Substance use, mental health conditions, and health-related quality of life among young people in Ethiopia: A mixed-method study

Shifa, Jemal Ebrahim

Substance use, mental health conditions, and health-related quality of life among young people in Ethiopia: A mixed-method study

Shifa, Jemal Ebrahim

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Issue Date:: 2025

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Field	Value	Language
dc.contributor.author	Shifa, Jemal Ebrahim
dc.date.accessioned	2026-04-07T07:20:28Z
dc.date.available	2026-04-07T07:20:28Z
dc.date.issued	2025
dc.identifier.uri	http://hdl.handle.net/10453/194599
dc.description	University of Technology Sydney. Faculty of Health.	en_US.UTF-8
dc.description.abstract	𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Substance use and mental health conditions are major public-health challenges for young people globally, with a heavy burden in LMICs such as Ethiopia. Evidence on how substance use, mental health, and quality of life intersect among young Ethiopians remains limited. Cultural taboos, family dynamics, and structural barriers compound risks and impede care. Data on prevalence, correlates, and lived experiences are needed to guide context-appropriate interventions. 𝗔𝗶𝗺: To (i) estimate prevalence and associations of substance use and mental health conditions, (ii) assess health-related quality of life (HRQoL), and (iii) explore the lived experiences of young people who use substances and stakeholder perspectives in West Arsi, Ethiopia—while (iv) synthesising regional evidence to inform public-health strategies. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀: Mixed-methods design: (1) a community-based cross-sectional survey of 427 randomly selected young people (14–29) using interviewer-administered questionnaires on substance use, mental health, social support, and HRQoL; logistic and linear regressions identified associated factors; (2) a systematic review and meta-analysis of 60 studies (n=83,859; ages 10–24; sub-Saharan Africa) estimating substance-use prevalence and evidence gaps; and (3) qualitative semi-structured interviews with young substance users and focus groups with stakeholders, thematically analysing motivations, patterns, and perceived consequences. Ethical approval was obtained from University of Technology Sydney and Madda Walabu University. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: In West Arsi, lifetime substance use was 48.1%; the most common were khat (76.5%), alcohol (49.0%), tobacco (33.3%), and cannabis (23.0%). The systematic review (60 studies; n=83,859; SSA) found a prevalence of 21% (lifetime), 18% (12-month), and 15% (current), with alcohol, khat, and stimulants most reported; local and regional data indicate rising use. Mental health conditions were more prevalent among users (47%) than non-users (26%); among non-users, sex, education, and family histories of substance use and mental illness were correlates. Users’ HRQoL was low (mean 54.8 ± 16.7), especially in social and environmental domains; mental health conditions (β = −18.66, p < 0.001) and family history of mental illness (β = −9.80, p < 0.001) predicted poorer HRQoL. Qualitative analysis (seven themes) traced a pathway from initiation to continuation, driven by familial exposure, peers, trauma, economic hardship, and gendered experiences, with consequences including dependency, stigma, school dropout, and crime. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: Substance use among young Ethiopians is common and linked to poorer mental health and HRQoL. Family and social contexts are central drivers. Multi-level, youth-responsive, culturally tailored interventions—integrating prevention, mental health support, and quality-of-life strategies—are needed, alongside strengthened community awareness, expanded school/community services, and primary-care integration.	en_US.UTF-8
dc.format	Thesis (PhD)
dc.language.iso	en	en_US.UTF-8
dc.relation	https://opus.lib.uts.edu.au/bitstream/10453/194599/1/thesis.pdf
dc.rights	info:eu-repo/semantics/openAccess
dc.rights	The author owns the copyright in this thesis including all reproduction and reuse rights for the work. The work may not be altered without the permission of the copyright owner. Attribution is essential when quoting or paraphrasing from this thesis.
dc.rights	©Jemal Ebrahim Shifa
dc.rights	au.edu.uts.lib/cph
dc.title	Substance use, mental health conditions, and health-related quality of life among young people in Ethiopia: A mixed-method study	en_US.UTF-8
dc.type	Thesis
utslib.copyright.status	open_access	*

Abstract:

𝗕𝗮𝗰𝗸𝗴𝗿𝗼𝘂𝗻𝗱: Substance use and mental health conditions are major public-health challenges for young people globally, with a heavy burden in LMICs such as Ethiopia. Evidence on how substance use, mental health, and quality of life intersect among young Ethiopians remains limited. Cultural taboos, family dynamics, and structural barriers compound risks and impede care. Data on prevalence, correlates, and lived experiences are needed to guide context-appropriate interventions. 𝗔𝗶𝗺: To (i) estimate prevalence and associations of substance use and mental health conditions, (ii) assess health-related quality of life (HRQoL), and (iii) explore the lived experiences of young people who use substances and stakeholder perspectives in West Arsi, Ethiopia—while (iv) synthesising regional evidence to inform public-health strategies. 𝗠𝗲𝘁𝗵𝗼𝗱𝘀: Mixed-methods design: (1) a community-based cross-sectional survey of 427 randomly selected young people (14–29) using interviewer-administered questionnaires on substance use, mental health, social support, and HRQoL; logistic and linear regressions identified associated factors; (2) a systematic review and meta-analysis of 60 studies (n=83,859; ages 10–24; sub-Saharan Africa) estimating substance-use prevalence and evidence gaps; and (3) qualitative semi-structured interviews with young substance users and focus groups with stakeholders, thematically analysing motivations, patterns, and perceived consequences. Ethical approval was obtained from University of Technology Sydney and Madda Walabu University. 𝗥𝗲𝘀𝘂𝗹𝘁𝘀: In West Arsi, lifetime substance use was 48.1%; the most common were khat (76.5%), alcohol (49.0%), tobacco (33.3%), and cannabis (23.0%). The systematic review (60 studies; n=83,859; SSA) found a prevalence of 21% (lifetime), 18% (12-month), and 15% (current), with alcohol, khat, and stimulants most reported; local and regional data indicate rising use. Mental health conditions were more prevalent among users (47%) than non-users (26%); among non-users, sex, education, and family histories of substance use and mental illness were correlates. Users’ HRQoL was low (mean 54.8 ± 16.7), especially in social and environmental domains; mental health conditions (β = −18.66, p < 0.001) and family history of mental illness (β = −9.80, p < 0.001) predicted poorer HRQoL. Qualitative analysis (seven themes) traced a pathway from initiation to continuation, driven by familial exposure, peers, trauma, economic hardship, and gendered experiences, with consequences including dependency, stigma, school dropout, and crime. 𝗖𝗼𝗻𝗰𝗹𝘂𝘀𝗶𝗼𝗻: Substance use among young Ethiopians is common and linked to poorer mental health and HRQoL. Family and social contexts are central drivers. Multi-level, youth-responsive, culturally tailored interventions—integrating prevention, mental health support, and quality-of-life strategies—are needed, alongside strengthened community awareness, expanded school/community services, and primary-care integration.

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