Kebede Tirfessa1,2, Crick Lund3,4, Girmay Medhin5, Yohannes Hailemichael6, Kassahun Habtamu7, Abebaw Fekadu1,8,9, Charlotte Hanlon10,11,12. 1. Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. 2. College of Education and Behavioral Studies, Kotebe Metropolitan University, Addis Ababa, Ethiopia. 3. Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. 4. Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK. 5. Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia. 6. School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. 7. College of Education and Behavioral Studies, School of Psychology, Addis Ababa University, Addis Ababa, Ethiopia. 8. Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. 9. Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, UK. 10. Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. charlotte.hanlon@kcl.ac.uk. 11. Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, King's College London, London, UK. charlotte.hanlon@kcl.ac.uk. 12. Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia. charlotte.hanlon@kcl.ac.uk.
Abstract
PURPOSE: In this study, we aimed to identify factors associated with severe food insecurity and work impairment in people with severe mental disorders (SMD) in a rural African setting, with a view to identifying potential areas for intervention. METHODS: A community-based, cross-sectional survey was conducted in Sodo district, south central Ethiopia. Key informant-identified people with possible SMD were referred for assessment by trained primary care workers and received confirmatory psychiatric diagnoses from psychiatric nurses using a standardized clinical interview. Food insecurity was measured using a locally validated measure, the Household Food Insecurity Access Scale (HFIAS). Work impairment was assessed using the Longitudinal Interval Follow-up Evaluation-Range of Impaired Functioning Tool. Potential moderator variables were specified a priori. RESULTS: A total of 282 people with SMD participated in the study. The proportion of participants reporting severe food insecurity was 32.5% (n = 94), with 53.6% (n = 147) of participants reporting severe work impairment. In the multivariable model, severe food insecurity was associated with poor social support, experience of negative discrimination, higher disability and lower household annual income, but not with symptom severity or work impairment. Work impairment was associated significantly with symptom severity and disability. CONCLUSION: Work impairment and food insecurity were associated with distinct explanatory factors: predominantly social factors associated with food insecurity and clinical factors associated with work productivity. Longitudinal and intervention studies are needed to evaluate the extent to which clinical interventions need to be augmented by social interventions to alleviate food insecurity in people with SMD.
PURPOSE: In this study, we aimed to identify factors associated with severe food insecurity and work impairment in people with severe mental disorders (SMD) in a rural African setting, with a view to identifying potential areas for intervention. METHODS: A community-based, cross-sectional survey was conducted in Sodo district, south central Ethiopia. Key informant-identified people with possible SMD were referred for assessment by trained primary care workers and received confirmatory psychiatric diagnoses from psychiatric nurses using a standardized clinical interview. Food insecurity was measured using a locally validated measure, the Household Food Insecurity Access Scale (HFIAS). Work impairment was assessed using the Longitudinal Interval Follow-up Evaluation-Range of Impaired Functioning Tool. Potential moderator variables were specified a priori. RESULTS: A total of 282 people with SMD participated in the study. The proportion of participants reporting severe food insecurity was 32.5% (n = 94), with 53.6% (n = 147) of participants reporting severe work impairment. In the multivariable model, severe food insecurity was associated with poor social support, experience of negative discrimination, higher disability and lower household annual income, but not with symptom severity or work impairment. Work impairment was associated significantly with symptom severity and disability. CONCLUSION: Work impairment and food insecurity were associated with distinct explanatory factors: predominantly social factors associated with food insecurity and clinical factors associated with work productivity. Longitudinal and intervention studies are needed to evaluate the extent to which clinical interventions need to be augmented by social interventions to alleviate food insecurity in people with SMD.
Entities:
Keywords:
Bipolar disorder; Food insecurity; Psychosis; Schizophrenia; Stigma and discrimination; Work
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