Abstract
BACKGROUND: Schizophrenia is a chronic-relapsing condition that in most cases, requires life-long treatment and follow-up. However, disengagement from care threatens the achievement of therapeutic targets for these patients, their families and the society. This study aimed to determine the burden of disengagement, and the socio-demographic and clinical predictors among patients with incident schizophrenia in a Nigeria Psychiatric Hospital in 8 years of follow-up. METHOD: This was a naturalistic study involving 160 clinically well-characterized patients with schizophrenia on follow-up, whose outcome data for 16 weeks had been reported. Subsequent follow-up data during scheduled appointments were obtained directly from the patients, case notes and via telephone interviews with participants and/or their caregivers. Disengagement from care and time to disengagement were operationally defined. The proportion that disengaged was calculated using percentages and 95% confidence interval. Time to disengagement was estimated using Kaplan-Meier time-to-event analysis, while the associated factors were analyzed by logistic regression. RESULTS: At the 8th year of follow-up, we had contact with 147 (91.9%) subjects, mostly by phone, out of whom 82.3% (95% CI: 75.2%-88.1%) had disengaged from care. The median time to disengagement and number of visits in 8 years were: 1 year and five visits, respectively. A quarter (40/160) of the original participants never came for their first appointment. The common reasons given for disengagement were financial constraints and dissatisfaction with improvement. A quarter (38/147) had sought care with religious and traditional faith healers after encountering our service. The mortality rate was 47.6 per 1000 (7/147). Cause of death was attributed to suicide (3/7) and other chronic medical conditions (3/7). Those who relapsed had significantly longer time to disengagement than those without relapse. CONCLUSION: Disengagement is a common phenomenon in our setting, as elsewhere in the literature, despite adequate family support and good clinical outcome. The finding on the time to disengagement has implications for designing interventions to promote adherence to treatment plans.