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- Muhwezi, WW, et al.
(author)
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Life events associated with major depression in Ugandan primary healthcare (PHC) patients: issues of cultural specificity
- 2008
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In: The International journal of social psychiatry. - : SAGE Publications. - 0020-7640 .- 1741-2854. ; 54:2, s. 144-163
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Journal article (peer-reviewed)abstract
- Objective: The study compared life events experienced by depressed patients seen at primary healthcare (PHC) centres with those among healthy community controls. Method: Data was collected from 74 depressed patients and 64 unmatched controls from village locales of patients. Interview instruments included the depression module of the Mini International Neuropsychiatric Interview (MINI) and Interview for Recent Life Events (IRLE). Associations between type of respondent and demographic variables were examined. Statistical comparisons were done for the two groups on other variables. Results: Most depressed patients were single by marital status, lacked formal employment and had less post-primary education.They had experienced more life events; job changes, discomforting working hours, unfavourable working conditions, and job losses; personal health problems; loss of valuables; difficulties with intimate partners and family members' marital problems. Independent life events were more among depressed patients and clustered around work, health, bereavement and marriage. Most events reported by depressed patients had high negative impact ratings compared to controls. Conclusion: Compared to healthy community controls, depressed patients reported more undesirable life events. The relationship between life events and depression implies that in PHC settings of poor countries, deploying mental health-oriented workers to manage life events may lessen escalation of distress.
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- Bangirana, P, et al.
(author)
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Cognition, behaviour and academic skills after cognitive rehabilitation in Ugandan children surviving severe malaria: a randomised trial
- 2011
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In: BMC NEUROLOGY. - 1471-2377. ; 11
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Journal article (peer-reviewed)abstract
- Background Infection with severe malaria in African children is associated with not only a high mortality but also a high risk of cognitive deficits. There is evidence that interventions done a few years after the illness are effective but nothing is known about those done immediately after the illness. We designed a study in which children who had suffered from severe malaria three months earlier were enrolled into a cognitive intervention program and assessed for the immediate benefit in cognitive, academic and behavioral outcomes. Methods This parallel group randomised study was carried out in Kampala City, Uganda between February 2008 and October 2010. Sixty-one Ugandan children aged 5 to 12 years with severe malaria were assessed for cognition (using the Kaufman Assessment Battery for Children, second edition and the Test of Variables of Attention), academic skills (Wide Range Achievement Test, third edition) and psychopathologic behaviour (Child Behaviour Checklist) three months after an episode of severe malaria. Twenty-eight were randomised to sixteen sessions of computerised cognitive rehabilitation training lasting eight weeks and 33 to a non-treatment group. Post-intervention assessments were done a month after conclusion of the intervention. Analysis of covariance was used to detect any differences between the two groups after post-intervention assessment, adjusting for age, sex, weight for age z score, quality of the home environment, time between admission and post-intervention testing and pre-intervention score. The primary outcome was improvement in attention scores for the intervention group. This trial is registered with Current Controlled Trials, number ISRCTN53183087. Results Significant intervention effects were observed in the intervention group for learning mean score (SE), [93.89 (4.00) vs 106.38 (4.32), P = 0.04] but for working memory the intervention group performed poorly [27.42 (0.66) vs 25.34 (0.73), P = 0.04]. No effect was observed in the other cognitive outcomes or in any of the academic or behavioural measures. Conclusions In this pilot study, our computerised cognitive training program three months after severe malaria had an immediate effect on cognitive outcomes but did not affect academic skills or behaviour. Larger trials with follow-up after a few years are needed to investigate whether the observed benefits are sustained.
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- Muhwezi, W W, et al.
(author)
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Detection of major depression in Ugandan primary health care settings using simple questions from a subjective well-being (SWB) subscale
- 2007
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In: Soc Psychiatry Psychiatr Epidemiol. ; 42:1, s. 61-9
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To explore whether the 4-item subjective well-being subscale could be used to detect a major depressive illness. Secondly, to describe the prevalence and characteristics of depressed health care attendees at primary healthcare centres. METHOD: Using a descriptive, cross-sectional study design, we interviewed 199 consecutive patients about their socio-demographics, subjective well-being (SWB), major depressive illness symptoms and depression severity. The instruments used were translated into Luganda. RESULTS: Point prevalence of a current Major Depressive Episode (MDE) was 31.6%. Using a one week reference period, we found that experiencing a lot of distress, having less energy or poor health, having poor emotional and psychological adjustment and not being satisfied with life were significantly more common among patients with a current MDE. The 4-item SWB subscale detected depression of up to 87.1% (95% CI: 0.818-0.923). In logistic regression, all four SWB items predicted a current MDE. CONCLUSION: Major depressive illness is a common at primary healthcare level in Uganda. Four simple questions reflecting SWB items have potential to detect diagnosable patients likely to have a current MDE, making general screening procedures less necessary.
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- Nakasujja, N., et al.
(author)
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Cognitive Dysfunction among HIV Positive and HIV Negative Patients with Psychosis in Uganda
- 2012
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In: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 7:9
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Journal article (peer-reviewed)abstract
- Background: Cognitive impairment is an established phenomenon in HIV infected individuals and patients that have psychosis. However there is need to establish the severity of the impairment if patients are co morbid with both conditions. Aim: To compare cognitive function among HIV positive individuals and HIV negative individuals with psychosis. Methods: We recruited patients with psychosis at two national referral hospitals. A standardized demographics questionnaire and psychiatric, physical, and laboratory assessments were conducted. Types of psychosis were diagnosed using the Mini International Neuropsychiatric Inventory-PLUS while cognitive functioning was determined using the Mini mental state examination (MMSE) and a neuropsychological test battery. Follow-up assessments on cognitive function and severity of psychiatric illness were performed at 3 and 6 months. Pairwise comparison and multivariable logistic regression analysis were used to determine the differences between the HIV positive and HIV negative individuals. Results: There were 156 HIV positive and 322 HIV negative participants. The mean age was 33 years for the HIV positive group and 29 years for the HIV negative group (p<0.001). The HIV positive individuals were almost three times (OR = 2.62 CI 95% 1.69-4.06) more likely to be cognitively impaired on the MMSE as well as the following cognitive tests:- WHO-UCLA Auditory Verbal Learning Test (OR 1.79, 95% CI 1.09-2.92), Verbal Fluency (OR 3.42, 95% CI 2.24-5.24), Color Trails 1 (OR 2.03, 95% CI 1.29-3.02) and Color Trails 2 (OR 3.50 95% 2.00-6.10) all p = 0.01. There was improvement in cognitive function at follow up; however the impairment remained higher for the HIV positive group (p<0.001). Conclusion: Cognitive impairment in psychosis was worsened by HIV infection. Care plans to minimize the effect of this impairment should be structured for the management of individuals with HIV and psychosis.
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