Prevalence of Mental Health Disorders and Predictors of Substance Use Disorders among Hospitalized Patients at the Sierra Leone Psychiatric Teaching Hospital, Freetown, Sierra Leone, 2020-2023

Introduction: Sierra Leone has one of the highest rates of mental health disorders (MHDs) in Africa, affecting an estimated 15% of the population. The 1991-2002 civil war, 2014/2015 Ebola outbreak, 2017 mudslide, and COVID-19 pandemic have exacerbated the burden of MHDs in Sierra Leone. Despite this, limited data exists on the burden and predictors of MHDs, particularly substance use disorders (SUDs). This study aimed to determine the burden of MHDs and predictors of SUDs among hospitalized patients at the Sierra Leone Psychiatry Teaching Hospital (SLPTH). Methods: A retrospective cross-sectional hospital-based study was conducted in June 2024, analyzing MHD cases admitted from January 1, 2020, to December 31, 2023. MHDs were defined as clinically significant disturbance in cognition, emotional regulation, or behavior. Data on socio-demographic characteristics, clinical diagnoses, and treatment outcomes were extracted from digital hospital records. Adjusted odds ratios (AOR) with 95% confidence intervals (CIs) were calculated using STATA version 16.0 to identify predictors of SUDs. Results: Of 3,584 admissions, 3,241 (90.4%) with complete variables were included. The mean patient age was 29 years (SD± 9.9), with 77.9% (n=2,525) aged 14-35 years. Males comprised 82.9% (n=2,687), and 78.0% (n=2,526) resided in the Western Area Urban District. Annual admissions increased from 19.8% (n=642) in 2020 to 36.5% (n=1,183) in 2023. Of the 3,241 patients, SUDs accounted for 1,966 (60.7%), psychosis 804 (24.8%), bipolar disorder 293 (9.0%), depression 109 (3.4%), epilepsy 12 (0.4%), and other conditions 57 (1.7%). Among SUD cases, inhalation was the most common route (69%), followed by intravenous (28%). The average hospital stay was 45 days (range: 18-80). Predictors of SUDs included age 14-35 years (AOR: 2.5, 95% CI: 2.04-3.06), male gender (AOR: 2.50, 95% CI: 1.85-2.94), unmarried status (AOR: 1.43, 95% CI: 1.10-2.00), and unemployment (AOR: 1.72, 95% CI: 1.37-2.13). Conclusion: The burden of MHDs is substantial, with SUDs comprising over half of cases. Younger age, male gender, unmarried status, and unemployment are significant predictors of SUDs. The increasing number of cases, particularly among the most productive age group, highlights an urgent need for targeted interventions, including youth-focused mental health education, gender-sensitive strategies, and integrated mental health and economic empowerment programs.