STUDY OF PSYCHIATRIC MORBIDITY OF SPOUSE OF MALE ALCOHOLIC PATIENTS IN NEPAL Dr.C P Sedain Department of Psychiatry Chitwan Medical College Bharatpur ,Chitwan,Nepal

Abstract

Background:

The Problem of alcohol consuming is increasing in the world.  The subjects for this study comprised of all consecutive spouses of male alcoholic patients on  psychiatric department  of CMC  Teaching Hospital, Bharatpur, Nepal  are taken as cases. 

Methods:

This is a prospective study on the data recorded in the psychiatric department of  CMC Teaching Hospital. The ratios and proportions were used for statistical analysis. The study was conducted from 1st January 2011 to 30 th December 2011.The GHQ-12 was applied and score above 2 was again examined by psychiatrist for psychiatric diagnosis ICD-10 DCR was used for diagnosis.

Results:

This study  shows that total number of cases ( spouses of male alcoholic patients) is 46  (100%).  Depressive disorder  is 13 (28.26 %) followed by conversion disorder 5 ( 10.86 %) and  anxiety disorder 4 ( 8.70 %). Data shows highest number of cases were age group 30-39 (N-16, 34.78%) followed by 40-49 (N-10, 21.74%).HIghest number of cases were caste of Baisya  (N-22, 47.83%) followed by Sudra (N-11, 23.91%).

 Conclusions:

The current study shows that souses of male alcoholic developed depressive disorder i.e. in highest number  (N-13,28.26 %) followed by conversion disorder 5 (N-5, 10.86 %)  and  anxiety disorder  (N-4, 8.70% ) etc. 

Key words: spouse, bipolar disorder, alcoholic

Correspondence

Dr.C P Sedain

Chitwan Medical College Bharatpur ,Chitwan,Nepal

Email-drcpsedai@yahoo.com

phone-9779855056666

Introduction

The Kingdom of Nepal is situated in the heart of Asia, between its two big neighbors China and India. Nepal is home to several ethnic groups. The majority of the 27 million population resides in the countryside. Although figures on many of the health and socio-economic indicators are non-existing, some existing ones show gradual improvement over the years. Frequent natural disasters and recent violent conflicts in Nepal have further added hardship to life¹. People suffering from alcoholism are often called "alcoholics". The World Health Organization estimated that there are 140 million people with alcoholism worldwide ^2,3. The Problems of alcohol consuming is increasing in the world. Nepal is a developing country. The female people are still less educated in the rural village. Alcohol consumption is traditionally started. Taking alcohol by the male Nepali adults becomes departed and crated problem at home. This may be the causes of domestic violence. Many Nepali women at the village of Nepal suffered with depressive disorder because of husband’s alcoholic habit. Because of alcoholism there is frequent quarrel at home, road traffic accident and poor image on community. Financial problems in family and physical emotional abuse to wife by husband are associated with alcoholism in Nepal. Because of cultural effect they couldn’t give up the habit of alcohol taking. There is strong evidence of an association between the consumption of alcohol and violence⁴. Alcohol consumption among young people is typified by frequent episodes of binge drinking and heavy drinking has been shown to be associated with aggression and violence. Alcohol is most frequently associated with those deaths involving physical altercations, blunt force injuries and stab wounds ^5.

  The women of Nepal particularly in the village do work hard. However the husband (male people) does less work. They spent the time in small hotel called Bhatti (small shop)   and taking alcohol daily. Usually they come late night with shouting. Husband usually quarrels with wife without any reason.  In many occasions do physical assaults to wife.  Therefore female develop depression even suicidal attempt. Report from district police office Chitwan has published that the female are suffer and assaulted by husband. The husband blames to wife that she has extra affair with another male without any reason. Because of psychiatric problem of alcohol there is daily discussion, cold relationship, and difficult situation at home. This effect create mental problem to wife and children at home.

The remote Village Development Committee (VDC) of Nepal reported that most of woman in the village abused by husband including physical, emotional and torture. The husband later develops alcoholic liver disease bring to hospital which may create financial problems. On many occasion husband died with road traffic accident, alcoholic liver disease and wife taking care of many children at home and financial problem because of no any source of income at home. This may cause mental problem at family member including wife and children. Many alcoholic man play card, takes alcohol, involves on prostitute and gambling and due to with the family becomes suffering from financial problems. Alcoholism is also known as a family disease. Alcoholics may have young, teenage, or grown-up children; they have wives or husbands; they have brothers or sisters; they have parents or other relatives. An alcoholic can totally disrupt family life and cause harmful effects that can last a lifetime. Alcoholism is responsible for more family problems than any other single cause.  One of every four families has problems with alcohol6.

           

Methods

1.The subjects for this study comprised of all consecutive patients whose spouse are consuming alcohol regularly,  attending psychiatric  department of CMC  Teaching Hospital, Bharatpur, Nepal . The study was performed over 1 year (1st January 2010 to 30 th December 2010).A brief explanation about the study was offered to the subjects and written or verbal consent was obtained either from them or guardians and all the subjects   were included in the study. The GHQ-12 were filled and cut off score 2< were further interviewed by psychiatrist.  The diagnosis was made on the basis of ICD-10 DCR.

2. A continuous sequential number was given to each subject and available necessary information was kept confidential in a separate file. The socio demographic profile which contains name, age, sex, caste, marital status, occupation, and other information was also filled.

Results

Data shows total number of cases (spouse of male alcoholics) was 46.      Data shows highest number of cases were age group 30-39 (N-16, 34.78%) followed by 40-49 (N-10, 21.74%).HIghest number of cases were caste of Baisya  (N-22, 47.83%) followed by Sudra (N-11, 23.91%). Data shows highest cases were education up to primary level (N-29, 63.04%) followed by education up SLC to were (N-8, 17.39%). Data shows most of cases were farmer (N-13, 28.26 %) followed by house wife (N-11, 23.91%).

 Data shows the highest number of cases were depressive disorder  (N-13,28.26 %) followed by conversion disorder 5 (N-5, 10.86 %)  and  anxiety disorder  (N-4, 8.70 )  Similarly somatoform disorder (N-2, 4.35 %)  , bipolar  disorder(N-2, 4.35 %)  and   psychosexual disorder (N-1, 2.17%)  respectively .  The spouses of male alcoholic patients not developed any psychiatric disorder (GHQ < 2) were (N-19, 41.30 %)  .

Table-1

 DISTRIBUTION ON THE BASIS OF AGE OF THE SPOUSE

AGE	NO	%
>20	1	2.17
20-29	7	15.22
30-39	16	34.78
40-49	10	21.74
50-59	8	17.39
60 <	4	8.70
Total	46	100

Table-2

DISTRIBUTION ON THE BASIS OF CASTE

CASTE	NO	%
BRAMIN	7	15.22
CHHETRI	6	13.04
BAISYA	22	47.83
SUDRA	11	23.91
TOTAL	46	100

Table 3

DISTRIBUTION ON THE BASIS OF EDUCATION  STATUS

EDUCATION	CASE
	NO	%
UNEDUCATED	7	15.22
PRIMARY	29	63.04
SLC	8	17.39
INTERMEDIATE	1	2.17
GRADUATE	1	2.17
TOTAL	46	100

Table-4

DISTURIBUTION ON THE BASIS OF OCCUPATION

OCCUPATION	N	%
FARMER	13	28.26
HOUSEWIFE	11	23.91
SERVICE HOLDER	5	10.87
UNEMPLOYED	10	21.74
BUSINESS	8	17.39
TOTAL	46	100

Table-5

DISTURIBUTION ON THE BASIS OF DIAGNOSIS

DIAGNODIS	NO	%
DEPRESSIVE DISORDER	13	28.26
CONVERSION  DISORDER	5	10.86
ANXIETY DISORDER	4	8.70
SOMATOFORM DISORDER	2	4.35
BIPOLAR DISORDER	2	4.35
PSYCHO SEXUAL DISORDER	1	2.17
GHQ < 2 (NORMAL)	19	41.30
TOTAL	46	100

Discussion

  Alcohol use disorder is one of the 5 mental disorders in the list of 10 leading causes of disability worldwide. Alcohol is the most comment substance used in Nepal and is the commonest cause of domestic violence and road traffic accidents.7 The Problems of alcohol consuming is increasing in the world. Nepal is a developing country. The female people are still less educated in the rural village. Alcohol consumption is traditionally started. Taking alcohol by the male Nepali adults becomes departed and crated problem at home. The social problems arising from alcoholism are serious, caused by the pathological changes in the brain and the intoxicating effects of alcohol ^8,9. Alcohol abuse is associated with an increased risk of committing criminal offences, including child abuse, domestic violence, rape, burglary and assault.¹⁰ Alcoholism is associated with loss of employment,¹¹ which can lead to financial problems. An alcoholic's behavior and mental impairment, while drunk, can profoundly affect those surrounding them and lead to isolation from family and friends. This isolation can lead to marital conflict and divorce, or contribute to domestic violence. Alcoholism can also lead to child neglect, with subsequent lasting damage to the emotional development of the alcoholic's children ^12.

The consumption of alcohol, either by the offender or victim or both, is also a significant contributing factor in incidents of non-fatal domestic violence, with research demonstrating that women whose partners consume alcohol at excessive levels are more likely to experience domestic violence ¹³. Societal attitudes and values, including a culture of drinking to deliberately become intoxicated, using alcohol as an excuse for behaviour not normally condoned and for holding individuals less responsible for their actions ^14.Individuals involved in violent incidents also frequently report having consumed an excessive amount of alcohol in residential locations, rather than in licensed premises, prior to the incident, including those incidents where the violence took place in or around a licensed premise ¹⁵. Intimate partner homicides involving an indigenous offender and victim are 13 times as likely to be alcohol related than other intimate partner homicides ¹⁶. Alcohol is also an important risk factor for both domestic violence and child abuse and neglect. The high rate of alcohol involvement in intimate partner homicide has already been reported. To be effective in reducing alcohol-related violence, prevention efforts must aim to influence the relationships between individuals and the environment in which alcohol is consumed. Environmental conditions (including social, physical and cultural factors) can be manipulated to influence individual drinking behaviors and related problems, including alcohol-related violence ^17.

 There have been two large epidemiological studies of psychiatric disorders: the National Institute of Mental Health's Epidemiologic Catchment Area (ECA) study ^18,19. The ECA study  revealed that 60.7 percent of people with bipolar I disorder had a lifetime diagnosis of a substance use disorder (i.e., an alcohol or other drug use disorder), 46.2 percent of those with bipolar I disorder had an alcohol use disorder. Forty–eight percent of people with bipolar II disorder had a substance use disorder, 39.2 percent had an alcohol use disorder, and 21 percent had a drug abuse or dependence diagnosis (these figures reflect overlap, as above.) Alcohol dependence was twice as likely to co–occur in people with bipolar spectrum disorders than in those with unipolar depression. As part of the ECA study found that mania (i.e. bipolar I disorder) and alcohol use disorders are far more likely to occur together (i.e., 6.2 times more likely) than would be expected by chance ^20. It was also reported that antisocial personality disorder was more likely to be related to alcoholism. An alcoholic's behavior and mental impairment, while drunk, can profoundly affect those surrounding them and lead to isolation from family and friends. This isolation can lead to marital conflict and divorce, or contribute to domestic violence. Alcoholism can also lead to child neglect, with subsequent lasting damage to the emotional development of the alcoholic's children ^21. For this reason, children of alcoholic parents can develop a number of emotional problems. For example, they can become afraid of their parents, because of their unstable mood behaviors. In addition, they can develop considerable amount of shame over their inadequacy to liberate their parents from alcoholism. As a result of this failure, they develop wretched self-images, which can lead to depression ²².

In the current study data shows total number of cases (spouse of male alcoholics) were 46.      Data shows highest number of cases were age group 30-39 (N-16, 34.78%) followed by 40-49 (N-10, 21.74%). Highest number of cases were caste of Baisya  (N-22, 47.83%) followed by Sudra (N-11, 23.91%). Data shows highest cases were education up to primary level (N-29, 63.04%) followed by education up SLC to were (N-8, 17.39%). Data shows most of cases were farmer (N-13, 28.26 %) followed by house wife (N-11, 23.91%).

 Data shows the highest number of cases were depressive disorder  (N-13,28.26 %) followed by conversion disorder 5 (N-5, 10.86 %)  and  anxiety disorder  (N-4, 8.70 )  Similarly somatoform disorder (N-2, 4.35 %)  , bipolar  disorder(N-2, 4.35 %)  and   psychosexual disorder (N-1, 2.17%)  respectively .  The spouses of male alcoholic patients not developed any psychiatric disorder (GHQ < 2)  were  (N-19, 41.30 %)  .

 Conclusions:

The Problem of alcohol consuming is increasing in the world.  The current study shows that spouses of male alcoholic developed depressive disorder i.e. in highest number  (N-13,28.26 %) followed by conversion disorder 5 (N-5, 10.86 %)  and  anxiety disorder  (N-4, 8.70% ) etc.     

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