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Ndetei DM, Mutiso V, Musyimi C, Nyamai P, Lloyd C, Sartorius N. Association of type 2 diabetes with family history of diabetes, diabetes biomarkers, mental and physical disorders in a Kenyan setting. Sci Rep 2024; 14:11037. [PMID: 38745063 PMCID: PMC11094016 DOI: 10.1038/s41598-024-61984-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/13/2024] [Indexed: 05/16/2024] Open
Abstract
This study aimed to determine the degree of family relations and associated socio-demographics characteristics, clinical/physical and mental disorders in type 2 diabetes mellitus in a Kenyan diabetes clinic. This study was part of a large multicentre study whose protocol and results had been published. It took place at the outpatient diabetes clinic at a County Teaching and Referral Hospital in South East Kenya involving 182 participants. We used a socio-demographic questionnaire, the Hamilton Depression (HAM-D) and PHQ-9 rating scales for depression, the MINI International Neuropsychiatric Interview (MINI; V5 or V6) for DSM-5 diagnoses, the WHO-5 Well-being scale and Problem Areas in Diabetes Scale (PAID). We extracted from the notes all physical conditions. We enquired about similar conditions in 1st and 2nd degree relatives. Descriptive, Chi-square test, Fisher's exact test, one way ANOVA, and Multinomial logistic regression analysis were conducted to test achievements of our specific aims. Of the 182 patients who participated in the study, 45.1% (82/182) reported a family history of diabetes. Conditions significantly (p < 0.05) associated with a degree of family history of diabetes were retinopathy, duration of diabetes (years), hypertension, and depressive disorder. On average 11.5% (21/182) scored severe depression (≥ 10) on PHQ-9 and 85.2% (115/182) scored good well-being (≥ 13 points). All DSM-5 psychiatric conditions were found in the 182 patients in varying prevalence regardless of relations. In addition, amongst the 182 patients, the highest prevalence was poor well-being on the WHO quality of life tool. This was followed by post-traumatic disorders (current), suicidality, and psychotic lifetime on DSM-5. The least prevalent on DSM-5 was eating disorders. Some type 2 diabetes mellitus physical disorders and depression have increased incidence in closely related patients. Overall, for all the patients, the prevalence of all DSM-5 diagnoses varied from 0.5 to 9.9%.
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Affiliation(s)
- David M Ndetei
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya.
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya.
| | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Pascalyne Nyamai
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | | | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland
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Ndetei DM, Wasserman D, Mutiso V, Shanley JR, Musyimi C, Nyamai P, Munyua T, Swahn MH, Osborn TL, Johnson NE, Memiah P, Bhui K, Gilbert S, Weisz JR, Javed A, Sourander A. Methods and associations of suicidality in Kenyan high school students: clinical and public health implications. BJPsych Open 2024; 10:e112. [PMID: 38738349 PMCID: PMC11094434 DOI: 10.1192/bjo.2024.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 02/26/2024] [Accepted: 03/11/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Most evidence on suicidal thoughts, plans and attempts comes from Western countries; prevalence rates may differ in other parts of the world. AIMS This study determined the prevalence of suicidal thoughts, plans and attempts in high school students in three different regional settings in Kenya. METHOD This was a cross-sectional study of 2652 high school students. We asked structured questions to determine the prevalence of various types of suicidality, the methods planned or effected, and participants' gender, age and form (grade level). We provided descriptive statistics, testing significant differences by chi-squared and Fisher's exact tests, and used logistic regression to identify relationships among different variables and their associations with suicidality. RESULTS The prevalence rates of suicidal thoughts, plans and attempts were 26.8, 14.9 and 15.7%, respectively. These rates are higher than those reported for Western countries. Some 6.7% of suicide attempts were not associated with plans. The most common method used in suicide attempts was drinking chemicals/poison (18.8%). Rates of suicidal thoughts and plans were higher for older students and students in urban rather than rural locations, and attempts were associated with female gender and higher grade level - especially the final year of high school, when exam performance affects future education and career prospects. CONCLUSION Suicidal thoughts, plans and attempts are prevalent in Kenyan high school students. There is a need for future studies to determine the different starting points to suicidal attempts, particularly for the significant number whose attempts are not preceded by thoughts and plans.
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Affiliation(s)
- David M. Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Nairobi, Kenya; and World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | | | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; and World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | | | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; and World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Pascalyne Nyamai
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; and World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Timothy Munyua
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; and World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Monica H. Swahn
- Department of Health Promotion and Physical Education, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, USA
| | | | - Natalie E. Johnson
- Shamiri Institute, Nairobi, Kenya; Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland; and University of Basel, Basel, Switzerland
| | | | - Kamaldeep Bhui
- Department of Psychiatry, Nuffield Department of Primary Care Health Sciences, Wadham College, University of Oxford, UK; National Institute for Health Research (NIHR) Oxford Health Biomedical Research Centre; Oxford, UK; and World Psychiatric Association Collaborating Centre, Oxford, UK
| | - Sonja Gilbert
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland; and INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - John R. Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Afzal Javed
- World Psychiatric Association, Geneva, Switzerland
| | - Andre Sourander
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland; INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland; and Department of Child Psychiatry, Turku University Hospital, Turku, Finland
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Kalaria R, Maestre G, Mahinrad S, Acosta DM, Akinyemi RO, Alladi S, Allegri RF, Arshad F, Babalola DO, Baiyewu O, Bak TH, Bellaj T, Brodie-Mends DK, Carrillo MC, Celestin KKM, Damasceno A, de Silva RK, de Silva R, Djibuti M, Dreyer AJ, Ellajosyula R, Farombi TH, Friedland RP, Garza N, Gbessemehlan A, Georgiou EEZ, Govia I, Grinberg LT, Guerchet M, Gugssa SA, Gumikiriza-Onoria JL, Hogervorst E, Hornberger M, Ibanez A, Ihara M, Issac TG, Jönsson L, Karanja WM, Lee JH, Leroi I, Livingston G, Manes FF, Mbakile-Mahlanza L, Miller BL, Musyimi CW, Mutiso VN, Nakasujja N, Ndetei DM, Nightingale S, Novotni G, Nyamayaro P, Nyame S, Ogeng'o JA, Ogunniyi A, de Oliveira MO, Okubadejo NU, Orrell M, Paddick SM, Pericak-Vance MA, Pirtosek Z, Potocnik FCV, Raman R, Rizig M, Rosselli M, Salokhiddinov M, Satizabal CL, Sepulveda-Falla D, Seshadri S, Sexton CE, Skoog I, George-Hyslop PHS, Suemoto CK, Thapa P, Udeh-Momoh CT, Valcour V, Vance JM, Varghese M, Vera JH, Walker RW, Zetterberg H, Zewde YZ, Ismail O. The 2022 symposium on dementia and brain aging in low- and middle-income countries: Highlights on research, diagnosis, care, and impact. Alzheimers Dement 2024. [PMID: 38696263 DOI: 10.1002/alz.13836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 05/04/2024]
Abstract
Two of every three persons living with dementia reside in low- and middle-income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high-income countries (HICs), with dementia research predominantly focusing on HICs. This imbalance necessitates LMIC-focused research to ensure that characterization of dementia accurately reflects the involvement and specificities of diverse populations. Development of effective preventive, diagnostic, and therapeutic approaches for dementia in LMICs requires targeted, personalized, and harmonized efforts. Our article represents timely discussions at the 2022 Symposium on Dementia and Brain Aging in LMICs that identified the foremost opportunities to advance dementia research, differential diagnosis, use of neuropsychometric tools, awareness, and treatment options. We highlight key topics discussed at the meeting and provide future recommendations to foster a more equitable landscape for dementia prevention, diagnosis, care, policy, and management in LMICs. HIGHLIGHTS: Two-thirds of persons with dementia live in LMICs, yet research and costs are skewed toward HICs. LMICs expect dementia prevalence to more than double, accompanied by socioeconomic disparities. The 2022 Symposium on Dementia in LMICs addressed advances in research, diagnosis, prevention, and policy. The Nairobi Declaration urges global action to enhance dementia outcomes in LMICs.
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Affiliation(s)
- Raj Kalaria
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Gladys Maestre
- Departments of Neuroscience and Human Genetics, University of Texas Rio Grande Valley, One W. University Blvd, Brownsville, Texas, USA
| | - Simin Mahinrad
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
| | - Daisy M Acosta
- Universidad Nacional Pedro Henriquez Urena (UNPHU), Santo Domingo, Dominican Republic
| | - Rufus Olusola Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Oyo, Nigeria
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ricardo F Allegri
- Fleni Neurological Institute, Buenos Aires, Argentina
- Department of Neurosciences, Universidad de la Costa (CUC), Barranquilla, Colombia
| | - Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Olusegun Baiyewu
- Department of Psychiatry, University of Ibadan, Ibadan, Oyo, Nigeria
| | | | | | | | - Maria C Carrillo
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
| | - Kaputu-Kalala-Malu Celestin
- Department of Neurology, Centre Neuropsychopathologique (CNPP), Kinshasa University Teaching Hospital, University of Kinshasa, Kinshasa, Republic Democratic of the Congo
| | | | - Ranil Karunamuni de Silva
- Interdisciplinary Centre for Innovation in Biotechnology and Neuroscience, Faculty of Medical Sciences, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
- Institute for Combinatorial Advanced Research and Education (KDU-CARE), General Sir John Kotelawala Defence University, Ratmalana, Sri Lanka
| | - Rohan de Silva
- Reta Lila Weston Institute and Department of Clinical, Movement Neuroscience, UCL Queen Square Institute of Neurology, London, UK
| | - Mamuka Djibuti
- Partnership for Research and Action for Health (PRAH), Tbilisi, Georgia
| | | | - Ratnavalli Ellajosyula
- Cognitive Neurology Clinic, Manipal Hospital, and Annasawmy Mudaliar Hospital, Bengaluru, Karnataka, India
- Manipal Academy of Higher Education (MAHE), Manipal, Karnataka, India
| | - Temitope H Farombi
- Tony Anenih Geriatric Center, University College Hospital, Ibadan, Oyo, Nigeria
| | | | - Noe Garza
- Department of Neuroscience and Human Genetics, University of Texas Rio Grande Valley, Harlingen, Texas, USA
| | - Antoine Gbessemehlan
- Inserm U1094, IRD U270, University of Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Inserm, Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
| | - Eliza Eleni-Zacharoula Georgiou
- Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Ishtar Govia
- Caribbean Institute for Health Research, The University of the West Indies, Jamaica, West Indies, Jamaica
- Institute for Global Health, University College London, London, UK
| | - Lea T Grinberg
- Department of Neurology and Pathology, University of California San Francisco, San Francisco, California, USA
- Department of Pathology, University of Sao Paulo, R. da Reitoria, R. Cidade Universitária, São Paulo, Sao Paulo, Brazil
| | - Maëlenn Guerchet
- Inserm U1094, IRD U270, University of Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Seid Ali Gugssa
- Department of Neurology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Eef Hogervorst
- Loughborough University, Loughborough, UK
- Respati University, Yogyakarta, Indonesia
| | | | - Agustin Ibanez
- Latin American Institute for Brain Health (BrainLat), Universidad Adolfo Ibanez, Peñalolén, Santiago, Chile
- Global Brain Health Institute (GBHI), University California San Francisco (UCSF), San Francisco, California, USA
- Global Brain Health Institute (GBHI), Trinity College Dublin, Lloyd Building Trinity College Dublin, Dublin, Ireland
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, and National Scientific and Technical Research Council (CONICET), Victoria, Provincia de Buenos Aires, Argentina
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Thomas Gregor Issac
- Centre for Brain Research, Indian Institute of Science (IISc), Bengaluru, Karnataka, India
| | - Linus Jönsson
- Department of Neurobiology, Care Science and Society, section for Neurogeriatrics, Karolinska Institute, Solnavägen, Solna, Sweden
| | - Wambui M Karanja
- Global Brain Health Institute (GBHI), Trinity College Dublin, Lloyd Building Trinity College Dublin, Dublin, Ireland
- Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Joseph H Lee
- Sergievsky Center, Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Departments of Neurology and Epidemiology, Columbia University, New York, New York, USA
| | - Iracema Leroi
- Global Brain Health Institute (GBHI), Trinity College Dublin, Lloyd Building Trinity College Dublin, Dublin, Ireland
| | | | - Facundo Francisco Manes
- Institute of Cognitive and Translational Neuroscience (INCYT), INECO Foundation, Favaloro University, Buenos Aires, Argentina
| | - Lingani Mbakile-Mahlanza
- Global Brain Health Institute (GBHI), University California San Francisco (UCSF), San Francisco, California, USA
- University of Botswana, Gaborone, Botswana
| | - Bruce L Miller
- Department of Neurology, Memory and Aging Center, University of California San Francisco Weill Institute for Neurosciences, San Francisco, California, USA
| | | | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | | | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Sam Nightingale
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Gabriela Novotni
- University Clinic of Neurology, Medical Faculty University Ss Cyril and Methodius Institute for Alzheimer's Disease and Neuroscience, Skopje, North Macedonia
| | - Primrose Nyamayaro
- Global Brain Health Institute (GBHI), Trinity College Dublin, Lloyd Building Trinity College Dublin, Dublin, Ireland
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Solomon Nyame
- Kintampo Health Research Centre, Ghana Health Service, Hospital Road, Near Kintampo-north Municipal Hospital, Kintampo, Ghana
| | | | | | - Maira Okada de Oliveira
- Global Brain Health Institute (GBHI), University California San Francisco (UCSF), San Francisco, California, USA
- Global Brain Health Institute (GBHI), Trinity College Dublin, Lloyd Building Trinity College Dublin, Dublin, Ireland
- Department of Psychiatry at Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Cognitive Neurology and Behavioral Unit (GNCC), University of Sao Paulo, R. da Reitoria, R. Cidade Universitária, São Paulo, Sao Paulo, Brazil
| | - Njideka U Okubadejo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Yaba, Lagos, Nigeria
| | - Martin Orrell
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Stella-Maria Paddick
- Newcastle University, Newcastle upon Tyne, UK
- Gateshead Health NHS Foundation Trust, Sheriff Hill, Tyne and Wear, UK
| | - Margaret A Pericak-Vance
- John P Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Coral Gables, Florida, USA
- Dr. John T Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Zvezdan Pirtosek
- Faculty of Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Felix Claude Victor Potocnik
- Old Age Psychiatry Unit, Depth Psychiatry, Stellenbosch University, Western Cape, Stellenbosch Central, Stellenbosch, South Africa
| | - Rema Raman
- Alzheimer's Therapeutic Research Institute, University of Southern California, Los Angeles, California, USA
| | - Mie Rizig
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Mónica Rosselli
- Department of Psychology, Charles E. Schmidt College of Science, Florida Atlantic University, Boca Raton, Florida, USA
- Florida Alzheimer's Disease Research Center, Gainesville, Florida, USA
| | | | - Claudia L Satizabal
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, Texas, USA
- Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, USA
- The Framingham Heart Study, Framingham, Massachusetts, USA
| | - Diego Sepulveda-Falla
- Molecular Neuropathology of Alzheimer's Disease, Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and South Texas ADRC, UT Health San Antonio, San Antonio, Texas, USA
- University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Claire E Sexton
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
| | - Ingmar Skoog
- Institute of Neuroscience and Fysiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter H St George-Hyslop
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, Columbia University Irving Medical Center, New York, New York, USA
- Cambridge Institute for Medical Research and Department of Clinical Neurosciences, School of Clinical Medicine, University of Cambridge, Addenbrookes Biomedical Campus, Trumpington, Cambridge, UK
- Department of Medicine (Neurology), Temerty Faculty of Medicine, University of Toronto, and University Health Network, 27 King's College Cir, Toronto, Ontario, Canada
| | - Claudia Kimie Suemoto
- Division of Geriatrics, University of Sao Paulo Medical School, R. da Reitoria, R. Cidade Universitária, São Paulo, Sao Paulo, Brazil
| | - Prekshy Thapa
- Global Brain Health Institute (GBHI), Trinity College Dublin, Lloyd Building Trinity College Dublin, Dublin, Ireland
| | - Chinedu Theresa Udeh-Momoh
- Global Brain Health Institute (GBHI), University California San Francisco (UCSF), San Francisco, California, USA
- FINGERS Brain Health Institute, c/o Stockholms Sjukhem, Stockholm, Sweden
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institute, Solnavägen, Solna, Sweden
- Imarisha Centre for Brain health and Aging, Brain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Victor Valcour
- Memory and Aging Center, Department of Neurology, University of California, San Francisco, California, USA
| | - Jeffery M Vance
- John P Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami, Coral Gables, Florida, USA
| | - Mathew Varghese
- St. John's Medical College, Sarjapur - Marathahalli Rd, beside Bank Of Baroda, John Nagar, Koramangala, Bengaluru, Karnataka, India
| | - Jaime H Vera
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, UK
| | - Richard W Walker
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, Queen Square, London, UK
- UK Dementia Research Institute at UCL, University College London, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yared Z Zewde
- Department of Neurology, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ozama Ismail
- Division of Medical and Scientific Relations, Alzheimer's Association, Chicago, Illinois, USA
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Sæle RH, Ndetei DM, Mutiso VN, Mamah D. Epidemiology of DSM-5 psychiatric disorders in Kenyan Youth with Low and High Psychosis Risk. Compr Psychiatry 2024; 131:152473. [PMID: 38503003 DOI: 10.1016/j.comppsych.2024.152473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/30/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION There are few psychiatric epidemiology studies among Kenyan youth and fewer among those at high psychosis risk (HR). METHODS This study assessed the epidemiology of DSM-5 psychiatric disorders in HR and low-risk (LR) individuals to inform research and mental health services. 567 participants (aged 15-25) in HR (n = 246) and LR (n = 260) groups based on Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen scores. Diagnostic Interview Schedule, version 5 (DIS-5) assessed DSM-5 psychiatric disorder prevalence. Diagnostic comorbidity and demographic relationships were investigated. RESULTS A higher prevalence was observed for all DSM-5 disorders in the HR group, significantly for gambling disorder (13% vs. 5.8%), major depressive disorder (9.8% vs. 3.8%), antisocial personality disorder (5.7% vs. 2.3%), general anxiety disorder (4.9% vs. 0.4%), oppositional defiant disorder (3.3% vs. 0.4%), panic disorder (2.8% vs. 0.8%), and anorexia nervosa (2.8% vs. 0%). Gambling disorder was the most prevalent and showed significant gender effects (males>females). DISCUSSION Psychiatric disorders occur at increased rates among HR compared to LR. Prevalence rates found are lower than in US studies, except for gambling disorder which was highly prevalent. Large-population-based epidemiology studies in Africa are needed to estimate rates, particularly of disorders such as schizophrenia, accurately.
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Affiliation(s)
- Rebekka H Sæle
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States of America.
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Kenya
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Daniel Mamah
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States of America
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Ndetei DM, Mutiso V, Shanley JR, Musyimi C, Nyamai P, Munyua T, Osborn TL, Johnson NE, Gilbert S, Abio A, Javed A, Sourander A. Face-to-face bullying in and outside of schools and cyberbullying are associated with suicidality in Kenyan high school students: a public health issue. BMC Psychiatry 2024; 24:277. [PMID: 38609874 PMCID: PMC11015663 DOI: 10.1186/s12888-024-05739-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/04/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Childhood bullying has been classified as a major public health concern by WHO, with negative effects on the health education and social outcomes of both bullies and victims. There is no current Kenyan data on the prevalence of face-to-face bullying and cyberbullying co-occurring in the same cohort of youth and how they are associated with different aspects of suicidality and socio-demographic characteristics. This study aims to fill these gaps in the Kenyan situation so as to inform current policy and practice. METHODOLOGY This cross-sectional study involved 2,652 students from ten secondary schools in Kenya, selected from three regions representing different levels of public funded schools and socioeconomic spaces. The outcome variable was derived from the questionnaire which asked students questions related to self-harm, suicide thoughts, plans, and attempts. Predictor variables were based on response on experience of bullying in school, out of school, at home, and cyberbullying. Other variables such as gender, age, family background, and class were also collected from the self-reported questions. Data were analyzed using SPSS version 25, with descriptive summary statistics and chi-square tests used to examine variables, and logistic regression analysis used to determine the associations between suicidality and experience of bullying. RESULTS The mean age was 16.13 years. More than half of the participants were male, with the largest proportion living in rural areas. Face-to-face bullying was more prevalent than cyberbullying, with 82% of participants experiencing bullying and 68% experiencing it almost daily in the past six months. Both face-to-face bullying and cyberbullying were associated with suicidal thoughts, plans, and attempts. Predictors of suicidal attempts included being bullied outside of school and being a victim of group bullying, while being bullied every day and being bullied by adult men were predictors of suicidal attempts in cyberbullying. CONCLUSION There is a high prevalence of face-to-face bullying both in and outside schools. There is also a high prevalence of cyberbullying. Both face-to-face and cyberbullying are associated with suicidality in Kenyan high school students.
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Affiliation(s)
- David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya.
| | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | | | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Pascalyne Nyamai
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Timothy Munyua
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | | | - Natalie E Johnson
- Shamiri Institute, Nairobi, Kenya
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sonja Gilbert
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Department of Clinical Medicine, Faculty of Medicine, INVEST Child Psychiatry, INVEST Research Flagship Center, University of Turku, Turku, Finland
| | - Anne Abio
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Afzal Javed
- World Psychiatric Association, Geneva, Switzerland
| | - Andre Sourander
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Department of Clinical Medicine, Faculty of Medicine, INVEST Child Psychiatry, INVEST Research Flagship Center, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Turku, Finland
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Mutiso V, Ndetei DM, Musyimi C, Shanley J, Swahn M, Bhui K. Towards agreement amongst parents, teachers and children on perceived psychopathology in children in a Kenyan socio-cultural context: a cross-sectional study. BMC Psychiatry 2024; 24:259. [PMID: 38580991 PMCID: PMC10998386 DOI: 10.1186/s12888-024-05679-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/12/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Our objective was to determine levels of agreement between parents, teachers and children on mental symptoms in the children. Teachers, children and parents constitute the TRIAD in the perception of psychopathology in children. Analyzing the perceptions of psychopathology from the perspectives of parents, teachers, and children is essential for a comprehensive understanding of a child's mental health. METHODS We identified 195 participants across ten randomly sampled primary schools in South East Kenya. Potential participants were randomly selected and a sampling interval calculated to determine the study participants. The children (Class 5-8; aged 11-14) completed the Youth Self-Report (YSR) scale, the parents the Child Behavior Check List (CBCL) on their children and the teachers completed the Teachers Rating Form (TRF) on the children. Only parents and teachers who gave consent as well as children who gave assent were included in the study. Analysis was conducted using Stata 14.1 and Pearson correlation coefficients used to calculate the correlations between CBCL, YSR and TRF. RESULTS The children agreed least with the parents and more with the teachers. There was a greater agreement between the children and their teachers in 5 (2 internalizing disorders and 3 externalizing disorders) out of the 8 conditions. Children and parents agreed only on somatic disorders and conduct disorders. YSR mean scores were significantly lower than those for CBCL for all problem scales. Mean scores of TRF and YSR were comparable in the majority of the problems measured. CONCLUSION We suggest broad-based psychoeducation to include children, parents/guardians and teachers to enhance shared awareness of psychopathology and uptake of treatment and for the consideration of an integrated mental health system.
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Affiliation(s)
- Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya.
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Jenelle Shanley
- School of Graduate Psychology, Pacific University, Hillsboro, USA
| | - Monica Swahn
- Department of Health Promotion and Physical Education, Wellstar College of Health & Human Services, Kennesaw State University, Kennesaw, GA, USA
| | - Kamaldeep Bhui
- Department of Psychiatry, University of Oxford, England, UK
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Mutiso VN, Musyimi CW, Gitonga I, Tele A, Ndetei DM. Depression and Intimate Partner Violence (IPV) in mothers 6 weeks to 12 months post-delivery in a rural setting in Kenya. Transcult Psychiatry 2024:13634615231187259. [PMID: 38500372 DOI: 10.1177/13634615231187259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
Using a cohort of 544 postpartum mothers, 6 weeks to 12 months post-delivery in the largely rural Makueni County in Kenya, we aimed to determine: (1) the prevalence of postpartum depression (PPD) and the prevalence of each of the four domains of intimate partner violence (IPV), that is physical violence, sexual violence, emotional violence, and controlling behavior; (2) the co-occurrence of PPD and IPV; (3) risk factors and associations between sociodemographic variables and IPV, PPD and IPV and PPD co-occurring. We concurrently administered a researcher-designed sociodemographic ad hoc questionnaire, the WHO Intimate Partner Violence questionnaire and the Mini-International Neuropsychiatric Interview for adults (MINI Plus) for DSM-IV/ICD10 depression. The prevalence of PPD was 14.5%; Emotional violence 80.3%; Controlling behavior 74.4% (a form of emotional violence); Physical violence 40.3%; Sexual violence 28.9%. We found the following overlaps: 39% of participants reported both physical and emotional violence; 39% had both sexual and emotional violence; 15% experienced physical and sexual violence; and 15% of participants reported physical, sexual, and emotional violence. Postpartum depression was associated with physical violence during pregnancy, self-employed status, history of mood disorders and medical problems in the child. Further, we report associations between various types of IPV and history of depression, physical violence during pregnancy, low education level, marital status, and current depression diagnosis. IPV and PPD were highly prevalent in our population of postpartum mothers. Various types of IPV were significantly associated with various sociodemographic indicators while only sexual violence was significantly associated with PPD. Based on our results, we provide suggestions for potential interventions in the Kenyan setting.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Ndetei DM, Wasserman D, Mutiso V, Shanley JR, Musyimi C, Nyamai P, Munyua T, Swahn MH, Weisz JR, Osborn TL, Bhui K, Johnson NE, Pihkala P, Memiah P, Gilbert S, Javed A, Sourander A. The perceived impact of climate change on mental health and suicidality in Kenyan high school students. BMC Psychiatry 2024; 24:117. [PMID: 38347450 PMCID: PMC10860278 DOI: 10.1186/s12888-024-05568-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Climate change has psychological impacts but most of the attention has been focused on the physical impact. This study was aimed at determining the association of climate change with adolescent mental health and suicidality as reported by Kenyan high school students. METHODS This was a cross sectional study with a sample size of 2,652. The participants were high school students selected from 10 schools in 3 regions of Kenya. A questionnaire was used to assess climate change experiences, mental health problems, and suicidality of the youth. Data were analyzed descriptively and with logistic regression to determine various associations of the different variables and the predictors of the various scores of SDQ and suicidality at 95% CI. RESULTS Significant differences were observed between gender and two of the threats of climate change - worry and being afraid as subjectively experienced by the participants. Females were more worried and afraid of climate change than males. On univariate and multivariate logistic regression, we found that various experiences of climate change were significantly associated with various scores of SDQ and much fewer of the experiences predicted SDQ scores. The same pattern was reflected in suicidality. CONCLUSION Climate change appears to be associated with mental health concerns and suicidality according to Kenyan high school students' reports with gender differences in some associations.
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Affiliation(s)
- David M Ndetei
- Africa Mental Health Research and Training Foundation, Mawensi Garden, Mawensi Road, Off Elgon Road, P.O. Box, Nairobi, 48423-00100, Kenya.
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya.
| | | | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Mawensi Garden, Mawensi Road, Off Elgon Road, P.O. Box, Nairobi, 48423-00100, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | | | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Mawensi Garden, Mawensi Road, Off Elgon Road, P.O. Box, Nairobi, 48423-00100, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Pascalyne Nyamai
- Africa Mental Health Research and Training Foundation, Mawensi Garden, Mawensi Road, Off Elgon Road, P.O. Box, Nairobi, 48423-00100, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Timothy Munyua
- Africa Mental Health Research and Training Foundation, Mawensi Garden, Mawensi Road, Off Elgon Road, P.O. Box, Nairobi, 48423-00100, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Monica H Swahn
- Department of Health Promotion and Physical Education, Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, USA
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | | | - Kamaldeep Bhui
- University of Oxford, Oxford, UK
- World Psychiatric Association Collaborating Centre, Oxford, UK
| | - Natalie E Johnson
- Shamiri Institute, Nairobi, Kenya
- Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Panu Pihkala
- Faculty of Theology, University of Helsinki, Helsinki, Finland
| | | | - Sonja Gilbert
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
| | - Afzal Javed
- World Psychiatric Association, Geneva, Switzerland
| | - Andre Sourander
- Research Centre for Child Psychiatry, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- INVEST Child Psychiatry, INVEST Research Flagship Center, Department of Clinical Medicine, Faculty of Medicine, University of Turku, Turku, Finland
- Department of Child Psychiatry, Turku University Hospital, Turku, Finland
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Ndetei DM, Mutiso V, Musyimi C, Momanyi R, Nyamai P, Tyrer P, Mamah D. DSM-5 conduct disorder and symptoms in youths at high risk of psychosis in Kenya with DSM-5 mental disorders and substance use: towards integrated management. Sci Rep 2023; 13:22889. [PMID: 38129579 PMCID: PMC10739967 DOI: 10.1038/s41598-023-50192-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 12/16/2023] [Indexed: 12/23/2023] Open
Abstract
Little is known about the prevalence of Conduct Disorder (CD) and symptoms of CD in high risk psychosis persons at both clinical and community populations in LMICs and in particular Kenya. This study aimed to document (1) the prevalence of CD diagnosis and symptoms in youth who screened positive for psychosis and (2) the associated mental disorders and substance use in the same cohort in LMIC. The sample size was 536 students who had screened positive on the Washington Early Recognition Center Affectivity and Psychosis (WERCAP) from a population of 9,742 high school, college and university students, but had not converted to a psychotic disorder. We collected data on socio-demographic characteristics and used the following tools: Economic indicators tool; the Diagnostic Interview Schedule (DIS) tool for DSM-5 diagnosis; World Health Organization (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Basic descriptive statistics, chi-square test, Fisher's exact test, Pearson correlation and Poisson regression were conducted. Five percent (5%) of the respondents met the criteria for DSM-5 CD. Indeterminate CD comprised 10.1%. Male gender, all substances except hallucinogens lifetime, obsessive compulsive disorder, psychosis, agoraphobia, social phobia, drug abuse/dependence, antisocial personality disorder, oppositional defiant disorder, suicidality, WERCAP screen for bipolar disorder and WERCAP screen for schizophrenia were significantly (p < 0.05) associated with CD. Deceitfulness or theft criteria symptoms showed that CD had no significant gender difference. Criteria symptoms in aggression to people and animals, destruction of property and serious violations of rules were more common among males. Our findings suggest the need to screen for and diagnose CD, mental disorders and substance use in high risk psychosis youths in Kenya. This will inform integrated management.
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Affiliation(s)
- David M Ndetei
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya.
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya.
| | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Reinpeter Momanyi
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Pascalyne Nyamai
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | | | - Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
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Osborn TL, Ndetei DM, Sacco PL, Mutiso V, Sommer D. An arts-literacy intervention for adolescent depression and anxiety symptoms: outcomes of a randomised controlled trial of Pre-Texts with Kenyan adolescents. EClinicalMedicine 2023; 66:102288. [PMID: 38192586 PMCID: PMC10772152 DOI: 10.1016/j.eclinm.2023.102288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 01/10/2024] Open
Abstract
Background Mental health problems are prevalent among youth in low-resource countries and are further compounded by stigma and limited access to traditional treatments. The need for scalable, accessible, and stigma-free mental health interventions is urgent. We developed and tested Pre-Texts, an arts-literacy intervention that targets adolescent depression and anxiety, in Kenya. Methods We conducted a universal RCT (Randomized Controlled Trial). Students from Kenyan high schools (N = 235, ages 13-19, 53.19% female) were randomized to either Pre-Texts or a study skills control intervention. Pre-Texts involves the use of a text-such an excerpt from a novel, a physics lesson, or a technical manual-to inspire art-making that is followed by collective reflection on the process of interpretation through artmaking. Participants met daily for a week in groups of 6-12 youths for 1-h sessions. Groups were facilitated by high school graduates trained as lay-providers. This study was pre-registered at the Pan African Clinical Trials Registry (PACTR; registration number: PACTR202111497122432). The trial took place between August 11th 2021 and December 18th 2021. Findings Pre-Texts produced a greater reduction in depression (d = 0.52, 95% CI [0.19, 0.84]) and anxiety (d = 0.51, 95% CI [0.20, 0.81]) symptoms from baseline to 1-month follow-up compared to the control group. Similarly, in a sub-sample of participants with elevated depression and anxiety symptoms, Pre-Texts produced a greater reduction in depression (d = 1.10, 95% CI [0.46, 1.75]) and anxiety (d = 0.54, 95% CI [-0.07, 1.45]) symptoms. Interpretation Our findings suggest that a brief arts-literacy intervention with challenging school material in a group setting, implemented as an afterschool program, can reduce depression and anxiety symptoms in adolescents in Sub-Saharan Africa. Future replication trials with larger sample sizes with extended follow-ups will help assess the strength and sustainability of these effects. Funding The study was funded by grants from the Mind, Brain, and Behaviour (MBB) Initiative at Harvard University and the Center for African Studies at Harvard University.
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Affiliation(s)
| | - David M. Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Pier Luigi Sacco
- DiSFiPEQ, University of Chieti-Pescara, Italy
- metaLAB (at) Harvard, Cambridge, MA, USA
| | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Doris Sommer
- Department of Romance Languages and Literatures, Harvard University, Cambridge, MA, USA
- Department of African and African American Studies, Harvard University, Cambridge, MA, USA
- Cultural Agents, Inc., Boston, MA, USA
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Copeland WE, Ivanova MY, Achenbach TM, Turner LV, Tong G, Ahmeti-Pronaj A, Au A, Bellina M, Caldas JC, Chen YC, Csemy L, da Rocha MM, Dobrean A, Ezpeleta L, Funabiki Y, Harder VS, Lecannelier F, Leiner de la Cabada M, Leung P, Liu J, Mahr S, Malykh S, Markovic J, Ndetei DM, Oh KJ, Petot JM, Riad G, Sakarya D, Samaniego VC, Sebre S, Shahini M, Silvares E, Simulioniene R, Sokoli E, Talcott JB, Vazquez N, Wolanczyk T, Zasepa E. Cultural contributions to adults' self-rated mental health problems and strengths: 7 culture clusters, 28 societies, 16 906 adults. Psychol Med 2023; 53:7581-7590. [PMID: 37203460 DOI: 10.1017/s0033291723001332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
BACKGROUND It is unknown how much variation in adult mental health problems is associated with differences between societal/cultural groups, over and above differences between individuals. METHODS To test these relative contributions, a consortium of indigenous researchers collected Adult Self-Report (ASR) ratings from 16 906 18- to 59-year-olds in 28 societies that represented seven culture clusters identified in the Global Leadership and Organizational Behavioral Effectiveness study (e.g. Confucian, Anglo). The ASR is scored on 17 problem scales, plus a personal strengths scale. Hierarchical linear modeling estimated variance accounted for by individual differences (including measurement error), society, and culture cluster. Multi-level analyses of covariance tested age and gender effects. RESULTS Across the 17 problem scales, the variance accounted for by individual differences ranged from 80.3% for DSM-oriented anxiety problems to 95.2% for DSM-oriented avoidant personality (mean = 90.7%); by society: 3.2% for DSM-oriented somatic problems to 8.0% for DSM-oriented anxiety problems (mean = 6.3%); and by culture cluster: 0.0% for DSM-oriented avoidant personality to 11.6% for DSM-oriented anxiety problems (mean = 3.0%). For strengths, individual differences accounted for 80.8% of variance, societal differences 10.5%, and cultural differences 8.7%. Age and gender had very small effects. CONCLUSIONS Overall, adults' self-ratings of mental health problems and strengths were associated much more with individual differences than societal/cultural differences, although this varied across scales. These findings support cross-cultural use of standardized measures to assess mental health problems, but urge caution in assessment of personal strengths.
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Affiliation(s)
- William E Copeland
- University of Vermont, 1 South Prospect Street, Burlington, VT 05401, USA
| | - Masha Y Ivanova
- University of Vermont, 1 South Prospect Street, Burlington, VT 05401, USA
| | - Thomas M Achenbach
- University of Vermont, 1 South Prospect Street, Burlington, VT 05401, USA
| | - Lori V Turner
- University of Vermont, 1 South Prospect Street, Burlington, VT 05401, USA
| | - Guangyu Tong
- Yale University, 135 College St, New Haven, CT 06510, USA
| | - Adelina Ahmeti-Pronaj
- Department of Child and Adolescent Psychiatry, University Clinical Center of Kosova, 10000 Prishtine, Kosova
| | - Alma Au
- Department of Applied Social Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - Monica Bellina
- Department of Child Psychiatry, Eugenio Medea Scientific Institute, 7 Padiglione, Via Don Luigi Monza 20, Bosisio Parini, Lecco 23842, Italy
| | - J Carlos Caldas
- Departamento de Ciências Sociais e do Comportamento, Instituto Superior de Ciências da Saúde - Norte, Rua Central de Gandra, 1317, 4585-116 Gandra, PRD, Portugal
| | - Yi-Chuen Chen
- Department of Psychology, National Chung Cheng University, 168 University Road, Min-Hsiung, Chia-Yi 62102, Taiwan
| | - Ladislav Csemy
- Prague Psychiatric Centre, Laboratory of Social Psychiatry, Ustavni 91, 181 03 Praha 8, Prague, Czech Republic
| | - Marina M da Rocha
- University Paulista (Unip), Institute of Human Sciences, Rua Francisco Bautista, 300, São Paulo, Brazil
| | - Anca Dobrean
- Department of Clinical Psychology and Psychotherapy, Babes-Bolyai University, 400015, Rupublicii st. 37, Cluj Napoca, Romania
| | - Lourdes Ezpeleta
- Departament de Psicologia Clinica i de la Salut, Universitat Autonoma de Barcelona, Edifici B, Bellaterra 08193, Spain
| | - Yasuko Funabiki
- Department of Psychiatry, Kyoto University Hospital, 54 Kawaharacho, Shogoin, Sakyo-ku, Kyoto, Japan
| | - Valerie S Harder
- University of Vermont, 1 South Prospect Street, Burlington, VT 05401, USA
| | | | - Marie Leiner de la Cabada
- Department of Pediatrics, Texas Tech University Health Sciences Center, P. O. Box 43091 Lubbock, Texas 79409, USA
| | - Patrick Leung
- Department of Psychology, The Chinese University of Hong Kong, Room 356, Sino Building, Shatin, New Territories, Hong Kong, People's Republic of China
| | - Jianghong Liu
- School of Nursing and Medicine, University of Pennsylvania, 418 Curie Blvd., Room 426, Claire M. Fagin Hall, Philadelphia, PA, USA
| | - Safia Mahr
- Departement de Psychologie, Université Paris Ouest Nanterre la Défense, Laboratoire EVACLIPSY, Batiment C, 3e Etage, Salles C.319 & C.321, 200 Avenue de la Republique, Nanterre 92001, France
| | - Sergey Malykh
- Psychological Institute of Russian Academy of Education, Mokhovaya str, 9/4, Moscow 125009, Russia
| | - Jasminka Markovic
- Medical Faculty Novi Sad, University of Novi Sad, Clinical Center of Vojvodina, Hajduk Veljkova 1, Novi Sad 21000, Serbia
| | - David M Ndetei
- Africa Mental Health Foundation, P.O. Box 48423-00100, Nairobi, Kenya
| | - Kyung Ja Oh
- Department of Psychology, Yonsei University, 50 Yonsei-ro, Soedaemun-gu, Seoul, South Korea
| | - Jean-Michel Petot
- Departement de Psychologie, Université de Paris Ouest, Laboratoire EVACLIPSY, Batiment C, 3 Etage, Salles C.319 & C.321, 200 Avenue de la Republique, Nanterre 92001, France
| | | | - Direnc Sakarya
- Department of Psychiatry, Ankara University Faculty of Medicine, Ankara, Turkey
| | | | - Sandra Sebre
- Department of Psychology, University of Latvia, Jurmalas Avenue 74/76, Riga, Latvia LV-1083
| | - Mimoza Shahini
- Department of Child and Adolescent Psychiatry, University Clinical Center of Kosova, 10000 Prishtine, Kosova
| | - Edwiges Silvares
- University of São Paulo, Instituto de Psicologia, Av. Prof. Mello Moraes 1721, Cidade Universitária, São Paulo, Brazil
| | - Roma Simulioniene
- Department of Psychology, Klaipeda University, Herkaus Manto str. 84, Klaipeda 92294, Lithuania
| | - Elvisa Sokoli
- Department of Psychology, University of Tirana, Tirana, Albania
| | - Joel B Talcott
- Aston Brain Centre, School of Life and Health Sciences, Aston University, Aston Triangle, Birmingham, UK B4 7ET
| | - Natalia Vazquez
- Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Tomasz Wolanczyk
- Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Zasepa
- The Maria Grzegorzewska Academy of Special Education, Room 3609, Szczesliwicka 40, 02-353, Warsaw, Poland
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Mutiso VN, Ndetei DM, Muia EN, Masake M, Alietsi RK, Onsinyo L, Musyimi C, Mamah D. Risk of autism spectrum disorder and association of its symptoms with psychiatric and substance use disorders in non-clinical student sample in Kenya: cross-sectional study. BJPsych Open 2023; 9:e160. [PMID: 37605834 PMCID: PMC10486240 DOI: 10.1192/bjo.2023.503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND The prevalence and patterns of autism spectrum disorder (ASD) symptoms/traits and the associations of ASD with psychiatric and substance use disorders has not been documented in non-clinical students in Sub-Saharan Africa, and Kenya in particular. AIMS To document the risk level of ASD and its traits in a Kenyan student population (high school, college and university) using the Autism-Spectrum Quotient (AQ); and to determine the associations between ASD and other psychiatric and substance use disorders. METHOD This was a cross-sectional study among students (n = 9626). We used instruments with sufficient psychometric properties and good discriminative validity to collect data. A cut-off score of ≥32 on the AQ was used to identify those at high risk of ASD. We conducted the following statistical tests: (a) basic descriptive statistics; (b) chi-squared tests and Fisher's exact tests to analyse associations between categorical variables and ASD; (c) independent t-tests to examine two-group comparisons with ASD; (d) one-way analysis of variance to make comparisons between categorical variables with three or more groups and ASD; (e) statistically significant (P < 0.05) variables fitted into an ordinal logistic regression model to identify determinants of ASD; (f) Pearson's correlation and reliability analysis. RESULTS Of the total sample, 54 (0.56%) were at high risk of ASD. Sociodemographic differences were found in the mean scores for the various traits, and statistically significant (P < 0.05) associations we found between ASD and various psychiatric and substance use disorders. CONCLUSIONS Risk of ASD, gender characteristics and associations with psychiatric and substance use disorders are similar in this Kenyan sample to those found in Western settings in non-clinical populations.
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Affiliation(s)
| | - David M. Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Nairobi, Kenya; and World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Esther N. Muia
- Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Monicah Masake
- Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Rita K. Alietsi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Lydia Onsinyo
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St Louis, Missouri, USA
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Ochuku B, Osborn TL, Nerima D, van der Markt A, Rusch T, Omune H, Akello S, Ndetei DM, Venturo-Conerly KE. Testing pathways to scale: study protocol for a three-arm randomized controlled trial of a centralized and a decentralized ("Train the Trainers") dissemination of a mental health program for Kenyan adolescents. Trials 2023; 24:526. [PMID: 37574545 PMCID: PMC10424401 DOI: 10.1186/s13063-023-07539-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/25/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Providing care in Kenya to all youth in need is difficult because of a shortage of professional providers and societal stigma. Previous trials of the Anansi model, which involves delivering low-touch mental health interventions through a tiered caregiving model (including lay-providers, supervisors, and clinical experts), have shown its effectiveness for reducing depression and anxiety symptoms in school-going Kenyan adolescents. In this trial, we aim to assess two different scale-up strategies by comparing centralized implementation (i.e., by the organization that designed the Anansi model) against implementation through an implementing partner. METHODS In this three-arm trial, 1600 adolescents aged 13 to 20 years will be randomized to receive the Shamiri intervention from either the Shamiri Institute or an implementation partner or to be placed in the treatment as usual (TAU) control group. The implementation partner will be trained and supplied with protocols to ensure that the same procedures are followed by both implementors. Implementation activities will run concurrently for both implementors. The Shamiri intervention will be delivered by trained lay providers to groups of 10-15 adolescents over four weekly sessions which will take place in secondary schools in Machakos and Makueni counties in Kenya. The TAU group will receive the usual care offered by their respective schools. Outcomes will be assessed at baseline, midpoint (2 weeks), endpoint (4 weeks), and 1 month follow-up. The analysis will be based on an intent-to-treat approach. Mixed effects models will be used to assess trajectories over time of the primary outcomes (anxiety and depressive symptoms, mental well-being, perceived social support, and academic performance) and secondary outcomes for the intervention groups and the control group. Effect sizes will be computed for the mean differences of the intervention and control arms at midpoint, endpoint, and follow-up. DISCUSSION This trial will provide insight into the comparative effectiveness of different strategies for scaling a school-based mental health care model. Findings will also indicate areas for improved efficiency of the model to enhance its replicability by other implementors. TRIAL REGISTRATION Pan African Clinical Trials Registry (PACTR) (ID: PACTR202305589854478, Approved: 02/05/2023).
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Affiliation(s)
- Brenda Ochuku
- Shamiri Institute, Nairobi, Kenya
- Shamiri Institute, Allston, MA, USA
| | - Tom L Osborn
- Shamiri Institute, Nairobi, Kenya
- Shamiri Institute, Allston, MA, USA
| | - Daisy Nerima
- Shamiri Institute, Nairobi, Kenya
- Shamiri Institute, Allston, MA, USA
| | - Afra van der Markt
- Shamiri Institute, Nairobi, Kenya.
- Shamiri Institute, Allston, MA, USA.
- Amsterdam UMC location VUmc, Psychiatry, Amsterdam, The Netherlands.
| | - Thomas Rusch
- Competence Center for Empirical Research Methods, WU Vienna University of Economics and Business, Vienna, Austria
| | - Herman Omune
- Shamiri Institute, Nairobi, Kenya
- Shamiri Institute, Allston, MA, USA
| | - Solace Akello
- Shamiri Institute, Nairobi, Kenya
- Shamiri Institute, Allston, MA, USA
| | - David M Ndetei
- African Mental Health Research & Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Katherine E Venturo-Conerly
- Shamiri Institute, Nairobi, Kenya
- Shamiri Institute, Allston, MA, USA
- Department of Psychology, Harvard University, Cambridge, MA, USA
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Ndetei DM, Nyamai P, Mutiso V. Boredom-understanding the emotion and its impact on our lives: an African perspective. Front Sociol 2023; 8:1213190. [PMID: 37456271 PMCID: PMC10342197 DOI: 10.3389/fsoc.2023.1213190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023]
Affiliation(s)
- David M. Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Pascalyne Nyamai
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
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15
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Mutiso VN, Musyimi CW, Tele A, Alietsi R, Andeso P, Ndetei DM. Edinburgh Postnatal Depression Scale (EPDS) for screening for depression in the first year post delivery in a low-resourced rural setting in Kenya. Transcult Psychiatry 2023; 60:476-483. [PMID: 34986050 DOI: 10.1177/13634615211043764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Postnatal depression is one of the most common mental disorders among postnatal mothers and may have severe consequences for mothers and their children. Locally validated screening tools that can be self- or lay interviewer-administered are required to identify at-risk women, especially in settings with no mental health specialists. This study aimed to assess the validity and reliability of a culturally adapted version of the Edinburgh Postnatal Depression Scale (EPDS) in a local dialect (Kamba) in a Kenyan setting. Trained research assistants administered the local-language version of self-report scales (EPDS) to a sample of 544 Kamba-speaking women. The same scale was re-administered to the same research participants two weeks later by the same research assistants. The test scores were compared with an external 'gold standard' according to the DSM-IV criteria Mini-International Neuropsychiatric Interview for adults (MINI-Plus). The EPDS had an area under the curve (AUC) of 0.867 with 95% C.I of 0.836 to 0.894, with a cut-off point of ≥11, sensitivity of 81.0% (95% C.I 70.6-89.0) and specificity of 82.6% (95% CI 78.8-85.9). The positive predictive value (PPV) and negative predictive value (NPV) were 44.1% and 96.2%, respectively. The internal reliability was 0.852 and the test-retest reliability was 0.496. The EPDS showed good utility in detecting depressive disorder in Kamba-speaking postnatal women. It does not have to be administered by mental health workers (who are few in low- and middle-income countries); rather, this can be done by a trained lay interviewer.
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Affiliation(s)
| | | | - Albert Tele
- Africa Mental Health Research and Training Foundation
| | - Rita Alietsi
- Africa Mental Health Research and Training Foundation
| | | | - David M Ndetei
- Africa Mental Health Research and Training Foundation
- University of Nairobi
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16
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Musyimi CW, Muyela LA, Mutiso VN, Mutunga E, Ndetei DM. Understanding dementia care pathways for policy development and service planning in Kenya. Dementia (London) 2023:14713012231166743. [PMID: 37036049 DOI: 10.1177/14713012231166743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
BACKGROUND In Kenya, there is lack of evidence on existing dementia care pathways, with minimal or no presentation for dementia-related symptoms in health care settings. Understanding the services available for people with dementia as well as how communities access the services could offer a practical pattern for policy makers to identify strategies that encourage early detection, care and support for people with dementia and their families. OBJECTIVES To elucidate initial responses of individuals and their families to dementia and challenges encountered in help seeking through care pathways to inform dementia care-related policies and practice. METHODS The Strengthening Responses to dementia in Developing Countries (STRiDE) Kenya team adapted case vignettes (brief hypothetical stories meant to elicit responses on how the characters would behave) developed by the entire STRiDE team. A total of 29 stakeholders were then asked to provide feedback on the completed vignettes and summarize a common pathway to dementia care in Kenya while using the proposed case vignettes. FINDINGS We found four initial responses to dementia suspicion in Kenya where individuals:(i) Perceive symptoms as normal part of ageing, (ii) Consult a spiritual or traditional healer, (iii) Visit a private clinic or primary health care facilities, or (iv) No action taken. These were the first points within the care pathways which determined the care trajectory the person with dementia would follow. CONCLUSIONS Identification of dementia care pathways could form a basis for improving the way communities perceive dementia etiology and establish standard pathways to care whilst ensuring that some pathways do not further pose an impediment to care and treatment for dementia.
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Affiliation(s)
| | - Levi A Muyela
- 585760Africa Mental Health Research and Training Foundation, Kenya
| | | | | | - David M Ndetei
- 585760Africa Mental Health Research and Training Foundation, Kenya
- University of Nairobi, Kenya
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17
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Ndetei DM, Mutiso V, Momanyi R, Nyamai P, Musyimi C, Mamah D. The co-morbidity of DSM-V Gambling with DSM-V mental disorders and substance abuse in a Kenyan context of high risk schizophrenia. BMC Psychiatry 2023; 23:239. [PMID: 37038149 PMCID: PMC10084586 DOI: 10.1186/s12888-023-04738-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 03/31/2023] [Indexed: 04/12/2023] Open
Abstract
INTRODUCTION There is evidence that gambling disorder shares similarities with other types of addictive behavior, such as occurs in substance abuse. In addition, co-morbidity of gambling with mental disorders has been established in school-going students. AIM This study aimed at determining the comorbidity of DSM-V gambling disorder with DSM-V mental disorders and substance abuse in high school, college and university students in Kenya. METHODS This was a cross-sectional study among 536 high school, college and university students. We collected data on socio-demographic characteristics, economic indicators, DSM-V diagnosis including DSM-V gambling disorder and substance use disorders using the WHO ASSIST tool. Descriptive and inferential analyses were done. RESULTS A total of 536 students participated in the study, of which 11.4% (61 out of 536) had DSM-V gambling disorder. Male gender (AOR = 12.0, 95% CI: 4.99-34.3), antisocial personality disorder (AOR = 3.42, 95% CI: 1.34-8.54), tobacco use (AOR = 4.42, 95% CI: 1.15-18.3) and conduct disorder (AOR = 7.56, 95% CI: 2.34-25.1) were predictors of gambling disorder. CONCLUSION Gambling is highly prevalent in Kenya learning institutions at 11.4% and is associated with mental disorders and substance use. There is a need for public awareness of gambling among Kenyan youths.
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Affiliation(s)
- David M Ndetei
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya.
| | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Reinpeter Momanyi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Pascalyne Nyamai
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
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18
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Casey R, Wiener JC, Krupa T, Lysaght R, Le Ber MJ, Ruhara R, Price E, Pervez R, Kidd S, Mutiso V, Ndetei DM, MacDougall AG. Evaluating the feasibility and potential impacts of a recovery-oriented psychosocial rehabilitation toolkit in a health care setting in Kenya: A mixed-methods study. Psychiatr Rehabil J 2023; 46:55-64. [PMID: 36809017 DOI: 10.1037/prj0000545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
OBJECTIVES This pilot study evaluated the feasibility and potential impacts of delivering the Psychosocial Rehabilitation (PSR) Toolkit for people with serious mental illness within a health care setting in Kenya. METHOD This study used a convergent mixed-methods design. Participants were people with serious mental illness (n = 23), each with an accompanying family member, who were outpatients of a hospital or satellite clinic in semirural Kenya. The intervention consisted of 14 weekly group sessions of PSR cofacilitated by health care professionals and peers with mental illness. Quantitative data were collected from patients and family members using validated outcome measures before and after the intervention. Qualitative data were collected from focus groups with patients and family members, and individual interviews with facilitators, after the intervention. RESULTS Quantitative findings indicated that patients experienced moderate improvement in illness management and, in contrast to qualitative findings, family members experienced moderate worsening in attitudes toward recovery. Qualitative findings revealed positive outcomes for both patients and family members, as reflected in greater feelings of hope and mobilization to reduce stigma. Factors that facilitated participation included: helpful and accessible learning materials; committed and involved stakeholders; and flexible solutions to promote continued involvement. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE This pilot study found that delivery of the Psychosocial Rehabilitation Toolkit was feasible within a health care setting in Kenya and associated with overall positive outcomes among patients with serious mental illness. Further research on its effectiveness on a larger scale and using culturally validated measures is needed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Regina Casey
- Department of Psychology and Social Science, Faculty of Humanities and Social Sciences, Douglas College
| | - Joshua C Wiener
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University
| | - Terry Krupa
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University
| | - Rosemary Lysaght
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University
| | - Marlene Janzen Le Ber
- School of Leadership and Social Change, Brescia University College, Western University
| | - Ruth Ruhara
- Africa Mental Health Research and Training Foundation
| | - Elizabeth Price
- Parkwood Institute Research, Lawson Health Research Institute and St. Joseph's Health Care
| | - Romaisa Pervez
- Parkwood Institute Research, Lawson Health Research Institute and St. Joseph's Health Care
| | - Sean Kidd
- Division of Psychology, Centre for Addiction and Mental Health
| | | | | | - Arlene G MacDougall
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University
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Ndetei DM, Mutiso V, Osborn T. Moving away from the scarcity fallacy: three strategies to reduce the mental health treatment gap in LMICs. World Psychiatry 2023; 22:163-164. [PMID: 36640407 PMCID: PMC9840495 DOI: 10.1002/wps.21054] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
- David M. Ndetei
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya,Africa Mental Health Research and Training Foundation, Nairobi, Kenya,WPA Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya,WPA Collaborating Centre for Research and Training, Nairobi, Kenya
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20
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Affiliation(s)
| | | | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
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21
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Venturo-Conerly KE, Johnson NE, Osborn TL, Puffer ES, Rusch T, Ndetei DM, Wasanga CM, Mutiso V, Musyimi C, Weisz JR. Long-term health outcomes of adolescent character strength interventions: 3- to 4-year outcomes of three randomized controlled trials of the Shamiri program. Trials 2022; 23:443. [PMID: 35614514 PMCID: PMC9132569 DOI: 10.1186/s13063-022-06394-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 05/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents in low- and middle-income countries in need of mental health care often do not receive it due to stigma, cost, and lack of mental health professionals. Culturally appropriate, brief, and low-cost interventions delivered by lay-providers can help overcome these barriers and appear effective at reducing symptoms of depression and anxiety until several months post-intervention. However, little is known about whether these interventions may have long-term effects on health, mental health, social, or academic outcomes. METHODS Three previous randomized controlled trials of the Shamiri intervention, a 4-week, group-delivered, lay-provider-led intervention, have been conducted in Kenyan high schools. Shamiri teaches positively focused intervention elements (i.e., growth mindset and strategies for growth, gratitude, and value affirmation) to target symptoms of depression and anxiety and to improve academic performance and social relationships, by fostering character strengths. In this long-term follow-up study, we will test whether these mental health, academic, social, and character-strength outcomes, along with related health outcomes (e.g., sleep quality, heart-rate variability and activity level measured via wearables, HIV risk behaviors, alcohol and substance use), differ between the intervention and control group at 3-4-year follow-up. For primary analyses (Nanticipated = 432), youths who participated in the three previous trials will be contacted again to assess whether outcomes at 3-4-year-follow-up differ for those in the Shamiri Intervention group compared to those in the study-skills active control group. Multi-level models will be used to model trajectories over time of primary outcomes and secondary outcomes that were collected in previous trials. For outcomes only collected at 3-4-year follow-up, tests of location difference (e.g., t-tests) will be used to assess group differences in metric outcomes and difference tests (e.g., odds ratios) will be used to assess differences in categorical outcomes. Finally, standardized effect sizes will be used to compare groups on all measures. DISCUSSION This follow-up study of participants from three randomized controlled trials of the Shamiri intervention will provide evidence bearing on the long-term and health and mental health effects of brief, lay-provider-delivered character strength interventions for youth in low- and middle-income countries. TRIAL REGISTRATION PACTR Trial ID: PACTR202201600200783 . Approved on January 21, 2022.
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Affiliation(s)
- Katherine E Venturo-Conerly
- Shamiri Institute, Nairobi, Kenya
- Shamiri Institute, Allston, MA, USA
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Natalie E Johnson
- Shamiri Institute, Nairobi, Kenya
- Shamiri Institute, Allston, MA, USA
| | - Tom L Osborn
- Shamiri Institute, Nairobi, Kenya.
- Shamiri Institute, Allston, MA, USA.
| | - Eve S Puffer
- Global Health Institute, Duke University, Durham, NC, USA
| | - Thomas Rusch
- Competence Center for Empirical Research Methods, WU Vienna University of Economics and Business, Vienna, Austria
| | - David M Ndetei
- African Mental Health Research & Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | - Victoria Mutiso
- African Mental Health Research & Training Foundation, Nairobi, Kenya
| | - Christine Musyimi
- African Mental Health Research & Training Foundation, Nairobi, Kenya
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
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Bianchi V, Rescorla L, Rosi E, Grazioli S, Mauri M, Frigerio A, Achenbach TM, Ivanova MY, Csemy L, Decoster J, Fontaine JR, Funabiki Y, Ndetei DM, Oh KJ, da Rocha MM, Šimulioniene R, Sokoli E, Molteni M, Nobile M. Emotional Dysregulation in Adults from 10 World Societies: An Epidemiological Latent Class Analysis of the Adult-Self-Report. Int J Clin Health Psychol 2022; 22:100301. [PMID: 35572074 PMCID: PMC9055064 DOI: 10.1016/j.ijchp.2022.100301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background/Objective Method Results Conclusions
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Affiliation(s)
- Valentina Bianchi
- Scientific Institute, IRCCS E. Medea, Developmental Psychopathology Unit, Italy
| | | | - Eleonora Rosi
- Scientific Institute, IRCCS E. Medea, Developmental Psychopathology Unit, Italy
- Corresponding author: Scientific Institute, IRCCS E. Medea, Developmental Psychopathology Unit, Bosisio Parini, Lecco, Italy (23842)
| | - Silvia Grazioli
- Scientific Institute, IRCCS E. Medea, Developmental Psychopathology Unit, Italy
| | - Maddalena Mauri
- Scientific Institute, IRCCS E. Medea, Developmental Psychopathology Unit, Italy
- PhD School in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Italy
| | - Alessandra Frigerio
- Scientific Institute, IRCCS E. Medea, Developmental Psychopathology Unit, Italy
| | - Thomas M. Achenbach
- Department of Psychiatry, Larner College of Medicine, University of Vermont, USA
| | - Masha Y. Ivanova
- Department of Psychiatry, Larner College of Medicine, University of Vermont, USA
| | - Ladislav Csemy
- Prague Psychiatric Centre, Laboratory of Social Psychiatry, Czech Republic
| | - Jeroen Decoster
- Department of Department of Work, Organization, and Society, Faculty of Psychology and Educational Sciences, Ghent University, Belgium
| | - Johnny R.J. Fontaine
- Department of Department of Work, Organization, and Society, Faculty of Psychology and Educational Sciences, Ghent University, Belgium
| | | | | | - Kyung Ja Oh
- Department of Psychology, Yonsei University, South Korea
| | | | | | - Elvisa Sokoli
- Department of Psychology, University of Tirana, Albania
| | - Massimo Molteni
- Scientific Institute, IRCCS E. Medea, Developmental Psychopathology Unit, Italy
| | - Maria Nobile
- Scientific Institute, IRCCS E. Medea, Developmental Psychopathology Unit, Italy
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Kariuki EW, Kuria MW, Were FN, Ndetei DM. Predictors of postnatal depression in the slums Nairobi, Kenya: a cross-sectional study. BMC Psychiatry 2022; 22:242. [PMID: 35382788 PMCID: PMC8981836 DOI: 10.1186/s12888-022-03885-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postnatal depression (PND) is a universal mental health problem that prevents mothers' optimal existence and mothering. Although research has shown high PND prevalence rates in Africa, including Kenya, little research has been conducted to determine the contributing factors, especially in low-resource communities. OBJECTIVE This study aimed to investigate the PND risk factors among mothers attending Lang'ata and Riruta Maternal and Child Health Clinics (MCH) in the slums, Nairobi. METHODS This study was cross-sectional. It is part of a large study that investigated the effectiveness of a brief psychoeducational intervention on PND. Postnatal mothers (567) of 6-10 weeks postanatal formed the study population. Depression rate was measured using the original 1961 Beck's Depression Inventory (BDI). In addition, a sociodemographic questionnaire (SDQ) was used to collect hypothesized risk variables. Multivariable logistic regression analysis was used to explore predictors of PND. RESULTS The overall prevalence of PND in the sample of women was 27.1%. Women aged 18-24 (β = 2.04 95% C.I.[0.02; 4.05], p = 0.047), dissatisfied with body image (β = 4.33 95% C.I.[2.26; 6.41], p < 0.001), had an unplanned pregnancy (β = 2.31 95% C.I.[0.81; 3.80], p = 0.003 and felt fatigued (β = - 1.85 95% C.I.[- 3.50; 0.20], p = 0.028) had higher odds of developing PND. Participants who had no stressful life events had significantly lower depression scores as compared to those who had stressful life events (β = - 1.71 95% C.I.[- 3.30; - 0.11], p = 0.036) when depression was treated as a continuous outcome. Sensitivity analysis showed that mothers who had secondary and tertiary level of education had 51 and 73% had lower likelihood of having depression as compared to those with a primary level of education (A.O.R = 0.49 95% C.I.[0.31-0.78], p = 0.002) and (A.O.R = 0.27 95% C.I.[0.09-0.75], p = 0.013) respectively. CONCLUSION This study reveals key predictors/risk factors for PND in low-income settings building upon the scanty data. Identifying risk factors for PND may help in devising focused preventive and treatment strategies.
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Affiliation(s)
- Esther W. Kariuki
- grid.10604.330000 0001 2019 0495Department of Psychiatry, School of Medicine, The University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
| | - Mary W. Kuria
- grid.10604.330000 0001 2019 0495Department of Psychiatry, School of Medicine, The University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
| | - Fredrick N. Were
- grid.10604.330000 0001 2019 0495Department of Psychiatry, School of Medicine, The University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
| | - David M. Ndetei
- grid.10604.330000 0001 2019 0495Department of Psychiatry, School of Medicine, The University of Nairobi, P.O. Box 30197, GPO, Nairobi, Kenya
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Ndetei DM, Mutiso VN, Weisz JR, Okoth CA, Musyimi C, Muia EN, Osborn TL, Sourander A, Wasserman D, Mamah D. Socio-demographic, economic and mental health problems were risk factors for suicidal ideation among Kenyan students aged 15 plus. J Affect Disord 2022; 302:74-82. [PMID: 35032509 PMCID: PMC10448955 DOI: 10.1016/j.jad.2022.01.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/09/2021] [Accepted: 01/11/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND About a third of youth with suicidal ideation develop suicidal plans and about 60% of youth with suicidal plans make suicidal attempts. This study aimed to study different types of suicidal ideation and the risk factors in Kenyan youth. METHODS We studied a total of 9742 high school, college and university students using following self-administered instruments: - a researcher design socio-demographic questionnaire, Psychiatric Diagnostic Screening Questionnaire (PDSQ) to document psychiatric disorders and various types of suicidal ideas in previous two weeks, Washington Early Recognition Center Affectivity and Psychosis tool to assess stress, affectivity and psychosis, Wealth index questionnaire to document economic indicators based on household items for the families of the students. We used descriptive statistics, univariate analysis, bivariate logistic regression analysis and variables with a p-value of less than <.05 were entered into generalized linear models using logit links to identify independent predictors. RESULTS The overall prevalence of different types of suicidal ideation was (22.6%), major depression was found in 20.0%, affectivity, psychosis and stress was found in 10.4%, 8.7% and 26.0% respectively. Female gender, major depression, stress, affectivity and psychosis and being in high school were significant (p < 0.05) predictors of suicidal ideation. LIMITATIONS This was a cross sectional study that focused only on suicidal ideas and associated economic factors and mental health disorders. It did not study suicidal behavior. CONCLUSION Future studies are needed to study the progression from suicidal ideas to suicidal attempts and the factors associated with that progression.
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Affiliation(s)
- David M Ndetei
- Department of Psychiatry, University of Nairobi, Kenya and Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden P.O. Box 48423-00100, Nairobi, Kenya; Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Consolate A Okoth
- Department of Public and Community Health, Machakos University, Kenya
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Esther N Muia
- Department of Public and Community Health, Machakos University, Kenya
| | - Tom L Osborn
- Department of Psychology, Harvard University, Cambridge, MA, USA; Shamiri Institute - Allston, MA, U.S.A. and Nairobi, Kenya
| | - Andre Sourander
- Department of Child Psychiatry, Turku University Hospital, Finland
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Karolinska Institutet, Sweden
| | - Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, USA
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Mutiso VN, Ndetei DM, N.Muia E, Musyimi C, Osborn TL, Kasike R, Onsinyo L, Mbijjiwe J, Karambu P, Sounders A, Weisz JR, Swahn MH, Mamah D. Prevalence and perception of substance abuse and associated economic indicators and mental health disorders in a large cohort of Kenyan students: towards integrated public health approach and clinical management. BMC Psychiatry 2022; 22:191. [PMID: 35300637 PMCID: PMC8932181 DOI: 10.1186/s12888-022-03817-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/28/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The earlier younger people begin to use drugs, the more vulnerable they become to both their short term and long-term harmful effects. The overall aim of this study is to determine the prevalence of alcohol and drug abuse, the socio-demographic characteristic, perception of abuse and associated economic indicators and mental disorders and how they inform potential intervention in a cohort of Kenyan students. METHODS This was a cross-sectional study on a total of 9742 high school, college and university students. We used tools to document socio-demographic characteristics, economic indicators, drug and alcohol use and related perceptions and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) related psychiatric disorders. Basic descriptive statistics (means and standard deviations for numerical variables and frequencies for nominal and ordinal variables) were done. Logistic regression models were used to assess the association and odds ratios between the use of a given substance and the use of the other substances, as well as associations with the various available socio-demographic factors and economic indicators. Chi-squared tests were used in socio-economic characteristics disaggregated by current alcohol use. RESULTS The mean age was 21.4 ± 2.4; median = 21.3 (range 15-43) years. We found a wide range of different drugs of abuse. Alcohol abuse was the commonest and inhalants were the least, with different perceptions.Both alcohol and drug abuse were associated with various economic indicators and various mental disorders. CONCLUSION This study has established for the first time in Kenya the multifaceted associations and predictors of alcohol and drug abuse in a cross-sectional student population ranging from high school to college and university levels. In the process, the study contributes to global data on the subject. These associations call for an integrated and multifaceted approach in addressing alcohol and substance abuse. This approach should take into account various associations and predictors as part of holistic approach in both public awareness and clinical interventions.
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Affiliation(s)
- Victoria N. Mutiso
- grid.490737.eAfrica Mental Health Research and Training Foundation, Nairobi, Kenya ,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - David M. Ndetei
- grid.490737.eAfrica Mental Health Research and Training Foundation, Nairobi, Kenya ,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya ,grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, Kenya and Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Esther N.Muia
- grid.493101.e0000 0004 4660 9348Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Christine Musyimi
- grid.490737.eAfrica Mental Health Research and Training Foundation, Nairobi, Kenya ,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Tom L. Osborn
- grid.38142.3c000000041936754XDepartment of Psychology, Harvard University, Cambridge, MA USA ,Shamiri Institute, Allston, MA USA ,Shamiri Institute, Nairobi, Kenya
| | - Rita Kasike
- grid.490737.eAfrica Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Lydia Onsinyo
- grid.490737.eAfrica Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Jane Mbijjiwe
- grid.493101.e0000 0004 4660 9348Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Pamela Karambu
- grid.493101.e0000 0004 4660 9348Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Andre Sounders
- grid.410552.70000 0004 0628 215XDepartment of Child Psychiatry, Turku University Hospital, Turku, Finland
| | - John R. Weisz
- grid.38142.3c000000041936754XDepartment of Psychology, Harvard University, Cambridge, MA USA
| | - Monica H. Swahn
- grid.256304.60000 0004 1936 7400Department of Population Health Sciences, Georgia State University, Atlanta, USA
| | - Daniel Mamah
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University Medical School, St. Louis, MO USA
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26
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Mamah D, Mutiso VN, Ndetei DM. Longitudinal and cross-sectional validation of the WERCAP screen for assessing psychosis risk and conversion. Schizophr Res 2022; 241:201-209. [PMID: 35144059 PMCID: PMC10448956 DOI: 10.1016/j.schres.2022.01.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 01/05/2022] [Accepted: 01/16/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen was developed to assess risk for developing psychosis. Its validity has not been investigated in a large population-based study or with longitudinal analyses. METHODS 825 participants, aged 14-25, were recruited from Kenya. Symptoms were assessed using the WERCAP Screen, as experienced over the prior 3-months (3MO), 12-months (12MO) or lifetime (LIF). ROC curve analysis was used to determine the validity of the WERCAP Screen against the Structured Interview of Psychosis-Risk Syndromes. Longitudinal validity was assessed by comparing baseline p-WERCAP scores in psychotic disorder converters and non-converters, and using ROC curve analysis. Relationship of the p-WERCAP was examined against clinical variables. RESULTS ROC curve analyses against SIPS showed an AUC of 0.83 for 3MO, 0.79 for 12MO and 0.65 for LIF psychosis scores. The optimal cut-point on 3MO was a score of >12 (sens: 0.78; spec: 0.77; ppv: 0.41), and >32 for 12MO (sens: 0.71; spec: 0.74; ppv: 0.24). Baseline 3MO scores (but not LIF scores) were higher in converters compared to high-risk non-converters (p = 0.02). 3MO scores against conversion status had an AUC of 0.75, with an optimal cutoff point of >16 (sens: 1.0; spec: 0.53). All p-WERCAP scores significantly correlated with substance use and stress severity. 12 MO scores were most related to cognitive impairment. CONCLUSIONS The WERCAP Screen is a valid instrument for assessing psychosis severity and conversion risk. It can be used in the community to identify those who may require clinical assessment and care, and for recruitment in psychosis-risk research.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, United States of America.
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Kenya
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Ndetei DM, Mutiso VN, Musyimi CW, Alietsi RK, Shanley JR, Bhui KS. The feasibility of using life skills training in primary schools to improve mental health and academic performance: a pilot study in Kenya. BMC Psychiatry 2022; 22:131. [PMID: 35177007 PMCID: PMC8855590 DOI: 10.1186/s12888-022-03781-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 02/14/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND There is no Kenyan evidence on the relationship between mental illness and academic performance. We aimed to determine the effect of life skills training on mental health and academic performance. METHODS We administered to 1848 primary school children a researcher designed socio-demographic questionnaire, and the Youth Self Report (YSR) and Child Behavior Checklist (CBCL) to their parents, followed by eight sessions of life skills training. We extracted data from the individual records of each child on overall performance pre and post training separated by one year. We conducted descriptive statistics, paired sample t-tests, multivariate linear regression analysis and linear mixed model analysis to assess changing patterns of academic performance and any predictive characteristics. RESULTS There was significant (p < 0.05) improvement in overall academic performance (aggregate marks and all individual subjects) for both lower primary and upper primary classes after the life-skills training intervention. For lower classes (2-4 grades) increase in academic performance was significantly associated with fathers and mothers education levels, region and class. For upper classes, (5-7 grades) increase in academic performance was associated with region, class and age. CONCLUSIONS Life skills training is recommended as it could improve academic performance, but predicted by socio-demographic factors.
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Affiliation(s)
- David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya. .,Department of Psychiatry, University of Nairobi, Nairobi, Kenya. .,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya.
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Rita K Alietsi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,World Psychiatric Association Collaborating Centre for Research and Training, Nairobi, Kenya
| | - Jenelle R Shanley
- School of Graduate Psychology, Pacific University, Forest Grove, USA
| | - Kamaldeep S Bhui
- Department of Psychiatry, University of Oxford, Oxford, England.,World Psychiatric Association Collaborating Centre for Research and Training, London, UK
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28
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Mutiso VN, Ndetei DM, N Muia E, K Alietsi R, Onsinyo L, Kameti F, Masake M, Musyimi C, Mamah D. The prevalance of binge eating disorder and associated psychiatric and substance use disorders in a student population in Kenya - towards a public health approach. BMC Psychiatry 2022; 22:122. [PMID: 35172765 PMCID: PMC8848944 DOI: 10.1186/s12888-022-03761-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 09/15/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Kenya in particular and Africa in general lack data on Binge Eating Disorder (BED). The overarching objective of this study is to fill that gap. Kenyans may not be aware that BED exists when a "very good" appetite is considered a sign of good health, especially if food is available either at home, in fast food shops or when communally eating together, a very common cultural practice. On the other hand where there is relatively insufficient food, it is not expected that one could be having a problem of eating too much. METHOD We administered the following tools and measurements to 9742 participants (high school, college and university students): 1) Researcher designed socio-demographic and economic indicator questionnaire; 2) An instrument documenting DSM-IV diagnostic criteria for BED and its various symptoms; 3) An instrument to determine DSM-IV psychiatric disorders and substance abuse;4) An instrument measuring high risk for psychosis ,affectivity and stress; 5) A WHO designed instrument measuring the severity of substance abuse for specific substances. We used descriptive and inferential analysis to determine the prevalence and association of the different variables. Independent predictors of BED were generated from a generalized linear model (p<0.05). RESULTS We found a prevalence of 3.2% of BED and a wide range of prevalence for BED and BED related symptoms (8.1% to 19%). The least prevalent was "To prevent weight gain from eating binge did you force yourself to vomit, or used laxatives?". The most common was "Did you often go on eating binges (eating a very large amount of food very quickly over a short period of time)." Major depression, obsessive compulsive disorder, panic disorder, agoraphobia, generalized anxiety disorder ,a positive stress screen and drug abuse were independent predictors of BED (p<0.05). CONCLUSION Our findings on the prevalence of BED and significant associations with various psychiatric disorders and substance use disorders are similar to those obtained in High Income Countries (HIC) using similar large-scale samples in non-clinical populations. Our findings suggest the need fora public health approach to enhance awareness of BED and to promote health-seeking behaviour towards management of BED.
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Affiliation(s)
- Victoria N. Mutiso
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - David M. Ndetei
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya ,grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Esther N Muia
- grid.493101.e0000 0004 4660 9348Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Rita K Alietsi
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Lydia Onsinyo
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Frida Kameti
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Monicah Masake
- grid.493101.e0000 0004 4660 9348Department of Public and Community Health, Machakos University, Machakos, Kenya
| | - Christine Musyimi
- grid.490737.eAfrica Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. Box 48423-00100, Nairobi, Kenya
| | - Daniel Mamah
- grid.4367.60000 0001 2355 7002Department of Psychiatry, Washington University Medical School, St. Louis, Missouri USA
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Mamah D, Mutiso V, Gitonga I, Tele A, Ndetei DM. A population-based survey of autistic traits in Kenyan adolescents and young adults. S Afr J Psychiatr 2022; 28:1694. [PMID: 35281966 PMCID: PMC8905436 DOI: 10.4102/sajpsychiatry.v28i0.1694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 08/30/2021] [Indexed: 11/20/2022] Open
Abstract
Background To date, there have been no large-scale population studies of autistic traits (AUT) conducted in Africa. Aim The study aimed to estimate the prevalence and characteristics of autism spectrum disorders in a large sample of Kenyan adolescents and young adults. Setting Tertiary academic institutions (87%) and directly from the community (13%). Methods Our study surveyed 8918 youths (aged 15–25 years) using the autism spectrum quotient (AQ). Based on AQ scores, we derived groups with low (L-AUT), borderline (B-AUT), and high (H-AUT) autistic traits. Relationships of AUT with demographic factors, psychosis, affectivity and stress were investigated. Results Internal consistency of the AQ in the population was excellent (Cronbach’s α = 0.91). Across all participants, 0.63% were estimated as having H-AUT, while 14.9% had B-AUT. Amongst community youth, prevalence of H-AUT was 0.98%. Compared to those with low and borderline traits, H-AUT participants were more likely to be males, to have lower personal and parental educational attainment, and to be of a lower socioeconomic status. The H-AUT group also had higher psychotic and affective symptoms as well as higher psychosocial stress than other groups. Conclusion The prevalence of H-AUT amongst Kenyan youth is comparable to Autism spectrum disorder (ASD) rates in many countries. Autistic traits in Kenya are associated with worse social and clinical profiles. Further research on autism across Africa is needed to investigate cross-cultural heterogeneity of this disorder, and to guide healthcare policy.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University, St. Louis, United States of America
| | | | | | - Albert Tele
- Africa Mental Health Foundation, Nairobi, Kenya
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30
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Ochuku BK, Johnson NE, Osborn TL, Wasanga CM, Ndetei DM. Centering decriminalization of suicide in low - and middle - income countries on effective suicide prevention strategies. Front Psychiatry 2022; 13:1034206. [PMID: 36465309 PMCID: PMC9712720 DOI: 10.3389/fpsyt.2022.1034206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 11/02/2022] [Indexed: 11/18/2022] Open
Abstract
Globally, over 800,000 people die by suicide every year. For every one completed suicide, 20 more attempts have been made. As previous attempts are one of the strongest predictors of future suicide, help-seeking in moments of crisis, particularly after an attempt, may have important implications for suicide prevention. Unfortunately, the criminalization of suicide in several countries hinders help-seeking, increases the stigmatization of those who attempt suicide and obstructs the accurate tracking of suicides. Here, we highlight the negative effects of suicide criminalization and discuss evidence-based strategies for suicide prevention such as means restriction, improved mental health literacy and access to psychosocial support, and responsible media coverage of suicides.
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Affiliation(s)
| | | | | | - Christine M Wasanga
- Shamiri Institute, Nairobi, Kenya.,Department of Psychology, Kenyatta University, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Mutiso VN, Musyimi CW, Gitonga I, Rebello TJ, Tele A, Pike KM, Ndetei DM. Toward Community Coverage on Self-Screening, Diagnosis, and Help-Seeking Behavior for Both Gender Victims of Intimate Partner Violence (IPV) in a Kenyan Setting: The Development of IPV-Brief Self-Screener (IPV-BSS) Version of the WHO-IPV Instrument. J Interpers Violence 2021; 36:NP9344-NP9363. [PMID: 31208269 DOI: 10.1177/0886260519855666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Intimate partner violence (IPV) is a major public health concern. The prevalence of IPV in women in Kenya is in the range of 41% to 45% but has also been reported in 20% of men. The most widely used instrument for the screening and diagnosis of IPV is the World Health Organization-Intimate Partner Violence (WHO-IPV). However, it is lengthy for routine large-scale screening and is administered by a trained person, thus limiting the number it can reach for screening. There is therefore a need for a shorter screening version that can be self-administered to reach critical masses. Those who screen positive can then be subjected to the longer version. In addition, the short version should be culturally sensitive, can be used by either gender, can be used in busy clinical settings as the patients wait to be attended to, and can be used for large-scale community populations to raise awareness and promote help-seeking behavior. It should be applicable in similar cultural settings and is aligned to the longer version of the WHO-IPV instrument. This study aimed to develop such a tool. We administered the WHO-IPV to two groups: firstly, postnatal mothers attending postnatal clinics and secondly, men and women attending general clinics to which they had been referred. These referrals were by traditional healers (TH), faith healers (FH), and community health workers (CHW) who had been trained to screen for mental disorders using the Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG) master checklist. Using factor analysis of the scores, we came up with questions that had the highest predictive value for different types of IPV diagnosis and which could therefore be used for self-screening purposes. We call the tool the Intimate Partner Violence-Brief Self-Screener (IPV-BSS; Adapted by the Africa Mental Health Research and Training Foundation from the WHO-IPV).
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | | | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | | | - Albert Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Kathleen M Pike
- Columbia University, Global Mental Health Program, New York, USA
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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32
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Osborn TL, Venturo-Conerly KE, Arango G. S, Roe E, Rodriguez M, Alemu RG, Gan J, Wasil AR, Otieno BH, Rusch T, Ndetei DM, Wasanga C, Schleider JL, Weisz JR. Effect of Shamiri Layperson-Provided Intervention vs Study Skills Control Intervention for Depression and Anxiety Symptoms in Adolescents in Kenya: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:829-837. [PMID: 34106239 PMCID: PMC8190694 DOI: 10.1001/jamapsychiatry.2021.1129] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Low-cost interventions for adolescent depression and anxiety are needed in low-resource countries such as those in Sub-Saharan Africa. OBJECTIVE To assess whether Shamiri, a 4-week layperson-delivered group intervention that teaches growth mindset, gratitude, and value affirmation, can alleviate depression and anxiety symptoms in symptomatic Kenyan adolescents. DESIGN, SETTING, AND PARTICIPANTS This school-based randomized clinical trial included outcomes assessed at baseline, posttreatment, and 2-week and 7-month follow-up from 4 secondary schools in Nairobi and Kiambu County, Kenya. Adolescents aged 13 to 18 years with elevated symptoms on standardized depression or anxiety measures were eligible. Intent-to-treat analyses were used to analyze effects. Recruitment took place in June 2019; follow-up data were collected in August 2019 and February 2020. INTERVENTION Adolescents were randomized to the Shamiri intervention or to a study skills control. All adolescents in both conditions met in groups (mean group size, 9) for 60 minutes per week for 4 weeks. MAIN OUTCOMES AND MEASURES Primary outcomes were depression (Patient Health Questionnaire-8 item) and anxiety (Generalized Anxiety Disorder-7 item) symptoms. Analyses of imputed data were hypothesized to reveal significant reductions in depression and anxiety symptoms for adolescents assigned to Shamiri compared with those in the study skills group. RESULTS Of 413 adolescents, 205 (49.6%) were randomized to Shamiri and 208 (50.4%) to study skills. The mean (SD) age was 15.5 (1.2) years, and 268 (65.21%) were female. A total of 307 youths completed the 4-week intervention. Both Shamiri and study skills were rated highly useful (4.8/5.0) and reduced symptoms of depression and anxiety, but analyses with imputed data revealed that youths receiving Shamiri showed greater reductions in depressive symptoms at posttreatment (Cohen d = 0.35 [95% CI, 0.09-0.60]), 2-week follow-up (Cohen d = 0.28 [95% CI, 0.04-0.54]), and 7-month follow-up (Cohen d = 0.45 [95% CI, 0.19-0.71]) and greater reductions in anxiety symptoms at posttreatment (Cohen d = 0.37 [95% CI, 0.11-0.63]), 2-week follow-up (Cohen d = 0.26 [95% CI, -0.01 to 0.53]), and 7-month follow-up (Cohen d = 0.44 [95% CI, 0.18-0.71]). CONCLUSIONS AND RELEVANCE Both the Shamiri intervention and a study skills control group reduced depression and anxiety symptoms; the low-cost Shamiri intervention had a greater effect, with effects lasting at least 7 months. If attrition is reduced and the clinical significance of outcome differences is established, this kind of intervention may prove useful in other global settings where there are limited resources, mental illness stigma, or a shortage of professionals and limited access to mental health care. TRIAL REGISTRATION Pan-African Clinical Trials Registry Identifier: PACTR201906525818462.
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Affiliation(s)
- Tom L. Osborn
- Shamiri Institute, Allston, Massachusetts,Department of Psychology, Harvard University, Cambridge, Massachusetts,Shamiri Institute, Nairobi, Kenya
| | - Katherine E. Venturo-Conerly
- Shamiri Institute, Allston, Massachusetts,Department of Psychology, Harvard University, Cambridge, Massachusetts,Shamiri Institute, Nairobi, Kenya
| | - Susana Arango G.
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Elizabeth Roe
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Micaela Rodriguez
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Rediet G. Alemu
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Jenny Gan
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Akash R. Wasil
- Department of Psychology, University of Pennsylvania, Philadelphia
| | - Benny H. Otieno
- Shamiri Institute, Allston, Massachusetts,Shamiri Institute, Nairobi, Kenya
| | - Thomas Rusch
- Department of Psychology, Harvard University, Cambridge, Massachusetts,Competence Center for Empirical Research Methods, WU Vienna University of Economics and Business, Vienna, Austria
| | - David M. Ndetei
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya,Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | | | | | - John R. Weisz
- Department of Psychology, Harvard University, Cambridge, Massachusetts
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Abstract
OBJECTIVE To investigate the prevalence and characteristics of psychotic-like experiences (PLE) in a large cohort of Kenyan adolescents and young adults. METHOD The Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen was used to the study the 12-month prevalence of PLE's among 9,564 Kenyan youths (aged 15-25 yrs), and the rates of psychosis high-risk (HR) and medium-risk (MR) cases, based on cut-off scores. Relationships with clinical, demographic and economic profiles were investigated. RESULTS Across all participants, 72% reported having had at least one PLE over the last year. 4.6% and 30.6% were HR and MR based on symptom scores. There were similar PLE rates in females and males. PLE severity correlated with mood (r=0.67), stress (r=0.46), and autistic traits (r=0.18). PLE severity was also related to poverty, lower education attainment, and underemployment. Compared to controls, HR and MR youths were more likely to report lifetime substance use and to have more significant use. CONCLUSION Psychosis screening can provide valuable information about individuals and may help identify those who may require clinical assessment and intervention to improve outcomes. This is particularly relevant in many parts of Africa where the resources are limited for treating more advanced illness.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, 660 S. Euclid, Saint Louis, Missouri, 63110, USA.
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Kenya
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MacDougall AG, Krupa T, Lysaght R, Mutiso V, Casey R, Le Ber MJ, Ruhara R, Price E, Kidd S, Ndetei DM. The CREATE strategy of rehabilitation and recovery for mental illness in low resource settings: Development processes and evaluation from a proof of concept study in Kenya. International Journal of Mental Health 2021. [DOI: 10.1080/00207411.2021.1926725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Arlene G. MacDougall
- Departments of Psychiatry and Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Terry Krupa
- School of Rehabilitation Therapy, Queen's University, London, Ontario, Canada
| | - Rosemary Lysaght
- School of Rehabilitation Therapy, Queen's University, London, Ontario, Canada
| | - Victoria Mutiso
- Department of Research, Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Regina Casey
- Department of Psychology, Douglas College, New Westminster, British Columbia, Canada
| | - Marlene J. Le Ber
- Brescia University College, Western University, London, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ruth Ruhara
- Department of Research, Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | | | - Sean Kidd
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - David M. Ndetei
- Department of Research, Africa Mental Health Research and Training Foundation, Nairobi, Kenya
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Mamah D, Mutiso VN, Ndetei DM. Neurocognition in Kenyan youth at clinical high risk for psychosis. Schizophr Res Cogn 2021; 25:100198. [PMID: 34094888 PMCID: PMC8167199 DOI: 10.1016/j.scog.2021.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 11/27/2022]
Abstract
Introduction Cognitive deficits are typically seen in schizophrenia and in the prodrome, and are a major predictor of functional outcomes in patients. In Africa, few studies have investigated neurocognition in psychosis, which presents a gap in our understanding of the heterogeneity of the illness. In this study, we assessed neurocognition among the largest sample of psychosis-risk participants recruited in the continent to date. Methods The study was conducted in Kenya, and involved 295 psychiatric medication-naïve participants at clinical high-risk (CHR) for psychosis and healthy controls, aged 15–25 yrs. Psychosis-risk status was determined separately using the Structured Interview of Psychosis-Risk Syndromes (i.e. CHR) and by self-report with the Washington Early Recognition Center Affectivity and Psychosis Screen. Eleven tests were administered using the University of Pennsylvania Computerized Neurocognitive Battery. Test performance across groups were investigated, as well as demographic and clinical effects. Results Fewer participants were designated as being at psychosis-risk with structured interview (n = 47; CHR) than with self-report (n = 155). A MANOVA of cognitive test performance was significant only when groups were ascertained based on self-report (p = 0.03), with decreased performance in the risk group on verbal intelligence (p = 0.003; d = 0.39), emotion recognition (p = 0.003; d = 0.36), sensorimotor processing (p = 0.01; d = 0.31) and verbal memory (p = 0.035; d = 0.21). Only verbal intelligence was significantly worse in the CHR group compared to controls (p = 0.036; d = 0.45). There were no significant age and gender relationships. Conclusion Deficits across multiple cognitive domains are present in Kenyan psychosis-risk youth, most significantly in verbal intelligence. The pattern of cognitive deficits and an absence of gender effects may represent ethnicity-specific phenotypes of the psychosis-risk state. Longitudinal studies of neurocognition in Kenyan patients who convert to psychosis may enhance risk prediction in this population, and facilitate targeted interventions.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO, United States of America
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,Department of Psychiatry, University of Nairobi, Kenya
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Musyimi CW, Ndetei DM, Evans-Lacko S, Oliveira D, Mutunga E, Farina N. Perceptions and experiences of dementia and its care in rural Kenya. Dementia (London) 2021; 20:2802-2819. [PMID: 33928810 DOI: 10.1177/14713012211014800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES We aimed to explore the perceptions towards dementia and related care across three stakeholder groups in rural Kenya. METHODS A total of 38 key stakeholders (carers of persons with dementia, health care providers and the general public) participated in focus group discussions. Additional five individual interviews were held with carers. Thematic analysis was used to analyse the data. FINDINGS Across the three participant groups, a total of four themes were identified: (i) negative stereotypes of dementia, (ii) limited knowledge about dementia, (iii) diagnostic pathway and (iv) neglect and abuse. CONCLUSIONS We found a general lack of knowledge of dementia amongst family carers, healthcare professionals and the general public. The combination of poor awareness and ill-equipped healthcare systems leads to stigma manifested in the form of patchy diagnostic pathways, neglect and abuse. Local governments could take advantage of the existing family- and community-based systems to improve understanding of dementia nationally.
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Affiliation(s)
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, 107854University of Nairobi, Nairobi, Kenya
| | - Sara Evans-Lacko
- 4905Care Policy and Evaluation Centre, London School of Economics and Political Science, UK
| | | | | | - Nicolas Farina
- Centre for Dementia Studies, 12190Brighton and Sussex Medical School, Brighton, UK
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Osborn TL, Wasil AR, Weisz JR, Kleinman A, Ndetei DM. Where is the global in global mental health? A call for inclusive multicultural collaboration. Gen Psychiatr 2020; 33:e100351. [PMID: 33225214 PMCID: PMC7646349 DOI: 10.1136/gpsych-2020-100351] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/14/2020] [Accepted: 09/22/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Tom L Osborn
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
- Shamiri Institute, Nairobi, Kenya
| | - Akash R Wasil
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - John R Weisz
- Department of Psychology, Harvard University, Cambridge, Massachusetts, USA
| | - Arthur Kleinman
- Department of Anthropology, Harvard University, Cambridge, Massachusetts, USA
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Mamah D, Cloninger CR, Mutiso VN, Gitonga I, Tele A, Ndetei DM. Personality Traits as Markers of Psychosis Risk in Kenya: Assessment of Temperament and Character. ACTA ACUST UNITED AC 2020; 1:sgaa051. [PMID: 33215089 PMCID: PMC7656989 DOI: 10.1093/schizbullopen/sgaa051] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Specific personality traits have been proposed as a schizophrenia-related endophenotype and confirmed in siblings at risk for psychosis. The relationship of temperament and character with psychosis has not been previously investigated in Africa. The study was conducted in Kenya, and involved participants at clinical high-risk (CHR) for psychosis (n = 268) and controls (n = 251), aged 15–25 years. CHR status was estimated using the Structured Interview of Psychosis-Risk Syndromes (SIPS) and the Washington Early Psychosis Center Affectivity and Psychosis (WERCAP) Screen. Student’s t-tests were used to assess group differences on the Temperament and Character Inventory (TCI). Neurocognitive functioning, stress severity, and substance use were correlated with the TCI, correcting for psychosis severity. CHR participants were more impulsive (ie, higher novelty seeking [NS]) and asocial (ie, lower reward dependence) than controls. They were also more schizotypal (ie, high self-transcendence [ST] and lower self-directedness [SD] and cooperativeness [CO] than controls). CO was related to logical reasoning, abstraction, and verbal memory. Stress severity correlated with high HA and schizotypal character traits. Lifetime tobacco use was related to NS, and lifetime marijuana use to high NS, low SD and high ST. Temperament and character of Kenyan CHR youth is similar to that observed in schizophrenia. Psychosis risk in Kenya is associated with impulsive, asocial, and schizotypal traits. CHR adolescents and young adults with schizophrenia-specific personality traits may be most at risk for developing a psychotic disorder and to require early intervention to improve outcomes.
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Affiliation(s)
- Daniel Mamah
- Department of Psychiatry, Washington University Medical School, St. Louis, MO
| | - C Robert Cloninger
- Department of Psychiatry, Washington University Medical School, St. Louis, MO
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Musyimi CW, Mutiso VN, Nyamai DN, Ebuenyi I, Ndetei DM. Suicidal behavior risks during adolescent pregnancy in a low-resource setting: A qualitative study. PLoS One 2020; 15:e0236269. [PMID: 32697791 PMCID: PMC7375578 DOI: 10.1371/journal.pone.0236269] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022] Open
Abstract
Background Suicide is one of the most common causes of death among female adolescents. A greater risk is seen among adolescent mothers who become pregnant outside marriage and consider suicide as the solution to unresolved problems. We aimed to investigate the factors associated with suicidal behavior among adolescent pregnant mothers in Kenya. Methods A total of 27 Focus Group Discussions (FGDs) and 8 Key Informant Interviews (KIIs) were conducted in a rural setting (Makueni County) in Kenya. The study participants consisted of formal health care workers and informal health care providers (traditional birth attendants and community health workers), adolescent and adult pregnant and post-natal (up to six weeks post-delivery) women including first-time adolescent mothers, and caregivers (husbands and/or mothers-in-law of pregnant women) and local key opinion leaders. The qualitative data was analyzed using Qualitative Solution for Research (QSR) NVivo version 10. Results Five themes associated with suicidal behavior risk among adolescent mothers emerged from this study. These included: (i) poverty, (ii) intimate partner violence (IPV), (iii) family rejection, (iv) social isolation and stigma from the community, and (v) chronic physical illnesses. Low economic status was associated with hopelessness and suicidal ideation. IPV was related to drug abuse (especially alcohol) by the male partner, predisposing the adolescent mothers to suicidal ideation. Rejection by parents and isolation by peers at school; and diagnosis of a chronic illness such as HIV/AIDS were other contributing factors to suicidal behavior in adolescent mothers. Conclusion Improved social relations, economic and health circumstances of adolescent mothers can lead to reduction of suicidal behaviour. Therefore, concerted efforts by stakeholders including family members, community leaders, health care workers and policy makers should explore ways of addressing IPV, economic empowerment and access to youth friendly health care centers for chronic physical illnesses. Prevention strategies should include monitoring for suicidal behavior risks during pregnancy in both community and health care settings. Additionally, utilizing lay workers in conducting dialogue discussions and early screening could address some of the risk factors and reduce pregnancy- related suicide mortality in LMICs.
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Affiliation(s)
| | | | - Darius N. Nyamai
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Ikenna Ebuenyi
- Department of Psychology and Assisting Living and Learning Institute, Maynooth University, Maynooth, Ireland
| | - David M. Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- University of Nairobi, Nairobi, Kenya
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Harder VS, Musau AM, Musyimi CW, Ndetei DM, Mutiso VN. A randomized clinical trial of mobile phone motivational interviewing for alcohol use problems in Kenya. Addiction 2020; 115:1050-1060. [PMID: 31782966 PMCID: PMC8353663 DOI: 10.1111/add.14903] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/06/2019] [Accepted: 11/08/2019] [Indexed: 01/13/2023]
Abstract
AIM To test the effectiveness of a motivational interviewing (MI) intervention using the mobile phone among adults with alcohol use problems. DESIGN A randomized clinical trial of mobile MI and standard in-person MI with 1- and 6-month follow-up, including a 1-month waitlist control followed by mobile MI. SETTING A primary health center in rural Kenya. PARTICIPANTS Three hundred adults screening positive for alcohol use problems were randomized and received immediate mobile MI (n = 89), in-person MI (n = 65) or delayed mobile MI (n = 76) for waiting-list controls 1 month after no treatment, with 70 unable to be reached for intervention. INTERVENTION AND COMPARATOR One MI session was provided either immediately by mobile phone, in-person at the health center or delayed by 1 month and then provided by mobile phone. MEASUREMENTS Alcohol use problems were repeatedly assessed using the Alcohol Use Disorder Identification Test (AUDIT) and the shorter AUDIT-C. The primary outcome was difference in alcohol score 1 month after no intervention for waiting-list control versus 1 month after MI for mobile MI. The secondary outcomes were difference in alcohol score for in-person MI versus mobile MI one and 6 months after MI. FINDINGS For our primary outcome, average AUDIT-C scores were nearly three points higher (difference = 2.88, 95% confidence interval = 2.11, 3.66) for waiting-list controls after 1 month of no intervention versus mobile MI 1 month after intervention. Results for secondary outcomes supported the null hypothesis of no difference between in-person and mobile MI at 1 month (Bayes factor = 0.22), but were inconclusive at 6 months (Bayes factor = 0.41). CONCLUSION Mobile phone-based motivational interviewing may be an effective treatment for alcohol use problems among adults visiting primary care in Kenya. Providing mobile motivational interviewing may help clinicians in rural areas to reach patients needing treatment for alcohol use problems.
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Affiliation(s)
- Valerie S. Harder
- University of Vermont, Departments of Pediatrics and Psychiatry, 1 S. Prospect Street, Burlington, VT, 05401 USA,Africa Mental Health Foundation, P.O. Box 48423-00100, Nairobi, Kenya,CORRESPONDING AUTHOR: Valerie S. Harder, PhD, MHS, Associate Professor of Pediatrics and Psychiatry, University of Vermont Larner College of Medicine, 1 S. Prospect Street, Burlington, VT, 05401 USA, , Phone: 802-656-8210
| | - Abednego M. Musau
- Africa Mental Health Foundation, P.O. Box 48423-00100, Nairobi, Kenya
| | | | - David M. Ndetei
- Africa Mental Health Foundation, P.O. Box 48423-00100, Nairobi, Kenya,University of Nairobi, Department of Psychiatry, P.O. Box 19676-00202, Nairobi, Kenya
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Mutiso VN, Musyimi CW, Gitonga I, Tele A, Pervez R, Rebello TJ, Pike KM, Ndetei DM. Using the WHO-AIMS to inform development of mental health systems: the case study of Makueni County, Kenya. BMC Health Serv Res 2020; 20:51. [PMID: 31959175 PMCID: PMC6971996 DOI: 10.1186/s12913-020-4906-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 01/14/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND In order to develop a context appropriate in mental health system, there is a need to document relevant existing resources and practices with a view of identifying existing gaps, challenges and opportunities at baseline for purposes of future monitoring and evaluation of emerging systems. The World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) was developed as a suitable tool for this purpose. Our overall objective of this study, around which research questions and specific aims were formulated, was to establish a baseline on mental health system as at the time of the study, at Makueni County in Kenya, using the WHO-AIMS. METHODS To achieve our overall objective, answer our research questions and achieve specific aims, we conducted a mixed methods approach in which we did an audit of DHIS records and county official records, and conducted qualitative interviews with the various officers to establish the fidelity of the data according to their views. The records data was processed via the prescribed WHO-Aims 2.2 excel spreadsheet while the qualitative data was analyzed thematically. This was guided by the six domains stipulated in the WHO AIMS. RESULTS We found that at the time point of the study, there were no operational governance, policy or administrative structures specific to mental health, despite recognition by the County Government of the importance of mental health. The identified interviewees and policy makers were cooperative and participatory in identifying the gaps, barriers and potential solutions to those barriers. The main barriers and gaps were human and financial resources and low prioritization of mental health in comparison to physical conditions. The solutions lay in bridging of the gaps and addressing the barriers. CONCLUSION There is a need to address the identified gaps and barriers and follow up on solutions suggested at the time of the study, if a functional mental health system is to be achieved at Makueni County.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Gardens, P.O.BOX 48423-00100, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Gardens, P.O.BOX 48423-00100, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Gardens, P.O.BOX 48423-00100, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Gardens, P.O.BOX 48423-00100, Nairobi, Kenya
| | - Romaisa Pervez
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, Ontario, N6A 5C1, Canada
| | - Tahilia J Rebello
- Columbia University Global Mental Health Program, 1051 Riverside Drive, New York, NY, 1003, USA
| | - Kathleen M Pike
- Columbia University Global Mental Health Program, 1051 Riverside Drive, New York, NY, 1003, USA
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon Road, Mawensi Gardens, P.O.BOX 48423-00100, Nairobi, Kenya. .,Department of Psychiatry, University of Nairobi, P. O. Box 30197 - 00100, Nairobi, Kenya.
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Clair V, Rossa-Roccor V, Mokaya AG, Mutiso V, Musau A, Tele A, Ndetei DM, Frank E. Peer- and Mentor-Enhanced Web-Based Training on Substance Use Disorders: A Promising Approach in Low-Resource Settings. Psychiatr Serv 2019; 70:1068-1071. [PMID: 31551043 PMCID: PMC7034956 DOI: 10.1176/appi.ps.201900201] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Stigma and insufficient training contribute significantly to the substance use disorder pandemic. This 2014 study assessed the impact in Kenya of online competency-based courses on peer and mentor interactions, using NextGenU.org, the world's only portal to free and accredited higher education. A total of 99 health care workers participated in one of two courses. Completers (50% of those who logged in) reported significant increases in knowledge about substance use disorders and decreases in stigma. Most (92%) stated that they preferred the NextGenU.org courses over classroom courses. All respondents were very confident that they gained useful knowledge and skills and would recommend the courses to peers. Learners' improvements in knowledge, skills, and stigma-related attitudes were comparable to those seen in "gold-standard," contact-intensive, and costly educational models. Free, accredited, easily scalable, clinically interactive, Web-based training courses can teach knowledge and skills while reducing stigma, even in low-resource settings.
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Affiliation(s)
- Veronic Clair
- Africa Mental Health Foundation, Nairobi, Kenya (Clair, Mokaya, Mutiso, Musau, Tele, Ndetei); School of Population and Public Health, University of British Columbia, Vancouver, Canada (Clair, Rossa-Roccor, Frank); NextGenU.org (Clair, Rossa-Roccor, Frank); Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Ndetei). Kathleen M. Pike, Ph.D., and Pamela Scorza, Sc.D., M.P.H., are editors of this column
| | - Verena Rossa-Roccor
- Africa Mental Health Foundation, Nairobi, Kenya (Clair, Mokaya, Mutiso, Musau, Tele, Ndetei); School of Population and Public Health, University of British Columbia, Vancouver, Canada (Clair, Rossa-Roccor, Frank); NextGenU.org (Clair, Rossa-Roccor, Frank); Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Ndetei). Kathleen M. Pike, Ph.D., and Pamela Scorza, Sc.D., M.P.H., are editors of this column
| | - Aggrey G Mokaya
- Africa Mental Health Foundation, Nairobi, Kenya (Clair, Mokaya, Mutiso, Musau, Tele, Ndetei); School of Population and Public Health, University of British Columbia, Vancouver, Canada (Clair, Rossa-Roccor, Frank); NextGenU.org (Clair, Rossa-Roccor, Frank); Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Ndetei). Kathleen M. Pike, Ph.D., and Pamela Scorza, Sc.D., M.P.H., are editors of this column
| | - Victoria Mutiso
- Africa Mental Health Foundation, Nairobi, Kenya (Clair, Mokaya, Mutiso, Musau, Tele, Ndetei); School of Population and Public Health, University of British Columbia, Vancouver, Canada (Clair, Rossa-Roccor, Frank); NextGenU.org (Clair, Rossa-Roccor, Frank); Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Ndetei). Kathleen M. Pike, Ph.D., and Pamela Scorza, Sc.D., M.P.H., are editors of this column
| | - Abednego Musau
- Africa Mental Health Foundation, Nairobi, Kenya (Clair, Mokaya, Mutiso, Musau, Tele, Ndetei); School of Population and Public Health, University of British Columbia, Vancouver, Canada (Clair, Rossa-Roccor, Frank); NextGenU.org (Clair, Rossa-Roccor, Frank); Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Ndetei). Kathleen M. Pike, Ph.D., and Pamela Scorza, Sc.D., M.P.H., are editors of this column
| | - Albert Tele
- Africa Mental Health Foundation, Nairobi, Kenya (Clair, Mokaya, Mutiso, Musau, Tele, Ndetei); School of Population and Public Health, University of British Columbia, Vancouver, Canada (Clair, Rossa-Roccor, Frank); NextGenU.org (Clair, Rossa-Roccor, Frank); Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Ndetei). Kathleen M. Pike, Ph.D., and Pamela Scorza, Sc.D., M.P.H., are editors of this column
| | - David M Ndetei
- Africa Mental Health Foundation, Nairobi, Kenya (Clair, Mokaya, Mutiso, Musau, Tele, Ndetei); School of Population and Public Health, University of British Columbia, Vancouver, Canada (Clair, Rossa-Roccor, Frank); NextGenU.org (Clair, Rossa-Roccor, Frank); Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Ndetei). Kathleen M. Pike, Ph.D., and Pamela Scorza, Sc.D., M.P.H., are editors of this column
| | - Erica Frank
- Africa Mental Health Foundation, Nairobi, Kenya (Clair, Mokaya, Mutiso, Musau, Tele, Ndetei); School of Population and Public Health, University of British Columbia, Vancouver, Canada (Clair, Rossa-Roccor, Frank); NextGenU.org (Clair, Rossa-Roccor, Frank); Department of Psychiatry, University of Nairobi, Nairobi, Kenya (Ndetei). Kathleen M. Pike, Ph.D., and Pamela Scorza, Sc.D., M.P.H., are editors of this column
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Ndetei DM, Mutiso V, Gitonga I, Agudile E, Tele A, Birech L, Musyimi C, McKenzie K. World Health Organization life-skills training is efficacious in reducing youth self-report scores in primary school going children in Kenya. Early Interv Psychiatry 2019; 13:1146-1154. [PMID: 30277311 DOI: 10.1111/eip.12745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 06/28/2018] [Accepted: 09/09/2018] [Indexed: 01/07/2023]
Abstract
AIM Documented evidence shows that training in life skills for school going children improves their physical and mental health status. Although Kenya has a curriculum and a policy for life-skills training in schools, these have not been implemented because lack of local evidence for efficacy. Therefore, the objective of this study was to determine the efficacy and effectiveness of the life-skill training curriculum for primary schools developed by the Ministry of Education, Kenya. METHODS We randomly selected 23 schools from two randomly selected sub-counties representing urban/peri-urban and rural contexts in Kenya. We collected baseline socio-demographic characteristics and administered the locally validated youth self-report (YSR) for 11 to 18 years old at baseline and 9 months post-intervention. We used the Ministry of Education validated curriculum for life-skills training for upper primary school as the intervention immediately after the baseline. RESULTS The World Health Organization life-skills training is efficacious in reducing YSR scores in primary school going children in Kenya. We found that socio-demographic characteristics were predictors for mental health and that there were significant positive improvements in internalizing and externalizing YSR symptoms and syndromes in both sites. The improvement was over 40% and therefore unlikely to be attributable to placebo effect or natural recovery without intervention. However, attention problems worsened more so in rural sites and particularly in girls. CONCLUSIONS Life-skills training is efficacious in improving mental health in school going children in the Kenyan context. However, it is not effective in attention problems which seem to be cognitive in nature.
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Affiliation(s)
- David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Victoria Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Isaiah Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Emeka Agudile
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Lilian Birech
- Directorate of Policy, Ministry of Education, Nairobi, Kenya
| | - Christine Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Kwame McKenzie
- Department of Psychiatry, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Mutiso VN, Pike KM, Musyimi CN, Rebello TJ, Tele A, Gitonga I, Thornicroft G, Ndetei DM. Changing patterns of mental health knowledge in rural Kenya after intervention using the WHO mhGAP-Intervention Guide. Psychol Med 2019; 49:2227-2236. [PMID: 30345938 DOI: 10.1017/s0033291718003112] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Despite the high prevalence of mental disorders, mental health literacy has been comparatively neglected. People's symptom-management strategies will be influenced by their mental health literacy. This study sought to determine the feasibility of using the World Health Organization mhGAP-Intervention Guide (IG) as an educational tool for one-on-one contact in a clinical setting to increase literacy on the specified mental disorders. METHODS This study was conducted in 20 health facilities in Makueni County, southeast Kenya which has one of the poorest economies in Kenya. It has no psychiatrist or clinical psychologist. We recruited 3267 participants from a community that had already been exposed to community mental health services. We used Mental Health Knowledge Schedule to measure the changing patterns of mental health knowledge after a period of 3 months, following a training intervention using the WHO mhGAP-IG. RESULTS Overall, there was a significant increase in mental health related knowledge [mean range 22.4-23.5 for both post-test and pre-test scores (p < 0.001)]. This increase varied with various socio-demographic characteristics such as sex, marital status, level of education, employment status and wealth index. CONCLUSIONS mhGAP-IG is a feasible tool to increase mental health literacy in low-resource settings where there are no mental health specialists. Our study lends evidence that the WHO Mental Health Action Plan 2013-2020 and reduction of the treatment gap may be accelerated by the use of mhGAP-IG through improving knowledge about mental illness and potentially subsequent help seeking for early diagnosis and treatment.
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Affiliation(s)
- V N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - K M Pike
- Columbia University, Global Mental Health Program, New York, USA
| | - C N Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - T J Rebello
- Columbia University, Global Mental Health Program, New York, USA
| | - A Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - I Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - G Thornicroft
- Institute of Psychiatry, King's College London, London, UK
| | - D M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Mutiso VN, Musyimi CW, Rebello TJ, Ogutu MO, Ruhara R, Nyamai D, Pike KM, Ndetei DM. Perceived impacts as narrated by service users and providers on practice, policy and mental health system following the implementation of the mhGAP-IG using the TEAM model in a rural setting in Makueni County, Kenya: a qualitative approach. Int J Ment Health Syst 2019; 13:56. [PMID: 31423149 PMCID: PMC6693225 DOI: 10.1186/s13033-019-0309-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022] Open
Abstract
Background A team approach is key to reduction of the mental health treatment gap. It requires collaborative effort of all formal and informal community based service providers and the consumers of the services. Qualitative evaluations of such an approach add value to the quantitative evaluations. Methods A qualitative study was conducted among 205 participants. These were grouped into a total of 19 focus group discussions for community health workers (CHW), traditional healers (TH), faith healers (FH) and patients. For nurses and clinical officers we held 10 key informant interviews and three key informant discussions. We aimed to document personal perceptions as expressed in narratives on mental health following a community based application of the WHO mental health treatment Gap-intervention guideline (mhGAP-IG) using the TEAM model. We also aimed to document how the narratives corroborated key findings on the quantitative wing of the TEAM model. Results There were three categories of perceptions: (i) patient-related, (ii) health provider-related and, (iii) health system related. The patient related narratives were linked to improvement in their mental and physical health, increased mental health awareness, change in lifestyle and behavior, enhanced social functioning and an increase in family productivity. Health provider perceptions were related to job satisfaction, capacity building and increased interest in mental health training. Mental health system related narratives included effectiveness and efficiency in service delivery and increase in number of referrals at the primary health care facilities. Conclusion The TEAM is a feasible model for the implementation of the mhGAP-IG. It led to positive perceptions and narratives by service provides and service consumers. The qualitative findings corroborated the quantitative findings of TEAM.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | | | - Michael O Ogutu
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Ruth Ruhara
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Darius Nyamai
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya
| | - Kathleen M Pike
- 2Global Mental Health Program, Columbia University, New York, USA
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Matumbato Road, Mawensi Gardens, Upper Hill, Nairobi, Kenya.,3Department of Psychiatry, University of Nairobi, Nairobi, Kenya
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Mutiso VN, Pike KM, Musyimi CW, Gitonga I, Tele A, Rebello TJ, Thornicroft G, Ndetei DM. Feasibility and effectiveness of nurses and clinical officers in implementing the WHO mhGAP intervention guide: Pilot study in Makueni County, Kenya. Gen Hosp Psychiatry 2019; 59:20-29. [PMID: 31096165 DOI: 10.1016/j.genhosppsych.2019.04.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVES (1) To determine the feasibility and effectiveness of nurses and clinical officers in using the mental health Global Action Programme Intervention Guide (mhGAP-IG) as an intervention tool in reducing disability, improving quality of life in the clinical outcomes in patients with the mhGAP-IG priority mental disorders in a Kenyan rural setting. (2) To identify any gaps that can be contributed towards future research. METHODS This study was conducted in 20 healthcare facilities across Makueni County in the South East of Kenya. This county had a population of approximately one million people, with no psychiatrist or clinical psychologist. We recruited 2306 participants from the healthcare facilities in the catchment areas that had previously been exposed to the community mental health awareness campaigns, while being subjected to screening for the mhGAP-IG disorders. We used the Mini-International Neuropsychiatric Interview for adults (MINI-Plus) for DSM-IV confirmatory diagnosis on those who screened positive on the mhGAP-IG. We measured disability using WHO-Disability Assessment Schedule II (DAS II), Quality of Life (QoL) using the WHO QoL-BREF, depression using Patient Health Questionnaire (PHQ-9), suicidality using The Beck Suicide Scale (BSS), psychosis using the Washington Early Recognition Center Affectivity and Psychosis (WERCAP), epilepsy using a seizure questionnaire and alcohol and substance abuse using The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). These measurements were at the baseline, followed by the training for the health professionals on using the WHO mhGAP-IG as an interventional tool. The measurements were repeated at 3 and 6 months post-intervention. RESULTS Of the 2306 participants enrolled in the study, we followed 1718 at 3 months and 1371 at 6 months a follow-up rate of 74.5% and 59.4% respectively. All participants received psycho-education and most depending on condition also received medication. Overall, there was significant decline in disabilities, improvement in seizure control and improvement in clinical outcomes on the identified mental disorders. CONCLUSIONS Trained, supervised and supported nurses and clinical officers can produce good outcomes using the mhGAP-IG for mental health.
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Affiliation(s)
- V N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - K M Pike
- Columbia University, Global Mental Health Program, New York, USA.
| | - C W Musyimi
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - I Gitonga
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - A Tele
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya.
| | - T J Rebello
- Columbia University, Global Mental Health Program, New York, USA.
| | | | - D M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Nairobi, Kenya.
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Mutiso VN, Musyimi CW, Krolinski P, Neher CM, Musau AM, Tele A, Ndetei DM. Relationship between Bullying, Substance Use, Psychiatric Disorders, and Social Problems in a Sample of Kenyan Secondary Schools. Prev Sci 2019; 20:544-554. [PMID: 30993591 DOI: 10.1007/s11121-019-01014-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
We aimed to investigate how direct bullying and victimization relate with substance use, the presence of psychiatric disorders, poor school performance, disruptive behaviors, and social problems among secondary school students. A cross-sectional study was conducted in 20 randomly selected mixed-day secondary school students in forms one to three in Machakos County, equivalent to students in grades 1 to 11. From a random starting point, every sixth student in the class was invited to participate. The Drug Use Screening Inventory (revised) (DUSI-R) and the Olweus Bully/Victim Questionnaire (OBVQ) were administered in a classroom-setting by trained research assistants with experience in data collection. Four categories, i.e., bully only, bully-victim, victim only, and neither bully nor victims (neutrals) were developed and problem density scores computed. Descriptive statistics, bivariate, and multinomial logistic regression analysis summarized the findings. Of the 471 students, 13.6% had not experienced bullying problems. Bully-victim was the most prevalent form of bullying. No significant gender differences were reported across categories. Bully-victims reported significant higher problem density scores in eight out of the nine problem domains, and effect sizes of the differences in problem scores between neutrals and bully-victims were larger compared with other categories. Behavioral and family system problem scores retained a significant relationship with bully-victim category (p < 0.001). A high prevalence of bullying problems was documented in both genders. However, bully-victims had a higher risk of multiple negative individual and environmental and social problems. Assessment of bullying problems is an indirect route to identifying significant youth problems. Bullying interventions should be multifaceted to address psycho-socio-behavioral problems.
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Affiliation(s)
- Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya
| | - Christine W Musyimi
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya.,Vrije Universiteit, Amsterdam, Netherlands
| | | | | | - Abednego M Musau
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya
| | - Albert Tele
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Mawensi Road, Off Elgon road, Mawensi Garden, Nairobi, Kenya. .,University of Nairobi, Nairobi, Kenya.
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Adorjan K, Mulugeta S, Odenwald M, Ndetei DM, Osman AH, Hautzinger M, Wolf S, Othman M, Kizilhan JI, Pogarell O, Schulze TG. [Psychiatric care of refugees in Africa and the Middle East : Challenges and solutions]. Nervenarzt 2019. [PMID: 28646248 DOI: 10.1007/s00115-017-0365-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Violence, flight, famine, and natural disasters as well as the absence of a psychosocial healthcare system are major psychological burdens for refugees. The level of provision of mental healthcare is particularly low in developing countries. Internally displaced people and refugees place high demands on the healthcare system because they often suffer from psychiatric disorders, such as depression, posttraumatic stress disorder, and substance use disorders. We present first initiatives to improve psychiatric care in refugee camps in Ethiopia, Kenya, and Sudan. Moreover, we provide first insights into a project based in Northern Iraq and Germany aimed at the treatment of people who were severely traumatized by the terror regime of the so-called Islamic State (IS).
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Affiliation(s)
- K Adorjan
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstraße 7, 80336, München, Deutschland. .,Institut für Psychiatrische Phänomik und Genomik, Klinikum der Universität München, LMU, München, Deutschland. .,Center for International Health, Ludwig Maximilians Universität München, München, Deutschland.
| | - S Mulugeta
- International Medical Corps, Mental Health and Psychosocial Support Program, (UNHCR and ARRA) Dolo Ado Refugee Camps, Dolo Ado, Äthiopien
| | - M Odenwald
- Klinische Psychologie und klinische Neuropsychologie, Universität Konstanz, Konstanz, Deutschland.,vivo international e. V., Konstanz, Deutschland
| | - D M Ndetei
- Department of Psychiatry, University of Nairobi and Africa Mental Health Foundation, Nairobi, Kenia
| | - A H Osman
- Department of Psychiatry, University of Khartoum, Khartoum, Sudan
| | - M Hautzinger
- Klinische Psychologie und Psychotherapie, Universität Tübingen, Tübingen, Deutschland
| | - S Wolf
- Klinische Psychologie und Psychotherapie, Universität Tübingen, Tübingen, Deutschland
| | - M Othman
- Institut für Psychotherapie und Psychotraumatologie, Universität Dohuk, Dohuk, Nordirak, Irak
| | - J I Kizilhan
- Institut für Psychotherapie und Psychotraumatologie, Universität Dohuk, Dohuk, Nordirak, Irak.,Fakultät für Sozialwesen, Duale Hochschule Baden Württemberg, Villingen-Schwenningen, Deutschland
| | - O Pogarell
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Klinikum der Universität München, LMU, Nußbaumstraße 7, 80336, München, Deutschland.,Klinik und Poliklinik für Psychiatrie und Psychotherapie, Migrationsambulanz, Klinikum der Universität München, LMU, München, Deutschland
| | - T G Schulze
- Institut für Psychiatrische Phänomik und Genomik, Klinikum der Universität München, LMU, München, Deutschland
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Ebuenyi ID, Regeer BJ, Ndetei DM, Bunders-Aelen JFG, Guxens M. Experienced and Anticipated Discrimination and Social Functioning in Persons With Mental Disabilities in Kenya: Implications for Employment. Front Psychiatry 2019; 10:181. [PMID: 31024353 PMCID: PMC6459950 DOI: 10.3389/fpsyt.2019.00181] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 03/12/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Persons with mental illness experience social life restriction and stigma that may have implications for their work ability. The aims of this study are (i) to report experienced and anticipated discrimination and social functioning in persons with mental disabilities in Kenya and (ii) to investigate the association between experienced and anticipated discrimination, social functioning, and employment in this population. Materials and Methods: Cross-sectional study design where we randomly recruited 72 persons with mental illness through two networks of persons with psychosocial disabilities in Kenya. Experienced and anticipated discrimination were measured using the Discrimination and Stigma Scale version 12 (DISC 12) while social functioning was measured using the Social Functioning questionnaire (SFQ). Results: Experienced discrimination was reported by 81.9% in making or keeping friends, 69.7 and 56.3% in finding or keeping job, respectively, and 63.3% in dating or having an intimate relationship. Anticipated discrimination stopped 59.2% from applying for work, 40.8% from applying for education or training courses, and 63.4% from having a close personal relationship. Females reported an overall higher experienced discrimination than males. Unemployed participants had slightly increased rates of experienced and anticipated discrimination (9.5 vs. 9.1 and 2.5 vs. 2.3, respectively) (p > 0.05), while there was a significant association between impaired social functioning and unemployment [14.0 vs. 11.2 (p = 0.037)]. Conclusion: The rates of experienced and anticipated discrimination faced by persons with mental disabilities in Kenya is high and with significant gender disparity. Although no strong associations were observed between experienced and anticipated discrimination and employment, impaired social functioning of persons with mental disabilities seems to have implications for employment. Further research is essential to understand the predictors of the discrimination and measures to reduce them in persons with psychosocial disabilities.
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Affiliation(s)
- Ikenna D Ebuenyi
- Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Barbara J Regeer
- Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - David M Ndetei
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya.,Africa Mental Health Foundation, Nairobi, Kenya
| | - Joske F G Bunders-Aelen
- Athena Institute, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mònica Guxens
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, Netherlands
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Musyimi CW, Mutiso VN, Loeffen L, Krumeich A, Ndetei DM. Exploring mental health practice among Traditional health practitioners: a qualitative study in rural Kenya. BMC Complement Altern Med 2018; 18:334. [PMID: 30547778 PMCID: PMC6295025 DOI: 10.1186/s12906-018-2393-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 11/28/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Involvement of traditional health practitioners (THPs) in the form of collaboration with the formal health care system is suggested to improve the pathways to mental health care in Kenya, yet understanding of the current traditional practice and THPs' perspectives is lacking. The aim of this study was to explore the views of THPs with respect to their mental health practice. METHODS This study qualitatively explored the views of THPs, using four focus group discussions (FDGs) each consisting of 8-10 traditional and faith healers, resulting in a total of 36 participants. Thematic content analysis using a grounded theory approach was performed using QSR NVivo 10. Emerging topics were identified and examined by re-reading the transcripts several times and constantly re-sorting the material. RESULTS Four themes that reflect THPs' mental health practice perspectives emerged as follows: 1) Categorization of mental illness; 2) Diagnostics in traditional mental health practice; 3) Treatments and challenges in current traditional mental health practice; and 4) Solutions to improve traditional mental health practice. CONCLUSIONS These themes provide insight into the perspectives of Kenyan traditional and faith healers on their mental health practice, in an attempt to offer a meaningful contribution to the debate on collaboration between informal and formal health care providers in improving mental health services in Kenya. Furthermore, the presented challenges and solutions can inform policy makers in their task to improve and scale up mental health services in resource-poor areas in Kenya. Addressing these issues would be a first step towards understanding the solid foundation of traditional medicine that is necessary before collaboration can be successfully attempted. Further research is also recommended to assess patients' needs and explore potential forms of collaboration, in order to achieve sustainable improvement in the mental health care pathways for patients.
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Affiliation(s)
- Christine W. Musyimi
- Africa Mental Health Foundation and Department of Psychiatry, University of Nairobi, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. BOX 48423-00100, Nairobi, Kenya
- Vrije Universiteit, 1081 HV Amsterdam, Netherlands
| | - Victoria N. Mutiso
- Africa Mental Health Foundation and Department of Psychiatry, University of Nairobi, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. BOX 48423-00100, Nairobi, Kenya
| | - Lianne Loeffen
- Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands
| | - Anja Krumeich
- Maastricht University, P.O. Box 616, 6200 MD Maastricht, Netherlands
| | - David M. Ndetei
- Africa Mental Health Foundation and Department of Psychiatry, University of Nairobi, Mawensi Road, Off Elgon road, Mawensi Garden, P.O. BOX 48423-00100, Nairobi, Kenya
- University of Nairobi, P. O. Box 30197 00100, Nairobi, Kenya
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