Prevalence and Sociodemographic Characteristics Associated With Depression and Substance Use Disorders Among Medical Officer Interns in Kenya

Abstract

Medical officer interns frequently develop psychological distress in their line of duty due to their uniquely demanding nature of work thus exposing them to a higher risk of developing disorders such as depression and substance use disorders. Several studies have noted that failing to recognise the dual diagnosis of substance use disorder and depression can result in the chronicity of the illness. Health care workers are at a high risk of succumbing to mental health conditions, however, there is scanty macro level data on mental health by profession, specifically on medical officer interns. There is limited data on depression and substance use disorders among medical officer interns, which can serve as a barrier to developing solutions to the problem. This study will serve as a starting point and aid decision makers in developing effective solutions. Objectives The main objective of the study was to determine the prevalence and sociodemographic characteristics associated with depression and substance use disorders and the association between depression and substance use disorders among medical officer interns in Kenya. Methodology A descriptive cross-sectional study was employed. This was an online study targeting 223 medical officer interns in Kenya. A researcher developed questionnaire was used to collect socio-demographic characteristics of the participants. The Patient Health Questionnaire-9 (PHQ-9) was used to evaluate depression symptoms and Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was used to establish substance use disorders. Data Analysis Data analysis was conducted using STATA version 17. Frequency distributions, measures of central tendency and measures of dispersion were used to summarise data. Summary statistics were described in graphs and tables. PHQ-9 and ASSIST were averaged and converted to risk level. Risk levels were reported in frequency tables and charts/graphs with corresponding 95% confidence intervals (CI). Relationships between depression and substance use disorders, with socio-demographic characteristics, and association between depression and substance use disorders were assessed using independent sample t-test and Chi square test of significance. Statistical significance was reported for all bivariate associations. All variables found to be confounders in the bivariate analysis were included in the multivariate analysis using logistic regression model. Results were deemed significant when p-values <0.05 were obtained, and 95% CI reported. Results Out of the 223 sampled respondents, 96% (214 of 223) successfully completed the survey. Of the 214, majority were female (50.9%), aged 25-29 years (83.6%), never married (73.8%), had no children (77.6%), were Christians (82.7%), had no chronic illness (81%), worked in a public health facility (70.1%), and worked at least 40 hours per week (79.4%). Most respondents (55.6%) reported medium stress levels at work, majority (38.3%) reported being satisfied with the social support they receive at work, and nearly half (49.5%) expressed neutral job satisfaction. About two-thirds (66%) of the medical officer interns screened positive for depression (PHQ-9>5). The correlation between depression and job stress levels was found to be significant in bivariate analysis (p -value =0.03). Lifetime substance use rate was highest for alcohol (65%), cannabis (41.6%), and tobacco

(34.1%). Past-three months substance use rate was highest for alcohol (77.6%), amphetamine-like stimulants (67.3%), and cannabis (48.1%). Over a fifth (21.5%) of the medical officer interns were found to be high risk due to alcohol use; while 7.4% of them were found to be at high risk because of tobacco use. Despite these findings, the analyses did not show statistically significant associations between depression and substance use disorders, though trends suggested that depressed interns might be more inclined towards higher-risk substance use. Conclusion This study has shown that depression is high among medical officer interns in Kenya. Additionally, the findings indicate a relatively high prevalence of lifetime and previous 3-month substance use among this population compared to the reported national prevalence. The high prevalence of lifetime tobacco use may be influenced by the use of modern substance products such as vape and shisha. Although the study found no statistically significant association between depression and substance use disorders, the observed trends suggest that depressed interns may be more inclined toward higher-risk substance use. These results highlight the mental health challenges faced by medical officer interns, emphasising the need for support of this population to ensure their well-being and enhance the quality of healthcare services in Kenya.