Although individuals with mental disorders are reported to experience dental problems similar to the general population, evidence suggests they actually have higher risks of dental disease and increased oral health needs. This study describes the dental status of 105 psychiatric outpatients in a Nigerian hospital. Information was obtained from subject interviews, medical records, and an oral examination to determine their dental caries and periodontal disease status. The oral hygiene status of the study participants was poor; the mean oral hygiene index score was 2.7 ± 1.20. The decayed, missing, and filled teeth ranged from 0 to 9 with a mean of 2.3 ± 2.28. Only five subjects (4.9%) had restorations and the mean number of filled teeth was .14 ± .67. The subjects' age was significantly related to the mean oral hygiene score (p=.005), the mean gingival score (p=.006), and caries occurrence (p=.047). The oral health status of psychiatric patients in Nigeria is poor, indicating the need to provide oral health education and increase access to dental care for these patients.

BACKGROUND Studies in this region have all been limited to public stigma whereas little is known about the extent of self-stigma. AIMS To assess the extent, domains and correlates of self-stigma among psychiatric outpatients in Lagos, Nigeria. METHOD Psychiatric outpatients (n = 342) from three centres completed a modified version of the Internalized Stigma of Mental Illness scale (ISMI) as a measure of their self-stigma. They were also evaluated for various sociodemographic and clinical related variables. RESULTS A total of 74 (n = 21.6%) patients were classified as having 'high self-stigma'. The correlates of high self-stigma included unemployment (OR 3.85, 95% CI 2.55-7.00), poor social support (OR 10.82, 95% CI 4.85-24.84), longer duration of illness (OR 10.35, 95% CI 4.36-25.78) and having full insight into the illness (OR 4.23, 95% CI 2.16-8.76). CONCLUSIONS Self-stigma is a common phenomenon in psychiatric outpatients in this environment. The present anti-stigma programmes must extend to regions of sub-Saharan Africa and incorporate self-stigma as a matter of priority.

OBJECTIVE This study explored life satisfaction among patients with schizophrenia in Nigeria and its relationship with objective living situation. METHODS Adult outpatients (N=99) were assessed with the brief version of the World Health Organization Quality of Life Scale. They also rated aspects of their objective living situation corresponding to the satisfaction items. RESULTS In contrast to their poor living conditions, most patients expressed a high level of life satisfaction. Items with the highest scores included satisfaction with self,"life meaningful,""enjoying life," and overall quality of life; items with the lowest scores included personal relationships, transport, money, and capacity to work. Of 12 satisfaction items, only four (sleep, daily living, relationships with individuals of the same gender, and condition of living place) were significantly correlated with objective measures. CONCLUSIONS The correlation between subjective life satisfaction and objective living conditions of Nigerian patients with schizophrenia was poor. Efforts to enhance their quality of life should focus on improving work opportunities and transportation options.

BACKGROUND A high level of adherence to prescribed antiretroviral (ARV) regimens is required to achieve and maintain suppression of human immunodeficiency virus (HIV) replication and prevent drug resistance. OBJECTIVE This study aimed to determine the possible relationship between psychopathology and ARV medication adherence in Nigeria. METHOD Persons with HIV infection (N=182) completed various questionnaires on sociodemographic and clinical details, general psychopathology, self-esteem, and medication adherence. RESULTS Low medication adherence was reported in 26.9% of the participants; significant correlates included presence of psychopathology and perceived poor social support. CONCLUSION The success of any intervention policy for HIV-infected persons in sub-Saharan Africa must consider both low level of medication adherence and its associated factors.

BACKGROUND Maternal psychopathology and self-esteem during childbirth may have an effect on maternal parenting self-efficacy. OBJECTIVE This study aimed to asses the self-esteem of newly delivered primiparous mothers who had cesarean section (CS) in relation to their parenting self-efficacy. METHODS A total of 115 primiparous women who delivered by CS were compared with 97 matched controls who had vaginal delivery during the same period. They completed the Rosenberg self-esteem scale prior to discharge. They also completed the parent-child relationship questionnaire at six weeks postpartum, together with the Rosenberg self-esteem scale. RESULTS The mean score on the Rosenberg self-esteem scale was significantly lower for the CS group, both prior to discharge (p = 0.006) and at six weeks (p < 0.001), than the vaginal delivery group. The mean score on the parent-child relationship questionnaire was also lower in those who had CS compared with those who had vaginal delivery (p < 0.001, OR 4.71, 95% CI 1.75-14.71). CONCLUSION CS in Nigerian women is associated with lowered self-esteem and predicts poor parenting self-efficacy in the postnatal period. Psychological support and techniques to improve self-esteem and parenting should be incorporated into the management of women having CS.

OBJECTIVE This study aims to assess the level of self-esteem of newly delivered mothers who had caesarean section (CS) and evaluate the sociodemographic and obstetrics correlates of low self-esteem in them. METHODS Newly delivered mothers who had CS (n = 109) and who had spontaneous vaginal delivery (SVD)(n = 97) completed questionnaires on sociodemographic and obstetrics variables within 1 week of delivery. They also completed the Rosenberg self-esteem scale. RESULTS. Women with CS had statistically significant lower scores on the self-esteem scale than women with SVD (p = 0.006). Thirty (27.5%) of the CS group were classified as having low self-esteem compared with 11 (11.3%) of the SVD group (p = 004). The correlates of low self-esteem in the CS group included polygamy (odd ratio (OR) 4.99, 95% confidence interval (95% CI) 1.62-15.33) and emergency CS (OR 4.66, 95% CI 1.55-16.75). CONCLUSIONS CS in South-Western Nigerian women is associated with lowered self-esteem in the mothers.

This study aimed to evaluate the pattern and correlates of premenstrual symptomatology amongst Nigerian female undergraduates. Female University students (n = 409) completed questionnaires detailing sociodemographic, menstruation/gynecological history and personality traits. They were then rated with a checklist for premenstrual symptoms. The most frequent premenstrual symptoms were 'breast tenderness'(35.5%),'sleeplessness'(15.6%),'decreased interest in usual activities'(15.4%),'lethargy/easy fatigability/lack of energy'(13.2%) and 'change in appetite'(13.2%). The prevalence of premenstrual symptomatology was 50.1% and the correlates of increasing premenstrual symptomatology included increasing age, increasing severity of menstrual pain, personality traits of neuroticism and agreeableness and increasing body mass index. Although the rate of premenstrual symptomatology in sub-Saharan African women was comparable with that in the western cultures, there may be cross-cultural differences in the pattern of presentation. Dysmenorrhoea and personality traits should be taken into consideration when planning and implementing effective strategy to manage perimenstrual problems in this region.

OBJECTIVE The aim of this study was to assess the rate of adherence to medications amongst psychiatric outpatients in Nigeria and examine factors associated with medication nonadherence amongst this group. METHOD Psychiatric outpatients (n=342) from three centres were assessed for medication adherence using the Morisky Medication Adherence Questionnaire. Details regarding sociodemographic variables (age, sex, education, religion, marital status, employment, income, medication cost), illness related variables (diagnosis, duration, number of episodes/admissions, insight, severity of symptoms, mental state, functional status), medication related variables (type, mode of administration, side effect, attitude to medication) and perception related variables (self-stigma, perceived causation and prognosis) were also obtained. RESULTS There were 76 participants (22.2%) with good medication adherence, 102 (29.8%) with moderate adherence and 164 (48.0%) with poor adherence. The significant independent correlates of poor medication adherence included being employed [odds ratio (OR) 3.42, 95% confidence interval (95% CI) 2.17-5.39], poor social support (OR 5.86, 95% CI 2.87-12.17), high self-stigma (OR 4.70, 95% CI 2.24-9.96) and perceived spiritual causation of mental illness (OR 3.74, 95% CI 1.87-7.74). CONCLUSIONS The majority of psychiatric outpatients in southwestern Nigeria had poor medication adherence. Our findings stressed the importance of patients' perception and social environment in determining treatment adherence and the necessity of educating the patient. Clinicians' attention to psychological barriers early in treatment may improve medication adherence and ultimately affect the course of illness.

BACKGROUND One of the most distressing concerns of many people living with HIV in sub-Saharan Africa is the stigma. Intense stigma may be traumatic. This study aimed to investigate the probability and correlates of Posttraumatic stress disorder (PTSD) following intense stigmatizing events and situations in HIV infected individuals in Nigeria. METHODS Adult sero-positive attendees of an HIV care centre (N = 190) completed questionnaires regarding sociodemographic and clinical details; the 12-item General Health Questionnaire (GHQ-12) and the Rosenberg's Self-Esteem Scale. The clients were then interviewed for the presence of stigma related PTSD with a modified version of the mini international neuropsychiatry interview (MINI). RESULTS About 2/3 of the participants had experienced at least an intense HIV-related stigmatizing event or situation. The rate of HIV-stigma related PTSD was 27.4%. Independent predictors of HIV stigma-related PTSD included past history of traumatic events (Single event, OR 2.28, 95% CI 1.08-4.73; Multiple events, OR 9.47, 95% CI 2.97-32.20), low self esteem (OR 6.52, 95% CI 2.59-16.55), poor level of social support (OR 3.33, 95% CI 1.24-9.79) and presence of general psychopathology (OR 2.18, 95% CI 1.07-4.44). CONCLUSION PTSD may not be specific to traumatic events alone. There is a possibility of PTSD after an intense stigmatizing event or situation. While the validity for the validity of HIV-stigma related PTSD warrants further investigation, stigma needs to be considered when planning rehabilitation strategies for HIV infected individuals in sub-Saharan Africa. A closer attention to self esteem, level of social support and presence of psychopathology is needed in these individuals.

Objectives: Depression is common in cancer patients. However, only limited evidence is available for Asian populations. The authors therefore examine the prevalence of depression in Thai patients with cancer. In addition, associated factors were determined. Methods: This cross-sectional study was conducted in cancer patients admitted to a university hospital during December 2006 - December 2007. The Patient Health Questionnaire (PHQ-9) was used to assess all cancer patients. Suicidal risk was assessed by using the Mini-International Neuropsychiatric Interview (MINI) in the module of suicidal risk assessment. Results: Of 108 cancer patients, 29.6 % were diagnosed with a depressive disorder (mild, 14.8 %; moderate, 5.6 %; severe, 9.3 %). However, only 25.0 % of these were recognized as being depressed by the primary physician. According to the MINI., 28.1 % of these depressed cancer patients had a moderate to severe level of suicidal risk. In addition, the findings suggest that increased risk of depression is significantly associated with increased pain score, lower number of cancer treatments (< 2 methods), increased educational duration (>13 years), increased age (> 50 years old) and being female. Conclusions: The prevalence of depression is high in Thai cancer patients. However, depressive disorder in those patients is frequently undiagnosed. It is associated with several factors including pain, a number of cancer treatments, education duration, age and sex. To improve quality of life, increase compliance with treatments and prevent of suicide, screening for depressive disorders in this patient group is strongly recommended.

BACKGROUND: To examine whether lifetime DSM-IV diagnosis of major depressive disorder (MDD), including age at onset and number of episodes, is associated with brain atrophy in older persons without dementia.MethodWithin the population-based Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study, 4354 persons (mean age 76±5 years, 58% women) without dementia had a 1.5-T brain magnetic resonance imaging (MRI) scan. Automated brain segmentation total and regional brain volumes were calculated. History of MDD, including age at onset and number of episodes, and MDD in the past 2 weeks was diagnosed according to DSM-IV criteria using the Mini-International Neuropsychiatric Interview (MINI). RESULTS: Of the total sample, 4.5% reported a lifetime history of MDD; 1.5% had a current diagnosis of MDD (including 75% with a prior history of depression) and 3.0% had a past but no current diagnosis (remission). After adjusting for multiple covariates, compared to participants never depressed, those with current MDD (irrespective of past) had more global brain atrophy [B=-1.25%, 95% confidence interval (CI)-2.05 to -0.44], including more gray- and white-matter atrophy in most lobes, and also more atrophy of the hippocampus and thalamus. Participants with current, first-onset MDD also had more brain atrophy (B=-1.62%, 95% CI -3.30 to 0.05) whereas those remitted did not (B=0.06%, 95% CI -0.54 to 0.66). CONCLUSIONS: In older persons without dementia, current MDD, irrespective of prior history, but not remitted MDD was associated with widespread gray- and white-matter brain atrophy. Prospective studies should examine whether MDD is a consequence of, or contributes to, brain volume loss and development of dementia.

STUDY OBJECTIVE Premenstrual dysphoric disorder (PMDD) often starts in adolescence, but there are limited data on its prevalence. The specific aims of this study were to (1) describe the prevalence of PMDD in adolescents presenting to clinics in the midwestern United States and 2 Nigerian cities,(2) identify cultural differences, and (3) screen for comorbidities. DESIGN A cross-sectional survey was conducted among adolescents attending outpatient clinics in the 3 sites. Study participants provided demographic information and completed a modified version of the Premenstrual Symptoms Screening Tool. They also completed the modified Mini International Neuropsychiatric Interview screen for comorbid psychiatric conditions. RESULTS Five-hundred thirty-seven patients participated in the study. The participants were between 13-21 years old (mean [SD]=16.9 [2.02] years). The overall prevalence of PMDD was 4.1%(Maiduguri, Nigeria 6.5%; Lagos, Nigeria 3.1%; and 2.9% in Akron, United States). The differences were not statistically significant (P =.167). The prevalence of moderate to severe premenstrual syndrome ranged from 12.4%-16.3% among the 3 sites, with an overall prevalence of 14.5%. There was a significantly higher prevalence of other mood disorders in Akron (19.3%) compared to the Nigerian sites (P <.001.). This difference across cultures was statistically significant. CONCLUSIONS Premenstrual dysphoric disorder is prevalent across different cultures. It is a chronic condition that causes significant morbidity among adolescents. There is a need for simple diagnostic methods for early detection and evidence-based management guidelines.

Objective: Our objective is to measure the prevalence and correlates of major depressive disorder (MDD) among Chinese breast cancer patients after surgery, which is essential for analyzing the service needs and allocating mental health resources. Methods: A total of 505 patients were randomly recruited from 1580 post-surgery breast cancer outpatients from one tertiary hospital in Shanghai, and the Mini International Neuropsychiatric Interview was used to assess 1-month prevalence of MDD according to the Diagnostic and Statistical Manual Fourth Edition (DSM-IV) in a two-phase design. Results: The adjusted 1-month prevalence of MDD was 20.59%(95% CI 17.06-23.82). The risk for depression within the first year was two times as higher as that in more than 1 year. Patients within 1 year after surgery, with lower income, disrupted marriage or being single, recurrent breast cancer and psychiatric history were more likely to have MDD. There was no significant association between depression and disease stage, type of surgery, receptor status and cancer treatment. Conclusions: Depression is quite common in Chinese breast cancer patients and survivors. A more sensitive and responsive mental health service is recommended for this population. Copyright © 2011 John Wiley & Sons, Ltd.

OBJECTIVES To identify the prevalence and correlates of depression among Chinese peritoneal dialysis patients. METHODS In this cross-sectional study, from October 2007 to June 2008, 141 peritoneal dialysis patients were recruited from a local renal clinic. All participants were interviewed by the first author using the Chinese bilingual version of the Structured Clinical Interview for DSM-IV (Axis I) to identify patients suffering from major depressive disorders and psychiatric illnesses associated with elevated depressive symptoms. Socio-demographic and clinical data were collected. Co-morbid medical illnesses and perceived social support were assessed by standardised questionnaires, namely: the Cumulative Illness Rating Scale, and the Chinese version of Multidimensional Scale of Perceived Social Support (MSPSSC). RESULTS The point prevalence of a current major depressive episode was 16%; another 21% had had at least 1 past episode of major depression. Low MSPSS-C score, muscle cramps, chronic back pain, joint stiffness, and receipt of Social Security Allowance were independent correlates of elevated depressive symptoms. CONCLUSIONS The prevalence of depression was higher in Chinese patients receiving peritoneal dialysis. Independent correlates are useful to help physicians identify patients suffering from depressive disorders in busy renal clinics.

BACKGROUND: The aim of the present study was to examine the use of health-care services and medication, as well as health risk behaviours such as smoking, in relation with post-traumatic stress disorder (PTSD) and major depressive episode (MDE) in post-war Kosovo. METHODS: A sample of 864 adults was interviewed in 2007 of which 551 took part in a 2001 survey. They were assessed using the PTSD and MDE sections of the Mini International Neuropsychiatric Interview (MINI) and the Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Use of health-care services, alcohol and tobacco were also recorded. RESULTS: Respondents were predominantly female (56.6%) with a median age of 36 years and a primary educational level (44.6%). While 11.9% of participants met diagnostic criteria for PTSD, MDE prevalence was 30.6%. Both PTSD and MDE were significantly associated with lower scores on the SF-36 physical component summary. After adjustment for sex, age, education, unemployment, municipality and SF-36 perceived physical health, no significant association was observed between PTSD and medical visits in the past 12 months, hospitalizations in the past 12 months and use of medication in the past 7 days. Results were similar for MDE, except for a significantly higher frequency of medication use that included psychotropic and other drug classes. CONCLUSION: Eight years after the war in Kosovo, poor perceived physical health displayed a long-lasting association with PTSD and MDE and was a major determinant of increased use of health-care services without additional contribution of PTSD per se.

OBJECTIVES To assess suicide risk in men with mood disorders at the postpartum period. METHODS We conduct a longitudinal study with 650 men whose child has born from April 2007 to May 2008 at maternity hospital. The first assessment was in the antenatal period and the second within 30 to 60days postpartum. Suicide risk, anxiety disorders, hypomanic, manic and mixed episodes were assessed by the Mini International Neuropsychiatric Interview (MINI). RESULTS The prevalence of suicide risk in fathers in postpartum was of 4.8%. Fathers with postpartum depression were 20.97 (CI: 5.74; 76.53) more likely to present suicide risk and those with mixed episodes showed a chance of 46.50 (CI: 10.52; 205.53) times higher than those who did not suffer from any mood disorder. CONCLUSION Mixed episodes are common in fathers at postpartum, posing a higher suicide risk than depressive and manic/hypomanic episodes. Therefore, in order to reduce the suicide risk, clinicians should address and treat adequately mixed affective states in this specific population.

BACKGROUND Little is known about the prevalence and severity of DSM-IV mental disorders treated by traditional healers in Uganda. OBJECTIVE To describe the prevalence and severity of DSM-IV disorders handled by traditional healers in Jinja and Iganga districts, Eastern Uganda. METHOD Between January and March 2008, Face-to-Face Interviews were conducted with 400 patients attending traditional healers' shrines for mental health problems, using Self Rating Questionnaire 25 (SRQ-25) for screening, the Mini International Neuropsychiatric Interview (MINI-Plus) for specific DSM-IV diagnosis and the Global Assessment of Functioning (GAF) for severity of illness. Descriptive data analysis and frequency estimates were performed using SPSS version 15.0 for Windows. Pearson's chi-square tests and odds ratios were used to explore the relationship between severity and combined use of biomedical services and traditional healing. RESULTS Of 387 respondents, 60.2% had diagnosable current mental illness and 16.3% had had one disorder in their lifetime. Of the diagnosable current mental illnesses, 29.7% were Psychosis; 5.4% Major depressive episode; 5.6% Anxiety disorders; 3.6% mixed Anxiety-Depression; and 3.9% Suicidality. In terms of severity, 37.7% of the current mental illnesses were severe, 35.1% moderate and 13.2% mild. Patients with moderate to severe symptoms were more likely to use both biomedical services and traditional healers. Conclusion: These findings suggest that a considerable number of patients with DSM-IV diagnosable mental disorders attend traditional healing shrines; the majority had moderate to severe symptoms. Mental health professionals therefore need to come up with ways to co-operate with traditional healers, e.g. as officially designated Traditional Mental Attendants (TMA), for the benefit of their patients.

AIMS OF THE STUDY To compare the impact of anxiety disorders, major depressive episodes (MDEs), and subsyndromic depressive episodes (SSDEs) on the quality of life of patients with epilepsy (PWEs), and to identify the variables predictive of poor quality of life. METHODS A psychiatric diagnosis according to DSM-IV-TR criteria was established in 188 consecutive PWEs with the MINI International Neuropsychiatric Interview. Patients also completed the Beck Depression Inventory-II (BDI-II), the Centers for Epidemiologic Studies-Depression (CES-D), and the Quality of Life in Epilepsy-89 (QOLIE-89). A diagnosis of SSDE was made in any patient with total scores of the BDI-II >12 or CES-D >16 in the absence of any DSM-IV diagnosis of mood disorder according to the MINI. RESULTS Patients with SSDEs (n = 26) had a worse quality of life than asymptomatic patients (n = 103). This finding was also observed among patients with MDEs only (n = 10), anxiety disorders only (n = 21), or mixed MDEs/anxiety disorders (n = 28). Furthermore, having mixed SSDEs/anxiety disorders yielded a worse quality of life than having only SSDEs. Independent predictors of poor quality of life included having a psychiatric disorder and persistent epileptic seizures in the last 6 months. CONCLUSIONS Although isolated mood and anxiety disorders, including SSDE, have a comparable negative impact on the quality of life of PWEs; the comorbid occurrence of mood and anxiety disorders yields a worse impact. In addition, seizure freedom in the previous 6 months predicts a better quality of life.

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