Volume 1, Issue 2, July-December, 2019

ISSN: 2582-1393 (Online)

An
official
Publication of

A
I
I
A
J
M
H
S
S
W
W
P All India Association of
Medical Social Work
Professionals
 Indian Journal of Health Social Work
An official Publication of All India Association of Medical Social Work Professionals

Volume 1, Issue 2, July-December, 2019

ISSN: 2582-1393 (Online)

CHIEF EDITOR
Narendra Kumar Singh

MANAGING EDITOR
O. P. Giri

ASSOCIATE EDITOR
Ambrish Kumar

ASSISTANT EDITORS
Prashant Srivastava
Vivek Kumar Singh
Raghavendra K Rai

ADVISORY BOARD
Anil K. Goswami Pankaj Singh
Rashmi Sharma W. Ranbir Singh
B. R. Shekhar Narbdeshwar Singh
Ajay K. Singh Akhilesh Kr.Tripathi

EDITORIAL BOARD
Sushil K. Mishra, New Delhi Aftab Alam Shah, New Delhi
R. Srividhya, Puducherry Santosh Kr. Upadhyay, Safai
Malti Kumari, Ranchi Pradeep Kumar, Rohtak
Sanjay Bhonge, Mumbai Subashish Saha, Agartala

Editorial Office:
Department of Psychiatric Social Work, Teaching Block
Central Institute of Psychiatry (CIP), Kanke, Ranchi-834006 (Jharkhand)
Website- https://aiamswp.org.in, E-mail- aiamswpeditor@gmail.com
 Indian Journal of Health Social Work
An official Publication of All India Association of Medical Social Work Professionals

Volume 1, Issue 2, July-December, 2019

Office Bearers of All India Association of

Medical Social Work Professionals

Patron Chief Editor

Dr. Anil K. Goswami Dr. Narendra Kumar Singh

President Zonal Secretary

Ms.Rashmi Sharma Central- Shri Akhilesh Kr. Tripathi

East- Dr. Narendra Kumar Singh

Vice President West- Shri Pankaj Singh

Shri B. R. Shekhar North- Shri Raghavendra K Rai

Dr. Santosh Kr. Upadhyay South- Ms. R. Srividhya

North- East- Dr. W. Ranbir Singh

General Secretary

Dr. O.P. Giri Executive Members

Shri Narbdeshwar Singh

Joint Secretary Shri Subhasish Saha

Shri Sushil K. Mishra Shri Mukesh Kumar

Shri Aftab Alam Shah Shri Ajeet Kumar

Dr. Jaswinder Kaur

Treasurer Shri Shrikant Pawar

Ms. Manpreet Kaur Shri Prashant Srivastava

 Indian Journal of Health Social Work
An official Publication of All India Association of Medical Social Work Professionals

Volume 1, Issue 2, July-December, 2019

ISSN: 2582-1393 (Online)

CONTENTS

Editorial
Social Work Health and Wellness 1
Narendra Kumar Singh

Review Articles
Sex Work in Indian Society: Then and Now 3
Shuvabrata Poddar
Aggression and Substance Use Disorder in Adolescents: In Changing Era 8
Arzu Ahlawat, Kavya Ahuja, Prashant Srivastava

Original Articles
Interaction Patterns in the Families of Individual with Cannabis 17
Dependence
Nirmala Kumari Ahirwar, Manisha Kiran
Quality of life, Hardiness and Self-esteem of Employed & Non-Employed 23
Females: A Comparative Study
Dharmendra Kumar Singh
Relationship Between Intellecual Fuctioning, Family Burden and Quality 28
of Life of Parents with Intellectual Impairment, Muzaffarpur, Bihar
Pradeep kumar, Sushma Rathee, Amrita Rani Singh

Brief Communication
Perceived Social Support and Ego Resilience in School Going 29
Adolescents: A Gender Based Study
Lokesh Kumar Ranjan, Anand M Ghadse, Pramod R Gupta

Forum
Effects of Medical Litigation on Society 43
Neelam Prasad Yadav

Case Reports
Early Onset of schizophrenia: A case Study of High Genetic loading in 47
the Family of Origin and Procreation
Neinunnem Grace Khaute, Virupaksha Kiccha, Gobinda Majhi
A Clinical Case Study of Individual with Obsessive Compulsive Disorder 53
(OCD)
Prashant Srivastava, Kavya Ahu, Vani Narula

Instruction for Authors 58

 EDITORIAL
SOCIAL WORK HEALTH AND WELLNESS
The pri mary mission of the Soci al Work
profession is to enhance the well-being of all
people with particular attention to basic needs
and bio -ps ycho-social functio ni ng of
marginalized populations (NASW, 2012). The
World Health Organization defines Health as
“a state of complete physical, mental, and
social well-being and not merely the absence
of di s eas e o r i n fi r mi t y” ( Wor l d Heal th
Organization, 2009). Social work may adopt
the World Health Organization’s account of
health as a working definition for developing
and contrasting the idea of social work health
and wellness. The Social Work intervention
includes the activities that promote wellness
and phys i cal fi tnes s . It al s o addres s es
important mental, emotional, and s ocial
“fitness” factors that support the profession’s
vi s i on. Soci al work profes s i on has the
potential to strengthen the present national
di sco urs e on hol ist ic growth a nd
empowerment through developing a synergy
among physical-psychological-social-spiritual
aspects of life. According to Saxena et al,
(2005) Social worker plays significant role in
bringing positive physical and psychological
changes in human-beings. These positive
changes hel p the indi vi dual to cope up
effectively with stressful situations, thus
improving the quality of life. According to
McLean and Andrew (2000) Social worker has
gr ea t abi l i ty i n a s s es s i n g th e di f fi cu l t
circumstances of human life and resolute the
problem for welfare of individuals. There are
researches indicating that physical activity has
good impact i n reducing burnout & job
dissatisfaction, increase positive energy and
encou rage the peopl e to devel op s el f-
efficiency (Gillison et al, 2009). Social worker
Indian Journal of Health Social Work. 1(2) July-December, 2019
inspires the individuals to engage themselves
in physical activities for betterment of life
such as activities in group and enjoying life
with optimal level of wellness.
Social worker always focuses to find out the
r el a ti o n s h i p b et w ee n th e p r of e s s i o na l
assignment and commitment for wellbeing and
development. They are also maintaining an
ideal level of social wellness allows building
healthy relationships with others. They create
supporti ve s oci al network for agrees to
impro ve pos iti ve ski lls and beco me
comfortable with stressful situations. It is
know that health social workers play a vital
role to increases positive coping, self-esteem
and confident of human and social wellness
enables to create boundaries that encourage
co mmunicati on, trus t a nd confli ct
management.
In social work education, it seems that there
is inclusion of intervention like physical activity
and quality of life for increasing the work
efficiency and wellbeing throughout the life
of people. Previous researches indicate that
physical workout develops cardiovascular,
respiratory and digestive fitness, as well as
reduce metabolic problems and enhances
energy and flexibility (Barnett, et al., 2009).
Social Work profession gives importance on
good health and sustainable development. It
also emphasizes to create an environment
which aims at maintaining good physical and
mental health and provide better quality of
life. Social Worker empowers the deprived
and weaker section of society by providing
services which aims at enhancing their skill
to cope with problem and finding out the
solution for their well-being.
I t c an b e c o nc l u d ed th at So c i a l W or k
1
profession has the unique potential and
opportunity to contribute to overall wellbeing
and address the growing issue of physical
inactivity, burnout and poor quality of life at
individual, family, group, community and
society level.
REFERENCES
Barnett, L.M., Van.,Beurden, E., Morgan, P.J.,
Brooks, L.O., &Beard, J.R (2009).
Childhood motor skill proficiency as a
predi c tor of ado l es cent ph ys i cal
activity. Journal of Adolescent Health,
44, 252–259.
Gillison, F. B., Skevington, S. M., Sato, A.,
S ta nd ag e, M ., & E van ge l i do u, S .
( 20 09 ). T h e ef fe c ts o f e x e rc i s e
interventions on quality of life in
Indian Journal of Health Social Work. 1(2) July-December, 2019
clinical and healthy populations; a
me ta- ana l ys i s . So ci al Sc ien ce &
Medicine , 68, 1700.
McLea n, J ., & A n d r e w, T. (2000).
Commitment, Satisfaction, Stress and
Co ntrol Among So cia l Services
Managers and Social Workers in the
UK. Administration in Social Work, 23,
93-118.
National As soci ation of Soci al Workers .
(2012). Social work speaks: National
Association of Social Workers policy
statements, 2012-2014. Washington,
D.C: NASW Press.
Saxena, S., Van, O. M., Tang, K. C., &
Armstrong, T. P. (2005). Mental health
benefits of physical activity. Journal of
Mental Health, 14, 445-451.
(Narendra Kumar Singh)
Chief Editor
2
REVIEW ARTICLES

SEX WORK IN INDIAN SOCIETY: THEN AND NOW

Shuvabrata Poddar
Assistant Professor & Coordinator Department of Applied Psychology, Kazi Nazrul University,
Asansol, West Bengal
Correspondence: Shuvabrata Poddar, e-mail: shuvabrata.poddar@gmail.com

ABS TRACT
The current paper provides an overview of how prostitution has changed from ancient ages till
now. It provides a brief typology of the ancient and the current era. It provides a theoretical
frame work to understand how prostitution has evolved in the society from ancient ages till now.
The paper also highlights the socioeconomic aspect of sex work, need for rehabilitation programs
and legal aspects to tackle the problems associated with it. This paper may act as a quick
reference for those interested in studying the various psychosocial aspects of sex work.

Keywords: Prostitution, typology, rehabilitation.

PROSTITUTION IN INDIA
The profession of prostitution is one of the
oldest in almost all the countries since long
in every type of society. In the ancient history
of India, the prostitution was present as an
organized and established institution and it
was also referred in our Vedas. In the earlier
Indian mythology there were many instances
of high class prostitution in form of very
beautiful demigods showing as prostitutes.
T h ey a re p opul arl y kn own as M enak a,
Rambha, Urvashi and Tillotama (Jaishankar
& Haldar, 2008). These are very beautiful,
charming and are very perfect in giving
attractive dance and musical performances.
These prostitutions are used in heaven for
amusement of guest in the court of Lord Indra,
the Lord of Hindu Gods.
In ancient time the names of prostitution
varied and as per duties given to them. For
example prostitutes who served nobility were
called Ganikas, and were well versed in the
arts, Ganika adheksha was superintendent of
pros ti tute s , Prati gani ka was s ubs ti tute
employed for a short term period during
absence of Ganika, Punschal was low grade
prostitute, Kritavardha and Avarudha were
professional prostitutes who lived as mistress
and under the protection of one master (Sinha
& Basu, 1992). The profession of prostitution
was state managed and the pros ti tutes
besides providing sexual services to the
citizens and nobility also acted as spies to
keep a watch on the enemies, thieves and
other anti-state activities (Acharya, 2011).
Other authors were classified prostitutes into
‘Ganikas’ at the top, ‘Kulata’ the married
woman involved with other men, ‘Paricharika’
a mi s tress i n the hous e of nobl es and
‘K umbhadas i’ as the lowest category of
prostitutes. During 18th and 19th century
‘Nautch girls’ or the dancing girls became very
popular in providing recreation and sensual
pleasures to rich and resourceful people in
India, especially in Bengal province. Jordar
(1984) had mention three types of prostitutes
in his study in Calcutta city, namely:
1. Chukli- lower category of prostitutes,
who provides food and shelter in lieu of
her services,
2. Adia-a prostitute who gets half of her

Indian Journal of Health Social Work. 1(2) July-December, 2019 3


income. In both the cases Mashi or
female brothel keeper takes charge of
the income, and
3. S e l f -e mp l oy ed o r i nd ep en de nt
prostitute- where she is the owner of
brothel who is famous in the name of
Mashi (Sinha & Basu, 1992).
DEVADASI SYSTEM
I n I n d i a , u n t i l r e c e n t l y, t h e t e m p l e s
entertained dancing girls. The dancing girls
att ached to each temple were cal led
devadasis. They were considered the servants
of g ods . T he d eva da s i s y s te m s ta rt ed
declining in North India as a result of the
destruction of major Hindu temples by the
Muslim invaders, but it continued to flourish
in the big temples of South India. Devadasis
were women who were dedicated in the
service of God. They were married to God -
and entertained God and his associates by
their talents of singing and dance. At one time
the devadasis were the only women in India
who enjoyed the privilege of learning to read,
dance and sing. They were highly respected
and given more accomplishments by the
society and were adorned by the rulers. In
South India the devadasis originally provided
service to the temples but later turned into
secular prostitutes by entertaining pilgrims for
personal earnings. According to Henriques
(1961) there were seven types of devadasis
namely:
Datta- devadasi woman who gave herself as
a gift to the temple.
Vikrita- devadasi woman who sold herself to
the temple.
Abhritya- devadasi woman who dedicated
herself for the sake of her family.
Bhakta- devadasi woman who joined temple
through devotion.
Hrita- devadasi woman who was enticed into
this service.
Alankaras- devadasi woman who belonged
to the special class of highly trained
Indian Journal of Health Social Work. 1(2) July-December, 2019
SEX WORK IN INDIAN SOCIETY: THEN AND NOW
prostitutes presented to temples by kings and
noblemen.
Rudraganika or Gopnika- devadasi who
received wages from the temple in return for
her services.
The amount received by the devadasis for the
religi ous duties was very meagre. They
supplemented it by selling their favours to
temple pilgrims. This led to temple based
rel i gi ous pros ti tuti on i n anci e nt I nd i a.
Religious prostitution differs from commercial
prostitution because the woman is a religious
ministrant and the money given to her is used
fo r re l i g i ou s pu rpo s es , an d t he act of
intercourse itself is viewed as religious ritual.
Various efforts were created within the past
to arrest its growth by the state through
legislation or by opinion with very little
impact. There was aggregation of prostitutes
in a town and a list of them kept by the state.
Kautilya ordered down the foundations for
keeping the general public ladies (prostitutes)
in restraint. The reference to prostitutes also
comes in Mahabharata and Jataka stories, and
all Hindu Shastrakars such as Manu, Gautam,
and Brihaspati recommended suppression of
prostitution.
BASAVI SYSTEM
T hi s s ystem i s l es s organi zed than the
D e va d a s i s y s te m b ot h r el i g i ou s l y a n d
financially. This is made possible by the social
realities of poverty and gender discrimination.
This system is practiced in Andhra Pradesh
state of India. Basavi means ‘female bull’,
which ostensibly connotes the bull’s freedom
to wander. Historically, Basavi were forbidden
to marry and spent their lives performing
religious duties for God Hanuman (Monkey
God). Like Devadasi system, Basavi also come
from the lower caste families both poor and
uneducated and believe that religion will fulfill
their economic needs. They too feel that
scarification of a daughter can bring them a
4

son and also god will relief them from all types
of financial problem (Nandi, 1973).
JOGIN SYSTEM
T hi s i s another form of rel i gi ous rural
prostitution practiced in Andhra Pradesh state
of India. In this system the girls are married
to a god before puberty and enter to the
prostitution when they reach puberty. The
girls from the lower castes group dedicated
themselves to this profession in a wish to
improve their financial position. In this system,
a wealthy person will select a young girl from
the lower caste and request her family to
marry the village deity. The person finances
all the expenditure and this ceremony will
occur before attaining the puberty. But when
the girl attain the puberty, her family perform
another ceremony and after that the person
who financed the ceremony he has right to
sleep with the girls first. After that the girl
has to live in the temple and work as prostitute
and generate the money for her family (Moti,
1973).
BHAVINS SYSTEM
Bhavins system practices in the Goa state of
India, where the girls engaged in the service
of God Ganesh. In this profession, the family
of a girl dedicated her to the temple during
her infancy, where the girls work Bhavins,
where she pours the oil in the god’s lamp. On
attaining the puberty the girl is formally
ma rri e d a nd t her eaft er s he wor ked as
prostitute in that region (Naik, 1928).
CLA S S IFIC A T ION OF S E X WOR K IN
CURRENT TIMES (DONOVAN & HARCOURT,
2005)
♦ Street: shoppers invited on the road,
park or other public places. Serviced in
side streets, vehicles, or short stay
premises
♦ Bondage and di s ci pl i ne: s ex u al
fantasy through role play. May involve
Indian Journal of Health Social Work. 1(2) July-December, 2019
SEX WORK IN INDIAN SOCIETY: THEN AND NOW
the inflicting of pain, but genital contact
is not routine
♦ Brothel: Premises explicitly dedicated
to providing sex. Better security than
street. Often licensed by authorities
♦ Lap dancing: A recent development
i nv o l vi n g e r ot i c d a nc i n g a t c l os e
quarters without sexual contact
♦ Escort: consumer co ntacts
sex empl oyee by pho ne or
via building workers. Most covert form
of s ex work. Rel ati vel y ex pens i ve
because of low client turnover. Service
provided at client’s home or hotel room
♦ Massage parlour: Premises ostensibly
dedicated to providing massage, but a
r an g e o f s e x u al s e r v i c e s m a y b e
provided. In South East Asia similar
arrangements may apply in barbershops
Private: Client contacts sex worker by phone.
Similar to escorts except services provided in
sex worker’s premises. A variant in London
and other big cities is ‘flat’ prostitution—high
cost services in rented, serviced, inner city
units Travelling entertainers: Actors, dancers
and others involved in entertainment may also
provide sexual services
♦ Window or doorway: Brothels with
sex empl oyees on publi c sho w.
Windows preferred in cold climates,
doorways in warmer places
♦ Beer girls: Young women hired by
major companies to promote and sell
products in bars and clubs. Sexual
services sold to supplement income
♦ Club, pub, bar, karaoke bar, dance
hall: Clients solicited in alcohol vending
venues a nd servi ced on si te or
elsewhere
♦ Stree t vendors and traders:
Ostensibly marketing rural produce or
other goods but supplementing income
with sexual services
5

♦ Other all-male venues: shoppers
invited in al l-male venues lik e
barbershops, bathhouses, saunas, and
mi ni ng camps . Servi ced on s ite or
elsewhere.
♦ Opportunistic: A person approached in
a social venue may occasionally choose
to charge for sexual favours if the client
appears wealthy enough
♦ Door knock or hotel: Unattached
males are approached in their hotel
rooms or boarding houses
♦ Femme libre: Women, usually single or
divorced, who exchange sexual services
for gifts. The gifts are then converted
to cash
♦ Transport (ship, truck, train): Sex
workers may board vehicles to service
the crew or passengers or pick up clients
at stations and terminals
♦ Individual arrangements: The single
mother who may have sex together with
her landowner in situ of rent. Older
sex employ ees U nit ed Na tio ns
agency s olely wear down a ti ny
low variety of normal s hoppers , by
appointment. ‘Kept’ women or men.
Concubines. The number of possible
arrangements is vast
♦ CB radio: Sex employees dri ve on
highways victimi zation CB radi o to
ex ch ange ( jargon ) mes s ages w i th
potential driver shoppers. Serviced at
truck stops or parking areas
♦ Swingers clubs: Some swingers or
couples sex clubs employ (undisclosed)
sex workers if there is a shortage of
female guests
♦ Oth er met hods o f s ol i ci tati on:
T h ro u g h va r i o u s m e d i a i n c l ud i n g
no ticebo ard and news paper
advertisements, ‘sex worker catalogues’
w i t h m o bi l e p h o n e n u m be r s , t h e
i n te rne t v i a vi rtu al br ot hel s , et c.
Services are delivered mostly in
Indian Journal of Health Social Work. 1(2) July-December, 2019
SEX WORK IN INDIAN SOCIETY: THEN AND NOW
brothels and other indoor venues
♦ Geisha: Women engaged primarily to
provide social company, but sex may
ensue
♦ ‘Sex for drugs’: ladies providing oral
sex for cocaine in crack homes. Young
ho mos ex ual men might give
opport uni st s exual serv ices pa id
with medicine.
♦ Beach boys, bumsters, and gigolos:
Men and boys engaged by ladies on the
face of it for social functions however
s ex i s commonl y concerned. Some
b e a c h b o y s a r e a u n i t u n d er n e a t h
aged and plenty of conjointly service
male shoppers.
♦ Survival sex: A matter of degree,
where s tarvati on or other s eri ous
deprivation is imminent, particularly for
dependents. Food or security could also
be the currency, instead of cash.
♦ Pornography: Pornography has been
on a rise all over the world and it has
because one of the greatest industries
and provides lot of employment when it
comes to US but in India it is still illegal.
SOCIETAL IMPLICATION OF THE ANCIENT
AND CURRENT TYPOLOGIES
The ancient classification was mostly based
on religious grounds and the involvement of
money was very less whereas the current
typologies focus is mostly on money making
and there are many micro economies which
are running parallel with each and every
typology. The paradigm shift in the changes
in the typologies also indicate the causative
factors which are responsible for the growth
of sex work industries. The most prominent
causative factors that have come up from the
researches include poverty, unemployment,
trafficking a nd other so cio -po li tical
implications.
6

HEALTH AND MENTAL HEALTH
IMPLICATIONS OF THE TYPOLOGIES
The typologies specially the current typologies
have lot of health as well as mental health
implications. The most common being the
i ncreas ed ri s k for s ex ual l y trans mi tted
diseases (HIV/AIDS). The street prostitutes,
drug and survivor groups being at greatest
risk for both STDs and STIs (Buzdugan, Halli
& Cowan, 2009). Growing trends have also
shown increase in the psychological distress
and psychiatric morbidity among the sex
workers (Iaisuklang & Ali, 2017). They are
also becoming victims of the criminal acts.
CONCLUSION
Prostitution has been present since ages the
current paper provides how the profession
has changed in India through ages. The need
for research regardi ng sex work is very
important keeping in mind the health hazards,
psychosocial risks and socio economic policies
associated with this. Prevention in terms of
addressing the issues of poverty, access to
e du c a ti o n , e m pl o y me n t o p p or t u ni t i es ,
programs for sustainable li veli hood and
poverty alleviation. Special attention for
education of the tribal people and financial
upliftment through agriculture. Abolish of the
cultural practices like Devadasi, Basavi, Jogin,
and Bhavin and the social milieu like dowry,
and widow from the Indian society. Promoting
gender equality.
REFERENCES
Acharya, A. K. (2011). Impact of cultural and
religious practices of prostitution on
the tra ffi ck ing of women in
India. Trayectorias , 14 (33-34), 95-
114.
Buzdugan, R., Halli, S. S., & Cowan, F. M.
Indian Journal of Health Social Work. 1(2) July-December, 2019
SEX WORK IN INDIAN SOCIETY: THEN AND NOW
(2009). The female sex work typology
in India in the context of HIV/AIDS.
Tropical Medicine & International
Health , 14(6), 673-687.
Chandra, M. (1973). Studies in the cult of the
mo ther goddess in ancient
India. Bulletin of the Prince of Wales
Museum of Western India , 12 , 45.
Halder, D., & Jaishankar, K. (2008). Property
rights of Hindu women: A feminist
review of succession laws of ancient,
medieval, and modern India. Journal
of law and religion , 24 (2), 663-687.
Harcourt, C., & Donovan, B. (2005). The many
faces of sex wo rk. Sexual ly
transmitted infections , 81 (3), 201-
206.
Henriques, F. (1961). Stews and Strumpets:
A Survey of Pro st itutio n, 2
vols. London, 63, 143-91.
Iaisuklang, M. G., & Ali, A. (2017). Psychiatric
morbidity among female commercial
s e x w o rk e r s . I n d i a n J o u r n a l o f
Psychiatry , 59(4), 465.
Joardar, B. (1984). Prostitution in historical
and modern perspectives. Inter-India
Publications.
Maya, M. (2004). Social Status of Women in
India.Naik, P C (1928), Prostitution
under religious customs, Bombay:
Bombay Vigilance Asso.
Nandi, R. N. (1973). Religious Institutions and
Cults in the Deccan, CAD 600-AD 1000.
Motilal Banarsidass Publishe.
Sinha, S. N. & Nitish K. B. (1992). The history
of marriage and prostitution (Vedas to
Vatsyayana), Rita D. Sil (Ed.), New
Delhi: Kharna.
Conflict of interest: None
Role of funding source: None
7
 AGGRESSION AND SUBSTANCE USE DISORDER IN ADOLESCENTS:
IN CHANGING ERA

Arzu Ahlawat 1, Kavya Ahuja 2, Prashant Srivastava 3

1
Bachelor’s in Psychology, Lady Shri Ram College for Women, Delhi University, Delhi. 2M.Sc Clinical
Psychology Scholar, Amity University, Gurugram, Haryana. 3Psychiatric Social Worker, Dept. of
Psychiatry, Kalpana Chawla Government Medical College and Hospital, Karnal, Haryana.
Correspondence: Prashant Srivastava, e-mail: 21prashantsrivastava@gmail.com

ABS TRACT

Background: Aggression is a word used daily to characterise the behaviour of others and perhaps
even of ourselves. Aggression as behaviour is intended to harm another individual who does not
wish to be harmed. With an ever growing population, aggression is one of the major issues
faced by many youngsters these days. This vigoursly attributes towards teenagers’ consumptions
of drugs leading to aggressive behaviour and to control it as well. Aim: To know the association
between aggression and substance use disorder. Conclusion: Substance involvement is a critical
factor in the assessment and treatment of youth aggression. Despite high levels of need,
adolescents with aggression and comorbid substance use tend to be underserved. Several
interventions have been developed that are effective in reducing aggressive, delinquent behaviors
and substance use. Treatment is most likely to be effective when it addresses dysfunction and
risk factors across multiple domains (e.g., individual, family, school, peer systems).

Keywords: Voilence, substance, adolescents.

INTRODUCTION
Adolescence as we all know is a traditional
st age of phys ica l a nd psy cholo gical
development that generally occurs during the
period from puberty to adult hoo d.
Adolescence is usually associated with the
teenage years but can prolong until depending
on ea ch of th e p ers on ’s ps y cho l o gi c al
development. Duri ng the transformati ve
teenage years, psychological changes affect
a child and shape them in a different manner
t he r e fo r e , a d ol e s ce n t m a t ur a t i o n i s a
personal phase of development where a child
has to establish his/her own beliefs, values
and what needs to be accomplished in life.
The phase of adolescence constantly and
realistically appraise the kids with material
happiness around often leading to being
extremely self-conscious. However, s elf-
evaluation process leads to the beginning of
long-range goal setting, emotional and social
independence and the making of a mature
adult.
Adolescence as a phase of life marked by
chaos and distress. During this period of life
adolescents are not just prone to high risk
anti-social activities but they also experience
stress and high levels of negative emotions
due to biological changes that occur during
puberty (Gottfredson & Hirschi, 1990). Various
st udi es ha ve pro vided evi dence that
adolescent phase of life is marked by hassles,
negative emotions and heightened anguish
(Agnew & Brezina, 1997; Compass & Wanger,
1991). Aggression is a term widely used in
the literature on problem behaviour, but it is
rarely defined and it is often not distinguished

Indian Journal of Health Social Work. 1(2) July-December, 2019 8

 Aggression and Substance Use Disorder in Adolescents: In Changing Era
from “anti -s oci al behaviour ”. T he word
“aggression” covers a multitude of behaviours
from open defiance and hostility to covert
anti-social acts such as stealing or lying. Lewis
defines human “aggression” as “behaviours
by one person intended to cause physical pain,
damage or destruction to another” (Lewis,
1996). Other writers have expanded the
concept to include “instrumental aggression”
whi ch i s ai med at s ecuri ng ex traneous
rewards, not the pain of the victim, while
others stil l have us ed the term “hostile
aggression” to encompass the aim of inflicting
injury on others. Bandura (1973) makes the
point that such distinctions are misleading as
most aggression has some other goal than
injury to the victim. He defines “aggression”
as “behaviour that results in personal injury
and in the destruction of property”. The injury
may be psychological or physical in nature.
Aggressi on as purely physical with acts
involving hitting or pushing, psychological
aggress ion can al so be very damagi ng.
Addi tionall y, aggres si on can heavi l y be
influenced by factors biological, environmental
and/or social factors.
MOTIVATION THEORY IN AGGRESSION
Inspiration speculations of animosity state
that hostility is a human intuition. That is,
motivation theories see aggression as part of
human nature. People are motivated to be
aggressive because it’s just part of thier
personality.
There are many different types of motivation
theories. The evol uti onary theo ry of
aggression says that aggression is a human
instinct because it makes sure that we get
the res our ces we need to s ur vi ve i nto
adulthood and pass on our genetic material.
That is, the aggressive people survive, and
their children are aggressive like they are, and
so on through generations.
Another motivational theory is Si gmund
Freud’s psychoanalytic theory of aggression,
Indian Journal of Health Social Work. 1(2) July-December, 2019
which says that aggression is a human instinct
related to our dread of death. Thus,
aggression is part of our dealing with (or not
dealing with) our own mortality.
SUBSTANCE USE DISORDER (SUD) AND
AGGRESSION
Early substance use initiation is a serious
c on ce rn b e ca us e i t i s a s s oc i at ed w i t h
significantly increased risks for developing
substance use disorders (King & Chassin,
2007). Substance-involved youth are also
likely to become involved in the mental health
system, and the majority meet criteria for
another Axis I disorder (Deas, 2006). There
are multiple pathways through which co-
occurrence may develop. Some disorders,
including mood and conduct disorders, are
as sociat ed wit h i ncreas ed SUD ri sk
(Armstrong & Costello, 2002). Alternatively,
SUDs, es peciall y with early onset, may
i n cr e a s e t h e ri s k of o t he r p s yc h i a tr i c
co ndi tio ns (Armst ro ng & Costell o,
2002; Lamps, Sood, & Sood, 2008).
DRUGS USE AND AGGRESSION
Drugs use can change a person’s physical or
mental state, with a vast majority being used
to treat medical conditions. Some however are
used outside the medical setting for their
effects on the mind. These are referred to as
recreational drugs. Psychoactive drugs have
an effect on the cognitive thought process of
an individual, which in turn may manifest into
a range of behaviours. These drugs may be
taken for fun, excitement, to feel good, better
or different, or to combat negative feelings.
Some teenagers may be bored or curious,
because their friends and family are involved
in it or because they have a dependence on
the drug. Over a period of time, alcohol and
d r ug s h av e b ee n l i n k e d t o an g e r a n d
aggression. Stimulants, anabolic steroids,
marijuana and other drugs have either been
used to get rid of uncomfortable emotional
9
 Aggression and Substance Use Disorder in Adolescents: In Changing Era
s t ate s or hav e b een i mpl i ca ted i n t he
precipitation of anger and aggression. Mood-
altering substances impair perception through
their ability to regulate neurotransmitters’
levels. Amongst teenagers, it has become
customary to use drugs to suppress their
emotions of frustration or isolation which they
are unable to elucidate.
Some of the common drugs which are used
illegally are cannabinoids, with marijuana
being used most. These drugs not only have
effects in relaxation, but also cause slowed
reaction time. Let’s get “mellow” and “let’s
chi l l out” are subjective terms us ed to
des cribe the cannabis experience. Many
marijuana consumers use this drug to reduce
levels of anger and anxiety. This in turn, for
many teenagers, is helpful in overcoming their
problems and not become impatient giving a
soothing effect to the mental state. On the
other hand, the main class of drug that should
be suspected in causing aggressive behaviour
are stimulants such as cocaine, amphetamine,
methamphetamine and synthetics nicknamed
“bath salts” and “spice”. They all cause a
person to feel energetic and euphoric.
One of the major downsides of these drugs is
that they cause paranoia, aggression and even
delusional behaviour leading to a criminal
behaviour sometimes. Such drugs if used
frequently can cause major damage to the
body and brain and particularly during the age
of development, it might cause addiction and
s ev er e b e ha vi o ur al pr o bl em s a m on gs t
teenagers. Often during teenage years, to
vanquish their problems like disturbance of
emotions or aggression, they tend to consume
drugs like hallucinogens in which their thought
process and make them believe what they see
are real Anabolic steroids also cause rage
and agg res s i on, as w el l a s ma ni a and
delusional behaviour. Such steroids are
usually swallowed or injected to the body
which can cause premature stoppage of
growth, high blood pressure and many other
Indian Journal of Health Social Work. 1(2) July-December, 2019
after effects to the body a nd mind.
Consumption of steroids can get teenagers
into physical fights with others or commit
aggressive crimes.
Consumption of these drugs leads a teenager
during their development age into factors like:
♦ Withdrawal from their deci sions or
activities which they would prefer to do;
♦ Avoidance havi ng the fear to face
problems, running away from daily life
situations;
♦ Attack self-turning for impulsive
behaviour such as cutting, burning,
sexual angst and aggression;
♦ Attack others in order to overcome their
aggression and stressful situation which
might intend to hurt others or put others
to enhance their self-image.
Hence, as stated above how consumption of
drugs is affecting the aggressi on l evels
specially amongst teenagers which is turning
out on their development stages and also
affecting their brain cells which increases
chances of irrational thoughts, mood swings,
irritability and being paranoid. Drugs majorly
contribute to aggressive behaviour as it
causes high blood pressure or rapid shift in
emotions. Not all drugs have the same effect,
some might lower the rates of aggression but
in most cases, it leads to increase in violent
o r a g g r e s s i v e b e h a v i o u r. A g g r e s s i o n
nowadays has become very common amongst
teenagers and the reason falling in for drugs
is as it creates the means for teenagers to
escape from reality and live in their own
bubble.
ASSESSING RISK OF AGGRESSION AND
VIOLENCE
Although it is possible to make a general
assessment of relative risk, it is impossible
to predict an i ndividual , specific act of
aggression and violence, given that such acts
usually occur when the perpetrator is highly
emotional due to their conditions. During a
10
 Aggression and Substance Use Disorder in Adolescents: In Changing Era
clinical session, the same person may be
guarded, less emotional, and even thoughtful,
thereby making any signs of violent intent. And
also when the patient explicitly expresses an
intention to harm someone else, the relative
risk for acting on that plan is still significantly
influenced by the following life circumstances
and clinical factors as well.
Person ality disorders: Pe rs ona li ty
disorders like, borderline personality disorder,
anti s oci al pers onal i ty di sorder, conduct
disorder, and other personality disorders often
manifest and are the reasons for aggression
or violence. When a personality disorder
occurs in conjunction with another psychiatric
disorder, the combination may also increase
risk of aggression and violent behavior.
Nature of symptoms: One of the major
symptoms followed up for aggression usually
ar e, p ati ent s wi th par anoi d d el u s i on s ,
command hallucinations, and florid psychotic
thoughts are more likely to become violent
than other patients. For clinicians, it is an
important factor to understand the patient’s
own percept i on of p s ychoti c thoug hts ,
because this may reveal when and how a
patient may feel compelled to fight back or
become highly aggressive.
Age and gender. Young people are more
likely than older adults to act violently and
aggressive. According to various studies it is
also believed that men are more likely than
women to act violently.
Social s tress . People who are poor or
ho mel ess , o r o therwise ha ve a l ow
socioeconomic status, are more likely than
others to become aggressive.
Personal stress, crisis, or loss. Major
personal factors like unemployment, divorce,
or separation in the past year increases a
Indian Journal of Health Social Work. 1(2) July-December, 2019
patient’s risk of violence. People who were
victims of crime in the past year are also more
likely to assault someone or show aggressive
behavior as well.
Early exposure. The risk of aggression and
violence rises with exposure to aggressive
family fights during childhood, physical abuse
by a parent, or having a parent with a criminal
record.
A S S ES S MENT OF A GGR ES SION A ND
SUBSTANCE USE DISORDER
Childhood aggression predicts early onset and
frequency of substance use in adolescence
(Pulkkinen & Pitkanen, 1994), consistent with
a common cause or deviance proneness
model (Martel et al., 2009). Thi s model
appears to operate through both direct and
i ndirect pathways , al though underlyi ng
mechanisms are not yet clear (Zucker, 2008).
Aggression has been classified in terms of
both function and form. Function can be
classified as either proactive (i.e., calculated
and goal-oriented, motivated by external
reward) or reactive (i.e., defensive, impulsive
responding to threat or frustration) (Dodge &
Co ie, 1987). Proactive aggres si on is
associated with delinquency and violence in
youth, but reactive aggression has been a less
co nsi st ent predict or (Card & Li ttl e,
2006; Raine et al., 2006). Proactive and
reactive aggression have been prospectively
linked to SUDs via separate pathways (Fite,
Colder, Lochman, & Wells, 2008). Proactive
aggression predicts substance use directly and
via association with delinquent peers, whereas
reactive aggression is indirectly associated
with peer delinquency and rejection by peers
(Fite & Colder, 2007).
Aggression form can be categorized as either
direct or relational (Card, Stucky, Sawalani,
& Little, 2008). Direct aggression is defined
as behavior directed at individuals with the
intent to harm (Coie & Dodge, 1998), while
11
 Aggression and Substance Use Disorder in Adolescents: In Changing Era
relational aggression refers to acts intended
to manipulate or damage relationships (Crick
& Grotpeter, 1995). Early direct (Swaim,
Deffenbacher, & Wayman, 2004) and relational
(Herrenk ohl , Catalano, Hemphi ll,
To umbourou, 2009; Skara et al ., 2008)
aggression are associated with subsequent
substa nce use. Several measures of
aggression form are available, including
observer rating scales (Coie & Dodge, 1998)
an d th e s el f rep ort Re acti ve- Pro acti ve
Aggression Questionnaire (Raine et al., 2006).
Two methodological issues are common to
these measures.
PSYCHO-SOCIAL INTERVENTION AND
TREATMENT
Treatment for adolescent substance use
disorder and comorbid problems such as
aggression has often been poorly integrated
(Lamps et al., 2008). Barriers to successful
treatment include poor coordination between
delivery systems (E. H. Hawkins, 2009), a
relative lack of research into developmentally
ap pr op ri at e i n te rv en ti on s (Lys au gh t &
Wodars ki, 1996), and a lack of fundi ng
specific to SUDs and comorbid disorders (E.
H. Hawkins, 2009). Moreover, animosity is
related with poor treatment results (Crowley,
Mikulich, MacDonald, Young, & Zerbe, 1998).
Consequently, there is increasing interest in
interventions that address youth needs across
multiple areas, including problem-solving and
communication skills, family, mental health,
and substance use disorder (Libby & Riggs,
2005). When treating youth in secure settings,
five general strategies are recommended
(Greenwood, 2008). First, intervention should
focus on malleable problem behaviors (e.g.,
problem-solving skills, peer associations,
family dysfunction). Second, interventions
should be evidence-based and tailored to
individual needs. Third, institutional treatment
programs should focus on youth at highest risk
for relapse and recidivism, who have both the
Indian Journal of Health Social Work. 1(2) July-December, 2019
most room for improvement and for whom
f ai l u re w i l l t en d t o ha ve m o re s ev er e
consequences (Latessa, Listwan, & Hubbard,
2005). Fourth, consistent implementation of
& evidence-based interventions is critical to
positive outcomes. Finally, interventions are
most effective when provided by mental health
professionals (Greenwood, 2008).
Family Therapy:
Family therapy aims to create more adaptive
patterns of famil y interaction, reducing
problem behaviors thought to be a result of
family dysfunction (Waldron, 1997). Multiple
family therapies have been developed for the
treatment of youth substance use disorders,
aggression, and delinquency. Those with the
most empirical support include Multisystemic
T herapy (MST; Henggel er et al., 1991),
Functional Family Therapy (FFT; Alexander &
Parsons, 1973), and Multidimensional Family
Therapy (MDF T; Liddle, 2010). Evidence
indicates that family therapy is more effective
than individual therapy for youth substance
use disorders and other problem behaviors
(Diamond & Josephson, 2005).
Cognitive-behavioral therapy (CBT):
CBT for substance use disorders (Wright,
Beck, Newman, & Liese, 1993) is based on
the idea that problem behaviors result from
maladaptive cognitions (Winters, 1999). Youth
who use drugs ma y have dist ort ed
expectancies about the positive effects of
drugs and may not consider the negative
consequences. Failure to develop problem-
solving, social, and self-control skills or
adaptive strategies for coping with peer
pressure and negative emotions are also
thought to contribute to substance use,
aggression, and delinquency. CBT aims to
correct maladaptive beliefs by examining their
rational basis and substituting beliefs that are
consistent with adaptive behavior (Winters,
1999). Meta-analytic studies and reviews have
12
 Aggression and Substance Use Disorder in Adolescents: In Changing Era
shown CBT to effective for SUDs (Dennis et
a l ., 20 0 4a ; De n n i s et a l ., 2 0 0 4b ) an d
delinquency (Lipsey, Landenberger, & Wilson,
2007) in male and female adolescents. The
inclusion of anger management and problem-
solving components appears to be particularly
important in terms of minimizing aggression
(Lipsey et al., 2007).
M ot i vat i onal enh ance ment ther apy
(MET):
MET is a brief therapy based on motivational
interviewing (W. R. Miller & Rollnick, 1991).
ME T i nt erve nti o ns f ocus on i ncr eas i ng
mo tiv ati on to cha nge by addressi ng
ambival ence. Therapis ts empathi ze with
clients and collaboratively assist clients in
developing discrepancy between their current
behavi ors and thei r goal s (Fel ds tei n &
Ginsburg, 2006). MET has been shown to be
an effective treatment for substance use
disorders (Dunn, Deroo, & Rivara, 2001).
Contingency management (CM ) and
community reinforcement (CR):
CM interventi ons are bas ed on operant
conditioning principles, in which behavior is
a function of its consequences (Higgins &
Si lverma n, 200 8). CM requi res that
nonabstinence be readily detectible (Higgins,
Alessi, & Dantona, 2002). Rewards are given
for verified abstinence and other targeted
behaviors (e.g., nonaggression), but withheld
f o r n o n a bs t i n e nc e ( H i g g i n s , A l e s s i , &
Dantona, 2002). Abstinent clients may receive
vouchers with monetary values that increase
with longer abstinence (Higgins et al., 1991)
or may draw slips of paper from a bowl which
may contain either written reinforcement or
a voucher (Petry & Martin, 2002). CM is well-
established as an effective treatment for adult
SU Ds (Higgins & Sil verman, 2008), and
several recent studies have assessed its use
for youth substance use disorders and conduct
problems. For example, adolescent outpatient
Indian Journal of Health Social Work. 1(2) July-December, 2019
interventions combining CM with CBT and/or
motivational enhancement have been reported
to reduce marijuana use and externalizing
behaviors (Carroll et al., 2006) and cigarette
smoking (Krishnan-Sarin et al., 2006).
CONCLUSION AND FUTURE
RECOMMENDATIONS
Substance involvement is a critical factor in
the assessment and treatment of youth
aggression. Despite high levels of need,
adolescents with aggression and comorbid
s ubstance us e tend to be unders erved.
Several interventions have been developed
that are effective in reducing aggressive,
delinquent behaviors and substance use.
Treatment is most likely to be effective when
it addresses dysfunction and risk factors
across multiple domains (e.g., individual,
family, school, peer systems).
Family-based therapies focus on reducing
dysfunction in family and other systems that
is thought to influence problem behaviors. The
literature demonstrates that family therapies
are superior to other modalities (Diamond &
Josephson, 2005) and should be considered
first-line treatments for youth SUDs and
aggression.
REFERENCES
Agnew, R, & Brezina, T. (1997). Relational
problems with peers, gender, and
delinquency. Youth & Society, 29, 84-
111.
Alexander, J., & Parsons, B. (1973). Short-
term behavioral intervention with
delinquent families: Impact on family
process and recidivism. Journal of
Abnormal Psychology, 81 , 219-225.
Armstrong, T. D., & Costello, E.J. (2002).
Community studies on adolescent
substance use, abuse, or dependence
and psychiatric comorbidity. Journal of
Consulting and Clinical Psychology, 70,
1224-1239.
13
 Aggression and Substance Use Disorder in Adolescents: In Changing Era
Bandura, A. (1973). Aggression. A Social
Learning Analysis. Prentice Hall Inc.
Card, N. A., & Little, T. D. (2006). Proactive
and reactive aggression in childhood
and adolescence: A meta-analysis of
di fferenti al rela tio ns wi th
ps ychoso cial adj ust ment.
International Journal of Behavioral
Development, 30, 466-480.
Card, N. A., Stucky, B. D., Sawalani, G. M., &
Little, T. D. (2008). Direct and indirect
aggres s ion duri ng chi l dhood and
adolescence: A meta-analytic review
of gender differences,
intercorrelations, and relations to
maladjustment. Child Development,
79, 1185-1229.
Carroll, K. M., Easton, C., Nich, C., Hunkele,
K. A., Neavins, T. M., & Sinha, R.
(2 006 ). T he us e of co nti n gen cy
management and motivational/skills-
building therapy to treat young adults
with marijuana dependence. Journal
of Consulting and Clinical Psychology,
74, 955-966.
Chass in, L. (2008). Juvenile justice and
substance use. The Future of Children,
18, 165-183.
Coie, J. D., & Dodge, K. A. (1998). Aggression
and antisocial behavior. In W. Damon
& N. Eisenberg (Eds.), Handbook of
child psychology. Social, emotional,
and personality development, 3, 779-
862.
Compass , B .E ., & Wanger, B.M. (1991).
Ps ychos oci al stress duri ng
a do l e s c e n ce : I n t ra p er s o na l an d
interpersonal processes. In Colten ME,
Gore S. (Eds.), Adolescent stress:
Causes and Consequences New York:
AldineDeGruyter. International Journal
of P rev en ti on an d Tre at men t of
Substance Use Disorders, 67, 92- 116.
Crick, N. R., & Grotpeter, J. K . (1995).
Relational aggression, gender, and
Indian Journal of Health Social Work. 1(2) July-December, 2019
social-psychological adjustment. Child
Development, 66, 710-722.
Crowley, T.J., Mikulich, S. K., MacDonald, M.,
Young, S. E., & Zerbe, G. O. (1998).
Substance-dependent, conduct-
disordered adolescent males: Severity
of diagnosis predicts 2-year outcome.
Drug and Alcohol Dependence, 49 ,
225-237.
Deas, D. (2006). Adolescent substance abuse
and psychiatric comorbidities. Journal
of Clinical Psychiatry, 67, 18-23.
Dennis, M., Godley, S. H., Diamond, G., Tims,
F., Babor, T., & Donaldson, J. (2004a).
The Cannabis Youth Treatment (CYT)
st udy : Mai n findings fro m t wo
Jo urna l of
ra ndo miz ed t ria ls.
Substance Abuse Treatment, 27, 197-
213.
Dennis, M., Godley, S. H., Diamond, G., Tims,
T. M., Babor, T., & Donaldson, J.
( 2 0 0 4 b ) . T h e C a n n a b i s Yo u t h
Treatment (CYT) study: Main findings
from two randomized trials. Journal
of Substance Abuse Treatment, 27,
197-213.
Diamond, G., & Josephson, A. (2005). Family-
based treatment research: A 10-year
update. J ournal of the American
A ca d em y o f C hi l d & A do l es c en t
Psychiatry, 44 , 872-887.
Dodge, K. A., & Coie, J. D. (1987). Social-
information-process ing factors in
reactive and proactive aggression in
children’s peer groups. Journal of
Personality and Social Psychology, 53,
1146-1158.
Dunn, C., Deroo, L., & Rivara, F. P. (2001).
The use of brief interventions adapted
from motivational interviewing across
behavioral domains: A systematic
review. Addiction, 96, 1725-1742.
Feldstein, S. W., & Ginsburg, J. I. D. (2006).
Motivational interviewing with dually
diagnosed adolescents in juvenile
14
 Aggression and Substance Use Disorder in Adolescents: In Changing Era
justice settings. Brief Treatment and
Crisis Intervention, 6, 218-233.
Fite, P. J., & Colder, C. R. (2007). Proactive
and reactive aggression and peer
delinquency: Implicati ons for
preventi on and i nterventi on. The
Journal of Early Adolescence, 27, 223-
240.
Fite, P. J., Colder, C. R., Lochman, J. E., &
Wells, K. C. (2008). The relation
between chi ldhood proactive and
reactive aggression and substance use
initiation. Journal of Abnormal Child
Psychology, 36, 261-271.
Gottfredson, M.R., & Hirschi, T. A. (1990).
General Theory of Crime. Stanford,
California: Stanford University Press.
Gre enwo od, P. (2 008) . Pre vent i on and
intervention programs for juvenile
offenders. The Future of Children, 18,
185-211.
Hawkins, E. H. (2009). A tale of two systems:
Co -o cc ur ri ng m en ta l he al th a nd
substance abuse disorders treatment
for adolescents. Annual Review of
Psychology, 60, 197-227.
Henggeler, S. W., Borduin, C. M., Melton, G.
B., Mann, B. J., Smith, L., & Hall, J. A.
(1991). E ffects of mul ti s ys temi c
therapy on drug use and abuse in
serious offenders: A progress report
from two outcome studies. Family
Dynamics of Addiction Quarterly, 1 ,
40-51.
Herrenkohl, T. I., Catalano, R. F., Hemphill,
S. A., & Toumbourou, J. W. (2009).
Longitudinal examination of physical
and rel ati ona l aggres si on as
precursors to later problem behaviors
in adolescents. Violence and Victims,
24, 3-19.
Higgins , S. T., & Si l verman, K . (2008).
Co nti ngency ma nagement in
substance abuse treatment. In S. T.
Higgins, K. Silverman, & S. H. Heil
Indian Journal of Health Social Work. 1(2) July-December, 2019
(Eds.), Contingency management in
substance abuse treatment (pp. 1-18).
New York: Guilford Press.
Higgins, S. T., Alessi, S. M., & Dantona, R. L.
(2002). Voucher-based incentives: A
subst ance a bus e t rea tment
innovation. Addictive Behaviors, 27 ,
887-910.
Higgins, S. T., Delaney, D. D., Budney, A. J.,
Bickel, W. K., Hughes, J. R., 7 Foerg,
F. (1991). A behavioral approach to
achieving initial cocaine abstinence.
American Journal of Psychiatry, 148,
1218-1224.
Krishnan-Sarin, S., Duhig, A. M., McKee, S.
A ., M c M a h o n , T. J ., L i s s , T., &
McFetridge, A. (2006). Contingency
management for smoking cessation in
adolescent smokers. Experimental
and Clinical Psychopharmacology, 14,
306-310.
Lamps, C. A., Sood, A. B., & Sood, R. (2008).
Youth wi th s ubstance abus e and
comorbid mental health disorders.
Current Psychiatry Reports, 10, 265-
271.
Latessa, E. J., Listwan, S. J., & Hubbard, D. J.
(2005). Correctional interventions:
Changing offender behavior. Boston:
Roxbury Publishing.
Lewis, D.O. (1996). Development of the
Symptom of Violence, In Lewis M.
(Ed.), Child and Adolescent Psychiatry.
A Comprehensiv e Te x t b o o k .
Baltimore: Williams and Wilkins, 334-
44.
Libby, A. M., & Riggs, P. D. (2005). Integrated
substance use and mental health
treatment for adolescents: Aligning
organizational and financial incentives.
J ourna l of Child and Adole scent
Psychopharmacology, 15, 826-834.
Liddle, H. A. (2010). Theory development in
a family-based therapy for adolescent
drug abuse. Journal of Clinical Child
15
 Aggression and Substance Use Disorder in Adolescents: In Changing Era
Psychology, 28, 521-532.
Lipsey, M. W., Landenberger, N. A., & Wilson,
S. J. (2007). Effects of cognitive-
behavioral programs for cri mi nal
offenders (Campbell Collaboration
Systematic Review).
Lysaught, E., & Wodarski, J. S. (1996). A dual-
focused intervention for depression
and addiction. Journal of Child and
Adolescent Substance Abuse, 5 , 55-
71.
Martel, M. M., Pierce, L., Nigg, J. T., Jester, J.
M., Adams, K. M., & Puttler, L. I.
(2009). Temperament pathways to
childhood disruptive behavior and
adolescent substance abuse: Testing
a cascade model. Journal of Abnormal
Child Psychology, 37, 363-371.
M i l l e r, W. R ., & Ro l l n i c k , S . ( 1 9 9 1 ) .
Motivational interviewing: Preparing
people to change addictive behavior.
New York: Guilford Press.
Petry, N. M., & Martin, B. (2002). Low-cost
contingency management for treating
co ca ine- a nd opio id-abusi ng
m et ha d on e p at i e n ts . J ou r na l o f
Consulting and Clinical Psychology, 70,
398-405.
Pul kki nen, L., & Pitkanen, T. (1994). A
prospective study of the precursors to
problem drinking in young adulthood.
Journal of Studies on Alcohol, 55, 578-
587.
Raine, A., Dodge, K., Loeber, R., Gatzke-Kopp,
L., Lynam, D., & Reynolds, C. (2006).
The reactive-proactive aggression
Indian Journal of Health Social Work. 1(2) July-December, 2019
questionnaire: Differential correlates
of reactive and proactive aggression
i n a do l e s c e n t bo y s . A g g r e s s i v e
Behavior, 32, 159-171.
Swaim, R. C., Deffenbacher, J. L., & Wayman,
J. C. (200 4). Concurrent a nd
prospectiv e effects of mult i-
dimensional aggression and anger on
adolescent alcohol use. Aggressive
Behavior, 30, 356-372.
Waldron, H. B. (1997). Adolescent substance
abuse and family therapy outcome: A
review of randomized trials. In T. H.
O l l e n d i c k & R . J . P r i n z ( E d s .) .
Advances in clinical chi ld
psychology,19, 199-234.
Winters, K. C. (1999). Treating adolescents
with substance use disorders: An
ove rvi e w of prac ti ce i s s ues and
treatment outcome. Substance Abuse,
20, 203-225.
Wright, F. D., Beck, A. T., Newman, C. F., &
Liese, B. S. (1993). Cognitive therapy
of s ubs t ance abus e: T he oreti cal
rationale. National Institute on Drug
Abuse Research Monograph Series,
Behavioral Treatments for Drug Abuse
and Dependence, 137, 123-146.
Zucker, R. A. (2008). Anticipating problem
alcohol use developmentally from
childhood into middle adulthood: What
have we learned? Addiction, 10(1),
100-108.
Conflict of interest: None
Role of funding source: None
16
ORIGINAL ARTICLES

INTERACTION PATTERNS IN THE FAMILIES OF INDIVIDUAL WITH

CANNABIS DEPENDENCE

Nirmala Kumari Ahirwar 1 & Manisha Kiran 2

1
Ph. D Scholar (PSW), Department of Psychiatric Social Work, Ranchi Institute of Neuro-Psychiatric
and Allied Science, Jharkhand India. 2Associate Professor & Head, Department of Psychiatric
Social Work, Ranchi Institute of Neuro-Psychiatric and Allied Science, Jharkhand India
Correspondence: Nirmala Kumari Ahirwar, e-mail: nirmalakumariahirwar@gmail.com

ABS TRACT
Background: Cannabis dependency is often due to prolonged and increasing use of the drug.
Increasing the strength of the cannabis taken and an increasing use of more effective methods
of delivery often increase the progression of cannabis dependency. Interaction pattern in a family
has been found critical tasks in keeping family development, system and well-being as well as
maintaining its integrity. Aim: This study was planned to see the family interaction pattern of
individuals with cannabis dependence in Indian setting. Method: The study was a cross sectional,
hospital based and the samples were selected through purposive sampling technique. This study
was included 30 individuals (patients diagnosed with cannabis dependence as per ICD -10) and
30 individuals from family of normal controls (i.e., a family without any cannabis dependence
member). Age, education and family income matched with either group.GHQ-12 & Family
Interaction Pattern Scale were applied on all the selected individuals in the study. Results and
Conclusion: Dysfucntional interaction was found in the domains of “reinforcement”, “social
support”, “roles”, “communication”, & “total FIPS” in the families of individual with cannabis
dependence as compared to families of normal controls.

Keyword: Family interaction pattern, cannabis dependence, indian families.

INTRODUCTION
Family interaction patterns were defined as
those various social psychological transactions
occurring in the family as a system, to evolve
proces s for deci si on maki ng, emotional
expressions and personal view, assigning
tasks and social status, enabling the family
member to contribute for the growth of the
fami l y by generati ng morphogenes i s at
emoti onal, intell ectual and social l evels
through the manipulation of internal and
external social milieu of the family as a whole.
According to the evolutionary point of view
every family has patterns of leadership,
communication, role, cohesiveness, and social
s upport s ys tem which were defi ned as
fol l ows . Leadership: A famil y member
engaged in decisi on mak ing through
consensus for the growth of the family as a
s y s t e m i s t h e l e a d e r o f t h e fa m i l y.
Communication: Processes through which
the family members convey their feelings,
emotions and personal views. Roles: Socio-
culturally prescribed and ascribed tasks to be
performed by different famil y members
accordi ng to their age a nd sex.
Reinforcement: Processes adopted by the
family to enable the members to imbibe
socially approved behavior. Cohesiveness:
Process adopted by the family for a firm
degree of mutual trust and interpersonal
commitment. Social support: Social support
system refers to manipulation of internal and

Indian Journal of Health Social Work. 1(2) July-December, 2019 17

 I NT E R ACT ION P A T TE R NS IN T HE FA M IL I E S OF I NDI V ID UAL W IT H CA NNA B IS DE P END E NCE
external social milieu of the family for its
existence and growth (Bhatti et al., 1986).
Family interactions of substance use, and the
p o te n t i a l e f f e ct o f ca n n a b i s o n th o s e
interactions, has been a consistent concern
in both the clinical and research literature for
more than 20 years. Some authors like Jacob
et al (1981) suggests that cannabis and other
s ub s tan ce f ami l i es di ff er f rom wi th out
cannabis families in affective expression, as
reflected in lower rates of positive affect and
hi gh er rat es of negati ve aff ect. T hes e
differences seem to characterize parent child
interactions. However some studies also
characterize interactions between the male
cannabis and his spouse (Jacob & Krahn,
1988). Thus it was evident that cannabis
consumption not only causes disturbance in
i nt erac ti on al p atte rn b etwe en p aren t’s
children but also between marital couples. In
those studies family distress and marital
distresses were equally emphasized.
Although most studies in the cannabis smoke
and marriage literature have emphasized the
pers onal ity trai ts and characteris ti cs of
spouses, behavioral systems theories of the
past decade have directed increasing attention
toward interaction variables that might elicit
and mai ntain cannabis abuse. The most
elaborate of these models, proposed by
Steinglas s (1981), has incorporated the
provocative hypothesis that cannabis can
serve adaptive functions in some families and
as a result be reinforced and perpetuated
through change in family processes. Most
relevant to this, is a cross sectional finding
by Jacob et al (1978) that revealed a negative
relation between the husband’s substance
cons umpti on and the wi fe’s ps ychi atri c
symptomatology and a positive relati on
between the husband’s alcohol consumption
and the wife’s marital satisfaction, findings
that emerged only with steady drinkers and
not with binge drinkers.
In a study by Frankenstein et al (1985) found
Indian Journal of Health Social Work. 1(2) July-December, 2019
that cannabis increased positive interactions,
whereas t wo s tudi es by J aco b and hi s
colleagues found that substance use (i.e.
alcohol & cannabi s ) i ncreas ed negative
interactions of alcoholics and their spouses
(Jacob et al, 1981; Jacob & Krahn, 1988)
indicating that alcohol does exert an impact
on marital interactions of alcoholics, although
the direction of such effects has not been
entirely consistent across studies. Various
cross-study differences in methodology could
be related to thes e di screpant findings,
including differences in experimental task,
dose level, administration format, and the
presence or absence of comparison groups
(Chakravarthy, 1990).i
AIM
The present study was carried out to examine
the family interaction patterns in Indian
fa mil ies with i ndi vidua l o f cannabis
dependence.
MATERIALS AND METHODS
Design
This was a cross-sectional study and carried
out among families of patients who came at
Ranchi Institute of Neuro-Psychiatry and allied
science (RINPAS), a state government- owned
psychiatric hospital situated in the Ranchi
di stri ct of Jharkhand State in India.T he
‘purposive sampling method’ was used.
Participants
The sample consisted of 30 families of male
patients diagnosed with cannabis dependence
syndrome (CDS) using the criteria laid out in
the ICD-10 (WHO, 1993) and 30 families of
appropriately matched males (control group)
with no history of cannabis dependence, who
scored less than 3 on the GHQ-12.
Inclusi on and exclus ion criteria were as
follows. The experimental group was made
up of families diagnosed as having ‘Mental
and behavioural disorders due to use of
18
 I NT E R ACT ION P A T TE R NS IN T HE FA M IL I E S OF I NDI V ID UAL W IT H CA NNA B IS DE P END E NCE
cannabis’ from the RINPAS according to the
ICD-1 0 Cla ssi ficati on of Me nta l a nd
Behavioural Disorders – Diagnostic Criteria for
Research (ICD-10 DCR). Those who had been
married for 2 or more years, scored less than
3 in the General Health Questionnaire–12
(GHQ-12), were free from major physical
illnesses, and who gave their informed consent
to participation in the study were included.
The families of control group were selected
after matching their ages, educational and
income levels with the experimental group and
scored less than 3 in the GHQ-12, no history
of major physical illnesses, and gave their
informed consent to participation in the study.
Procedure
Participants completed a socio-demographic
data sheet, then were administered the Family
Interaction Pattern Scale (FIPS).Both groups
were given the GHQ-12 and those who scored
below the cut-off (3) in the GHQ-12 underwent
further assessments.
TOOLS
Study tools included a specially designed
socio-demographic datasheet, the FIPS and
the GHQ-12.The FIPS, developed by Bhatti et
al (1986), was used to assess patterns of
interaction within couples. This is a scale with
106 items in 6 domains, e.g. ‘reinforcement’,
‘soci al support’, ‘role’, ‘communi cation’,
‘cohesiveness’, and ‘leadership’. It measures
the family functioning within those 6 domains
on a 1-4–point Likert type scale. A higher
Indian Journal of Health Social Work. 1(2) July-December, 2019
score shows dysfunction in that sub-domain.
It has been shown that this scale is able to
effectively measure dysfunction in the families
of alcoholics, hysterics and depressives, and
has demonstrated satisfactory inter-rater
reliability and test- retest reliability. The GHQ-
12 is widely used to screen for psychiatric
distress in communities (Goldberg & William,
1978)
STATISTICAL ANALYSIS
Descriptive statistics (percentage, mean, and
standard deviation) were used to describe
sample characteristics. The Chi-square test
was us ed for describing and compari ng
categorical data. The independent sample ‘t’
were used to compare continuous variables
between these two groups.
RESULTS
Present study finding revealed that there was
no si gnifi cant differences in s oci o-
demographic variables between families of
pati ents with cannabis dependence and
famil ies o f normal contro ls such as
i nformant’s age, education occupati on,
domicile, educati on, religion and fami ly
income (table-1-2).Finding of the present
study also indicated that the families with
ca nna bis dependents were perceiv ed
dysfunctional interaction pattern in the areas
of “reinforcement”, “social support”, “role”,
“communication” & “total FIPS” as compared
to families without cannabis dependents.
(table-3).
19
 I NT E R ACT ION P A T TE R NS IN T HE FA M IL I E S OF I NDI V ID UAL W IT H CA NNA B IS DE P END E NCE

TABLE 1: Comparison of Socio-demographic characteristics of families with and without

Cannabis Dependent.

Groups χ2/Fish
Socio Demographic
Study group Control group er Exact df P
Variables
(N=30) n (%) (N=30) n (%) test
Sex of the Male 22(73.3) 25(83.3)
0.890 - 0.532
informants Female 8(26.7) 5(16.7)
Marital Status Married 17(56.7) 13(43.3)
1.067 1 1.000
of the Patients Unmarried 13(43.3) 17(56.7)
Marital Status Married 25(83.3) 28(93.3)
of the 1.498 - 0.424
informants Unmarried 5(16.7) 2(6.7)
Rural 13(43.3) 21(70)
Domicile Semi-urban 3(10) 3(10) 5.082 - 0.078
Urban 14(46.7) 6(20)
Hindu 28(93.3) 29(96.7)
Religion 1.498 - 0.424
Muslim 2(6.7) 1(3.3)
Occupation of Employed 21(70) 24(80)
0.800 1 0.371
the Informants Unemployed 9(30) 6(20)
Occupation of Employed 9(30) 13(43.3)
1.148 1 0.284
the Patients Unemployed 21(70) 17(56.7)

TABLE 2: Comparison of Socio-demographic characteristics of families with and without

Cannabis Dependent.
G rou ps
Socio D em o gra p hic Stud y g rou p C on tro l g rou p t
P
V a ria b les (N = 30) (N = 3 0) (df = 58 )
M ea n ± S D M ea n ± SD
Age of the patients 31.46± 10.75 27.63± 7.7 2 1.5 86 0.11 8
A ge of the Inform ants 38.5 0±9 .6 2 42 .70± 1 0.10 1.6 49 0.10 5
E ducation o f the Inform ants 9.80± 2.73 9.0 3±2 .91 1.0 50 0.29 8
Education o f the Patients 10.5 6±2 .3 2 9.7 0±2 .85 1.2 92 0.20 2
Inform ants Incom e 810 0.00± 754 4.76 8 466 .00± 6 532 .33 0.2 01 0.84 1
Fam ily Incom e 176 83 .00 ±65 2.61 1 213 3.0 0± 195 .76 1.7 65 0.08 3

TABLE 3: Comparison of families with and without Cannabis Dependent on domain of

Family Interaction Pattern Scale.
G ro u p s
D o m a in s o f F a m i ly
S tu d y g r o u p C o n tr o l g r o u p
I n t e r a c tio n t p
(N = 30 ) (N= 30)
P a tte r n S c a l e (d f= 5 8 )
M ean ± SD M ean ± SD
R e in fo rc e m e n t 2 5 . 8 0 ± 1 .9 3 2 1 .2 0 ± 2 .8 0 7 .3 8 4 .0 0 1 * * *
S o c ia l S u p p o rt 3 0 . 0 6 ± 2 .2 4 2 3 .7 3 ± 3 .1 9 8 .8 8 8 .0 0 1 * * *
R o le 6 4 . 6 3 ± 3 .4 3 5 4 .7 0 ± 8 .3 0 5 .9 1 5 .0 0 1 * * *
C o m m u n ic a tio n 6 4 . 6 3 ± 5 .6 5 5 4 .0 0 ± 7 .1 0 6 .4 0 9 .0 0 1 * * *
C o h e s iv e n e s s 3 5 . 8 6 ± 5 .1 9 3 0 .6 8 ± 3 .3 8 1 .5 6 3 .1 2 3
L e a d e rs h ip 3 3 . 7 3 ± 3 .8 0 3 3 .7 3 ± 3 .5 9 0 .1 0 5 .9 1 7
F I P S T o ta l 9 5 .5 3 ± 1 4 .3 9 6 1 . 7 6 ± 1 3 .5 5 8 .4 2 9 .0 0 1 * * *
*** P <0. 001

Indian Journal of Health Social Work. 1(2) July-December, 2019 20

 I NT E R ACT ION P A T TE R NS IN T HE FA M IL I E S OF I NDI V ID UAL W IT H CA NNA B IS DE P END E NCE
DISCUSSION
The present study was conducted on the Out
Patient Department of the Ranchi Institute of
Neuro Psychiatry & Allied Sciences (RINPAS),
Kanke, Ranchi. It was based on purposive
sampling technique. This was a comparative
study and 30 families from the patients
diagnosed with cannabis dependence and 30
of families from normal controls (i.e., a family
without any cannabis dependence member).
T h i s s tu dy was pl an ned to as s es s t he
interaction patterns in the families of patients
with cannabis dependence and families of
normal controls.
The result of the present indicated that there
was s i gni fi cant di fference between the
families with and without cannabis dependents
in various areas of family interaction pattern
scale. We found that families with cannabis
dependents percei ved dy sfunct ional
interaction pattern as compared to families
without cannabis dependents. The mean of
present study was found significantly higher
in the va rious domains of t he family
interaction pattern scale i.e. “reinforcement”,
“social support”, “role”, “communication” &
“Total FIPS” in the fami lies of cannabis
dependents as compared to families without
cannabis dependents. Present study finding
impli ca te significa nt dy sfunct io ns in
interaction patterns in families with cannabis
dependents. The dysfunction is widespread
and enco mpass es areas such
reinforcement , social s upport , rol e,
communi cati on, and s o forth. I mpai red
interaction pattern in families of cannabis
dependents, manifesting in the form of poor
family support and communication marred
wit h negative connotat ions has been
highlighted by various previous researchers
with population of alcohol and substance use
(Suman & Nagalakkshmi, 1995; Jacob &
Seilhamer, 1989; Christine & Victor 1993;
Akhito et al., 2003) and, therefore, the
findings of this study i s in cons onance.
Indian Journal of Health Social Work. 1(2) July-December, 2019
Impaired interaction pattern can have serious
implications as far as substance is concerned.
In fact, it can have implication from both
cause as well as effect perspectives. For
example, on the one hand, a person can
become vulnerable for cannabis consumption
due to persistent nagging as a result of
negative communication and, on the other;
hi s can na bi s / s u bs tan ce co ns ump ti on
behaviour can force the family members to
make negative comments on him. It applies
to other sub-domains of interaction pattern
as well. For example, a person can have
deficient role functioning due to his substance
cons umpti on behaviour whi le poor rol e
assignment can leave a person despondent
and make him vulnerable for cannabis and
s u b s t an c e u s e . A s t r o n g p a r e n t– c h i l d
relationship is an important protective factor
in preventing substance abuse in the families
(Davis & Spillman, 2011). A positive and
protective relationship is determined by the
degree of parental intimacy, expression of
excitement and pride for success and skills of
the child, and expression of intimacy and love
(Amato, 1990). Studies have demonstrated
that qualified interaction between parents and
the child, consistent and effective discipline
methods, and a positive parenting model
reduce the risk to consume substance use
disorders (Ogel et al., 2004).
as CONCLUSION
Finding of the present study concludes that
Cannabis can have a negative effect on various
areas of the family interaction pattern i.e
“reinforcement”, “social support”, “role”,
“communication” So, it is know that individual
with cannabis dependents has significant
impact on interaction patterns and it has
become significant predictors and tends to
appear among the families who have spent
some years in their caring and service of the
individuals with cannabis users. Present study
has some limitations i.e. the sample size is
21
 I NT E R ACT ION P A T TE R NS IN T HE FA M IL I E S OF I NDI V ID UAL W IT H CA NNA B IS DE P END E NCE
s mall and i s cross -s ecti onal . T he other
variables like that treatment adherence and
duration of taking cannabis have not been
included. Cultural factors are also important
in this issue but the effects of race and
et hni cit y have no t been ta ken into
consideration in this study.
REFERENCES
Akihito, H., Kim, T., & Koichi, N.(2003). Positive
and Negative Effects of Social Support
on the Relationship between Work
Stress and Alcohol Cons umption.
Journal of Studies on Alcoho l, 64,
874-883.
Amato, P.(1986). Dimensions of the family
environment as perceived by children:
A mul ti dimens ional scali ng
study. Journal of Marriage and
Family, 19, 52, 613–620.
Bhatti, S. R., Cuba, K.D.K., & Benedi cta,
L. A. (1986). Val i dati on of Fa mi l y
Interaction Pattern Scal e. Indian
Journal of Psychiatry, 28, 211-216.
Chakravarthy (1990). Community workers
estimate of drinking and alcohol-
rel ated probl ems i n rural areas .
I nd i an J o ur n al o f P s yc h ol og i ca l
Medicine , 13, 49-56.
Christine, M.O., & Victor, M.H.( 1993). The
influence of perceived social support
on the relationship between family
history of alcoholism and drinking
behaviors. Addiction, 88, 1651-1658.
Davis, S.J., & Spillman, S.(2001). Reasons for
drug abstention: A study of drug use
and resilience. Journal of Psychoactive
Drugs, 43, 14–19.
Frankenstein, W., Hay, W.M., & Nathan,
P.E.(1985). Effects of intoxication on
alcoholics’ marital communication and
problem solving. Journal of Studies on
Alcohol , 46, 1-6.
Goldberg, D.P., & William, P.(1978). A user
Indian Journal of Health Social Work. 1(2) July-December, 2019
guide to General Health Questionnaire.
Windsor, NFER-Nelson,.
Jacab, T., Richey, D., Evitkovic, J.F., & Blane,
H.T. (1981). Communications styles of
alcoholic and nonalcoholic families
when dri nki ng and not dri nki ng.
Journal of Studies on Alcohol, 42,
466-482.
J a co b, T., & S e i l h a m e r, R . A . ( 1 9 89 ) .
Alcoholism and family interaction.
Recent Developments in Alcoholism, 7,
129-145.
Jacob, T., Favorini, A., Meisel, S., & Anderson,
C. (1978). The spouse, Children and
family interactions of the alcoholic:
Subst ant ive findings a nd
methodological issues. Journal of
Studies on Alcohol , 39, 1231-1251.
J a co b, T., & K rah n , G. ( 1 98 8 ) . M a r i t a l
i nteracti on of al cohol i c coupl es :
Comparison with depressed and non-
di stressed coupl es. Jo urna l of
Consulting and Clinical Psychology ,
56,73-79.
O gel , K ., Taner, S., & Eke, C. Y. (2004).
Evaluating the effectiveness of the
teacher and parent education program
in addiction prevention. Anatolian
Journal of Psychiatry , 5, 213–221.
Steinglass, P.(1981). The impact of alcoholism
on the family: Relationship between
degree of alcoholism and psychiatric
symptomatology. Journal of Studies on
Alcoho l, 42, 288-303.
Suman, L.N., & Nagalakshmi, S.V.(1995).
Family interaction patterns in alcoholic
families. NIMHANS Journal , 13, 47-
52.
World Health Organisation, (1993).The ICD-
1 0 c l a s s i f i c a t i o n o f m e nt a l a n d
behavi oural disorders –diagnostic
criteria for research. WHO, Geneva.
Conflict of interest: None
Role of funding source: None
22
 QUALITY OF LIFE, HARDINESS AND SELF-ESTEEM OF EMPLOYED &
NON-EMPLOYED FEMALES: A COMPARATIVE STUDY

Dharmendra Kumar Singh

Associate Professor, Centre for Psychological Science, Central university of South Bihar, Gaya,
Bihar.
Correspondence: Dharemendra Kumar Singh, e-mail: dharmendra.gla2012@gmail.com

ABS TRACT

Background: Traditional gender roles which viewed male as breadwinner and female as
homemaker have changed over the time and there has been an increase in families headed by
two working spouses and support to this notion keeps increasing. Aim: Present study was carried
out to compare the quality of life, self-esteem and hardiness between employed & non employed
females. Sample: Fifty each both from employed & non-employed; thus a total of 100 female
subjects were included in the study from Medininanagr (Palamau) through purposive sampling
technique. Tools: World Health Organization -Quality of Life (WHOQOL) – BREF (Hindi Version),
Personal view survey and The Cooper smith Self-Esteem Inventory (CSEI) were used. Results
and Conclusion: Non-employed females had better quality of life. A significant positive correlation
was found between quality of life with hardiness & self-esteem.

Key words: Quality of life, self-esteem, hardiness.

INTRODUCTION
Quality of life reflects the overall well-being
of an individual’s life. It is also known as
individuals’ perception of their position in the
context of culture and value system in which
they live. The quality of life measures the gap,
at a particular time between the hopes and
expectati ons of i ndi vi dual s and pres ent
experiences of individuals (Calman, 1984).
Slowly but surely, women are entering to
semi-pro fes sio nal and professional
occupati ons . Many occupati ons s uch as
engineering, medical, law and university
teaching that were dominated earlier by men,
are now equally shared by both the genders.
Traditional gender roles which viewed male
as breadwinner and female as homemaker,
have changed over the time and there has
been an increase in families headed by two
working spous es. The man is no longer
considered as the only “economic provider”
for the family. Women are also associating
career with self-dignity and identity. In the
wake of rapid social change in various aspects
of Indian Society, the roles and positions of
women are undergoing changes at a rapid
pace. These days, women have become more
conscious of their own identity and status.
Modern women wish to develop self-reliance
and self-esteem by taking up jobs in various
aspects. Many researchers over the past years
have made comparative studies of employed
an d non -em pl oye d f em al e s on var i o us
psychological variables and the relationships
between them. Chaudhry (1995) found
significant negative correlation between life
stres s and general wel l-being among
profess ional, non-profes si onal and non-
empl oyed females . Very few study was
conducted earlier to measure quality of life
and Hardiness in working female in Indian
setup, so, present study was carried out with
following objectives;

Indian Journal of Health Social Work. 1(2) July-December, 2019 23

 Quality of life, Hardiness and Self-esteem of employed & non-employed females: A Comparative study
OBJECTIVES
♦ To compare quality of life, Hardiness
and Self Esteem between employed &
non employed females.
♦ To explore relationship amongst quality
of l i fe, s el f-es teem and hardi nes s
among empl oyed & non-empl oyed
females.
MARERIALS AND METHOD
Sample: A total of 100 females were included
in the study from different l ocali ties of
Palamau dis tri ct, among which 50 were
employed and rest 50 were non-employed.
Sampl e was selected through purposi ve
sampling technique.
Inclusion criteri a for non empl oyed and
employed females:
♦ Age must be 25 Years & above
♦ Must be educated minimum up to 12th
class.
♦ Must be employed in any organization/
institute on paid basis
♦ Must be cooperative
TOOLS
(i) A semi-structured Socio demographic
and personal data sheet consists of age,
education, marital Status, domicile,
religion & type of family.
(ii) World Health Organization- Quality of
Life (WHOQOL)–BREF (Hindi Version):
The questionnaire has been developed
by world health organization group in
order to provide a short form for quality
of life assessment that looks at the
do mai n lev el pro fi les . I t is an
abbreviated 26 items assessment and
contains 2 items from the overall QOL
and general health, and one item from
Indian Journal of Health Social Work. 1(2) July-December, 2019
each of the 24 facets included in WHO
Q O L- 1 0 0 t o p r o v i d e b r o a d a n d
comprehensive assessment. Each item
is rated on a five point s cale. The
questionnaire assesses the quality of
life in 4 domains, namely, physical
health, psychological health, social
relationship, and environment.
(iii) Personal View Survey (PVS): The PVS
scale (Kobasa, 1986) consists of 50
items with three subscales, challenge,
commitment, and control with 17, 16,
17 items respectively. Scores of 39
items are reversed. Ratings of each item
are 0 (not at all true) to 3 (completely
true) i n 4 es cal ations. Each s core
indicates positive value of hardiness.
The scoring was reversed in case of
negatively items and mean score of
three subscales show total score.
(iv) The Coopersmith Self-Esteem Inventory
(CSEI): The Coopersmith Self-Esteem
Inventory (Coopersmith, 1970) was
designed to measure the respondent’s
attitudes toward self in personal, social,
fa m i l y, and academi c areas of
experience. With 25 items, scores range
from 0 to 25, and the obtained score is
multiplied by 4. The maximum possible
total score is 100. Low score indicates
low self-esteem and high score shows
high self-esteem.
Statistical Analysis
Sampl es were s el ected on the bas i s of
inclusion criteria and informed consent was
obtained. After rapport building, the tools
were administered. Raw data was analyzed
with the help of SPSS windows 13.0 version.
Mean, S. D., t tes t and Pears on r were
calculated.
24
 Quality of life, Hardiness and Self-esteem of employed & non-employed females: A Comparative study

RESULTS

Table-1 Socio demographic characteristics of sample.

Employed Non-employed
Socio Demographic Variables females females
N=50 N=50

Married 32 35
Marital status
Unmarried 18 15
Up to graduation 21 24
Education
Above graduation 29 26
Rural 11 09
Domicile Urban 13 12
Semi-urban 26 29
Hindu 23 24
Religion Muslim 14 11
Other 13 15
Nuclear 38 34
Type of family
Joint 12 16
Age(in Yr) 32.5±6.5 31.6±5.6

Table-1 Sows that most of the subjects belonged to Hindu religion, semi urban area, were
married, belong to nuclear family and educated more than graduation level in both study groups.
Both groups were comparable on all variables except occupation.

Table-2: Comparison of quality of life between employed and non-employed females

Non-employed
Domain of Quality Employed females
females t p
of Life N=50
N=50
Physical domain 51.13±4.43 66.2±.76 19.4 .01**
Psychological domain 47.45±3.34 52.98±.56 11.6 .01**
Social domain 39.89±3.89 48.23±.90 12.3 .01**
Environmental domain 51.45±.73 54.67±1.59 3.2 NS
Total QOL 71.34±13.76 124.99±4.56 36.31 .01**
** P<0.01

Table-2 shows that both groups differed significantly on total score of quality of life scale (t=36.31,
P<.01) as well as three domains of the scale; Physical domain (t= 19.4, p<.01), Psychological
domain (t= 11.6, p<.01) and social domain (t= 12.3, p<.01). Result shows that Non-employed
females had better quality of life than subjects who were involved in any working status.

Table-3: Comparison of self esteem between employed and non-employed females:

Employed females Non-employed

Self Esteem Inventory t p
N=50 N=50
Self esteem 53.2±9.76 65.13±14.43 5.6 .01**
** P<0.01

Table-3 shows that both groups differed significantly on total score of self esteem scale (t= 5.6,
p<.01). It means non-employed females had higher self-esteem than employed females.

Indian Journal of Health Social Work. 1(2) July-December, 2019 25

 Quality of life, Hardiness and Self-esteem of employed & non-employed females: A Comparative study

Table-4: Comparison of Hardiness between employed and non-employed females:

Employed females Non-employed

Hardiness Scale t p
N=50 N=50
Hardiness 24.2±3.16 33.21±2.45 12.3 .01**
** P<0.01

Table-4 shows that both groups differed significantly on total score of hardiness scale (t= 12.3,
p<.01). It means non-employed females have higher hardiness than employed females

Table 5: Pearson’s Correlation (r value) amongst Quality of life, Hardiness, and Self-
esteem for the total sample.

Variable QOl Hardiness

Self esteem .49** .56**
Hardiness .53**
** P<0.01
Table-5 shows that significant positive correlation are obtained among quality of life and self-
esteem (r=.49), quality of life and hardiness (r=.53) and hardiness and self-esteem (r=.56).

DISCUSSION
Present study found that quality of life, self
esteem and hardiness is significantly low in
the employed females in comparison to non-
employed females. Findings of the present
study are supported by the study done by
Asadi Sadeghi Azar et al, 2006. This study
reveals that to carry out effectively the double
burden of work at home and at the work place,
the employed females often face unavoidable
physical and psychological stress. They have,
in fact, to carry out two full time jobs with
little time for rest, leisure or self-care. Results
also show that quality of life is positively
correlated with self esteem and hardiness
level. Many earlier researchers found that
hardiness is associated with greater well-
being (Diener et al,1997; Rhodewalt and
Agustsdottir, 1984).The plausible reasons for
hardiness and quality of life having positive
relati onship are that hardines s leads to
resilience and is a general health promoting
factor (Maddi, 1999) thus leading to better
quality of life. People high on hardiness are
able to cope up with stress better as they are
able to reframe and reinterpret adverse
experiences (Bigbee, 1985). Since people high
on hardiness have more problem solving
f o c u s e d s t r a t eg i e s a n d a r e h i g he r o n
commitment, control and challenge; such
people are likely to perceive themselves as
self-efficacious. Hardiness and self-esteem
were found to be positively correlated. People
high on hardiness, because of their being
highly motivated and committed are likely to
be attaining more success and have positive
experiences. These outcomes of hardiness
enhance feeling of self-worth and self-esteem.
CONCLUSION
Employed females have comparatively poor
quality of life, lower hardiness and lower self-
esteem than non employed females. This study
e x pl o r es t ha t em p l o ye d fe m a l e s ne e d
psychologi cal and emotional s upport for
having the better quality of life. So policy
makers and other stakeholders working in this
field should develop programmes on grass
root level to target the problems of employed
females and thus enhancing their quality of
life.

Indian Journal of Health Social Work. 1(2) July-December, 2019 26

 Quality of life, Hardiness and Self-esteem of employed & non-employed females: A Comparative study
REFERENCES
Bigbee, J.L.(1985). Hardiness: a new health
perspecti ve i n heal th promoti on .
Nurse Practioner, 10 , 51-56.
Calman, K. (1984). Quality of Life in Cancer
Patients - An Hypothesis. Journal of
Medical Ethics, 10 (3), 124-127.
Chaudhry, M. (1995). A study of marital
adjus tment, role confli ct, fear of
success, general well-being and life
stress amongst working and non-
working married women. Unpublished
P h . D t h e s is . Pa n j a n U n i v e r s i t y,
Chandigarh, India.
Coope rs mi th, S . (1970). Manual of Sel f
es teem Inv ent ories. Palo Alt o,
Ca lifornia . C Av Counsulti ng
Psychologist Press.
Diener, E. Suh, E.M., Lucas, R,E., & Smith, H.
(1997).Subjective well-being: Three
d e c a d e s o f p r o g r e s s - 1 9 6 7 - 1 9 9 7.
Manuscript submitted for publication.
University of Illinois.
Irandokht, A.S., Vasudeva, Z.& Abdolghani, A.
Indian Journal of Health Social Work. 1(2) July-December, 2019
(2006). Relationship between quality
of life, hardiness and self efficacy
among employed and non employed
women in Zabol . Iran J ournal of
Psychiatry, 1, 104-111.
Kobasa, S.C. (1986). Personal views survey.
The graduate school and university
center of the City, University of New
York.
Maddi, S.R. (1997). Personal Values Survey
II : A measure of di spo sitional
hardiness. In: Zalaquett CP, Wood RJ,
eds. Evaluating stress: A book of
resources. Lanham, MD: Scarecrow
Press, 293-309.
Rhodewalt, F ,& Agustsdottir, S. (1984). On
the relationship of hardiness to the
type Abehavior pattern: Perception of
life events versus coping with life
events. Journal of Research in
Personality, 18,211–223.
Conflict of interest: None
Role of funding source: None
27
 RELATIONSHIP BETWEEN INTELLECUAL FUCTIONING, FAMILY
BURDEN AND QUALITY OF LIFE OF PARENTS WITH INTELLECTUAL
IMPAIRMENT, MUZAFFARPUR, BIHAR

Pradeep kumar 1, Sushma Rathee 2, Amrita Rani Singh 3

1
Consultant, Psychiatric Social Work, State Institute of Mental Health, PT., B. D. Sharma University
of Health Sciences, Rohtak, Haryana. 2Assistant Clinical Psychologist, PGIMER Chandigarh.
3
Director, HOPE special school, a unit of Sachin Divyang Jan Sewa Sansthan, at Juran Chapra
Road, Muzaffarpur, Bihar.
Correspondence: Sushma Rathee, e-mail: sushmarateecp@gmail.com

ABS TRACT
Background: Parents who have children with intellectual disabilities are often reported to have
physical and psychological distress related to caring for their children, thus affecting their quality
of life. Parents or care-givers are definitely the heart of the family; who not only have to deal
with the issues associated with child’s impairment but also have to maintain the household.
Today, a number of studies have demonstrated that caregivers are more vulnerable to develop
mental and physical problems as compared to non-caregivers. Aim: The aim of the present
study was to assess the relationship between quality of life and family burden among the parents
of children with Intellectual. Sample: Quality of life scale and family burden schedule was
administered on 120 parents of children diagnosed with Intellectual Impairment. Design: This
study was cross-sectional study and conducted at a day care center of a non-governmental
registered organization, Muzaffarpur, Bihar. Results and conclusion: It has been found that
quality of life negatively related with economic family burden, family functioning, family relations,
interpersonal relations of parents, other family burden and the quality of life positively related
with intellectual functioning. It indicates that the level of intellectual functioning will increase
then quality of life become also better.

Kew Words: Quality of Life, family burden, parents, intellectual impairment.

INTRODUCTION
The field of intellectual impairment (ID) is
strongly influenced by the Quality of Life
paradigm (QOL), from a research, a practice-
based, and a policy-oriented perspective
(Claes, van Hove & van Loon et al., 2010).
Parenting style of intellectual disable (ID)
children is more challenging in comparison to
normal children, because, ID is characterized
by significant impairment in cognitive and
adaptive behavior. The term used to describe
this condition has gone under constant change
over the years due to social and political
compulsions. The main reason to search for
a new term was to find a least stigmatizing
terminology. Thus, mental retardation, which
was in use world over till late 20th century,
has now been replaced with I D in most
English speaking countries (Chavan, Rozatkar,
& Abhijit, 2014). Worldwide prevalence of
intellectual impairment is reported to be as
high as 2.3% (Franklin & Mansuy, 2011) and
in India it is reported to be around 2% for
mild intellectual impairment and 0.5% for
severe intellectual impairment (Srinath &
Girimaji, 1999). According to National Sample
Survey of 2004, 94 people per 100,000 were
found to be mentally retarded 1.

Indian Journal of Health Social Work. 1(2) July-December, 2019 28

 Relationship Between Intellecual Fuctioning, Family Burden and Quality of
Life of parents with intellectual impairment, Muzaffarpur, Bihar
Intellectual impairment has enormous social
effects; it not only affects the people who
suffer from it but also the family and society
as a group. Parents show a series of reactions
after knowing that their child is disabled. These
include shock, denial, guilt, sorrow, rejection
and acceptance. Question like ‘why me?’ How
can it be?’ keep arising without answers.
Some of them undergo tremendous guilt
feeling, experience deep sorrow, have strong
under expectations of achievement, may have
unrealistic goals, may want to escape from
reaction and ultimately turn to accept the child
(Berdine & Blackhurst, 1985).
A study examined the social problems related
to the presence of intellectually disabled child.
Results indicated that parental feelings were
marked by anxiety about future. Also, negative
effects towards other siblings, psychological
stress, decreased interaction with neighbors
and relatives, misunderstandings within family
and economic loss were significant facts
associated with presence of a child with
intellectual impairment in the family. The
definition of individual quality of life has been
debated more over the last three decades and
has been defined differently depending on the
researcher (Brown 1997). Quality of life is a
multidimensional construct encompassing
several core domains, generally identified as
material conditi ons, physical status and
functional abilities, social interactions, and
emotional well-being (Schipper et al.,1996).
Regardless of the specific way individual
quality of life is defined as general feelings
of well-being, feelings of positive social
involvement, and opportunities to achieve
personal potential (Schalock, Brown & Brown
et al., 2002).
They have also agreed that quality of life
should include various domains of life and
taken together as a whole should encompass
the entirety of life (Schalock, Brown & Brown
et al., 2002). The predominant view is that
mental retardation creates stress and burden
Indian Journal of Health Social Work. 1(2) July-December, 2019
for the care gi vers (Sethi , B hargava &
Dhiman, 2007). Parents may experience the
impact of financial burden, restricted social
interactions, and mental worries and so on
and the high level of stress or mental health
problems experienced by parents of children
with ID could be related to subjective factors
such as feel ing soci al isolation and li fe
d i s s a t i s fa c t i o n ( M a j u m d a r, Pe r e i ra &
Fernandes 2005). According to a 2012 report
from the National Council on Impairment, in
custody cases, “removal rates where parents
have a psychiatric impairment have been
found to be as high as 70 percent to 80
percent; where the parent has an intellectual
impairment, 40 percent to 80 percent. Parents
of th es e chi l dr en may s tr ugg l e w i th a
multitude of emotions interchangeably over
years, and often have feelings of guilt that
s o me ho w th ey c au s e d th e ch i l d to b e
disabled, for logical or ill ogical reasons
(Upadhyaya & Havalappanavar 2008). Panday
and Fatima (2016) have found that direct
relationship between the degree of perceived
burden, social emotional burden, disruption
of family routine and disturbance in family
interactions for women with intellectually
disabled children rather than men (Panday &
Fatima 2016). Another finding indicated that
parents of male children have good Quality
of Life in comparison to the parents of female
children. There was a significant gender
difference in perceived stress among parents
having children with I D. Mothers perceive
more stress than father (Verma, Srivastava
& Kumar 2017). Mothers of children with ID
displayed lower physical health, impairment
in social relationships, in their psychological
st ate a nd poo rer perceptio n o f their
e n v i r o n m e n t ( S i n g h , K u m a r, K u m a r &
Chakarborti, 2016).
AIM
I n the pr es en t s tudy we as s es s ed t he
relationship between intellecual fuctioning,
29
 Relationship Between Intellecual Fuctioning, Family Burden and Quality of
family burden and quality of life of parents
with intellectual impairment.
MATERIALS AND METHOD
The study was conducted at a day care center
HOPE special school, a unit of Sachin Divyang
Jan Sewa Sansthan, a non-governmental
registered organization at Juran Chapra Road,
Muzaffarpur, Bihar nearby 55 k. m. from
Sitamarhi the great Indi an mythologi cal
Ramayan character Mata Sita birth place The
study was conducted between the periods of
March 2019- June 2019. This study was cross-
sectional and correlational research.
Sample:
A group 240 sample was recruited in the
present study. The one hundred twenty
children with intellectual impairment Mean ±
SD (54.90±11.33) and 120 parents (60 male
and 60 female) were selected with the Mean
± SD of (37.96±6.97) on the basis of their
av ail abi li ty and purpo siv e sampli ng
techniques. The education of the caregivers
was ranged with Mean ± SD of (12.45±3.62).
The Mean ± SD of the children’s age were
10.40±4.27.
Inclusion Criteria:
♦ The parents who were living with the
child with Intellectual functioning (I.Q.
between 70-40)
♦ Parti cipants have at l eas t pri mary
education.
♦ Exclusion Criteria
♦ Participants having primary diagnoses
of psychiatric illness.
♦ Pres ence of any major medi cal or
neuro logical ill nes s or
developmental disabilities in children.
♦ Refuse to give informed consent.
TOOLS
Inform Consent Form and Socio-demographic
and Clinical data Sheet:
Indian Journal of Health Social Work. 1(2) July-December, 2019
Life of parents with intellectual impairment, Muzaffarpur, Bihar
A consent form and socio-demographic record
sheet was prepared for taking the written
inform consent and collecting the information
about various areas of social, demographic
and clinical variables. Information relating to
age, sex, residence, marital status, education,
types of family, occupation, age of child, level
of intellectual impairment of child, duration
of illness, other psychiatric illness, family
history of psychiatric illness, were recorded
in as structured interview setting and Seguin
Form B oard Test (SFBT), Fami ly burden
interview schedule (FBIS) and WHO Quality
of Li fe BREF Scale were appl ies on the
participants.
Procedure:
A t o t a l 1 20 c h i l d r e n w i t h i nt e l l e c t u a l
impairment and 120 parents of intellectual
impaired children were selected for the study,
those who fulfilling the inclusion criteria. After
explaining the purpose of study to caregivers
their written informed consent was taken and
then the actual administration of the study was
started. In the study first, the intellectual
functioning of the children were assessed
after that their parents were assessed on
famil y burden and quali ty of life s cal es
respectively. The parents of the selected
intellectual impaired children’s were equally
involved as father and mother. The scoring
of the scales was done with the help of their
respective manual.
RESULTS
The data was analyzed with using SPSS 16.5
as per suitable analysis techniques including
descriptive and inferential analysis. In the
other de mogr aphi c v ari a bl e s on l y c are gi ve rs
information was analysized (N=120), because
the caregivers were actul participants of the
present study tha t is why only their
demographic details were recoreded. The
children’s intellectual functioning and their age
were taken as covariate variables in the
30
 Relationship Between Intellecual Fuctioning, Family Burden and Quality of
Life of parents with intellectual impairment, Muzaffarpur, Bihar
present study. In the rest part of analysis complete data (N=240) was included.
including descriptive and correlation the

Table 1 showing the characteristics of demographic varaibles

Socio Demographic variables Frequency Percent

Gender Female 60 50.00
Male 60 50.00
Residence Rural 24 20.00
Urban 92 76.70
Sub-urban 4 3.30
Religion Hindu 114 95.00
Muslim 6 5.00
Occupation Business 22 18.30
Govt. Job 17 14.20
Student 1 0.80
Others 80 66.70
Family history of No 109 90.80
psychiatric illness Yes 11 9.20

Table 2 showing the discriptive analysis of Quality of life & Family burden

Quality of life & Family Burden

Mean Std. Deviation
Interview Schedule
Quality of Life 78.37 12.01
Financial burden 8.52 3.76
Disruption of routine family activities 5.68 2.50
Disruption of family leisure 4.49 1.97
Disruption of family interaction 5.59 2.24
Effect on Physical health to other 2.81 1.39
Effect on Mental health to other 2.79 1.26
Total family burden 32.68 10.05

Table 3 Showing the results of correlation between intellectual functioning of childrens and family
burden and quality of life of their parents

Age of the
Variables of Family Burden
Quality of life IQ Child
Interview Schedule

Quality of Life - 0.211* -0.03

Financial burden -0.483** -0.251** 0.034
Disruption of routine family activities -0.323** -0.190** 0.068
Disruption of family leisure -0.253** 0.125 0.044
Disruption of family interaction -0.200* -0.051 0.111
Effect on Physical health to other -0.171 -0.178 0.016
Effect on Mental health to other -0.116 -0.075 0.045
Total family burden -0.284** -0.107 0.109
* P <0.05; ** P <0.01

Indian Journal of Health Social Work. 1(2) July-December, 2019 31

 Relationship Between Intellecual Fuctioning, Family Burden and Quality of
Life of parents with intellectual impairment, Muzaffarpur, Bihar
DISCUSSION
The socio-demographic findings of the present
study indicated that the sample was equally
divided (Male=50% & female= 50%). In the
residence variable 20% sample belongs to
rural background, 76.7% were urban and
3. 3% were s ub-urban. O ccupati on-wis e
distribution indicated that 0.8% sample was
students and 18. 3% were bus inessmen,
whereas in government job and other work
were found as 14.2% and 66.7% respectively.
In the total participant 95% were Hindu and
9.2% were Muslim.
The discriptive analysis of varaibles (Socio
demoghaphic, intellectual fuctioning, quality
of life and familty burden) disclose that that
mean age of the sample was 37.96±6.97. In
the education mean (SD) has been found
12.45±3.62. Age of the child found as mean
value of 10.40(4.27). On the age of the child
variable the mean value is 54.90(11.33), while
variable of intellectual functioning of child the
mean value of the sample is 54.90 (11.33).
The main aim of the present study was to find
out the relati onship between i ntel lecual
fuctioning,family burden and quality of life of
parents with intellectual impairment . Earlier
studies have shown that parents of children
with disabilities feel the sense of failure,
helplessness and guilt (Dervishaliaj 2013).
The findings of the this study emphasized that
quality of life negatively related with economic
family burden, family functioning, family
relations, interpersonal relations of parents,
other faily burden. There are several studies
have been done, which shows the relationship
between QOL and family burden of parents
with ID. Venkatesan and Das (1994) report
that the type of burden reported by family
members may range from difficulti es in
transportation of the child to the place of
service delivery, management of behaviour
problems, disruption of their daily routine,
ec ono mi c, ph ys i cal and s o ci a l bu rde n.
Kermanshahi et al., (2008) in their study on
Indian Journal of Health Social Work. 1(2) July-December, 2019
percepti ons of l i ves wi th chil dren wi th
intell ectual i mpai rment found s ix major
themes: cha llengi ng the process of
acceptance, painful emotional reactions, the
interrelatedness of mother’s health and child’s
well- being, struggles to deal with oneself or
the child, inadequate support from the family
and the community, and the anxiety related
to child’s uncertain future.
Lin et al. (2009) found the reduced quality of
life of caregivers of children with intellectual
disabilities, which are caused by factors such
as health of caregivers, family income and the
stress caused by a lack of social supports. In
another way we can say that the qaulity of
life increase the level of family burden in all
dimensions decrease.
The quality of life positively related with
intellectual functioning. It indicates that when
the level of intellectual functioning increased
the of quality of life become healthy and much
better. Si mi lary in the resul ts negati ve
relationship found between qaulity of life and
age of the child that is not significant but it
indicates that as the age of the child incserase
the quality of life decrease. In the dimension
of family burden i.e. economic family burden,
reduction in family functioning due to family
burden negativel y related wi th level of
intellectual functioning at significant level. It
i n di c ates th at the l ev el of i nt el l e ctu al
functioning are increased the family burden
in these dimension be reduced. Another
domains of family burden (Family Relations,
Interpersonal relations of parents, Effect on
Physical Health, Effect on Mental Health and
Other family burden) were also negatively
related with intellectual funcioning.Growing
evidence suggests that care giving to these
children leads to burden in the caregivers.
There is a big chal lenge to manage the
negative consequence of care giving, to
devel op and i mpl ement rea li sti c a nd
appropri ate res ponse s trategies . In our
country where we have limited resources and
32
 Relationship Between Intellecual Fuctioning, Family Burden and Quality of
Life of parents with intellectual impairment, Muzaffarpur, Bihar
it is high time that we should realize that we
may not develop holistic health of the patients
if the care givers are overburdened. So,
treatment providers should shift their focus
to the mental health of care givers too along
wi th that of indiv idual s with ment al
retardation and on successful resettlement in
society, as it will be associated with increased
met needs (Kuldeep et al., 2014). In the
variables of age of child and domains of family
burden also found positive relationship. It
indicates that if the age of child increase the
the family burden also increase.
Now it’s clear that the family burden of the
parents of intellectually disabled children is
important for providing professional support
to families who suffer from burden and for
identifying coping behaviors. The families of
these children will feel that they are not alone
and will be able to receive professi onal
support for the issues that burden them.
Doing so will make it possible to teach people
according to their abilities and ensure that
they can lead lives without causing stress and
burden for their families and society.
CONCLUSION
The results of this study can have large
practical implicati ons . Parent s are
undoubtedly the heart of the family; who not
o n l y h a ve t o c o n c er n w i t h t he i s s u e s
associated with child’s impairment but also
have to maintain the household. Parents
should be provided with individual and group
suppo rt in co ping with the everyday
challenges. Individual counseling will help
them in development of competences for
parental role and empower them to advocate
for the rights of their children. As the mothers
are more vulnerable in this sense, they should
be a priority for support provi sion. The
position of mothers can be facilitated with
additional financial resources from the state,
which will help in getting a better childcare
and better child treatments. Mothers should
Indian Journal of Health Social Work. 1(2) July-December, 2019
also have some benefits regarding their
employment status in the sense of flexible
working hours. Society as a whole should
recogni z e the efforts mothers make i n
supporting their children with disabilities. It
is time t o accept the chall enges and
responsibility, specially the mental health
professionals and speci al educators and
provide care to this vulnerable as well as
needy population. These finding must be taken
into account in policy making to provide better
and more specific support and interventions
for parents of chi ldren wi th intel lectual
impairment.
REFERENCES
Berdine, W. H., & Blackhurst, A. E. (1985). An
introduction to special education. US:
Little Brown and Company, 618-625.
Brown, R. I. (1997). Quality of life for people
with disabilities Models, research and
practice (2nded.). Cheltenham, UK:
Stanley Thornes, Ltd.
Chavan, B. S., Rozatkar, & Abhijit, R. (2014).
Intellectual disability in India: Charity
to ri ght based. Indian Journal of
Psychiatry ,56 (2), 113–116.
Cl aes , C., van Hove, G., van Loon , J .,
Vandevelde, S., & Schalock, R. L.
(2010). “Quality of life measurement
in the field of intellectual disabilities:
eight principles for assessing quality
of li fe-rel ated personal
o u t c o m e s ”. S o c i a l Indi cato rs
Research, 98 (1), 61–72.
Dervishaliaj, E. (2013). Parental stress in
families of children with disabilities:
A li terature rev iew. Journal of
Educational and Social Research, 3
(7), 579–584.
Disabled Persons in India–Ministry of Statics
and Programme (2002), mospi.nic.in/
s i t e s / d e f a u l t / f i l e s /
publication_reports/485_final. pdf
cited on June 2019.
33
 Relationship Between Intellecual Fuctioning, Family Burden and Quality of
Life of parents with intellectual impairment, Muzaffarpur, Bihar
Karmanshahi, S. M., Vanaki, Z., Ahmadi, F.,
K az e mn ez a d, A., Mo r do eh , E ., &
Azadfalah, P. (2008). Iranian Mothers’
perceptions of their lives with children
with mental retardation: A preliminary
Phenom enol ogi cal I nves ti ga ti on.
Journal of Developmental and Physical
Disabilities, 20 (14), 317-326.
Kuldeep, S., Raj, K., Sharma, N. R., & Nehra,
D. K. (2014). Study of burden of
children with mental retardation.
Indian Journal of Health Psychology,
8 (2), 14-20.
Lin, J.D., Hu, J., Yen, C.F., Hsu, S.W., Lin, L.P.,
& Loh, C.H., et al. (2009). Quality of
life and caregivers of children and
adolescent s with intel lectual
disabilities: use of WHOQOL-BREF
survey. Research in Developmental
Disabilities, 30 (6), 1448-1458.
Majumdar, M., Pereira, Y.S., & Fernandes, J.
(2005). Stress and Anxiety in Parents
of Mentally Retarded Children. Indian
Journal of Psychiatry, 47(3), 144-147.
Pal, S. & Kapur, R.L. (1981) The burden of
the family of a psychiatric patient :
development of an intervi ew
schedule. British Journal of Psychiatry,
138, 331-335.
Panday R. & Fatima, N. (2016). Quality of Life
among Parents of Mentally Challenged
Children. International Journal of
Indian Psychology, 3(3),152-157.
Sc hal o ck, R. L., B r own , I ., B row n, R .,
Cummins, R. A., Felce, D., & Matikka,
L. (2002). Co nceptuali za tio n,
Meas urement, and Appli cation of
Q ual i t y of Li fe for Pers on s wi th
Intellectual Disabilities: Report of an
International Panel of Experts. Mental
Retardation, 40 (6), 457-470.
Sethi, S., Bhargava, S.C., & Dhiman, V. (2007).
Study of Level of Stress and Burden
in the Caregivers of Children with
Indian Journal of Health Social Work. 1(2) July-December, 2019
Mental Retardation. Eastern Journal of
Medicine. 12 (1-2), 21-24.
Singh, K., Kumar, P., Kumar, R., & Chakarborti,
S. (2016). Quality of Life among
Parents of Children with Intellectual
D i s a b i l i t y. J o u r n a l o f D i s a b i l i t y
Management and Rehabilitation, 2(1),
13-17.
S r i n a t h , S ., & G i r i m a j i , S . R . ( 1 9 9 9 ) .
Epidemiology of child and adolescent
mental health problems and mental
reta rdatio n. NI MHANS Journa l,
17(4),355-366.
Upadhyaya, G. R., & Havalappanavar, N. B.
(2008). Stres s in parents of the
mentally challenged. Journal of the
Indian Academy of Applied Psychiatry.
34 , 53–59.
Venkatesan, S. (2014). Celebrating a century
on form boards with special reference
to Seguin Form Board as measure of
i n te l l i ge n c e i n c h i l d r e n. G l o b J
Interdiscip Soc Sci, 3(6), 43–51.
Venkatesan, S., & Das, A. K. (1994). Reported
Burden on the family members in
receiving implementing home based
training programs for children with
menta l handica ps. Jo urna l of
Psychological Researches, 38 (1), 39-
45.
Verma, A., Srivastava, P., & Kumar, P. (2017).
Stress among Parents having Children
with Mental Retardation: A Gender
Perspecti ve. Journal of Disability
Management and Rehabilitation, 2(2),
68-72.
World Health Organization Quality of Life
A s s es s m en t (W HO Q o L) . (1 99 5) .
Position Paper from the World Health
Organization. Soc Sc Med, 41 , 1403-
1409.
Conflict of interest: None
Role of funding source: None
34
BRIEF COMMUNICATION

PERCEIVED SOCIAL SUPPORT AND EGO RESILIENCE IN SCHOOL

GOING ADOLESCENTS: A GENDER BASED STUDY

Lokesh Kumar Ranjan 1, Anand M Ghadse 2, Pramod R Gupta 3

1
Psychiatric Social Worker, Central India Institute of Mental Health Neuro Sciences, Dewada,
Rajnandgaon, Chhattisgarh, India. 2Occupational Therapist, Central India institute of mental health
and Neuro Science, Dewada, Rajnanadgaon, Chhattisgarh, India. 3Psychiatrist and Director, Central
India institute of mental health and Neuro Science, Dewada, Rajnanadgaon, Chhattisgarh, India.
Correspondence: Lokesh Kumar Ranjan, e-mail: lokeshr00@gmail.com

ABS TRACT
Background - Adolescence stage is a confused stage. At this stage for adolescent there is need
of detachment from parents but on the other side there is also a challenge to be independent
from parents. Person’s physical and mental health can be maintained through perceived social
support and ego resiliency. It refers to the ability to adapt to constantly varying situations and
regulate emotions effectively. Aim-To assess and compare the perceived social support and ego
resilience among the school going adolescents. Method-The present study included 240
adolescents who were the students of theclass10th, 11th, and 12 thgrade of Delhi public school
Rajnandgoan Chhattisgarh India. Male and female students were selected randomly from each
grade. The sample included 120 female adolescents and 120 male adolescents. Multidimensional
Scale of Perceived Social Support and Ego- Resilience Scale were used for the assessment of
socio-demographic and clinical details of all the adolescents. Results-This study found that
female has more perceived social support and ego resilience as compare to male and has positive
correlation with school going adolescents. Conclusion- The perceived social support is directly
proportional to ego resilience. In female social support is better than male as a result of this ego
resilience is also better in female as compare to male.

Keywords- Perceived social support, ego resiliency, adolescents, gender.

INTRODUCTION
In a person’s life usually large cognitive,
emotional, social, and physical changes are
major transitional period in adolescence.
Adolescence has been referred as a sensitive
stage due to brain development, a phase in
the life-span where susceptible towards
development of depression is heightened
(Andersen &Teicher, 2008).In adolescents,
co ncerni ng famil y rela tio ns , s cho ol
performance, interpersonal relations hips
(friends and romantic partners), and financial
restraints are some stressful situation that
experienced by individuals (Moksnes, 2010).
According to the Planning Commission (2001),
Adolescents account for one fifth of the
world’s population. This implies 230 million
(22.8%) Indians are adolescents in the age
group of 10 to 19 years. In India’s population
with every third person belonging to the age
10-24 years accounts for 373 million (30.9%)
ad ol e s ce nts (C ent ral bu rea u o f H eal th
Intelligence, 2012).
Social support resources include family and
relatives, friends, opposite sex, teachers,
colleagues, neighbors, and ideological and
religious groups or ethnic groups (Yildi, 1997).

Indian Journal of Health Social Work. 1(2) July-December, 2019 35

 Perceived Social Support and Ego Resilience in School Going Adolescents: a gender based study
Hence, social support network can lead to
positive health outcomes. Whereas, lack of
social support will in turn create unhealthy
state and delinquent behavior (Cohen & Wills,
1985 ).Besi des so cial s upport s’ direct
relationship with being healthy and feeling
good, it is effective in reducing the impact of
stressful life events (Eskisu, 2009).People
who are social entities call people to support
them when they have psychological problems.
As natural s upportive res ources , s oci al
support resources play a role in facilitating
the solution of psychological problems (Eker
et al., 2001).Social support has also been
linked to academic achievement. Here, the
assumption is that a higher perception of
support functions as a buffer against stress
(Cohen & Wills, 1985).Social support seems
to play this buffering role since it improves
achievement at all educational levels of the
students (Rosenfeld et al., 2000).
Block and Block (2006) stated that ego-
Resiliency represents a protective factor
against negative outcomes in major domains
of life. There are a better adjustment and
higher attainments at all stages of resilient
in an individual’s life (Block, & Block, 1980).
Ego-resiliency is a safe attachment and better
preschool problem-solving ability in infancy
(Arend et al., 1979). It is associated with
empathic behavior toward peers, adaptability
and social ly competent behaviors under
st res si ng circumst ances in chil dho od
(Eisenberg et al., 2004 & Luthar, 1991). On
the other hand, low levels of ego - resiliency
predicted later use of age -Inappropriate
defense of denial (Cramer, & Block, 1998) and
were rel ated to chi l dren’s egocentri sm,
although with different implications for boys
and girls (Gjerde et al., 1988).
OBJECTIVES
1. To assess and compare socio
demographic among male and female
with school going adolescents.
Indian Journal of Health Social Work. 1(2) July-December, 2019
2. To assess and compare perceived social
support among male and female with
school going adolescents.
3. To assess and compare ego resilience
among male and female with school
going adolescents
4. To the relationship of perceived social
support and ego resilience with school
going adolescents.
MATERIALS AND METHODS
The research study was a cross-sectional
comparative study among the male and
female with school going adolescents. The
present study included 240 adolescents who
are the students of the class10th, 11th, and
12 thgrade of Delhi public school Rajnandgoan,
Chhatti s garh, I ndia. T he sampl es were
selected randomly which included 120 female
adolescents and 120 male adolescents. Male
and female students were selected from each
grade. Rapport was established by explaining
the importance and the relevance of the study.
Pa rti ci pants were ass ured tha t their
responses would be kept confidential and
utilized only for the research purpose. They
were asked to complete the questionnaires
by following the instructions written on the
top of the first page. Data was collected on
the month of October 2018.
Inclusion and Exclusion Criterion
Inclusion criteria for adolescents:
♦ Age ranges o f a dol escents were
between 15-19 years,
♦ Adolescents of both sex,
♦ Adol escents wi th written i nformed
consent.
♦ Exclusion criteria for adolescents: -
♦ Age less than 15 and more than 19 years,
♦ Adolescents without written informed
consent.
36
 Perceived Social Support and Ego Resilience in School Going Adolescents: a gender based study

TOOLS Ego-Resilience Scale (ER89):

Socio-demographic datasheet:
The socio-demographic datasheet was semi-
structured and developed for the present
study, and consisted of variables like age, sex,
education, family income, and domicile.
Multidimensional scale of perceived social
support (MSPSS):
It was developed by Zimet et al., (1988).
MSPSS was used to assess the perceived
soci al support. The s cale eval uates the
adequacy of social support received from three
different sources namely family, friends and
significant others. The scale has 12 items.
Each item of the scale has 7 point options (1,
very strongly disagree to 7, very strongly
agree). Total scores range from 12 to 84. High
scores indicate high social support. The scale
demonstrated good internal consistency with
an alpha coefficient of 0.85–0.91. Each item
of the scale has 7 options which range.
It was developed by Block &Kremen (1996)
and was determined to have an adequate level
of internal consistency (Cronbach‘s á = .82).
The ER89 is comprised of 14 items, each rated
on a 4-point Li kert-type scale.Response
options range from 1 (does not apply at all)
to 4 (applies very strongly). Scores are
determined by summing each item, with total
scores ranging from 14 to 56.
STATISTICAL ANALYSIS
The statis ti cal analysi s was done usi ng
Statistical Packages for the Social Science
(SPSS)-16 software package for windows. For
socio-demographic and variables, descriptive
statis tics were us ed such as frequency,
percentage, mean, and standard deviation
(SD). Chi square test was used for comparing
categorical variables and t test was used for
comparing continuous variables. Significance
level of P <0.05 and P<0.01 was set at the
outset of the study.

RESULTS

Table 1: Comparison of age among male and female with school going adolescents

Socio Group
Demographic Male (N-120) Female(N-120) p
t-value Df
Variables Mean±SD Mean±SD
Age 16.42 ± 0.91 16.20 ±0.94 1.871 238 0.063

N=Number, SD=Standard deviation

Table 1 shows that mean age and standard deviation (SD) of male (16.42±0.91) and female
(16.20±0.94) with school going adolescents. There was no significant difference in the age among
male and female with school going adolescents (t=1.871, P<0.05).

Indian Journal of Health Social Work. 1(2) July-December, 2019 37

 Perceived Social Support and Ego Resilience in School Going Adolescents: a gender based study

Table 2: Comparison socio-demographic details among male and female with school
going adolescents

Socio Group
Demographic Male Female
df χ2
Variables (N-120) (N-120)
10 th Class 26 (21.7%) 18(15.0%)
th
11 Class 48 (40.0%) 57(47.5%)
Education 2 2.237NS
12 th Class 46 (38.3%) 45(37.5%)
Low class 13(10.8%) 10(8.3%)
2
Family Income Middle class 67(55.8%) 63(52.5%)
1.078NS
Higher class 40(33.3%) 47(39.2%)
N=Number, df=Degree of freedom, NS=Not significant

Table 2 reveals that there was no significant difference in education and family income between
both groups. In education, the number of adolescents who belonged to 10 th class (21.7% male
and 15.0% female)and 12 th class (38.3% male and 37.5% female) were higher in comparison to
adolescents who belonged to 11 th class in both the groups. Results also show most of the family
income of adolescents was belonged to middle class (55.8% and 52.5%) in both the groups.

Table3: Comparison of the perceived social support among male and female with
school going adolescents

Group
Perceived Social
Support Male(N-120) Female(N-120) t p-value
Mean±SD Mean±SD
Family 22.41 ± 5.80 22.82 ±5.94 0.538 0.691
Friend 19.93 ± 5.47 21.20 ±5.59 1.785 0.076*
Significant other 19.57 ± 5.90 20.74 ±4.94 1.659 0.098*
Total MPSS 61.92 ± 13.43 64.77 ±13.13 1.662 0.098*
*P<0.05, N=Number, SD=Standard deviation

Table 3 shows the comparison of perceived social support among male and female with school
going adolescents using independent t-test which indicated that there were no significant
differences in the domains of family (t=0.538) & significant difference found in friend (t=1.785,
P<.05), significant other (t=1.659, P<0.05), and total perceived social support(t=1.662, P<0.05)in
both the groups. Finding of this study showed that perceived social support was more in female
as compare to male with school going adolescents.

Indian Journal of Health Social Work. 1(2) July-December, 2019 38

 Perceived Social Support and Ego Resilience in School Going Adolescents: a gender based study

Table 4: Comparison of the ego resilience among male and female with school going
adolescents.

Groups
Ego Resilience
Scale Male(N-120) Female(N-120) t p-value
Mean±SD Mean±SD
Ego resilience 36.13 ± 4.37 37.07 ±4.31 1.679 0.094*
* P<0.05, N=Number, SD=Standard deviation

Table-4 Shows mean score and SD (Standard deviation) of the ego resilience among male and
female with school going adolescents. The mean and SD of ego resilience in male was 36.13 ±
4.37 and female was 37.07 ±4.31. Result reveals that there was no significant difference found
in ego resilience among male and female with school going adolescents (t=1.679, P<0.05).
Finding of this study showed that ego resilience was more in female as compare to male with
school going adolescents.

Table 5: The relationship between perceived social support and ego resilience with
school going adolescents.

Variables Ego Resilience MPSS

**
MPSS 166 1
** P<0.01

The table 5 shows the correlation between perceived social support and ego resilience with
school going adolescents. The Pearson correlation was calculated to see the relationship between
these variables. The findings reveal that the significant positive correlation was found between
perceived social support and ego resilience with school going adolescents (P<0.01). It means
that as perceived social support become better than ego resilience also became better.

DISCUSSION
Findings of this study show that perceived
social support and ego resilience were more
in female adolescents in comparison to male
adolescents. Some earlier studies were also
supports present findings as Sun & Stewart
(2007) reported that girls having better and
positive connections with parents, teachers
and peer relations than boys. In another study
it has found that female adolescents having
more perceived support structure received
from parents, peers and other as compared
to male adolescents (Mahaffy, 2004). It has
seen that female adolescents as compared to
male adolescents are more oriented toward
peers for social support and they are also
more satisfied with the support gained from
their peers (Colarossi, 2001). Dumont and
Provost(1999) found out in their study that
female adolescents are generally having
better social networks and are more open in
socializing with their peers. In another study
it has found that girls more cope with daily
stressors by seeking s ocial support and
utilising social resources compared to male
adolescents (Frydenberg & Lewis, 1993).It
has seen that girls evaluated a higher amount
of perceived interpersonal stress and getting
social support more than boys (Hampel &
Petermann, 2005).
Finding of this study showed that there was
no s i gn i fi ca nt di f fe ren ce fo und i n e go
resilience but ego resilience was more in

Indian Journal of Health Social Work. 1(2) July-December, 2019 39

 Perceived Social Support and Ego Resilience in School Going Adolescents: a gender based study
female as compare to male with school going
adolescents. The result of this study regarding
gender di fferences i n ego res i l i ence i s
incons is tent wi th those of other earli er
studies. Hampel & Petermann (2005) found
that girls have been using resilience factors
such as seeking and getting support more
than boys. In another study it has found that
the resilience subscales on empathy and help-
seeking decrease with girls students having
higher scores than boys (Sun & Stewart,
2007).It has seen that higher scores in girls
than boys in communication, empathy, help-
seeking and goals and aspiration which are
related to social relations and social skills
development are consistent (Broderick &
Korteland, 2002).
The finding reveals that the significant positive
correlation was found between perceived
social support and ego resilience with school
going adolescents. It means that as perceived
s oc i a l s u pp or t be co me b et te r th e eg o
resilience also became better. Some earlier
studies also support this such as Achour and
Nor (2014) conducted a study and found that
th ere ex i s ts a p os i t i ve an d s i gni fi ca nt
correlation between resilience and social
support. In another study it has found that
resilience model is emphasized promotive
factors (assets and resources), with social
support as a main resource contributing to
resilience. Social support was found to be
s i gni fi cantl y p os i ti vel y as s oci ated wi th
resilience (Fergus and Zimmerman’s, 2005).It
has seen that social support as a buffer against
the negative effects of stressful events, it is
reasonable, then, that social support would
be integral to and positively associated with
resilience (Lazarus & Folkman, 1984).
CONCLUSION AND RECOMMENDATIONS
Individuals with high resiliency have personal
qualities such as an internal locus of control,
e m p a t h y, co nst ructi ve s e l f- i m a g e ,
hopefulness, an ability to consolidate daily
Indian Journal of Health Social Work. 1(2) July-December, 2019
responsibilities, and the ability to adjust
effectively by reacting flexibly to varying
situational needs. The concept of resilience
ha s a st rong i mpo rta nce during t he
adolescence stage with its ever changing
emotional states and responses. Resilience
assists healthy, well-adjusted individuals to
cope better with everyday hassles, preparing
them for future challenges, and possible
adversity. Ego resilient individuals would
experience lower levels of perceived stress
and would use more effective coping strategies
to handle such stress. This study is based on
cross-sectional research design to assess and
co mpa re a gender di fference amo ng
perceived social support and ego resilience
in school going adolescents Findings of this
study indicate that perceived social support
and ego resilience were more in female
adolescents in co mpari son to male
ad ol es ce nt s . T he re w as n o s i gn i f i c an t
difference found in ego resilience among male
and female with school going adolescents. The
perceived social support and ego resilience
were found positive correlation with school
going adolescents. It means that if perceived
s oc i a l s u pp or t be co me b et te r th e eg o
resilience also became better simultaneously.
It is needed that adolescent’s resilience could
be promoted through giving continuous
encouragement, enhancement of their self-
es te em and s el f-con fi dence as wel l as
promoting their independence.
REFERENCES
Achour, M., & Nor, M. R. M. (2014). The effects
of social support and resilience on life
s ati s facti on of s econdary s chool
students. Journal of Academic and
Applied Studies , 4(1), 12-20.
Andersen, S. L ., & Te i c h e r, M. H.
(2008).Stress, sensitive periods and
maturational events in adolescent
depression.Trends in Neurosci-ences,
31, 183-191.
40
 Perceived Social Support and Ego Resilience in School Going Adolescents: a gender based study
Arend, R., Gove, F. L., &Sroufe, L. A. (1979).
Continuity of individual adaptation
from i nfan cy to ki nder garten : A
predictive study of ego-resiliency and
c ur i o s i t y i n pr e s ch o o l e r s . C hi l d
Development, 950-959.
Block, J., &Kremen, A. M. (1996). IQ and ego-
resiliency: conceptual and empirical
co nnecti ons a nd separa tenes s.
Journal of personality and social
psychology, 70(2), 349.
Block, J. H., & Block, J. (2006).Venturing a 30-
year longitudinal s tudy. American
Psychologist, 61 , 315-327.
Block, J.H., & Block, J. (1980). The role of ego-
control and ego-res il iency in the
organi zation of behavior. I n W.A.
Collins (Ed.), Minnesota symposia on
child psychology , 13, 39–101.
Broderick, P. C., &Korteland, C. (2002). Coping
style and depres sion i n early
adolescence: Relationships to gender,
gender role, and implicit beliefs. Sex
Roles , 46 (7-8), 201-213.
Central bureau of Health Intelligence (2012,
June 18). National Health Profile 2011.
P r a b h a t P u b l i c i t y, N e w D e l h i .
Retri eved from ht tp: //
www.cbhidghs.nic.in
Cohen, S., & Wills, T. A. (1985).Stress, social
support, a nd the bufferi ng
hypothesi s. Psychological bulletin ,
98 (2), 310.
Colarossi, L. G. (2001). Adolescent gender
di fferences in s oci al support:
Structure, function, and provider type.
Social Work Research , 25 (4), 233-
241.
Cramer, P., & Block, J. (1998). Preschool
antecedents of defense mechanism
use in young adults: A longitudinal
study. Journal of Personality and
Social Psychology, 74(1), 159.
Du mont , M ., & Pr ovos t, M. A . ( 1999 ).
Resilience in adolescents: Protective
Indian Journal of Health Social Work. 1(2) July-December, 2019
ro le of social s upport , copi ng
strategies, self-esteem, and social
activities on experience of stress and
depress ion. Journal of youth and
adolescence , 28 (3), 343-363.
Eisenberg, N., Spinrad, T. L., Fabes, R. A.,
Reiser, M., Cumberland, A., Shepard,
S. A., & Murphy B . (2004) . T he
rel ations of effortful control and
impulsivity to children’s resiliency and
adjustment. Child Development , 75,
25–46.
E s k i s u, M. ( 2009) . I nv es ti g ati on of the
relationship between the bullying
grade, family functions and perceived
social support among high school
students.(Master’s Thesis, University
of I s tanb ul U ni vers i ty, I s tanbul ,
Tur k ey ). Ret r i e ve d f r om ht tp s :/ /
tez.yok.gov.tr.
Eker, D., Arkar, H., &Yaldýz, H. (2001).Factorial
structure, validity, and reliability of
revised form of the multidimensional
scale of perceived s oci al
support.Turkish Journal of Psychiatry,
12 (1), 17-25.
Fergus, S., & Zimmerman, M. A. (2005).
Adolescent resilience: A framework
fo r underst anding healt hy
development in the face of risk. Annu.
Rev. Public Health , 26, 399-419.
Frydenberg, E., & Lewis, R. (1993). Boys play
sport and girls turn to others: Age,
gender and ethnicity as determinants
of coping. Journal of adolescence ,
16 (3), 253.
Gjerde, P. F., Block, J., & Block, J. H. (1988).
Depressive symptoms and personality
duri ng late adol escence: Gender
differences in the externalization-
internalization of symptom expression.
J ournal of Abnormal Psychology ,
97 (4), 475.
Hampel, P., &Petermann, F. (2005).Age and
gender effects on coping in children
41
 Perceived Social Support and Ego Resilience in School Going Adolescents: a gender based study
and adolescents. Journal of youth and
adolescence , 34 (2), 73-83.
Lazarus, R. S., & Folkman, S. (1984). Stress,
appraisal, and coping. New York:
Springer.
Luthar, S. S. (1991). Vul nera bi l i ty and
r es i l i e nc e : A s t u dy of hi g h- r i s k
adolescents. Child Development , 62,
600–616.
Mahaffy, K. A. (2004). Girls’ Low Self-Esteem:
Ho w Is It Rel ated to Later
socioeconomic Achievements?.Gender
and Society, 18 (3), 309-327.
Moksnes, U. K., Byrne, D. G., Mazanov, J.,
&Espnes, G. A. (2010). Adolescent
s t re s s : E v al uat i o n o f the fa ct or
structure of the Adolescent Stress
Questionnaire (ASQ-N). Scandinavian
Journal of Psychology, 51, 203-209
Planning Commission. (2001). Report of the
Sub-Group on Adolescents for the
Indian Journal of Health Social Work. 1(2) July-December, 2019
Tenth Five Year Plan (2002-2007).
Rosenfeld, L. B., Richman, J. M., & Bowen, G.
L. (2000). Social support networks
and school outcomes: The centrality
of the teacher. Child and Adolescent
Social Work Journal , 17 (3), 205-226.
Sun, J., & Stewart, D. (2007).Age and gender
effects on resilience in children and
adolescents. International Journal of
Mental Health Promotion, 9(4), 16-25.
Yeldirin, Y. (1997). Development of perceived
social support scale: A validity and
reliability study. H.U Education Faculty
Journal . 13. 81-87.
Zimet, G. D., Dahlem, N. W., Zimet, S. G., &
Fa r l e y, G. K. (1988). T he
multidimensional scale of perceived
social support. Journal of personality
assessment , 52 (1), 30-41.
Conflict of interest: None
Role of funding source: None
42
FORUM

EFFECTS OF MEDICAL LITIGATION ON SOCIETY

Neelam Prasad Yadav

Medical Social Worker cum Lecturer, Department of Community Medicine (SPM), Silchar Medical
College, Silchar, Assam
Correspondence: Neelam Prasad Yadav, e-mail: yadav.neelamprasad@gmail.com

ABS TRACT

Medico legal problems in India are gaining more and more importance. Society as whole is
always guided by certain ethic and it is so in case of health care providers as well. Medical
profession, through the ages, was believed to be the noblest one as it demands great responsibility,
trust and has a unique opportunity to serve the diseased and the downtrodden and bestow upon
them the light of health and peace. Doctor are now becoming subject of various litigations
accountable for their dearth or adequate clinical acumen, professional misconducts and medical
negligence. Patients and their relatives are now provoked by some groups of people and have
joined to form a forum to fight against medical injustice shown to them. However, adequate
communication with the patient party and a written patient’s consent form are definitely important3
to prevent such litigations. The social work professional with deep insight of knowledge about
society and its values can play vital role in the overall solution of problems. Social work
practitioners can play a vital role in analyzing the situation, improving the doctor patient
relationship.

Key words: CPA (Consumer Protection Act), MCI (Medical Council of India).

INTRODUCTION
Medical profession, through the ages, was
believed to be the noblest one as it demands
great responsibility, trust and has a unique
opportunity to serve the diseased and the
downtrodden and bestow upon them the light
of health and peace. In other “Doctor” almost
had an image next to god, the Almighty. He
was the sole “friend, philosopher and guide”.
Patients with full trust and confidence used
to give written or unwritten consent and
submit themselves to his treatment. Doctor
on the other hand with full sincerity and good
faith did the utmost for his This Godly image
of the Doctor is gradually fading into oblivion.
Nowadays people claim“ health for money”
and gradual ly mi strus t and s us picion is
suspicion is creeping into the Doctor – Patient
relationship. Doctor are now becoming subject
Indian Journal of Health Social Work. 1(2) July-December, 2019
of various litigations accountable for their
deart h o r adequa te cli nical acumen,
p ro f es s i o n al mi s co nd u ct s a n d m ed i ca l
negligence.
Gradually medicolegal problems in India are
gaining more and more importance, despite
p ov er ty, l ac k o f he a l t h e du ca ti o n an d
unsatisfactory infrastructure in most health
care set-up. In 1986, the Supreme Court of
India included the medical profession under
Consumer Protection Act (CPA), adding fuel
to the fire.
WHA T IM P A CT D O T HES E M E D ICA L
LITIGATIONS
On Our Society:
1. People have taken the medical care
services as a commodi ty i n this
43

commercialized society. They cannot
trust the doctors, and undertaken a
procedure of “Doctor Swapping” (going
from one doctor to another), taking
multiple advices before arriving to a
decision.
2. Medical services are becoming costly for
the patients because of unnecessary
ex penses i n doing troubl eso me
diagnostic procedures.
3. I n cas e of mi shap, peopl e usuall y
become emotional without analyzing it
rationally and the outlet of grief is
through aggression and anger against
the medical personnel and set-up.
4. Running to the court with every flimsy
ground and asking for compensation has
become easier for the party as it does
not involve any money. Unfortunately
some of them are provoked by other
physicians due to professional rivalry,
which is against medical ethics.
5. Patients and their relatives are now
provoked by some groups of people and
have joined to form a forum to fight
agains t medical i njus tice shown to
them.
However, adequate communication with the
patient party and a written patient’s consent
form are definitely important to prevent such
3
litigations.
On Doctors:
Medical litigations have both bad and good
effects on the practicing doctors.
Bad Effects:
1. Wi th increasi ng trend of medical
litigations, the doctors all over the world
have started looking into each patient they
treat as a potential litigant. They are
under tremendous stress and practicing
“evidence based defensive medicine”.
Even though they can assess the patient
clinically, they have started becoming
mo re dependent on ex pensi ve
Indian Journal of Health Social Work. 1(2) July-December, 2019
Effects of Medical Litigation on Society
unnecessary investigations for keeping
evidence and to save their skin thereby
increasing the cost of medical care. 4
2. New doctors are avoiding trial of labor
as it carries risk and as a result the rate
of cesarean section is greatly increased.
Forceps delivery is almost abandoned.
However, contrary to the common belief,
high cesarean section rates have not
contributed to an improved pregnancy
outcome as shown in 2005 WHO global
study.5 a higher rate of cesarean section
in this study was associated with greater
risk of maternal and newborn illness and
death. In the private practices set-up, this
change in the trend is thought as a means
of financial gain by the patient parties
resulting in suspicion against the doctors.
3. St udent s a nd junio r doct ors a re
f o rg e t ti n g t h e a r t o f ma n i pu l a ti v e
obstetri cs , which is very necess ary,
Particularly in the rural set-up. They are
very much dependent on the diagnostic
gadgets thereby los ing thei r cl inical
acumen.
4. Due to apprehension of litigation there is
suppression or forgery of documents,
keeping the public unaware of the actual
events, resulting in fallacious medical
audit. This will have a tremendous impact
on future health policies.
5. Junior doctors are now taking up less
risky field of medicine. In USA, UK and
other developed countries there has
become dearth of specialists in the clinical
fields like gynae, obstetrics, surgery,
orthopedics, anesthesiology, etc. one-
thi rd of the U ni ted St ates hos pi tal
residency positions were found to be
empty in 2005. 6 ACOG professional liability
survey revealed 62 percent American
obs tetrici ans stopped thei r practice
before 55 years and 31 percent dared to
continue beyond 45 years.
44

Good Effects:
A doctor is expected to have a “reasonable
skill” adopting the “ordinary skill” and must
practice with “ordinary care” 7
He can only be sued if it is proved that he
was negligent in his duty, and did not offer
the required medical care and the patient
suffered from actual damage for which he is
responsible.
1. Threat of litigations has improved the
awareness of the doctors in good patient
care. They now counsel their patients
properly, keep themselves update about
recent dev elo pment and mai nta in
adequate records.
2. Medical Council of India (MCI) has now
become very strict in scrutinizing the
c o m pl a i n t s l o d g ed b y t he p a t i e n t s
thoroughly. They have also set many
regulations to identify fake doctors and
also to keep doctors updated.
On Politics:
1. High cost of medical services owing to the
fear of medical litigation is putting a
t re me nd ou s b ur de n on he al th c ar e
budgets and adversely affecting the health
care system, especially in the Govt. and
semi Govt. set-up which are meant for
poor people. Hence, privatizations of Govt.
hospital for supporting the diagnostic
facilities are going on.
2. Doctors are not willing to go to the rural
hospitals without adequate infrastructure,
clinical support and adequate facilities for
transport and referral services.
3. Taking advantage of this depl orabl e
condition many insurance companies are
co ming up like mus hro oms a nd
complicating the health care set-up.
4. Many forums are s et up to help the
patients to go to the court for medical
litigation.
Indian Journal of Health Social Work. 1(2) July-December, 2019
Effects of Medical Litigation on Society
ROLE OF MEDIA
Any health hazard going up to the court, is
becoming “spice’ for the media. Medical
litigations always get extensive coverage,
irrespective of the nature of the case. Media
reporters doesn’t hesitate to humiliate the
doctor emotionally and professionally even
b ef or e an y c on cr et e ev i d e nc e th er eb y
developing a public opi nion against the
medical profession and making people more
suspicious and tarnishing the doctor – patient
relationship.
How to Minimize Medical Litigations in Future?
Doctors are human beings, so complications
may occur in spite of excellent professional
care and infrastructural support. Medical
Litigations cannot be avoided altogether but
can certainly be minimized to some extent.
As per law, doctors are only accountable for
his acts of omissions causing civil or criminal
offences.
MEDICAL LITIGATIONS IN FUTURE
1. All medical students must be taught to
keep detailed record of the patient whom
they are treating. They must know how
to communicate with the patient and their
aggrieved relatives and how to break bad
news.
2. Before every operation the patient and the
husband should sign an informed consent
written in the vernacular language.
3. Proper selection of the medical students
must be made on merit and aptitude tests
in entrance examination.
4. Media reporters must have adequate
medical knowledge and analyze the case
properly an rationally before publishing it
in the press.
5. Before the final verdict Judges should also
consider expert medical opinion.
6. Me di cal e thi cs s h oul d be a par t of
undergraduate and postgraduate medical
curriculum.
45

7. All practicing doctors must have medical
indemnity policy to protect them from
financial loss.
8. A Govt. authorized organization must be
set up for legal protection of the doctors.
CONCLUSION
In the present era of CPA “Doctor – Patient”
relation has turned into “consumer seller”
relationship. Doctors look at their patient as
a potential litigant whereas patient look at the
doctors with lot of suspicion and often
challenging their honesty. Doctors alone can
try to restore the age old health doctor -
patient relationship. People, media and the
government should jointly contribute to it.
Doctors must be transparent, honest, sincere
and sympathetic to their patients and would
not involve themselves in professional rivalry;
cultivate the values which can bring back
respect to our noble profession. The role of
So cia l Worker i s a lso carries a hi gh
importance.
Indian Journal of Health Social Work. 1(2) July-December, 2019
Effects of Medical Litigation on Society
REFERENCES
Cherv ena k, JL (20 07 ), Overvi ew of
professional liability.
Hoyote P, (1995), U ns ound practice. T he
epidemiology of medical negligence.
Ka ta ria M r i t y u n j a y, Kat ar ia
Pras hant(2003;11(SC) Journal 1,
negligence: criminal liability of the
doctor and establishment.
Mavroforu A, Koumantakis E, Michalodimitrkis
E , ( 20 0 5 ) , P h ys i c i a n s ’ l i a b i l i t y i n
obstetrics and gynecology practice.
P e ar l m an M D, ( 2 0 06 ) , Pa t i e nt s af e t y i n
obstetrics and gynecology: An agenda
for the future.
Sue Scheible,(2005),The Patriot Ledger.
Villar J, Vallarades E, Wojdyla, Zavaleta N,
Carro li G, Ve l a z c o A, et
al,(2006),Cesarean delivery rates and
pregnancy outcomes: the 2005 WHO
globa l survey o n materna l and
perinatal health in Latin America.
Conflict of interest: None
Role of funding source: None
46
CASE REPORTS

EARLY ONSET OF SCHIZOPHRENIA: A CASE STUDY OF HIGH

GENETIC LOADING IN THE FAMILY OF ORIGIN AND PROCREATION

Neinunnem Grace Khaute 1, Virupaksha Kiccha 2, Gobinda Majhi 3

1
State Project Coordinator, NIMHANS- UNDP, Department of Psychiatric Social Work, National
Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru-29, Karnataka, India, 2PhD
Scholar, Department of Psychiatric Social Work, National Institute of Mental Health and
Neurosciences (NIMHANS), Bengaluru-29, Karnataka, India, 3Associate Professor, Department of
Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS),
Bengaluru-29, Karnataka, India
Correspondence: Gobinda Majhi, e-mail: majhi.gobinda10@gmail.com

ABS TRACT
Family plays a very important role in the promotion of one’s mental wellbeing. Often times, it is
found that individual with a high family psychopathology are more at risk of developing mental
illness Early exposure to a disturbed environment during childhood can have a psychological
impact in the individual which further can also affect the marital life. This is a typical case of the
impact of high genetic loading in the family of origin which was further carried to the family of
procreation.

Key words: family of origin, family of procreation, genetic loading.

INTRODUCTION Case report:

Early onset of schizophrenia can have a
persistent adverse effect on an individual’s
physical and mental health wellbeing. It is also
believed to be associated with decreased
functionality due to multiple relapses and
hospitalization which hampers one to function
fully especially when it comes to establishing
the family of procreation. It is found that
multiple relapses often occur after marriage.
Studies have shown that the success rates of
ma rri age a re lower in pat ients wi th
s ch i z op hr en i a . Se ve ra l fa ct or s i n cl ud e
multi ple rel aps es due to marital stres s,
marriage acting as both the risk and maintain
factor of the illness, sexual dissatisfaction,
stigma and misconception etc. (Srivastava,
2013). This case is about a patient with an
early onset of schizophrenia with a high
genetic loading in the family of origin.
Mrs. Y is a 22-year-old married female, born
in a Hindu family, studied upto 8 th standard,
belonging to a lower socio- economic status
hailing from Anekal, Bangalore. Patient was
diagnosed of schizophrenia since the past 15
years with insidious in onset and continuous
with episodic exacerbation in course along
with a history of multiple seizures in the past,
history of attempted suicide in mother, marital
discord in parents and patient herself, history
of mental retardation in brother with history
of cannabis used in father and poor social
support both primary and secondary, poor
knowledge regarding the illness of the patient
from the family of origin and procreation
Patient had an arranged marriage on 2016.
The families of procreation were not informed
about her illness. Few days later after her
wedding, she was abused by her husband and

Indian Journal of Health Social Work. 1(2) July-December, 2019 47

 Early onset of schizophrenia: A case study of high genetic loading in the family of origin and procreation

in-laws both verbally and physically due to her
decreased functionality coupled with dowry
related issue. Patient was reported to have
multiple burnt marks and injuries where the
patient’s mother lodged a complaint against
the in-laws at Sarjapura’s Police Station.
However, a settlement was done between the
two parties after several negotiations. As part
of the negotiation patient’s family were given
some amount of money as compensation.
From the time patient got married, she was
off medication where her symptoms relapsed
following the incident and was brought to
Short Stay Ward on compl aints of
unresponsiveness and was advised inpatient
care. Since then, patient was taken to her
mother’s place. Subsequent to that patient
was again brought to NIMHANS on complaints
of multiple body pains, muttering and laughing
to self, expressing sadness and crying spells,
expressing death wishes, withdrawn behavior,
disturbed sleep, appetite and self -care.
Reasons for referral:
The case was referred to the psychiatric social
work team for Psychosocial assessment and
Intervention.

Diagrammatic Representation of Psychosocial Analysis and Diagnosis

Factors involved in patient’s current condition

4

4
4

Risk factors Maintaining Factors

Individual factors: Individual factors:

Inadequate financial and emotional
support from husband and in-
laws, poor compliance, inadequate
secondary social support, poor
insight and long duration of illness.
Family factors:
Poor knowledge about mental
illness in the family and lack of
supervision of medication
Environmental factors:
Stigma and misconception
Long duration of illness, poor
coping skills, poor compliance,
poor social support, poor insight
and financial problems
Illness of
4 patient Familial factors:
Criticality and hostility from family
of origin, husband and in-laws’
family
Environmental factors:
Stigma and Misconception

PSYCHOSOCIAL INTERVENTION BY SOCIAL ♦ To help engage in regular follow-up

WORK TEAM to maintain medication adherence.
Objectives of Intervention ♦ To reduce stigma and misconception
♦ To improve the level of insight towards ♦ To reduce expressed emotion
illness The intervention was provided at two
♦ To en han ce drug an d t rea tme nt levels, one at the individual level and the other
compliance at the family level.
Indian Journal of Health Social Work. 1(2) July-December, 2019 48
 Early onset of schizophrenia: A case study of high genetic loading in the family of origin and procreation
Psychoeducation:
A therapeutic relationship was established and
psychoeducation was provided as part of the
intervention. The sessions were focused on
providing information about the nature of the
illness, its relation with stressors in the
pa ti e nt’ s l i f e a nd her wa ys of co pi n g,
identifying early signs of relapse and the
fa cto rs as socia ted wi th, t he st res s-
vulnerability model and the steps patient can
take to maintain her mental health, like
engaging in meaningful activities and regular
follow up for treatment.
Addressing expressed emotion:
Five minutes speech sample was taken from
the mother. Patient’s mother was found to be
critical towards patient. It was found that
mother would displace her anger towards the
patient by scolding and shouting at her. The
mother was made to understand the negative
impact which could have on the patient due
to high expressed emotions.
Addressing stigma and misconception:
Family members of a patient with mental
i l l ne s s u s u al l y f ac e d s t i g ma a nd h av e
misconception about mental illness. As a
result, parents tend to blame themselves for
their children’s illness or either becomes
critical and hostile to them. Often patients are
taken for medico- religious practices where
family members spend an enormous amount
of money but to no avail. In other cases, the
patients are secluded from the society. Family
members often believe that mental illness is
due to some magic or a punishment from god.
Such misconceptions were cleared.
Arranging for free medication:
A request letter for free medication was given
to the Resident Medical Officer which as
approved. Patient was provided with free
medication after the approval.
Indian Journal of Health Social Work. 1(2) July-December, 2019
Pre discharge counseling:
Pre-discharge counseling was given to the
patient and mother. The importance of regular
medication, practicing a healthy lifestyle and
engaging in small household chores so as to
maintain the functionality of the patient were
discussed. Importance of regular follow- ups
and monitoring of medication was discussed
which was conducted over two sessions.
OUTCOME
♦ Insight facilitation was provided.
♦ Family member developed knowledge
regarding mental illness.
♦ Expressed emotion was reduced to some
extend from the mother
♦ Welfare benefits were received.
DISCUSSION
Ms. Y is a 22-year-old married woman, born
from a non- cons angui neous marri age,
s t u d i e d u p t o t h e 8 th s t d . S h e w a s
temperamentally, a slow to warmth child, with
a family history of marital discord in the
parents where father deserted the family 20
years ago leaving the family with no economic
support. The personal history of the patient
revealed early onset of illness, with many
breakthrough episodes and multiple relapses
secondary to poor drug compliance due to
poor insi ght, inadequate supervi si on of
medication and inadequate social support.
The family history showed marital discord in
parents and patient herself with substance
use in the father and mental retardation in
brother along with expressed emotions in the
form of criticality and hostility from the family
procreation and partly from the family of
origin. The patient has an illness of more than
15 years. In a study by (Matheson et al., 2017)
showed the childhood maltreatment and
history of parental schizophrenia spectrum
disorders were associated with the early onset
of schizophrenia. Some studies have shown
that childhood trauma may be associated with
49
 Early onset of schizophrenia: A case study of high genetic loading in the family of origin and procreation
one’s mental health and wellbeing. Childhood
trauma maybe in the forms of bullyi ng,
victimization, parental loss and separation,
abuse, negligence in terms of physical and
emotional negligence (Norman et al., 2012;
Vares e et al ., 2012). I n thi s cas e, the
psychosocial analysis revealed multiple risk
and maintaining factors to the patient’s illness.
The patient has many breakthrough episodes
and multiple relapses secondary to poor drug
compliance due to poor insight, inadequate
supervision of medication and inadequate
social support. A study conducted in Pakistan
showed that the prime factors concomitant to
mul ti pl e rel ap s es were treatment non-
adherence due to poor insight fear of the
patient, poor socio- economic status of the
patient and possible side effects (Ahmad et
al., 2017). It is a known fact that non-
adherence is commonly seen among patients
with schizophrenia mostly due significant
psychopathology, stigma related issues and
various cultural factors. Non- adherence
among pati ents wi th mental i ll ness has
become a serious probl em as there are
m u l t i p l e r e l a p s e s l e a d i n g to f r e q u e n t
hospitalization due to the exacerbation of
symptoms and declined in their functionality
(Phan, 2016).
Family plays a very important role in the
prevention of relapses of individuals with
schizophrenia. Significant expressed emotion
in the form of criticality, hostility and over
involvement leads to multiple relapses and
hospitalization compared to families with less
express emotion. Addressing the expressed
emotions of the family at all levels have been
wi del y used a s part of ps ychos oci al
intervention (Pharoah et al., 2010). Patient’s
mother was psycho-educated about the illness
of the patient which focused on imparting
s t at eme nt o f d i a gno s i s , ea rl y w ar ni ng
symptoms, importance of medication and
continued treatment and relapse prevention.
It was also on reducing critical comments
Indian Journal of Health Social Work. 1(2) July-December, 2019
towards the patient and an appropriate way
of communicating with the patient, without
being indifferent, but at the same time,
fostering the patient’s independence. High
expressed emotions and how genetic loading
can be a causal factor for schizophrenia as
wel l as mu l ti pl e rel ap s es we re fur ther
addressed. There have been recent studies
on the direct and indirect effects of offspring
of couples with mental health problems. It is
said that intrauterine environment, antenatal
and postnatal exposure to depression have a
high risk on the offspring. Some of the
indirect impacts found were poor economic
condition, marital discord in parents along
with dysfunctional pattern of communication
in the family and various other psychosocial
stressors during childhood (Alvus et al., 1994;
Tsuang, 2000; Manning et al., 2006). Various
studies have shown that the factors of
multiple relapses include substance abuse,
forgetfulness, anxiety about si de effect,
inadequate knowledge, lack of insight, lack of
motivation fear of stigma, poor patient health
care provider relationship, poor services and
access to services and low economic
conditions (Lacro et al., 2002; Fenton et al.,
1997). Stressful life events such as depression
were al s o found to be as s oci ated wi th
relapses (Siris, 2000). Adherence to treatment
was also found to be poor in case of poor
insight and discontinuation of medication
prematurely (Hunter et al., 1994). In India,
there has always been a misconception that
marriage would solve almost all problems
even mental disorders (Behere et al., 2011).
As a result, the prevalence of marriage of
individuals with mental disorders before the
marriage is quite common in India. However,
various studies have found that patients with
schiz ophrenia develop more stress after
marriage and reports of higher undesirable
events post marriage. Around the globe,
violence against women has become a major
health concern both in the society and family
50
 Early onset of schizophrenia: A case study of high genetic loading in the family of origin and procreation
which includes wo men with chronic
schizophrenia. Studies have found that women
with severe mental illness are 2- 8 times more
likely to be victims of sexual and domestic
violence compared to the general population
( K h a l i f e h e t a l ., 2 0 1 5 ) . Wo m e n w i t h
schizophrenia are more at risk of intimate
partner violence that are more in the form
verbal and physical assault associated with
psychopathology (Afe et al., 2016). Higher
marital discords and abuses have also been
found among patients with mental illness
(Dominian, 1979: Das et al., 1997).
IMPLICATIONS AND FUTURE DIRECTIONS
This case shows that the early exposure to
childhood trauma can highly have an impact
in an individual’s mental health problems such
as depression, anxiety and stress with early
psychosis. Literatures have also shown that
childhood trauma is commonly associated with
an ea rl y on s et of ex h i bi ti n g p s yc hot i c
symptoms (Ramsay et al., 2011; Wang et al.,
2011; Bendal et al., 2013). Bearing this in
mind, it is important to address the early
psychosis treatment program for patients who
have experienced childhood trauma. However,
at times most treating teams are reluctant to
enquire about such cases on fear of rupture
of rapport between the patient and the
treating team. Understanding the patient’s
childhood trauma as well as the trauma which
the patient faced later in life needs to be taken
into account for an effective intervention.
Further, psychiatric social work intervention
re qui res a det ai l ed as s es s men t o f t he
psychosocia l issues prevai ling at the
individual, familial and community level.
Understanding the underlying problems of
such issues will help in framing and providing
a better intervention plan.
REFERENCES
Afe, T. O., Emedoh, T. C., Ogunsemi, O., &
Adegbohun, A. A. (2016). Intimate
Indian Journal of Health Social Work. 1(2) July-December, 2019
partner violence, psychopathology and
the women with schizophrenia in an
outpa tient cli ni c Sout h-Sout h,
Nigeria. BMC psychiatry, 16 (1), 197.
Ahmad, I., Khalily, M. T., & Hallahan, B. (2017).
Reasons associated with treatment
non-adherence in schizophrenia in a
Paki stan cohort. Asian journal of
psychiatry, 30, 39-43.
A l b u s , M ., S c h e r e r, J ., H u e b e r, S .,
Lechleuthner, T., Kraus, G., Zausinger,
S., & Burkes, S. (1994). The impact
of fa mil ia l l oading on gender
di fferences in a ge at ons et of
s c hi z oph ren i a. Ac ta P syc hi at ri ca
Scandinavica , 89 (2), 132-134.
Behere, P. B., Rao, S. T., & Verma, K. (2011).
Effect of marriage on pre-existing
ps ycho ses. Indi an jo urna l of
psychiatry, 53(4), 287.
Bendall, S., Hulbert, C. A., Alvarez-Jimenez,
M., Al l ott, K ., M cGorry, P. D., &
Jackson, H. J. (2013). Testing a model
of the relationship between childhood
sexual abuse and psychosis in a first-
episode psychosis group: the role of
ha llucinat ions a nd del us ions,
posttraumatic intrusions, and selective
attention. The Journal of nervous and
mental disease , 201 (11), 941-947.
Das, M. K., Kulhara, P. L., & Verma, S. K.
(1997). Life events preceding relapse
of s ch i z op hr en i a . I n te rn at io na l
Journal of Social Psychiatry , 43 (1),
56-63.
Dominian, J. (1979). Marriage and psychiatric
il lnes s. British medical journal , 2
(6194), 854.
Fenton, W. S., Blyler, C. R., & Heinssen, R. K.
(1997). Determinants of medication
compliance in schizophrenia: empirical
and clinical findings. Schizophrenia
bulletin , 23 (4), 637-651.
Hunter, E. P., & Storat, B. (1994). Psychosocial
triggers of relapse in persons with
51
 Early onset of schizophrenia: A case study of high genetic loading in the family of origin and procreation

chronic menta l i ll nes s: A pil ot schizophrenia. Cochrane database of

s t u d y. I s s u e s i n m e n t a l h e a l t h systematic reviews , (12).
nursing , 15 (1), 67-72. Rams ay, C. E., Flanagan, P., Gantt, S.,
Khalifeh, H., Moran, P., Borschmann, R., Dean, Brouss ard, B., & Compton, M. T.
K., Hart, C., Hogg, J., ... & Howard, L. (2011). Cli nical co rrelat es of
M. (2015). Domes ti c and s ex ual ma ltrea tment and traumatic
violence against patients with severe ex periences i n chi ldhoo d a nd
menta l ill nes s. Ps ycholo gical adolescence among predominantly
medicine , 45 (4), 875-886. African Ameri can, socially
Lacro, J .P., Dunn, L. B., Dolder, C. R., disadvantaged, hospitalized, first-
Leckband, S. G., & Jeste, D. V. (2002). episode psychosis patients. Psychiatry
Prevalence of and risk factors for research , 188(3), 343-349.
medication non adherence in patients Si ris , S. G. (2000). De pre ssi on in
with schizophrenia: a comprehensive schizophrenia: perspective in the era
review of recent literature. J Clin of “atypical ” a nt ips ychot ic
Psychiatry, 63(10), 892- 909. agent s. America n J ourna l of
Manning, C., & Gregoire, A. (2006). Effects Psychiatry, 157(9), 1379-1389.
of pa renta l ment al ill ness on Sri vastav a, A. (2013). Marriage as a
children. Psychiatry , 5 (1), 10-12. perceived panacea to mental illness
Matheson, S. L., Kariuki, M., Green, M. J., in India: Reality check. Indian journal
Dean, K., Harris, F., Tzoumakis, S., ... of psychiatry, 55 (Suppl 2), S239.
& C ar r, V. J . (2 01 7) . E ff ec ts o f Tsuang, M. (2000). Schizophrenia: genes and
maltreatment a nd parent al environment. Biological
schizophrenia spectrum disorders on psychiatry, 47(3), 210-220.
earl y chi l dhood s oci al -emoti onal Varese, F., Smeets, F., Drukker, M., Lieverse,
functi oni ng: a popul ati on record R., Lataster, T., Viechtbauer, W., ... &
l i nkage s tudy. Epidemio logy and B ental l , R. P. (2012). Chi l dhood
psychiatric sciences , 26(6), 612-623. a dv er s i t i es i n cr ea s e th e r i s k o f
Norman, R. E., Byambaa, M., De, R., Butchart, psychosis: a meta-analysis of patient-
A., Scott, J., & Vos, T. (2012). The c o n t ro l , p r o s p ec t i v e - a n d c r o s s -
long-term health consequences of sectional co ho rt
child physical abuse, emotional abuse, studies. Schizophrenia bulletin, 38(4),
and neglect: a systematic review and 661-671.
meta-analysis. PLoS medicine, 9 (11), Wang, Z., Xue, Z., Pu, W., Yang, B., Li, L., Yi,
e1001349. W., ... & Rosenheck, R. A. (2013).
Phan, S. V. (2016). Medication adherence in Compari s on of fi rs t epi s ode and
pati ents wi th schi z ophreni a. T he chr oni c pati e nts d i agno s ed w i th
International Journal of Psychiatry in schi zophreni a: symptoms a nd
Medicine, 51(2), 211-219. childhood trauma. Early intervention in
Pharoah, F., Mari, J. J., Rathbone, J., & Wong, psychiatry , 7(1), 23-30.
W. (2010). Family intervention for Conflict of interest: None
Role of funding source: None

Indian Journal of Health Social Work. 1(2) July-December, 2019 52

 A CLINICAL CASE STUDY OF INDIVIDUAL WITH OBSESSIVE
COMPULSIVE DISORDER (OCD)

Prashant Srivastava 1, Kavya Ahu 2, Vani Narula 3

1
Psychiatric Social Worker, Dept. of Psychiatry, Kalpana Chawla Government Medical College and
Hospital, Karnal, Haryana, 2M.Sc Clinical Psychology, Amity University, Gurugram, Haryana.
3
Associate Professor, Dept. of Social Work, Jamia Millia Islamia, New Delhi.
Correspondence: Kavya Ahu, e mail: lifelikekavyaahuja92@gmail.com

ABS TRACT

Background: Obsessive Compulsive Disorder (OCD) is a severe and debilitating anxiety disorder
with a lifetime prevalence of 0.6% in Indian population. It is twice as prevalent as schizophrenia
and bipolar disorder, and the fourth most common psychiatric disorder. Aim: The present study
aims to explore the course of obsessive compulsive disorder and to assess the effectiveness of
obsessive compulsive disorder management in alleviating the symptoms associated with obsessive
compulsive disorder and to improve the client’s overall functioning. Research design: Case
study. Sample and method: This study was carried out in Karnal at KCGMC and 36 years old
married male was included. The treatment plan was formulated according to psychotherapeutic
management in which different techniques were utilized to improve the client’s associated
compulsive behavior and his beliefs. Results: Findings of the assessment showed a significant
change in overall functioning. Psychosocial management techniques successfully changed his
beliefs, anxiety and remarkably improved his overall functioning. Conclusion: On the basis of
the results shown in the report it can be determined that psychotherapeutic management is an
effective approach to treat obsessive compulsive disorder.

Keywords: Psychotherapeutic, belief, case study

INTRODUCTION
Obsessive Compulsive Disorder (OCD) is an
impai ring anxiety dis order portrayed by
di squieting, undes ira bl e perceptio ns
(obsession) serious and tedious repetitive
co mpulsi on. (American Psy chi atric
association, 2000) OCD is characterized by
means of obsessive thoughts, impulses, or
images and compulsions which might be tough
to suppress and take a large amount of time
and energy far away from residing your life,
taking part in your own family and friends or
maybe doing your activity or any work. The
average age of onset is 19 years antique.
Sometimes the circumstance manifests itself
tempo raril y a nd in some cas es it is
conventional for an entire life. OCD may be
Indian Journal of Health Social Work. 1(2) July-December, 2019
extraordinarily burdensome to the victim,
regularly impacting the everyday life of now
not handiest the man or woman with OCD but
their households as nicely. Most individuals
with OCD understand that their obsessions are
not just immoderate issues approximately real
problems and that the compulsions they
perform are immoderate or unreasonable.
The quantity to which a person with OCD
realizes that his or her ideals and actions are
unreasonable is known as his or her “insight.”
OCD includes issues in conversation among
elements of the brain. These troubles can be
because of insufficient ranges of sure mind
chemi cal s ubs tances , k no wn as
neurotransmitters. Drugs that increase the
53
 A Clinical Case Study of Individual wi th Obsessive Compulsive D isorder (OCD)
mind awareness of those chemical substances
often assist enhance OCD symptoms. Cormier
and N urius (2 00 3) cla ri fied t ha t t he
insignificant demonstration of watching and
checking one’s very own conducted and
encounters can create changes. As individuals
watch themselves and gather information
about what they watch, their conduct might
be impacted. Rao, Sudarshan, Pai (2005)
conclude that antipsychotics have a restricted
role in OCD and are best constrained to the
circumstances.
Although a causal role of a sense of guilt in
the genesis and maintenance of obsessive
compulsive disorder (OCD) has not been fully
demo ns trate d, many publ i c ati ons have
identified investment in protection from guilt
or one of its elements as a central factor in
the disorder. Even in the initial 17th century
descriptions of the disorder, OCD was related
to marked scrupulousness and excessive
preo ccupati on (Mancini, 2005). Many
descriptions of the role of an exaggerated
sense of responsibility have been reported in
the development and maintenance of OCD
(Sa l kov s ki s , 19 85; 2002 ; Sa l kov s ki s &
Forrester, 2002; Rachman, 1993; 1997, 2002;
Ladouceur et al., 1995).
A CASE REPORT
Mr. S, 36 years old Male, Muslim, Married,
Less than matric, 6k- 9k per month, was
brought to the department of psychiatry,
outpatient department of Kalpana Chawla Gov.
Medical College and Hospital, Karnal, Haryana
came along with his wife with the chief
complaints of repetitive counting, follow the
same routine, repetitive arranging things,
worry s ome thoughts , l oss of i nteres t,
irritability, low mood.
According to patient till august 2014, he was
functioning well. In September 2014, when
he was working in his shop someone told him
that eating things 3 time is not good pick one
more from that day this thing fix in his mind ,
Indian Journal of Health Social Work. 1(2) July-December, 2019
on the same day he forget his diary in his
shop there is no specific thing or important
thing in that according to patient but because
of that he can’t able to sleep he even asked
his father to go to shop and take that diary
he get anxious in the night and in the morning
when he got the diary he feel relaxed. Patient
said” meri bechani tab se badh gayi hai”. He
reported some incidence he said if he switch
on the light he only switch off that, if he came
from the lift then he came back to the lift only
not from the stairs mentioned by her wife.
Patient said “agar kisi ko kuch hota hai to
mujhe lagta hai mujhe bhi vo ho jayega.”
Patient went to the PGIMS, Rohtak for the
treatment on September 20, 2014. Here, the
patient was diagnosed with OCD and he was
on the medication. On feb 8 2017, he came to
KCGMC for the treatment same medicine were
continue with the major chief complaints of
suspicious ness, disturbance in sleep,
repetitive arranging things, do things four
time, anxious. At present, he is also suffering
from high blood pressure issues and also
tensed about having a girl child fourth time.
The patient has been taking medication from
various places but is not serious due to which
the illness has been deteriorating since many
years. IQ assessment was done and IQ came
out to be 90 which mean average level of
intellectual functioning at present. The
patients stay in a nuclear family and first
among five siblings. There is no family history
of psychiatric illness and major medical
illness. According to his personal history the
pati ent completed his s tudies upto IInd
standard and he is an average student.
Presently, he is a tailor and the patient
interaction with his family is limited due to
his compulsive activities. On mental state
ex aminati on (MSE ), the pati ent i s wel l
g r o o m e d a n d d r e s s e d p r o p e r l y. H i s
psychomotor activity is normal. He makes eye
contact, and rapport is easily established. He
has no tics and cooperative. The patient’s
54
 A Clinical Case Study of Individual wi th Obsessive Compulsive D isorder (OCD)
s p e e c h i s s p o n t a ne o u s a n d c o h e r e n t .
Subjectively, the patient says he is okay and
objectively he appears anxious. The patient
has no hallucination, delusion and illusions.
The patient could not able to perform digit
forward and backward for attention and
con cent rati on. Henc e i t app ears to be
inadequate. The patient is well oriented to
time, place and person. The patient remote,
recent and immediate memories were intact.
Abstract thinking found to be inadequate. The
patient judgement is intact. The patient level
of insight is Grade-III.
REASONS FOR TAKING AN INTERVENTION
To reduce the anxiety and thoughts that
coming in his mind to perform compulsive
activities, enhance the quality of life, poor
coping skills, to reduce distress. Also provide
awareness regarding the manifestation of
OCD and to reduce his illness from stagnation.
Specific areas to be focused
Short-term objectives
♦ Establish a firm therapeutic alliance with
the patient.
♦ E d u c a t e t h e p a t i e n t r e g ar d i n g t h e
manifestations of the disorder.
♦ To reduce the severity of the symptoms.
♦ To manage any other ps ychi atri c or
medical emergencies.
♦ Maintain regular, consistent contact with
the client for his recovery.
♦ Long- term objectives
♦ To motivate the client towards recovery
rather than eliminating the symptoms and
trying to cope up with symptoms too.
♦ To engage the client in various activities
for improvement in daily basis working.
♦ Maintain or improve patient’s level of
function and quality of life.
TYPES AND TECHNIQUES OF INTERVENTION
Psycho education:
The patient and his family members were
Indian Journal of Health Social Work. 1(2) July-December, 2019
offered psych educated to make the patient
and his family well aware about the nature of
the illness, course, treatment, and prognosis
and to clear any misconceptions about the
illness. This was done so that the patient is
in a better position to deal with the illness as
he had no hope for any improvement with his
illness. Proper guidance for medication and
to be prompt was also directed to the patient
and his family members so that they take
proper care as well.
Jacobs on’s progressive mus cular
relaxation(JPMR):
JPMR is generally used to manage and reduce
anxiety and automatic arousal. The major
steps associated with it are learning to identify
excessive tension in specific muscles and
learning to unwind and if conceivable, wipe
out that strain. This procedure is rehashed
with different muscle gatherings of the body.
Supportive psychotherapy:
Supportive psychotherapy was ai med at
validating the distress the client is undergoing.
The patient is given reassurance, support, and
his ability to cope with distress is reinforced.
Exposure Response Prevention Therapy
(ERP Therapy):
This therapy includes the individual with OCD
confronting his or her feelings of dread and
after that ceasing from ritualizing. This can
be very nervousness inciting at first, yet in
the long run the uneasiness begins to fade
and can now and then even vanish. Studies
demonstrate that introduction and reaction
counteractive action can really “retrain” the
mind, forever diminishing the event of OCD
indications (Singer,2018)
Cognitive Distraction and Restructuring
technique:
By using various distraction strategies such
as focusing on other work rather than thinking
55
 A Clinical Case Study of Individual wi th Obsessive Compulsive D isorder (OCD)
o n s a me t h ou gh t, i n vo l v e i n di ff er en t
activities. And also find out illogical cognition
and to modify maladaptive cognitions and
replace with adaptive thoughts.
THERAPY PROCESS
Session-1
Rapport is build up with the patient firstly so
that he is comfortabl e wi th s hari ng his
thoughts and feelings and then psycho-
education was given to the patient reason for
expanding awareness about the illness. This
helped them in seeing how his indication
started. Firstly therapist listened him with care
and consolation and sympathy was given to
him. And he was educated about the disorder
which he thought he harboured. Supportive
psychotherapy was given to his wife as she
was very anxious and worried. Supportive
meas ures for exampl e, Cons ol ati on and
influences were utilized furthermore, were
approached to support the patient. This helps
him to develop trust and confidence. JPMR
was introduced to the patient. Therapist
clarified JPMR components and its basis. He
was educated about his illness, JPMR, and its
implications.
Session-2
Patient was reviewed. The client was told
about importance of relaxation of his problem
and also explained the rationale for the same.
Second session of JPMR was held. Before the
session the therapist illustrated to the patient
how to tense and loosen up different gathering
of muscles. He was approached to come
successi vel y for four days of relax ati on
training. After the relaxation, the client was
offered chance to ventilate his sentiments and
consolation was given to the client that the
i s s ues coul d be i l l umi nated over s ome
undefined time frame.
Session-3
Patient was seen. Third session of JPMR was
Indian Journal of Health Social Work. 1(2) July-December, 2019
conducted and als o ERP therapy was
introduced patient was given a brief about
exposure response therapy. Therapist makes
him touch the switch board once then stop
patient for doing this again three times as
resul ted patients anxiety increases then
therapist make patient relaxed by doing deep
breathing exercise. As that day patient came
from lift and were told to go from stairs. He
was told that firstly you anxiety will increases
and slightly it will decrease down.
Session-4 & 5
Fourth ses sion of JPMR was conducted.
Patient reported that he was getting some
relief from his anxiety from the relaxation
procedure. Co gniti ve di stract io n a nd
restructuring technique was done to find out
the illogical cognition he has, he was instructed
to replace with more adaptive thoughts or
engage himself in some other activities. On
the same time again he was asked to switch
on the light but don’t off that. He was getting
anxious for at least half an hour but when he
started talking with his wife and get distracted
from that situation he gets normal. Patient
was s ee n. P ati e nt s e emed to be m ore
comfortable and confident. He seems to be
very positive and told his therapist that he feel
so motivated and thinks that he will overcome
with all his problems. After the session
therapist explained about the importance of
regular practice of relaxation and advice the
client to practice it at home. For further
review, appointment was scheduled.
CONCLUSION AND OUTCOME
In this case study five sessions were held with
the patient. Later the patient came for follow
up and reported the therapist considerable
improvement in terms of his symptoms. He
reported that his distress, his worries, and
taking unnecessary medicines reduced and felt
confident. His mood continued to improve and
he became more comfortable and confident.
56
 A Clinical Case Study of Individual wi th Obsessive Compulsive D isorder (OCD)
His obsessive thoughts got reduced. Several
years ago, OCD was regarded as one of the
least treatable illnesses. However, in the last
three decades this picture has changed with
the development of effecti ve treatment
methods such as exposure and response
prevention therapy [ERP] and cognitive-
behav ioral thera py [CB T] as well as
antiobsession medication (Cordioli, 2008;
Cordioli & B raga, 2011; Vivan, Bicca, &
Cordioli, 2011).
REFERENCES
American Psychiatric Association (2000).
Diagnostic and Statistical Manual of
th
Menta l Disoredrs, 4 E dn.
Washington, DC: American Psychiatric
Association.
Cordioli, A. V. (2008). A terapia cognitivo-
co mpo rt amenta l no tra ns torno
obses siv o-compul siv o. Revista
Brasileira de Psiquiatria , 30( 2), 65-
72.
Cordioli, A. V., & Braga, D. T. (2011). Terapia
co gniti vo-co mpo rt amenta l do
transtorno obsessivo-compulsivo. In
B. Ra ngé, Psi coterapi as
co gni ti vocomportament ai s: Um
diálogo com a psiquiatria, 325-343.
Porto Alegre: Artmed
Cormier, L. S., Nurius, P., & Cormier, L. S.
(2003). Interviewi ng and change
strategies for helpers: Fundamental
sk ills and cognit ive beha vioral
i nterventions . Paci fi c Grove, CA:
Thomson/Brooks/Cole.
Ladouceur, R., Rhéaume, J., Freeston, M.H.,
Aublet, F., Jean, K., Lachance, S.,
Langlois, F. & De Pokomandy-Morin,
K. (1995). Experimental manipulations
of responsibility: An analogue test for
mo del s of ob s es s i v e-c ompu l s i ve
disorder. Behaviour Research and
Therapy , 35, 955-960.
Indian Journal of Health Social Work. 1(2) July-December, 2019
Ra chman, S. (1993). O bsess ions,
responsibility and guilt. Behaviour
Research and Therapy , 31, 149-154.
Rachman, S. (1997). A cognitive theory of
obsessions. Behaviour Research and
Therapy , 31, 793-802.
Rachman, S. (2002). A cognitive theory of
co mp ul s i v e ch eck i n g. Be ha vi ou r
Research and Therapy , 40, 625-640.
Rachman, S., Thordarson, D., Shafran, R., &
Wo o d y, S . R . ( 1 9 9 5 ) . Pe r c e i v e d
respo nsi bi lit y: Struct ure a nd
significance. Behaviour Research and
Therapy, 33, 779-784.
Rao K.N., Sudarshan, C.Y., & Pai, P. (2005).
Obsessive-compulsive disorder: An
i nterface with pos si bl e ps ychoti c
features. Indian journal of Psychiatry,
47, 175-8.
S a l k o v s k i s , P. M . ( 1 9 85 ) . O b s e s s i o na l -
compulsive problems: A cognitive-
be ha vi ou ra l a na l y s i s . Be ha vi ou r
Research and Therapy , 23, 571-583.
Salkovskis, P.M., & Forrester, E. (2002).
Responsibility. In R.O. Froste, & G.
Steketee (Eds), Cognitive Approaches
to O bs es s i ons and Compul si ons .
Oxford: Pergamon Press.
Singer, J. (2018). ERP Therapy-A Good Choice
for Treating Obsessive Compulsive
Disorder (OCD) An American Addiction
centers Resource. ht tps: //
psychcentral.com/lib/erp-therapy-a-
good-choice-for-treating-ocd/
Vivan, A. S., Bicca, M. G., & Cordioli, A. V.
(2011). Modelo
co gni ti vocomport ament al do
transtorno obsessivo-compulsivo. In
I. Andretta, & M. S. Oliveira (Eds.),
Manual prático de terapia cognitivo-
comportamental (pp. 373-388). São
Paulo: Casa do Psicólogo.
Conflict of interest: None
Role of funding source: None
57
 INSTRUCTION FOR AUTHORS
The “Indian Journal of Health Social Work” is a bi-
annual E-journal which will be published in the month
of January and July in every year. The Indian Journal
of Health Social Work is an official publication of All
India Association of Medical Social Work Professionals
(AIAMSWP). The journal accepts original research
work, review articles, case reports, commentary,
forum, & brief communication related to social work
practice in health care.
AIM AND SCOPE
The Indian Journal of Health Social Work is a forum
for the publication, dissemination and debate of key
ideas and researches focused to contemporary social
work practice with individuals, couples, families, groups
& community in the field of health care. It also presents
innovations in theory, practice, evidence-based clinical
& comm uni ty rese arc hes, an d i nter dis cip lina ry
approaches. The Indian Journal of Health Social Work
is committed for updating the clinical knowledge of
practitioners, educators & researchers. The journal
welcomes submissions from areas of medical &
psychiatric social work and also from the other
i nt er di s ci pl in ar y s ub je c t re la t ed t o he a lt hc ar e
fraternity.
ARTICLE TYPES
n Review Articles: In this section some good
quality information & reviews on pertinent topics
can be published.
n Or igi na l Rese arch P ap ers : Or i gin al
Quantitative as well as qualitative research
papers are published under this section.
n Commentary & Invited articles: In this
section short article can be describes an author’s
personal experience or view of a specific topic in
the different areas. Unlike a review article, the
author gives his own opinions and perspectives.
n Forum: Ideas and views on a particular issue
can be exchanged under this section.
n Case Reports: This section contains reports of
new/ interesting/ rare cases of clinical significance
in the field of health care social work practice.
n Brief Communication: Under this section data
from preliminary studies, studies done with
smaller sample size and others short important
topics are published.
n Letters to the Editor: Brief letter (maximum of
500 words. Including references, no tables &
figures) will be considered under this section.
ORGANIZATION OF MANUSCRIPTS
A. Title with author’s details
n The title of the article should be bold, centered
and type in normal size with 12 point and Times
New Roman Font.
n The author details should also be 12 point Times
New Roman Font in normal size accordingly: full
name, educational qualification designation,
postal address, pin code email and mobile number.
B. Abstract and Keywords
n Al l ma nusc ript s an d wr itte n wo rk m ust be
Indian Journal of Health Social Work. 1(2) July-December, 2019
accompanied by a brief abstract.
n Abstract including key words must not exceed 500
words.
n Author has to mention 3 to 6 keywords.
n Abstract consists background, aims & objective,
method , result, Conclusion & keywords
C. Contents of the Write up
n The manuscript should be written in English & it
should not exceed 5000 words (Five thousand).
n Manuscript or informative material typed in 12
point-Times New Roman with line spacing of 1.5
and single column on standard A4 size paper.
n All heading must be bold-faced, aligned left with
12 point-Times New Roman and sub-heading in
10 point.
n Article tittles should be informative reflecting true
sense of the manuscript and within two lines.
n Tables should be included in a separate page,
numbered with Arabic numerals and accompanied
by short tittles at the top.
n The authors should make sure that table and
figures are referred to from the main text.
n References should include a list of all articles and
b o o k s a t t h e e n d o f t h e p a p e r. A r ra n g e
alphabetically by the author’ names and date of
publication in parentheses. Author should follow
APA style for reference list using.
n Declaration of interest must be mentioned by the
author at the submission. Any financial support
should clearly be given before ‘reference’ in
manuscript.
PLAGIARISM POLICY
The journal is strictly against any unethical act of
copying or plagiarism in any form. Plagiarism is said to
have occurred when large portions of a manuscript
have been copied from existing previously published
resources. All manuscripts submitted for publication
to the Indian Journal of Health Social Work will be
cross-checked for plagiarism. Manuscripts found to
be plagiarized during any stages of review are out-
rightly rejected and not considered for publication in
the journal.
COPYRIGHT POLICY
Authors note that manuscript cannot be withdrawn at
any condition once it is accepted. The authors may
not publish his/her manuscript anywhere else without
the prior permission of the editor. The author warrants
that his/her contribution is original. The Corresponding
author accepts responsibility for publishing his/her
manuscript/material on the behalf of any and all co-
authors. Editor or Association is not responsible for
any discrepancies or any conflict of interest arising
out of manuscript.
SUBMISSION
The au th o rs can s u bmit th eir man us cr i pt s
as an att ac h men t through e-mail:
aiamswpeditor@gmail.com.
58
 INDIAN JOURNAL OF HEALTH SOCIAL WORK
An official publication of All India Association of Medical Social Work
Professionals

SUBSCRIPTION FORM

Name in Block Letters : ...............................................................................

Affiliating Institution : ...............................................................................

Designation : ...............................................................................

Address : ...............................................................................

...............................................................................

Contact Number : ...............................................................................

Email- ID : ...............................................................................

Signature

SUBSCRIPTION RATES
Sl. No. Year Individual Institutional
1. 1 Year 1200/- 2000/-
2. 2 Years 2000/- 3800/-
3. 5 Years 4000/- 6500/-

The DD should be in favour of “All India Association of Medical Social Work

Professionals” Payable at Chandigarh, India.