INTRODUCTION:

Care givers play a vital role in supporting family members who are sick, infirm or disabled. There is no doubt that the families of those with mental disorders are affected by the condition of their near ones. Families not only provide practical help and personal care but also give emotional support to their relative with a mental disorder.

Therefore the affected person is dependent on the care giver, and their well-being is directly related to the nature and quality of the care provided by the care giver. These demands can bring significant levels of depression and anxiety among the care giver and can affect their overall quality of life including work, socializing and relationships.

NEED FOR STUDY:

The demands of caring for a person with a chronic mental illness has both emotional and practical impact on the caregiver. Research into the impact of care-giving shows that one-third to one-half of care givers suffer significant psychological distress or depression and experience higher rates of anxiety than the general population. Being a care giver can raise difficult personal issues about duty, responsibility, adequacy and guilt. Caring for a relative with a mental health problem is not a static process since the needs of the care recipient alter as their condition changes. The role of the carer can be more demanding and difficult if the care recipient’s mental disorder is associated with behavioral problems or physical disability. Over the past few decades, research into the impact of care-giving has led to an improved understanding of this subject including the interventions that help. It has now been realized that developing constructive working relationships with care giver, and considering their needs, is an essential part of service provision for people with mental disorders who require and receive care from their relatives. Paying attention to mental health status of family members and caregivers of the patients with mental disorders is really of importance regarding its pivotal role on controlling and prevention of the disease and its recurrence. In addition, it may have a role on the public mental health status and prevention of mental disorders in patient's family members.

OBJECTIVES:

1. To assess the levels of anxiety and depression among care givers of psychotic clients

2. To find out the co-relation between levels of anxiety and depression among caregivers of psychotic clients

3. To find out the association of levels of anxiety and depression with the selected demographic variables of caregivers of psychotic clients

Hypothesis:

H₁.:

There will be a significant correlation between anxiety and depression among the care givers of clients with psychotic disorders.

H₂.:

There will be a significant association between the level of anxiety and selected demographic variables of care givers of clients with psychotic disorders.

H₃.:

There will be a significant association between the level of depression and selected demographic variables of care givers of clients with psychotic disorders.

METHODOLOGY:

Research approach:

Quantitative research approach

Research design:

Descriptive survey design

Study Setting:

Manasa hospital, Rajahmundry

Sample:

100 caregivers of psychotic patients

Sampling Technique:

Non Probability Convenient Sampling Technique.

Variables:

Demographic Variables:

Age, Gender, Occupation, Education, Family Income, Marital Status, Relationship With Client, Type of Disorder, Duration of Care giving, Severity of Illness, Dependency of Patients, and Type of Family

Research Variables:

Anxiety and depression:

Description of data collection tool:

It consisted of 2 sections:

Section A:

Demographic variables:

The first part of the tool consists of 12 items for obtaining information about the selected background factors such as: Age of the care giver, gender, occupation, education, family income per month, marital status, relationship with the clients, type of disorder, duration of care giving, severity of illness, dependency of patients, and type of family

Section B:

Part 1: Modified Hamilton Anxiety Inventory:

Modified Hamilton anxiety scale consists of 20 aspects and each aspect consists of 5 items. Each item was graded on 0 – 4 point rating scale. The total score is 80. The anxiety level has been arbitrarily divided into four categories based on this scale.

Part 2:

Modified Beck’s Depression Inventory:

Modified Beck’s depression inventory consists of 20 aspects and each aspect consists of 5 items. Each item was graded on 0 – 4 point rating scale. The total score is 80. The anxiety level has been arbitrarily divided into four categories based on this scale. Interpretation of tool:

Section B:

Levels Of Anxiety	Score As Per Scale	Percentage
Minimal Anxiety	0 – 20	0% - 25%
Mild Anxiety	21 – 40	26% - 50%
Moderate Anxiety	41 – 60	51% - 75%
Severe Anxiety	61 – 80	76% - 80%
Levels Of depression	Score As Per Scale	Percentage
Minimal Depression	0 – 20	0% - 25%
Mild Depression	21 – 40	26% - 50%
Moderate Depression	41 – 60	51% - 75%
Severe Depression	61 – 80	76% - 80%

100 care givers of clients with psychotic disorders were selected using non probability convenient sampling technique, and then the modified scales were administered to each care giver of clients with psychotic disorders by the investigator. Each sample was given 30 - 35 min for responding to the items on the scale.

Statistical Analysis:

Collected data was analyzed using descriptive and inferential statistics, where descriptive statistics included analysis of frequency, percentage distribution of the demographic variables, mean and standard deviation to assess the anxiety and depression among the care givers of clients with psychotic disorders and inferential statistics included use of Karl Pearson correlation coefficient to find out the correlation between anxiety and depression and Chi-square test to find out the association between the levels of anxiety with selected demographic variables and depression with selected demographic variables of caregivers of clients with psychotic disorders.

RESULTS:

Among 100 samples majority of care givers were in the age group of 21-30 years were 14% where as 29% were in the age group of 31-40 years, and 36% were in the age group of 41-50 years and 21% were above 50 years. In relation to gender 59% of the care givers were female and only 41% of them were male. Regarding occupation farming was the occupation of 15% of the care givers, 25% were involved in business, 27% were government employees, 28% of them had private jobs and 5% of them were either self-employed or labourers. Regarding education 21% of care givers had no formal education 30% of them had primary education, 31% of them had secondary education, 16% of the caregivers were graduates and 2% of them had done various courses after their 12^th. In relation to family income per month 22% of the care givers were belongs to the income of Rs. <3000, 23% of them were belongs to the income of Rs. 3001-4000, and 29% belongs to the income of Rs. 4001 – 5000 and 26% of the caregivers have an income above Rs. 5001. In regards to marital status 46% of the caregivers were married, 7% of them were unmarried and 47% of the caregivers were widowed. In regards to relationship with the clients 44 % of the care givers were parents, 23% were siblings, 23% spouses, 8% in – laws and 2% others were friends. Regarding type of disorder 23% of caregivers were related to clients with schizophrenia, 33% of them were related to the clients with mania, 31 % were related to clients with depression, 11% of them were related to clients with depression and 2% of them were related to the clients with alcohol induced psychosis. In regards to the duration of care giving 50% of the caregivers were providing care from 1 or 2 weeks, 34% of them were providing care since one or two months, and 16% of caregivers were providing care from one or two years. In relation to the severity of illness 63% of caregivers provided care to clients with acute illness and 37% of them provided care to the clients with chronic illnesses. Regarding dependency of the clients 18% of caregivers provide care to the clients who are completely dependent on them whereas 82% of caregivers provide care to the clients who are partially dependent on them. Regarding the type of family 65% of care givers were belongs to joint family, 22% were belongs to the nuclear family and 13% of them are separated.

Figure – 1 Percentage distribution of levels of anxiety among the care givers of clients with psychotic disorders

Figure – 2 Percentage distribution of levels of depression among the care givers of clients with psychotic disorders

Table-1: Distribution of mean, standard deviation, and correlation between levels of anxiety and depression n=100

Sr no	Anxiety		Depression		Corelation between anxiety and depression
	Mean	Standard deviation	Mean	Standard deviation	Corelation between anxiety and depression
1	42.28	12.2	45.51	11.2	0.98

Table-2: Association of anxiety with their demographic variables

Aspect	Demographic Variable	Minimal Anxiety	Mild Anxiety	Moderate Anxiety	Severe Anxiety	Degree of Freedom	Chi Square Value	Table Value	Inference
1. Age	21 - 30 years		7	7		9	13.72	16.92	NS
	31 - 40 Years		15	13	1
	41 - 50 Years	1	15	17	2
	51 Years and above	2	7	8	5
2. Gender	Male	1	17	18	5	3	2.02	7.82	NS
2. Gender	Female	2	27	27	3	3	2.02	7.82	NS
3.Occupation	Farming		6	5	4	12	16.93	21.03	NS
	Business		12	11	2
	Government service	1	8	16	2
	Private service	2	16	10
	Any other		2	3
4.Education	No formal education	1	13	5	1	12	14.95	21.03	NS
	Primary education	1	16	10	3
	Secondary education		12	16	3
	Graduate	1	2	12	1
	Any other		1	1
5.Family Income	Below rs. 3000/month	1	15	6		9	12.25	16.92	NS
	Rs. 3001 -Rs 4000/month		11	11	1
	Rs. 4001 -Rs 5000/month	1	10	14	4
	Rs. 5001 and above	1	8	14	3
6. Marital Status	Married	2	22	19	3	6	2.74	12.59	NS
	Unmarried		4	2	1
	Others	1	18	24	4
7. Relationship With Clients	Parents		20	20	4	12	21.04	21.03	S
	Siblings	1	13	10	1
	Spouse	1	9	10	3
	In - laws		3	5
	Others	1	1
8.Type Of Disorder	Schizophrenia		14	8	1	12	24.29	21.03	S
	Mania		15	14	4
	Depression	2	10	17	2
	Manic depressive psychosis		4	6	1
	Alcohol induced psychosis	1	1
9.Duration of Caregiving	Weeks	1	22	25	2	6	9.41	12.59	NS
	Months	1	15	16	2
	Years	1	7	4	4
10.Severity of Illness	Acute	2	28	30	3	3	2.49	7.82	NS
10.Severity of Illness	Chronic	1	16	15	5	3	2.49	7.82	NS
11.Dependency of The Client	Completely dependent	3	5	7	3	3	17.19	7.82	S
11.Dependency of The Client	Partially dependent		39	38	5	3	17.19	7.82	S
12.Type of Family	Nuclear	1	32	27	5	6	17.48	12.59	S
	Joint		8	14
	Others	2	4	4	3

N.S = Not significant (p > 0.05) S = significant (p < 0.05)

Table-3: Association of depression with their demographic variables

Aspect	Demographic Variable	Minimal Depression	Mild Depression	Moderate Depression	Severe Depression	Degree of Freedom	Chi Square Value	Table Value	Inference
1. Age	21 - 30 years		7	7		9	12.75	16.92	NS
	31 - 40 Years		7	18	4
	41 - 50 Years		12	22	2
	51 Years and above	2	7	10	2
2. Gender	Male	1	12	27	1	3	3.97	7.82	NS
2. Gender	Female	1	21	30	7	3	3.97	7.82	NS
3.Occupation	Farming		6	8	1	12	6.57	21.03	NS
	Business		10	15	2
	Government service	1	4	17	3
	Private service	1	11	14	2
	Any other		2	3
4.Education	No formal education		12	8	1	12	13.14	21.03	NS
	Primary education	1	11	16	2
	Secondary education		6	22	3
	Graduate	1	3	10	2
	Any other		1	1
5.Family Income	Below rs. 3000/month		13	8	1	9	38.67	16.92	S
	Rs. 3001 -Rs 4000/month	1	6	15	1
	Rs. 4001 -Rs 5000/month		7	18	4
	Rs. 5001 and above	1	7	16	2
6. Marital Status	Married	1	19	22	4	6	7.73	12.59	NS
	Unmarried		4	3
	Others	1	10	32	4
7. Relationship With Clients	Parents		16	26	3	12	33.94	21.03	S
	Siblings		5	15	3
	Spouse	1	10	10	2
	In - laws		1	7
	Others	1	1
8.Type of Disorder	Schizophrenia		13	9	1	12	42.5	21.03	S
	Mania		7	25	2
	Depression	1	8	19	3
	Manic depressive psychosis		4	5	2
	Alcohol induced psychosis	1	1
9.Duration of Care giving	Weeks	1	14	30	5	6	1.89	12.59	NS
	Months	1	12	19	2
	Years		7	8	1
10.Severity of Illness	Acute	2	19	37	5	3	1.66	7.82	NS
10.Severity of Illness	Chronic		14	20	3	3	1.66	7.82	NS
11.Dependency of The Client	Completely dependent		5	11	2	3	0.91	7.82	NS
11.Dependency of The Client	Partially dependent	2	28	46	6	3	0.91	7.82	NS
12.Type of Family	Nuclear	1	21	38	5	6	5.75	12.59	NS
	Joint		10	10	2
	Others	1	2	9	1

N.S = Not significant (p > 0.05) ; S = significant (p < 0.05)

The data presented in table shows that there is a statistically significant association between the demographic variables, family income, and relationship with client and type of disorder and levels of depression. Hence hypothesis 3 is partially accepted.

CONCLUSION:

The study concludes that anxiety and depression have a positive correlation and the caregivers of psychotic patients suffer from both, which if goes unidentified may become a cause for mental disorders among the caregivers, thereby increasing the morbidity rates.

RECOMMENDATIONS:

· In service education programmes can be planned for staff nurses to educate caregivers of psychotic patients regarding effective steps to be taken to deal with anxiety and depression

· Students can plan health education for the caregivers regarding preventing anxiety and depression

· The information from present study can also be presented at various nursing forums so that more number of nurses can become aware about the emotional problems and psychological stress among caregivers and can plan for future related researches.

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Received on 17.01.2017 Modified on 30.01.2017

Int. J. Adv. Nur. Management. 2017; 5(2):137-142.

DOI: 10.5958/2454-2652.2017.00029.4