Associations between mental health challenges, sexual activity, alcohol consumption, use of other psychoactive substances and use of COVID-19 preventive measures during the first wave of the COVID-19 pandemic by adults in Nigeria

(2023) 23:1506 Folayan et al. BMC Public Health https://doi.org/10.1186/s12889-023-16440-x BMC Public Health Open Access RESEARCH Associations between mental health challenges, sexual activity, alcohol consumption, use of other psychoactive substances and use of COVID‑19 preventive measures during the first wave of the COVID‑19 pandemic by adults in Nigeria Morenike Oluwatoyin Folayan1,2*, Olanrewaju Ibigbami3, Maha El Tantawi1,4, Nourhan M. Aly1,4, Roberto Ariel Abeldaño Zuñiga1,5, Giuliana Florencia Abeldaño1,6, Eshrat Ara1,7, Passent Ellakany1,8, Balgis Gaffar1,9, Nuraldeen Maher Al‑Khanati1,10, Ifeoma Idigbe1,11, Anthonia Omotola Ishabiyi1,12, Abeedha Tu‑Allah Khan1,13, Zumama Khalid1,13, Folake Barakat Lawal1,14, Joanne Lusher1,15, Ntombifuthi P. Nzimande1,16, Bamidele Olubukola Popoola1,17, Mir Faeq Ali Quadri1,18, Mark Roque1,19, Joseph Chukwudi Okeibunor1,20, Brandon Brown1,21 and Annie Lu Nguyen1,22 Abstract Background The aims of this study were to assess: 1) the associations among sexual activity, alcohol consumption, use of other psychoactive substances and mental health during the COVID-19 pandemic; and 2) the associations between COVID-19 preventive measures, alcohol consumption and use of psychoactive substances. Methods This was a secondary analysis of data collected from adults in Nigeria between July and December 2020. The variables extracted included change in sexual activity, alcohol consumption and use of other psychoactive sub‑ stances, COVID-19 preventive behaviors (wearing face masks, washing hands, physical distancing), anxiety, depression, post-traumatic stress disorder (PTSD) and sociodemographic variables (age, sex, education, HIV status, employment status). Multivariable logistic regressions were conducted. A model was run to regress depression, anxiety, PTSD, increased alcohol consumption, and increased use of other psychoactive substances, on increased sexual activity. In separate models, anxiety, depression, and PTSD were regressed on increased alcohol consumption and on increased use of other psychoactive substances. Finally, three models were constructed to determine the associations between increased alcohol consumption and increased use of other psychoactive substances on three separate COVID-19 preventive behaviors. All models were adjusted for sociodemographic variables. Results Increased alcohol consumption (AOR:2.19) and increased use of other psychoactive substances (AOR: 3.71) were significantly associated with higher odds of increased sexual activity. Depression was associated *Correspondence: Morenike Oluwatoyin Folayan Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecom‑ mons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Folayan et al. BMC Public Health (2023) 23:1506 Page 2 of 11 with significantly higher odds of increased alcohol consumption (AOR:1.71) and increased use of other psychoac‑ tive substances (AOR:3.21). Increased alcohol consumption was associated with significantly lower odds of physical distancing (AOR:0.59). Conclusion There was a complex inter-relationship between mental health, sexual health, increased use of psycho‑ active substances. The consumption of alcohol also affected compliance with physical distancing. Further studies are needed to understand the observed relationships. Keywords Physical distancing, Sexual activity, Alcohol consumption, Anxiety, Depression, Post-traumatic stress disorder, SARS-CoV-2 Background During the COVID-19 pandemic, lockdowns instituted in response to the public health emergency created economic losses and social disruptions that led to multiple direct and indirect health consequences [1]. One such consequence was the global increase in anxiety, depression, and post-traumatic stress disorder [2–4]. Concurrently, there were shifts in sexual behaviors [5–11]. Research has demonstrated greater sexual dysfunction to be associated with greater mental health challenges [12–17]. During the pandemic, frequency of sexual activity may be reduced due to restrictions in physical movement among couples who live in separate dwellings or geographical locations [13]. In the absence of sexual partners, individuals may engage in solitary sexual activities, which may cause emotional distress for people in certain cultures. In Nigeria, for example, solitary sexual activities are stigmatized by traditional religious and societal norms [18, 19]. Individuals with unmet needs for their sexual desires may also experience a perceived reduction in sexual and mental well-being [20–22]. Mental health challenges were also associated with increased use of psychoactive substances during the COVID-19 pandemic. In fact, increases in psychoactive substance use during the COVID-19 pandemic were reported in Australia [23], Brazil [24], Canada [25], Germany [26] and the United States [27]. Some individuals use substances, including alcohol, as a maladaptive coping strategy for reducing stress, maintaining a state of physical and mental relaxation, and improving social behavior [28–33]. However, high levels of psychoactive substance use can result in the inhibition of the central nervous system, reduce discernment, weaken attention and memory, resulting in increased risk for poor decision-making [34], anxiety and depression [35, 36]. Within the context of COVID-19, the confluence of altered decision-making capacity, anxiety and depression may serve to negatively impact the uptake and use of COVID-19 prevention measures [37]. There is limited empirical evidence on psychoactive substance use in sub-Saharan Africa during the pandemic, although general use of psychoactive substances by adolescents in sub-Saharan Africa is high. Up to 41.6% of adolescents use at least one psychoactive substance with 32.8% reporting consumption of alcohol and 3.9% reporting the use of cocaine [38]. In Nigeria, about 14.3 million people between ages 15 and 64 years used psychoactive subs (...truncated)