Assessment of Burden among Caregivers of Mentally Ill Patients in Psychiatric Hospital

 

Liji Jiju Chacko^1*, Dr. Alka Pawar², Mr Suresh³, Mr David⁴, Mr Sushant⁴, Mr Darshan⁴,

Mrs. Yojana⁴, Mrs Shweta⁴, Mrs Ashwini⁴

¹Asst. Professor, Nursing Department, Maharashtra Institute of Mental Health, Government of Maharashtra, Sassoon Hospital, Pune. 411001.

²Director-Professor, MIMH, Pune

³Lecturer Nursing MIMH, Pune.

⁴Former PBDPN Students, MIMH, Pune

 

ABSTRACT:

In India the families are the primary caregivers for the illness including chronic mental illness, but there is a dearth of studies in this area.the families have relentlessly faced the stigma, the burden and displayed great lenacity in dealing with the illness, its disability and social consequences. The Objectives are to assess the level of burden among caregivers of mentally ill patients to associate the findings with selected demographic variables. A standardised tool on burden developed by Zarit et al in 1980 is a 22-item scale used to measure feelings of burden experienced by individuals caring for patients with mental illness. A sample of 60 caregivers were chosen from selected hospitals. According to the assessment done with the care givers burden scale it was found that 58% of care givers were having moderate stress, 22 % were under mild stress and 20 % had severe stress and there was no significant association of caregiver’s burden with defined demographic variables. The results of this study have substantial implications for the planning of intervention strategies. assessing the burden thus helps towards a more rational and responsible patient care.

 

INTRODUCTION:

When 21^st century is on the verge of down the psychiatric illness is still a dilemma for both clinician as well as the community. An edition described schizophrenia as the worst disease affecting mankind.¹ chronic mental illness effects many people and is a problem of devastating dimensions. Chronic psychiatric illness especially schizophrenia not only wrecks the life of an individual but also has an immense impact on the family as well as the community,this impact being increased by shift in the trend towards community care for the schizophrenia. Since late 1950s the burden on the family who has to come for the schizophrenic patient and the impact of the reaction of the family members on the outcome of the illness is documented.²

 

In India the families are the primary caregivers for the illness including chronic mental illness, but there is a dearth of studies in this area. The families have relentlessly faced the stigma, the burden and displayed great lenacity in dealing with the illness, its disability and social consequences.

 

As time is changing fast in all the departments of work psychiatric management is also changing with the new concepts like half way homes, family ward, children’s and adolescence department coming up in psychiatric hospital. With this evolution in the management of psychiatric patients and family plays an important role, hence caregivers play a major factor in treatment of psychiatric ill patients with this. Care givers goes through lot of changes in life while caring such patient their responsibilities increases which increases burden on them (physical, social psychological).

 

NEED OF STUDY:

In developing country like India where financial resources and manpower of health programmes are limited, it’s important that much of the research activities in psychiatry be directed towards practical issues. Thus one of the areas of practical research will be on burden on caregivers as knowledge about burden will be helpful to us in planning therapies, after care and rehabilitation services.

 

 A Study by Mills in the year 2007 assessed selected 200 psychiatry patients and found that particularly all were a source of anxiety to their relatives. More than 50% were described as difficult at home and only 12 % caused no practical difficulties. Those patients who did not speak often created more distress than those whose speech was excessive though the later caused suffering too.

 

In the light of above mentioned aspects a study depicting burden of caregivers of mentally ill patients was undertaken for the better management of them and community in which they resided.

 

PROBLEM STATEMENT:

“A study to assess the burden among caregivers of mentally ill patients in psychiatric hospital, Pune”.

 

OBJECTIVES:

1.      To assess the level of burden among caregivers of mentally ill patients.

2.      To associate the findings with selected demographic variables

 

INCLUSION CRITERIA:

1.      Caregivers who are willing to participate

2.      Who can understand Marathi, Hindi

3.      Caregivers whose patients are diagnosed more than one month

EXCLUSION CRITERIA:

Caregivers who are physically and mentally challenged.

 

Research approach: Quantitative

Research design: Descriptive design nonexperimental

Setting of study: Psychiatric Hospital, Pune

Sample: Caregivers of mentally ill patients attending psychiatric OPD, IPD.

Sampling technique: no$nprobability purposive sampling technique

Sampling size: 60 caregivers

 

Description of tool:

A standardised tool on burden developed by Zarit et al in 1980 is a 22 item scale used to measure feelings of burden experienced by individuals caring for patients with mental illness.

 

PROCEDURE OF DATA COLLECTION:

Permissions were taken from director professor of the institute Consent taken from the caregiversData was collected by interview method.

 

ANALYSIS OF DATA:

Analysis was done in 3 sections:

Section 1: Frequency and percentage distribution of demographic variables

Section 2: Assessment of level of burden among caregivers

Section 3: Association of findings with demographic variables

 

Section 1: Frequency and percentage distribution of demographic variables:

In this section it was found that the demographic variables ie age, gender, address, cast, marital status, socioeconomic status, occupation, education, family, relationship with patient were assessed. In age maximum caregivers were between 40-60 years i.e 60 %,in gender 50 % were female and 50% were male, about 58% resided in urban area, 80% were Hindus, 86% were married, 56 % were from lower class, about 30 % were  doing job and 25 % were farmers. 35% were illiterate, 53% were from nuclear families. 28% were parents of patients, 26% were spouse and children of patients.

 

Section 2: Assessment of level of burden among caregivers:

According to the assessment done with the care givers burden scale it was found that 58% of care givers were having moderate stress, 22 % were under mild stress and 20 % had severe stress.

 

 

Section 3: Association of findings with demographic variables:

According to statistical analysis there is no significant association of caregiver’s burden with defined demographic variables.

 

DISCUSSION:

Burden as a research construct has been examined in a diverse examples and conceptualised in various ways the burden is experienced by all caregivers irrespective of the country or culture to which they belong. The objective burden ie which occurs due to patients disturbance is seen in all caregivers, the subjective distress however varies, some disturbance leading to more emotional reactions to the patients disturbances.

 

No statistical significant difference has come out thus presence of mental illness is sufficient to cause burden. Thus there is a high level of subjective distress due to excess behaviour, there is a lot of adverse effect on health of caregiver. The worry of the future of the patient is a significant concern of the caregiver.

 

IMPLICATION:

Nursing practice: For health of every individual as nurse needs to pay attention to all the comprehensive aspects of health. Nurse can assess the level of burden among caregivers and find out the effect of burden on them Nursing education and administration: the need of nursing colleges to think on awareness and promotion of health

 

Nursing administrators play a vital role in education of staff nurses.

 

Nursing research: it’s a important aspect in nursing profession as it uplifts the profession and develop new norms and body of nursing knowledge.

 

 

 

REFERENCES:

1.       Kaplan I H, B. J Sandock. 1995.Brief psychiatric rating scale, Comprehensive Textbook of Psychiatry; 555-558.

2.       Vaughn V.E.1976. The influence of family and social factors on course of psychiatric illness, a comparison between schizophrenia and depressed neurotic. British Journal of Psychiatry;125-137.

3.       Kapur R L.1992.The family and schizophrenia priority areas for intervention and research in India. Indian Journal of Psychiatry. 34(1):3-7.

4.       Kuruvilla K.1993. Editorial towards more rational and responsible patient care. Indian Journal of Psychiatry: 35(2):71-72.

5.       Rice D P. Kelman S. Miller L S.1992.The economic burden of Illness, Hospital and Community Psychiatry: 43(9):1227-1232.

6.       Grad J. Sanisbury P.1963. Mental Illness and The Family Lancet. 545-547.

 

 

 

Received on 27.08.2018          Modified on 06.09.2018

Accepted on 14.10.2018          © A&V Publications all right reserved