RAJIV GANDHI UNIVESITY OF HEALTH SCIENCES,KARNATAKABANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 / Name of the candidate and address(in block letters) / : / Dr.GIRISH KUMAR M.N.
DEPARTMENT OF PSYCHIATRY
RAJARAJESHWARI MEDICAL COLLEGE AND HOSPITAL, BANGALORE-560074
Permanent address / : / Dr.GIRISH KUMAR M.N.
18/30, 1STMain Road, Marenahalli.
Vijayanagar,Bangalore-560040.
2 / Name of the institution / : / Rajarajeshwari Medical College and Hospital.
3 / Course of study and subject / : / M.D. Psychiatry
4 / Date of admission to the course / : / 17th August 2012
5 / Title of the topic / : / A Study of Psychosocial Profile of Patients’ Attendants In The Medical ICU of Tertiary Care Hospital.
6 / Brief resume of the intended work
Having family member with a critical illness admitted in the Medical ICU creates
unanticipated crisis,alters family patterns in ways that are stressful and makes coping demands for dealing with a family member admitted in Medical ICU more pronounced for the family system.
6.1 / Need for the study
Worldwide,therate of Medical ICU admission is on the rise.Medical ICU admission subjects not only the patients but also their primary care giver (Key Person)to immense stress and burden. How one can copes with this, will influence their psychiatric status, whose influence will decide the quality of care they render to the patient. As the focus of research has been the patient, little is known of their care givers status. This study will help to plan further large scale studies and to develop appropriate interventional strategies.
6.2 / Review of Literature
Nearly 5 million patients are admitted in Medical ICU in India every year. Yet, studies of psychological impact on their relatives is scant. Stress related anxiety, depression and post traumatic stress symptoms are commonly seen in the primary care givers. .A comparative cross sectional study was carried out among 50 relatives of patients in each American and Indian hospital, Mumbai. It was found that early anxiety, depressionand post traumatic stress symptoms were common in relatives of ICU patients. Relatives of Indian ICUpatients had more anxiety symptoms, a score of 11. Anxiety and depression symptoms were both present
in 79% of Indian relatives.1
Care giver is referred to a person who spends most of his time in caringfor the ill member. In the present study, Primary care giver can be any adult member of the family who looks after the needs of the patient and who is staying with the patient during his Medical ICU admission.
Admission in intensive care unit produces a crisis situation for both the patient and family members. During this period, families deal with many stresses including role changes, financial concerns uncertain patient prognosis. If the event is not handled properly, the result may be prolonged physical and psychological instability of key care giver, a situation that may adversely affect patient outcome.2
If the illness is life threatening it can produce severe stress within the family system.3
How families respond to stress will depend on the interaction of multiple factors such as economic and social stability of the family and its internal support systemand the amount of external support to which the family has access.
Having a family member admitted in Medical ICU creates the stressful situation for primary care givers.Primary care givers of patients admitted in Medical ICU, typically responding to the crisis of sudden illness of the patient of the gravity of planned major surgery. Primary care givers experience interruption of normal activities and their other responsibilities.
A prospective multi centre study was conducted in Paris among 544 family members to identify the symptoms of anxiety and depression in family member of ICU patients. Symptoms of anxiety and depression were found in 73.4% and 35.3% of family members respectively. 75.5% of family members and 82.7% of spouses had symptoms
of anxiety and depression.4
A study was conducted at Pittsburghto describe the caregiver burden and care giver depression symptomology among 115 care giver of the patients. 75.9% were women and more than half were spouses (52.2%). It showed that higher score was associated with more hours per day helping with patients activities of daily living. Study concluded that 34% of caregivers are at risk of clinical depression.5
Patients may suffer from both psychological and physical functional impairment after critical care. Due to emotional turmoil experienced during the patientsMedical ICU stay, the relatives, own mental and physical functioning is weakened which can lead them to mental illness. The symptoms seen are the anxiety, depressionby stress and frequently used coping strategies of spouse are seeking support.
A study conducted by McAdam JL, Dracup KA and others showed high prevalence of psychological and physical symptoms among family members during Medical ICU admission.Shows traumatic stress(57%), boarder line symptoms of anxiety(80%) and 70% having boarder line symptoms of depression.6
Caring of a family member detected with the critical illness associated with HIV/AIDS presents multiple challenges that strain a family’s physical, economic and emotional resources.Care givers in developing countries like India, face even greater challenges, due to lack of medical& support services,poverty and wide spread discrimination against those with HIV/AIDS.
Burden refers to physical,psychological,social and economic problems that are experienced by the caregiver in relation to the impairment. The literature from India is however scanty
with studies focusing on one aspect of burden.7
Myocardial infarction is one of the commonest conditionsseenin the Medical ICU.Its acute stage is a life-threatening situation and places a significant stress on the caregivers.8In emergency situations like heart attack, families of patients encounter the potential loss of the loved one, high expenses and loss of income, and extreme change in their environment from their home to a hospital waiting room. These families have multiple needs related to the patients but are often unprepared and without adequate coping skills or strategies (Maucer, 2001).9
Stress is the inability to cope with a perceived or real threat to one’s mental, physical, emotional and spiritual wellbeing which results in a series of physiological responses and adaptations. The focus of effective stress management is to find out the optimal level of stress and to reduce physical arousal levels using both coping skills and relaxation techniques.10
There are two types of coping responses: problem focused and emotion focused.
Problem focused coping involves efforts to deal with the sources of stress, whether by changing one’s own problem maintainingbehavior or by changing environmental conditions.
Emotion focused coping is aimed at reducing emotional distress and maintaining a satisfactory internal state for processing information and action.
In primary caregivers, faith has been identified as one of the coping mechanisms. In an interesting study an attempt was made to explore coping strategies used by family members in two different cultural contexts, UK and India. While the carers from UK used a larger number of different coping strategies and scored higher on measures of problem focused coping, positive reappraisal, seeking social support, self-controlling and distancing/detachment, respondents from India scored higher on a measure of self-blame.11
In conclusion, the literature clearly shows that there is a significant amount of psychopathology in the primary care giver of the patient admitted in the Medical ICU. There also seems to be psychosocial burden and use of varied coping skills.
6.3 / Aim of study:
To assess the psychosocial profile of patients’ attendantsin the medical ICU of tertiary care hospital
Objectives of the study :
To assess the primary care giver on the following parameters:
  1. The psychosocial burden.
  2. The varying patterns of coping.
  3. Their psychiatric status.
4. To establish their socio-demographic profile
5. To explore the correlation between the above parameters
7. / Material and method
7.1 / Source of data
Study Setup:
Study will be conducted on all key care givers of patients admitted in the Medical ICU for any condition in Rajarajeshwari Medical College Hospital.
Study Design:
Cross sectional study, hospital based study.
Statistical Analysis:
Described in Descriptive nature like in percentage, mean, standard deviation etc.
Study Duration:
From January 2013 to December 2013.
Study Population:
Primary care giver of patients admitted in Medical ICU.
7.2 / Method of collection of data
Cross sectional study on primary care givers of patients admitted in the Medical ICU. To collect their socio-demographic profile using semi structured proformas.
Their care giver burden will be assessed using – Burden Assessment Schedule.
Their coping pattern will be assessed using – Coping Check List.
Their psychiatric status will be assessed using-SCID-1
All the above scales are standardized and internationally accepted.
7.3 / Does the study require any investigation or intervention to be conducted on patients or other humans or animals? If so please describe briefly
NO
7.4 / Has ethical clearance been obtained from your institution in case of 7.3?
YES
8 / List of references
  1. Kulkarni HS,Mallampalli A, Parker SR, Kainad DR, Guntapalli K. Psychological impact of an ICU admission on relatives of patients in American and Indian hospital. Indian Journal of Critical Care Medicine 2011;15(3):147-56.
  2. Chartier L, Coutu W. Families in ICU, their needs and anxiety level. Intensive Care Nurse 2005;5(1):10-8.
  3. Paniyadi NK, Prakash R. Descriptive study to assess theanxiety level of relatives of the patients admitted in ICU. Nightingale Nursing Times 2008 Sep;4(6-9):21-8.
  4. Pochard F, Darmon M. Symptoms of anxiety and depression in family member of ICU. J Crit Care 2005 Mar;20(1):90-6.
  5. Steven H, Schulz R. Prevalence and outcomes of caregivers after prolonged mechanical ventilation in ICU. Chest 2011 Dec;140(6).
  6. McAdam JL, Dracup KA, White DB, Fontaine DK, Puntillo KA. Symptom experiences of family members of intensive care unit patients at high risk for dying. Crit Care Med. 2010 Apr,38(4):1078-85.
  7. Prabha S Chand, Geetha Desai and SanjeevRajan, 2005.HIV and Psychiatric Disorders. Indian Journal Of Med Res, 121,(pp.451-457).
  8. Tak YR, McCubbin MF. Family stress, perceived social support and coping following the diagnosis of child’s congenital heart disease. Journal of Advanced Nursing:39(2):190-8.
  9. Paniyadi NK, Prakash R. A descriptive study to assess the anxiety level of relatives of the patients admitted in ICUs of selected hospitals of Udupi district, Karnataka. Nightingale Nursing Times 2008 Sep:21-3.
  10. Luke SB. Managing stress-principles and strategies for health and well being. 2nd ed. Massachusetts: Jones and Bartlett Publishers;1997.
  11. Palattiyil, G; Chakrabarti, M: Coping strategies of families in HIV/AIDS care: Some exploratory data from two developmental contexts AIDS Care, Volume 20, Issue 7 August 2008.

9 / Signature of candidate
10 / Remarks of guide
11 / 11.1 / Name and designation of the guide / Dr.AmarBavle
Professor and Head
Department of Psychiatry
RajarajeshwariMedical College and Hospital. Bangalore.
11.2 / Signature
11.3 / Co-guide(if any) / ------
11.4 / Signature / ------
11.5 / Head of department / Dr.AmarBavle
Department of Psychiatry
RajarajeshwariMedical College and Hospital, Bangalore
11.6 / Signature
12 / 12.1 / Remarks of the chairman and principal
12.2 / Signature