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Prevalence of Mental Disorders and Profile of Disablement among Primary Health Care Service Users in Lagos Island

Prevalence of Mental Disorders and Profile of Disablement among Primary Health Care Service Users... Hindawi Publishing Corporation Epidemiology Research International Volume 2012, Article ID 357348, 6 pages doi:10.1155/2012/357348 Research Article Prevalence of Mental Disorders and Profile of Disablement among Primary Health Care Service Users in Lagos Island 1 2 3 V. O. Lasebikan, A. Ejidokun, andO.A.Coker Department of Psychiatry, College of Medicine, University of Ibadan, PMB 5116, Ibadan, Nigeria School of Psychiatric Nursing, Federal Neuropsychiatric Hospital, P.O. Box 1912, Sabo, Yaba, Lagos, Nigeria Department of Psychiatry, Lagos State University Teaching Hospital, c/o P.O. Box 1912, Sabo, Yaba, Lagos, Nigeria Correspondence should be addressed to V. O. Lasebikan, victorlash@yahoo.com Received 18 December 2011; Accepted 13 January 2012 Academic Editor: Huibert Burger Copyright © 2012 V. O. Lasebikan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. The aim of this study was to determine the prevalence of psychiatric morbidity in selected semiurban primary care centers in Lagos Island, Nigeria using the screening tool GHQ-12 and the ICD 10 mental disorders checklist (primary care) (ICD 10 PC). Methods. In this multistage cross-sectional study, 400 participants were recruited by using proportional sampling of 17,787 attendees. Results. Of all respondents, 45.8% scored positive on GHQ-12. The most prevalent “any ICD 10 disorder” was unexplained somatic disorder (57.5%), while 2.0 to 7.8% of the respondents reported varying levels of disablement. Younger age (P< 0.001) and being widowed (P = 0.03) were significantly associated with high GHQ scores while younger age (P< 0.001) and male gender (P = 0.04) were significantly associated with “any ICD 10 disorder”. Conclusion. These findings are a useful guide to the probable prevalence of psychiatric morbidity in primary care in Nigeria and in the design of appropriate interventions. 1. Introduction The prevalence of mental disorders could be as high as 33% in the elderly age group, seen in primary care [17, 18]. The majority of individuals with psychiatric morbidity in the The commonest diagnoses are depression and dementia [19]. community are usually seen at the primary care level [1– Several studies in primary care facilities have measured 5], with prevalence rates ranging from 16 to 43% of general the prevalence of other specific mental disorders, due to practice users [1, 6–8]. their public health importance. The prevalence of postnatal In different countries of the world, the prevalence of depression was 14% in Turkey [20] and 19% in Nigeria [21]. mental disorders in primary care settings has been exten- Despite this high prevalence, primary care practitioners sively researched and, in adults, ranges between 10% and have difficulties in detecting about one-third of those with 60% [8, 9]. The most prevalent mental disorders presenting mental health problems [4, 22, 23]. This can be adduced to a in primary care settings are depression, 5% to 20% [10], number of reasons, such as reports indicating that patients generalized anxiety disorder, 4% to 15% [11], harmful alco- seeking treatment in primary care tend to somatize their hol use and dependence, 5% to 15% [12], and somatization emotional distress, thereby presenting with physical symp- disorders, 5% to 11% [13]. toms rather than overt psychological symptoms [24]. Fur- Studies of children and adolescents have also demon- thermore, medical history is often taken with complacency strated a high prevalence of mental disorders in primary care and little confidentiality thereby discouraging patients from settings. For example, about 20% of children and adolescent sharing sensitive aspects of their psychological/emotional were found to have mental health problems in Ibadan, Nigeria [14], 30% of children aged 6 to 11 years in Valencia, distress [6]. Also, primary care practitioners have difficulties in diagnosing and treating psychiatric disorders [25, 26]and Spain [15], and 43% of children aged 6 to 18 years in United Arab Emirates [16]. often have limited time to obtain a psychiatric history [26]. 2 Epidemiology Research International Thus, screening for psychiatric disorders in primary care Adele recorded 3523 service users and Broad Street centre can improve the detection rate and may be helpful in pre- recorded 3095 service users. In all 17,787 clients utilized all venting grave consequences of unrecognized and untreated the primary care centers in preceding year. psychiatric morbidity. This is relevant to the Nigerian setting where mental health service at the primary care has received 2.2.3. Stage Three. Since the number of service users in each little attention. centre varied, a quota was determined for each of the primary The main objective of the present study was to determine health care centers, using proportional sampling method. the prevalence and sociodemographic correlates of mental Hence, 41 clients were interviewed in Sura Primary disorders among primary health care service users in Lagos Health Care Centre, 98 from City Hall, 62 from Oko-awo, Island. 50 from Olowogbowo,79fromAdeniji Adele, and93from Broad Street Primary Health Care Centre, respectively. The first respondent in each facility was interviewed by simple 2. Methodology random sampling and subsequent ones one after the other The study was a descriptive survey that determined the until each quota was fulfilled. prevalence of psychiatric morbidity and syndromes and established the relationship between the demographic vari- 3. Procedure for Data Collection ables of the study population with psychiatric morbidity among the primary health care service users in Lagos Island. One stage assessment was used in the data collection for The study setting was Lagos Island area of Lagos State, south this study. The study was introduced and briefly described west of Nigeria with an estimated population of 400,000 to the participants at the waiting room before they entered residents (projected 2007 population at 3% annual increase the consulting room. Consent was also obtained from each of 1991) [27]. The target population was primary care users, participant. aged 15 years and above, who utilized a selected number of Patients aged from 12 to 70 years. Patients were given tal- Primary Health Care Centre of Lagos Island between January lies. The first subject was chosen by simple random sampling and April, 2008. and subsequent ones by proportional sampling method. Excluded from the study were patients who did not consent and those who were not literate. 2.1. Sample Size Estimation. Minimum sample size was obtained using minimum sample size estimation table for a population of at least 10,000 persons at 5% margin error, 3.1. Instruments. All respondents were administered both yielding a minimum sample of 370 [28]. Thus, 400 subjects the GHQ-12 [29] and the ICD 10 PC [30]. The GHQ- were interviewed. 12 was used to screen for psychiatric morbidity while the Mental Health Checklist (ICD-10 PC) was used to determine prevalence of psychiatric syndromes. The respondents were 2.2. Sampling Procedure. A Multistage sampling method was also requested to complete a data form consisting of used. sociodemographic data, psychiatric history, and recent life events. The time taken for each respondent to be interviewed 2.2.1. First Stage. All primary health care centers were group- was between 12 and 20 minutes. ed into two according to the local government area they are located in, namely, Lagos Island West andLagos Island East. 3.2. Ethical Considerations. Consent was obtained from each (i) Lagos Island West participant before the study so also was ethical approval from the Lagos State Ministry of Health Ethical Review (a) Sura Primary Health Care Centre. Committee. (b) City-Hall Primary Health Care Centre. (c) Oko-awo primary Health care Centre. 3.3. Analysis. Analysis was performed using SPSS software [31]. Categorical data were analyzed using person χ statis- (ii) Lagos Island East tics, while continuous variables were analyzed using student t-test. All tests of significance were set at 95% confidence (a) Olowogbowo Primary Health Care Centre. interval. (b) Adeniji Adele Primary Health Care Centre. (c) Broad Street Primary Health Care Centre. 4. Results 2.2.2. Second Stage. The total number of clients registered The sociodemographic characteristics of the sample are in the preceding year was obtained from the information shown in Table 1. A total of 400 out of an initial 470 subjects officers for each local government. In Lagos Island East, Sura completed the interview, a response rate of (85.1%). The Primary Health Care Centre registered 1833 service users sample consisted of 88 (22.0%) children and young adults in preceding year; City Hall recorded 4367 service users, belowaged29years,55(13.8%)aged30to39years,72 while Oko-awo recorded 2762 service users. In Lagos Island (18.0%) aged 40 to 49 years, 63 (15.8%) aged 50 to 59 years, West, Olowogbowo recorded 2207 service users; Adeniji and 122 (30.5%) who were above 59 years. Epidemiology Research International 3 Table 1: Demographic data of respondents. 2 2 N %HighGHQ χ P Any ICD 10 Disorder χ P Demographic characteristics n = 182% n = 230% Age (years) <29 88 22.0 61.4 11.8 <0.001 79.5 21.3 <0.001 30 – 39 55 13.8 63.6 72.7 40 – 49 72 18.0 48.6 55.5 50 – 59 63 15.8 48.3 47.6 >59 122 30.5 23.8 32.8 Sex Male 174 43.5 47.1 0.24 0.6 63.2 4.1 0.04 Female 226 56.5 44.7 53.1 Marital status Married 250 62.5 44.8 10.1 0.03 56.0 5.7 0.2 Single 100 25.0 39.0 55.0 Divorced 25 6.3 72.0 80.0 Separated 17 4.2 58.8 58.8 Widow 8 2.0 50.0 62.5 Level of education No formal education 69 17.3 49.3 1.6 0.7 58.0 3.4 0.3 Primary school 60 15.0 50.0 66.7 Secondary school 133 33.2 45.9 52.6 Postsecondary education 138 34.5 42.0 57.9 Religion Christianity 188 47.0 47.9 1.7 0.4 58.5 0.4 0.8 Islam 196 49.0 42.9 56.1 Traditional 16 4.0 56.3 62.5 Occupation High level professional 65 16.3 44.6 4.4 0.2 61.5 1.2 0.8 Skilled worker 100 25.0 43.0 60.0 Semiskilled/unskilled 126 31.5 40.0 55.5 Worker Not on any job 109 27.3 40.4 55.0 Of the 400 respondents, 226 (56.5%) were females, and half (50.0%) of the respondents, any anxiety disorder 250 (62.5%) were married. Only 69 (17.3%) had no formal, (49.3%), primary insomnia (45.3%), and alcohol use dis- and 109 (27.3%) were unemployed (Table 1). order (11.3%). Between 2.0 and 7.8% of respondents had disablement in various areas of life, out of which the commonest was in the domain of family relations (7.8%). 4.1. Psychiatric Morbidity. Prevalence of psychiatric morbid- ity was significantly highest for respondents below 39 years Mean duration of inability to carry out activities of daily and tended to reduce with increasing age; χ for trend = life in past month was 4.2± 2.1. Mean duration of days spent on bed in past month was 5.4 ± 3.2(Table 2). 11.8, P< 0.001. Prevalence of psychiatric morbidity was significantly highest among those who were divorced 72%; χ = 10.1, P = 0.03 (Table 1). 5. Discussion 4.2. ICD 10 Disorder. Prevalence of any ICD 10 disorder was The present study, aimed at determining the prevalence highest among those below 29 years of age and tended to of psychiatric morbidity among primary health centers reduce with increasing age χ for trend 21.3; P< 0.001. service users in Lagos Island, revealed a high prevalence Prevalence of any ICD 10 disorder was significantly higher of psychiatric morbidity of 47.8%. The most prevalent in males; χ = 4.1, P = 0.04 (Table 1). ICD syndrome was unexplained somatic complaint disorder The most prevalent clinical syndrome was unexplained (57.5%) while half (50.0%) of the respondents had depres- somatic complaints (57.5%), followed by depression among sive disorder. A prevalence rate of 11.3% was reported for 4 Epidemiology Research International Table 2: Clinical data of respondents. more sensitive tool in screening for psychiatric morbidity in the primary care. ICD 10 disorders Frequency Percentage (%) The pattern of symptom presentation and common men- Depressive episode 200 50.0 tal disorders in this study are similar and comparable to Any anxiety disorder 219 49.3 other studies of mental health prevalence in primary health Alcohol use disorder 45 11.3 care. The disorders are depression, anxiety, difficulty in social functioning and disablement, sleep problems, Chronic Primary insomnia 223 45.3 fatigue, alcohol use problems, and unexplained somatic Fatigue problem 23 5.8 complaints. The findings correspond with World Health Unexplained somatic disorder 230 57.5 Organization’s [34] report that the commonest problems Limited in one or more of the identified among primary health care attendants were following activities in the past month 17 4.3 depression, anxiety, alcohol misuse, somatoform disorder, Self-care; bathing, dressing, eating and neurasthenia. Family relation; spouse, children, We found a prevalence rate of 50.0% for depressive syn- 31 7.8 relatives drome, a figure close to 51.7% (depressive neurosis) earlier Going to school or work 16 4.0 reported in some parts of Nigeria. The prevalence of Doing household work or task 12 3.0 unexplained somatic complaint of 57.5% was higher than that of somatoform disorder (47.6%) reported in an earlier Social activities; seeing friends 9 2.3 study in Nigeria [35]. The high prevalence of unexplained Remembering things 8 2.0 somatic complaints reported in this study may not be Unable to carry out activities (days) 4.2 ± 2.1 — explained as a reflection of the tendency of African patients to Spent on bed (days) 5.4 ± 3.2 — present their psychological distress with somatic symptoms as studies have shown that there is no cultural variation in somatization [36]. However, this high rate of somatization alcohol use disorder. We observed varying levels and profiles may suggest a pathway to more severe mental disorders. of disablement (up to 7.8%) among the respondents as well. An interesting finding from this study is the higher than Before discussing our findings, the results must first be expected prevalence of disablement experienced by these considered in the context of some potential study limitations. patients (2.0–7.8%) which is, to the best of our knowledge, Firstly, we obtained our results only from primary care sites the first estimate of prevalence of disability from psychosis in Lagos Island, whose patients particularly in terms of in a primary care setting in Nigeria. This suggests the impact social class may not be representative of most primary care of psychosis on its sufferers in nonclinical population, in this practices; however, the healthcare centers in which the study instance primary care setting where the primary reason for was carried out share some other common features with service use is for general medical conditions. many other centers in Nigeria. Secondly, there is the potential The present study found certain sociodemographic cor- for the sources of error associated with studies involving relates of psychiatric morbidity somewhat different from pre- subjects whose primary aims were to receive medical treat- vious ones that found female gender, being unemployed, and ments rather than being interviewed for research purposes. being separated or divorced to be associated with a higher Notwithstanding the above caveats, it should be emphasized prevalence of psychiatric disorder [1, 2, 4]. The present study that screening for psychiatric disorders in primary care identified only young age, male gender, and being divorced is an important step to improving services. This should to be associated with psychiatric morbidity. prompt physicians to consider the subsequent use of a full A major problem of the estimates of psychiatric disorders diagnostic interview and referral to specialized psychiatric in Nigeria is the choice of research methodology. Most services whenever necessary. psychiatric screening instruments were developed in coun- Our findings corroborate earlier ones indicating high tries outside Nigeria. In other words, there is a scarcity of prevalence of psychiatric morbidity in the primary care published literature on different Nigeria languages. [14, 21]. In this study it was found that the prevalence The use of psychiatric screening scales in a language of psychiatric morbidity was 45.8%. This figure seemingly appears higher than reported prevalence between 25% and and culture other than that for which it was designed and 38% from some other countries of the world [2, 32, 33]. developed may create considerable problems. This is because of the influence of translation and other sociocultural factors. There is no simple explanation for this high figure, but a possible consideration may be the fact that this study was Some researchers prefer to design new, culture-specific carried out in Lagos, a city with very difficult living and instruments. Ideally, a screening scale should be developed working conditions. in the cultural setting in which it is to be used. It would, More striking still is the higher prevalence of psychiatric however, be irrational to ignore well-established instruments developed in other cultures since many phenomena and syndromes among these primary care service users as described by the ICD 10 PC as compared with the GHQ- concepts are common between cultures. A critical, careful 12. This suggests that ICD 10 PC captures some other mental approach is, therefore, vital when translating, modifying, and validating psychiatric instruments before they are used across health problems than the GHQ screens for. Such may include alcohol use disorder. This suggests that ICD 10 PC may be a cultures. Epidemiology Research International 5 Disclosure [13] B. Duran, M. Sanders, B. Skipper et al., “Prevalence and correlates of mental disorders among Native American women All authors agree to the construct of the paper. in primary care,” American Journal of Public Health, vol. 94, no. 1, pp. 71–77, 2004. [14] O. Gureje,O.O.Omigbodun, R. Gater,R.A.Acha, B. A. Conflict of Interests Ikuesan, and J. Morris, “Psychiatric disorders in a pediatric primary care clinic,” British Journal of Psychiatry, vol. 165, pp. The authors declare that they have no conflict interests. 527–530, 1994. [15] M. J. L. Pedreira and G. E. Sardinero, “Prevalence of mental Acknowledgments disorders in childhood in paediatric primary care,” Actas Luso- Espanolas de Neurologia, Psiquiatriay Ciencias Afines, vol. 24, Acknowledgment is given to the Director of Ethical Review no. 4, pp. 173–190, 2003. Board of The Lagos State Ministry of Health, for granting [16] V. Eapen, M. Al-Sabosy, M. Saeed, and S. Sabri, “Child ethical approval to undertake this study. The assistance of Dr. psychiatric disorders in a primary care Arab population,” A Akinnuoye, Dr. O Ayinde, Dr. O Ojediran, Sola Ogundeji International Journal of Psychiatry in Medicine, vol. 34, no. 1, and Christie Alabi in data collection is also appreciated. 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Prevalence of Mental Disorders and Profile of Disablement among Primary Health Care Service Users in Lagos Island

Epidemiology Research InternationalFeb 7, 2012

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Hindawi Publishing Corporation Epidemiology Research International Volume 2012, Article ID 357348, 6 pages doi:10.1155/2012/357348 Research Article Prevalence of Mental Disorders and Profile of Disablement among Primary Health Care Service Users in Lagos Island 1 2 3 V. O. Lasebikan, A. Ejidokun, andO.A.Coker Department of Psychiatry, College of Medicine, University of Ibadan, PMB 5116, Ibadan, Nigeria School of Psychiatric Nursing, Federal Neuropsychiatric Hospital, P.O. Box 1912, Sabo, Yaba, Lagos, Nigeria Department of Psychiatry, Lagos State University Teaching Hospital, c/o P.O. Box 1912, Sabo, Yaba, Lagos, Nigeria Correspondence should be addressed to V. O. Lasebikan, victorlash@yahoo.com Received 18 December 2011; Accepted 13 January 2012 Academic Editor: Huibert Burger Copyright © 2012 V. O. Lasebikan et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. The aim of this study was to determine the prevalence of psychiatric morbidity in selected semiurban primary care centers in Lagos Island, Nigeria using the screening tool GHQ-12 and the ICD 10 mental disorders checklist (primary care) (ICD 10 PC). Methods. In this multistage cross-sectional study, 400 participants were recruited by using proportional sampling of 17,787 attendees. Results. Of all respondents, 45.8% scored positive on GHQ-12. The most prevalent “any ICD 10 disorder” was unexplained somatic disorder (57.5%), while 2.0 to 7.8% of the respondents reported varying levels of disablement. Younger age (P< 0.001) and being widowed (P = 0.03) were significantly associated with high GHQ scores while younger age (P< 0.001) and male gender (P = 0.04) were significantly associated with “any ICD 10 disorder”. Conclusion. These findings are a useful guide to the probable prevalence of psychiatric morbidity in primary care in Nigeria and in the design of appropriate interventions. 1. Introduction The prevalence of mental disorders could be as high as 33% in the elderly age group, seen in primary care [17, 18]. The majority of individuals with psychiatric morbidity in the The commonest diagnoses are depression and dementia [19]. community are usually seen at the primary care level [1– Several studies in primary care facilities have measured 5], with prevalence rates ranging from 16 to 43% of general the prevalence of other specific mental disorders, due to practice users [1, 6–8]. their public health importance. The prevalence of postnatal In different countries of the world, the prevalence of depression was 14% in Turkey [20] and 19% in Nigeria [21]. mental disorders in primary care settings has been exten- Despite this high prevalence, primary care practitioners sively researched and, in adults, ranges between 10% and have difficulties in detecting about one-third of those with 60% [8, 9]. The most prevalent mental disorders presenting mental health problems [4, 22, 23]. This can be adduced to a in primary care settings are depression, 5% to 20% [10], number of reasons, such as reports indicating that patients generalized anxiety disorder, 4% to 15% [11], harmful alco- seeking treatment in primary care tend to somatize their hol use and dependence, 5% to 15% [12], and somatization emotional distress, thereby presenting with physical symp- disorders, 5% to 11% [13]. toms rather than overt psychological symptoms [24]. Fur- Studies of children and adolescents have also demon- thermore, medical history is often taken with complacency strated a high prevalence of mental disorders in primary care and little confidentiality thereby discouraging patients from settings. For example, about 20% of children and adolescent sharing sensitive aspects of their psychological/emotional were found to have mental health problems in Ibadan, Nigeria [14], 30% of children aged 6 to 11 years in Valencia, distress [6]. Also, primary care practitioners have difficulties in diagnosing and treating psychiatric disorders [25, 26]and Spain [15], and 43% of children aged 6 to 18 years in United Arab Emirates [16]. often have limited time to obtain a psychiatric history [26]. 2 Epidemiology Research International Thus, screening for psychiatric disorders in primary care Adele recorded 3523 service users and Broad Street centre can improve the detection rate and may be helpful in pre- recorded 3095 service users. In all 17,787 clients utilized all venting grave consequences of unrecognized and untreated the primary care centers in preceding year. psychiatric morbidity. This is relevant to the Nigerian setting where mental health service at the primary care has received 2.2.3. Stage Three. Since the number of service users in each little attention. centre varied, a quota was determined for each of the primary The main objective of the present study was to determine health care centers, using proportional sampling method. the prevalence and sociodemographic correlates of mental Hence, 41 clients were interviewed in Sura Primary disorders among primary health care service users in Lagos Health Care Centre, 98 from City Hall, 62 from Oko-awo, Island. 50 from Olowogbowo,79fromAdeniji Adele, and93from Broad Street Primary Health Care Centre, respectively. The first respondent in each facility was interviewed by simple 2. Methodology random sampling and subsequent ones one after the other The study was a descriptive survey that determined the until each quota was fulfilled. prevalence of psychiatric morbidity and syndromes and established the relationship between the demographic vari- 3. Procedure for Data Collection ables of the study population with psychiatric morbidity among the primary health care service users in Lagos Island. One stage assessment was used in the data collection for The study setting was Lagos Island area of Lagos State, south this study. The study was introduced and briefly described west of Nigeria with an estimated population of 400,000 to the participants at the waiting room before they entered residents (projected 2007 population at 3% annual increase the consulting room. Consent was also obtained from each of 1991) [27]. The target population was primary care users, participant. aged 15 years and above, who utilized a selected number of Patients aged from 12 to 70 years. Patients were given tal- Primary Health Care Centre of Lagos Island between January lies. The first subject was chosen by simple random sampling and April, 2008. and subsequent ones by proportional sampling method. Excluded from the study were patients who did not consent and those who were not literate. 2.1. Sample Size Estimation. Minimum sample size was obtained using minimum sample size estimation table for a population of at least 10,000 persons at 5% margin error, 3.1. Instruments. All respondents were administered both yielding a minimum sample of 370 [28]. Thus, 400 subjects the GHQ-12 [29] and the ICD 10 PC [30]. The GHQ- were interviewed. 12 was used to screen for psychiatric morbidity while the Mental Health Checklist (ICD-10 PC) was used to determine prevalence of psychiatric syndromes. The respondents were 2.2. Sampling Procedure. A Multistage sampling method was also requested to complete a data form consisting of used. sociodemographic data, psychiatric history, and recent life events. The time taken for each respondent to be interviewed 2.2.1. First Stage. All primary health care centers were group- was between 12 and 20 minutes. ed into two according to the local government area they are located in, namely, Lagos Island West andLagos Island East. 3.2. Ethical Considerations. Consent was obtained from each (i) Lagos Island West participant before the study so also was ethical approval from the Lagos State Ministry of Health Ethical Review (a) Sura Primary Health Care Centre. Committee. (b) City-Hall Primary Health Care Centre. (c) Oko-awo primary Health care Centre. 3.3. Analysis. Analysis was performed using SPSS software [31]. Categorical data were analyzed using person χ statis- (ii) Lagos Island East tics, while continuous variables were analyzed using student t-test. All tests of significance were set at 95% confidence (a) Olowogbowo Primary Health Care Centre. interval. (b) Adeniji Adele Primary Health Care Centre. (c) Broad Street Primary Health Care Centre. 4. Results 2.2.2. Second Stage. The total number of clients registered The sociodemographic characteristics of the sample are in the preceding year was obtained from the information shown in Table 1. A total of 400 out of an initial 470 subjects officers for each local government. In Lagos Island East, Sura completed the interview, a response rate of (85.1%). The Primary Health Care Centre registered 1833 service users sample consisted of 88 (22.0%) children and young adults in preceding year; City Hall recorded 4367 service users, belowaged29years,55(13.8%)aged30to39years,72 while Oko-awo recorded 2762 service users. In Lagos Island (18.0%) aged 40 to 49 years, 63 (15.8%) aged 50 to 59 years, West, Olowogbowo recorded 2207 service users; Adeniji and 122 (30.5%) who were above 59 years. Epidemiology Research International 3 Table 1: Demographic data of respondents. 2 2 N %HighGHQ χ P Any ICD 10 Disorder χ P Demographic characteristics n = 182% n = 230% Age (years) <29 88 22.0 61.4 11.8 <0.001 79.5 21.3 <0.001 30 – 39 55 13.8 63.6 72.7 40 – 49 72 18.0 48.6 55.5 50 – 59 63 15.8 48.3 47.6 >59 122 30.5 23.8 32.8 Sex Male 174 43.5 47.1 0.24 0.6 63.2 4.1 0.04 Female 226 56.5 44.7 53.1 Marital status Married 250 62.5 44.8 10.1 0.03 56.0 5.7 0.2 Single 100 25.0 39.0 55.0 Divorced 25 6.3 72.0 80.0 Separated 17 4.2 58.8 58.8 Widow 8 2.0 50.0 62.5 Level of education No formal education 69 17.3 49.3 1.6 0.7 58.0 3.4 0.3 Primary school 60 15.0 50.0 66.7 Secondary school 133 33.2 45.9 52.6 Postsecondary education 138 34.5 42.0 57.9 Religion Christianity 188 47.0 47.9 1.7 0.4 58.5 0.4 0.8 Islam 196 49.0 42.9 56.1 Traditional 16 4.0 56.3 62.5 Occupation High level professional 65 16.3 44.6 4.4 0.2 61.5 1.2 0.8 Skilled worker 100 25.0 43.0 60.0 Semiskilled/unskilled 126 31.5 40.0 55.5 Worker Not on any job 109 27.3 40.4 55.0 Of the 400 respondents, 226 (56.5%) were females, and half (50.0%) of the respondents, any anxiety disorder 250 (62.5%) were married. Only 69 (17.3%) had no formal, (49.3%), primary insomnia (45.3%), and alcohol use dis- and 109 (27.3%) were unemployed (Table 1). order (11.3%). Between 2.0 and 7.8% of respondents had disablement in various areas of life, out of which the commonest was in the domain of family relations (7.8%). 4.1. Psychiatric Morbidity. Prevalence of psychiatric morbid- ity was significantly highest for respondents below 39 years Mean duration of inability to carry out activities of daily and tended to reduce with increasing age; χ for trend = life in past month was 4.2± 2.1. Mean duration of days spent on bed in past month was 5.4 ± 3.2(Table 2). 11.8, P< 0.001. Prevalence of psychiatric morbidity was significantly highest among those who were divorced 72%; χ = 10.1, P = 0.03 (Table 1). 5. Discussion 4.2. ICD 10 Disorder. Prevalence of any ICD 10 disorder was The present study, aimed at determining the prevalence highest among those below 29 years of age and tended to of psychiatric morbidity among primary health centers reduce with increasing age χ for trend 21.3; P< 0.001. service users in Lagos Island, revealed a high prevalence Prevalence of any ICD 10 disorder was significantly higher of psychiatric morbidity of 47.8%. The most prevalent in males; χ = 4.1, P = 0.04 (Table 1). ICD syndrome was unexplained somatic complaint disorder The most prevalent clinical syndrome was unexplained (57.5%) while half (50.0%) of the respondents had depres- somatic complaints (57.5%), followed by depression among sive disorder. A prevalence rate of 11.3% was reported for 4 Epidemiology Research International Table 2: Clinical data of respondents. more sensitive tool in screening for psychiatric morbidity in the primary care. ICD 10 disorders Frequency Percentage (%) The pattern of symptom presentation and common men- Depressive episode 200 50.0 tal disorders in this study are similar and comparable to Any anxiety disorder 219 49.3 other studies of mental health prevalence in primary health Alcohol use disorder 45 11.3 care. The disorders are depression, anxiety, difficulty in social functioning and disablement, sleep problems, Chronic Primary insomnia 223 45.3 fatigue, alcohol use problems, and unexplained somatic Fatigue problem 23 5.8 complaints. The findings correspond with World Health Unexplained somatic disorder 230 57.5 Organization’s [34] report that the commonest problems Limited in one or more of the identified among primary health care attendants were following activities in the past month 17 4.3 depression, anxiety, alcohol misuse, somatoform disorder, Self-care; bathing, dressing, eating and neurasthenia. Family relation; spouse, children, We found a prevalence rate of 50.0% for depressive syn- 31 7.8 relatives drome, a figure close to 51.7% (depressive neurosis) earlier Going to school or work 16 4.0 reported in some parts of Nigeria. The prevalence of Doing household work or task 12 3.0 unexplained somatic complaint of 57.5% was higher than that of somatoform disorder (47.6%) reported in an earlier Social activities; seeing friends 9 2.3 study in Nigeria [35]. The high prevalence of unexplained Remembering things 8 2.0 somatic complaints reported in this study may not be Unable to carry out activities (days) 4.2 ± 2.1 — explained as a reflection of the tendency of African patients to Spent on bed (days) 5.4 ± 3.2 — present their psychological distress with somatic symptoms as studies have shown that there is no cultural variation in somatization [36]. However, this high rate of somatization alcohol use disorder. We observed varying levels and profiles may suggest a pathway to more severe mental disorders. of disablement (up to 7.8%) among the respondents as well. An interesting finding from this study is the higher than Before discussing our findings, the results must first be expected prevalence of disablement experienced by these considered in the context of some potential study limitations. patients (2.0–7.8%) which is, to the best of our knowledge, Firstly, we obtained our results only from primary care sites the first estimate of prevalence of disability from psychosis in Lagos Island, whose patients particularly in terms of in a primary care setting in Nigeria. This suggests the impact social class may not be representative of most primary care of psychosis on its sufferers in nonclinical population, in this practices; however, the healthcare centers in which the study instance primary care setting where the primary reason for was carried out share some other common features with service use is for general medical conditions. many other centers in Nigeria. Secondly, there is the potential The present study found certain sociodemographic cor- for the sources of error associated with studies involving relates of psychiatric morbidity somewhat different from pre- subjects whose primary aims were to receive medical treat- vious ones that found female gender, being unemployed, and ments rather than being interviewed for research purposes. being separated or divorced to be associated with a higher Notwithstanding the above caveats, it should be emphasized prevalence of psychiatric disorder [1, 2, 4]. The present study that screening for psychiatric disorders in primary care identified only young age, male gender, and being divorced is an important step to improving services. This should to be associated with psychiatric morbidity. prompt physicians to consider the subsequent use of a full A major problem of the estimates of psychiatric disorders diagnostic interview and referral to specialized psychiatric in Nigeria is the choice of research methodology. Most services whenever necessary. psychiatric screening instruments were developed in coun- Our findings corroborate earlier ones indicating high tries outside Nigeria. In other words, there is a scarcity of prevalence of psychiatric morbidity in the primary care published literature on different Nigeria languages. [14, 21]. In this study it was found that the prevalence The use of psychiatric screening scales in a language of psychiatric morbidity was 45.8%. This figure seemingly appears higher than reported prevalence between 25% and and culture other than that for which it was designed and 38% from some other countries of the world [2, 32, 33]. developed may create considerable problems. This is because of the influence of translation and other sociocultural factors. There is no simple explanation for this high figure, but a possible consideration may be the fact that this study was Some researchers prefer to design new, culture-specific carried out in Lagos, a city with very difficult living and instruments. Ideally, a screening scale should be developed working conditions. in the cultural setting in which it is to be used. It would, More striking still is the higher prevalence of psychiatric however, be irrational to ignore well-established instruments developed in other cultures since many phenomena and syndromes among these primary care service users as described by the ICD 10 PC as compared with the GHQ- concepts are common between cultures. A critical, careful 12. This suggests that ICD 10 PC captures some other mental approach is, therefore, vital when translating, modifying, and validating psychiatric instruments before they are used across health problems than the GHQ screens for. Such may include alcohol use disorder. This suggests that ICD 10 PC may be a cultures. Epidemiology Research International 5 Disclosure [13] B. Duran, M. Sanders, B. Skipper et al., “Prevalence and correlates of mental disorders among Native American women All authors agree to the construct of the paper. in primary care,” American Journal of Public Health, vol. 94, no. 1, pp. 71–77, 2004. [14] O. 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