Adherence and Treatment Outcomes among Patients with Comorbidity of Depression and Other Mental Disorders attending Psychiatric Hospitals in Rwanda
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Mental disorders constitute a serious public health problem. Besides, the co-morbidities of mental disorders pose a major problem with regard to adherence and treatment outcomes. This pseudo-longitudinal study aimed to investigate adherence and treatment outcomes among patients with comorbidity of depression and other mental disorders attending psychiatric hospitals in Rwanda. A sample of 382 patients was selected using systematic random sampling from three neuropsychiatric sites. The first and second assessments of patients took place after two and four months from each date of recruitment respectively. Data was collected during interviews using validated semi- structured tools and scales and from medical records of patients and analyzed using SPSS. It was found that the point prevalence of comorbidity of depression and other mental or neurological disorders was 31.4%. Among these patients, 18.1% had comorbidity of depression and other mental disorders but without any neurological disorder and 12.3% had depression and other neurological disorders but without any other mental disorders and 1% had depression, other mental and neurological disorders. The mean perceived social support (31.4%) was low and some patients lacked the support they needed. The mean perceived social stress (11.5%) was also low but could have effects on specific patients who experienced it. The overall level of functioning among patients was 57±13.8 falling in the GAF interval of [51-60]. This means that on average patients had moderate symptoms or moderate impairments in functioning. The overall level of adherence to treatment was found to be 65.8%. This indicates that the patients did not adhere optimally to their treatment: only 32.5% of patients achieved optimal adherence (score ≥ 80%). This is a lower rate compared to developed countries. The t-tests and chi-square tests were undertaken. The significant factors (p<0.05) influencing (hindering or promoting) adherence to treatment were medication side effects, affordability of treatment regimen, poor fit between treatment requirements and patient’s lifestyles or daily routine, poor communication, attitudes of service providers, availability of appointment staff, comorbidity of depression and other disorders, being busy, forgetfulness, travelling, social support, problems in social environment, having relatives who were stressful to patients, having economic barriers to access healthcare services and stigmatization. A weak significant relationship between adherence to treatment and treatment o number of patients who adhere optimally to treatment in order to have better treatment outcomes.