BACKGROUND OF THE STUDY:

In recent times the word ‘Mental Health’ has gathered the attention that it deserved in the society since a long time.

Mental health services focus on the prevention and management of mental disorders and contribute in maintaining, improving and restoring the mental as well as overall health and wellbeing of the individual and society.¹

Major mental disorders such as mental illness and bipolar disorder, anxiety, mood disorders, eating disorders, and other mental illnesses alter an individual's emotions, perceptions, thoughts, and behaviours interferes with these two important aspects that is human identity and self-concept of individual caring mentally ill.²

Mental illness is not easily cured as other physical disorder and it requires long treatment course and close supervision. Irritated behaviour of patient coupled with responsibilities of caregivers for long time results in exhaustion and stress among caregivers.³

According to World Health Organization, the caregiver burden affects "emotional, physical, and psychological status, along with the financial demands and responsibilities of an individual's illness that are put on other members of the family, friends, or other persons involved with the individual or neighbour outside the health care system."⁴

Caregivers caring for such as parents, sons and daughters, siblings, and spouses, and other relatives.⁵

Caregiver has many responsibilities while caring for people who have mental illnesses, involves giving the patient daily care, monitoring of their medications, getting them to the hospital, and taking care of their financial needs.⁶

The word “coping” is typically used to describe stress-reduction techniques known as adaptive coping mechanisms. Other coping skills, on the other hand, can be termed maladaptive if they make people feel more stressed.⁷

NEED FOR THE STUDY:

The term “a mental disorder implies that the disease has a biological basis just like other medical diseases and needs to be dealt with in the same way in the public eye. 450 million citizens worldwide are suffering from some mental illness. Almost 30% of the world's population suffers from mental health problems stated by World Health Organization. It is said that, for about 20% of caregivers, there is a lot of stress, health problems, and disturbances in family life and inability to cope. In the current context of healthcare scenario in India, little attention is paid to the needs of caregivers who caring mentally ill family individual.⁸

Mental illness is a condition that affects millions of people every year and causes stress not only to the mentally ill, but also to their families.⁹

In India, caregivers who are staying with mentally ill are facing extreme problems in daily life. Providing care to those living with mental illness is difficult. The evolution of India's social environment, such as urbanization and the nuclear family, places a heavy burden on family members. This can help reduce the burden of care giving and produce positive feelings in those who are caregiving.¹⁰

OBJECTIVES OF THE STUDY:

Primary objectives:

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

2. To assess the coping strategies among caregivers of mentally ill patient.

Secondary objectives:

1) To find out the correlation between burden of care and coping strategies among caregivers of mentally ill patients.

2) To find out the association between burden of care with their selected demographic variables among caregivers of mentally ill patients.

3) To find out the association between coping strategies with selected demographic variables among caregivers of mentally ill patients.

Subjects and Methods:

A quantitative approach was adopted and Descriptive Survey research design was chosen.

Research approach:

A quantitative approach was adopted.

Research design:

Quantitative research design was adopted to assess the burden of care and coping strategies among caregivers of mentally ill.

Description of the research setting:

IPD and OPD at Himalayan Hospital Dehradun, Uttarakhand.

Target Population:

Caregivers of mentally ill patients.

Sample:

Sample for study were 140 caregivers of mentally ill patients’ attending psychiatry OPD and admitted in IPD, fulfilling inclusion criteria.

Sampling Technique:

In this, Non-Probability Sampling Design; convenience sampling technique were used.

Sample Selection Criteria:-

Inclusion criteria:

1. Caregivers of mentally ill patients admitted in Psychiatric ward and attending Psychiatric OPD.

2. Caregivers who will be willing to participate in the study.

3. Caregivers who were staying with mentally ill patient at least for past 3 months.

Exclusion criteria:

1. Those caregivers who are below the age 18 years.

2. Caregivers who are physically handicapped like deaf/dumb/blind.

Data Collection Tools:

Self-structured tools used for the study included the following:

1. Socio demographic variable among caregivers of mentally ill patients

2. Burden scale for family caregivers

3. Coping scale for family caregivers.

Research Tool:

Tool-I

Socio-demographic baseline data among caregivers of mentally ill patients consist items include (age, gender, marital status, education, occupation, monthly income of caregivers, duration of patient illness and duration of care giving, and relationship with patient, type of family, health expenditure in rupees) and baseline data of mentally ill patients include 6 items were age, gender, marital status, patience diagnosis and number of OPD in month and days in IPD.

Tool-II

Burden scale for family Caregivers:

Was used to assess burden among caregivers of mentally ill patient consist of 15 items related to the care of client who were mentally ill. The questions were organized under three domains, namely physiological (4 items), psychological (6 items) and sociological (5 items). The total score had been obtained with a mean and standard deviation of 27.86±6.630.

Scoring of Structured Tool on Burden of care

S. No.	Median value
1	<(27) Median (Less burden)
	³(27) Median (High burden)

Tool-III:

Coping Scale for family caregivers:

Was used to assess coping strategy among caregivers of mentally ill patients consist of 16 items and were organized under three domains, namely physiological(4 items), psychological (8items) and sociological(4 items).

The total score had been obtained with a mean and standard deviation of 43.61±5.918

The responses were given by below median (<43) applying less coping and (³43) applying sufficient coping strategy.

ETHICAL CONSIDERATION:

1. Administrative permission will be taken from the Principal, Himalayan college of Nursing, SRHU.

2. Institute ethical clearance from SRHU ethical committee

3. Permission will be taken from medical superintendent, Himalayan Hospital, Dehradun, Uttarakhand.

4. Tool will be prepared according to ethical guidelines of ICMR.

5. Written informed consent will be obtained from each participant.

Reliability:

Tools were administered on 20 Caregivers of Mentally Ill Patients Who Fulfilled Inclusion Criteria.

Burden scale for family caregivers:

· Test-retest method by using “Spearman formula”

r = 0.81; Validated from 7 experts, (Which was found to be reliable).

Coping scale for family caregivers strategies:

Test-retest method by using “spearman formula”

r = 0.88, Validated from 7 experts, which was found to be reliable.

Pilot Study:

Conducted sample size which is 13 samples as calculated. The pilot study was conducted to evaluate the feasibility of the research work as well as to assess the utmost fault in selected technique, and amp; to decide the analysis plan.

Data Analysis and Interpretation:

Data collected from sample of 140 caregivers of mentally ill patients attending Psychiatry OPD and Psychiatry IPD in a Himalayan Hospital. The master data sheet was filled with responses given by the study participants. The analysis was made based on the objectives by using SPSS. Retrospective data analysis was done using descriptive (frequency, percentage mean and standard deviation) and inferential statistics (Chi- Square, Fisher’s Exact Test).

RESULTS:

Frequency and percentage distribution of socio- demographic variables of the caregivers:

Two-thirds of the carers of mentally ill patients (61.4%) were between the ages of 20 and 43 years, half of the study participants (57.1%) were male, more than half of the those who care of mentally ill patients (86.3%) were married, and 2.9% were widowed, separated, or divorced. The majority of carers of mentally ill patients (92.1%) were educated, while 7.9% were uneducated; 3/4th of carers of mentally ill patients (72.9%) were employed, while less than 1/4th, or 27.1%, were unemployed or had no job; 2/3rd of participants (62.1%) were mentally ill patients with monthly incomes ranging from 5000 to 20000 /Rs; and the duration of patients with mental illness was greater than one year.

To assess burden of care among caregivers of mentally ill patients in selected hospital Dehradun, Uttarakhand:

2/5^th of the participants in this study were having less burden (46.4%) and half of the caregivers of mentally ill patients showing higher burden (53.6%).

1. To assess coping strategies among caregivers of mentally ill patients in selected hospital Dehradun, Uttarakhand.

Depicts about median <43(45.0%) caregivers were applying less coping strategies and median ³43(55.0%) caregivers were applying higher coping strategies.

2. To find out the co-relation between burden of care and coping strategies among caregivers of mentally ill patients.

Burden of care and coping strategies among caregiver’s of mentally ill patient’s having positive correlation were 0.96 which was statistically not significant.

3. To find out the association between burden of care among caregivers of mentally ill patients with their selected demographic variable.

Burden of care among caregivers of mentally ill patients with their selected demographic variables that caregivers have statistically significant association between the age, education level, duration of patients illness and duration of care giving to mentally ill patients is significant at level of 0.05*p value. No association were found with gender, marital status, occupational status, Monthly Income, Relationship with Patient, Type of family, Health expenditure.

4. To find out the association between coping strategies with selected demographic variables among caregivers of mentally ill patients.

There is statistically significant association with coping strategies are marital status, educational level, type of family, and health expenditure having significant at level of 0.05 *p value.

No association were found with age, gender, occupational status, monthly income of caregivers, duration of care giving, relationship with patients, type of family.

Table No 1. Mean and Standard deviation of burden of care among caregivers of mentally ill patients n=140

Domains of the tool	Mean±SD	Range
Domains of the tool	Mean±SD	Minimum	Maximum
Physiological	6.14 ± 2.498	4	13
Psychological	13.74 ± 3.475	6	23
Sociological	7.98 ± 2.306	5	15
Total Burden score among caregivers of mentally ill patients	27.86 ± 6.630	15	44

Table No 2. Median of Burden of care n=140

S. No.

Median value

Frequency

Percentage

<(27) Median

(Less burden)

46.4%

³ (27) Median

³ (High burden)

53.6%

Table No 3. Mean and Standard deviation of coping strategies among caregivers of mentally ill patients n=140

Domains of the tool	Mean ± SD	Range
Domains of the tool	Mean ± SD	Minimum	Maximum
Physiological	12.73 ± 1.340	08	16
Psychological	22.06 ± 3.571	16	30
Sociological	8.81 ± 2.643	04	15
Total Coping score among caregivers of mentally ill patient	43.61 ± 5.918	33	57

Table No 4. Median of coping strategy n=140

S. No.

Median value

Frequency

Percentage

<(43) Median

(less coping)

45.0%

³ (43) Median (sufficient coping)

55.0%

Table No 5. Co-relation between burden of care and coping strategies n=140

Serial No.	Variables	r-value	p-value
1.	Burden of care and Coping strategies	0.96	0.259

DISCUSSION:

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

A finding depicts that caregivers of mentally ill patients having burden of care falling towards domain: Psychological, Sociological, and Physiological. 53.6% of the caregivers were having high burden.

A. Giramalla et al. noted exploratory study to assess level of burden and coping strategies revealed that the caregivers of affective disorders patients was 50% were had moderate to severe level of burden, 6.67% were using inadequate coping strategies.¹¹

B. Another supportive study depicts Sujata C.W. et al (2018) study among caregivers of mentally ill patients having a burden.¹²

2. To assess the coping strategies among caregivers of mentally ill patients:

Findings depicts 55.0% caregivers were found that caregivers applying sufficient coping strategy falling towards the domain psychological, physiological, and least in sociological.

A. The study results were supported by Bharati B. et al (2016) identifies in their study that different problem solving and behavioural strategies (Psychological) utilized by the caregivers. Total mean score of caregivers 96.38 with SD+6.47 (64.25%). FCOPES subscales, acquiring social support, mean score was 27.81 with SD +3.95 (61.80%).¹³

3. To find out the correlation between burden of care among caregivers of mentally ill patients:

Spearman Correlation Coefficient was used. Study depicts that there is positive correlation between burden of care and coping strategies among caregivers of mentally ill patients that is 0.96 which was statistically not significant.

A. The supportive study Renuka A. et al (2020) undergone study in which Caregivers use different Strategies to cope with their burden. Positive correlation between caregivers’ burden and coping strategies. Mean score and SD of using Active coping as coping strategies was 6.97±1.167, followed by acceptance 6.28±1.621 and Religion 6.28±1.471.¹⁴

B. Results of study were contradictory by Mishra S.K. et al (2016) of caregiver burden and coping strategies in schizophrenia patient in which there was no positive correlation. 36 admitted cases their caregivers were selected. 47.2% caregivers were having severe burden, and most severely affected were physical and mental health, caregiver's routine.¹⁵

4. To find out the association between burden of care with their selected demographic variables among caregivers of mentally ill patients.

Study depicts that there association of burden of care with selected demographic variables among caregivers with age, education, duration of care giving at the significance level of (p<0.05).

A. The supportive study by Amal A. et al (2018) revealed in study indicated a significant positive correlation between level of burden with marital status, level of education. Descriptive correlation design was used. Convenient sample of family caregivers included.¹⁶

B. The result of this study is contradictory by Nidesh S. et.al (2020) depicts that there is no association between Burden of care with their selected demographic variables at the significance level of (p< 0.05). Caregivers (66%) had severe burden, 28% had moderate to severe burden and six percent of them had mild to moderate burden.¹⁷

5. To find out the association between coping strategies with their selected demographic variables among caregivers of mentally ill patients:

In this Finding depicts, there is association of coping strategy with selected demographic variables of caregivers with education, health expenditure, marital status, and type of family at the significance level of (P< 0.05).

A. The supportive study by Rajesh k. et al. (2016) revealed in their study that socio-demographic feature gender of the caregivers was found to significantly associated. Convenience sampling technique was used, 32 caregivers were interviewed, “Family Burden Interview Schedule (FBIS)” and “Coping Checklist (CCL)”were used.¹⁸

B. Using convenience

C. sampling technique, 32 relatives/caregivers were interviewed using semi-structured “Family Burden

D. Interview Schedule (FBIS)” and “Coping Checklist (CCL)

E. Using convenience

F. sampling technique, 32 relatives/caregivers were interviewed using semi-structured “Family Burden

G. Interview Schedule (FBIS)” and “Coping Checklist (CCL

B. The contradictory study was done by Nirmala S. revealed in their study that association between caregivers coping strategies and selected demographic variables of caregivers shows no statistical association.¹⁹

LIMITATION OF THE STUDY:

The study was confined to a small sample size and as used convenience sampling technique to select the sample which may limit the generalization of the study.

· The investigator has to rely on responses of the participants.

· The study was limited to only Psychiatry OPD and IPD and sometimes difficult to assess the burden of care and coping strategies due to lack of time.

· Some caregivers of mentally ill patients who were in inclusion criteria in present study had not spent much time during data collection.

· Different cultural beliefs interfere with caregivers’ care giving process and coping strategy.

RECOMMENDATION:

1. A parallel study may be implicated on huge sample size of caregivers of mentally ill patients

2. A related study can be headed in other settings to know the burden of care and coping strategies of caregivers as per nurses, perspectives and comparative study.

3. A similar study can be carried out to assess the burden of caregivers of elderly living with organic brain disorder

4. A descriptive study can be done to identify the factors contributing to an organic brain disorder in a community setting.

5. An interventional study can be done on burden of care of primary caregivers of elderly with mental illness with the view of an instructional module to deal with the elderly living with mental illness.

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Received on 13.05.2023 Modified on 29.06.2023

Int. J. Nur. Edu. and Research. 2023; 11(4):293-298.

DOI: 10.52711/2454-2660.2023.00066