Determinants of Relapse Among Schizophrenia Patients in West Kalimantan: A Cross-sectional Study
Abstract
Relapse can affect functional impairment, rehospitalization, readmission, and long-term disability among schizophrenia patients. Although several factors, such as medication adherence, internalized stigma, and family support, are recognized as determining factors, there is still limited evidence from the Indonesian context, especially in West Kalimantan. This study aimed to evaluate the factors associated with relapse among schizophrenia patients. A quantitative, cross-sectional design was conducted at a mental hospital in West Kalimantan. A total of 63 patients and their families participated in this study, selected using a consecutive sampling technique. The MMAS-8, ISMI-9, and family support questionnaires were used to collect the data; patients completed the MMAS-8 and ISMI-9 questionnaires directly, whereas their families completed the family support questionnaire using a Google Form. The patients' medical reports were used to identify the relapse rate. Data were analyzed using Fisher's exact test and multivariate logistic regression.? Fisher's exact test showed that medication adherence was significantly associated with relapse (p = 0.02, p < 0.05), while internalized stigma and family support were not associated (p = 0.21; p = 0.12, p > 0.05). Medication adherence was the strongest factor associated with relapse, with an Adjusted Odds Ratio (AOR) of 2.091. This finding suggests that schizophrenia patients with a low level of medication adherence were over two times more likely to experience a lifetime relapse compared to those with a higher level of medication adherence
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Keywords: ?Family Support, Internalized Stigma, Medication Adherence, Relapse, SchizophreniaFull Text:
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Abdisa, E., Fekadu, G., Girma, S., Shibiru, T., Tilahun, T., Mohamed, H., Wakgari, A., Takele, A., Abebe, M., & Tsegaye, R. (2020). Self-stigma and medication adherence among patients with mental illness treated at Jimma University Medical Center, Southwest Ethiopia. International Journal of Mental Health Systems, 14(1), 1?13. https://doi.org/10.1186/s13033-020-00391-6
Adebiyi, M. O., Mosaku, S. K., Irinoye, O. O., & Oyelade, O. O. (2018). Socio-demographic and clinical factors associated with relapse in mental illness. International Journal of Africa Nursing Sciences, 8(November 2017), 149?153. https://doi.org/10.1016/j.ijans.2018.05.007
Agenagnew, L., & kassaw, C. (2020). The Lifetime Prevalence and Factors Associated with Relapse Among Mentally Ill Patients at Jimma University Medical Center, Ethiopia: Cross Sectional Study. Journal of Psychosocial Rehabilitation and Mental Health, 7(3), 211?220. https://doi.org/10.1007/s40737-020-00176-7
Barlati, S., Morena, D., Nibbio, G., Cacciani, P., Corsini, P., Mosca, A., Deste, G., Accardo, V., Turrina, C., Valsecchi, P., & Vita, A. (2022). Internalized stigma among people with schizophrenia: Relationship with socio-demographic, clinical and medication-related features. Schizophrenia Research, 243(1), 364?371. https://doi.org/https://doi.org/10.1016/j.schres.2021.06.007
Birhan, B., Rtbey, G., & Gelaw, K. A. (2025). Relapse and associated factors among psychiatric patients in Africa : a systematic review and meta-analysis. BMC Psychiatry, 25(333). https://doi.org/https://doi.org/10.1186/s12888-025-06759-7
Cahir, C. (2020). Primary nonadherence: the forgotten component of medication adherence? Polish Archives of Internal Medicine, 130(1), 1?3. https://doi.org/10.20452/PAMW.15164
Chen, H. H., Hsu, H. T., Lin, P. C., Chen, C.-Y., Hsieh, H.-F., & Ko, C. H. (2023). Efficacy of Smartphone App in Enhancing Medication Adherence and Accuracy in individuals with Schizophrenia during the COVID-19 Pandemic: A Randomized Controlled Trial (Preprint). JMIR Mental Health, 10. https://doi.org/10.2196/50806
Faden, J., & Citrome, L. (2023). Schizophrenia: One Name, Many Different Manifestations. The Medical Clinics of North America, 107(1), 61?72. https://doi.org/10.1016/j.mcna.2022.05.005
Febriana, B., Susanto, W., Rochmawati, D. H., & Setiawati, W. E. (2020). Family Support is the Key to Compliance with the Treatment of Relapsing Schizophrenia Patients. Jurnal Ners, 15(2), 457?461. https://doi.org/10.20473/jn.v15i2.20361
Guo, J., Lv, X., Liu, Y., Kong, L., Qu, H., & Yue, W. (2023). Influencing factors of medication adherence in schizophrenic patients: a meta-analysis. Schizophrenia (Heidelberg, Germany), 9(1), 31. https://doi.org/10.1038/s41537-023-00356-x
Iswanti, D. I., Nursalam, N., Fitryasari, R., Sarfika, R., & Saifudin, I. M. M. Y. (2024). Effectiveness of an Integrative Empowerment Intervention for Families on Caring and Prevention of Relapse in Schizophrenia Patients. SAGE Open Nursing, 10(46), 1?13. https://doi.org/10.1177/23779608241231000
Karabulut, B., & Uslu, E. (2024). Schizophrenia and medication adherence: Associated factors. Archives of Psychiatric Nursing, 49(4), 47?54. https://doi.org/https://doi.org/10.1016/j.apnu.2024.01.015
Kareem, M. A., & Mahmood, H. (2022). Adherence to Pharmacological Treatment Among Patients with Schizophrenia. Iraqi National Journal of Medicine, 4(1), 31?42. https://doi.org/10.37319/iqnjm.4.1.4
Kieling, C., Buchweitz, C., Caye, A., Silvani, J., Ameis, S. H., Brunoni, A. R., Cost, K. T., Courtney, D. B., Georgiades, K., Merikangas, K. R., Henderson, J. L., Polanczyk, G. V, Rohde, L. A., Salum, G. A., & Szatmari, P. (2024). Worldwide Prevalence and Disability From Mental Disorders Across Childhood and Adolescence: Evidence From the Global Burden of Disease Study. JAMA Psychiatry, 81(4), 347?356. https://doi.org/10.1001/jamapsychiatry.2023.5051
Kim, S.-H., & Park, S. (2023). Effectiveness of family interventions for patients with schizophrenia: A systematic review and meta-analysis. International Journal of Mental Health Nursing, 32(6), 1598?1615. https://doi.org/10.1111/inm.13198
Loots, E., Goossens, E., Vanwesemael, T., Morrens, M., Rompaey, B. Van, & Dilles, T. (2021). Interventions to Improve Medication Adherence in Patients with Schizophrenia or Bipolar Disorders : A Systematic Review and Meta-Analysis. Internation Journal of Environment Research and Public Health, 18(10213). https://doi.org/https://doi.org/10.3390/ijerph181910213
Mi, W. F., Chen, X. M., Fan, T. T., Tabarak, S., Xiao, J. B., Cao, Y. Z., Li, X. Y., Bao, Y. P., Han, Y., Li, L. Z., Shi, Y., Guo, L. H., Wang, X. Z., Liu, Y. Q., Wang, Z. M., Chen, J. X., Wu, F. C., Ma, W. Bin, Li, H. F., ? Lu, L. (2020). Identifying Modifiable Risk Factors for Relapse in Patients With Schizophrenia in China. Frontiers in Psychiatry, 11(September), 1?11. https://doi.org/10.3389/fpsyt.2020.574763
Ministry of Health of the Republic of Indonesia. (2023). Indonesian Health Survey. Jakarta: Ministry of Health of the Republic of Indonesia, 1?68.
Moges, S., Belete, T., Mekonen, T., & Menberu, M. (2021). Lifetime relapse and its associated factors among people with schizophrenia spectrum disorders who are on follow up at Comprehensive Specialized Hospitals in Amhara region, Ethiopia: a cross-sectional study. International Journal of Mental Health Systems, 15(1), 42. https://doi.org/10.1186/s13033-021-00464-0
Rodolico, A., Bighelli, I., Avanzato, C., Concerto, C., Cutrufelli, P., Mineo, L., Schneider-Thoma, J., Siafis, S., Signorelli, M. S., Wu, H., Wang, D., Furukawa, T. A., Pitschel-Walz, G., Aguglia, E., & Leucht, S. (2022). Family interventions for relapse prevention in schizophrenia: a systematic review and network meta-analysis. The Lancet Psychiatry, 9(3), 211?221. https://doi.org/10.1016/S2215-0366(21)00437-5
Rohmi, F., Yusuf, A., Fitriasari, R., & Pandin, M. G. R. (2023). Factors Affecting Medication Adherence Among Patient With Schizophrenia: A Literature Review. Malaysian Journal of Medicine and Health Sciences, 19(May), 180?190. https://doi.org/10.1101/2022.01.12.22269187
Schneider, M. P., & Burnier, M. A. (2022). Partnership between patients and interprofessional healthcare providers along the multifaceted journey to medication adherence. British Journal of Clinical Pharmacology, 89(7), 1992?1995. https://doi.org/10.1111/bcp.15325
Semahegn, A., Torpey, K., Manu, A., Assefa, N., Tesfaye, G., & Ankomah, A. (2020). Psychotropic medication non-adherence and its associated factors among patients with major psychiatric disorders: a systematic review and meta-analysis. Systematic Reviews, 9(1), 17. https://doi.org/10.1186/s13643-020-1274-3
Yu, B. C. L., Chio, F. H. N., Mak, W. W. S., Corrigan, P. W., & Chan, K. K. Y. (2021). Internalization process of stigma of people with mental illness across cultures: A meta-analytic structural equation modeling approach. Clinical Psychology Review, 87(July), 102029. https://doi.org/10.1016/j.cpr.2021.102029
Zaouali, J., Askri, F., Ellini, S., Cheour, M., Damak, R., Hallit, S., & Fekih‐Romdhane, F. (2025). Correlates of adherence to antipsychotic Medications in Patients with Schizophrenia and Bipolar Disorders. European Psychiatry, 68(S1), S1129. https://doi.org/10.1192/j.eurpsy.2025.2282
Zubi, A. khalaf Y., Hasan Al-jarrah, L. T., Mohammed Al-Alwan, M. M., Tahseen Swalmeh, W., & Salem Habarneh, A. F. (2022). Factors associated with relapse among mentally ill patients attending military mental health clinics. International Journal of Scientific Research and Management, 10(03), 558?567. https://doi.org/10.18535/ijsrm/v10i03.mp01
DOI: http://dx.doi.org/10.30829/contagion.v7i3.26541
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