Ideological vs. Instrumental Barriers to Accessing Formal Mental Health care in the Developing World: Focus on South-eastern Nigeria

Ikwuka, Ugo; Galbraith, Niall; Manktelow, Ken; Chen-Wilson, Josephine; Oyebode, Femi; Muomah, Rosemary C.; Igboaka, Anuli

doi:10.1353/hpu.2016.0025

Cited by 11 publications

(10 citation statements)

References 47 publications

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“…Second, a suggestion of mental illness is still associated with perceived stigma in the Nigerian context. 30 As such, it is possible that some of the respondents in the present study may have been too embarrassed to admit to some of the anxiety-related symptoms. Others may especially find it unusual to reveal health information to non-clinician assessors.…”

Section: | Discussionmentioning

confidence: 90%

Prevalence and predictors of anxiety in an African sample of recent stroke survivors

et al. 2017

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Objectives Studies considering emotional disturbances in the setting of stroke have primarily focused on depression and been conducted in high-income countries. Anxiety in stroke survivors, which may be associated with its own unique sets of risk factors and clinical parameters, has been rarely investigated in sub-Saharan Africa (SSA). We assess the characteristics of anxiety and anxiety-depression comorbidity in a SSA sample of recent stroke survivors. Materials and methods We assessed baseline data being collected as part of an intervention to improve one-year blood pressure control among recent (≤1 month) stroke survivors in SSA. Anxiety in this patient population was measured using the Hospital Anxiety and Depression Scale (HADS), while the community screening instrument for dementia was used to evaluate cognitive functioning. Independent associations were assessed using logistic regression analysis. Results Among 391 participants, clinically significant anxiety (HADS anxiety score≥11) was found in 77 (19.7%). Anxiety was comorbid with depression in 55 (14.1%). Female stroke survivors were more likely than males to have anxiety (OR=2.4, 95% CI=1.5–4.0). Anxiety was significantly associated with the presence of cognitive impairment after adjusting for age, gender and education (OR=6.8, 95% CI=2.6–18.0). Conclusions One in five recent stroke survivors in SSA has clinically significant anxiety, and well over 70% of those with anxiety also have depression. Future studies will need to determine what specific impact post-stroke anxiety may have on post-stroke clinical processes and outcomes.

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Section: | Discussionmentioning

confidence: 90%

Prevalence and predictors of anxiety in an African sample of recent stroke survivors

et al. 2017

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“…Significant factors limiting access to formal mental health care in Nigeria include the scarcity of mental health specialists, with only 0.15 psychiatrists per 100 000 of the population (compared to the US’s 10.54 per 100 000) [ 12 ], a lack of community-level care for mental disorders [ 13 ], the limited integration of mental health integration in primary care [ 14 ], and the pervasive stigma towards mental disorders, even among health care providers [ 15 , 16 ]. In Nigeria, stigma has been widely documented as a deterrent to help-seeking [ 17 – 20 ]. Self-stigma (internalized mental illness stigma leading to diminished self-esteem and self-efficacy) and public stigma (the prejudice and discrimination endorsed by the general population that affects a person) about mental illness are pervasive [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project

Chu¹,

Roxas

Aguocha

et al. 2022

BMC Health Serv Res

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Background The Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) project trains non-specialist and primary health care workers in Imo State, Nigeria. This project adapted the World Health Organization’s Mental Health Gap Action Programme-Intervention Guide (mhGAP-IG), emphasizing stigma reduction among trainees. This convergent mixed-methods proof-of-concept study evaluates the HAPPINESS pilot project mhGAP-IG training’s impact on mental illness stigma among trainees and barriers, facilitators, and opportunities to consider for project improvement. Methods Trainees (n = 13) completed a 43-item questionnaire before and after their 5-day training to assess perceptions of mental disorders and attitudes towards people with mental illness. These responses were analyzed using paired-sample t-tests for four subscales of the questionnaire: acceptance of socializing with people with mental illness, normalizing activities and relationships with people with mental illness, supernatural causation of mental illness, and endorsement of a biopsychosocial approach to mental illness. Semi-structured key informant interviews (n = 11) with trainees, trainers, and local health officials who participated in or supported the HAPPINESS project were thematically analyzed to understand their experiences and perspectives of the project’s barriers, facilitators, and opportunities. Results Trainees showed significant improvements on socializing, normalizing, and supernatural causation subscales of the stigma questionnaire (p < 0.05). No significant effect was seen on the biopsychosocial subscale; however, evidence of biopsychosocial beliefs was found in interview responses. Key informant interviews revealed that the HAPPINESS project enhanced trainees’ diagnostic and treatment abilities, mental health awareness, and empathy towards patients. Misinformation, stigma, inadequate funding, and lack of road access to clinics were identified as barriers to mental health care integration into general care in Imo State. Respondents also suggested ways that the HAPPINESS project could be improved and expanded in the future. Conclusions This study adds to the limited evidence on the implementation of mhGAP-IG in Nigeria. Using mixed methods, it evaluates how mhGAP-IG can impact perceptions and knowledge of stigma among primary care trainees. It also highlights barriers, facilitators, and opportunities to consider for project growth. Future efforts should focus on clinical support, supervision, health outcomes, as well as scaling up and assessing the cost-effectiveness of the HAPPINESS project intervention.

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“…Although there are arguments in the literature that socioeconomic status and other psychosocial factors (e.g., perceived seriousness of the mental illness, stigmatization, socio-cultural factors, issues of confidentiality, etc.) have the potential to influence professional help-seeking (e.g., Ikuwka et al, 2016 ; Memon et al, 2016 ), it, however, remains unclear if this is true from a comparative study involving Black family members in the UK and Nigeria where many unknown barriers limit these target groups from seeking professional help.…”

Section: Introductionmentioning

confidence: 99%

Seeking Professional Help for Mental Illness: A Mixed-Methods Study of Black Family Members in the UK and Nigeria

Ogueji

Okoloba

2022

Psychol Stud

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Seeking professional help for mental illness is a limited practice among Black family members in low and middle socioeconomic groups in the United Kingdom (UK) and Nigeria. Guided by the theory of planned behavior, we explored some factors restricting professional help-seeking practices among the target groups. This mixed-methods study recruited a heterogeneous sample of 105 ( ranging from 19–64 years) UK and Nigerian Black family members in low or middle socioeconomic groups. Data were collected using a standardized questionnaire and open-ended questions. Collected data were analyzed using IBM SPSS statistics (version 22.0) and thematic analysis. There was no statistically significant difference in professional help-seeking behavior among the UK and Nigerian Black family members in low and middle socioeconomic groups [ F (3, 83) = 1.13; p > .05]. The qualitative data analysis revealed that respondents were limited from professional help-seeking due to high consultation fees to see a mental health professional, perceived accessibility to mental health services within their various locations, stigmatization and socio-cultural factors (such as, “The perception that a man should be strong” or “Mental health isn’t as important as physical health”), concerns about the safety of information shared during professional help-seeking or therapy sessions, poor knowledge about mental health services, long waiting time to see a professional in face-to-face therapy, and risk of contracting the infectious disease in the hospital setting. Implications of findings for theory and practice and direction for future research are thus discussed.

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Ideological vs. Instrumental Barriers to Accessing Formal Mental Health care in the Developing World: Focus on South-eastern Nigeria

Cited by 11 publications

References 47 publications

Prevalence and predictors of anxiety in an African sample of recent stroke survivors

Prevalence and predictors of anxiety in an African sample of recent stroke survivors

Integrating mental health into primary care: evaluation of the Health Action for Psychiatric Problems In Nigeria including Epilepsy and SubstanceS (HAPPINESS) pilot project

Seeking Professional Help for Mental Illness: A Mixed-Methods Study of Black Family Members in the UK and Nigeria

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