Substance use disorders among adult in-patients at the mental health unit, Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Background: Substance use disorders are often under-diagnosed among psychiatric in-patients, yet are frequent and are associated with adverse outcomes. Additionally, the provision of integrated management which is the evidence based approach for co-occurring disorders, remains the exception in most mental health treatment settings. Evidence relating to the prevalence and associated factors of substance use disorders has been shown to be beneficial in facilitating diagnosis and in planning for management of these disorders. Little is known as regards this information in our setting. Objectives: This study aimed to determine the 12-month prevalence of substance use disorders and to establish the association between socio-demographic and clinical factors and these disorders among adult patients admitted at the Mental Health Unit, MTRH. Methods: Design: The study was a descriptive cross-sectional one and employed the Mini International Neuropsychiatric Interview Version 7.0 for DSM-5 in generating substance use disorder and other mental disorder diagnoses. Setting: Mental Health Unit, Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya. Subjects: One hundred and thirty one consenting adult patients consecutively discharged from the unit between March 2015 and February 2016 were interviewed by the investigator. Data analysis: Descriptive statistics were used to explore the data while inferential statistics were used to assess associations. Results: The mean age for the respondents was 34.5 years (SD=12.20 years). The most frequent mental disorder diagnoses were bipolar disorder (44.3%) and psychotic disorder (42%). Close to a half (49.6%) of the participants had at least one substance use disorder diagnosis. Alcohol (40.5%), tobacco (30.5%) and cannabis (17.6%) use disorders were the most common. Being male (OR, 5.13, 95% CI, 2-13.6, p=0.001), the number of suicide attempts in the preceding 12-month period (OR, 2.19, 95% CI, 1.11- 4.32, p=0.020) and having a higher level of education (OR, 3.41, 95% CI, 1.08-10.81, p=0.040) were associated with the diagnosis of a substance use disorder. Cannabis use disorder was associated with the mental disorder diagnoses of suicide behavior disorder (p=0.001); anxiety disorder (p=0.002); and antisocial personality disorder (p=0.024). Conclusion: A large proportion of patients admitted to the Mental Health Unit, MTRH had a 12- month substance use disorder particularly alcohol, tobacco and cannabis use disorder. Being male, the number of suicide attempts in the preceding 12-month period and having a higher level of education were associated with the diagnosis of a substance use disorder. Cannabis use disorder was associated with the mental disorder diagnoses of suicide behavior disorder, anxiety disorder and antisocial personality disorder. Recommendations: Based on the findings, we recommend the routine screening for substance use disorders for patients admitted at the unit in order to enhance diagnosis. The results also justify the need for an integrated management program at the unit and are applicable in the formulation and planning of such an initiative.