Understanding Relapse in Bipolar Disorder at a Tertiary Mental Health Facility in Uganda

Background: Bipolar disorder (BD) is a chronic psychiatric condition characterized by recurrent episodes of mania, hypomania, and depression, affecting approximately 1 in 150 adults globally. BD contributes significantly to disability and years of life lost, with a notable prevalence in Africa. The high relapse rates in BD, exacerbated by limited mental health resources and underdiagnosis, highlight the need for targeted interventions. This study explores the factors contributing to relapse among BD patients at Butabika National Referral Mental Hospital, Uganda, a crucial mental health facility in the region. Methods: This cross-sectional qualitative study was conducted at Butabika National Referral Mental Hospital. Adult patients aged 18-65, diagnosed with BD and experiencing relapse after treatment, were included. Data were collected through purposive sampling, focusing on obtaining detailed personal accounts from approximately 15 participants until data saturation was achieved. Thematic analysis identified key themes and subthemes related to relapse factors. Results: Five major themes emerged: treatment adherence, psychosocial factors, cultural beliefs, economic challenges, and coping mechanisms. Non-adherence to medication, driven by side effects, forgetfulness, and financial constraints, was a significant relapse factor. Psychosocial stressors, such as life events and social isolation, alongside stigma and cultural beliefs in traditional healing, further complicated relapse patterns. Economic hardships affected medication access and treatment consistency. Supportive social networks and psychoeducation emerged as crucial for effective management and relapse prevention. Conclusion: Addressing medication adherence, psychosocial stressors, cultural beliefs, and economic barriers through a holistic approach integrating medical treatment with psychoeducation and support systems is essential for improving patient outcomes and reducing relapse rates in this setting. Therefore, the effective management of bipolar disorder at Butabika National Referral Mental Hospital requires a complex interplay between biological, psychological, and social factors.