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

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.

Does bullying predict suicidal behaviors among in-school adolescents? A cross-sectional finding from Tanzania as an example of a low-income country.

BACKGROUND: Bullying and suicidal behaviors are a silent public health problem among adolescents. Little is known about the link between bullying and suicidal behaviors in low-income countries such as Tanzania. In the current study, we estimated the prevalence of being bullied and determined its association with suicidal behaviors among in-school adolescents. METHODS: We performed a secondary analysis of the Tanzania Global School-based Student Health Survey (GSHS) conducted in 2014. This was the first nationally representative survey conducted to a sample of 3793 in-school adolescents. The primary independent variable was being bullied, while the outcome variables of interest were suicide ideation and suicide attempt. We used a chi-square χ2 test for group variables comparisons and multivariate logistic regression for statistical associations between independent and outcome variables. In our analysis, a p < 0.05 was considered statistically significant at 95% confidence intervals. RESULTS: The prevalence of being bullied among 3793 surveyed in-school adolescents was 27.0%. In an adjusted multivariate regression model, being bullied was independently associated with suicidal ideation and suicide attempt: [AOR; 1.9, 95% C.I; 1.5-2.4], and [AOR; 3.6, 95% C.I; 2.9-4.5] respectively, p < 0.001. CONCLUSIONS: Bullying is prevalent and possibly a potential predictor of suicidal behaviors among in-school adolescents in Tanzania. There is a need for all educational stakeholders: teachers, parents, students, mental health professionals, and policymakers to design a program for mitigating the problem of bullying in schools.

Does food insecurity link to suicidal behaviors among in-school adolescents? Findings from the low-income country of sub-Saharan Africa.

BACKGROUND: Suicidal behaviors among adolescents is a major public health concern. Psychological factors have been extensively studied known risks linked to suicidal behaviors in the general population. However, the association between food insecurity and suicidal behaviors is less researched, particularly in low and middle-income countries. The present study sought to assess the link between food insecurity and suicide behaviors among in-school adolescents. METHODS: The present study was based on the secondary analysis of the first nationally representative sample of the 2014 Tanzania Global School-based Student Health Survey (GSHS). A total sample of 3,793 in-school adolescents was included in the present analysis. The primary independent variable was food insecurity while the dependent variables of interest were suicide ideation and suicide attempt. Chi-square χ2 and multivariate logistic regression were used to ascertain the measure of statistical association. In all analyses, a p < 0.05 was considered statistically significant. RESULTS: Of the 3,793 in-school adolescents, 254 (6·7%) were food insecure. A significantly large proportion of adolescents with suicidal ideation and suicidal attempt were food insecure than their counterparts, respectively. In the adjusted multivariate model, food insecure adolescents were more likely to have experienced suicidal ideation and suicidal attempt: [AOR; 1·8 95% C. I; 1·3-2·5] and [AOR; 2·4, 95% C. I; 1·7-3·3]; p < 0.001, respectively. CONCLUSION: Food insecurity was an independent predictor of suicidal behaviors among in-school adolescents. An intervention that targets food security at the school level may protect adolescents of food insecure household from suicidal behaviors. Nevertheless, school-based mental health screening, evaluation, and promotion may be needed for adolescents with suicidal behaviors.

Adrenal Insufficiency: A Forgotten Diagnosis in HIV/AIDS Patients in Developing Countries.

Adrenal insufficiency (AI) is one of the most common endocrine disease in patients with HIV/AIDS, leading to high morbidity and mortality in HIV patients who become critically ill. Various etiologies are associated with the condition, including cytomegalovirus (CMV), Mycobacterium tuberculosis, lymphoma, Kaposi's sarcoma, and drugs such as rifampin, among others. HIV patients with advanced disease develop relative cortisol deficiency largely due to the reduction of cortisol reserve, which predisposes patients to adrenal crisis in periods of stress or critical illness. The prevalence of AI in HIV/AIDS patients during HAART era is higher in developing than developed countries, probably due to limited access to both diagnosis and adequate treatments which increases the risk of opportunistic infections. The clinical features of functional adrenal insufficiency in HIV/AIDS patients can be masked by various infectious, noninfectious, and iatrogenic causes, which reduce clinical recognition of the condition. Development of simple screening algorithms may help clinicians reach the diagnosis when approaching these patients. In many low-income countries, most HIV patients are diagnosed with advanced disease; thus, further research is necessary to elucidate the prevalence of adrenal insufficiency in HIV/AIDS patients and the condition's impact on mortality in this population.