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      Burden of mental disorders and unmet needs among street homeless people in Addis Ababa, Ethiopia


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          The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems. As a first step towards advocacy and provision of care, we conducted a study to determine the burden of psychotic disorders and associated unmet needs, as well as the prevalence of mental distress, suicidality, and alcohol use disorder among homeless people in Addis Ababa, the capital of Ethiopia.


          A cross-sectional survey was conducted among street homeless adults. Trained community nurses screened for potential psychosis and administered standardized measures of mental distress, alcohol use disorder and suicidality. Psychiatric nurses then carried out confirmatory diagnostic interviews of psychosis and administered a locally adapted version of the Camberwell Assessment of Needs Short Appraisal Schedule.


          We assessed 217 street homeless adults, about 90% of whom had experienced some form of mental or alcohol use disorder: 41.0% had psychosis, 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month. Homeless people with psychosis had extensive unmet needs with 80% to 100% reporting unmet needs across 26 domains. Nearly 30% had physical disability (visual and sensory impairment and impaired mobility). Only 10.0% of those with psychosis had ever received treatment for their illness. Most had lived on the streets for over 2 years, and alcohol use disorder was positively associated with chronicity of homelessness.


          Psychoses and other mental and behavioural disorders affect most people who are street homeless in Addis Ababa. Any programme to improve the condition of homeless people should include treatment for mental and alcohol use disorders. The findings have significant implications for advocacy and intervention programmes, particularly in similar low income settings.

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          The online version of this article (doi:10.1186/s12916-014-0138-x) contains supplementary material, which is available to authorized users.

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          Major mental disorders and criminal violence in a Danish birth cohort.

          This epidemiological investigation was designed to examine the relationships between each of the major mental disorders and criminal violence. Specifically, we assessed whether a significant relationship exists between violence and hospitalization for a major mental disorder, and whether this relationship differs for schizophrenia, affective psychoses, and organic brain syndromes. Subjects were drawn from a birth cohort of all individuals born between January 1, 1944, and December 31, 1947, in Denmark (N = 358 180). Because of the existence of accurate and complete national registers, data were available on all arrests for violence and all hospitalizations for mental illness that occurred for individuals in this cohort through the age of 44 years. There was a significant positive relationship between the major mental disorders that led to hospitalization and criminal violence (odds ratios 2.0-8.8 for men and 3.9-23.2 for women). Persons hospitalized for a major mental disorder were responsible for a disproportionate percentage of violence committed by the members of the birth cohort. Men with organic psychoses and both men and women with schizophrenia were significantly more likely to be arrested for criminal violence than were persons who had never been hospitalized, even when controlling for demographic factors, substance abuse, and personality disorders. Individuals hospitalized for schizophrenia and men hospitalized with organic psychosis have higher rates of arrests for violence than those never hospitalized. This relationship cannot be fully explained by demographic factors or comorbid substance abuse.
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            Validation of brief screening tools for depressive and alcohol use disorders among TB and HIV patients in primary care in Zambia

            Background This study was conducted to evaluate the diagnostic accuracy and determine the optimum cut-off scores for clinical use of the Center for Epidemiological Studies Depression scale (CES-D) and Alcohol Use Disorders Identification Test (AUDIT) against a reference psychiatric diagnostic interview, in TB and anti-retroviral therapy (ART) patients in primary care in Zambia. Methods This was a cross-sectional study in 16 primary level care clinics. Consecutive sampling was used to select 649 participants who started TB treatment or ART in the preceding month. Participants were first interviewed using the CES-D and AUDIT, and subsequently with a psychiatric diagnostic interview for current major depressive disorder (MDD) and alcohol use disorders (AUDs) using the Mini-International Neuropsychiatric Interview (MINI). The diagnostic accuracy was calculated using the Area Under the Receiver Operating Characteristic curve (AUROC). The optimum cut-off scores for clinical use were calculated using sensitivity and positive predictive value (PPV). Results The CES-D and AUDIT had high internal consistency (Cronbach's alpha = 0.84; 0.98 respectively). Confirmatory factor analysis showed that the four-factor CES-D model was not a good fit for the data (Tucker-Lewis Fit Index (TLI) = 0.86; standardized root-mean square residual (SRMR) = 0.06) while the two-factor AUDIT model fitted the data well (TFI = 0.99; SRMR = 0.04). Both the CES-D and AUDIT demonstrated good discriminatory ability in detecting MINI-defined current MDDs and AUDs (AUROC for CES-D = 0.78; AUDIT = 0.98 for women and 0.75 for men). The optimum CES-D cut-off score in screening for current MDD was 22 (sensitivity 73%, PPV 76%) while that of the AUDIT in screening for AUD was 24 for women (sensitivity 60%, PPV 60%), and 20 for men (sensitivity 55%, PPV 50%). Conclusions The CES-D and AUDIT showed high discriminatory ability in measuring MINI-defined current MDD and AUD respectively. They are suitable mental health screening tools for use among TB and ART patients in primary care in Zambia.
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              The ICD-10 Classification of Mental and Behavioural Disorders


                Author and article information

                BMC Med
                BMC Med
                BMC Medicine
                BioMed Central (London )
                20 August 2014
                20 August 2014
                : 12
                : 1
                : 138
                [ ]Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia
                [ ]King’s College London, Institute of Psychiatry, Department of Psychological Medicine, Centre for Affective Disorders, London, UK
                [ ]Health Services and Population Research Department, King’s College London, Institute of Psychiatry, London, UK
                [ ]Amanuel Specialized Mental Hospital, Addis Ababa, Ethiopia
                [ ]Department of Internal Medicine, St Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
                [ ]Addis Ababa University, Aklilu Lemma Institute of Pathobiology, Addis Ababa, Ethiopia
                [ ]University of Toronto, Ontario Shores Center for Mental Health Sciences, Toronto, Canada
                [ ]Addis Ababa University, Ethiopian Institute of Architecture, Building Construction and City Development, Addis Ababa, Ethiopia
                [ ]Mental Health Society-Ethiopia, Addis Ababa, Ethiopia
                [ ]South London and Maudsley NHS Foundation Trust, London, UK
                © Fekadu et al.; licensee BioMed Central Ltd. 2014

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                : 27 April 2014
                : 28 July 2014
                Research Article
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                © The Author(s) 2014

                homelessness,rooflessness,mental illness,severe mental disorder,prevalence,unmet needs,low- and middle-income country,ethiopia


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