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      Prevalence and Factors Associated With Depression and Suicidal Ideation During the COVID-19 Pandemic Among University Students in Uganda: A Cross-Sectional Study


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          The COVID-19 pandemic has negatively impacted psychosocial well-being and mental health of students across the world. Although students are vulnerable to depression and suicidal ideation, few studies have been conducted in Uganda. This study aimed to determine the prevalence of depression and suicidal ideation, and associated factors among undergraduate university students in Uganda.


          A cross-sectional study was conducted among undergraduates [ N = 540; 363 males; mean age = 23.3 (± 2.64) years] recruited from four universities using an online questionnaire that explored sociodemographic factors, depression, and other associated factors. The Patient Health Questionnaire (PHQ-9) was used to assess depression, and Item 9 was used to assess suicidal ideation in the past 2 weeks. Multivariable logistic regression analyses were performed to determine the factors associated with depression and suicidal ideation.


          The prevalence of moderate to severe depression was 20% ( n = 108) (cut-off: 10/27 based on the PHQ-9), and the prevalence of past-2-week suicidal ideation was 13.89% ( n = 75) (cut-off: 1/3 based on the PHQ-9 Item 9). About half of the individuals who screened positive for depression had suicidal ideation. Factors associated with depression were: having relationship issues [adjusted odds ratio (aOR) = 1.79, 95% confidence interval (CI) = 1.13–2.81, p = 0.012], and having a history of sexual abuse (aOR = 2.06, 95% CI = 1.10–3.84, p = 0.023). Factors associated with reducing the risk of depression were: satisfaction with current academic performance (aOR = 0.50, 95% CI = 0.32–0.79, p = 0.003), and being in the fifth year of academic study (aOR = 0.16, 95% CI = 0.03–0.73, p = 0.018). Factors associated with suicidal ideation were: smoking cigarettes and/or marijuana (aOR = 4.83, 95% CI = 1.10–21.12, p = 0.037), and having financial tuition constraints (aOR = 1.85, 95% CI = 1.08–3.16, p = 0.024), However, satisfaction with current academic performance reduced the likelihood of suicidal ideation (aOR = 0.40, 95% CI = 0.23–0.70, p = 0.001).


          Approximately one-fifth of undergraduate university students were moderately to severely depressed, especially those who had relationship issues and those with a history of sexual abuse. Suicidal ideation was common among smokers and those having financial tuition constraints. Therefore, it is recommended that the university authorities implement measures to provide psychological support for the students with problems concerning financial tuition constraints, relationships, and sexual abuse. Also, all students with depression should be screened for suicidality.

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          The PHQ-9: validity of a brief depression severity measure.

          While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.
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            Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality

            Background The coronavirus disease 2019 (COVID-19) is profoundly affecting life around the globe. Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment in affected countries. These measures have the potential to threaten the mental health of children and adolescents significantly. Even though the current crisis can bring with it opportunities for personal growth and family cohesion, disadvantages may outweigh these benefits. Anxiety, lack of peer contact and reduced opportunities for stress regulation are main concerns. Another main threat is an increased risk for parental mental illness, domestic violence and child maltreatment. Especially for children and adolescents with special needs or disadvantages, such as disabilities, trauma experiences, already existing mental health problems, migrant background and low socioeconomic status, this may be a particularly challenging time. To maintain regular and emergency child and adolescent psychiatric treatment during the pandemic is a major challenge but is necessary for limiting long-term consequences for the mental health of children and adolescents. Urgent research questions comprise understanding the mental health effects of social distancing and economic pressure, identifying risk and resilience factors, and preventing long-term consequences, including—but not restricted to—child maltreatment. The efficacy of telepsychiatry is another highly relevant issue is to evaluate the efficacy of telehealth and perfect its applications to child and adolescent psychiatry. Conclusion There are numerous mental health threats associated with the current pandemic and subsequent restrictions. Child and adolescent psychiatrists must ensure continuity of care during all phases of the pandemic. COVID-19-associated mental health risks will disproportionately hit children and adolescents who are already disadvantaged and marginalized. Research is needed to assess the implications of policies enacted to contain the pandemic on mental health of children and adolescents, and to estimate the risk/benefit ratio of measures such as home schooling, in order to be better prepared for future developments.
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              Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis

              Abstract Objective To determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression. Design Individual participant data meta-analysis. Data sources Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-February 2015). Inclusion criteria Eligible studies compared PHQ-9 scores with major depression diagnoses from validated diagnostic interviews. Primary study data and study level data extracted from primary reports were synthesized. For PHQ-9 cut-off scores 5-15, bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, among studies that used semistructured diagnostic interviews, which are designed for administration by clinicians; fully structured interviews, which are designed for lay administration; and the Mini International Neuropsychiatric (MINI) diagnostic interviews, a brief fully structured interview. Sensitivity and specificity were examined among participant subgroups and, separately, using meta-regression, considering all subgroup variables in a single model. Results Data were obtained for 58 of 72 eligible studies (total n=17 357; major depression cases n=2312). Combined sensitivity and specificity was maximized at a cut-off score of 10 or above among studies using a semistructured interview (29 studies, 6725 participants; sensitivity 0.88, 95% confidence interval 0.83 to 0.92; specificity 0.85, 0.82 to 0.88). Across cut-off scores 5-15, sensitivity with semistructured interviews was 5-22% higher than for fully structured interviews (MINI excluded; 14 studies, 7680 participants) and 2-15% higher than for the MINI (15 studies, 2952 participants). Specificity was similar across diagnostic interviews. The PHQ-9 seems to be similarly sensitive but may be less specific for younger patients than for older patients; a cut-off score of 10 or above can be used regardless of age.. Conclusions PHQ-9 sensitivity compared with semistructured diagnostic interviews was greater than in previous conventional meta-analyses that combined reference standards. A cut-off score of 10 or above maximized combined sensitivity and specificity overall and for subgroups. Registration PROSPERO CRD42014010673.

                Author and article information

                Front Psychiatry
                Front Psychiatry
                Front. Psychiatry
                Frontiers in Psychiatry
                Frontiers Media S.A.
                14 April 2022
                14 April 2022
                : 13
                [1] 1Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology , Mbarara, Uganda
                [2] 2African Centre for Suicide Prevention and Research , Mbarara, Uganda
                [3] 3Faculty of Medicine, Mbarara University of Science and Technology , Mbarara, Uganda
                [4] 4Department of Psychiatry, Mbarara Regional Referral Hospital , Mbarara, Uganda
                [5] 5Department of Nursing, Bishop Stuart University , Mbarara, Uganda
                [6] 6School of Medicine, Kabale University , Kabale, Uganda
                [7] 7College of Health Sciences, Makerere University , Kampala, Uganda
                [8] 8Faculty of Clinical Medicine and Dentistry, Kampala International University , Kampala, Uganda
                [9] 9Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University , Gulu, Uganda
                [10] 10Department of Psychology, Nottingham Trent University , Nottingham, United Kingdom
                [11] 11CHINTA Research Bangladesh , Savar, Bangladesh
                [12] 12Department of Public Health and Informatics, Jahangirnagar University , Savar, Bangladesh
                [13] 13Department of Public Health, Daffodil International University , Dhaka, Bangladesh
                Author notes

                Edited by: Haibo Yang, Tianjin Normal University, China

                Reviewed by: N. A. Uvais, IQRAA International Hospital and Research Centre, India; Rui Liu, Capital Medical University, China

                *Correspondence: Mark Mohan Kaggwa, Kmarkmohan@ 123456gmail.com

                This article was submitted to Public Mental Health, a section of the journal Frontiers in Psychiatry

                Copyright © 2022 Kaggwa, Arinaitwe, Nduhuura, Muwanguzi, Kajjimu, Kule, Ajuna, Machacha, Nkola, Najjuka, Wamala, Bongomin, Griffiths, Rukundo and Mamun.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                Page count
                Figures: 1, Tables: 3, Equations: 0, References: 63, Pages: 12, Words: 8364
                Original Research

                Clinical Psychology & Psychiatry
                depression,university students,sexual abuse,academic satisfaction,covid-19,suicidal ideation


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