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Background Ageing comes with its own associated physical and psychosocial challenges. Depression is reported as one of the most prevalent psychopathology found among elderly people. However, there is dearth of literature in Ghana regarding mental health and its associated risk and protective factors among Ghanaians who are aged 65years and above. This study examined the prevalence and factors associated with depression among the aged in Ghana. Methods A cross-sectional survey design was employed and a total of 262 elderly people (65+years) were sampled. The Geriatric Depression Scale, Brief COPE and demographic questionnaires were administered to the participants. Results There was 37.8% prevalence of depression among the participants. Socio-demographic characteristics such as religion, living status and presence of chronic illness independently predicted depression among the participants. The use of religion, acceptance and active coping were the most commonly reported coping strategies among the participants while denial, behavioural disengagement and substance use were the least used coping strategies among the participants. The use of active coping predicted decreased depression levels whereas the use of behavioural disengagement and self-blame significantly predicted increased depression levels among the participants. Conclusions Depression is a major challenge among the aged in this study and therefore, mental health screening should form part of the routine health screening practices for the elderly. The findings call for interventions aimed at promoting healthy ageing among the elderly in Ghana.

The birth of a first child can be stressful on intimate partner relationships and the women having their first child. Conflict can occur, and hurts might be experienced, which could lead to post-partum depression. Thus, capacity for forgiveness with specific hurts might affect post-partum depression. We investigated women having their first child (N = 52), and examined whether dyadic adjustment, trait forgiveness, and situational forgiving during pregnancy predicted postpartum depression. This study found that marital forgiveness predicted lower levels of depression above and beyond the effects of general dyadic adjustment. Dyadic adjustment and trait forgiveness predicted postpartum depression while situational forgiving was mixed. Postpartum depression researchers are encouraged to consider the inclusion of positive psychology variables, such as forgiveness, in future research studies.

Background: HIV-related stigma and HIV status disclosure are important elements in the continuous fight against HIV as these impact the prevention efforts and antiretroviral treatment adherence among people living with HIV/AIDS (PLWHA) in many communities. Objectives: The objectives of the study were to examine the prevalence and experience of various types of HIV-related stigma and HIV status disclosure among PLWHA in Volta region. Methods: A cross-sectional design was used to collect quantitative data from 301 PLWHA. Descriptive statistics were used to analyze and present data on socio-demographic variables. Correlation analysis was done to determine factors associated with HIV stigma and status disclosure while a Mann-Whitney U test was used to determine differences in internalized HIV stigma. Findings:The mean age of the participants was 44.82 (SD: 12.22), 224 (74.4%) were female, and 90% attained at least primary education. A Pearson r analysis revealed that ethnicity (r[299] = 0.170, p = 0.003), religious affiliation (r[299] = –0.205, p = 0.001) and social support (r[299] = 0.142, p = 0.014) significantly predicted disclosure of HIV status. Fear of family rejection (62%) and shame (56%) were reasons for non-disclosure of HIV status. A Mann-Whitney’s U-test revealed that females are more likely than males to internalize HIV stigma. Community-related HIV stigma in the form of gossip (56.1%), verbal harassment (30.9%), and physical harassment (8.6%) was reported. Conclusion: A high rate of HIV status disclosure was found with social support, ethnicity, and religious affiliation being the associated factors. Internalized HIV stigma is prevalent among PLWHA while community-related stigma impacts HIV status disclosure. Strengthening social support systems and implementing culturally appropriate educational interventions may help in reducing community-related HIV stigma.

Background Mental disorders, also called psychiatric disorders, refer to unconventional or anomalous behavioral patterns, feelings, thoughts, perceptions and beliefs that cause distress or disability, and which are not developmentally or socially acceptable. Plasmodium falciparum (P. falciparum) malaria is the most common parasitic infection of the central nervous system and sub-Saharan Africa has the highest burden of this disease. Children living in this region of the world bear the brunt of P. falciparum malaria and neurological complications commonly associated with it. Objectives The objective of this review was to synthesize the best available evidence on the association of P. falciparum malaria and the short-term and long-term mental disorders of children. Inclusion criteria Types of participants Study participants aged five to 19 years who were residing in sub-Saharan Africa. Types of intervention(s)/phenomena of interest This review considered studies that examined the association between P. falciparum malaria (cerebral malaria, repetitive uncomplicated malaria or asymptomatic malaria) as exposure and a range of mental disorders as an outcome. Types of studies This review considered epidemiological study designs including randomized controlled trials, non-randomized controlled trials, quasi-experimental trials, prospective and retrospective cohort studies, case control studies and analytical cross-sectional studies. Types of outcomes This review considered studies that included (but were not limited to) the following mental disorder outcome measures: cognitive deficits and impairments, acquired language disorder, school performance and psychomotor skills. There are many tests to measure these outcomes. Cognitive deficits and impairments are commonly measured with the Mini-Cog Test, language disorders with the Language Delays Assessment Test and psychomotor skills are measured with the Two-point Threshold Test (distance perception) and the Color Timing Test that measures mental speed. School performance is not commonly measured with norm-referenced standardized tests due to the large disparities in achievement between schools. This outcome measure is often picked from class assessment and examination records of the students, relative to their classmates. Search strategy A three-step search strategy was utilized in this review. Relevant studies published in the English language from 1980 to 2012, when the association between malaria and mental disorders was highlighted, were considered for inclusion in this review. Unpublished data was also searched for within the same period. The databases searched included PubMed, CINAHL, PsycARTICLES, PsycBITES, PsycINFO, Social Science Citation Index, ProQuest Dissertations and Theses (PQDT)/Digital dissertations, ProQuest Social Services abstracts, ProQuest Sociological abstracts, World Bank, British Library for Development Studies, SCOPUS and Mednar. Methodological quality Quantitative papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute (i.e. JBI-MAStARI). Any disagreements that arose between the reviewers were resolved through discussion. Data collection Data were extracted from quantitative papers included in the review using the standardized data extraction tool from JBI-MAStARI. The data extracted included specific details about the interventions, populations, study methods and outcomes of significance to the review question and specific objectives. Data synthesis Meta-analysis was not done because the nature of the results from included studies did not make it statistically prudent to pool the results. Results A total of eight studies which met the inclusion criteria for this review were identified. Four (50%) studies were conducted in Kenya, three (37.5%) from Uganda and one (12.5%) from Senegal. The results of the review suggested that P. falciparum malaria was associated with mental disorders. Conclusions The review suggested that P. falciparum malaria is associated with mental disorders. However, there should be collaboration between investigators in this area so that multi-center trials can be conducted to ascertain the effects of P. falciparum malaria on more focused mental disorder outcomes.

Review objectives The objective of this review is to identify and synthesise the best available evidence on the association of Plasmodium falciparum malaria and the short-term and long-term mental health deficiencies of children aged between 5 years and 19 years in sub-Saharan Africa. More specifically, the objectives are to identify the effects of malaria episodes on children’s memory, attention, general school performance, schizophrenic and manic syndromes, typical and atypical depression, anxiety attacks, mental confusion, amnesia, irritability, violence and acute personality changes. In addition, this review will also consider studies that look at other negative sequelae such as visual hallucinations, motor agitation and those that report negative effects on the executive functions of the victims in sub-Saharan Africa. Inclusion criteria Type of participants This review will consider studies that include children aged between 5 years and 19 years, who reside in sub-Saharan Africa. Children below 5 years of age are prone to active bouts of falciparum malaria as compared to older children, 18 hence the lower age limit of 5 years to capture persons less prone to active malaria disease. The review focuses on children; the upper age limit of that group is 19 years. Phenomenon of interest/exposure This review will consider studies that examine the association between severe malaria, cerebral malaria, repetitive uncomplicated malaria or asymptomatic malaria and mental disorders. Type of outcomes The main outcome of interest is the association between malaria and mental health outcomes. This review will consider studies that include the following mental health outcome measures: cognitive deficits and impairments, acquired language disorder, school performance and psychomotor skills

Despite radical health transformations in Zambia over the last decade, mental health continues to be marginalized, as reflected in the un-coordinated and under-resourced mental health care system. 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 Zambia's mental health system and the primary ways of addressing them. Fifty interviews and six focus group discussions were held with policy makers in and outside of the ministry of health, general and mental health care professionals, users of psychiatric services, teachers, police officers, academics, members of three NGOs and traditional healers. The major challenges identified included: marginalization of mental health; flawed policy development; outdated and harmful legislation; human rights abuses, including stigma; limited mental health services; and inadeq...

Limited research has been conducted to explore the factors that support or obstruct collaboration between traditional healers and public sector mental health services. The first aim of this study was to explore the reasons underpinning the widespread appeal of traditional/faith healers in Ghana. This formed a backdrop for the second objective, to identify what barriers or enabling factors may exist for forming bi-sectoral partnerships. Eighty-one semi-structured interviews and seven focus group discussions were conducted with 120 key stakeholders drawn from five of the ten regions in Ghana. The results were analysed through a framework approach. Respondents indicated many reasons for the appeal of traditional and faith healers, including cultural perceptions of mental disorders, the psychosocial support afforded by such healers, as well as their availability, accessibility and affordability. A number of barriers hindering collaboration, including human rights and safety concerns, scepticism around the effectiveness of 'conventional' treatments, and traditional healer solidarity were identified. Mutual respect and bi-directional conversations surfaced as the key ingredients for successful partnerships. Collaboration is not as easy as commonly assumed, given paradigmatic disjunctures and widespread scepticism between different treatment modalities. Promoting greater understanding, rather than maintaining indifferent distances may lead to more successful co-operation in future.

BACKGROUND: Timely and appropriate management of febrile illness among children under five years of age will contribute to achieving Millennium Development Goal-4. The revised World Health Organization-Global Malaria Programme's policy on test-based management of malaria must integrate effectively into the Integrated Management of Childhood Illness (IMCI). This study reports on perceptions of health workers on the health system factors influencing effective delivery of test-based diagnosis of malaria with IMCI. METHODS: A qualitative study was conducted among a range of health workers at different levels of the health system in the Brong Ahafo Region of Ghana. Interview transcripts were transferred into Nvivo 8 software for data management and analysis. A frame-work approach at two levels was used in the analysis, which included the processes required for implementation of test-based management of malaria and the health systems context. RESULTS: Forty-nine in-depth interviews were conducted. The National Health Insurance Scheme (NHIS) was perceived to have led to an increase in health facility attendance, thereby increasing the workload of health workers. Workload was reported as the main reason that health workers were not able to complete all of the examinations included in the IMCI algorithm. The NHIS financing guidelines were seen to be determining diagnosis and treatment practices by health-care givers. Concern was expressed about the erratic supply of malaria rapid diagnostic test kits (RDTs), the quality of RDTs related to potential false negative results when clinical symptoms were consistent with malaria. IMCI was seen as important but practically impossible to fully implement due to workload. CONCLUSIONS: Implementation of the WHO-revised IMCI guideline is confronted with a myriad of health systems challenges. The perceptions of front-line health workers on the accuracy and need for RDTs together with the capacity of health systems to support implementation plays a crucial role. The NHIS financing guidelines of diagnostics and treatments are influencing clinical decision-making in this setting. Further study is needed to understand the impact of the NHIS on the feasibility of integrating test-based management for malaria into the IMCI guidelines.

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.

Background There have been few attempts formally to validate screening measures for postnatal common mental disorder in low income country settings. We have investigated the comparative validity of three different screening approaches in a community-based study in Kintampo, Ghana. Method 160 women aged 15–45 years, and 5–11 weeks postpartum were first screened using the Self-Report Questionnaire (SRQ-20), with oversampling of higher scorers. The other test assessments were the Edinburgh Postnatal Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9). Criterion validity was measured against the Comprehensive Psychopathological Rating Scale (CPRS), and concurrent validity against the WHO Disability Assessment Schedule. A sub-sample ( n = 40) was re-interviewed 2 weeks later for test–retest reliability. Results Internal consistency (Cronbach's Alpha) was equivalent across all three test scales; EPDS (0.79), SRQ-20 (0.78) and PHQ-9 (0.79). Test–retest reliability was better for PHQ-9 (ICC 0.75) than for the EPDS (0.51). For criterion validity the PHQ-9 (AUROC 0.90 (0.81–0.98)), was superior to the SRQ-20 (0.74 (0.62–0.86)) and the EPDS ((0.84 (0.76–0.92). Youden's Index was also superior for PHQ-9. Item analysis revealed that a mixture of somatic and cognitive symptoms best discriminated between cases and non-cases for all three scales. Limitations Inability to ascertain inter-rater reliability, order effects and possible loss of technical equivalence due to item modifications. Conclusions The evidence for the validity, reliability, and superiority of the PHQ-9 over other screening assessments has been extended. The PHQ-9 is short, easy to administer and acceptable to a largely illiterate population of Ghanaian women, 5 to 11 weeks post partum.