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 for 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 and their caregivers in Tanzania. Methods: This study utilized longitudinal data collected as part of a randomized controlled trial testing a culturally-tailored model of Family Psychoeducation in Tanzania. The Herth Hope Index was used to measure hopefulness among PLWS and their caregivers at baseline and three months 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 PLWS and their caregivers. APIM can help determine how an individuals’ level of hope at time 0 impacts his or her own level of hope at time 1 and their partner’s level of hope at time 1. Results: For PLWS and their caregivers, actor effects were less than one (PLWS, β=0.261; caregivers, β=0.318), indicating stability in hopefulness over time. Regarding partner effects, caregivers baseline hopefulness had a positive effect on PLWS hopefulness at follow-up (β=0.100). 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 caregiver hopefulness at follow-up (β= -0.106). This suggests that higher PLWS hope at time 0 is associated with lower levels of hope in caregivers at time 1. Conclusions: Hopefulness seems to be interesting to consider because caregiver hopefulness can influence improvements in patient hopefulness over time. Future studies should further explore the dyadic relationship of hopefulness in this population, as hope is a non-pharmacological mechanism of change that is underutilized globally.