The Challenges and Opportunities for Mental Health Twin Research in Nigeria

The recent interest in increasing diversity in genetic research can be useful in uncovering novel insights into the genetic architecture of mental health disorders - globally and in previously unexplored settings such as low- and middle-income settings like Nigeria. Genetic research into mental health is potentially promising in Nigeria and we reflect on the challenges and opportunities for twin research which may be particularly suited to Nigeria. The higher rates of twinning in Africa and Nigeria specifically, make the twin design an affordable and readily maintainable approach for genetic research in the country. Despite potential challenges with recruitment, data collection, data analysis and dissemination; the success of current efforts suggest that the twin design can tapped even further for greater impact in the country. We highlight some ways in which the scope of twin research can be increased and suggest some ways in which existing challenges can be overcome including recent Patient Participant Involve and Engagement activities.

Genetic and Environmental Influences on Sexual Orientation: Moderation by Childhood Gender Nonconformity and Early-Life Adversity

Existing evidence indicates genetic and non-genetic influences on sexual orientation; however, the possibility of gene-environment interplay has not been previously formally tested despite theories indicating this. Using a Finnish twin cohort, this study investigated whether childhood gender nonconformity and early-life adversities independently moderated individual differences in sexual orientation and childhood gender nonconformity, the relationship between them, and the etiological bases of the proposed moderation effects. Sexual orientation, childhood gender nonconformity, and early-life adversities were assessed using standard questionnaires. Structural equation twin model fitting was carried out using OpenMx. Childhood gender nonconformity was significantly associated with reduced phenotypic variance in sexual orientation (β =  - 0.14, 95% CI - 0.27, - 0.01). A breakdown of the underlying influences of this moderation effect showed that this was mostly due to moderation of individual-specific environmental influences which significantly decreased as childhood gender nonconformity increased (βE =  - 0.38; 95% CI - 0.52, - 0.001) while additive genetic influences were not significantly moderated (βA = 0.05; 95% CI - 0.30, 0.27). We also observed that the relationship between sexual orientation and childhood gender nonconformity was stronger at higher levels of childhood gender nonconformity (β = 0.10, 95% CI 0.05, 0.14); however, significance of the underlying genetic and environmental influences on this relationship could not be established in this sample. The findings indicate that beyond a correlation of their genetic and individual-specific environmental influences, childhood gender nonconformity is further significantly associated with reduced individual-specific influences on sexual orientation.

A cross-sectional study on resilience, anxiety, depression, and psychoactive substance use among heterosexual and sexual minority adolescents in Nigeria

BACKGROUND

Mental health-related problems predispose alcohol and other psychoactive substances use as coping strategies. We assessed associations between resilience and anxiety symptoms, depressive symptoms, problematic alcohol, and multiple psychoactive substance use among sexual minority and heterosexual adolescents in Nigeria.

METHODS

This was a secondary analysis of a subset of data generated through an online cross-sectional study conducted between 16th and 31st of October 2020. Data extracted for adolescents in Nigeria age 13-19 years were: dependent variables (alcohol use using the CAGE test, multiple psychoactive substance use, depressive symptoms using the Patient Health Questionnaire-9, and anxiety symptoms using the Generalized Anxiety Disorder-7 measure); independent variables (resilience using the Connor-Davidson resilience scale and sexual identity), and confounding factors (age and sex). Associations between dependent and independent variables were determined using multivariable logistic regression analyses after controlling for confounders.

RESULTS

Of the 1419 adolescent participants, 593 (42%) were sexual minority individuals, 533 (37.6%) had high depressive symptoms, 381 (26.8%) had high anxiety symptoms, 177 (12.5%) had problematic alcohol use and 389 (27.4%) used multiple psychoactive substances. Resilience was significantly associated with lower odds of anxiety (AOR:0.96, 95% CI: 0.94-0.97, p < 0.001) and depressive (AOR:0.94, 95% CI: 0.92-0.96, p < 0.001) symptoms, problematic alcohol use (AOR:0.97, 95% CI: 0.95-0.99, p = 0.002), and multiple psychoactive substance use (AOR:0.95, 95% CI: 0.93-0.96, p < 0.001). Sexual minority adolescents had significantly higher odds of anxiety (AOR:4.14, 95% CI: 3.16-5.40, p < 0.001) and depressive symptoms (AOR:4.79; 95% CI: 3.73-6.15, p < 0.001), problematic alcohol use (AOR:2.48, 95% CI: 1.76-3.49, p < 0.001), and multiple psychoactive substance use (AOR:5.69, 95% CI: 4.34-7.47, p < 0.001).

CONCLUSION

Sexual minority adolescents and adolescents with low resilience have a higher need for interventions to reduce the risk of anxiety, depression, and the use of alcohol and other psychoactive substances.

Prevalence and pattern of intimate partner violence during COVID-19 pandemic among Nigerian adults

OBJECTIVES

Our objectives were to determine the prevalence, pattern, and associated sociodemographic, psychosocial, and COVID-19-related factors associated with intimate partner violence (IPV) during the COVID-19 pandemic among Nigerian adults.

METHOD

We conducted an online survey among Nigerian adults (n = 994, aged 18-72 years) who completed the HARK questionnaire, Hospital Anxiety and Depression Scale, Perceived Social Support Scale, and factors associated with the COVID-19 pandemic. Logistic regression was carried out with presence or absence of IPV as the outcome variable.

RESULTS

Prevalence of IPV among women was 57.5%, while it was 42.5% among men, during the COVID-19 pandemic. IPV was significantly associated with younger age; having no children; increased threat of income due to COVID-19; anxiety; depression; reduced frequency of accessing COVID-19 updates via TV, radio, and news outlet; self-isolation due to COVID-19 symptoms; and self-reported impact of COVID-19 on recreation. A high monthly income, presence of anxiety and depressive symptoms, threat of COVID-19 to income, and self-reported impact of COVID-19 on recreation increased the odds of experiencing IPV.

CONCLUSION

Our findings indicate that the ongoing COVID-19 pandemic has had a significant impact on the experience of IPV among adult Nigerians. The implications of our findings are that both men and women were affected by IPV during the COVID-19 pandemic. Modalities for reducing IPV and its aftermath among this population should include online psychosocial support measures, which may offer anonymity and reduced stigma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Causal Influences of Same-Sex Attraction on Psychological Distress and Risky Sexual Behaviors: Evidence for Bidirectional Effects

Although health disparities among same-sex attracted compared to heterosexual individuals are typically explained by minority stress, there is limited evidence for a causal effect. This study investigated whether same-sex attraction was causally associated with psychological distress and risky sexual behavior using sociosexual behavior as a proxy. The sample comprised monozygotic and dizygotic twins and their non-twin siblings (n = 2036, 3780 and 2356, respectively) genotyped and assessed for same-sex attraction, psychological distress (anxiety and depressive symptoms), and risky sexual behavior. Causal influences were investigated with same-sex attraction as the predictor and psychological distress and risky sexual behavior as the outcomes in two separate Mendelian Randomization-Direction of Causation (MRDoC) models using OpenMx in R. The MRDoC model improves on the Mendelian Randomization and Direction of Causation twin models by allowing analyses of variables with similar genetic architectures, incorporating polygenic scores as instrumental variables and specifying pleiotropy and residual covariance. There were significant causal influences flowing from same-sex attraction to psychological distress and risky sexual behavior (standardized coefficients = 0.13 and 0.16; 95% CIs 0.03-0.23 and 0.08-0.25, respectively). Further analyses also demonstrated causal influences flowing from psychological distress and risky sexual behavior toward same-sex attraction. Causal influences from same-sex attraction to psychological distress and risky sexual behavior may reflect minority stress, which reinforces ongoing measures to minimize social disparities. Causal influences flowing in the opposite direction may reflect rejection sensitivity, stigma-inducing outcomes of risky sexual behavior, and recall bias; however, further research is required to specifically investigate these processes.

Psychological Distress, Anxiety, Depression, and Associated Factors Among Nigerian Healthcare Workers During COVID-19 Pandemic: A Cross-Sectional Study

Objectives: We determined the prevalence of psychological distress, and the associations between sociodemographic factors, anxiety, depression, COVID-19-related experiences, and psychological distress, among nurses and doctors in Nigeria. Methods: The study was a cross-sectional descriptive study, conducted over a month (1st of July-31st of July 2021) among 434 Health Care Workers (HCWs) [225 (51.8%) nurses and 209 (48.2%) doctors] from two tertiary health facilities in southwestern Nigeria. Binary logistic regression was carried out to determine the factors associated with psychological distress (dependent variable), while the independent variables were anxiety, depression, and COVID-19 experience-related factors. Results: The prevalence of moderate and severe psychological distress was 49.1% and 5.8%, respectively. Individuals who had the first degree had significantly lower odds (AOR: 0.43; p = 0.037) of experiencing psychological distress while being a nurse (AOR: 2.03; p = 0.014), higher levels of anxiety (1.28; p < 0.001), and depression (AOR: 1.17; p = 0.005) were associated with significantly higher odds of experiencing moderate to severe levels of psychological distress. Conclusion: There is a high level of psychological distress experienced by these health workers. Hence, they will benefit from strategies to reduce their distress.

Developmental Language Disorder and Psychopathology: Disentangling Shared Genetic and Environmental Influences

There is considerable variability in the extent to which young people with developmental language disorder (DLD) experience mental health difficulties. What drives these individual differences remains unclear. In the current article, data from the Twin Early Development Study were used to investigate the genetic and environmental influences on psychopathology in children and adolescents with DLD (n = 325) and those without DLD (n = 865). Trivariate models were fitted to investigate etiological influences on DLD and psychopathology, and bivariate heterogeneity and homogeneity models were fitted and compared to investigate quantitative differences in etiological influences on psychopathology between those with and without DLD. The genetic correlation between DLD and internalizing problems in childhood was significant, suggesting that their co-occurrence is due to common genetic influences. Similar, but nonsignificant effects were observed for externalizing problems. In addition, genetic influences on internalizing problems, but not externalizing problems, appeared to be higher in young people with DLD than those without DLD, suggesting that the presence of DLD may exacerbate genetic risk for internalizing problems. These findings indicate that genetic influences on internalizing problems may also confer susceptibility to DLD (or vice versa) and that DLD serves as an additional risk factor for those with a genetic predisposition for internalizing problems.

Increased depressive and anxiety symptoms in non-heterosexual individuals: Moderation by childhood factors using a twin design

BACKGROUND

Evidence indicates that minority stress does not sufficiently explain mental health disparities in non-heterosexual compared to heterosexual individuals. We investigated alternative mechanisms whereby childhood factors (childhood gender nonconformity, early-life adversities and parent-child interactions) moderate the relationships between sexual orientation and depressive and anxiety symptoms.

METHODS

The sample comprised twin pairs from the Finnish Genetics of Sexuality and Aggression cohort (n = 3166 individuals, mean age = 37.5 ± 2.93 years). Twin analyses using structural equation modelling was performed in OpenMx. Specifically, we tested whether childhood factors differentially moderated the underlying genetic and environmental influences on the relationships between sexual orientation, and depressive and anxiety symptoms.

RESULTS

The associations between non-heterosexuality, and depressive and anxiety symptoms (r = 0.09, 0.10 respectively) were significantly influenced by both genetic and environmental factors. The genetic influences explaining the relationships of sexual orientation with depressive and anxiety symptoms were maximal at high levels of childhood gender nonconformity (β_A = 0.09 and 0.11 respectively) whereas the individual-specific environmental influences on these relationships were maximal at lower levels of childhood gender nonconformity (β_E = -0.10).

LIMITATIONS

Childhood factors were assessed retrospectively in a cross-sectional design.

CONCLUSIONS

Childhood gender nonconformity is associated with increased genetic and decreased individual-specific environmental influences on mental health among non-heterosexual individuals. Childhood gender nonconformity may, thus, enhance genetic risk and non-genetic protective processes for depressive and anxiety symptoms among non-heterosexual individuals.

Do psychosocial factors mediate sexual minorities' risky sexual behaviour? A twin study

OBJECTIVES

Risky sexual behavior among sexual minorities (lesbian, gay, and bisexual individuals) are partly attributed to mental health and other social disparities; but this may be confounded by correlated genetic and environmental influences. As preregistered, the present study investigated indirect associations between sexual minority status and increased lifetime sexual partners through increased psychosocial adversity (depressive and anxiety symptoms, intimate partner violence, and early life adversities) and substance use (alcohol, cannabis, and other illicit drugs), confounding by correlated genetic and environmental influences, and sex differences in these relationships.

METHOD

The sample comprised sexual minority and heterosexual twins who participated in the first and second phases of the latest wave of data collection in the U.K. population-based Twins Early Development study cohort (June 2017 through February 2019; n = 9,697 and 8,718, respectively, Mage = 22.3 ± .92 years). Structural equation modeling was used to specify psychosocial adversity and substance use as mediators while genetic and environmental confounding was further determined by biometrical genetic analyses in which similarities in identical and nonidentical twins were compared.

RESULTS

Increased psychosocial adversity and substance use fully mediated increased lifetime sexual partners in sexual minority women while this effect was partial (31.1%) in men. The best-fitting genetic models indicated that these relationships were not confounded by correlated genetic and environmental influences.

CONCLUSIONS

The relationships between sexual minority status, psychosocial adversity, substance use, and sexual health disparities appeared independent of genetic and environmental influences. Individual and systemic interventions to reduce psychosocial disadvantage and substance use can also decrease sexual health disparities among sexual minorities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Depressive and anxiety symptoms and COVID-19-related factors among men and women in Nigeria

Despite the greater adverse economic impacts in low and middle-income (LAMI) compared to high-income countries, fewer studies have investigated the associations between COVID-19-related stressor and mental health in LAMI countries. The objectives of this study were to determine the associations between COVID-19-related stressors and anxiety and depressive symptoms while controlling for known risk and protective factors and to investigate any sex differences. An online survey was carried out to assess sociodemographic, psychosocial (previous mental health conditions, sexual orientation, intimate partner violence and perceived social support) and COVID-19-related variables. Hierarchical linear regression was carried out with anxiety and depressive symptoms as separate outcomes. Of the COVID-19-related factors, testing positive for COVID-19 infection, having COVID-19 symptoms, having other medical conditions, self-isolating due to COVID-19 symptoms, worry about infection, perception of the pandemic as a threat to income and isolation during the lockdown were significantly associated with higher anxiety and depressive symptoms. Of these, worry about infection, isolation during lockdown and disruption due to the pandemic retained independent associations with both outcomes. The variance in anxiety and depressive symptoms explained by COVID-19-related factors was larger in women (11.8%) compared to men (6.1% and 0.8% respectively). COVID-19-related stressors are associated with higher anxiety and depressive symptoms, with these effects being larger in men compared to women. Enhancing social support can be an affordable strategy to mitigate this risk but this needs to be investigated using appropriate designs.

Mental Health Disparities Mediating Increased Risky Sexual Behavior in Sexual Minorities: A Twin Approach

Increased risky sexual behavior in sexual minorities relative to heterosexual individuals may be partly explained by mental health disparities, and both factors may be further jointly influenced by common genetic and environmental factors. However, these relationships have not been previously investigated. The objectives of the present study were to investigate mental health disparities as a mediator of the relationship between sexual orientation and risky sexual behavior, controlling for genetic and environmental effects in this relationship and testing for sex differences. Participants included 5814 twins from a Finnish twin cohort. Specified latent factors included sexual orientation, mental health indicators, and risky sexual behavior. Twin models were fitted to the factor structure of the data whereby a Cholesky decomposition on the factors was compared to a mediation submodel using OpenMx. Sex differences were tested in the final model. Phenotypically, mental health disparities partially mediated the relationship between sexual orientation and increased risky sexual behavior, with comparable effects in males and females. However, while this indirect route from sexual orientation to risky sexual behavior mainly contained transmitted genetic effects in males, there was a significant proportion of transmitted shared environmental effects in females. This is the first study to demonstrate that the mediation relationships between sexual orientation, mental health disparities, and risky sexual behavior are not confounded by genetic and environmental factors. The significant sex differences need to be recognized in future research and intervention design to improve sexual health in sexual minorities.

Mediators of increased self-harm and suicidal ideation in sexual minority youth: a longitudinal study

BACKGROUND

Sexual minority youth have elevated suicidal ideation and self-harm compared with heterosexual young people; however, evidence for mediating mechanisms is predominantly cross-sectional. Using a longitudinal design, we investigated self-esteem and depressive symptoms as mediators of increased rates of suicidal ideation or self-harm (SISH) among sexual minority youth, and the roles of childhood gender nonconformity (CGN) and sex as moderators of these relationships.

METHOD

In total, 4274 youth from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort reported sexual orientation at age 15 years, and past-year SISH at age 20 years. Self-esteem and depressive symptoms were assessed at ages 17 and 18 years, respectively. CGN was measured at 30-57 months. Covariates included sociodemographic variables and earlier measures of mediator and outcome variables. Mediation pathways were assessed using structural equation modelling.

RESULTS

Sexual minority youth (almost 12% of the sample) were three times more likely than heterosexual youth to report past-year SISH (95% confidence interval 2.43-3.64) at 20 years. Two mediation pathways were identified: a single mediator pathway involving self-esteem and a multiple-mediated pathway involving self-esteem and depressive symptoms. Although CGN was associated with past-year SISH, it did not moderate any mediation pathways and there was no evidence for moderation by sex.

CONCLUSIONS

Lower self-esteem and increased depressive symptoms partly explain the increased risk for later suicidal ideation and self-harm in sexual minority youth. Preventive strategies could include self-esteem-enhancing or protecting interventions, especially in female sexual minority youth, and treatment of depression.

Economic Cost of Asthma and Psychiatric Morbidity in Nigerian Patients with Asthma

BACKGROUND

Asthma is known to constitute a huge economic burden to its sufferers and their carers. There is a dearth of studies documenting this burden among asthmatics in Nigeria.

OBJECTIVE

This study assessed the relationship between economic cost and psychiatric morbidity among stable Nigerian patients with asthma.

METHODS

85 patients with asthma completed a socio-demographic and illness-related questionnaire, the modified Economic Cost Questionnaire and General Health Questionnaire 12 (GHQ 12). Associations between socio-demographic characteristics, illness related variables, psychiatric morbidity and the direct, indirect and total costs in relation to asthma were assessed.

RESULTS

The average annual total, direct and indirect cost were $309, $190.65 and $118.34 respectively per patient for subjects with asthma. Direct cost constituted 62.7% while the indirect cost was 38.3% of the total cost for asthma. Drugs and hospitalisation were leading contributors to direct costs for asthma. Psychiatric morbidity was found to be present in 35% of subjects with asthma, those with psychiatric morbidity had a higher economic burden.

CONCLUSION

The economic cost of asthma is high, psychiatric morbidity increases this cost. The cost is largely due to drugs and hospitalisations for exacerbation. There is an urgent need to optimize means of helping to minimize this cost and increase measures for detecting and treating psychiatric morbidity.

Economic Cost of Schizophrenia in a Nigerian Teaching Hospital

Objective:

This study evaluated the economic cost of schizophrenia in Nigerian patients and identified factors that influence cost.

Methods:

A total of 100 participants with schizophrenia were assessed using the modified economic cost questionnaire, the mini-international neuropsychiatric interview, the positive and negative syndrome scale, the Liverpool University Neuroleptic side-effect rating scale, and the global assessment of functioning scale. Associations between sociodemographic characteristics, illness-related variables and direct, indirect, and total costs of schizophrenia were assessed.

Results:

The average annual total, direct, and indirect costs of the treatment were $818.48, $349.59, and $468.89, respectively, per patient. The direct cost constituted 42.7%, while the indirect cost was 57.3% of the total costs of treatment. Hospitalization was the leading contributor to the direct cost, while productivity loss was a major component of the indirect cost.

Conclusion:

Schizophrenia is an expensive disease in Nigeria, measures to reduce hospitalization could significantly reduce the cost of illness to the patient and their relatives.

Caregiver burden in families of patients with depression attending Obafemi Awolowo University teaching hospitals complex Ile-Ife Nigeria

OBJECTIVE

The objective of this study was to assess caregiver burden among relatives of patients on treatment for depressive disorder attending the psychiatry outpatient clinic of the Obafemi Awolowo University Teaching Hospitals Complex, Ile Ife, Nigeria.

METHODS

A cross sectional design was used. Hundred caregivers of patients with ICD-10 diagnosis of depression, on outpatient treatment for at least six months were recruited from the psychiatric outpatient clinic. Caregivers completed a semi-structured socio-demographic questionnaire, the Zarit Burden Interview and General Health Questionnaire (GHQ) 12. Descriptive statistics were used to describe socio-demographic variables; association between dependent and independent variables were assessed using Pearson's correlation, chi squared and t test as appropriate.

RESULTS

The mean ZBI score was 41.32 (S.D. = 9.82), 45% of respondents reported moderate to severe burden, spouses constituted 57% of caregivers. Age at onset of depression (t = 2.46, P = .02) number of hospitalization,(χ(2) = 9.82, P = 0.001), and current active symptoms (χ(2) = 36.1, P = .001) were all significantly associated with burden score. Severity of symptoms (r = 0.48, P < .01) and age at onset of illness (r = -0.26, P < .01) both correlated significantly with burden scores, while GHQ score among caregivers also correlated significantly with burden scores (r = 0.52, P < .01).

CONCLUSIONS

Caregivers of depressed patients experience moderate to severe burden. Caring for the depressed need to change from a patient focused approach to a combined patient and caregiver approach.