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 Table of Contents  
Year : 2017  |  Volume : 33  |  Issue : 3  |  Page : 187-188

How mental illness affects the family - Different worlds, similar suffering

1 Department of Psychiatry, AIIMS, Jodhpur, Rajasthan, India
2 Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication14-Sep-2017

Correspondence Address:
B N Subodh
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijsp.ijsp_65_17

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How to cite this article:
Nebhinani N, Subodh B N. How mental illness affects the family - Different worlds, similar suffering. Indian J Soc Psychiatry 2017;33:187-8

How to cite this URL:
Nebhinani N, Subodh B N. How mental illness affects the family - Different worlds, similar suffering. Indian J Soc Psychiatry [serial online] 2017 [cited 2020 Oct 29];33:187-8. Available from: https://www.indjsp.org/text.asp?2017/33/3/187/214601

As per World health organization, about 450 million people suffer from psychiatric disorders and nearly 1 million people commit suicide every year. Neuropsychiatric disorders such as depression, substance use disorders, schizophrenia, and bipolar disorder are leading causes of years lived with disability.[1] There is an enormous gap between the need for treatment and the resources available for psychiatric disorders, and in developing countries, this gap is close to 90%.[1]

Family members are often the primary caregivers of people with mental disorders, as majority of such patients stay with family members (nearly 50% in West and 98% in India).[2] Family caregivers' shoulder the vast majority of long-term care responsibilities and pay a huge price in the form of discrimination, stigma, psychiatric, and physical morbidity, yet the extent and impact of associated burden are often ignored.[3] Caregiver studies have documented low quality of life, loss of work, financial stresses, lesser time for leisure and socializing, greater use of tranquilizers, and increased risk of hospitalization among family caregivers.[4]

Burden of care of schizophrenia is similar or more than chronic physical disorders,[5] and caregiver burden is a strong predictor of caregivers' depression.[6] Therefore, to alleviate caregivers' burden and psychiatric symptoms, caregivers and caregiving experience should receive due concern and timely appropriate intervention strategies should be instituted.[6]

Several studies have reported the association of maladaptive, emotion-focused coping strategies (e.g., avoidance, resignation, and coercion) with greater family burden, expressed emotions, and low social support.[7],[8] On the other side, social support and adaptive coping have been found protective for the patient and caregivers.[9]

Index issue of Indian Journal of Social Psychiatry is focusing on caregiving experience, with emphasis on family burden, coping, caregivers' psychological distress, and also on help-seeking behavior, psychosocial interventions, and adolescent school mental health program. It highlights the similar impact of mental illness on caregivers in different regions, religions, and geography.

Verma et al.[10] studied the stressor, family environment, and family burden in 100 dissociative (conversion) disorder patients and reported significant family burden in leisure, physical, mental, financial, and routines family interrelationship domains. The family environment in terms of personal growth and relationship dimensions has a casual effect on symptoms of dissociative disorder patients. Cohesion and expressiveness in dissociative disorder patients and excessive negative conflicts in family is related to occurrence or appearance of dissociative symptoms. Orientation for achievement, intellectual culture, and active recreation play an important role in the appearance of dissociative symptoms.[10]

Ravindran and Joseph[11] studied coping and psychological distress in fifty wives of alcohol-dependent individuals. They reported greater depression, anxiety, physical abuse, and specific coping strategies such as discord, avoidance, indulgence, anti-drink assertion, and sexual withdrawal among the wives whose partners have a longer duration of alcohol abuse than the other group. Coping resources of the spouses were adversely affected in proportion to the severity of alcohol dependence in the male partner. Therefore, alcohol plays a significant role in partner violence and spousal mental distress, resulting in loss of their coping resources.[11]

Osundina et al.[12] studied burden and coping styles among 400 caregivers of patients with major mental disorders and hypertension. They found a greater burden in the caregivers of patients with major mental illnesses and similar coping styles in both the groups, except in the use of denial coping style, which was used significantly by caregivers of patients with major mental disorders.[12]

To improve quality of life, functionality, and social support, family interventions should focus on imparting knowledge and skills to patients and caregivers, about the illness and its holistic management. Family-based interventions should focus on the strengths of patients and caregivers, building relationships, and support system, assisting them in identifying community resources, skill-based interventions to promote medication compliance, early identification of relapse, and symptomatic and functional recovery.[13] Psychoeducational interventions are found to be effective in reducing family burden by providing information about the disease, emotional support, and effective strategies for active coping, communication, stress management, and crisis intervention.[14]

A combination of well-targeted treatment and preventive mental health programs could reduce disability, stigma, and caregivers' distress. Investing in mental health today can generate enormous returns for the patients, caregivers, community, and nation, as even in different worlds family suffering is similar with mental illness. Individual, society, and policymakers must be sensitized to realize the importance of fostering the institution of family[3] and positive mental health. Really, time has come to be a responsible citizen by taking a coordinate step toward full integration of family in the care of the mentally ill, to combat the ill effects of rapid globalization, urbanization, and industrialization.

  References Top

Investing in Mental Health. World Health Organization; 2003. Available from: http://www.who.int/mental_health/media/investing_mnh.pdf. [Last cited on 2017 May 01].  Back to cited text no. 1
Sharma V, Murthy S, Kumar K, Agarwal M, Wilkinson G. Comparison of people with schizophrenia from Liverpool, England and Sakalwara, Bangalore, India. Int J Soc Psychiatry 1998;44:225-30.  Back to cited text no. 2
Avasthi A. Preserve and strengthen family to promote mental health. Indian J Psychiatry 2010;52:113-26.  Back to cited text no. 3
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Carretero S, Garcés J, Ródenas F, Sanjosé V. The informal caregiver's burden of dependent people: Theory and empirical review. Arch Gerontol Geriatr 2009;49:74-9.  Back to cited text no. 4
Gautam S, Nijhawan M. Burden on families of schizophrenic and chronic lung disease patients. Indian J Psychiatry 1984;26:156-9.  Back to cited text no. 5
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Perlick DA, Berk L, Kaczynski R, Gonzalez J, Link B, Dixon L, et al. Caregiver burden as a predictor of depression among family and friends who provide care for persons with bipolar disorder. Bipolar Disord 2016;18:183-91.  Back to cited text no. 6
Magliano L, Fadden G, Economou M, Xavier M, Held T, Guarneri M, et al. Social and clinical factors influencing the choice of coping strategies in relatives of patients with schizophrenia: Results of the BIOMED I study. Soc Psychiatry Psychiatr Epidemiol 1998;33:413-9.  Back to cited text no. 7
Magliano L, Fadden G, Economou M, Held T, Xavier M, Guarneri M, et al. Family burden and coping strategies in schizophrenia: 1-year follow-up data from the BIOMED I study. Soc Psychiatry Psychiatr Epidemiol 2000;35:109-15.  Back to cited text no. 8
Magliano L, Fadden G, Madianos M, de Almeida JM, Held T, Guarneri M, et al. Burden on the families of patients with schizophrenia: Results of the BIOMED I study. Soc Psychiatry Psychiatr Epidemiol 1998;33:405-12.  Back to cited text no. 9
Verma KK, Solanki OP, Baniya GC, Goyal S. Study of the stressor, family environment and family burden in dissociative (conversion) disorder patients. Indian J Soc Psychiatry 2017;33:196-201.  Back to cited text no. 10
  [Full text]  
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.  Back to cited text no. 11
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Osundina AF, Fatoye FO, Akanni OO, Omoreagba JO, Akinsulore A, Oloniniyi IO. Burden and coping styles among caregivers of patients with major mental disorders and hypertension attending a Nigerian Tertiary Hospital. Indian J Soc Psychiatry 2017;33:189-95.  Back to cited text no. 12
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Murthy RS. Family interventions and empowerment as an approach to enhance mental health resources in developing countries. World Psychiatry 2003;2:35-7.  Back to cited text no. 13
Tabeleão V, Tomasi E, de Avila Quevedo L. A randomized, controlled trial of the effectiveness of a psychoeducational intervention on family caregivers of patients with mental disorders. Community Ment Health J 2017. DOI 10.1007/s10597-017-0126-7. (Ahead of print).  Back to cited text no. 14


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