Prevalence and Associated Factors of Depression in Outpatients of Internal Medicine Department of Kigali University Teaching Hospital, Rwanda

Background Depression is more prevalent in medically ill patients than in the general population. More is not known about depression rates in internal medicine outpatients consulting the teaching hospitals in Rwanda. Adults with medical diseases are more likely to develop depression, it is an often-unrecognized co-morbidity in this group, and it has a major impact on their function and disability. In the absence of studies in our region, we did this research in our country with interest in what factors might be associated with depressive symptoms. Methods The descriptive cross-sectional study was used to determine the prevalence of depression and associated factors among internal medicine outpatients of Kigali university teaching hospital (CHUK). The 9 items Patient Health Questionnaire (PHQ-9) instrument was used to screen depression symptoms among outpatients. The validated cut-off score of 10 for diagnosing depression was applied in this study. Patients’ clinical and socio-demographic characteristics were collected and analyzed for their relationship with depression. All patients who scored PHQ-9 above 10 were referred to CHUK mental health department for appropriate management. Results Three hundred patients were recruited, of whom 65.3%) were females and 51% had an age between 45 and 96 years. The overall prevalence of depression among outpatients in the internal medicine department of CHUK was 45.7%. Outpatients had 20.7%, 17%, and 10% for moderate, moderately severe, and severe depression, respectively. Age, educational status, and follow-up visits as current physical complaints were independently associated with depression (P < 0.05). As much as 22.7% of patients were presenting with Suicidal ideas. The study showed that low income was strongly associated with suicide ideation (P < 0.001). Regardless of age and gender, the prevalence of depression was higher among outpatients of internal medicine than the general population. Conclusions A holistic approach in the management of internal medicine outpatients should be implemented to facilitate the early detection and treatment of depression in general tertiary hospitals. Furthermore, intervention programs that address depression and suicide in adults are needed.

Quality of Life and Clinical Correlates in Adults with Social Phobia: A Scoping Review

Objective: In light of the substantial clinical and societal burden of social phobia (SP) and impact on the sense of well-being of affected individuals, we sought to summarise extant data related to quality of life and relevant correlates in adults with SP to distill clinical profiles for earlier identification and appropriate management. Methods: A scoping review was carried out on studies examining quality of life in adults with SP and clinical correlates within different settings. PubMed/Medline and Web of Science databases were searched for relevant articles beginning from database inception until May 2021. Results: A total of 25 papers were included. Most of the studies (92%) were cross sectional in nature (80%), conducted in the West (92%), and within clinic or community settings (88%). Patients with comorbid psychiatric conditions, and undergraduate students reported higher rates of SP compared with community population. Significant correlates of SP included demographic (such as females, younger age, living alone, fewer years of education, unemployment) and clinical factors (such as family history of anxiety disorders, suicidal ideas, avoidant personality features). SP was widely associated with decreased QoL involving several domains and especially related to complexity, greater number of feared or trigger situations, and comorbid medical and psychiatric conditions. Conclusion: SP is not uncommon within clinical, and undergraduate populations, and has a significantly negative impact on quality of life. Awareness of its associated clinical profiles allows better identification and overall management of this condition including improvement in QoL.

Confronting and Coping with Multidrug-Resistant Tuberculosis: Life Experiences in Thailand

In this article, we aimed to understand the life experiences of Thai persons diagnosed with multi-drug-resistant tuberculosis (MDR-TB). A qualitative study using a face-to-face in-depth interview was conducted at a hospital in Thailand which has the highest prevalence of MDR-TB in the country between January and February 2019. Twenty persons living with MDR-TB in Thailand were purposively selected to represent a variety of experiences based on different gender, ages, and treatment phases. Qualitative data were transcribed and thematic analysis was applied to identify common themes and sub-themes. The results indicated that all participants faced emotional difficulties, such as fear of death, fear of stigmatization, confusion, and sadness when first knowing of their diagnosis. Family and social support were the main ways that the patients coped with difficult situations. Suicidal ideas were more prevalent among patients with poor family support. Screening for mental health problems should be routinely performed in MDR-TB patients. Proper health education should be provided to patients and families to reduce emotional difficulties and stigmatization.

Effectivity of Psychotherapy Interventions for Anxiety in Medical Students: A Systematic Review

BACKGROUND: The mental health of medical students has long been a topic of concern in many countries. Much research in Europe reported that around 30% of medical students suffered from anxiety. Anxiety disorders have significant physical and emotional consequences. Various studies show that excessive, unmanaged stress related to poor academic performance in medical students leads to cynical personalities, lack of empathy, and suicidal ideas. AIM: This study aimed to identify studies for psychotherapy interventions carried out in medical students and analyze each impact on anxiety level in medical students. METHODS: This systematic review was conducted with evidence sourced from 2000 to 2020. The review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The study was registered with the Prospective Registering of Systematic Reviews database (Protocol ID: CRD42020180650). RESULTS: Twenty-three studies meet the inclusion criteria, and there are various psychotherapy interventions to deal with anxiety. Most studies reported that students who received mindfulness-based interventions reported lower anxiety, depression, and stress. CONCLUSION: There are various interventions carried out to decrease stress levels, depression, and anxiety in medical students. The most effective psychotherapy was found in cognitive and behavior intervention and mindfulness intervention.

Suicidal Ideation and Pesticide Exposure in Rural Communities of Central India

Background This study aims to evaluate association between suicidal ideation and pesticide exposure in rural communities of Wardha district of Central rural India compared with villagers who are not exposed to it. Method It was a cross-sectional study done in rural community of Wardha district in Central India. About 100 farmers who were exposed to pesticides and 100 controls who were not exposed to pesticides were included. A Semistructured proforma to record sociodemographic variables and Indian version of the Self Reporting Questionnaire-20 was used. Results Of these 200 subjects, data were available for 85 farmers in study group and 74 in control group. In the farmers group, 31% of farmers had suicidal ideas, while 8% of controls felt like ending their life. Conclusion Measures must be taken to store pesticides at a safer place thus reducing long-term exposure. Organic farming is a better choice to avoid suicidal ideas.

Suicide Ideation and Its Risk Factors among Secondary School Adolescent in Ebonyi State, South East, Nigeria

Background: Globally, suicidal behaviour is seen as a growing public health problem, However, little is known about the suicide ideation and its risk factors among secondary school adolescent in Ebonyi State. Suicidal thought negatively impacts the quality of life, physical, and mental well-being of the students. However, research on suicide ideation among students in low- and middle-income countries are limited. Therefore, this study aimed to explore suicide ideation and its risk factors among secondary school adolescent in Ebonyi State, Nigeria. Methods: A descriptive cross-sectional survey research design was conducted to assess 399 secondary school adolescents in Ebonyi State between January to May 2021. Simple random sampling technique was used to select 399 participants. However, three hundred and ninety-four (394) were properly filled and used for the study. Data were collected using a self-administered questionnaire. Results: The findings indicated that student with suicidal ideas, 68.3% are in stressful situation, 65.7% has been absence in school for 3 days consecutively, 62.7% have been disappointed by boy/girl-friend, 59.9% feel disappointed from academic performance, 58.4% have been sad or depressed most of the time, 55.6% have been lonely, and 52.3% felt so sad in a way that the situation was unbearable. The result further shows that the major risk factor of suicidal ideation among secondary school students are cultism (71.3%), alcoholism (56.9%), poverty (61.7%), drug use disorders such as (drug addiction, drug dependence, tolerance) 228 (57.9%), and mental illness (54.8%). Other risk factors identified are mental illness 216 (54.8%), sexual harassment/assault (51.8%), unemployment (51.8%), physical assault/bullying (51.8%), and family history of suicide (50.8%). Conclusions: The study concluded that suicide ideation among students was high and recommended among others that the Nigeria ministry of health both state and federal in collaboration with school management should develop a guideline on how to screen and manage factors associated with suicide ideation among secondary school adolescents.

Feasibility of Race by Sex Intersectionality Research on Suicidality in the Adolescent Brain Cognitive Development (ABCD) Study

Intersectional research on childhood suicidality requires studies with a reliable and valid measure of suicidality, as well as a large sample size that shows some variability of suicidality across sex by race intersectional groups. Objectives: We aimed to investigate the feasibility of intersectionality research on childhood suicidality in the Adolescent Brain Cognitive Development (ABCD) study. We specifically explored the reliability and validity of the measure, sample size, and variability of suicidality across sex by race intersectional groups. Methods: We used cross-sectional data (wave 1) from the ABCD study, which sampled 9013 non-Hispanic white (NHW) or non-Hispanic black (NHB) children between the ages of 9 and 10 between years 2016 and 2018. Four intersectional groups were built based on race and sex: NHW males (n = 3554), NHW females (n = 3158), NHB males (n = 1164), and NHB females (n = 1137). Outcome measure was the count of suicidality symptoms, reflecting all positive history and symptoms of suicidal ideas, plans, and attempts. To validate our measure, we tested the correlation between our suicidality measure and depression and Child Behavior Checklist (CBCL) sub-scores. Cronbach alpha was calculated for reliability across each intersectional group. We also compared groups for suicidality. Results: We observed some suicidality history in observed 3.2% (n = 101) of NHW females, 4.9% (n = 175) of NHW males, 5.4% (n = 61) of NHB females, and 5.8% (n = 68) of NHB males. Our measure’s reliability was acceptable in all race by sex groups (Cronbach alpha higher than .70+ in all intersectional groups). Our measure was valid in all intersectional groups, documented by a positive correlation with depression and CBCL sub-scores. We could successfully model suicidality across sex by race groups, using multivariable models. Conclusion: Given the high sample size, reliability, and validity of the suicidality measure, variability of suicidality, it is feasible to investigate correlates of suicidality across race by sex intersections in the ABCD study. We also found evidence of higher suicidality in NHB than NHW children in the ABCD study. The ABCD rich data in domains of social context, self-report, schools, parenting, psychopathology, personality, and brain imaging provides a unique opportunity to study intersectional differences in neural circuits associated with youth suicidality.

MASS THERAPEUTIC EDUCATION FOR MONITORING SUICIDAL BEHAVIOR IN COMMUNITY

Background: Suicide is a worrying problem in Indonesia because of increase in case reported. There has been an increase in suicide rates both globally and in Indonesia. The negative stigma, lack of education, and lack of understanding of the role of the community make it difficult to reduce the number of suicides. This study aims to discuss mass therapeutic education for monitoring suicidal behavior in community. Method: Researchers used 15 journals and literature that discuss the impact and vulnerability of distance learning on students' mental health conditions. Conclusion: The role of society in reducing the suicide rate is very much needed. The community can help make early detection of suicide. Society can help prevent suicidal ideas from arising in those around them. The public can provide information to the authorities and give advice for suicide perpetrators to visit a health center. The role of the community can be integrated in a structured and neat system that can make suicide prevention efforts become optimal.

Socio-demographic, economic and mental health problems were risk factors for suicidal ideation among Kenyan students aged 15 plus

Background: Understanding the prevalence of different suicidal ideas and context appropriate wide range of risk factors in youth in particular is important because about a third of youth with suicidal ideation develop suicidal plans and about 60% of youth with suicidal plans make suicidal attempts. This study aims to provide for the first time wide ranging Kenyan data on the above so as to inform context appropriate practice and policy. Methods: To achieve our aim, we studied a total of 9742 high school, college and university students using following self-administered instruments: - a researcher design socio-demographic questionnaire, Psychiatric Diagnostic Screening Questionnaire (PDSQ) to document psychiatric disorders and various types of suicidal ideas in previous two weeks, Washington Early Recognition Center Affectivity and Psychosis tool to assess stress, affectivity and psychosis, Wealth index questionnaire to document economic indicators based on household items for the families of the students. We used descriptive statistics to document the prevalence of suicidal ideas and socio-demographics, univariate analysis to determine associations between suicidal ideas and mental health disorders, socio-demographic characteristics and economic indicators. All the independent variables were then estimated using bivariate logistic regression, fitted to identify potential confounding factors. Variables with a p-value of less than <.05 were entered into generalized linear models using logit links to identify independent predictors. Results: The median age was 21.3 years (range 15-43),with a majority of males (53.5%)and 93.4% single. The overall prevalence of different types of suicidal ideation was (22.6%), the commonest of which was thinking of specific ways to take their life (19.3%) and least wanting to be dead (10.7%). Major depression was found in 20.0%. Affectivity, psychosis and stress was found in 10.4%, 8.7% and 26.0% respectively. Female gender, major depression, stress, affectivity and psychosis and being in high school were significant (p<0.05) predictors of suicidal ideation. Conclusion: We have documented the prevalence of different types of suicidal ideas and the risk factors in Kenyan students. We have therefore achieved our aims. Future studies are needed to study the progression from suicidal ideas to suicidal attempts and the factors associated with that progression.

Depressive symptoms and automatic negative thoughts as predictors of suicidal ideation in Mexican adolescents

Introduction. Since little is known about the factors associated with suicidal ideation in adolescents, identifying them is important for developing suitable preventive strategies. Objective. To analyze the variables associated with the presence of suicidal ideation, as well as the predictive power of depressive symptoms and negative automatic thoughts. Method. A prospective cross-sectional study was conducted with 409 students between the ages of 15 and 19 randomly selected in a public school in the State of Mexico. An ad hoc questionnaire that gathered information on sociodemographic and psychological variables and substance use, the Depression Scale of the Center for Epidemiological Studies (CESD-R), the Automatic Thoughts Questionnaire (ATQ-30), and the Beck Scale for Suicide Ideation (SSI) were administered. Results. From the total of the sample, 14.9% presented suicidal ideation. A positive, significant association was observed between the latter and gender, having divorced parents, professing Catholicism, using tobacco and drugs, and having experienced violence and anguish in the last semester, presenting depressive symptoms, negative automatic thoughts and having attempted suicide. Being a woman (OR = 2.55 [1.02, 6.38]), using drugs (OR = 3.44 [1.23, 9.57]), having probable depression (OR = 4.37 [1.68, 11.36]), experiencing negative thoughts (OR = 6.03 [2.40, 15.10]), and having attempted suicide (OR = 22.66 [1.58, 325.29]) predicted the appearance of suicidal ideas. Discussion and conclusion. Risk factors for suicidal ideation in adolescents have been identified and they must be taken into account in preventive programs.