Hopefulness among individuals living with schizophrenia and their caregivers in Tanzania: an actor-partner interdependence model

Abstract

Background: Hopefulness is a positive orientation or state of mind that can aid in the recovery and treatment of mental illness, as it can have significant impacts on clinical and psychosocial outcomes. As resource-constrained settings work to implement recovery-oriented care, there is a need to better understand hopefulness among people living with schizophrenia (PLWS) and caregivers in their extended family networks. This study seeks to examine the dyadic relationship of hopefulness and its associated correlates among PLWS attending outpatient psychiatric clinics and their caregivers in Tanzania.

Methods: This study utilized baseline and immediate post-intervention data collected as part of a randomized controlled trial testing a culturally tailored model of Family Psychoeducation, KUPAA, in Tanzania. The Herth Hope Index was used to measure hopefulness among PLWS (n = 33) and their caregivers (n = 33) at baseline and immediate post-intervention. Univariable and multivariable regression models were conducted to determine correlates of hopefulness at baseline, while the Actor-Partner Interdependence Model (APIM) was employed to examine the longitudinal, dyadic relationship of hopefulness among and between PLWS and their caregivers.

Results: Better family functioning was associated with higher levels of hopefulness in PLWS and their caregivers. Lower levels of stigma, lower symptom severity, and lower disability were associated with higher levels of hopefulness in PLWS. For PLWS and their caregivers, actor effects from the APIM model were less than one (PLWS, [Formula: see text]; caregivers, [Formula: see text]), indicating stability (within each person) in hopefulness over time. Regarding partner effects, a caregiver's baseline hopefulness had a positive effect on the hopefulness of their PLWS at follow-up ([Formula: see text]). This indicates that higher caregiver hope at time 0 is associated with higher levels of hope in PLWS at time 1. Baseline hopefulness levels for PLWS had a negative effect on caregivers' hopefulness at follow-up ([Formula: see text]). This suggests that higher hopefulness among PLWS at baseline is associated with lower levels of hope in caregivers at follow-up.

Conclusion: Hopefulness is important to consider in family or caregiver-based treatments for PLWS because caregiver hopefulness may influence improvements in hopefulness among PLWS over time. Future studies should further explore the longitudinal dyadic relationship of hopefulness for these populations, as hope is a non-pharmacological and modifiable mechanism of change that is underutilized in care and treatment plans for PLWS globally.

Trial registration: Clinical Trials #NCT04013932, July 10, 2019.

Keywords: Actor-partner interdependence model (APIM); Caregiving; Hopefulness; Psychotic disorders; Schizophrenia.

Fig. 1

Actor-partner interdependence model of hopefulness. Time 0 is baseline data collection and time 1 is data collection immediately post-intervention

Fig. 2

Results of APIM analysis. Time 0 is baseline data collection and time 1 is data collection immediately post-intervention

Fig. 3

Partner effects for caregivers and patients. Predicted patient HHI Total score at post-intervention follow-up by changes in caregiver baseline score, holding patient baseline HHI Total score at its observed mean (left panel); and predicted caregiver HHI Total score at post-intervention follow-up by changes in patient baseline score, holding caregiver baseline HHI Total score at its observed mean (right panel)