Prevalence of Substance Use Disorders During the Covid-19 Pandemic: A Cross-Sectional Study in Kanyama Township of Lusaka District, Zambia

Download Article

DOI: 10.21522/TIJPH.2013.11.03.Art010

Authors : Steward Mudenda, Alfred Kasongo, Paul Ravi, Akakandelwa Akakandelwa, Billy Chabalenge, Maisa Kasanga, Lumwanga Kasongo, Michelo Banda, Victor Daka, Webrod Mufwambi

Abstract:

The coronavirus disease (Covid-19) pandemic has caused suffering and pain to mankind leading to many individuals practising self-medication and substance abuse that could elevate substance use disorders (SUDs). This study assessed the impact of Covid-19 on SUDs among Kanyama residents of Lusaka district, Zambia. We conducted a retrospective cross-sectional study using patient files at Kanyama First-Level Hospital from September 2021 to October 2021. Data analysis was done using IBM SPSS version 26.0. Of the 101 participants, 86.1% were male. The study showed that Covid-19 had an impact on SUDs with alcohol (83.2%) being the most abused substance. There was no significant difference in the type of substances abused (p=0.870) and intoxication symptoms (p=0.331) between the pre-Covid and post-Covid groups. There was a significant difference between substance use (p=0.001) and withdrawal symptoms (p=0.002) in both cohorts, with the post-Covid group consuming more substances and experiencing more withdrawal symptoms. Factors that influenced substance abuse included recent unemployment (p<0.001), boredom (p<0.001), overcrowding at home (p<0.001), and gender-based violence (p<0.001) influenced the change in the pattern of substance use. Recreational use was not associated with a change in the pattern of substance abuse (p=0. 667). This study found that the Covid-19 pandemic increased the practices of substance abuse among Kanyama residents, especially those who were unemployed, bored, overcrowded at home and experienced gender-based violence. There is a need to heighten the monitoring and restriction of substance use, especially among adolescents and youths to curb some mental health problems.

Keywords: Covid-19; Pandemic; Self-medication; Substance abuse; substance use disorders; Zambia.

References:

[1] Fournier, A.; Laurent, A.; Lheureux, F.; Ribeiro-Marthoud, M.A.; Ecarnot, F.; Binquet, C.; Quenot, J.P. Impact of the Covid-19 Pandemic on the Mental Health of Professionals in 77 Hospitals in France. PLoS One 2022, 17, e0263666, doi: 10.1371/journal.pone.0263666.

[2] Joaquim, R.M.; Pinto, A.L.C.B.; Guatimosim, R.F.; de Paula, J.J.; Souza Costa, D.; Diaz, A.P.; da Silva, A.G.; Pinheiro, M.I.C.; Serpa, A.L.O.; Miranda, D.M.; et al. Bereavement and Psychological Distress during Covid-19 Pandemics: The Impact of Death Experience on Mental Health. Curr. Res. Behav. Sci. 2021, 2, 100019, doi: 10.1016/j.crbeha.2021.100019.

[3] Dawood, B.; Tomita, A.; Ramlall, S. ‘Unheard,’ ‘Uncared for’ and ‘Unsupported’: The Mental Health Impact of Covid -19 on Healthcare Workers in KwaZulu-Natal Province, South Africa. PLoS One 2022, 17, e0266008, doi: 10.1371/JOURNAL.PONE.0266008.

[4] Mudenda, S.; Chabalenge, B.; Matafwali, S.; Daka, V.; Chileshe, M.; Mufwambi, W.; Mfune, R.L.; Chali, J.; Chomba, M.; Banda, M.; et al. Psychological Impact of Covid-19 on Healthcare Workers in Africa, Associated Factors and Coping Mechanisms: A Systematic Review. Adv. Infect. Dis. 2022, 12, 518–532, doi:10.4236/AID.2022.123038.

[5] Pitlik, S.D. Covid-19 Compared to Other Pandemic Diseases. Rambam Maimonides Med. J. 2020, 11, e0027.

[6] Mudenda, S.; Mukosha, M.; Godman, B.; Fadare, J.O.; Ogunleye, O.O.; Meyer, J.C.; Skosana, P.; Chama, J.; Daka, V.; Matafwali, S.K.; et al. Knowledge, Attitudes, and Acceptance of Covid-19 Vaccines among Secondary School Pupils in Zambia: Implications for Future Educational and Sensitisation Programmes. Vaccines 2022, 10, 2141, doi:10.3390/VACCINES10122141.

[7] Etando, A.; Amu, A.A.; Haque, M.; Schellack, N.; Kurdi, A.; Alrasheedy, A.A.; Timoney, A.; Mwita, J.C.; Rwegerera, G.M.; Patrick, O.; et al. Challenges and Innovations Brought about by the Covid-19 Pandemic Regarding Medical and Pharmacy Education Especially in Africa and Implications for the Future. Healthcare 2021, 9, 1722, doi:10.3390/healthcare9121722.

[8] Kasanga, M.; Mudenda, S.; Gondwe, T.; Chileshe, M.; Solochi, B.; Wu, J. Impact of Covid-19 on Blood Donation and Transfusion Services at Lusaka Provincial Blood Transfusion Centre, Zambia. Pan Afr. Med. J. 2020, 35, 74, doi: 10.11604/pamj.supp.2020.35.2.23975.

[9] Chileshe, M.; Mulenga, D.; Mfune, R.L.; Nyirenda, T.H.; Mwanza, J.; Mukanga, B.; Mudenda, S.; Daka, V. Increased Number of Brought-in-Dead Cases with Covid-19: Is It Due to Poor Health-Seeking Behaviour among the Zambian Population? Pan Afr. Med. J. 2020, 37, 136, doi:10.11604/pamj.2020.37.136.25967.

[10] Opanga, S.A.; Rizvi, N.; Wamaitha, A.; Abebrese Sefah, I.; Godman, B. Availability of Medicines in Community Pharmacy to Manage Patients with Covid-19 in Kenya; Pilot Study and Implications. Sch. Acad. J. Pharm. 2021, 10, 36–42, doi:10.36347/sajp. 2021.v10i03.001.

[11] Lee, A.M.; Wong, J.G.W.S.; McAlonan, G.M.; Cheung, V.; Cheung, C.; Sham, P.C.; Chu, N.M.; Wong, P.C.; Tsang, K.W.T.; Chua, S.E. Stress and Psychological Distress among SARS Survivors 1 Year after the Outbreak. Can. J. Psychiatry 2007, 52, 233–240, doi:10.1177/070674370705200405.

[12] Khalid, I.; Khalid, T.J.; Qabajah, M.R.; Barnard, A.G.; Qushmaq, I.A. Healthcare Workers Emotions, Perceived Stressors and Coping Strategies during a MERS-CoV Outbreak. Clin. Med. Res. 2016, 14, 7–14, doi:10.3121/cmr.2016.1303.

[13] Liu, X.; Kakade, M.; Fuller, C.J.; Fan, B.; Fang, Y.; Kong, J.; Guan, Z.; Wu, P. Depression after Exposure to Stressful Events: Lessons Learned from the Severe Acute Respiratory Syndrome Epidemic. Compr. Psychiatry 2012, 53, 15–23, doi: 10.1016/j.comppsych.2011.02.003.

[14] Wu, P.; Liu, X.; Fang, Y.; Fan, B.; Fuller, C.J.; Guan, Z.; Yao, Z.; Kong, J.; Lu, J.; Litvak, I.J. Alcohol Abuse/Dependence Symptoms among Hospital Employees Exposed to a SARS Outbreak. Alcohol Alcohol. 2008, 43, 706–712, doi:10.1093/alcalc/agn073.

[15] Maunder, R.; Hunter, J.; Vincent, L.; Bennett, J.; Peladeau, N.; Leszcz, M.; Sadavoy, J.; Verhaeghe, L.M.; Steinberg, R.; Mazzulli, T. The Immediate Psychological and Occupational Impact of the 2003 SARS Outbreak in a Teaching Hospital. C. Can. Med. Assoc. J. 2003, 168, 1245–1251.

[16] Maunder, R.G. Was SARS a Mental Health Catastrophe? Gen. Hosp. Psychiatry 2009, 31, 316–317.

[17] Chua, S.E.; Cheung, V.; McAlonan, G.M.; Cheung, C.; Wong, J.W.S.; Cheung, E.P.; Chan, M.T.; Wong, T.K.; Choy, K.M.; Chu, C.M.; et al. Stress and Psychological Impact on SARS Patients during the Outbreak. Can. J. Psychiatry 2004, 49, 385–390, doi:10.1177/070674370404900607.

[18] Jeong, H.; Yim, H.W.; Song, Y.J.; Ki, M.; Min, J.A.; Cho, J.; Chae, J.H. Mental Health Status of People Isolated Due to Middle East Respiratory Syndrome. Epidemiol. Health 2016, 38, e2016048, doi:10.4178/epih. e2016048.

[19] Delanerolle, G.; Zeng, Y.; Shi, J.-Q.; Yeng, X.; Goodison, W.; Shetty, A.; Shetty, S.; Haque, N.; Elliot, K.; Ranaweera, S.; et al. Mental Health Impact of the Middle East Respiratory Syndrome, SARS, and Covid-19: A Comparative Systematic Review and Meta-Analysis. World J. Psychiatry 2022, 12, 739–765, doi:10.5498/wjp. v12.i5.739.

[20] Abramson, A. Substance Use During the Pandemic. Am. Psychol. Assoc. 2021, 52, 22.

[21] Melamed, O.C.; Hauck, T.S.; Buckley, L.; Selby, P.; Mulsant, B.H. Covid-19 and Persons with Substance Use Disorders: Inequities and Mitigation Strategies. Subst. Abus. 2020, 41, 286–291, doi:10.1080/08897077.2020.1784363.

[22] Thiyagarajan, A.; James, T.G.; Marzo, R.R. Psychometric Properties of the 21-Item Depression, Anxiety, and Stress Scale (DASS-21) among Malaysians during Covid-19: A Methodological Study. Humanit. Soc. Sci. Commun. 2022, 9, 220, doi:10.1057/s41599-022-01229-x.

[23] Marzo, R.R.; Aye, S.S.; Naing, T.W.; Kyaw, T.M.; Win, M.T.; Soe, H.H.K.; Soe, M.; Kyaw, Y.W.; Soe, M.M.; Lin, N. Factors Associated with Psychological Distress among Myanmar Residents during Covid-19 Pandemic Crises. J. Public Health Res. 2021, 10, jphr.2021.2279, doi:10.4081/jphr.2021.2279.

[24] Marzo, R.R.; Ismail, Z.; Nu Htay, M.N.; Bahari, R.; Ismail, R.; Villanueva, E.Q.; Singh, A.; Lotfizadeh, M.; Respati, T.; Irasanti, S.N.; et al. Psychological Distress during Pandemic Covid-19 among Adult General Population: Result across 13 Countries. Clin. Epidemiol. Glob. Heal. 2021, 10, 100708, doi: 10.1016/j.cegh.2021.100708.

[25] Marzo, R.R.; Villanueva, E.Q.; Faller, E.M.; Baldonado, A.M. Factors Associated with Psychological Distress among Filipinos during Coronavirus Disease-19 Pandemic Crisis. Open Access Maced. J. Med. Sci. 2020, 8, 309–313, doi:10.3889/oamjms.2020.5146.

[26] RilleraMarzo, R.; Villanueva, E.Q.; Chandra, U.; Htay, M.N.N.; Shrestha, R.; Shrestha, S. Risk Perception, Mental Health Impacts and Coping Strategies during Covid-19 Pandemic among Filipino Healthcare Workers. J. Public Health Res. 2021, 10, jphr.2021.2604, doi:10.4081/jphr.2021.2604.

[27] El-Abasiri, R.A.; Marzo, R.R.; Abdelaziz, H.; Boraii, S.; Abdelaziz, D.H. Evaluating the Psychological Distress of the Coronavirus Disease 2019 Pandemic in Egypt. Eur. J. Mol. Clin. Med. 2020, 7, 1–12.

[28] Htay, M.N.N.; Marzo, R.R.; AlRifai, A.; Kamberi, F.; Radwa Abdullah, E.A.; Nyamache, J.M.; Hlaing, H.A.; Hassanein, M.; Moe, S.; Su, T.T.; et al. Immediate Impact of Covid-19 on Mental Health and Its Associated Factors among Healthcare Workers: A Global Perspective across 31 Countries. J. Glob. Health 2020, 10, 020381, doi:10.7189/jogh.10.020381.

[29] Htay, M.N.N.; Marzo, R.R.; Bahari, R.; AlRifai, A.; Kamberi, F.; El-Abasiri, R.A.; Nyamache, J.M.; Hlaing, H.A.; Hassanein, M.; Moe, S.; et al. How Healthcare Workers Are Coping with Mental Health Challenges during Covid-19 Pandemic? - A Cross-Sectional Multi-Countries Study. Clin. Epidemiol. Glob. Heal. 2021, 11, 100759, doi: 10.1016/j.cegh.2021.100759.

[30] Marzo, R.R.; Singh, A.; Mukti, R.F. A Survey of Psychological Distress among Bangladeshi People during the Covid-19 Pandemic. Clin. Epidemiol. Glob. Heal. 2021, 10, 100693, doi: 10.1016/j.cegh.2020.100693.

[31] Ali, F.; Russell, C.; Nafeh, F.; Rehm, J.; LeBlanc, S.; Elton-Marshall, T. Changes in Substance Supply and Use Characteristics among People Who Use Drugs (PWUD) during the Covid-19 Global Pandemic: A National Qualitative Assessment in Canada. Int. J. Drug Policy 2021, 93, 103237, doi: 10.1016/j.drugpo.2021.103237.

[32] Layman, H.M.; Thorisdottir, I.E.; Halldorsdottir, T.; Sigfusdottir, I.D.; Allegrante, J.P.; Kristjansson, A.L. Substance Use Among Youth During the Covid-19 Pandemic: A Systematic Review. Curr. Psychiatry Rep. 2022, 24, 307–324.

[33] Ornell, F.; Moura, H.F.; Scherer, J.N.; Pechansky, F.; Kessler, F.H.P.; von Diemen, L. The Covid-19 Pandemic and Its Impact on Substance Use: Implications for Prevention and Treatment. Psychiatry Res. 2020, 289, 113096.

[34] Ignaszewski, M.J. The Epidemiology of Drug Abuse. J. Clin. Pharmacol. 2021, 61, S10–S17, doi:10.1002/jcph.1937.

[35] Arble, E.; Manning, D.; Arnetz, B.B.; Arnetz, J.E. Increased Substance Use among Nurses during the Covid-19 Pandemic. Int. J. Environ. Res. Public Health 2023, 20, 2674, doi:10.3390/ijerph20032674.

[36] Ritchie, H.; Arriagada, P.; Roser, M. Opioids, Cocaine, Cannabis and Illicit Drugs Available online: https://ourworldindata.org/illicit-drug-use (accessed on 28 June 2023).

[37] Brooks, S.K.; Webster, R.K.; Smith, L.E.; Woodland, L.; Wessely, S.; Greenberg, N.; Rubin, G.J. The Psychological Impact of Quarantine and How to Reduce It: Rapid Review of the Evidence. Lancet 2020, 395, 912–920.

[38] Venkatesh, A.; Edirappuli, S. Social Distancing in Covid-19: What Are the Mental Health Implications? BMJ 2020, 369, m1379.

[39] Conway, F.N.; Samora, J.; Brinkley, K.; Jeong, H.; Clinton, N.; Claborn, K.R. Impact of Covid-19 among People Who Use Drugs: A Qualitative Study with Harm Reduction Workers and People Who Use Drugs. Harm Reduct. J. 2022, 19, 72, doi:10.1186/s12954-022-00653-1.

[40] Dubey, S.; Biswas, P.; Ghosh, R.; Chatterjee, S.; Dubey, M.J.; Chatterjee, S.; Lahiri, D.; Lavie, C.J. Psychosocial Impact of Covid-19. Diabetes Metab. Syndr. Clin. Res. Rev. 2020, 14, 779–788, doi: 10.1016/j.dsx.2020.05.035.

[41] Alonso, S.; Català, M.; López, D.; Álvarez-Lacalle, E.; Jordan, I.; García-García, J.J.; Fumadó, V.; Muñoz-Almagro, C.; Gratacós, E.; Balanza, N.; et al. Individual Prevention and Containment Measures in Schools in Catalonia, Spain, and Community Transmission of SARS-CoV-2 after School Re-Opening. PLoS One 2022, 17, e0263741, doi: 10.1371/journal.pone.0263741.

[42] Giallonardo, V.; Sampogna, G.; Del Vecchio, V.; Luciano, M.; Albert, U.; Carmassi, C.; Carrà, G.; Cirulli, F.; Dell’Osso, B.; Nanni, M.G.; et al. The Impact of Quarantine and Physical Distancing Following Covid-19 on Mental Health: Study Protocol of a Multicentric Italian Population Trial. Front. Psychiatry 2020, 11, 533, doi:10.3389/fpsyt.2020.00533.

[43] Piret, J.; Boivin, G. Pandemics Throughout History. Front. Microbiol. 2021, 11, 631736.

[44] Harker, N.; Johnson, K.; Erasmus, J.; Myers, B. Covid-19—Impact on Substance Use Treatment Utilization and Provision in South Africa. Subst. Abus. Treat. Prev. Policy 2022, 17, 15, doi:10.1186/s13011-022-00446-6.

[45] Panchal, N.; Kamal, R.; Cox, C.; Garfield, R. The Implications of Covid-19 for Mental Health and Substance Use | KFF Https://Www.Kff.Org/Coronavirus-Covid-19/Issue-Brief/the-Implications-of-Covid-19-for-Mental-Health-and-Substance-Use/ The Implications of Covid-19 for Mental Health and Substance Use. Kaiser Fam. Found. 2021, 1–16, doi:10.1377/hpb20201228.198475/full.

[46] Simulundu, E.; Mupeta, F.; Chanda-Kapata, P.; Saasa, N.; Changula, K.; Muleya, W.; Chitanga, S.; Mwanza, M.; Simusika, P.; Chambaro, H.; et al. First Covid-19 Case in Zambia — Comparative Phylogenomic Analyses of SARS-CoV-2 Detected in African Countries. Int. J. Infect. Dis. 2021, 102, 455–459, doi: 10.1016/j.ijid.2020.09.1480.

[47] Mudenda, S.; Botha, M.; Mukosha, M.; Daka, V.; Chileshe, M.; Mwila, K.; Banda, M.; Mfune, R.L.; Mufwambi, W.; Kampamba, M.; et al. Knowledge and Attitudes towards Covid-19 Prevention Measures among Residents of Lusaka District in Zambia. Aquademia 2022, 6, ep22005, doi:10.21601/AQUADEMIA/12210.

[48] Mudenda, S.; Witika, B.A.; Sadiq, M.J.; Banda, M.; Mfune, R.L.; Daka, V.; Kalui, D.; Phiri, M.N.; Kasanga, M.; Mudenda, F.; et al. Self-Medication and Its Consequences during & after the Coronavirus Disease 2019 (Covid-19) Pandemic: A Global Health Problem. Eur. J. Environ. Public Heal. 2020, 5, em0066, doi:10.29333/ejeph/9308.

[49] Amukoto, S. Experiences on Alcohol Abuse among Adolescents of Kanyama Compound, Lusaka District. Dissertation 2022.

[50] Mudenda, S.; Mukosha, M.; Mwila, C.; Saleem, Z.; Kalungia, A.C.; Munkombwe, D.; Daka, V.; Witika, B.A.; Kampamba, M.; Hikaambo, C.N.; et al. Impact of the Coronavirus Disease on the Mental Health and Physical Activity of Pharmacy Students at the University of Zambia: A Cross-Sectional Study. Int. J. Basic Clin. Pharmacol. 2021, 10, 324, doi:10.18203/2319-2003.ijbcp20211010.

[51] Mudenda, S.; Mainza, P.; Mfune, R.L.; Mufwambi, W.; Hangoma, J.; Kampamba, R.M.; Muungo, T.L.; Hikaambo, C.N.; Kampamba, M.; Mohamed, S.; et al. Psychological Impact of Covid-19 on Community Pharmacists: A Cross-Sectional Study in Lusaka District, Zambia. Fortune J. Heal. Sci. 2022, 5, 579–587.

[52] Mudenda, S.; Chomba, M.; Mukosha, M.; Daka, V.; Chileshe, M.; Okoro, R.N.; Fadare, J.; Al-Fayyadh, S.; Munsaka, S.; Kampamba, M.; et al. Psychological Impact of Coronavirus Disease (Covid-19) on Health Professions Students at the University of Zambia: A Cross-Sectional Study. Pan Afr. Med. J. 2022, 42, 237, doi:10.11604/PAMJ.2022.42.237.34041.

[53] Mudenda, S. Coronavirus Disease 2019 (Covid-19) and Its Psychological Impact on Students in Zambia. Acad. Lett. 2021, 837, doi:10.20935/AL837.

[54] Lorenz, H.S.; Stuebing, M.D.; Nambeye, C.; Lungu, G.; Littlefield, L.M. Substance Use Treatment Using Cultural Arts and 12 Steps: Curriculum Training and Community-Led Implementation in Zambia. Addict. Behav. Reports 2022, 15, 100424, doi: 10.1016/j.abrep.2022.100424.

[55] Tyler, K.A.; Handema, R.; Schmitz, R.M.; Phiri, F.; Kuyper, K.S.; Wood, C. Multi-Level Risk and Protective Factors for Substance Use Among Zambian Street Youth. Subst. Use Misuse 2016, 51, 922–931, doi:10.3109/10826084.2016.1156702.

[56] Hammerstein, N.; Paul, R.; Ncheka, J. Increasing Problem of Alcohol Abuse among the Zambian Population in the Psychiatric Setting. Heal. Press Zambia Bull 2017, 1, 29–34.

[57] Masiye, I.; Ndhlovu, D. Drug and Alcohol Abuse Prevention Education in Selected Secondary Schools in Zambia: Policy Guidelines Used. Int. J. Humanit. Soc. Sci. Educ. 2016, 3, 42–48, doi:10.20431/2349-0381.0311006.

[58] Charan, J.; Biswas, T. How to Calculate Sample Size for Different Study Designs in Medical Research? Indian J. Psychol. Med. 2013, 35, 121–126, doi:10.4103/0253-7176.116232.

[59] Chacon, N.C.; Walia, N.; Allen, A.; Sciancalepore, A.; Tiong, J.; Quick, R.; Mada, S.; Diaz, M.A.; Rodriguez, I. Substance Use during Covid-19 Pandemic: Impact on the Underserved Communities. Discoveries 2021, 9, e141, doi:10.15190/d.2021.20.

[60] Zaami, S.; Marinelli, E.; Varì, M.R. New Trends of Substance Abuse During Covid-19 Pandemic: An International Perspective. Front. Psychiatry 2020, 11, 700, doi:10.3389/fpsyt.2020.00700.

[61] Wang, Q.Q.; Kaelber, D.C.; Xu, R.; Volkow, N.D. Covid-19 Risk and Outcomes in Patients with Substance Use Disorders: Analyses from Electronic Health Records in the United States. Mol. Psychiatry 2021, 26, 30–39, doi:10.1038/s41380-020-00880-7.

[62] Spagnolo, P.A.; Montemitro, C.; Leggio, L. New Challenges in Addiction Medicine: Covid-19 Infection in Patients with Alcohol and Substance Use Disorders—the Perfect Storm. Am. J. Psychiatry 2020, 177, 805–807.

[63] Dodge, K.A.; Skinner, A.T.; Godwin, J.; Bai, Y.; Lansford, J.E.; Copeland, W.E.; Benjamin Goodman, W.; McMahon, R.J.; Goulter, N.; Bornstein, M.H.; et al. Impact of the Covid-19 Pandemic on Substance Use among Adults without Children, Parents, and Adolescents. Addict. Behav. Reports 2021, 14, 100388, doi: 10.1016/j.abrep.2021.100388.

[64] Avena, N.M.; Simkus, J.; Lewandowski, A.; Gold, M.S.; Potenza, M.N. Substance Use Disorders and Behavioral Addictions During the Covid-19 Pandemic and Covid-19-Related Restrictions. Front. Psychiatry 2021, 12, 653674.

[65] European Monitoring Centre for Drugs and Drug Addiction; Europol EU Drug Markets: Impact of Covid-19; 2020.

[66] Ismail, R.; Manaf, M.R.A.; Hassan, M.R.; Nawi, A.M.; Ibrahim, N.; Lyndon, N.; Amit, N.; Zakaria, E.; Razak, M.A.A.; Nor, N.I.Z.; et al. Prevalence of Drug and Substance Use among Malaysian Youth: A Nationwide Survey. Int. J. Environ. Res. Public Health 2022, 19, 4684, doi:10.3390/ijerph19084684.

[67] Jadnanansing, R.; Blankers, M.; Dwarkasing, R.; Etwaroo, K.; Lumsden, V.; Dekker, J.; Bipat, R. Prevalence of Substance Use Disorders in an Urban and a Rural Area in Suriname. Trop. Med. Health 2021, 49, 12, doi:10.1186/s41182-021-00301-7.

[68] Zewdu, S.; Hanlon, C.; Fekadu, A.; Medhin, G.; Teferra, S. Treatment Gap, Help-Seeking, Stigma and Magnitude of Alcohol Use Disorder in Rural Ethiopia. Subst. Abus. Treat. Prev. Policy 2019, 14, 4, doi:10.1186/s13011-019-0192-7.

[69] Kaggwa, M.M.; Abaatyo, J.; Alol, E.; Muwanguzi, M.; Najjuka, S.M.; Favina, A.; Rukundo, G.Z.; Ashaba, S.; Mamun, M.A. Substance Use Disorder among Adolescents before and during the Covid-19 Pandemic in Uganda: Retrospective Findings from a Psychiatric Ward Registry. PLoS One 2022, 17, e0269044, doi: 10.1371/journal.pone.0269044.

[70] Compton, W.M.; Flannagan, K.S.J.; Silveira, M.L.; Creamer, M.L.R.; Kimmel, H.L.; Kanel, M.; Blanco, C.; Volkow, N.D. Tobacco, Alcohol, Cannabis, and Other Drug Use in the US Before and During the Early Phase of the Covid-19 Pandemic. JAMA Netw. open 2023, 6, e2254566, doi:10.1001/jamanetworkopen.2022.54566.

[71] Sylvestre, M.P.; Dinkou, G.D.T.; Naja, M.; Riglea, T.; Pelekanakis, A.; Bélanger, M.; Maximova, K.; Mowat, D.; Paradis, G.; O’Loughlin, J. A Longitudinal Study of Change in Substance Use from before to during the Covid-19 Pandemic in Young Adults. Lancet Reg. Heal. 2022, 8, 100168, doi: 10.1016/j.lana.2021.100168.

[72] Karn, M.; Kandel, D.; Subedi, N. Prevalence of Substance Abuse and Its Associated Factors among Medical Students: A Cross-Sectional Study. F1000Research 2022, 10, 797, doi:10.12688/f1000research.54585.2.

[73] Blows, S.; Isaacs, S. Prevalence and Factors Associated with Substance Use among University Students in South Africa: Implications for Prevention. BMC Psychol. 2022, 10, 309, doi:10.1186/s40359-022-00987-2.

[74] Mavura, R.A.; Nyaki, A.Y.; Leyaro, B.J.; Mamseri, R.; George, J.; Ngocho, J.S.; Mboya, I.B. Prevalence of Substance Use and Associated Factors among Secondary School Adolescents in Kilimanjaro Region, Northern Tanzania. PLoS One 2022, 17, e0274102, doi: 10.1371/journal.pone.0274102.

[75] Olanrewaju, J.A.; Hamzat, E.O.; Enya, J.I.; Udekwu, M.O.; Osuoya, Q.; Bamidele, R.; Feyisike Johnson, O.; Johnson, B.S.; Olanrewaju, I.; Owolabi, J.O. An Assessment of Drug and Substance Abuse Prevalence: A Cross-Sectional Study among Undergraduates in Selected Southwestern Universities in Nigeria. J. Int. Med. Res. 2022, 50, 03000605221130039, doi:10.1177/03000605221130039.

[76] Siziya, S.; Muula, A.S.; Besa, C.; Babaniyi, O.; Songolo, P.; Kankiza, N.; Rudatsikira, E. Cannabis Use and Its Socio-Demographic Correlates among in-School Adolescents in Zambia. Ital. J. Pediatr. 2013, 39, 13, doi:10.1186/1824-7288-39-13.

[77] Jones, C.M.; Clayton, H.B.; Deputy, N.P.; Roehler, D.R.; Ko, J.Y.; Esser, M.B.; Brookmeyer, K.A.; Hertz, M.F. Prescription Opioid Misuse and Use of Alcohol and Other Substances Among High School Students - Youth Risk Behavior Survey, United States, 2019. MMWR Suppl. 2020, 69, 38–46, doi:10.15585/mmwr.su6901a5.

[78] Byregowda, H.; Alinsky, R.; Wang, X.; Johnson, R.M. Non-Medical Prescription Opioid Use among High School Students in 38 U.S. States. Addict. Behav. Reports 2023, 17, 100498, doi: 10.1016/j.abrep.2023.100498.

[79] Creamer, M.L.R.; Everett Jones, S.; Gentzke, A.S.; Jamal, A.; King, B.A. Tobacco Product Use Among High School Students - Youth Risk Behavior Survey, United States, 2019. MMWR Suppl. 2020, 69, 56–63, doi:10.15585/mmwr.su6901a7.

[80] Sung, C.W.; Chen, C.H.; Fan, C.Y.; Chang, J.H.; Hung, C.C.; Fu, C.M.; Wong, L.P.; Huang, E.P.C.; Lee, T.S.H. Mental Health Crisis in Healthcare Providers in the Covid-19 Pandemic: A Cross-Sectional Facility-Based Survey. BMJ Open 2021, 11, e052184, doi:10.1136/bmjopen-2021-052184.

[81] Nguemeni Tiako, M.J. Addressing Racial & Socioeconomic Disparities in Access to Medications for Opioid Use Disorder amid Covid-19. J. Subst. Abuse Treat. 2021, 122, 108214, doi: 10.1016/j.jsat.2020.108214.

[82] Yazdi-Feyzabadi, V.; Mehrolhassani, M.H.; Zolala, F.; Haghdoost, A.A.; Oroomiei, N. Determinants of Risky Sexual Practice, Drug Abuse and Alcohol Consumption in Adolescents in Iran: A Systematic Literature Review. Reprod. Health 2019, 16, 115, doi:10.1186/s12978-019-0779-5.

[83] Singh, S.; Balhara, Y.P.S.; Gupta, P.; Christodoulou, N.G. Primary and Secondary Prevention Strategies against Illicit Drug Use among Adults Aged 18–25: A Narrative Review. Australas. Psychiatry 2020, 28, 84–90.

[84] Medina-Mora, M.E. Prevention of Substance Abuse: A Brief Overview. World Psychiatry 2005, 4, 25–30.

[85] Griffin, K.W.; Botvin, G.J. Evidence-Based Interventions for Preventing Substance Use Disorders in Adolescents. Child Adolesc. Psychiatr. Clin. N. Am. 2010, 19, 505–526.

[86] Kvillemo, P.; Hiltunen, L.; Demetry, Y.; Carlander, A.K.; Hansson, T.; Gripenberg, J.; Elgán, T.H.; Einhorn, K.; Skoglund, C. How to Prevent Alcohol and Illicit Drug Use among Students in Affluent Areas: A Qualitative Study on Motivation and Attitudes towards Prevention. Subst. Abus. Treat. Prev. Policy 2021, 16, 83, doi:10.1186/s13011-021-00420-8.

[87] Hsiung, H.; Patel, K.; Hundal, H.; Baccouche, B.M.; Tsao, K.-W. Preventing Substance Abuse in Adolescents: A Review of High-Impact Strategies. Cureus 2022, 14, e27361, doi:10.7759/cureus.27361.

[88] Griswold, M.G.; Fullman, N.; Hawley, C.; Arian, N.; Zimsen, S.R.M.; Tymeson, H.D.; Venkateswaran, V.; Tapp, A.D.; Forouzanfar, M.H.; Salama, J.S.; et al. Alcohol Use and Burden for 195 Countries and Territories, 1990-2016: A Systematic Analysis for the Global Burden of Disease Study 2016. Lancet (London, England) 2018, 392, 1015–1035, doi:10.1016/S0140-6736(18)31310-2.

[89] Enrico, C.; Caldiroli, A.; Di Brita, C.; Colmegna, F.; Nava, R.; Colzani, L.C.; Sibilla, M.; Prodi, T.; Buoli, M.; Clerici, M. Profile of Patients Attending Psychiatric Emergency Care during the Coronavirus 2019 (Covid 19) Pandemic: A Comparative Cross-Sectional Study between Lockdown and Post-Lockdown Periods in Lombardy, Italy. Int. J. Psychiatry Clin. Pract. 2022, 26, 132–138, doi:10.1080/13651501.2021.1939385.

[90] Syed, N.K.; Griffiths, M.D. Nationwide Suicides Due to Alcohol Withdrawal Symptoms during Covid-19 Pandemic: A Review of Cases from Media Reports. J. Psychiatr. Res. 2020, 130, 289–291.

[91] Kristensen, P.; Weisaeth, L.; Heir, T. Bereavement and Mental Health after Sudden and Violent Losses: A Review. Psychiatry 2012, 75, 76–97.

[92] de Miquel, C.; Domènech-Abella, J.; Felez-Nobrega, M.; Cristóbal-Narváez, P.; Mortier, P.; Vilagut, G.; Alonso, J.; Olaya, B.; Haro, J.M. The Mental Health of Employees with Job Loss and Income Loss during the Covid-19 Pandemic: The Mediating Role of Perceived Financial Stress. Int. J. Environ. Res. Public Health 2022, 19, 3158, doi:10.3390/ijerph19063158.

[93] Blomqvist, S.; Högnäs, R.S.; Virtanen, M.; LaMontagne, A.D.; Magnusson Hanson, L.L. Job Loss and Job Instability during the Covid-19 Pandemic and the Risk of Depression and Anxiety among Swedish Employees. SSM - Popul. Heal. 2023, 22, 101424, doi: 10.1016/j.ssmph.2023.101424.

[94] Griffiths, D.; Sheehan, L.; van Vreden, C.; Petrie, D.; Grant, G.; Whiteford, P.; Sim, M.R.; Collie, A. The Impact of Work Loss on Mental and Physical Health During the Covid-19 Pandemic: Baseline Findings from a Prospective Cohort Study. J. Occup. Rehabil. 2021, 31, 455–462, doi:10.1007/s10926-021-09958-7.

[95] Veeroja, P.; Goodall, Z.; Guity-Zapata, N.A.; Stone, W. Private Renters in Shared Housing: Investigating Housing Conditions and Mental Well-Being in Australia during Covid-19. J. Hous. Built Environ. 2023, 1–22, doi:10.1007/s10901-023-10038-w.

[96] Dubey, S.; Sahoo, K.C.; Dash, G.C.; Sahay, M.R.; Mahapatra, P.; Bhattacharya, D.; Barrio, M.O. del; Pati, S. Housing-Related Challenges during Covid-19 Pandemic among Urban Poor in Low- and Middle-Income Countries: A Systematic Review and Gap Analysis. Front. Public Heal. 2022, 10, 1029394.

[97] Newton, D.; Lucock, M.; Armitage, R.; Monchuk, L.; Brown, P. Understanding the Mental Health Impacts of Poor Quality Private-Rented Housing during the UK’s First Covid-19 Lockdown. Heal. Place 2022, 78, 102898, doi: 10.1016/j.healthplace.2022.102898.

[98] Sediri, S.; Zgueb, Y.; Ouanes, S.; Ouali, U.; Bourgou, S.; Jomli, R.; Nacef, F. Women’s Mental Health: Acute Impact of Covid-19 Pandemic on Domestic Violence. Arch. Womens. Ment. Health 2020, 23, 749–756, doi:10.1007/s00737-020-01082-4.

[99] Raj, A.; Johns, N.E.; Barker, K.M.; Silverman, J.G. Time from Covid-19 Shutdown, Gender-Based Violence Exposure, and Mental Health Outcomes among a State Representative Sample of California Residents. EClinicalMedicine 2020, 26, 100520, doi: 10.1016/j.eclinm.2020.100520.

[100] Mittal, S.; Singh, T. Gender-Based Violence During Covid-19 Pandemic: A Mini-Review. Front. Glob. Women’s Heal. 2020, 1, 570087, doi:10.3389/FGWH.2020.00004/BIBTEX.

[101] Alibudbud, R. Gender in Mental Health: Gender-Based Violence, Suffering, Recovery, and the Greater Responsibility of Society during the Covid-19 Pandemic. Asian J. Psychiatr. 2022, 67, 102953.

[102] Madanes, S.B.; Levenson-Palmer, R.; Szuhany, K.L.; Malgaroli, M.; Jennings, E.L.; Anbarasan, D.; Simon, N.M. Acute Stress Disorder, and the Covid-19 Pandemic. Psychiatr. Ann. 2020, 50, 295–300, doi:10.3928/00485713-20200611-01.

[103] Zhang, J.; Shuai, L.; Yu, H.; Wang, Z.; Qiu, M.; Lu, L.; Cao, X.; Xia, W.; Wang, Y.; Chen, R. Acute Stress, Behavioural Symptoms and Mood States among School-Age Children with Attention-Deficit/Hyperactive Disorder during the Covid-19 Outbreak. Asian J. Psychiatr. 2020, 51, 102077, doi: 10.1016/j.ajp.2020.102077.

[104] Taylor, S.; Paluszek, M.M.; Rachor, G.S.; McKay, D.; Asmundson, G.J.G. Substance Use and Abuse, Covid-19-Related Distress, and Disregard
for Social Distancing: A Network Analysis. Addict. Behav. 2021, 114, 106754, doi: 10.1016/j.addbeh.2020.106754.

[105] Marzo, R.R.; Vinay, V.; Bahari, R.; Chauhan, S.; Ming, D.A.F.; Nelson Fernandez, S.F.A.; Johnson, C.C.P.; Thivakaran, A.Q.A.; Rahman, M.M.; Goel, S. Depression and Anxiety in Malaysian Population during Third Wave of the Covid-19 Pandemic. Clin. Epidemiol. Glob. Heal. 2021, 12, 100868, doi: 10.1016/j.cegh.2021.100868.

[106] Kamberi, F.; Sinaj, E.; Jaho, J.; Subashi, B.; Sinanaj, G.; Jaupaj, K.; Stramarko, Y.; Arapi, P.; Dine, L.; Gurguri, A.; et al. Impact of Covid-19 Pandemic on Mental Health, Risk Perception and Coping Strategies among Health Care Workers in Albania - Evidence That Needs Attention. Clin. Epidemiol. Glob. Heal. 2021, 12, 100824, doi: 10.1016/j.cegh.2021.100824.

[107] Marzo, R.R.; Khanal, P.; Ahmad, A.; Rathore, F.A.; Chauhan, S.; Singh, A.; Shrestha, S.; Alrifai, A.; Lotfizadeh, M.; Younus, D.A.; et al. Quality of Life of the Elderly during the Covid-19 Pandemic in Asian Countries: A Cross-Sectional Study across Six Countries. Life 2022, 12, 365, doi:10.3390/life12030365.