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.

     

Monitoring Information-Seeking Patterns and Obesity Prevalence in Africa With Internet Search Data: Observational Study

BackgroundThe prevalence of chronic conditions such as obesity, hypertension, and diabetes is increasing in African countries. Many chronic diseases have been linked to risk factors such as poor diet and physical inactivity. Data for these behavioral risk factors are usually obtained from surveys, which can be delayed by years. Behavioral data from digital sources, including social media and search engines, could be used for timely monitoring of behavioral risk factors.ObjectiveThe objective of our study was to propose the use of digital data from internet sources for monitoring changes in behavioral risk factors in Africa.MethodsWe obtained the adjusted volume of search queries submitted to Google for 108 terms related to diet, exercise, and disease from 2010 to 2016. We also obtained the obesity and overweight prevalence for 52 African countries from the World Health Organization (WHO) for the same period. Machine learning algorithms (ie, random forest, support vector machine, Bayes generalized linear model, gradient boosting, and an ensemble of the individual methods) were used to identify search terms and patterns that correlate with changes in obesity and overweight prevalence across Africa. Out-of-sample predictions were used to assess and validate the model performance.ResultsThe study included 52 African countries. In 2016, the WHO reported an overweight prevalence ranging from 20.9% (95% credible interval [CI] 17.1%-25.0%) to 66.8% (95% CI 62.4%-71.0%) and an obesity prevalence ranging from 4.5% (95% CI 2.9%-6.5%) to 32.5% (95% CI 27.2%-38.1%) in Africa. The highest obesity and overweight prevalence were noted in the northern and southern regions. Google searches for diet-, exercise-, and obesity-related terms explained 97.3% (root-mean-square error [RMSE] 1.15) of the variation in obesity prevalence across all 52 countries. Similarly, the search data explained 96.6% (RMSE 2.26) of the variation in the overweight prevalence. The search terms yoga, exercise, and gym were most correlated with changes in obesity and overweight prevalence in countries with the highest prevalence.ConclusionsInformation-seeking patterns for diet- and exercise-related terms could indicate changes in attitudes toward and engagement in risk factors or healthy behaviors. These trends could capture population changes in risk factor prevalence, inform digital and physical interventions, and supplement official data from surveys.     

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...     

Outcomes of a Home Cycling Program Using Functional Electrical Stimulation or Passive Motion for Children With Spinal Cord Injury: A Case Series

Abstract

Background/Objective: Children with spinal cord injury (SCI) are at risk for musculoskeletal and cardiovascular complications. Stationary cycling using functional electrical stimulation (FES) or passive motion has been suggested to address these complications. The purpose of this case series is to report the outcomes of a 6-month at-home cycling program for 4 children with SCI.

Methods: Two children cycled with FES and 2 cycled passively at home for 1 hour, 3 times per week.

Outcome Measures: Data collected included bone mineral density of the left femoral neck, distal femur, and proximaltibia; quadriceps and hamstring muscle volume; stimulated quadriceps and hamstring muscle strength; a fasting lipid profile; and heart rate and oxygen consumption during incremental upper extremity ergometry testing.

Results: The 2 children cycling with FES and 1 child cycling passively exhibited improved bone mineral density, muscle volume, stimulated quadriceps strength, and lower resting heart rate. For the second child cycling passively, few changes were realized. Overall, the lipid results were inconsistent, with some positive and some negative changes seen.

Conclusions: This case series suggests that cycling with or without FES may have positive health benefits and was a practical home exercise option for these children with SCI.     

Seasonal ataxia: A case report of a disappearing disease

Introduction

Seasonal ataxia is a clinical syndrome of acute cerebellar ataxia which follows ingestion of roasted larvae of Anaphe venata Butler, an alternative protein source consumed in western Nigeria. It was first reported in the 1950s in western Nigeria when it caused a wave of epidemics. This is the first case report of this condition in the literature since 1993.

Case report

We present the case of a 35 year old woman from western Nigeria who was admitted in October 2012 with acute onset of gait instability and bilateral hand tremors, preceded by several episodes of vomiting. She had ingested a meal containing roasted larvae of the African silkworm, 2 hours before the onset of vomiting.

Conclusion

Seasonal ataxia is an important differential diagnosis of acute cerebellar ataxia among the indigenous ethnic population of western Nigeria.It is non-fatal and treatable, with complete resolution of symptoms usually following thiamine therapy.     

Parental psychopathology and the risk of suicidal behavior in their offspring: results from the World Mental Health surveys

Previous research suggests that parental psychopathology predicts suicidal behavior among offspring; however, the more fine-grained associations between specific parental disorders and distinct stages of the pathway to suicide are not well understood. We set out to test the hypothesis that parental disorders associated with negative mood would predict offspring suicide ideation, whereas disorders characterized by impulsive aggression (for example, antisocial personality) and anxiety/agitation (for example, panic disorder) would predict which offspring act on their suicide ideation and make a suicide attempt. Data were collected during face-to-face interviews conducted on nationally representative samples (N=55?299; age 18+) from 21 countries around the world. We tested the associations between a range of parental disorders and the onset and persistence over time (that is, time since most recent episode controlling for age of onset and time since onset) of subsequent suicidal behavior (suicide ideation, plans and attempts) among offspring. Analyses tested bivariate and multivariate associations between each parental disorder and distinct forms of suicidal behavior. Results revealed that each parental disorder examined increased the risk of suicide ideation among offspring, parental generalized anxiety and depression emerged as the only predictors of the onset and persistence (respectively) of suicide plans among offspring with ideation, whereas parental antisocial personality and anxiety disorders emerged as the only predictors of the onset and persistence of suicide attempts among ideators. A dose-response relation between parental disorders and respondent risk of suicide ideation and attempt was also found. Parental death by suicide was a particularly strong predictor of persistence of suicide attempts among offspring. These associations remained significant after controlling for comorbidity of parental disorders and for the presence of mental disorders among offspring. These findings should inform future explorations of the mechanisms of intergenerational transmission of suicidal behavior.     

Depression in adult Nigerians: Results from the Nigerian Survey of Mental Health and Well-being

BackgroundCommunity-based studies of the rates and profile of depression among Africans are still sparse.MethodsAs part of the World Mental Health Surveys initiative, a clustered multi-stage sampling of households in 21 of Nigeria's 36 states (representing 57% of the national population) was implemented to select adults aged 18 years and over (N = 6752) for face-to-face interviews using the Composite International Diagnostic Interview (CIDI 3.0). Diagnosis of major depressive episode (MDE) was based on the criteria of the Diagnostic and Statistical Manual, 4th edition.ResultsLifetime and 12-month estimates of MDE were 3.1% (standard error 0.3) and 1.1% (s.e. 0.1), receptively. Increasing age was associated with higher estimates of positive responses to stem (screen) questions for depression and of lifetime disorders among stem-positive respondents. The mean age of onset was about 29.2 years. The median (inter quantile range, IQR) duration of an episode among lifetime cases was 1.0 (2.0–2.4) year and the median (IQR) number of lifetime episodes was 1.5 (2.0–2.8). MDE was highly comorbid with anxiety disorders, musculoskeletal conditions, chronic pain and ulcer. The odds ratio of lifetime suicide attempt among persons with lifetime MDE was 11.6 (95% confidence interval, 3.9–34.9). Over 25% of 12-month cases were rated as severely disabled in the performance of usual roles. Only 16.9% (s.e. 5.0) of 12-month cases had received any treatment.LimitationsAll data were based on self-reports.ConclusionMDE, defined according to DSM-IV, is a risk factor for mental and physical comorbidity as well as disability in Nigerians. Age-related telescoping or denial may partly explain the low rates in this young population.