Prevalence and Factors Associated With Relapse in Patients Admitted at Jubilee Psychiatric Unit, Nyangabgwe Referral Hospital, Botswana.
Abstract
Background
Relapse defined as exacerbation of mental illness symptoms after recovery has a negative
impact on the quality of the patient’s life as well as their caregivers; it also weighs down
on the quality of mental health care services. There is a dearth of information on the
prevalence and factors associated with relapse among patients with mental illnesses in
Botswana.
Objective of the study
The study objective was to determine the prevalence and factors associated with relapse
in patients admitted at Jubilee Psychiatric Unit, Nyangabgwe Hospital, Botswana.
Methodology
A hospital based descriptive cross sectional study was conducted at Jubilee Psychiatric
Unit, Nyangabgwe Referral Hospital, Botswana. Purposive sampling was used to select
eligible patients. Data collection was carried out using semi-structured questionnaire to
obtain socio-demographic, clinical and psychosocial data, relapse evaluation tool and
Medication adherence rating scale.
Statistical Package of Social Sciences (SPSS) Version 26 was used to analyze the data.
Multivariate logistic regression was used to identify factors associated with relapse.
Variables found with P value <0.05 were considered statistically significant. .
Results
A total of 68 participants were enrolled for this study. The age range for the participants
was from 18-70 years with over half of them (58.8%) belonging to the 31-44 years age
group. The mean age was 37.9 with a Standard deviation of 10.5. Majority of the
participants were male (64.7%), single (82.3%), unemployed (70.6%) and stayed with
family (91.2%). This study found a prevalence of relapse of 75.0% (n=51). Participants
who relapsed were significantly younger at initial diagnosis compared to those who did
not have a relapse (p-value= 0.003). In bivariate analysis, male gender was significantly
associated with relapse as compared to female gender (OR, 95% CI= 3.78, {1.20, 11.78},
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p-value=0.02). Participants who were employed/self-employed were 76% less likely to
have a mental illness relapse as compared to those unemployed/students (OR, 95% CI=
0.24, {0.73, 0.80}, p-value=0.02). Bivariate analysis revealed that participants with
previous 0-2 admissions were 96% less likely to develop relapse compared to those with
≥3 previous admissions (OR, 95% CI= 0.04, {0.05, 0.33}, p-value<0.01). Participants
who experienced problems with medications were 9.48 times more likely to have a
relapse as compared to those who had no problems with medications (89.1% versus
45.5%), (OR, 95% CI= 9.48, {2.82, 34.4}, p-value<0.01). Participants with the full
insight of the mental illness were 77% less likely to relapse compared to those with
partial or nil insight (OR, 95% CI= 0.23, {0.07, 0.75}, p-value=0.01). Participants who
received family support were 72% less likely to develop relapse as compared to those
were either dissatisfied or received no family support (OR, 95% CI= 0.28, {0.07, 0.80},
p-value=0.02). Participants who were adherent to mental illness medications were 75%
less likely to have a relapse compared to those non-adherent (OR, 95% CI= 0.25, {0.08,
0.81}, p-value=0.02). Multivariate logistic regression revealed the following factors to be
independently associated with relapse: number of previous admission; family support and
experiencing problems with medications.
Conclusions
The prevalence of relapse in this study was very high; this is despite efforts made locally
to curb the situation. History of several previous admissions, poor family support and
experiencing problems with medications were independently associated with increased
relapses. There is a need to conduct future interventional studies involving large sample
size to determine factors at family, patient levels that contribute to relapse.
Psychoeducation and other community programmes at local level should put more
emphasis on factors found to increase the chances of relapse.
Publisher
University of Nairobi
Rights
Attribution-NonCommercial-NoDerivs 3.0 United StatesUsage Rights
http://creativecommons.org/licenses/by-nc-nd/3.0/us/Collections
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