successfully articulate CAMH policies. In this discourse, we present a narrative on the child mental-health risk and vulnerability factors in sub-Saharan Africa. Through an ecological point of view, we identified widespread family poverty, poor availability and uptake of childcare resources, inadequate community and institutional childcare systems, and inadequate framework for social protection for vulnerable children as among the risk and vulnerability factors for CAMH in the region. Others are poor workplace policy/practice that does not support work-family life balance, poor legislative framework for child protection, and some harmful traditional practices. We conclude that an ecological approach shows that child mental-health risks are diverse and cut across different layers of the care environment. The approach also provides a broad and holistic template from which appropriate CAMH policy direction in sub-Saharan Africa can be understood.

PedsQLTM 4.0 Generic Core Scales for adolescents in the Yoruba language: translation and general psychometric properties

BACKGROUND

Quality of life (QOL) is a universally accepted concept for measuring the impact of different aspects of life on general well-being. Adaptation of existing QOL instruments to local cultures has been identified as a better strategy than development of new ones.

AIMS

To translate and adapt the Paediatric Quality of Life Inventory™ Version 4.0 Generic Core Scales (PedsQL™) to the Yoruba language and culture and to test the psychometric properties of the adapted instrument among adolescents.

METHODS

Psychometric properties including internal consistency reliability, construct and factorial validity of the Yoruba version of PedsQL™ were evaluated using standard procedures.

RESULTS

The self report and proxy scales of the Yoruba PedsQL™ were developed with good cultural relevance and semantic/conceptual equivalence. Results from 527 adolescents revealed a Cronbach's coefficient which exceeded 0.7 for internal consistency reliability for all scores. The healthy subjects reported higher PedsQL™ scores than those with mental health and physical problems, which confirmed construct validity. Confirmatory factor analysis revealed a good model fit for the Psychosocial Health score, but not for the other measures.

CONCLUSIONS

The Yoruba PedsQL™ is culturally appropriate and with good internal consistency, reliability and construct validity. More work is needed regarding its factorial validity.

Neurological and intellectual disabilities among adolescents within a custodial institution in South-West Nigeria

A total of 67 adolescents from a juvenile remand home were matched with 67 other adolescents by age and gender, with a view to determine the prevalence and spectrum of neurological and intellectual disabilities. Intelligence quotient (IQ) was estimated using an adapted version of the Slosson's Intelligence Test and a full neurological evaluation was carried out. The mean IQ score for the remand home participants was significantly lower than the controls (77 ± 11 vs. 99 ± 14; t = 1.6, P = 0.001). Almost half (46.7%) of the participants in the remand home had intellectual disability of varying degrees, including borderline intellectual functioning, compared with only two (3.3%) of the comparison group (P < 0.001). Epilepsy and neurological deficits were significantly more prevalent among the remand home group, particularly those admitted as victims of neglect, compared with the comparison group (P ≤ 0.02). These findings and recent literature were used to speculate the possible underlying factors. Policy implications for child social welfare in Nigeria were suggested.

Taking the first step towards entrenching mental health in the workplace: insights from a pilot study among HR personnel in Nigeria

BACKGROUND

The continued relevance of optimal employee mental health to sustainable human capital development in the workplace underscores the need to start harnessing all resources that can be mobilized to promote the entrenchment of workplace mental health. The strategic place of workplace Human Resource (HR) units in formulating and implementing workplace welfare schemes makes them potential partners. To actualize this, it is important to initially assess the preparedness of HR personnel for, and the possible barriers to entrenching mental health in the workplace. To suggest the initial course of action and to serve as a template for a robust large-scale study, we conduct a pilot assessment of the experience with, attitudes towards, and level of prioritization of mental health in the workplace among a cohort of HR personnel in Nigeria.

METHODS

Participants were recruited in the course of a seminar/workshop and questionnaires were developed by authors to assess variables of interest. Attitudes were examined using an adapted form of the Link's Discrimination-Devaluation (LD-D) scale.

RESULTS

A total of 90 human-resource personnel completed the questionnaires. Only 16% of the participants reported having handled the case of an employee with a suspected mental health problem in the preceding 2 years. Attitudes toward employees and prospective employees with mental illness were largely poor. For instance, more than 70% were likely to consider for employment someone with a pre-existing physical disability than for someone with a history of mental illness. In terms of workplace health promotion priorities, physical health seminars took wide precedence over mental health seminars.

CONCLUSION

The preliminary findings of this pilot study justify a need to conduct a large scale study. Significant challenges encountered in the course of this pilot study were highlighted while insights were drawn for the conduct of the main study/project.

Beyond prevalence and pattern: problematic extent of alcohol and substance use among adolescents in Ibadan South-west Nigeria

BACKGROUND

Previous research on adolescent alcohol/substance use in Nigeria had focused on the pattern of use without consideration for the extent of use. Socio-demographic correlates have also not been well explored. Information about socio-demographic correlates can also inform target-points in preventive strategies. Knowledge of the prevalence of problematic pattern of alcohol/substance use can inform the inclusion of rehabilitation strategies in intervention policies.

OBJECTIVES

To determine the prevalence, pattern and extent-as well as socio-demographic correlates-of alcohol/substance use among a cohort of adolescents in Nigeria.

METHODS

Pattern and extent of alcohol/substance use was examined using the CRAFFT instrument.

RESULTS

A total of 538 adolescents with a mean age of 15.1 ± 1.4 years returned completed questionnaires. 12-month prevalence of alcohol and other substance use was 21.4%. About 46% of those who reported use of alcohol or any other substance had a CRAFFT score of >2 which suggests problematic pattern of use. Older age, male gender, parental alcohol and substance and lower than average school performance were independently associated with 12-moNth use of alcohol or any other substance.

CONCLUSIONS

Adolescent alcohol and substance use is common in Nigeria and a large proportion of users show a problematic pattern of use that warrants rehabilitative intervention.

Frames of mental illness in the Yoruba genre of Nigerian movies: implications for orthodox mental health care

This study examines the modes of framing mental illness in the Yoruba genre of Nigerian movies. All Yoruba films on display in a convenient sample of movie rental shops in Ibadan (Nigeria) were sampled for content. Of the 103 films studied, 27 (26.2%) contained scenes depicting mental illness. Psychotic symptoms were the most commonly depicted, while effective treatments were mostly depicted as taking place in unorthodox settings. The most commonly depicted aetiology of mental illness was sorcery and enchantment by witches and wizards, as well as other supernatural forces. Scenes of mental illness are common in Nigerian movies and these depictions-though reflecting the popular explanatory models of Yoruba-speaking Nigerians about mental illness- may impede utilization of mental health care services and ongoing efforts to reduce psychiatry stigma in this region. Efforts to reduce stigma and improve service utilization should engage the film industry.