Browsing by Author "Mugisha, James"

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Adherence to physical activity recommendations and physical and mental health risk in people with severe mental illness in Uganda
(Elsevier: Psychiatry Research, 2018-02) Vancampfort, Davy; Probst, Michel; Basangwa, David; De Hert, Marc; Myin-Germeys, Inez; Winkel, Ruudvan; Ward, Philip B.; Rosenbaum, Simon; Mugisha, James
This study investigated cardio-metabolic risk factors among patients with severe mental illness who do or do not meet the recommendations of 150 min per week of physical activity. A secondary aim was to assess whether those that do meet the recommendations report lower levels of mental health symptoms. 107 (60♀) Ugandan in- and outpatients (mean age=34.4 ± 9.7 years) with severe mental illness (depression=7, bipolar disorder=55, schizophrenia=45) completed the Physical Activity Vital Sign (PAVS) method and Brief Symptoms Inventory −18. Participants were also screened for abdominal obesity (waist circumference>90 cm), overweight (body mass index≥25) and hypertension (systolic pressure≥140 mmHg and/or diastolic pressure≥90 mmHg).48.6% (n = 52) of patients met the physical activity recommendations as assessed by the PAVS method. 41.1% (n = 44) were overweight, 40.2% (n = 43) had abdominal obesity and 23.4% (n = 25) had hypertension. Those who did not meet the physical activity recommendations were significantly older, had a higher BSI-18 somatisation score, and had a higher risk of overweight [relative risk (RR) = 2.88, 95% confidence interval (CI) = 1.59–4.99], abdominal obesity (RR = 1.82, 95%CI = 1.13–2.93), and hypertension (RR = 2.16, 95%CI = 0.99–4.73). The PAVS is a feasible method of assessing physical activity among patients with severe mental illness in a low resource setting. The PAVS may have clinical utility for physical and mental health risk stratification.
Assessing quality of life in older adults: psychometric properties of the OPQoL-brief questionnaire in a nursing home population
(Springer Link: Health and Quality of Life Outcomes, 2020-01-02) Haugan, Gørill; Drageset, Jorunn; André, Beate; Kukulu, Kamile; Mugisha, James; Utvær, Britt Karin S.
Well-adapted and validated quality-of-life measurement models for the nursing home population are scarce. Therefore, the aim of this study was to test the psychometrical properties of the OPQoL-brief questionnaire among cognitively intact nursing home residents. The research question addressed evidence related to the dimensionality, reliability and construct validity, all of which considered interrelated measurement properties. Methods Cross-sectional data were collected during 2017–2018, in 27 nursing homes representing four different Norwegian municipalities, located in Western and Mid-Norway. The total sample comprised 188 of 204 (92% response rate) long-term nursing home residents who met the inclusion criteria: (1) municipality authority’s decision of long-term nursing home care; (2) residential time 3 months or longer; (3) informed consent competency recognized by responsible doctor and nurse; and (4) capable of being interviewed. Results Principal component analysis and confirmative factor analyses indicated a unidimensional solution. Five of the original 13 items showed low reliability and validity; excluding these items revealed a good model fit for the one-dimensional 8-items measurement model, showing good internal consistency and validity for these 8 items. Conclusion Five out of the 13 original items were not high-quality indicators of quality-of-life showing low reliability and validity in this nursing home population. Significant factor loadings, goodness-of-fit indices and significant correlations in the expected directions with the selected constructs (anxiety, depression, self-transcendence, meaning-in-life, nurse-patient interaction, and joy-of-life) supported the psychometric properties of the OPQoL-brief questionnaire. Exploring the essence of quality-of-life when residing in a nursing home is highly warranted, followed by development and validation of new tools assessing quality-of-life in this population. Such knowledge and well-adapted scales for the nursing home population are beneficial and important for the further development of care quality in nursing homes, and consequently for quality-of-life and wellbeing in this population.
Associations between physical inactivity, major depressive disorder, and alcohol use disorder in people living with HIV in a Ugandan fishing community
(International Journal of STD & AIDS, 2019-09-27) Vancampfort, Davy; Byansi, Peter; Kinyanda, Eugene; Namutebi, Hilda; Nalukenge, Lillian; Bbosa, Richard S; Ward, Philip B; Mugisha, James
The aim of this cross-sectional study was to explore which variables were associated with physical inactivity in people living with HIV living in a fishing community in Uganda. Secondary aims were to explore the reasons for and barriers to physical activity (PA). Two hundred and fifty-six individuals living with HIV (77 men, 40.5 ± 10.3 years) completed the Physical Activity Vital Sign (PAVS), Patient Health Questionnaire-9 (PHQ-9), and the Alcohol Use Disorders Identification Test. Women had a 1.62 (95% CI = 1.01–2.57), those not having a job a 2.81 (95% CI = 2.00–3.94), and those with depression a 5.67 (95% CI = 2.27–14.17) higher odds for not being physically active for 150 min/week at moderate intensity. Employment and depression status were the only independent significant predictors explaining 27.2% of the PAVS variance. Becoming more healthy and energetic again and reducing stress were the most important PA motives, and musculoskeletal pain, body weakness, and lack of time were the most important PA barriers.
Associations of the built environment with physical activity and sedentary time in Ugandan outpatients with mental health problems
(Journal of Physical Activity and Health, 2018) Vancampfort, Davy; Stubbs, Brendon; Sallis, James F.; Nabanoba, Justine; Basangwa, David; Oyeyemi, Adewale L.; Kasoma, Sandra S.; De Hert, Marc; Myin-Germeys, Inez; Mugisha, James
This study investigated whether reported neighborhood variables explained variance in time spent walking, exercising, and being sedentary, in addition to mental health and demographic variables among Ugandan outpatients with mental illness. Methods: Ninety-nine outpatients (78 men; 31.1 [8.6] y) of the Butabika National Referral Hospital in Uganda completed the Neighborhood Environment Walkability Scale for Africa, the Simple Physical Activity Questionnaire, and the Brief Symptoms Inventory-18. Multiple regression analyses were performed. Results: Seven percent of the variance in walking time was explained by the variance in anxiety/depression and an additional 13% by the variance in perceived mixed land use and the availability of roads and walking paths. Eight percent of the variance in exercise time was explained by variance in age and an additional 6% by the variance anxiety/depression. The availability of recreational space added 8%. Six percent of variance in time spent sedentary was explained by family income, while availability of roads and walking paths added another 6%. Conclusions: This study shows the relevance of availability of roads and walking paths and recreational space for more physical activity and less sedentary behavior in people with mental illness. This is particularly relevant in low-income countries where a rapid urbanization is taking place.
Barriers, attitudes, confidence, and knowledge of nurses regarding metabolic health screening and intervention in people with mental illness: a pilot study from Uganda
(AJOL: African Health Sciences., 2019-11-06) Vancampfort, Davy; Watkins, Andrew; Ward, Philip B; Probst, Michel; De Hert, Marc; Van Damme, Tine; Mugisha, James
People with mental illness are at an increased risk for developing cardio-metabolic disorders. Routine screening following pharmacotherapy is however unacceptably low in sub-Saharan African countries with less than 1% adequately screened. It is unknown whether this is due to a lack of adequate competences. Objectives: The aim of this pilot study was to assess the barriers, attitudes, confidence, and knowledge of nurses regarding metabolic health, prevention and treatment in Uganda. Methods: Twenty-eight nurses (39% female, 30.9±6.9 years) completed the Metabolic – Barriers, Confidence, Attitudes and Knowledge Questionnaire and the physical activity prescription rate item of the Exercise in Mental Illness Questionnaire. Results: More than 75% had a positive attitude towards metabolic screening and intervention and more than 50% were confident in providing smoking cessation advice, and physical activity and nutritional counseling. However, 57% stated that their heavy workload prevented them from doing health screening and promotion activities. There was a negative correlation (ρ=-0.54, P=0.003) between the frequency of physical activity prescription and the perception of the inability of patients to change. Conclusion: The present findings suggest that nurses are generally supportive of metabolic health screening and intervention but their high workload prevents them from implementing metabolic health interventions.
Cardiorespiratory fitness levels and moderators in people with HIV: a systematic review and meta-analysis
(Elsevier: Preventive Medicine, 2016-12) Vancampfort, Davy; Mugisha, James; Rosenbaum, Simon; Firth, Joseph; De Hert, Marc; Probst, Michel; Stubbs, Brendon
Cardiorespiratory fitness (CRF) is a modifiable risk factor for cardiovascular disease and premature mortality. CRF levels and moderators among people living with HIV (PLWH) are unknown. The aim of the current meta-analysis was to (1) determine mean CRF in PLWH and compare levels with age- and gender-matched healthy controls (HCs), (2) explore moderators of CRF, (3) and (4) explore moderators of CRF outcomes following physical activity (PA) interventions. Major electronic databases were searched systematically for articles reporting CRF expressed as maximum or peak oxygen uptake (ml/min/kg) in PLWH. A random effects meta-analysis calculating the pooled mean CRF including subgroup- and meta-regression analyses was undertaken. Across 21 eligible studies, the CRF level was 26.4 ml/kg/min (95% CI = 24.6 to 28.1) (n = 1010; mean age = 41 years). There were insufficient data to compare CRF levels with HCs. A higher body mass index (β = − 0.99, 95% CI = − 1.93 to − 0.06, P = 0.04), older age (β = − 0.31, 95% CI = − 0.58 to − 0.04, P = 0.02) and the presence of lipodystrophy (β = − 4.63, 95% CI = − 7.88 to − 1.39, P = 0.005) were significant moderators of lower CRF levels. Higher CD4 + counts (β = 0.004, 95% CI = 0.0007 to 0.007, P = 0.016), supervised interventions (P < 0.001) and interventions with a lower frequency of weekly sessions (2 or 3 versus 4 times) (P < 0.001) predicted a better CRF-outcome following PA. CRF levels of PLWH are among the lowest in comparison to other vulnerable populations. More research on the most optimal physical activity intervention characteristics is needed.
Chronic physical conditions, multimorbidity and physical activity across 46 low- and middle-income countries
(Springer Link: International Journal of Behavioral Nutrition and Physical Activity., 2017-01-18) Vancampfort, Davy; Koyanagi, Ai; Ward, Philip B.; Rosenbaum, Simon; Schuch, Felipe B.; Mugisha, James; Richards, Justin; Firth, Joseph; Stubbs, Brendon
There are no nationally representative population-based studies investigating the relationship between physical activity, chronic conditions and multimorbidity (i.e., two or more chronic conditions) in low- and middle-income countries (LMICs), and studies on a multi-national level are lacking. This is an important research gap, given the rapid increase in the prevalence of chronic diseases associated with lifestyle changes in these countries. This cross-sectional study aimed to assess the association between chronic conditions, multimorbidity and low physical activity (PA) among community-dwelling adults in 46 LMICs, and explore the mediators of these relationships. Methods World Health Survey data included 228,024 adults aged ≥18 years from 46 LMICs. PA was assessed by the International Physical Activity Questionnaire (IPAQ). Nine chronic physical conditions (chronic back pain, angina, arthritis, asthma, diabetes, hearing problems, tuberculosis, visual impairment and edentulism) were assessed. Multivariable logistic regression and mediation analyses were used to assess the association between chronic conditions or multimorbidity and low PA. Results Overall, in the multivariable analysis, arthritis (OR = 1.12), asthma (1.19), diabetes (OR = 1.33), edentulism (OR = 1.46), hearing problems (OR = 1.90), tuberculosis (OR = 1.24), visual impairment (OR = 2.29), multimorbidity (OR = 1.31; 95% CI = 1.21–1.42) were significantly associated with low PA. More significant associations were observed in individuals aged ≥50 years. In older adults, depression mediated between 5.1% (visual impairment) to 23.5% (angina) of the association between a chronic condition and low PA. Mobility difficulties explained more than 25% of the association for seven of the eight chronic conditions. Pain was a strong mediator for angina (65.9%) and arthritis (64.9%), while sleep problems mediated up to 43.7% (angina) of the association. Conclusions In LMICs, those with chronic conditions and multimorbidity are significantly less physically active (especially older adults). Research on the efficacy and effectiveness of PA in the management of chronic diseases in LMICs is urgently needed. Targeted promotion of physical activity to populations in LMICs experiencing chronic conditions may ameliorate associated depression, mobility difficulties and pain that are themselves important barriers for initiating or adopting an active lifestyle.
Correlates of physical activity among community-dwelling individuals aged 65 years or older with anxiety in six low- and middle-income countries
(Cambridge University Press: International Psychogeriatrics, 2017-11-08) Vancampfort, Davy; Stubbs, Brendon; Hallgren, Mats; Veronese, Nicola; Mugisha, James; Probst, Michel; Koyanagi, Ai
Given the important health benefits of physical activity (PA) and the higher risk for physical inactivity in people with anxiety, and the high prevalence of anxiety and low PA among the elderly, there is a need for research to investigate what factors influence PA participation among anxious older individuals. We investigated PA correlates among community-dwelling adults aged ≥ 65 years with anxiety symptoms in six low- and middle-income countries. Methods: Cross-sectional data from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. PA level was assessed by the Global Physical Activity Questionnaire. 980 participants with anxiety (mean age 73.3 years; 62.4% females) were grouped into those who do and do not (low PA) meet the 150 minutes of moderate-to-vigorous PA per week recommendation. Associations between PA and the correlates were examined using multivariable logistic regressions. Results: The prevalence of low PA was 44.9% (95% CI = 39.2–50.7%). Older age, male gender, less consumption of alcohol, mild cognitive impairment, pain, a wide range of somatic co-morbidities, slow gait, weak grip strength, poor self-rated health, and lower levels of social cohesion were identified as significant positive correlates of low PA. Conclusions: Our data illustrate that a number of sociodemographic and health factors are associated with PA levels among older people with symptoms of anxiety. The promotion of social cohesion may increase the efficacy of public health initiatives, while from a clinical perspective, somatic co-morbidities, cognitive impairment, pain, muscle strength, and slow gait need to be considered.
Correlates of physical activity among depressed older people in six low-income and middle-income countries: a community-based cross-sectional study
(Wiley Online Library: International Journal of Geriatric Psychiatry, 2017-10-10) Vancampfort, Davy; Stubbs, Brendon; Veronese, Nicola; Mugisha, James; Swinnen, Nathalie; Koyanagi, Ai
Despite the benefits of physical activity (PA) in older people with depression, many do not comply with the International PA guidelines. Thus, we investigated what factors influence PA participation among 915 community-dwelling older adults (aged ≥65 years) with depression in 6 low-income and middle-income countries (LMICs). Methods Cross-sectional data were analyzed from the World Health Organization's Study on Global Ageing and Adult Health. The sample was restricted to those with DSM-IV depression or receiving depression treatment in the last 12 months. PA was assessed by the Global Physical Activity Questionnaire. Participants were dichotomized into low (ie, not meeting 150 minutes of moderate PA per week) and moderate-to-high physically active groups. Associations between PA and a range of correlates were examined using multivariable logistic regressions. Results The prevalence of low PA was 40.4% (95%CI = 34.8%–46.1%). After adjusting for age, sex, and country, larger household size and unemployment were significant sociodemographic correlates of low PA. Former smoking (vs never), anxiety, mild cognitive impairment (MCI), lower body mass index, bodily pain, asthma, chronic back pain, chronic obstructive pulmonary disease, hearing problems, stroke, slow gait, poor self-rated health, higher levels of disability, and lower levels of social cohesion were identified as significant negative correlates of PA. Conclusions The current data provide guidance for future interventions across LMICs to assist older people with depression engage in regular PA. The promotion of social cohesion may increase the efficacy of future public health initiatives, while from a clinical perspective, somatic co-morbidities, MCI, pain, and slow gait need to be considered.
Correlates of physical activity among middle-aged and older adults with hazardous drinking habits in six low- and middle-income countries
(Kinetic: Aging and Physical Activity, 2017) Vancampfort, Davy; Stubbs, Brendon; Hallgren, Mats; Lundin, Andreas; Mugisha, James; Koyanagi, Ai
We investigated physical activity (PA) correlates among middle-aged and older adults (aged ≥50 years) with hazardous drinking patterns in six low- and middle-income countries. Cross-sectional data were analyzed from the World Health Organization’s Study on Global Ageing and Adult Health. Hazardous drinking was defined as consuming >7 (females) or >14 (males) standard drinks per week. Participants were dichotomized into low (i.e., not meeting 150 min of moderate PA/week) and moderate–high physically active groups. Associations between PA and a range of correlates were examined using multivariable logistic regressions. The prevalence of low PA in 1,835 hazardous drinkers (60.5 ± 13.1 years; 87.9% males) was 16.2% (95% confidence interval [13.9%, 18.9%]). Older age, living in an urban setting, being unemployed, depression, underweight, obesity, asthma, visual impairment, poor self-rated health, and higher levels of disability were identified as significant PA correlates. The current data provide important guidance for future interventions to assist older hazardous drinkers to engage in regular PA.
Correlates of physical activity stages of change in people living with HIV in a Ugandan community
(Taylor& Francis Online: Disability and Rehabilitation., 2020-05-29) Vancampfort, Davy; Byansi, Peter Kayiira; Namutebi, Hilda; Nalukenge, Lillian; Kinyanda, Eugene; Bbosa, Richard Serunkuma; Ward, Philip B.; Lukwata, Hafsa; Mugisha, James
The transtheoretical model (TTM) of behavioral change posits that individuals move through five stages of change when adopting new behaviors: pre-contemplation, contemplation, preparation, action, and maintenance. The aim of this study was to determine the proportion of patients with HIV/AIDS within a Ugandan fishing community in the different physical activity (PA) stages. We also explored differences in variables, motives, and barriers for PA across the stages. Methods: In total, 256 individuals (77 men, 40.5 ± 10.3 years) completed the Patient-centered Assessment and Counseling for Exercise Questionnaire, the Patient Health Questionnaire-9 (PHQ-9) to assess depressive symptoms, and the Alcohol Use Disorders Identification Test. They were also asked about their most important PA motive and barrier. Results: Seventy-five individuals (29%) were in the (pre-)preparatory stages, 140 (55%) in the action and 41 (16%) in the maintenance stage. Those in the (pre-)preparatory stages had higher PHQ-9 total scores (p < 0.001) and were more likely to report barriers than those in the later stages (p < 0.001). Compared with those in the (pre-)preparatory stage, patients in the action stage experienced less body weakness (p = 0.015). Conclusions: Depression and barriers to PA should be considered in people with HIV/AIDS in low-resource settings when implementing interventions to assist them to become more active.
Correlates of sedentary behavior in 2,375 people with depression from 6 low- and middle-income countries
(Elsevier : Journal of effective Disorders., 2018-07) Vancampfort, Davy; Stubbs, Brendon; Mugisha, James; Firth, Joseph; Schuch, Felipe B.; Koyanagi, Ai
Sedentary behaviour (SB) is harmful for health and well-being and may be associated with depression. However, little is known about the correlates of SB in people with depression. Thus, we investigated SB correlates among community-dwelling adults with depression in six low- and middle-income countries. Methods Cross-sectional data from the World Health Organization’s Study on Global Ageing and Adult Health were analyzed. The analysis was restricted to those with DSM-IV Depression or receiving depression treatment in the last 12 months. Self-reported time spent sedentary per day was the outcome. High SB was defined as ≥8 hours of SB per day. The correlates (sociodemographic and health-related) of SB were estimated by multivariable linear and logistic regression analyses. Results In 2375 individuals with depression (mean age=48.0 years; 60.7% female), the prevalence of high SB was 11.1% (95%CI=8.2%-14.9%), while the mean (±SD) time spent sedentary was 215 (±192) minutes per day. Socio-demographic factors significantly associated with high SB were older age and being unmarried, being male and being unemployed. In other domains, no alcohol consumption, current smoking, mild cognitive impairment, bodily pain, arthritis, stroke, disability, and lower levels of social cohesion, COPD, visual impairment, and poor self-rated health was associated with greater time spent sedentary. Conclusion Our data suggest that future interventions seeking to reduce SB among individuals with depression may target at risk groups based on identified sociodemographic correlates while the promotion of social cohesion may have the potential to increase the efficacy of future public health initiatives. From a clinical perspective, bodily pain and somatic co-morbidities need to be taken into account.
Cultural responses towards the aftermath of suicide among the Acholi in northern Uganda
(International Journal of Social Psychiatry, 2018-07-02) Mugisha, James; Muyinda, Herbert; Hjelmeland, Heidi; Kinyanda, Eugene; Vancampfort, Davy; Knizek, Birthe Loa
Suicide is a public health problem in Uganda among indigenous societies, and different societies manage its aftermath differently. Aim: To explore how the Acholi in Northern Uganda manage the aftermath of suicide. Methods: We conducted a qualitative study in Gulu district, a post-conflict area in Northern Uganda. We conducted a total of four focus group discussions (FGDs) and 12 key informant (KI) interviews. KI interviews were conducted with community leaders, while the FGDs were conducted with members of the general population. We analysed the data by means of Grounded Theory. Results: Our findings indicate that rituals form a large part in managing suicide among the Acholi. Study communities practised distancing (symbolically and physically) as a way of dealing with the threat of suicide. Conclusion: Distancing was organized into two broad themes: affect regulation and securing future generations. It is recommended that public health interventions should utilize cultural institutions in the prevention of suicide.
Effectiveness and cost-effectiveness of integrating the management of depression into routine HIV care in Uganda (the HIV + D trial): a protocol for a cluster-randomised trial
(Springer Nature: International Journal of Mental Health Systems, 2021-05-12) Kinyanda, Eugene; Kyohangirwe, Leticia; Mpango, Richard S.; Tusiime, Christine; Ssebunnya, Joshua; Katumba, Kenneth; Tenywa, Patrick; Mugisha, James; Taasi, Geoffrey; Sentongo, Hafsa; Akena, Dickens; Laurence, Yoko; Muhwezi, Wilson; Weiss, Helen A.; Neuman, Melissa; Greco, Giulia; Knizek, Birthe; Levin, Jonathan; Kaleebu, Pontiano; Araya, Ricardo; Ssembajjwe, Wilber; Patel, Vikram
An estimated 8-30% of people living with HIV (PLWH) have depressive disorders (DD) in sub- Saharan Africa. Of these, the majority are untreated in most of HIV care services. There is evidence from low- and middle- income countries of the effectiveness of both psychological treatments and antidepressant medication for the treatment of DD among PLWH, but no evidence on how these can be integrated into routine HIV care. This protocol describes a cluster-randomised trial to evaluate the effectiveness and cost-effectiveness of the HIV+D model for the integration of a collaborative stepped care intervention for DD into routine HIV care, which we have developed and piloted in Uganda. Methods: Forty public health care facilities that provide HIV care in Kalungu, Masaka and Wakiso Districts will be randomly selected to participate in the trial. Each facility will recruit 10-30 eligible PLWH with DD and the total sample size will be 1200. The clusters will be randomised 1:1 to receive Enhanced Usual Care alone (EUC, i.e. HIV clinicians trained in Mental Health Gap Action Programme including guidelines on when and where to refer patients for psychiatric care) or EUC plus HIV+D (psychoeducation, Behavioural Activation, antidepressant medication and referral to a supervising mental health worker, delivered in a collaborative care stepwise approach). Eligibility criteria are PLWH attending the clinic, aged >18 years who screen positive on a depression screening questionnaire (Patient Health Questionnaire, PHQ-9≥10). The primary outcome is the mean depressive disorder symptom severity scores (assessed using the PHQ-9) at 3 months post-randomisation, with secondary mental health, disability, HIV and economic outcomes measured at 3 and 12 months. The cost-effectiveness of EUC with HIV+D will be assessed from both the health system and the societal perspectives by collecting health system, patient and productivity costs and mean DD severity scores at 3 months, additional to health and non-health related quality of life measures (EQ-5D-5L and OxCAP-MH). Discussion: The study 􀂦ndings will inform policy makers and practitioners on the cost-effectiveness of a stepped care approach to integrate depression management in routine care for PLWH in low-resource settings.
The efficacy of a lay health workers – led physical activity counselling program in patients with HIV and mental health problems: a real-world intervention from Uganda
(Taylor and Francis online : AIDS Care Psychological and Socio-medical Aspects of AIDS/HIV., 2021-01-23) Vancampfort, Davy; Byansi, Peter Kayiira; Namutebi, Hilda; Kinyanda, Eugene; Bbosa, Richard Serunkuma; Ward, Philip B.; Lukwata, Hafsa; Mugisha, James
This study explored the efficacy of a lay health worker (LHW)-led physical activity (PA) counselling program for inactive patients with HIV/AIDS and mental health problems living in a Ugandan farming community. In total 49 (35 women) community patients (40.0 ± 11.2 years) followed an 8-week once weekly LHW-led PA counselling program based on a self-determination theory and motivational interviewing framework. Participants completed the Simple Physical Activity Questionnaire, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, HIV/AIDS Stress Scale and World Health Organization Disability Assessment Schedule 2 (WHODAS 2) pre- and immediately post-intervention. Small, significant (P < 0.05) effect sizes were found for reductions in HIV/AIDS-related stress (Cohen’s d = 0.26) and in global disability (Cohen’s d = 0.46). Large effect sizes were observed for reductions in time spent sedentary (Cohen’s d = 1.97) and reductions in depressive (Cohen’s d = 2.04) and anxiety (Cohen’s d = 1.47) symptoms and increases in time spent active (Cohen’s d = 1.98). Greater decrease in sedentary time was associated with greater anxiety symptoms reduction (r = 0.32, P = 0.021). In physically inactive patients with HIV/AIDS and mental health problems, an LHW-led PA counselling program reduced stress, anxiety, depression and disability. Randomized controlled trials are needed to confirm these preliminary positive findings.
The efficacy of meditation-based mind-body interventions for mental disorders: a meta-review of 17 meta-analyses of randomized controlled trials
(Elsevier: Journal of Psychiatric Research., 2021-02) Vancampfort, Davy; Stubbs, Brendon; Van Damme, Tine; Smith, Lee; Hallgren, Mats; Schuch, Felipe; Deenik, Jeroen; Rosenbaum, Simon; Ashdown-Franks, Garcia; Mugisha, James; Firth, Joseph
There is increasing interest in the potential efficacy of meditation-based mind-body interventions (MBIs) within mental health care. We conducted a systematic metareview of the published randomized control trial (RCT) evidence. MEDLINE/PubMed, PsycARTICLES and EMBASE were searched from inception to 06/2020 examining MBIs (mindfulness, qigong, tai chi, yoga) as add-on or monotherapy versus no treatment, minimal treatment and passive and active control conditions in people with a mental disorder. The quality of the methods of the included meta-analyses using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and the methodological quality of the RCTs using AMSTAR-Plus. Sixteen (94%) of 17 meta-analyses had good overall methodological quality. The content validity of the included RCTs was considered good in 9 (53%) meta-analyses. In meta-analyses with good methodological quality (AMSTAR 8≤) and content validity (AMSTAR+ 4≤), large effect sizes (0.80 or higher) were observed for mindfulness in schizophrenia and in ADHD, a moderate (0.50 ≤ 0.80) effect size for mindfulness in PTSD and a small (0.20 < 0.50) effect size for yoga in schizophrenia No serious adverse events were reported (n RCTs = 43, n in the MBI arms = 1774), while the attrition rates were comparable with the rates in passive and active control conditions. Our meta-review demonstrates that mindfulness and to a lesser extent yoga may serve as an efficacious supplement to pharmacotherapy, and psychotherapy and can be complementary in healthy lifestyle interventions for people with mental disorders. Meta-analytic evidence of high methodological quality and content validity of included trials is currently lacking for qigong and tai chi.
The efficacy of physical activity counseling in Ugandan patients with HIV and a co-morbid mental disorder: a pilot study
(Taylor and Francis: AIDS Care Psychological and Socio-medical Aspects of AIDS/HIV., 2019-07-08) Vancampfort, Davy; Byansi, Peter; Namutebi, Hilda; Nalukenge, Lillian; Kinyanda, Eugene; Bbosa, Richard Serunkuma; Ward, Philip B.; Lukwata, Hafsa; Mugisha, James
This study explored the efficacy of physical activity (PA) counseling in inactive patients with HIV/AIDS and a co-morbid mental health disorder living in a Ugandan fishing community. We investigated associations between changes in PA, sedentary behavior, mental health burden and quality of life (QoL) following an 8-week once per week PA counseling program using the self-determination theory and motivational interviewing framework. In total 41 (33 women) patients (39.8 ± 10.9years) completed the Simple Physical Activity Questionnaire, Patient Health Questionnaire, Alcohol Use Disorder Identification Test and World Health Organization Quality of Life Questionnaire pre- and post-intervention. Large effect sizes were found for reductions in time spent sedentary (Cohen’s d = 2.85) and reductions in depressive symptoms (Cohen’s d = 1.47). We also found large effect sizes for increases in time spent walking (Cohen’s d = 1.38), in incidental PA such as household chores (Cohen’s d = 1.69), and physical health (Cohen’s d = 1.38), psychological health (Cohen’s d = 0.95), and social relationships. (Cohen’s d = 1.39). The more time spent sedentary decreased, the more the psychological health increased (r = −0.33, P = 0.037). In sedentary patients with HIV/AIDS and a co-morbid mental disorder, the mental health burden reduces and QoL improves following PA counseling. Controlled studies are however needed to confirm our findings.
The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: data from 43 low- and middle-income countries
(Elsevier: General Hospital Psychiatry, 2016-12) Stubbs, Brendon; Koyanagi, Ai; Thompson, Trevor; Veronese, Nicola; Carvalho, Andre F.; Solomi, Marco; Mugisha, James; Schofield, Patricia; Cosco, Theodore; Wilson, Nicky; Vancampfort, Davy
Back pain (BP) is a leading cause of global disability. However, population-based studies investigating its impact on mental health outcomes are lacking, particularly among low- and middle-income countries (LMICs). Thus, the primary aims of this study were to: (1) determine the epidemiology of BP in 43 LMICs; (2) explore the relationship between BP and mental health (depression spectrum, psychosis spectrum, anxiety, sleep disturbances and stress). Methods Data on 190,593 community-dwelling adults aged ≥18 years from the World Health Survey (WHS) 2002–2004 were analyzed. The presence of past-12 month psychotic symptoms and depression was established using questions from the Composite International Diagnostic Interview. Anxiety, sleep problems, stress sensitivity, and any BP or chronic BP (CBP) during the previous 30 days were also self-reported. Multivariable logistic regression analyses were undertaken. Results The overall prevalence of any BP and CBP were 35.1% and 6.9% respectively. Significant associations with any BP were observed for subsyndromal depression [OR (odds ratio) = 2.21], brief depressive episode (OR = 2.64), depressive episode (OR = 2.88), psychosis diagnosis with symptoms (OR = 2.05), anxiety (OR = 2.12), sleep disturbance (OR = 2.37) and the continuous variable of stress sensitivity. Associations were generally more pronounced for chronic BP. Conclusion Our data establish that BP is associated with elevated mental health comorbidity in LMICs. Integrated interventions that address back pain and metal health comorbidities might be an important next step to tackle this considerable burden.
Evaluation of performance and perceived utility of mental healthcare indicators in routine health information systems in five low- and middle-income countries
(Cambridge University Press., 2019-08-06) Jordans, Mark; Chisholm, Dan; Semrau, Maya; Gurung, Dristy; Abdulmalik, Jibril; Ahuja, Shalini; Mugisha, James; Mntambo, Ntokozo; Kigozi, Fred; Petersen, Inge; Shidhaye, Rahul; Upadhaya, Nawaraj; Lund, Crick; Thornicroft, Graham; Gureje, Oye
In most low- and middle-income countries (LMIC), routine mental health information is unavailable or unreliable, making monitoring of mental healthcare coverage difficult. This study aims to evaluate a new set of mental health indicators introduced in primary healthcare settings in five LMIC. Method A survey was conducted among primary healthcare workers (n = 272) to assess the acceptability and feasibility of eight new indicators monitoring mental healthcare needs, utilisation, quality and payments. Also, primary health facility case records (n = 583) were reviewed by trained research assistants to assess the level of completion (yes/no) for each of the indicators and subsequently the level of correctness of completion (correct/incorrect – with incorrect defined as illogical, missing or illegible information) of the indicators used by health workers. Assessments were conducted within 1 month of the introduction of the indicators, as well as 6–9 months afterwards. Results Across both time points and across all indicators, 78% of the measurements of indicators were complete. Among the best performing indicators (diagnosis, severity and treatment), this was significantly higher. With regards to correctness, 87% of all completed indicators were correctly completed. There was a trend towards improvement over time. Health workers' perceptions on feasibility and utility, across sites and over time, indicated a positive attitude in 81% of all measurements. Conclusion This study demonstrates high levels of performance and perceived utility for a set of indicators that could ultimately be used to monitor coverage of mental healthcare in primary healthcare settings in LMIC. We recommend that these indicators are incorporated into existing health information systems and adopted within the World Health Organization Mental Health Gap Action Programme implementation strategy.
Exercise self-efficacy correlates in people with psychosis
(Elsevier: Psychiatry Research, 2018-04) Vancampfort, Davy; Gorczynski, Paul; De Hert, Marc; Probst, Michel; Naisiga, Annetie; Basangwa, David; Mugisha, James
Despite the recognition of the importance of exercise self-efficacy in exercise adoption and maintenance, previous investigations on exercise self-efficacy in people with psychosis is scarce. The present study aimed to (1) explore if exercise self-efficacy differed between stages of behavior change in Ugandan outpatients with psychosis, and (2) assess sociodemographic, clinical and motivational correlates of exercise self-efficacy. In total, 48 patients (24 women) completed the Exercise Self-Efficacy Scale (ESES), the Patient-centered Assessment and Counseling for Exercise questionnaire, the Brief Symptoms Inventory-18 (BSI-18), and questions pertaining to intrinsic motivation in the Behavioral Regulation in Exercise Questionnaire-2. Additionally, participants were asked about their exercise behavior in the past 7 days and screened for cardio-metabolic risk factors. Higher ESES-scores were observed in those in the maintenance (n = 17) versus those in the pre-action stage (n = 17) of behavior change. Higher ESES-scores were also significantly associated with lower BSI-18 somatization and higher intrinsic motivation scores. Our data indicated that health care professionals should assist patients with psychosis in interpreting physiological states during exercise. Future research should explore whether bolstering such sources of information might directly or indirectly effect exercise self-efficacy.