Cannabis was the most commonly used substance among first-episode psychosis patients at a South African hospital | Research

The takeaway

In a review of 200 first-episode psychosis patients at a Soweto hospital, 73.6% had used substances, with cannabis being the most common at 46%, and substance-induced psychotic disorder was the most frequent diagnosis.

Mental health professionals, public health researchers focused on sub-Saharan Africa, and anyone interested in the cannabis-psychosis relationship across different populations.

73.6% of first-episode psychosis patients used substances; cannabis most common at 46%

What the researchers found

Substance use prevalence among first-episode psychosis patients was 73.6%. Cannabis was the most commonly used substance (46%). Substance-induced psychotic disorder was the most common diagnosis, and substance use was associated with aggression in 45% of cases.

Why it matters

South Africa has limited mental health resources and high rates of substance use. Understanding the overlap between substance use and first-episode psychosis in this population can inform targeted prevention and integrated treatment strategies.

The numbers in context

200 patients reviewed. 73.6% prevalence of substance use. Cannabis most common at 46%. Most patients were male, aged 21-30 (37%). Aggression associated with substance use in 45% of cases. Only 34% of substance users were referred to social services.

How the study worked

Retrospective chart review of 200 patients presenting with first-episode psychosis at Chris Hani Baragwanath Academic Hospital, a tertiary facility in Soweto, South Africa. Clinical records were analyzed and patients with and without substance use were compared statistically.

What this study cannot tell us

Retrospective chart review limits data quality and completeness. Single hospital setting in Soweto may not generalize to other South African populations. Cannot establish causal direction between substance use and psychosis.

How to read the evidence

Moderate: retrospective chart review at a single tertiary hospital with a reasonable sample size but inherent limitations of chart-based data.

When this study was published

Published 2026.

The bigger picture

This study adds to the global evidence on cannabis-psychosis associations from an understudied population in sub-Saharan Africa, where substance use patterns and available healthcare resources differ substantially from high-income countries.

Questions still open

Why were only 34% of substance users referred to social services? How do outcomes differ when integrated mental health and substance use treatment is provided in this setting?

Common questions

How common is substance use among people with first-episode psychosis in South Africa?

This study found 73.6% of first-episode psychosis patients at a Soweto hospital had used substances, with cannabis being the most common at 46%.

What was the most common diagnosis among substance-using psychosis patients?

Substance-induced psychotic disorder was the most common diagnosis in this population.

Read the original research

Substance abuse in first-episode psychosis at Chris Hani Baragwanath Hospital.

The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa, 32, 2542

View on PubMed ↗Publisher’s paper ↗

Citation

Shandu, Precious N; Minty, Yumna. (2026). Substance abuse in first-episode psychosis at Chris Hani Baragwanath Hospital.. The South African journal of psychiatry : SAJP : the journal of the Society of Psychiatrists of South Africa, 32, 2542. https://doi.org/10.4102/sajpsychiatry.v32i0.2542