Browsing by Author "Wasserman, Danuta"

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    Integrating mental health into primary health care: local initiatives from Uganda
    (World Psychiatry, 2007) Ovuga, Emilio; Boardman, Jed; Wasserman, Danuta
    Uganda has passed through political and bloody civil strife stretching over 40 years. Since 1987 the HIV/AIDS pandemic has compounded the problems of the country. The present paper describes some initiatives to develop mental health services in one district of the country. A bottom-up approach in the district resulted in the formation of a community-led mental health program with strong support from two self-help groups, district political leaders and district representatives in parliament. Primary health care providers at all levels of health care in the district were trained in order to make services accessible to the rural population. Further plans based on initial exploratory discussions aim to involve the education department, the welfare and probation office, prisons and police, the military, church and cultural leaders and traditional healers. These initiatives show that it is possible to empower communities to participate in the development of mental health programs in a low-income country.
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    The prevalence of depression in two districts of Uganda
    (Social psychiatry and psychiatric epidemiology, 2005) Ovuga, Emilio; Boardman, Jed; Wasserman, Danuta
    Background Little information is available on the prevalence of depression in Uganda.Given the recent political history of Uganda, depression may be common. Method The aim was to estimate the point prevalence of probable clinical depressive disorder among the general population in two contrasting districts of Uganda. Translated versions (in Madi and Lusoga) of the 13-item Beck Depression Inventory (BDI) were administered to a systematic sample of adult residents in the Adjumani and Bugiri districts of Uganda. Results The overall prevalence of probably clinically significant depression (BDI score of 20–39) was 17.4%.Significantly higher rates were found in women and in Adjumani District. Conclusion Depression is common in Uganda and particularly in the more troubled and less socially cohesive district of Adjumani.
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    Psychiatric disorders in HIV-positive individuals in urban Uganda
    (Psychiatric Bulletin, 205) Ovuga, Emilio; Boardman, Jed; Wasserman, Danuta
    There is a well-documented strong association between depressive disorders and HIV/AIDS (e.g. Maj et al, 1994; Perkins et al, 1994; Judd et al, 1997). High levels of depression are seen in people with HIV/AIDS attending primary care clinics (Savetsky et al, 2001) and in HIV medical clinics (Lyketsos et al, 1994a). There appears to be a sustained rise in depressive symptoms as AIDS develops (Lyketsos et al, 1994b). Depression is also associated with HIV-related risk behaviours among those without HIV (Kelly et al, 1993). Nevertheless, most persons affected by HIV/AIDS in Uganda do not receive any care for their mental health problems. The early cases of AIDS were described in Uganda, but there has been little work examining the existence of psychiatric disorders in AIDS/HIV in that country. The national rate of HIV at the end of 2003 was 4.1% (UNAIDS, 2004), but is as high as 13% in war-torn northern Uganda. Of adult deaths at Mulago Hospital, Kampala, 60-70% are attributable to HIV.Wilk & Bolton (2002) investigated how people in two districts of Uganda (Masaka and Rakai), which have been severely affected by HIV, perceive the mental health affects of the disease. The individuals interviewed described two independent depression-like syndromes resulting from the HIV epidemic and rates of depressive disorder were estimated to be 21% in these districts (Bolton et al, 2004). Anecdotal evidence also links HIV/AIDS to suicide in Uganda (Musisi et al, 2001; Kinyanda & Musisi, 2002).
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    The Response Inventory for Stressful Life Events (RISLE) I. refinement of the 100-item Version
    (African health sciences, 2005) Ovuga, Emilio; Boardman, Jed; Wasserman, Danuta
    No indigenous screening instruments are available for the detection of depression and suicide risk relevant to the context of patients in Uganda. The Response Inventory for Stressful Life Events (RISLE) may be an appropriate tool, but requires validation. Objective: The paper reports on the development of the RISLE and the refinement of the 100-item RISLE into a shorter version for use in large samples. Methods: Two samples were used in the validation exercise: a general population sample from Adjumani and Bugiri districts and a student sample from Makerere University in Kampala district. The RISLE responses were subjected to Principal Components Analysis and Discriminant Function Analysis. The 100-item RISLE and resulting shorter version were compared and their concurrent validity assessed by comparing test results to the individuals’ responses to the Beck Depression Inventory (BDI) and the Beck Scale for Suicide ideation (BSS). Results: Nine hundred thirty nine questionnaires were available for the population sample, 101 for the student sample. The 100- item RISLE was reduced to 36-items without loss of face validity. Both the 100- and 36-item versions had high internal consistency, were highly correlated with each other and with the BDI and BSS. Conclusion: The 36-item RISLE appears to be an advance on the 100-item version, retaining its internal consistency and concurrent validity.
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    The Response Inventory for Stressful Life Events (RISLE) II: Validation of the 36-item Version
    (African health sciences, 2005) Ovuga, Emilio; Boardman, Jed; Wasserman, Danuta
    A 36-item version of the Response Inventory for Stressful Life Events (RISLE) was derived from the longer 100- item version. The 36-item version may be more appropriate for use in larger population sample. Objective: To compare the responses of the 36-item RISLE to interview derived psychiatric diagnoses and suicidal ideation in a sub-sample of the general population and student samples reported in the accompanying paper. Methods: Clinical interviews using the Mini International Neuropsychiatric Interview (MINI) were carried out on 67 members of the general population and 58 members of the student samples. Receiver Operating Characteristic (ROC) curves were constructed for the RISLE responses using current depressive disorder, any current psychiatric disorder, and past month suicidality variables. Sensitivities, specificities, predictive values and likelihood ratios were determined based on various cut-off points based on ROC curves. Kappa statistic was determined to evaluate the level of agreement between the result of questionnaire surveys and research clinical interviews at different cut-off points on the RISLE. Results: The probability of correct detection of current depression was 79%, any current psychiatric disorder 83% and past month suicidality 83%. The optimal cut-offs for the general population was 10 and for the students 6. High scores on the 36-item RISLE were associated with a past history of suicide attempt and recent and past suicide ideation. Conclusion: The 36-item RISLE appears to have good concurrent validity and may be a reasonable screening instrument for psychological distress in the Ugandan population. The results suggest that the RISLE alone is capable of screening for both depressive mood and suicidal ideation effectively at different cut-off points. Thus the RISLE is capable of achieving what normally takes two scales such as the BDI and BSS to do separately. However, further validation work is required using larger population samples in clinical interviews in prospective studies.
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    Undergraduate student mental health at Makerere University, Uganda
    (World psychiatry, 2006) Ovuga, Emilio; Boardman, Jed; Wasserman, Danuta
    There is little information on the current mental health of University students in Uganda. The present study was carried out to determine the prevalence of depressed mood and suicidal ideation among students at Makerere University. Two student samples participated. Sample I comprised 253 fresh students admitted to all faculties at the University in the academic year 2000/2001, selected by a simple random sampling procedure. Sample II comprised 101 students admitted to the Faculty of Medicine during the academic year 2002/2003. The prevalence of depressed mood was measured using the 13-item Beck Depression Inventory (BDI). The prevalence of depressed mood (BDI score 10 or more) was significantly higher in sample I (16.2%) than sample II (4.0%). Sample I members were significantly more likely than those of sample II to report lifetime and past week suicide ideation. Thus, there is a high prevalence of mental health problems among the general population of new students entering Makerere University and this is significantly higher than for new students in the Faculty of Medicine.