Browsing by Author "Oladeji, B. D."

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A pilot randomized controlled trial of a stepped care intervention package for depression in primary care in Nigeria
(2015) Oladeji, B. D.; Kola, L.; Abiona, T.; Montgomery, A. A.; Araya, R.; Gureje, O.
Background: Depression is common in primary care and is often unrecognized and untreated. Studies are needed to demonstrate the feasibility of implementing evidence-based depression care provided by primary health care workers (PHCWs) in sub-Saharan Africa. We carried out a pilot two-parallel arm cluster randomized controlled trial of a package of care for depression in primary care. Methods: Six primary health care centers (PHCC) in two Local Government Areas of Oyo State, South West Nigeria were randomized into 3 intervention and 3 control clinics. Three PHCWs were selected for training from each of the participating clinics. The PHCWs from the intervention clinics were trained to deliver a manualized multicomponent stepped care intervention package for depression consisting of psychoeducation, activity scheduling, problem solving treatment and medication for severe depression. Providers from the control clinics delivered care as usual, enhanced by a refresher training on depression diagnosis and management. Outcome measures Patient’s Health Questionnaire (PHQ-9), WHO quality of Life instrument (WHOQOL-Bref) and the WHO disability assessment schedule (WHODAS) were administered in the participants’ home at baseline, 3 and 6 months. Results: About 98% of the consecutive attendees to the clinics agreed to have the screening interview. Of those screened, 284 (22.7%) were positive (PHQ-9 score ≥ 8) and 234 gave consent for inclusion in the study: 165 from intervention and 69 from control clinics. The rates of eligible and consenting participants were similar in the control and intervention arms. In all 85.9% (92.8% in intervention and 83% in control) of the participants were successfully administered outcome assessments at 6 months. The PHCWs had little difficulty in delivering the intervention package. At 6 months follow up, depression symptoms had improved in 73.0% from the intervention arm compared to 1.6% control. Compared to the mean scores at baseline, there was improvement in the mean scores on all outcome measures in both arms at six months. Conclusion: The results provide support for the feasibility of conducting a fully-powered randomized study in this setting and suggest that the instruments used may have the potential to detect differences between the arms.
Achieving health security in Nigeria: A strategic blueprint for addressing psychoactive substance use
(College of Medicine, University of Ibadan, 2019) Abdulmalik, J.O.; Lasebikan, V.O.; Makanjuola, V.A.; Oshiname, F. O.; Oladeji, B. D.; Esan, O. B.; Bella - Awusah, T. T.; Ojagbemi, A. A.; Adeniyi, Y. P.; Gureje, O.; Omigbodun, O. O.
Introduction: Psychoactive substance use is an important component of health and national security. Nigeria has evolved from a largely transit nation for psychoactive substances to a high consumption nation. Increasing rates of use result in a concurrent rise in crime rates and insecurity, as well as road traffic accidents. The use of psychoactive substances is also implicated in episodes of civil strife, conflicts and wars, such as the ongoing Boko Haram insurgency in North East Nigeria. This observation is likely to worsen over time if there is no coherent and strategic plan to halt and reverse this trend. The forecast portends higher crime rates, heightened insecurity, civil unrest and violent conflicts by 2050, if the rising trend of psychoactive substance use is not reversed. It is a scenario that will not augur well for the stability of Nigeria and the West African region. Methods: A narrative review of the published literature, as well as expert opinion deliberations was utilized to develop a comprehensive analysis of the strategic strengths, weaknesses, opportunities and threats (SWOT) of psychoactive substance use and health security implications for Nigeria. Results: An array of the unique strengths and opportunities are spelt out; along with the inherent weaknesses and threats that should be taken into consideration in mapping out strategies to address the clear and present danger from the rising use of psychoactive substances in Nigeria. Conclusion: Recommended interventions should focus on public awareness campaigns, utilizing behaviour change communication strategies – with a special focus on prevention, mental health promotion activities, training and re-training of regulatory agencies, development and revision of existing policies, as well as better policing and enforcement of access restriction.
Adaptation of evidence-based approaches to promote HIV testing and treatment engagement among high-risk Nigerian youth
(Public Library of Science, 2021-10) Kuhns, L. M.; Johnson, A. K.; Adetunji, A.; Kuti, K. M.; Garofalo, R.; Omigbodun, O.; Awolude, O. A.; Oladeji, B. D.; Berzins, B.; Okonkwor, O.; Amoo, O. P.; Olomola, O.; Taiwo, B.
Nigeria has the second highest number of people living with HIV (PLWH) globally, and evidence- based approaches are needed to achieve national goals to identify, treat, and reduce new infections. Youth between the ages of 15–24, including young men who have sex with men (YMSM), are disproportionately impacted by the Nigerian HIV epidemic. The purpose of this study was to inform adaptation of evidence-based peer navigation and mHealth approaches (social media outreach to promote HIV testing; short messaging service text message reminders to promote HIV treatment engagement) to the local context within iCARE Nigeria, a multi-phase study designed to investigate combination interventions to promote HIV testing and care engagement among youth in Nigeria. Methods To elicit expert and community perspectives, a local group of advisors from academia, community, and governmental sectors provided feedback on intervention adaptation, which then informed a series of focus groups with stakeholders in Ibadan, Nigeria. Focus group data were collected over a period of three days in December of 2018. Participants in focus groups included YMSM and HIV-positive youth in care ages 16–24, and HIV service providers from local AIDS service organizations (ASO). Groups were stratified by HIV serostatus, gender, and stakeholder type. Focus group sessions were conducted using a semi-structured interview guide, audio-recorded, transcribed verbatim, and analyzed using a content analysis approach. Results Local experts recommended intervention adaptations specific to the status of peer navigators as volunteers, peer characteristics (slightly older age, high maturity level, HIV/YMSM status), and intervention characteristics and resources (low navigator to peer ratio; flexible matching by demographic and social characteristics; social media platforms and content). Five focus group discussions with stakeholders, including 27 participants were conducted to elicit feedback on these and other potential adaptations. Youth participants (n = 21) were mean age 20 years (range = 16–24); 76% HIV-positive, 76% men and 48% MSM. Service providers (n = 6) represented both HIV prevention and care services. Participants across stratified subgroups reported largely positive perceptions and high perceived acceptability of both mHealth and peer navigation strategies, and echoed the recommendations of the advisory group for volunteer-based navigators to promote altruism, with a low navigator peer ratio (1:5). Participants emphasized the need to incorporate minimal mobile data use strategies and popular social media platforms among YMSM (e.g., Facebook, Grindr) for widespread access and reach of the interventions. Conclusions In Ibadan, Nigeria, stakeholders support the adaptation of combined mHealth and peer navigation strategies to promote HIV testing and care engagement among high-risk youth. Recommended adaptations for the local context reflect concerns about the feasibility and sustainability of the intervention and are expected to improve accessibility and acceptability.
Adaptation of evidence-based approaches to promote HIV testing and treatment engagement among high-risk Nigerian youth
(Public Library of Science (PLoS), 2021) Kuhns, L. M.; Johnson, A. K.; Adetunji, A.; Kuti, K. M.; Garofalo, R.; Omigbodun, O.; Awolude, O. A.; Oladeji, B. D.; Berzins, B.; Okonkwor, O.; Amoo, O. P.; Olomola, O.; Taiwo, B.
Background Nigeria has the second highest number of people living with HIV (PLWH) globally, and evi- dence-based approaches are needed to achieve national goals to identify, treat, and reduce new infections. Youth between the ages of 15–24, including young men who have sex with men (YMSM), are disproportionately impacted by the Nigerian HIV epidemic. The purpose of this study was to inform adaptation of evidence-based peer navigation and mHealth approaches (social media outreach to promote HIV testing; short messaging service text message reminders to promote HIV treatment engagement) to the local context within iCARE Nigeria, a multi-phase study designed to investigate combination interventions to promote HIV testing and care engagement among youth in Nigeria. Methods To elicit expert and community perspectives, a local group of advisors from academia, com- munity, and governmental sectors provided feedback on intervention adaptation, which then informed a series of focus groups with stakeholders in Ibadan, Nigeria. Focus group data were collected over a period of three days in December of 2018. Participants in focus groups included YMSM and HIV-positive youth in care ages 16–24, and HIV service providers from local AIDS service organizations (ASO). Groups were stratified by HIV serostatus, gender, and stakeholder type. Focus group sessions were conducted using a semi-structured interview guide, audio-recorded, transcribed verbatim, and analyzed using a content analy- sis approach. Results Local experts recommended intervention adaptations specific to the status of peer naviga- tors as volunteers, peer characteristics (slightly older age, high maturity level, HIV/YMSM status), and intervention characteristics and resources (low navigator to peer ratio; flexible matching by demographic and social characteristics; social media platforms and content). Five focus group discussions with stakeholders, including 27 participants were conducted to elicit feedback on these and other potential adaptations. Youth participants (n = 21) were mean age 20 years (range = 16–24); 76% HIV-positive, 76% men and 48% MSM. Service providers (n = 6) represented both HIV prevention and care services. Participants across stratified subgroups reported largely positive perceptions and high perceived acceptability of both mHealth and peer navigation strategies, and echoed the recommendations of the advisory group for volunteer-based navigators to promote altruism, with a low navigator- peer ratio (1:5). Participants emphasized the need to incorporate minimal mobile data use strategies and popular social media platforms among YMSM (e.g., Facebook, Grindr) for widespread access and reach of the interventions. Conclusions In Ibadan, Nigeria, stakeholders support the adaptation of combined mHealth and peer navi- gation strategies to promote HIV testing and care engagement among high-risk youth. Rec- ommended adaptations for the local context reflect concerns about the feasibility and sustainability of the intervention and are expected to improve accessibility and acceptability.
Antidepressant use in low- middle- and high-income countries: a world mental health surveys report
(Cambridge University Press, 2021) Kadzin, A. E.; Wu, C.; Hwang, I.; Puac-Polanco, V.; Sampson, N. A.; Al-Hamzawi, A.; Alonso, J.; Andrade, L. H.; Benjet, C.; Caldas-de-Almeida, J.; de Girolamo, G.; de Jonge, P.; Florescu, S.; Gureje, O.; Haro, J. M.; Harris, M. G.; Karam, E. G.; Karam, G.; Kovess-Masfety, V.; Lee, S.; McGrath, J. J.; Navarro-Mateu, F.; Nishi, D.; Oladeji, B. D.; Posada-Villa, J.; Stein, D. J.; Üstün, T. B.; Vigo, D. V.; Zarkov, Z.; Zaslavsky, A. M.; Kessler, R. C.; WHO World Mental Health Survey collaborators
Background. The most common treatment for major depressive disorder (MDD) is antidepressant medication (ADM). Results are reported on frequency of ADM use, reasons for use, and perceived effectiveness of use in general population surveys across 20 countries. Methods. Face-to-face interviews with community samples totaling n = 49 919 respondents in the World Health Organization (WHO) World Mental Health (WMH) Surveys asked about ADM use anytime in the prior 12 months in conjunction with validated fully structured diagnostic interviews. Treatment questions were administered independently of diagnoses and asked of all respondents. Results. 3.1% of respondents reported ADM use within the past 12 months. In high-income countries (HICs), depression (49.2%) and anxiety (36.4%) were the most common reasons for use. In low- and middle-income countries (LMICs), depression (38.4%) and sleep problems (31.9%) were the most common reasons for use. Prevalence of use was 2–4 times as high in HICs as LMICs across all examined diagnoses. Newer ADMs were proportionally used more often in HICs than LMICs. Across all conditions, ADMs were reported as very effective by 58.8% of users and somewhat effective by an additional 28.3% of users, with both proportions higher in LMICs than HICs. Neither ADM class nor reason for use was a significant predictor of perceived effectiveness. Conclusion. ADMs are in widespread use and for a variety of conditions including but going beyond depression and anxiety. In a general population sample from multiple LMICs and HICs, ADMs were widely perceived to be either very or somewhat effective by the people who use them.
Determinants of length of stay in the psychiatric wards of the University College Hospital, Ibadan, Nigeria
(2012) Oladeji, B. D.; Ogundele, A. T.; Dairo, M.
Background: Inpatient care constitutes the most expensive component of psychiatric services and pressure is increasingly being mounted on clinicians to discharge patients early. With the advent of managed care in Nigeria, psychiatrists as well as other physicians will be faced with the challenge of having to justify patient’s length of hospital admission. This study was designed to examine the factors that influence the length of stay (LOS) in an acute psychiatric ward. Methods'. A list of all patients admitted to the psychiatric unit of the UCH for the twelve month period between June 1st 2006 and May 31st 2007 was compiled from the ward admission registers. Data were extracted from the patient’s case notes using specially designed data record forms. Results: There were a total of three hundred and seventy one (371) admissions made up of three hundred and thirty three (333) patients, out of which a total of 247 (74.5%) case notes were successfully reviewed. The most common diagnoses necessitating admission were schizophrenia and mood disorders. The mean LOS was 28.7 days and bed turnover for this period was 5.8. Factors found to be significantly associated with longer LOS include age, diagnosis, previous admissions and receiving electroconvulsive therapy with medication. These factors need to be considered in determining the period of hospitalization covered under managed care schemes.
Effect of a stepped-care intervention delivered by lay health workers on major depressive disorder among primary care patients in Nigeria (STEPCARE): a cluster randomised controlled trial
(Elsevier Ltd., 2019) Gureje, O.; Oladeji, B. D.; Montgomery, A. A.; Bello, T.; Kola, L.; Ojagbemi, A.; Chisolm, D.; Araya, R.
Background Little is known about how to scale up care for depression in settings where non-physician lay workers constitute the bulk of frontline providers. We aimed to compare a stepped-care intervention package for depression with usual care enhanced by use of the WHO Mental Health Gap Action Programme intervention guide (mhGAP-IG). Methods We did a cluster-randomised trial in primary care clinics in Ibadan, Nigeria. Eligible clinics were those with adequate staffing to provide various 24-h clinical services and with regular physician supervision. Clinics (clusters), anonymised and stratified by local government area, were randomly allocated (1:1) with a computer-generated random number sequence to one of two groups: an intervention group in which patients received a stepped-care intervention (eight sessions of individual problem-solving therapy, with an extra two to four sessions if needed) plus enhanced usual care, and a control group in which patients received enhanced usual care only. Patients from enrolled clinics could participate if they were aged 18 years or older, not pregnant, and had moderate to severe depression (scoring ≥11 on the nine-item patient health questionnaire [PHQ-9]). The primary outcome was the proportion of patients with remission of depression at 12 months (a score of ≤6 on the PHQ-9, with assessors masked to group allocation) in the intention-to-treat population. This trial is registered with the International Standard Randomised Controlled Trials Number registry (ISRCTN46754188) and is completed. Findings 35 of 97 clinics approached were eligible and agreed to participate, of which 18 were allocated to the intervention group and 17 to the control group. 1178 patients (631 [54%] in the intervention group and 547 [46%] in the control group) were recruited between Dec 2, 2013, and June 29, 2015, among whom 976 (83%) were female and baseline mean PHQ-9 score was 13·7 (SD 2·6). Of the 562 (89%) patients in the intervention group and 473 (86%) in the control group who completed 12-month follow-up, similar proportions in each group had remission of depression (425 [76%] in the intervention group vs 366 [77%] in the control group; adjusted odds ratio 1∙0 [95% CI 0·70–1·40]). At 12 months, 17 (3%) deaths, one (<1%) psychotic illness, and one (<1%) case of bipolar disorder in the intervention group, and 16 deaths (3%) and one (<1%) case of bipolar disorder in the control group were recorded. No adverse events were judged to be related to the study procedures. Interpretation For patients with moderate to severe depression receiving care from non-physician primary health-care workers in Nigeria, a stepped-care, problem-solving intervention combined with enhanced usual care is similarly effective to enhanced usual care alone. Enhancing usual care with mhGAP-IG might provide simple and affordable approach to scaling up depression care in sub-Saharan Africa.
Effect of intervention delivered by lay maternal care providers to improve outcome and parenting skills among adolescents with perinatal depression in Nigeria (the RAPiD study): a cluster randomized controlled trial
(Elsevier, 2022) Gureje, O.; Oladeji, B. D.; Kola, L.; Bello, T.; Ayinde, O.; Faregh, N.; Bennett, I.; Zelkowitz, P.
Background: Perinatal depression is more common and is associated with greater negative consequences among adolescents than adults. Psychosocial interventions designed for adults may be inadequate at addressing the unique features of adolescent perinatal depression. Methods: In a two-arm parallel cluster randomized trial conducted in thirty primary maternal care clinics in Ibadan, Nigeria (15-intervention and 15-control) we compared age-appropriate intervention consisting of problem-solving therapy, behavioral activation, parenting skills training, and parenting support from a self- identified adult to care as usual. Pregnant adolescents (aged <20 years) at fetal gestational age16–36 weeks with moderate to severe depression were recruited. Primary outcomes were depression symptoms (Edinburgh Postnatal Depression Scale, EPDS) and parenting practices (Infant-Toddler version of the Home Inventory for Measurement of the Environment, HOME-IT) at six-months postnatal. Results: There were 242 participants (intervention arm: 141; Control arm: 101), with a mean age of 18∙0 (SD- 1∙2). Baseline mean EPDS score was 14∙2 (SD-2.1); 80∙1 % completed the six-month postnatal follow-up. The intervention group had lower level of depressive symptoms than the control group, mean EPDS scores: 5∙5 (SD- 3∙6) versus 7∙2 (SD-4∙0) (adjusted mean difference -1∙84 (95%CI- 3∙06 to 􀀀0∙62; p =0∙003) and better parenting practices, mean total HOME-IT scores: 29∙8 (SD-4∙4) versus 26∙4 (SD-4∙2) (adjusted mean difference 3∙4 (95%Cl- 2∙12 to 4∙69, p =0∙001). Limitations: This study explored the effect of complex interventions making it difficult to know precisely what aspects produced the outcomes. Conclusions: An age-appropriate psychosocial intervention package holds promise for scaling up care for adolescents with perinatal depression especially in resource-constrained settings.
Effect of text messaging plus peer navigation on viral suppression among youth with HIV in the iCARE Nigeria pilot study
(Lippincott Williams & Wilkins (Wolters Kluwer), 2021) Taiwo, B. O.; Kuti, K. M.; Kuhns, L. M.; Omigbodun, O.; Awolude, O.; Adetunji, A.; Berzins, B.; Janulis, P.; Johnson, A. K.; Okonkwor, O.; Oladeji, B. D.; Muldoon, A.; Adewumi, O. M.; Amoo, P.; Atunde, H.; Kapogiannis, B.; Garofalo, R.
Background—Consistent with the global trend, youth with HIV (YWH) in Nigeria have high rates of viral non-suppression. Novel interventions are needed. Methods—In a single-arm trial, participants aged 15–24 years old received 48 weeks of a combination intervention, comprising daily two-way text message medication reminders plus peer navigation. The primary outcome measure was viral suppression below 200 copies/mL. Secondary outcomes measures included self-reported adherence on a visual analogue scale and medication possession ratio (MPR), each dichotomized as ≥90% (good) or < 90% (poor) adherence. Outcomes were analyzed using McNemar’s test. Retention in care, intervention feasibility and acceptability, and participants’ satisfaction were also assessed. Results—Forty YWH (50% male) were enrolled: mean age 19.9 years (SD=2.5), 55% perinatally-infected, and 35% virologically suppressed at baseline. Compared to baseline, the odds of virologic suppression was higher at 24 weeks (OR = 14.00, p < 0.001) and 48 weeks (OR = 6.00, p = 0.013). Self-reported adherence (≥90%) increased from baseline at 24 weeks (63%, p = 0.008) and 48 weeks (68%, p = 0.031). MPR ≥90% increased at weeks 24 and 48 (85% and 80%, respectively), achieving statistical significance at 24 weeks only (p = 0.022). Retention in care at 48 weeks was 87.5%. All (37/37) participants at week 48 were fully or mostly satisfied with the intervention. Conclusion—Daily, two-way text message reminders plus peer navigation is a promising combination intervention to improve viral suppression among YWH in Nigeria.
Exploring differences between adolescents and adults with perinatal depression-data from the expanding care for perinatal women with depression trial in Nigeria
(2019-10) Oladeji, B. D.; Bello, T.; Kola, L.; Araya, R.; Zelkowitz, P.; Gureje, O.
Background: Depression is common among women in the perinatal period. Although pregnancy and motherhood among adolescents are global public health issues, little is known about how adolescents differ from adults in the occurrence and correlates of perinatal depression. Methods: Data were derived from a cluster randomized controlled trial of psychosocial interventions for perinatal depression in primary maternal care in Nigeria (the Expanding Care for Perinatal Women with Depression trial). Adolescents and adult participants recruited during pregnancy and followed up till 6-month postpartum were compared: proportions with depression [screening positive to depression on the Edinburgh Postnatal Depression Scale (score ≥ 12) and meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria using the short form of the Composite International Diagnostic Interview]; adjustment and attitude to pregnancy and motherhood (using the Maternal Adjustment and Maternal Attitudes scale); and parenting skills (measured on Infant–Toddler version of the Home Inventory for Measurement of the Environment). Infant and fetal growth were assessed by measures of weight and head circumference at birth and upper mid-upper arm circumference (MUAC) at 6 months. Results: Of 8,580 adults screened, 6.9% had major depression compared with 17.7% of 772 screened adolescents (p < 0.001). Adolescents had significantly poorer adjustment and attitudes to pregnancy, lower mean fetal gestational age at birth, and a smaller mean baby’s birth weight. At 6-month postpartum, there were no significant differences in the rates of remission from depression between adolescent and adult women (Edinburgh Postnatal Depression Scale score <6). Adolescent mothers continued to have poorer maternal attitudes and parenting skills indicated by significantly lower scores on the Infant–Toddler version of the Home Inventory for Measurement of the Environment responsivity and involvement subscales. Infants of adolescent mothers had a higher rate of undernutrition (defined as MUAC < 12.5 cm) compared with those of adult mothers: 14.8 and 6.3%, respectively (p = 0.008), with the mean MUAC remaining significantly lower for infants of adolescent mothers after adjusting for their lower birth weight (p = 0.04). Conclusion: Perinatal depression is more common and is associated with poorer maternal attitudes and parenting skills in adolescents compared with those in adults. Evidence from this exploratory study suggests that in improving outcomes in infants of adolescent mothers with perinatal depression, depression treatment may need to be supplemented with specific approaches to improve parenting skills.
Family related adverse childhood experiences as risk factors for psychiatric disorders in Nigeria
(Cambridge University Press, 2010) Oladeji, B. D.; Makanjuola, V. A.; Gureje, O.
"Adverse childhood experiences have been associated with a variety of mental health problems in adult life. Aims To examine whether this reported link between childhood experiences and mental health disorders in adult life applies in a Sub-Saharan African setting where cultural and family attributes may be different. Method A multistage random sampling was used in the Nigerian Survey of Mental Health and Well-Being (NSMHW) to select respondents for face-to-face interviews. Assessments of family-related adverse childhood experiences and lifetime mental health disorders were conducted with the Composite International Diagnostic Interview (CIDI 3.0). Results Almost half of the respondents had experienced an adverse childhood experience within the context of the family before they were 16 years of age. Associations between adverse childhood experiences and adult mental health disorders were few and were attenuated when clustering of adverse childhood experience and disorder comorbidities were accounted for. There was an elevated likelihood of adult substance use disorders among individuals who had experienced family violence and neglect or abuse. Parental psychopathology was associated with a significantly increased risk for developing mood disorders. Conclusions Adverse childhood experiences reflecting violence in the family, parental criminality and parental mental illness and substance misuse were more likely to have significant mental health consequences in adulthood"
Findings from world mental health surveys of the perceived helpfulness of treatment for patients with major depressive disorder
(American Medical Association, 2020-05) Harris, M. G.; Kazdin, A. E.; Chiu, W. T.; Sampson, N. A.; Aguilar-Gaxiola, S.; Al-Hamzawi, A.; Alonso, J.; Altwaijri, Y.; Andrade, L. H.; Cardoso, G.; Cía A.; Florescu, S.; Gureje, O.; Hu, C.; Karam, E. G.; Karam, G.; Mneimneh, Z.; Navarro-Mateu, F.; Oladeji, B. D.; O'Neill, S.; Scott, K.; Slade, T.; Torres, Y.; Vigo, D.; Wojtyniak, B.; Zarkov, Z.; Ziv, Y.; Kessler, R. C.; WHO World Mental Health Survey Collaborators
IMPORTANCE The perceived helpfulness of treatment is an important patient-centered measure that is a joint function of whether treatment professionals are perceived as helpful and whether patients persist in help-seeking after previous unhelpful treatments. OBJECTIVE To examine the prevalence and factors associated with the 2 main components of perceived helpfulness of treatment in a representative sample of individuals with a lifetime history of DSM-IV major depressive disorder (MDD). DESIGN, SETTING, AND PARTICIPANTS This study examined the results of a coordinated series of community epidemiologic surveys of noninstitutionalized adults using theWorld Health OrganizationWorld Mental Health surveys. Seventeen surveys were conducted in 16 countries (8 surveys in high-income countries and 9 in low- and middle-income countries). The dates of data collection ranged from 2002 to 2003 (Lebanon) to 2016 to 2017 (Bulgaria). Participants included those with a lifetime history of treated MDD. Data analyses were conducted from April 2019 to January 2020. Data on socioeconomic characteristics, lifetime comorbid conditions (eg, anxiety and substance use disorders), treatment type, treatment timing, and country income level were collected. MAIN OUTCOMES AND MEASURES Conditional probabilities of helpful treatment after seeing between 1 and 5 professionals; persistence in help-seeking after between 1 and 4 unhelpful treatments; and ever obtaining helpful treatment regardless of number of professionals seen. RESULTS Survey response rates ranged from 50.4%(Poland) to 97.2%(Medellín, Columbia), with a pooled response rate of 68.3%(n = 117 616) across surveys. Mean (SE) age at first depression treatment was 34.8 (0.3) years, and 69.4%were female. Of 2726 people with a lifetime history of treatment of MDD, the cumulative probability (SE) of all respondents pooled across countries of helpful treatment after seeing up to 10 professionals was 93.9% (1.2%), but only 21.5%(3.2%) of patients persisted that long (ie, beyond 9 unhelpful treatments), resulting in 68.2%(1.1%) of patients ever receiving treatment that they perceived as helpful. The probability of perceiving treatment as helpful increased in association with 4 factors: older age at initiating treatment (adjusted odds ratio [AOR], 1.02; 95%CI, 1.01-1.03), higher educational level (low: AOR, 0.48; 95%CI, 0.33-0.70; low-average: AOR, 0.62; 95%CI, 0.44-0.89; high average: AOR, 0.67; 95%CI, 0.49-0.91 vs high educational level), shorter delay in initiating treatment after first onset (AOR, 0.98; 95%CI, 0.97-0.99), and medication received from a mental health specialist (AOR, 2.91; 95%CI, 2.04-4.15). Decomposition analysis showed that the first 2 of these 4 factors were associated with only the conditional probability of an individual treatment professional being perceived as helpful (age at first depression treatment: AOR, 1.02; 95%CI, 1.01-1.02; educational level: low: AOR, 0.48; 95%CI, 0.33-0.70; low-average: AOR, 0.62; 95%CI, 0.44-0.89; high-average: AOR, 0.67; 95%CI, 0.49-0.91 vs high educational level), whereas the latter 2 factors were associated with only persistence (treatment delay: AOR, 0.98; 95%CI, 0.97-0.99; treatment type: AOR, 3.43; 95%CI, 2.51-4.70). CONCLUSIONS AND RELEVANCE The probability that patients with MDD obtain treatment that they consider helpful might increase, perhaps markedly, if they persisted in help-seeking after unhelpful treatments with up to 9 prior professionals.
Global neuroAIDS
(Springer, 2015) Oladeji, B. D.; Yosief, S.; Robertson, K. R.
High versus low intensity interventions for perinatal depression delivered by non-specialist primary maternal care providers in Nigeria: a cluster randomized controlled trial: (the EXPONATE trial)
(2019) Gureje, O.; Oladeji, B. D.; Montgomery, A. A.; Araya, R.; Bello, T.; Chisholm, D.; Groleau, D.; Kirmayer, L. J.; Kola, L.; Olley, L.; Tan, W.; Zelkowitz, P.
Contextually appropriate interventions delivered by primary maternal care providers (PMCPs) might be effective in reducing the treatment gap for perinatal depression. Aim To compare high-intensity treatment (HIT) with low-intensity treatment (LIT) for perinatal depression. Method Cluster randomised clinical trial, conducted in Ibadan, Nigeria between 18 June 2013 and 11 December 2015 in 29 maternal care clinics allocated by computed-generated random sequence (15 HIT; 14 LIT). Interventions were delivered individually to antenatal women with DSM-IV (1994) major depression by trained PMCPs. LIT consisted of the basic psychosocial treatment specifications in the World Health Organization Mental Health Gap Action Programme – Intervention Guide. HIT comprised LIT plus eight weekly problem-solving therapy sessions with possible additional sessions determined by scores on the Edinburgh Postnatal Depression Scale (EPDS). The primary outcome was remission of depression at 6 months postpartum (EPDS < 6). Results There were 686 participants; 452 and 234 in HIT and LIT arms, respectively, with both groups similar at baseline. Follow-up assessments, completed on 85%, showed remission rates of 0% with HIT and 66% with LIT: risk difference 4% (95% CI −4.1%, 12.0%), adjusted odds ratio 1.12 (95% CI 0.73, 1.72). HIT was more effective for severe depression (odds ratio 2.29; 95% CI 1.01, 5.20; P = 0.047) and resulted in a higher rate of exclusive breastfeeding. Infant outcomes, cost-effectiveness and adverse events were similar. Conclusions Except among severely depressed perinatal women, we found no strong evidence to recommend high-intensity in preference to low-intensity psychological intervention in routine primary maternal care.
Incidence and risk factors of late life depression in the Ibadan study of ageing
(Cambridge University Press, 2011) Gureje, O.; Oladeji, B. D.; Abiona, T.
Background. We present the incidence and risk factors for major depressive disorder (MDD) among community dwelling elderly Nigerians. Method. A cohort study of persons aged o65 years residing in eight contiguous Yoruba-speaking states in southwest and north-central Nigeria was conducted between November 2003 and December 2007. Of the 2149 baseline sample, 1408 (66%) were successfully followed up after approximately 39 months. Face-to-face in-home assessments were conducted with the World Health Organization (WHO) Composite International Diagnostic Interview, version 3 (CIDI.3) and diagnosis was based on the DSM-IV. Incident MDD was determined in the group with no prior lifetime history of MDD at baseline and who were free of dementia at follow-up (n=892). Results. During the follow-up period, 308 persons had developed incident MDD, representing a rate of 104.3 [95% confidence interval (CI) 93.3–116.6] per 1000 person-years. Compared to males, the age-adjusted hazard for females was 1.63 (95% CI 1.30–2.06). Lifetime or current subsyndromal symptoms of depression at baseline did not increase the risk of incident MDD. Among females, but not males, rural residence and poor social network were risk factors for incident MDD. Physical health status at baseline did not predict new onset of MDD. Conclusions. The finding of a high incidence of MDD among elderly Nigerians complements earlier reports of a high prevalence of the disorder in this understudied population. Social factors, in particular those relating to social isolation, constitute a risk for incident MDD.
Mental health and HIV in Africa
(Jones and Bartlett Learning, 2012) Oladeji, B. D.; Gureje, O.
Neuropsychological evaluation for persons with HIV and AIDS
(Oxford University Press, 2017-05) Oladeji, B. D.; Robertson, K. R.
Optimal mental health for achieving health security in Nigeria: a strategic blueprint
(College of Medicine, University of Ibadan, 2019) Ojagbemi, A. A.; Abdulmalik, J. O.; Lasebikan, V. O.; Oladeji, B. D.; Makanjuola, V. A.; Esan, O. B.; Bella - Awusah, T. T.; Adeniyi, Y. P.; Gureje, O.; Omigbodun, O.O.
Objectives: Optimal mental health refers to ‘a state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make contributions to his or her own community’. As such, the catchphrase ‘No health without mental health’ is not just a slogan but an acknowledgement of the importance of mental health in the drive to improve overall wellbeing and productive participation in community and economic activities. Methods: We combined an overview of current literature with opinions of key experts from different sub specialties of mental health practice and present an analysis of the Strengths, Weaknesses, Opportunities and Threats (SWOT) to optimal mental health as a strategy to attaining health security in Nigeria by 2050. We also offered recommendations for feasible strategies to optimize mental health. Results: There is poor mental health coverage in Nigeria, with over 80% of persons coping with mental health problems remaining untreated in their lifetime. Also, only about 3% of the National health budget is allocated to mental health and this is mostly focused on large psychiatric institutions to the exclusion of primary health care (PHC) services. Conclusions: In recognition of the critical role of optimal mental health to global development, the Sustainable Development Goals (SDGs) has mental health firmly covered in its third goal, ‘Health and Well-being’. The SDGs further envision a better world in which, in tandem with the WHO definition of health, “physical, mental and social wellbeing are assured”. Thus, the identification and implementation of strategies to promote optimal mental health for all Nigerians is vital for ensuring health security and national development.
Parental mental disorders and suicidal behavior in the Nigerian survey of Mental health and well-being
(Routledge, 2011-10) Oladeji, B. D.; Gureje, O.
The objective of this study was to determine which parental mental disorders predict offspring suicidal behavior in a general adult population sample of a sub-Saharan African country. The World Health Organization Composite International Diagnostic Interview, version 3 was used to assess respondents’ suicidal behaviors as well as psychopathology in their parents. The effects of parental disorders in predicting offspring suicide ideation and attempts were examined in a series of bivariate and multivariate models. Sections on suicidality were dministered to the entire sample (n=6752), but associations with parental psychopathology were examined in a subsample of respondents (n=2143). Lifetime prevalence (95% confidence interval) of suicide ideation, plans, and attempts was 3.2% (1.4–6.5), 1.0% (0.4–7.5), and 0.7% (0.5–1.0) respectively. Parental panic disorder and substance abuse were associated with suicide ideation in offspring, but only parental panic disorder was linked to suicide attempts. Parental panic disorder predicted the onset and persistence of suicide ideation and attempts and also which persons with suicide ideation go on to make a suicide attempt. This study further affirms findings from previous studies of the role of disorders characterized by anxiety and impulse control in suicide attempts and as being a probable link in the transmission of suicidal behavior to offspring.
Patterns and correlates of patient-reported helpfulness of treatment for common mental and substance use disorders in the WHO World Mental Health Surveys
(Elsevier Srl, 2022) Kessler, R. C.; Kazdin, A. E.; Aguilar-Gaxiola, S.; Al-Hamzawi, A.; Alonso, J.; Altwaijri, Y. A.; Andrade, L. H.; Benjet, C.; Bharat, C.; Borges, G.; Bruffaerts, R.; Bunting, B.; Caldas de Almeida, J. M.; Cardoso, G.; Chiu, W. T.; Cía, A.; Ciutan, M.; Degenhardt, L.; de Girolamo, G.; de Jonge, P.; de Vries, Y. A.; Florescu, S.; Gureje, O.; Haro, J. M.; Harris, M. G.,; Hu, C.; Karam, A. N.; Karam, E. G.; Karam, G.; Kawakami, N.; Kiejna, A.; Kovess-Masfety, V.; Lee, S.; Makanjuola, V.; McGrath, J. J.; Medina-Mora, M. E.; Moskalewicz, J.; Navarro-Mateu, F.; Nierenberg, A. A.; Nishi, D.; Ojagbemi, A.; Oladeji, B. D.; O’Neill, S.; Posada-Villa, J.; Puac-Polanco, V.; Rapsey, C.; Ruscio, A. M.; Sampson, N. A.; Scott, K. M.; Slade, T.; Stagnaro, J. C.; Stein, D. J.; Tachimori, H.; ten Have, M.; Torres, Y.; Viana, M. C.; Vigo, D. V.; Williams, D. R.; Wojtyniak, B.; Xavier, M.; Zarkov, Z.; Ziobrowski, H. N.; WHO WMH survey collaborators
Patient-reported helpfulness of treatment is an important indicator of quality in patient-centered care. We examined its pathways and predictors among respondents to household surveys who reported ever receiving treatment for major depression, generalized anxiety disorder, social phobia, specific phobia, post-traumatic stress disorder, bipolar disorder, or alcohol use disorder. Data came from 30 community epidemiological surveys –17 in high-income countries (HICs) and 13 in low- and middle-income countries (LMICs) – carried out as part of the World Health Organization (WHO)’s World Mental Health (WMH) Surveys. Respondents were asked whether treatment of each disorder was ever helpful and, if so, the number of professionals seen before receiving helpful treatment. Across all surveys and diagnostic categories, 26.1% of patients (N=10,035) reported being helped by the very first professional they saw. Persisting to a second professional after a first unhelpful treatment brought the cumulative probability of receiving helpful treatment to 51.2%. If patients persisted with up through eight professionals, the cumulative probability rose to 90.6%. However, only an estimated 22.8% of patients would have persisted in seeing these many professionals after repeatedly receiving treatments they considered not helpful. Although the proportion of individuals with disorders who sought treatment was higher and they were more persistent in HICs than LMICs, proportional helpfulness among treated cases was no different between HICs and LMICs. A wide range of predictors of perceived treatment helpfulness were found, some of them consistent across diagnostic categories and others unique to specific disorders. These results provide novel information about patient evaluations of treatment across diagnoses and countries varying in income level, and suggest that a critical issue in improving the quality of care for mental disorders should be fostering persistence in professional help-seeking if earlier treatments are not helpful.