Co-occurring mental and substance use disorders in South African men: A Community survey

Background: The co-occurrence of mental and substance use disorders (SUDs) poses major public health challenges. Understanding their prevalence and risk factors is critical for developing targeted interventions. Aim: To estimate the prevalence of substance use and risk of co-occurring common mental disorders in three South African provinces (Western Cape, Eastern Cape [EC] and North West [NW]). Setting: The study was conducted in three provinces in South Africa (Madibeng district in NW province, King Sabata Dalindyebo [KSD] in the EC and Khayelitsha in the Western Cape). Methods: A stratified multistage random household survey was conducted using the 9-item Patient Health Questionnaire (PHQ-9), 7-item Generalised Anxiety Disorder Assessment (GAD-7) and Primary Care PTSD Screen (PC-PTSD-5) to assess mental disorders. Alcohol and substance use were measured with the Alcohol Use Disorders Identification Test (AUDIT) and Drug Use Disorders Identification Test (DUDIT). Weighted prevalence estimates were calculated, and Rao–Scott adjusted Chi-square tests accounted for the complex survey design. Unweighted Chi-square tests explored demographic associations. Results: Of 1597 participants, 64.9% screened positive for at least one mental disorder. The prevalence of alcohol use disorder (AUD) was 31.9% and SUD 7.4%. Co-occurrence of AUD and SUD was 6.3%. Alcohol use disorder was significantly associated with depression, anxiety and posttraumatic stress disorder (PTSD), whereas SUD (excluding alcohol) showed no significant associations. Conclusion: Psychiatric comorbidity was partly associated with substance use. The findings highlight a substantial burden of co-occurring alcohol use and mental disorders among South African men, underscoring the need for integrated, trauma-informed primary healthcare services. Contribution: The study provides population-based evidence to inform service delivery and policy for under-resourced settings.