Eugene Kinyanda | Makerere College Of Health Sciences (original) (raw)

Papers by Eugene Kinyanda

Crisis-the Journal of Crisis Intervention and Suicide Prevention, 2011

This article describes and discusses the challenges faced by researchers who conducted a qualitat... more This article describes and discusses the challenges faced by researchers who conducted a qualitative interview study on attitudes toward suicide among the Baganda, Uganda. Many of the challenges addressed in this article have not been described earlier in suicide research conducted in the developing world. The aim of this study was to explore attitudes and cultural responses toward suicide among the Baganda, Uganda. Data were collected and analyzed using grounded theory. A total of 28 focus group discussions and 30 key informant interviews were conducted. The findings of this study are organized under two broad categories: community access challenges and expectation challenges. Community access challenges entailed cultural, legal, rapport, informed consent, language, and other research process related issues that could hinder effective access to the study respondents. Expectation challenges concerned how to deal with the immediate and strategic needs of the study communities. This study demonstrates that culturally sensitive approaches to data collection can reduce ethical challenges and, through innovative approaches, practical challenges faced during data collection can be minimized.

BMC Psychiatry, 2011

Background The problem of severe mental distress (SMD) in sub-Saharan Africa is difficult to inve... more Background The problem of severe mental distress (SMD) in sub-Saharan Africa is difficult to investigate given that a substantial proportion of patients with SMD never access formal health care. This study set out to investigate SMD and it's associated factors in a rural population-based cohort in south-west Uganda. Methods 6,663 respondents aged 13 years and above in a general population cohort in southwestern Uganda were screened for probable SMD and possible associated factors. Results 0.9% screened positive for probable SMD. The factors significantly associated with SMD included older age, male sex, low socio-economic status, being a current smoker, having multiple or no sexual partners in the past year, reported epilepsy and consulting a traditional healer. Conclusion SMD in this study was associated with both socio-demographic and behavioural factors. The association between SMD and high risk sexual behaviour calls for the integration of HIV prevention in mental health care programmes in high HIV prevalence settings.

BMC Psychiatry, 2011

Background This study was conducted to evaluate the diagnostic accuracy and determine the optimum... more 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.

Crisis-the Journal of Crisis Intervention and Suicide Prevention, 2012

Alcohol has been noted to be an important factor in nearly 68% of the suicides in Northern Uganda... more Alcohol has been noted to be an important factor in nearly 68% of the suicides in Northern Uganda, yet exactly how alcohol contributes to suicide in this region has not been studied. To determine how alcohol contributes to suicide in this region. Qualitative psychological autopsy interviews were conducted with bereaved relatives and friends of 20 suicides mainly from Internally Displaced Peoples' camps in Northern Uganda. Data were analyzed using a modified Interpretative Phenomenological analysis (IPA). Alcohol had a direct or an indirect influence on the suicide of 16 out of the 20 decedents. Directly, alcohol facilitated the suicidal process, was a means to suicide, or had an influence on the decedents' lifestyles. Indirectly, alcohol had an influence on the suicidal process of the deceased through the drinking behavior of significant others. This study established that alcohol not only contributes to the suicidal process of the individuals through acute and chronic alcohol consumption, but also through victimization of those lowest in the power hierarchy by alcohol abusers higher up in the power hierarchy. Therefore, future development of suicide prevention programs should address the interrelated public health problem of alcohol abuse.

Crisis-the Journal of Crisis Intervention and Suicide Prevention, 2008

In this study, we attempt to even out some of the imbalance in suicide research caused by the fac... more In this study, we attempt to even out some of the imbalance in suicide research caused by the fact that most such research has been conducted in the Western part of the world with the corresponding common disregard of the potential problems in generalizing findings to different cultural settings. Our point of departure was to look at suicidal behavior as communication and our main purpose was to investigate whether Qvortrup's semiotic four-factor model, which has been empirically supported in the West, would be applicable in an African context, exemplified by Uganda. Interviews of patients admitted to hospital following an act of nonfatal suicidal behavior were conducted in Uganda and Norway and the data were compared. The results showed that the four-factor structure found in the West was not applicable in the Ugandan context, but that two by two of these factors were collapsed into a two-factor model in Uganda: One factor regarding the external dialog and one factor regarding the internal dialog. Some differences and some similarities were found between Norway and Uganda when suicidal behavior was considered as a communicative act. The results are discussed in terms of the differences in the psychological characteristics of the suicidal persons in the two countries, as well as the different cultural settings of the study.

Archives of Suicide Research, 2006

The main purposes of this study was to test the psychometric properties of a questionnaire on att... more The main purposes of this study was to test the psychometric properties of a questionnaire on attitudes towards suicide in a cross-cultural setting, and to discuss the value of cross-cultural studies in the search of meaning(s) of suicidal behavior as well as the methodological challenges encountered in such studies. Data on attitudes towards suicide among health and social science students from Norway and Uganda were employed to illustrate the points made. Both exploratory and confirmatory factor analyses showed different factor structures in the two countries. Whether this result is due to different latent variables indicating differences in meaning(s) of suicidal behavior between the two countries or lack of reliability and/or validity of the instrument is discussed.

Crisis-the Journal of Crisis Intervention and Suicide Prevention, 2008

Self-reported suicidal behavior and attitudes toward suicide in psychology students are reported ... more Self-reported suicidal behavior and attitudes toward suicide in psychology students are reported and compared in Ghana, Uganda, and Norway. Small differences only were found in own suicidal behavior. However, experience of suicidal behavior in the surroundings was more common in Uganda than in Ghana and Norway. Although differences were found between the three countries in attitudes toward suicide, which emphasizes the need for culture-sensitive research and prevention, many of the differences were not as big as expected. The most pronounced difference was that the Norwegian students were more reluctant to take a stand on these questions compared to their African counterparts. Some differences were also found between the two African countries. The implications of the results for suicide prevention in Africa are discussed.

Social Psychiatry and Psychiatric Epidemiology, 2004

Objectives: A study to investigate deliberate self-harm (DSH) in an African context was undertake... more Objectives: A study to investigate deliberate self-harm (DSH) in an African context was undertaken in Uganda. Methods: A case-control study in which 100 cases of DSH and 300 controls matched on age and sex were recruited from three general hospitals in Kampala and subjected to a structured interview using a modified version of the European Parasuicide Study Interview Schedule I. Results: Among the cases, 63% were males, with a male to female ratio of 1.7:1 and a peak age range of 20–24 years. Higher educational attainment, higher socio-economic class and poor housing were significantly associated with DSH. District of current residence, district of birth, religion, ethnicity, marital status, number of children, current living arrangement, area of usual residence, employment status of respondent and partner were not significantly associated with DSH. Pesticides and medications, mainly antimalarials and diazepam, were the main methods of DSH used. The most commonly reported psychiatric disorders were adjustment disorder, acute stress reactions and depression. Conclusion: DSH in Uganda appears to predominantly afflict the young. Disturbed interpersonal relationships, poverty and loneliness were important factors in the immediate precipitation of this behaviour. The fact that pesticide poisoning is still the predominantly used method in DSH in this area calls for a review of the legislation that controls the sale and availability of these agricultural chemicals.

Crisis-the Journal of Crisis Intervention and Suicide Prevention, 2011

This article describes and discusses the challenges faced by researchers who conducted a qualitat... more This article describes and discusses the challenges faced by researchers who conducted a qualitative interview study on attitudes toward suicide among the Baganda, Uganda. Many of the challenges addressed in this article have not been described earlier in suicide research conducted in the developing world. The aim of this study was to explore attitudes and cultural responses toward suicide among the Baganda, Uganda. Data were collected and analyzed using grounded theory. A total of 28 focus group discussions and 30 key informant interviews were conducted. The findings of this study are organized under two broad categories: community access challenges and expectation challenges. Community access challenges entailed cultural, legal, rapport, informed consent, language, and other research process related issues that could hinder effective access to the study respondents. Expectation challenges concerned how to deal with the immediate and strategic needs of the study communities. This study demonstrates that culturally sensitive approaches to data collection can reduce ethical challenges and, through innovative approaches, practical challenges faced during data collection can be minimized.

Crisis-the Journal of Crisis Intervention and Suicide Prevention, 2005

Negative life events associated with deliberate self-harm (DSH) were investigated in an African c... more Negative life events associated with deliberate self-harm (DSH) were investigated in an African context in Uganda. Patients admitted at three general hospitals in Kampala, Uganda were interviewed using a Luganda version (predominant language in the study area) of the European Parasuicide Study Interview Schedule I. The results of the life events and histories module are reported in this paper. The categories of negative life events in childhood that were significantly associated with DSH included those related to parents, significant others, personal events, and the total negative life events load in childhood. For the later-life time period, the negative life events load in the partner category and the total negative life events in this time period were associated with DSH. In the last-year time period, the negative life events load related to personal events and the total number of negative life events in this time period were associated with DSH. A statistically significant difference between the cases and controls for the total number of negative life events reported over the entire lifetime of the respondents was also observed, which suggests a dose effect of negative life events on DSH. Gender differences were also observed among the cases. In conclusion, life events appear to be an important factor in DSH in this cultural environment. The implication of these results for treatment and the future development of suicide interventions in this country are discussed.

Aids Care-psychological and Socio-medical Aspects of Aids/hiv, 2012

This article sets out to investigate the psychiatric and psychosocial risk factors for high risk ... more This article sets out to investigate the psychiatric and psychosocial risk factors for high risk sexual behaviour in a war-affected population in Eastern Uganda. A cross-sectional survey was carried out in four sub-counties in two districts in Eastern Uganda where 1560 randomly selected respondents (15 years and above) were interviewed. The primary outcome was a derived variable “high risk sexual behaviour” defined as reporting at least one of eight sexual practices that have been associated with HIV transmission in Uganda and which were hypothesised could arise as a consequence of psychiatric disorder or psychosocial problems. Multivariable logistic regression was used to assess factors associated with high risk sexual behaviour in this population. Males were more likely to have at least one “high risk sexual behaviour” than females (11.8% vs. 9.1% in the last year). Sex outside marriage was the most commonly reported high risk sexual behaviour. Among males, the factors independently associated with high risk sexual behaviour were: being married, belonging to non-Catholic/non-Protestant religions, poverty, being a victim of intimate partner violence and having a major depressive disorder (MDD). Among females, the factors that were independently associated with high risk sexual behaviour were: being in the reproductive age groups of 25–34 and 35–44 years, not seeing a close relative killed and having experienced war-related sexual torture. Holistic HIV/AIDS prevention programming in conflict and post-conflict settings should address the psychiatric and psychosocial well-being of these communities as a risk factor for HIV acquisition.

Mental Health, Religion & Culture, 2012

A negative attitude towards suicide is generally assumed to be predominant in low-income countrie... more A negative attitude towards suicide is generally assumed to be predominant in low-income countries. In order to understand the negative attitude in general it is necessary to look at how religion and morality influence the attitudes. Our aim in this qualitative interview study was to investigate what attitudes professional mental health workers in Uganda bear towards suicide and suicidal persons. The professionals argue for their attitude by employing religious, communal and medical ethics arguments, which draw both in a negative and positive direction. The professionals are in general unambiguously negative towards suicide and positive towards suicidal people who are mentally ill. In cases other than mental illness non-accepting attitudes surface. This is discussed against previous research showing that effective treatment of suicidal people is to be based on a trusting and accepting relationship.

Aids Care-psychological and Socio-medical Aspects of Aids/hiv, 2011

This study investigated HIV seroprevalence and it's correlates among patients with first-time psy... more This study investigated HIV seroprevalence and it's correlates among patients with first-time psychiatric admissions to two national referral hospitals in urban Kampala, Uganda. A structured standardised evaluation was used to assess patients for: Diagnostic and Statistical Manual IV psychiatric diagnosis, socio-demographics, sexual behaviour and HIV status (for those HIV-positive, CDC classification and CD4 cell counts).The HIV-1 seroprevalence was 18.4% (95% CI, 13.8–23.0%). Factors that were independently associated with HIV-1 seropositivity were female gender and older age (41+years) and after adjusting for sex and age group, the nature of the current episode (highest among those with first episode of mental illness) and psychiatric diagnoses (highest in the organic affective disorders and delirium, lowest in those with bipolar affective disorder and psychotic syndromes).These results demonstrate that the prevalence of HIV is high among patients with severe mental illness in Africa and that HIV/AIDS adds to the burden of mental illness in high HIV prevalence countries in sub-Saharan Africa. Both HIV care programmes and psychiatric care clinics should be made aware of the frequent association of HIV infection and mental illness, and adopt important diagnostic and care elements of these complementary disciplines in the training and the day-to-day work of clinicians, nurses and counsellors.

Suicide and Life-threatening Behavior, 2005

Psychological factors associated with deliberate self-harm (DSH) as seen in an African population... more Psychological factors associated with deliberate self-harm (DSH) as seen in an African population in Uganda are described. A case-control study design was employed in which a Luganda version (predominant language in the study area) of the modified European Parasuicide Interview Schedule I (EPSIS I) was used to collect data. The controls were patients admitted to the participating hospitals for non-recurrent medical conditions. Hopelessness, global psychological distress, and state anger, but not depression, were significantly associated with DSH after controlling for other factors. Both depression and hopelessness were significantly associated with suicidal intent independent of each other. Differences were observed on the psychological factors associated with suicidal intent in the different age/sex groups and in the depressed/ nondepressed group. Interventions for DSH in this population should include treatments for both depression and hopelessness. This study further raises questions about the universality of the structural relationship among depression, hopelessness, and suicidality.

Archives of Suicide Research, 2005

Described is the presentation of repetition of deliberate self-harm (DSH) as seen in an African p... more Described is the presentation of repetition of deliberate self-harm (DSH) as seen in an African population in urban Uganda. A Luganda version (local language in study area) of the modified European Parasuicide Interview Schedule I (EPSIS I) was used to collect the data. An univariate analysis was conducted. Results indicated that repeaters of DSH differed significantly from non-repeaters on several dimensions. The factors included were: more often single, less often had children, staying alone or with their parents, reported sexual problems as a precipitant of current DSH event, more negative life events in childhood and less negative life events in the last year. Furthermore, a multivariate analysis was conducted resulting in only sexual problems and the psychological factor of trait anger, which retained statistical significance. The significance of these findings is discussed.

Social Psychiatry and Psychiatric Epidemiology, 2011

Background Understanding the determinants of major depression in sub-Saharan Africa is important ... more Background Understanding the determinants of major depression in sub-Saharan Africa is important for planning effective intervention strategies. Objective To investigate the social and life-event determinants of major depressive disorder in the African sociocultural context of rural Uganda. Methods A cross-section survey was carried out in 14 districts in Uganda from 1 June 2003 to 30 October 2004. 4,660 randomly selected respondents (15 years and above) were interviewed. The primary outcome was the presence of ‘probable major depressive disorder’ (PMDD) as assessed by the Hopkins symptom checklist. Results The prevalence of PMDD was 29.3% (95% confidence interval, 28.0–30.6%). Factors independently associated with depression in both genders included: the ecological factor, district; age (increase with each age category after 35 years); indices of poverty and deprivation (no formal education, having no employment, broken family, and socioeconomic classes III–V). Only a few adverse life events, notably those suggestive of a disrupted family background (death of a father in females and death of a mother in males) were associated with increased risk. Conclusion Socioeconomic and sociodemographic factors, operating at both ecological and the individual level are the strongest independent determinants of depression. Adverse life events were less strongly associated with depression in this sample.

BMC International Health and Human Rights, 2010

Background: Despite the recent adoption of the UN resolution 1820 (2008) which calls for the cess... more Background: Despite the recent adoption of the UN resolution 1820 (2008) which calls for the cessation of war related sexual violence against civilians in conflict zones, Africa continues to see some of the worst cases of war related sexual violence including the mass sexual abuse of entire rural communities particularly in the Great Lakes region. In addition to calling for a complete halt to this abuse, there is a need for the systematic study of the reproductive, surgical and psychological effects of war related sexual violence in the African socio-cultural setting. This paper examines the specific long term health consequences of war related sexual violence among rural women living in two internally displaced person's camps in Kitgum district in war affected Northern Uganda who accessed the services of an Isis-Women's International Cross Cultural Exchange (Isis-WICCE) medical intervention.

Crisis-the Journal of Crisis Intervention and Suicide Prevention, 2011

Suicidal behavior in adolescence is a public health concern and has serious consequences for adol... more Suicidal behavior in adolescence is a public health concern and has serious consequences for adolescents and their families. There is, however, a paucity of data on this subject from sub-Saharan Africa, hence the need for this study. A cross-sectional multistage survey to investigate adolescent suicidality among other things was undertaken in rural northeastern Uganda. A structured protocol administered by trained psychiatric nurses collected information on sociodemographics, mental disorders (DSM-IV criteria), and psychological and psychosocial risk factors for children aged 3-19 years (N = 1492). For the purposes of this paper, an analysis of a subsample of adolescents (aged 10-19 years; n = 897) was undertaken. Lifetime suicidality in this study was 6.1% (95% CI, 4.6%-7.9%). Factors significantly associated with suicidality included mental disorder, the ecological factor district of residence, factors suggestive of low socioeconomic status, and disadvantaged childhood experiences.

Background: Suicidal behavior in adolescence is a public health concern and has serious consequen... more Background: Suicidal behavior in adolescence is a public health concern and has serious consequences for adolescents and their families. There is, however, a paucity of data on this subject from sub-Saharan Africa, hence the need for this study. Aims: A cross-sectional multistage survey to investigate adolescent suicidality among other things was undertaken in rural northeastern Uganda. Methods: A structured protocol administered by trained psychiatric nurses collected information on sociodemographics, mental disorders (DSM-IV criteria), and psychological and psychosocial risk factors for children aged 3-19 years (N = 1492). For the purposes of this paper, an analysis of a subsample of adolescents (aged 10-19 years; n = 897) was undertaken. Results: Lifetime suicidality in this study was 6.1% (95% CI, 4.6%-7.9%). Conclusions: Factors significantly associated with suicidality included mental disorder, the ecological factor district of residence, factors suggestive of low socioeconomic status, and disadvantaged childhood experiences.

Crisis-the Journal of Crisis Intervention and Suicide Prevention, 2011

This article describes and discusses the challenges faced by researchers who conducted a qualitat... more This article describes and discusses the challenges faced by researchers who conducted a qualitative interview study on attitudes toward suicide among the Baganda, Uganda. Many of the challenges addressed in this article have not been described earlier in suicide research conducted in the developing world. The aim of this study was to explore attitudes and cultural responses toward suicide among the Baganda, Uganda. Data were collected and analyzed using grounded theory. A total of 28 focus group discussions and 30 key informant interviews were conducted. The findings of this study are organized under two broad categories: community access challenges and expectation challenges. Community access challenges entailed cultural, legal, rapport, informed consent, language, and other research process related issues that could hinder effective access to the study respondents. Expectation challenges concerned how to deal with the immediate and strategic needs of the study communities. This study demonstrates that culturally sensitive approaches to data collection can reduce ethical challenges and, through innovative approaches, practical challenges faced during data collection can be minimized.

BMC Psychiatry, 2011

Background The problem of severe mental distress (SMD) in sub-Saharan Africa is difficult to inve... more Background The problem of severe mental distress (SMD) in sub-Saharan Africa is difficult to investigate given that a substantial proportion of patients with SMD never access formal health care. This study set out to investigate SMD and it's associated factors in a rural population-based cohort in south-west Uganda. Methods 6,663 respondents aged 13 years and above in a general population cohort in southwestern Uganda were screened for probable SMD and possible associated factors. Results 0.9% screened positive for probable SMD. The factors significantly associated with SMD included older age, male sex, low socio-economic status, being a current smoker, having multiple or no sexual partners in the past year, reported epilepsy and consulting a traditional healer. Conclusion SMD in this study was associated with both socio-demographic and behavioural factors. The association between SMD and high risk sexual behaviour calls for the integration of HIV prevention in mental health care programmes in high HIV prevalence settings.

BMC Psychiatry, 2011

Background This study was conducted to evaluate the diagnostic accuracy and determine the optimum... more 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.

Crisis-the Journal of Crisis Intervention and Suicide Prevention, 2012

Alcohol has been noted to be an important factor in nearly 68% of the suicides in Northern Uganda... more Alcohol has been noted to be an important factor in nearly 68% of the suicides in Northern Uganda, yet exactly how alcohol contributes to suicide in this region has not been studied. To determine how alcohol contributes to suicide in this region. Qualitative psychological autopsy interviews were conducted with bereaved relatives and friends of 20 suicides mainly from Internally Displaced Peoples' camps in Northern Uganda. Data were analyzed using a modified Interpretative Phenomenological analysis (IPA). Alcohol had a direct or an indirect influence on the suicide of 16 out of the 20 decedents. Directly, alcohol facilitated the suicidal process, was a means to suicide, or had an influence on the decedents' lifestyles. Indirectly, alcohol had an influence on the suicidal process of the deceased through the drinking behavior of significant others. This study established that alcohol not only contributes to the suicidal process of the individuals through acute and chronic alcohol consumption, but also through victimization of those lowest in the power hierarchy by alcohol abusers higher up in the power hierarchy. Therefore, future development of suicide prevention programs should address the interrelated public health problem of alcohol abuse.

Crisis-the Journal of Crisis Intervention and Suicide Prevention, 2008

In this study, we attempt to even out some of the imbalance in suicide research caused by the fac... more In this study, we attempt to even out some of the imbalance in suicide research caused by the fact that most such research has been conducted in the Western part of the world with the corresponding common disregard of the potential problems in generalizing findings to different cultural settings. Our point of departure was to look at suicidal behavior as communication and our main purpose was to investigate whether Qvortrup's semiotic four-factor model, which has been empirically supported in the West, would be applicable in an African context, exemplified by Uganda. Interviews of patients admitted to hospital following an act of nonfatal suicidal behavior were conducted in Uganda and Norway and the data were compared. The results showed that the four-factor structure found in the West was not applicable in the Ugandan context, but that two by two of these factors were collapsed into a two-factor model in Uganda: One factor regarding the external dialog and one factor regarding the internal dialog. Some differences and some similarities were found between Norway and Uganda when suicidal behavior was considered as a communicative act. The results are discussed in terms of the differences in the psychological characteristics of the suicidal persons in the two countries, as well as the different cultural settings of the study.

Archives of Suicide Research, 2006

The main purposes of this study was to test the psychometric properties of a questionnaire on att... more The main purposes of this study was to test the psychometric properties of a questionnaire on attitudes towards suicide in a cross-cultural setting, and to discuss the value of cross-cultural studies in the search of meaning(s) of suicidal behavior as well as the methodological challenges encountered in such studies. Data on attitudes towards suicide among health and social science students from Norway and Uganda were employed to illustrate the points made. Both exploratory and confirmatory factor analyses showed different factor structures in the two countries. Whether this result is due to different latent variables indicating differences in meaning(s) of suicidal behavior between the two countries or lack of reliability and/or validity of the instrument is discussed.

Crisis-the Journal of Crisis Intervention and Suicide Prevention, 2008

Self-reported suicidal behavior and attitudes toward suicide in psychology students are reported ... more Self-reported suicidal behavior and attitudes toward suicide in psychology students are reported and compared in Ghana, Uganda, and Norway. Small differences only were found in own suicidal behavior. However, experience of suicidal behavior in the surroundings was more common in Uganda than in Ghana and Norway. Although differences were found between the three countries in attitudes toward suicide, which emphasizes the need for culture-sensitive research and prevention, many of the differences were not as big as expected. The most pronounced difference was that the Norwegian students were more reluctant to take a stand on these questions compared to their African counterparts. Some differences were also found between the two African countries. The implications of the results for suicide prevention in Africa are discussed.

Social Psychiatry and Psychiatric Epidemiology, 2004

Objectives: A study to investigate deliberate self-harm (DSH) in an African context was undertake... more Objectives: A study to investigate deliberate self-harm (DSH) in an African context was undertaken in Uganda. Methods: A case-control study in which 100 cases of DSH and 300 controls matched on age and sex were recruited from three general hospitals in Kampala and subjected to a structured interview using a modified version of the European Parasuicide Study Interview Schedule I. Results: Among the cases, 63% were males, with a male to female ratio of 1.7:1 and a peak age range of 20–24 years. Higher educational attainment, higher socio-economic class and poor housing were significantly associated with DSH. District of current residence, district of birth, religion, ethnicity, marital status, number of children, current living arrangement, area of usual residence, employment status of respondent and partner were not significantly associated with DSH. Pesticides and medications, mainly antimalarials and diazepam, were the main methods of DSH used. The most commonly reported psychiatric disorders were adjustment disorder, acute stress reactions and depression. Conclusion: DSH in Uganda appears to predominantly afflict the young. Disturbed interpersonal relationships, poverty and loneliness were important factors in the immediate precipitation of this behaviour. The fact that pesticide poisoning is still the predominantly used method in DSH in this area calls for a review of the legislation that controls the sale and availability of these agricultural chemicals.

Crisis-the Journal of Crisis Intervention and Suicide Prevention, 2011

This article describes and discusses the challenges faced by researchers who conducted a qualitat... more This article describes and discusses the challenges faced by researchers who conducted a qualitative interview study on attitudes toward suicide among the Baganda, Uganda. Many of the challenges addressed in this article have not been described earlier in suicide research conducted in the developing world. The aim of this study was to explore attitudes and cultural responses toward suicide among the Baganda, Uganda. Data were collected and analyzed using grounded theory. A total of 28 focus group discussions and 30 key informant interviews were conducted. The findings of this study are organized under two broad categories: community access challenges and expectation challenges. Community access challenges entailed cultural, legal, rapport, informed consent, language, and other research process related issues that could hinder effective access to the study respondents. Expectation challenges concerned how to deal with the immediate and strategic needs of the study communities. This study demonstrates that culturally sensitive approaches to data collection can reduce ethical challenges and, through innovative approaches, practical challenges faced during data collection can be minimized.

Crisis-the Journal of Crisis Intervention and Suicide Prevention, 2005

Negative life events associated with deliberate self-harm (DSH) were investigated in an African c... more Negative life events associated with deliberate self-harm (DSH) were investigated in an African context in Uganda. Patients admitted at three general hospitals in Kampala, Uganda were interviewed using a Luganda version (predominant language in the study area) of the European Parasuicide Study Interview Schedule I. The results of the life events and histories module are reported in this paper. The categories of negative life events in childhood that were significantly associated with DSH included those related to parents, significant others, personal events, and the total negative life events load in childhood. For the later-life time period, the negative life events load in the partner category and the total negative life events in this time period were associated with DSH. In the last-year time period, the negative life events load related to personal events and the total number of negative life events in this time period were associated with DSH. A statistically significant difference between the cases and controls for the total number of negative life events reported over the entire lifetime of the respondents was also observed, which suggests a dose effect of negative life events on DSH. Gender differences were also observed among the cases. In conclusion, life events appear to be an important factor in DSH in this cultural environment. The implication of these results for treatment and the future development of suicide interventions in this country are discussed.

Aids Care-psychological and Socio-medical Aspects of Aids/hiv, 2012

This article sets out to investigate the psychiatric and psychosocial risk factors for high risk ... more This article sets out to investigate the psychiatric and psychosocial risk factors for high risk sexual behaviour in a war-affected population in Eastern Uganda. A cross-sectional survey was carried out in four sub-counties in two districts in Eastern Uganda where 1560 randomly selected respondents (15 years and above) were interviewed. The primary outcome was a derived variable “high risk sexual behaviour” defined as reporting at least one of eight sexual practices that have been associated with HIV transmission in Uganda and which were hypothesised could arise as a consequence of psychiatric disorder or psychosocial problems. Multivariable logistic regression was used to assess factors associated with high risk sexual behaviour in this population. Males were more likely to have at least one “high risk sexual behaviour” than females (11.8% vs. 9.1% in the last year). Sex outside marriage was the most commonly reported high risk sexual behaviour. Among males, the factors independently associated with high risk sexual behaviour were: being married, belonging to non-Catholic/non-Protestant religions, poverty, being a victim of intimate partner violence and having a major depressive disorder (MDD). Among females, the factors that were independently associated with high risk sexual behaviour were: being in the reproductive age groups of 25–34 and 35–44 years, not seeing a close relative killed and having experienced war-related sexual torture. Holistic HIV/AIDS prevention programming in conflict and post-conflict settings should address the psychiatric and psychosocial well-being of these communities as a risk factor for HIV acquisition.

Mental Health, Religion & Culture, 2012

A negative attitude towards suicide is generally assumed to be predominant in low-income countrie... more A negative attitude towards suicide is generally assumed to be predominant in low-income countries. In order to understand the negative attitude in general it is necessary to look at how religion and morality influence the attitudes. Our aim in this qualitative interview study was to investigate what attitudes professional mental health workers in Uganda bear towards suicide and suicidal persons. The professionals argue for their attitude by employing religious, communal and medical ethics arguments, which draw both in a negative and positive direction. The professionals are in general unambiguously negative towards suicide and positive towards suicidal people who are mentally ill. In cases other than mental illness non-accepting attitudes surface. This is discussed against previous research showing that effective treatment of suicidal people is to be based on a trusting and accepting relationship.

Aids Care-psychological and Socio-medical Aspects of Aids/hiv, 2011

This study investigated HIV seroprevalence and it's correlates among patients with first-time psy... more This study investigated HIV seroprevalence and it's correlates among patients with first-time psychiatric admissions to two national referral hospitals in urban Kampala, Uganda. A structured standardised evaluation was used to assess patients for: Diagnostic and Statistical Manual IV psychiatric diagnosis, socio-demographics, sexual behaviour and HIV status (for those HIV-positive, CDC classification and CD4 cell counts).The HIV-1 seroprevalence was 18.4% (95% CI, 13.8–23.0%). Factors that were independently associated with HIV-1 seropositivity were female gender and older age (41+years) and after adjusting for sex and age group, the nature of the current episode (highest among those with first episode of mental illness) and psychiatric diagnoses (highest in the organic affective disorders and delirium, lowest in those with bipolar affective disorder and psychotic syndromes).These results demonstrate that the prevalence of HIV is high among patients with severe mental illness in Africa and that HIV/AIDS adds to the burden of mental illness in high HIV prevalence countries in sub-Saharan Africa. Both HIV care programmes and psychiatric care clinics should be made aware of the frequent association of HIV infection and mental illness, and adopt important diagnostic and care elements of these complementary disciplines in the training and the day-to-day work of clinicians, nurses and counsellors.

Suicide and Life-threatening Behavior, 2005

Psychological factors associated with deliberate self-harm (DSH) as seen in an African population... more Psychological factors associated with deliberate self-harm (DSH) as seen in an African population in Uganda are described. A case-control study design was employed in which a Luganda version (predominant language in the study area) of the modified European Parasuicide Interview Schedule I (EPSIS I) was used to collect data. The controls were patients admitted to the participating hospitals for non-recurrent medical conditions. Hopelessness, global psychological distress, and state anger, but not depression, were significantly associated with DSH after controlling for other factors. Both depression and hopelessness were significantly associated with suicidal intent independent of each other. Differences were observed on the psychological factors associated with suicidal intent in the different age/sex groups and in the depressed/ nondepressed group. Interventions for DSH in this population should include treatments for both depression and hopelessness. This study further raises questions about the universality of the structural relationship among depression, hopelessness, and suicidality.

Archives of Suicide Research, 2005

Described is the presentation of repetition of deliberate self-harm (DSH) as seen in an African p... more Described is the presentation of repetition of deliberate self-harm (DSH) as seen in an African population in urban Uganda. A Luganda version (local language in study area) of the modified European Parasuicide Interview Schedule I (EPSIS I) was used to collect the data. An univariate analysis was conducted. Results indicated that repeaters of DSH differed significantly from non-repeaters on several dimensions. The factors included were: more often single, less often had children, staying alone or with their parents, reported sexual problems as a precipitant of current DSH event, more negative life events in childhood and less negative life events in the last year. Furthermore, a multivariate analysis was conducted resulting in only sexual problems and the psychological factor of trait anger, which retained statistical significance. The significance of these findings is discussed.

Social Psychiatry and Psychiatric Epidemiology, 2011

Background Understanding the determinants of major depression in sub-Saharan Africa is important ... more Background Understanding the determinants of major depression in sub-Saharan Africa is important for planning effective intervention strategies. Objective To investigate the social and life-event determinants of major depressive disorder in the African sociocultural context of rural Uganda. Methods A cross-section survey was carried out in 14 districts in Uganda from 1 June 2003 to 30 October 2004. 4,660 randomly selected respondents (15 years and above) were interviewed. The primary outcome was the presence of ‘probable major depressive disorder’ (PMDD) as assessed by the Hopkins symptom checklist. Results The prevalence of PMDD was 29.3% (95% confidence interval, 28.0–30.6%). Factors independently associated with depression in both genders included: the ecological factor, district; age (increase with each age category after 35 years); indices of poverty and deprivation (no formal education, having no employment, broken family, and socioeconomic classes III–V). Only a few adverse life events, notably those suggestive of a disrupted family background (death of a father in females and death of a mother in males) were associated with increased risk. Conclusion Socioeconomic and sociodemographic factors, operating at both ecological and the individual level are the strongest independent determinants of depression. Adverse life events were less strongly associated with depression in this sample.

BMC International Health and Human Rights, 2010

Background: Despite the recent adoption of the UN resolution 1820 (2008) which calls for the cess... more Background: Despite the recent adoption of the UN resolution 1820 (2008) which calls for the cessation of war related sexual violence against civilians in conflict zones, Africa continues to see some of the worst cases of war related sexual violence including the mass sexual abuse of entire rural communities particularly in the Great Lakes region. In addition to calling for a complete halt to this abuse, there is a need for the systematic study of the reproductive, surgical and psychological effects of war related sexual violence in the African socio-cultural setting. This paper examines the specific long term health consequences of war related sexual violence among rural women living in two internally displaced person's camps in Kitgum district in war affected Northern Uganda who accessed the services of an Isis-Women's International Cross Cultural Exchange (Isis-WICCE) medical intervention.

Crisis-the Journal of Crisis Intervention and Suicide Prevention, 2011

Suicidal behavior in adolescence is a public health concern and has serious consequences for adol... more Suicidal behavior in adolescence is a public health concern and has serious consequences for adolescents and their families. There is, however, a paucity of data on this subject from sub-Saharan Africa, hence the need for this study. A cross-sectional multistage survey to investigate adolescent suicidality among other things was undertaken in rural northeastern Uganda. A structured protocol administered by trained psychiatric nurses collected information on sociodemographics, mental disorders (DSM-IV criteria), and psychological and psychosocial risk factors for children aged 3-19 years (N = 1492). For the purposes of this paper, an analysis of a subsample of adolescents (aged 10-19 years; n = 897) was undertaken. Lifetime suicidality in this study was 6.1% (95% CI, 4.6%-7.9%). Factors significantly associated with suicidality included mental disorder, the ecological factor district of residence, factors suggestive of low socioeconomic status, and disadvantaged childhood experiences.

Background: Suicidal behavior in adolescence is a public health concern and has serious consequen... more Background: Suicidal behavior in adolescence is a public health concern and has serious consequences for adolescents and their families. There is, however, a paucity of data on this subject from sub-Saharan Africa, hence the need for this study. Aims: A cross-sectional multistage survey to investigate adolescent suicidality among other things was undertaken in rural northeastern Uganda. Methods: A structured protocol administered by trained psychiatric nurses collected information on sociodemographics, mental disorders (DSM-IV criteria), and psychological and psychosocial risk factors for children aged 3-19 years (N = 1492). For the purposes of this paper, an analysis of a subsample of adolescents (aged 10-19 years; n = 897) was undertaken. Results: Lifetime suicidality in this study was 6.1% (95% CI, 4.6%-7.9%). Conclusions: Factors significantly associated with suicidality included mental disorder, the ecological factor district of residence, factors suggestive of low socioeconomic status, and disadvantaged childhood experiences.