|Year : 2017 | Volume
| Issue : 3 | Page : 202-207
Loss of coping resources and psychological distress in spouses of alcohol dependents following partner violence
Ottilingam Somasundaram Ravindran1, Shica Ann Joseph2
1 Department of Psychiatry, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
2 Clinical Psychology, Sri Ramachandra University, Porur, Chennai, Tamil Nadu, India
|Date of Web Publication||14-Sep-2017|
Ottilingam Somasundaram Ravindran
Department of Psychiatry, Sri Ramachandra University, Porur, Chennai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background and Objectives: A study to assess the psychological distress of married women due to their spousal violence under alcohol dependence. This study is aimed at studying partner violence, various coping styles and psychological distress among spouses of men with alcohol dependence and to explore the association between partner violence and coping behaviour. Materials and Methods: The study was conducted on 50 wives of alcohol dependent individuals in the age range of 20-50 years, who were divided into two groups based on the duration of drinking of their husbands. They were assessed by GHQ-12, Measure of Wife Abuse, Coping with Drinking Questionnaire and Depression Anxiety and Stress Scale. Results: Partner alcohol use was associated with increased psychological distress in their spouses and they have used both adaptive and maladaptive coping strategies. Conclusion: Alcohol plays a role in partner violence and spousal mental distress resulting in loss of their coping resources.
Keywords: Alcohol, coping, psychological distress, spouses
|How to cite this article:|
Ravindran OS, Joseph SA. Loss of coping resources and psychological distress in spouses of alcohol dependents following partner violence. Indian J Soc Psychiatry 2017;33:202-7
|How to cite this URL:|
Ravindran OS, Joseph SA. Loss of coping resources and psychological distress in spouses of alcohol dependents following partner violence. Indian J Soc Psychiatry [serial online] 2017 [cited 2017 Dec 12];33:202-7. Available from: http://www.indjsp.org/text.asp?2017/33/3/202/214594
| Introduction|| |
Alcoholism is a major public health problem. India is reported to be the most populous country in the world with 33% of its population consuming alcohol. Alcoholism is considered as an ongoing stressor, not only for the individual but also for the family members as well. Spouses are particularly affected because of their higher rates of exposure to domestic violence in the form of physical, verbal, or sexual abuse by their intimate partners.
Intimate partners are the most common perpetrators of violence against women. WHO defines intimate partner violence broadly, as any behavior with an intimate relationship that causes physical, psychological, or sexual harm to those in the relationship; it includes: physical aggression, psychological abuse, forced intercourse, and other forms of sexual coercion, as well as various controlling behaviors. Alcohol is thought to play an important role in intimate partner violence. The British Crime Survey indicated that 32% incidents of intimate partner violence were committed when the perpetrator was under the influence of alcohol. Studies have found that alcohol appears to be particularly important in escalating existing conflict,, and the higher frequency and quantity of male drinking increases the likelihood of male-to-female partner violence. Studies conducted in India reported that alcohol misuse by the male partner is associated with poor mental health and spousal violence among married women.,
Low marital satisfaction, poor social support, and economic burden are the other major issues among the spouses of men with alcohol dependence. The psychological distress seems to be apparent from such factors making the spouses to cope less efficiently. Maladaptive coping skills adversely affect their social and functional roles as mothers, sisters, homemakers etc., thus having a significant impact on the family harmony. Wives of alcoholics undergo tremendous stress caused by their partners' drinking, and they cope in response to the intensity or frequency of the alcohol abusive episode. An earlier Indian study explored the coping behavior among the spouses of alcoholics and concluded that discord, avoidance, indulgence, and fearful withdrawal were the commonest coping behaviors while marital breakdown, taking special action, assertion, and sexual withdrawal were endorsed by them least frequently.
Alcohol-related problems constitute a clear risk factor for spousal mental distress. Female spouses of male at-risk drinkers tend to experience more mental distress than spouses of controls. Another study found a three times higher risk of mood disorders and two times higher risk of anxiety disorders among female spouses of male alcohol abusers. Homish and colleagues found marital and other problems among newlywed individuals resulting from their husbands' drinking to be associated with concurrent depression. Very few Indian studies have specifically examined the presence of psychological distress in spouses. An Indian study found high rates of psychological distress and low marital satisfaction among women whose partners have alcohol problems.
Intimate partner violence is a significant global public health problem. There is a paucity of studies in India on the impact of domestic violence on spouses of alcohol-dependent individuals. They are the victims of intimate partner violence and face numerous stressful life events and negative interpersonal relations. With coping resources compromised, they are less likely to use adaptive coping strategies and thereby increasing the likelihood of developing stress-related psychiatric disorders. Western studies, found a correlation between duration of alcohol dependence and marital discord, and one Indian study found a positive correlation between duration of dependence in men and higher levels of distress in their spouses. Hence, it was decided to divide the participants into two groups on the basis of duration of partner alcohol use. Understanding and addressing the impact of domestic violence on the mental health of spouses of alcoholics will not only decrease their psychological distress, but also improve their coping resources and overall quality of life. It is also likely to have a bearing on the treatment of alcohol-dependent individuals by helping them reduce alcohol-related problems to the extent that it also reduces their violence.
With this background, the present study was carried out with the following objectives:
- To study partner violence, various coping styles and psychological distress among the spouses of men with alcohol dependence.
- To explore the association between partner violence and coping behavior.
| Materials and Methods|| |
Fifty spouses of men with alcohol-dependence syndrome diagnosed according to the ICD-10 criteria in the age range of 20-50 years who presented to the Department of Psychiatry, Sri Ramachandra University, Chennai, for the treatment of their husbands formed the study group. They were divided into two groups on the basis of duration of partner alcohol use. Group one comprised of 20 wives (alcoholics with less than 10 years of drinking) while group two comprised of 30 wives (alcoholics with more than 10 years of drinking).
Eligibility criteria included: (1) spouses of alcohol-dependent men who were regularly attending the psychiatry out-patient department, (2) educational qualification of 6th standard and above, (3) wives who are currently staying with their husbands with a duration of marriage of a minimum of 3 years, and (4) those who obtain a score of 5 and above on the GHQ-12. Wives who have separated from their husbands and those with a known psychiatric or medical illness were excluded from the study. A written informed consent was obtained from the participants after the nature of the study was explained to them and only those who satisfied the inclusion and exclusion criteria were taken up for the present study.
The tools used in this study were as follows:
- General health questionnaire (GHQ) 12 item version was used to screen for the possible presence of psychological distress among the spouses of alcohol-dependent individuals. A cut-off score of 5 or more was taken up for detecting the psychological distress and the similar score was used in another Indian study for screening common mental disorders with community samples.
- Measure of wife abuse
Experience of victimization by partner violence was assessed using the measure of wife abuse (MWA). It is devised to assess the type of abuse directed by a man toward his wife. The instrument measures four types of abusive behaviors viz., physical, sexual, psychological, and verbal. It has 60 items, each with four possible responses, scored as 0, 1, 2, and 3. Higher scores in each of its domains indicate greater abuse. The MWA assesses the emotional consequences experienced by the victim as a measure of the severity of the abuse. The scale was found to have adequate levels of both reliability and concurrent validity using the conflict tactics scales as the criterion measure.
- Coping with drinking questionnaire
This is a shortened version of the questionnaire used by Orford et al. on 100 wives of alcoholics to interpret drinking outcome. It consists of 56 items and 10 components of coping behaviors can be assessed. The 10 coping behaviors are discord, avoidance, indulgence, competition, antidrink, assertion, sexual withdrawal, fearful withdrawal, taking special action, and marital breakdown. Each item is rated on a four point Likert scale where 1 = No; 2 = Yes, once or twice; 3 = Yes, sometimes; and 4 = Yes, often. Thus 10 component scores are obtained. A higher score indicates the most used coping strategy.
- Depression anxiety and stress scale
Spousal mental distress was assessed using the depression, anxiety and stress scale (DASS). It is a 21 item instrument measuring current symptoms of depression, anxiety, and stress over the past week. Each of the three scales consists of 7 items in which the respondents are expected to rate each of the statement on a four-point scale ranging from 0 to 3. The range of possible scores for each scale is 0–21. The scores for depression, anxiety, and stress are calculated by summing up the scores for the relevant items.
All consented subjects were interviewed. Their sociodemographic details were collected and they were assessed by the GHQ-12, MWA, coping with drinking questionnaire and DASS. The questions were read out and the responses were marked by the experimenter himself to avoid cognitive and perceptual factors affecting self-report accuracy. The data from each subject was collected in a single session, which lasted for 1 h. After collecting data and coding and entering the SPSS software, analysis was done using Mann-Whitney U test, t-test, and Kendall's tau coefficient. When distribution was significantly non-normal, quantitative variables were ranked and compared using the Mann-Whitney test. The t-test was used to find out the difference between the means. Kendall's tau coefficient was used to measure the association between two measured quantities. The significant level was set at 0.05.
| Results|| |
The sociodemographic profile of the study group is shown in [Table 1]. The age of the wives in the sample ranged from 20 to 50 years, with the mean age being 31.73 years. A large number of subjects had completed college (32%). Most of them were unemployed (54%). Majority of them had a monthly income of less than Rs.7000 (70%). Fifty two percent had a marriage duration of more than 10 years. About 60% of the husbands were drinking for more than 10 years.
As depicted in [Table 2], spouses of alcoholics are subjected to more abuse by the partners who have longer duration of drinking than the other group. Significant differences were observed between the two groups on the factors of verbal abuse and psychological abuse. There is no significant difference between the two groups on the factors of sexual abuse and physical abuse, though mean differences were observed between the two groups.
On coping behavior, the results indicated that, except the factors of fearful withdrawal and marital breakdown, there is a significant difference between the two groups on the remaining factors and the results are shown in [Table 3]. The coping strategies more often used were discord, avoidance, indulgence, antidrink, assertion, sexual withdrawal, and taking special action among the wives whose partners have longer duration of alcohol abuse than the other group. None of the wives in our sample used competition as a coping strategy by taking drinks themselves, trying to make their husbands jealous, or pretending to be drunk and having a whale at time. Spouses in both groups occasionally used the coping strategies of fearful withdrawal and marital breakdown. Though there was marital disharmony, they strongly felt the need to keep the marital bond together and expressed their unwillingness to desert their husbands. In fearful withdrawal, they pretended all was well and this may be due to the fact that their husbands became violent or abusive under the influence of alcohol.
Spouses of men with alcohol dependence who have longer duration of drinking experienced higher levels of depression, anxiety, and stress than the other group and the results are shown in [Table 4].
The relationship between coping behavior and partner violence (as measured by wife abuse scale) was examined. The results [Table 5] showed that coping behaviors namely, discord and indulgence significantly correlated with verbal abuse in a negative direction. Other coping components namely, competition, sexual withdrawal, and fearful withdrawal significantly correlated with psychological abuse. In contrast, no relationship was observed between the coping behavior and partner violence among the spouses of alcohol-dependent individuals who have less than 10 years of duration of alcohol abuse.
| Discussion|| |
Intimate partner violence is a form of domestic violence occurring between intimate partners or ex-partners that distinguishes it from other forms of violence, which may occur in a family or domestic setting. Compared to others, families of persons with alcohol abuse have more conflicts with parents, spouses, and children. As a result of this, it is likely to affect the spouse who may be on the receiving end of violence and sexual abuse. More recently, Govindappa and Pankajakshi studied the different types of violence among the wives of alcoholics in the community and concluded that spouses of alcohol-dependent individuals are subjected to physical, emotional, intellectual, and economic violence. The present study demonstrated significant differences between the two groups on the factors of verbal abuse and psychological abuse contradicting our hypothesis. We found that the spouses of alcoholics whose partners have been drinking for more than 10 years are subjected to domestic violence more often than the other group. They became the victims of partner violence when their husbands were under the influence of alcohol. The results of this study support the findings of Roizen who observed that male partners were drunk prior to the onset of the violence. The presence of drinking in a partner violence incident, however, does not necessarily mean that alcohol is the cause of violence. We found that violence often occurred even in the absence of alcohol. This may be due to relationship conflicts, which increase the risk of intimate partner violence. Frequent heavy drinking by the male partners can create an unhappy and stressful partnership, which increases the risk of conflict and violence. Our findings are consistent with those previously reported studies.,
Several studies demonstrated an association between men's alcohol-related problems and depression reported by wives., We found that spouses of men with alcohol dependence with a longer duration of drinking have experienced higher levels of depression, anxiety, and stress than the other group. The results of the present study is in accord with a previous Indian study, which found that the risk of spousal mental distress increases with the duration of dependence increased in the abusing male partner. The role of stressful life events and alcohol-related marital problems may play a role in predicting subsequent depression in women. Partner violence and problems related to the partner's alcohol use, such as economic deprivation, health problems, interpersonal fights, and employment decreases are some of the significant risk factors for depression in women who report excessive alcohol use by their partners. Our findings are consistent with the findings of Nayak et al. who reported that excessive partner alcohol use increased the risk of depression in women by two- to three-fold.
Coping refers to both cognitive and behavioral strategies that can be used to deal with a stressful event. Coping has been studied in relation to how women learn to live with alcoholic husbands., In the present study, we have focused on identifying and comparing the various coping behaviors adopted by the spouses of alcoholics in relation to the duration of partner alcohol use. The coping strategies such as discord, avoidance, indulgence, antidrink, assertion, sexual withdrawal, and taking special action were the most common coping components identified among the spouses whose partners have been drinking for more than 10 years. Other researchers namely Orford et al. and later Schaffer and Tyler observed that elements like avoiding, refusing to talk, feeling frightened, making special financial arrangements, seeking outside help, and contemplating terminating the marital bond predict poor outcome. On the other hand, elements such as pleading, arguing, hitting, or wife getting drunk herself, trying to make them jealous or seem ridiculous and hiding or pouring away his alcohol are associated with good outcome. In the present study, spouses adopted both adaptive (discord, indulgence, assertion, antidrink) and maladaptive (avoidance, sexual withdrawal, taking special action) coping strategies to deal with the stress arising out of alcohol addiction in their male partners. It is evident from this study that wives use more number of coping strategies. Personality may play a role in determining the individual style of coping behavior. In an Indian study, Chandrasekaran and Chitraleka reported that both personality and situational variables play a role in determining the coping behavior of the wives of alcoholics.
Spouses experiencing stressful life events in this study following the partner alcohol use and violence have experienced higher rates of mental distress and are less likely to cope efficiently. Coping resources of the spouses were adversely affected in proportion to the severity of alcohol dependence in the male partner. Partner violence and coping behavior in the spouses significantly correlated with each other, and their association was robust particularly when problems in the domains of verbal and psychological abuse were high. An Indian study had found that domestic violence had influenced the coping strategies of spouses of alcoholics. Similar findings are observed in the present study also.
Limitations of the study
The study has few limitations. The sample was selected from a hospital population who accompanied their husbands for the treatment of their alcohol problems. The sample size was small and the estimation of partner violence was assessed using self-report questionnaires. No attempt was made to assess the behavior of alcoholics under the influence of alcohol. Other stressful events such as childhood abuse and adult victimization were not assessed.
Implications of the study
Our findings have important implications on women's mental health that warrant attention. Alcohol dependence in the male partner is associated with mental distress and spousal violence among married women in India. Alcohol problems of men increase the risk of depression and anxiety disorders in their female partners. Hence, partner alcohol problems and violence must be periodically assessed to prevent and treat psychiatric problems in female partners. Given the association between alcohol problems and partner violence, interventions for male heavy drinkers need to address partner violence. Integrating violence prevention and intervention programs as part of alcohol treatment programs help women, in particular, to get relief from their psychological distress, enhance their psychological well-being, and help them to cope efficiently.
To conclude, the results of the study indicate that partner alcohol use and violence increased the psychological distress in spouses of alcohol-dependent individuals.
Financial support and sponsorship
Conflict of interest
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]