Research methodology: Family support in bipolar disorder

Research methodology: Family support in bipolar disorder CHAPTER 111 RESEARCH METHODOLOGY NEED FOR THE STUDY Bipolar affective disorder is a recurrent and long term mental illness which can affect the lives of the people in a much serious manner. Globally the lifetime prevalence of all forms of the illness, often referred to as bipolar spectrum disorders, has been estimated to be 5% in the general population. The national rate of affective disorder in India as 34 per 1000 population.(Ganguli 200) For most of the patients family is the primary care givers. There are not many studies in India done in this area. The most important protective factor for a person with mental illness is social support and emotional support from a closely associated relationship. Often, but not always, this close relationship is with a spouse/partner or parent. People lacking such a close supportive relationship are at greater risk of anxiety and depression and any kind of mental illness. Despite the high burden of mental disorders and the fact that a significant portion of this burden can be reduced by primary and secondary prevention, most of the people in India do not have access to mental health care due to inadequate facilities and lack of human resources. India has a community mental health program that consists of integrating basic mental health care into general health care services by training primary health care personnel in mental health care. It can, however, be safely concluded that a sole reliance on the trained mental health professionals may not be the best way to move ahead. So this study attempt to see if there is any association between recovery and family support. This study would enhance the involvement of family in mentally ill patients, especially Patients suffering from BPAD. SCOPE OF THE STUDY Family support is a significant factor for a person with any kind of illness, let alone mental illness. This study aims to see if there is any significant relation between the family support and recovery in the patients with BPAD. Family systems are very much intact in traditional Indian families. This is an excellent resource in the area of mental health services. The finding of this study will help to reinforce the necessity of the community based mental health services. Also this may help to bring more awareness in the society regarding the significance of support from family and friends. AIM OF THE STUDY To study the comparison of family support in recovered persons and non recovered persons with Bipolar affective disorder. OBJECTIVES To study the socio demographic details of persons with BPAD To study the family support among patients with BPAD who are recovered and who are not recovered To compare the family support of recovered persons and non recovered persons with BPAD OPERATIONAL DEFINITIONS Family: The primary care givers of the patient, who can be father, mother, brother, sister, spouse, son, daughter, uncle, aunt, daughter in law, son in law, grandmother/father, grand daughter/son. Family support Aid or help given by the members in the family in order to meet physical as well as emotional needs of the patient. Bipolar Affective Disorder: F31-ICD 10 A disorder characterised by two or more episodes in which patient’s mood and activity level are significantly disturbed, this disturbance consisting of some occasions of an elevation of mood and increased energy and activity ( hypomania or mania) and on others of lowering of mood and decreased energy and activity( depression).Repeated episodes of hypomania or mania only are considered as Bipolar. Recovery: Recovery requires_>8 consecutive weeks with either no symptoms or only 1–2 mild symptoms with no functional impairment.(Research diagnostic criteria) HYPOTHESIS: There will be high family support for recovered persons than non recovered persons with bipolar affective disorder. RESEARCH DESIGN The researcher has used descriptive research design for the current study. UNIVERSE Mental Health Action Trust Clinics in Malappuram, and Wayanad is the universe of the study. POPULATION: Persons with Bipolar affective disorder in Morayur, Vengara,Ponnani, Pulikkal,Veliyancode, Ambalavayal, kambalakkad was selected. SAMPLE: Sample size of the study was 60. 30 recovered patients and 30 non recovered patients. Non probability sampling method (Purposive sampling) was used to select both recovered and non recovered patients. Clinician impression as per RDC criteria was used to select both the groups; 30 recovered patients and 30 non recovered patients. Researcher informed the clinics early and the listed patients in the list were asked to be present on the clinic day. Thus data was collected TOOLS OF DATA COLLECTION A structured Questioner schedule to retrieve the socio-demographic details. Standardised tool for Family support Secondary data will be collected from the patient files of the clinics. Description of tools: 1. A structured Questioner schedule is developed by the researcher to profile the personal, family, social, work. There are total 13 questions among which 9 are about the personal details of the participant. The remaining four questions are directed to the family. 2. Social Support Appraisal scale (SSA; Vaux et al, 1986): The social support appraisal scale developed by Vaux et al, (1986) is to measure subjective appraisal of support. The SSA is a 23-item instrument based on the idea that the social support is in fact a support only if the individual believes it is available. These subjective appraisals are also viewed as related to overall psychological well being. The SSA taps the extent to which the individual believes he or she is loved by, esteemed by and involved by family, friends and others. The SSA was studied with 10 undergraduate and community samples involving 979 respondents. The mean age ranged from mid teens to 48. The samples were approximately 60% female. The SSA has very good internal consistency, with alpha coefficients that ranges from 0.81 to 0.90. No data on stability was reported. The SSA was subject to considerable evaluation of its validity resulting in very good concurrent, predictive, known groups and construct validity. The SSA is significantly correlated in predicted ways with a variety of measures of social support and psychological well-being, including net work satisfaction, perceived support, family environment, family environment, depression, positive affect, negative affects, loneliness, life satisfaction and happiness. Each item is rated on a scale of 1 (strongly agree), 2 (agree), 3 (disagree), 4 (strongly disagree). The subjects were asked to mark one of the four options given for each of the items in the scale. The SSA is scored by reverse scoring on items 3, 10, 13, 21, 22 and adding up the individual items for a total score, with lower scores indicating a stronger subjective appraisal of social support. In addi tion to the total score, the 8 ‘family’ items make up SSA- family scale and 7 ‘friend’ items make up a friend subscale. The remaining items refer to others in general. This scale has been used in different studies for measuring perceived social support among the people. Panditi (2004) to study the perceived social support among cured alcoholics, Uthaman (2004) to study social support among persons with depressive disorder, Jaison (2004), to study social support among wives of prisoners and Bhadra (2006) to assess the social support among disaster survivors . Secondary data Secondary data was collected from the file records from the clinics as well as a small questionnaire prepared by the researcher. The questionnaire has 6 questions. These questions included the name of the clinic, duration of illness, last episode, is the patient functioning well or not. METHOD OF DATA COLLECTION The administrative head of the clinic was met for the permission and plan would be sought to identify the respondents for the current study- and patient Interview tool was used for the data collection The clinician listed out the respondents in the both groups of participants. The administrative head of the clinic was informed beforehand and tools were administered to each of the participants. The objective of the study was clearly explained to the respondents. Ethical issues were clearly explained to them and informed consent of the participants were obtained. They were given freedom in deciding to participate in study. The respondents were allowed to withdraw from the study during the study. None of the respondents from both groups refused to participate in the study. Socio demographic details were taken down from both the patient and the bystander. The tool for family support was translated in Malayalam and questions were asked by the researcher. Each interview took 15 to 20 minutes. DATA ANALYSIS The data collected from 60 patients were coded into binary data manually for the purpose of statistical tests using SPSS 16.0 version. The statistical method used were descriptive statistics namely mean to compare the family support between the 2 groups of patients. Frequency distribution and percentage for items on age, gender, religion, education, occupation, relationship with the primary care giver was done. T test of the mean of the social support of both the groups was done to see the significance of the Hypothesis. INCLUSION CRITERIA Patients who have at least a 2 years of history of Bipolar affective disorder Patients Who are taking treatment at MHAT clinics Patients and family members who will give consent for the study EXCLUSION CRITERIA Patients of other diagnosis other than BPAD. Patients and families who do not give consent Patients who are staying in institutions other than with families Patients who are not under the treatment in MHAT clinics ETHICAL ISSUES The participants were clearly explained the purpose of the study and they were given the freedom to withdraw from the study. Informed consent obtained from the samples for the study. Confidentiality of the information was maintained.