Chronic Sorrow: Lived Experiences of Caregivers of Schizophrenic Patients in Butabika Mental Hospital, Kampala, Uganda.

Grief is a central experience by people diagnosed with mental illness, families, and friends. Chronic sorrow is defined as pervasive sadness and/or other emotional reactions commonly associated with grief that is permanent, periodic and potentially progressive in nature. It is viewed as a normal reaction to loss that may be to a single event or ongoing. During the experience of chronic sorrow, people feel emotional commotion, discomfort, & hopelessness. It may progress to pathological grief or depression. It may also trigger some of the psychiatric disorders in individuals who are vulnerable. No documented study in Uganda has addressed the problem of chronic sorrow among caregivers of patients with mental illness. Objective The theory of chronic sorrow was used to guide this study. The aim of the study was to explore the experience of chronic sorrow among caregivers of patients with schizophrenia in Uganda. Methodology This study employed a descriptive qualitative design using Focus Groups and In-depth interviews. The research was carried out at Butabika National Mental Hospital in Kampala. The study was conducted in Luganda. There were 10 in-depth interviews and 2 focused group discussions. The sample size was based on the principle of data saturation and purposive sampling technique was used. The caregivers who met the inclusion criteria, consented and were interviewed using the chronic sorrow questionnaire guide (caregiver version). The interviews were recorded, transcribed, translated to English and analyzed through content analysis of a framework by Graneheim & Lundman (2004). Results 9 out of 10 caregivers experienced Chronic Sorrow. The triggers identified were, unending care giving, change in behavior (refusal to take drugs, refusal to go to hospital), management of crises (during relapse and side sides of drugs), society reaction to mental illness (abandoning and mistreating patients, discrimination) and missed companionship. Unhelpful factors were poor communication by health workers, stigma from community, Uncooperative iii police. The coping strategies used were, interpersonal strategies, action oriented activities (keeping busy), positive thinking, avoidance, emotional (crying). Caregivers indicated that health workers should show understanding, communicate properly, and provide information, facts about mental illness to them and community. Taking mental health services nearer to the people throughout the country and follow up visits were also suggested. Conclusions. Caregivers of patients with schizophrenia are most likely to have chronic sorrow, the sadness and the grief related feelings are triggered by different factors which can be internal or external. Effective coping strategies are needed to be used by the caregivers in order to help them keep up with the task of caregiving and health workers have a great role to play

Stigma towards people with mental illness: a cross-sectional study among nursing staff in health facilities in Amolatar district, Uganda

Includes bibliographical referencesIntroduction: Mental health of Ugandans could be improved through mainstreaming the services into primary care systems. Nurses constitute a high percentage of the workforce in health; therefore they can significantly contribute towards several experiences by patients with mental illness. Stigma towards mental illness and individuals living with mental illness is among the major hindrances to effective mental health service delivery amongst healthcare workers. Therefore it is important for stigma to be explored among general nurses as mental health services are being integrated into the primary health care. The aim of this study was to explore stigma among general nurses towards mental illness and individuals living with mental illness. Methods: This was a cross-sectional quantitative study. Self-administered questionnaires were distributed to nurses working in Amolatar district health facilities that measured knowledge, attitudes and behaviour towards individuals living with mental illness, in addition to their familiarity with a person with mental illness. Descriptive statistics were used to determine the extent to which stigma was reported in this population. Bivariate and multivariate analyses were done using linear and logistic regressions to identify the predictors of the knowledge, attitudes and behaviours of nurses regarding mental illness and individuals living with mental illness. Results: Sixty-three general nurses participated in the study. Most of the participants identified schizophrenia as an SMI, however 79% considered stress to be mental illness and only a quarter of respondents scored above 80% on knowledge about mental illness. Most of the participants believed that psychotherapy was the most effective treatment for mental disorders. The nurses were benevolent (mean 3.06, s.d 0.29) and showed acceptance towards mental health services and individuals living with mental illness in the community (mean 3.56, s.d 0.30) however the nurses tended towards authoritarianism (mean 3.74, s.d 0.34) and social restrictiveness (mean 2.98, s.d 0.27). Level of contact with individuals living with mental illness predicted community mental health ideology and authoritarianism. No demographic variables were associated with level of knowledge using MAKS score and intended behaviour using RIBS tool. Conclusion: This study has provided some of the first data on stigma among primary health care nurses towards people with mental illness in Uganda and has added to knowledge of stigma towards people with mental illness by health care providers in LAMIC. Many of the findings were positive and bode well for the planned integration of mental health in primary health care. The negative findings of this study have shown that there are many areas for improvement which could be tackled by interventions such as public and community education, and in-service training regarding causes and management of mental disorders. Further research could be done to understand more about the negative attitudes found in many LAMIC

Intimate partner violence among pregnant teenagers in Lira district, northern Uganda: a cross-sectional study

Background/aims: Intimate partner violence during pregnancy is associated with adverse health outcomes for mothers and their unborn babies. Whereas the literature on intimate partner violence in the general population is extensive, little is known about this type of violence among pregnant teenagers, especially in resource-limited settings. This study aimed to determine the prevalence and factors associated with intimate partner violence among pregnant teenagers attending antenatal care clinics in Lira District, northern Uganda. Methods: This was a cross-sectional study of 310 pregnant teenagers attending antenatal care clinics at the Lira Regional Referral Hospital and Ogur Health Center IV. Eligible teenagers were recruited consecutively until the required sample size was accrued. Data were collected using a structured questionnaire. Intimate partner violence was determined using the Revised Conflict Tactile Scale 2. Logistic regression analysis was performed to identify factors associated with violence during pregnancy, while considering potential confounding factors. Results: The overall prevalence of intimate partner violence among pregnant teenagers was 40.6%. The prevalence of psychological violence was 37.1%, sexual assault was 29%, and physical violence was 24.8%. Partner alcohol intake (odds ratio=5.00, P=0.000); polygamy (odds ratio=2.80, P=0.001) and the inability of the teenage mother to make major decisions in the home (odds ratio=2.42, P=0.006) were independently associated with intimate partner violence during pregnancy. Conclusions: Approximately 4 in 10 pregnant teenagers in Lira district, northern Uganda experienced intimate partner violence. This is higher than has been reported in the general population of pregnant women in Uganda. Intimate partner violence screening and counselling should be part of the routine antenatal care package.publishedVersio

Pre-intervention child maltreatment risks, intervention engagement, and effects on child maltreatment risk within an RCT of MHealth and parenting intervention

IntroductionEvidence-based mental health and parenting support services for mothers postpartum can reduce risk for child maltreatment. However, women suffering economic and cultural stressors disproportionately shoulder the burden of infant caregiving while experiencing profound barriers to accessing mental health and parenting services. This article reports on an MHealth and parenting intervention targeting maternal mood and positive parent practices within a randomized controlled trial, which provided a unique opportunity to view pre-intervention child maltreatment risk, its relationship to subsequent intervention engagement, and intervention engagement effects on pre-post child maltreatment risk reduction.MethodPrincipal component factor analysis was conducted to identify a modifiable pre-intervention child maltreatment risk construct within a combined MHealth and parenting intervention sample of 184 primarily Black mothers and their infants. An independent t-test was conducted to compare pre-intervention child maltreatment risk levels between mothers who went on to complete at least two-thirds of the intervention and those who did not. A GLM repeated measures analysis of variance was conducted to determine effects of intervention engagement on child maltreatment risk reduction.ResultsPre-intervention child maltreatment risk did not differentiate subsequent maternal intervention completion patterns. Mothers who completed two-thirds of the intervention, compared to those who did not, demonstrated significant reductions in pre-post child maltreatment risk.DiscussionFindings underscore the potential of MHealth parenting interventions to reduce substantial child maltreatment risk through service delivery addressing a range of positive parenting and behavioral health needs postpartum, a particularly vulnerable developmental period for maternal depression and child maltreatment risk

Examing how Nurses\u27 Personal Experiences with Mental Illness Relate to Stigma and Discrimination against People with Mental Illness in Rural Northern Uganda.

Introduction: Rural Primary Health Care (PHC) nurses in post-war settings experience mental health problems resulting from traumatic exposures. They also experience burnout and compassion fatigue caring for high number of patients with untreated mental health problems due to cultural practices that promote stigma, and lack of adequate mental health services. Social stigma is society’s negative perceptions of an individual with mental illness, viewing them as socially unacceptable. The purpose of the study is to provide foundational understanding to inform future development of anti-stigma interventions PHC in rural northern Uganda. Research questions included;(1) What percentage of PHC nurses have personal experience with mental health disorders? (2) How do knowledge of and beliefs about mental health relate to mental health attitudes of PHC nurses in rural northern Uganda? (3) Do personal experiences with mental illness moderate the relations between knowledge, beliefs, and mental health related attitudes? (4) Following through with findings from research questions 2 and 3, do the mental health attitudes of nurses, explained by their knowledge and beliefs about mental illness and moderated by their personal experience with mental illness, relate to nurses’ future intended behavior with individuals suffering with mental illness? Methods. To address these research questions, an existing data set of 65 nurse participants that captured stigma measures was used to conduct secondary analysis. In addition to original study variables (attitude, reported future intended behavior, age and sex), new variables of interest were constructed. These included: personal experience with mental illness derived from a 12 item Level of Contact Report (Corrigan et al., 2001), knowledge about common mental disorders and beliefs about mental health both derived from the Mental health Knowledge Schedule (MAKS; Evans-Lacko, et al., 2010). SPSS version 28 was used to generate descriptive statistics and conduct linear regression modelling to answer the research questions. Results: More than a quarter of the study participants (28%) had personal experience with mental illness. Beliefs about mental illness explained significant variance in nurses’ benevolence attitude (β=.755, R2=.135, p=.003), with higher levels of positive beliefs about mental illness being related to higher levels of benevolence attitudes. The interaction of knowledge x beliefs explained significant variance in social restrictiveness attitude (β=-.146, R2=.122, p=.022), with higher levels of knowledge interacting with higher levels of positive beliefs being related to lower levels of social restrictiveness attitudes. Personal experience with mental illness moderated the relationship between combined knowledge of and beliefs about mental illness and social restrictiveness attitudes (β=.070, p Conclusion: To better address nurses’ mental health needs and to counter mental health stigma in rural Uganda, future rigorous studies, which employ sensitive measures of nurses’ personal experience, mental health beliefs, and cultural practices are needed. Future studies should also explore nurses’ mental health needs and innovative ways of addressing their mental health needs in the rural setting

Existence, triggers, and coping with chronic sorrow: a qualitative study of caretakers of children with sickle cell disease in a National Referral Hospital in Kampala, Uganda

Abstract Background Worldwide, sickle cell disease is recognized as one of the major causes of morbidity and mortality. Caregivers and patients with such chronic illnesses experience economic, physical, social and psychological distresses which may lead to chronic sorrow. Chronic sorrow is viewed as a normal reaction to loss, however it can progress to a pathological state such as depression if the coping styles are ineffective. Therefore, the aim of this study was to explore the existence of chronic sorrow, triggers and coping with grief related feelings among caretakers of children with sickle cell disease. Methods A descriptive qualitative study was conducted. Twelve in-depth interviews were conducted with eligible participants who were purposively selected. Deductive thematic analysis methods were used for data analysis. Results Many (9 out of 12) of the caretakers experienced chronic sorrow. The grief related feelings were triggered by health worker related, disease related and support related factors. Caretakers used both external and internal coping strategies. External support was derived from community, family and health facility. Internal coping strategies were behavioral and cognitive. Conclusion Caretakers of children with sickle cell disease experienced chronic sorrow and employed both internal and external coping strategies to deal with it, which could be either effective or ineffective. This study recommends that health workers should routinely screen for chronic sorrow among caretakers of children with sickle cell disease and assist caretakers to strengthen effective coping strategies to ameliorate the negative effects of chronic sorrow

Intimate partner violence among pregnant teenagers in Lira district, northern Uganda: a cross-sectional study

Background/aims: Intimate partner violence during pregnancy is associated with adverse health outcomes for mothers and their unborn babies. Whereas the literature on intimate partner violence in the general population is extensive, little is known about this type of violence among pregnant teenagers, especially in resource-limited settings. This study aimed to determine the prevalence and factors associated with intimate partner violence among pregnant teenagers attending antenatal care clinics in Lira District, northern Uganda. Methods: This was a cross-sectional study of 310 pregnant teenagers attending antenatal care clinics at the Lira Regional Referral Hospital and Ogur Health Center IV. Eligible teenagers were recruited consecutively until the required sample size was accrued. Data were collected using a structured questionnaire. Intimate partner violence was determined using the Revised Conflict Tactile Scale 2. Logistic regression analysis was performed to identify factors associated with violence during pregnancy, while considering potential confounding factors. Results: The overall prevalence of intimate partner violence among pregnant teenagers was 40.6%. The prevalence of psychological violence was 37.1%, sexual assault was 29%, and physical violence was 24.8%. Partner alcohol intake (odds ratio=5.00, P=0.000); polygamy (odds ratio=2.80, P=0.001) and the inability of the teenage mother to make major decisions in the home (odds ratio=2.42, P=0.006) were independently associated with intimate partner violence during pregnancy. Conclusions: Approximately 4 in 10 pregnant teenagers in Lira district, northern Uganda experienced intimate partner violence. This is higher than has been reported in the general population of pregnant women in Uganda. Intimate partner violence screening and counselling should be part of the routine antenatal care package