|Year : 2013 | Volume
| Issue : 3 | Page : 143-147
Comparison of the demographic profile among caregivers of schizophrenia and depression
Sateesh R Koujalgi1, Shobhadevi R Patil2
1 Department of Psychiatry, KLE University's J.N. Medical College, Belgaum; Social Work, Karnatak University, Dharwad, Karnataka, India
2 Social Work, Karnatak University, Dharwad, Karnataka, India
|Date of Web Publication||19-Oct-2013|
Sateesh R Koujalgi
Department of Psychiatry, KLE University's J.N. Medical College, Nehru Nagar, Belgaum - 10, Karnataka
Source of Support: None, Conflict of Interest: None
Aim: This study aimed to explore the care givers socio-demographic and compare among schizophrenia and depression. Materials and Methods: A series of one hundred schizophrenia and one hundred depression consecutive patients attending psychiatry department who were accompanied by caregivers have been taken up for the study within the age group of 18-63 and above. To identify the primary care givers of above patients Pollack and Perlick scale was used. The International Classification of Disease, Diagnostic Criteria for Research ICD-10 criteria were used for psychiatric diagnosis and caregivers of the patients were assessed and compared on self-developed socio demographic proforma. Analysis was carried out using the SPSS-PC, version 17. Chi-square tests were carried out for comparison of the variables between the two groups. Results: Two groups of caregivers of patients with schizophrenia and depression have differed on variables such as age, gender, education, occupation, family income, length of contact with the patient, and relationship with the patient. Conclusion: The study finds significant difference in caregivers demographic variables in schizophrenia and depressive disorder.
Keywords: Care givers socio demographic variables, depression, schizophrenia
|How to cite this article:|
Koujalgi SR, Patil SR. Comparison of the demographic profile among caregivers of schizophrenia and depression. J Sci Soc 2013;40:143-7
| Introduction|| |
Caregivers can be explained in various ways. Caregivers may be spouse, child, parent, professional having a relationship with the patient. Such caregivers may be either primary or secondary caregivers wherein they may reside together with the patient or separately.  The role of these caregivers may be providing required assistance to the needy of the family member.  Lubkin and Larsen  describe about caregivers wherein they explain these caregivers are named as informal caregivers, where they assume caregiving responsibility without accepting any source of income. The reason could be emotional attachment toward the patient. On the other hand, formal caregivers are those who except payment for their service toward the patient. Walker et al. viewed providing care to their relative is often perceived as women because most of the needs of the ill person are fulfilled by women in the family. Bedini and Phoenix  asserted that 80% of informal caregivers are women. If the spouse is absent then it is the daughter or daughter in law who may assumes caregiving responsibility. The literature suggested that about 40% caregivers are male gender. There is lack of data on the demographic profile of cagegivers in psychiatric disorders. Moreover, from the available literature, it so far appears that socio-demographic variables of schizophrenia and depressive disorders have not yet been compared. Keeping this in mind, the present study was conducted with the aim of assessing and comparing both cohorts of socio-demographic variables.
| Materials and Methods|| |
The study sample consisted of two groups that were 100 schizophrenia patients caregivers and 100 depressive caregivers patients. The data were collected from the psychiatry outpatient and in-patient department by adopting the stratified sample random sampling technique. To identify the primary care givers of above patients Pollack and Perlick scale was used. Caregivers within the age group of 18 to above 63 years of age were taken up for the study after ensuring confidentiality. Informed consent was obtained for such cases. Caregivers were excluded if they were found to have organic mental disorder or other co-morbid psychiatric disorder.
A structured socio demographic variable proforma was prepared for the current study, which included the registration number, age, sex, education status, occupation, family income length of contact with the patient, and relationship with the patient. Data were analyzed using the SPSS ver. 19 software. Descriptive statistics and chi-square tests were used in the analysis.
All the probands were classified into two groups is schizophrenia key care givers and depression key caregivers. There is lack of studies, which have actually compared the socio demographic variables among these two groups of disorders. In this section, attempts was made to assess and compare key caregiver profile that of sex, education, occupation family income, length of caregivers contact, and relationship with a patient.
| Results|| |
[Table 1] shows, the socio demographic characteristics of the caregivers. In the schizophrenia group 4, (4%) probands were passing through the age between 18 years and 22 years and 13 (13%) in case of depression. In schizophrenia 7, (7%) probands were passing through the age between 23years and 27 years and 15 (15%) in case of depression. 6 (6%) of schizophrenia probands were belonged to age between 28 years and 32 years and that of 12 (12%) in case of depression. 17 (17%) of schizophrenia probands were passing thorough the age of 38-42 and 18 (18%) in case of depression. 14 (14%) of schizophrenia respondents were observed between age of 43 and 47 and that 13 (13%) in case of depression. Higher number of schizophrenia probands were observed under the age of 48-52 when compared to depression, 21 (21%) vs. 13 (13%). Greater schizophrenia probands were observed between age of 53 and 57 when compared to depression, 18 (18%) vs. 2 (2%). 2 (2%) of schizophrenia probands were observed under the age of 58-62 and 0 (0%) in case of depression. 2 (2%) of schizophrenia probands were observed in the above 63 age and 2 (2%) in case of depression. There was a significant difference in between both groups with regard to age of caregiver (P < 0.001).
There was apparent difference between both groups with regard to sex of caregivers and which was statistically significant (P < 0.001). In the schizophrenia group male as a caregiver constitute 34, (34%) and in depression group male as a caregiver constitute 70 (70%). Female proportion were greater in looking after schizophrenia group and 30 (30%) in case of depression.
The education status of caregivers of both groups was compared and which was non-statistically significant (p). 15 (15%) were illiterate in the schizophrenia group and 4 (4%) in case of depression. 28 (28%) studied up to primary school in the schizophrenia group and 9 (9%) in case of depression. 24 (24%) had higher study in the schizophrenia group and 19 (19%) in case of depression. 16 (16%) of schizophrenia population could complete higher secondary where as in depression group 25 (25%) caregiver could complete higher secondary. 16 (16%) had graduation in the schizophrenia group and whereas in depression group 30 (30%) had graduation. In the schizophrenia group 1, (1%) did complete post-graduation and 8 (8%) of depressive population could compete post-graduation course. None of the caregiver in the schizophrenia group could study for professional course, where as in depression 5 (5%) had professional course.
There was a significant difference in occupational level of both groups (P < 0.002). 3 (3%) of schizophrenia probands were found to be a student and that of 9 (9%) in case of depression group. 0 (0%) of both cohort population were seen as unemployed. 14 (14%) of schizophrenia population were employed and that of 19 (19%) in case of depression. None of schizophrenia population were seen having professional work, where as in depression 3 (3%) of the population were seen having professional work. 8 (8%) of schizophrenia population were employed in the government sector, where as in depression it was high 16 (16%). 9 (9%) of schizophrenia probands were found owning their own private business and that of 14 (14%) in depression. Both groups were dominated by housewives, 43 (43%) vs. 25 (25%). 23 (23%) of schizophrenia probands were occupied in agriculture work and 14 (14%) in case of depression.
Caregiver income was compared in both groups and was statistically significant (P < 0.002). 1 (1%) of both groups were seen having income up to Rs. 1, 000. 29 (29%) of schizophrenia group were seen earning between Rs. 1,001 and 5,000 and that of 14 (14%) in depression. 43 (43%) schizophrenia group were earning between Rs. 5,001 and 10,000 and 27 (27%) in case of depression. 21 (21%) of schizophrenia group could earn between Rs. 10,000 and Rs. 20,000 and that of 42 (42%) in depression. 6 (6%) of schizophrenia group were seen having income more than Rs. 20,000 and 16 (16%) in case of depression.
The length of care giver contact with a patient was compared in both groups and was statically significant (P < 0.001). 10 (10%) of schizophrenia group and 22 (22%) of depression group fell under the category of 5-9 age group. 4 (4%) in case of schizophrenia group and 10 (10%) in case of depression fell under the category of 10-14 years. 8 (8%) of schizophrenia group and 20 (20%) of depression group fell under the category of 15-19 years. 27 (27%) in case of schizophrenia and 25 (25%) in case of depression were observed under the category of 20-24 years. 17 (17%) of schizophrenia group and 13 (13%) of depression group fell under the category of 25-29 years of contact with a patient. 11 (11%) of schizophrenia group and 5 (5%) in case of depression group were seen having contact with patient between 30 years and 34 years. 23 (23%) in case of schizophrenia and 5 (5%) in case of depression were observed having more than 35 years of contact with their ill relative.
The caregiver relationship with a patient was compared in both groups, which was statically significant (P < 0.001). 23 (23%) in case of schizophrenia group and 64 (64%) in case of depression were observed as a having spouse relationship with a patient. 4 (4%) in case of schizophrenia group and 26 (26%) in case of depression were seen as having children relationship with their ill relative. 58 (58%) in case of schizophrenia group and 7 (7%) in case of depression were observed havening as parent relationship with a patient. 15 (15%) in case of schizophrenia group and 3 (3%) in case of depression were seen having another relationship with a patient.
| Discussion|| |
The present study provided clear evidence that age of caregiver in both porbands differ (P < 0.001). This further supported by the findings of age of onset that schizophrenia disorder tends to start at an earlier age as compared to depression. The other explanation could be depressive disorder people tend to come for treatment early in the course of their illness, where as schizophrenia symptoms may go unnoticed by key caregivers and this may arrest the treatment. This element may block their education and occupational carrier and further more they would not establish independence in their life. Hence due to unemployment, financial strain, these people remain with their parents. Due to all these reasons parents of such a population did not prefer them for marriage. Moreover, people may not choose their partner who is mentally ill. By any means if they get into martial life the divorce risk is high due to people with schizophrenia find difficulty performing family role.
The distribution of caregiver age in the schizophrenia group is fairly high compared to depression group. The reason may be schizophrenia continues and has relapse course of illness. The symptomatology of illness may block their martial life. Hence, they remain unmarried and stay with an immediate family member who has a close association with patient. The other reason may be it is often difficult for caregivers to accept that their relative has schizophrenia. Therefore, the families of people with schizophrenia hide the illness may not allow them for marriage life. Stigma is another factor that has identified as a barrier to patient marriage life. The other reason may be that family is afraid that after marriage, their ill relatives will be rejected by the partner. Due to these entire reason patient with schizophrenia stay with their parents.
There was apparent difference in two groups with regard to gender of care giving (P < 0.001). The results indicate that more patients in depressive group were married, where as major proportion of schizophrenia remained unmarried. This could be again explained on the basis of age of onset where in depression before the age of onset of illness people get into martial life.
Male gender of care giving in the schizophrenia group constitutes 34%, where as 70% were assumed cares giving responsibility in depression. The female gender constitutes 66% in the schizophrenia group and that of 30% in depression. Marriage allows for the formation of strong bonds of emotional attachment considerable social and economic support all of which either have a positive influence on accepting care giving. In schizophrenia positive symptoms behaviour such as hallucinations and delusions together with a high degree of social dysfunction and recurrent relapse are often linked with greater distress for caregivers and burdening. Moreover, male member may be having more of economic responsibility and female may assumed family caring responsibility. The other reason may be care giving is often perceived as an excluding providence of women because many of the requirements of the ill persons are mostly met by women in families. In depression due to symptomlogy male gender may be much distressful although caring for their ill relative, but caring may benefited to them includes satisfaction, reciprocity, and personal growth. Overall care giving broadened caregiver horizons and assisted them grow as people.
The groups did not differ with regard to education status of care giver. It may be apparent that the education status of caregiver does not effect in caregiving of their ill relatives.
As regard to occupation of the caregivers, there was a significant difference between two groups (P < 0.002). Both groups with the majority of respondents being occupied as a house wife (43% vs. 25%) Certain socio-cultural factors unique to the Indian setting could have contributed to the particular pattern of women work; where in the majority of women are assigned to household work. The majority of rural respondents were engaged in agriculture work (23% vs. 14%). An explanation for this the greater numbers of rural people are accessible to agriculture work. The results of the present study perhaps evident that schizophrenia illness impact on caregivers occupation. The distress of caregivers may reflect on their occupation. Many of schizophrenia patients may not attend to work or not earn, may not care for personal hygiene and were considered most distressful and thus relative need to spend extra time in caring. Moreover, historically schizophrenia has been considered to be a chronic mental illness with less hope of remission or recovery. This may not be in case of depression disorder. Hence, therefore, more responsibility lies on caregivers. These are considerable factors for group differences.
There was a significant difference in family income of both groups. i.e., greater income affect was observed in the schizophrenia group although compared to depression (P < 0.001), which is probably due to disability, schizophrenia patient participate in work training skills, and once they reach to the task level, they might be placed in a sheltered workshop. Unfortunately, although after work skill training person with schizophrenia may not work productively. This work would be part time for less than minimum wage. People may not achieve independence in work; hence, they are placed in supportive employment. This is because a person with schizophrenia manifest some level of cognitive impartment, mostly in the functional areas of memory, attention, and higher executive functioning. The other possible reason is that person with schizophrenia finds it difficult in accessing services at the community level after discharge form inpatient services. Whereas, depressive patient may return to a state of remission. Thus, all these factors in schizophrenia disorder affect financial status of caregivers.
There was a significant difference between two groups with regard to length of caregivers contact (P < 0.001). Most of the patients in the schizophrenia group were remained unmarried. Despite of positive, negative affective, and cognitive symptoms family extend their care giving toward their ill relative. This could be because of social, emotional bondage of family. The other reason may be care giving may benefit caregiver, which is may be psychological satisfaction. The course of illness in schizophrenia lengthens the caregiver contact. The other reason may be care giver of schizophrenia typically tolerates the difficulty behaviours of their ill relative. Probably these people may have knowledge about the nature of their patient illness and also receives help form professionals in the management of difficult behaviour. Another explanation may be this population may have accepted their relative illness and adopted a healthy coping skill, which reduces adverse effect on their own health, both psychical and psychological.
There was a significant difference between two groups with regard to the relationship with patient (P < 0.001). In the schizophrenia group, spouse constitute 23% and in depression group spouse constitute 64%. This indicates despite of nature of illness small part of schizophrenia population get married and spouse extent their caring support. Such spouses may not be having more choices for their economic independence or probably they might have some benefit for their life. In female counterpart once they married their parents may force them to lead a life with the ill person and parents of such females counter may not extend their support. The other reason may be these spouses may not use projection defence mechanism. The use of projection is more prone to increase interpersonal conflict. In depression, male counterpart extends their caring support. This could be because possibly due to the discrete nature of the episodes. The other reason may be their own children may extend their caring support or they take an active part in the caring process. That is why present study showed out of 30 samples 26% caregivers were children in depressive disorder group and while 4% in the schizophrenia group. As consequences of illness patient remains unmarried. Hence, the majority of the caregivers in the schizophrenia group were parents that constitute 58% and that of 7% in depression. The reason may be parent may find the solution to the problem and feel that they are doing fair to improve the situation. With the longer course of management, the parents could have learned to handle the stages of crisis. Moreover, continuation of illness management may gradually improve interpersonal relationship of the family members.
| Conclusion|| |
The present work highlighted difference in various non-illness variables in the caregivers of two groups of schizophrenia and depression. Age of caregivers, gender, caregiver occupation, caregivers family income, length of caregiver contact with the patient, and relationship with the patient among schizophrenia and depression significantly differ. Both groups did not differ in occupation variable.
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