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Evidence-based psychosocial treatment for psychotic disorders in low- and middle-income countries has been severely neglected. Family Psychoeducation (FPE) is an evidence-based practice developed in high-income countries to support and improve recovery among adults living with schizophrenia-spectrum disorders. FPE could be highly appropriate for cultural contexts, such as Tanzania, where the vast majority of affected individuals live with families, independent living is rare, and problem-solving often involves the larger community. There is currently no evidence base for using FPE in sub-Saharan Africa. Our team culturally tailored FPE for implementation by social workers and other clinic-based mental health providers in Tanzania in order to position the intervention for optimal patient-oriented outcomes. Given the scarcity of evidence-based psychosocial interventions for schizophrenia in low- and middle-income countries, a culturally tailored version of FPE is being tested in a pilot clinical trial in Dar es Salaam and Mbeya, Tanzania among outpatients of mental health services. In anticipation of testing the intervention’s impact on functioning as a main trial outcome, we first wanted to better understand functioning at baseline for our study population. Our study objectives are to 1) to describe the psychiatric treatment-engaged population that enrolled in the culturally tailored FPE pilot clinical trial, and to 2) assess differences in baseline functioning by demographic and behavioral factors, such as sex, length of illness, symptom severity, and hopefulness.
Methods:
A total of 66 adults ages 18-50, diagnosed with a psychotic disorder, and receiving psychiatric outpatient services from two tertiary care hospitals in Tanzania were enrolled in the trial along with a matched relative caregiver. Baseline data used for this analysis are from patient interviews conducted prior to randomization into FPE or standard of care (typically medication management and ad hoc family counseling by providers). Functioning was measured by the WHO Disability Assessment Schedule (WHODAS 2.0). Exploratory analyses were conducted using univariable and multivariable linear regression with bootstrapped standard errors.
Results:
The mean age of participants was 33 (SD: 8.2) years, 33% were women, 68% had their diagnosis for 4 or more years, 62% completed secondary education or higher, 20% were sexually active, and 58% worked in the past three months. Preliminary analyses suggest that mean functioning did not differ by participant sex, but that higher functioning (lower disability) was associated with being sexually active. Lower functioning was weakly associated with length of illness and strongly associated with symptom severity (PANSS general score) and internalized stigma. Higher functioning was strongly associated with hopefulness and self-efficacy. Associations were similar, though attenuated, on multivariable adjustment for all other variables.
Conclusions & Implications:
Individuals living with psychotic disorders and their families have a right to recovery-oriented mental health services tailored to their cultural context. There is very little published data on characteristics of the treatment-engaged population in Tanzania and this information helps clinicians and policy-makers to better understand who is being served in the absence of population level psychiatric epidemiology. The results also inform psychosocial interventions that target improved functioning as an outcome.