| dc.description.abstract | Introduction and Background
Psychiatric and neurological disorders are important contributors to the global burden of disease in both developed and developing countries, accounting for 12% of all deaths globally. Depression and anxiety disorders, either alone or co morbid are found among the general population. They contribute significantly to the aggregate point prevalence of about 10% of neuropsychiatric disorders among adults and they greatly affect one's general functioning if left unmanaged. Substance abuse behaviour patterns are some of the most pervasive and intransigent mental health problems globally and Kenya is no exception. It has been found that a significant intake of different substances of abuse exist among different categories of people including college students. Alcohol and drug abuse among college and university students remains an important area of research due to the implications of early substance dependence on the development of the youth.
Hopelessness is associated with suicidality in that hopelessness is a negative expectation concerning one's self and one's future life and may lead to suicidal ideations, suicidal plans and even suicidal attempts. Hopelessness and suicidality are symptoms that can be experienced in a number of mental disorders such as depression, schizophrenia, anxiety or substance abuse. Suicide is now one of the third leading causes of death among those aged between 15-34 years worldwide and cannot therefore be ignored. The average age of onset for many mental health conditions is the typical college age of 18-24 years and is believed to be generally due to the many first encounters in life style, friendships, roommates, new cultures and alternative ways of thinking. There is substantial evidence to support the use of psychological therapies particularly cognitive behavioural therapy (CBT) through various methods including psycho-education in the prevention or management of mild to moderate depression, anxiety, moderate substance abuse and consequently, hopelessness and suicidality. Various methods of psycho-education to deal with these mental disorders have been employed and found to be effective in the management of these conditions. Psycho-education puts emphasis on teaching of symptom recognition, understanding the general causes which precipitate and/or predispose one to develop them and stress coping strategies.
The ability of an individual to understand the effects of psycho stressors as precipitators of depression, anxiety, substance/drug abuse and consequently hopelessness and suicidality is of significant importance. Ability to employ appropriate stress coping strategies to deal with any of the psycho stressors can go a long way to minimize occurrence of these conditions. Ability to recognize the specific symptoms related to any of the said conditions before they become severe may encourage self referral and in this way go a long way to prevent/reduce the prevalence of these conditions among patients or the general population. If these disorders are not diagnosed and managed early, they may lead to undesirable consequences in the life of the affected and others. There is need to explore cost effective and appropriate methods to enhance awareness of the causes of these conditions, their presentation as well as stress coping strategies/skills through psycho-education.
Objectives
The general objective of this study was to determine the effectiveness of psycho-education as an 'intervention on depression, hopelessness, suicidality, anxiety, alcohol and other drug abuse. The specific objectives were to determine the following among the 2 study groups across the 3 assessments: -
1. Prevalence of depression, hopelessness, suicidality, anxiety and risk of alcohol and other psychoactive drug abuse.
2. Co-morbidity of depression, hopelessness, suicidality, anxiety, alcohol and drug abuse
3. Views of the respondent's ability to cope with psycho stressors.
4. Trends of self referral to a mental health facility/professional.
5. Trends in changes of the symptoms of depression, hopelessness, suicidality, anxiety, risk of alcohol and drug abuse across the 3 assessments.
Study Design, Subjects and Setting
.This was a clinical trial design study with psycho-education as the intervention. It recruited the total population of the 1st and 2nd year basic diploma students in the seven largest KMTCs in Kenya. Nairobi campus respondents constituted the experimental group and the number of respondents who were willing to be involved as well as the questionnaires which were well completed in the 3 assessments at 3 monthly intervals were (n=1181, n=1156, n=959) respectively. The control group consisted of the next six largest KMTCs namely; Mombasa, Port Reizt, Nakuru, Kisumu, Muranga and Meru MTCs (n=1926, n=1741 and n=1493) in the 3 assessments respectively.
: Instruments
Self administered questionnaires were used which included; (i) Social Demographic Questionnaires (SDQ) (ii) Beck's Depression Inventory (BDI) (iii) Beck's Hopelessness Scale (BHS) (iv) Beck's suicide ideation scale (BSIS) (v) Beck's Anxiety Inventory (BAI) and (vi) WHO ASSIST version 6 instrument adopted by the National Institute of Drug Abuse (NIDA). The SDQ was developed by the researcher, while the other questionnaires which have good psychometric properties and which have been used worldwide, were adopted for this study.
Methodology
Ethics approval for this study was obtained from the University of Nairobi/ KNH Research and Ethics Committee. The potential respondents were explained the nature of the study, anonymity, confidentiality and voluntary participation with the right to withdraw any time in the cause of the study without loss of benefits. They were also explained personal benefits i.e. those who felt they indentified with any of the symptoms could come consult with the researcher/data collectors in confident for help and that generally the results were to be used to inform policy at the KMTC on the mental health of the students. Apart from possible emotional pain of relating self to some of the questions, there were no other risks. In particular there were no physically invasive procedures. Three assessments were carried out using similar instruments at an interval of 3 months among the 2 study groups. The experimental group was given 2 direct contact psycho-education interventions immediately after the baseline and midpoint assessments. Each psycho-education intervention totalled 8 hours where the baseline psycho-education was split into 4 sessions each session lasting 2 hours while the midpoint psycho-education was split into 3 sessions the 1 st session lasting 2 hours and the other 2 sessions lasted 3 hours each. The psycho-education method included; lecture method, simulations, role plays and small group discussions. It covered; symptom recognition of the conditions under study, factors which may precipitate and/or predispose their development, 11 appropriate stress coping strategies/skills to enhance/facilitate prevention of development of these conditions and facilitate symptom reduction for these disorders in case of their occurrence.
Data Analysis
The collected data was double entered by two separate groups of data entry clerks, cleaned and analyzed using SPSS version 16, utilizing descriptive and inferential statistics in form of tables, graphs, bar charts, and narratives.
Results
The prevalence rates of all the conditions of the current study did not differ in the 2 study groups in the l' baseline assessment. Prevalence of all the conditions and risk of alcohol and drug abuse reduced in both study groups across the 3 assessments with a higher progressive reduction in the experimental group where the highest reduction was in the 3rd assessment i.e. 6 months after inception of the 1 st intervention. There was a statistically significance difference in prevalence between the 2 study groups in; depression in the 3rd assessment (p<OOOI), hopelessness in the 2nd and 3rd assessments (p<0001 and p=OOI respectively), suicidal ideas in assessment 3 p= (059), suicidal plans (p=005) and attempts in assessment 3 (p<0001) and anxiety in the 3rd assessment (p<OOOI). There was a statistically significant association between the 2 study groups and risk of; cannabis abuse in the 3 rd assessment (p=026) and cocaine abuse in the 3rd assessment (p=034).
There was prevalence of co morbidity between various conditions which reduced in both study groups across the 3 assessments with a higher and more consistent reduction in the experimental group. There was a statistically significant association between co morbidity of several of the conditions and the experimental group in the 2nd or 3rd assessment. These were; depression and anxiety; depression and risk of abuse of alcohol, tobacco, cocaine and amphetamines; hopelessness and risk of abuse of cocaine, amphetamines and inhalants in either experimental or control group; Suicidal ideas and risk of abuse of alcohol, tobacco, cannabis, cocaine, amphetamines, inhalants, sedatives, opioids and hallucinogens in both the 2 study groups in the 2nd or 3rd assessment; suicidal plans and risk of abuse of alcohol, tobacco, inhalants and hallucinogens in the 1 st assessment in both or one study groups; tobacco, cannabis, ;inhalants and hallucinogens in either assessment 2 or 3 among the experimental group; suicidal attempts and risk of abuse of alcohol, cannabis and inhalants in the 2nd or 3rd assessment in either of the 2 study groups; anxiety and risk of abuse of alcohol, tobacco and cannabis in the 1 st assessment among either of the study groups as well as sedatives in the 3rd assessment among the experimental group.
The means of the experimental respondent's views on their ability to deal/cope with environmental stressors were higher than those of control group in the last 2 assessments (= f.l 0.73, f.l =0.92) for
experimental group and (f.l =09, f.l =0.63) for control group respectively. ANOVA analysis showed a statistically significant association between the means of the 2 study groups in the 2nd and 3rd assessments only (p=001 and p<0001 respectively).
The means of experimental respondents who self referred to a mental health facility/professional were higher in the 2nd and 3rd assessments compared to those of control group (f.l = 0.1787, f.l =0.2495) and
(,u =0835, f.l =0919) respectively. ANOV A analysis showed a statistically significant association between the means of the 2 study groups in the 3rd assessment only (p<0001).
Trends of individual symptom change across the 3 assessments among the 2 study groups indicated a progressive reduction in severity and prevalence with a higher reduction among the experimental group
particularly in the 3rd assessment.
ANOV A analysis of the means of the symptom reduction of the individual conditions of this study showed progressive decrease of means across the assessments among the 2 study groups with higher reduction among the experimental group in the 3 rd assessment where several had a statistically significant association between the means. In assessment 2, those whose means had a statistically significant association was only suicidal ideas (p<000 1) while in assessment 3 those which had a statistically significant association were; depression (p<000 1), hopelessness (p<OOO 1), suicidal ideas (p<0001), suicidal attempts (p=050) cannabis (p=036) and cocaine (p=033).
Co-relation coefficient test of the means of all the conditions of this study in the 2 groups on the effectiveness of formulated psycho-education between assessment 1 and 2 showed almost similar statistically significant difference between some of the means of some conditions in both groups while
between assessment 1 and 3, means of 11 conditions in the experimental group had a statistically significant difference while in the control group, only means of 4 conditions had a statistically significance difference, which meant there was more effectiveness within the experimental group.
Conclusion
Comparing the experimental and control groups, psycho-education intervention model employed was effective in significant symptoms reduction at 6 months except for only one symptom- suicidal ideas which was significantly reduced at 3 months and maintained at 6 months. The symptoms which showed significant differences between the 2 groups at 6 months were, depression, hopelessness, suicidal plans and suicidal attempts, abuse of alcohol, tobacco, cannabis, cocaine, amphetamines and sedatives. Those that did not at 6 months were suicidal ideas, abuse of inhalants, opioids and hallucinogens all of which are drugs with propensity for causing addiction. It can therefore be concluded that psycho-education is effective in reducing most common mental disorder symptoms. | en_US |
