A correlative Study
to Assess the Self Esteem and Psychological Well Being among Adult Children of Mentally
Ill Parents in Kasturba Hospital, Manipal
of Udupi district
K. Jayakrishnan1,
Shalini2, Savitha3
1Lecturer, SUM Nursing College, SOA
University, Bhubaneswar
2Asst. Professor, Manipal
College of Nursing, Manipal University, Manipal
3Asst. Professor, Manipal
College of Nursing, Manipal University, Manipal
Corresponding
author Email: jk.snc007@gmail.com,
savitha.umesh@manipal.edu
ABSTRACT:
The research study
titled “A correlative study to assess the self esteem and psychological well
being among adult children of mentally ill parents in Kasturba
hospital, Manipal of Udupi
district”, whose objectives were to (a) assess the level of self esteem of
adult children of their mentally ill parents as measured by Rosenberg’s self
esteem scale. (b) assess the psychological well being by the adult children of
mentally ill parents by psychological well being tool of Jaiprakash
and Bhogle(c) find the relationship between self
esteem and psychological well being of adult children of mentally ill parents.
A survey approach using a descriptive correlational study design was used for the study. A total
of 63 samples who were adult children of parents who had been diagnosed as
having schizophrenia, mood disorder or organic mental disorder for more than 6
months, attending the psychiatric OPD and ward of Kasturba
Hospital in Manipal.
The findings of
the study supports that there is no significant relationship between self
esteem and psychological well being among the adult children of mentally ill
parents.
KEY
WORDS: adult
children, self esteem, psychological well being, mentally ill parents, caregiver
burden
INTRODUCTION:
Caregivers across the world, who
are often unrecognised and under supported, are
deeply and personally impacted by the care they provide. The recognition of
high levels of caregiver morbidity demands a holistic approach and nurses need
to be more responsive to the needs of carers and
care-recipients rather than focusing on the patient alone. The adult children
are the group that is taken for the study, which is specifically people above
18 years, has a parent with a mental illness. The group is specific as it is
the most productive category, who had been burdened with the task of care
giving.
Through the Pearlin’s
model of stress process in caregivers, it is also understood that the care
giving process disrupts the intra-psychic state of the caregiver.
A study conducted
by Kathleen, LeClear
and O’Connell about the experiences, needs of, and interventions for children of seriously mentally ill mothers. Childhood variables related to
attachment, family environment, and parenting were compared to adult well-being
outcomes of depression, quality of life, sense of coherence, and self-esteem.
The study revealed that severe disruption of self esteem for adult children had
occurred.1 Another
study by Daniel Fu Keung Wong, Angus Yuk Kit Lam, SauKam Chan, and
Shuk Fan Chan on
2010 to find the Quality of life of caregivers with relatives suffering from mental
illness in Hong Kong: the study revealed that, caregivers who were
younger, had chronic illness, a lower level of education experienced more care
giving burden and had more dissatisfaction with mental health services and poorer Quality of life.2 Yet another correlative study done by Binil.V in 2008 at Udupi district
to find association between burden and coping strategies among caregivers of
patients with affective disorder among 100 caregivers in Kasturba
hospital, Udupi revealed that more than 30%
caregivers had moderate to high levels of burden and 32% caregivers were found
to be using medium level of coping strategies.3 Through studies it is understood
that a caregiver will go under a lot of psychological demand that influences
the self esteem and psychological well being of the caregivers.4
Health professionals, mental health nurses have an important role to
acknowledge the burden of the caregivers. They are in a position to render
support and refer to get further support through social workers and community
agencies.7
Caring for older
frail and chronically ill family members is not without costs; although the
care giving role can be rewarding, it can also be highly stressful. It is now
well established that family members who provide care to frail and disabled
older adults are at greater risk for experiencing health problems, as well as
psychiatric morbidities, such as anxiety and depressive symptomology,
than are non-caregivers.6
OBJECTIVES OF THE
STUDY WERE TO:
1. Assess the level of self esteem
of adult children of their mentally ill parents as measured by Rosenberg’s self
esteem scale.
2. Assess the psychological well
being by the adult children of mentally ill parents as measured by
psychological well being questionnaire.
3. Find the relationship between
self esteem and psychological well being
MATERIALS AND
METHODS:
Participants:
Sixty three adult
children who were aged more than 18 years and had a parent who had been
diagnosed as having schizophrenia, mood disorder or organic mental disorder for
more than 6 months, attending the psychiatric OPD and/or ward of Kasturba Hospital in Manipal, Udupi district were selected as participants. Ethical
clearance was obtained from institutional ethics committee. After obtaining
administrative and individual participant’s consent the confidentiality of the
data was ensured.
Measures:
Tools utilised were the Rosenberg self esteem scale and
psychological well being scale by Jaiprakash and Bhogle. Questionnaires were filled by the participants
itself.
Mentally ill parent:
Parent/s
that has been diagnosed with schizophrenia, mood disorder or organic
psychiatric disorder like dementia and has one or more children who are above
18 years of age.
Self esteem:
Adult children’s overall sense of self-worth or personal value,
which is measured by using Rosenberg’s self esteem scale.
Psychological well being:
Adult
children’s perception about their own health and well being, that is measured
by Psychological wellbeing scale by Bhogle and Jaiprakash
Adult children:
A son or daughter
having one or more parent/s diagnosed with schizophrenia, mood disorder or
organic psychiatric disorder, who gives direct care to the parent/s and is
above 18 years of age.
Rosenberg’s self esteem scale:
This is a
structured rating scale to assess self esteem of general population, developed by
Rosenberg (1965). Rosenberg reported that internal consistency reliability of
the instrument range from(r=0.85 to 0.88). The scale consists of 10 items; each
item is scored on a four point scale under the options: strongly agree, agree,
disagree, and strongly disagree, five statements were positive and five
negative with a total score of 30. Scores are classified as below 15 as low
self esteem, 15-25 scores as normal self esteem and above 25 are considered as
high self esteem. Higher the scores, higher the self esteem.
Psychological well being scale:
This is a
structured questionnaire to assess the psychological wellbeing of general
population, developed by Jaiprakash and Bhogle (1995). The questionnaire consists of 28 item in a
forced choice (Yes/No) format to assess psychological wellbeing. In the tool,
10 statements are negative and rest 18 statements are positive. Scores are
classified as (0-9) as low psychological wellbeing, (10-20) as intermediate
psychological wellbeing and (21-28) as high psychological wellbeing. Higher the
score, higher the psychological wellbeing.
METHODOLOGY:
The present study
was conducted to assess the intensity of self esteem and psychological well
being of adult children of mentally ill parents, its interrelationship and also
their relationship with selected variables. Therefore, a survey approach was
considered best, for the study.
Descriptive correlational study design was found suitable as the whole
study was intended to find the relationship between self esteem and psychological
well being of adult children of mentally ill parents.
Methods:
On the period of
data collection researcher would approach the participants directly and explain
the purpose and method of using the questionnaires, also ensured the
confidentiality of the data. Once the questionnaires were completed it was
scored and interpreted according to the tool.
RESULTS:
Description of self esteem
Figure 1shows that
out of 63 participants. Majority, 43 (68.3%) of the samples were found to be
having normal self esteem. 19 (30.2%) of the samples were low self esteem and
only 1 (1.6%) participant was having high self esteem.
Figure 1: Doughnut
diagram showing the Percentage and distribution of self esteem of adult
children
Description of psychological well being
The data presented
in figure 2 shows that out of 63 participants. Majority, 35 (55.6%) of the
samples were found to be having high psychological wellbeing. 27 (42.9%) of the
samples were with intermediate psychological wellbeing and only 1 (1.6%) participant
was having low psychological wellbeing.
Figure 2: Pie
diagram showing the percentage and distribution of psychological well
being in the adult children.
Relationship
between self esteem and psychological well being
In order to test
the relationship between the adult children’s self esteem and their
psychological well being, Spearman’s correlation coefficient was used.
Following null hypothesis was stated to test the significance of relationship
between self esteem and psychological well being and was tested at 0.05 level
of significance. The data in presented in the table 1 shows that Spearman ‘r’
computed between self esteem and psychological well being that there is no
significant relationship.
Table 1:
Correlation between the psychological well being, and self esteem
|
Variables |
(r) value |
P value |
|
Self esteem and psychological well being |
0.044 |
0.730 |
* p=< 0.05 level
DISCUSSION:
In the present study, no correlation was
found between self esteem and psychological well being (r = 0.044, p= 0.730)
among adult children of mentally ill parents and it contradicts with a
correlative study which was done by The findings are contradicting to the
finding by a study conducted by Noonan
AE and Tennstedt
SL, in new England shows that the relationship between meaning in care
giving that is, positive beliefs about the care giving situation and the self
as caregiver and the psychological well-being of 131 caregivers to community
residing frail elders. Measures of well-being included depression, self-esteem,
mastery, role captivity, and loss of self. Meaning in care giving explained a
significant portion of correlation in well being and self-esteem scores even
after demographic and stressor variables had been controlled.8
In the present
study, out of 63 participants, majority, 35 (55.6%) of the samples were found
to be having high psychological wellbeing. 27 (42.9%) of the samples were
moderate psychological wellbeing and only 1 (1.6%) participant was having low
psychological wellbeing. This finding supports the reports of a study conducted
by Roy K. George et al to observe the behavioral symptoms and caregiver burden of
dementia patients revealed that many factors might positively and
negatively influence the experience of caregiver burden and modulate the
psychological impact of providing care to the demented relative.5
In the present
study, out of 63 participants, majority, 43 (68.3%) of the samples were found
to be having normal self esteem. 19 (30.2%) of the samples were with low self
esteem and only 1 (1.6%) participant was having high self esteem. These
findings were supported by the study conducted by Kathleen,
LeClear and O’Connell about the experiences, needs
of, and interventions for children of seriously mentally ill mothers. Childhood variables related to
attachment, family environment, and parenting were compared to adult well-being
outcomes of depression, quality of life, sense of coherence, and self-esteem.
The study revealed that severe disruption of self esteem for adult children had
occurred.9
Thus, the study
findings interpret that change in self esteem does not change the psychological
well being among the adult children of mentally ill parents. The study,
further, also shows that 71% of the participants were having mild psychological
well being about their parent.
Recommendations:
·
A similar study can be done conducted by selection of samples by
random sampling method
·
A comparative study can be done among the adult children of
mentally ill parents of rural and urban area.
·
A similar study can be done among adult children of substance
abuse parents
·
The study may be replicated using a larger population drawn from
different hospitals.
·
A correlational study can be conducted
to find relationship between psychological well being and other variables like
quality of life, job satisfaction, and burnout among adult children of mentally
ill parents.
IMPLICATIONS:
Nurses working with mentally ill adults need to
inquire about the children and adolescents, especially about their mental
health and emotional development. If there are serious concerns or questions
about a child, it may be helpful to have an evaluation by a qualified mental
health professional. Nurses should initiate individual or family psychiatric
treatment that can help a child toward healthy development, despite the
presence of parental psychiatric illness. With treatment, the family can learn
ways to lessen the effects of the parent's mental illness on the child. Nurses
can make them understand about their parent/s illness and that they are not to
blame themselves. Provide them information about the extended care facilities
like half way homes, day care centers, sheltered workshops etc.
CONCLUSION:
Strengths:
Easy and cost
effective method to collect data within a specific group of adult children with
mentally ill parents who were often unrecognised.
Research had been able to pour light to the matter of caregiver burden due to
increased psychological well being persisting within the group.
Limitations:
In the group of
mentally ill parent, the researcher has only included schizophrenia, mood
disorders and organic psychiatric disorder, which could be extended to more
disease conditions. The study is limited to Kasturba
hospital, Manipal and purposive sampling was used
.the sample size was limited to 63 samples.
Further, the study
concludes that most of the samples were having low self esteem (30% of
subjects) and Most of the adult children were also having mild stigma towards
their mentally ill parent. No association was found between psychological well
being and self esteem of adult children of mentally ill parent.
ACKNOWLEDGEMENT:
I express my
sincere thanks and deep sense of gratitude to all the participants of this
study, administrators for granting permission, validators
of the tool and to all those who directly or indirectly helped me during the
study.
REFERENCES:
5.
Shaji KS, George K, Prince J, and Jacob KS. Behavioural symptoms and caregiver
burden in dementia. Indian journal of psychiatry. [citied 2009]; 51(1): 45-49
8. Noonan AE, Tennstedt
SL. Meaning in caregiving and its contribution to caregiver
well-being. Gerontologist. 1997 Dec; 37 (6): 785-94. (52 ref).
Received on 30.12.2014 Modified on 05.01.2015
Accepted on 07.01.2015 ©
A&V Publication all right reserved
Int. J. Nur. Edu. and Research 3(1):
Jan.-March, 2015; Page 87-90
DOI: