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  • 1.
    Alem, Atalay
    et al.
    Amanuel Psychiatric Hospital, Addis Ababa. Ethiopia.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Araya, Mesfin
    Kebede, D
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    How are mental disorders seen and where is help sought in a rural Ethiopian community? A key informant study in Butajira, Ethiopia.1999In: Acta Psychiatrica Scandinavica Supplementum, ISSN 0065-1591, E-ISSN 1600-5473, Vol. 100, no S397, p. 40-47Article in journal (Refereed)
    Abstract [en]

    One hundred key informants were interviewed about their awareness, attitudes and practices regarding mental illness using the Key Informant Questionnaire developed by WHO. Case vignettes of seven common neuropsychiatric disorders were presented to the key informants. Informants' awareness about these disorders and help-seeking practices for mental and physical symptoms or conditions were assessed. An additional question on the prototype symptoms of mental disorders was also posed. Among the presented seven conditions, epilepsy was perceived as the most common condition and major depression was regarded as the least common one. Schizophrenia was judged as the most severe problem, and mental retardation was considered the second most severe condition. Talkativeness, aggression and strange behaviour were the most frequently perceived prototype symptoms of mental illness. Traditional treatment methods were preferred more often for treating symptoms of mental disorders and modern medicine was preferred more often for treating physical diseases or symptoms. Findings of this study are similar to other studies conducted in socio-culturally different communities. Working in close connection with traditional healers would give the primary health care worker a better opportunity to gain acceptance from the community and modify certain harmful practices.

  • 2.
    Alem, Atalay
    et al.
    Amanuel Psychiatric Hospital, Addis Ababa. Ethiopia.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kebede, D
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Awareness and attitudes of a rural Ethiopian community toward suicidal behaviour. A key informant study in Butajira, Ethiopia.1999In: Acta Psychiatrica Scandinavica Supplementum, ISSN 0065-1591, E-ISSN 1600-5473, Vol. 100, no S397, p. 65-69Article in journal (Refereed)
    Abstract [en]

    One hundred key informants were interviewed regarding their awareness and attitudes toward suicidal behaviour. Eighty-eight informants were male, 58 were Muslim and 42 were Christian. Informants on average, claimed to know more persons who had completed suicide than those who had attempted suicide. Almost all informants mentioned more than one cause for suicide. Of these, frustration was the most frequently mentioned cause. Most informants believed that suicide attempters are cruel, feared and not trustworthy. Their attitude toward suicide completers was expressed as condemned sinners, do not deserve funeral ceremony, and should be buried separately from others. Christians gave importance to the funeral issue more than did the Muslims. Generally, the attitudes of informants were punitive and disapproving.

  • 3.
    Alem, Atalay
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lynöe, Niels
    Kohn, Robert
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Attitudes and practices among Ethiopian health care professionals in psychiatry regarding compulsory treatment.2002In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 25, no 6, p. 599-610Article in journal (Refereed)
  • 4.
    Alem, Atalay
    et al.
    Arnanuel Psychiatric Hospital, Addis Ababa, Ethiopia.
    Kebede, D
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Suicide attempts among adults in Butajira, Ethiopia.1999In: Acta Psychiatrica Scandinavica Supplementum, ISSN 0065-1591, E-ISSN 1600-5473, Vol. 100, no S397, p. 70-76Article in journal (Refereed)
    Abstract [en]

    In a cross-sectional survey, 10,468 adults of a rural and semi-urban community were interviewed to determine lifetime suicide attempts. Among the study population, 58% were female, 74.4% were Muslim and 79.3% had had no formal education. The majority of the population were in the age group 25-59 years. Lifetime suicide attempt was reported by 3.2% (n = 332) of the study population. Of these, 63% (n = 208) were women. The most frequent age of attempt was between 15 and 24 years and the frequency of attempt decreased with increasing age. Hanging and poisoning were the most frequently reported methods of attempting suicide. Marital or family conflict was the most frequently reported cause for attempting suicide and most of those who reported this cause were women (Chi-square = 17.42; P < 0.001). Men were significantly more likely to use hanging to attempt suicide than women (Chi-square = 8.21; P < 0.001). Among Christians 3.9% had a lifetime suicide attempt compared to 2.9% among Muslims (Chi-square = 6.15; P < 0.05). People who currently had mental distress and problem drinking reported lifetime suicide attempt more often than others.

  • 5.
    Alem, Atalay
    et al.
    Amanuel Psychiatric Hospital, Addis Ababa, Ethiopia.
    Kebede, D
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The epidemiology of problem drinking in Butajira, Ethiopia.1999In: Acta Psychiatrica Scandinavica Supplementum, ISSN 0065-1591, E-ISSN 1600-5473, Vol. 100, no S397, p. 77-83Article in journal (Refereed)
    Abstract [en]

    In order to determine the prevalence and socio-demographic correlates of problem drinking, a total of 10,468 persons aged 15 and above, most residing in a rural district, were interviewed using the CAGE questionnaire as an important element of a general mental health survey. Twenty-three per cent of the respondents admitted that they currently drank alcohol. The prevalence of alcohol drinking was 15% for women and 36% for men. Among those who drank, 16% met the criterion for problem drinking as defined by two or more positive responses to the CAGE. The overall prevalence for problem drinking was found to be 3.7%. Stratified analysis for sex showed that Christian religion, male sex, being ethnically non-Gurage, and smoking were strongly associated with problem drinking in both sexes. Marital status, mental distress and income were found to be associated factors with problem drinking only in men.

  • 6.
    Alem, Atalay
    et al.
    Amanuel Psychiatric Hospital. Addis Ababa, Ethiopia.
    Kebede, D
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The prevalence and socio-demographic correlates of khat chewing in Butajira, Ethiopia.1999In: Acta Psychiatrica Scandinavica Supplementum, ISSN 0065-1591, E-ISSN 1600-5473, Vol. 100, no S397, p. 84-91Article in journal (Refereed)
    Abstract [en]

    A house-to-house survey was carried out in a rural Ethiopian community to determine the prevalence and socio-demographic correlates of khat use. A total of 10,468 adults were interviewed. Of these, 58% were female, and 74% were Muslim. More than half of the study population (55.7%) reported lifetime khat chewing experience and the prevalence of current use was 50%. Among current chewers, 17.4% reported taking khat on a daily basis; 16.1% of these were male and 3.4% were female. Various reasons were given for chewing khat; 80% of the chewers used it to gain a good level of concentration for prayer. Muslim religion, smoking and high educational level showed strong association with daily khat chewing.

  • 7.
    Alem, Atalay
    et al.
    Amanuel Psychiatric Hospital, Addis Ababa, Ethiopia.
    Kebede, D
    Woldesemiat, G
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The prevalence and socio-demographic correlates of mental distress in Butajira, Ethiopia.1999In: Acta Psychiatrica Scandinavica Supplementum, ISSN 0065-1591, E-ISSN 1600-5473, Vol. 100, no S397, p. 48-55Article in journal (Refereed)
    Abstract [en]

    A cross-sectional survey was conducted on 10,468 rural and semi-urban adults in an Ethiopian district using the Self Reporting Questionnaire (SRQ) to detect the prevalence of mental distress and its association with socio-demographic risk factors. Fifty-eight per cent of the study population were women, 74% were Muslim, 79% were illiterate. Those experiencing 11 or more symptoms out of the 20 SRQ items were considered as having mental distress. Accordingly, the prevalence of mental distress was 17%, which is comparable with the previous hospital-based studies in Ethiopia and elsewhere. However, it was higher than the previous community-based studies in Ethiopia. Mental distress was more prevalent among women. Part of the explanation was that women in the study population were older and that they were more often widowed or divorced, which were factors associated with mental distress. Illiteracy, which was more common among women and older individuals, was also independently associated with mental distress.

  • 8.
    Alem, Atalay
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Pain, Clare
    Araya, Mesfin
    Hodges, Brian D
    Co-creating a psychiatric resident program with Ethiopians, for Ethiopians, in Ethiopia: the Toronto Addis Ababa Psychiatry Project (TAAPP)2010In: Academic Psychiatry, ISSN 1042-9670, E-ISSN 1545-7230, Vol. 34, no 6, p. 424-432Article in journal (Refereed)
    Abstract [en]

    An important issue that underscores such a partnership is the risk of simply exporting Western, America-centric psychiatric training versus creating culturally appropriate models of education.

  • 9. Amberbir, Alemayehu
    et al.
    Medhin, Girmay
    Alem, Atalay
    Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.
    Britton, John
    Davey, Gail
    Venn, Andrea
    The role of acetaminophen and geohelminth infection on the incidence of wheeze and eczema: a longitudinal birth-cohort study2011In: American Journal of Respiratory and Critical Care Medicine, ISSN 1073-449X, E-ISSN 1535-4970, Vol. 183, no 2, p. 165-170Article in journal (Refereed)
    Abstract [en]

    These findings suggest frequent acetaminophen use early in life increases the risk of new-onset wheeze, whereas the role of geohelminth infection on allergic disease incidence remains to be seen as the cohort matures.

  • 10. Bauer, Amy M
    et al.
    Fielke, Ken
    Brayley, John
    Araya, Mesfin
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Frankel, Bernard L
    Fricchione, Gregory L
    Tackling the global mental health challenge: a psychosomatic medicine/consultation-liaison psychiatry perspective2010In: Psychosomatics, ISSN 0033-3182, E-ISSN 1545-7206, Vol. 51, no 3, p. 185-193Article in journal (Refereed)
    Abstract [en]

    C-L psychiatrists have the potential to marshal their unique skill-set to reduce the global burden of mental disorders.

  • 11. Belyhun, Yeshambel
    et al.
    Medhin, Girmay
    Amberbir, Alemayehu
    Erko, Berhanu
    Hanlon, Charlotte
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Venn, Andrea
    Britton, John
    Davey, Gail
    Prevalence and risk factors for soil-transmitted helminth infection in mothers and their infants in Butajira, Ethiopia: a population based study2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, p. 21-Article in journal (Refereed)
    Abstract [en]

    In this rural Ethiopian community with a relatively high prevalence of STH infection, we found a reduced risk of infection in relation to maternal hygiene and urban living. Daily use of soap and a safe supply of water are likely to reduce the risk of STH infection.

  • 12.
    Desta, Menelik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Kebede, Derege
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Psychiatric disorders in urban children in Ethiopia: a population based cross sectional surveyIn: Social psychiatry and psychiatric epidemiologyArticle in journal (Refereed)
  • 13.
    Desta, Menelik
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Kebede, Derege
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Stenlund, Hans
    Demographic and social factors associated with disruptive behaviour disorders and anxiety disorders in children in an urban community in EthiopiaIn: Nordic journal of psychiatryArticle in journal (Refereed)
  • 14.
    Deyessa Kabeta, Negussie
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Berhane, Y
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Depression among women in rural Ethiopia as related to socioeconomic factors: a community-based study on women in reproductive age groups2008In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 36, no 6, p. 589-597Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Several previous studies have reported on socioeconomic and sociodemographic factors associated with depression among women, but knowledge in this area remains scarce regarding women living in extreme poverty in developing countries.

    OBJECTIVE: The study was aimed at examining the 12-month prevalence of depressive episodes as related to socioeconomic and sociocultural conditions of women in the reproductive age group in rural Ethiopia.

    METHODS: A community-based cross-sectional study was undertaken among 3016 randomly selected women in the age group 15-49 years. Cases of depression were identified using the Amharic version of the Composite International Diagnostic Interview. A standardized World Health Organization questionnaire was used to measure the socioeconomic status of the women and their spouses. Data were analysed among all women and then separately among currently married women.

    RESULTS: The 12-month prevalence of depression among all women was 4.4%. After adjusting for common sociodemographic characteristics, only marital status showed a significant association with depressive episode in terms of higher odds ratios (ORs) for divorced/separated women and widowed women than for not-married women (4.05 and 4.24, respectively). Among currently married women, after adjusting for common sociodemographic characteristics, living in rural villages (OR=3.78), a frequent khat-chewing habit (OR=1.61), having a seasonal job (OR=2.94) and being relatively better off in terms of poverty (OR=0.48) were independently associated with depression.

    CONCLUSIONS: The prevalence of depression among women was in the lower range as compared to studies from high-income countries, but very poor economic conditions were associated with a higher prevalence of depression in this overall very poor setting. This further supports the notion that the relative level of poverty rather than the absolute level of poverty contributes to depression among women. Whether the association with khat chewing and depression is a causative effect or can be explained by self-medication remains unclear.

  • 15.
    Deyessa Kabeta, Negussie
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Berhane, Yemane
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ellsberg, Mary
    Emmelin, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences.
    Högberg, Ulf
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Public Health Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Intimate partner violence and depression among women in rural Ethiopia: a cross-sectional study2009In: Clinical practice and epidemiology in mental health, ISSN 1745-0179, Vol. 5, no 1, p. 8-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Studies from high-income countries have shown intimate partner violence to be associated with depression among women. The present paper examines whether this finding can be confirmed in a very different cultural setting in rural Ethiopia.

    METHOD: A community-based cross-sectional study was undertaken in Ethiopia among 1994 currently married women. Using the Composite International Diagnostic Interview (CIDI), cases of depressive episode were identified according to the ICD-10 diagnosis. Using a standardized questionnaire, women who experienced violence by an intimate partner were identified. A multivariate analysis was conducted between the explanatory variables and depressive status of the women, after adjusting for possible confounders.

    RESULTS: The 12-month prevalence of depressive episode among the women was 4.8% (95% CI, 3.9% and 5.8%), while the lifetime prevalence of physical intimate partner violence was 49.5%. Physical violence (OR=2.56, 95% CI, 1.61, 4.06), childhood sexual abuse (OR=2.00, 95% CI, 1.13, 3.56), mild emotional violence (OR=3.19, 95% CI, 1.98, 5.14), severe emotional violence (OR= 3.90, 95% CI, 2.20, 6.93) and high spousal control of women (OR=3.30, 95% CI, 1.58, 6.90) by their partners were independently associated with depressive episode, even after adjusting for socioeconomic factors.

    CONCLUSIONS: The high prevalence of intimate partner violence, a factor often obscured within general life event categories, requires attention as an independent factor for depression, and thus to find new possibilities of prevention and treatment in terms of public health strategies, interventions and service provision.

  • 16.
    Fekadu, Abebaw
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Medhin, Girmay
    Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
    Shibre, Teshome
    Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.
    Cleare, Anthony
    King's College London, Institute of Psychiatry, London, UK.
    Prince, Martin
    King's College London, Institute of Psychiatry, London, UK.
    Kebede, Derege
    World Health Organization, Regional Office for Africa, Brazzaville, Congo.
    Utility of the concept of minor depressive disorder: evidence from a large rural community sample in a developing country setting2007In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 104, no 1-3, p. 111-118Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Evidence on the utility of the minor depressive disorder diagnostic construct in rural communities and developing countries is scarce. AIM: To assess the utility and validity of definitive minor depressive disorder in Ethiopia by determining its impact and sociodemographic correlates.

    METHODS: Assessment of 68,378 adults, aged 15-49 years, living in a largely rural district in Ethiopia using the Composite International Diagnostic Interview.

    RESULTS: The lifetime prevalence of minor depressive disorder was 2.2% (95% CI=2.1%, 2.3%). Age, marital status, education and unemployment independently predicted minor depressive disorder. Over 80% of cases used health services, 55.1% experienced persistent thoughts of death and 14.6% attempted suicide.

    LIMITATION: Findings are based on lifetime estimates.

    CONCLUSIONS: Minor depressive disorder is an important public health problem in rural Ethiopia, as shown by the associated high health service use and risk behaviour. Sociodemographic correlates suggest aetiological continuity with major depression. Thus our findings extend the clinical and public health utility of this diagnostic construct to rural community and developing country settings.

  • 17.
    Fekadu, Abebaw
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    O'Donovan, Michael C
    Department of Psychological Medicine, School of Medicine, Cardiff University, Cardiff, UK.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kebede, Derege
    Department of Community Health, Addis Ababa University, Addis Ababa, Ethiopia.
    Church, Steve
    Maudsley Hospital, South London and Maudsley NHS Trust, London, UK.
    Johns, Louise
    Section of Epidemiology, Health Services Research Department, Institute of Psychiatry, King’s College London, UK.
    Medhin, Girmay
    Department of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia.
    Prince, Martin
    Section of Epidemiology, Health Services Research Department, Institute of Psychiatry, King’s College London, UK.
    Shibre, Teshome
    Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.
    Validity of the concept of minor depression in a developing country setting2008In: Journal of Nervous and Mental Disease, ISSN 0022-3018, E-ISSN 1539-736X, Vol. 196, no 1, p. 22-28Article in journal (Refereed)
    Abstract [en]

    Evidence for validity of the diagnostic construct of minor depressive disorder comes primarily from reports on subthreshold depressive states rather than minor depressive disorder per se. We report on the prevalence, impact, and sociodemographic correlates of minor depressive disorder in a developing country setting as further validation of this diagnostic construct. Diagnostic assessment of 1714 adults of an island population in Ethiopia was carried out using the Composite International Diagnostic Interview. The lifetime prevalence of minor depressive disorder was 20.5% (95% confidence interval 18.6, 22.5%). One-third of cases had sought help and expressed suicidal ideation. Being divorced/widowed, middle-aged, and having somatic pain were independently associated with having minor depressive disorder. Only being divorced/widowed was a shared risk factor for both minor depressive disorder and bereavement. Minor depressive disorder seems to be a useful and valid diagnostic construct with particular clinical significance in this and, possibly, similar developing country settings.

  • 18.
    Fekadu, Abebaw
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Shibre, Teshome
    Department of Psychiatry and Department of Community Medicine, Addis Ababa University Medical Faculty, Addis Ababa, Ethiopia.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kebede, Derge
    Department of Psychiatry and Department of Community Medicine, Addis Ababa University Medical Faculty, Addis Ababa, Ethiopia.
    Kebreab, Samuel
    Department of Psychiatry and Department of Community Medicine, Addis Ababa University Medical Faculty, Addis Ababa, Ethiopia.
    Negash, Alemayehu
    Department of Psychiatry and Department of Community Medicine, Addis Ababa University Medical Faculty, Addis Ababa, Ethiopia.
    Owen, Michael J
    Department of Psychological Medicine, University of Wales College Medicine, Cardiff, UK.
    Bipolar disorder among an isolated island community in Ethiopia2004In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 80, no 1, p. 1-10Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychiatric data on population groups of geographic and social isolates are rare, but can potentially give insights into factors of aetiological importance. The Zeway islanders have lived in geographic and cultural isolation for over three centuries.

    AIM: To determine the prevalence of major psychiatric disorders among the adult population of Zeway islands.

    METHODS: A three stage screening design that included the use of structured interview instruments (CIDI and SCAN), key informants, and clinical assessment by psychiatrists was employed for case identification.

    RESULTS: Prevalence of bipolar disorders among the adult population (n = 1691) was 1.83% (n = 31) with 66% of the cases originating from one of the islands that constitutes only 17.33% of the study population. Only one subject was identified with schizophrenia.

    CONCLUSIONS: A pattern of differential prevalence for bipolar disorders and schizophrenia appears to exist in this isolated population, which also seems shared by other isolated population groups. The high prevalence of bipolar disorders with clustering of cases on one island may represent an environmental or genetic factor of etiologic relevance that deserves further exploration.

  • 19.
    Fekadu, Daniel
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Child labour and emotional disorders in an urban district, Ethiopia: a rapid assessment on community perception of child labour2001In: Ethiopian journal of health development, ISSN 1021-6790, Vol. 15, no 3, p. 197-202Article in journal (Refereed)
  • 20. Hanlon, Charlotte
    et al.
    Medhin, Girmay
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Araya, Mesfin
    Abdulahi, Abdulreshid
    Hughes, Marcus
    Tesfaye, Markos
    Wondimagegn, Dawit
    Patel, Vikram
    Prince, Martin
    Detecting perinatal common mental disorders in Ethiopia: validation of the self-reporting questionnaire and Edinburgh Postnatal Depression Scale.2008In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 108, no 3, p. 251-62Article in journal (Refereed)
    Abstract [en]

    EPDS demonstrated limited clinical utility as a screen for perinatal CMD in this rural, low-income setting. The SRQ-20 was superior to EPDS across all domains for evaluating cultural equivalence and showed validity as a dimensional measure of perinatal CMD.

  • 21. Hanlon, Charlotte
    et al.
    Medhin, Girmay
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Araya, Mesfin
    Abdulahi, Abdulreshid
    Tesfaye, Markos
    Wondimagegn, Dawit
    Taha, Hassan
    Anbesse, Birke
    Baheretibeb, Yonas
    Dewey, Michael
    Prince, Martin
    Measuring common mental disorders in women in Ethiopia: reliability and construct validity of the comprehensive psychopathological rating scale.2008In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 43, no 8, p. 653-9Article in journal (Refereed)
    Abstract [en]

    Detection of socioculturally meaningful cases of CMD in Ethiopia can be reliably achieved with local psychiatrist assessment using CPRS, although thorough training is essential.

  • 22. Hanlon, Charlotte
    et al.
    Medhin, Girmay
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Araya, Mesfin
    Abdulahi, Abdulreshid
    Tomlinson, Mark
    Hughes, Marcus
    Patel, Vikram
    Dewey, Michael
    Prince, Martin
    Sociocultural practices in Ethiopia: association with onset and persistence of postnatal common mental disorders2010In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 197, p. 468-475Article in journal (Refereed)
    Abstract [en]

    There is evidence for an independent role of sociocultural practices in maintaining perinatal mental health in this Ethiopian community.

  • 23. Hanlon, Charlotte
    et al.
    Whitley, Rob
    Wondimagegn, Dawit
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Prince, Martin
    Between life and death: exploring the sociocultural context of antenatal mental distress in rural Ethiopia2010In: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102, Vol. 13, no 5, p. 385-393Article in journal (Refereed)
    Abstract [en]

    The high prevalence of antenatal common mental disorders in sub-Saharan Africa compared to high-income countries is poorly understood. This qualitative study explored the sociocultural context of antenatal mental distress in a rural Ethiopian community. Five focus group discussions and 25 in-depth interviews were conducted with purposively sampled community stakeholders. Inductive analysis was used to develop final themes. Worry about forthcoming delivery and fears for the woman's survival were prominent concerns of all participants, but only rarely perceived to be pathological in intensity. Sociocultural practices such as continuing physical labour, dietary restriction, prayer and rituals to protect against supernatural attack were geared towards safe delivery and managing vulnerability. Despite strong cultural norms to celebrate pregnancy, participants emphasised that many pregnancies were unwanted and an additional burden on top of pre-existing economic and marital difficulties. Short birth interval and pregnancy out of wedlock were both seen as shameful and potent sources of mental distress. The notion that pregnancy in traditional societies is uniformly a time of joy and happiness is misplaced. Although antenatal mental distress may be self-limiting for many women, in those with enduring life difficulties, including poverty and abusive relationships, poor maternal mental health may persist.

  • 24. Hanlon, Charlotte
    et al.
    Wondimagegn, Dawit
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lessons learned in developing community mental health care in Africa2010In: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 9, no 3, p. 185-189Article in journal (Refereed)
    Abstract [en]

    This paper summarizes the findings for the African region of the WPA task force on steps, obstacles and mistakes to avoid in the implementation of community mental health care. We present an overview of mental health policies, plans and programmes in the African region; a summary of relevant research and studies; a critical appraisal of community mental health service components; a discussion of the key challenges, obstacles and lessons learned, and some recommendations for the development of community mental health services in the African region.

  • 25. Kebede, D
    et al.
    Alem, Atalay
    Dept. of Community Health, Addis Ababa University, Addis Ababa, Ethiopia.
    Shibre, Teshome
    Negash, Alemayehu
    Fekadu, A
    Fekadu, Daniel
    Deyessa, Negussie
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Onset and clinical course of schizophrenia in Butajira-Ethiopia--a community-based study.2003In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 38, no 11, p. 625-631Article in journal (Refereed)
    Abstract [en]

    Background:

    There are reports on favourable course and outcome of schizophrenia in lowincome countries. The aim of the present study was to examine onset and clinical course of the illness in a community-based sample in rural Ethiopia based on crosssectional information.

    Method:

    A two-stage survey was carried out in Butajira-Ethiopia, a predominantly rural district. Altogether 68,378 individuals aged 15–49 years were CIDI-interviewed, of whom 2,159 were identified as cases according to the CIDI interview with regard to psychotic or affective disorders. Key informants identified another group of 719 individuals as being probable cases and a total of 2,285 individuals were SCAN-interviewed. The present paper reports on cases with schizophrenia.

    Results:

    There were 321 cases of schizophrenia giving an estimated lifetime prevalence of 4.7/1,000). Of the cases,83.2% (N = 267) were males. Mean age of first onset of psychotic symptoms for males was 23.8 (sd 8.6) compared to 21.0 (sd 7.8) for females (P = 0.037; 95 %CI 0.16–5.47). Over 80% had negative symptoms and over 67% reported continuous course of the illness. Less than 10% had a history of previous treatment with neuroleptic medication. About 7% were vagrants, 9 % had a history of assaultive behaviour,and 3.8% had attempted suicide. The male to female ratio was nearly 5:1.

    Conclusion:

    This large community-based study differs from most previous studies in terms of higher male to female ratio, earlier age of onset in females and the predominance of negative symptoms.

  • 26. Medhin, Girmay
    et al.
    Hanlon, Charlotte
    Dewey, Michael
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Tesfaye, Fikru
    Lakew, Zufan
    Worku, Bogale
    Aray, Mesfin
    Abdulahi, Abdulreshid
    Tomlinson, Mark
    Hughes, Marcus
    Patel, Vikram
    Prince, Martin
    The effect of maternal common mental disorders on infant undernutrition in Butajira, Ethiopia: the P-MaMiE study2010In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 10, p. 32-Article in journal (Refereed)
    Abstract [en]

    Our negative finding adds to the inconsistent picture emerging from SSA. The association between CMD and infant undernutrition might be modified by study methodology as well as degree of shared parenting among family members, making it difficult to extrapolate across low- and middle-income countries.

  • 27. Medhin, Girmay
    et al.
    Hanlon, Charlotte
    Dewey, Michael
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Tesfaye, Fikru
    Worku, Bogale
    Tomlinson, Mark
    Prince, Martin
    Prevalence and predictors of undernutrition among infants aged six and twelve months in Butajira, Ethiopia: the P-MaMiE birth cohort2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, p. 27-Article in journal (Refereed)
    Abstract [en]

    There was a high prevalence of undernutrition in the first year of infancy in this rural Ethiopia population, with significant gender imbalance. Our prospective study highlighted the importance of prenatal maternal nutritional status and household sanitary facilities as potential targets for intervention.

  • 28.
    Negash, Alemayehu
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kabede, D
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Melaku, Z
    Deyessa, Negussie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Shibire, Teshome
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Fekadu, Abebaw
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Fekadu, Daniel
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Neurological soft signs in bipolar I disorder patients2004In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 80, no 2/3, p. 221-230Article in journal (Refereed)
    Abstract [en]

    Background: Neurological soft signs (NSS) have been reported to be more prevalent in patients with schizophrenia compared to other psychiatric and non-psychiatric controls. However, this issue in bipolar I disorder seems to be understudied.

    Aims: The aims of the study were to examine the extent to which NSS are associated with bipolar I disorder cases compared to healthy controls, to assess the possible relationship between NSS and clinical dimensions of the disorder, and to explore the association of sociodemographic characteristics with the occurrence of NSS in cases with this disorder.

    Methods: Predominantly treatment naïve cases of bipolar I disorder from rural communities were assessed for NSS using the Neurological Evaluation Scale (NES).

    Results: This study showed that patients with bipolar I disorder performed significantly worse on two NES items from the sensory integration subscale, on one item from motor coordination and on four items from the ‘others’ subscale, the highest difference in performance being in items under the sequencing of complex motor acts subscale. Clinical dimensions and sociodemographic characteristics appeared to have no relationship with NES total score.

    Conclusions: Bipolar I disorder patients seem to have more neurological dysfunction compared to healthy controls particularly in the area of sequencing of complex motor acts. In addition, the finding suggests that NSS in bipolar I disorder are stable neurological abnormalities established at its onset or may be essential characteristic features of the disorder representing stable disease process that existed long before its onset.

  • 29. Ross, Joanna
    et al.
    Hanlon, Charlotte
    Medhin, Girmay
    Alem, Atalay
    Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia .
    Tesfaye, Fikru
    Worku, Bogale
    Dewey, Michael
    Patel, Vikram
    Prince, Martin
    Perinatal mental distress and infant morbidity in Ethiopia: a cohort study2011In: Archives of Disease in Childhood: Fetal and Neonatal Edition, ISSN 1359-2998, E-ISSN 1468-2052, Vol. 96, no 1, p. F59-F64Article in journal (Refereed)
    Abstract [en]

    Persistent perinatal CMD was associated with infant diarrhoea in this low-income country setting. The observed relationship was independent of maternal health-promoting practices. Future research should further explore the mechanisms underlying the observed association to inform intervention strategies.

  • 30. Servili, Chiara
    et al.
    Medhin, Girmay
    Hanlon, Charlotte
    Tomlinson, Mark
    Worku, Bogale
    Baheretibeb, Yonas
    Dewey, Michael
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Prince, Martin
    Maternal common mental disorders and infant development in Ethiopia: the P-MaMiE birth cohort2010In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 10, p. 693-Article in journal (Refereed)
    Abstract [en]

    The study supports the hypothesis that it is the accumulation of risk exposures across time rather than early exposure to maternal CMD per se that is more likely to affect child development. Further investigation of the impact of chronicity of maternal CMD upon child development in LAMICs is indicated. In the Ethiopian setting, poverty, interpersonal violence and infant undernutrition should be targets for interventions to reduce the loss of child developmental potential.

  • 31. Shibre, Teshome
    et al.
    Alem, Atalay
    Department of Psychiatry, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia .
    Abdulahi, Abdulreshid
    Araya, Mesfin
    Beyero, Teferra
    Medhin, Girmay
    Deyassa, Negusse
    Negash, Alemayehu
    Nigatu, Alemayehu
    Kebede, Derege
    Fekadu, Abebaw
    Trimethoprim as adjuvant treatment in schizophrenia: a double-blind, randomized, placebo-controlled clinical trial2010In: Schizophrenia Bulletin, ISSN 0586-7614, E-ISSN 1745-1701, Vol. 36, no 4, p. 846-851Article in journal (Refereed)
    Abstract [en]

    Various infectious agents, such as Toxoplasma gondii, have been hypothesized to be potentially relevant etiological factors in the onset of some cases of schizophrenia. We conducted a randomized, double-blind, placebo-controlled treatment trial in an attempt to explore the hypothesis that the symptoms of schizophrenia may be related to infection of the central nervous system with toxoplasma gondii. Systematically selected patients with ongoing and at least moderately severe schizophrenia from Butajira, in rural Ethiopia, were randomly allocated to trimethoprim or placebo, which were added on to participants' regular antipsychotic treatments. Trial treatments were given for 6 months. The Positive and Negative Syndrome Scale (PANSS) was used to assess outcome. Ninety-one patients were included in the study, with 80 cases (87.9%) positive for T. gondii immunoglobulin G antibody. Seventy-nine subjects (87.0%) completed the trial. The mean age of subjects was 35.3 (SD = 8.0) years, with a mean duration of illness of 13.2 (SD = 6.7) years. Both treatment groups showed significant reduction in the overall PANSS score with no significant between-group difference. In this sample of patients with chronic schizophrenia, trimethoprim used as adjuvant treatment is not superior to placebo. However, it is not possible to draw firm conclusion regarding the etiological role of toxoplasmosis on schizophrenia based on this study because the timing and the postulated mechanisms through which toxoplasmosis produces schizophrenia are variable.

  • 32.
    Shibre, Teshome
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Tekle-Haimanot, Redda
    Medhin, Girmaye
    Tessema, Alemayehu
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Community attitudes towards epilepsy in a rural Ethiopian setting: a re-visit after 15 years.2008In: Ethiopian Medical Journal, ISSN 0014-1755, Vol. 46, no 3, p. 251-9Article in journal (Refereed)
    Abstract [en]

    The results show ongoing negative attitudes towards epilepsy within the community. In addition to attempts to improve seizure control, our findings highlight the importance of ongoing educational programmes directed towards community misconceptions and negative attitudes about epilepsy.

  • 33. Shibre, Teshome
    et al.
    Kebede, D
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kebreab, S
    Melaku, Z
    Deyassa, Negussie
    Negash, Alemayehu
    Fekadu, A
    Fekadu, Daniel
    Medhin, G
    Negeri, C
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Neurological soft signs (NSS) in 200 treatment-naïve cases with schizophrenia: a community-based study in a rural setting.2002In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 56, no 6, p. 425-31Article in journal (Refereed)
    Abstract [en]

    Several studies have reported neurological soft signs (NSS) to be common in individuals with schizophrenia. The majority of these studies are based on clinical samples exposed to neuroleptic treatment. The present study reports on 200 treatment-naïve and community-identified cases of schizophrenia and 78 healthy individuals from the same area, evaluated using the Neurological Evaluation Scale (NES). The median NES score was 5.0 for cases of schizophrenia and 1.5 for healthy subjects. The impairment rate of NSS in cases with schizophrenia was 65.0% against 50.0% in healthy subjects, and the difference was statistically significant (chi2 = 5.30; df = 1; P < 0.021). NSS abnormality is as common in treatment-naïve cases as reported in many studies in those on neuroleptic medication. There was no significant relation between the NSS impairment and duration of illness, remission status, positive symptoms, negative symptoms and disorganized symptoms.

  • 34. Shibre, Teshome
    et al.
    Kebede, D
    Alem, Atalay
    Dept. of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.
    Negash, Alemayehu
    Deyessa, Negussie
    Fekadu, A
    Fekadu, Daniel
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Schizophrenia: illness impact on family members in a traditional society--rural Ethiopia.2003In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 38, no 1, p. 27-34Article in journal (Refereed)
    Abstract [en]

    Background: Studies have consistently shown that both the subjective and objective dimensions of burden among family members of schizophrenia patients and other psychiatric disorders are prevalent. However, as most of these reports were from western societies, we lack information on the subject in developing countries.

    Method: The study was conducted within the framework of the ongoing epidemiological study of course and outcome of schizophrenia and bipolar disorders in a rural population of 15–49 years of age. Three hundred and one cases of schizophrenia and their close relatives participated in the study.

    Results: Family burden is a common problem of relatives of cases with schizophrenia. Financial difficulty is the most frequently endorsed problem among the family burden domains (74.4 %). Relatives of female cases suffered significantly higher social burden (Z = 2.103; p = 0.036). Work (Z = 2.180; p = 0.029) and financial (Z = 2.088; p = 0.037) burdens affected female relatives more often than males. Disorganised symptoms were the most important factors affecting the family members in all family burden domains. Prayer was found to be the most frequently used coping strategy in work burden (adj. OR = 1.99; 95 % CI = 1.08–3.67; p = 0.026).

    Conclusion: Negative impact of schizophrenia on family members is substantial even in traditional societies such as those in Ethiopia where family network is strong and important. The scarce existing services in the developing countries should include family interventions and support at least in the form of educating the family members about the nature of schizophrenia illness and dealing with its stigma and family burden.

  • 35. Shibre, Teshome
    et al.
    Negash, Alemayehu
    Kullgren, Gunnar
    Kebede, D
    Alem, Atalay
    3.Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia XX.
    Fekadu, A
    Fekadu, Daniel
    Madhin, G
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Perception of stigma among family members of individuals with schizophrenia and major affective disorders in rural Ethiopia.2001In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 36, no 6, p. 299-303Article in journal (Refereed)
    Abstract [en]

    Stigma was found to be a common problem, with few differences between socio-demographic groups or between types of mental disorder. Beliefs about causes differ from those held by professionals. Popular beliefs and attitudes must be taken into account when planning for intervention.

  • 36.
    Shibre, Teshome
    et al.
    Department of Psychiatry, Faculty of Medicine, Addis Ababa University, P.O. Box 9086, Addis Ababa, Ethiopia.
    Teferra, Solomon
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Morgan, Craig
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Exploring the apparent absence of psychosis amongst the Borana pastoralist community of Southern Ethiopia. A mixed method follow-up study.2010In: World psychiatry : official journal of the World Psychiatric Association (WPA), ISSN 1723-8617, Vol. 9, no 2, p. 98-102Article in journal (Refereed)
    Abstract [en]

    There are few reports of the prevalence of psychotic disorders among isolated population groups. Where present, variations in prevalence estimates raise questions about the validity of methods of case ascertainment in such settings. In a previous population-based survey of the Borana pastoralist community in Ethiopia using the Composite International Diagnostic Interview, no cases of schizophrenia were identified. In order to further explore this finding and investigate how serious mental disorder is conceptualized, we conducted focus group discussions with key members of the Borana pastoralist community. Subsequently, focus group participants were used as key informants to identify cases with possible psychotic disorder, based on their conceptualization. Cases identified by key informants were interviewed by a trained psychiatrist using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), to confirm presence of disorder. Focus group discussions were subjected to thematic analysis. The incongruity between local and psychiatric concepts lay mainly in the fact that key informants described characteristics of marata ("madness") in terms of overt behavioural symptoms. Following the focus group discussions, participants identified eight individuals with schizophrenia and 13 with a psychotic mood disorder, confirmed through SCAN interview. Studies of psychotic disorders in such communities are likely to benefit from combining structured interviews with the key informant method.

  • 37.
    Solomon, Teferra
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Shibre, Teshome
    Fekadu, Abebaw
    Medhin, Girmay
    Wakwoya, Asfaw
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Five-year mortality in a cohort of people with schizophrenia in rural EthiopiaManuscript (preprint) (Other academic)
  • 38.
    Teferra, Solomon
    et al.
    Addis Ababa University .
    Hanlon, Charlotte
    Institute of Psychiatry, London .
    Alem, Atalay
    Addis Ababa University .
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Shibre, Teshome
    Addis Ababa University .
    Khat-chewing in persons with severe mental illness in Ethiopia: A qualitative study exploring perspectives of patients and caregivers2011In: Transcultural Psychiatry, ISSN 1363-4615, E-ISSN 1461-7471, Vol. 28, no 4, p. 455-472Article in journal (Refereed)
    Abstract [en]

    People with severe mental illness (SMI) in Ethiopia chew khat despite advice from their physicians to desist. We wanted to better understand their reasons for khat chewing, including any benefits that they might gain. A qualitative study was conducted involving patients with SMI and their caregivers in Butajira. Reasons given by patients as well as caregivers were more or less congruent: social pressure, a means for survival by improving function, combating medication side effects, to experience pleasure and curbing appetite. These findings will be of value to health workers, caregivers and policymakers alike in improving care and understanding for this patient group. Furthermore, our study indicates a role for future research to explore potentially beneficial effects of khat in this population.

  • 39.
    Teferra, Solomon
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Shibre, Teshome
    Fekadu, Abebaw
    Medhin, Girmay
    Wakwoya, Asfaw
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Five-year clinical course and outcome of schizophrenia in rural EthiopiaManuscript (preprint) (Other academic)
  • 40.
    Teferra, Solomon
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Shibre, Teshome
    Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
    Fekadu, Abebaw
    Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
    Medhin, Girmay
    Aklilu Lemma Institute of Pathobiology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia .
    Waqwoya, Asfaw
    Amanauel Specialized Mental Hospital, Addis Ababa, Ethiopia.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Five-year mortality in a cohort of people with schizophrenia in Ethiopia2011In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 11, no 1, article id 165Article in journal (Refereed)
    Abstract [en]

    Background: Schizophrenia is associated with a two to three fold excess mortality. Both natural and unnatural causes were reported. However, there is dearth of evidence from low and middle income (LAMIC) countries, particularly in Africa. To our knowledge this is the first community based report from Africa. 

    Methods: We followed a cohort of 307 (82.1% males) patients with schizophrenia for five years in Butajira, rural Ethiopia. Mortality was recorded using broad rating schedule as well as verbal autopsy. Standardized Mortality Ratio (SMR) was calculated using the mortality in the demographic and surveillance site as a reference.

    Result: Thirty eight (12.4%) patients, 34 men (11.1%) and 4 women (1.3%), died during the five-year follow up period. The mean age (SD) of the deceased for both sexes was 35 (7.35). The difference was not statistically significant (p = 0.69). It was 35.3 (7.4) for men and 32.3 (6.8) for women. The most common cause of death was infection, 18/38 (47.4%) followed by severe malnutrition, 5/38 (13.2%) and suicide 4/38 (10.5%). The overall SMR was 5.98 (95% CI = 4.09 to7.87). Rural residents had lower mortality with adjusted hazard ratio (HR) of 0.30 (95% CI = 0.12-0.69) but insidious onset and antipsychotic treatment for less than 50% of the follow up period were associated with higher mortality, adjusted HR 2.37 (95% CI = 1.04-5. 41) and 2.66(1.054-6.72) respectively.

    Conclusion: The alarmingly high mortality observed in this patient population is of major concern. Most patients died from potentially treatable conditions. Improving medical and psychiatric care as well as provision of basic needs is recommended.

  • 41. Tesfaye, Markos
    et al.
    Hanlon, Charlotte
    Wondimagegn, Dawit
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Detecting postnatal common mental disorders in Addis Ababa, Ethiopia: validation of the Edinburgh postnatal depression scale and Kessler scales2010In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 122, no 1-2, p. 102-108Article in journal (Refereed)
    Abstract [en]

    The EPDS, K6 and K10 all demonstrated acceptable clinical utility as screening scales for postnatal CMD in an urban setting in Ethiopia. The marked urban-rural difference in EPDS performance within Ethiopia highlights the difficulty of applying urban-validated instruments to rural settings in LAMIC.

  • 42. Thornicroft, Graham
    et al.
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Antunes Dos Santos, Renato
    Barley, Elizabeth
    Drake, Robert E
    Gregorio, Guilherme
    Hanlon, Charlotte
    Ito, Hiroto
    Latimer, Eric
    Law, Ann
    Mari, Jair
    McGeorge, Peter
    Padmavati, Ramachandran
    Razzouk, Denise
    Semrau, Maya
    Setoya, Yutaro
    Thara, Rangaswamy
    Wondimagegn, Dawit
    WPA guidance on steps, obstacles and mistakes to avoid in the implementation of community mental health care2010In: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, ISSN 1723-8617, Vol. 9, no 2, p. 67-77Article in journal (Refereed)
    Abstract [en]

    This paper provides guidance on the steps, obstacles and mistakes to avoid in the implementation of community mental health care. The document is intended to be of practical use and interest to psychiatrists worldwide regarding the development of community mental health care for adults with mental illness. The main recommendations are presented in relation to: the need for coordinated policies, plans and programmes, the requirement to scale up services for whole populations, the importance of promoting community awareness about mental illness to increase levels of help-seeking, the need to establish effective financial and budgetary provisions to directly support services provided in the community. The paper concludes by setting out a series of lessons learned from the accumulated practice of community mental health care to date worldwide, with a particular focus on the social and governmental measures that are required at the national level, the key steps to take in the organization of the local mental health system, lessons learned by professionals and practitioners, and how to most effectively harness the experience of users, families, and other advocates.

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