Rwanda journal of medicine and health sciences · 2025
Prevalence, Predictors, and Moderators of Relapse in Severe Mental Disorders: Evidence from Ndera Neuropsychiatric Teaching Hospital, Rwanda.
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Nkubili Charles, Uwamungu Pascal, Ntirenganya Schadrack, Twizeyimana Eric Ferdinand, Kagabo Emmanuel, Ntakiyisumba Emmanuel, Musabyimana Jean Claude, Nshimiyimana Michel, Mbabazi Andrine, Niyonsaba Emile, Uwamwezi Béatrice, Baho Felix Uwimana, Sebera Fidele, Nyirandamutsa Fortunée, Niyonsenga Japhet
Аннотация
BACKGROUND: Relapse remains a major challenge in managing mental disorders, particularly in low-resource settings where empirical evidence is limited. This study estimated relapse prevalence and associated factors, and examined whether disorder type and psychological well-being moderated, and self-stigma mediated, the medication adherence-relapse link.
METHODS: A cross-sectional study was conducted among 310 outpatients at Ndera Neuropsychiatric Teaching Hospital. Data were collected using structured questionnaires and validated scales measuring relapse, self-stigma, medication adherence, and psychological well-being. Chi-square tests assessed associations, while binary logistic regression identified independent predictors using SPSS version 29.
RESULTS: Relapse prevalence was 76.1% in schizophrenia, 69.4% in bipolar disorder, 47.8% in depression, and 64.9% in substance misuse. Disorder type strongly predicted relapse: schizophrenia (AOR = 3.01, 95% CI: 1.28-7.09) and bipolar disorder (AOR = 2.74, 95% CI: 1.19-6.31) showed significantly higher risk than depression. Substance misuse, self-stigma, poor medication adherence, and low psychological well-being were associated with relapse in crude models but lost significance after adjustment. Moderation analysis revealed that psychological well-being significantly strengthened adherence's protective effect, reducing relapse from 91.7% at low adherence to 34.8% at high adherence. Disorder type shaped adherence effects: high adherence reduced relapse only in schizophrenia, with inconsistent effects in other disorders. Self-stigma did not mediate the adherence-relapse link.
CONCLUSION: Medication adherence alone showed inconsistent effects; its protective role was pronounced in schizophrenia and among patients with high psychological well-being. Relapse prevention should prioritize enhancing adherence in schizophrenia and integrating psychological well-being interventions. Tailoring management to diagnostic subgroups is essential for improving outcomes.
METHODS: A cross-sectional study was conducted among 310 outpatients at Ndera Neuropsychiatric Teaching Hospital. Data were collected using structured questionnaires and validated scales measuring relapse, self-stigma, medication adherence, and psychological well-being. Chi-square tests assessed associations, while binary logistic regression identified independent predictors using SPSS version 29.
RESULTS: Relapse prevalence was 76.1% in schizophrenia, 69.4% in bipolar disorder, 47.8% in depression, and 64.9% in substance misuse. Disorder type strongly predicted relapse: schizophrenia (AOR = 3.01, 95% CI: 1.28-7.09) and bipolar disorder (AOR = 2.74, 95% CI: 1.19-6.31) showed significantly higher risk than depression. Substance misuse, self-stigma, poor medication adherence, and low psychological well-being were associated with relapse in crude models but lost significance after adjustment. Moderation analysis revealed that psychological well-being significantly strengthened adherence's protective effect, reducing relapse from 91.7% at low adherence to 34.8% at high adherence. Disorder type shaped adherence effects: high adherence reduced relapse only in schizophrenia, with inconsistent effects in other disorders. Self-stigma did not mediate the adherence-relapse link.
CONCLUSION: Medication adherence alone showed inconsistent effects; its protective role was pronounced in schizophrenia and among patients with high psychological well-being. Relapse prevention should prioritize enhancing adherence in schizophrenia and integrating psychological well-being interventions. Tailoring management to diagnostic subgroups is essential for improving outcomes.