Coping with spousal burden in chronic schizophrenia: a gender based analysis.
Burden of care in schizophrenia correlates with patients' illness variables (Dyck et al., 1999; Salleh, 1994; Pai & Kapur, 1982; Raj et al., 1991; Chakraborty et al., 1995), availability of caregivers resources as well as coping skills (Biegel et al., 1994; Magliano et al., 2000; Dyck et al., 1999). Birchwood and Cochrane (1990) found that relatives of schizophrenic patients adopted broad styles of coping across all areas of patients' behavior change. Solomon and Draine (1995) described factors associated with adaptive coping by family members with psychiatrically disabled relatives. More extensive adaptive coping was associated with increased social support as measured by the density of the social network, the extent of affirming social support, and participation in a support group for families. Better coping was also associated with a greater sense of self-efficacy in dealing with the relative's mental illness. Adaptive coping was not associated with the severity of the relative's illness.
Scazufca and Kuipers (1999) examined how relatives coped with schizophrenic patients. Problem-focused coping was the strategy used more often. Avoidance coping was strongly associated with burden, distress and high expressed emotion. Avoidance strategies seem to be less effective in regulating the distress of care-givers than problemfocused strategies.
Magliano et al. (2000) found a reduction of family burden over time among relatives who adopted less emotion-focused coping strategies and received more practical support from their social network. In addition, family burden decreased in relation to the improvement of patient's social functioning. When relatives of patients with schizophrenia are able to improve their coping strategies, it is possible for burden to be reduced even after several years
Karp and Tanarugsachock (2000) considered how caregivers to a spouse, parent, child, or sibling suffering from depression, manic-depression, or schizophrenia manage their emotions overtime. Caregivers' eventual recognition that they cannot control their family member's illness allows them to decrease involvement without guilt.
Chakrabarti and Gill (2002) examined coping and its correlates in caregivers of bipolar patients, in comparison with schizophrenia. Problem-focused coping strategies were more common in caregivers of bipolar patients and emotion-focused strategies in caregivers of schizophrenic patients.
Rammohan, Rao and Subbakrishna (2002) examined the use of religious coping and its relation to psychological wellbeing in carers of relatives with schizophrenia. Coping strategies of denial and problem solving, strength of religious belief and perceived burden were significant predictors of wellbeing.
Strous et al. (2005) reported that coping strategies play an important role in one's ability to adapt to stressful life conditions such as schizophrenia. Severity of symptoms accounted for 3.5% and 5.5% to 9% of the total variance of emotion- and task-oriented coping strategies, respectively.
Nehra et al. (2005) compared caregiver-coping in bipolar disorder and schizophrenia. Coping and other elements of the care-giving experience in bipolar disorder are no different from schizophrenia.
In married schizophrenics, mostly the spouse is a primary caregiver. The studies on spousal burden (Kumar et al. 2001) revealed a very high level of burden in the spouses of chronic schizophrenic patients. The exploration of coping mechanisms of spouses has received little attention in the literature.
Objectives: We aimed at delineating: (a) gender differences in spousal burden in chronic schizophrenia, (b) contribution of coping mechanisms in burden experienced by the spouses of chronic schizophrenic patients, and (c) exploration of differential use of coping mechanisms across genders.
Sample: A sample of 100 spouses of chronic schizophrenic patients was drawn from Institute of Mental Health and Hospital, Agra. Following inclusion/exclusion criteria was adopted: (i) Age range 21-55 years, (ii) Minimum two years duration of exposure to spousal schizophrenic illness, (iii) No history of substance abuse or major medical illness in either spouse, (iv) Co-operative and consenting spouses, (v) Diagnosis of chronic schizophrenia as per ICD-10.
1. Personal Data Sheet: For recording identifying information of patients and spouses and pertinent clinical information regarding participants
2. Coping Checklist (CC): It is developed by Rao et al. (1989). The checklist consists of 70 items in seven subscales categorized in three domains: problem focused, emotion focused and; problem and emotion focused. The retest reliability is .74. It has been validated in a community sample.
3. Burden Assessment Schedule (BAS): The schedule is developed by Thara et al (1998). It measures burden in nine areas: (a) Spouse related (b) Physical and mental health (c) external support (d) caregiver's routine (e) support of patient (f) taking responsibility (g) other relations (h) patients' behaviour (i) caregivers' strategy. There are 40 items rated on three point scale. The reliability is .80. The validity ranges from .71 -.80.
Procedure: The spouses of prospective participants were approached. They were briefed about the study and its relevance. Consent was obtained. The above tools were administered individually after ascertaining inclusion criteria.
RESULTS AND DISCUSSION
Gender Differences in Spousal Burden: Initial analysis was conducted to explore gender differences across spousal burden in chronic schizophrenia. Independent sample t-test was computed on total BAS (Burden Assessment Schedule) scores. The results revealed significant differences across gender. The results are presented in following table:
Table 2: Mean, S.D. and t-values of BAS Scores across Gender Measure Gender Mean S.D. t-value Significance Level BAS Total Male 86.58 11.07 2.90 ** .01 Scores Female 92.35 10.63
The significant gender differences are in expected direction. Female spouses of chronic schizophrenic patients experience greater burden. Similar results were obtained by Kumar and Mohanty (2007). Typically, female spouses feel more anxious, tired, frustrated, isolated and greater workload. Besides full domestic responsibilities, the illness in husbands places extra financial, caring, treatment and social responsibilities on female spouses which add to their burden.
Coping Mechanisms as Predictors of Spousal Burden: Our next query was to explore the quantum of variance in spousal burden explained by coping mechanisms. Standard Multiple Regression was computed for this purpose. The results revealed that coping mechanisms explain 11.30% variance in the spousal burden, R square = .113 [F (2,112) = 2.032; p=.05].
The coping mechanisms account for a small amount of variance in the spousal burden. There are host of variables like socio-economic status, symptom severity, family composition, nature and quantum of responsibilities, personality which contribute to spousal burden. Coping mechanisms is just one of the various variables that influence the magnitude of burden in spouses of chronic schizophrenic patients.
Gender, Spousal Burden and Coping Mechanisms: The coping mechanisms significantly predict the variance in spousal burden. In view of gender differences in spousal burden and contribution of coping mechanisms, we were interested to know if there were differential uses of coping mechanisms across male and female spouses of chronic schizophrenic patients. To accomplish this, we compared the groups based on gender by splitting the data file. Seven coping mechanisms assessed by coping checklist were entered as predictor variables and total BAS scores as dependent variable.
The analysis in this way revealed that in male spouses, Emotion Focused --Acceptance / Redefinition coping mechanisms significantly predicted the variance in spousal burden, R square = .111 [F (1,58) = 7.227; p=.009]. Whereas in female spouses, Emotion Focused--Religion/Faith, and Problem Focused--Problem Solving coping mechanisms significantly contributed to the variance in spousal burden, R square = .185 [F (2,57) = 6.490; p=.003]. These results do suggest differential use of coping mechanisms across gender.
The results appear to be in expected direction. In emotion focused acceptance / redefinition coping mechanism spouses typically feel that accept it as nothing can be done, compare yourself with others and feel that you are better off, console yourself that things are not all that bad and could be worse, try to look on the bright side of things, refuse to get serious about it, feel that time will remedy things; the only thing to do is wait, find a purpose or meaning in suffering, prepare yourself for worse to come. This coping mechanism is used more by male spouses.
Female spouses were found high on Emotion Focused--Religion / Faith coping mechanisms. In this coping mechanism one visits places of worship, go on a pilgrimage, participates in religious groups, pray to God, perform special 'Puja'. Miller (2002) reported that women are more religious than men to the extent that being irreligious constitutes risktaking behavior. The differential use of high religious coping by female spouses is obviously because of their high religiosity.
In female spouses, problem solving coping mechanism is negatively associated with spousal burden, (Beta: -.268; t-value=2.236, p=.029). Problem focused coping is considered the best. It points out to the ways of solving the problem and minimizes negative emotional consequences. In this approach an individual typically review the problems several times to enhance understanding, come up with a variety of probable solutions, works harder to manage the situation, analyze the problem bit by it and seek assistance from others. The problem solving coping mechanism gets collapsed in female spouses faced with the schizophrenic illness. This failure may account a portion of higher magnitude of burden in female spouses. Also, it strongly indicates the need for strengthening problem solving coping mechanism in female spouses during supportive psychotherapy.
The results of index study indicate significant differences in quantum of burden across gender and differential use of coping mechanisms by male and female spouses of chronic schizophrenic patients. The results emphasize the need for more attention to female spouses for burden management and consolidation of problem solving coping mechanism in them.
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Received: February 10, 2016
Revised: April 23, 2016
Accepted: June 16, 2016
O. P. Gangil *, A Gaur **, S. Mohanty *** and S. Kumar ****
* Ex-Associate Professor, ** Ex-Assistant Professor, *** Research Officer and **** Director; Institute of Mental Health and Hospital, Agra, India
Table 1: Sample Characteristics Particulars N Age 20-35 Years 60 35-55 Years 60 Gender Male 60 Female 60 Domicile Rural 60 Urban 60 Family Set up Nuclear 60 Joint / Extended 60
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|Author:||Gangil, O.P.; Gaur, A.; Mohanty, S.; Kumar, S.|
|Publication:||Indian Journal of Community Psychology|
|Date:||Sep 1, 2016|
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