Post-traumatic stress disorder, survivor guilt and substance use - a study of hospitalised Nigerian army veterans

Objectives: To investigate the prevalence of post-traumatic stress disorder (PTSD) and survivor guilt in a sample of hospitalised soldiers evacuated from the Liberian and Sierra-Leonean wars in which Nigerians were involved as peace keepers. The relationships between PTSD, survivor guilt and substance use were also investigated. Design: A socio-demographic data questionnaire, the PTSD checklist and a validated World Health Organization substance use survey instrument were used to obtain data from the subjects.Setting: The study took place at the 68 Nigerian Army Reference Hospital, Lagos, Nigeria, which was the base hospital for all casualties from the Liberian and Sierra-Leonean operations. Subjects: All hospitalised patients from the military operations during a 4-year period (1990 - 1994) who were physically capable of being assessed were included in the study. Results: The prevalence rate for PTSD was found to be 22% and survivor guilt was found in 38% of the responders. PTSD was significantly associated with long duration of stay in the mission area, current alcohol use, lifetime use of an alcohol/ gunpowder mixture, and lifetime cannabis use. Survivor guilt was significantly associated with avoidance of trauma-related stimuli but not duration of combat exposure. Conclusions: Although the sample studied was specific, PTSD might be quite common and probably undetected among Nigerian military personnel engaged in battle in Liberia and Sierra-Leone. Detection of such persons through deliberate screening in military community studies should help to alleviate the symptoms since good intervention methods are now available. Primary prevention efforts with regard to alcohol and cannabis use should help to reduce the incidence of PTSD. South African Medical Journal Vol. 96(2) 2006: 144-14

A Multilevel Analysis of the Impact of Socio-Structural and Environmental Influences on Condom Use Among Female Sex Workers

This study uses multilevel analysis to examine individual, organizational and community levels of influence on condom use among female commercial sex workers (FSW) in the Philippines. A randomized controlled study involving 1,382 female commercial sex workers assigned to three intervention groups consisting of peer education, managerial training, combined peer and managerial intervention and a usual care control group was conducted. The results of the multilevel analysis show that FSWs who work in establishments with condom use rules tend to have a higher level of condom use (β = .70, P < 0.01). Among the different intervention groups, the combined peer and managerial intervention had the largest effect on condom use (β = 1.30, P < 0.01) compared with the usual care group. Using a three-level hierarchical model, we found that 62% of the variation lies within individuals, whereas 24% and 14% of the variation lies between establishments, and communities, respectively. Standard errors were underestimated when clustering of the FSWs in the different establishments and communities were not taken into consideration. The results demonstrate the importance of using multilevel analysis for community-based HIV/AIDS intervention programs to examine individual, establishment and community effects

Psychiatric Morbidity in Private General Practice in Lagos, Nigeria -

Two hundred and ninety-eight consecutive patients referred to the author by general practitioners working in a private general hospital in Lagos were studied. Sixty eight percent of the patients were less than 40 years old. 88% of them presented with somatization symptoms mostly of chronic nature. Internal heat was the commonest somatization symptom. Anxiety and depressive disorders were most commonly diagnosed. At least 58% of the patients reported important psychosocial stresses most of which were related to physical illnesses and financial difficulties. Private general hospital setting might be having a fairly heavy load of psychiatric disorders particularly those with physical symptoms presentation. The importance of early identification of psychiatric disorders in primary care centres has been emphasized. Nigerian Quarterly Journal of Hospital Medicine Vol.9, No.2 (1999) pp.124-12

Prevalence and Correlates of Spouse Violence Among Women in a Primary Health Care Facility in Lagos Nigeria

Background: Violence against women is a major public health problem that affects millions of women each year worldwide. Spouse violence is said to have three broad dimensions: physical, psychological and sexual, but these often overlap in reality. Aims: The aims of the study were to determine the prevalence of spouse violence among women of reproductive age group 15 to 50 yrs attending a primary care clinic in Yaba, Lagos state and to describe the patterns of spouse violence. Method: Three hundred and twenty one participants, who were patients and/or mothers of (children) patients, were selected through a systematic sampling method; 265 of them eventually participated in the study (82.5% response rate). A questionnaire on domestic violence was used to collect data. The data were analyzed using SPSS version 10. Results: The results showed a high life time prevalence rate of violence of 50.9 % among the women. The most commonly experienced physical abuse was demand for sex when the women did not want it (52.2%). Marital rape accounted for 21%. Controlling actions, associated with psychological trauma, were found in 71.9% of the participants; while about 35% had felt afraid of their partners at some time

Prevalence of anxiety and depressive disorders among informal caregivers of patients attending the Federal Neuropsychiatric Hospital, Yaba, Lagos, Nigeria

Background: Studies on the informal caregivers of the mentally-ill in Europe and America have revealed a high prevalence rate of anxiety anddepressive disorders among this group when compared with controls. Thereis a dearth of studies on the effect of the caregiving role on informalcaregivers in Nigeria.Aims: The aim of the study was to compare the prevalence of anxietydisorders and depression among informal caregivers of mentally-illpatients attending the Federal Neuropsychiatric Hospital Yaba, Lagos, Nigeria with that of a noncaregiving population.Methods: The self-administered questionnaire consisted of the sociodemographic data and the two screening instruments - the GeneralHealth Questionnaire-28 (GHQ-28) and the Hospital Anxiety and Depression Scale (HADS). An interview was carried out thereafter using the Present State Examination (PSE) to obtain an ICD-10 diagnosis from those subjects who scored above the cut-off marks on either of the screening instruments earlier used.Results: Most of the caregivers were offspring of the care-receivers (35.7%) and siblings (24.1%). Many of them (84%) did not know the care-receiver's diagnosis. More than half of the caregivers had lived and cared for their wards for more than two years. A lot of the caregivers (77.4%) had respite relief from care mostly given by the hospitals (43.7%) and other family members (35.8%) and about 72.2% of them also had other supportive measures from their relatives which included money (31.6%) and visits (25.4%). Despite this, most (64.2%) of the caregivers had difficulty with their care giving roles which was mainly financial in nature (42.4%) and sometimes antagonism from their care-recipients (15.1%). No social welfare or inter-agency assistance was available for 78.7% of caregivers. At least 90% of these caregivers reportedself as being deeply religious individuals and 71.4% of them wereappreciated for their care giving role by the care-recipients. A higher prevalence rate (16.5%) of depressive disorders was found in caregivers than in the noncaregivers (11.1%) but this was not statistically significant (X2=2.817, df=1, p=0.093). The prevalence of anxiety disorder was relatively similar for the two comparison groups being 11.3% in caregivers and 11.6% in the non-caregivers (X2=0.009, df=1, p=0.924). Noted however is that being single, elderly and formal-healthcareseekingwas significantly associated with psychopathology in these caregivers.Conclusion: Overall, these Nigerian informal caregivers seemed not to beat a significantly higher risk for development of anxiety and depressivedisorders in reaction to a stressful life situation like care giving to mentally-ill persons than their non-caregiving population. This is despite poor welfare support, major financial constraints and difficulty with their caregiving roles. Most of these caregivers however had good family support, appreciation from the care-receivers and deep religiousaffiliations and practices

Prevalence Of Sleep Disturbances Among Primary Informal Caregivers To Persons With Mental Illness Attending The Neuropsychiatric Facility In Lagos, Nigeria: A Comparative Study

Background : Sleep is a physiological process that is important to the physical and psychological  wellbeing of humans. Sleep can become disturbed for medical , psychological and environmental reasons. Studies from different parts of the world has shown that informal caregivers of chronically ill persons have high prevalence for sleep disturbances. There is a dearth of such studies among Nigerians.Aim: To determine the prevalence of sleep disturbances among primary informal caregivers to persons with mental illness and to compare it with that obtained among non-caregivers within the same region.Methods: This study was a crosssectional, comparative study conducted among 250 caregivers to persons with mental illness and 216 non-caregivers. All the subjects were randomly selected and had to meet the inclusion criteria. The selfadmini s tered ques t ionnai re contained the General Health Questionnaire-28 and a proforma which was designed to elicit sociodemographic data and the presence of sleep disturbance in the subjects within the last 6-12 months period.Results: The prevalence of sleep disturbance was found to be significantly higher among caregivers  (27.7%) when compared with non-caregivers (12.3%). The general health questionnaire (GHQ) which is popularly used for screening for psychological distress was only able to pick out 53.3% of the caregivers with sleep disturbances. Amongst the caregivers, advancing age and belonging to a polygamous family setting were significantly associated with sleep disturbances.Conclusion: Caregivers are at almost thrice the risk of sleep disturbances than the noncaregivers (OR = 2.7, CI= 1.26-1.74). Periodic screening of caregivers should be done with specific sleep instruments especially for those of them who operate dangerous machinery and commercial vehicles.Keywords: Prevalence, Sleep disturbances, primary informal caregiver, persons with mental illnes