|Year : 2022 | Volume
| Issue : 2 | Page : 124-130
Basic functioning and resilience in families of adolescents with intellectual disability and psychosis: A comparative study
Manisha Chandra1, Dipanjan Bhattacharjee1, Basudeb Das2, Hariom Pachori3
1 Department of Psychiatric Social Work, Central Institute of Psychiatry, Ranchi, Jharkhand, India
2 Department of Psychiatry, Central Institute of Psychiatry, Computer, Ranchi, Jharkhand, India
3 Department, Central Institute of Psychiatry, Ranchi, Jharkhand, India
|Date of Submission||17-Jul-2020|
|Date of Decision||02-Aug-2020|
|Date of Acceptance||13-Sep-2020|
|Date of Web Publication||30-Jun-2022|
Dr. Dipanjan Bhattacharjee
Department of Psychiatric Social Work, Central Institute of Psychiatry, Kanke, Ranchi - 834 006, Jharkhand
Source of Support: None, Conflict of Interest: None
Background: Family functions and resilience (hardiness) are two important aspects of families for keeping them stable. How those two aspects are present and operate in families having adolescents with mental retardation and psychosis is the aim of this study. Materials and Methods: A total of 45 adolescents (comprising 15 intellectually disabled adolescents, 15 adolescents with psychosis [schizophrenia and bipolar disorder], and 15 normal adolescents) and one of the key relatives of each adolescent were selected purposively. One key caregiver of each adolescent in all the three groups was selected, and the McMaster Family Assessment Device and the Family Hardiness Index were applied on them to collect data on family functioning and hardiness. Results: Families of the first two groups have reported problems in family functions. No difference could be seen in the family resilience among these three groups of families. Conclusion: Families with mentally retarded and psychotic adolescents have family problems; however, both the families show resilience against the stress of having mentally retarded or psychotic adolescents.
Keywords: Adolescent, family functioning, intellectual disability, psychosis, resilience
|How to cite this article:|
Chandra M, Bhattacharjee D, Das B, Pachori H. Basic functioning and resilience in families of adolescents with intellectual disability and psychosis: A comparative study. Indian J Soc Psychiatry 2022;38:124-30
|How to cite this URL:|
Chandra M, Bhattacharjee D, Das B, Pachori H. Basic functioning and resilience in families of adolescents with intellectual disability and psychosis: A comparative study. Indian J Soc Psychiatry [serial online] 2022 [cited 2022 Aug 9];38:124-30. Available from: https://www.indjsp.org/text.asp?2022/38/2/124/349332
| Introduction|| |
Issues such as intellectual disability and psychosis to children can cause a significant negative impact on the basic structure and functions of the concerned families. The dynamics of family which is known to be the pattern of intrafamily relationship and transactions among members is deeply affected in families with children with those two issues.,,, Increase in disruptive behavior and psychopathology has been found to have a significant impact on family variables such as “family climate,” “family's ability to perform important essential functions,” and “family stability and homeostasis.”, Family systems perspective defines family to be a living organism and advocates a comprehensive study of the family covering each aspect and segment associated with it. Within a family, there are several subsystems which have mutual interdependency among each other., It was noted that parents showing supportive, emotionally sensitive, and accommodative attitudes toward their children could ensure better care to their children as well as growth and development of the family as a whole.,,, Family resilience is known as the ability of family to respond positively to an adverse event and emerging as resourceful and stronger against stressful events. Resilient families were seen to be more capable of balancing patient care and stability of family system. Resilience has been considered to be the positive biopsychosocial adaptive skills against adversities.,,,,,, Families with intellectual disability or mentally ill children do feel at loss, worried, and apprehensive because of several reasons, ranging from core illness-related factors to larger sociocultural factors.,, There are three effects of resilience, for example, interactive effects, main effects, and mediating effects. The interactive effect denotes development of relative resistance to environmental risks or putting up efforts to address stress or adversity by individuals. It is a dynamic process of doing positive adaptation against adverse situations or pressing situations. In main effects, people who are being exposed to stress tend to focus on factors causing varying impact among groups, and finally, mediating effects entail the mediating relationship between risk factors and development outcomes or positive outcomes. In their resiliency model of family stress, adjustment, and adaptation, McCubbin and McCubbin posited that family hardiness has a key role in developing overall resilience in a given family unit. Hardiness is understood as the family's sense of control over adversities, life events, and stressors. Families possessing a high degree of hardiness have the confidence that they can withstand challenges.
The primary objective of the current study was to conduct a comparative assessment of the basic family functions and family resilience (hardiness) among the families having the adolescents with intellectual disability, adolescents with psychosis (schizophrenia and bipolar affective disorder [manic or depressive]), and families with normal adolescents. Family functions and resilience (hardiness) are two important prerequisites for keeping family stable and optimally functional. A normal family unit should have optimal performances in important areas such as “problem-solving skills,” “communication (intrafamily),” “role or task performance,” “emotional bonding or cohesiveness among family members,” “behavioral control mechanism adopted by the family,” and “overall functioning of the family.” Those factors are to be present satisfactorily for fulfillment of needs of each member. Family resilience is an important prerequisite for withstanding the negative events. Families with the adolescents with mental health issues such as “intellectual disability” and “psychosis” do have the feelings of distress and negative emotions such as sadness, anxiety, sense of guilt, and shame; however, families with high degree of resilience may be in a better position to master the situation. Families showing optimal performances in essential areas can balance the patient care and family chores and tasks satisfactorily. In the Indian context, such kinds of studies are relatively lesser in number, and this study would reduce the knowledge gap related to these two important areas associated with the families.
| Materials and Methods|| |
The current study was a hospital-based cross-sectional study. The venues of the present study were Central Institute of Psychiatry and Deepshikha Institute for Child Development and Mental Health. Both the institutes are located at the city of Ranchi, which is the capital city of the state of Jharkhand, India. The Central Institute of Psychiatry is the Government of India owned tertiary mental hospital established by the Imperial British Government in 1918, whereas the Deepshikha Institute for Child Development and Mental Health is a registered nonprofit, voluntary organization working in the field of childhood and other disabilities.
Samples and sampling
The sample was selected through the purposive sampling technique. The sample size was 45, consisting of 15 families with adolescents with mental retardation, 15 families with adolescents with psychosis (schizophrenia and bipolar affective disorder [manic or depressive]), and 15 families of normal adolescents. Families of the first two groups were collected from the Central Institute of Psychiatry or Deepshikha Institute. Samples belonging to normal control groups were selected after matching them with the first two groups as per sociodemographic parameters.
Key caregivers (any one of the parents) of all 45 adolescents (15 adolescents with mental retardation, 15 adolescents with psychosis [schizophrenia and bipolar affective disorder], and 15 normal adolescents) were selected for assessment related to family resilience and family functioning. Data collection was done by sociodemographic and clinical data, sheet, the Family Hardiness Index (FHI), and the McMaster Family Assessment Device (FAD). The sociodemographic and clinical data sheet contained age, sex, education, occupation, socioeconomic status, and clinical information of the adolescents with intellectual disability and psychosis. The FHI is a 20-item summated rating scale developed to measure the concept of family hardiness – a stress-resistance resource of families. The FHI measures the family's hardiness in four dimensions: control, commitment, challenge, and confidence. Higher scores reflect higher degrees of family hardiness. The McMaster FAD is a 60-item self-report measure designed to assess family functioning in the following areas: problem-solving, communication, roles, affective responsiveness, affective involvement, behavior control, and general functioning. This scale is based on the McMaster Model of Family Functioning. The 12-item General Health Questionnaire (GHQ) was applied on the key caregivers (any one of the parents) of normal adolescents for ruling out the psychological problems in them. Key caregivers of normal adolescents scoring <3 in the GHQ-12 were included in the study. Caregivers (parents) selected in the current study were an intermediate or higher level of education, and they were given the aforesaid questionnaires for recording their responses. They were explained the items of each measure by the authors, and they filled up the questionnaires thereafter. Majority of them did not have a problem in understanding the questions, however, some of them did require some assistance, and they were being assisted accordingly.
This study was carried out in the Central Institute of Psychiatry, Ranchi, India. This study was a time-bound single contact hospital-based study. Samples of all the three groups (both caregivers and adolescents) were selected purposively as per the inclusion and exclusion criteria of the study. Adolescents who belonged to the first two groups were previously diagnosed by the consultant psychiatrists and clinical psychologists of the institute using the DSM-5. After the diagnosis made by the consultant psychiatrists and clinical psychologists of adolescents of the first two clinical groups, the research team had taken the written informed consent from their parents. Parents were thoroughly explained about the purpose of the study, and they were being assured that whatever information they would share will be kept confidential. The FHI and McMaster FAD were administered on one parent of each adolescent selected in the study. GHQ-12 was administered on normal adolescents and all caregivers selected (three groups) in the study to rule out psychological disorder. Persons who scored <3 in the GHQ-12 were included in the study. After the collection of data, appropriate statistical measures were used to analyze the data. Data analysis was done by the Statistical Package of the Social Sciences, Windows Version 23, New York, USA for Windows. One key caregiver who lives with the patient/adolescent (in the normal control group) at the same household was approached by the research team for giving permission to apply necessary scales and instruments for data collection. In most of the cases (in all the three groups), the caregivers were fathers. The diagnosis of the adolescents who belonged to the first two groups was done by the consultant psychiatrists as per the DSM-IV-TR.
Data analysis was done by the Statistical Package of the Social Sciences (SPSS), version 16 for Windows. Frequency and percentage tables were used for the presentation of qualitative data, and the Chi-square test and Kruskal–Wallis test were used for seeing the comparability of these two groups. The nonparametric Kruskal–Wallis test was used to compare these three groups in the scores of FHI and FAD. The diagnosis of the adolescents who belonged to the first two groups was done by the consultant psychiatrists as per the DSM-5.
[Table 1.1] shows the comparison of sociodemographic profiles of three groups. Chi-square and Fisher's exact tests were done for comparing the three groups. In most of the sociodemographic parameters, no significant difference was noted among these three groups, barring in three areas, for example, “gender of the adolescents,” “occupational status of the adolescents,” “position of adolescent among siblings,” and “primary caregiver at home.” In the psychosis group, a preponderance of girls was seen, whereas, in the other two groups, boys were in majority. With regard to educational status of the adolescents, in two clinical groups, most of the selected adolescents were school dropouts, whereas in the normal control group, most of the adolescents were students. In terms of position of siblings, majority of the adolescents were first child and middle child in the intellectual disability group and the psychosis group, respectively. In the normal control group, most of them were noted to be the youngest child. In relation to primary caregiving at home, in two clinical groups, mothers were noted to be the primary caregivers of the adolescents, but in the normal control group, the responsibility of caregiving was almost equally shared by mothers and other family members including their fathers.
[Table 1.2] shows the comparability of three groups with regard to age of the adolescents, educational level of their caregivers, and the monthly income of their families. A significant difference was noted among these three groups in monthly income of the family. The average monthly income was observed to be significantly higher than that of the other two groups of the study.
In order to assess the resilience of the family, the FHI (for measuring family's resilience) was applied on the key caregivers of adolescents of these three groups. The Kruskal–Wallis test was applied comparing the level of family hardiness of these three groups. A significant difference was noted in the “control” domain of FHI. Caregivers of the adolescents with intellectual disability and psychosis had reported significantly higher resiliency in the form of ability to control the situation than families of normal adolescents [Table 2].
|Table 2: Comparison of family hardiness index scores between three groups|
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Significant differences among these three groups were seen in family functions (scores reported by the selected key caregivers in the McMaster FAD). The FAD was applied on the selected key caregivers of the adolescents of three groups. As per the manual of this scale, higher scores indicate higher problems in family's basic areas of functioning. Families of the two clinical groups had reported significantly higher scores in all domains of FAD [Table 3].
|Table 3: Comparison of McMaster Family Assessment Device scores between three groups|
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| Discussion|| |
One key caregiver of the three groups of adolescents, i.e. intellectual disability (n = 15), psychosis (n = 15) and normals (n = 15) was selected in the study. Those key caregivers were selected as the primary participants of the study. One of parents of these three groups of adolescents were selected purposively by using the selection criteria of the study. This study was a time-bound (duration: 3 months) cross-sectional institution-based study. A purposive sampling technique was used to select the samples (key caregivers and adolescents). In current study, Study Groups (Key Caregivers of the Adolescents with Intellectual Disability and Key Caregivers of the Adolescents with Psychosis) were compared with a Control Group, i.e., key caregivers of the normal adolescents. Family structure and functions are expected to be normally functioning in healthy families. Optimal family structure and functions is important for fulfillment of basic needs of the family's generic as well as individualized needs.,,,, Normal families are thought to have adequacy in these two areas and how families with the adolescents with intellectual disability and psychosis (schizophrenia and bipolar disorder) are different with regard to family functions and family resilience was the reason for keeping a normal control group. The researcher of the present study could not find any similar study which has compared family resilience as well as basic family functions among three groups what the present study did, but many studies had been done in the past which examine family resilience separately on families with intellectually disabled children or families with psychiatrically ill children.,,,,,, The primary rationale of carrying out comparison between these two groups was: in either condition, primary caregivers, especially parents, are seen to be at loss due to several reasons, namely problem associated with mind and mental health, anticipating stigma, and social abhorrence.,,,,,,,, Resilience enables individuals to fight with the adversity diligently and develop the skills to master the challenges of life circumstances. Resilience might be hastened if the overall family situation and environment are stable. A stable family has adequacy in all areas related to basic family functions.,,, Family resiliency has been found to have a significant association with positive outlook, good understanding and attachment among family members, flexibility in relation to specific issues, communication pattern among members, family's financial management, bondage among family members, shared recreation, routines and rituals, and support networks.,, Therefore, it could be assumed that family resilience can best be harnessed in families with normal structures and functions. Providing care to the adolescents with intellectual disability and adolescents with psychosis is stress inducing, however, key caregivers of adolescents with psychosis might have the positive feeling that psychosis is a treatable condition. However, intellectual disability is not treatable like psychosis; in this case, caregivers need to be more compassionate and skillfully supportive toward them. In the present study, one intriguing finding was noted in the form of higher level of family hardiness or resiliency (significantly higher score in families of adolescents with intellectual disability and psychosis than families of normal adolescents). A similar kind of observations was made by few authors in the past that parents tend to be more resilient and motivated to provide the best possible care and nurturance to their intellectually disabled children. Those caregivers tend to accept the reality and motivate themselves to do whatever best they could for the benefit of their children.,, Past observations suggested that family functioning can be affected negatively in families of individuals with severe and chronic mental disorders such as schizophrenia, psychosis, bipolar disorder, and recurrent depressive disorder.,,, More than three decades back, Miller et al. observed that there was no such difference in the quality and pattern of basic family functioning between the families of the individuals with severe mental disorders (e.g., schizophrenia or bipolar disorder) and normal families. However, some studies done subsequently had noted a significant difference in normal families and families with mental patients in various important areas of family functions. Families of chronic mentally ill individuals do exhibit conditions like burden of care, and expressed emotions. In these families, caregiver tend to be overly critical or overly protective to their ailing members. Families also have problem in conveying emotions and keeping flexibility in areas pertaining to family's structure and functions.,, In the current study too, family functions of the adolescents with intellectual disability and psychosis were found to be significantly different in comparison to families with normal adolescents. Selected key caregivers of the adolescents with intellectual disability and psychosis had reported significantly higher scores in all domains of FAD, suggesting dysfunctions in family's basic areas of functioning. This study has some limitations in the forms of small sample size, not including both parents in the study, not considering coping of parents and most importantly taking of adolescents with psychosis at the remission phase, which caused a reduction in comparability with the first group, i.e., adolescents with intellectual disability.
The authors of this study would like to express sincere gratitude to the administration of the Central Institute of Psychiatry and Deepshikha Institute for Child Development and Mental Health, Ranchi, India, for giving permission for data collection and Ethical Clearance to conduct the study and offering their active support in the course of the study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]