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}, xii 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.