Theory-driven development of a mobile phone supported intervention for adolescents with perinatal depression

Purpose

This paper describes the design of a theory-informed pragmatic intervention for adolescent perinatal depression in primary care in Nigeria.

Methods

We conducted Focus Group Discussions (FGDs) among 17 adolescent mothers and 25 maternal health care providers with experience in the receipt and provision of care for perinatal depression. The Consolidated Framework for Implementation Research (CFIR) was used to systematically examine the barriers and facilitators affecting adolescent mothers' use of an existing intervention package for depression. The Theoretical Domain Framework (TDF) and the Capability, Opportunity, Motivation, Behaviour (COM-B) model were used to analyze the results of the data across the five CFIR domains.

Results

FGD analysis revealed that care providers lacked knowledge on approaches to engage young mothers in treatment. Young mothers had poor treatment engagement, low social support, and little interest in parenting. A main characteristic of the newly designed intervention is the inclusion of age-appropriate psychoeducation supported with weekly mobile phone calls, to address treatment engagement and parenting behaviours of young mothers. Also in the outer setting, low social support from relatives was addressed with education, “as need arises” phone calls, and the involvement of "neighborhood mothers”. In the inner settings, care providers’ behaviour is addressed with training to increase their capacity to engage young mothers in treatment.

Conclusion

A theory-based approach helped develop an age-appropriate intervention package targeting depression and parenting skills deficit among perinatal adolescents in primary maternal care and in which a pragmatic use of mobile phone was key.

     

Apolipoprotein E—associated risk for Alzheimer's disease in the African-American population is genotype dependent

As a part of our ongoing study on Alzheimer's disease (AD) in elderly African Americans, we obtained clinical assessment and apolipoprotein E (ApoE) genotype data on 288 individuals (including 60 with AD). The ApoE σ4 allele frequency was significantly increased in AD patients compared with controls. The age-adjusted odds ratio (OR) for AD in σ4 homozygotes was 4.83 (95% confidence interval [CI], 1.71–13.64) compared with the σ3/σ3 genotype, but the OR for AD with the σ3/σ4 genotype did not reach significance (1.20; 95% CI, 0.58–2.45). These findings suggest that the association between ApoE σ4 and AD is weaker in African Americans than in whites.     

The significance of subtyping tardive dyskinesia: a study of prevalence and associated factors

The prevalence of tardive dyskinesia (TD) in 137 Nigerian psychiatric patients was 27%. There were no differences in the prevalence rate between patients with affective disorder and those with schizophrenia. There were also no significant differences between the sexes but a trend for the more severe forms of dyskinesia to be commoner in females was noticed. Demographic, clinical and treatment variables were investigated for association with TD and each of its two putative subsyndromes: orofacial and appendicular dyskinesias. Two cases of severe and persistent tardive dystonia, associated with orofacial TD, were seen in two young adults, one with relatively short exposure to neuroleptics. After initial univariate screening, multivariate statistical methods revealed that different factors were associated with each of the two subsyndromes. While length of hospitalization correlated significantly with orofacial dyskinesia, cumulative duration of exposure to high-potency neuroleptics and number of ECTs received were significantly associated with appendicular TD. Neither age nor sex correlated with either of the subsyndromes. The findings confirm and extend previous observations suggesting that these dyskinesias may involve different pathophysiological mechanisms.     

Tardive dyskinesia in schizophrenics. Prevalence, distribution and relationship to neurological "soft" signs in Nigerian patients

The prevalence of tardive dyskinesia (TD) in 70 Nigerian schizophrenics was 37%. Age was related to the presence of TD in males but not in females. Significantly more females had TD in the lower extremities. Comparison of patients with TD and those without revealed no significant differences with regard to the presence of neurological "soft" signs.     

Traumatic events and suicidal behaviour in the Nigerian Survey of Mental Health and Well‐Being

Uwakwe R, Oladeji BD, Gureje O. Traumatic events and suicidal behaviour in the Nigerian Survey of Mental Health and Well‐Being. Objective: Not much is known about the role of different traumatic events in predicting suicidal outcomes. We investigated the association of specific traumatic events with different suicidal outcomes. Method: Data are from the Nigerian Survey of Mental Health and Well‐Being, a multistage probability household survey of persons aged 18 years and over. Information on traumatic events and suicidal behaviours (ideation, plan and attempts) was collected in face‐to‐face interviews using the Composite International Diagnostic Interview (CIDI.3) from a subsample of the respondents (N = 2143). Results: At least one traumatic event was reported by 63% of the sample. Traumatic events were more likely to have been experienced by individuals with different suicidal outcomes, with a dose–response relationship between the number of traumatic events and suicide ideation. The risks of suicidal ideation were elevated among persons with a history of combat experience (OR 6.3 95% CI 1.8–21.8) and those with exposure to war (OR 4.2; 95% CI 1.6–10.6), while that of suicidal attempt was increased among persons with experience of interpersonal violence (OR 4.3; 95% CI 1.4–13.0). Conclusion: Traumatic events are common in the general population. This report highlights the role of traumatic events (especially those related to violence) in predicting suicidal behaviour.     

Pre-marital predictors of marital violence in the WHO World Mental Health (WMH) Surveys

Social Psychiatry and Psychiatric Epidemiology - Intimate partner violence (IPV) is a pervasive public health problem. Existing research has focused on reports from victims and few studies have...