|Year : 2018 | Volume
| Issue : 1 | Page : 19-23
Caregiver burden in alcohol dependence syndrome in relation to the severity of dependence
RS Swaroopachary1, Lokesh Kumar Kalasapati2, Sarath Chandra Ivaturi1, C M. Pavan Kumar Reddy3
1 Department of Psychiatry, SVS Medical College, Mahboobnagar, Telangana, India
2 Department of Psychiatry, Bhaskar Medical College, Hyderabad, Telangana, India
3 Department of Psychiatry, Shadan Institute of Medical Sciences, Hyderabad, Telangana, India
|Date of Web Publication||26-Jun-2018|
Dr. R S Swaroopachary
Department of Psychiatry, SVS Medical College, Mahboobnagar - 509 001, Telangana
Source of Support: None, Conflict of Interest: None
Background: Alcohol dependence is a maladaptive pattern of substance use for a period of 12 months, which is characterized by tolerance, withdrawal symptoms, loss of control, and craving. Burden is defined as the presence of problems, difficulties, or adverse events which affect the life (lives) of the psychiatric patient's significant others. Objective burden is used to identify anything that occurs as a disrupting factor in family life owing to the patient's illness while subjective burden refers to the feeling that a burden is being carried in a subjective sense.
Aims: To compare the amount of burden among the caregivers with the severity of alcohol dependence in patients.
Methodology: Severity of Alcohol Dependence Questionnaire is used to determine the severity of their condition in alcohol-dependent patients. Caregivers were administered Family Burden Interview Schedule to assess the burden experienced by them. The diagnosis of alcohol dependence syndrome is made in accordance to the ICD-10 criteria.
Results: Severe burden is more seen in females, unemployed, in families where domestic violence is present.
Conclusions: More severe is the dependence, more is the amount of burden experienced by the caregivers.
Keywords: Alcohol dependence syndrome, caregiver burden, severity of dependence
|How to cite this article:|
Swaroopachary R S, Kalasapati LK, Ivaturi SC, Reddy C M. Caregiver burden in alcohol dependence syndrome in relation to the severity of dependence. Arch Ment Health 2018;19:19-23
|How to cite this URL:|
Swaroopachary R S, Kalasapati LK, Ivaturi SC, Reddy C M. Caregiver burden in alcohol dependence syndrome in relation to the severity of dependence. Arch Ment Health [serial online] 2018 [cited 2021 Apr 14];19:19-23. Available from: https://www.amhonline.org/text.asp?2018/19/1/19/235322
| Introduction|| |
Alcohol dependence is a maladaptive pattern of substance use for a period of 12 months, which is characterized by tolerance, withdrawal symptoms, loss of control, and craving. The 1-year prevalence of alcohol abuse and dependence is estimated to be 6% or more. General population surveys in India have reported a prevalence of alcohol use ranging from 1.15% to 50%., Excessive partner alcohol use increased the risk for mental health disorders above and beyond significant sociodemographic risk factors, including older age, poor education, fewer children in the home and lack of paid employment, with an associated population-attributable fraction of 17.5%. Partner violence and partner alcohol-related problems mediated the association of partner excessive alcohol use with women's common mental health disorders.
Burden is defined as the presence of problems, difficulties, or adverse events which affect the life (lives) of the psychiatric patient's significant others. Families of patients with mental illness face stigmatization, long-term economical and emotional burden of taking care of the patient. Illness in the patient has an impact on the work, social relationship, and leisure activities of family members. This evokes different feelings in the family members, which can have an impact on the course and prognosis of the illness.
Hoenig and Hamilton were the first to make a clear distinction between objective and subjective burden. Objective burden is used to identify anything that occurs as a disrupting factor in family life owing to the patient's illness  while subjective burden refers to the feeling that a burden is being carried in a subjective sense. Bhowmick et al. reported that the presence of individual with alcohol or drug dependence in the family affects various aspects of family such as leisure time activities, family and social relationships, and finances.
Thus, an overall limitation of the preexisting research is the lack of simultaneous examination of different psychosocial risk factors and thereby, a limited understanding of the interrelationships between such factors in women's poor mental health.
- To know the prevalence of alcohol dependence syndrome in relation to the sociodemographic variables
- To assess the severity of alcohol dependence among the patients
- To assess the caregiver burden among the primary caregivers
- To compare the amount of burden among the caregivers with the severity of alcohol dependence in patients.
| Methodology|| |
This is a cross-sectional hospital-based study. The study was conducted in the In-patient Department of Psychiatry, SVS Medical College and Hospital. This is a tertiary care hospital, providing specialist clinical care to Mahbubnagar and the adjoining districts. The present study was conducted for 6 months, i.e., from November 1, 2016 to April 30, 2017. The study sample was collected from patients admitted for alcohol dependence syndrome and their caregivers. Patients were selected consecutively. The study sample consisted of seventy patients diagnosed to have alcohol dependence syndrome and their respective caregivers.
Patients and their caregivers fulfilling selection criteria were approached and informed consent was obtained. Interview was carried out after 2 weeks to rule out the possibility of the presence of withdrawal symptoms in alcohol-dependent patients.
Clinical and sociodemographic details of patients and their caregivers were collected using a semi-structured proforma. Severity of Alcohol Dependence Questionnaire  is used to determine the severity of their condition in alcohol-dependent patients. Caregivers were administered Family Burden Interview Schedule  to assess the burden experienced by them. Assessments were cross-sectional and nonblind. The diagnoses of alcohol dependence syndrome are made in accordance to the ICD-10 criteria.
- Availability of caregivers
- Age of patient and the caregiver should be >16 years
- Both should be physically fit to answer the questions.
- Patients and their caregivers taking any medication, which can produce cognitive and other psychological defect
- Patients and their caregivers with other co-morbid general medical condition, those needing urgent attention for physical problems
- Patients without caregivers who can give reliable and adequate information
- Those who did not give consent for the study.
| Results|| |
[Table 1] shows the sociodemographic variables of patients and caregivers. The total number of patients are 70 (n = 70). The mean age of patients is 37.76 ± 7.84. All patients were males. With reference to education, the sample was divided into four categories: illiterate, <5 years, 6–10 years, and >10 years. Majority are employed. Depending on the family income, patients were divided into four categories: <5000 Rs./month, 5000–10,000 Rs./month, 10,000–15,000 Rs./month, and >15,000 Rs./month. Majority of the patients were in the category of <10,000 Rs./month. Majority of the patients belonged to nuclear family. Majority are from rural locality. The mean of age of caregivers among alcohol-dependent patients is 33.03 ± 9.17. All the caregivers of alcohol-dependent patients were females. Majority of the caregivers were unemployed.
[Table 2] shows the comparison of sociodemographic variables with the severity of caregiver burden.
|Table 2: Comparison of sociodemographic variables with burden in caregivers of ADS|
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The mean age of the caregivers is 33.03 ± 9.17. Comparing the amount of burden among the three age groups, it is found that burden is more seen in age groups of 16–30 years and 31–45 years than in caregivers whose age is >45 years. Young caregivers experience more burden. This may be because of the presence of any dysfunctional and disabled family member effects their mental health and brings down their productivity. Education level of the caregivers is divided into four subgroups of illiterate, 0–5 years, 6–10 years, and >10 years. Burden, when compared among these four subgroups, it is found that there is not much difference observed in our study.
Comparison of severity of alcohol dependence in patients and burden in caregivers is depicted in [Table 3]. In our study, it is found that severe burden is seen in caregivers of patients having severe alcohol dependence.
|Table 3: Comparison of severity of alcohol dependence in patients and burden in caregivers|
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| Discussion|| |
Burden is more experienced by the caregivers who are unemployed than the employed group. This is an obvious fact as unemployment precedes the poverty and impoverishment which inevitably is a cause for burden. Burden in caregivers is not much affected in relation to the duration of marital life. Severe burden is more commonly seen in those families where domestic violence is present.
Drunkenness and alcohol misuse by the male partner are associated with poor mental health and spousal violence among married women in India.,, Kendler et al. have noted the multifactorial nature of depression, highlighting the role of stressful life events and negative interpersonal relations. Specifically, risks associated with male partners' alcohol use problems for women's depression have been shown to present an additive burden to women's mental health, exceeding those associated with women's own alcohol use disorders or domestic violence.,
The association between these two variables is statistically significant (P < 0.05). This is an obvious and self-explanatory finding as alcohol dependence in individual effects his physical and mental health which causes a terrible plight in the caregivers. Women whose partners had alcohol problems were more likely to experience victimization, injury, mood disorders, anxiety disorders, and being in fair or poor health than women whose partners did not have alcohol problems. They also experienced more life stressors and had lower mental/psychological quality-of-life scores. Partner alcohol problems pose diverse health threats for women that go beyond their well-documented association with domestic violence.
Alcohol ranks high as a cause of disease burden. Drunkenness and alcohol misuse by the male partner are associated with poor mental health and spousal violence among married women in India.,, Research outside India documents that men's alcohol problems increase the risk of depression in their female partners;,, exceeding the risks associated with women's own alcohol use disorders or spousal violence.
Gender inequities play a key role in women's health,, including in the impact of spousal violence  but have not been included in studies on partner alcohol use and women's mental health. Alcohol misuse represents a public health crisis in India that has yet to receive adequate attention., Similarly, most studies do not include women's own alcohol use and may overestimate associations between partner alcohol use and depression in women.
| Summary and Conclusions|| |
- The mean age of patients is 37.76 ± 7.84. All patients were males and majority are employed. Majority of them had a family income <10,000 Rs./month. Majority belonged to nuclear family and belonged to rural locality
- The mean of age of caregivers among alcohol-dependent patients is 33.03 ± 9.17. All the caregivers of alcohol dependence patients were females. Majority of the caregivers were unemployed
- More amount of burden is seen in age groups of 16–30 years and 31–45 years than in other age groups
- In the caregivers of ADS, severe burden is more seen in females, unemployed, in families where domestic violence is present
- Difference in educational level did not contribute to any difference in the burden experienced by caregivers
- More severe is the dependence, more is the amount of burden experienced by the caregivers.
- The time-bound nature of the study dictated a small sample size
- All the patients with alcohol dependence syndrome were male and all their caregivers were females of whom most of them are spouses of the patients
- Restricted nature of sample means that the findings are not readily applicable to other population
- Assessment was cross-sectional and nonblind
- Those who did not/never attend outpatient department were obviously out of study
- On direct enquiry, there could be chances of wrong information
- Several factors such as coping, expressed emotions were not assessed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, IV Edition Text Revision. Washington, DC: American Psychiatry Association; 2000.
Schuckit MA. Alcohol related disorders. In: Sadock BJ, Sadock VA, editors. Kaplan and Sadock's Comprehensive Textbook of Psychiatry. 8th
ed. Philadelphia: Lippincott Williams and Wilkins; 2005. p. 1168-87.
ICMR-CAR-CMH. Longitudinal Study of Mental Health Problems in a PHC Area. Indian Council of Medical Research Centre for Advanced Research on Community Mental Health. NIMHANS, Bangalore, Unpublished Report; 2017.
Chakravarthy C. Community workers estimate of drinking and alcohol related problems in rural areas. Indian J Psychol Med 1990;13:49-56.
Platt S. Measuring the burden of psychiatric illness on the family: An evaluation of some rating scales. Psychol Med 1985;15:383-93.
World Health Organization. Burden of Mental and Behavioral Disorders, the World Health Report, Mental Health: New Understanding, New Hope. Geneva: World Health Organization; 2001.
Hoenig J. The de-segregation of the psychiatric patient. Proc R Soc Med 1968;61:115-20.
Hoenig J, Hamilton MW. The burden on the household in an extramural psychiatric service. In: Freeman H, Farndale J, editors. New Aspects of the Mental Health Services. London: Pergamon; 1967. p. 612-35.
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.
] [Full text]
Stockwell T, Murphy D, Hodgson R. The severity of alcohol dependence questionnaire: Its use, reliability and validity. Br J Addict 1983;78:145-55.
Pai S, Kapur RL. The burden on the family of a psychiatric patient: Development of an interview schedule. Br J Psychiatry 1981;138:332-5.
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorder, Tenth Revision. Geneva: World Health Organization; 1992.
Kumar S, Jeyaseelan L, Suresh S, Ahuja RC. Domestic violence and its mental health correlates in Indian women. Br J Psychiatry 2005;187:62-7.
Peedicayil A, Sadowski LS, Jeyaseelan L, Shankar V, Jain D, Suresh S, et al.
Spousal physical violence against women during pregnancy. BJOG 2004;111:682-7.
Varma D, Chandra PS, Thomas T, Carey MP. Intimate partner violence and sexual coercion among pregnant women in India: Relationship with depression and post-traumatic stress disorder. J Affect Disord 2007;102:227-35.
Kendler KS, Kessler RC, Neale MC, Heath AC, Eaves LJ. The prediction of major depression in women: Toward an integrated etiologic model. Am J Psychiatry 1993;150:1139-48.
Homish GG, Leonard KE, Kearns-Bodkin JN. Alcohol use, alcohol problems, and depressive symptomatology among newly married couples. Drug Alcohol Depend 2006;83:185-92.
Dawson DA, Grant BF, Chou SP, Stinson FS. The impact of partner alcohol problems on women's physical and mental health. J Stud Alcohol Drugs 2007;68:66-75.
Ovuga E, Madrama C. Burden of alcohol use in the Uganda police in Kampala district. Afr Health Sci 2006;6:14-20.
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.
Moss NE. Gender equity and socioeconomic inequality: A framework for the patterning of women's health. Soc Sci Med 2002;54:649-61.
Murphy EM. Being born female is dangerous for your health. Am Psychol 2003;58:205-10.
Neufeld KJ, Peters DH, Rani M, Bonu S, Brooner RK. Regular use of alcohol and tobacco in India and its association with age, gender, and poverty. Drug Alcohol Depend 2005;77:283-91.
Benegal V. India: Alcohol and public health. Addiction 2005;100:1051-6.
[Table 1], [Table 2], [Table 3]