Background
Methods
Study setting
Sample size determination and sampling procedure
Data collection instrument
-
Relapse among patients with psychotic disorderA structured interviewer administered questionnaire containing a yes or no question was used to assess relapse. We assessed relapse based on the DSM IV-TR relapse definition criteria [24]. Patients were asked about the numbers of relapses they had. In addition, we reviewed their charts to identify the recorded numbers of relapses.
-
Factors associated with relapse
-
Socio demographic factors: The structured questionnaire contained questions on socio-demographic and socio-economic status of the patients (age, sex, marital status, and educational level, and ethnicity, frequency of attending a place of worship, occupation, income and living condition).
-
Medication related factors: We used medication adherence scale (MARS) to assess adherence to anti-psychotic medication [25]. Patients who responded ‘no’ for questions numbers 1–6 and 9–10 and ‘yes’ for question numbers 7–8 were considered as compliant. And those patients who responded ‘yes’ for question numbers 1–6 and 9–10 and ‘no’ for question numbers 7–8 were considered as non-compliant [26]. Also abnormal involuntary movement scale (AIMS) was used to assess medication side effects. The AIMS is considered as standard clinical practice for patients receiving long term neuroleptic drugs and it was applied by clinicians [27, 28].
-
Substance use disorders: We utilized CAGE (cudown, annoyed, guilty and eye opener) to screen alcohol use disorder. Two or more positive responses on CAGE are indicative of alcoholism [29]. We used Drug abuse screening test (DAST) to assess khat abuse [30]. Khat is a leaf, which is one among psychoactive substances and it is commonly used in East Africa including Ethiopia [31, 32] The interpretation of DAST is follows: a score of zero indicates absence of substance abuse, 1–2 indicate low level of substance abuse, 3–5 indicate moderate level of substance abuse, 6–8 indicate substantial level of substance abuse and 9–10 indicate severe level of substance abuse. Those participants having moderate level of substance abuse need referral to professionals [33‐35].
-
Duration of untreated psychotic disorder and Comorbidity: The participants were asked to indicate the duration of time they stayed before they sought therapy at modern health services after the onset of the illness. In addition, we asked the places they went before they sought services at modern health institutions.
-
Social support: We measured social support using six items. Each question had two parts. The first part is about the number of individuals that participants listed as a source of support and the second one is their level of satisfaction [36].
-
Data collection procedures
Data analysis
Results
Paricipants characteristics
Socio demographic characteristics | Number (percent) |
---|---|
Sex | |
Male | 279 (72.3 %) |
Female | 107 (27.7 %) |
Age | |
18–24 | 79 (20.5 %) |
25–34 | 186 (46.2 %) |
35–44 | 82 (21.2 %) |
45–54 | 28 (7.3 %) |
55–68 | 11 (2.8 %) |
Religion | |
Orthodox | 97 (25.1 %) |
Muslim | 234 (60.4 %) |
Protestant | 51 (13.2 %) |
Catholic | 1 (0.3 %) |
Other* | 3 (0.8 %) |
Frequency | |
Frequent | 170 (44 %) |
Sometimes | 196 (50.8 %) |
Never | 20 (5.2 %) |
Ethnicity | |
Oromo | 239 (61.9 %) |
Amhara | 66 (17.1 %) |
Gurage | 19 (4.9 %) |
Kaffa | 26 (6.7 %) |
Dawro | 20 (5.2 %) |
Yem | 5 (1.3 %) |
Other** | 11 (2.8 %) |
Marital status | |
Single | 179 (46.4 %) |
Married | 188 (48.7 %) |
Divorced | 11 (2.88 %) |
Separated | 2 (0.5 %) |
Widowed | 6 (1.6 %) |
Educational | |
Illiterate | 50 (13 %) |
Primary | 176 (45.6 %) |
Secondary | 96 (24.9 %) |
Tertiary | 64 (16.6 %) |
Occupation | |
Unemployed | 112 (29 %) |
gov't employee | 87 (22.5 %) |
Merchant | 26 (6.7 %) |
Private | 29 (7.5 %) |
Farmer | 97 (25.1 %) |
Other*** | 35 (9.1 %) |
Income | |
167–541 | 96 (24.9 %) |
542–1000 | 120 (31.1 %) |
1001–1888 | 75 (19.4 %) |
1889–10000 | 95 (24.6 %) |
Prevalence of relapse among patients with psychotic disorders
Variables | N | Relapse | No relapse |
P-value | Crude OR | 95 % CI |
---|---|---|---|---|---|---|
Sex | ||||||
Male | 279 | 71 (25.4 %) | 208 (74.6 %) | 0.54 | 1.18 | 0.50, 2.00 |
Female | 107 | 24 (22.4 %) | 83 (77.6 %) | Reference | ||
Age | ||||||
18–24 | 79 | 14 (17.7 %) | 65 (82.3 %) | 0.16 | 0.62 | 0.39, 1.20 |
25–34 | 186 | 48 (25.8 %) | 138 (74.2 %) | Reference | ||
35–44 | 82 | 23 (28 %) | 59 (72 %) | 0.70 | 1.12 | 0. 63, 2.01 |
45–54 | 28 | 9 (32.1 %) | 19 (67.9 %) | 0.48 | 1.36 | 0. 58, 3.21 |
55–68 | 11 | 1 (9.1 %) | 10 (90.9 %) | 0.24 | 0.29 | 0. 04, 2.31 |
Ethnicity | ||||||
Oromo | 239 | 55 (23 %) | 184 (77 %) | Reference | ||
Amhara | 66 | 20 (30.3 %) | 46 (69.7 %) | 0.23 | 1.46 | 0. 79, 2.66 |
Gurage | 19 | 4 (21.1 %) | 15 (78.9 %) | 0.85 | 1. 89 | 0. 28, 2.80 |
Kaffa | 26 | 4 (15.4 %) | 22 (84.6 %) | 0.379 | 0.61 | 0. 20, 1.84 |
Dawro | 20 | 7 (35 %) | 13 (65 %) | 0.23 | 1.80 | 0. 69, 4.74 |
Yem | 5 | 1 (20 %) | 4(80 %) | 0.87 | 0.84 | 0. 09, 7.64 |
Other* | 11 | 4 (36.4 %) | 7 (63.6 %) | 0.32 | 1.91 | 0. 54, 6.77 |
Religion | ||||||
Orthodox | 97 | 25 (25.8 %) | 72 (74.2 %) | 0.79 | 1.08 | 0. 63, 1.86 |
Muslim | 234 | 57 (24.4 %) | 177 (75.6 %) | Reference | ||
Other** | 55 | 13 (23.6 %) | 42 (76.4 %) | 0.91 | 0.96 | 0. 48, 1.92 |
Frequency of worship | ||||||
Frequently | 170 | 35 (20.6 %) | 135 (79.4 %) | Reference | ||
Sometime | 196 | 51 (26 %) | 145 (74 %) | 0.22 | 1.36 | 0.83, 2.21 |
Never | 20 | 9 (45 %) | 11 (55 %) | 0. 02 | 3.16 | 1.21, 8.21 |
Marital status | ||||||
Single | 179 | 44 (24.6 %) | 135 (75.4 %) | 0.93 | 0.98 | 0. 61, 1.57 |
Married | 188 | 47 (25 %) | 141 (75 %) | Reference | ||
Divorced | 11 | 1 (9.1 %) | 10 (90.9 %) | 0.26 | 0.30 | 0. 04, 2.41 |
Separated/widowed | 8 | 3 (37.5 %) | 5 (62.5 %) | 0.43 | 1.80 | 0. 41, 7.82 |
Educational status | ||||||
Illiterate | 50 | 12 (24 %) | 38 (76 %) | 0.65 | 1.19 | 0. 56, 2.50 |
Primary | 176 | 37 (21 %) | 139 (79 %) | Reference | ||
Secondary | 96 | 19 (19.8 %) | 77 (80.2 %) | 0.81 | 0.93 | 0. 50, 1.72 |
tertiary | 64 | 27 (42.2 %) | 37 (57.8 %) | 0.001 | 2.74 | 1.48, 5.07 |
Occupation | ||||||
Unemployed | 112 | 25 (22.3 %) | 87 (77.7 %) | Reference | ||
Government employee | 87 | 29 (33.3 %) | 58 (66.7 %) | 0.09 | 1.74 | 0. 93, 3.27 |
Merchant | 26 | 4 (15.4 %) | 22 (84.6 %) | 0.44 | 0.63 | 0.20, 2.01 |
Farmer | 97 | 23 (23.7 %) | 74 (76.3 %) | 0.81 | 1.08 | 0. 57, 2.06 |
Other*** | 64 | 14 (21.9 %) | 50 (78.1 %) | 0.95 | 0.97 | 0.46, 2.04 |
Income | ||||||
167–541 | 96 | 21 (21.9 %) | 75 (78.1 %) | 0.73 | 1.12 | 0.58, 2.17 |
542–1000 | 120 | 24 (20 %) | 96 (80 %) | Reference | ||
1001–1888 | 75 | 26 (34.7 %) | 49 (65.3 %) | 0.02 | 2.12 | 1.11, 4.08 |
1889–10000 | 95 | 24 (25.3 %) | 71 (74.7 %) | 0.36 | 1.35 | 0.71, 2.57 |
Living condition | ||||||
Alone | 32 | 5(15.6 %) | 27(84.4 %) | Reference | ||
With family | 339 | 88(26 %) | 251(74 %) | 0.20 | 0.53 | 0.20, 1.41 |
With relative | 15 | 2(13.3 %) | 13(86.7 %) | 0.28 | 0.44 | 0.10, 1.98 |
Variables | N | Relapse | No relapse |
P-value | Crude OR | 95 % CI |
---|---|---|---|---|---|---|
Diagnosis | ||||||
Schizophrenia | 280 | 70 (25 %) | 210 (75 %) | 0.62 | 1.19 | 0.60, 2.39 |
Schizophreniform and schizoaffective | 51 | 13 (25.5 %) | 38 (74.5 %) | 0.66 | 1.23 | 0.50, 3.01 |
Brief psychotic | 55 | 12 (21.8 %) | 43 (78.2 %) | Reference |
Factors associated with relapse
Variables | N | Relapse | No relapse |
P-value | Crude OR | 95 % CI |
---|---|---|---|---|---|---|
MARSa
| ||||||
Compliant | 356 | 80 (22.5 %) | 276 (77.5 %) | 0.001 | 0.29 | 0.14, 0.62 |
Non-compliant | 30 | 15 (50 %) | 15 (50 %) | Reference | ||
AIMSb
| ||||||
Below mean | 229 | 49 (21.4 %) | 180 (78.6 %) | Reference | ||
Above mean | 157 | 46 (29.3 %) | 111 (70.7 %) | 0.08 | 1.52 | 0.96, 2.43 |
Variables | N | Relapse | No relapse |
P-value | Crude OR | 95 % CI |
---|---|---|---|---|---|---|
CAGEa
| ||||||
No problem problem drinking | 359 | 84 (23.4 %) | 275 (76.6 %) | Reference | ||
Problem drinking | 27 | 11 (40.7 %) | 16 (59.3 %) | 0.05 | 2.25 | 1.01, 5.04 |
DASTb
| ||||||
No | 213 | 43 (20.2 %) | 170 (79.8 %) | Reference | ||
Low | 33 | 4 (12.1 %) | 29 (87.9 %) | 0.28 | 0.55 | 0.18, 1.63 |
Moderate | 114 | 36 (31.6 %) | 78 (68.4 %) | 0.02 | 1.83 | 1.09, 3.06 |
Substantial | 26 | 12 (46.2 %) | 14 (53.8 %) | 0.004 | 3.39 | 1.46, 7.85 |
Variables | N | Relapse | No relapse |
P-value | Crude OR | 95 % CI |
---|---|---|---|---|---|---|
Social support | ||||||
Low score | 261 | 70 (26.8 %) | 191 (73.2 %) | Reference | ||
High score | 125 | 25 (20 %) | 100 (80 %) | 0.15 | 0.68 | 0.41, 1.14 |
DUPa
| ||||||
Below mean | 221 | 50 (22.6 %) | 171 (77.4 %) | Reference | ||
Above mean | 165 | 45 (27.3 %) | 120 (72.7 %) | 0.30 | 1.28 | 0. 81, 2.04 |
Sought support from traditional sources | ||||||
Yes | 148 | 41 (27.7 %) | 107 (72.3 %) | 0.27 | 1.31 | 0.82, 2.09 |
No | 238 | 54 (22.7 %) | 184 (77.3 %) | Reference | ||
Sought religious support | ||||||
Yes | 210 | 61 (29 %) | 149 (71 %) | Reference | ||
No | 176 | 34 (19.3 %) | 142 (80.7 %) | 0.03 | 0.59 | 0.36, 0.94 |
Variables | N | Relapse | No relapse |
P-value | Crude OR | 95 % CI |
---|---|---|---|---|---|---|
Comorbid psychiatric illness | ||||||
Yes | 89 | 30 (33.7 %) | 59 (66.3 %) | 0.02 | 1.82 | 1.08, 3.05 |
No | 297 | 65 (21.9 %) | 232 (78.1 %) | Reference | ||
Comorbid medical illness | ||||||
Yes | 24 | 9 (37.5 %) | 15 (62.5 %) | 0.14 | 1.93 | 0.81, 4.56 |
No | 362 | 86 (23.8 %) | 276 (76.2 %) | Reference |
Variables |
P-value | Adjusted OR | 95 % CI | |
---|---|---|---|---|
Lower | Upper | |||
Sex | ||||
Male | 0.75 | 0.89 | 0.45 | 1.76 |
Female | Reference | |||
Age | ||||
18–24 | 0.13 | 0.53 | 0 .24 | 1.20 |
25–34 | Reference | |||
35–44 | 0.57 | 1.22 | 0.62 | 2.42 |
45–54 | 0.45 | 1.49 | 0.53 | 4.14 |
55–68 | 0.25 | 0.26 | 0.03 | 2.63 |
Ethnicity | ||||
Oromo | Reference | |||
Amhara | 0.81 | 1.10 | 0.50 | 2.45 |
Gurage | 0.43 | 0.58 | 0.15 | 2.22 |
Kaffa | 0.08 | 0.31 | 0.08 | 1.17 |
Dawro | 0.33 | 1.87 | 0.54 | 6.49 |
Yem | 0.76 | 0.67 | 0.02 | 8.58 |
Other* | 0.66 | 0.65 | 0.09 | 4.56 |
Frequency of worship | ||||
Frequently | Reference | |||
Sometime | 0.18 | 1.51 | 0.83 | 2.77 |
Never | 0.05 | 3.64 | 0.99 | 13.34 |
Educational status | ||||
Illiterate | 0.52 | 1.34 | 0.56 | 3.18 |
Primary | Reference | |||
Secondary | 0.99 | 0.99 | 0.47 | 2.09 |
Tertiary | 0.01 | 3.49 | 1.29 | 9.47 |
Occupation | ||||
Unemployed | Reference | |||
Government employee | 0.99 | 0.99 | 0.35 | 2.84 |
Merchant | 0.73 | 0.79 | 0.21 | 2.95 |
Farmer | 0.62 | 1.25 | 0.51 | 3.06 |
Other*** | 0.62 | 1.26 | 0.51 | 3.12 |
Income | ||||
167–541 | 0.43 | 1.35 | 0.64 | 2.82 |
542–1000 | Reference | |||
1001–1888 | 0.10 | 1.10 | 0.87 | 4.58 |
1889–10000 | 0.87 | 1.07 | 0.49 | 2.34 |
Living condition | ||||
Alone | Reference | |||
With family | 0.04 | 0.28 | 0.08 | 0.93 |
With relative | 0.23 | 0.32 | 0.05 | 2.02 |
MARSa
| ||||
Compliant | 0.02 | 0.31 | 0.12 | 0.80 |
Non-compliant | Reference | |||
AIMSb
| ||||
Below mean | Reference | |||
Above mean | 0.04 | 1.83 | 1.01 | 3.31 |
CAGEc
| ||||
No problem of drinking | Reference | |||
Drinking Problem | 0.95 | 1.04 | 0.32 | 3.34 |
DASTd
| ||||
No | Reference | |||
Low | 0.48 | 0.64 | 0.19 | 2.19 |
Moderate | 0.16 | 1.68 | 0.82 | 3.45 |
Substantial | 0.11 | 2.61 | 0.810 | 8.42 |
Social support | ||||
Low score | Reference | |||
High score | 0.04 | 0.52 | 0.28 | 0.95 |
Religious help seeking | ||||
Yes | Reference | |||
No | 0.04 | 0.55 | 0.31 | 0.96 |
Comorbid psychiatric illness | ||||
Yes | 0.52 | 0.77 | 0.35 | 1.70 |
No | Reference | |||
Comorbid medical illness | ||||
Yes | 0.22 | 1.98 | 0.67 | 5.90 |
No | Reference |