Caregivers’ Quality of Life: Comparative Analysis of Psychiatric ward and General Caregivers Quality of Life

 

Venkateswaramurthy N*, Syed Munavvar VT, Sudha M,. Sambathkumar. R

Department of Pharmacy Practice, J. K. K. Nattraja College of Pharmacy, Kumarapalayam - 638183, India.

*Corresponding Author E-mail: venkateswaramurthy.n@jkkn.ac.in

 

ABSTRACT:

Mental illness affects at least one in four people, either directly or indirectly. Caregivers play a significant role in fulfilling the vital physical needs and psychological wellbeing of mentally ill patients. Caregiving for mentally ill persons causes a burden to the caregivers. This burden reflects in the physical and mental health of the caregiver. This study was designed to explore the Quality of Life (QOL) of caregivers of mentally ill inpatients. In this descriptive, comparative cross-sectional study, the quality of life of caregivers of the psychiatric ward and general wards was studied by inpatients settings using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) Scale. Caregivers of mentally ill patients have lower QOL levels, and it was observed that the WHOQOL-BREF score of the general ward was significantly higher than that of the psychiatric ward caregivers in all domains. This study would help manage, intervene, and identify the physical and mental health caregivers.

 

KEYWORDS: Caregiver, mentally ill patients, quality of life, World Health Organization quality of life.

 

 


INTRODUCTION:

Mental health disorders are one of the common problems that cause disease burden.  According to the World Health Organization, approximately 450 million persons are fighting mental health challenges worldwide, and it's one of the significant causes of disease burden globally. It accounted for 21.20% of years lived with disability1. Mentally ill patients are primarily dependent on the people closest to their day-to-day life activities. Caregivers play a significant role in fulfilling the vital physical needs and psychological wellbeing of mentally ill patients. On the other hand, caregiving for mentally ill persons causes a burden to the caregivers, affecting their physical and psychological health. Mental illness affects people in developed as well as developing countries. Epidemiological studies report prevalence rates for psychiatric disorders from 9.5 to 370/1000 populations in India2,3. More than 90% of mentally ill patients live with their families4.

 

A study on caregivers5 reported that caregiving is connected with more psychological illnesses and inadequate physical and psychological quality of life. This study has been focused on exploring the quality of life of caregivers of mentally ill inpatients by using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) Scale6 and comparing with the quality of life of caregivers general ward patients.

 

METHODOLOGY:

In this descriptive, comparative cross-sectional study 200 caregivers were selected from tertiary care hospital, Erode, India. Caregivers were recruited randomly. General ward caregivers (n=100) were recruited from the Medical, Orthopedic, and Surgical departments. Similarly, psychiatric ward (n=100) caregivers were randomly selected. Caregivers are defined as family members keenly offering day-to-day care for a person with medical, orthopaedic, surgical, mentally ill patients, and those who are accustomed to the patients' health and social status. This study was approved by the Institutional Ethics Committee of J.K.K.Nattraja College of Pharmacy, Kumarapalayam. Tamilnadu, India (JKKNCP/Ethics_Practice/019PDS02).

 

Inclusion Criteria:

Caregivers who gave informed consent, who did not have any significant mental illness, caregivers aged 20 years or above; able to read/speak Tamil/English; Caregivers who have been providing care to the patient for a minimum of 1 month.

 

Exclusion criteria:

The caregivers aged less than 20 years, not willing to co-operative. Caregivers were having chronic physical illness and past/current psychiatric illness. Caregivers who are taking care of additional family members for either psychiatric or physical ailments.  After checking the eligibility criteria for participation, the purpose of the study was explained. If the caregivers were in a group for a single patient, only one caregiver was allowed to answer the questionnaire.

 

Instruments:

After collecting caregivers’ informed consent, data were collected using self-administered/interviewer assisted (in case of insufficient ability, the interviewer translated the questionnaire into the vernacular language in which both the patient and the interviewer were well versed) WHOQOL-BREF questionnaire6. A predesigned questionnaire was used to collect sociodemographic details. WHOQOL-BREF questionnaire has four main domains derived from the 26 items in this questionnaire, comprising the physical, psychological, social, and environmental domains. These four domains were shown to be valid measures of overall QOL and health. This questionnaire is cross-culturally sensitive and has good, excellent reliability and validity6.

 

Statistical analysis:

Data were analyzed by using SPSS, Version 17.0 (SPSS Inc. Illinois, USA).

 

RESULTS:

The study was conducted to assess the quality of life of caregivers of the psychiatric ward and general ward. In this study, the quality of life of our caregivers was measured using the World Health Organization Quality of Life Scale - BRIEF Version6. A total of 200 caregivers were interviewed in the psychiatric ward and general ward using interviewer-administered WHOQOL-BREF questionnaires. In the psychiatric ward, 57 caregivers were male, and 43 caregivers were female.

 

Table 1 shows the comparison data of the age-wise distribution of QOL of caregivers of the psychiatric ward and general ward on various domains of quality of life scale. In both the category, most caregivers were in the age group between 41-60 years (49% and 56%). In this category, the overall QOL in all domains caregivers of the psychiatric ward were less than caregivers of the general ward. A positive correlation was observed between the age of the caregiver and QOL (p < 0.05). It reveals that the QOL of caregivers were decreased with respect to their age. In the relationship-wise distribution of QOL of caregivers, the overall QOL in all domains caregivers of the psychiatric ward were less than caregivers of the general ward. In this classification, parents were mostly provided care to psychiatric patients (37%) and general ward patients (36%). In our study population, spouses had a significantly lower quality of life in all the domains compared to other relationships (p < 0.05).

 

In our study population, most caregivers (78% of caregivers of the psychiatric ward and 81% of the caregivers of the general ward) were married. Table 1 shows the QOL comparison based on the marital status of caregivers of the psychiatric ward and general ward on various domains of quality if life scale. In this category, the overall QOL in all domains caregivers of the psychiatric ward were less than caregivers of the general ward. It was observed that single (unmarried) caregivers had lower QOL than married caregivers (p < 0.05). The educational level of caregivers affects their QOL. In our study, education was found to increase the QOL of caregivers. Based on the academic level, the overall QOL in all domains caregivers of the psychiatric ward were less than caregivers of the general ward. Most of the caregivers in our study population had secondary level education (36% of caregivers of the psychiatric ward and 33% of the caregivers of the general ward). Based on the working status category, overall QOL in all domains caregivers of psychiatric ward caregivers were less than caregivers of the general ward. Employed caregivers had lower QOL compared to unemployed. Most of the caregivers in our study population were employed (36% of caregivers of the psychiatric ward and 33% of the caregivers of the general ward).

 

Similarly, the impact of the duration of caregiving on QOL was studied. 34% of the psychiatric ward caregivers had 1-3 years of caregiving, and 77% of the caregivers of the general ward had less than one year of caregiving. In this category, the overall QOL in all domains caregivers of the psychiatric ward were less than caregivers of the general ward. The duration of diseases reduces the quality of life of caregivers. It may be due to an increase in the burden on caregivers due to continuous caregiving. Table 3, shows the comparative WHOQOL-BREF score of the psychiatric ward and general ward caregivers. It observed that the WHOQOL-BREF score of the general ward was significantly higher than that of the psychiatric ward caregivers in all domains (p < 0.05).


 

Table 1: WHOQOL – BREF Score of Psychiatric ward and General ward caregivers

Distribution WHOQOL – BREF Score of caregivers of Psychiatric ward

Distribution WHOQOL – BREF Score of caregivers of General ward

 

 

Number of caregivers

Domains

Total

Number of caregivers

Domains

 

Total

Mean score (SD)

Mean score (SD)

 

Physical Health

Psychological Health

Social Health

Environmental Health

Physical Health

Psychological Health

Social Health

Environmental Health

Distribution of WHOQOL – BREF Score of caregivers according to Gender

Male

57

18.74

(2.5)

11.45

(3.3)

11.65

(2.4)

14.91

(3.1)

14.18 (2.96)

54

34.87

(3.1)

31.24

(3.1)

33.41

(2.8)

35.87

(2.5)

33.84

(1.74)

Female

43

17.35

(2.1)

10.22

(2.5)

10.18

(2.5)

13.01

(2. 8)

12.69

(2.92)

46

32.14

(2.1)

30.22

(3.2)

32.11

(2.8)

35.04

(1.9)

32.37

(1.72)

Total

100

18.04

(0.69)

10.83

(0.61)

10.91

(0.73)

13.96

(0.95)

-

100

33.50

(1.36)

30.73

(0.51)

32.76

(0.65)

35.45

(0.41)

-

P Value

-

0.037

0.031

0.024

0.04

-

-

0.041

0.387

0.028

0.041

-

Distribution of WHOQOL – BREF Score of caregivers according to Age

20-40

years

27

16.55

(2.2)

14.12

(3.1)

14.38

(2.8)

14.78

(3.5)

14.95

(0.96)

24

37.11

(2.8)

35.42

(2.7)

35.22

(2.9)

34.11

(3.0)

35.46

(1.07)

41-60

years

49

15.97

(2.7)

12.58

(3.0)

15.11

(3.3)

12.38

(2.4)

14.01

(1.56)

56

35.41

(2.5)

34.87

(2.9)

33.65

(3.1)

33.48

(3.0)

34.35

(0.81)

61-80

years

24

14.41

(1.9)

11.58

(2.1)

11.45

(2.0)

11.42

(2.6)

12.21

(1.26)

20

34.89

(3.0)

30.21

(2.8)

33.67

(2.7)

33.01

(2.9)

32.94

(1.71)

Total

100

15.64

(0.90)

12.76

(1.04)

13.64

(1.58)

12.86

(1.41)

 

100

35.80

(0.94)

33.5

(2.33)

34.18

(0.73)

33.53

(0.45)

-

P Value

 

0.02

0.03

0.04

0.01

--

-

0.042

0.039

0.024

0.045

-

Distribution of WHOQOL – BREF Score of caregivers according to relationship

Parents

37

13.43

(2.1)

15.22

(2.3)

14.21

(1.8)

13.27

(2.1)

14.03

(0.77)

36

34.44

(2.9)

37.98

(2.5)

35.75

(2.8)

33.58

(3.0)

35.43

(1.65)

Son/ Daughter

19

15.97

(2.5)

16.12

(2.1)

13.88

(1.8)

14.28

(3.2)

15.06

(0.99)

23

36.61

(2.1)

39.20

(2.8)

36.28

(2.5)

34.25

(2.5)

36.58

(1.75)

Spouse

28

11.35

(3.1)

12.31

(2.4)

13.01

(2.7)

12.97

(2.5)

12.41

(0.67)

27

31.26

(2.8)

32.76

(2.5)

32.21

(2.5)

30.02

 (2.0)

31.56

(1.03)

Others

16

14.33

(2.8)

15.27

(2.6)

19.87

(2.5)

14.99

(2.5)

16.11

(2.19)

14

35.91

(2.8)

36.01

(2.4)

35.87

(2.7)

33.11

(2.8)

35.22

(1.22)

Total

100

13.77

(1.66)

14.73

(1.44)

15.24

(2.70)

13.87

(0.80)

-

100

34.55

(2.05)

36.48

(2.43)

35.02

(1.63)

32.74

(1.62)

-

P Value

 

0.049

0.011

0.038

0.081

-

-

0.045

0.019

0.013

0.021

-

 

Table 2::WHOQOL – BREF Score of Psychiatric ward and General ward caregivers

Distribution WHOQOL – BREF Score of caregivers of Psychiatric ward

Distribution WHOQOL – BREF Score of caregivers of General ward

 

 

Number of caregivers

Domains

Total

Number of caregivers

Domains

 

Total

Mean score (SD)

Mean score (SD)

 

Physical Health

Psychological Health

Social Health

Environmental Health

Physical Health

Psychological Health

Social Health

Environmental Health

Distribution of WHOQOL – BREF Score of caregivers according to Marital status

Single

09

14.99

(3.3)

13.98

(3.1)

13.98

(2.8)

13.87

(3.0)

14.20

(0.45)

9

31.23

(3.1)

30.07

(3.3)

30.91

(2.5)

31.46

(3.0)

30.91

(0.52)

Married

78

15.41

(2.8)

14.99

(3.1)

14.41

(2.8)

14.11

(2.4)

14.73

(0.50)

81

33.87

(3.7)

32.94

(3.4)

34.14

(2.8)

34.41

(2.8)

33.84

(0.55)

Widower/Divorced

13

14.41

(2.5)

13.54

(2.5)

13.34

(2.1)

13.11

(2.6)

13.6

(0.49)

10

31.97

(2.9)

30.22

(2.5)

31.41

(2.4)

32.54

(2.5)

31.53

(0.85)

Total

100

14.93

(0.40)

14.17

(0.60)

13.91

(0.43)

13.69

(0.42)

-

100

32.35

(1.11)

31.07

(1.31)

32.15

(1.41)

32.80

(1.21)

-

P Value

-

0.049

0.011

0.038

0.081

-

-

0.033

0.041

0.031

0.047

-

Distribution of WHOQOL – BREF Score of caregivers according to Educational level

illiterate

07

12.34

(2.8)

11.33

(2.9)

11.14

(2.5)

11.22

(3.0)

11.50

(0.48)

09

31.31

(2.8)

31.22

(2.5)

32.24

(2.2)

31.33

(2.3)

31.52

(0.41)

Primary

29

13.21

(2.9)

12.21

(3.1)

13.45

(2.8)

12.31

(2.8)

12.79

(0.54)

 27

35.29

(3.0)

33.99

(2.8)

33.87

(2.8)

32.54

(2.1)

33.92

(0.97)

Secondary

36

14.31

(2.7)

12.75

(2.9)

12.11

(3.0)

12.87

(3.2)

13.01

(0.80)

33

36.42

(2.8)

35.45

(2.3)

35.25

(2.5)

32.33

(2.7)

34.86

(1.52)

Tertiary

28

16.87

(2.8)

14.35

(2.9)

14.11

(2.8)

14.21

(2.4)

14.88

(1.14)

31

35.11

(2.5)

37.11

(2.5)

34.82

(3.0)

33.24

 (3.1)

35.07

(1.37)

Total

100

14.18

(1.70)

12.66

(1.09)

12.70

(1.15)

12.65

(1.07)

-

100

34.53

(1.92)

34.44

(2.16)

34.04

(1.15)

32.36

(0.68)

-

P Value

-

0..021

0.031

0.007

0.032

-

-

0.018

0.023

0.045

0.028

-

Distribution of WHOQOL – BREF Score of caregivers according to Working status

 

Yes

67

15.23

(2.8)

13.21

(2.5)

13.21

(2.4)

13.21

(2.5)

13.71

(0.87)

68

34.45

(2.8)

35.14

(2.5)

35.03

(2.5)

35.41

(2.7)

35.00

(0.35)

No

33

17.34

(1.9)

14.87

(2.1)

14.21

(2.8)

14.77

(2.4)

15.29

(1.20)

31

39.21

(2.9)

36.87

(3.0)

38.42

(2.8)

39.58

(2.5)

38.52

(1.04)

Total

100

16.28

(1.05)

14.04

(0.83)

13.71

(0.5)

13.99

(0.78)

 

100

36.83

(2.38)

36.00

(0.86)

36.72

(1.69)

37.49

(2.08)

-

P Value

-

0.002

0.021

0.09

0.041

 

-

0.08

0.031

0.041

0.048

-

Distribution of WHOQOL – BREF Score of caregivers according to duration of caregiving

Less than 1 year

11

19.41

(2.8)

16.22

(2.2)

15.41

(2.9)

16.21

(2.4)

16.81

(1.53)

77

35.41

(2.9)

32.54

(2.5)

35.47

(2.5)

36.41

(2.8)

34.95

(1.45)

1-3

34

18.13

(2.9)

15.41

(2.8)

14.39

(2.1)

15.14

(2.8)

15.76

(1.41)

14

32.47

(3.1)

30.98

(3.0)

33.25

(2.8)

31.25

(3.0)

31.98

(0.92)

4-6

22

16.99

(2.5)

14.97

(2.6)

14.11

(2.8)

14.87

(2.8)

15.23

(1.06)

09

31.98

(3.2)

30.03

(2.8)

33.21

(2.7)

30.33

(2.8)

31.38

(1.28)

More than 7 years

33

15.22

(2.8)

13.88

(2.7)

13.74

(2.0)

14.11

(3.4)

14.23

(0.58)

0

0

0

0

0

0

Total

100

17.43

(1.54)

15.12

(0.84)

14.41

(0.62)

15.08

(0.75)

-

100

24.96

(14.46)

23.3

(13.53)

25.48

(14.74)

24.49

(14.33)

-

P Value

-

0.031

0.044

0.011

0.023

-

 

0.042

0.039

0.042

0.034

-

 

Table: 3 Distribution of WHOQOL – BREF Score of general ward caregivers

 

Mean WHOQOL-BREF Score

SD

P-value

Conclusion

Physical Health

Psychiatric ward caregivers

15.59

1.55

 

0.041

 

Significant

General ward caregivers

32.18

4.65

Psychological Health

Psychiatric ward caregivers

13.66

1.49

 

0.037

Significant

General ward caregivers

31.38

4.79

Social Health

Psychiatric ward caregivers

13.57

1.29

0.031

Significant

General ward caregivers

32.09

4.042

Environmental Health

Psychiatric ward caregivers

13.80

0.78

0.028

Significant

General ward caregivers

31.76

4.66

 

 

Figure 1: Distribution of WHOQOL – BREF Score of Psychiatric ward caregivers according to diagnosis

 

Figure 2: Distribution of WHOQOL – BREF Score of general ward caregivers according to diagnosis

 

 

DISCUSSION:

This study reveals that male caregivers of the psychiatric ward and general ward had significantly high on physical health, psychological, social relationships, and environmental health (p < 0.05) than female caregivers, which suggests that male caregivers of patients had good physical health, psychological health, social relationships, and environmental health compared to female caregivers. Many studies have reported experience of caregiving differences among males and females.  These variations may be due to the role of coping approaches employed by males and females7. Males have a broader coping range than females, and they use it for acceptance, problem-solving, distancing, or detachment more frequently8.

 

Some studies have reported that female caregivers suffer a higher burden and distress because of the lack of available social support. According to the studies, female caregivers are less likely to obtain support because of their caregiving roles' limitations imposed on them. The male caregivers are usually requested and obtain external help for caregiving from formal and informal sources9,10. The QOL of caregivers were decreased concerning their age. Physical health is positively related to physical work and a healthy diet with work engagement. Caregiving burden increases their physical burden as well as the mental burden of the caregivers. Caregiving for mentally ill persons causes a burden to the caregivers, which is reflected in their physical health. Usually, physical health is generally used as an indicator to measure the wellbeing of individuals. As individuals grow older, they might think that their physical health is not as good as it was early. The study conducted by Borg and Hallberg reported that caregivers aged 50-89 years of life satisfaction decreased as age increased. The age of caregivers directly related to their vulnerability, necessitating to deal with caregiving and their own health needs in the same period11-13.

 

Disability alterations of psychiatric patients alter the patient's entire social and work status, change the family members' lifestyle, and disrupt the steadiness within the family. Adults play diverse roles in their lives. The caregiving process impacts these responsibilities, leading to rearranging priorities and affecting emotional, mental, and physical aspects. Consequently, it negatively impacts the quality of life of caregivers14-16 . In this study, population spouses had lower QOL compared to other relationships. Spouses are usually managing the spousal and caregiver roles simultaneously. Spousal caregivers fulfil their supportive roles concurrently as well as handle the burden generated by the caregiving.  It may be one of the reasons for the burdens faced by spouses17. It was observed that single (unmarried) caregivers had lower QOL than married caregivers. It may be due to the mental and physical support provided by spouses. Studies reported that married caregivers have more QOL compared to unmarried18-21.  Strong evidence of the positive association between marital relationship and QOL with increased intimacy was reported22.23.

 

A higher level of education among caregivers might help deal with stressful situations, which results in good QOL. Highly educated caregivers have good jobs with higher salaries, which could help care for ill family members; it may also contribute to their better QOL24-26. It is essential to study the educational status of the caregivers because it is helpful to them to receive information and guidance from the healthcare group. Low levels of education may interfere, directly or indirectly, in diets and the handling of medications. In our study, the employed caregivers had lower QOL compared to the unemployed. It may be the due impact of time consumed in caregiving on time spent on their occupations27,28. In our study, it was observed that the duration of diseases reduces the quality of life of caregivers. It may be due to an increase in the burden on caregivers due to continuous caregiving. It is reported that increased duration of caregiving was directly related to higher levels of caregiver burden29-31. Period of caregiving has a negative effect on caregiver burden and impacts the caregivers' life, like work, parenting, and social life32-34

 

Our study observed that the WHOQOL-BREF score of the general ward was significantly higher than that of the psychiatric ward caregivers in all domains. A caregiver is a person responsible for fulfilling the physical and psychological requirements of the dependent patient. It was observed that caring for someone with mental illness is associated with a lower level of QOL than caring for someone with other medical illnesses. The QOL perceived by caregivers of patients with mental illness is a structural prognostic aspect of the illness, and the caregiver QOL is reportedly a critical determinant for negative caregiving outcomes. The study highlights the necessity of proper educational interventions to caregivers to improve their quality of life. This is necessary to ensure the mental ill persons' constant care and help the caregivers maintain their health to care for the care demands.

 

CONCLUSION:

Caregivers play a fundamental role in the management of psychologically ill patients. Studies determining caregivers' quality of life can help open primary intervention among the exposed caregivers. This study will also help the professionals working in the management of mentally ill patients to identify vulnerable caregivers.  This present study observed a significant difference in the Quality of life score in all domains WHOQOL-BREF of general ward caregivers and psychiatric ward caregivers. The psychiatric ward caregivers had a comparatively lower quality of life on WHOQOL-BREF score in all domains than the general ward caregivers. This study will be helpful to the physicians to manage the psychiatric ward caregivers and plan interventions that are required, psychiatric ward caregivers. The overall QOL in all domains caregivers of the psychiatric ward were less than caregivers of the general ward. In both categories, the female caregivers had a significantly lesser quality of life than male caregivers.

 

CONFLICT OF INTEREST:

The authors declare no conflict of interest

 

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Received on 20.04.2021            Modified on 15.11.2021

Accepted on 17.03.2022           © RJPT All right reserved

Research J. Pharm. and Tech 2022; 15(10):4601-4606.

DOI: 10.52711/0974-360X.2022.00772