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CAREGIVERS OF MENTALLY ILL PATIENTS: ROLE OF COPING STYLE AND EMOTIONAL INTELLIGENCE.

Byline: Ashar Saeed, Shoaib Kiani and Saira Javed

Keywords: Coping skills, Emotional quotient, Mental health.

INTRODUCTION

Emotional intelligence is the ability of an individual to recognize, perceive, and develop emotions, assisted by thoughts in order to understand their own and others' emotions. Stable emotional intelligence is a strong predictor of better coping abilities1. These coping styles get triggered by any disturbance at emotional level in form of internal or external stress, depression, anxiety, fear, danger and anger2. Poor coping abilities directly reflect the weak emotional stability3. In America and rest of European countries friends, family or other significant individuals provide paid care to patients. Though Asian countries, like Pakistan have a versatile culture but there is no trend of paid care to any patient by his/her significant. Being a care taker is a demanding job which also comes with mental and physical distress, emotional instability, financial burden, disturbed socialization and depression4,5.

These factors eventually weaken the coping abilities of care taker that might later also impact the health of mentally ill patient7. Due to limited documentation of unstable emotional intelligence, mishandling of mentally ill patients by their caregivers, very few to no intervention plan has been designed for the caregivers of mentally ill patients. For this reason, present study was pursued to determine the role of coping style and emotional intelligence among caregivers of mentally ill patients.

PATIENTS AND METHODS

The present study was conducted at Armed Forces Institute of Mental Health (AFIMH) Rawalpindi. The study design was cross sectional. Permission to conduct present study was taken from Psychological Research Cell, Personnel Administration Directorate, GHQ Rawalpindi, Pakistan. Data was calculated from only those participants, who were available at time of study. Sample comprised of 53 male and 47 females respondents (N = 100). Before data collection formal permission was taken from each author of the scale. Data was collected through purposive sampling technique from all respondents. They belonged to middle socio-economic class and were present at the time of study at AFIMH. After providing general instructions, caregivers were asked to sign a consent form before providing data on demographic sheet i.e. (age, gender, qualification and relationship status), brief coping scale was used.

It was designed by Charles Carver 1997 and translated into Urdu by Akhtar in 2005, consisting of 28 items including four sub scales i.e., Active Avoidance Coping, Problem Focused Coping, Positive Coping, Religious/Denial Coping. Selfreport measure of emotional intelligence developed by Schutte, Marlouf, Hall, Hargger cotypper, Golden and Donhelm, (1998) was also used. It consists of 33 items. Data of the present study was analyzed by descriptive statistics, t-test, One way ANOVA, Bivariate Correlation, and Moderation (Process Marco developed by Andrew F.) by using IBM SPSS version 23 p-value a$? 0.05 considered significant.

Table-I: Mean, standard deviation cronbach's alpha reliability, skewness, kurtosis and range of brief coping scale and self-report measure of emotional intelligence scale, (N = 100).

Variables###No. of###M###S.D###[alpha]###Skewness###Kurtosis###Range

###Items###Potential###Actual

###AAC###10###19.52###3.43###0.50###0.51###-0.76###10-50###13-27

Subscales###PFC###07###20.16###2.59###0.63###0.20###-0.21###7-35###14-26

of BCS###PC###07###18.01###2.31###0.61###0.42###0.54###7-35###12-25

###R/DC###04###9.04###2.44###0.60###0.46###-0.39###4-20###5-15

Complete BCS###28###62.25###13.74###0.72###-0.003###-0.73###28-140###40-94

###SRMEI###33###123.28###11.80###0.81###0.17###-0.22###33-165###100-153

Table-II: Gender and marital status differences on scores of briefcoping scale and self-report measure of emotional intelligence scaleamong caregivers of mentally ill patients (N = 100).

Variables###M###S.D###M###S.D###t###p###95% CI###Cohen's d

###Men (n=53)###Women (n=47)###LL###UL

AAC###20.59###3.34###18.32###3.14###3.47###0.001###0.97###3.56###0.7

PFC###20.00###2.41###20.70###2.72###-1.10###0.049###-2.04###-0.01###0.2

PC###17.83###2.28###18.21###2.36###-0.83###0.412###-1.31###0.54###-

R/DC###8.89###2.55###9.21###2.32###-0.67###0.51###-1.30###0.64###-

BCS###58.79###13.11###66.15###13.51###-2.76###0.007###-12.65###-2.06###0.5

SRMEI###119.81###8.79###127.19###13.52###-3.27###0.001###-11.86###-2.90###0.6

Variables###M###S.D###M###S.D###t###p###95% CI###Cohen's d

###Married (n=70)###Unmarried (n=30)###LL###UL

AAC###19.18###3.45###20.30###3.30###-1.49###0.14###-2.59###0.36###-

PFC###20.41###2.55###19.56###2.63###1.50###0.14###-0.27###1.69###-

PC###18.34###2.48###17.23###1.65###2.24###0.03###0.13###2.09###0.5

R/DC###8.75###2.39###9.70###2.43###-1.79###0.08###-1.98###0.100###-

BCS###62.38###14.72###61.93###11.33###0.15###0.87###-5.52###6.43###-

SRMEI###124.15###12.88###121.23###8.59###1.13###0.26###-2.17###8.02###-

Table-III: Qualification level differences on scores of brief coping scale and self - report measure of emotional intelligence scaleamong caregivers of mentally ill patients (N = 100).

###Primary to###Intermediate to###Post-Graduation and

###Matric###Graduation###Above

###n=14###n=66###n=20

Variables###M###S.D###M###S.D###M###S.D###F###P

BriefCoping###58.71###17.35###63.09###12.60###14.94###3.34###0.59###0.56

Emotional###121.29###15.65###121.05###10.05###121.13###10.84###0.006###0.99

Intelligence

Table-IV: Correlation of age, brief coping scale and self-report measure of emotional intelligence scaleamong caregivers of mentally ill patients (N = 100).

S. No. Variables###1###2###3###4###5###6###7

1###Age###-###-0.05###0.01###0.21*###-0.147###-0.05###0.01

2###AAC###-###-###0.09###0.23*###0.09###-0.13###-0.10

3###PFC###-###-###-###0.43**###-0.04###0.17*###0.24**

4###PC###-###-###-###-###-0.09###0.06###0.33**

5###R/DC###-###-###-###-###-###-0.12###0.02

6###BCS###-###-###-###-###-###-###0.56**

7###SRMEI###-###-###-###-###-###-###-

Table-V: Moderating role of age, gender and marital status in relationship of brief coping scale and self - report measure of emotional intelligence scaleamong caregivers of mentally ill patients (N = 100).

###BCS

###95% CI

Predictor###B###LL###UL

Constant###62.26**###59.10###64.52

Age###-0.11###-0.66###0.44

SRMEI###0.65**###0.45###0.84

Age x SRMEI###-0.023###-0.071###0.025

R2###0.33

F###15.74**

IR2###0.32

IF###0.90

Constant###62.99**###59.81###64.39

Marital Status (MS)###1.10###-3.95###6.16

SRMEI###0.63**###0.42###0.83

MS x SRMEI###-0.25###-0.78###0.29

R2###0.33

F###15.66**

IR2###0.29

IF###0.84

Constant###62.07**###59.67###64.48

Gender###2.87###-1.94###7.67

SRMEI###0.60**###0.38###0.83

Gender x SRMEI###0.10###-0.34###0.53

R2###0.001

F###15.81**

IR2###0.31

IF###0.19

RESULTS

Total of 100 caregivers of mentally ill patients were taken that comprising males (n = 53) and females (n = 47) with mean age of 29.87 years and 4.30 standard deviation. About 70 participants married while 30 were unmarried 14 participants had done intermediate, 66 had graduated, and 20 had done masters and above. Table-I gives information about mean, standard deviation, cronbach's alpha reliability, Skewness, Kurtosis and range of each used scale and subscales. BCS consists of four subscales of Active Avoidance Coping (M = 19.52, SD = 3.43, [alpha] = 0.50), Problem Focused Coping (M = 20.16, SD = 2.59, [alpha] = 0.63), Positive Coping (M = 18.01, SD = 2.31, [alpha] = 0.61), Religious/Denial Coping (M = 9.04, SD = 2.44, [alpha] = 0.60), whereas, complete Brief Coping Scale consists of 28 items (M = 62.25, SD = 13.74). However, Cronbach's alpha reliability, Skewness, Kurtosis and Range SRMEI (M = 123.28, SD = 11.80, [alpha] = 0.81) was also satisfactory.

So it has been found that all scales have acceptable reliabilities coefficient (i.e. [alpha]>0.7). Results further revealed that data were normally distributed and were fulfilling assumption of parametric testing. The values of Skewness and Kurtosis ranged between -2 to + 2 and they are statistically acceptable (George and Mallery, 2010). Findings of table-II shows significant gender differences on score of subscales of BCS i.e., Active Avoidance Coping (t = 3.47, p = 0.001), Problem Focused Coping (t = -1.10, p = 0.049), in overall Brief Coping Scale (t = -2.76, p = 0.007), and on scores of Self-Report measure of Emotional Intelligence scale (t = -3.27, p = 0.001). However results further elaborates that in subscale of BCS i.e., AAC men score higher than women whereas, in subscale of PFC, complete scale of BCS and in SRMEI women scores more than men. Table further explains significant marital status differences only on score of subscales of BCS i.e., Positive Coping (t = 2.24, p = 0.03).

Whereas, rest of subscales and overall scale of BSC and SRMEI show no significant differences in category of gender and marital status. A one way Anova has been applied on category of qualification on scores of brief coping scale and self report measure of emotional intelligence scale among caregivers of mentally ill patients and has found no significant mean differences between and within groups at 0.05 significant level (table-III). Table-IV of bivariate correlation shows positive correlation of Positive Coping with age (r = 0.21*), Active Avoidance Coping (r = 0.23*), Problem Focused Coping (r = 0.43**) and SRMEI (r = 0.33**). Whereas Problem Focused Coping is significantly positively correlated with BCS (r = 0.17*) and SRMEI (r = 0.24**). Lastly BCS and SRMEI (r = 0.43**) also shows positive correlation between two variables (r = 0.56**). To study the effects of moderator age, marital status and gender in the relationship between emotional intelligence and coping skills.

Moderation analysis was performed by using Process Marco developed by Andrew F. Hayes. Results of table-IV show the main role presented by age, marital status and gender on the scores of brief coping style is non-significant, which means emotional intelligence or having better emotional intelligence do not predicts increase in coping style or enhance coping skills. Which means age, marital status and gender have neutral effect in relationship of EI and CS. It also has been seen that effect of EI and CS is positively significant (p<.001***) that means increase in EI predicts increase in CS. However, the overall model does not show significant moderation of age, marital status, and gender in relationship between emotional intelligence and coping skills.

DISCUSSION

The present study explored the role of coping style and emotional intelligence among patient's caregivers of Armed Forces Institute of Mental Health (AFIMH) Rawalpindi. Findings of the study revealed that male care givers of mentally ill patients show more active avoidance coping strategy as compared to female care givers. It has been seen that males usually give less attention to any stressors and indoor stressors as compared to women that's why female care givers have shown strong coping styles and emotional intelligence as compare to male care givers of mentally ill patients6,7. Females also have to maintain peace and balance at home, and are responsible for giving care to patients that's why they adopt more problem focused coping strategy as compared to male care givers8. Results further revealed that some female caregivers show more emotional stability and better coping styles compared to male caregivers.

Whereas, it has been analyzed that married caregivers show more problem focused coping strategy than unmarried caregivers, this could be a reason that married individuals better understand their respon-sibilities regarding taking care of mentally ill patients than unmarried9,10,11. On the other side marital status has shown no mean differences in overall coping style and emotional intelligence. In Pakistan being married or unmarried does not make much difference in sense of responsibilities, as per cultural rituals one has to perform his/her duty, if assigned any patient to take care. Both married and unmarried caregivers of mentally ill patients experience same amount of emotional instability, active avoidant coping style, denial and positive coping10. Results further explain the correlation of age with coping style and emotional intelligence. Findings of the study explain that age is a reflection of maturity level.

Greater the age better would be a positive coping; problem focused coping and emotional intelligence. Whereas, it also has been seen that with advancement of age people start avoiding stressful and challenging situation and many times chose to escape from the situation as they are tired of being victimized by stressors and want escape, so they adopt active avoidance coping11-13. Whereas, coping style and emotional intelligence has shown positive and strong correlation like previous studies1-7,11. Parallel to previous studies present study also has shown that caregivers with better emotional intelligence are more empathetic, composed and opt better skills. Emotional Intelligence had a statistically positive correlation with problem focused coping agreeing with study which has shown that EI was positively associated with the problem-focused style1-3,11,12.

Lastly it has been explored that no significant moderating role of age, gender and marital status in relationship of coping styles and emotional intelligence has been found among caregivers of mentally ill patients. This means there is direct and significant correlation between coping styles and emotional intelligence but age groups, being male or female, married or unmarried caregivers do not have any positive or negative impact in relationship of coping styles and emotional intelligence14-18. Though current study has strengthened such as using advance statics and broadly investigates the coping styles and emotional intelligence among care givers of mentally ill patents, which lacks in documentation. Further study has explored the moderating role of socio-demographic variables in relationship of CS and EI, however results were non-significant but they have their importance to scientific world.

With the help of these non-significant findings budding researchers will be able to design their researches by keeping more defined inclusion and exclusion criteria. The sample size of the study was small, mostly were graduates and from AFIMH Rawalpindi, therefore, the findings of this study would not be able to generalize on whole Pakistani population.

CONCLUSION

Emotional intelligence of caregivers of mentally ill patients gets affected by taking care of these patients which disturbs the coping abilities of care givers that brings stress to their lives also.

CONFLICT OF INTEREST

This study has no conflict of interest to be declared by any authors.

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Publication:Pakistan Armed Forces Medical Journal
Geographic Code:9PAKI
Date:Jun 30, 2019
Words:3324
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