PREVALENCE OF PSYCHOLOGICAL MORBIDITY AMONG MEDICALLY ILL PATIENTS

Presented By:

30083044

INTRODUCTION
The theme of World Mental Health Day 2009 is Mental Health in Primary Care and it stresses the importance of identifying and treating mental illness in general health care settings. Mental health disorders continue to be a serious and expensive global health issue, affecting people of all ages and from all cultures and socio economic status.

SIGNIFICANCE AND NEED FOR THE STUDY In a study of a general medical clinic in an American hospital. It has been found that one third of psychiatric problems were undetected in medical patients [Brody et al., (1972)] This is for the first time in the history of nursing, a research has been carried out in assessing the prevalence of psychological morbidity among medically ill patients.

STATEMENT OF THE PROBLEM

A study to determine the prevalence of psychological morbidity among medically ill patients admitted to non-psychiatric wards in Government Rajaji Hospital Madurai.

OBJECTIVES
To determine the prevalence of distress in patients admitted to non-psychiatric wards.

To determine the prevalence of depression in patients admitted to non-psychiatric wards.

Cont.
To determine the prevalence of anxiety in patients admitted to non-psychiatric wards. To determine the prevalence of Somatization in patients admitted to non-psychiatric wards.

To find out the association between psychological morbidity and

selected demographic variables such as age, sex, religion, education, occupation, income, type of family etc. To find out the correlation between psychological morbidities of medically ill patients.

HYPOTHESES
There will be a significant association between

psychological

morbidity

and

selected

demographic variables such as age, sex, religion,

education, occupation, income and type of family

etc.

There will be a significant correlation in the

variables of psychological morbidity.

KING'S GOAL ATTAINMENT THEORY &PEPLAU'S THEORY OF INTERPERSONAL RELATIONS

Communication IDENTIFICATION PHASE

Nurse researcher and medically ill patient get introduced. Explanation of the procedure Identification of mutual goal

EXPLOITATION PHASE
Nurse researcher collects data on psychological morbidity by means of 4DSQ through interview schedule

RESOLUTION PHASE
Nurse researcher thank the medically ill patient

Interaction

Transaction

&

METHODOLOGY
RESEARCH APPROACH

Survey Approach
Descriptive Co relational Design Government Rajaji Hospital - Madurai

RESEARCH DESIGN

SETTING

Cont
STUDY POPULATION

Medically ill patients

SAMPLE

Samples were selected based on the inclusive criteria.

Cont.
SAMPLING SIZE SAMPLING TECHNIQUE Two Hundred and Ten Medically ill Patients
Stratified Random & Simple Random {Cardiology, Respiratory, Gastro-Enterology, Nephrology, Endocrinology and Infection Wards}
Part-II

RESEARCH TOOL

Part-I

Demographic Variables

Four Dimensional Symptom Questionnaire {4DSQ}

Cont.
Part-II
1. Distress 2. Depression 3. Anxiety 4. Somatization Cronbachs Alpha scores {Distress 0.90. Depression 0.89. Anxiety 0.88 & Somatization 0.84} 5 Experts in the field of Psychiatry, Psychiatric Nursing and Clinical Psychology

RELIABILITY

VALIDITY

Cont..
PILOT STUDY

30 Medically ill patients

DATA COLLECTION PROCEDURE

Structured Interview Schedule by using 4DSQ.

DATA ANALYSIS

Descriptive Statistics {Percentage, Frequency, Chi-square and Correlation}

MAJOR FINDINGS OF THE STUDY

Majority of the samples (73%) had low distress and a little over one fourth (26.5%) had moderately high level of distress. (40% of the samples with cardiac disorder and endocrinology disorder had moderately high distress) A little less than one fourth (23%) of the samples were moderately depressed. And very few (2%) of them scored very high on the depression subscale of 4DSQ.

Cont..
(43.4% of the samples with cardiac disorder suffered from moderately high level of depression. 10% of the samples with endocrinology disorder had very high depression) In anxiety, an overwhelming majority (97%) of the samples were under low level of anxiety were as only a very few (3%) are with moderately high level of anxiety. (16.6% of the samples with endocrinology disorder were under moderately high level of anxiety)

Cont.
An overwhelming majority of samples (93%) had low somatization, and very few (3%) of them had moderately high somatization. (16.6% of patients with cardiac disorder had moderately high somatization)
There was a statistically significant association between demographic variables like age [2 (48.1), (P<0.01***)], marital status [2 (7.6), (P<0.05*)], education [2 (62.2), (P<0.01***)], occupation [2 (6.0}, (P<0.05*)], social support [2 (11), (P<0.05*)], physical dependence [2 {25.4), (P<0.01***)] and distress of the medically ill patients.

Cont..
There was a statistically significant association between the demographic variables like age [2 (66.1), (P<0.01***)], marital status [2 (9.5), (P<0.02**)], education [2 (55.3), (P<0.01***)], monthly income [2 (13.7), (P<0.01***)], physical dependence [2 (10.3), (P<0.05*)], diagnosis [2 (28.2) (P<0.01***)], and the depression of the medically ill patients

Cont.

There was a statistically significant association between demographic variables like, age [2 (7.0), (P<0.01***)] and the anxiety of the medically ill patients. For other variables the association was insignificant. There was a statistically significant association between demographic variables like age [2 (11.9), (P<0.02**)] and education [2 (16.9), (P<0.05*)] and somatization of the medically ill patient.

Cont
There was a significant positive correlation between distress & depression (r = 0.8) distress & anxiety (r= 0.30) distress & somatization (r= 0.54) depression & anxiety (r= 0.42) depression & somatization (r = 0.57) and anxiety &

somatization (r = 0.39)

IMPLICATIONS

Implications for Nursing Practice The study findings revealed the importance of identifying psychological problems of medically ill patients in general settings. The study findings signify the importance of constructing Self Instruction Module for nurses working in medical wards in identifying psychological problems of the medically ill patients.

Cont.
Mental health aspects of the medically ill patients must also be considered in daily care planning by the nurses working in general wards. Nurses must be trained in identifying psychological problems of the medically ill patients. The study findings stress the importance of collaborative management of medically ill patients by various health team personnels. And it also emphasizes the World Mental Health Day 2009 theme MENTAL HEALTH IN PRIMARY CARE.

Implications for Nursing Education

Psychosocial care of general medical and surgical patients must be stressed by nursing educators to the nursing students. Nursing students in all levels should be trained in identifying and managing psychological problems of the medically ill patients. Implications for Nursing Research

The implications for the nursing research are given in the form of recommendation.

Implications for Nursing Administration

Administrators can organize an in-service education programme for nurses on capacity building in identifying psychological problems among medically ill patients. Administrators can organize a workshop for nursing students and staff nurses on integrating mental health services in medical care settings. Nursing administrators can issue pamphlets on common psychological problems present during the time of medical illness.

LIMITATIONS
This study was conducted only among general patients; surgical patients were not included in the study. So generalization must be done with caution.

RECOMMENDATION
A similar kind of study can be done among patients in different settings such as out patient department, emergency department and surgical wards. Similar study can be conducted among cancer patients and HIV / AIDS Patients.