Factors associated with relapse among mentally ill patients attending military mental health clinics
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Objectives: To assess the prevalence and factors contributing to relapse among mentally ill patients attending military mental health clinics. Method: A cross sectional study was conducted on patients attending military mental health clinics at King Hussein Medical City, Princes Aisha Center, Prince Hashim Hospital and Prince Rashid Hospital. Socio-demographic data questionnaire, internalized stigma of mental illness scale (ISMI), medication adherence scale (MMAS-8), the list of threatening events questionnaire (LTE-Q), oslo’s three items social support scale (OSSS-3) and the alcohol, smoking, and substance involvement screening test (ASSIST-3.0) were utilized for data collection. Data were analyzed using statistical package for social sciences (SPSS) version 22. Results: A total of 311 patients with mental illnesses were included in the study. Prevalence of relapse was 37.3%. Relapse was significantly associated with unemployment (OR = 1.84, 95% CI: 0.92 - 2.63), duration of diagnosis more than 5 years (OR = 2.42, 95% CI: 1.39 – 3.73), severe internalized stigma (OR = 3.12, 95% CI: 1.75 – 4.87) and low adherence to medication (OR = 2.14, 95% CI: 1.54 – 3.89). Conclusion: Around one third of the study participants had relapsed. Unemployment, duration of diagnosis more than 5 years, severe internalized stigma and low adherence to medication were significant predictors for relapse. Researchers suggest the need for future interventional studies focused on modifiable predictors of relapse such as stigma, employment, and medication adherence.
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Dattani S, Ritchie H, Roser M. Mental Health. Published online at OurWorldInData.org. 2021 Retrieved from: 'https://ourworldindata.org/mental-health' [Online Resource]
Global Burden of Disease Collaborative Network. Global burden of disease study 2016 (GBD 2016) results. 2017 Accessed: 10/30/ 2018. Available from: http://ghdx.healthdata.org/gbd-results-tool.
Rehm J, Shield KD. Global burden of disease and the impact of mental and addictive disorders. Curr Psychiatry Rep 2019 Feb 7; 21(2):10. doi: 10.1007/s11920-019-0997-0. PMID: 30729322.
WHO. WHO-aims report on mental health system in Jordon (2017). Retrieved from: http://www.who.int/mental_health/evidence/mh_aims_ report_jordan_jan_2011_en.pdf
Graca J, Klut C, Trancas B, Borja-Santos N, Cardoso G. Characteristics of frequent users of an acute psychiatric inpatient unit: a five-year study in Portugal. Psychiatr Serv 2013 Feb 1; 64(2): 192-5. doi: 10.1176/appi.ps.000782012. PMID: 23280315.
Miller DAA, Ronis ST, Slaunwhite AK, et al. Longitudinal examination of youth readmission to mental health inpatient units. Child Adolesc Ment Health 2020 Nov; 25(4): 238–48
Haywood TW, Kravitz HM, Grossman LS, Cavanaugh JL Jr, Davis JM, Lewis DA. Predicting the "revolving door" phenomenon among patients with schizophrenic, schizoaffective, and affective disorders. Am J Psychiatry 1995 Jun;152(6):856-61. doi: 10.1176/ajp.152.6.856. PMID: 7755114.
D’Orta I, Herrmann FR, Giannakopoulos P. Determinants of revolving door in an acute psychiatric ward for prison inmates. Front. Psychiatry 2021 Apr 15; 12: 626773. doi: 10.3389/fpsyt.2021.626773
Vázquez GH, Holtzman JN, Lolich M, Ketter TA, Baldessarini RJ. Recurrence rates in bipolar disorder: Systematic comparison of long-term prospective, naturalistic studies versus randomized controlled trials. Eur Neuropsychopharmacol 2015 Oct; 25(10):1501-12. doi: 10.1016/j.euroneuro.2015.07.013. Epub 2015 Jul 21. PMID: 26238969.
Kazadi NJB, Moosa MYH, Jeenah FY. Articles factors associated with relapse in schizophrenia. Soc Anxiety J Psychiatry 2008; 14(2): 52–3
NIDA. 2020, July 10. Treatment and Recovery. Retrieved from https://www.drugabuse.gov/publications/drugs-brains-behavior-science-addiction/treatment-recovery on 2021, December 11
Sariah AE, Outwater AH, Malima KIY. Risk and protective factors for relapse among individuals with schizophrenia: A qualitative study in Dar es Salaam, Tanzania. BMC Psychiatry 2014; 14: 240
Markose A, Varghese A, Jose C, Varghese E, Jacob E, Baby B, Mathew B, Paul B, Gupta S, Renju S, Baby S. Assessment of the risk factors for relapse/ lapse among currently abstinent patients with alcohol dependence. Indian J Psy Nsg 2014; 8: 26-9
Rylander M, Colon-Sanchez D, Keniston A, et al. Risk factors for readmission on an adult inpatient psychiatric unit. Qual Manag Health Care 2016 Jan-Mar; 25(1): 22-31. doi: 10.1097/QMH.0000000000000077. PMID: 26783864.
Agenagnew L, kassaw C. The Lifetime prevalence and factors associated with relapse among mentally ill patients at Jimma University Medical Center, Ethiopia: Cross Sectional Study. J Psychosoc Rehabil Ment Health 2020; 7(2): 211–20. https://doi.org/10.1007/s40737-020-00176-7
Mi W-F, Chen X-M, Fan T-T, Tabarak S, Xiao J-B, Cao Y-Z, Li X-Y, Bao Y-P, Han Y, Li L-Z, Shi Y, Guo L-H, Wang X-Z, Liu Y-Q, Wang Z-M, Chen J-X, Wu F-C, Ma WB, Li H-F, Xiao W-D, Liu F-H, Xie W, Zhang H-Y and Lu L. Identifying modifiable risk factors for relapse in patients with schizophrenia in China 2020 Sep. Front Psychiatry 11: 574763. doi: 10.3389/fpsyt.2020.574763
Moges S, Belete T, Mekonen T, Menberu M. Lifetime relapse and its associated factors among people with schizophrenia spectrum disorders who are on follow up at Comprehensive Specialized Hospitals in Amhara region, Ethiopia: a cross-sectional study. Int J Ment Health Syst 2021 May 6; 15(1): 42. doi: 10.1186/s13033-021-00464-0. PMID: 33957944; PMCID: PMC8101248.
Di Giovanni P, Di Martino G, Zecca IAL, Porfilio I, Romano F, Staniscia T. The revolving door phenomenon: psychiatric hospitalization and risk of readmission among drug-addicted patients. Clin Ter 2020 Sep-Oct; 171(5): e421-e424. doi: 10.7417/CT.2020.2252. PMID: 32901786.
Ciudad A, San L, Bernardo M, Olivares JM, Polavieja P, Valladares A, Gilaberte I. Relapse and therapeutic interventions in a 1-year observational cohort study of nonadherent outpatients with schizophrenia. Prog Neuropsychopharmacol Biol Psychiatry 2012; 36: 245–50
Alphs L, Nasrallah HA, Bossie CA, Fu DJ, Gopal S, Hough D, Turkoz I. Factors associated with relapse in schizophrenia despite adherence to long-acting injectable antipsychotic therapy. Int Clin Psychopharmacol 2016 Jul; 31(4): 202-9. doi: 10.1097/YIC.0000000000000125. PMID: 26974214.
Najafi-Vosough R, Ghaleiha A, Faradmal J, Mahjub H. Recurrence in patients with bipolar disorder and its risk factors. Iran J Psychiatry 2016 Jul; 11(3): 173-177. PMID: 27928249; PMCID: PMC5139952.
Menculini G, Gobbicchi C, Verdolini N, Cirimbilli F, Moretti P, Tortorella A. Revolving door and bipolar disorders: a retrospective study in an acute inpatient unit. Psychiatr Danub 2020; 32 (1): 58–63.
Simhandl C, König B, Amann BL. A prospective 4-year naturalistic follow-up of treatment and outcome of 300 bipolar I and II patients. J Clin Psychiatry 2014 Mar; 75(3):254-62; quiz 263. doi: 10.4088/JCP.13m08601. PMID: 24717379.
Fikreyesus M, Soboka M, Feyissa GT. Psychotic relapse and associated factors among patients attending health services in Southwest Ethiopia: a cross-sectional study. BMC Psychiatry 2016 Oct 20; 16(1): 354. doi: 10.1186/s12888-016-1076-2. PMID: 27765033; PMCID: PMC5072324.
Owens DC, Johnstone EC, Miller P, Macmillan JF, Crow TJ. Duration of untreated illness and outcome in schizophrenia: test of predictions in relation to relapse risk. Br J Psychiatry. 2010 Apr;196(4):296-301. doi: 10.1192/bjp.bp.109.067694. PMID: 20357306.
Liu NH, Daumit GL, Dua T, Aquila R, Charlson F, Cuijpers P, Druss B, Dudek K, Freeman M, Fujii C, Gaebel W, Hegerl U, Levav I, Munk Laursen T, Ma H, Maj M, Elena Medina-Mora M, Nordentoft M, Prabhakaran D, Pratt K, Prince M, Rangaswamy T, Shiers D, Susser E, Thornicroft G, Wahlbeck K, Fekadu Wassie A, Whiteford H, Saxena S. Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas. World Psychiatry 2017 Feb; 16(1): 30-40. doi: 10.1002/wps.20384. PMID: 28127922; PMCID: PMC5269481.
Merikangas KR, He JP, Burstein M, Swendsen J, Avenevoli S, Case B, Georgiades K, Heaton L, Swanson S, Olfson M. Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2011 Jan;50(1):32-45. doi: 10.1016/j.jaac.2010.10.006. Epub 2010 Dec 3. PMID: 21156268; PMCID: PMC4408275.
Ritsher JB, Otilingam PG, Grajales M. Internalized stigma of mental illness: psychometric properties of a new measure. Psychiatry Res 2003 Nov 1; 121(1): 31-49. doi: 10.1016/j.psychres.2003.08.008. PMID: 14572622.
Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich) 2008 May; 10(5): 348-54. doi: 10.1111/j.1751-7176.2008.07572.x. PMID: 18453793; PMCID: PMC2562622.
Brugha T, Bebbington P, Tennant C, Hurry J. The List of Threatening Experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychol Med 1985 Feb; 15(1):189-94. doi: 10.1017/s003329170002105x. PMID: 3991833.
Dalgard O. S.: Community mental health profile as tool for psychiatric prevention. In Trent D. R. and Reed C. Eds., Promotion of mental health, 1996. Aldershot: Avebury.
WHO ASSIST Working Group. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility. Addiction 2002 Sep; 97(9):1183-94. doi: 10.1046/j.1360-0443.2002.00185.x. PMID: 12199834.
Arlington. Diagnostic and statistical manual of mental disorders. America; 2013, pp 153–
Lam DH, Watkins ER, Hayward P, Bright J, Wright K, Kerr N, Parr-Davis G, Sham P. A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Arch Gen Psychiatry. 2003 Feb; 60(2):145-52. doi: 10.1001/archpsyc.60.2.145. PMID: 12578431.
Abdisa E, Fekadu G, Girma S, Shibiru T, Tilahun T, Mohamed H, Wakgari A, Takele A, Abebe M, Tsegaye R. Self-stigma and medication adherence among patients with mental illness treated at Jimma University Medical Center, Southwest Ethiopia. Int J Ment Health Syst. 2020 Jul 29;14:56. doi: 10.1186/s13033-020-00391-6. PMID: 32760443; PMCID: PMC7391813.
Alemayehu Y, Demilew D, Asfaw G, Asfaw H, Alemnew N, Tadesse A. Internalized stigma and associated factors among patients with major depressive disorder at the outpatient department of Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia, 2019: A Cross-sectional study. Psychiatry J 2020 Aug 17; 2020: 7369542. doi: 10.1155/2020/7369542. PMID: 32879876; PMCID: PMC7448122.
D Szcześniak, A Kobyłko, I Wojciechowska, M Kłapciński, J Rymaszewska, Internalized stigma and its correlates among patients with severe mental illness. Neuropsychiatr Dis. Treat 2018; 14: 2599–608
Adebiyi MO, Mosaku SK, Irinoye OO, et al. Socio-demographic and clinical factors associated with relapse in mental illness. Int J Afr Nurs Sci 2018; 8: 149–53.
TT James, VR Kutty. Assessment of internalized stigma among patients with mental disorders in Thiruvananthapuram district, Kerala, India. Asia Pac J Public Health 2015; 27 (4): 439 –49
Semahegn A, Torpey K, Manu A, Assefa N, Tesfaye G, Ankomah A. Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis. Syst Rev 2020; 9(1):1–18.
Ahmad I, Khalily MT, Hallahan B. Reasons associated with treatment non-adherence in schizophrenia in a Pakistan cohort. Asian J Psychiatr 2017; 30: 39–43
Kane JM, Kishimoto T, Correll CU. Non-adherence to medication in patients with psychotic disorders: epidemiology, contributing factors and management strategies. World Psychiatry. 2013 Oct; 12(3): 216-26. doi: 10.1002/wps.20060. PMID: 24096780; PMCID: PMC3799245
Haslett WR, McHugo GJ, Bond GR, Drake RE. Use of Software for Tablet Computers to Promote Engagement With Supported Employment: Results From an RCT. Psychiatr Serv 2014 Jul; 65(7): 954-6. doi: 10.1176/appi.ps.201300275. PMID: 26037006.
Sam SP, Nisha A, Varghese PJ. Stressful life events and relapse in bipolar affective disorder: A cross-sectional study from a tertiary care center of Southern India. Indian J Psychol Med 2019 Jan-Feb; 41(1): 61-7. doi: 10.4103/IJPSYM.IJPSYM_113_18. PMID: 30783310; PMCID: PMC6337920.
Hussein HA, Jacoob S, Sharour LA. Impact of life events on the relapse of schizophrenic patients. J Educ Pract 2016; 7(10): 40–7.
Gupta S, Hendricks S, Kenkel AM, Bhatia SC, Haffke E A. Relapse in schizophrenia: is there a relationship to substance abuse?. Schizophr Res 1996; 20(1-2): 153–6. doi:10.1016/0920-9964(95)00108-5
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