Prevalence of Substance Use among Psychotic Patients and Determining Its Strongest Predictor

Association between psychosis and substance use in Kenya. Findings from the NeuroGAP-Psychosis study

Background

Substance use is prevalent among people with mental health issues, and patients with psychosis are more likely to use and misuse substances than the general population. Despite extensive research on substance abuse among the general public in Kenya, there is a scarcity of data comparing substance use among people with and without psychosis. This study investigates the association between psychosis and various substances in Kenya.

Methods

This study utilized data from the Neuro-GAP Psychosis Case-Control Study between April 2018 and December 2022. The KEMRI-Wellcome Trust Research Programme recruited participants from various sites in Kenya, including Kilifi County, Malindi Sub-County, Port Reitz and Coast General Provincial Hospitals, and Moi Teaching and Referral Hospital, as well as affiliated sites in Webuye, Kapenguria, Kitale, Kapsabet, and Iten Kakamega. The collected data included sociodemographic information, substance use, and clinical diagnosis. We used the summary measures of frequency (percentages) and median (interquartile range) to describe the categorical and continuous data, respectively. We examined the association between categorical variables related to psychosis using the chi-square test. Logistic regression models were used to assess the factors associated with the odds of substance use, considering all relevant sociodemographic variables.

Results

We assessed a total of 4,415 cases and 3,940 controls. Except for alcohol consumption (p-value=0.41), all forms of substance use showed statistically significant differences between the case and control groups. Cases had 16% higher odds of using any substance than controls (aOR: 1.16, 95%CI: 1.05-1.28, p=0.005). Moreover, males were 3.95 times more likely to use any substance than females (aOR:3.95; 95%CI: 3.43-4.56). All the categories of living arrangements were protective against substance use.

Conclusion

The findings of this study suggest that psychotic illnesses are associated with an increased likelihood of using various substances. These findings are consistent with those of previous studies; however, it is crucial to investigate further the potential for reverse causality between psychosis and substance abuse using genetically informed methods.

Comparison of Caregivers' Burden among Family Members of Patients with Severe Mental Disorders and Patients with Substance Use Disorder

Objective: The burden on caregivers of patients with severe mental disorders is significantly higher than the care burden of patients with other medical conditions. Substance use disorder is also one of the most common psychiatric disorders that has negative effects on people's quality of life. This study was designed to investigate caregiver burden in severe mental disorders versus substance use disorder. Method : First-degree relatives of patients admitted to the Razi Psychiatric Hospital of Tehran with a diagnosis of schizophrenia, bipolar disorder type1, schizoaffective disorder, or substance use disorder entered this study. They completed the sociodemographic questionnaire for patients and caregivers and the Zarit burden interview for caregivers. Results: Our study shows that caregiver burden in substance use disorder has no significant difference with that in severe mental disorders (P > 0.05). In both groups, the highest spectrum of burden was moderate to severe. To find caregiver burden related factors, a general linear regression model with multiple predictor variables was fitted. In this model, caregivers' burden was significantly higher in patients with comorbidity (P = 0.007), poor compliance (P < 0.001), and in female caregivers (P = 0.013). Conclusion: Statistically speaking, the caregiver burden in substance use disorders is as severe as other mental disorders. The considerable burden on both groups necessitates serious efforts to minimize its negative effects.

The prevalence of substance use disorders and associated patterns among patients admitted to a psychiatric hospital in Botswana

OBJECTIVE

Substance use disorders (SUDs) have risen substantially, especially in developing nations, and has become one of the world's most significant public health and socioeconomic challenge. This study aimed to determine the prevalence and patterns of substance use disorders among patients admitted at the main psychiatric hospital, Sbrana Psychiatric Hospital in Botswana.

METHOD

The study design was descriptive cross-sectional, involving patients admitted to a psychiatric hospital. SUDs were assessed using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) v13.0. Bivariate analysis was conducted to determine the association between socio-demographic characteristics and SUDs. Multivariate logistic regression was performed to rule out the effect of confounders.

RESULTS

The final analysis involved one hundred and one (101) participants. Participants ages ranged from 18-60 years with over half (59.4%) being male. Majority of participants (85.1%) had ever used studied substances; with 63.4% found to have substance use disorders. The most frequently used substances were tobacco, cannabis, alcohol and cocaine at 58.4%, 42.6%, 34.7% and 12.8% respectively. SUDs were more common among participants who were male, younger age of 18-35 years, single, tertiary education and unemployed.

CONCLUSIONS

There is a high prevalence of substance use and SUDs among psychiatric patients in Botswana. Structured screening and interventions to manage substance use disorders should be part of routine care at the psychiatric health care facilities in Botswana. Consideration should be given to screening all patients admitted to psychiatric hospitals in Botswana for SUDs using the ASSIST.