RISK FACTORS FOR REHOSPITALIZATIONOF PATIENTS WITH MENTAL DISORDERSA CASE CONTROL STUDY

Margaret Eliphy Nkangala, Bsc Health Science Education,Malawi College of Health Sciences, Dr Robert Start and Dr Felix Kauye

04/20/23

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INTRODUCTION

Studies from other parts of the world indicate that severe mental disorders can be treated and the affected individuals can lead a normal life again [WHO 2008].

However, Zomba Mental Hospital, Malawi, is experiencing a lot of rehospitalization some of which take place in less than a year after discharge.

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Aim of study

•To find out the factors that lead to rehospitalization of patients at the mental hospital in Malawi.

•To assist policy makers to utilize the findings to come up with measures to minimize relapses and hence improve community integration of patients discharged from the psychiatric hospital.

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Specific Objectives

•To compare persons who have been readmitted within one year of discharge and those who have not been readmitted on a number of variables including:▫demographic characteristics▫ illness characteristics▫ family support▫ substance abuse▫compliance to medication

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Method•The study used an unmatched case control design

Cases were:•Current inpatient in ZMH •Having a severe mental disorder•Readmitted in less than a year after last dischargeControls were:•Currently attending outpatient clinic at ZMH•Previously admitted with a severe mental disorder•Discharged at least 1 year before recruitment to the study.

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Data collection

•Data was collected by the researcher through the use of a structured questionnaire. This took place in the month of July 2011 for a period of 4 weeks.

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DEMOGRAPHICS

Variable Cases (n=75) Controls(n=71)  Subjects N=146 N percentage N percenta

gep-value

Males 43 57.3 45 63.4 0.501

Employed 29 38.7 40 56.3 0.046*

Married 21 28 25 35.2 0.377*

Primary or no education

55 73.3 37 52.1 0.010*

Residence: Rural 63 84 45 63.4 0.005*

Mean SD Mean

SD

Age 31.36 9.390 34.92 9.694

DIAGNOSIS (CASENOTE)

• 46 (61.3%) of the cases and 41 (57.7%) of the controls were diagnosed as schizophrenia.

• The next common condition was Mania/bipolar disorder. There were 14 (18.7%) cases with this diagnosis and 12 (16.9%) controls

• The third diagnosis was drug-induced psychosis. Eight of the cases (10.7%) and 14.1% of the controls were diagnosed as having this condition

• No significant differences between cases/controls

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ILLNESS CHARACTERISTICS• Mean admission number for the cases was

3.84(SD 1.748) while the controls had a mean admission number of 2.46 (SD1.43). Independent 2 tailed T-test p-value of <0.005

• 66.7% 0f the cases and 25% of the controls had been violent (p value of 0.005).

• 74.7% of the cases and 94.4% of the controls believed that they had a mental disorder (p value of 0.001).

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FAMILY SUPPORT

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SUBSTANCE MISUSE04/20/23

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MEDICATION COMPLIANCE

•53% of the cases and 83.1% of the controls were compliant with medication following discharge (p value of 0.005)

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Multivariate Analysis (logistic regression)The factors significantly associated with

being a case vs. control were:• primary or no education• living in rural area• having a history of violence to others• Lack of insight• non compliant with medication after discharge• not receiving financial and practical support

from family• not getting help with medication

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DISCUSSION• From the findings we conclude that the nature of the

illness is associated with rehospitalization due to:▫ having a history of violence to others▫ not believing that has a mental illness

• We did not find an association with marijuana misuse (but this was self-report)

• Those who are not rehospitalized are getting less support from the family:▫ receiving financial support from family▫ getting help with medication

• .

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DISCUSSION• Several modifiable factors are associated with

rehospitalization of patients:

▫ not receiving practical support from family• not compliant with medication after discharge• residing in rural areas

• These could be improved by improving community outreach services particularly in rural areas.

• Home visiting to include psychoeducation, support with medication compliance, and rehabilitation

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Limitations of the study

We depended on cases to give information which may not be reliable.

The study only looked at cases and controls from Zomba which may not be representative for Malawi

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Recommendations for practice and future research

For future research involve other districts and health centers.

A prospective cohort study can also be done to recruit patients on discharge and follow them up.

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Acknowledgements

•Dr Robert Stewart•Dr Felix Kauye•Professor Linda Kalilani•The executive Director MCHS•Colleagues•Students

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ct

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