CLINICAL PROFILE AND OUTCOME OF CARE AMONG VAGRANT AND NON-VAGRANT MENTALLY ILL PATIENTS ADMITTED TO NEUROPSYCHIATRIC HOSPITAL, ARO-ABEOKUTA-NIGERIA

Abstract

The vagrant mentally ill patients constitute an especially marginalised group with a scanty attention paid to them. There is a dearth of literature on this group of patients in the developing countries and most of the work done in the developed countries was community based prevalence studies. No study has compared the clinical profile and time to improvement among vagrant and non vagrant mentally ill patients, a lacuna which this study aims to bridge. The study aims at comparing the clinical profiles and outcome of care among vagrant and non vagrant mentally ill patients admitted to Aro psychiatric hospital. This was a retrospective review of records of all admitted vagrant and selected non vagrant mentally ill patients who fulfilled the inclusion criteria within a five year period (2004-2008). Sixty-one Vagrant and 122 non vagrant patients case files were studied. Data was collected using a semi-structured proforma. Descriptive statistics was used to summarise socio-demographic characteracteristics of the patients. Statistical test of significance used to compare variables between the groups included: chi-square, fisher exact and the t- test. The time to improvement of symptoms between the groups was compared using Kaplan-Meier method of survival analysis technique for censored observations and its significance was obtained by the log rank test . Factors influencing time to improvement was modelled using the Cox' Proportional Hazard model. P value of significance was set at p<0.05. One hundred and eighty - three patients' case files that satisfied the inclusion criteria were reviewed. There were 6 1(33.3%) vagrant and 122(66.7%) non vagrant mentally ill patients. The mean age of the patients was 40.3years and males were (59.8%). They were predominantly unemployed (68.9%), single (66.7%), low educational status (5 1.0%) with the diagnosis of schizophrenia (68.3%) and with a prevalence of 33.9% medical co morbid conditions. In comparison with the non vagrant group of patients, the vagrant was statistically (p<0.05) older, more single marital status, had lower education, unemployed, more unskilled labour and lived alone. The diagnosis of schizophrenia and physical co-morbidities were statistically (p=0.010) greater in the vagrant group. The median time to improvement among the vagrant (211.0 days) was significantly (p<0.001) longer than for the non vagrant patients (43.0 days). The factors found to prolong time to improvement at a significant level (p<0.05) were:old age, low education, being single, unemployment and the diagnosis pf schizophrenia and substance use disorders. From the study, the clinical profile and outcome of care among the vagrant mentally ill patients is poor compared to the non vagrant mentally ill patients. Health workers have the need for early identification of the risk factors that will help in the prevention of the mentally infirm from the pathway to vagrancy. The public health implication of this study is that it will create the awareness on the need for a collective endeavour for the care of vagrant mentally ill persons in our community.