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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 21  |  Issue : 2  |  Page : 59-64

Resilience and sociooccupational functioning among caregivers of obsessive-compulsive disorder


1 PhD Scholar, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
2 Additional Professor, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
3 Professor and Head, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
4 Professor, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Date of Submission13-Aug-2020
Date of Acceptance27-Oct-2020
Date of Web Publication14-Jan-2021

Correspondence Address:
Dr, B P Nirmala
Additional Professor, Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AMH.AMH_25_20

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  Abstract 


Context: Obsessive-compulsive disorder (OCD) is known to cause significant burden to patients and their caregivers. Variables like stress, anxiety, depression, associated psychiatric co-morbidly, functionality, quality of life, family accommodation, stigma, and social support has been studied extensively, but the caregiver functionality has been overlooked. There is limited data on resilience and psycho social functioning in caregivers of OCD.
Aims: The current study examines the level of socio occupational functioning and resilience in caregivers of persons with obsessivecompulsive disorder (OCD).
Settings and design: In our study 200 DSM5 OCD adult patients evaluated using Mini International Neuropsychiatric Interview (MINI) and the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and their healthy primary caregivers were recruited in OCD clinic NIMHANS.
Material and Methods: Caregivers were evaluated using the socio-demographic MINI, Resilience and Socio-Occupational Functioning Assessment Scale (SOFAS), in a cross-sectional interview.
Statistics: Means and Standard Deviations (SD) were calculated for continuous variables; frequencies and percentages for categorical variables, for descriptive analyses. Shapiro-Wilk test was used to test the normality of data. Based on the distribution of the data, Pearson Correlation tests were used.
Results: Patients had a mean YBOCS score of 25.8 (±5.4), 118/200(59%) had contamination/washing as the principle symptom. Caregivers of the OCD adult patients had varied levels of (17.22±9.09) resilience and moderate to severe impairment in (55.67±16.53) socio occupational functioning.
Conclusions: Study result shows that higher the resilience better the socio occupational functioning in caregivers. Promoting a resilient coping style in caregivers would increase their socio occupational functioning.

Keywords: Caregivers OCD, Resilience, socio-occupational functioning


How to cite this article:
Murthy NS, Nirmala B P, Pandian R D, Reddy Y C. Resilience and sociooccupational functioning among caregivers of obsessive-compulsive disorder. Arch Ment Health 2020;21:59-64

How to cite this URL:
Murthy NS, Nirmala B P, Pandian R D, Reddy Y C. Resilience and sociooccupational functioning among caregivers of obsessive-compulsive disorder. Arch Ment Health [serial online] 2020 [cited 2021 Apr 14];21:59-64. Available from: https://www.amhonline.org/text.asp?2020/21/2/59/306864




  Introduction Top


Obsessive-compulsive disorder (OCD) is a chronic, distressing, and disabling illness, which is characterized by obsessive thought and compulsive behavior. It is a common psychiatric illness with a prevalence of 2%–3% and is one of the 10 leading causes of disability worldwide.[1] OCD inflicts a huge burden on the society.[2] This disorder generates an additional burden for relatives, which may, in turn, affect the family dynamics caregivers (parents, spouse, and other family members) often become involved in the individual's ritualistic behaviors either through enabling avoidance or assisting ritualistic behaviors.[3] They often feel confused and frustrated by the symptom of OCD. OCD is typically considered an individual phenomenon, but effects are not restricted to the individual with the disorder alone. Understandably, the family may find it difficult to cope with the exaggerated behavior seen members with OCD and may not know how to handle the situation. Hence, the study focuses on resilience which represents the ability to bounce back and sociooccupational functioning is a person's role, action, and activity expected to perform by people, explained the association between the resilience and sociooccupational functioning of the caregivers.


  Methodology Top


Aims and objectives

The objectives of the present study were to examine the level of sociooccupational functioning and resilience in caregivers of persons with OCD and examine the sociodemographic and clinical correlates of variables.

This cross-sectional study was conducted from April 2017 to February 2019. The sample consisted of 200 OCD patients recruited through consecutive sampling (n = 200) according to DSM-5 criteria and their (n = 200) healthy primary caregivers were recruited, from the OCD clinic at NIMHANS Bengaluru.

Research design

The study adopted a cross-sectional research design.

Universe

Primary caregivers involved in providing care for persons with OCD, attending OCD clinic NIMHANS, were considered as the universe of the study.

Population

Participants were recruited from the specialty OCD Clinic of the National Institute of Mental Health And Neurosciences (NIMHANS) Bengaluru, India. Patients who have diagnosed to have OCD, along with their healthy primary care giver who sought help for the OCD at the Inpatient and Outpatient services of NIMHANS OCD specialty clinic.

Sampling procedure

A consecutive sampling method was used for the recruitment of the participants. 200 consecutive consenting patients with OCD and one primary caregiver for each of the patients have been recruited for the study.

Patient

Patients with serious concomitant medical disorders and with severe physical ailments that can impair significant physical/ occupation performance were excluded from the study. Patients with psychotic illnesses, bipolar disorders and clinical evidence of intellectual disability were also excluded.

Exclusion criteria

Patient

Person with intellectual impairment, person with comorbid diagnosis of psychosis, bipolar disorders, alcohol/substance dependence, and severe neurological disorders including dementia were excluded.

Caregivers

Caregiver with intellectual impairment and caregiver with psychosis, bipolar disorders, alcohol/substance dependence, and severe neurological disorders were excluded.

Researcher conducted the assessment using the following instruments

Sociodemographic schedule is prepared by the researcher for the patients and caregivers. Kuppuswamy socioeconomic scale, Mini International Neuropsychiatric Interview (MINI) as a screening tool, YBOC checklist and Yale-Brown Obsessive Compulsive Severity Scale (YBOCS), CGI, Insight 11, and avoidance were used for patients. MINI, Sociooccupational Functioning Assessment Scale (SOFAS), and Connor Davidson Resilience Scale were used for caregivers. The data were collected using the interview method.

Ethical consideration

The study was approved by the institutional ethical committee and informed consent was taken before the start of the assessment from both patients and caregivers. Ref: NIMH:AandE/C:PhD(PSW):2016-17:NS.

Scale description

Connor Davidson Resilience Scale

Primary caregivers of all adult person with OCD aged 18-60 years and residing with the patient at least for a year, who provided written informed consent before participation in the study were included.

The 10-item CD-RISC which is uni-dimensional, was administered to measure resilience. The scale assesses one's ability to endure difficult experiences, including “change, personal problems, illness, pressure, failure, and painful feelings.” It has got good internal consistency and constructs validity.[4]

The CD-RISC 10 is a unidimensional self-reported scale consisting of 10-item measuring resilience. Respondents rate items on a 5-point Likert scale, ranging from 0 (not true at all) to 4 (true nearly all the time). Each item has a minimum score of 0 and a maximum score of 4.

The sociooccupational functioning scale (SOFAS) is a new scale that differs from the Global Assessment of Functioning (GAF) Scale in that it focuses exclusively on the individual's level of social and occupational functioning. The SOFAS is usually used to rate functioning for the current period (i.e., the level of functioning at the time of the evaluation). The SOFAS may also be used to rate functioning for other time periods. For example, for some purposes, it may be useful to evaluate functioning for the past year (i.e., the highest level of functioning for at least a few months during the past year).[5]

Statistical analysis

Means and standard deviations (SD) were calculated for continuous variables; frequencies and percentages for categorical variables, for descriptive analyses. Shapiro–Wilk test was used to test the normality of data. Based on the distribution of the data, Pearson correlation tests were used to see the correlation between the caregiver's resilience and the relevant sociodemographic and clinical characteristics of the participants.


  Results Top


[Table 1] elicit the sociodemographic data of the patients, we find that the sample was an almost equally distributed among both the gender, age was observed between 18 and 59 years, literature shows equal prevalence in both genders, the present sample is majority of 55% female.[6],[7] The mean education in years was 12.21 ± 3.31, 43% were unemployed, and 52% were married. Majority of them were from Hindus. These data show that patients were not functioning well with moderate-to-severe degree of illness.
Table 1: Characteristics of patients in the sample (n=200)

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Regarding the clinical data, most of the sample was drawn from outpatient setup, having a diagnosis of OCD mixed; for majority of the sample, the mean age at the time of onset was 24 years and most of them had a mean duration of illness of about 3 years. Most had no previous psychiatric consultations, had a continuous course of illness, and were compliant. This sample predominantly has patients having a chronic illness. The data related to clinical characteristics of the study sample revealed that the mean age at onset of OCD is 21.6 (±7.53) years. The mean score of YBOCS of patients is 25.75 with SD ± 5.39. These scores indicate that these patients currently moderate to severe obsessive-compulsive symptoms. Most of them had fair to good insight into their illness.

[Table 2] depicts the sociodemographic data of the caregivers, we find that the sample was a predominantly male sample, between 25 and 59 years, of the caregivers are spouses and caregivers. The mean age is 44.78 ± 8.99, male representation is 57.5%, mean education is 10.65 ± 4.6, had studied up to secondary school, were employed, and were married. They had been living with the patient and taking care of the patient's day to day needs. The mean family income in (24025 ± 22924.4) financial effect is the most rottenly expressed concern, followed by work and difficulty in day to day family functioning. Majority of 48% are from the lower middle class. Majority of them are from Hindu 90% background, majority of 72% are from nuclear family, majority of 41% belong to the rural background.
Table 2: Characteristics of the caregivers in the sample (n=200)

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The significant findings of the correlation between the sociodemographic data, Socio-occupational functioning and resilience were mentioned [Table 3]. Age, education of the caregivers and YBOCS symptom were significantly correlated with socio occupational functioning and resilience.
Table 3: Correlations table

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  Discussion Top


In India, much investigation has been done on persons among OCD covering a range of variables and issues such as stress, anxiety, depression, associated psychiatric comorbidly, functionality, quality of life, family accommodation, stigma, and social support, but the caregiver functionality has been overlooked.

Resilience in caregivers of persons with OCD is not given much attention. The study indicated that caregivers had varied resilience levels. Few had poor resilience and very few had good resilience levels 17.22 ± 9.09. A very strong positive correlation was found among resilience and SOFAS. However, there is a paucity of research regarding the resilience of OCD caregivers of adult patients.

Managing OCD requires a focus on day-to-day coping rather than on an ultimate cure. Several researchers have proposed that family support is necessary for clients to benefit from behavioral therapy. Implementation of ERP, CBT, and other behavioral therapy techniques by caregivers is not easy, especially in a country like India in the home context. Focusing on resilience in caregivers can help them to manage family accommodative behavior such as not giving reassurance, not to take part in doing any proxy compulsions, stopping from avoidance behavior, modifying family routine, and not taking patients' responsibility.

The sociooccupational functioning of the caregivers was assessed using SOFAS. The current study findings showed that caregivers had moderate to severe level impairment in 55.67 ± 16.53 of individual's functioning difficulty such as social, occupational, or school functioning (e.g., few friends, conflicts with peers, relatives, or coworkers). Our results show that higher the severity of the illness poorer the sociooccupational functioning of the caregiver.

Severe cases of OCD can cause an extreme amount of sociooccupational dysfunction, and it can dramatically interfere with a caregiver's daily life. OCD creates a considerable financial burden on society due to disability, use of general and specialized health services, and hospitalization.[8] As this is the first study to look at caregivers' sociooccupational functioning with respect to OCD, we could not compare the data with existing literature.

Greater objective burden disruption of family leisure and interaction on the caregivers due to OCD has been studied extensively by Grover and Dutt.[9] In an Indian study, severe OCD was associated with significant disability, poor quality of life, and high family burden, often comparable to schizophrenia.[10] The role of the primary caregivers is stressful. They are unable to balance between providing care for a loved one and maintaining their own health status.[11] The long duration of caregiving leads to loss of friends, social isolation, loss of intimacy, anxiety, and depression of the caregivers.[12] Illness severity and patient disability have a direct positive relationship, which is similar to our findings.[13] These studies explain that the role of caregiver is burdensome and stressful. OCD has been associated with high levels of distress, frequent comorbid depression, social isolation, and occupational disability.[14],[15] This relates to low self-esteem, interference with family functioning, difficulty maintaining relationships, academic, and career under-achievement, and suicidality,[16] but how it affects the sociooccupational functioning of the caregiver has not been studied. Our study addresses this gap in research and tells how resilient coping style can diminish the risk of sociooccupational dysfunction and promote adaptation in the caregiver.


  Conclusion Top


Building resilience in caregivers may really help them to improve their psychosocial functioning. Healthy primary caregivers would influence better clinical outcomes. Hence, resilient coping styles can diminish the risk of sociooccupational dysfunction and promote adaptation in the caregiver.

Strength of the study

It included all the consecutive patients and caregivers who approached NIMHANS services with obsessive-compulsive symptoms; therefore, it would be a representative sample of patients with OCD who seek treatment from the tertiary care center. The present study had a relatively large sample size, which helped in the higher generalizability of the results. Consecutive sampling is typically better than convenience sampling in controlling sampling bias. We have used structured assessment tools, which allowed the researcher to evaluate the patients systematically. Such a study on the resilience and sociooccupational functioning of the caregivers of OCD for such a big sample has not been done so far. The nature and severity of the illness and its relationship with the sociooccupational functioning of the caregivers have been studied. You already mentioned structured scales.

Limitation

The study had relied on the hospital population rather than the community sample. The emotional climate and interaction patterns within the family were not measured. It was an observational study assessed in a cross-sectional way. There was no baseline assessment with comparable groups.

Acknowledgment

The authors would like to extend the utmost gratitude to all the patients and caregivers who have participated in the study and to Dr. Srinivas Balachandar for statistical analysis throughout the study.

Financial support and sponsorship

This study was financially supported by CIHR-Project: mood stabilizer plus antidepressant versus mood stabilizer plus placebo in the maintenance treatment of bipolar disorder.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the connor–davidson resilience scale (CD-RISC): Validation of a 10-item measure of resilience. Journal of Traumatic Stress: Official Publication of The International Society for Traumatic Stress Studies, 2007;20:1019-1028.  Back to cited text no. 4
    
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Kalra H, Nischal A, Trivedi JK, Dalal PK, Sinha PK. Extent and determinants of burden of care in Indian families: A comparison between obsessive-compulsive disorder and schizophrenia. International Journal of Social Psychiatry, 2009;55:28-38.  Back to cited text no. 13
    
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Dell'Osso B, Allen A, Hollander E. Fluvoxamine: A selective serotoninre-uptake inhibitor for the treatment of obsessive-compulsive disorder. Expert Opin Pharmacother 2005;6:2727-40.  Back to cited text no. 14
    
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Altman SE, Shankman SA. What is the association between obsessive-compulsive disorder and eating disorders?. Clinical psychology review, 2009;29:638-46.  Back to cited text no. 15
    
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Stein DJ, Roberts M, Hollander E, Rowland C, Serebro P. Quality of life and pharmaco-economic aspects of obsessive-compulsive disorder: a South African survey. South African Medical Journal, 1996;86 (12 SUPPL.), 1579-85.  Back to cited text no. 16
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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