Swai Praxeda, Desjardins Monica, Minja Anna, Headley Jennifer, Lawala Paul, Ndelwa Liness, Maboja Carina, Temu Joseph, Lukens Ellen, Kaaya Sylvia, Baumgartner Joy Noel
Department of Psychiatry and Mental Health, School of Clinical Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
Duke Global Health Institute, Duke University, Durham, NC, USA.
SSM Ment Health. 2024 Jun;5. doi: 10.1016/j.ssmmh.2024.100312. Epub 2024 Mar 2.
In lower-resource settings like Tanzania, people living with schizophrenia (PWS) rely on their families for much of their social support, thus leading family members to become their main caregivers. How PWS and their families understand and implement social support can profoundly impact recovery pathways. This study examines how PWS and caregivers of PWS in Tanzania describe receiving and giving social support. We describe, from the perspectives of treatment engaged PWS and unmatched caregivers, different types of social support experienced and provided and examine any differences in the types and expectations of social support expressed by PWS versus caregivers.
A total of 39 semi-structured in-depth interviews were conducted with PWS (n = 19) and caregivers (n = 20) recruited from outpatient psychiatric clinics in tertiary-level hospitals in Tanzania across two geographic regions. Thematic content analyses were based on four dimensions of social support (instrumental, emotional, informational, and appraisal).
Results revealed four themes: 1) Financial and basic needs support from families is common yet critical for daily living (instrumental support); 2) There were mixed experiences regarding provision and receipt of love and acceptance with desires and calls for more encouragement and moral support (emotional support); 3) Caregivers try to provide knowledge, guidance, and reminders related to illness management for PWS but acknowledge their own gaps in understanding recovery promotion and effective caregiving (informational & appraisal supports), 4) A cross-cutting issue was calls for more social support from the wider community.
Social support is a multi-dimensional construct recognized by PWS and caregivers as critical for illness management, yet gaps remain, often due to lack of knowledge of how to bolster social support. Given the heavy reliance on families for social support in lower-resource contexts, psychiatric services can intervene with clinic-based psychoeducation for PWS and their families to improve quality of life and functioning.
在坦桑尼亚这样资源匮乏的地区，精神分裂症患者很大程度上依赖家人提供社会支持，这使得家庭成员成为他们的主要照料者。精神分裂症患者及其家人如何理解和实施社会支持会对康复途径产生深远影响。本研究考察坦桑尼亚的精神分裂症患者及其照料者如何描述接受和给予社会支持。我们从接受治疗的精神分裂症患者及其不匹配的照料者的角度，描述所经历和提供的不同类型的社会支持，并研究精神分裂症患者与照料者在社会支持类型和期望方面的差异。
在坦桑尼亚两个地理区域的三级医院门诊精神科诊所招募了共39名参与者，对19名精神分裂症患者和20名照料者进行了半结构化深度访谈。主题内容分析基于社会支持的四个维度（工具性、情感性、信息性和评价性）。
结果揭示了四个主题：1）家庭提供的经济和基本需求支持很常见，但对日常生活至关重要（工具性支持）；2）在给予和接受爱与接纳方面存在复杂的体验，人们渴望并呼吁更多鼓励和精神支持（情感性支持）；3）照料者试图为精神分裂症患者提供与疾病管理相关的知识、指导和提醒，但承认自己在促进康复和有效照料方面存在理解差距（信息性和评价性支持）；4）一个贯穿各方面的问题是呼吁更广泛的社区提供更多社会支持。
社会支持是一个多维度的概念，精神分裂症患者及其照料者都认为它对疾病管理至关重要，但差距仍然存在，这往往是由于缺乏如何加强社会支持的知识。鉴于在资源匮乏的环境中人们严重依赖家庭提供社会支持，精神科服务机构可以通过为精神分裂症患者及其家人提供基于诊所的心理教育来进行干预，以提高生活质量和功能。
