SUBSTANCE USE AND QUALITY OF LIFE OF YOUNG PEOPLE WITH MENTAL DISORDERS ATTENDING PSYCHIATRIC CLINICS IN KUMASI, GHANA

Abstract

BACKGROUND: Substance use is a public health issue of immense concern and most often occurs co-morbidly with other mental disorders. The onset of substance use is usually in adolescence which is considered a vulnerable period. Many young people with mental illness or problems may resort to the use of substances for solutions to their mental health problems. Likewise, substance use can lead to serious mental health problems and predispose to mental illness. Mental illness and early substance use can adversely affect the quality of life, however, better diagnosis of youth mental illness and early identification of substance use disorders may help reduce co-morbidity and improve quality of life. Aim: The aim of this study was to identify the patterns of substance use and the association between substance use and quality of life of young persons with mental disorders attending Psychiatric clinics in Kumasi, Ghana. METHODOLOGY: This was a cross-sectional study design using structured and standardized questionnaires. The study population included all young people aged 10-25 years with mental disorders accessing mental health care services in three government facilities in Kumasi, Ghana. A sample size of 170 participants was calculated for this study based on a previous similar study in South Africa. All participants who met the criteria were recruited until the sample size was attained. Data was collected through one-on-one interviews with participants (with or without their guardian) who consented to the study. The modified socio-demographic questionnaire was first administered to all participants after which they were diagnosed using the Kiddie Schedule of Affective Disorders and Schizophrenia (KSADS DSM 5) supplements based on their primary or main symptoms or their working diagnosis (for those diagnosed by psychiatrists). Those who screened positive for substance use on the socio-demographic questionnaire were administered the substance use supplements of the KSADS DSM 5 version and diagnosed according to severity (mild, moderate, severe). Each participant also gave their subjective quality of life on the WHOQOL-BREF which was administered and gave ratings of 1-5 across four main domains, and a score for overall quality of life and overall perception of health. The data collected was managed and analyzed using the Statistical Package for Social Sciences (SPSS) version 25. Data collected was cleaned and summarized in tables, charts and percentages. The Chi-squared test was used to test association between categorical variables. Logistic regression analysis was used to determine independent factors predicting substance use. The student t-test was used to find the association between substance use and quality of life. RESULTS: Comorbid substance use rate of 25.3% was recorded among young people with mental disorders; 23.5% had mild to severe forms of Substance Use Disorders (SUDs) of which 67% of users had a severe form of SUD. Onset of substance use was predominantly between 15-19 years. Cannabis, alcohol and opioids were the most frequently used substances. Topmost reasons users gave for their use was to fit in with peers, for pleasure and to provide relief from stress and mental problems. Substance use was most common in those with Schizophrenia and other psychotic disorders, bipolar disorders, depression and anxiety disorders. Being male and aged 15-19years were significantly associated with substance use (p<0.05). Other factors such as having no religious affiliation (p=0.036), dislike for family/family dissatisfaction (p=0.001), being in a large class of more than 100 (p=0.011) and perceived poor academic performance (p=0.012) had significant associations with substance use, whilst difficulty with teachers maintained a borderline significance (p=0.046) with substance use. Participants with comorbid substance use had lower scores on the WHOQOL-BREF in all domains except the physical domain; however significantly lower scores among users compared to non-users were observed in the environmental domain (p=0.005), overall quality of life (0.001) and overall perception of health (0.024). CONCLUSION: This study found that substance use is common amongst the young people of Ghana and poses a challenge on the mental health as well as the quality of life of users. Substance use disorders were found to have high comorbid rates with other mental disorders, though often the former is not detected and managed. Further findings from this study revealed that the family, school and community environment play a major role in substance use amongst the youth and preventive interventions need to focus on these areas and not just the individual. Preventive interventions and early identification and management of substance use disorders in young people could help reduce possible mental health problems and rate of mental disorders due to the high risk associated with the use. Education in schools, community centres, media and religious bodies to alert the youth on the implications of substance use on their quality of life and their mental health need to be aggressive and unabated.