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

Measuring alcohol use among adolescents in Africa: A systematic scoping review of consumption, screening and assessment tools

ISSUES

Globally, adolescent drinking is a major public health concern. Alcohol measurements are influenced by local consumption practices, patterns and perceptions of alcohol-related harm. This is the first review to examine what tools are used to measure alcohol consumption, or screen for or assess harmful use in African adolescents, and how these tools take into account the local context.

APPROACH

A systematic scoping review was conducted in line with the Arksey and O'Malley framework. A search in MEDLINE, CINAHL, Global Health and the Cochrane Database covered the period of 2000-2020.

KEY FINDINGS

The search identified 121 papers across 25 African countries. A range of single- and multi-item tools were identified. Very few adaptations of existing questions were specified, and this search identified no tools developed by local researchers that were fundamentally different from established tools often designed in the USA or Europe. Inconsistencies were found in the use of cut-off scores; many studies used adult cut-off scores.

IMPLICATIONS AND CONCLUSION

The possible impact of African drinking practices and culture on the accuracy of alcohol screening tools is currently unknown, but is also not taken into account by most research. This, in combination with a limited geographical distribution of alcohol-related research across the continent and inconsistent use of age- and gender-specific cut-off scores, points towards probable inaccuracies in current data on adolescent alcohol use in Africa.

Mental health interventions for adolescents in sub-Saharan Africa: A scoping review

BACKGROUND

Globally, adolescents are vulnerable to mental health problems, particularly those from sub-Saharan Africa (SSA) due to impoverished living conditions and a higher prevalence of chronic conditions such as HIV/AIDS in the region. The COVID-19 pandemic has further exacerbated this risk. This calls for an urgent need for evidence-based adolescent mental health interventions to reduce the risk and burden of mental health problems in SSA. The review aims to identify and characterize existing adolescent mental health interventions in SSA, as well as to evaluate their implementation strategies and effectiveness.

METHODS

We systematically searched PubMed, African Index Medicus, PsycINFO, Web of Science, and CINAHL databases for relevant articles. Furthermore, we searched gray literature databases, including Think Tank search, open gray, NGO search engine, and IGO search engine for additional relevant articles. The scoping review was conducted to identify original research articles on mental health interventions among adolescents in sub-Saharan Africa published from database inception to 31 December 2021. We carried out a narrative synthesis to report our findings.

RESULTS

Our literature search generated 4,750 studies, of which 1,141 were duplicates, 3,545 were excluded after screening, and 64 articles met the inclusion criteria. The 64 studies describe a total of 57 unique mental health interventions comprising 40,072 adolescents. The nature of these interventions was diverse, encompassing various implementation strategies such as economic-based, family strengthening, psychoeducation, interpersonal psychotherapy, Cognitive Behavioral Therapy, and resilience training, among others. Most of the interventions were selective interventions that targeted adolescents at high risk of developing mental health problems including adolescents living with HIV, war-affected adolescents, orphans, adolescents from poorer backgrounds, and survivors of sexual violence. Half of the interventions were delivered by lay persons. Sixty-two of the eligible studies examined the effectiveness of the mental health interventions, of which 55 of them reported a positive significant impact on various mental health outcomes.

CONCLUSIONS

The review findings show that there exist several diverse interventions that promote mental health among adolescents in sub-Saharan Africa. These interventions can be implemented in diverse settings including schools, communities, health facilities, and camps, and can be delivered by lay persons.

Psychiatric morbidity amongst adolescents in a Nigerian juvenile correctional facility

Background

The high occurrence of psychiatric disorders amongst adolescents within the Juvenile Justice System (JJS) has been confirmed. Most of the available data are from developed countries and some of them focus on just a single psychiatric disorder which may not be representative of the situation in low-income countries, hence the need for more studies in developing countries, including Nigeria.

Aim

The study aimed to determine the prevalence of psychiatric disorders amongst adolescent residents of a correctional facility.

Setting

The study was carried out at a Borstal Institution in North-Central Nigeria.

Methods

A descriptive cross-sectional study design was used. One hundred and twenty adolescents were assessed using the socio-demographic pro forma questionnaire designed by the researcher and the Kiddies Schedule for Affective Disorders and Schizophrenia (KSADS-PL). Data were analysed using EPI-INFO 4.06 d version 6.04 software.

Results

A total of 62.5% of the male respondents were older than 15 years. The percentage of respondents with a psychiatric disorder was 82.5%. The rate of psychiatric disorders was high with disruptive behaviour disorders being the most common at 40.8%, others were substance use disorders (15.8%), anxiety disorders (14.2%), psychosis (6.7%) and mood disorders (5%).

Conclusion

This study has established a high prevalence rate of psychiatric disorders amongst incarcerated adolescents. This is in line with the findings of numerous studies worldwide. This study has identified the need to increase awareness and knowledge about the high morbidity of mental disorders in growing juvenile detainee populations. This will allow early identification of adolescents at risk of psychiatric disorders and ensure efficient resource distribution of both JJS service and mental healthcare. Effective and appropriate interventions have shown to improve overall health, quality of life and reduce the rate of recidivism amongst incarcerated juveniles.

Psychiatric morbidity among adolescents and youth involved with the juvenile justice system in sub-Saharan Africa: Systematic scoping review of current studies and research gaps

The current body of knowledge on the prevalence rate of psychiatric morbidity among adolescents and youth within the juvenile justice system in sub-Saharan Africa is yet to be systematically synthesized.. Consequently, African literature in the field has remained obscure, out of consideration in global discourses around the subject.; and incoherent to policy-makers. The situation has also hampered the identification of and filling of regional research-gaps in the field. The aim of this study, therefore, was to conduct a systematic scoping review of available data on psychiatric morbidity among adolescents and youth within the juvenile justice system in sub-Saharan Africa. The search was conducted using PubMed/MEDLINE, Science Direct, EMBASE, CINAHL and Psych Info. Additional searches were done in Google Scholar and African Journal Online (AJOL) databases. Twenty-six studies from 21 different research projects were identified. More than two-thirds were conducted in Nigeria and published within the last decade. Similar to what has been established around the world, the prevalence rate of psychiatric disorder was often very high, with a range of 59.7% - 63.0% among respondents. Key strengths of identified studies included use of standardized clinician-administered instruments for assessment and exploration of a wide range of psychiatric disorders. The main weaknesses in the studies included male gender-bias, lack of normative comparison groups, emphasis on custodial settings with little data on non-custodial systems, and considerable length of time-lag between the points of incarceration and psychiatric evaluation among the samples studied.. The study concluded that a modest number of studies have been conducted on psychiatric morbidity among justice-involved adolescents in sub-Saharan Africa, but there are still significant research gaps which could be bridged in order to aid context-appropriate interventions.

Prevalence of mental illness among adolescents (15-18 years) treated at Federal Neurospsychiatric Hospital, Enugu Nigeria, from 2004 to 2013

PURPOSE

The aim of this study was to investigate the prevalence of mental illness among adolescents treated at Federal Neurospsychiatric Hospital, Enugu Nigeria.

METHODS

A retrospective descriptive design was used to assess 1255 adolescents within the age of 15-18 years diagnosed with mental illness from 2004 to 2013. A proforma designed by the researchers was used to document information on prevalence, type, and relationship with age and gender.

RESULTS

The prevalence of mental illness within the 10 year period was 9.9%. Schizophrenia spectrum and other psychotic disorders 869 (69.2%) were the commonest conditions recorded. Higher prevalence of mental illness was seen among males 752 (59.9%) compared to females 503 (40.1%). Schizophrenia spectrum and other psychotic disorders 384 (76.3%); depressive disorders 20 (4.0%) were more common among female adolescents while substance-related and addictive disorders 84(11.2%) and neurodevelopmental disorders 48(6.8%) were more common among male adolescents. The prevalence of mental illness increased with age, being highest at 18 years and lowest at 15 years while prevalence of drug induced psychosis was 90 (7.2%).

CONCLUSIONS

The study highlights the need to focus on the mental health of adolescents by planning preventive programs and creating awareness on mental health promoting strategies, and to introduce child and adolescent psychiatric health services in the study setting.

Mental health of people detained within the justice system in Africa: systematic review and meta-analysis

Worldwide, people with mental disorders are detained within the justice system at higher rates than the general population and often suffer human rights abuses. This review sought to understand the state of knowledge on the mental health of people detained in the justice system in Africa, including epidemiology, conditions of detention, and interventions. We included all primary research studies examining mental disorders or mental health policy related to detention within the justice system in Africa. 80 met inclusion criteria. 67% were prevalence studies and meta-analysis of these studies revealed pooled prevalence as follows: substance use 38% (95% CI 26-50%), mood disorders 22% (95% CI 16-28%), and psychotic disorders 33% (95% CI 28-37%). There were only three studies of interventions. Studies examined prisons (46%), forensic hospital settings (37%), youth institutions (13%), or the health system (4%). In 36% of studies, the majority of participants had not been convicted of a crime. Given the high heterogeneity in subpopulations identified in this review, future research should examine context and population-specific interventions for people with mental disorders.

The Nigerian juvenile justice system: from warehouse to uncertain quest for appropriate youth mental health service model – RETRACTED

Mental health services for youths within the juvenile justice system remain a contemporary global discourse. To bring perspectives from under-resourced regions, we examine the current limitations of some globalised models for mental health services within the juvenile justice system in Nigeria. The important, multi-systemic steps needed to adapt the system for modern mental health promotion and services are highlighted.

The Nigerian juvenile justice system: from warehouse to uncertain quest for appropriate youth mental health service model

Mental health service provision for youth within the juvenile justice system remains a topic of contemporary global discourse. To bring perspectives from under-resourced regions, we examine the current limitations of some globalised models for mental health services within the juvenile justice system in Nigeria. The important multi-systemic steps needed to reposition the system for modern mental health promotion and services are highlighted.