Depression and anxiety in the caregivers of mentally ill patients

Journal:
January-June 2005 Volume 2(1)

Original Article

Author(s):
Fareed A Minhas, Rashda Saif Niazi, Shabana Basheer, Najma Najam
Page No:
27

ABSTRACT

Objective: This research was a comparative study aimed at assessing the level of depression and anxiety among the caregivers of male and female patients with different psychiatric diagnosis.

Design: It was a Retrospective study.

Place and Duration of the Study: The data was taken from both In and Out patient departments Institute of Psychiatry Rawalpindi General Hospital, Rawalpindi from January 2004 to April 2004.

Subject and Method: The sample consisted of primary caregivers of 50 patients’ of both genders, 25 male and 25 female patients. One primary caregivers of each patient was taken. Hamilton Rating Scale for depression (HAM-D) and HAM-A were used to assess depression and Anxiety. Sample was taken from the out patient department of Rawalpindi general Hospital.

Results: The result of study revealed that caregivers of the patients with psychiatric illnesses have significant high level of depression and anxiety and significant gender differences were also observed. Results showed that caregivers of young male patients have high level of depression as compare to older male patients and young female patient. No significant differences were observed between care givers of young male and female patients. The caregivers of patients carrying the diagnosis of schizophrenia have higher level of depression as compared to caregivers of depression and substance abuse. The duration of illness is also important dimension as care givers of the patients who were ill more that 18 months their family reported about being depressed and anxious.

Conclusion: It can be suggested that the care givers of young patients have higher levels of depression and anxiety as compared to older patients and duration of illness and gender are important parameters to this.

KEY WORDS: Depression, Anxiety, Care Givers

 

INTRODUCTION

Care giving and care receiving can occur at any point in the life-course, and is typically associated with chronic illnesses or disabilities, which result in losses of independence and functioning. There is no standard definition of family care giving, which can be used consistently from one study to another (National Alliance of Care Giving, 1997). What the term care giving means is not always clear and frequently varies with the purpose for which such definitions are used (Schulz et al., 1997). Successful management of major mental illness in the community relies significantly on an informal or non-professional network of caregivers. The needs and experiences of such caregivers have been little studied with respect to major chronic mood disorders (Dore & Romans, 1999).

Care giving does not cause depression, nor will everyone who provides care experience the negative feelings that go with depression. But in an effort to provide the best possible care for a family member, caregivers often sacrifice their own physical and emotional needs and the emotional and physical experiences involved with providing care can strain even the most capable person. Everyone has negative feelings that come and go over time, but when these feelings become more intense and leave caregivers totally drained of energy, crying frequently or easily angered by their loved one or other people, it may well be a warning sign of depression. Concerns about depression arise when the sadness and crying don't go away or when those negative feelings are unrelenting (Family Caregiver Alliance Fact Sheet, 2002).

Almost one-third of all caregivers is balancing employment and care giving responsibilities, and of this group, two-thirds report conflicts in roles that require them to rearrange their work schedules, work fewer than normal hours, and/or take unpaid leaves of absence. Because care giving is such an emotionally draining experience, caregivers have high rates of depression when compared to the general population. Research on family caregivers of mentally ill relatives has historically focused on negative aspects of care giving, often described as caregiver burden. Caregivers' perspectives on both negative and positive aspects of care giving in Canada. A qualitative approach was used. Data collection involved 20 in -depth, audio taped, semi structured interviews focusing on caregiver's positive and negative personal experiences with care giving to a relative with mental illness. Caregivers reported common negative impacts but also beneficial effects, such as feelings of gratification, love and pride. Main themes included stigma, systems issues, life lessons learned, and love and caring for the ill relative. This study counterbalance the predominantly negative consequences previously reported and add to emerging literature on positive aspects of care giving. Mental health professionals need to help care giving families make choices to improve their challenging situations & identify rewards of care giving & to advocate for increased systemic supports to ease caregiver burden. More than one quarter (26.6 percent) of the adult population has provided care for a chronically ill, disabled or aged family member or friend during the past year, (National Family Caregivers Association NFCA, 1997). Based on current census data, that translates into more than 54 million people. About three-fourths are women, many of whom also juggle work and child-care responsibilities. According to a 1997 survey by National Family Caregivers Association, 61 % of caregivers reported feeling more depressed than before.

Some researchers use the concepts of objective and subjective burden. Objective caregiver burden refers to the practical problems associated with care giving (e.g. difficulties with neighbors and police, disrupted family relationships). Subjective caregiver burden refers to the caregiver's emotional reaction (e.g. reduce morale, anxiety and depression.

Some researchers use the concepts of objective and subjective burden. Objective caregivers burden refers to the practical problems associated with care giving (e.g., difficulties with neighbors and police, disrupted family relationships). Subjective caregiver burden refers to the caregiver's emotional reactions (e.g., reduced morale, anxiety and depression. A recent study conducted by the National Alliance for Care giving found that more than half of those who provide major care for their parents (and one in four who provide any care) experienced stresses and burden. This is a major concern because prolonged stress can have serious emotional consequences. Emotional impact of any psychiatric disorder on family or primary caregivers can vary from frustration, anxiety, fear, depression and guilt to grief Depression is one of the emotion, which is experienced by caregivers. Four types of caregiver burden resulting from stress have been identified (Select Committee on Aging, 1987); emotional burden, physical burden, financial burden and family burden, the 1982 long-term care study demonstrated that the self-assessed health status (or physical burden) of caregivers was poorer than a comparison groups of non-care giving age peers in the general population. In contrast, other studies found that caregiver's self-assessed health status is compare able to (George & Gwyther, 1986) or better than (Danis, 1978) comparison group of on-caregivers.

Deimling and Bass (1986) reported that self assessed change in caregiver's health since becoming a caregiver was best explained by patient's daily activities' limitations, suggestions that those who provided the highest level of care had the greatest change in physical heath. A new Yale study looks more deeply at family caregivers' mental health specifically, at the effects on caregivers when their patient suffers frequent distress. Severe pain, delirium, choking, vomiting — all these can leave family caregivers feeling frightened and helpless (Bradley, 2003). For most caregivers, helplessness — rather than fear — was the overwhelming emotion attached to their experience. The study by Bradley (2003) "demonstrates that caregivers not only experience the burdens of providing essential care to their terminally ill loved ones, but that they also extensively and frequently witness their loved ones in serious distress". More attention should be given to these detrimental effects.

Close to one-third of caregivers surveyed said that the emotional and behavioral symptoms of the illness caused them extreme hardship. Drug abuse, suicide threats and violent behavior, while not necessarily daily realities, exist as constant sources of anxiety and are cited by more than half of caregivers as their most pressing concerns. Researchers have also explored another dimension, the effect of race on caregiver's depression, Flanagan (1994) conducted interviews to explore the relationship among race, caregiver depression and global role strain with African American and white spouse caregivers. Although African American caregivers were less likely to report depression and role strain, there was no interaction by race in the process influencing caregiver distress.

According to the literature on stress and coping, the burden of care giving to a mentally ill partner might have an impact on the mental health of spouse. As part of a study on the burden of care giving to a mentally ill family member. Smith (1998) conducted a structured psychiatric interview with spouses of the patients suffering from depression, anxiety disorders and schizophrenia (N=151) in university of Leipzig Germany. A significantly increased prevalence of depressive disorders was found. It was concluded that psychiatric patients' partners are at a high risk of developing a depressive disorder. It appears necessary to develop special interventions for spouses reducing stress and the risk of getting depressed.

Caregivers reported significant difficulties in their relationships with the patient when she or he was unwell, with considerable impact on their own employment, finances, legal matters, co-parenting and other social relationships. Violence was a particular worry for partner/parent caregivers of both male and female patients when the patient was severely depressed. The caregiver's own mental health appeared unaffected. Despite this, the caregivers appeared emotionally committed to the patients and showed considerable tolerance of problem behaviors, which they rank-ordered for difficulty. Among non family partners, knowledge of the illness before cohabitation was poor.

 

SUBJECTS AND METHODS

In the present research primary care givers of 50 (25male, 25female) patients carrying the diagnosis of schizophrenia, substance abuse, and depression (age range 16—70 in which young and old patients with duration of illness of 2 weeks to 24 weeks were selected. Patients were selected from the out patient department of the Rawalpindi General Hospital Rawalpindi, with the help of consultant psychiatrist, through the technique of non probability purposive sampling. Caregivers with prior history of any psychiatric ailment, caregivers of inpatient department and those using depression-inducing drugs were not included in the study sample. Following instruments were used for the data collection.

1. Demographic Sheet

2. Hamilton Rating Scale for Anxiety

3. Hamilton Rating Scale for Depression

 

RESULTS

 

Table 1. Comparison for HAM-D between the Caregivers of Younger Male and Older Male Patients

 

Groups

N

M

SD

t-value

p-value

Younger male

13

18.92

3.09

 

 

 

 

 

 

1.957

.063

Older male

12

16.17

3.93

 

 

Note: df =23 and HAM-D = Hamilton Rating Scale for depression.

 

The result presented in table 1 indicates that there is significant difference in the level of depression among the caregivers of young male patients and older male patients (t =1.957, df=23, p<. 063). The mean score of the caregivers of young male patients are (M=18.92, SD= 3.09) while the mean score of the caregivers of older male patients are (M =16.17, SD =3.93).

 

Table 2. Comparison for HAM-A between the Caregivers of Younger Male and Older Male

 

Groups

N

M

SD

t-value

p-value

Younger male

13

26.77

3.30

 

 

 

 

 

 

1.218

0.236

Older male

12

24.75

4.90

 

 

Note: df =23 and HAM-A= Hamilton Rating Scale for anxiety.

 

The result presented in table 2 also indicated that there is no significant difference in the anxiety level of caregivers of young male and older male patients (t= 1.218, df=23, p<. 236). The mean score on HAM-A of caregivers of young male patients are (M=26.77, SD=3.30) while the mean score of the caregivers of the older male patients are (M=24.75, SD=4.90).

 

Table 3. Comparison for HAM-D between the Caregivers of Younger Female and Older Female

 

Groups

N

M

SD

t-value

p-value

Younger male

13

16.08

3.01

 

 

 

 

 

 

0.339

0.737

Older male

12

15.67

3.03

 

 

 

The result presented in table 3 indicate the there is little difference in the level of depression among the caregivers of young female and older female patients (t=.339, p=.737). The mean score of the caregivers of young female patients are (X=16.92, SD=3.01) while the mean score of the caregivers of older male patients are (X=15.67, SD=3.03).

 

Table 4. Comparison for HAM-A between the Caregivers of Younger Female and Older Female

 

Groups

N

M

SD

t-value

p-value

Younger male

13

25.15

5.30

 

 

 

 

 

 

0.0941

0.926

Older male

12

25.33

4.16

 

 

The result presented in table indicated that there is no difference in the anxiety level of caregivers of young female and older female patients. (t=.094, p<.926). The mean score on HAM-A of caregivers of young female patients are (M=25.15, SD=5.30) while the mean score of the caregivers of the older female patients are (M=25.33, SD=4.16).

 

Table 5. Comparison for HAM-D between the Caregivers of Young Male and Young Female Patients

 

Groups

N

M

SD

Highlights

  • Survey COH-FIT

    Pakistan Psychiatric Society is a collaborative partner in the survey COH-FIT.
    It's a global survey available in over 25 languages

Subscribe Now!

Enter your e-mail address