Prevalence of depression in Uganda: A systematic review and meta-analysis

Appetitive aggression and associated factors among military soldiers retiring from active service in Uganda

Background: Appetitive aggression is a type of aggression that is characterized by a fascination with violence and a desire to inflict pain on the perceived enemy. This type of aggression has mainly been studied among former child soldiers and demobilized combatants. Information on appetitive aggression among retiring active service officers is limited. This study aimed to determine the prevalence of appetitive aggression and the associated factors among soldiers who are retiring from active service in Uganda.Methods: A sample of 247 retiring military soldiers from the Uganda People's Defence Force (UPDF), who had assembled at Gaddafi Barracks in Jinja district in eastern Uganda in preparation for the retirement exercise, was randomly selected for this cross-sectional study. We assessed participants for appetitive aggression using the Appetitive Aggression Scale, and also collected information on alcohol and drug use, exposure to traumatic life events, post-traumatic stress disorder, childhood trauma, and depression. We ran logistic regression models to determine the factors associated with appetitive aggression among the study participants.Results: Ninety-seven per cent (n = 239) of the participants were male and the mean age was 46 years. The prevalence of appetitive aggression was 58%. Not being depressed (p = .040) and experience of traumatic events (p = .001) were associated with high odds of appetitive aggression.Conclusion: The prevalence of appetitive aggression among the study participants was high. Having experienced traumatic events was associated with a greater odds of appetitive aggression, while having depression was protective against appetitive aggression. Interventions aimed at preventing appetitive aggression among soldiers should target addressing the trauma experienced during their line of duty.

Depression among pregnant teenagers receiving antenatal care from primary healthcare facilities in Mbarara city, Southwestern Uganda

BACKGROUND

Depression is a serious mental health condition whose risk is highest among women during pregnancy. The risk is high among pregnant teenagers due to intertwined developmental, hormone-mediated physical and psychosocial changes of pregnancy, with significant negative impacts on the unborn baby and the mother. This study aimed to determine the prevalence of depression and associated factors among pregnant teenagers in Mbarara city, southwestern Uganda.

METHODS

This was a cross-sectional study where we enrolled pregnant teenagers (13-19 years) attending antenatal care at 4 selected lower healthcare facilities in Mbarara City southwestern Uganda. We collected information on depression, resilience, social support and household food insecurity. Depression was defined as a score > 10 on the Edinburgh Postnatal Depression Scale (EPDS). Resilience was assessed using the 14-item Wagnild and Young Resilience Scale, Multi-dimensional Scale of perceived social support (MDSPSS) assessed perceived social support, and Household Food Insecurity Access Scale (HFIAS) assessed food insecurity in addition to sociodemographic variables. We run logistic regression analysis to determine factors associated with depression.

RESULTS

A total of 373 participants were recruited; median age was 19 (IQR: 18-19) years, 59% attained primary level education. The prevalence of depression was 35.9% (95% CI: 31.1% to 41.0%). Factors significantly associated with depression were current alcohol use (aOR = 1.98, 95% CI: 1.18 - 3.32, p = 0.010), and food insecurity (aOR = 2.24, 95% CI: 1.25 - 4.01, p = 0.006). Factors that reduced the odds of depression included resilience (aOR = 0.93, 95% CI: 0.91 - 0.97, p = 0.001) and family social support (aOR = 0.94, 95% CI: 0.88 - 0.99, p = 0.031). CONCLUSIONS AND RECOMMENDATIONS: In this study the prevalence of depression among pregnant teenagers was significantly high. Mental health services should be integrated in the antenatal care clinics to address the mental health needs of pregnant teenagers. We recommend further studies to explore the lived experiences focusing on the challenges and further understanding of their coping strategies and other possible confounders of depression. In addition, longitudinal studies should be conducted to establish the temporal relationships between the different factors related to depression to support intervention studies that promote the mental health of young mothers.

Barriers to treatment seeking for depression among elderly service users at Butabika National Referral and Teaching hospital, Kampala- Uganda

OBJECTIVES

Depression among the elderly is a significant public health concern in Uganda, where cultural, social, and healthcare-related barriers hinder access to treatment and support. This study examines the barriers to mental health service access faced by elderly service-users in Uganda.

METHOD

Using an interpretive phenomenological approach, in-depth interviews were conducted to capture the lived experiences of elderly Baganda service users receiving treatment at Butabika National Referral and Teaching hospital.

RESULTS

The findings reveal an intricate interaction between cultural, social, economic, and healthcare system-related barriers. Key barriers include limited mental health awareness, financial constraints, fragmentation, drug shortage and geographical access. Social and cultural stigma further exacerbate these challenges contributing to delayed or avoided help-seeking behaviours among the elderly.

CONCLUSION

The study highlights the intersectionality of aging and mental health issues, underscoring the urgent need for a comprehensive, integrated approach to mental health care for the elderly. This research calls for targeted interventions to reduce stigma, increase mental health literacy, and improve the accessibility and affordability of care for vulnerable elderly populations in Uganda. Such services can improve mental health outcomes and quality of life for the elderly in Uganda.

Six-Week Problem Area-Concordant vs 8-Week Problem Area-Discordant Group Interpersonal Psychotherapy: A Randomized Clinical Trial

Importance

Depression is a prevalent mental health condition contributing to morbidity worldwide. The World Health Organization (WHO) recommends group-based interpersonal psychotherapy (IPT-G) for first-line depression treatment in resource-constrained settings. Standard of care in the study context is 8 to 12 weekly sessions in groups with a mix of depression problem areas (eg, grief, life changes, loneliness, conflict).

Objective

To investigate whether grouping participants with a common depression problem area (problem area-concordant) using shortened IPT-G (6 sessions) is noninferior to grouping participants with a mix of problem areas (problem area-discordant) using standard IPT-G (8 sessions) in Uganda.

Design, Setting, and Participants

This noninferiority randomized clinical trial included adults 18 years or older in central Uganda with 9-item Patient Health Questionnaire (PHQ-9) scores of 10 or greater, indicating symptoms consistent with probable depression. Assessors were masked to treatment arm. Data were accrued from October 31, 2022, to March 24, 2023.

Interventions

Participants were randomized 1:1 to 6-session problem area-concordant or 8-session problem area-discordant IPT-G.

Main Outcome and Measures

The primary outcome was PHQ-9 score reduction at 3 months. Secondary outcomes were treatment response (PHQ-9 5-point, 10-point, and 50% score reduction), reduction in disability (WHO Disability Assessment Schedule 2.0), and improvement in subjective quality of life (WHO Quality of Life tool).

Results

Among 328 enrolled participants (303 [92.4%] female; mean [SD] age, 42.3 [15.2] years), retention was high, with 321 [97.9%] undergoing assessment at the end of therapy and 292 [89.0%] at 3-month follow-up. From baseline to the end of therapy, PHQ-9 scores dropped a mean (SD) of 15.2 (5.1) points in the problem area-concordant arm and 13.3 (5.3) points in the problem area-discordant arm. Problem area-concordant 6-week IPT-G was noninferior (P < .001) at end of therapy and 3 months post therapy. Compared with the 8-week problem area-discordant arm, posttherapy PHQ-9 scores in the 6-week problem area-concordant arm were 1.86 (95% CI, 0.74-3.00) points lower (P = .001). At 3 months, PHQ-9 scores were 1.98 (95% CI, 0.60-3.36) points lower (P = .005). Disability score reduction was significantly larger post therapy in the 6-week arm compared with the 8-week arm (2.70 [95% CI, 0.95-4.44] points) but not significantly different between arms after 3 months. Quality of life scores across all domains were not significantly different between arms at end of therapy and 3 months post therapy.

Conclusions and Relevance

In this randomized clinical trial, 6-week problem area-concordant IPT-G was noninferior to 8-week problem area-discordant IPT-G for reducing depression symptoms, with similar to larger improvements in disability and quality of life. Problem area-concordant group therapy appears to be a promising approach to increase efficiency and scalability of depression treatment.

Trial Registration

Pan African Clinical Trials Registry Identifier: PACTR202306771120632.

The global, regional, and national late-life depression burden and trends from 1990 to 2021: A systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND

Late-life depression (LLD) represents a growing global public health concern. This study aimed to assess the worldwide burden of LLD using comprehensive data.

METHODS

Leveraging the latest evidence from the Global Burden of Disease Study, we analyzed trends in LLD burden from 1990 to 2021, encompassing incidence, prevalence, and disability-adjusted life years (DALYs). We quantified disparities in LLD burden across socioeconomic, gender, regional, and national dimensions. Decomposition analysis was employed to identify key drivers of LLD burden variation. Frontier analysis illustrated the potential for burden reduction in various countries.

RESULTS

Globally, there were 49,137,544 new cases, 46,672,175 prevalent cases, and 7,351,377 DALYs attributed to LLD in 2021. Between 1990 and 2021, the agestandardised incidence rate (ASIR), age-standardised prevalence rate (ASPR), and age-standardised DALYs rate (ASDR) of LLD all rose. In 2021, low SDI regions exhibited the highest all ASRs, while middle SDI regions had the fastest growth rates in these indicators. Regionally, Central and Eastern Sub-Saharan Africa had the highest ASIR, ASPR, and ASDR, respectively. Nationally, Uganda ranked highest in all ASRs in 2021. Women had higher burdens than men. Population growth was a primary driver of DALYs increase in middle SDI regions that had the greatest potential for improvement.

CONCLUSIONS

The global burden of LLD has risen, with marked inequities across SDI, gender, region, and country. The burden is most pronounced in low and middle SDI regions. These findings offer guidance for developing LLD screening guidelines and enhancing prevention and intervention strategies in relevant countries, particularly Uganda.

Prevalence and Factors Associated With Antepartum Depression Among Pregnant Women in Latent Labor: A Multi-Facility Cross-Sectional Study in Rural Southwestern Uganda

Background

Despite limited studies on antepartum depression (APD) in Sub-Saharan Africa (SSA), it is suggested that the prevalence on the continent may be higher than the global average. This study aimed at determining the prevalence of APD and identifying its associated factors among pregnant women in latent labor in rural south western Uganda.

Methods

The findings in this manuscript were part of a prospective cohort that aimed at investigating Social Support and Perinatal Depression among women in latent labor through six weeks postpartum. We conducted a multi-facility study enrolling women in latent labor to assess for APD and its associated factors from November 2023 to March 2024. The study was carried out in three health facilities in Mbarara District, rural southwestern Uganda. The prevalence of APD based on the Mini International Psychiatric Interview (M.I.N.I 7.0.2) using the depression module. Factors associated with APD were analyzed using bivariate and multivariate logistic regression. Variables with a p-value <0.2 in bivariate analysis were included in the multivariable model, with statistical significance set at p<0.05. Odds ratios (OR) and 95% confidence intervals (CI) were reported. Data were analyzed using STATA software version 14.0.

Results

Of the 448 enrolled participants, 37 had APD giving a prevalence of 8.2% (95% CI: 6.0-11.2%). Factors that were significantly associated with APD were Maternal age 30-49 years, bad health status before pregnancy, not happy about being pregnant, having had complications during pregnancy and having a history of stressful life events during pregnancy.

Conclusion

This study reveals a very significant yet comparatively lower prevalence of antepartum depression among pregnant women in latent labor in rural southwestern Uganda. These insights highlight the persistent need for comprehensive mental health strategies especially the non-pharmacological approaches within antenatal care to enhance maternal and child health outcomes.

Prevalence of depression and its correlates among undergraduate health science students in Mogadishu, Somalia: a cross-sectional study

BACKGROUND

Depression among undergraduate health science students is increasingly recognized as a significant public health issue globally. These students face immense academic pressure, often leading to stress and mental exhaustion, particularly for students studying in a humanitarian crisis situation. However, there is a scarcity of information in this regard in higher education institutions in Somalia. Hence, this investigation was conducted to assess the prevalence of depression and its correlates health science students in Somalia.

METHODS

A cross-sectional study was conducted on 321 health science students from some universities in Mogadishu, Somalia. The data was collected from students studying medicine, nursing and midwifery, laboratory science and public health at SIMAD university, Banadir university, Mogadishu university and Jamhuriya university, all located in Mogadishu. Simple random sampling based on class list was used to select the participants and a web-based self-administered Patient Health Questionnaire (PHQ-9) was used to screen for depression. The collected data were cleaned and checked for completeness before exporting into SPSS version 27 Statistical software for analysis, where descriptive statistics as well as logistic regression analysis was done to determine the independent predictors of the outcome variable. Significant association was determined at a 95% confidence interval and p-value < 0.05.

RESULT

The prevalence of depression among the students was 58.6%. A total of 41.5% (133/321) of the participants were free from depression (Normal), while 30.8% had mild depression, 27.1% had moderate depression and 0.6% had severe depression. Analysis of the association between the sociodemographic variables and depressive state of the participant showed statistical significance (p-value = 0.045) for course of study. Students studying nursing and midwifery had the highest case of depression with 68.6% (59/86), followed by public health 66.7% (30/45), laboratory science 52.3% (34/65), and medicine having the least number of depressed students with 52.0% students (65/125). Similarly, gender of students was also found to be statistically significant (p-value = 0.001) with female students having 65% depression which is 41.1% of the total students studied.

CONCLUSION

The prevalence of depression among health science students in Mogadishu was high and positively associated with gender, having trouble with authorities, emotional problems, as well as experience of sexual abuse or violence. Hence, routine screening and monitoring of students' mental health state on the campus and providing mental health services is necessary to address this growing problem.

Mental health phenotypes of well-controlled HIV in Uganda

Introduction

The phenotypic expression of mental health (MH) conditions among people with HIV (PWH) in Uganda and worldwide are heterogeneous. Accordingly, there has been a shift toward identifying MH phenotypes using data-driven methods capable of identifying novel insights into mechanisms of divergent MH phenotypes among PWH. We leverage the analytic strengths of machine learning combined with inferential methods to identify novel MH phenotypes among PWH and the underlying explanatory features.

Methods

A total of 277 PWH (46% female, median age = 44; 93% virally suppressed [<50copies/mL]) were included in the analyses. Participants completed the Patient Health Questionnaire (PHQ-9), Beck Anxiety Inventory (BAI), and the PTSD Checklist-Civilian (PCL-C). A clustering pipeline consisting of dimension reduction with UMAP followed by HBDScan was used to identify MH subtypes using total symptom scores. Inferential statistics compared select demographic (age, sex, education), viral load, and early life adversity between clusters.

Results

We identified four MH phenotypes. Cluster 1 (n = 76; PTSD phenotype) endorsed clinically significant PTSD symptoms (average PCL-C total score > 33). Clusters 2 (n = 32; anxiety phenotype) and 3 (n = 130; mixed anxiety/depression phenotype) reported minimal PTSD symptoms, with modest BAI (Cluster 2) and PHQ-9 (Cluster 3) elevations. Cluster 4 (n = 39; minimal symptom phenotype) reported no clinical MH symptom elevations. Comparisons revealed higher rates of sexual abuse during childhood among the PTSD phenotype vs. the minimal symptom phenotype (p = 0.03).

Discussion

We identified unique MH phenotypes among PWH and confirmed the importance of early life adversity as an early risk determinant for unfavorable MH among PWH in adulthood.

Depression symptom severity and behavioral impairment in school-going adolescents in Uganda

BACKGROUND

During adolescence, a critical developmental phase, cognitive, psychological, and social states interact with the environment to influence behaviors like decision-making and social interactions. Depressive symptoms are more prevalent in adolescents than in other age groups which may affect socio-emotional and behavioral development including academic achievement. Here, we determined the association between depression symptom severity and behavioral impairment among adolescents enrolled in secondary schools of Eastern and Central Uganda.

METHODS

This cross-sectional study was conducted among 1,669 adolescents enrolled in secondary schools in Eastern and Central Uganda. Our outcome variable was behavioral impairment defined as self-reported behavior that interferes with an individuals' ability to do schoolwork (school performance) or get along with others (peer interaction) (yes/no). The key independent variable was depression symptom severity assessed using the Child and Adolescent Symptom Inventory-5 (CASI-5), a behavior rating scale for symptoms of DSM-5 emotional and behavioral disorders. Modified Poisson regression models tested the independent association between depressive symptom severity and behavioral impairment. Prevalence Rate Ratios (PRR) and 95% confidence intervals (95%CI) were reported.

RESULTS

Participants' mean age was 15.3 years (SD = 1.8), 58.5% were female, 86.8% witnessed domestic violence, 47.4% had behavioral impairment, and 2.8% had mild depression symptoms. School-going adolescents with mild depression symptoms had two times higher risk of behavioral impairment when compared to those with no or slight depression symptoms, after controlling for potential confounders. Other factors independently associated with higher risk for behavioral impairment were female sex (Adj. PRR 1.27, 95%CI 1.12, 1.43) compared to males, taking alcohol (Adj. PRR 1.42, 95%CI 1.25, 1.61) compared to not taking alcohol, boarding school enrollees (Adj. PRR 1.62, 95%CI 1.33, 1.98), and day school enrollees (Adj. PRR 1.46, 95%CI 1.21, 1.76) compared to mixed (day and boarding) school enrollees respectively, advanced level enrolment (Adj. PRR 1.25, 95%CI 1.05, 1.48) compared to ordinary level enrolment, and attending urban schools (Adj. PRR 1.27, 95%CI 1.11, 1.45) compared to rural secondary school attendance.

CONCLUSIONS

Behavioral impairments are widespread among Ugandan secondary students. Mild depression symptoms adversely affect adolescents' academic and social lives, potentially leading to long-term consequences. Where feasible, early detection of depressive symptoms and treatment may mitigate their negative effects on student school performance ability and peer/social interaction. Future research should examine school-level factors influencing academic performance by depression status. Policymakers in education and gender sectors should prioritize mental health programs in secondary schools.

Prevalence and correlates of common mental disorders among participants of the Uganda Genome Resource: Opportunities for psychiatric genetics research

Genetics research has potential to alleviate the burden of mental disorders in low- and middle-income-countries through identification of new mechanistic pathways which can lead to efficacious drugs or new drug targets. However, there is currently limited genetics data from Africa. The Uganda Genome Resource provides opportunity for psychiatric genetics research among underrepresented people from Africa. We aimed at determining the prevalence and correlates of major depressive disorder (MDD), suicidality, post-traumatic stress disorder (PTSD), alcohol abuse, generalised anxiety disorder (GAD) and probable attention-deficit hyperactivity disorder (ADHD) among participants of the Uganda Genome Resource. Standardised tools assessed for each mental disorder. Prevalence of each disorder was calculated with 95% confidence intervals. Multivariate logistic regression models evaluated the association between each mental disorder and associated demographic and clinical factors. Among 985 participants, prevalence of the disorders were: current MDD 19.3%, life-time MDD 23.3%, suicidality 10.6%, PTSD 3.1%, alcohol abuse 5.7%, GAD 12.9% and probable ADHD 9.2%. This is the first study to determine the prevalence of probable ADHD among adult Ugandans from a general population. We found significant association between sex and alcohol abuse (adjusted odds ratio [AOR] = 0.26 [0.14,0.45], p < 0.001) and GAD (AOR = 1.78 [1.09,2.49], p = 0.019) respectively. We also found significant association between body mass index and suicidality (AOR = 0.85 [0.73,0.99], p = 0.041), alcohol abuse (AOR = 0.86 [0.78,0.94], p = 0.003) and GAD (AOR = 0.93 [0.87,0.98], p = 0.008) respectively. We also found a significant association between high blood pressure and life-time MDD (AOR = 2.87 [1.08,7.66], p = 0.035) and probable ADHD (AOR = 1.99 [1.00,3.97], p = 0.050) respectively. We also found a statistically significant association between tobacco smoking and alcohol abuse (AOR = 3.2 [1.56,6.67], p = 0.002). We also found ever been married to be a risk factor for probable ADHD (AOR = 2.12 [0.88,5.14], p = 0.049). The Uganda Genome Resource presents opportunity for psychiatric genetics research among underrepresented people from Africa.

The long-term impact of family economic empowerment on viral suppression and mental health outcomes among adolescents living with HIV in low-income settings: A cluster-randomized controlled trial in Southern Uganda

OBJECTIVES

We examined the impact of a family-based economic empowerment intervention on viral suppression and mental health among ALHIV.

STUDY DESIGN

Between 2013 and 2014, 702 participants aged 10-16, living with HIV, and taking antiretroviral therapy, were recruited from 39 clinics in Uganda. Twenty clinics (n = 358 participants) were randomized to the intervention and 19 clinics (n = 344 participants) were randomized to the control conditions. The intervention comprised a matched savings account, financial literacy training, and microenterprise workshops. The primary outcome was viral suppression, while the secondary outcomes included depression, hopelessness, and self-concept. We ran mixed-effects models to determine the intervention effects.

RESULTS

At enrollment, participants' mean age was 12 years. The intervention improved viral suppression, evidenced by significant intervention-by-time interaction effects [χ2(5) = 12·81, p = 0·025], further qualified by increased viral suppression in the intervention group at year two, OR = 1.89 (95% CI: 1.14-3.15), year three, OR = 2.31 (95% CI: 1.05-5.04), and year four, OR = 2.34 (95% CI: 1.03-5.33). Regarding mental health, we did not find significant intervention main effects or intervention-by-time interaction effects for depressive symptoms, hopelessness, or self-concept for the entire sample. However, for participants owning fewer assets, we found significant intervention-by-time interaction effects for hopelessness [χ2(5) = 12·33, p = 0·031], and self-concept [χ2(5) = 27·26, p < 0·001], suggesting beneficial intervention effect for this demographic.

CONCLUSIONS

Family EE interventions have the potential to improve viral suppression and mental health outcomes among ALHIV. These findings offer insights in designing programs and policies to improve outcomes among ALHIV.

Does disability modify the association between poor mental health and violence victimisation over adolescence? Evidence from the CoVAC cohort study in Uganda

We aimed to estimate the impact of poor mental health in early adolescence on subsequent poor mental health, depression, and violence victimisation in late adolescence and to determine whether young people living with disabilities experienced a stronger relationship between mental health and these outcomes. Data from two waves of a longitudinal cohort study of 2773 Ugandan adolescents were used to assess the impact of mental health difficulties in early adolescence (aged 11-14) on presence of subsequent mental health difficulties, depression and past year violence victimisation in later adolescence (aged 15-18). We used g-computation to examine how these outcomes changed dependent on levels of poor mental health in early adolescence and explored functional difficulties as an effect modifier. This study demonstrates high prevalence of mental health difficulties in adolescence. There is a positive association between mental health difficulties in early adolescence and experience of mental health difficulties, depression, and past year violence in later adolescence. The risk of poor outcomes is greater for individuals experiencing poorer mental health in early adolescence. The relationships between early mental health difficulties and both mental health difficulties in later adolescence and past year violence are stronger in young people with functional difficulties. Poor mental health in early adolescence is associated with depression and violence victimisation in later adolescence, and the association is stronger among adolescents living with disabilities. School-aged adolescents would benefit from violence prevention and mental health promotion interventions which are inclusive and engage and respond to the needs and rights of adolescents with disabilities.

A Narrative-Gamified Mental Health App (Kuamsha) for Adolescents in Uganda: Mixed Methods Feasibility and Acceptability Study

BACKGROUND

Many adolescents in Uganda are affected by common mental disorders, but only a few affordable treatment options are available. Digital mental health interventions offer promising opportunities to reduce these large treatment gaps, but interventions specifically tailored for Ugandan adolescents are limited.

OBJECTIVE

This study aimed to determine the feasibility and acceptability of the Kuamsha program, an intervention delivered through a gamified app with low-intensity telephonic guidance, as a way to promote mental health among adolescents from the general population in Uganda.

METHODS

A 3-month pre-post single-arm trial was conducted with adolescents aged between 15 and 19 years living in Wakiso District, Central Uganda. The intervention was coproduced with adolescents from the study site to ensure that it was culturally acceptable. The feasibility and acceptability of the intervention were evaluated using an explanatory sequential mixed methods approach. Feasibility was assessed by collecting data on trial retention rates and treatment adherence rates. Acceptability was assessed through a questionnaire and in-depth interviews with participants following the conclusion of the intervention period. As a secondary objective, we explored the changes in participants' mental health before and after the intervention.

RESULTS

A total of 31 adolescents were recruited for the study. Results from the study showed high levels of feasibility and acceptability. Trial retention rates exceeded 90%, and treatment adherence was ≥80%. These results, evaluated against our predefined trial progression criteria, indicate a successful feasibility study, with all criteria exceeding the thresholds necessary to progress to a larger trial. App engagement metrics, such as time spent on the app and modules completed, exceeded existing literature benchmarks, and many adolescents continued to use the app after the intervention. In-depth interviews and questionnaire responses revealed high acceptability levels. Depressive symptoms trended toward reduction (mean difference: 1.41, 95% CI -0.60 to 3.42, Cohen d=0.30), although this was not statistically significant (P=.16). Supporting this trend, we also observed a reduction in the proportion of participants with moderate depressive symptoms from 32% (10/31) to 17% (5/29) after the intervention, but this change was also not significant (P=.10).

CONCLUSIONS

This study presents evidence to support the Kuamsha program as a feasible and acceptable digital mental health program for adolescents in Uganda. A fully powered randomized controlled trial is needed to assess its effectiveness in improving adolescents' mental health.

Sociodemographic factors associated with trajectories of depression among urban refugee youth in Kampala, Uganda: A longitudinal cohort study

Background

There is a high prevalence of depression among refugee youth in low- and middle-income countries, yet depression trajectories are understudied. This study examined depression trajectories, and factors associated with trajectories, among urban refugee youth in Kampala, Uganda.

Methods

We conducted a longitudinal cohort study with refugee youth aged 16-24 in Kampala, Uganda. We assessed depression using the Patient Health Questionnaire-9 and conducted latent class growth analysis (LCGA) to identify depression trajectories. Sociodemographic and socioecological factors were examined as predictors of trajectory clusters using multivariable logistic regression.

Results

Data were collected from n = 164 participants (n = 89 cisgender women, n = 73 cisgender men, n = 2 transgender persons; mean age: 19.9, standard deviation: 2.5 at seven timepoints; n = 1,116 observations). Two distinct trajectory clusters were identified: "sustained low depression level" (n = 803, 71.9%) and "sustained high depression level" (n = 313, 28.1%). Sociodemographic (older age, gender [cisgender women vs. cisgender men], longer time in Uganda), and socioecological (structural: unemployment, food insecurity; interpersonal: parenthood, recent intimate partner violence) factors were significantly associated with the sustained high trajectory of depression.

Conclusions

The chronicity of depression highlights the critical need for early depression screening with urban refugee youth in Kampala. Addressing multilevel depression drivers prompts age and gender-tailored strategies and considering social determinants of health.

"When you are alone you have a narrow mind, but when you are with others you think broader into the other aspects". A qualitative study on the role of sense of belonging and mattering in attempted suicide in Uganda

INTRODUCTION

Suicide is globally a severe problem with an estimated 700.000 deaths annually. Six of the 10 countries with the highest suicide rates worldwide are in Africa, though, reliable statistics are scarce.

METHOD

In this qualitative interview study in Uganda, we analysed the stories of 16 people admitted to hospital following a serious suicide attempt. We focussed especially on each person's decision process towards their resolution to attempt suicide.

FINDINGS

Despite the huge heterogeneity of the narratives, we could identify problems regarding the sense of belonging and mattering in all the stories. Both the sense of belonging and mattering have been related to suicidal behaviour in earlier theories, but they were never studied together or under consideration of the influence of this specific cultural context. We found that the participants' sense of belonging and mattering to a large degree was influenced by their traditional communalistic context with a worldview where the line between the natural and spiritual world was blurry.

CONCLUSION

This kind of knowledge could be a valuable source for health professionals in their treatment of suicidal persons; it could direct their approach to the core of each person's relational problems and meaning-making, which is crucial for their decisions with regard to suicide.

Prevalence of depression and associated factors among caregivers of stroke survivors in developing countries: A systematic review and meta-analysis

BACKGROUND

Stroke is a leading cause of death and disability worldwide. While caregivers play a vital role in recovery, their long-term support can affect their mental well-being. This study aims to estimate the pooled prevalence of depression and associated factors among caregivers of stroke survivors in developing countries.

METHOD

A comprehensive literature search using the preferred reporting items for systematic review and meta-analysis (PRISMA) statement was conducted on Scopus, PsycINFO, EMBASE, Google Scholar, Psychiatry Online, and PubMed/MEDLINE. Data were extracted via a Microsoft Excel spreadsheet and analyzed via STATA version 11.0. Egger regression tests and funnel plot analysis were used to check for publication bias, and the I2 statistic was used to evaluate statistical heterogeneity. Sensitivity and subgroup analyses were also conducted to identify potential causes of heterogeneity.

RESULTS

Seventeen articles from 12 different countries were analyzed. The pooled prevalence of depression among caregivers of stroke survivors was 48.75% (95% confidence interval (CI): 38.64- 58.86). However, the prevalence of depression ranged widely from 17.2%-76%, which may be due to the variation in the depression assessment tools used, types of caregivers, and continent. A long duration of caregiving was the only significant factor associated with depression among caregivers of stroke survivors.

CONCLUSION

The current systematic review and meta-analysis revealed a high prevalence of depression among caregivers of stroke survivors in developing countries. However, there was significant heterogeneity between studies, which could be explained by differences in the depression assessment tools used, types of caregivers, and continents. Factors such as long caregiving times were significantly associated with depression among caregivers of stroke survivors. The study suggests that the depression assessment tool utilized itself could have modified the prevalence of depression among caregivers of stroke survivors. Therefore, a single depression assessment tool needs to be authorized.

Antidepressant-Like Effects of Lavandula angustifolia Mill (Lamiaceae) Aqueous and Total Crude Extracts in Wistar Albino Rats

Background

Depression continues to be a serious mental health problem among communities in Uganda, with limited access to mental healthcare services. Communities often use medicinal plants, such as L. angustifolia, in the management of depressive disorders with limited information on its effectiveness.

Objective

Study assessed antidepressant-like effects of stem-leaf aqueous and total crude extracts of L. angustifolia in depression-like induced behavior in Wistar albino rats.

Methods

An experimental laboratory study was conducted on 36 Wistar albino rats (18 males, 18 females). Group I received normal saline, Group II received 10 mg/kg bwt escitalopram, Group III received 200 mg/kg bwt, Group IV received 1000 mg/kg bwt aqueous extract and same doses of total crude extract were used for Group V and Group VI, respectively, using intragastric tube. Depression-like behavior in rats was induced by several manipulations of CUS for 1-5 weeks. Sucrose preference test (SPT) was used to confirm depressive-like behaviors. Antidepressant-like effects were determined by FST. Durations of immobility, swimming, and struggling were recorded. Data were analyzed using STATA version 13.

Results

In the chronic mild stress group, 19.2% preferred sucrose compared to 66.9% in the unstressed group (p<0.05). L. angustifolia extract (LAE) exhibited antidepressant-like effects in the rats in a completely dose dependent manner at aqueous doses of 200 mg/kg bwt and 1000 mg/kg bwt, respectively. In the FST, dose of 200 mg/kg bwt and 1000 mg/kg bwt of the extract showed a significant reduction in mean immobility time of 1.33±0.52 min and 1.83±1.17 min (p<0.0001) as compared to 1.00±0.00 min for escitalopram drug and 3.17±0.41 min of the normal saline control groups.

Conclusion

Aqueous extract of L. angustifolia at a dose of 200 and 1000 mg/Kg bwt reduced the duration of immobility and similar findings were observed on struggling and swimming. Findings have provided evidence on the use of L. angustifolia by local communities in the management of depressive-like behaviors in Uganda.

Recent advances in the synthesis of antidepressant derivatives: pharmacologic insights for mood disorders

Mood disorders, including depression, remain a significant global health concern, necessitating continuous efforts to develop novel and more effective antidepressant therapies. Although there have been significant advancements in comprehending the biology of Major Depressive Disorder (MDD), a considerable number of people suffering from depression do not exhibit positive responses to the pharmacologic treatments now available. This study specifically examines emerging targets and potential future approaches for pharmaceutical interventions in the treatment of MDD. The discussion revolves around novel therapeutic agents and their effectiveness in treating depression. The focus is on the specific pathophysiological pathways targeted by these agents and the amount of evidence supporting their use. While conventional antidepressants are anticipated to continue being the primary treatment for MDD in the foreseeable future, there is currently extensive research being conducted on numerous new compounds to determine their effectiveness in treating MDD. Many of these compounds have shown encouraging results. This review highlighted the recent advances in the synthesis of antidepressant derivatives and explores their pharmacologic insights for the treatment of mood disorders.

Effects of decision making and impulsivity on the addictive features of non-suicidal self-injury behaviors in adolescents with depressive disorder

BACKGROUND

Non-suicidal self-injury (NSSI) behaviors pose a significant threat to the physical and psychological well-being of adolescents. Recent research suggests that persistent, uncontrollable and repetitive NSSI can be conceptualized as a behavioral addiction. The addictive feature of NSSI behavior can be assessed using Ottawa self-injury inventory (OSI), the higher addiction score indicates the more serious NSSI behavior. This study aims to explore the relationship of impulsivity and decision-making on the addictive features of NSSI in adolescents with depressive disorder, to explore the influencing factors of behavioral addictive features of NSSI and to predict the addictive features of NSSI.

METHODS

Using a cross-sectional design, a total of 126 adolescent outpatients and inpatients with a mean age of 15.49 years old (M = 15.49, SD = 1.56), male students (n = 28, 22.2%) and female students (n = 98, 77.8%) diagnosed with depressive disorders were recruited according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and clinical interviews were completed by two psychiatrists. NSSI addictive features according to the OSI's addictive features items. The final group was categorized into three groups: depression without NSSI (n = 42), depression with NSSI without addictive features (n = 44), and depression with NSSI and addictive features (n = 40). The present study employed the Hamilton Depression Scale (HAMD-24), Chinese Revised Barratt Impulsiveness Scale Version 11 (BIS-11), OSI, and the Adolescent Non-Suicidal Self-Injury Questionnaire (ANSSIQ). Cognitive decision-making abilities were assessed using the Iowa Gambling Task (IGT).

RESULTS

The depression with NSSI addictive features group had significantly lower total net scores and net scores of block3, block4, and block5 in the IGT than the depression without NSSI group, whereas there was no statistically significant difference between the two in net scores of block1 and block2. Lower scores mean more unfavorable decisions and strategy adjustments. The addictive features of NSSI behaviors were significantly and positively correlated with the severity of NSSI behaviors, depression, and cognitive impulsiveness, and significantly and negatively correlated with the total net score of the IGT. The severity of NSSI behaviors, severity of depression, cognitive impulsiveness positively predicts the addictive features of NSSI behaviors, the total net score of the IGT negatively predicted the addictive features of NSSI behaviors.

CONCLUSION

Adolescents with depressive disorders with NSSI behavioral addictive features had higher severity of depression, exhibited higher cognitive impulsivity, and made more unfavorable decisions when making choices.

Prevalence and correlates of depressive symptoms among undergraduate health science students at the University of Parakou, Benin

OBJECTIVES

Research on psychological distress in African students is scarce. This study aimed at exploring the epidemiology (prevalence and correlates) of depressive symptoms among undergraduate health sciences students at the University of Parakou (Benin).

METHODS

We conducted a cross-sectional survey from June to July 2022 at the University of Parakou, the second-largest university in the Republic of Benin. Depressive symptoms were assessed using the Patient Health Questionnaire depression scale (PHQ-9). Information on several independent factors was collected and their associations with depressive symptoms were investigated using logistic regression models.

RESULTS

Data from 560 students were analyzed (mean age: 21.3± 2.3 years, 60 % were male, and 50.4 % were registered in the first year of study). The overall prevalence of depressive symptoms was 39.1 % [95 % CI: 35.2 %-43.1 %]. Moderate and severe depressive symptoms were observed in 15.3 % and 1.8 % of participants, respectively. In the multivariable model, being aged 21-23 (adjusted Odds Ratio=1.8, p-value: 0.007), a female (aOR=1.5, p-value: 0.050), a medical student (aOR=2.9, p-value: <0.001), a public health student (aOR=3.6, p-value: <0.001), belonging to households with higher incomes (aOR= 2.4, p<0.001), and experiencing stress (aOR=1.5, p-value: 0.048) independently increased the probability of having depressive symptoms. However, having support from close relatives (aOR= 0.5, p-value: 0.026) was associated with a lower probability of depressive symptoms.

CONCLUSIONS

Our findings revealed a high prevalence of depressive symptoms among undergraduate health science students. Given the correlates identified, actions to promote coping skills in stress and encourage more parental support may be real avenues likely to help reduce the frequency and consequences of depressive symptoms.

A community case detection tool to promote help-seeking for mental health care among children and adolescents in Ugandan refugee settlements: a stepped wedge cluster randomised trial

BACKGROUND

Strategies to promote mental health care help-seeking among children are needed, especially in low-income and middle-income countries and in complex settings. The aim of this trial was to compare a vignette-based, community-level, proactive case detection tool (CCDT) against standard awareness raising for promoting mental health help-seeking among children and adolescents.

METHODS

This stepped wedge cluster randomised trial was conducted in the Bidi Bidi, Kyaka II, Kyangwali, Omugo, and Rhino refugee settlements in Uganda. Community gatekeepers received a 2-day training session on using the CCDT to proactively detect children with mental health concerns and encourage children (or their caregivers) to use the mental health-care service run by Transcultural Psychosocial Organization Uganda. At baseline, organisations implemented routine detection or mental health awareness-raising activities. At cross-over to CCDT implementation, gatekeepers used the tool in their daily activities. The primary outcome was mental health-care service use by children and adolescents. Child population size estimates at the zone level were not available. Therefore, service use was calculated using total population size. We report the effect of CCDT implementation as an incidence rate ratio (IRR), which we produced from a model that accounts for calendar time, exposure time, and person-time. IRRs were estimated for the analysis of effect over time in the per-protocol and intention-to-treat populations. The trial is registered with the ISRCTN registry, number ISRCTN19056780.

FINDINGS

28 administrative zones were selected for trial participation by October, 2021. Between Jan 1, and Nov 8, 2022, seven clusters of four zones sequentially crossed over from routine care to CCDT implementation in 1-month intervals. The CCDT was implemented by 177 trained community gatekeepers. In 9 months, 2385 children visited a mental health-care service; of these, 1118 (47%) were girls and 1267 (53%) were boys (mean age 12·18 years [SD 4.03]). 1998 children made a first or re-entry visit to a service; of these, 937 (47%) were girls and 1061 (53%) were boys (mean age 12·08 years [SD 4·06]). Compared to standard awareness-raising activities, CCDT implementation was associated with an increase in mental health-care service use in the first month after implementation (20·91-fold change [95% CI 12·87-33·99]). Despite a slight decline in service use over time in both the CCDT and pre-CCDT zones, CCDT zones maintained a time-average 16·89-fold increase (95% CI 8·15-34·99) in mental health service use.

INTERPRETATION

The CCDT enabled community gatekeepers to increase mental health-care service use by children and adolescents. Vignette-based strategies rooted in the community could become a valuable contribution towards reducing the mental health-care gap among children, especially when accompanied by accessible mental health-care services.

FUNDING

Sint Antonius Stichting Projects.

TRANSLATIONS

For the Arabic, French and Spanish translations of the abstract see Supplementary Materials section.

Screening of Depression Among Medical Outpatients Visiting the University Teaching Hospital of Kigali, Rwanda

Background

Depression is a significant global public health concern, affecting individuals across different age groups and cultural backgrounds. However, screening for depression remains an essential but often neglected aspect of healthcare, particularly in outpatient settings. This study aimed to assess the prevalence of depression among outpatients visiting the internal medicine department of the University Teaching Hospital of Kigali in Rwanda and evaluate the feasibility of implementing a depression screening program in this setting.

Methods

An institution-based cross-sectional study design was employed, involving 300 adult medical outpatients through convenience sampling, aged 18 years and above, who visited the internal medicine department between October 7 to November 6, 2019. The Patient Health Questionnaire-9 (PHQ-9) was used as the screening tool to assess depressive symptoms. Additionally, socio-demographic and clinical data were collected to explore potential risk factors associated with depression using a binary logistic regression model.

Results

A high prevalence of depression was identified among internal medicine outpatients, with 45.7% of participants screened positive for depression, with moderate, moderately severe, and severe depression accounting for 21%, 17%, and 8%, respectively. The following factors were significantly associated with positive screening for depression: lack of formal education (OR=4.463, p=0.011, 95% CI= [1.410; 14.127]), secondary education (OR=3.402, p=0.003, 95% CI= [1.517; 7.630]), low-income (OR=2.392, p=0.049, 95% CI= [1.003; 5.706]) and headache as a chief complaint (OR=3.611, p=0.001, CI= [1.718; 7.591]).

Conclusion

This study highlights the high prevalence of depression among medical outpatients. Due to the stigma associated with mental health, patients frequently seek help for physical symptoms such as headaches and other bodily complaints rather than mental health concerns. Introducing routine depression screening in medical departments could potentially facilitate early identification, and intervention, and lead to improved patient care. Future research should focus on evaluating such screening programs' effectiveness and long-term outcomes in resource-limited settings like Rwanda.

Life Satisfaction Factors, Stress, and Depressive Symptoms among Young Women Living in Urban Kampala: Findings from the TOPOWA Project Pilot Studies

Young women living in Kampala, Uganda, often face adversities related to Social Determinants of Mental Health (SDoMH) including poverty, food scarcity, environmental stressors such as high levels of community violence, and lack of adequate healthcare access. Two consecutive pilot studies were conducted to assess the feasibility and acceptability of survey questions, wearable fitness trackers, and daily diaries before launching a larger prospective cohort study. Preliminary associations between SDoMH factors with depressive symptoms, stress levels, and life satisfaction were examined among the total sample of 60 women across two pilot studies. A total of 32.2% of respondents (out of n = 59) reported being depressed most or all of the time in the past 30 days. Frequent depressive symptoms correlated with food insecurity (χ2 = 5.38, df = 1, p = 0.02). Higher stress levels were significantly associated with lower overall life satisfaction scores (t = 2.74, df = 6.20, p = 0.03). Additionally, frequent depressive symptoms were associated with lower satisfaction scores in the living conditions and lifestyle domain (t = 2.22, df = 36.18, p = 0.03). However, overall life satisfaction scores and other domains (social relationships and personal independence) were not statistically associated with frequent depressive symptoms. Identifying the most impactful SDoMH factors among young women in Kampala can inform targeted approaches to improve mental health outcomes.

Coping strategies, challenges and potential interventions among adult patients with HIV and mental illness comorbidity in southwestern Uganda

HIV and mental illness comorbidity presents significant healthcare challenges, especially in low- and middle-income countries where healthcare systems often address individual conditions rather than comorbidities. This results in poor coping, increased vulnerability and diminished health-related quality of life. This study investigated coping strategies, challenges and potential interventions for individuals with HIV-mental illness comorbidity in Southwestern Uganda. The study included purposively selected people with HIV and mental illnesses seeking care in health facilities across Southwestern Uganda. Data from in-depth, semi-structured interviews were transcribed verbatim and entered into ATLAS.ti-7 for analysis. Thematic analysis was employed, generating codes from the transcripts to develop themes. The data revealed three categories: coping strategies, challenges and potential interventions. Three key coping strategies emerged: conscious avoidance of emotional stressors, maintaining emotional stability through social interactions and reliance on prayer. Challenges included social isolation, financial crises, vulnerability to abuse and medication management issues. Respondents recommended scaling up mass educational programmes to increase awareness of causes, preventive measures and association between the two comorbidities, together with implementing financial aid initiatives as viable interventions. These findings highlight the importance of addressing comorbidities together for improved emotional stability and underscore the value of the proposed potential interventions for healthcare systems and policymakers.

Combining Asset Accumulation and Multifamily Group Intervention to Improve Mental Health for Adolescent Girls: A Cluster-Randomized Trial in Uganda

PURPOSE

The aim of this study is to expand the current knowledge on the relationship between poverty, family functioning, and the mental health of adolescent girls in families affected by poverty and HIV/AIDS in southern Uganda. The study investigates the association between family functioning and mental health and examines whether family functioning moderates the intervention effect on adolescent mental health.

METHODS

Longitudinal data were collected over the course of 24 months in a cluster randomized controlled trial conducted among N=1,260 girls aged 14-17 years in Uganda. Participants were randomized into control group (n=408 girls from n=16 schools), matched youth development accounts treatment, YDA (n=471 girls from n=16 schools), and integrated intervention combining YDA with multiple family group component (n=381 girls from n=15 schools).

RESULTS

We found a significant positive association between family functioning and mental health of adolescent girls in our sample. Moderator analyses suggests that effect of the intervention on Beck Hopelessness Scale was significantly moderated by family cohesion (χ2 (4) =21.43; p = .000), frequency of family communication (χ2 (4) =9.65; p = .047), and quality of child-caregiver relationship (χ2 (4) =11.12; p = .025). Additionally, the intervention effect on depression was moderated by the comfort of family communication (χ2 (4) =10.2; p = .037).

DISCUSSION

The study findings highlight the importance of family functioning when examining the link from poverty to adolescent mental health. The study contributes to the scarce evidence suggesting that asset-accumulation opportunities combined with a family strengthening component may improve parenting practices and adolescent mental health in poor households.

The mental health impact of the ongoing Russian-Ukrainian war 6 months after the Russian invasion of Ukraine

Objective

This study aimed to investigate the impact of the ongoing war in Ukraine on the mental health of Ukrainians, focusing on war-induced trauma, disturbances in self-organization, post-traumatic stress disorder, complex post-traumatic stress disorder, anxiety, stress, and depression.

Methods

Data was collected from 703 participants 6 months after the full-scale invasion using a structured questionnaire that included sections on socio-demographic information, trauma-related issues, and mental health.

Results

The study found that levels of depression and anxiety were relatively low, while stress and resilience were relatively high among Ukrainians affected by the war. However, those who were directly exposed to military actions, physical violence, or severe human suffering had higher levels of anxiety, depression, stress, and trauma-related symptoms. The war experience varied by gender, age, and living conditions. Participants who stayed in Ukraine had significantly lower anxiety, depression, stress, and trauma-related symptoms compared to those who moved abroad. Anxiety, depression, stress, low resilience, and subjective satisfaction with living conditions were predictors of trauma-related symptoms, including PTSD and CPTSD.

Conclusion

These findings suggest that the mental health of Ukrainians affected by the war was impacted differently depending on their level of exposure to violence and their living conditions. Additionally, the study identified several predictors of trauma-related symptoms, including PTSD and CPTSD, such as anxiety, depression, stress, low resilience, and subjective satisfaction with living conditions. Future research should further explore the relationships between trauma type, sociodemographic factors, resilience, stress, anxiety, depression, and PTSD and CPTSD to better understand the mediation mechanisms underlying these relationships and to develop effective interventions to support the well-being of Ukrainians during this difficult time.

Problematic use of the internet, smartphones, and social media among medical students and relationship with depression: An exploratory study

BACKGROUND

Students in sub-Saharan African countries experienced online classes for the first time during the COVID-19 pandemic. For some individuals, greater online engagement can lead to online dependency, which can be associated with depression. The present study explored the association between problematic use of the internet, social media, and smartphones with depression symptoms among Ugandan medical students.

METHODS

A pilot study was conducted among 269 medical students at a Ugandan public university. Using a survey, data were collected regarding socio-demographic factors, lifestyle, online use behaviors, smartphone addiction, social media addiction, and internet addiction. Hierarchical linear regression models were performed to explore the associations of different forms of online addiction with depression symptom severity.

RESULTS

The findings indicated that 16.73% of the medical students had moderate to severe depression symptoms. The prevalence of being at risk of (i) smartphone addiction was 45.72%, (ii) social media addiction was 74.34%, and (iii) internet addiction use was 8.55%. Online use behaviors (e.g., average hours spent online, types of social media platforms used, the purpose for internet use) and online-related addictions (to smartphones, social media, and the internet) predicted approximately 8% and 10% of the severity of depression symptoms, respectively. However, over the past two weeks, life stressors had the highest predictability for depression (35.9%). The final model predicted a total of 51.9% variance for depression symptoms. In the final model, romantic relationship problems (ß = 2.30, S.E = 0.58; p<0.01) and academic performance problems (ß = 1.76, S.E = 0.60; p<0.01) over the past two weeks; and increased internet addiction severity (ß = 0.05, S.E = 0.02; p<0.01) was associated with significantly increased depression symptom severity, whereas Twitter use was associated with reduced depression symptom severity (ß = 1.88, S.E = 0.57; p<0.05).

CONCLUSION

Despite life stressors being the largest predictor of depression symptom score severity, problematic online use also contributed significantly. Therefore, it is recommended that medical students' mental health care services consider digital wellbeing and its relationship with problematic online use as part of a more holistic depression prevention and resilience program.

Association between recent COVID-19 diagnosis, depression and anxiety symptoms among slum residents in Kampala, Uganda

BACKGROUND

Despite the known link between poor living conditions and mental health, there has been little research on the mental health of slum dwellers worldwide. Although the Coronavirus disease 2019 (COVID-19) pandemic has led to an increase in mental health issues, little focus has been given to the impact on slum dwellers. The study aimed to investigate the association between recent COVID-19 diagnosis and the risk of depression and anxiety symptoms among people living in an urban slum in Uganda.

METHODS

A cross-sectional study was conducted among 284 adults (at least 18 years of age) in a slum settlement in Kampala, Uganda between April and May 2022. We assessed depression symptoms and anxiety using validated Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder assessment tool (GAD-7) questionnaires respectively. We collected data on sociodemographic characteristics, and self-reported recent COVID-19 diagnosis (in the previous 30 days). Using a modified Poisson regression, adjusted for age, sex, gender and household income, we separately provided prevalence ratios and 95% confidence intervals for the associations between recent COVID-19 diagnosis and depressive and anxiety symptoms.

RESULTS

Overall, 33.8% and 13.4% of the participants met the depression and generalized anxiety screening criteria respectively and 11.3% were reportedly diagnosed with COVID-19 in the previous 30 days. People with recent COVID-19 diagnosis were more likely to be depressed (53.1%) than those with no recent diagnosis (31.4%) (p<0.001). Participants who were recently diagnosed with COVID-19 reported higher prevalence of anxiety (34.4%) compared to those with no recent diagnosis of COVID-19 (10.7%) (p = 0.014). After adjusting for confounding, recent diagnosis with COVID-19 was associated with depression (PR = 1.60, 95% CI 1.09-2.34) and anxiety (PR = 2.83, 95% CI 1.50-5.31).

CONCLUSION

This study suggests an increased risk of depressive symptoms and GAD in adults following a COVID-19 diagnosis. We recommend additional mental health support for recently diagnosed persons. The long-term of COVID-19 on mental health effects also need to be investigated.

Exploring adverse childhood experiences (ACEs) among Ugandan university students: its associations with academic performance, depression, and suicidal ideations

BACKGROUND

Adverse childhood experiences (ACEs) among university students have been linked to a variety of factors and have been shown to have a dose-response relationship with adult health and behavior.

OBJECTIVE

To investigate the effect of exposure to ACEs on academic performance, depression, and suicidal ideations among university students.

METHODS

A cross-sectional survey among university students at a public university in southwestern Uganda was conducted in 2021, integrating the Adverse Childhood Experiences International Questionnaire for assessing ACEs, the Patient Health Questionnaire for assessing depression symptoms and suicidal ideations, and questions assessing the family structure and academic performance as adopted from similar studies. Regression analysis was performed, and 3 models were generated to answer the study hypotheses.

RESULTS

A total of 653 undergraduate university students with a mean age of 22.80 (± 3.16) years were recruited. Almost all students (99.8%) experienced one or more ACEs, with physical abuse being the common ACE reported. The average depression symptom severity was statistically higher among individuals who experienced any form of ACEs. No relationship was observed between the ACEs experienced and self-rated academic performance. Similarly, on regression analysis, the cumulative number of ACEs was not associated with self-rated academic performance (β =  - 0.007; 95% CI - 0.031 to 0.016; p = 0.558). However, the cumulative number of ACEs was positively associated with depression symptom severity (β = 0.684; 95% CI 0.531-0.837; p < 0.001), as well as increased the likelihood of suicidal ideations (aOR = 1.264; 95% CI 01.090-1.465; p < 0.001).

CONCLUSIONS

The burden of ACEs is exceedingly high among Ugandan university students, highlighting the urgency in strengthening effective child protection strategies to protect Uganda's rapidly growing population from mental ill-health and avoid future psychological disability, a burden to the healthcare system. The study's findings will also be useful to practitioners/policymakers working to prevent/limit child maltreatment globally.