Background: The study was carried out to investigate the manifestations of psychological distress and symptoms among individuals receiving treatment for sexually transmitted diseases and to compare them with individuals who were not suffering from sexually transmitted diseases.Methods: Patients attending the sexually transmitted disease clinic of the Lagos State University Teaching Hospital, Ikeja, Lagos were recruited for this study; while the comparison group (n=50) was made up of participants attending the outpatient clinic of the University of Lagos Medical Centre, Akoka, Lagos. The participants completed the Symptoms Distress Checklist-90 (SLC-90) and Psychophysiological Symptoms Checklist (PSC).Results: The findings showed that 80% were males. The ages of the respondents ranged from 22 to 52 years, with a mean of 31.4 years. The participants in the study group obtained higher mean scores on interpersonal sensitivity (C), depression (D), anxiety (E) and hostility (F). The participants in the study group also had higher mean score in the PSC than those in the control group. Significant differences were found in SLC-(B) obsessive-compulsive, (E) anxiety and (F) Hostility. Of the total participants, 15 (30%) of the study group had previous STI infections when compared to 3 (6%) of the comparison group.Conclusion: It is suggested that clinicians running the sexually transmitted diseases should screen their patients for psychological disturbances and also work with mental health experts to provide psychological services for identified patients suffering from psychological distress among those attending the STI clinic.Keywords: Psychological reactions, sexually transmitted infections, Lagos, Nigeri

Agiobu-Kemmer, I

Coker, AO

Coker, OO

English

AJOL - African Journals Online

4Introduction be elusive.  However, published literature demonstrated that individuals who seek Sexually transmitted Infections (STIs) are treatment for sexually transmitted  diseases reported to be highly prevalent worldwide experienced various degrees of psychological with an estimate of about 448 million new 5-6distress.  The reported prevalence rates of STI in 1cases of curable STDs.  These reported cases the general population ranged from 5.2% to of STIs also have serious public health and 1,621.3%   and for those in high risk groups, 2-3economic consequences.  Despite this high prevalence rates ranged from 22.0% to 51.0%.7-8 numbers, accurate estimates of incidence and Common mental health illnesses such as prevalence of sexually transmitted infections generalised anxiety disorders, unipolar, bipolar in the world have been repeatedly reported to and somatoform disorders have been reported Psychological distress and symptoms among patients attending sexually transmitted infections clinic in Lagos, NigeriaCorrespondence to:Coker A.OSenior Lecturer/Consultant PsychiatristDepartment of  Behavioural Medicine,Lagos State University College of  Medicine,Ikeja, Lagos, NigeriaEmail: cokerrotimi@gmail.comTel: (+234)80332675441 2 3Coker O.O , Coker A.O , Agiobu-Kemmer I1Medical Department, University of  Lagos Medical Centre, University of  Lagos, Akoka, Lagos, Nigeria2Department of  Behavioural Medicine, Lagos State University College of  Medicine, Ikeja, Lagos, Nigeria3Department of  Psychology, University of  Lagos, Akoka, Lagos, NigeriaABSTRACTBackground  The study was carried out to investigate the manifestations of  psychological distress and symptoms among individuals receiving treatment for sexually transmitted diseases and to compare them with individuals who were not suffering from sexually transmitted diseases. MethodsPatients attending the sexually transmitted disease clinic of  the Lagos State University Teaching Hospital, Ikeja, Lagos were recruited for this study; while the comparison group (n=50) was made up of  participants attending the outpatient clinic of  the University of  Lagos Medical Centre, Akoka, Lagos. The participants completed the Symptoms Distress Checklist-90 (SLC-90) and Psychophysiological Symptoms Checklist (PSC). ResultsThe findings showed that 80% were males. The ages of  the respondents ranged from 22 to 52 years, with a mean of  31.4 years. The participants in the study group obtained higher mean scores on interpersonal sensitivity (C), depression (D), anxiety (E) and hostility (F). The participants in the study group also had higher mean score in the PSC than those in the control group. Significant differences were found in SLC-(B) obsessive-compulsive, (E) anxiety and (F) Hostility. Of  the total participants, 15 (30%) of  the study group had previous STI infections when compared to 3 (6%) of  the comparison group. ConclusionIt is suggested that clinicians running the sexually transmitted diseases should screen their patients for psychological disturbances and also work with mental health experts to provide psychological services for identified patients suffering from psychological distress among those attending the STI clinic.KEYWORDSPsychological reactions, sexually transmitted infections, Lagos, Nigeriajournal ofCOMMUNITY HEALTH& PRIMARY HEALTH CARE  Journal of Community Medicine and Primary Health Care. 27(1) 20-26JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 27, NO 1, MARCH 2015                     20to make a significant contribution to the carry out the study was sought from the burden of disease and disability in Research and Ethics Committee of the hospital. 9developing countries.   These mental health Written informed consents were obtained from disorders were also found to be responsible every participant of this study. Fifty consecutive for up to 10% of the total global disease patients who visited the STI clinic of the 10 department of medicine of LASUTH were burden.   Recent reports also showed that at invited to take part in the study. Another fifty least a third of all patients seen in primary convenience consecutive participants were care settings in developing countries present 10-11 recruited from the medical outpatients' clinic of with these common mental illnesses.  These the University of Lagos, Medical Centre. The comorbid psychopathologies are usually not participants completed a questionnaire that recognised thus ineffectively treated. collected data on sociodemographic details such However, psychological symptoms such as as age, sex, education, previous STD infection low moods, panic, anxiety, hypochondriasis and condom use. The participants also and depression were found to be common 14completed the Symptom Distress Checklist 90  among patients receiving treatment for 1511-13 and Psychophysiological Symptoms Checklist.  sexually transmitted illnesses.  Studies of The Symptoms Checklist (SCL-90) is a 90-item the associations of STI and psychological 10morbidity remain unexplored in Nigeria and inventory designed to assess  primary sub-Saharan countries. Both manual and categories of symptoms associated with distress electronic literature search showed very in medical and community settings. The ten scanty reports from sub-Saharan countries. categories are: somatisation, obsessive-Many studies on the important association compulsive behaviour, interpersonal sensitivity, were carried out in Western countries. This depression, anxiety, hostility, phobic anxiety, study was therefore designed to determine paranoid ideat ion,  psychot ic ism and the degrees of psychological distress and neuroticism. The Psychophysiological  symptoms among patients attending a Symptoms Checklist (PSC) was designed to sexually transmitted disease clinic of a measure stress reaction among those various teaching hospital in Lagos, Nigeria and clinical populations. It is a 50-item inventory that compare the findings with a control group of has a 5-point Likert-typed response format.  The non-sufferers of sexually transmitted PSC and SCL-90 had been widely used in illnesses from another outpatient clinic of university and community based studies in 16-17other physical diseases. Nigeria.Data analysis Materials and MethodsData collected was analysed with the aid of the This study had a descriptive cross-sectional Statistical Package for Social Sciences (SPSS) design. The study took place at the sexually version 15.0.1. Continuous variables were transmitted illness (STI) clinic of the medical expressed as means and standard deviation. outpatients department of the Lagos State One-way Analysis of variance (ANOVA) was University Teaching Hospital,  Ikeja used to find out if there were significant (LASUTH), Lagos, Nigeria. The permission to JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 27, NO 1, MARCH 2015                     21differences among the two groups of respondents, 36 (72.4%) were single and 12 respondents in all the eleven psychometric (24%) were married. Approximately half of the measures.  A p value < 0.05 was taken as respondent population 26 (52.2%) had higher significant. education while 20 (40%) had secondary school completed as shown in Table I. With regards to psychopathological reactions, the mean scores Resultsand standard deviations of the 10 scales of the SCL-90 and PSC were computed. The results are Of the one hundred participants that were reflected in Table II. The Summary of one-way surveyed, 40 (80.0%) were males while 10 ANOVA in comparing the two groups on the 11 (20%) were females. The ages of the psychological measures was shown in Table III. respondents ranged from 22 to 52 years, with a mean of 31.4 years. Majority of the Table I: Sociodemographic details of the participants   Variable     Frequency   Percent (%) ________________________________________________________________ Age 16-24     22    44 25-34     10    20 35-44     8    16 45-54     5    10 55-64     5    10  Sex Male     40    80 Female     10    20  Educational status No education Primary school completed  4    8 Secondary school completed  20    40 Tertiary education completed  26    52 Marital status Single     36    72 Married    12    24 Separated/ Divorced   2    4 JOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 27, NO 1, MARCH 2015                     22 Measures Between Groups Within Groups Total Feal  SS   MS SCL-90 A 3213.56 1406.91 4620.48 91 B 1233.03 141.167 1374.20 3.24* C 1092.34 371.33  1463.68 1.17 D 24123.07 76255.33 100378.42 .12 E 1633.45 252.167 1885.62 2.59* F 1572.20 98.917  1771.12 3.16* G 415.35            396.66  812.02   .41 H 642.25  122.167 764.42  2.10 I 788.61  652.66  1441.28  .48 J 1449.50 477.00  1936.50 1.21 PSC  668.52  334.26  73515.94  0.66     Group I                  Group II      (n=50)         (n=50)  SN  (X)  (SD)   (X)  (SD) SCL-90 A  9.46  5.35   7.68  7.84 B  11.08  5.46   7.46  7.04 C  14.48  9.71   7.68  7.83 D   26.46  45.26   8.00  8.16 E  10.74  6.20   6.74  8.36 F  10.24  6.01   2.26  3.12 G   1,14  4.07   2.14  3.30 H   4.84  3.94   4.70  5.80 I   1.12  5.42   3.54  5.29 J   8.10  6.27   4.44  5.98  PSC  43.70  27.29   26.04  23.60   Table II: Mean scores (x) and standard deviation (SD) of the two groups on II psychometric measures. Table III: Summary of one-way ANOVA in comparing the two groups on the 11 psychological measuresJOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 27, NO 1, MARCH 2015                     2319Discussion However, Erbelding et al  found that 39.2% of their respondents in the STI clinic had This study sought out to investigate the depression and women were found to suffer psychological distress and symptoms among more from depression. They concluded that patients attending the sexually transmitted symptoms of depression were extremely high illnesses clinic of the medical department of among STI patients, which may compromise the the Lagos State University Teaching success of risk reduction counselling.Hospital, Lagos, Nigeria and compared them  The possible explanation for the manifestations with patients attending the outpatients' of psychological distress and psychiatric clinic of the Medical Centre of the University symptoms could be due to social stigma of Lagos, Lagos, Nigeria. The findings of this associated with STIs, embarrassment and shame study showed that participants in the study of visiting an STI clinic; physical and emotional group obtained higher mean scores on pain associated with STI, possibility of interpersonal sensitivity (C), depression (D), transmitting sexually transmitted illnesses to anxiety (E) and hostility (F) when compared partners, fear of infertility, the negative belief with participants in the control group. The that certain forms of STIs are incurable or fear of participants in the study group also scored death may have led to these high scores.5,18-19 higher in the PSC when compared to those in Some individuals who are suffering from mental the control group. However, participants in health disorders such as mania, personality the control group obtained higher mean disorders or grandiose delusions may easily scores on phobic anxiety (G) and psychotism contract sexual infection due to lack of control (I) scales.  Significant differences were found over their impulsive sexual desires or 2 0 - 2 3in three out of the 11 psychometric measures b e h a v i o u r .  I f  t h e s e  a s s o c i a t e d  and these were (B) obsessive-compulsive, (E) psychopathologies are not detected early, it anxiety and (F) Hostility. These findings could prolong recovery period or even worsen appear to be in consonance with findings of the disease conditions. However, In order to similar studies from other countries. For alleviate the psychological distress associated example One Australian study showed that with STIs, sessions of cognitive behaviour 44% of their patients with STI had therapy were observed to reduce the distress and 18psychological distress.  Another study from also facilitate change in risk behaviour.24 This Pakistan showed that 34% of total sexually study is not without its shortcomings; they transmitted disease patients had mental include its small sample size and specific health disorders. Anxiety disorder (11.2%) prevalence of each psychiatric disorder was not was found to be most common, followed by determined. Likewise, specific diagnoses of the depressive disorder (8.4%), psychoactive STI being treated were not included. substance use disorder (6.8%), sexual Nonetheless, in spite of these limitations, the dysfunction (6.8%), bipolar mood disorder study was able to add to the body of knowledge 18(0.4%), and schizophrenia (0.4%).  In a a s  r e g a r d s  c o m o r b i d i t y  b e t w e e n  similar manner, 18 reported that psychopathology and STI. However, future more than 50% of their respondents had researches should be directed at replicating this significant levels of increased anxiety. study with larger samples in different hospitals Osborn et alJOURNAL OF COMMUNITY MEDICINE AND PRIMARY HEALTH CARE VOL. 27, NO 1, MARCH 2015                     24Transmission and Infection 2008;84(7): throughout Nigeria. 535-40. Conclusion 4. Cates W. 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Psychological distress and symptoms among patients attending sexually transmitted infections clinic in Lagos, Nigeria

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Psychological distress and symptoms among patients attending sexually transmitted infections clinic in Lagos, Nigeria

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