Addressing the challenges of integrating care for perinatal depression in primary care in Nigeria.

Purpose: This report provides the results of a task-shared approach for integrating care for perinatal depression (PND) within primary maternal and child healthcare (PMCH), including the factors that may facilitate or impede the process.

Methods: This hybrid implementation-effectiveness study guided by the Replicating Effective Programmes framework was conducted in 27 PMCH clinics in Ibadan, Nigeria. The primary implementation outcome was change in the identification rates of PND by primary health care workers (PHCW) while the primary effectiveness outcome was the difference in symptom remission (EPDS score ≤ 5) 6 months postpartum.

Cascade training for scaling up care for perinatal depression in primary care in Nigeria.

Background: Task-shared care is a demonstrated approach for integrating mental health into maternal and child healthcare (MCH) services. Training and continued support for frontline providers is key to the success of task sharing initiatives. In most settings this is provided by mental health specialists.

Effect of intervention delivered by frontline maternal care providers to improve outcome and parenting skills among adolescents with perinatal depression in Nigeria (the RAPiD study): A cluster randomized controlled trial.

Background: Perinatal depression is more common and is associated with greater negative consequences among adolescents than adults. Psychosocial interventions designed for adults may be inadequate at addressing the unique features of adolescent perinatal depression.

Methods: In a two-arm parallel cluster randomized trial conducted in thirty primary maternal care clinics in Ibadan, Nigeria (15-intervention and 15-control) we compared age-appropriate intervention consisting of problem-solving therapy, behavioral activation, parenting skills training, and parenting support from a self-identified adult to care as usual.

Scaling up care for perinatal depression for improved maternal and infant health (SPECTRA): protocol of a hybrid implementation study of the impact of a cascade training of primary maternal care providers in Nigeria.

Background: The large treatment gap for mental disorders in low- and middle-income countries (LMIC) necessitates task-sharing approaches in scaling up care for mental disorders. Previous work have shown that primary health care workers (PHCW) can be trained to recognize and respond to common mental disorders but there are lingering questions around sustainable implementation and scale-up in real world settings.

Method: This project is a hybrid implementation-effectiveness study guided by the Replicating Effective Programmes Framework.

Engaging culture and context in mhGAP implementation: fostering reflexive deliberation in practice.

In 2002, WHO launched the Mental Health Gap Action Programme (mhGAP) as a strategy to help member states scale up services to address the growing burden of mental, neurological and substance use disorders globally, especially in countries with limited resources. Since then, the mhGAP program has been widely implemented but also criticised for insufficient attention to cultural and social context and ethical issues. To address this issue and help overcome related barriers to scale-up, we outline a framework of questions exploring key cultural and ethical dimensions of mhGAP planning, adaptation, training, and implementation.

Stigma and utilization of treatment for adolescent perinatal depression in Ibadan Nigeria.

Background: Depression is a common and severe disorder among low-income adolescent mothers in low-and middle-income countries where resources for treatment are limited. We wished to identify factors influencing health service utilization for adolescent perinatal depression, in Nigeria to inform new strategies of care delivery.

Methods: Focus Group Discussions (FGDs) were conducted among purposively selected low-income young mothers (with medical histories of adolescent perinatal depression), and separately with primary care clinicians treating this condition in Ibadan, Nigeria.

Considering culture, context and community in mhGAP implementation and training: challenges and recommendations from the field.

Background: Major efforts are underway to improve access to mental health care in low- and middle-income countries (LMIC) including systematic training of non-specialized health professionals and other care providers to identify and help individuals with mental disorders. In many LMIC, this effort is guided by the mental health Gap Action Programme (mhGAP) established by the World Health Organization, and commonly centres around one tool in this program: the mhGAP-Intervention Guide.

Objective: To identify cultural and contextual challenges in mhGAP training and implementation and potential strategies for mitigation.

Moderate to severe gambling problems and traumatic brain injury: A population-based study.

Traumatic brain injury (TBI) is a common injury characterized by a change in brain function after an external blow to the head and is associated with substance abuse, psychological distress, risk-taking, and impulsivity. Convenience and clinical samples have also linked TBI to problem gambling, but have not ruled out confounding variables such as hazardous drinking and psychological distress. This study examines the relationship between TBI and moderate to severe problem gambling in a general population probability sample controlling for hazardous drinking and psychological distress.

Opioid use in fibromyalgia is associated with negative health related measures in a prospective cohort study.

As pain is the cardinal symptom of fibromyalgia (FM), strategies directed towards pain relief are an integral component of treatment. Opioid medications comprise a category of pharmacologic treatments which have impact on pain in various conditions with best evidence for acute pain relief. Although opioid therapy other than tramadol has never been formally tested for treatment of pain in FM, these agents are commonly used by patients.

Problem gambling in adolescents: an examination of the pathways model.

This research tests the applicability of the Integrated Pathways Model for gambling to adolescent problem gamblers, utilizing a cross-sectional design and self-report questionnaires. Although the overall sample consisted of 1,133 adolescents (Quebec: n = 994, 87.7 %; Ontario: n = 139, 12.

Gambling behavior among adolescents with attention deficit/hyperactivity disorder.

Impulsivity is inherent to both problem gambling and ADHD. The purpose of this study is to examine ADHD key symptoms, and gambling behaviors and problem severity among adolescents. Additionally, internalizing and externalizing behaviors exhibited among these individuals and the role of these symptoms in gambling are examined.

Reflections on the voluntary self-exclusion of gamblers and the law-suits against Ontario Lottery and Gaming Corporation.

Legalized gambling in Canada is governed by Provincial legislation. In Ontario, the Ontario Lottery and Gaming Corporation is responsible for all aspects of gambling in the Province. There have been a number of recent lawsuits against this Crown agency of the Government of Ontario by gamblers, most of which have been settled or otherwise resolved.