Factors influencing relapse among patients with schizophrenia in Muhimbili national hospital: the perspectives of patients and their caregivers

Abstract

Background Relapse in patients with schizophrenia is a major challenge for mental health service providers in Tanzania and other countries. Approximately 10% of patients with schizophrenia are re-admitted due to relapse at Muhimbili National Hospital (MNH) Psychiatric Unit each month. Relapse brings about negative effects and it results in a huge burden to patients, their families and mental health sector and country economy as well. So far no study has been done to address relapse in Tanzania. That is why there is a need to find out as to why individuals with schizophrenia experience relapse. Objectives This study aimed to explore perspectives on factors influencing relapse to patients with schizophrenia and their caregivers attended at Muhimbili National Hospital Psychiatric Out-patient Department, Dar es Salaam, Tanzania. Methodology A qualitative study was conducted, involving in-depth interviews of 7 schizophrenic out-patients and their 7 caregivers at MNH Psychiatric Out-patient Department in Dar es Salaam, Tanzania. Purposive sampling procedure was used to select participants for the study. Audio recorded in-depth interviews in Swahili language were conducted with all participants in the study. The recorded information was transcribed to text in computer files and analyzed by using NVivo 9 computer assisted qualitative data analysis software. Findings Personal and environmental factors for relapse were the main themes that emerged from this study. Patients and their caregivers perceived non adherence to antipsychotic medication as a leading factor to relapse. Other factors included poor family support, stressful life events and substance use. Family support, adherence to antipsychotic medication, employment and religion were viewed as protectors of relapse. Participants suggested strengthening mental health psychoeducation sessions and community home visits conducted by mental health nurses to help reduce relapse. Other suggestions included strengthening of nurse-patient therapeutic relationship in provision of mental health care. Conclusion and recommendations It is important for mental health nurses to strengthen their therapeutic relationships with patients and their caregivers. Regular individual psychoeducation sessions and community based interventions would help reduce relapse and mental health service ix costs. Further larger studies with more diverse sample of people with schizophrenia and their caregivers are necessary to understand the issue of relapse in patients with schizophrenia.