Relapse and associated factors among psychiatric patients in Africa: a systematic review and meta-analysis

Abstract

BACKGROUND: Relapse refers to the deterioration or recurrence of a patient's previous illness after either partial or full recovery. It is commonly observed in various mental disorders, with relapse rates ranging from 50 to 92%. This phenomenon can adversely affect the prognosis of the disorder, the functionality of individuals, and may even increase the overall costs of treatment. To achieve the desired outcomes in psychiatric treatment, it is crucial to prevent relapse whenever possible. Evidence-based data is essential for this purpose. This systematic review and meta-analysis provide an estimated pooled effect size of relapse and its determinants within this population, thereby guiding the development of appropriate intervention plans. METHODS: Observational studies on relapse and its contributing factors among African individuals living with mental illness were included based on predetermined criteria following independent evaluations by two authors. Multiple databases, including PubMed, African Journals Online, ScienceDirect, and EMBASE, were utilized to ensure comprehensive coverage of relevant studies. The data extracted using Microsoft Excel were imported into STATA version 14 for further analysis. Funnel plots and Egger regression tests were employed to assess the presence of publication bias. Additionally, subgroup analysis and sensitivity analysis were conducted. RESULTS: This systematic review and meta-analysis included sixteen research articles involving 4,660 participants. The pooled prevalence of relapse among individuals with mental health disorders was found to be 60.66% (95% CI: 50.00-70.26). A regional subgroup analysis revealed that the southern region of Africa exhibited the highest relapse rate at 74.05%, while the eastern region recorded the lowest rate at 56.08%. Factors associated with relapse included medication non-adherence [AOR = 3.09 (2.05, 4.66)] and comorbidity of mental illness [AOR = 2.45 (1.41, 4.27)]. CONCLUSION AND RECOMMENDATION: Overall, the results of our review indicated that six out of ten individuals with mental illnesses experienced a relapse. Factors associated with relapse included non-adherence to medication and the presence of comorbid mental health conditions. Therefore, it would be beneficial for mental health care providers to discuss the reasons for relapse with patients and their families in order to prevent these occurrences.