Proforma Synopsis for Registration of Subject For

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES

KARNATAKA

PROFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. / NAME OF CANDIDATE / Ms. LEENA JOSEPH, M.Sc. NURSING,
UNIVERSAL COLLEGE OF NURSING.
2. / NAME OF THE INSTITUTION AND ADDRESS / UNIVERSALCOLLEGE OF NURSING, CARMEL JYOTHI CAMPUS, BANERGHATTAMAIN ROAD, GOTTIGERE PO, BANGLORE. 560083.
3. / COURSE OF STUDY AND SUBJECT / M.Sc. NURSING 1ST YEAR IN PSYCHATRIC NURSING.
4. / DATE OF ADMISSION TO COURSE / 1st JUNE 2010
5. / TITLE OF THE TOPIC / A STUDY TO IDENTIFY THE
PREVALENCE OF PHOBIC
DISORDERS AMONG THE GENERAL POPULATION IN A SELECTED URBAN AREA IN BANGLORE, WITH A VIEW TO PREPARE AN INFORMATION BOOKLET.

6. INTRODUCTION:

“Mental health problems do not affect three or four out of every five persons but one out of one.”

“A SOUND BODY HAS A SOUND MIND”...... Health, it is recognized as a fundamental right of human being. It is an important asset of all human, community, family. Therefore it is said that “No Health, No wealth” or “Health is wealth”.

“Mental health is a condition which permits optimal, physical, intellectual, and emotional development of individual, so far as this is compatible with that of other individual.1

Phobia is the most common anxiety disorder and the third most common psychiatric disorder, after major depressive disorder and alcohol dependence.2 Lifetime prevalence estimates for social phobia vary greatly and range from 0.4 to 20.4 percent in different studies. Among more well know epidemiological studies, the epidemiological catchment area survey in 1991 suggests a life time prevalence of social phobia at 2.73percent.3

Phobia is an exaggerated fear of a specific type of stimulus or situation. “A stressful stimulus produces an unconditioned response to fear”. When the stressful stimuli are repeatedly paired with a harmless object alone produces a “conditioned” response i.e. fear. This becomes a phobia when the individual consciously avoids the harmless object to escape fear.4

Social phobia even through being a common psychiatric disorder is under recognized and undertreated.it is most common in youth, is associated with lower educational achievements, unstable employment, higher frequency of being absent to work, individuals are less likely to marry, more likely to get divorced, and have reduced productivity that can lead to dependence from family, state, society and country.5Disability in diverse functional areas and impaired quality of life are two important domains of consequences of social phobia.

Studies on mental health in anxiety disorders in particular, often neglect a person’s perception of his or her quality of life. Judging the impact of a mental disorder based on symptomatic distress, while ignoring one’s overall quality of life, is incomplete. Thus, as a humanistic and holistic approach to health and health care, mental health studies should consider measure of the impact of disease and impairment on daily activities and behaviour, perceived health measures and disability status measures.6

Social phobia even through being a common psychiatric disorder is still under recognized and undertreated. The investigator conducted a study on prevalence, severity, disability and quality of life with respect to social phobia among university students in India.380 students were taken and 19.5 percent of participants were found to be having social phobia and it resulted in significant disability and impaired quality of life. The present studyis about phobia and its impact on population, its prevalence, demographic variables due to phobia. High prevalence and marked impact on life demands stringent efforts to recognize and treat social phobia.7

Brief Resume of Intended Work

6.1 NEED FOR STUDY

A phobia is defined as an irrational fear that produces a conscious avoidance of the feared subject, activity, or situation. The affected person usually recognizes that the reaction is excessive. 8

A most recent data on the three main types of phobia i.e. social, agoraphobia and specific phobia reveal that they are likely to affect between 5 and 10 people in every 100. Females are more prone to irrational fears than males. Phobia statistics suggest that roughly twice as many women as men suffer from panic disorder, post traumatic stress disorder, generalised anxiety disorder and specific phobia though about equal numbers of women and men have obsessive-compulsive disorder and social phobia.

The WHO estimates that approximately 1 in 23 people suffer from phobias. That’s nearly 4.25percent of the population. There are roughly 11.5 million sufferers in the US and 2.5 million in the UK. Approximately 19.1 million American adults aged between 18 and 54 (13.3percent of people in this age group) in a given year have an anxiety disorder. 5.2 million Americans (aged 18 to 54) or 3.7percent of people in this age group have social phobia. Approximately 3.2 million Americans have agoraphobia according to the latest specific phobia statistics. Almost 6.2 million US citizens have some sort of specific phobia.

In England in 2002-3, there were 310 hospital consultant episodes for phobic anxiety disorders. 94percent required hospital admission. 40percent were for men, 60percent for women.9

3258 randomly selected adult household residents of the city of Edmonton were interviewed by trained lay interviewers using the Diagnostic Interview Schedule. Using DMS-III criteria, hierarchy-free, the lifetime prevalence for all phobias was 8.9 percent. Rates for women (11.7percent) were almost twice those for men (6.1percent). The age at which first phobic symptoms had been reported by 50 percent of subjects was 12 years for men and 6 years for women. High rates of co-morbidity with depression, alcohol abuse/dependence, drug abuse/dependence and obsessive-compulsive disorder were found in all types of phobia, an important point in clinical management.9

A study by the National Institute of Mental Health in Bethesda, Maryland found that between 8.7 and 18.1 per cent of Americans suffer from at least one phobia. Yet for reasons unknown, the mental health profession cannot agree on the term to be used for many of the most common phobias. 10

The prevalence of social phobia varies widely among different countries. In this study, social phobia was found in 19.5percent of subjects, much more than other studies among university students11. Previously, when prevalence estimates were based on the examination of psychiatric clinic samples, social anxiety disorder was thought to be a relatively rare disorder but social anxiety was common and many were afraid to seek psychiatric help, leading to an understatement ofthe problem. Prevalence rates may vary widely because of overlapping symptoms with other disorders. Because of difficulty in separating social phobia from poor skills or shyness developmentally, some studies have a large range of prevalence.11

The recent epidemiologic studies report extremely varied rates for social phobia. One of the reasons for this may be the difficulty in diagnosing Social Phobia, the boundaries of which are uncertain. Two thousand three hundred and fifty-five people (out of the 2,500 randomly selected from the population) living in Italy, were interviewed by their own general practitioner. Six hundred and ten of the 623 subjects were found positive for any form of psychopathology at the screening interview, and 57 negative subjects, were re-interviewed by residents in psychiatry using the Florence Psychiatric Interview. It was found that 6.58percent of subjects showed social anxiety not attributable to other psychiatric or medical conditions during their life. Social or occupational impairments meeting DSM-IV diagnostic requirements for SP was detected in 76 subjects.Correction for age raises the lifetime expected prevalence to 4 percent. Sex ratio was approximately (F: M) 2:1. The most common fear was speaking in public (89.4 percent), followed by entering a room occupied by others (63.1 percent) and meeting with strangers (47.3 percent). Eighty-six point nine percent of subjects with social phobia complained of more than one fear. The mean age of onset (when the subjects first fully met DSM-IV criteria for Social phobia) was 28.8 years, but the first symptoms of Social phobia usually occurred much earlier, with a mean age of onset at 15.5 years. Ninety-two percent of cases with Social phobia also showed at least one other co-morbid psychiatric disorder during their life. Lifetime prevalence of avoidant personality disorder was 3.6 percent. Forty-two point nine percent of cases with social phobia also had avoidance personality disorder, whereas 37.9 percent of cases with APD developed social phobia.12

The statistical data indicates that there is a need to be carefully evaluated for phobia for an appropriate referral and treatment. So its prevalence among the population should be brought forward.

Based on the above studies, the investigator left the need for identifying the prevalence rate of phobic disorder and to prepare an information booklet so as to give knowledge to the public especially on referral and treatment.

Nurses are often in ideal position to assess the health and its problems and to offer education and support. Nurse needs to be knowledgeable about the sign and symptoms of various forms of phobia and the treatment of each form. When the nurse develops an effective plan for nursing management, she should consider family involvement, appropriate referral resources.

6.2 REVIEW OF LITERATURE

A study was conducted on phobic fears and dsm-iv specific phobia in 70-year olds.A representative population sample of Swedish 70-year-olds without dementia (N=558) was examined using semi-structured interviews. Phobic fears 71.0 percentand social phobia 13.8 percent were more common in women than in men. Among those with phobic fears, more than 80 percent reported onset before age 21. Of those with social phobia, 35.7 percent had another DSM-IV diagnosis. Fear of specific situations and 'other' fears were related to social phobia and other anxiety disorders. The study conclude that specific phobia in the elderly should receive attention from health professionals as it is common and associated with a decrease in global functioning.13

A study was done to investigate the prevalence of blood and injection phobia in an unselected pregnant population, in order to estimate the need for curative intervention programmes in antenatal care clinics in the southeast region of Sweden. 1,606 consecutively registered pregnant women attending their first visit with a midwife, was selected and the women were asked to complete the Injection Phobia-Anxiety scale, measuring phobic symptoms. Women who scored>20 on the questionnaire were telephone-interviewed and then diagnosed or dismissed according to the DSM-IV criteria for blood and injection phobia.Prevalence of blood and injection phobia according to the DSM-IV of 1,529 women who chose to participate (92.5percent), 110 women or 7.2 percent fulfilled the DSM-IV criteria for blood and injection phobia. The mean age of the women was 29.1 years.Blood and injection phobia is hitherto unreported in the literature, but seems to be relatively common and needs to be recognized during pregnancy as it causes a great deal of discomfort and fear among pregnant women. The Injection Phobia-Anxiety scale is suitable as a screening tool in an antenatal care clinic setting.14

A study was done on prevalence, correlates, and co-morbidity of social phobia in a Nigerian undergraduate university population. A cross-sectional survey of students at the University was carried out. Instruments used were the Composite International Diagnostic Interview (CIDI), the Alcohol Use Identification Test, the General Health Questionnaire and the WHO-Disability Assessment Schedule. The lifetime and 12-month prevalence of social phobia were 9.4 and 8.5 percent respectively. On bivariate analysis, social phobia was significantly associated with lifetime. Lifetime depression, psychological distress and perceived poor overall health remained strongly and independently associated with social phobia after regression analysis. The prevalence of social phobia among Nigerian university students is similar to what has been found in other parts of the world. There is a need for increased awareness of this disorder and its association with depression so that sufferers can receive early treatment to prevent long-term disability.15

A cross-sectional study was conducted to assess the prevalence and characteristics of anxiety disorders in the medically ill.A sample of 1,660 medical patients was recruited from different medical settings in different periods from 1996 to 2007. All patients underwent detailed semistructured interviews with the Structured Clinical Interview for DSM-IV and the Structured Interview for Diagnostic Criteria for Psychosomatic Research.Generalized anxiety disorder was the most frequent anxiety disturbance (10.3percent). Panic disorder with agoraphobia and agoraphobia without history of panic disorder had almost identical prevalence (about 4.5percent). Agoraphobia without panic attacks was related to illness denial, persistent somatisation, anniversary reactions, and demoralization. The findings indicate that anxiety disorders are common in the setting of medical disease. The links between agoraphobia without history of panic disorder and illness denial may provide an explanation for some discrepancies that have occurred in the literature as to the prevalence of agoraphobia in clinical samples compared to epidemiologic studies.16

A study was conducted on Agoraphobia, Simple Phobia, and Social Phobia in the National Co morbidity Survey.Data are presented on the general population prevalence’s, correlates,comorbidities, and impairments associated with DSM-III-R phobias.Phobiaswere assessed with a revised version of the Composite InternationalDiagnostic Interview.Lifetime prevalence estimates are 6.7 percent for agoraphobia, 11.3 percent for simple phobia, and 13.3 percent for social phobia. Increasing lifetime prevalence’sare found in recent cohorts. Earlier median ages at illnessonset are found for simple 15 years of age and social 16years of age phobias than for agoraphobia 29 years of age.Phobias are highly comorbid. Most comorbid simple and socialphobias are temporally primary, while most comorbid agoraphobiais temporally secondary. Comorbid phobias are generally moresevere than pure phobias. Despite evidence of role impairmentin phobia, only a minority of individuals with phobia ever seekprofessional treatment.Phobias are common, increasingly prevalent, often associatedwith serious role impairment, and usually go untreated. Focusedresearch is needed to investigate barriers to help seeking.17

In a prospectively constructed study 29 patients with cardiac phobia were examined prior to hospitalization and again after a follow-up period of 2.5 years. When first examined a high percentage (82.8 percent) of these patients showed a depression in addition to suffering from anxiety symptoms. The findings demonstrate that an additional affective disorder constitutes a prognostic allyunfavourable factor, particularly in the case of a 'secondary' depression. Compared with patients suffering from a 'primary' depression these patients more frequently exhibited a chronic course of the depression and had a significantly smaller chance of being free of cardiophobic complaint at the last examination. An attempt to categorize cardiac phobia according to DSM-III revealed that the present classification does not provide a satisfactory solution. The frequent presence of a depression in these patients strongly indicates that a clarification of the controversial opinions which continue to exist with regard to a linkage between depressive disorders and anxiety disorders would need further research; in such studies it would seem preferable not to employ a hierarchic classification procedure, in view of the fact that all cross-sectional psychopathological symptoms should be taken into consideration. The findings also point to the advisability of paying closer attention to course traits in studying this question.18

STATEMENT OF THE PROBLEM

A study to assess the prevalence of phobic disorders among the general population in selected urban area in Bangalore, with a view to prepare an information booklet.

6.3 OBJECTIVES OF THE STUDY

1. To identify the prevalence of phobic disorder among the general population.
2. To find association between selected phobic disorders and demographic variable.
3. To prepare an information booklet regarding phobic disorder.

6.4 OPERATIONAL DEFINITIONS

• PREVALENCE: It refers to the old and new cases which is present in the community related to phobias.
• PHOBIC DISORDER: In this study, it refers to phobic disorders such as social phobia, specific phobia,agoraphobia that will be assessed using (SPIN) social phobia inventory scale and structured self administered questionnaire
• GENERAL POPULATION: It refers to the people living in community of age groups above 18 years in selected urban area in Bangalore.
• INFORMATION BOOKLET: It refers to small book of few pages which contains important information aboutawareness on phobic disorder, its sign and symptoms, self help tips, reference no of hospitals.

6.5ASSUMPTIONS

• Phobic disorders are common in general population.
• There may be a significant association between demographic variable and research variable.

VARIABLES UNDER THE STUDY

• Research variable:

Phobic disorder

• Demographic variable:

Age, sex, education, religion, marital status, cultural background, socio economic status, area of residence, past experiences.

DELIMITATIONS:

• The study is delimited to selected urban areasof Bangalore.

• The study is limited to 200 samples.

7. MATERIAL AND METHODS:

7.1 SOURCE OF DATA

The data will be collected from the general population above 18 years of age in selected urban areas in Bangalore.

RESEARCH APPROACH:

The investigator will use descriptive exploratory approach to conduct the study.

RESEARCH DESIGN:

The research design for the study will be descriptive survey design.

RESEARCH SETTINGS:

Study will be done in the selected urban areas(Arekare) in Bangalore.

SAMPLING TECHNIQUE:

Investigator is using convenient sampling technique to draw the samples.

SAMPLE SIZE:

The sample size will be 200.

POPULATION:

The target population for study is general population of urban area.

SAMPLING CRITERIA:

INCLUSION CRITERIA:

• People who are willing to participate in this study.
• People who can write and read English, Kannada, Hindi.
• People present at the time of data collection.

EXCLUSION CRITERIA:

• People who are terminally ill or have critical illness.

METHODS OF COLLECTING DATA

Structured self reporting technique will be used to collect the data. Permission will be taken from samples and an informed consent will be obtained from the samples.

7.2 DATA COLLECTION TOOL