|Year : 2017 | Volume
| Issue : 4 | Page : 274-277
Caregiver burden on wives of substance-dependent husbands and its correlates at a Tertiary Care Centre in Northern India
Bharat Singh Shekhawat1, Shreyance Jain2, Hariom Kumar Solanki3
1 Professor, Department of Psychiatry, Government Medical College, Kota, Rajasthan, India
2 PG Resident, Department of Psychiatry, Government Medical College, Kota, Rajasthan, India
3 Assistant Professor, Department of Community Medicine, Government Medical College, Haldwani, Uttrakhand, India
|Date of Web Publication||6-Dec-2017|
Indcon, Jaltedeep Mkt, Gole Bldg, Sardarpura, Jodhpur - 342 001, Rajasthan
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: Substance dependence is well recognized as a complex biopsychosocial phenomenon. Complications arising out of it not only impairs life of substance-dependent patient but also causes enormous burden on their caregivers. Little attention has been paid to the relationship between caregiver burden and substance use. Objectives: The study was conducted to assess and compare the quantum of burden on wives of alcohol and heroin-dependent patients and also to determine the correlation between sociodemographic factors and caregiver burden. Methods: A cross-sectional study was conducted at a tertiary care center of North India to compare burden on wives of alcohol and heroin dependent husbands. Burden was assessed using burden assessment schedule (Sell et al.). Data obtained were analyzed using SPSS software. Results: Wives of both alcohol and heroin dependent patients had moderate-to-high burden of caregiving (Score of 38.1 out of maximum 60), those of heroin dependent patients perceived more burden in the factors of “impact on marital relationship,” “appreciation of caregiving,” “impact on relation with others,” and overall burden as compared to wives of alcohol-dependent patients. Significant negative correlation was found between “impact on marital relationship,” “appreciation of caregiving,” and “impact on relation with others” scores and patients' education status as well as between “appreciation of caregiving” score and wives' age where higher score denotes more burden. Conclusion: Significant burden exists on wives of substance-dependent patients; thus management plans must be devised aiming not only patients but also wives so as to reduce burden.
Keywords: Alcohol dependence, caregiver burden, heroin dependence
|How to cite this article:|
Shekhawat BS, Jain S, Solanki HK. Caregiver burden on wives of substance-dependent husbands and its correlates at a Tertiary Care Centre in Northern India. Indian J Public Health 2017;61:274-7
|How to cite this URL:|
Shekhawat BS, Jain S, Solanki HK. Caregiver burden on wives of substance-dependent husbands and its correlates at a Tertiary Care Centre in Northern India. Indian J Public Health [serial online] 2017 [cited 2020 Dec 5];61:274-7. Available from: https://www.ijph.in/text.asp?2017/61/4/274/220067
| Introduction|| |
Substance dependence has been showing a rising trend all over the world including India, and substance use disorders constitute one of the most serious public health problems. It is well recognized as a complex biopsychosocial phenomenon and considered as a “family disease.” It is estimated that a total of 246 million people, or 1 out of 20 people between the age group of 15 and 64 years, used an illicit drug in 2013 (World Drug Report 2015). In India according to National Family Health Survey 3, alcohol (21.4%) was primary substance used followed by cannabis (3.0%) and opioid (0.7%), respectively. Seventeen to twenty-six percent of alcohol users were qualified for International Classification of Diseases (ICDs) 10 diagnosis of dependence. Thus, with rising numbers, there is also increase in problems faced by the caregivers of these groups of patients. The adverse effects of substance dependence include physical, emotional, social, and financial distress; this leads to problems, difficulties, or adverse events in the lives of patient and his/her family members and the adverse impact has been described as burden.
In India, family is the key source in providing the care of patients including those with mental illness  and substance dependence. Studies have reported significant burden on the caregivers of substance-dependent patients.,, Prior study had shown wives as primary care providers to their alcoholic husbands  and bear a considerable amount of burden in taking care. Only a few studies had compared burden specifically on wives of different substance-dependent groups.
The study was planned to assess and compare the quantum of burden borne by wives of two major substance-dependent groups, i.e., alcohol and heroin (for which treatment is sought in Hadoti region of Rajasthan in North India) and also to study its correlates. The present study assumes much relevance because of the needed emphasis on developing community mental health services and community participation under National Mental Health Programme  where the aim is to focus not only the treatment of the patients but also to meet the needs of the caregivers.
| Materials and Methods|| |
The study was conducted in the inpatient unit of a tertiary care teaching hospital of North India from January 2015 to December 2015. Institute's Ethical Committee's approval and written informed consent from the participants before data collection were obtained. The sample population of the study comprised of patients alcohol dependence and heroin dependence.
The inclusion criteria for patients were those aged between 18 and 65 years, fulfilled alcohol or heroin (opioid) dependence criteria as per the WHO ICD-10, duration of heroin or alcohol dependence for more than 1 year, whose primary caregiver was wife, and who gave informed consent. The inclusion criteria for wives were those who gave informed consent, living with the patient for more than 1 year (the >1 year cutoff for caring was taken for the sake of comparability as majority of studies from India have used this cutoff),, directly involved in the care of patient, aged between 18 and 65 years, and able to understand the questionnaire. Patients having significant physical, surgical, or psychiatric illness and/or mental retardation, substance dependence other than alcohol or heroin, having dependence of both alcohol and heroin simultaneously, intravenous drug users, and patients in severe withdrawal state were excluded from the study. The exclusion criteria for wives were those having substance dependence, incapacitating medical/surgical or psychiatric illness, any disability, and/or mental retardation.
With the previous studies  reporting caregiver burden close to 50% and the desirability to not underestimate the sample size for the present study, we decided to take the prevalence of burden on wives substance-dependent patients to be 50%. With precision of 10%, power 50%, and keeping alpha error at 0.05, a sample size of 100 was determined using the formula 4 pq/d, where P is the proportion of the outcome of interest, q compliment of p, and d denotes precision. A design factor of 1.2 was taken to compensate for the fact that patients were being admitted to the same hospital and that there might be clustering of such patients in the hospital catchment area. To keep a number of alcohol and heroin-dependent patients balanced in the study, it was decided to include sixty patients each of alcohol and heroin dependence. Consecutive eligible male patients were then included in the study. As soon as 60 patients were reached in a group, inclusion in the study for that group was stopped.
A semi-structured questionnaire was used to obtain sociodemographic information of both patients and their wives. Details of substance (alcohol/heroin) and patients' clinical profile were also recorded.
Burden on wives was assessed using a modified burden assessment schedule Sell H. et al. It is a standardized 20-item scale modified from 40-item scale of Thara et al. which is used to measure burden in five factors that include impact on well-being (any feelings of frustration, exhaustion, depression, and impact on health in general, as a result of caring for the patient), impact on marital relationships (reflects the ability of the mentally ill patient to give adequate attention and affection to other members of the family and to satisfy the emotional needs of his/her partner), appreciation for caregiving (a positive factor reflects the satisfaction received from the appreciation and acknowledgment for caregiving from family and friends), impact on relations with others (refers to disruption of family and other social relations, as a consequence of the presence of a mentally ill patient), and perceived severity of the disease as assessed by the caregiver's opinion. Each item is rated on a three-point scale (not at all, to some extent, and very much). The total burden score ranges from 20 to 60 for each individual study participant, with higher scores indicating greater burden. Criteria validity was computed by Sell et al. against the interview schedule of Thara et al. and Pai and Kapur, in which correlation of the items ranged from 0.71 to 0.82 and the internal consistency, as measured by the alpha co-efficient, for the full scale was found to be 0.81.
For data analysis, SPSS SPSS version 17.0 for Windows (Chicago, Illinois, USA) was used. Alcohol-dependent (AD) and Heroin dependent HD group were compared using the Chi-square test and t-tests where appropriate. For correlation, Pearson's correlation coefficient was calculated.
| Results|| |
In the present study, majority of substance abusers belonged to age group of 26–35 years. The mean age of patients was 38.7 ([SD] 8.9) years and that of their wives was 33.4 (SD 8.3) years. Majority (66.7%) of the patients were Hindus, 21% were Muslims, and 11.7% were Sikhs or others. Majority (57.5%) of patients were from urban background and (42.5%) patients belonged to rural background. If we classify patients according to the education status most of the patients (36.7%) studied up to the middle school level, around 28.3% of the patients were educated up to secondary level and above, 19% were illiterate, and 15.8% studied up to the primary level only. According to the occupation, majority (41.6%) of patients were laborers (skilled and unskilled) and earned daily wages, around 15% were farmers, and 9.2% were businessman. Distribution according to the monthly family income showed that majority (68%) of the patients were from lower socioeconomic group having monthly family income of Rs. 10,000 or less. Around 54% belonged to nuclear family and 46% from joint/extended families. Family history of drug dependence/use which included common substance such as tobacco, alcohol, cannabis, and opioids was positive in around 40% of patients. The mean age of initiation of substance (alcohol or heroin) was 25.7 years (SD 6.4) and total duration of dependence was 10.9 years (SD 7.2). Majority (75%) of the wives of these patients were either unemployed or housewives and 45.2% were illiterate.
The mean burden score of AD group was 36.6 (SD 4.64) and of HD group was 39.5 (SD 3.64). It signifies moderate-to-high burden of caregiving on the wives of these patients affecting adversely all aspects of their lives covered by the study instrument significantly. On comparing mean factor scores of burden assessment schedule and overall burden between AD and HD group, there was more burden (in all factors as well as in overall burden) on wives of HD patients than on wives of AD patients. Statistically significant difference was found in the factors of “impact on marital relationship,” “appreciation of caregiving,” and “impact on relation with others” but no statistical significant difference was found in the factors of “impact on well-being” and “perceived severity of disease” [Table 1].
|Table 1: Caregiver burden score along with comparison of burden scores between alcohol and heroin-dependent group (n=120)|
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Statistically significant negative correlation was found between scores of “impact on marital relationship,” “appreciation of caregiving,” and “impact on relation with others” and education status of patients, where higher score denotes more burden that means wives of less educated husbands felt more burdened as compared to wives of comparatively higher educated ones. Likewise, significant negative correlation was found between “appreciation of caregiving” score and wives' age, where higher score denotes more burden and less appreciation of care given; thus, younger wives perceived more burden as compared to older ones [Table 2].
|Table 2: Correlation between sociodemographic profile of substance dependent patients and caregiver burden (n=120)|
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| Discussion|| |
The demographic and clinical profile of our sample was similar to earlier studies ,, which reported the majority of substance abusers belonged to the adult working population. Substance use in this phase of life results in the loss of productivity and working capacity of the patients subsequently disturbing the personal, familial, and social life as a whole. Present and previous Indian study  had shown a higher prevalence of substance addiction in people from lower sociodemographic status and those who live on daily wages. This group of population is the primary target of drug peddlers and also among them peer group pressure is an important factor for initiation of substance use. More patients from nuclear families reflect the disintegration of joint family system and trend toward nuclear families. The trend toward the nuclear family system in our country highlights the importance of wives as the primary care providers and thus bearing significant caregiver burden.
The result of the present study shows that significant caregiver burden exists on wives of alcohol and HD husbands. An earlier Indian study comparing burden on caregivers of alcohol- and opioid-dependent patients also found moderate to severe burden in 95%–100% of the caregivers. The present study not only shows higher burden on wives of HD patients as compared to the wives of AD patients but also shows a significant difference between two groups in contrast to previous studies.,
More deterioration in a marital relationship as perceived by wives of HD patients may be because of the fact that heroin is the illegal drug and time spent in the procurement of the heroin through illicit sources is quite high as compared to alcohol. Hence, there is inadequate attention and affection toward the spouse and inability to satisfy the emotional needs of partner. Due to lack of appreciation of care given higher burden was perceived by wives of HD patients as compared to wives of patients of alcohol dependence. More burden on the wives of the HD patients in the area of social relationship may be because of the low societal acceptance of heroin unlike alcohol which has comparatively higher sociocultural acceptance, thus along with patient, family members of such patients also have a poor reputation in the society.
Correlation of sociodemographic variables with burden factors revealed some significant findings. More educated patient understands and appreciates the care provided to him by his wife, thus there is better marital and social life in comparison to patients of relatively lower education level. An Indian study  also reported higher burden in primary caretaker of illiterate patients. Hence, education becomes an integral part and also important contributor in reducing burden. As the age of the wife increases, she gets more mature and better understands the need and care of the patient; hence, she perceives less burden and more satisfaction because of appreciation and acknowledgment of good caregiving from family and friends of patients.
The results of the current study should be interpreted in the background of following limitations; it is a point prevalence study with a relatively small sample size that included admitted patients in a tertiary care government medical college hospital located in the urban area; therefore study population may not be the true representative sample of the community.
Our study is one of the few and probably first one of Hadoti regions in Rajasthan assessing and comparing burden on wives of two important substance-dependent groups seeking care. Future research should be planned and carried out keeping in view the methodological limitations of the present study. Factors such as stressors, life events, coping, and social support should also be considered in future studies.
| Conclusion|| |
Present study shows wives of substance-dependent patients suffer substantial burden as a result of caregiving and various factors contribute to it and education playing important role in reducing burden. Thus, it is very important for health professionals to identify the needs of the caregiver/s and develop healthy coping strategies so as to reduce the burden.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
O Farrell TJ, Fals-Stewart W. Treatment models and methods: Family models. Addictions: A Comprehensive Guidebook for Practitioners. New York: Oxford University Press; 1999. p. 287-305.
International Institute for Population Sciences (IIPS) and Macro International 2007 National Family Health Survey (NFHS-3), 2005-06: Vol. I. India. Available Available from: http://www. Nfhsindia.org/nfhs3.html
. [Last accessed on 2016 Aug 20].
Platt S. Measuring the burden of psychiatric illness on the family: An evaluation of some rating scales. Psychol Med 1985;15:383-93.
Avasthi A. Preserve and strengthen family to promote mental health. Indian J Psychiatry 2010;52:113-26.
] [Full text]
Lamichhane N, Shyangwa PM, Shakya R. Family burden in substance dependence syndrome. J Gandaki Med Coll 2008;1:56-65.
Mattoo SK, Nebhinani N, Kumar BN, Basu D, Kulhara P. Family burden with substance dependence: A study from India. Indian J Med Res 2013;137:704-11.
] [Full text]
Shareef N, Srivastava M, Tiwari R. Burden of care and quality of life (QOL) in opioid and alcohol abusing subjects. Int J Med Sci Public Health 2013;2:880-4.
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: WHO; 1992.
Chakrabarti S, Kulhara P, Verma SK. Extent and determinants of burden among families of patients with affective disorders. Acta Psychiatr Scand 1992;86:247-52.
Nebhinani N, Anil BN, Mattoo SK, Basu D. Family burden in injecting versus noninjecting opioid users. Ind Psychiatry J 2013;22:138-42.
] [Full text]
Sell H, Thara R, Padmavati R, Kumar S. The Burden Assessment Schedule (BAS). Vol. 27. WHO Regional Publication, South – East Asia Series No 1998. p. 13-20.
Thara R, Padmavati R, Kumar S, Srinivasan L. Burden assessment schedule. Instrument to assess burden on caregivers of the chronically mentally ill. Indian J Psychiatry 1998;40:21-9.
] [Full text]
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.
Kadri AM, Bhagylaxmi A, Kedia G. Study of socio-demographic profile of substance users attending a de-addiction centre in Ahmedabad city. Indian J Community Med 2003;28:74-6. [Full text]
Adityanjee DM, Saxena S, Lal S. Changing trends in heroin abuse in India: An assessment based on treatment records. Bull Narc 1985;37:19-24.
Margoob MA, Dutta KS. Drug abuse in Kashmir - Experience from a psychiatric diseases hospital. Indian J Psychiatry 1993;35:163-5.
] [Full text]
Malik P, Kumar N, Sidhu BS, Sharma KC, Gulia AD. Impact of substance dependence on primary caretaker in rural Punjab. Delhi Psychiatry J 2012;15:72-8.
[Table 1], [Table 2]