{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T20:29:07Z","timestamp":1769632147517,"version":"3.49.0"},"reference-count":0,"publisher":"African Journals Online (AJOL)","issue":"3","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rwanda J Med Health Sci"],"abstract":"<jats:p>BackgroundRelapse remains a major challenge in managing mental disorders, particularly in low-resource settings where empirical evidence is limited. This study estimated relapse prevalence and associated factors, and examined whether disorder type and psychological well-being moderated, and self-stigma mediated, the medication adherence\u2013relapse link.MethodsA cross-sectional study was conducted among 310 outpatients at Ndera Neuropsychiatric Teaching Hospital. Data were collected using structured questionnaires and validated scales measuring relapse, self-stigma, medication adherence, and psychological well-being. Chi-square tests assessed associations, while binary logistic regression identified independent predictors using SPSS version 29.ResultsRelapse prevalence was 76.1% in schizophrenia, 69.4% in bipolar disorder, 47.8% in depression, and 64.9% in substance misuse. Disorder type strongly predicted relapse: schizophrenia (AOR = 3.01, 95% CI: 1.28\u20137.09) and bipolar disorder (AOR = 2.74, 95% CI: 1.19\u20136.31) showed significantly higher risk than depression. Substance misuse, self-stigma, poor medication adherence, and low psychological well-being were associated with relapse in crude models but lost significance after adjustment. Moderation analysis revealed that psychological well-being significantly strengthened adherence's protective effect, reducing relapse from 91.7% at low adherence to 34.8% at high adherence. Disorder type shaped adherence effects: high adherence reduced relapse only in schizophrenia, with inconsistent effects in other disorders. Self-stigma did not mediate the adherence\u2013relapse link.ConclusionMedication adherence alone showed inconsistent effects; its protective role was pronounced in schizophrenia and among patients with high psychological well-being. Relapse prevention should prioritize enhancing adherence in schizophrenia and integrating psychological well-being interventions. Tailoring management to diagnostic subgroups is essential for improving outcomes.Rwanda J Med Health Sci 2025;8(3):631-649<\/jats:p>","DOI":"10.4314\/rjmhs.v8i3.15","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T08:30:07Z","timestamp":1769589007000},"page":"631-649","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence, Predictors, and Moderators of Relapse in Severe Mental Disorders: Evidence from Ndera Neuropsychiatric Teaching Hospital, Rwanda"],"prefix":"10.4314","volume":"8","author":[{"family":"Charles Nkubili","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Pascal Uwamungu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Schadrack Ntirenganya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric Ferdinand","family":"Twizeyimana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Emmanuel Kagabo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Emmanuel Ntakiyisumba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Jean Claude Musabyimana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Michel Nshimiyimana","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Andrine Mbabazi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Emile Niyonsaba","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"B\u00e9atrice Uwamwezi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Felix","family":"Uwimana Baho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Fidele Sebera","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Fortun\u00e9e Nyirandamutsa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"family":"Japhet Niyonsenga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2895","published-online":{"date-parts":[[2025,12,22]]},"container-title":["Rwanda Journal of Medicine and Health Sciences"],"original-title":[],"link":[{"URL":"https:\/\/www.ajol.info\/index.php\/rjmhs\/article\/download\/313461\/294878","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.ajol.info\/index.php\/rjmhs\/article\/download\/313461\/294878","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T08:30:08Z","timestamp":1769589008000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ajol.info\/index.php\/rjmhs\/article\/view\/313461"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,22]]},"references-count":0,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,11,27]]}},"URL":"https:\/\/doi.org\/10.4314\/rjmhs.v8i3.15","relation":{},"ISSN":["2616-9827","2616-9819"],"issn-type":[{"value":"2616-9827","type":"electronic"},{"value":"2616-9819","type":"print"}],"subject":[],"published":{"date-parts":[[2025,12,22]]}}}