Submitted by,

Siji Mole Joseph

1st year M.Sc Nursing

Psychiatric Nursing

2007-2009

Sarvodaya College of Nursing

Bangalore – 79.

RAGIVGANDHIUNIVERSITY OF HEALTH SCIENCE, BANGALORE, KARNATAKA

1 / NAME OF THE CANDIDATE AND ADDRESS / Siji Mole Joseph
I st year M.Sc. Nursing

SarvodayaCollege of Nursing 11/2, Magadi Road,

Agrahara Dasarahalli
Banaglore – 560 079.
2 / NAME OF THE INSTITUTION / Sarvodaya College of Nursing
Banaglore – 560 079.
3. / COURSE OF THE STUDY AND SUBJECT / I st year M.Sc. Nursing
Psychiatric Nursing
4. / DATE OF ADMISSION OF COURSE / 01.06.2007
5. / TITLE OF THE STUDY / “A Study To Assess The Care Givers Burden And Family Well Being Among Primary Care Givers Of Patient With Depression In The Selected Hospitals, Bangalore”
6 / BRIEF RESUME OF THE INTENDED WORK
6.1 Introduction
6.2 Need for the study
6.3 Statement of the problem
6.4 Objectives of the study
6.5 Operational definitions
6.6 Inclusion and exclusion criteria
6.7 Assumptions
6.8 Review of related literature / Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
Enclosed
7 / MATERIALS AND METHODS
7.1 Source of data-Data will be collected from care givers of patient with depression in selected hospital Bangalore.
7.2 Method of data collection : Structure and Interview Schedule
7.3 Does the study require and investigation or interventions to be conducted on
the on the patients or other human being or animals - NO
7.4 Has ethical clearance been obtained from your institutions?
YES,ethical committee's report is here with enclosed.

PRO FORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

RAGIVGANDHIUNIVERSITY OF HEALTH SCIENCE, BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. / NAME OF THE CANIDATE AND ADDRESS / Siji Mole Joseph
I st year M.Sc. Nursing

Sarvodaya College of Nursing

11/2, Magadi Road,
Agrahara Dasarahalli
Banaglore – 560 079.
2. / NAME OF THE INSTITUTION / Sarvodaya College of Nursing
Banaglore – 560 079.
3. / COURSE OF THE STUDY AND SUBJECT / I st year M.Sc. Nursing
Psychiatric Nursing
4. / DATE OF ADMISSION / 01.06.2007
5. / TITLE OF THE STUDY / “A Study To Assess The Care Givers Burden And Family Well Being Among Primary Care Givers Of Patient With Depression In The Selected Hospitals, Bangalore”

6. BRIEF RESUME OF THE INTENDED WORK

6.1 Introduction

Depression is nourished by a life time of ungrieved and unforgiven hurts.

[penelope sweet].

The 18th century is fondly addressed by the Sociologists as the century of inventions, 19th as the century of progress and 20th, the century of anxiety by extrapolation, the 21st century is the century of depression. 1

Depression is among the 20 most Common causes of morbidity and disability in India, leading to substantial decrease in quality of life and productivity. Over 18 million Americans are depressed. As many as 2 million of these are adolescents. 2

Depression is one of the most common psychological disorders affecting 340 million people in the world today. Accounting for a full 10% productive years lost through out the world No one is immune from depression, as it occurs in people of all classes, all countries and all cultural settings. 3

World health Report (WHO, 2001) Defines Depression as a common Mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self worth, disturbed sleep or appetite low energy and poor concentration.

Major depression is the most diagnosis, showing lifetime prevalence in women of 4.9% to 8.7% and in men of 2.3% to 4.4%. One in four women and one in ten men can expect to develop depression during their life time. About half of all cases of depression go unrecognized and untreated. About 10-15% of depressed persons take their own lives. For a better treatment of these people not only medical care, but also participation and family cohesion are essential.4

The American Heritage dictionary describes depression as being a psychiatric disorder characterized by an inability to concentrate, insomnia, loss of appetite, anhedonia, guilt, helplessness, and hopeless-ness and thoughts of death. Depression is a disease that affects many Americans Five percent of the U.S. population over the age of 18, suffers from a severe depressive disorder.

An article published by Saldanha explains about the role played by one family member; and his health status can influence the health and functioning level of the rest of the family. When a member is Sick he would discontinue from his normal social activities. So the other family members have to undertake the care of the sick person. One person’s poor social performance is another person’s burden.5

Care giver burden and expressed emotion are too different constructs that may be related. Care givers of depressive patients have high levels of expressed emotions including critical, hostile, or over involved attitudes.

6.2 Need for the study
It has been predicted by WHO,2001, that by the year 2020, depression will be the greatest burden of ill health to people in the developing countries, and that by then Severe Depression will be the second largest causes of death and disability therefore in the present age, depression constitutes a major public health concern.
De Silva & De’Silva (2006) conducted a study to assess the impact of long term psychotic disorders on care givers. Fifty care givers of patients suffering from psychotic disorders were studied at a psychiatric out patient clinic of National hospital Srilanka. The subjects were administered with burden assessment scale for measuring subjective and objective burden on the carers. Results showed that the illness was a heavy emotional burden to the family. Sixty percent of care givers felt very anxious and depressed 62% felt that the family financial situation deteriorated very much after illness. 82% of care givers felt that they were largely responsible for meeting the financial needs of the patient and 78% felt, they were responsible for meeting all needs of patient. 6
Care givers play an important and essential role in the care of patients with depressive disorders. According to Fink (1995) social support is an important factor in care giving of severely mentally ill persons. It plays a significant role in the care givers effective management of the burden and has been shown to affect family well being.6

Care givers of people with depressive disorder many experience a different quality of burden than is seen with other illnesses. A better understanding of their concern is necessary to improve the training of care givers. perception of care givers about depressive disorder have important effects on levels of burden experienced care giver burden is associated with depression, which affects patients recovery by adding stress to the living environment. Several measures have been developed to assess the care burden of patients with depression but still care givers burdens to be investigated more.7

Depressive disorders has a tendency to relapse and recurrent episodes are not uncommon Involvement in the family members in the treatment process of the patient is encouraged through psycho education.

The present study was undertaken to understand the family functioning among persons having depressive disorder. The family’s experience of disease and adaptation is a dynamic and ongoing process. Also the study will examine care giver burden among primary caretakers in order to understand its implication on family functioning. This information will help in identifying and targeting poor family functioning styles and they will gain a new perspective to reduce care giver burden.

After reviewing above facts the student researcher while working as a staff nurse in psychiatric ward she came across with many depressive patient’s care givers and their personal sharing reflects, really they were having burden with chronic depressive patients .Many research studies also revealed that care givers burden is too high. Hence the researcher is interested in studying the extent of burden of care givers regarding knowledge, and family well being.

6.3 Statement of the problem
“A Study To Assess The Care Givers Burden And Family Well Being Among Primary Care Givers Of Patient With Depression In The Selected Hospitals, Bangalore”
6.4 Objectives of the study:
  1. To determine care givers burden.
  1. To assess the family well being.
  1. To find the association between levels of care giver burden and family
wellbeing among selected demographic variables of primary care givers of
patients with depressive disorder.
6.5Operational definitions
  1. Depressive disorder: In this study a patient with depressive disorder is a person who is suffering from depressed mood loss of interest, reduced energy which leads to increased fatigability and diminished activity.
  1. Primary care giver: In this study care giver referred to any one of the patients close relatives (parents, in-laws, cousin, spouse, sibling, son or daughter) who is an adult, staying with or visiting the patient frequently in the hospital
  1. Care giver burden: In this study care giver burden referred to problems and hard ships faced by the care giver while giving care to depressive patient in the hospital. It included physical emotional, financial social burden.

  1. Family well being: In this study family well being referred to care giver perception about the functioning of the family, perception about their own health and well being perception about their family’s health and well being.
6.6Inclusion and Exclusion Criteria:
Inclusion criteria
  1. Care givers who are available at the time of data collection.
  2. Care givers who are willing to participate.
  3. Family care givers who have some degree of burden related to the care of depressive ill relatives.
  4. Both male and female care givers.
Exclusion criteria
  1. Care givers who are not available at the time of data collection
  2. Care givers who were not willing to participate.

6.7 Assumptions
It is assumed that,
  1. Family care givers would willingly participate in the study.
  2. Family care givers would have some degree of burden related to the care of depressive ill relatives
6.8 Review of Related Literature
Perlick DA(2007) conducted a study for relatives with bipolar disorders. Care givers were evaluated within one month. Results shows that 81% of care givers respectively experienced moderate or higher burden in relation to patient problem behaviors, role dysfunction , or disruption of household routine. Burden experienced by family care givers of people with bipolar disorder are associated with problems in health, mental health and cost. Psycho Social interventions targeting the strains of caregivers for a patient with bipolar disorder are needed.8
Carpentier,N.(2005) Conducted a study to assess the burden of care in the care givers of depressive patients. In the present burden of care was compared between male and female spouses of depressive disorder patients 70 spouses (35 males and 35 females) were drawn from Institute of mental health & hospital Agra. No significant differences emerged across gender on overall perceived burden of care. An analysis across factors of BAS suggested that female spouses have greater burden in the areas of external support, physical and mental health.9
Sisk(2002) conducted a study to investigate whether the perceptions of burden of care givers are related to the health promoting behaviors. The study was conducted in USA among 121 female care givers of elderly. Data were collected using objective burden scale. Subjective burden scale and health promoting life style profile. Data were analyzed using descriptive statistics. It was concluded that family members with higher burden participated in fewer health promoting behaviors.10
Berg – Weger, Rubio and Tebb(2002) Conducted a study on the relationship between depression and care giver well being. The study was conducted among 142 care givers of family members with chronic illness in USA. Data were collected using the care giver well being scale. Results revealed depression is negatively related to well being care givers perception of competence is positively related to achievement of well being.11
Jacob, Frank, Kupfer and Corpenter(2001) Studied on the burden experienced by care givers of patients with recurrent depression. The study was conducted in USA among 128 care givers of depressive patients. Data were collected using family distress scale for depression. Data were analyzed using descriptive statistics. Result indicated that recurrent depressive disorder constitutes significant burden on care givers. People who live with the patient had increased burden than those who do not live with the patient.12
Thara(1997) Described and evaluate the effectiveness of a psycho educational workshop for depressed patients, family and friends since 1982.Depressed patients enrolled in a treatment study at the western psychiatric institute and clinic and their family and friends have participated in a day long psycho educational workshop conducted by the clinics staff. The workshop is designed to help family and friends become useful long term resources for patients with recurrent depression and to enlist their assistance in the treatment
study. The Patients to discuss methods of coping with depression and interacting with significant others, and the families to discuss the impact of the patients depression on their lives and to share common problems. More than 83% of family and friends were evaluated the workshop considered it moderately or extremely helpful.13
Fadden(1987) examined to find out the social burden among 24 spouses of patients suffering from persistent depression. The study was conducted in London. Data were collected using social behavior assessment schedule. Data were analyzed using descriptive statistics. Results indicated that 71% of spouses experienced reduction in social activities as a result of patient illness. A sense of grief was more found in wives (58%) than husbands (8%).14
7. MATERIALS AND METHODS
7.1 Sources of data:
Data will be collected from care givers of depressive patients in selected hospitals,Bangalore.
7.2 Methods of data collection
  1. Research design : Correlational
descriptive design
  1. Setting : Selected hospital
wards, Bangalore.
  1. Sampling technique : Convenient
sampling.
  1. Sample size : 50
  2. Method of data collection : Structured
Interview Schedule.
  1. Tool for data collection : Structured
questionnaire.
  1. Method of data analysis and
interpretation : The researcher
will use a
appropriate statistical
technique for data
analysis and present in
the form of tables,
graphs and diagram.
  1. Duration of study : 4 Weeks
  2. Variables
Research variables * Family wellbeing
* Caregivers burden
Demographic variables : Age, Sex, Education status,
Occupation,Income,Type of
family, Position of the
family.
Projected outcome: : This study will help to
know the caregivers
burden and family well
being of depressive patients.
7.3 Does the study require any investigation or intervention to be conducted on the patient or other human beings or animals?
NO.
7.4 Has ethical clearance has been obtained from your institution
YES, ethical clearance report is here with enclosed..

8. BIBLIOGRAPHY

  1. Vebia N Vihang. Management of depression in primary care. Journal of Indian Medical Association 2005 Feb ; 103(2): 68-70.
  2. Ozgul.S.parental Grief and serious mental illness. The Hindu online edition of India’s National newspaper 2002 Sep 20; Sec.A:3 (Col.5).
  3. Gada Manilal. Treatment of depression with the serotonin reuptake enhancer Taioreptive in the primary care setting of India. Journal of the Indian Medical Association 2005 April; 105 (4): P 105-06.
  4. Donahve JM. Reducing the Societal burdens of depression a review of economic cost, quality. Pharmaco economics [Serial online} 2007 Jun [Cited 2007 July 20]; 25(1): [7-24]. Available from:

URL:

  1. Saldanha.P.Family burden and family distress among patients of acute and chronic schizophrenia. Workshop on psycho social rehabilitation (2002).

Fr. Muller’s Medical College Mangalore.

  1. De’silva, D & De’Silva, S.A preliminary study of the impact of long term psychotic disorder on patients families. Paper presentation 2006, University of Colombo.
  2. Alen D Oslivie. The burden on informed care givers of people with bipolar disorder. Prevalence and Correlates of burden among care givers [serial online] 2005 April [cited 2007 August 25]; 22 (1): [25-32]

Available from: URL:

  1. Perlick DA. Burden among care givers of patients with bipolar disorder enrolled in the systematic. Treatment enhancement programme for Bipolar Disorder. Bipolar disord [serial online] 2007 May [cited June 8] ; 9 (3): [262-73]

Available from: URL:

  1. Carpentier, N. Comparison of the extent and pattern of family burden in depressive disorders. Indian Journal of psychiatry 2005 May; 37 (3); 105-112.
  2. Sisk, RJ. Care giver burden and health promotion. International Journal of nursing studies 2002 July; 37 (2) : 34-43.
  3. Berg.Weger M, Rubio D.M. Tebb, SS. Depression as a mediater viewing care giver well being and strain in a different light.Indian journal of psychiatry 2002 sep;81(2):162-172.
  4. Jacob ,M.Frank,E,Kupter D &Corpentro L.L.Recurrent depression ,an assessment of family burden and family attitude.Journal of clinical Psychiatry2001 Jan ; 48(3):34-43.
  5. Thara R.Burden assessment schedule.Indian Journal of Psychiatry 1997 Nov;40(1):21-29.
  6. Fedden, G, Bebbington ,P& kuipers,L .Caring and its burden a study of the spouse of depressed patients. British Journal of Psychiatry 1987 Feb;151(2):660-667.