Prevalence, Predictors, and Moderators of Relapse in Severe Mental Disorders: Evidence from Ndera Neuropsychiatric Teaching Hospital, Rwanda
Year: 2025
Type: article
Study design: Observational Study
Abstract: 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.
Authors: Charles Nkubili, Pascal Uwamungu, Schadrack Ntirenganya, Eric Ferdinand Twizeyimana, Emmanuel Kagabo, Emmanuel Ntakiyisumba, Jean Claude Musabyimana, Michel Nshimiyimana, Andrine Mbabazi, Emile Niyonsaba, Béatrice Uwamwezi, Felix Uwimana Baho, Fidele Sebera, Fortunée Nyirandamutsa, Japhet Niyonsenga
Institutions: University of Rwanda, University of Parma
Language: English
Subfield: Social Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: diamond
OpenAlex ID: W7125898080
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