Utilization of health care services by depressed patients attending the general out‑patients department of the Jos University Teaching Hospital, Jos, Nigeria

Background: Depression is a common psychiatric disorder in primary health care throughout the world with increasing incidence and prevalence. It is often under-treated and under-diagnosed. Consequently, several studies have revealed that patients with depression are high utilizers of medical services. Objectives: The study was aimed at determining the frequency of consultation and the utilization of investigative procedures by the depressed and non-depressed patients in the last 12 months. Materials and Methods: This was a cross-sectional descriptive study among 200 consecutive patients attending the General Out-Patient Department of the Jos University Teaching Hospital between November 2006 and March 2007. A semi-structured questionnaire was used to collect socio-demographic data and health services utilization indices. Structured Clinical Interview for DSM-IV axis-1 Disorders (SCID) was used for diagnosis of depression. Results: The study found that 51(25.5%) of the respondents met DSM-IV criteria for the diagnosis of major depression while 149 (74.5%) did not. Depressed patients significantly had more number of consultations with their doctors (P=0.000), had consulted more number of hospitals (P=0.000), stayed longer on admission (P=0.000) and had consumed more types of medicine (P=0.005) in the last 12 months compared with the non-depressed. The depressed patients also had significantly higher mean of different types of investigations compared with non-depressed; urinalysis (1.69 vs 0.55, P=0.000), chest X-ray (0.57 vs 0.21, P=0.000) and Widal test (1.92 vs 0.39, P=0.000). Others are HIV screening (0.39vs0.11, P=0.000) urine mcs (0.94 vs 0.18, P=0.000), stool mcs (1.24 vs 0.20, P=0.000). Conclusion: The study demonstrated that patients who suffer from depression are higher utilizers of health care resources compared with the non-depressed. Therefore, it is recommended that general practitioners and other health workers need to be better equipped to deal with the diagnosis and management of depression.Keywords: Utilization, health care resources, depressionNigerian Journal of Clinical Practice • Jan-Mar 2012 • Vol 15 • Issue

Prevalence and socio-demographic correlates of alcohol use disorders among HIV patients

The rate of alcohol consumption is high among individuals living with HIV. The combination of hazardous alcohol drinking and HIV is deleterious to the health of the individual and the general public. Therefore, this study attempts to estimate the prevalence of alcohol use disorders in HIVinfected patients and to assess the socio-demographic factors associated with it. Across sectional descriptive study was conducted among 160 consecutive patients attending the infectious disease unit of the Plateau State Specialists Hospital Jos. A semi-structured questionnaire was used to collect data on socio-demographic variables and Alcohol Use Disorders Identification Test (AUDIT) was used to assess alcohol use disorders. The estimated prevalence of alcohol related problems was 39.4% with 28.8% harmful drinking and 10.6% hazardous drinking (alcohol abuse); 33.1% had started drinking before they were diagnosed with HIV and 6.3% after diagnosis. Male sex (p=0.000), poor education(p=0.000) and low income (p=0.002) were significantly associated with alcohol use disorders. The study revealed that alcohol use disorders are high among HIV infected patients who are males with low socio-economic status. We therefore recommend for screening and treating alcohol problems in HIV patients.Key Words: Alcohol use disorders, socio-demographics, HIV/AIDS, harmful us

Gender and psychiatric diagnosis: a 5-year retrospective study in a Nigerian federal medical centre

Background: The role of gender in psychiatry disorders is becoming increasingly important. This study is therefore, aimed at identifying gender pattern of admissions to a public mental health centre with regards to demographic characteristic, psychiatry diagnosis and length of stay on admission.Method: In this retrospective study Hospital records of 388 patients admitted at the psychiatric section of the Federal Medical Centre (FMC) Makurdi, between January, 2004 and December, 2008 were studied forgender differences regarding demographic attributes, length of stay and psychiatry diagnoses.                                                                Results: Findings revealed that more men than women were admitted overall. Most men (56%) were less than 30 years old whereas 60.6% of women were within 30-59 years aged bracket. For men the main diagnosis was schizophrenia (30.5%), followed by substance related disorders (16.5%) then depression (14.0%); for women the main diagnosis was alsoschizophrenia (30.3%), this was followed by depression (24.5%), only one woman was diagnosed with substance related disorder. A statisticallysignificant association was also found between having a personality disorder and being a male (p=0.009). Most female were single and belong to the lowest occupational group. There was no significant differencein the gender distribution of patients with respect to length of stay on admission (p=0.161).Conclusion: The results revealed how psychiatry diagnosis is significantly influence by gender issues. We therefore recommend that; for a more effective psychiatry formulation, it is imperative to pay attention to gender issues that may affect the development of psychopathology.Key words: Admission, Gender, Psychiatry diagnosis, Length of sta

Prevalence and predictors of delirium among medical inpatients admitted through accident and emergency unit of Jos University Teaching Hospital

Background: Delirium is a complex neuropsychiatric syndrome, commonly encountered across all healthcare settings. However, little is known about its magnitude and determining factors in medical inpatients especially at the Accident and Emergency (A&E) setting of tertiary institutions in low income countries.Objectives: This study was conducted to evaluate the prevalence of delirium among medical inpatients admitted through the A&E unit as well as to assess its predictors.Method: This was a cross-sectional study that employed a consecutive sampling technique to select 290 eligible subjects from medical inpatients that presented to A&E unit of Jos University Teaching Hospital (JUTH). Confusion Assessment Method (CAM) was used to assess for delirium.Results: The results showed that 35.9% of the respondents had delirium. The predictive variables for delirium were: Age groups 18-34 years and 35-64 years (P=0.014 and P = 0.003), prior cognitive impairment (P = 0.020), having estimated monthly income belowN50,000 (P<0.001 and P=0.008) , use of alcohol (P=0.026) and having rare/other medical diagnosis (P = 0.0016).Conclusion: Delirium is very common in medical inpatients and highly predictable especially in high risk patients. Consultation-Liaison Psychiatry services need to be integrated into the A&E unit management team particularly in the areas of prevention and management of identified cases.Keywords: Delirium, Medical Inpatients, Prevalence, Predictors, Accident and Emergency Uni

Substance abuse and adherence to antiretroviral therapy among patients attending clinic at a specialist hospital in Jos, Nigeria

Substance abuse does not only increase susceptibility to HIV/AIDS through high risk Sexual behaviors but it also hastens the progression of the disease among infected persons than in those who do not abuse drugs. Furthermore, drug use impairs adherence to antiretroviral therapy (ART) leading to reduction in ART effectiveness and ultimately increased HIV-related mortality. In North Central Nigeria there is a dearth of information concerning the influence of substance abuse on adherence to ART which has substantially altered the fate of HIV-infected people. The objectives of this study therefore, were to determine the type of substances abused by HIV-infected patients attending clinic at Plateau State Specialists Hospital (PSSH) and to determine the effect of substance abuse and sociodemographic factors on adherence to ART among these patients. Ethical approval was obtained before the commencement of the study which was crosssectional in design. The study was carried out at the infectious disease unit of the Plateau State Specialists Hospital, Jos among 160 consecutive patients. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was used for the assessment of the types of substance abused and AIDS Clinical Trials Group(ACTG) adherence instrument was used to assess reasons for non- adherence. The results showed that 61.9% of the patients did not use any substance of abuse, 38.1% either abused one substance or a combination of substances. Substance abuse were (p = 0.0001), alcohol abuse (p = 0.003) and educational status (p = 0.0001) significantly associated with non-adherence to ART while, age (p = 0.954), employment status (p = 0.924) and marital status (p = 0.466) were not. However, logistic regression revealed that only alcohol abuse (B = -1.383, df = 1, p = .002) predicted non adherence to ART. We recommend the screening of patients on ART for substance abuse and a multi-disciplinary approach to the treatment of HIV/AIDS.Keywords: HIV, substance abuse, medication adherenc

Suicide risk among psychiatric in-patients in north-central Nigeria

Background: Over the last 45 years, mortality due to suicide has increased in some developed and developing countries among both adults and young people. Suicide has also been reported to be high for individuals with substance abuse, mood and personality disorders, and relatively low rates were reported for patients with anxiety disorders. This study was therefore to determine the socio-demographic and clinical factors associated with the risk of suicide among psychiatric in-patients in North-Central Nigeria.Objective: The aim of this study is to look at the socio-demographic and clinical correlates of having suicide risk among psychiatric in-patients.Method: This is a cross-sectional descriptive study conducted on 112 in-patients admitted in the psychiatric wards of BSUTH Makurdi, FMC Makurdi and JUTH Jos during the study period of July to September, 2017. Every consecutive in-patient who consented for the study was assessed with a proforma carefully designed bythe authors to measure socio-demographic and clinical attributes. Suicide risk was determined using the 'Suicidality Module' of Mini International Neuropsychiatric Interview (M.I.N.I.).Results: Forty-five (40.2%) were males while 67(59.8%) were females. The mean age was 36.98 ±11.09 years, fifty- four (48.2%) subjects were still married at the time of the study. Eighty subjects representing 71.4% of the respondents reported having low (46), moderate (16) or high (18) suicide risk. Having a risk of suicide was significantly associated with the history of default (p=0.001), previous episodes of illness (p=0.005), co-morbid diagnosis (p=0.001), long duration of illness (p=0.001), and not having a good relationship with sexual partner (p=0.002).Conclusion: The study justifies the need for the assessment of suicide risk among in-patients with high degree of suspicion.Keywords: Suicide risk, in-patient, correlate

Prevalence of depression and associated clinical and socio-demographic factors in people living with lymphatic filariasis in Plateau State, Nigeria.

BACKGROUND: Lymphatic filariasis is a chronic, disabling and often disfiguring condition that principally impacts the world's poorest people. In addition to the well-recognised physical disability associated with lymphedema and hydrocele, affected people often experience rejection, stigma and discrimination. The resulting emotional consequences are known to impact on the quality of life and the functioning of the affected individuals. However, the management of this condition has focused on prevention and treatment through mass drug administration, with scant attention paid to the emotional impact of the condition on affected individuals. This study aimed to determine the prevalence and severity of depression among individuals with physical disfigurement from lymphatic filariasis in Plateau State, Nigeria. METHODOLOGY: A cross-sectional 2-stage convenience study was conducted at 5 designated treatment centers across Plateau State, Nigeria. All available and consenting clients with clearly visible physical disfigurement were recruited. A semi-structured socio-demographic questionnaire, Rosenberg Self-esteem and a 9-item Patient Health Questionnaire (PHQ-9) were administered at the first stage. Those who screened positive (with a PHQ-9 score of five and above) were further interviewed using the Depression module of the Composite International Diagnostic Interview (CIDI). RESULTS: Ninety-eight individuals met the criteria and provided consent. Twenty percent of the respondents met criteria for depression, with the following proportions based on severity: Mild (42.1%), Moderate (31.6%) and Severe (26.3%). History of mental illness (OR 40.83, p = 0.008); Median duration of the illness was 17 years (IQR 7.0-30 years) and being unemployed (OR 12.71, p = 0.003) were predictive of depression. High self-esteem was negatively correlated (OR 0.09, p<0.004). CONCLUSION: Prevalence of depression is high among individuals with lymphatic filariasis and depression in sufferers is associated with low self-esteem and low levels of life satisfaction

Depression and experience of incarceration in North Central Nigeria: a situation analysis at Makurdi medium security prison

Abstract Background Human rights watchdogs have described conditions in Nigerian correctional facilities and detention centers as damaging to the physical and mental health of inmates. While the prevalence of mental disorders is high, access to appropriate healthcare is grossly inadequate. Understanding the current state of prison inmates’ mental health and well-being is an essential first step to addressing this important issue. This study aims to document the mental health and experiences of incarceration of inmates of the largest medium security prison in Nigeria’s Benue State. Methods A cross-sectional survey and descriptive analysis was carried out with a random sample of 381 prison inmates of Benue State Makurdi Medium Security Prison. Survey tools included: (1) a structured questionnaire on participants’ experiences in prison, and (2) the Patient Health Questionnaire (PHQ-9), a screening tool for depression. Results Most participants were young men (95.5%, mean age 27.95) and had completed secondary school (63.5%). While prison authorities had identified only 27 participants as having a mental disorder, 144 (37.8%) screened positive for depression. Twenty six had received professional counseling while in prison. Of the six participants who were already taking a psychotropic medication at the time of imprisonment, four received medication after being imprisoned. Approximately half, (52%) of participants were dissatisfied with prison health care. Conclusions Despite the high prevalence of depression among prison inmates, few cases are detected and treated. Prison staff may not recognize depression as a mental disorder, and the mental health care available is generally poor. Inadequate mental health and social care not only affects prison inmates’ well-being, but may also impact recidivism and health outcomes upon release. Prison inmates should be screened routinely for depression and other less-commonly recognized mental health conditions, and appropriate treatment made available. </jats:sec