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Co-Occurrence of Study Difficulty

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Co-Occurrence of Study Difficulty CO-OCCURRENCE OF STUDY DIFFICULTY, PSYCHOACTIVE SUBSTANCE USE/ABUSE AND PSYCHIATRIC MORBIDITY (“THE TRIAD”) AMONG SENIOR STUDENTS OF UNIVERSITY OF ABUJA A DISSERTATION SUBMITTED TO THE NATIONAL POSTGRADUATE MEDICAL COLLEGE OF NIGERIA IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE FELLOWSHIP OF THE COLLEGE IN THE FACULTY OF PSYCHIATRY BY DR. IFEDILICHUKWU UZOEGHE UCHENDU M.B.B.S (ILORIN) 1995 MAY 2009 1 DECLARATION This dissertation is submitted in partial fulfilment for the award of Fellowship of the National Postgraduate Medical College of Nigeria in the Faculty of Psychiatry. The study reported here has not been published or presented for award of a degree by any other institution. Signed by: _____________________ ______________________ DR I. U. UCHENDU. Date 2 CERTIFICATION The study reported in this Dissertation was conducted by Dr. I.U. Uchendu of Psychiatric Hospital, Uselu Benin City, Edo State, under my supervision. I also supervised the writing of the dissertation. ___________________________ ____________________ PROF OLUFEMI MORAKINYO (FMCPsych.) DATE Consultant Psychiatrist Dept. of Mental Health University of Benin Teaching Hospital (UBTH) Benin City, Edo state, Nigeria. 3 TABLE OF CONTENT Declaration ii Certification iii Table of Contents iv List of Tables x List of Figures xii Abbreviations xiii Dedication xiv Acknowledgement xv Summary xvi CHAPTER ONE INTRODUCTION 1 Relevance of the study 4 CHAPTER TWO LITERATURE REVIEW 5 Students’ Mental Health 5 Study Difficulty 6 Classification of study difficulty 7 Factors associated with study difficulty 10 4 Psychoactive substance use/abuse 12 Socio-demographic correlates of psychoactive substance use 13 Psychiatric Morbidity 15 General psychiatric morbidity 15 Relationship between psychiatric morbidity & psychoactive substance use/abuse 15 Consequences of psychiatric morbidity in relation to study 17 Neurobiological basis for co-morbidity of psychiatric morbidity & psychoactive substance use /abuse 18 Specific psychiatric morbidity (Brain Fag Syndrome) 19 The Triad 20 CHAPTER THREE AIMS AND OBJECTIVES 22 Theoretical Framework 22 General Aims 23 Specific Objectives 24 Hypotheses 25 CHAPTER FOUR METHODOLOGY 26 Study Location &Settings 26 Inclusion Criteria 27 Exclusion Criteria 27 Ethical Considerations 27 5 Subjects Recruitment 27 Sample Size Determinations 29 Procedure 30 Sampling Procedure 30 Study Instrument 33 Part 1: Socio-demographic Questionnaire 33 Part 2: General Health Questionnaire 33 Part 3: The University College London Study Difficulty Questionnaire 34 Part 4: The World Health Organisation Questionnaire for Students Drug Use Survey 35 Part 5: The Brain Fag Syndrome Scale 36 Data Analysis 36 CHAPTER FIVE RESULTS 39 Socio-demographic characteristics of the respondents 39 Gender distribution 39 Age distribution 39 Religion 39 Respondents’ geopolitical zones of origin 39 Socio-demographic characteristics of the respondents parents 41 Educational levels 41 Occupational status 41 Study Difficulty 44 Measure of central tendencies and dispersions of the UCLSQ subscales 44 Psychoactive Substance Use/Abuse 47 6 Psychiatric Morbidity 49 General psychiatric morbidity 49 Specific psychiatric morbidity 49 Identification of co-morbidities and estimation of their magnitudes 49 Co-morbidity of study difficulty & psychoactive substance use/abuse 49 Co-morbidity of psychoactive substance use & psychiatric morbidity 50 Co-morbidity of study difficulty & psychiatric morbidity 50 Co-occurrence of study difficulty, psychoactive substance use & psychiatric morbidity 50 Relationships of the Brain Fag Syndrome with the co-morbidities 52 Socio-demographic characteristics of subgroup H (‘TheTriad’) 55 Specific psychoactive substances associated with study difficulty 64 Specific psychoactive substances associated with psychiatric morbidity 64 Specific aspects of study difficulty associated with psychoactive substance use 66 Specific aspects of study difficulty associated with psychiatric morbidity 66 Prevalence of psychoactive substance use, study difficulty & psychiatric morbidity among students with BFS 68 Psychoactive substances commonly used by students with BFS 69 Association between the psychoactive substances (life-time) use & BFS 71 Relationship between the subscales of UCLSQ & ‘The Triad’ 73 Types of study difficulty commonly associated with BFS 74 Correlation coefficient of the quantitative variables 75 CHAPTER SIX DISCUSSIONS 79 Response to self reported questionnaire 79 7 Socio-demographic characteristics of the respondents 80 Prevalence rates of study difficulty 81 Prevalence of psychoactive substance use 82 Prevalence of psychiatric morbidity 83 Prevalence rates of ‘The Triad’ 83 Socio-demographic characteristics of students with ‘The Triad’ 84 Specific psychoactive substances associated with study difficulty 87 Specific psychoactive substances associated with psychiatric morbidity 88 Specific aspects of study difficulty associated with psychoactive substances & psychiatric morbidity 89 The magnitude of Brain Fag Syndrome among students with ‘The Triad’ 91 Prevalence rates of Brain Fag Syndrome among subgroups of the cohort 92 Psychoactive substances commonly abused by students with BFS 93 Types of study difficulty commonly associated with BFS 94 CHAPTER SEVEN CONCLUSION 95 Implications of these finings 96 Recommendations 96 Limitations of the study 97 REFERENCES 98 8 APPENDICES 106 Appendix I: Socio-Demographic Variables 106 Appendix II: General Health Questionnaire (GHQ-30) 109 Appendix III: The WHO Questionnaire for Students Drug Use Survey 112 Appendix IV: University College London Study Difficulty Questionnaire 122 Appendix V: Brain Fag Syndrome Scale 127 Appendix VI: International Standard Classification of Occupations 128 Appendix VII: Respondents Consent Form 136 \ 9 LIST OF TABLES Table 1: Morakinyo’s Classification of Study Difficulty 9 Table 2: Full-time undergraduate students population according to their faculties 28 Table 3: Respondents Faculties, Departments & Levels by Gender 32 Table 4: Gender & Age distributions of the respondent 39 Table 5: Religion of the respondents 39 Table 6: Geopolitical zones of the respondents 40 Table 7: Socio-demographic characteristics of respondents parents 41 Table 8: Occupations of respondents’ parents 42 Table 9: Mean scores, Standard deviations & Median scores of subscales of UCLSQ 46 Table 10: Prevalence rates of psychoactive substance use among Respondents 48 Table 11: Prevalence rates of BFS among the subgroups of the cohort 54 Table 12: Associations between gender & ‘The Triad’ 55 Table 13: Relationships between age group & ‘The Triad’ 56 Table 14: Associations between respondents departments & ‘The Triad’ 58 Table 15: Associations between family status & ‘The Triad’ 60 Table 16: Associations between father’s level of education & ‘The Triad’ 61 Table 17: Associations between parental relationships & ‘The Triad’ 63 Table 18: Associations between specific psychoactive substances with study difficulty & psychiatric morbidity 65 Table 19: Specific aspects of study difficulty associated with psychoactive substance use & psychiatric morbidity 67 Table 20: Prevalence of BFS among students with study difficulty, psychoactive substance use and psychiatric morbidity 68 10 Table 21: Psychoactive substance most commonly associated with BFS 70 Table 22: Relationship between the psychoactive substances (lifetime) use and the BFS 72 Table 23: Relationship between subscales of UCLQ and ‘The Triad’ 73 Table 24: The types of study difficulty most commonly associated with BFS 74 Table 25: Correlation coefficient of the quantitative variable 78 11 LIST OF FIGURES Figure 1 Theoretical Framework depicting constituents of the total cohort 22 Figure 2 Prevalence rates of the various sub-groups of the study sample 51 Figure 3 Prevalence rates of BFS among subgroups of the cohort. 53 Figure 4 Respondents levels of education & ‘The Triad’ 57 Figure 5 Associations between family status & ‘The Triad’ 59 Figure 6 Associations between Parental relationship & ‘The Triad’ 62 12 ABBREVIATIONS ANX: Anxiety BFS: Brain Fag Syndrome BFSS: Brain Fag Syndrome Scale CSD: Consolidated Study Difficulty DEP: Depression DIS: Disorganised/Distractible GHQ-30: General Health Questionnaire Version 30 ISCO : International Standard Classification of Occupations L-MOT: Low motivation OR: Odds Ratio RR: Relative Risk SOM: Somatic SPSS: Statistical Package for Social Science Version 16 SYL: Sylbism UATH: University of Abuja Teaching Hospital UBTH: University of Benin Teaching Hospital UCLSQ: University College London Study difficulty questionnaire 13 DEDICATION This work is dedicated to God Almighty, my Saviour and Lord, Jesus Christ and to all those who found themselves within the intricate web of this syndrome ‘The Triad’. 14 ACKNOWLEDGEMENT First of all my profound gratitude and appreciation goes to my supervisor Prof. Olufemi Morakinyo, for his understanding, encouragements and guidance,; whom despite his busy schedules ensured that this work became a reality. I thank Dr.R.O. Osahon, the immediate past Medical Director of Psychiatric Hospital Uselu, Benin city, for giving me the opportunity to be trained in this institution. My thanks go to the current Medical Director (Dr (Mrs.) F O Ihenyen), The Head of Clinical Services (Dr. G.O. Eze), Dr. Ikeji O C, Dr. A.O. Lawani, and Dr (Mrs.) E Okogbeni, . for their support, and encouragements throughout the period of my training. I appreciate all the members of the Association of Resident Doctors (ARD) Psychiatric
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