Abstract
BackgroundMental disorders and substance use disorders (SUD) commonly occur together, impacting healthcare outcomes. The diagnosis of substance use is often inadequate when comorbidity is present. It is vital to understand the prevalence of substance use amongst psychiatric patients to inform both clinical practice and service development in South Africa.AimTo ascertain the prevalence and clinical correlates of SUD amongst acute psychiatric inpatients.SettingThe setting for this study was Helen Joseph Hospital acute psychiatric ward.MethodsA cross-sectional study was conducted whereby consecutively admitted patients were invited to participate in a structured clinical interview utilising the alcohol use disorders identification test (AUDIT) and drug use disorders identification test (DUDIT) questionnaires. Statistical comparisons were made between those with and without SUD.ResultsOf 150 participants, 100 (67%) were identified with a SUD. Those with SUD were younger (p = 0.0010), more often male (p = 0.012), less likely to have a disability grant (p = 0.015) and more likely to be brought to hospital by police, ambulance or self than by a family member (p = 0.025). Almost half of people with bipolar disorder (47.3%) and schizophrenia (41.4%) had comorbid SUD. Twenty-three (15%) participants identified with SUD on questionnaire had been missed clinically. Only two participants were referred for inpatient substance rehabilitation on discharge.ConclusionSubstance use disorders are highly prevalent amongst psychiatric inpatients. The AUDIT and DUDIT are potentially useful screening tools in routine clinical practice. Greater collaboration between psychiatric and substance rehabilitation services is recommended.
Highlights
Mental illness and substance use disorders (SUD) are estimated to affect 16% of the world’s population[1] and account for almost 19% of the global burden of disease because of years lived with disability
Whilst the SUD group was more likely to be brought to hospital by police or ambulance, there was no increased rate of aggression, psychosis or mania, which are conditions that could result in a need for police or ambulance escort
Notwithstanding the limitations, our study adds to the growing body of evidence of a high prevalence of SUD amongst patients admitted to psychiatric units in South Africa, young men
Summary
Mental illness and substance use disorders (SUD) are estimated to affect 16% of the world’s population[1] and account for almost 19% of the global burden of disease because of years lived with disability. They confer an indirect impact on mortality, which suggests a greater burden than what prevalence rates indicate.[1] Recognising the need to address these conditions, the United Nations has included them in the Sustainable Development[2] Goals, with health target 3.4: ‘by 2030, reduce by one-third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being’; and health target 3.5: ‘strengthen the prevention and treatment of substance use, including narcotic drug abuse and harmful use of alcohol’.2.
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Schedule a callMore From: The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa
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