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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 34  |  Issue : 1  |  Page : 52-56

Mental disorder and disability: A cross-sectional study of disability variance in severe mental disorders


1 Department of Psychiatric Social Work, Institute of Mental Health and Neurosciences, Kozhikode, Kerala, India
2 Department of Psychiatry, Institute of Mental Health and Neurosciences, Kozhikode, Kerala, India
3 Department of Clinical Psychology, Institute of Mental Health and Neurosciences, Kozhikode, Kerala, India

Date of Web Publication29-Mar-2018

Correspondence Address:
Dr. Anvar Sadath
Department of Psychiatric Social Work, Institute of Mental Health and Neurosciences, Government Medical College Campus, Kozhikode - 673 008, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_2_17

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  Abstract 


Background: Severe mental disorders are associated with long-standing functional impairment and disability. The degree of disability varies with diagnosis. However, limited evidence are available on the association of psychiatric diagnosis and disability, especially from community settings in India. Methods: We examined the association of psychiatric diagnosis and disability in 711 persons suffering from severe mental illness. The patients were recruited from 12 community psychiatry outreach clinics at Wayanad District, South India. The Indian Disability Evaluation and Assessment Scale was administered to measure disability. ANOVA was applied to examine the extent of disability variance in diagnosis. Results: Disability varied significantly with diagnosis (F = 3.866; P = 0.000). Persons with schizophrenia experienced higher disability than bipolar affective disorder and depressive disorder. However, the disability was found nonsignificant in other diagnosis groups. Conclusion: The result implies the need for illness-specific programs and rehabilitative measures for persons with disability.

Keywords: Community psychiatry, disability, mental disorder


How to cite this article:
Sadath A, Kumar S, Mathew S. Mental disorder and disability: A cross-sectional study of disability variance in severe mental disorders. Indian J Soc Psychiatry 2018;34:52-6

How to cite this URL:
Sadath A, Kumar S, Mathew S. Mental disorder and disability: A cross-sectional study of disability variance in severe mental disorders. Indian J Soc Psychiatry [serial online] 2018 [cited 2019 Aug 24];34:52-6. Available from: http://www.indjsp.org/text.asp?2018/34/1/52/228790




  Introduction Top


National mental health survey of 2015–2016 suggests that at least 13.7% of India's general population has various mental disorders and 10.6 percent of them require immediate interventions.[1] Surprisingly, a third of the global burden of disease for mental, neurological, and substance use disorders occurs in India and China, which is more than in all high-income countries combined.[2] The burden of these disorders is estimated to increase by 23% in India, between 2013 and 2025.[2] Mental and substance use disorders accounted for 7.4% of all disability-adjusted life years (DALYs) and were the leading cause of years lived with disability worldwide in 2010.[3] In this, depressive disorders accounted highest (40.5%) in DALYs while schizophrenia (7.4%) and bipolar affective disorder (BPAD) (7.0%) also contributed.[3] Schizophrenia, affective disorders, and obsessive–compulsive disorders (OCDs) as whole contributed a prevalence rate of 15.4 in thousand population in India [4], and these disorders have severe negative consequences on academic, occupational, social, and family functioning of the patients.[5]

Functional impairment is one of the most enduring consequences of psychiatric disorders,[6] and these disorders, in varying degrees, contribute significant amount of disability to the persons affected.[7] The degree of disability correlated with the severity of the disorder,[6],[8] and rate of psychopathology is found to be consistently associated with increased disability.[9] However, the severity of disorder and severity of disability assessing in different way. The severity of disorder usually assessed with reference to the numbers and the frequency of occurrence of symptoms, whereas the severity of disability by the type and number of activities in which the individual cannot take part.[10] Nevertheless, schizophrenia tops the list of disorders which lead to disability. Patients with schizophrenia experience disability in different areas of everyday life, such as employment, relationships, and independence, even after they achieve symptom remission.[11] Disability in these patients is also determined by their cognitive deficits and negative symptoms.[11] Evidently, persons with schizophrenia as compared to BPAD experience significantly higher disability [12] in self-care, getting along with others, life activities, and participation in society.[13] Similarly, in depression, functional impairment is inherent, and these impairments are more resistant to treatment than the actual symptoms of depression.[14] Studies demonstrate high rate of unemployment and disability in major depressive disorder.[15]

Interestingly, a longitudinal cohort study of a recent onset major depressive disorder, bipolar disorder, and schizophrenia reveals that the diagnosis of BPAD uniquely predicted rates of employment and independent living on follow-up,[16] indicating better functioning in persons with BPAD. To the best of our knowledge, not many studies in India examined the association of psychiatric disability in major mental disorders, except a few.[12],[17] Nonetheless, these available studies from India, are conducted in hospital setting. Thus, we examined the extent of disability and its association and differences in major mental disorder in community psychiatry outreach clinics at Wayanad, South India.


  Methods Top


The details about this study method have been explained elsewhere.[18] However, in brief, the patients suffering from severe mental illness and attending District Mental Health Programme (DMHP) outreach clinics in 12 centers at Wayanad District during 1 month period in 2012, were screened to include in this cross-sectional study. Participants were included if they were 18 years or more, suffering from any major mental disorder with a minimum of 2 years duration. All patients with comorbid medical and psychiatric illness, likely to contribute in disability, were excluded from the study. A total of 900 potential patients screened; 723 patients were found eligible to participate in this study. To make the group comparison effective, we further excluded the cases of OCD (n = 9) and dementia (n = 03) from the analysis as those samples were very less. Hence, final sample for this paper consisted 711 persons with major mental disorder. Informed consent was obtained from the patients and their caregivers.

We used a brief self-prepared sociodemographic data sheet to collect demographic and illness details of the respondents. The diagnosis was copied from the patients' case records. Disability was assessed using Indian Disability Evaluation and Assessment Scale (IDEAS).[19] Data collection was done by a consultant psychiatrist (MD), one clinical psychologist (M. Phil), and two trainee social workers pursuing postgraduate degree in social work. Adequate training was provided to the trainees for administering ideas, and their work was supervised by the consultant psychiatrist or the clinical psychologist. Each patient and their primary caregivers were interviewed for the disability assessment.

Data analysis

Data were analyzed using SPSS-16 version (IBM). Descriptive analysis was performed using frequencies, percentage, mean, and standard deviation. ANOVA and post hoc analysis were performed to examine the disability variance across groups.


  Results Top


[Table 1] shows the sociodemographic and disability characteristics of the patients in severe mental disorders.
Table 1: Sociodemographic details and disability characteristics of the patients

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[Table 1] shows ANOVA results of the domains of disability and global disability across various diagnoses. Result revealed that patients' self-care, communication and understanding, and their global disability significantly varies with their diagnosis [Table 1].

As the ANOVA result was significant, we further performed Tukey's honestly significant difference (HSD) test to understand the specific group differences in disability [20] [Table 2]. The Tukey's HSD is the most commonly used post hoc test when ANOVA result is significant.[20],[21]
Table 2: Disability variance with diagnosis

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The ANOVA post hoc Tukey's HSD result showed that patients' global disability was significantly high in schizophrenia in comparison with depression (P = 0.004) and BPAD (P = 0.001) [Table 2].

We additionally performed the Tukey's HSD to understand the IDEAS domain-specific differences in disability across the diagnosis groups. The analysis revealed that self-care disability was significantly high in schizophrenia as compared with depression (P = 0.003) and BPAD (P = 0.000). Disability in patients' interpersonal activities was found significantly high in schizophrenia as compared to BPAD (P = 0.035) but found nonsignificant with depression or any other disorder. The disability in communication and understanding domain was high in schizophrenia as compared with depression (P = 0.013) and BPAD (P = 0.000). Patients' disability in work was significantly higher in schizophrenia as compared to BPAD (P = 0.031) but found nonsignificant with other disorders.


  Discussion Top


We have conducted this study in Wayanad, a backward district of Kerala, with high concentration of tribal population in the state. As the data for this study was drawn from the community camps which provide services in interior places of Wayanad, it is expected to have substantial tribal population in our study. The tribes in Wayanad belong to various sects such as Paniyas, Kurumas, Adiyars, Kurichyas, Ooralis, Kattunaikkans, and Uraali Kurumas. These tribes live in the interior places, which limits their access to health-care institutions. At the time of this study, the district had no consultant psychiatrist or psychiatry inpatient ward in government sector to cater the mental health needs of the population. However, exception to this, the DMHP was available periodically in the district since 2007, and the Institute of Mental Health and Neurosciences, Kozhikode, is the nodal agency which conducts the program in the district.

Notably, our sample overrepresented with schizophrenia and BPAD. It does not indicate high prevalence of these disorders in this area but rather attributed to the services in the community clinics which offer predominantly pharmacological treatment. Most of the patients seeking treatment in these clinics were either a person with chronic psychosis or mood disorders.[18] Hence, these findings need to be interpreted cautiously. The prolonged duration of the illness in our sample could be due to the nature of their illness, increased age [Table 3], and also could be related to inadequate treatment facilities available in the district and poor help-seeking behavior. Similarly, relatively lesser education of our study sample to be viewed in the context of the overall educational backwardness of the district and also the fact that the data were being collected from the interior places which has dominant tribal population having low literacy.
Table 3: Multiple comparisons (post hoc Tukey honestly significant difference)

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Consistent with earlier findings from India or elsewhere, our results revealed that psychiatric disability in mental disorder occurs in varying proportions,[5],[22] and persons with schizophrenia suffered significantly higher disability [5],[12] in most of the domains of IDEAS. They have higher disability than depressive disorder in self-care and interpersonal activities while they experienced higher disability than persons with BPAD in all the four domains of IDEAS (self-care, interpersonal activities, communication and understanding, and work). Evidently, schizophrenia tends to cause higher disability in all the areas of functioning.[12],[23] Similar with earlier studies, the disability was lesser in persons with BPAD [16],[22] and depressive disorder than any other disorder examined, indicating comparatively better functioning in them. Interestingly, the disability in psychosis not otherwise specified, schizoaffective disorder, and delusional disorder was nonsignificant with schizophrenia or any other group studied. Nevertheless, the sample discrepancy in the groups needs to be considered. Schizoaffective disorder and delusional disorder groups represented lesser sample size.

Apart from diagnosis, disability is associated with many factors. We have earlier identified in a regression model that patients' gender status, years of education, occupation, duration of illness, age, and marital status significantly predict disability.[18] Others identified association with psychopathology [8] and many other variables. Thus, the current results need to be interpreted with other relevant findings in the literature.

Despite having a few shortcomings, this study has lots of strengths. We have conducted this study in community psychiatry clinics with large sample size. To the best of our knowledge, this is the first study in India that evaluated disability in different mental disorder in community psychiatry sample. Other available studies from India with similar objectives were conducted in hospital setting.[5],[12] Second, most of the patients undergoing treatment in these clinics were stable in their symptoms; hence, we could measure disability accurately. The limitations of our study include cross-sectional data, overrepresentation of schizophrenia and BPAD cases, scope limited in examining the association of disability and diagnosis and could not measure other critical variables associated with disability.


  Conclusion Top


Severe mental disorders causing significant disability and persons with schizophrenia experience higher disability than other disorders examined in this study. They experienced higher disability on all the four domains of IDEAS. The results suggest a need for specific programs and policies for persons with schizophrenia.

Acknowledgment

We would like to thank Ms. Asha and social work trainees in DMHP for extending support for data collection.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Gururaj G, Varghese M, Benegal V, Rao GN, Pathak K, Singh LK, et al. National Mental Health Survey of India 2015-2016. Bengaluru: National Institute of Mental Health and Neuro Sciences, NIMHANS Publication; 2016.  Back to cited text no. 1
    
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    Tables

  [Table 1], [Table 2], [Table 3]


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