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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 164-168

Comparison of psychiatric morbidity and quality of life among caregivers of substance abusers


1 Department of Psychiatry, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
2 Department of Clinical Psychology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India

Date of Submission10-Jul-2021
Date of Decision25-Jul-2021
Date of Acceptance01-Aug-2021
Date of Web Publication28-Oct-2021

Correspondence Address:
Dr. Rupesh Chaudhary
Department of Psychiatry, Dayanand Medical College and Hospital, Ludhiana, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aip.aip_86_21

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  Abstract 


Background: The effects of substance abuse are extended to primary caregiver who is vulnerable for psychiatric disorders and decreased quality of life (QOL). Aim: The aim of the study is to determine and compare the psychiatric morbidity and QOL in caregivers of various substance abusers (alcohol/opioid/alcohol + opioid dependence). Methodology: This cross-sectional study was conducted on caregivers of equal number of patients with alcohol/opioid/alcohol + opioid dependence presenting to Department of Psychiatry of a tertiary care center. The data were collected on sociodemographic parameters; psychiatric morbidity was assessed using the Mini-International Neuropsychiatric Interview (M. I. N. I.) questionnaire and the QOL was assessed by WHO-QOL BREF scale. Statistical analysis: The data were statistically analyzed on SPSS 21 software by using ANOVA, Chi-square, and Kruskal–Wallis tests. Results: Most of the caregivers were females. Out of 90 caregivers of each alcohol/opioid/alcohol + opioid dependence patients, 28.8% had dysthymia, 29% had major depression, 6.7% had social anxiety disorder, 13.3% had generalized anxiety disorder, 12.2% of the caregivers were found to have alcohol abuse, 15.5% of the caregivers were found to have substance abuse (nonalcohol), and 27% of the caregivers had no psychiatric morbidity. Deterioration of QOL was seen particularly in psychological and social domain. On comparing QOL, physical domain was affected adversely in caregivers of multiple substance abusers than alcohol dependence. On comparison among opioid dependence and multiple substance abusers, psychological, social, and environmental domains were significantly affected in the latter. The comparison among other pairs was insignificant. Conclusion: Substance abuse is a multidimensional problem which threatens the mental health and the QOL of the family member which needs to be addressed.

Keywords: Caregiver, psychiatric morbidity, quality of life, substance dependence


How to cite this article:
Kumar P, Chaudhary R, Bhalla JK, Mishra B P. Comparison of psychiatric morbidity and quality of life among caregivers of substance abusers. Ann Indian Psychiatry 2021;5:164-8

How to cite this URL:
Kumar P, Chaudhary R, Bhalla JK, Mishra B P. Comparison of psychiatric morbidity and quality of life among caregivers of substance abusers. Ann Indian Psychiatry [serial online] 2021 [cited 2021 Dec 6];5:164-8. Available from: https://www.anip.co.in/text.asp?2021/5/2/164/329436




  Introduction Top


Substance dependence is a “family disease” suffered not only by substance abuser but also by the caregivers[1],[2] as it places the caregiver at risk for developing deleterious physical, psychological, social, and emotional problems such as mood and anxiety disorders.[3],[4] The effects of stress include worry, anger, guilt; financial and emotional strain; marital dissatisfaction and discord; diminution in the quality of life (QOL) of family members; negative impacts on growth and development of children; and physical health consequences.[5] Thus, understanding and addressing these issues would not only decrease their burden and improve their coping skills but also improve their overall QOL.[6]


  Methodology Top


Design

It is a cross-sectional study conducted in Department of Psychiatry of a tertiary care center. After taking Institutional Ethics Committee approval, the primary caregivers of substance abusers were taken in the study after taking their informed consent. The data were statistically analyzed on SPSS 21 software (SPSS 21 version (SPSS Inc., Chicago, IL, USA)) by using ANOVA, Chi-square, and Kruskal–Wallis tests.

Sample size calculation – with power of 80%, assuming the prevalence of 30%, with precision of 10%, and confidence level of 95%, the calculated sample size is 81. Therefore, by rounding off, a sample of 90 was taken for the present study.

Sample selection

The primary caregivers of 90 patients with alcohol/opioid/alcohol + opioid dependence (30 each) were selected for the study using purposive sampling.

Inclusion criteria

  • Primary caregiver of the substance abuser
  • Those caregivers who consent for the study.


Exclusion criteria

  • Any caregiver who is already on psychotropic medications
  • Those caregivers who do not consent for the study.


Scales used

The Mini-International Neuropsychiatric Interview (M.I.N.I.) version 5.0.0, for assessment of psychiatric comorbidity, is a short structured diagnostic interview for DSM-IV and implantable cardioverter-defibrillator-10 psychiatric disorders. It is divided into 16 modules-identified by letters, each corresponding to a diagnostic category. Overall, the MINI diagnoses are characterized by good kappa values. The operating characteristics of the MINI are also good. Sensitivity is 0.70 or greater for all but three values (dysthymia, obsessive-compulsive disorder, and current drug dependence). Specificities, negative predictive values and efficiency scores are 0.85 or higher across all of the diagnoses. Positive predictive values are high for major depression, lifetime mania, current and lifetime panic disorder, lifetime agoraphobia, lifetime psychotic disorder, anorexia, and posttraumatic stress disorder. Inter-rater and test-retest reliabilities are good.[7]

The QOL was assessed by the WHO-QOL Assessment– BREF scale.[8] It consists of 26 items. Each item uses a Likert-type five-point scale. These items are distributed in four domains of physical health, psychological well-being, social relationships, and environment. Domain scores are scaled in a positive direction (higher scores denote higher QOL). The WHOQOL-BREF has been shown to display good discriminant validity, content validity, and test-retest reliability. Domain scores produced by the WHOQOL-BREF have been shown to correlate at around 0.9 with the WHOQOL-100 domain scores.[9]


  Results Top


our study shows that most of the caregivers of substance abusers are middle-aged females, educated upto high school, unemployed related as either mother or spouse of the substance abuser. The mean duration of carer living together with the patient is related in case of multiple substance abusers than with opioid dependent patients. Our study shows that dysthymia and social anxiety disorder are common among carers of alcohol dependence patients; generalised anxiety frequently found in carers of opioid dependent patients whereas major depression, alcohol and non-alcohol abuse being commonly seen among caregivers of multiple substance abusers. In our study, the overall QOL is affected in caregivers of substance abusers. All the 4 domains are affected especially in multiple substance abusers. On comparing QOL among care givers of alcohol and opioid dependence, psychological domain is significantly affected in latter (p 0.05). The comparison among other pairs on various domains of WHO-QOL-BREF was showing non-significant difference. In this study ,the deterioration of QOL of caregivers is seen in all the 3 groups with worst QOL of carers of multiple substance abusers in areas of psychological (p 0.05), social (p 0.05) and environmental (p 0.05) as compared to alcohol and opioid dependence alone.


  Discussion Top


In the presence of dependence, the whole family structure is shaken, however, the family members suffer varying degrees of closeness and distancing, faced with the negative impacts of substance dependence. Commonly in the family, a member assumes the role of caregiver,[11],[12],[13] being the person most directly linked to the care and/or emotionally to person dependent on the drug,[12] a condition that not only directly affects their QOL but also predisposes them to the emergence of depressive symptoms.[13] Most of the caregivers in our study are females [Table 1] which is similar to a study by Barroso et al. with women caregivers of substance abusers around 80.0% of their sample.[14]
Table 1: Distribution of caregivers (n=90)

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A Brazilian study investigating the impact of alcohol abuse in the family found a majority of females caregivers, and among them were mostly the wives.[15] These results reaffirm the literature and reflect the tradition of caring, relegating the responsibility for the care of the sick family member to the woman. Another study with wives of alcohol-dependent men, verified a high frequency of psychological symptoms (70.9%), followed by physical symptoms (19.3%) and physical and psychological symptoms together (3.2%), these findings demonstrate that the participants were found to be more psychologically vulnerable[16] in similar comparison to the psychiatric morbidities found among the caregivers in our study.

In our study, mostly the caregivers were found to be unemployed/dependent members (housewives/mother) [Table 1] and living with the patient since a long time [Table 2]. As in most of the cases, patients were the sole earning member of the family, the money was deviated for procuring the substance and treatment expenditures. Frequent arguments, verbal abuse, and physical abuse of family members under the influence of substance caused significant disruption in the communication between family members, disruption in their leisure activity, and significant adverse impact on caregiver physical and mental health.[17]
Table 2: Distribution with respect to duration of living together

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The present study was conducted with the goal of comparing psychiatric morbidity and QOL among caregivers of substance abusers (alcohol, opioid, and multiple substance abusers) and we found that dysthymia and social anxiety disorder are common among carers of alcohol dependence patients; generalized anxiety frequently found in carers of opioid-dependent patients whereas major depression, alcohol and nonalcohol abuse being commonly seen among caregivers 1 of multiple substance abusers [Table 3] which is in accordance 2 to a study by Lamichhane et al. in 2008.[10]
Table 3: Mini international neuropsychiatric interview questionnaire

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QOL, is an understanding of the situation in which people live with, the cultural context and value systems which is in communication with their goals, aspirations and standards (Barbot, 2001). QOL includes physical and mental function both of which are often related negatively to the psychological (depression and anxiety) and physical outcomes (e.g., bodily pain and physical weakness).[18]

In this study, the overall QOL is affected in caregivers of substance abusers [Table 4]. All the 4 domains are affected, especially in multiple substance abusers. Research has shown that physical and psychological consequences of addiction lead to degradation in the quality of carers of substance abuser (Bizzarri 2005, Smith and Larson 2003). According to research conducted about comparative aspects of family functioning and QOL, drug abusers and their caregivers had lower QOL (Ghamari, 2010).
Table 4: World Health Organization-quality of life BREF

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The results of several studies indicated that physical and mental consequences of addiction can lead to decrease in the quality and life satisfaction (Bizari, 2005 and Smith and Larson, 2003) and a drop in personal interactions, social and mental health of the abuser and their carers (Moalemi, 2010). Factors such as social stress, economic, and psychological have effects on addict and his family members. The various domains such as financial burden, disruption of routine family activities and family interactions, effect on the physical and mental health of others are positively correlated with the severity of addiction. On comparing QOL among caregivers of alcohol and opioid dependence, psychological domain is significantly affected in latter (P = 0.05) which is parallel to the earlier study from India comparing the family burden and life quality of patients with alcohol dependence and opioid dependence by using the Family Burden Interview Schedule showed moderate to severe burden in both the groups.[4]

The comparison among other pairs on various domains of WHO-QOL-BREF was showing nonsignificant difference in our study unlike the study by Aragão et al. in 2009.[19]

In this study, the deterioration of QOL of caregivers is seen in all the 3 groups with worst QOL of carers of multiple substance abusers in areas of psychological (P = 0.05), social (P = 0.05), and environmental (P = 0.05) as compared to alcohol and opioid dependence alone [Table 4]. A study on QOL evaluation among caregivers of chemical dependents using the WHOQOL-BREF showed better scores for physical domain (14.4) and poorer scores for social (13.2), psychological (12.5), and environmental (10.6).[4] It is also evidenced by another study from Nepal[20] among opioid users and alcohol-dependent patients found increased caregiver burden in both the groups; however, the burden was more with opioid users than alcohol-dependent patients. However, a study which assessed the family burden using Family Burden Interview Schedule in 120 subjects of alcohol and/or opioid dependence reported that almost all (95%–100%) caregivers had severe burden and impaired QOL.[4]


  Conclusion Top


The caregivers of substance abusers might themselves develop mental health problems during the process of caregiving the patient. They develop feelings of concern, fear, anger, anxiety, embarrassment, depression, guilt or have enabling behavior, and codependency. They are most often the neglected part in the management of the patient and form the unmet needs of the available standard treatment protocols of the patient. Thus, it is important to involve caregivers in the treatment process for the better prognosis and outcome of the patient in terms of recovery, relapse prevention, and rehabilitation.

Limitations

  • Our study was conducted on a small sample of caregivers of substance abusers which is not representative of the total substance abuser population. This limits the generalization of the results
  • The QOL was self-reported and subjective rather than objective.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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