RISK FACTORS FOR REHOSPITALIZATION OF PATIENTS WITH MENTAL DISORDERS A CASE CONTROL STUDY Margaret Eliphy Nkangala, Bsc Health Science Education, Malawi College of Health Sciences, Dr Robert Start and Dr Felix Kauye 10/31/2015 1

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. 2

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. 10/31/2015 3

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 10/31/2015 4

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 discharge Controls were: Currently attending outpatient clinic at ZMH Previously admitted with a severe mental disorder Discharged at least 1 year before recruitment to the study. 10/31/2015 5

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. 10/31/2015 6

7 DEMOGRAPHICS VariableCases (n=75)Controls(n=71) Subjects N=146NpercentageN p- valu e Males Employed * Married * Primary or no education * Residence: Rural * MeanSD Mea n SD Age

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 10/31/2015 8

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 < % 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). 10/31/2015 9

FAMILY SUPPORT 10/31/

SUBSTANCE MISUSE 10/31/

MEDICATION COMPLIANCE 53% of the cases and 83.1% of the controls were compliant with medication following discharge (p value of 0.005) 10/31/

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 10/31/

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. 10/31/

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 10/31/

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 10/31/

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. 10/31/

Acknowledgements Dr Robert Stewart Dr Felix Kauye Professor Linda Kalilani The executive Director MCHS Colleagues Students 10/31/

ct 10/31/