Prevalence Of Psychiatric Co-morbidity In Patients Admitted In Five Drug rehabilitation Centers In Kenya

Abstract

INTRODUCTION: Many persons with alcohol and substance use disorders often suffer simultaneously from a mental illness. Co-morbid psychiatry condition if not addressed do complicate and frustrate the management of substance abuse disorders. Many studies have been done across the world in regard to dual diagnosis showing a high rate of co-occurrence psychiatric illnesses and substance use disorders. Little work, however, has been done in Kenya specifically to investigate psychiatric co morbidity in patients on treatment for substance use. OBJECTIVES: To determine psychiatric co morbidity, the type of substance of abuse and the socio-demographic characteristics in patients admitted in drug rehabilitation centres in Kenya. DESIGN: A cross-sectional descriptive study using in patients in the drug rehabilitation centers who fulfilled the inclusion criteria. SETTING: The study was carried out at the Asumbi rehabilitation centers, Jorgs Ark rehabilitation centre, Red hill rehabilitation centre, Script Resource rehabilitation centre and Psycaca rehabilitation centre, all located in various part of Kenya. METHODS: The study sample comprised 234 inpatients at the drug rehabilitation centers who met the inclusion criteria. They were interviewed using a researcher designed social demographic questionnaire, the ASSIST to collect information on drug use and DSM-IVTR psychiatric co morbid diagnosis assessed with the SCID. Descriptive and inferential analysis was done using the Statistical Package for Social Sciences (SPSS) version 12 and the results presented in narratives, tables and charts. RESULTS: The 234 participants were aged between 18 and 65 years, mean age being 31 years. Two hundred and one (85.9%) were male and majority were single '(52.6%). Fifty eight point six percent had attained tertiary level of formal education with the sample being similarly distributed across different occupational categories with the lowest occupation being informal employment (15%) and highest category comprising 22% in business activity while 22% were unemployed. At least 80% were Christians and only 6.8% were Muslims. Onset of drug use for the majority was between age 10-18years (51.7%) and 59% reported family history of drug abuse while 20.1 % had family history of mental illness, Twenty five percent had previously undergone rehabilitation while 22.2% had been admitted in a psychiatric hospital for treatment. The most commonly used substance was alcohol. Eighty percent of patients had ever used alcohol at one point in their life, followed by tobacco (62%), cannabis (43%), amphetamine type stimulants (29%) and inhalants were the least used by 2%. The commonest drug use disorder in the current admission was alcohol dependence (74.4%), followed by cannabis dependence (32.1 %), nicotine dependence (18.4%) and opiod dependence (8.2%). Forty one percent reported having problems related to at least two different drugs during the. current admission. The study population had a psychiatric co-morbidity prevalence rate of 56% with depression being the commonest (20.1 %) followed by anxiety disorders (19.7%). Among those with anxiety disorders, generalized anxiety disorder was found among 5.9%, social phobia 5.5%, specific phobia 3.8%, PTSD 2.6%, OCD and agoraphobia each at 0.8%. Schizophrenia was found in 7.3%, dysthymia in 5.1%, manic episodes 4.7% while adjustment disorders occured in 4.2%. There was a statistically significant association (p<O.05) between psychiatric co morbidity and level of education (p=0.015), number of drugs abused (p=0.01), family history of mental illness (p=0.004), previous admission in a rehabilitation centre (p=O.O17). There was no statistical significant association (p>O.05) between psychiatric co morbidity and sex/gender, age, marital status, religion and family history of drug abuse. There was a statistically significant association (p<O.05) between alcohol dependence and dysthymia (p=O.04), sleeping pill abuse and depressive illness (p=O.006), as well as cannabis and schizophrenia (p=0.01). CONCLUSIONS: There is a high prevalence (56%) of psychiatric co morbidity in patients admitted in drug rehabilitation centers in Kenya, the most common co-morbidities being depression and anxiety disorders. This coupled with low detection rate could have an important impact on the quality of treatment offered and treatment outcome. Major determinants of psychiatric co morbidity were found to include the number of drugs abused, family history of mental 'illness and previous history of admission in a rehabilitation center. RECOMMENDATIONS: Management of patients with drug use disorder should include detection and treatment of co morbid psychiatric disorders and hence staff members working in rehabilitation urgently need to be trained in this area. Integration of psychiatric and rehabilitation services will ensure proper and wholesome management other than relying on referral systems as this creates a window for loss of proper follow up.