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Prevalence and clinical correlates of substance use disorders in South African Xhosa patients with schizophrenia

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Abstract

Purpose

To determine the prevalence of substance use disorders (SUDs) in patients with schizophrenia in a sample from South Africa and compare the clinical and demographic correlates in those with and without co-occurring SUDs.

Methods

Patients with schizophrenia were interviewed using the Xhosa version SCID-I for DSM-IV. We used logistic regression to determine the predictors of SUDs.

Results

In the total sample of 1420 participants, SUDs occurred in 47.8%, with the most prevalent SUD being cannabis use disorders (39.6%), followed by alcohol (20.5%), methaqualone (6.2%), methamphetamine (4.8%) and other SUDs (cocaine, ecstasy, opioids, 0.6%). Polydrug use occurred in 40%, abuse occurred in 13.5%, and 39.6% had at least one substance dependence diagnosis. Significant predictors of any SUD were younger age (41–55 vs. 21–30: OR = 0.7, 95% CI = 0.5–0.9), male sex (OR = 8.6, 95% CI = 5.1–14.6), inpatient status (OR = 1.7, 95% CI = 1.3–2.1), post-traumatic stress symptoms (OR = 4.6, 95% CI = 1.6–13.3), legal (OR = 3.4, 95% CI = 2.0–5.5) and economic problems (OR = 1.4, 95% CI = 1.0–2.0). Methamphetamine use disorders occurred significantly less often in the Eastern compared to the Western Cape provinces. Inpatient status and higher levels of prior admissions were significantly associated with cannabis and methamphetamine use disorders. Post-traumatic stress symptoms were significantly associated with alcohol use disorders. Anxiety disorders were associated with other SUDs.

Conclusion

SUDs occurred in almost half of the sample. It is important for clinicians to identify the presence of SUDs as their presence is associated with characteristics, such as male sex, younger age, inpatient status, more prior hospitalisations, legal and economic problems, PTSD symptoms and anxiety.

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Acknowledgements

We wish to acknowledge the support of Dr Adele Pretorius, project manager of the SAX study as well as the Cape Town and New York based SAX data teams, notably Megan Malan, Bronwyn Malagas, Howard Andrews and Kim Fader for their assistance with data management, quality control and access. We would like to thank Dr. Adam Baldinger, Prof. Mo Nagdee and Prof. Zuki Zingela for their support and groundwork in the Western and Eastern Cape SAX study sites.

Funding

The SAX study received funding from the National Institute of Mental Health (NIMH: Grant No. 5UO1MH096754) and is a member of the Human Heredity and Health in Africa Consortium (H3 Africa) (https://www.h3africa.org/). SM has received support from the Harry Crossley and National Research Foundation of South Africa’s post-doctoral research fellowships, a Claude Leon Foundation early career research award and a seed award from the School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. SM has received funding from the Columbia University Southern African AIDS International Training/Research Program.

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Authors and Affiliations

  1. Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

    Henk Temmingh, Sumaya Mall, Megan Campbell, Goodman Sibeko & Dan J. Stein

  2. Stellenbosch University/University of Cape Town, South African MRC Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa

    Dan J. Stein

  3. Mailman School of Public Health, Columbia University, New York, USA

    Ezra Susser

  4. New York State Psychiatric Institute, New York, USA

    Ezra Susser

  5. School of Public Health, Division of Epidemiology and Biostatistics, University of Witwatersrand, Johannesburg, South Africa

    Sumaya Mall

  6. Neuroscience Institute of South Africa, Cape Town, South Africa

    Dan J. Stein

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  1. Henk Temmingh
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  2. Ezra Susser
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  4. Megan Campbell
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  6. Dan J. Stein
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Contributions

HT conceptualised the study, analysed the data and wrote the first and subsequent drafts. All other authors contributed to the first and subsequent drafts.

Corresponding author

Correspondence to Henk Temmingh.

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Conflict of interest

HT, ES, SM, MC, and GS and have not received any financial or commercial related compensation that can be considered to represent a conflict of interest. DJS is supported by the Medical Research Council of South Africa and has received research grants and/or consultancy honoraria from: Abbott, Astrazeneca, Eli-Lilly, GlaxoSmithKline, Jazz Pharmaceuticals, Johnson & Johnson, Lundbeck, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, Sun, Takeda, Tikvah, and Wyeth. DJS is also on the scientific advisory board of the TLC Foundation for Body-Focused Repetitive Behaviours, the Anxiety and Depression Association of America (ADAA), and the South African Depression and Anxiety Support Group. SM has received incentive funding for rated researchers from the South African National Research Foundation (NRF) (Grant No. 119375).

Ethics approval

The Human Ethics Committee of the Faculty of Health Sciences, University of Cape Town, South Africa granted approval to the study (HREC No. 049/2013). In addition, ethical approval was also obtained from the Walter Sisulu University Research Ethics and Biosafety Committee, The Rhodes University Ethical Standards Committee, The Columbia University Internal Review Board and the University of Washington Institutional Review Board. To ensure that participants understood and had sufficient decisional capacity to understand the nature of the study, the University of California, San Diego Brief Assessment of Capacity to Consent (UBACC) questionnaire [30] was administered to all participants.

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Temmingh, H., Susser, E., Mall, S. et al. Prevalence and clinical correlates of substance use disorders in South African Xhosa patients with schizophrenia. Soc Psychiatry Psychiatr Epidemiol 56, 695–706 (2021). https://doi.org/10.1007/s00127-020-01942-5

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