Harvard Medical School, Department of Global Health & Social Medicine, Boston, MA, USA.
Duke Global Health Institute, Duke University, Durham, NC, USA.
BMC Psychiatry. 2023 Jul 13;23(1):508. doi: 10.1186/s12888-023-04990-8.
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.
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.
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.
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.
Clinical Trials #NCT04013932, July 10, 2019.
希望是一种积极的心态或状态，可以帮助精神疾病的康复和治疗，因为它会对临床和心理社会结果产生重大影响。在资源有限的环境中努力实施以康复为导向的护理时，需要更好地了解精神分裂症患者（PLWS）及其在扩展家庭网络中的照顾者的希望。本研究旨在检查坦桑尼亚参加门诊精神科诊所的 PLWS 及其照顾者之间希望的对偶关系及其相关关联。
本研究利用基线和即时干预后数据，作为一项测试文化上量身定制的家庭心理教育模型（KUPAA）的随机对照试验的一部分进行收集。使用赫特希望指数（Herth Hope Index）在基线和即时干预后测量 PLWS（n=33）及其照顾者（n=33）的希望。进行单变量和多变量回归模型以确定基线时希望的相关性，而采用演员-伙伴相互依赖模型（APIM）来检验 PLWS 和他们的照顾者之间以及彼此之间希望的纵向、对偶关系。
家庭功能越好，PLWS 和他们的照顾者的希望水平越高。耻辱感较低、症状严重程度较低和残疾程度较低与 PLWS 的希望水平较高有关。对于 PLWS 和他们的照顾者，APIM 模型的演员效应小于 1（PLWS，[公式：见文本]；照顾者，[公式：见文本]），这表明希望在时间上是稳定的（每个人内）。关于伙伴效应，照顾者的基线希望对随访时 PLWS 的希望有积极影响（[公式：见文本]）。这表明，在时间 0 时，照顾者的希望越高，在时间 1 时 PLWS 的希望水平就越高。PLWS 的基线希望水平对随访时照顾者的希望水平有负面影响（[公式：见文本]）。这表明，PLWS 基线时的希望越高，随访时照顾者的希望水平就越低。
在针对 PLWS 的家庭或照顾者为基础的治疗中，希望是一个重要的考虑因素，因为照顾者的希望可能会影响 PLWS 的希望随着时间的推移而提高。未来的研究应该进一步探索这些人群中希望的纵向对偶关系，因为希望是一种未被充分利用的非药物和可改变的变化机制，在全球范围内的 PLWS 护理和治疗计划中被忽视。
临床试验 #NCT04013932，2019 年 7 月 10 日。
