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Spousal Burden of Care in Schizophrenia
S. Kumar and S. Mohanty Institute of Mental Health and Hospital, Agra
Numerous studies have explored the existence of burden among primary caregivers and family members of schizophrenic patients. There were little convincing evidence to support the relationship between socio-demographic characteristics of the patients and family burden. The index study was designed to investigate the effects of sociodemographic variables on spousal burden of schizophrenic patients. 70 spouses of chronic schizophrenic patients were drawn from OPD of Institute of Mental Health and Hospital, Agra. Burden Assessment Schedule (Thara, Padmavati, Kumar & Srinivasan) was individually administered on each spouse. The results indicated significant effects of gender and family type on spousal burden. Keywords: Family burden, Schizophrenia, Spousal burden, Burden Assessment Schedule
Most key relatives of schizophrenic patients frequently report emotional, social, physical and financial burden associated with caring process of their patients. Numerous studies have explored the existence of burden among primary caregivers and family members of schizophrenic patients (Jenkins & Schumacher, 1999; Mors, Sorenson, & Therkildsen, 1992; Chakraborty, Raju, Kulhara, Avasthi, & Verma, 1992). Burden of care in schizophrenia correlates with patients illness variables (Dyck, Short, & Vitaliano., 1999; Salleh, 1994; Pai & Kapur, 1982; Raj, Kulhara, & Avasthi, 1991; Chakraborty et al., 1995), availability of caregivers resources as well as coping skills (Biegel et al., 1994; Magliano et al., 2000; Dyck et al., 1999). The relationship of burden and socio-demographic variables have also been studied. Martin-Yellowe (1992) found that rural families of the schizophrenic patients experienced significantly more financial burden than urban families. Stress level was higher
among the family members of male patients (Mors et al., 1992). The relatives of male patients with schizophrenia reported social deficits for male patients than the family members of female patients (Jenkins & Schumacher, 1999). In a study Trivedi, Dalal, Kalra, et al. (2003) found that the parents and siblings of schizophrenic patients experienced more burden in comparison to spouses. They also stated that young relatives and those having the age range of above 45 experienced more burden than the middle age group relatives. There is a positive correlation of family burden and duration of illness (Vohra, Garg, & Gaur, 2002). Jenkins and Schumacher (1999) contended that not only the patients gender but also the gender of the caregivers must be considered. There were little convincing evidence to support the relationship between socio-demographic characteristics of the patients and burden on family members. The
49±5. Procedure: The prospective patients were identified in consultation with consultant psychiatrists.58% (09) 37.54 ±5. Burden Assessment Schedule (Thara et al. The spouses of the patients were oriented towards the purpose and significance of the study.29% (19) 42. 1998) was administered on the spouses.85% (22) Illiterate Literate Nuclear Joint Rural Urban . Agra. BAS is a most frequently used tool to assess the burden of care of psychiatric patients in India. 6. of schizophrenic patients who currently met ICD-10 diagnostic criteria participated in the study. The duration of spousal exposure was determined on the basis of the onset and their stay with the patients. It measures burden in nine areas: (a) Spouse related (b) Physical and mental health (c) external support (d) caregiver’s routine (e) support of patient (f) taking responsibility (g) other relations (h) patients’ behavior (i) caregivers’ strategy.57% (24) 45.00±5.20 ±4.58 Male 33.71% (16) 54. The sample characteristics are displayed in table-1: Table-1: Sample Characteristics Characteristics Patients Age (in years) Age of Spouses in years) Education Family Type Domicile Duration of exposure to spousal illness (in years) Tools: Case History Record: The demographic and clinical characteristics of the patients and spouses were derived from the case history records which is a routine and mandatory procedure for the patients seeking consultation at the Institute. The reliability is . 70 spouses – 35 male and 35 female. They were asked how long they have been staying with the patients.26 ±7. The spouses who are living with the patients were taken up for the study.12 8.71-. There are 40 items rated on three point scale.15% (13) 62.14% (20) Female 40.190 Spousal Burden. did not give consent or had history of psychotic illness or systemic illness were not included. The spouses who were not co-operative.42% (26) 28.21 31.43% (11) 68.74 36. The Burden Assessment Schedule was administered on the spouses. Their suitability of inclusion was determined on the basis of inclusion and exclusion criteria. Method Sample: The study was conducted at Institute of Mental Health and Hospital.86% (15) 57.80. index study was designed to assess the effects of socio-demographic variables on spousal burden.80.27 37.70 60% (21) 40% (14) 71.23 ±8. The validity ranges from .
04* **p < 0.39 t-values 3. F = Female The gender effects are evident on total routine. family stress levels are use of projection is expected to increase likely to be significantly higher.55 2.64 1.59 1.62 SD 10. * p < 0.33 1.88 9.56 4.20 2.45 10.58 1. support of patient. Mohanty 191 Results and Discussion Table-2: Effects of Gender on Spousal Burden N = 35 in each category Areas of Burden BAS Total Scores Spouse Related Physical & Mental Health External Support Caregivers Routine Support of Patient Taking Responsibility Other Relations Patients Behaviour Caregivers Strategy Gender M F M F M F M F M F M F M F M F M F M F Mean 84.64 1.43** 2.25 14. The analysis of the areas of burden further themselves. The female spouses get revealed that the gender of spouses significantly lesser support from their spouses. (2005) observed that the female result is in expected direction. The routine of Besides full domestic responsibilities. caregivers engage themselves in work to earn and . tired. Mishra et al.37 9.31 1. The if the patient is male. Kumar and S. patients in females in all these areas.46 1.21 . spouses of schizophrenic patients primarily use (1992). isolated and greater workload.57 7.25 8. M = Male. The Kumar et al.44 1.01.25 6. (2005) also reported that projection as the defense mechanisms.S.94* . optimum external support.94 13.48 8.08* 1. The burden is higher caregivers routine.82 1. and caregivers strategy.14 11.08 9.62 10.37 1. Morse et al. In another study.05 8. Females lesser external support. caring.48** 1.54 9.43 3.38* 2.70 2.34 9.28 9. support of patient. find no time to care for their own health. contributed significantly to the burden in They face financial difficulties and try to following areas – external support. They illness in husbands places extra financial.40 92.69 1.72 1. patients behavior burden and in following areas–external support. Females get behavior and caregivers strategy. female spouses might find it difficult to get frustrated.20 6.98 1. Typically.40 1. experienced greater burden (table-2).68 8.82 6. treatment and social responsibilities on develop sleep disturbances and feel dissatisfied the way ill spouse looks after female spouses which add to their burden.84 .18 2. interpersonal conflict because of which the female spouses feel more anxious.05 . the female spouses gets adversely affected.
82 .24 1. The patients behavior also causes significantly higher burden in female spouses. N = Nuclear.28 6.00 10.75 SD 8. The caring spouses feel that there is no solution.05 1. J = Joint The family type significantly affects spousal burden in following areas – spouse related.09 1.69 8.23 8.75 6. The patient’s unpredictable behavior and disturbances at home cause marked burden in the spouses. in the initials stages of the crisis many persons come forward to extend support to the ill member and the family. external support and caregivers strategy.22 1. The continuation of illness gradually imposes restrictions on the interpersonal relationship of the family with other members of the society.97 9.58 2.14 13.190 1.79 1.53 8.85 t-values .90 6. In the area of caregivers strategy the female spouses experience greater burden.192 Spousal Burden. 28(Joint) Areas of Burden BAS Total Scores Spouse Related Physical & Mental Health External Support Caregivers Routine Support of Patient Taking Responsibility Other Relations Patients Behaviour Caregivers Strategy Family Type N J N J N J N J N J N J N J N J N J N J Mean 88.71 9. Nuclear family system causes more burden in the areas of external support and caregivers strategy.66 14.59 8.33 .25 1.40 11. Generally.46 2. N = 42(Nuclear).78 88.25 2.05 .50 1.75 1.29* *p < 0.34 .23 1. In nuclear family system the caring spouses get lesser support from others.41 2.57 1. support the family.42 9.57 8.08 1.57 1. .18* 1.55 3.22* .46 2. Table 3: Effects of Family Type on Spousal Burden.10 10. Female spouses feel that they have done more than enough to improve the situation and seek temporary separation.68 . Also it becomes very difficult for outsiders to continue to extend support to any other family.26 6.45 2. The joint family system is found to contribute significantly to the burden in the area of spouse related.81 13.15 3.89 9.
.57 1. caregiver’s routine and caregiver’s strategy.60 1. A.97 6.38 6.. L.16 SD t-values BAS Total Scores Spouse Related Physical & Mental Health External Support Caregivers Routine Support of Patient Taking Responsibility Other Relations Patients Behaviour Caregivers Strategy 11.S. Indian Journal of Psychiatry.. Avasthi..69 1. (1992). Predictors of burden in lower socioeconomic status caregivers of persons with chronic mental illness.61 87.41 1. S. P. Putaman.E.50 .70 1. Milligan..37. & Sang. external support. The specific areas on which particular attention is required are – spouse related. Comparison of the extent and pattern of family burden in affective disorders and schizophrenia.35 9.L.67 10.. 247-52. 30.14 1. Conclusion The results of the index study indicates significantly greater burden in female spouses.94 1.22 .46 .84 .52 10. Extent and determinants of burden among families of patients with affective disorder. P. Chakraborty. S.72 2.19 8. Kulhara. Raju.51 1.66 9.67 1. Chakraborty. S.65 1.30 2.30 1. (1995).81 1.72 14.47 10.64 10.06 .49 No significant effects are observed for duration of exposure on spousal burden (table-4). The results should contribute in family education and management of schizophrenic patients.32 9. 473-494.G.06 2.66 1.88 8.41 6. 105-112. Kumar and S. (1994).11 10. P.24 1.69 9.K. Kulhara. The passage of time does not affect spousal burden. References Biegel.13 6. & Verma.. S.K. Community Mental Health Journal. & Verma. S. L. .. Mohanty 193 Table 4: Effects of Duration of Exposure to Illness on Spousal Burden N = 34 (less than 5 years) 36 (above 5 years) Areas of Burden Exposure to Mean Spousal Illness < 5 years > 5 years < 5 years > 5 years < 5 years > 5 years < 5 years > 5 years < 5 years > 5 years < 5 years > 5 years < 5 years > 5 years < 5 years > 5 years < 5 years > 5 years < 5 years > 5 years 89.79 . The family system particularly nuclear family adds to the burden in some areas.08 13.11 1.78 3.Y.36 8.02 .76 8.47 1. 86. D. Acta Psychiatrica Scandinavica.13 .
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