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The prevalence and clinical correlates of substance use disorders in patients with psychotic disorders from an Upper-Middle-Income Country

ABSTRACT: Background Substance use disorders (SUDs) occur frequently in patients with psychotic disorders and have been associated with various demographic and clinical correlates. There is an absence of research on the prevalence and clinical correlates of SUDs in psychotic disorders in low-and-middle-income countries (LMICs). Aim We aimed to determine the prevalence and correlates of SUDs in psychotic disorders. Setting Patients attending a large secondary-level psychiatric hospital in Cape Town South Africa. Methods We used the Structured Clinical Interview for DSM-IV (SCID-I) to determine psychiatric and substance use diagnoses, depressive, anxiety, obsessive-compulsive and post-traumatic symptoms. We used logistic regression models to determine significant predictors of SUDs. Results In total sample (N = 248), 55.6% of participants had any SUD, 34.3% had cannabis use disorders, 30.6% alcohol use disorders, 27.4% methamphetamine use disorders, 10.4% methaqualone use disorders and 4.8% had other SUDs. There were significant associations with male sex for most SUDs, with younger age and Coloured ethnicity for methamphetamine use disorders, and with lower educational attainment for cannabis use disorders. Anxiety symptoms and suicide attempts were significantly associated with alcohol use disorders; a diagnosis of a substance induced psychosis with cannabis and methamphetamine use disorders. Across most SUDs legal problems and criminal involvement were significantly increased. Conclusion This study found a high prevalence and wide distribution of SUDs in patients with psychotic disorders, consistent with previous work from high income countries. Given clinical correlates, in individuals with psychotic disorders and SUDs it is important to assess anxiety symptoms, suicidality and criminal involvement.

SUBMITTER: Temmingh H

PROVIDER: S-EPMC7433243 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Project description:IntroductionSubstance use disorder (SUD) and problematic substance use are global public health concerns with significant multifaceted implications for physical health and psychosocial well-being. The impact of SUD extends beyond the individual to their family while imposing financial and social burdens on the community. Though family-centred interventions have shown promise in addressing SUD, their implementation and impact in low-income and middle-income countries (LMICs) remain underexplored.Methods and analysisPer Joanna Briggs Institute's scoping review protocol, a systematic search strategy was employed across OVID Medline, Embase, PsycINFO, Web of Science-Core Collection, Global Health and CINAHL from 22 February 2024 to 26 February 2024, to identify relevant studies focused on family-centred interventions for SUD in LMIC, devoid of publication time and language constraints. Two independent reviewers will screen the titles, abstracts and full texts, with discrepancies resolved through discussion or third-party reviews. The extracted data charted in a structured form will be visualised by diagrams or tables, focusing on the feasibility and impact of family-centred interventions for SUD in LMIC. For qualitative studies, the findings will be synthesised and presented in thematic clusters, and for studies that report quantitative outcomes, specific health, including SUD and psychosocial, outcomes will be synthesised, aligning with the Population, Concept and Context framework.Ethics and disseminationThese data on substance use, psychosocial outcomes and perspectives of individuals with SUD and their families will be presented in narrative format, highlighting patterns and identifying research gaps. This review aims to synthesise the existing evidence on family-centred interventions for improving substance use and/or psychosocial outcomes in individuals with SUD in LMIC and seeks to inform future policy and practice. Ethics approval is not required for this scoping review, and modifications to the review protocol will be disclosed. Findings will be disseminated through conference proceedings and peer-reviewed publication.

Project description:BackgroundAlthough more than two thirds of the world's incarcerated individuals are based in low-income and middle-income countries (LMICs), the burden of psychiatric disorders in this population is not known. This review provides estimates for the prevalence of severe mental illness and substance use disorders in incarcerated individuals in LMICs.MethodsFor this systematic review and meta-analysis, we searched 17 electronic databases to identify prevalence studies of psychiatric disorders in prison populations in LMICs, published between January, 1987, and May, 2018. We included representative studies from general prison samples, providing information about four major psychiatric diagnoses: psychosis, major depression, alcohol use disorders, and drug use disorders. We pooled data from studies using random-effects meta-analyses and assessed the sources of heterogeneity by meta-regression. We extracted general population estimates from the Global Burden of Diseases 2016 database to calculate comparative prevalence ratios. This study is registered with PROSPERO, number CRD42015020905.FindingsWe identified 23 publications reporting prevalence estimates of severe mental illness and substance use disorders for 14 527 prisoners from 13 LMICs. In this population, the estimated pooled 1 year prevalence rates for psychosis were 6·2% (95% CI 4·0-8·6), 16·0% (11·7-20·8) for major depression, 3·8% (1·2-7·6) for alcohol use disorders, and 5·1% (2·9-7·8) for drug use disorders. We noted increased prevalence at prison intake and geographic variations for substance use disorders. For alcohol use disorders, prevalence was higher in the southeast Asian region than in the eastern Mediterranean region; and drug use disorders were more prevalent in the eastern Mediterranean region than in Europe. Prevalence ratios indicated substantially higher rates of severe mental illness and substance use disorders among prisoners than in the general population (the prevalence of non-affective psychosis was on average 16 times higher, major depression and illicit drug use disorder prevalence were both six times higher, and prevalence of alcohol use disorders was double that of the general population).InterpretationThe prevalence of major psychiatric disorders is high in prisoners in LMIC compared with general populations. As these findings are likely to reflect unmet needs, the development of scalable interventions should be a public health priority in resource-poor settings.FundingCONICYT of the Chilean government and the Wellcome Trust.

Project description:The increasing prevalence and magnitude of harmful effects of substance use disorders (SUDs) in low- and middle-income countries (LMICs) make it imperative to embrace interventions which are acceptable, feasible, and effective in reducing this burden. Globally, the use of telehealth interventions is increasingly being explored as possible effective approaches in the management of SUDs. Using a scoping review of literature, this article summarizes and evaluates evidence for the acceptability, feasibility, and effectiveness of telehealth interventions for SUDs in LMICs. Searches were conducted in five bibliographic databases: PubMed, Psych INFO, Web of Science, Cumulative Index of Nursing and Allied Professionals and the Cochrane database of systematic review. Studies from LMICs which described a telehealth modality, identified at least one psychoactive substance use among participants, and methods that either compared outcomes using pre- and post-intervention data, treatment versus comparison groups, post-intervention data, behavioral or health outcome, and outcome of either acceptability, feasibility, and/or effectiveness were included. Data is presented in a narrative summary using charts, graphs, and tables. The search produced 39 articles across 14 countries which fulfilled our eligibility criteria over a period of 10 years (2010 to 2020). Research on this topic increased remarkably in the latter five years with the highest number of studies in 2019. The identified studies were heterogeneous in their methods and various telecommunication modalities were used to evaluate substance use disorder, with cigarette smoking as the most assessed. Most studies used quantitative methods. The highest number of included studies were from China and Brazil, and only two studies from Africa assessed telehealth interventions for SUDs. There has been an increasingly significant body of literature which evaluates telehealth interventions for SUDs in LMICs. Overall, telehealth interventions showed promising acceptability, feasibility, and effectiveness for SUDs. This article identifies gaps and strengths and suggests directions for future research.

Project description:BackgroundViolence against women by an intimate partner (DV) is a serious public health and human rights issue. Attitudes justifying DV strongly predict its perpetration and victimisation. This paper presents gendered ecological analyses of the societal acceptance of DV in 49 low- and middle-income countries (LMICs) across geographical regions.Methods and findingsWe utilised data from 49 Demographic and Health Surveys conducted between 2005 and 2017, United Nations Statistics and topic-specific meta-databases. DV acceptance was measured as the justification of 'wife-beating' in at least one of five circumstances, and by the summative scale. Stepwise multiple linear regression examined country-level social, economic and political empowerment predictors of societal acceptance of DV amongst women, men, and the aggregate gender difference. Women were more likely than men to justify DV in Sub-Saharan Africa and South (east) Asia with societal acceptance of DV being more widespread in these regions compared with Latin America, the Caribbean, Central/West Asia and Europe. Political conflict and limited economic rights for women were associated with higher levels of DV acceptance amongst women and men. Men in more democratic countries were less likely to justify DV. Amongst women, higher national female literacy rates predicted lower levels of justification. There were higher levels of DV acceptance amongst women and a wider aggregate gender difference in countries with a larger representation of women in national parliament.ConclusionJustification of DV is widespread amongst women and men in LMICs with acceptance rates varying across countries and regions. Gender differences in the impact of contextual factors on DV acceptance supports a gendered approach to national-level interventions. Our findings highlight the need for tailored interventions targeting DV acceptance in conflict-impacted societies. The emphasis of inter(national) policies on the 'empowerment' domains of widely-used gender (in)equality indices need to be coupled with strategies tackling discriminatory gender norms.

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The prevalence and clinical correlates of substance use disorders in patients with psychotic disorders from an Upper-Middle-Income Country

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