Department of Psychiatry

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    Risk factors and outcomes of delirium in hospitalized older Ghanaians
    (International Journal Geriatric Psychiatry, 2023) Omuojine, J.P.; Bello, T.; Ohene, S.; et al.
    Objectives: Delirium has been rarely studied in older West Africans. We sought to investigate its correlates and outcomes in hospitalized older Ghanaians. Methods: This was a one‐month prospective observational study. Delirium prevalence was assessed within 24 h of admission using the Confusion Assessment Method (CAM). Incident delirium was determined with repeat CAM assessments on post‐admission days 4, 7, 14, 21 and 28, after censoring participants with prevalent delirium. Multivariate logistic regression analyses were used to explore risk factors. Estimates of adjusted hazard ratios for mortality were derived with the discrete time version of the Cox regression model for time invariant explanatory variables. Results: Among 483 participants, 250 (51.8%, 95% CI: 47.3–56.3) had prevalent delirium while 10 of the remaining 233 (4.3%, 95% CI: 2.1–7.8) developed incident delirium. Being older than 80 years (adjusted odds ratio (OR) = 2.1, 95% CI: 1.2– 3.6), having no formal education (OR = 2.2, 95% CI: 1.4–3.4), stroke (OR = 1.8, 95% CI: 1.1–3.0), infection (OR = 1.9, 95% CI: 1.2–3.0), and high Triage Early Warning Score (OR = 6.9, 95% CI: 2.5–19.0) predicted delirium. Delirium (adjusted hazard ratio (HR) = 1.8, 95% CI: 1.0–3.3) and high TEWS (HR = 4.6 (95% CI: 1.7–12.7) at baseline predicted mortality. These factors also predicted longer hospital stay. Conclusion: Over half of hospital‐treated older Ghanaians in the present study had delirium on the first day of admission. The syndrome prolonged hospitalisation and increased mortality risk. Future studies in West Africa may investigate the epidemiology of delirium in primary care and community settings
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    Co-Designing M-Healer: Supporting Lay Practitioner Mental Health Workers in Ghana
    (Springer, 2021) Albright, L.; Le, H.; Meller, S.; Atta, A.O.; Attah, D.A.; Asafo, S.M.; Collins, P.Y.; Zeev, D.B.; Snyder, J.
    . Mental health is a vast problem around the globe and is one of the key population health issues in the world today. At any given time, up to 6.8% of the world’s population suffers from a serious mental illness (SMI) such as schizophrenia or bipolar disorder. The impacts of SMI on a population are especially challenging in low and middle-income countries (LMIC). Mobile healthcare application research is a growing area of research aiming to ameliorate these challenging impacts. In Ghana, a LMIC in West Africa, mental healthcare systems are severely under resourced and people with SMI often receive care from lay practitioners such as traditional and faith healers rather than trained mental health clinicians. These challenges exist alongside developed wireless infrastructure. In these contexts, mobile applications can substantially increase access to health information. This is the basis for our work developing a mobile health (mHealth) application to support mental health lay practitioners in Ghana. We describe the ways that our principled design research practice is intersecting with local faith-based practices, vernacular expertise and values, and the practicalities of technology adoption in Ghana.
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    A Digital Toolkit (M-Healer) to Improve Care and Reduce Human Rights Abuses Against People With Mental Illness in West Africa: User-Centered Design, Development, and Usability Study
    (JMIR, 2021) Ben-Zeev, D.; Meller, S.; Snyder, J.; Attah, D.A.; Albright, L.; Le, H.; Asafo, S.M.; Collins, P.Y.; Ofori-Atta, A.
    The resources of West African mental health care systems are severely constrained, which contributes to significant unmet mental health needs. Consequently, people with psychiatric conditions often receive care from traditional and faith healers. Healers may use practices that constitute human rights violations, such as flogging, caging, forced fasting, and chaining. The aim of this study is to partner with healers in Ghana to develop a smartphone toolkit designed to support the dissemination of evidence-based psychosocial interventions and the strengthening of human rights awareness in the healer community. Methods: We conducted on-site observations and qualitative interviews with healers, a group co-design session, content development and prototype system build-out, and usability testing. A total of 18 healers completed individual interviews. Participants reported on their understanding of the causes and treatments of mental illnesses. They identified situations in which they elect to use mechanical restraints and other coercive practices. Participants described an openness to using a smartphone-based app to help introduce them to alternative practices. A total of 12 healers participated in the co-design session. Of the 12 participants, 8 (67%) reported having a smartphone. Participants reported that they preferred spiritual guidance but that it was acceptable that M-Healer would provide mostly nonspiritual content. They provided suggestions for who should be depicted as the toolkit protagonist and ranked their preferred content delivery modality in the following order: live-action video, animated video, comic strip, and still images with text. Participants viewed mood board prototypes and rated their preferred visual design in the following order: religious theme, nature motif, community or medical, and Ghanaian culture. The content was organized into modules, including an introduction to the system, brief mental health interventions, verbal de-escalation strategies, guided relaxation techniques, and human rights training. Each module contained several scripted digital animation videos, with audio narration in English or Twi The module menu was represented by touchscreen icons and a single word or phrase to maximize accessibility to users with limited literacy. In total, 12 participants completed the M-Healer usability testing. Participants commented that they liked the look and functionality of the app and understood the content. The participants reported that the information and displays were clear. They successfully navigated the app but identified several areas where usability could be enhanced. Posttesting usability measures indicated that participants found M-Healer to be feasible, acceptable, and usable.The module menu was represented by touchscreen icons and a single word or phrase to maximize accessibility to users with limited literacy. In total, 12 participants completed the M-Healer usability testing. Participants commented that they liked the look and functionality of the app and understood the content. The participants reported that the information and displays were clear. They successfully navigated the app but identified several areas where usability could be enhanced. Posttesting usability measures indicated that participants found M-Healer to be feasible, acceptable, and usable.
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    Psychiatry as a specialization: influential factors and gender differences among medical students in a low- to middle-income country
    (Irish Journal of Psychological Medicine, 2019-09-04) Ohene, S.; Agyapong, V.I.O.; Owusu-Antwi, R.; Ritchie, A.; Agyapong-Opoku, G.; Khinda, H.; Hrabok, M.; Ulzen, T.; Osei, A.
    Objectives. To assess the perception of Ghanaian medical students about factors influencing their career interest in psychiatry and to explore gender differences in these perceptions. Methods. This is a cross-sectional quantitative survey of 5th and 6th year medical students in four public medical schools in Ghana. Data were analyzed with descriptive and inferential statistics using SPSS version 20. Results. Responses were obtained from 545 medical students (response rate of 52%). Significantly, more male medical students expressed that stigma is an important consideration for them to choose or not to choose a career in psychiatry compared to their female counterparts (42.7% v. 29.7%, respectively). Over two-thirds of the medical students perceived that psychiatrists were at risk of being attacked by their patients, with just a little over a third expressing that risk was an important consideration for them to choose a career in psychiatry. There were no gender differences regarding perceptions about risk. Around 3 to 4 out of 10 medical students will consider careers in psychiatry if offered various incentives with no gender differences in responses provided. Conclusion. Our study presents important and novel findings in the Ghanaian context, which can assist health policy planners and medical training institutions in Ghana to formulate policies and programs that will increase the number of psychiatry residents and thereby increase the psychiatrist-to-patient ratio in Ghana.
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    Evaluating the Impact of an Innovative Public Speaking Competition to Promote Psychiatry as a Career Option for Ghanaian Medical Students
    (Academic Psychiatry, 2019-04) Agyapong, V.I.O.; Hrabok, M.; Agyapong-Opoku, G.; Khinda, H.; Owusu-Antwi, R.; Osei, A.; Ohene, S.; Ulzen, T.; Gilligan, P.
    OBJECTIVE: The psychiatrist workforce has been identified as an area in need of development, especially in low- to middle-income countries. The purpose of this project is to assess the perceptions of Ghanaian medical students of a novel mental health inter-medical school speaking competition on career interest in psychiatry and mental health education and advocacy. METHODS: The study employed quantitative and qualitative methods in a cross-sectional design. A paper-based survey was administered to medical students from four schools in Ghana, and focus groups were conducted. RESULTS: A 52% response rate (545/1041 fifth- and sixth-year medical students from the four public medical schools in Ghana) was achieved. The competition was successful in stimulating interest in psychiatry as a subject (25%) and as a career (14%) and was viewed as serving an important public health and mental health advocacy function (65% and 66% respectively). The competition stimulated interest in students who were undecided or had previously ruled out psychiatry specialization, in both those who had and had not already completed a psychiatry clerkship (23% and 13% before and after completing a clinical rotation in psychiatry, respectively). Overall, 29% of respondents who participated in at least one competition-related activity reported that the competition stimulated their interest in psychiatry, compared to 4% who did not participate in any competition-related activity (Ӽ2 = 80, p = 0.0). Analysis of focus group content echoed these themes and highlighted opportunities for improvement. CONCLUSION: The innovative public speaking competition was successful in stimulating interest in psychiatry and furthering mental health education and advocacy. Implications are discussed.
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    Attitudes of primary health care providers towards people with mental illness: Evidence from two districts in Zambia
    (African Journal of Psychiatry (South Africa), 2011-09) Kapungwe, A.; Cooper, S.; Mayeya, J.; Mwanza, J.; Mwape, L.; Sikwese, A.; Lund, C.; Flisher, A.J.; Agossou, T.et.al.
    Objective: The aim of this study was to explore health care providers' attitudes towards people with mental illness within two districts in Zambia. It sought to document types of attitudes of primary health care providers towards people suffering from mental illness and possible predictors of such attitudes. This study offers insights into how health care providers regard people with mental illness that may be helpful in designing appropriate training or re-training programs in Zambia and other low-income African countries. Method: Using a pilot tested structured questionnaire, data were collected from a total of 111 respondents from health facilities in the two purposively selected districts in Zambia that the Ministry of Health has earmarked as pilot districts for integrating mental health into primary health care. Results: There are widespread stigmatizing and discriminatory attitudes among primary health care providers toward mental illness and those who suffer from it. These findings confirm and add weight to the results from the few other studies which have been conducted in Africa that have challenged the notion that stigma and discrimination of mental illness is less severe in African countries. Conclusion: There is an urgent need to start developing more effective awareness-raising, training and education programmes amongst health care providers. This will only be possible if there is increased consensus, commitment and political will within government to place mental health on the national agenda and secure funding for the sector. These steps are essential if the country is improve the recognition, diagnosis and treatment of mental disorders, and realize the ideals enshrined in the progressive health reforms undertaken over the last decade.
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    Stakeholders' perceptions of the main challenges facing Ghana's mental health care system: A qualitative analysis
    (International Journal of Culture and Mental Health, 2011-06) Doku, V.; Ofori-Atta, A.; Akpalu, B.; Osei, A.; Read, U.; Cooper, S.
    Mental health remains a low priority in Ghana. No comprehensive studies have assessed the current status of mental health policy, legislation and services in Ghana. This paper presents the qualitative results of a situation analysis conducted as part of the first phase of the Mental Health and Poverty Project. The aim of this paper was to explore what a range of stakeholders perceive as the main challenges facing Ghana's mental health system and the primary ways of addressing them. A total of 81 interviews and seven focus groups were held with key stakeholders drawn from five of the 10 regions in Ghana. The major challenges identified included: inadequate implementation of mental health policy; legislative limbo; inadequate human and financial resource; widespread stigma; dominance of psychiatric hospitals; and insufficient human rights protections for the mentally ill. A range of policy, legislative and service-related recommendations were made for addressing the situation. The results revealed that mental health services in Ghana need to scaled-up to respond to unmet needs in ways that are cost-effective within the budget of a low-income country. Enacting the current mental health bill and identifying strategies for overcoming the barriers to policy implementation will mark significant steps forward. © 2011 Taylor & Francis.
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    Common understandings of women's mental illness in Ghana: Results from a qualitative study
    (International Review of Psychiatry, 2010-12) Ofori-Atta, A.; Cooper, S.; Akpalu, B.; Osei, A.; Doku, V.; Lund, C.; Flisher, A.
    Despite the high rates of depression and anxiety disorders amongst women, the mental health of women is a neglected area, particularly in Africa. This study sought to explore what key stakeholders perceive as the main causes of mental illness in women in Ghana. Using qualitative methods, 81 semi-structured interviews and seven focus group discussions were conducted with 120 key stakeholders drawn from 5 of the 10 regions in Ghana. The analysis was undertaken using a grounded theory approach. Respondents attributed mental illness in women to a number of causes. These included women being the weaker sex, hormones, witchcraft, adultery, abuse and poverty. Explanations could be clustered under three broad categories: women's inherent vulnerability, witchcraft, and gender disadvantage. The way in which women's subordinate position within society may underpin their mental distress needs to be recognized and addressed. The results from this study offer opportunities to identify how policy can better recognize, accommodate and address the mental health needs of women in Ghana and other low-income African countries. © 2010 Informa UK Ltd All rights reserved.
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    From mental health policy development in Ghana to implementation: What are the barriers?
    (African Journal of Psychiatry (South Africa), 2010-07) Awenva, A.D.; Read, U.M.; Ofori-Attah, A.L.; Doku, V.C.K.; Akpalu, B.; Osei, A.O.; Flisher, A.J.
    Objective: This paper identifies the key barriers to mental health policy implementation in Ghana and suggests ways of overcoming them. Method: The study used both quantitative and qualitative methods. Quantitatively, the WHO Mental Health Policy and Plan Checklist and the WHO Mental Health Legislation Checklist were employed to analyse the content of mental health policy, plans and legislation in Ghana. Qualitative data was gathered using in-depth interviews and focus group discussions with key stakeholders in mental health at the macro, meso and micro levels. These were used to identify barriers to the implementation of mental health policy, and steps to overcoming these. Results: Barriers to mental health policy implementation identified by participants include: low priority and lack of political commitment to mental health; limited human and financial resources; lack of intersectoral collaboration and consultation; inadequate policy dissemination; and an absence of research-based evidence to inform mental health policy. Suggested steps to overcoming the barriers include: revision of mental health policy and legislation; training and capacity development and wider consultation. Conclusion: These results call for well-articulated plans to address the barriers to the implementation of mental health policy in Ghana to reduce the burden associated with mental disorders.
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    A situation analysis of mental health services and legislation in Ghana: Challenges for transformation
    (African Journal of Psychiatry (South Africa), 2010-05) Ofori-Atta, A.; Read, U.M.; Lund, C.
    Objective: To conduct a situation analysis of the status of mental health care in Ghana and to propose options for scaling up the provision of mental health care. Method: A survey of the existing mental health system in Ghana was conducted using the WHO Assessment Instrument for Mental Health Systems. Documentary analysis was undertaken of mental health legislation, utilizing the WHO Legislation checklists. Semi-structured interviews and focus group discussions were conducted with a broad range of mental health stakeholders (n=122) at the national, regional and district levels. Results: There are shortfalls in the provision of mental health care including insufficient numbers of mental health professionals, aging infrastructure, widespread stigma, inadequate funding and an inequitable geographical distribution of services. Conclusion: Community-based services need to be delivered in the primary care setting to provide accessible and humane mental health care. There is an urgent need for legislation reform, to improve mental health care delivery and protect human rights.