Family Experience Dealing with Relapse in People with Mental Disorders

Introduction: Recurrence is a problem that often occurs in patients with mental disorders. Families who have family members with mental disorders, said that relapse can be caused by not taking medication regularly and when they relapse the family is afraid to face the patient, because the patient is angry and throw things. This study aims to explore in depth the meaning of family experience dealing with relapse in people with mental disorders. Methods: This study uses a qualitative research design with an interpretative phenomenological approach. This study used purposive sampling, with total 15 participants with inclusion criteria: families who have family members with mental disorders who have experienced a relapse in the last six months and are willing to become participants by signing the participant's informed consent form. Exclusion criteria were families with family members with mental disorders who also had other illnesses. The data collection strategy used in-depth interview techniques with semi-structured interview guidelines. Researchers conducted data analysis using Interpretative Phenomenological Analysis (IPA). Results: There are four themes in this study, namely (1) Always pay attention to prevent recurrence, (2) Families are able to recognize signs of relapse in family members with mental disorders, (3) Families use medical health services when a relapse occurs, (4) Feel emotional and fearful when the patient relapses. Conclusion: The results of this study indicate that families feel emotional and fear when the patient experiences a relapse, and the family also knows about the signs of relapse in patients with mental disorders.

. The results showed that the recurrence rate of people with mental disorders in the community had a high recurrence rate of 95% [5]. In patients with severe mental disorders it is estimated that there is a recurrence of 50% in the first year and 70% in the second year [6]. Relapses usually occur because of adverse events before they relapse [7]. Several factors that can influence the recurrence of people with mental disorders include patient factors, patient care giver factors, family factors and environmental support factors [6].
Based on a preliminary study that was conducted in the Work Area of Puskesmas I Sukawati on families who have family members with mental disorders, the families said their family members experienced relapses because they did not take medication regularly and when they relapsed the family was afraid to face the patient, because the patient was angry and had a tantrum and throwing things. Research shows that there was still lower the ability of the family, even in some cases, patients with mental disorders are still found shackled [8] Exploration of family experience is important to understand, how the family experience dealing with relapse in family members with mental disorders, so as to increase family awareness of the importance of preventing relapse in mental patients. In order to be able to explore the experience of the family, a phenomenological study was chosen in this study. This study aims to explore in depth the family experience dealing with relapse in people with mental disorders. In data analysis, the researcher transcribed word for word from interviews that had been recorded and coded manually by the researcher. After coding the data, the researcher analyzed the data using Interpretative Phenomenological Analysis (IPA) [9]. In the first stage, the researcher repeated reading and rereading the transcript until it was possible to find information that had not been recorded in the initial reading.

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Researchers use different fonts or underlining to identify information related to their research in each text. In the second stage, the researcher identified the emerging themes by referring to the three types of comments that had been made in the first stage. In the third, the researcher looked for the relationship of various themes that had been found that emerged and made a chart, so that the relationship between themes was clearly visible. In the fourth stage, the researcher repeated from stage one to stage four for the next participant case. In the final stage, the researcher searches for patterns and relationships between cases and themes found.
The credibility of the data in this study was obtained through peer checking, where the researchers conducted discussions related to the data that had been obtained with researchers who were experts in this research.

Theme 1: Always pay attention to prevent recurrence
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If the family already has a positive attitude, the family will be able to determine good care for the patient, especially when there is a relapse. In addition to the proper understanding of the family, the distance to health services also affects the attitude of the family in utilizing health services, where health services are located in strategic and easily accessible locations.
This study shows that families often feel emotional and fearful when the patient relapses, such as a feeling of wanting to hit when the patient rages and also fear when the patient relapses. In general, the impact felt by families with family members experiencing mental disorders is the high economic burden, family emotional burden, stress on disturbed patient behavior [16]. The subjective burden or mental burden is also felt by the family in caring for family members with mental disorders, namely anxiety, fear of hurting and shame on neighbors, especially during relapses [17].

CONCLUSION
The results of this study indicate that families feel emotional and fearful when the patient experiences a relapse, and the family also knows about the signs of relapse in patients with mental disorders.

ACKNOWLEDGMENTS
Authors would like to thank the Puskesmas Sukawati I and Stikes KESDAM IX/Udayana for the permission and facilities that have been given during the research process.