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 Table of Contents  
Year : 2021  |  Volume : 6  |  Issue : 2  |  Page : 164-167

Family burden among caregivers of patients with chronic mental disorders

Dharawad Institute of Mental Health & Neurosciences (DIMHANS), Karnataka, India

Date of Submission25-Sep-2020
Date of Decision28-Feb-2021
Date of Acceptance08-May-2021
Date of Web Publication08-Jan-2022

Correspondence Address:
Dr. Sateesh Rangarao Koujalgi
M.Phil., Ph.D,. in Psychiatric Social Work, In Charge HOD & Associate Professor, Department of Psychiatric Social Work, DIMHANS, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/bjhs.bjhs_101_20

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BACKGROUND: Caregivers play an important role in dealing with people with chronic mental disorders. Rates of caregiver burden are high and it increases the risk of caregiver depression and health problems. Therefore, an in-depth study is needed to understand the burden faced by primary caregivers of patients suffering from chronic mental disorders.
AIM: The aim of the study is to examine the burden borne by families of individuals suffering from chronic mental disorders.
MATERIAL AND METHODS: From the caregivers of patients with chronic mental disorders some were chosen. It is a cross sectional study. Purposive sampling technique has been adopted. Patients were diagnosed as having mental disorders using International Classification of Disease -10, classification of Mental and Behavioral Disorders, Diagnostic Criteria for Research ICD-10 criteria. Pollack and Perlick scale was used to identify the key family caregivers. Patients with two or more than two-year duration of illness were included in the study group.
RESULTS: Caregivers of patients with chronic mental disorders experienced considerable high degree of family care burden.
CONCLUSION: The study finds that a high burden is borne by caregivers of patients suffering from chronic mental disorders.

Keywords: Family care burden, schizophrenia, mood disorder alcohol dependence syndrome

How to cite this article:
Koujalgi SR, Nayak RB. Family burden among caregivers of patients with chronic mental disorders. BLDE Univ J Health Sci 2021;6:164-7

How to cite this URL:
Koujalgi SR, Nayak RB. Family burden among caregivers of patients with chronic mental disorders. BLDE Univ J Health Sci [serial online] 2021 [cited 2022 Jul 6];6:164-7. Available from: https://www.bldeujournalhs.in/text.asp?2021/6/2/164/335315

Family caregiver burden is that personal emotional or physical response that is needed as a result of change or demand that arises as they provide help and support to the patient. A caregiver is one who has taken the responsibility of attending to the physical and psychological needs of the chronic patient. The long-term nature of chronic mental illnesses induces a tremendous burden on the caregivers. Psychiatric patients' caregivers experience a higher caregiver burden than those caregivers of other medical illnesses.[1] Family care burden has two main components, namely objective and subjective family care burden. The objective burden includes the effects of daily living tasks whereas the subjective burden is the burden the caregivers perceive while caring for the ill person. It is observed that both objective and subjective burden has physical, emotional, and social consequences. The expression of negative emotions, namely despair, loneliness, frustration, and anger by the patient affect the course and prognosis of psychiatric illness thereby increasing the stress on the family as a whole.[2] Keeping this in mind, the present study was conducted to assess the perceived burden among caregivers of chronically mentally ill people.

  Materials and Methods Top

The descriptive research was conducted on 40 caregivers of patients suffering from chronic mental illness. The purposive sampling techniques had been administered to collect the sample from the informants at both outpatient and inpatient departments in a tertiary care psychiatry hospital. The primary caregivers were selected with the help of the Pollack and Perlick scale.[3] Caregivers were belonging to the age group of 18–63 years, and the research ethics were followed in the selection of samples. Patients suffering from chronic mental illness as per International classification of Disease 10th Revision (ICD-10) guidelines with a history of illness more than 2-year duration were only included in the study. Patients having a history of organic mental disorders were excluded from the study. The caregiver was subjected to the Burden Assessment Schedule (BAS)[4] questionnaire and the same was translated into the vernacular language.

  Results and Discussion Top

This cross-sectional study describes the clinical diagnosis and level of family care burden in an Indian tertiary care hospital. The sociodemographic details of the sample and the details of the psychiatric diagnosis of the study population are described.

[Table 1] shows that out of 40 samples, 45% fall in the group of schizophrenia disorder. Mood disorders constitute 25% and 30% of the sample population fall under the diagnosis of alcohol dependence syndrome.
Table 1: Details of psychiatric diagnosis of the study population

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[Table 2] shows the age of the caregiver. Five percent of caregivers were under 23–27 years of age. 12.5% of caregivers were under 28–32 years of age. 7.5% of caregivers were under 33–37 years of age. 22.5% of caregivers were between 38 and 42 years of age. Twenty-five percent of caregivers were between 43 and 47 years of age. Twenty-five percent of caregivers were under 48–52 years of age. Only 2.5% of caregivers fall under the age group of 58–62.
Table 2: Demographic parameters of patient's caregiver, age of caregivers group

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[Table 3] shows the gender of the caregiver group. Majority of them were female caregivers, i.e. 60% of the sample population. [Table 4] shows the education status of the caregivers' group. Most of them were educated up to higher secondary and above, i.e. 60% excluding and 22.5% who were educated up to high school.
Table 3: Gender of caregiver group

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Table 4: Educational status of caregivers group

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[Table 5] shows occupations of the caregivers' group. 20% caregivers were employed, 57.5% caregivers were housewives, and 22.5% of study populations were doing agriculture work.
Table 5: Occupation of caregiver

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[Table 6] shows the family income of caregivers. The highest number of caregivers came from the category of Rs 10,000 > per month, i.e. 31 caregiver (77.5%). Next significant group is Rs. 5000–10,000 which constitutes 12.5%. Next category is Rs 1001–5000 which constitutes 7.5%.
Table 6: Family income of caregiver

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[Table 7] shows the length of caregiver contact with the patient. The maximum length of caregiver contact with the patient was >20 years which constitutes 47.5%. The next significant group is 15–19 years which constitutes 35% of the study population.
Table 7: Caregiver's contact duration with a patient

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The caregiver's relationship with the patient is shown in [Table 8]. Out of 40 samples, 20 were spouses, 4 were children and the remaining 2 were under any other category.
Table 8: Caregiver relationship with a patient

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[Table 9] shows the duration of the patient's illness. The highest duration was between 6 and 12 years (45%). The next duration of illness was found to be > 12 years (32.5%).
Table 9: Duration of patient illness

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[Table 10] shows the distribution of severity of family care burden among 40 participants constituting the study sample population as per BAS. The majority of the study population 33 in number (82.5%) had experienced moderate burden (60–80) followed by 4 (10%) had experienced the severe level of family care burden (80–100) and the remaining 3 (7.5%) had experienced mild family care burden (40–60). None among the sample population had a very severe burden.
Table 10: Burden parameters of caregivers

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Long-term care for psychiatric patients causes depression, anxiety, and burnout among family caregivers. In a study conducted by Muscroft and Bowl[5] that studied the impact of depression on a caregiver and other family members, it was found that 18%–47% of caregivers experienced depression. However, not all caregivers perceive an equal amount of burden of the illness because it varies according to their ways of coping and their awareness of symptomatology. Vaishnavi et al.[6] in a cross-sectional study conducted on 200 clients with alcohol dependence syndrome to assess the pattern of burden found that the caregiver had experienced moderate-to-severe burden. A study done by Rai et al.[7] revealed that 66.66% experienced moderate burden, 26.66% were found to have mild burden, and 6.66% were subjected to a severe burden. Bharat et al.[8] in a cross-sectional study conducted in North India on wives of alcohol and heroin-dependent husbands. In this study, they found that caregivers of substance-dependent patients experienced moderate to the high burden. The present study findings are consistent with those of the above studies and corroborate the fact that caregivers experience family care burden during the course and treatment of illness. Grover et al.[9] in a study of 103 caregivers of bipolar disorder found that the majority of caregivers attributed their stress and burden to the illness of the patient. The poor socio-occupational functioning of the patient added to the high family care burden. Murthy[10] conducted a study to assess the challenges of caregivers in India. A high level of burden was found in families dependent on patients with chronic mental disorders. A qualitative study conducted by Gonani[11] included a set of patients with schizophrenia, schizoaffective disorder, and bipolar disorder, and the result revealed that family caregivers experience isolation, neglect, rejection, poor social support, and economic burden as a result of caregiving responsibilities. Sharma et al.[12] found caregivers of bipolar disorder experience significantly high family care burden. It was seen that the pattern of family care burden among families with people suffering from a chronic mental disorder is high. The reason could be that relapsing chronic illness manifests as a psychological discrepancy in caregivers. More so an early age onset of illness may result in patients not being able to work for them. As a result, caregivers are forced to cut down their work hours to provide care for their patients. Our clinical observations find that most of the family members use denial as a defense mechanism about their relatives' illness. This also tends to add to the burden. Together with these studies, our findings provide strong evidence that the presence of a psychiatric ill person with a functional impairment results in a family care burden including multiple responsibilities such as financial costs, physical care of the patient, and compromises on the personal freedom and leisure activities.

The focus of the present study is regarding three chronic illnesses, i.e., schizophrenia, mood disorder, and alcohol dependence syndrome. However, it is limited by small sample size. Studying a larger sample of participants with chronic disorders could substantiate our preliminary findings.

  Conclusion Top

This study attempted to find the severity of the burden borne by caregivers of chronic mental disorders. Forty caregivers were interviewed and assessed on the BAS. The study has shown that family members of patients with chronic mental disorders experienced a considerably high degree of family care burden. This has important implications for the management of patients with chronic mental disorders.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Runic Y, Pilling S, Killaspy H, Dalton J. A study of family contact with clients and staff of community mental health teams. Psychiatr Bull 2005;29:174-6.  Back to cited text no. 1
Ayalew M, Workicho A, Tesfaye E, Hailesilasie H, Abera M. Burden among caregivers of people with mental illness at Jimma University Medical Center, Southwest Ethiopia a cross-sectional study. Ann Gen Psychiatry 2019;18:10.  Back to cited text no. 2
Pollak CP, Perlick D. Sleep problems and institutionalization of the elderly. J Geriatr Psychiatry Neurol 1991;4:204-10.  Back to cited text no. 3
Tara R, Padmavati R, Kumar S, Srinivasan L. Burden assessment schedule instrument to assess burden on caregivers of the chronically mentally. Indian J Psychiatry 1998;40:21-9.  Back to cited text no. 4
Muscroft J, Bowl R. The impact of depression on caregivers and other family members: Implications for professional support. Couns Psychol Q 2000;13:117-34.  Back to cited text no. 5
Vaishnavi R, Karthik MS, Balakrishnan R, Sathianathan R. Caregiver burden in alcohol dependence syndrome. J Addict 2017;2017:8934712. doi: 10.1155/2017/8934712.  Back to cited text no. 6
Rai N, Shah P, Pawar S, Naphade N. To Assess the Pattern and Severity of Alcohol Dependence Syndrome Patients and Burden of Caregiver of Alcohol Dependence Syndrome Patients: International Conference on Public Health: Issues Challenges, Opportunities, Prevention, Awareness 2016;10:129-32.  Back to cited text no. 7
Bharat SS, Shekhawat SJ, Hariom KS. Caregiver burden on wives of substance-dependence husband and its correlates at a tertiary care centre in Northern India. Indian J Public Health 2017;4:274-7.  Back to cited text no. 8
Grover S, Aneja J, Hazari N, Chakrabarti S, Avasthi A. Stigma and its correlates among caregivers of patients with bipolar disorder. Indian J Psychol Med 2019;41:455-61.  Back to cited text no. 9
[PUBMED]  [Full text]  
Murthy RS. Caregiving and caregivers: Challenges and opportunities in India. Indian J Soc Psychiatry 2016;32:94-102.  Back to cited text no. 10
Gonani CG. Family Care-Giving in Mental Health: Experiences of Family Caregivers of People Living with Severe Mental Illness in Rural Malawi. Master's Thesis, Harvard Medical School; 2019. Available from: http://nrs.harvard.edu/urn-3:HUL.InstRepos: 42057410. [Last accessed on 2020 Feb 19].  Back to cited text no. 11
Sharma H, Sharma B, Sharma DB. Burden perceived stigma and the coping style of caregivers of patients with schizophrenia and bipolar disorder. Int J Health Sci Res 2017;7:84-94.  Back to cited text no. 12


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]


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