Journal Articles

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Uganda’s vision 2040 and human needs promotion
(Council for the Development of Social Science Research in Africa, 2015) Balyejjusa, Senkosi Moses
In 2013 the President of Uganda Yoweri Kaguta Museveni launched Uganda’s Vision 2040, a thirty-year development master plan which has received both praise and criticism from Ugandans. Although Vision 2040 has received both praise and criticism in almost equal measure, in this article I argue that Vision 2040 does not adequately promote the satisfaction of the human needs of Ugandans, yet the satisfaction of these needs is a prerequisite for achieving genuine development. Using a human needs framework in general, and Doyal and Gough’s intermediate needs in particular, I show that the Vision’s strategies adequately promote the satisfaction of only three intermediate needs of Ugandans, partially promote the satisfaction of seven intermediate needs of Ugandans, and that there is no single strategy to promote the satisfaction of one of the intermediate needs. This is because some of the Vision strategies do not adequately tackle the current and likely future challenges and bottlenecks to the satisfaction of the human needs of Ugandans. This is mainly due to the central role placed on the private capital (sector) in Vision 2040. I argue that in order for Vision 2040 to adequately promote the satisfaction of the human needs of Ugandans, all and not just some of the needs must be adequately satisfied since human needs are interrelated and interdependent. In addition, Vision 2040 should also be in position to satisfy the human needs of all Ugandans and not just some.
Prevalence of suicidal ideation and attempt: associations with psychiatric disorders and HIV/AIDS in post-conflict northern Uganda
(AJOL: African Health Sciences, 2016) Mugisha, James; Muyinda, Herbert; Kagee, Ashraf; Wandiembe, Peter; Kiwuwa, Stephen M.; Vancampfort, Davy; Kinyanda, Eugene
Research on the prevalence of suicidal ideation, attempt, and cormorbid psychiatric disorders in post-conflict areas is still limited. Aim: We explored the prevalence of suicidal ideation, attempt, associated psychiatric disorders and HIV/AIDS in post-conflict Northern Uganda, an area that experienced civil strife for over two decades. Methods: A total of 2400 respondents (aged 18 and above) and randomly selected in three districts (Gulu, Amuru and Nwoya), were interviewed. Multivariable logistic regression was used to assess for associations between suicidality (suicidal ideation and attempt) and psychiatric cormorbidities. Results: The prevalence of suicidal ideation and attempt were 12.1 % and 6.2 % respectively. Suicidality was significantly (P<0.001) higher among respondents with major depressive disorder (adjusted Odds Ratio (OR) = 9.5; 95%CI= 7.4, 12.1) and post-traumatic stress disorder (adjusted OR =2.4; 95%CI= 1.6, 3.6). Men had lower odds of ideating or attempting suicide compared to women (adjusted OR = 0.55; 95%CI: 0.38, 0.82). Conclusion: The prevalence rate of suicide ideation and attempt indicate a major public health problem in post-conflict Northern Uganda. Effective public mental health programs that that target both suicidality and psychiatric co-morbodities will be vital. Special attention should be given to women in post conflict Northern Uganda.
Sedentary behavior in people living with HIV: a systematic review and meta-analysis
(Journal of Physical Activity and Health, 2016) Vancampfort, Davy; Mugisha, James; De Hert, Marc; Probst, Michel; Stubbs, Brendon
Sedentary behavior is independently associated with an increased risk of poor mental health, developing cardiovascular disease (CVD) and premature mortality. Despite the knowledge that CVD is one of the leading causes of non-AIDS related premature mortality in people living with HIV (PLWH), relatively little attention has been attributed to sedentary behavior in this population. The aims of this meta-analysis were to (a) establish the pooled mean time spent sedentary, (b) investigate predictors of sedentary levels, and (c) explore differences with age- and gender-matched healthy controls. Methods: Two independent authors searched major databases until August 2016. A random effects meta-analysis was performed. Results: Across 6 unique cross-sectional studies, including 9 sedentary levels, there were 523 (292 men) PLWH (age range = 37 to 58 years). PLWH spent 533 min/day (95% CI = 466 to 599) engaging in sedentary behavior. There was a trend (P = .07) for higher levels of sedentary behavior in self-report measures (551 min, 95% CI = 543 to 560, N = 4) than in objective sedentary behavior time (505 min, 95% CI = 498 to 512, N = 3). The time PLWH spend engaging in sedentary behavior is among the highest levels reported in the literature. Conclusions: Given that sedentary behavior is an independent predictor of CVD, future lifestyle interventions specifically targeting the prevention of sedentary behavior in PLWH are warranted.
Towards understanding governance issues in integration of mental health into primary health care in Uganda
(Springer Nature: International Journal of Mental Health Systems., 2016-03-24) Mugisha, James; Ssebunnya, Joshua; Kigozi, Fred N.
There is a growing burden of mental illness in low income countries. The situation is further worsened by the high poverty levels in these countries, resulting in difficult choices for their health sectors as regards to responding to the burden of mental health problems. In Uganda, integration of mental health into primary health care (PHC) has been adopted as the most vital strategy for ensuring mental health service delivery to the general population. Objectives: To identify governance related factors that promote/or hinder integration of mental health into PHC in Uganda. Methods: A qualitative research design was adopted at national and district level. A total of 18 Key informant interviews were conducted at both levels. Content thematic analysis was the main method of data analysis. Findings: There were positive gains in working on relevant laws and policies. However, both the mental health law and policy are still in draft form. There is also increased responsiveness/participation of key stakeholders; especially at national level in the planning and budgeting for mental health services. This however seems to be a challenge at both district and community level. In terms of efficiency, human resources, finances, medicines and technologies constitute a major drawback to the integration of mental health into PHC. Ethics, oversight, information and monitoring functions though reported to be in place, become weaker at the district level than at national level due to limited finances, human resources gaps and limited technical capacity. Other governance related issues are also reported in this study. Conclusions: There is some progress especially in the legal and policy arena to support integration of mental health into PHC in Uganda. However, adequate resources are still required to facilitate the effective functioning of all governance pillars that make integration of mental health into PHC feasible in Uganda.
Physical activity levels and psychosis: a mediation analysis of factors influencing physical activity target achievement among 204 186 people across 46 Low- and middle-income countries
(Schizophrenia Bulletin: The Journal of Psychoses and Related Disorders., 2016-08-24) Stubbs, Brendon; Koyanagi, Ai; Schuch, Felipe; Firth, Joseph; Rosenbaum, Simon; Gaughran, Fiona; Mugisha, James; Vancampfort, Davy
Physical activity (PA) can help reduce cardiovascular disease and premature mortality in people with psychosis. However, there is a paucity of representative data on PA in people with psychosis, especially from low- and middle-income countries (LMICs). Moreover, data on subclinical psychosis and PA is absent. This study explored whether complying with PA recommendations of 150 minutes of moderate-vigorous PA per week is related to: (1) psychotic symptoms without a psychosis diagnosis (subclinical psychosis); and (2) clinical psychosis (psychosis diagnosis). A total of 204 186 participants aged 18–64 years from 46 LMICs recruited via the World Health Survey were subdivided into those with (1) no psychosis diagnosis and no psychotic symptoms in the past 12 months (controls); (2) subclinical psychosis; and (3) psychosis diagnosis. People with a psychosis diagnosis had significantly higher odds for low PA in the overall sample (OR = 1.36; 95% CI = 1.04–1.78; P = .024) and among males (OR = 2.29; 95% CI = 1.57–3.34; P < .0001) but not females (OR = 0.93; 95% CI = 0.67–1.30; P = .6712). No difference was found among those with subclinical psychosis vs controls. Mediation analyses demonstrated that mobility difficulties explained the largest amount of low PA among males (18.5%) followed by self-care difficulties (16.3%), depression (16.1%), cognition (11.8%), pain and discomfort (11.4%), interpersonal activities (8.6%), sleep and energy (7.2%), and vision (3.0%). The results from the largest dataset on PA and psychosis and first in LMICs, found that psychosis diagnosis (especially among males) but not subclinical psychosis, is associated with physical inactivity. Population level interventions seeking to increase PA among people with psychosis may help improve health outcomes.
Physical activity and depression: a large cross-sectional, population-based study across 36 low- and middle-income countries
(Wiley Online Library: Acta Psychiatrica Scandinavica, 2016-10-05) Stubbs, B.; Koyanagi, A.; Schuch, F. B.; Firth, J.; Rosenbaum, S.; Veronese, N.; Solmi, M.; Mugisha, J.; Vancampfort, D.
Physical activity (PA) is good for health, yet several small-scale studies have suggested that depression is associated with low PA. A paucity of nationally representative studies investigating this relationship exists, particularly in low- and middle-income countries (LMICs). This study explored the global association of PA with depression and its mediating factors. Method Participants from 36 LMICs from the World Health Survey were included. Multivariable logistic regression analyses were undertaken exploring the relationship between PA and depression. Results Across 178 867 people (mean ± SD age = 36.2 ± 13.5 years; 49.9% male), the prevalence of depression and the prevalence of low PA were 6.6% and 16.8% respectively. The prevalence of low PA was significantly higher among those with depression vs. no depression (26.0% vs. 15.8%, P < 0.0001). In the adjusted model, depression was associated with higher odds for low PA (OR = 1.42; 95% CI = 1.24–1.63). Mediation analyses demonstrated that low PA among people with depression was explained by mobility limitations (40.3%), pain and discomfort (35.8%), disruptions in sleep and energy (25.2%), cognition (19.4%) and vision (10.9%). Conclusion Individuals with depression engage in lower levels of PA in LMICs. Future longitudinal research is warranted to better understand the relationships observed.
Physical multimorbidity and psychosis: comprehensive cross sectional analysis including 242,952 people across 48 low- and middle-income countries
(BMC Medicine, 2016-11-22) Stubbs, Brendon; Koyanagi, Ai; Veronese, Nicola; Vancampfort, Davy; Solmi, Marco; Gaughran, Fiona; Carvalho, André F.; Lally, John; Mitchell, Alex J.; Mugisha, James; Correll, Christoph U.
: In people with psychosis, physical comorbidities, including cardiovascular and metabolic diseases, are highly prevalent and leading contributors to the premature mortality encountered. However, little is known about physical health multimorbidity in this population or in people with subclinical psychosis and in low- and middle-income countries (LMICs). This study explores physical health multimorbidity patterns among people with psychosis or subclinical psychosis. Methods: Overall, data from 242,952 individuals from 48 LMICs, recruited via the World Health Survey, were included in this cross-sectional study. Participants were subdivided into those (1) with a lifetime diagnosis of psychosis (“psychosis”); (2) with more than one psychotic symptom in the past 12 months, but no lifetime diagnosis of psychosis (“subclinical psychosis”); and (3) without psychotic symptoms in the past 12 months or a lifetime diagnosis of psychosis (“controls”). Nine operationalized somatic disorders were examined: arthritis, angina pectoris, asthma, diabetes, chronic back pain, visual impairment, hearing problems, edentulism, and tuberculosis. The association between psychosis and multimorbidity was assessed by multivariable logistic regression analysis. Results: The prevalence of multimorbidity (i.e., two or more physical health conditions) was: controls = 11.4% (95% CI, 11.0–11.8%); subclinical psychosis = 21.8% (95% CI, 20.6–23.0%), and psychosis = 36.0% (95% CI, 32.1–40. 2%) (P < 0.0001). After adjustment for age, sex, education, country-wise wealth, and country, subclinical psychosis and psychosis were associated with 2.20 (95% CI, 2.02–2.39) and 4.05 (95% CI, 3.25–5.04) times higher odds for multimorbidity. Moreover, multimorbidity was increased in subclinical and established psychosis in all age ranges (18–44, 45–64, ≥ 65 years). However, multimorbidity was most evident in younger age groups, with people aged 18–44 years with psychosis at greatest odds of physical health multimorbidity (OR = 4.68; 95% CI, 3.46–6.32).(Continued from previous page) Conclusions: This large multinational study demonstrates that physical health multimorbidity is increased across the psychosis-spectrum. Most notably, the association between multimorbidity and psychosis was stronger among younger adults, thus adding further impetus to the calls for the early intervention efforts to prevent the burden of physical health comorbidity at later stages. Urgent public health interventions are necessary not only for those with a psychosis diagnosis, but also for subclinical psychosis to address this considerable public health problem.
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.
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.
The prevalence of diabetes mellitus type 2 in people with alcohol use disorders: a systematic review and large scale meta-analysis
(Elsevier: Psychiatry Research, 2016-12-30) Vancampfort, Davy; Mugisha, James; Hallgren, Mats; De Hert, Marc; Probst, Michel; Monsieur, Dirk; Stubbs, Brendon
Type 2 Diabetes Mellitus (T2DM) is highly predictive of cardiovascular diseases and is associated with worse quality of life and increased healthcare utilisation. The current meta-analysis aimed to (i) describe the pooled prevalence of T2DM in people with alcohol use disorders (AUDs), (ii) investigate the impact of demographic, clinical and treatment factors, and (iii) compare T2DM prevalences in AUDs versus the general population. The trim and fill adjusted pooled T2DM prevalence among 3998 people with AUDs (age range 34.8-51.1 years; 76.6% male) (N studies=7) was 12.4% (95%CI=11.8–13.9%). Higher T2DM prevalences were observed in studies with a higher mean age and a higher percentage of male participants, and in studies with self- or physician reported T2DM assessment. A trend for higher T2DM prevalences was found in inpatient settings, in studies assessing T2DM with the gold-standard oral glucose tolerance test compared with fasting glucose only, and with studies including patients with a higher percentage of physical co-morbidity. Although healthy control data are lacking, the pooled prevalence is similar to that observed in people with severe mental illness who are considered a high-risk group. Routine screening and multidisciplinary management of T2DM in people with AUDs is needed.
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.
Growing up HIV-positive in Uganda: “psychological immunodeficiency”? A qualitative study
(Springer Nature: BMC Psychology, 2017) Knizek, Birthe Loa; Mugisha, James; Osafo, Joseph; Kinyanda, Eugene
This study is part of a longitudinal study among children and adolescents with HIV in both urban and rural Uganda: ‘Mental health among HIV infected CHildren and Adolescents in KAmpala and Masaka, Uganda (CHAKA)’. Method The study is constructed of both quantitative and qualitative components. In this article we report a qualitative study on the experiences of 21 adolescents (twelve to seventeen years) living with HIV in Uganda. The purpose of the study was to investigate both the protective and the risk factors in HIV-infected adolescents’ care environment in order to understand what might contribute to negative outcomes and what might provide a protective buffer against harmful life events. Semi-structured interviews with vignettes about mental disorders were employed and a phenomenological analysis was done. Results The findings uncovered that the adolescents’ families were mostly characterized by instability and diffuse relationships that provided an insecure basis for secure attachment and emotional support. Even in stable and secure family environments, there was no guarantee for getting sufficient emotional support in order to develop a positive self-concept due to the fate being the only infected child in the family. Both secure attachment and positive self-concept are known psychological protective mechanisms that provide the individual with resilience. The adolescents in this study seemed hampered in the development of protective mechanisms and consequently seemed psychologically vulnerable and badly equipped for coping with challenges, which paves the way for the possible development of mental disorders. Conclusion To change the focus towards strengthening the children and adolescents’ development of psychological protective mechanisms implicates a change in focus from illness to health and has consequences for both treatment and prevention. Psychological health promotion must be systemic and aim at strengthening the family environment, but also to establish peer group support.
Dropout from physical activity interventions in people living with HIV: a systematic review and meta-analysis
(Taylor and Francis online : AIDS Care Psychological and Socio-medical Aspects of AIDS/HIV, 2017) Vancampfort, D.; Mugisha, J.; Richards, J.; De Hert, M.; Lazzarotto, A. R.; Schuch, F. B.; Probst, M.; Stubbs, B.
Physical activity (PA) interventions have been shown to improve the health of people living with HIV (PLWH), yet treatment dropout poses an important challenge. We conducted a meta-analysis to investigate the prevalence and predictors of treatment dropout in PA interventions in PLWH. Electronic databases were searched for records up to September 2016. Randomized control trials of PA interventions in PLWH reporting dropout rates were included. Random effects meta-analysis and meta-regression analyses were employed. In 36 studies involving 49 PA intervention arms, 1128 PLWH were included (mean age = 41.6 years; 79.3% male; 39% White). The trim and fill adjusted treatment dropout rate was 29.3% (95% CI = 24.5–34.7%). There was a significant lower dropout rate in resistance training interventions compared with aerobic (p = 0.003) PA interventions, in studies utilizing supervised interventions throughout the study period (p < 0.001), and in studies using adequately qualified professionals (p < 0.001). Exerciser/participant variables that moderated higher dropout rates were a lower percentage of male participants (β = 1.15, standard error (SE) = 0.49, z = 2.0, p = 0.048), a lower body mass index(BMI) (β = 0.14, SE = 0.06, z = 2.16, p = 0.03), and a lower cardiorespiratory fitness (β = 0.10, SE = 0.04, z = 2.7, p = 0.006). The dropout from PA interventions is much higher in PLWH than in many other populations with chronic morbidities. Qualified professionals (i.e., exercise physiologists, physical educators, or physical therapists) should be incorporated as key care providers in the multidisciplinary care of HIV/AIDS and should prescribe supervised PA for PLWH in order to enhance adherence and reduce the burden of HIV/AIDS. Special attention should be given men, those with a higher BMI, and those with a lower cardiorespiratory fitness.
Health systems context(s) for integrating mental health into primary health care in six Emerald countries: a situation analysis
(International Journal of Mental Health Systems., 2017-01-05) Mugisha, James; Abdulmalik, Jibril; Hanlon, Charlotte; Petersen, Inge; Lund, Crick; Upadhaya, Nawaraj; Ahuja, Shalini; Shidhaye, Rahul; Mntambo, Ntokozo; Alem, Atalay; Gureje, Oye; Kigozi, Fred
Mental, neurological and substance use disorders contribute to a significant proportion of the world’s disease burden, including in low and middle income countries (LMICs). In this study, we focused on the health systems required to support integration of mental health into primary health care (PHC) in Ethiopia, India, Nepal, Nigeria, South Africa and Uganda. Methods: A checklist guided by the World Health Organization Assessment Instrument for Mental Health Systems (WHO-AIMS) was developed and was used for data collection in each of the six countries participating in the Emerging mental health systems in low and middle-income countries (Emerald) research consortium. The documents reviewed were from the following domains: mental health legislation, health policies/plans and relevant country health programs. Data were analyzed using thematic content analysis. Results: Three of the study countries (Ethiopia, Nepal, Nigeria, and Uganda) were working towards developing mental health legislation. South Africa and India were ahead of other countries, having enacted recent Mental Health Care Act in 2004 and 2016, respectively. Among all the 6 study countries, only Nepal, Nigeria and South Africa had a standalone mental health policy. However, other countries had related health policies where mental health was mentioned. The lack of fully fledged policies is likely to limit opportunities for resource mobilization for the mental health sector and efforts to integrate mental health into PHC. Most countries were found to be allocating inadequate budgets from the health budget for mental health, with South Africa (5%) and Nepal (0.17%) were the countries with the highest and lowest proportions of health budgets spent on mental health, respectively. Other vital resources that support integration such as human resources and health facilities for mental health services were found to be in adequate in all the study countries. Monitoring and evaluation systems to support the integration of mental health into PHC in all the study countries were also inadequate. Conclusion: Integration of mental health into PHC will require addressing the resource limitations that have been identified in this study. There is a need for up to date mental health legislation and policies to engender commitment in allocating resources to mental health services.
Physical activity and anxiety: a perspective from the World Health Survey
(Elsevier: Journal of Affective Disorders ., 2017-01-15) Stubbs, Brendon; Koyanagi, Ai; Hallgren, Mats; Firth, Joseph; Richards, Justin; Schuch, Felipe; Rosenbaum, Simon; Mugisha, James; Veronese, Nicola; Lahti, Jouni; Vancampfort, Davy
Despite the known benefits of physical activity (PA) among people with anxiety, little is known about PA levels in people with anxiety at the population level. This study explored the global prevalence of anxiety and its association with PA. Methods Cross-sectional, community-based data from the World Health Survey was analyzed. Prevalence of anxiety was estimated for 237,964 individuals (47 countries). PA was categorized as low, moderate, and high based on the International Physical Activity Questionnaire (short form). The association between PA and anxiety was assessed by multivariable logistic regression. Results The overall global prevalence of anxiety was 11.4% (47 countries). Across 38 countries with available data on PA, 62.5%, 20.2%, and 17.3% of the sample engaged in high, moderate, and low levels of PA respectively. The prevalence of low physical activity in those with and without anxiety was 22.9% vs. 16.6% (p<0.001) (38 countries, n=184,920). In the pooled model adjusted for socio-demographics, depression, and country, individuals engaging in low PA (vs. high PA) had 1.32 (95% CI=1.17–1.47) times higher odds for anxiety than those with high PA. Female sex, older age, lower education and wealth, and depression were also associated with low PA. At the individual country level, there was a significant positive association between low PA and anxiety in 17 of the 38 countries. Conclusion Low PA levels are associated with increased prevalence of anxiety. There is a need for longitudinal research to establish the directionality of the relationships observed
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.
A systematic review of physical activity policy recommendations and interventions for people with mental health problems in Sub-Saharan African countries
(The Pan African Medical Journal, 2017-02-28) Vancampfort, Davy; Stubbs, Brendon; De Hert, Marc; Plessis, Christy du; Gbiri, Caleb Ademola Omuwa; Kibet, Jepkemoi; Wanyonyi, Nancy; Mugisha, James
There is a need for interventions to address the escalating mental health burden in Sub-Saharan Africa (SSA). Implementation of physical activity (PA) within the rehabilitation of people with mental health problems (PMHP) could reduce the burden and facilitate recovery. The objective of the current review was to explore (1) the role of PA within mental health policies of SSA countries, and (2) the current research evidence for PA to improve mental health in SSA. Methods We screened the Mental Health Atlas and MiNDbank for mental health policies in SSA countries and searched PubMed for relevant studies on PA in PMHP in SSA. Results Sixty-nine percent (=33/48) of SSA countries have a dedicated mental health policy. Two of 22 screened mental health policies included broad physical activity recommendations. There is clear evidence for the role of PA in the prevention and rehabilitation of depression in SSA. Conclusion Despite the existing evidence, PA is largely a neglected rehabilitation modality in the mental health care systems of SSA. Continued education of existing staff, training of specialized professionals and integration of PA for mental health in public health awareness programs are needed to initiate and improve PA programs within the mental health care systems of SSA.
Physical activity correlates in people living with HIV/AIDS: a systematic review of 45 studies
(Taylor&Francis: Disability and Rehabilitation, 2017-03-22) Vancampfort, Davy; Mugisha, James; Richards, Justin; De Hert, Marc; Probst, Michel; Stubbs, Brendon
Understanding barriers and facilitators of physical activity participation in persons living with HIV/AIDS is an essential first step in order to devise effective interventions. The present review provides a systematic quantitative review of the physical activity correlates in people with HIV/AIDS. Methods: Major electronic databases were searched till August 2016. Keywords included “physical activity” or “exercise” or “sports” and “AIDS” or “HIV”. Results: Out of 55 correlates from 45 studies (N = 13,167; mean age range = 30.5–58.3 years; 63.2% male) five consistent (i.e., reported in four or more studies) correlates were identified. Lower levels of physical activity were consistently associated with older age (6/10 studies), a lower educational level (6/7), a lower number of CD4 cells/μl (7/11), exposure to antiviral therapy (4/6), and the presence of lipodystrophy (4/4). Other important barriers were the presence of bodily pain (2/2), depression (3/3), and opportunistic infections (3/4). Facilitators were a higher cardiorespiratory fitness level (3/3), a higher self-efficacy (2/2), more perceived benefits (2/2), and a better health motivation (3/3). Conclusions: The current review has elucidated that participation in physical activity by people with HIV/AIDS is associated with a range of complex factors which should be considered in rehabilitation programs.
Depression and physical health multimorbidity: primary data and country-wide meta-analysis of population data from 190 593 people across 43 low- and middle-income countries
(Cambridge University Press, 2017-04-04) Stubbs, B.; Vancampfort, D.; Veronese, N.; Kahl, K. G.; Mitchell, A. J.; Lin, P.-Y.; Tseng, P.-T.; Mugisha, J.; Solmi, M.; Carvalho, A. F.; Koyanagi, A.
Despite the known heightened risk and burden of various somatic diseases in people with depression, very little is known about physical health multimorbidity (i.e. two or more physical health co-morbidities) in individuals with depression. This study explored physical health multimorbidity in people with clinical depression, subsyndromal depression and brief depressive episode across 43 low- and middle-income countries (LMICs). Method Cross-sectional, community-based data on 190 593 individuals from 43 LMICs recruited via the World Health Survey were analysed. Multivariable logistic regression analysis was done to assess the association between depression and physical multimorbidity. Results Overall, two, three and four or more physical health conditions were present in 7.4, 2.4 and 0.9% of non-depressive individuals compared with 17.7, 9.1 and 4.9% among people with any depressive episode, respectively. Compared with those with no depression, subsyndromal depression, brief depressive episode and depressive episode were significantly associated with 2.62, 2.14 and 3.44 times higher odds for multimorbidity, respectively. A significant positive association between multimorbidity and any depression was observed across 42 of the 43 countries, with particularly high odds ratios (ORs) in China (OR 8.84), Laos (OR 5.08), Ethiopia (OR 4.99), the Philippines (OR 4.81) and Malaysia (OR 4.58). The pooled OR for multimorbidity and depression estimated by meta-analysis across 43 countries was 3.26 (95% confident interval 2.98–3.57). Conclusions Our large multinational study demonstrates that physical health multimorbidity is increased across the depression spectrum. Public health interventions are required to address this global health problem.
Physical health policies and metabolic screening in mental health care systems of sub-Saharan African countries: a systematic review
(Springer Nature: International Journal of Mental Health Systems., 2017-04-19) Mugisha, James; De Hert, Marc; Stubbs, Brendon; Basangwa, David; Vancampfort, Davy
There is a need for interventions to address the escalating mental health burden in sub-Saharan Africa (SSA). Addressing physical health needs should have a central role in reducing the burden and facilitating recovery in people with severe mental illness (SMI). We systematically investigated (1) physical health policies in the current mental health plans, and (2) the routine metabolic screening rates for people with SMI in SSA. Methods: The Mental Health Atlas and MiNDbank of the World Health Organization were screened for physical health policies in mental health plans. Next, we systematically searched PubMed from inception until February 1st, 2017 for relevant studies on metabolic screening rates in people with SMI in SSA. Results: The current systematic review shows that in 22 screened plans only 6 made reference to a physical health component or policy. Only the South-African mental health plan reported about routine screening and treatment of physical illness for people with SMI. In 2 South-African studies (n = 431) routine screening was unacceptably low with less than 1% adequately screened for all modifiable metabolic syndrome risk factors. Conclusions: Our review data clearly show that a physical health policy is yet to be embraced in mental health care systems of most SSA countries. There is a clear need for integrated mental and medical services in SSA. All psychiatric services, including poorly developed community-based primary health care settings should standardly assess the body mass index and waist circumference at initiation of psycho-pharmacotherapy, and afterwards at regular intervals. Optimal monitoring should include assessments of fasting glucose, lipids, cholesterol, and blood pressure. Mental health care providers in SSA countries need to be informed that their roles extend beyond taking care of the mental health of their patients and assume responsibility for the physical health of their patients as well. Policy makers should be made aware that investment in continued medial education and in screening for physical health risks could optimize mental and physical health improvements. The increased physical health needs of people with mental illness should be integrated into the existing Information, Education and Communication public health awareness programs of the World Health Organization

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