The opioid crisis fuelled by health systems: how will future physicians fare?

The opioid crisis continues to affect many areas worldwide, raising questions regarding prescribing indications. There is no consensus on negotiating the need for pain relief and the potential for medically prescribed opioid-related harm/addiction. These issues present an enormous educational challenge to physicians in training, particularly those whose mandate is to understand and respond to varying forms of pain. This article examines the perspectives and educational challenges faced by two psychiatry residents from different parts of the globe during the crisis. Is the educational experience of future psychiatrists sufficient to prepare them for the responsibilities that lie ahead

Depression, anxiety, and stress among Ugandan university students during the COVID-19 lockdown: an online survey

Background: COVID19 pandemic forced most countries to lockdown, leading to the prolonged closure of many learning institutions. This dramatic shift led to increase of mental illness symptoms among university students. Objective: To determine the prevalence and factors associated with symptoms of depression, anxiety, and stress among Uganda’s university students during the COVID-19 lockdown. Methods: We conducted a one-month online survey using the Depression Anxiety and Stress Scale (DASS-21). Results: Participants n=321 were enrolled with mean age, 24.8(SD=5.1) years and 198(61.7%) were males. The prevalence of mental health symptoms among participants was 80.7%, 98.4%, and 77.9% for depression, high levels of anxiety,and stress, respectively. Statistically significant association between mental health symptoms on multi-logistic regression was found with Males (depression=2.97[1.61–5.48] and stress=1.90[1.07–3.35]), engagement in leisure activity (depression= 1.87[1.01–3.49] and stress=1.98[1.10–3.56]), and being finalist (stress=0.55[0.31– 0.97]). Use of addictive substances seem to potentially alleviate symptoms of depression, anxiety and stress in the short term.  Conclusions: The findings of this study suggest a high prevalence of symptoms of depression, anxiety and stress among university students during the COVID-19 lockdown. Students’ mental health should be monitored by all stakeholders, especially as the pandemic progresses. Keywords: COVID-19 lockdown; University students; Mental health

Gambling Prevalence and Factors Associated with Gambling Participation among University Students in Uganda

This paper examines the prevalence of gambling for gain among university students and to gain a theory-based understanding and knowledge of the influence factors of this gambling behaviour based on the University Student Psychosocial Problems Development Theory (USPPDT). Relatively little is known about the factors associated with students’ gambling for financial gain encompassing a student’s biosocial/cultural and psycho characteristics informed by a theory. Participants were recruited from two public and three private universities in Uganda. A total of 1101 randomly selected students participated in the study and 976 (88.6%) completed the survey instruments. The self-reported current prevalence of gambling participation was 281 (28.8%) among university students (≥ 19 years). In agreement with the theory and findings from the study, student demographic characteristics, study program characteristics, student-related health burden characteristics, psychosocial functioning, and antisocial behaviour items were particularly predictive of students’ participation in gambling for financial gain. These risk factors for gambling are not presumed as causation, identifying them points to important implications in terms of prevention and intervention on student gambling behaviour. This points to a considered interplay of different players in designing transversal strategies for a student at risk for gambling

Dual harm among patients attending a mental health unit in Uganda: a hospital based retrospective study

Abstract Background Dual harm encompasses the complex interplay of the co-occurrence of self-harm and aggression. Individuals with dual harm may display a more hazardous pattern of harmful behaviors like homicide-suicide compared to people with sole harm. This study aimed to examine the presence of dual harm among general psychiatry inpatients in a mental health unit in Uganda. Methods A retrospective chart review of 3098 inpatients from January 2018 to December 2021. Dual harm reported experience at admission was based on experiences of self-harm with harm to people or property or both. Logistic regression assessed the association between dual harm and sociodemographics and clinical characteristics. Results A total of 29 (1%) patients experienced dual harm, with five having experienced self-harm with both harm to others and property, 23 with harm to people, and one with harm to property. Dual harm was statistically significantly associated with the male gender at bivariate analysis. However, there were no statistically significant factors associated with dual harm at multivariate analysis or sensitivity analysis with the specific types of dual harm. Conclusion General psychiatry inpatients in Uganda experience dual harm before admission at lower prevalence than in previous literature. However, no investigated sociodemographic and clinical factors could explain these experiences. Further studies looking at dual harm are warranted to understand these unfortunate experiences with serious consequences among patients in Uganda

Absconding among admitted patients with bipolar affective disorder diagnosis in Uganda

Abstract Background Hospitalization is often necessary for individuals with Bipolar affective Disorder (BAD) during severe manic or depressive episodes, as well as for stabilizing treatment regimens. However, a significant proportion of patients admitted for treatment of BAD abscond or leave the hospital without permission during their stay. In addition, patients managed for BAD may have unique characteristics that might force them into absconding. For example, the high prevalence of co-morbid substance use disorder – craving to use substances, suicidal behaviors – attempts to die by suicide, and cluster B personality disorders – characterized by impulsive acts. It is, therefore, essential to understand the factors contributing to absconding among patients with BAD, to facilitate designing strategies for preventing and managing this behavior. Method This study was based on a retrospective chart review of the inpatients diagnosed with BAD at a tertiary psychiatry facility in Uganda from January 2018 to December 2021. Results Approximately 7.8% of those with BAD absconded from the hospital. The likelihood of absconding among those with BAD increased with the use of cannabis [adjusted odds ratio (aOR) = 4.00, 95% confidence interval (CI) = 1.22–13.09, p-value = 0.022] and having mood lability [aOR = 2.15, 95% CI = 1.10–4.21, p-value = 0.025]. However, receiving psychotherapy during the admission (aOR = 0.44, 95 CI = 0.26–0.74, p-value = 0.002) and treatment with haloperidol (aOR = 0.39, 95% CI = 0.18–0.83, p-value = 0.014) reduced the likelihood of absconding. Conclusion Absconding among patients with BAD is common in Uganda. Those with symptoms of affective lability and those with comorbid cannabis use tend to abscond more, while those who receive haloperidol and psychotherapy are less likely to abscond

Quality of life and relapse of Opioid Use Disorder: a scoping review protocol

Introduction Quality of life (QoL) greatly influences the outcomes of patients with mental illnesses and there is evidence that there is an association between QoL and the relapse of Opioid Use Disorder (OUD). However, no reviews elucidate the relationship between QoL and the relapse of OUD. This document provides a scoping review protocol that aims to systematically chart and synthesise the published, unpublished and grey literature about the relationship between QoL and relapse of OUD.Methods and analysis The enhanced six-stage methodological framework for scoping reviews of Arksey and O’Malley will be used. The main research question guiding the review will be: What is the relationship between QoL and relapse of OUD? Peer-reviewed and non-peer-reviewed articles, reports, and policy documents will be eligible to be included in the review with no limits on publication date. PubMed, PsycINFO, Google Scholar, Scopus, OVID and Cochrane Library will be among the databases searched. We shall identify grey literature from Google Scholar, ProQuest database, Grey Source Index, Open Grey and OpenDOAR. The reporting of the review will follow the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Criteria for evidence inclusion and exclusion will be used during literature screening and mapping.Ethics and dissemination Patients and the public will not be involved in the interpretations of the findings, therefore, we shall not seek approval from an ethics committee. Results will be disseminated through publication in a peer-reviewed, scientific journal, conference presentations

Suicidal behaviors and associated factors among medical students in Africa: A systematic review and meta-analysis

Background: Suicide behaviors are common among medical students, and the prevalence rates might vary across various regions. Even though various systematic reviews have been conducted to assess suicidal behaviors among medical students in general, no review has ever assessed or carried out a sub-analysis to show the burden of suicidal behaviors among African medical students which was fulfilled in the present study. Method: A systematic review and meta-analysis of prevalence studies among African medical students from PubMed, Scopus, PsycINFO, African Journals Online, and Google Scholar databases. A total of 204 publications were identified. The studies' selection, data extraction, and methodological evaluation were performed, and meta-analysis was performed based on the random effects model. Results: Data were obtained from 14 eligible studies, including 8585 medical students in Africa. The pooled prevalence of lifetime suicidal behaviors was 18.7% for suicidal ideation (95% CI: 14.1%-23.3; I 2 = 94.37%; p < 0.001), 3.8% for suicidal plans (95% CI: 2.7%-4.8%; I 2 = 0.03%; p < 0.001), and 5.5% for suicide attempts (95% CI: 3.8%-7.2%; I 2 = 89.47%; p < 0.001). The factors associated with suicidal ideations were female gender, use of alcohol, depression, and use of khat. Only depression was associated with suicide attempts. Limitations: The review involved few studies, and not all African regions were represented. Conclusion: Suicidal behaviors, particularly suicide attempts, are high among medical students in Africa. However, very few studies are done in the region to clearly quantify the burden and its associated factors

Suicide related to the COVID-19 pandemic in India: A systematic review

Abstract Background The suicide rate has increased during the pandemic in India. Moreover, several studies, especially press-media reporting suicide studies have been conducted but no systematic review has been attempted in this context. Therefore, the present study systematically investigated the risk factors associated with suicidal behaviors, and the method of suicide during the COVID-19 pandemic in India. Methods Following the PRISMA guidelines, a systematic search was performed to include papers published up until September 30, 2022. From an initial 144 papers, 18 studies which met the inclusion criteria were included in the present review. The Pierson’s method was used for quality assessment of the included studies in the present review. Results The risk factors associated with suicide comprised: (i) socio-demographic factors (e.g., being aged between 31 and 50 years, male, married, unemployed), (ii) behavior and health-related factors (e.g., unavailability of alcohol and alcohol withdrawal symptoms, poor state of physical health and health issues, family disputes, relationship complexities, and sexual harassment), (iii) COVID-19-related factors (e.g., fear of COVID-19, COVID-19 test results, quarantine or isolation, financial hardship due to the pandemic, having influenza-like symptoms, experiencing stigmatization and ostracism despite testing negative, separation from family due to transport restrictions, misinterpreting other illness symptoms as COVID-19, saving the village from infection, watching COVID-19 videos on social media, online schooling, perceived stigma toward COVID-19, and being suspected of having COVID-19), and (iv) psychopathological stressors (depression, loneliness, stress, TikTok addiction, and poor mental health, suicidal tendencies, helplessness, and worrying). Hanging was the most common method of suicide. In addition, jumping from high buildings, poisoning, drowning, burning, cutting or slitting throat or wrists, self-immolation, medication overdose, electrocution, pesticide, and gun-shot were also used to carry out the suicide. Conclusions Findings from this research suggest multiple reasons for suicide during the COVID-19 pandemic and knowledge of such factors could aid in developing suicide prevention strategies focusing the most vulnerable cohorts inside and outside India

The level of antiretroviral therapy (ART) adherence among orphan children and adolescents living with HIV/AIDS: A systematic review and meta-analysis.

BackgroundMany children and adolescents living with HIV have ended up as orphans. Due to HIV taking away their parents leaves them deprived of their most important social network and support, which predisposes them to poor adherence to antiretroviral therapy (ART). Various studies have shown poor adherence to ART among orphaned children and adolescents. This systematic review and meta-analysis, therefore, aims to determine the level of ART adherence among orphaned children and adolescents living with HIV/AIDS.MethodsThis PROSPERO registered review (CRD42022352867) included studies from PubMed, Google Scholar, Scopus, Web of Science, Africa Journal Online, and selected HIV/AIDS journals from data inception to June 01, 2022. We included articles published in all languages that report the prevalence of adherence to ART among children and adolescent orphans (single parent orphans and/or double orphans) living with HIV/AIDS. We excluded qualitative studies, case studies, opinion papers, and letters to editors. We used the random-effect model to calculate the pooled prevalence of ART adherence based on the highest prevalence provided by the various methods in a particular study. We used the Joanna Briggs Institute Appraisal tool for the prevalence study to evaluate for risk of bias in the included studies. The Egger's test was used to assess small study effects.ResultsOut of 1087 publications identified from the various databases, six met the selection criteria. The included six studies had a total 2013 orphans living with HIV/AIDS. The pooled prevalence of ART adherence was 78∙0% (95% Confidence Interval: 67.4-87.7; I2 = 82.92%, p95%, using one of the following methods: pill count, caregiver's self-report, clinical attendance, and nevirapine plasma levels (above three μg/mL). The factors associated with adherence were pill burden, caregiver involvement, stunting, and caregiver relationship.LimitationThere was a high level of heterogeneity in the finding.ConclusionApproximately four fifth of orphan children and adolescents living with HIV/AIDS adhere to ART. Strategies to improve adherence among this group should be prioritized, especially among the double orphaned children and adolescents