ALCOHOL USE AND MENTAL HEALTH IN GHANA
Introduction: Previous research has documented an increase in alcohol and mental ill health-related morbidity and mortality globally. They also suggest a positive association between alcohol use and mental disorders in high and limited income countries, which has implications for future morbidity and mortality trends particularly in limited income countries. Despite these, panel and mixed methods studies, which would help to provide a holistic account of alcohol use and mental health and produce stronger evidence to inform interventions are lacking. This thesis therefore sought to examine the association between alcohol use and mental health among adults in Ghana. Methodology: Qualitative and quantitative data were combined. The quantitative data were used to examine associations between alcohol use and depression in a subsample of individuals interviewed in Wave 1 and followed up in Wave 2 of the nationally representative World Health Organization’s Study on Global Ageing and Adult Health
(SAGE) Ghana survey. Among the 1499 participants of which 51% were males with mean age of 48.2±13.0 years in Wave 1, 12-month self-reported depression was assessed using DSM-IV diagnostic criteria yielding a composite outcome variable of counts of depressive symptoms. The categorical alcohol use measure comprised of lifetime abstinence, former use (alcohol not consumed 12 months prior to survey), moderate use (≤14 standard drinks
for men, ≤7 standard drinks for women) and hazardous use (≥15 standard drinks for men and ≥8 standard drinks for women). Daily counts of standard drinks of alcohol was the second measure of alcohol use. Data were analysed separately for men and women using cross-sectional, panel descriptive statistics, and Poisson multivariate panel regression models with random effects and robust variance specifications. The qualitative data were used to explore community level understandings of alcohol consumption and mental health.
The data comprised of transcripts from 30 focus group discussions (FGDs) on alcohol use and mental health from five communities in five regions in Ghana. Transcripts were analysed using thematic network analysis. The ages of FGD participants ranged from 20 to 80 years.
Results: Descriptive statistics showed a 39.5% increase in number of depressive symptoms in the total sample with women reporting more symptoms compared to men over time. Although there was a decline in alcohol consumption among men and women over time, alcohol initiation, use (moderate or heavy use) and discontinuation (former use) was higher among the men than women. Cross-sectional multivariate results showed male former, moderate and heavy drinkers and female heavy drinkers having higher counts of depressive symptoms in Wave 1.
Panel analysis, which aimed to test bidirectional associations, showed a unidirectional positive relationship between alcohol use and depression after adjusting for both timevariant and invariant confounding variables. Focus Group Discussions (FGD) of participants’ understandings of causes of mental health problems and alcohol consumption bordered on notions of both normal (biological) and abnormal (spiritual) causation. Participants indicated a bidirectional relationship between alcohol use and mental health. Their accounts of subpopulations such as females, persons living with chronic conditions and individuals undergoing stressful life events being predisposed to depression corroborated cross-sectional and longitudinal quantitative findings on depression. Local terms were used to define and describe mental illness and consequences of mental ill health as well as coping strategies adopted in the various communities were indicated.
Participants described the socio-cultural context of alcohol use in their communities revealing that alcohol in contemporary times still formed part of social and religious activities in their communities. Further, they explained the causes and outcomes of alcohol consumption.
Conclusions: Quantitative results showed an increased prevalence of depression particularly among females, heavy alcohol use among males, as well as both short term and long-term associations between alcohol use and depression therefore requiring increased gender-specific interventions on alcohol use and depression. In addition, qualitative results depicted community members holding dual notions of mental illness causation different from biomedicine, which in turn influenced their coping strategies and health-seeking behaviour. These findings necessitate increased policy interventions on the adoption of healthy lifestyles, enactment and enforcement of regulations on alcohol distribution, sale and use and collaborations between orthodox and traditional medicine to meet the needs of
persons with poor mental health.
ALCOHOL USE AND MENTAL HEALTH IN GHANA