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Schizophrenia is a chronic and disabling condition which produces
considerable burden in the caregivers. The quantum of burden is not the
same across different domains of life. A variety of correlates of burden
have been investigated in the caregivers of schizophrenic patients.
Literature suggests that caregivers of schizophrenic patients are at risk
of developing emotional problems. Burden of care is associated with less
optimal clinical and psychosocial outcome in schizophrenia. Researchers
have also been actively pursuing to investigate how the caregivers cope
with the difficulties posed by schizophrenic illness in a family member.
In married patients, the primary care is usually provided by the spouses.
A host of variables contribute to the burden and emotional states in
spouses of psychiatric patients. This can schematically be represented as
under
AIM:
The index
study aimed at delineating the determinants of emotional states and burden
in spouses of chronic schizophrenic patients.
Variables:
The identified variables for investigation are as follows:
Independent Variables:
1.
Patient Related:
·
Psychosocial Dysfunction
·
Duration
of Illness
2.
Spouse Related:
·
Defense
Mechanisms
·
Coping
Mechanisms
·
Personality
·
Gender
3.
Environment Related:
·
Family
Type
·
Domicile
Dependent Variables:
I.
Emotional States
II.
Spousal
Burden
A sample of 120 spouses of chronic schizophrenic patients was drawn from
Institute of Mental Health and Hospital, Agra through probability
sampling. Following tools were used:
1.
Personal Data Sheet
2.
Dysfunctional Analysis Questionnaire (DAQ)
3.
Defense Mechanism Inventory (DMI)
4.
Coping Checklist (CC)
5.
Eight State Questionnaire (8SQ)
6.
Burden Assessment Schedule (BAS)
The application of stepwise multiple regression yielded following main
results:
|
Summary of the Results of
Stepwise Multiple Regression |
|
Predictors/
Dependent |
Burden |
Anxiety |
Stress |
Depressi |
Guilt |
Arousa |
Regression |
Fatigue |
|
Psychosocial
Dysfunction |
Sig. |
Sig. |
Sig. |
n.s. |
Sig. |
Sig. |
n.s. |
Sig. |
|
Duration of
Illness |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
|
Gender |
n.s. |
n.s. |
Sig. |
n.s. |
Sig. |
. Sig. |
n.s. |
n.s. |
|
Extroversion |
n.s. |
n.s. |
Sig. |
n.s. |
Sig. |
n.s. |
Sig. |
Sig. |
|
Coping: Problem
Focused-Problem Solving |
n.s. |
n.s. |
n.s. |
Sig. |
n.s. |
n.s. |
Sig. |
Sig. |
|
Coping:Emotion
Focused – Positive |
Sig. |
n.s. |
Sig. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
|
Emotion Focused
- Distraction Negative |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
|
Emotion Focused
- Acceptance/Redefinition |
Sig. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
|
Coping: Emotion
Focused - Religion/Faith |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
|
Coping: Emotion
Focused - Denial/Blame |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
|
Problem and
Emotion Focused - Social Support |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
|
Turning Against
Object |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
|
Principalization |
n.s. |
n.s. |
Sig. |
n.s. |
Sig. |
n.s. |
n.s. |
Sig. |
|
Turning Against
Self |
Sig. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
|
Reversal |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
|
Projection |
Sig. |
Sig. |
n.s. |
n.s. |
n.s. |
Sig. |
n.s. |
n.s. |
|
Domicile |
Sig. |
Sig. |
n.s. |
n.s. |
n.s. |
n.s. |
Sig. |
Sig. |
|
Family Type |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
n.s. |
1.
Psychosocial dysfunction in the patients significantly contributes
to burden, anxiety, stress, guilt, arousal and fatigue states in the
spouses of chronic schizophrenic patients.
2.
Gender significantly contributes to following emotional states –
stress, guilt and arousal in the spouses of chronic schizophrenic
patients.
3.
Extraversion significantly contributes to stress, guilt, regression
and fatigue emotional states in the spouses of chronic schizophrenic
patients.
4.
Projection significantly contributes to burden, anxiety and arousal
in the spouses of chronic schizophrenic patients.
5.
Turning against self defense mechanism significantly contributes to
burden in the spouses of chronic schizophrenic patients.
6.
Principalization defense mechanism significantly contributes to
stress, guilt and fatigue state in the spouses of chronic schizophrenic
patients.
7.
Problem solving coping mechanism significantly contributes to
depression, regression and fatigue states in the spouses of chronic
schizophrenic patients.
8.
Emotion focused positive coping mechanism significantly contributes
to burden and stress in the spouses of chronic schizophrenic patients.
9.
Emotion focused: acceptance/redefinition significantly contributes
to burden in the spouses of chronic schizophrenic patients.
10.
Urban domicile significantly contributes to burden, anxiety
regression and fatigue state in the spouses of chronic schizophrenic
patients.
IMPLICATIONS:
Following
implications could be drawn based on the results of the present study:
1.
Effective rehabilitation - Social skills training, cognitive
rehabilitation and vocational rehabilitation measures could be undertaken
to manage the psychosocial dysfunction of the patient to reduce spousal
burden and negative emotional states.
2.
Periodic hospitalization can be recommended for the patients to provide
intermittent relief to the caring spouses.
3.
Palliative measures like yoga, meditation, social participation,
cultivation of hobbies etc can be recommended to the caring spouses.
4.
Psychoeducation should be provided to the caring spouses regarding nature,
causation, management, rehabilitation and prognosis of the chronic
schizophrenic illness.
5.
Spouses can be educated regarding blaming and its adverse consequences so
that they reduce the utilization of projective defense mechanisms.
6.
Supportive psychotherapy should be provided to reduce the guilt in the
spouses which shall have beneficial effects on depression state also.
7.
Self-help groups should be promoted for the families of chronic
schizophrenic patients.
8.
At a
policy level, psychiatric services should be extended to rural set up.
FUTURE
DIRECTIONS:
1.
Indigenous models could be developed to manage the burden and emotional
states in the spouses of chronic schizophrenic patients.
2.
Contribution of more variables like nature of symptoms, personality traits
of spouses, family composition etc in the spousal burden and emotional
states could also be explored.
3.
Moderator variables for burden and emotional states can also be
identified.
4.
The index and other variables should also be investigated in other
caregivers like parents and siblings.
5.
It shall be highly useful if future studies could investigate the effects
of burden and negative emotional states on patients and families. |