Mpango Richard Stephen, Ssembajjwe Wilber, Rukundo Godfrey Zari, Amanyire Philip, Birungi Carol, Kalungi Allan, Rutakumwa Rwamahe, Ibanda Jonah, Tusiime Christine, Gadow Kenneth D, Patel Vikram, Nyirenda Moffat, Kinyanda Eugene
Mental Health Section, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
Brown School, Washington University, St. Louis, MO, 63130, USA.
BMC Psychiatry. 2025 Jul 29;25(1):734. doi: 10.1186/s12888-025-07121-7.
Non-adherence to clinic visits among patients with severe mental illness (SMI) presents challenges to patient management, treatment outcomes, and research in resource-limited settings. This study investigated the factors associated with non-adherence to clinic visits in Uganda, using appointment attendance as a proxy for clinic adherence.
This cohort study took place at Butabika National Referral Mental Hospital and Masaka Regional Referral Hospital from January to March 2018. A total of 1,201 participants with confirmed diagnoses of SMI were systematically sampled from over 3,000 outpatients. Data on socio-demographic, psychosocial, psychiatric, and behavioural factors were collected, with adherence defined as attending scheduled visits at 3, 6, 9, and 12 months post-enrolment. Descriptive statistics, bivariate, and multivariate logistic regression analyses were employed to identify significant predictors of non-adherence.
The overall prevalence of non-adherence to clinic visits was 20% (95% CI: 17.8 − 22.3%), with males showing higher rates (22.9%) compared to females (17.6%). Factors significantly associated with increased non-adherence included younger age, being treated at Butabika National Referral Mental Hospital, and alcohol use. Conversely, higher social support was linked to improved adherence. Among psychiatric variables, patients with major depressive disorder and severe psychiatric symptoms were more likely to miss appointments.
The study highlights the multifaceted nature of non-adherence in patients with SMI, emphasizing the need for targeted interventions addressing socio-demographic, psychosocial, and clinical factors. Enhancing social support, managing psychiatric symptoms, and reducing substance use are critical strategies for improving adherence rates, which could, in turn, lead to better health outcomes and resource optimization in mental health services.
The online version contains supplementary material available at 10.1186/s12888-025-07121-7.
在资源有限的环境中，严重精神疾病（SMI）患者不按时就诊给患者管理、治疗结果及研究带来了挑战。本研究以预约就诊率作为门诊依从性的替代指标，调查了乌干达患者不按时就诊的相关因素。
这项队列研究于2018年1月至3月在布塔比卡国家转诊精神病医院和马萨卡地区转诊医院进行。从3000多名门诊患者中系统抽取了1201名确诊为SMI的参与者。收集了社会人口学、心理社会、精神和行为因素的数据，将依从性定义为在入组后3、6、9和12个月参加预定的就诊。采用描述性统计、双变量和多变量逻辑回归分析来确定不依从的显著预测因素。
不按时就诊的总体患病率为20%（95%置信区间：17.8−22.3%），男性患病率（22.9%）高于女性（17.6%）。与不依从增加显著相关的因素包括年龄较小、在布塔比卡国家转诊精神病医院接受治疗和饮酒。相反，更高的社会支持与更好的依从性相关。在精神变量中，患有重度抑郁症和有严重精神症状的患者更有可能错过预约。
该研究强调了SMI患者不依从的多面性，强调需要针对社会人口学、心理社会和临床因素进行有针对性的干预。加强社会支持、管理精神症状和减少物质使用是提高依从率的关键策略，这反过来可能会带来更好的健康结果和精神卫生服务资源的优化。
在线版本包含可在10.1186/s12888-025-07121-7获取的补充材料。
