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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 33  |  Issue : 2  |  Page : 171-176

Awareness about mental illness among the family members of persons with mental illness in a selected District of Assam


Department of Psychiatric Nursing, LGB Regional Institute of Mental Health, Tezpur, Assam, India

Date of Web Publication30-Jun-2017

Correspondence Address:
Nurnahar Ahmed
Department of Psychiatric Nursing, LGB Regional Institute of Mental Health, Tezpur - 784 001, Assam
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9962.209199

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  Abstract 

Background/Objectives: Knowledge about mental illness is essential for family members to provide effective care at home to the person with mental illness. Existing literature has shown that family members either have poor knowledge or aware about some facts but not adequate for effective patient management. Moreover, many of the time, attitude toward mental illness is seen to be negative. The present study aimed to assess the knowledge of family members of persons with mental illness about mental illness and to find the demographic associates. Subjects and Methods: A cross-sectional descriptive study was conducted at the outpatient department (OPD) of a Tertiary Care Mental Health Institute in North-East India. Total 111 family members of patients diagnosed as psychosis (F20-F39; as per the International Classification of Diseases-10 diagnostic criteria) attending OPD for follow-up were selected purposively for the study. Structured sociodemographic pro forma and the Knowledge of Mental illness Questionnaire were used to collect data about knowledge of mental illness among the family members. Results: Data were analyzed with descriptive statistics, Chi-square test, and Pearson's correlation by using SPSS version 16.0. Family members' knowledge about mental illness was found to be inadequate in some areas. Knowledge about mental illness was found significantly correlated with family members' age (r = 0.254, P = 0.007) and caregiving duration (P = 0.268, P = 0.004). Family members' gender and relationship with patients were found to be significantly associated with knowledge of mental illness. Conclusion: The present study finding suggests for the need of intervention to enhance knowledge of family members about mental illness for better patient management.

Keywords: Family member, knowledge of mental illness, mental illness


How to cite this article:
Ahmed N, Baruah A. Awareness about mental illness among the family members of persons with mental illness in a selected District of Assam. Indian J Soc Psychiatry 2017;33:171-6

How to cite this URL:
Ahmed N, Baruah A. Awareness about mental illness among the family members of persons with mental illness in a selected District of Assam. Indian J Soc Psychiatry [serial online] 2017 [cited 2019 Nov 21];33:171-6. Available from: http://www.indjsp.org/text.asp?2017/33/2/171/209199


  Introduction Top


Mental health problems have become the alarming condition in present health scenario. World Health Organization report reflects that one in four persons fulfill the criteria of any mental illness at least once at some point in their lifetime.[1] The national prevalence rate for mental illnesses in India is found to be 73/1000 population.[2] A meta-analysis result estimated the prevalence rate of mental disorder as 58.2/1000 population in which psychosis contributed a rate of 15.4/1000 population.[3] Besides its wide prevalence, common people are unaware about the facts related to mental illnesses.[4],[5] It is seen that public hold negative belief about mental illness saying people with mental illness are dangerous, unpredictable,[6],[7],[8] and they are not curable.[9] These negative perceptions have been remarkably constant despite advancement in scientific understanding of mental illnesses,[10] increased literacy rate and availability of scientific treatment of mental illness. Considerable number of people believe that mental illnesses are caused by supernatural power, excessive worrying,[11] black magic, curse, or evil spirit. Hence, they prefer religious remedies,[7] nonprofessional medical help, or alternative medicines [11] for treatment. Poor knowledge about the causative factors of mental illnesses was found to be associated with stigma and negative attitude [8],[12] in the form of fear and avoidance.[13] Sometimes family members of persons with mental illness know about the humane treatment but less aware about the nature and causative factors of mental illness.[14] In this situation, there is a probability of seeking help from nonscientific treatment which may lead to several complications.

Very often it is observed in the mass media that persons with mental illness are kept confined inside the room and treated inhumanly.[15],[16],[17] Most of the time family members are hesitant to disclose about having family members with mental illness. Researches showed that awareness regarding mental illness enhance positive attitudes toward it,[13] making people feel easy to disclose about the illness, and improve help-seeking behavior.[18] Knowledge of mental illness also predicts treatment adherence.[19],[20]

Knowledge of family members regarding mental illness has an important role in the treatment process. Persons with mental illness are cared and supervised by their family members in medication, self-care, and rehabilitation as well as to take decision about treatment on behalf of them. The researchers have observed that family members often express fear of negative impact on the physical health of a person with mental illness due to prolonged medications and also the patients are taken to some faith healers who treat in an unscientific way. Many a time persons with mental illness are deprived from proper care and treatment because of inadequate knowledge and misconceptions among the family members, and stigma associated with mental illness. By considering these, the need was felt to find the existing knowledge about mental illness among the family members so that interventions can be planned with appropriate strategies in the deficit areas.

Objectives of the study

  • To assess the knowledge about mental illness among the family members of persons with mental illness
  • To find the association between selected demographic variables of family members of persons with mental illness and their knowledge about mental illness.



  Subjects and Methods Top


The present study was a descriptive research conducted at the outpatient department of a Tertiary Mental Health Institute in North-East India. All the services provided in the hospital are free of cost. A multidisciplinary team approach is followed for total care of the mentally ill individuals. In an outpatient department, persons with mental illness are treated with medications along with psychosocial interventions. Psychoeducations are conducted on the regular basis for the patients and their relatives attending with them for follow-up.

One hundred and eleven family members of persons with mental illnesses were included in the study, and they were selected through purposive sampling method. Family members who are taking care of patient diagnosed as psychosis (F20-F39) as per the International Classification of Diseases-10 criteria and staying with them for minimum 1 month residing within the Sonitpur district of Assam were included in the study. Participants who are unable to read or understand Assamese language were excluded from the study.

Measurement tools

A validated sociodemographic pro forma was used measure the age, gender, religion, educational level, occupation, family type, habitat, and presence of any chronic illness of the family members of person with mental illness. The knowledge of family member about mental illness was assessed with “Knowledge of Mental Illness Questionnaire,” a structured tool in local language. The questionnaire consists of 46 items measuring six area of knowledge regarding mental illness, namely “basic information” (11 items), “need of treatment” (five items), “medication administration” (nine items), “side-effects and their management” (six items), “consequences of nonadherence” (six items), and “psycho-social management” (nine items). Each item has three options (“yes,” “no,” and “don't know”) to answer. Each correct answer scores one and the wrong or “don't know” answer scores 0. Thus, the total score of the questionnaire ranged from 0 to 46. The questionnaire is self-rated by the family members who are involved in the home-based care of the person with mental illness. The tool has good construct validity. Internal consistency was obtained by the split-half method, and Spearman–Brown coefficient was found to be 0.88 and the Chronbach's alpha for the tool was found to be 0.83.[21]

Data were collected from January 2014 to January 2015 by the principal investigator following ethical clearance from the Institutional Ethics Committee along with permission from the hospital authority. Family members of a person with mental illness coming for the follow-up with the patients were selected from the registration room. The purpose of the study was explained to the participants, and the written consent was obtained from them before collecting data with the selected measurement tools. Two sessions of psychoeducation were conducted for the participants following data collection. Confidentiality and anonymity of the participants were maintained.


  Results Top


The collected data were entered in a master data sheet and analyzed by both descriptive and inferential statistics with PASW statistics version 18.0 (SPSS, an IBM company as of 2009, in Chicago, Illinois) according to the previously set objectives.

Description of sociodemographic profile of family members of persons with mental illness

The sociodemographic data of the family members of persons with mental illness on the discrete level were analyzed with frequency and percentage as presented in [Table 1] and the data on the continuous level were analyzed with range, mean, and standard deviation as presented in the following [Table 2].
Table 1: Frequency and percentage of selected sociodemographic variables of family members of persons with mental illness (n=111)

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Table 2: Range, mean, and standard deviation of selected sociodemographic variables of family members of mental illness (n=111)

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Description of knowledge score of family members regarding mental illness

The data collected from the family members of persons with mental illness on knowledge about mental illness is described in the following [Table 3] with range, mean, and standard deviation. Description of the score in “Knowledge of Mental Illness Questionnaire” shows that average knowledge of family members about mental illness was considerably higher except for the knowledge about medication side-effects and their management.
Table 3: Description of total and domain-wise scores on knowledge of mental illness questionnaire in terms of range, mean, and standard deviation (n=111)

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Association of sociodemographic variables with knowledge of mental illness among family members

The Chi-square test was applied to find the association of knowledge about mental illness with the selected sociodemographic profiles of the family members of persons with mental illness. The results displayed in [Table 4] show that none of the sociodemographic variables of family members were significantly associated with the total knowledge about mental illness except gender and relationship with the patient (χ2 = 6.03, df = 1, P = 0.021; χ2 = 8.897, df = 2, P = 0.012, respectively). Participant's habitat was found to be associated with knowledge about mental illness, but the result was not statistically significant (χ2 = 4.222, df = 1, P = 0.056).
Table 4: Chi-square between the sociodemographic profiles and knowledge score of family members of person with mental illness (n=111)

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Chi-square test was also applied for demographic profile of family members with all domains of knowledge about mental illness. The result showed that family members' knowledge about medication administration was associated with habitat (χ2 = 5.973, P = 0.014, df = 1), gender (χ2 = 3.967, P = 0.05, df = 1), and education (χ2 = 4.526, P = 0.047, df = 1). Knowledge about medicine side-effects and management was associated with education (χ2 = 6.277, P = 0.019, df = 1), and occupational status (χ2 = 5.751, P = 0.023, df = 1) of the family members. Family members' knowledge about consequences of nonadherence was found to be associated with relationship with patients (χ2 = 8.455, P = 0.015, df = 2). Knowledge about psychosocial management was found to be associated with the presence of any chronic illness (χ2 = 6.2777, P = 0.015, df = 1) and relationship of the family members with patient (χ2 = 7.747, P = 0.021, df = 2).

Pearson's correlation was applied to find the relationship of total knowledge score with age, duration of caregiving, distance from the mental health care setting, and monthly family income. The results are shown in [Table 5]. Pearson's' correlation was also applied for these demographic variables with all the domains of knowledge questionnaire. Knowledge about basic information about mental illness was found to be positively correlated with duration of caregiving (r = 0.364, P = 000). Moreover, family members' age was found to be positively correlated with knowledge of consequences of nonadherence to treatment (P = 0.226, P = 0.017) and psychosocial management of mental illness (r = 0.236, P = 0.013).
Table 5: Pearson's correlation (r) between selected sociodemographic variables and knowledge score of family members of person with mental illness (n=111)

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  Discussion Top


The present study was conducted with the aim to assess the knowledge about mental illness in family members of persons with mental illness and to find the association with selected sociodemographic profiles. The results found in the statistical analyses are discussed in the light of existing literature.

The findings from the description of sociodemographic profile of family members of persons with mental illnesses were found to be comparable with the results of few published studies [9],[11],[14],[22] assessing caregivers' knowledge about mental illness. The results are also explainable in terms of demographic statistics of Sonitpur district of Assam from where the participants belong.[23] The descriptions in [Table 3] reveal that family members are having considerably higher overall knowledge of mental illness. However, family members are less aware about the side-effects of medicine and their management, basic information including causative factors and misconceptions, as well as consequences of nonadherence. The result can be explained by the fact that the family members are used to be in touch with the patients and therefore they can be experienced with some of the sign and symptoms, treatment process, and prognosis with the treatment. The present study results seem to be consistent with the finding of some studies conducted in Indian settings. Gogoi et al.[22] had found the satisfactory knowledge of mental illness in family members from both rural and urban area. A study by Das and Phookun [14] had found that relatives of admitted psychiatric patients had adequate overall information about mental illness and treatment, but they lack in information related to nature and etiology. Similarly, Poreddi et al.[9] had found that family members know about mental illness but stigmatized attitudes prevail along with. Family members' knowledge about mental illness may differ with type of illness that a person suffering from, however the scientific knowledge is often deficient. Chakraborty et al.[11] had found that majority (96.8%) of the relatives of patients with schizophrenia or related psychotic disorders believed in supernatural causation, whereas majority of the relatives of patients with depressive disorder, obsessive-compulsive disorder and other anxiety disorder, somatization or dissociative disorders attributed their relatives' symptom to excessive worrying/thinking. Caregivers of schizophrenia have subaverage knowledge about the disease of the person they are taking care of.[24] Knowledge about mental illness may be influenced by various factors and hence awareness about mental illness varies among the family members and the general public.[25] Majority of the Naga tribal people attributed the psychological issues as the causes of mental illness, but a considerable numbers believed in black magic, curse, or evil spirit as the cause of mental illness and they prefer prayer meeting as a treatment option.[7] A Nigerian study by Kabir et al.[13] had found that aggression, talkativeness, eccentric behavior, wandering, and self-neglect are the most common symptoms and drug misuse, divine punishment, and spirit possession are the common causes of mental illness. Another study by Gureje et al.[8] had also found poor knowledge of general public regarding causative factors of mental illness.

Gender of family members was found to be significantly associated with their knowledge regarding mental illness (χ2 = 6.03, df = 1, P = 0.021). Though it is not proved in studies, a difference is observed in learning characteristics and beliefs about illness among the genders and also literacy rate differs among the males and females. Hence, it is likely that knowledge of mental illness may be associated with their gender. An opposite result was observed in the result of a study by Das and Phookun,[26] where no statistical significant association was found between sex of relatives and knowledge, attitude, perception, and belief (KAPB) of mental illness.

The relationship between family members with the person with mental illness was found to be significantly associated with their knowledge regarding mental illness (χ2 = 8.897, df = 2, P = 0.012). The result is in contrast to the finding of a study by Das and Phookun,[26] where no statistical significant association was found between relationship and KAPB of mental illness in relatives. The present study result might be explained with the fact that the parents are always seem to be more concerned for the health of their children, and this leads them to be more inquisitive to know about the illness that their child is suffering from.

No significant association was found between educational level of family members with their knowledge regarding mental illness (χ2 = 1.103, df = 1, P = 0.397). The result indicates that general education does not necessarily influence the knowledge of mental illness. The result might be explained with the curriculum of the current general education system. The syllabus of school education includes a little information about health and illness but nothing is included about mental health and hygiene if somewhere mentioned it is very scanty. Moreover, the matter of mental health and hygiene is still a matter with pervasive stigma in the society. A contrasting result was found in the study by Das and Phookun,[26] where attitude and knowledge of social restrictiveness were found inversely related to educational level (P = 0.0145).

No significant association was found between religion, occupation, type of family, habitat, ethnicity, or presence of any chronic illness of family members with their knowledge regarding mental illness. The result is suggestive that awareness of mental illness is free from the influence of all these demographic variables.

Age and duration of caregiving were found to be positively correlated with the knowledge of mental illness among the family members. The result may be explained based on the fact that knowledge increases with the experiences. People with advanced age and who is taking care of the patients for longer time usually exposed to various experiences related to mental illness which may lead to more knowledge of mental illness.

Analyses for association and relation of knowledge domains with the sociodemographic variables of the family members of a person with mental illness showed that knowledge of basic information was positively correlated with caregiving duration. Knowledge about the need for treatment was found to be independent of any sociodemographic variables of family members. Knowledge about medication administration was found to be associated with gender, education, and habitat of the family members. Similarly, education and occupation of the family members were found to be associated with knowledge about medicine side-effects and management. Family members' knowledge about consequences of nonadherence was found to be correlated positively with age and associated with relationship with patients. Knowledge about psychosocial management was found to be associated with the presence of any chronic illness and relationship with the patient as well as positively correlated with age of family members.


  Conclusion Top


Knowledge of family member about the mental illness is imperative in caring the patients with mental illness. Overall knowledge about mental illness was found to be toward the higher side in the present study. However, family members of a person with mental illness were found to have a lack of knowledge in some areas such as medication side-effects and their management, causative factors of mental illness, misconceptions of mental illness, and consequences of treatment nonadherence. No sociodemographic variables except age, gender, relationship with the patients, and duration of caregiving were found to be associated with the knowledge of mental illness among the family members. Hence, the present study results indicate the need to include some interventions like psychoeducation for the family members routinely during follow-up visits for the patients. The hospital authority may develop various strategies like regular psychoeducation, distributing information booklet, awareness meetings, etc., to enhance the awareness about mental illness among the family members as well as to the public for greater benefits for the persons suffering from mental illness.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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