[Downloaded free from http://www.jfmpc.com on Saturday, March 2, 2019, IP: 77.54.155.

184]

Original Article

Psychiatric morbidity in spouses of patients with alcohol

related disorders
Aruna Dandu1, S. Bharathi2, Shankar Reddy Dudala3
1
Associate Professor, 2Senior Resident, and 3Assistant Professor, Sri Venkateswara Medical College, Tirupati, Andhra Pradesh, India

A bstract
Context: Alcohol dependence is on rise world over, especially in developing countries such as India. According to the World Health
Organization, about 30% of Indians consume alcohol, out of which 4%–13% are daily consumers and up to 50% of them, fall under
the category of hazardous drinking. Another worrying trend from India is that the average age of initiation of alcohol use has
reduced from 28 years during the 1980s to 17 years in 2007. In India, alcohol abuse also amounts to huge annual losses due to
alcohol‑related problems in workplaces. This was a cross‑sectional, noninterventional study which was carried out at the Department
of Psychiatry, Sri Venkateswara Ramnaraian Ruia Government General Hospital (SVRRGGH), Tirupati, Andhra Pradesh. Aim: The
aim of this study was to determine the frequency and nature of psychiatric morbidity in spouses of patients with alcohol‑related
disorders (ARDs). Methods: Study design ‑ Hospital‑based cross‑sectional study. Study setting ‑ Psychiatry Department of SVRRGGH,
Sri Venkateswara Medical College, Tirupati. Study period ‑ October 1, 2014 to September 30, 2015. Study units ‑ the spouses of
adult patients attending the Department of Psychiatry, with a diagnosis of ARDs. After the ethical clearance from the Institutional
Ethical Committee, the spouses of adult patients attending the Department of Psychiatry with a diagnosis of ARDs according to
the International Classification of Diseases‑10 classification of mental and behavioral disorders constitute the population for the
investigation. After obtaining written informed consent from each of the concerned subjects, demographic details and history of
psychiatric illness were noted as per the structured pro forma. Results: The age of the alcohol‑dependent men and spouses of men
with ADS ranged from 23 to 67 years (mean ± standard deviation [SD] 41.24 ± 10.101) and 21–60 years (mean ± SD 35.04 ± 8.98),
respectively. Among the study population, 36.6% of alcohol‑dependent men were in the age group of 31–40 years and 43.6% of
wives were in between 31 and 40 years. Conclusion: The findings of association of duration of alcohol abuse by husband, marital
life satisfaction, poor family support, low socioeconomic status with psychological morbidities in spouses of men of alcohol related
disorder are in agreement with earlier studies. But community studies with adequate sample size are required to estimate the effect
of these key determinants.

Keywords: Alcohol dependence, psychiatric disorders, Tirupati

Introduction of ARDs in a family agency setting described them as often

Spouses of patients with alcohol‑related disorders (ARDs), a key
member of such dysfunctional family system, are most vulnerable
to have significant psychiatric disorders such as adjustment
disorders, mood disorders, anxiety disorders, and psychosocial
problems. Spouses play an important role in treatment programs
of persons suffering from ARDs. Studies showed that the wives
Address for correspondence: Dr. Shankar Reddy Dudala,
Assistant Professor, Department of Community Medicine,
Sri Venkateswara Medical College, Tirupati ‑ 517 507,
Andhra Pradesh, India.
E‑mail: drshankarreddy1979@gmail.com
Access this article online
Quick Response Code:
Website:
www.jfmpc.com
equally as sick as their husbands with a need to dominate, to
suffer, to punish, or to belittle their maids. Such a wife and
frequently the daughter of an alcohol‑dependent father may also
suffer from feelings of basic anxiety and inadequacy which can
be denied or assuaged by their feeling superior to their husband.[1]
Alcohol abuse affects couple relationships in a variety of negative
ways. Studies show that spouses of alcohol‑dependent persons
have higher rates of psychological and stress‑related medical
problems (hypertension, diabetes). The current understanding
This is an open access article distributed under the terms of the Creative Commons
Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows others to remix, tweak,
and build upon the work non‑commercially, as long as the author is credited and the new
creations are licensed under the identical terms.
For reprints contact: reprints@medknow.com

DOI: How to cite this article: Dandu A, Bharathi S, Dudala SR. Psychiatric
10.4103/jfmpc.jfmpc_331_16 morbidity in spouses of patients with alcohol related disorders. J Family
Med Prim Care 2017;6:305-10.

© 2017 Journal of Family Medicine and Primary Care | Published by Wolters Kluwer - Medknow 305
[Downloaded free from http://www.jfmpc.com on Saturday, March 2, 2019, IP: 77.54.155.184]
Dandu, et al.: Psychiatry disorders among spouses of alcohol abuse patients
indicates differences in consequences among various family
members. Children as well as spouses are exposed to considerable
stress as per Moos and Billings.[2] Family members of ARDs very
often become codependent; codependency is an unconscious
addiction to another person’s abnormal behavior. This leads to
isolation, depression, emotional problems, and suicide attempt.
In 1964, a World Health Organization Expert Committee
introduced the term “dependence” to replace the terms
“addiction” and “habituation.” The term can be used generally
with reference to the whole range of psychoactive drugs
(drug dependence, chemical dependence, substance use
dependence) or with specific reference to a particular drug or
class of drugs (e.g., alcohol dependence, opioid dependence).[3]
Subjects and Methods
The study was conducted at the Psychiatric Department of
Sri Venkateswara Ramnaraian Ruia Government General
Hospital (SVRRGGH), Sri Venkateswara Medical College,
which is a government tertiary care center in Tirupati,
from October 1, 2014 to September 30, 2015. This was a
cross‑sectional, noninterventional study which was carried
out at the Department of Psychiatry, SVRRGGH, Tirupati,
Andhra Pradesh.
Study subjects
The spouses of adult patients attending the Department
of Psychiatry with a diagnosis of ARDs according to the
International Classification of Diseases‑10 (ICD‑10) of mental
and behavioral disorders constitute the population for the
investigation.
Inclusion criteria
The inclusion criteria include the spouses of adult patients
attending the Department of Psychiatry with a diagnosis of
ARDs according to the ICD‑10 classification of mental and
behavioral disorders and age group above 18 years.
Exclusion criteria
The exclusion criteria were physical and psychiatric disorders in
the patient and their spouses which are not related to alcohol use
and patients as well as their spouses not consenting for the study.
Study method
After the ethical clearance from the Institutional Ethical
Committee, the spouses of adult patients attending the
Department of Psychiatry with a diagnosis of ARDs according
to the ICD‑10 classification of mental and behavioral disorders
constitute the population for the investigation. After obtaining
written informed consent from each of the concerned subjects,
demographic details and history of psychiatric illness were noted
as per the structured pro forma.
1. Severity of alcohol dependence (SAD) in the patients was
assessed using SAD‑questionnaire (SAD‑Q)[4]
Journal of Family Medicine and Primary Care
2. General Health Questionnaire (GHQ) 28‑item version was
used to screen for the possible presence of morbidity among
spouses of ARDs, those who were found positive with a
score of 5 and above were further examined for psychiatric
morbidity and diagnosed according to ICD‑10 classification
of mental and behavioral disorders.[5]
Data were collected and entered into Excel software which was
later analyzed using  R version 3.2.1, Free Software Foundation’s
GNU General Public License. Appropriate statistical tests such
as calculating percentage and Chi‑square analysis were applied.
Results
During the study period, a total of 101 alcohol‑dependent men
and their spouses were studied. The age of the alcohol‑dependent
men and spouses of men with ADS ranged from 23 to
67 years (mean ± standard deviation [SD] 41.24 ± 10.101) and
21–60 years (mean ± SD 35.04 ± 8.98), respectively. Among the
study population, 36.6% of alcohol‑dependent men were in the
age group of 31–40 years and 43.6% of wives were in between
31 and 40 years. The psychiatric morbidity was more in between
31 and 40 years age group constituting about 29.7%, majority of
the sample population belongs to rural domicile (53.4%), and
psychiatric morbidity was also found to be more (33.4%) among
spouses belonging to rural domicile. About 77.2% of patients
belong to nuclear families and psychiatric morbidity was also
found to be more among them of about 52.5%. Majority (44.5%)
of the sample are from upper lower socioeconomic status,
but the psychiatric morbidity was found more among spouses
belonging to lower middle socioeconomic status, but there
was no significant impact (P > 0.05) on psychiatric morbidity
between the groups either due to age, domicile, type of family,
or socioeconomic status [Table 1].
The psychiatric morbidity was more in 1–10 years duration
of marital life (30.7%). There was no significant difference
between the groups. The psychiatric morbidity was more among
the families whose duration of marital life in between 1 and
10 years constituting for about 59.4%. There was no statistical
difference between the groups. Table 2 shows that psychiatric
morbidity was more among women who received the verbal and
physical violence constituting for about 37.6%. There was a nil
significant difference between these groups (P > 0.05). There is
no impact of psychiatric morbidity in relation to the distress of
alcohol‑dependent men [Table 2].
Table 3 shows the data regarding SAD on SAD‑Q in males.
The range of SAD‑Q score was from 9 to 53 (mean ± SD:
26.92 ± 10.83). Almost equal numbers of patients were found
in the mild, moderate, and severe dependence range; only 4%
of patients had very severe dependence.
There was statistically significant association (P < 0.05) between
SAD and psychiatric morbidity in their spouses [Table 4].
306 Volume 6 : Issue 2 : April-June 2017
[Downloaded free from http://www.jfmpc.com on Saturday, March 2, 2019, IP: 77.54.155.184]

Dandu, et al.: Psychiatry disorders among spouses of alcohol abuse patients

Table 1: Relationship with sociodemographic data and Table 3: Severity of alcohol dependence in the patients
psychiatric morbidity using severity of alcohol dependence‑questionnaire
Variable Psychiatric morbidity Total (%) P Type of dependence Scoring Number of Frequency (%)
Present (%) Absent (%) range alcohol‑dependent
men
Age of spouses (years)
21‑30 25 (24.7) 10 (9.9) 35 (34.6) 0.581 No dependence <3 0 0
31‑40 30 (29.7) 14 (13.8) 44 (43.6) Mild dependence 4‑19 33 32.7
41‑50 8 (7.9) 6 (5.9) 14 (13.9) Moderate dependence 20‑30 32 31.7
51‑60 4 (3.9) 4 (3.9) 8 (7.9) Severe 31‑44 32 31.7
Total 67 (66.3) 34 (33.6) 101 (100) Very severe >45 4 4
Domicile Total 101 100
Rural 34 (33.7) 20 (19.8) 54 (53.4) 0.743
Semiurban 21 (20.8) 9 (8.9) 30 (29.7)
Urban 12 (11.9) 5 (4.9) 17 (16.9) Table 4: Severity of alcohol dependence in the patients
Total 67 (66.3) 34 (33.7) 101 (100) using severity of alcohol dependence‑questionnaire versus
Type of family psychiatric morbidity
Nuclear 53 (52.5) 25 (24.7) 78 (77.2) 0.347 Type of Scoring Psychiatric morbidity Total (%) P
Combined 14 (13.9) 9 (8.9) 23 (22.7) dependence range Absent (%) Present (%)
Total 67 (66.3) 34 (33.7) 101 (100) No dependence <3 0 0 0 0.006
Socioeconomic status Mild dependence 4‑19 15 (14.8) 18 (17.8) 33 (32.6)
Upper middle 12 (11.9) 4 (3.9) 16 (15.8) 0.260 Moderate 20‑30 11 (10.9) 21 (20.8) 32 (31.7)
Lower middle 29 (28.7) 11 (10.9) 40 (39.6) dependence
Upper lower 26 (25.7) 19 (18.8) 45 (44.5) Severe 31‑44 3 (3) 29 (28.7) 32 (31.7)
Total 67 (66.3) 34 (33.7) 101 (100) Very severe >45 0 4 (4) 4 (4)
Total 29 (28.7) 72 (71.3) 101 (100)

Table 2: Relationship of psychiatric morbidity in spouses

with duration of marital life and characteristics of alcohol in men with alcohol dependence and psychiatric morbidity in
dependence their spouses [Table 5].
Variable Psychiatric morbidity Total (%) P
71.3% who were found positive on GHQ, 66.3% had some
Present (%) Absent (%)
diagnosis according to ICD‑10. This implies that there has been
Duration of marital
life (years) a high degree of correlation between screening test (GHQ)
1‑10 30 (29.7) 11 (10.9) 41 (40.6) 0.507 positivity and the presence of ICD‑10 diagnosis in spouses of
11‑20 20 (19.8) 11 (10.9) 31 (30.7) alcohol‑dependent men studied [Table 6].
21‑30 11 (10.9) 4 (4) 15 (14.9)
31‑40 4 (4) 7 (6.9) 11 (10.8) Among the study subjects, 44.6% had depressive disorders, 3%
41‑50 2 (2) 1 (1) 3 (3) had anxiety disorders, 18.8% had adjustment disorders, and
Duration of alcohol 33.7% had no psychiatric disorders [Table 7].
dependence (years)
1‑10 58 (57.4) 26 (25.7) 84 (83.2) 0.441
11‑20 7 (6.9) 7 (6.9) 14 (13.8)
Discussion
21‑30 1 (1) 1 (1) 2 (2)
In the current study, 101 men with diagnosis of ARDs according
31‑40 1 (1) 0 1 (1)
to ICD 10 classification of mental and behavioral disorders were
Type of violence
studied and their spouses were screened with GHQ‑28, for those
Verbal 25 (24.8) 18 (17.8) 43 (42.6) 0.062
Verbal and physical 34 (33.7) 9 (8.9) 43 (42.6) who were found positive for psychiatric morbidity were further
Nil 8 (7.9) 7 (6.9) 15 (14.8) interviewed and diagnosed according to ICD‑10.
Type of distress among
alcohol‑dependent men In the current study, mean age of men with ARD was found to
Economical 26 (25.7) 13 (12.9) 39 (38.6) 0.588 be 41.24 years and that their spouses were 35.04 years. Majority
Occupational 36 (35.6) 16 (15.8) 52 (51.5) of spouses were in between 31 and 40 years. The psychiatric
Economical and 3 (3) 4 (3.9) 7 (6.9) morbidity was present more in the age group of 31–40 years
occupational constituting for about 29.7%. It was found that there is no
Nil 2 (2) 1 (1) 3 (3)
significant difference between the age groups and spouses’
psychiatric morbidity. A study from Puducherry[6] observed 70%
There is no significant association (P > 0.05) between psychiatric of the spouses with psychiatric morbidity belonged to the age
diagnosis with or without physical and/or neuropsychiatric illness group 35–45. Sedain[7] also observed highest number of cases

Journal of Family Medicine and Primary Care 307 Volume 6 : Issue 2 : April-June 2017
[Downloaded free from http://www.jfmpc.com on Saturday, March 2, 2019, IP: 77.54.155.184]

Dandu, et al.: Psychiatry disorders among spouses of alcohol abuse patients

Table 5: Psychiatric diagnosis with physical/ The psychiatric morbidity was more among rural population
neuropsychiatric complications versus psychiatric constituting for about 33.7%. In the current study, nuclear
morbidity families had more of psychiatric morbidity compared to the
Psychiatric Psychiatric diagnosis Psychiatric diagnosis P
joint families constituting for about 52.5%. This is because good
morbidity with physical with neuropsychiatric family support is a protective factor for spouses who belong to
complications complications combined families. There is no significant association between
Present 53 (52.5) 55 (54.5) 0.499 psychiatric morbidity either with domicile or the type of family.
Absent 48 (47.5) 46 (45.5) This study is similar to the study done by Mattu et al.,[8] who also
Total 101 (66.3) 101 (33.7) found no significant association between psychiatric morbidity
of spouses and type of domicile and family type. This is because
both are Indian studies where majority of the population belong
Table 6: Prevalence of psychiatric disorders among
to rural domicile.
spouses of males with alcohol‑related disorders on
General Health Questionnaire and International
Forty‑one percent of the couples having their duration of marital
Classification of Diseases‑10
life between 1 and 10 years and psychiatric morbidity were also
Psychiatric Spouses of alcohol‑dependent males
disorders present to be more among them constituting about 29.7%. This
GHQ (screening test) ICD‑10 number
number of cases (%) of cases (%)
is in contrast to the study done from Maharashtra,[9] where they
observed more of psychiatric illness in spouses married for
Present 72 (71.3) 67 (66.3)
Absent 29 (28.7) 34 (33.7)
more than 21 years and they got significant association between
Total 101 101 psychiatric morbidity of spouses with their duration of marital
GHQ: General Health Questionnaire; ICD‑10: International Classification of Diseases‑10 life; this may be lower number of couples in the group above
21 years of married life in this study. We did not observe any
Table 7: Frequency and nature of psychiatric disorders in statistical significant difference between the groups.
spouses of males with alcohol‑related disorders
Psychiatric disorders (ICD‑10) Spouses of About 83.2% of males with ARD were having 1–10 years of
alcohol‑dependent males alcohol dependence and the psychiatric morbidity among spouses
Number of cases (%) was also found to be more in this group constituting for about
Depressive disorders 45 (44.6) 57.4%. This is in contrast to an Indian study,[9] where majority
Dysthymic disorder (F34.1) 11 (10.9) of population were alcohol dependent for more than 21 years
MDD 34 (33.7) constituting for about 43.33%. We observed highly statistical
Mild (F32.0) 5 (4.9) significant association between psychiatric disorders among
Moderate (F32.1) 16 (15.8) spouses and duration of alcohol dependence in males as seen
Moderate without somatic 14 (13.8) in many Western studies and few Indian studies.[10,11] There was
symptoms (F32.10) no statistical significant association between these groups in this
Moderate with somatic 2 (2)
study. The contrast between two studies is due to difference in
symptoms (F32.11)
Severe (F32.2) 13 (12.8)
the distribution of the study sample.
Anxiety disorders 3 (3)
Panic disorder (F41.0) 2 (2) The range of SAD‑Q score was from 9 to 53
Generalized anxiety disorder (F41.1) 1 (1) (mean ± SD: 26.92 ± 10.83). Almost equal numbers of patients
Adjustment disorders 19 (18.8) were found in the mild, moderate, and severe dependence
Prolonged depressive reaction (F43.21) 12 (11.9) range; only 4% of patients had very severe dependence. There
Mixed anxiety and depressive 4 (4) is statistically significant association present between SAD and
reaction (F43.22) psychiatric morbidity of spouses. A study done by Bagul et al.[9]
With predominant disturbance of 3 (3) observed scores on the short alcohol dependence data ranged
other emotions (F43.23)
from 4 to 45, with a mean score of 20.45 ± 9.356, indicating
Absent 34 (33.7)
significant dependence. In another study, the marital satisfaction
Total 101 (100)
ICD‑10: International Classification of Diseases; MDD: Major depressive disorder
negatively correlated with the SAD in men, satisfaction being
lower as severity of dependence increases.[12] Western studies have
in the age group of 30–39 years. Literature shows that spouses found a correlation between duration of alcohol dependence and
of this age group are more prone for depressive symptoms marital discord[13,14] while one Indian study had found a positive
as they have to perform roles of both the parents with family correlation between duration of dependence in men and higher
responsibility shifting from two parents to one parent and also levels of distress in their spouses.[15]
due to financial constraints.
In the current study, about 52.5% of males had physical
Majority of sample population belong to rural community complications such as gastritis, jaundice, hematemesis, and
constituting about 53.5% and 77.2% were nuclear families. pancreatitis; 54.5% had neuropsychiatric complications which

Journal of Family Medicine and Primary Care 308 Volume 6 : Issue 2 : April-June 2017
[Downloaded free from http://www.jfmpc.com on Saturday, March 2, 2019, IP: 77.54.155.184]
Dandu, et al.: Psychiatry disorders among spouses of alcohol abuse patients
included peripheral neuropathy, delirium, seizures, ideas of
infidelity, mood symptoms, and sexual dysfunction. In a study
done from Maharashtra,[9] about 22% alcohol‑dependent men
had physical complications in the form of gastritis, hematemesis,
and malena; 35% had neuropsychiatric complications. As our
institute is a tertiary care referral center, most of the cases
present with neuropsychiatric complications. In the current
study, majority of males (52%) had occupational distress like not
performing productive work and 39% of the males were lodging
their families to suffer with financial burden. Majority of spouses
with psychiatric morbidity had their husbands whose ARD poses
them to suffer from occupational distress.
About 85% of spouses were affected by verbal or physical
violence. Majority of spouses (34%) with psychiatric morbidity
affected by both verbal and physical violence from their
husbands, but there was no association between the groups with
psychiatric morbidity of spouses.
Out of 101 spouses of ARD men studied, 72 (71.3%) patients
were GHQ‑positive and 67 (66.3%) patients had at least one
psychiatric diagnosis on ICD‑10. Thus, the tool is highly sensitive
in diagnosing psychiatric morbidity. The above results were
similar to the study done by Bagul et al.[9] Out of 60 patients,
43 (71.66%) were GHQ‑positive and 38 (63.33%) patients had
at least one psychiatric diagnosis on Structured Clinical Interview
for Diagnostic and Statistical Manual of Mental Disorders Axis
I Disorders‑I (SCID‑I) and II; thus, the tool is highly sensitive
in identifying psychiatric morbidity.
In the present study, the prevalence of psychiatric morbidity
among spouses of alcohol‑dependent men was 66.3%. Most
common diagnosis being depressive disorder in 44.6% spouses,
which included dysthymia and major depressive disorder (MDD),
followed by adjustment disorder in 18.8% spouses. Anxiety
disorders were present in 3% of patients which include panic
disorder and generalized anxiety disorder. None of the spouses
had personality disorders. Few studies from India showed that
4% and 3.3% of the spouses had both anxiety and depressive
features.[6,12] This is similar to the current study. In a study done
by Bagul et al.[9] observed the overall prevalence of psychiatric
disorders among spouses of alcohol‑dependent men was
63.33%. Most common diagnosis being depressive disorder in
35% patients which included dysthymia and MDD, followed by
anxiety disorder in 15% which included panic disorder (without
agoraphobia), generalized anxiety disorder, and specific phobia.
Adjustment disorders were present in 13.33% patients. None of
the spouses had personality disorders on SCID II. In another
study by Kishor et al.,[12] 65% of the spouses had psychiatric
morbidity, which is more or less similar to the present study.
In their study, the diagnoses were primarily mood and anxiety
disorders, the most common being MDD (43.3%), followed by
dysthymia (35%), double depression, and panic disorder (15%).
There have been very few Indian studies and even fewer have
specifically examined the presence of psychiatric morbidity in
spouses.[16,17] Ponnu et al.[6] from Puducherry observed that the
Journal of Family Medicine and Primary Care
prevalence of psychiatric morbidity among the spouses was about
36%. They also showed a higher prevalence of mood disorders
including MDDs and dysthymia of about 18% comprising 50%
of the spouses who had psychiatric morbidity. The difference
in prevalence in between the studies may be due to variation in
the scales used. Kishor et al.[12] used GHQ and a score of 2/12
was considered positive; in this study, GHQ 28 was used and a
score of 5/28 was considered positive. Ponnu et al.[6] reported
that the subjects were diagnosed according to the various modules
of Mini International Neuropsychiatric Interview plus scale.
The high rates of mood disorders and low rates of personality
disorders are in agreement with Western literature.,[18,10]
Limitations
The major limitation of the study is that the sample was selected
from patients who sought help at a tertiary care teaching
hospital. It is likely that such patients have more serious physical
and psychiatric conditions, which necessitate consultation at a
hospital. Hence, the findings may not be generalized to patients
with similar problems in the community or who seek help in
other kinds of settings.
Conclusion
The results corroborate the findings of earlier studies of
association of psychological comorbidities of spouses of men
affected of alcohol related disorders with duration of alcohol
abuse by husband, marital life satisfaction, inadequate family
support of nuclear families, low socioeconomic status, and rural
families working in unorganized sector. The effect of these
determinants should be further assessed in large community
study with ample sample size. Hence, barriers to these key
determinants can be explored to design effective strategies to
mitigate the burden of broken families in the society.
Acknowledgments
We would like to acknowledge Dr. MS Sridhar, Principal SV
Medical College, Tirupati and Dr. CS Sandhya, Superintendent
of SVRRGG Hospital, for their constant support and
encouragement throughout the study. We would like to thank
all the spouse and patients who participated in this study. We
are grateful to authors/editors/publishers of all those articles,
journals, and books from where the literature for this article has
been reviewed and discussed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1. Fox R. Alcoholism: Behavior Research, Therapeutic
Approaches. New York: Springer; 1968. p. 134‑44.
309 Volume 6 : Issue 2 : April-June 2017
[Downloaded free from http://www.jfmpc.com on Saturday, March 2, 2019, IP: 77.54.155.184]
Dandu, et al.: Psychiatry disorders among spouses of alcohol abuse patients
2. Moos RH, Billings AG. Children of alcoholics during the
recovery process: Alcoholic and matched control families.
Addict Behav 1982;7:155‑63.
3. Management of Substance Abuse. WHO; 2015. Available
from: http://www.who.int/substance_abuse/terminology/
definition1/en/. [Last accessed on 2015 Sep 20].
4. Stockwell T, Murphy D, Hodgson R. The severity of alcohol
dependence questionnaire: Its use, reliability and validity.
Br J Addict 1983;78:145‑55.
5. Goldberg DP, Hillier VF. A scaled version of the General
Health Questionnaire. Psychol Med 1979;9:139‑45.
6. Ponnu MM, Pradeep T, Susan S. Pattern of psychiatric
morbidity in spouses of patients with alcohol dependence
syndrome. J Evol Med Dent Sci 2015;4:12309‑15.
7. Sedain CP. Study of psychiatric morbidity of spouse of male
alcoholic patients in Nepal. J Chitwan Med Coll 2013;3:10‑3.
8. Mattu SK, Nebhinani N, Kumar BN, Basu D, Kulhara P. Family
burden with substance dependence: A study from India.
Indian J Med Res 2013;137:704‑11.
9. Bagul KR, Deshmukh SB, Bagul MK, Deshmukh PS.
Psychiatric morbidity and marital quality among wives of
patients with alcohol dependence syndrome. J Evid Based
Med Healthc 2015;2:3284‑95.
10. Steinglass P. The impact of alcoholism on the family.
Relationship between degree of alcoholism and psychiatric
symptomatology. J Stud Alcohol. 1981;42:288‑303.
11. Nayak MB, Patel V, Bond JC, Greenfield TK. Partner alcohol
use, violence and women’s mental health: Population‑based
Journal of Family Medicine and Primary Care
survey in India. Br J Psychiatry 2010;196:192‑9.
12. Kishor M, Pandit LV, Raguram R. Psychiatric morbidity and
marital satisfaction among spouses of men with alcohol
dependence. Indian J Psychiatry 2013;55:360‑5.
13. Epstein EE, McCrady BS, Hirsch LS. Marital functioning in
early versus late‑onset alcoholic couples. Alcohol Clin Exp
Res 1997;21:547‑56.
14. Tempier R, Boyer R, Lambert J, Mosier K, Duncan CR.
Psychological distress among female spouses of male at‑risk
drinkers. Alcohol 2006;40:41‑9.
15. Bhowmick P, Tripathi BM, Jhingan HP, Pandey RM. Social
support, coping resources and codependence in spouses
of individuals with alcohol and drug dependence. Indian J
Psychiatry 2001;43:219‑24.
16. Naga Venkatesha PJ, Bengal V, Murthy P. Alcohol Dependence
in Indian Women: A Clinical Perspective. De‑addiction
Center. Bangalore: NIMHANS. Available from: http://www.
nimhans.kar.nic/Deaddiction/lit/alochol_dependence_in_
indian_women.pdf. [Last accessed on 2015 Sep 20].
17. Situational Analysis of Domestic Violence against Women
in Kerala: A Executive Summary. Department of Women
and Child Development, Ministry of Human Resource
and Development, Government of India; 2005. Available
from: http://www.ncw.nic.in/pdfReports/Domestic%20
Violence%20against%20women%20in%20Kerala.pdf. [Last
accessed on 2015 Sep 20].
18. Tomelleri CJ, Herjanic M, Herjanic BL. Wife of alcoholic.
In: Alcoholism-Clinical and Experimental Research. Vol. 1.
Baltimore, MD: Williams & Wilkins; 1977. p. 173.
310 Volume 6 : Issue 2 : April-June 2017