Medication Adherence, Stigma, and Access-to-Care as Predictors of Psychiatric Relapses in Tunisia
S. Ben Othman, M. Sehli, M. Touzeri, H. Mami, A. AissaIntroduction
Medication non-adherence and social stigma remain major barriers to relapse prevention in severe mental disorders. In low-resource settings, additional structural obstacles—such as cost and access to care—further compromise treatment continuity. Exploring these factors within the Tunisian context may provide insights into improving relapse prevention strategies.
Objectives
To evaluate how medication adherence, insight, internalized stigma, and structural barriers to care affect psychiatric relapses in Tunisian patients with severe mental disorders
Methods
Eighty-seven hospitalized patients (43 BD, 44 SCZ) were assessed using the Drug Attitude Inventory (DAI-10) for adherence, Birchwood Insight Scale (BIS) for insight, Internalized Stigma of Mental Illness scale (ISMI), and a questionnaire on access-to-care barriers (transport, availability, cost). Outcomes included number of relapses in the previous year. Analyses used Chi-square tests and Spearman correlations.
Results
Non-adherence was observed in 78% of patients (BD: 81%, SCZ: 75%; p=0.47). Insight (BIS mean 35/60) did not correlate with relapse (r=–0.12, p=0.24) or adherence (r=0.09, p=0.38). Internalized stigma (ISMI mean 2.8/4) correlated positively with relapse (r=0.32, p=0.005) and negatively with adherence (r=–0.28, p=0.012). Significant access-to-care barriers associated with relapse included medication shortages (52%; p=0.037) and transport difficulties (22%; p=0.027), particularly in rural areas.
Conclusions
Medication adherence, internalized stigma, and structural barriers significantly influence psychiatric relapses, while insight alone is not predictive. Interventions should combine psychoeducation, anti-stigma programs, family involvement, and improved rural access to care.
Disclosure of Interest
None Declared