- : Ms Word, Ms Word Format
- : 100 Pages
- : ₦5000
- : 1-5 Chapters
SCREENING FOR PREVALENCE OF ANXIETY AND DEPRESSION AMONG PATIENTS ATTENDING GENERAL OUTPATIENTS DEPARTMENT IN UNIVERSITY OF UYO TEACHING HOSPITAL, UYO.
SUMMARY
Anxiety and Depression are common mental disorders affecting patients that attend primary care clinics. They have negative impact on the patient, the family and the society.
This study was a cross- sectional study designed to screen for the prevalence of anxiety and depression among patients attending the General Outpatient Clinic of the University of Uyo Teaching Hospital between January and March 2011.
Two hundred and forty five (245) eligible participants were recruited through systematic random sampling. An adapted semi structured Hospital Anxiety and Depression Scale questionnaire was administered after a signed consent was obtained from them. The questionnaire assessed socio-demographic characteristics, medical illnesses and their score on the scale.
The result obtained showed the prevalence of anxiety and depression to be 36.7% and 24.5% respectively while 17.5% of the respondents had mixed anxiety and depression. Anxiety was high among respondents aged 30-39 years (30%), female respondents (70%) and married respondents (55%). Educational level, ethnic group and occupation had no statistically significant relationship with anxiety in this study.
There was no statistically significant relationship between religious affiliation and income earned by the respondent and anxiety. However, there was a statistically significant relationship between anxiety symptoms and hypertensive respondents with P < 0.044.
Respondents aged 50 – 59 years and females (65%) showed more depressive symptoms, more females were depressed but there was no statistically significant relationship between educational level, marital status and depression.
Farmers and traders were more likely to have depression with P < 0.035 and P< 0.034 respectively. Respondents that were hypertensive and those that had retroviral disease were likely to be depressed with P < 0.043 and p<0.016 respectively.
This study has buttressed the fact that there is a need for Family Physicians being the firstline medical practitioners to possess the skills needed to manage patients with anxiety and depression as many patients that attend our clinics have these disorders.
TABLE OF CONTENTS
Title page i
Abbreviation xiii
Summary/ Abstract 1
CHAPTER ONE
1.1 Introduction 3
1.2 Statement of the problem 5
1.3 Relevance of the study 6
1.4 Objectives 7
CHAPTER TWO
LITERATURE REVIEW 8
2.1 Historical perspective 8
2.2 Prevalence of anxiety and depression 9
2.3 Sociodemographic variables in anxiety and depression 12
2.3.1 Gender 12
2.3.2 Age 12
2.3.3 Occupation 13
2.3.4 Poverty/ low income 14
2.3.5 Education 15
2.3.6 Marital status 15
2.4 Medical illness and development of anxiety and depression 16
2.5 Diagnosis of anxiety and depression in primary care 22
2.6 Depressive disorders 23
2.7 Anxiety disorders 24
2.8 Treatment of anxiety and depression in primary care 26
2.9 Screening in Family Medicine 28
2.10 Screening tools for anxiety and depression in primary care 30
CHAPTER THREE
3.0 MATERIALS AND METHODS 33
3.1 Description of study area 33
3.2 Study design 33
3.3 Study population 34
- Inclusion criteria
-
Exclusion criteria
- Sample size determination 35
- Sample Methodology 35
- Data collection tools and technique 36
- Data analysis 37
- Ethical consideration 38
- Consent 38
- Funding 38
CHAPTER FOUR
4.0 RESULT 39
CHAPTERFIVE
5.0 DISCUSSION 66
5.1 Prevalence of anxiety and depression 66
5.2 Socio demographic Variables
5.2.1 Age 66
5.2.3 Sex 67
5.2.3 Educational Level 67
5.2.4 Marital Status 67
5.2.5 Occupation 68
5.2.6 Tribe and Ethnic Group 68
5.2.7 Religion 68
5.2.8 Income 69
5.3 Medical illness 69
5.4 Diagnostic Ability of the Hospital Anxiety and Depression scale 70
CHAPTER SIX
6.0 CONCLUSION AND RECOMMENDATIONS 71
6.1 Limitations 72
REFERENCES 73
APPENDICES 86
CHAPTER ONE
INTRODUCTION
Anxiety and depression are common mental disorders among patients attending general outpatient clinic.1 Estimates show that at least 20% of primary care patients have mental disorders of which 29.1% are depression and 24.3% are anxiety.2
The symptoms vary and are often unrecognised thereby leading to under-detection, misdiagnosis ,under treatment and unmet needs 3-5 . According to Abiodun O only 13.8% of mental disorders were identified by primary care physicians in primary care setting in Nigeria.6
According to Higgins in a meta analysis of studies over 25 years in primary care settings he found that 33-79% of mentally ill patients had not been recognised by their physicians.7 A number of factors are known to be responsible for the under recognition of mental disorders in primary care. These factors are classified as patient related, Doctor related and service related.
The patient related factors include nature of symptoms presented such as presentation of somatic rather than psychological symptoms, severity of the disorder, more severe psychological symptoms are likely to be detected than less severe psychological symptoms. Similarly, when psychological and medical conditions coexist, the patients will complain about the medical problem instead of the psychological problem. Stigmatization associated with psychological diagnosis and treatment also discourages the patients from disclosing their psychological symptoms. 8
Doctor – related factors include inadequate history taking arising from poor training and deficient diagnostic skills in mental health, excess clinic workload and lack of acquisition of new knowledge relevant for diagnosis and treatment of mental disorders.9
Service-related factors are insufficient remuneration for psychological interventions, inadequate support due to dearth of trained support staff in mental health in both public and private mental health services.
Predisposing factors for anxiety and depression are poverty ,low education ,chronic medical illness ,catastrophic live event ,lack of protective factors like high level of family support, strong religious belief, strong cultural identity and cohesion 10-14.
Screening is the search for disease among persons who are otherwise healthy. This helps to detect diseases among these persons for proper interventions to be done early. It is an important tool in family medicine as many diseases can be screened for in the population. Some of the diseases that can be screened for are tuberculosis, syphilis, cervical cancer, diabetes mellitus and others.
Although rapid socioeconomic change and organisation have contributed to a wide range of psychological problems in our environment, there is scarcity of data on anxiety and depression among patients attending General Outpatient Clinic of UUTH Uyo .This study will screen for the presence of anxiety and depression among adult patients attending the General Outpatient Clinic of UUTH in order to detect anxiety and depression among healthy patients and offer treatment, follow up and referrals where appropriate.
STATEMENT OF THE PROBLEM
Anxiety and depression are public health problems.15A study by the World Health Organisation showed that Neuropsychiatric conditions are responsible for twenty one percent( 21% ) of total disease burden in the world while infectious disease and cardiovascular diseases constitute forty one percent(41%) and twenty six percent (26%) respectively.16 In spite of this high prevalence of mental disorders, less than 50% of these conditions were recognised by primary care physicians and less than 50% of those diagnosed were offered appropriate treatment. 17
Anxiety and depression have tremendous adverse effects on the patient, the family, the healthcare system and the community. If these disorders are detected early and appropriate treatment given these effects could be ameliorated.2 Some of the effects include cognitive impairments and declining productivity 18-19. Boardman reported that in any one year, 3 in
10 people of working age took some days off duty because of mental health problems. About 91 million working days were lost annually to mental illness and fewer than 10% of these individuals were in contact with specialist mental health services.20
This study will screen for anxiety and depression among adults patients attending the General Outpatient Clinic of UUTH, determine association between anxiety and depression and the socio-demographic variables of respondents as well as the association between anxiety and depression and the presence of any medical and surgical illnesses among the respondents.
RELEVANCE OF THE STUDY
The majority of psychiatric presentations seen by clinicians are in primary care. Studies show that many attending physicians do not recognise the presence of anxiety and depression and as such do not diagnose these mental disorders because the patients present with physical symptoms rather than psychological symptoms.
Therefore, it is important for family physicians to identify the symptoms of anxiety and depression, diagnose the disorder, and appropriately manage those diagnosed. Referrals should be made where appropriate to specialist mental health services after adequate counselling and education of the patients though patients have been known to resist referral because of stigma.
Early recognition of mental disorders is reported to reduce the number of subsequent medical consultation and shortens the duration of an episode. It also reduces social impairment in the long run.
This study hopes to raise the awareness of clinicians regarding the presence of co-existing anxiety and depression among patients who may be presenting with other medical or surgical problems. It also hopes to prescribe interventions that will reduce the morbidity and mortality associated with these disorders.
OBJECTIVE
AIM
This study aimed to assess the level of anxiety and depression among patients attending General Outpatient Department of the University of Uyo Teaching Hospital.
OBJECTIVES
Specifically, it set to:
- determine the proportion of patients presenting with anxiety and depression among adult patients attending the General Outpatient Clinic of the University of Uyo Teaching Hospital.
- identify the relationship between socio-demographic variables and anxiety and depression among adult patients attending the General Outpatients Clinic of the University of Uyo Teaching hospital.
- determine the level of association between medical illnesses and anxiety and depression among the respondents.
SCREENING FOR PREVALENCE OF ANXIETY AND DEPRESSION AMONG PATIENTS ATTENDING GENERAL OUTPATIENTS DEPARTMENT IN UNIVERSITY OF UYO TEACHING HOSPITAL, UYO.
