Justus Uchenna Onu

Suicide remains a critical global mental health challenge, disproportionately affecting low- and middle-income countries where access to formal mental health services is limited. In such contexts, including sub-Saharan Africa, individuals in crisis often turn first to faith leaders. Clergy frequently encounter suicidal crises and serve as initial points of contact, yet there is little empirical evidence on their comfort or competence in responding to such crises. Our study examined clergy’s self-reported comfort and competence in handling suicidal crises, thereby addressing a critical gap in understanding clergy’s readiness for frontline suicide prevention in Nigeria. Participants were 253 Catholic clergy (all Black men; ages 27–72, M = 44.58, SD = 9.95) who completed a questionnaire form during monthly recollections and annual retreats for priests in eight Nigerian dioceses between June and October 2024. All participants reported having intervened in cases of suicidal thoughts or attempts. An ordinal logistic regression was applied for the data analysis. Findings indicated that roughly 40% felt comfortable or very comfortable and about 50% felt competent or very competent during the interventions. Findings showed that clergy who felt more comfortable were 2.34 times more likely to feel competent, after adjusting for age, years of experience in priestly work, additional academic qualification, annual number of individuals with suicidal thoughts requesting assistance, annual number of individuals with a suicide attempt requesting assistance, and annual number of suicide-related funerals. Results highlight the need for mandatory, structured suicide prevention training to strengthen clergy capacity in Nigeria and other low- and middle-income countries.

Background: Schizophrenia is a chronic-relapsing condition that in most cases, requires life-long treatment and follow-up. However, disengagement from care threatens the achievement of therapeutic targets for these patients, their families and the society. This study aimed to determine the burden of disengagement, and the socio-demographic and clinical predictors among patients with incident schizophrenia in a Nigeria Psychiatric Hospital in 8 years of follow-up. Method: This was a naturalistic study involving 160 clinically well-characterized patients with schizophrenia on follow-up, whose outcome data for 16 weeks had been reported. Subsequent follow-up data during scheduled appointments were obtained directly from the patients, case notes and via telephone interviews with participants and/or their caregivers. Disengagement from care and time to disengagement were operationally defined. The proportion that disengaged was calculated using percentages and 95% confidence interval. Time to disengagement was estimated using Kaplan-Meier time-to-event analysis, while the associated factors were analyzed by logistic regression. Results: At the 8th year of follow-up, we had contact with 147 (91.9%) subjects, mostly by phone, out of whom 82.3% (95% CI: 75.2%–88.1%) had disengaged from care. The median time to disengagement and number of visits in 8 years were: 1 year and five visits, respectively. A quarter (40/160) of the original participants never came for their first appointment. The common reasons given for disengagement were financial constraints and dissatisfaction with improvement. A quarter (38/147) had sought care with religious and traditional faith healers after encountering our service. The mortality rate was 47.6 per 1000 (7/147). Cause of death was attributed to suicide (3/7) and other chronic medical conditions (3/7). Those who relapsed had significantly longer time to disengagement than those without relapse. Conclusion: Disengagement is a common phenomenon in our setting, as elsewhere in the literature, despite adequate family support and good clinical outcome. The finding on the time to disengagement has implications for designing interventions to promote adherence to treatment plans.

Current evidence supports the idea that neurocognitive deficits (NCD) constitute a core dimension of schizophrenia. Studies on longitudinal changes in neurocognition among neuroleptic-naive first-episode schizophrenia (FES) from Africa are uncommon. We aimed to highlight the prevalence of, and changes in NCD among FES on naturalistic treatment follow-up for 8 weeks, and the relationship with psychopathological and psychosocial outcomes. Consecutive FES and Healthy Control (HC) were recruited. Diagnosis of schizophrenia was based on ICD-10 criteria. The HC (n = 86) consisted of nursing students in the same facility, recruited purposely to match the cases in age and gender. After the baseline assessment, 82 FES were followed up 4-weekly for changes in NCD, psychopathological and psychosocial ratings for a period of 8 weeks, using the 3 alternate forms of the Screen for Cognitive Impairment in Psychiatry (SCIP), the Wisconsin Card Test, the Mini Mental State Examination, as well as the Brief Psychiatric Rating Scale, the WHO Disability Assessment Scale, and the Global Assessment of Functioning scale. The control group was tested only once, and their scores were utilized for comparison with the patients’ scores only at week 8. The prevalence of neurocognitive deficits in the two groups was described using percentages and 95% confidence interval. Predictors of cognitive function was determined using multivariate linear regression. The prevalence of any NCD among FES at 8 weeks and HC was 62.9% (95% CI: 51.5%, 74.2%) and 1.2% (95% CI: 0.0%, 6.6%), respectively. With treatment, there was a significant improvement in cognitive function at each interval of follow-up. At week 8, the prevalence of any NCD among patients in remission was 55.1%. Total SCIP scores at week 8 had significant inverse moderate relationship with the dimensions of psychopathology. Conversely, total SCIP score was strongly positively correlated with functioning (rhos= 0.71, p < 0.001) at week 8. At week 8, the baseline predictors of total SCIP score were, duration of untreated psychosis (β = -0.33, p = 0.01, variance = 19.8%), negative symptoms (β = -0.35, p = 0.03, variance = 4.9%) and positive symptoms (β = -0.43, p = 0.01, variance = 4.8%). The high prevalence of NCD when patients were in remission indicates that they are enduring and merit consideration as a domain of psychopathology.

Background Despite robust reports in the literature concerning the effect of exposure to combat on mental health, there is a paucity of studies in the Nigerian Air Force (NAF) using a longitudinal design. This study was designed to determine the incidence of mental disorders among a cohort of NAF personnel exposed to combat and highlight its association with psychosocio-religious variables. Methods It was a follow-up study using a total population sampling in which all the 290 deployed personnel participated. Data was collected at two intervals: Baseline and 6 months after with sociodemographic questionnaire, Brief Coping Orientation to Problems Experienced Inventory, the Brief Religious Coping, the Oslo Social Support Scale and the Big Five Inventory, General Health Questionnaire (GHQ-12) and the Mini-International Neuropsychiatric Interview (MINI-Plus). A two-staged process involving screening with the GHQ and a further diagnostic interview using MINI-Plus for participants with a GHQ score of 2 and above. Results The incidence of any mental disorder was 243.1 per 1000 person-years. The top three priority conditions were: Substance use disorder (94.1 per 1000 person-years), major depressive disorder (43.8 per 1000 person-years) and post-traumatic stress disorder (PTSD) (41.6 per 1000 person-years). Being deployed in early adulthood was a risk factor for developing a mental illness (adjusted OR (AOR), (95% CI): 2.89, (1.28, 6.50), p=0.01) while longer duration in the military service was a protective factor (AOR, (95% CI): 0.95, (0.91, 0.99), p=0.03). Social support, personality traits, religious coping and other coping strategies did not significantly predict mental disorders in this population (p>0.05). Conclusion The incidence of any mental disorder among NAF personnel exposed to combat was huge. The three top priority conditions were substance use disorder, major depressive disorder and PTSD. These findings are useful in identifying priority conditions for interventions in the NAF population.

Background: The prevalence of atherosclerotic cardiovascular disease is rising, and its onset from childhood is widely studied. Prematurity and low birth weight were associated with higher atherogenic risk when assessed using some lipid ratios. However, the atherogenic index of plasma (AIP), a sensitive marker for atherosclerosis is understudied in newborns. Utilizing AIP, this study aimed to determine atherogenic risk prevalence among newborns and its association with gestational age and birth weight. Methods: Newborns were consecutively recruited, and their lipid profiles were determined. The AIP was calculated as the logarithm to base 10 (log10) of the ratio of molar concentrations of triglyceride to high-density lipoprotein cholesterol. The atherogenic risk was operationalized using AIP: high, >0.24; medium, 0.1–0.24; and low/no risk, <0.1. The relationship between AIP values, gestational age, and birth weight was analyzed using Pearson correlation. Results: The mean AIP of the 167 newborns studied was –0.35±0.34, which is within the global reference range. Three (1.8%), 10 (6.0%), and 154 (92.2%) newborns were in the high, medium, and low/no atherogenic risk categories, respectively. Hence, 13 newborns (7.8%) had medium to high atherogenic risk. AIP had a moderate significantly positive relationship only with gestational age (r=0.35, P<0.001). Conclusions: The study found an atherogenic risk prevalence of 7.8% using AIP in newborns which, contrary to previous studies that used other ratios, has no significant association with birth weight, correlating positively with gestational age, though is lowest in late preterms. Follow-up studies will elucidate these findings.

Background: Despite modest efforts to study and document the complications that arise after acute treatment of patients with coronavirus disease, its ramifications and regional variations are yet to be clearly understood. Progress in sub-Saharan Africa, notably Nigeria, has been impeded by patient disengagement from care and insufficient or non-existent follow-up arrangements. The aim of this study was to describe the barriers and enablers for follow-up services after discharge from COVID-19 care pathway in Nigeria. Methods: Seventeen experts involved directly in the care of patients with COVID-19 participated in brainstorming using the nominal group technique during a national workshop to review the new guidelines for COVID-19 case management in Nigeria. Participants discussed the barriers and facilitators of post-acute care follow-up of patients discharged from COVID-19 pathway and ranked their recommendations to arrive at three major factors per question. Results: Participants were mostly middle aged and predominantly clinicians. The top three barriers were patients’ perception of their symptom severity, lack of organizational clarity/structure/policies on follow-up care after discharge, and financial constraints. Similarly, participants identified providers’ initiated education on the reasons for follow-up at discharge, written organizational policies/structure and clarity and free follow-up services as the top three facilitators. Conclusion: This study has enumerated barriers to follow-up care after discharge patients with coronavirus disease and highlighted providers, institutional and governmental responses that will facilitator follow-up care after discharge of patients with COVID-19. The implication is that, there is need for clear institutional guidelines for tracking and documenting post-COVID condition. In the future, it would be necessary to assess the achievements and shortcomings of post-COVID condition tracking in Nigeria through the use of implementation science outcomes.

The South African Journal of Psychiatry publishes topical content in psychiatry for clinical practice and academic pursuits, including work in the subspecialty areas of psychiatry.

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Noma is a neglected tropical disease of an underserved population. Our review describes the volume and scope of existing research evidence on psychosocial aspects of Noma in sub-Saharan Africa (SSA). Our literature search was conducted on all original peer-reviewed research articles on the psychosocial aspects of Noma in each country in SSA using PubMed, Google Scholar, and a direct search of reference list of pertinent journal articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines was used to describe the review. A total of six studies were found in four countries of the region. One in three persons with Noma has a mental health condition, indices of social disadvantage and belief in the supernatural causation of the disease are very common. However, despite evidence of enormous need, a huge gap still exists in the area of psychosocial alleviation.

Background: Schizophrenia, from its early conceptualization, has been described in distinct clinical subtypes. However, these categories were found not to be stable phenotypes over time, hence the dimensional option, whereas at cross-sectional level, the dimensions of psychopathology have been replicated across studies; there is dearth of data on the longitudinal stability of the factor structure of the symptoms of schizophrenia in African populations. Aim: This study examined the longitudinal stability of the factor structure of the 18-item Brief Psychiatric Rating Scale (BPRS) across intervals of 16-week naturalistic treatment follow-up. Patients and Methods: Consecutive incident cases that fulfilled the criteria for schizophrenia were recruited into the study. After a baseline assessment, 160 incident cases of schizophrenia were followed up 4 weekly for indicators of symptomatic outcome for 16 weeks. The Brief Psychiatric Rating Scale (BPRS) assessments were conducted in clinical interviews and with the Scale for Assessment of Negative Symptoms (SANS). Five BPRS assessments were made across the monthly intervals of follow-up. Exploratory factor analyses (EFA) using maximum likelihood extraction and varimax rotation with Kaiser normalization was used to extract the factors. Results: A four-factor structure was found at baseline, namely negative, positive, depressive/anxiety, and manic symptom dimensions. From week 4, the manic and anxiety/depression dimensions remained invariant over time, while negative and positive symptoms merged into a psychosis dimension that was invariant. Conclusion: The persistence of the mood dimensions supports the DSM-5 recommendation to include these dimensions in the assessment of schizophrenia psychopathology. The longitudinal emergence and invariance of the psychosis factor echo the idea of unitary psychosis and, along with the prominence of mood dimensions over time, reflect recent molecular genetic findings about the sharing of genes by schizophrenia and mood disorders.