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Research Article CODEN: IJPRNK ISSN: 2277-8713 Vasanth Kumar Kasturi, IJPRBS, 2015; Volume 4(2): 263-271 IJPRBS
Available Online at www.ijprbs.com 263
A STUDY TO ASSESS THE STRESS AND COPING AMONG CAREGIVERS OF
MENTALLY ILL PATIENTS IN SVRRGGH, TIRUPATI.
VASANTH KUMAR KASTURI, BHAGYALAKSHMI M, HEMALATHA S
Department of Psychiatric (Mental Health) Nursing, College of Nursing, SVIMS, Tirupati, Andhra Pradesh
Accepted Date: 09/04/2015; Published Date: 27/04/2015
Abstract: Introduction: Care of mentally ill patients is an enduring stress and leads to considerable
amount of stress among caregivers. Little is known about the ways in which caregivers cope while
caring for a relative with mental illness in developing countries. Aim: The aim of the present study was
to assess the stress and coping among caregivers of mentally ill patients in SVRRGGH, Tirupati. Method:
the stress was measured my Cohen perceived stress scale and coping was measured by brief cope scale.
Results: A total number of 100 samples was taken for study, among 24 % had mild stress levels,
majority 52% had moderate stress levels and 24% had severe stress levels , for coping levels among 100
caregivers, 24% had inadequate, 52% had adequate, 24% had adequate respectively. There was a
statistical significant relationship between stress with caregivers variables like Education, Residence,
and Relationship to patient at p<0.01, Occupation and Income at p<0.05 Level. There was a statistical
significant relationship between coping with caregivers variables like Marital status, Education,
Occupation, Residence, Monthly and Income at p<0.01, Age in years and Relationship to patient at
p<0.05 Level. Moreover there was a high negative correlation between stress and coping i.e. -0.82 and
correlation was significant at the p<0.01 level. It is concluded that: Caregivers experienced 24% of High
stress levels and 24% were inadequate coping levels. Recommendation: Psycho educational program is
needed to assist caregivers cope successfully with stress resulting from the care of mentally ill patients.
Keywords: Stress, Coping, Mentally ill.
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Corresponding Author: MR. VASANTH KUMAR KASTURI
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How to Cite This Article:
Vasanth Kumar Kasturi, IJPRBS, 2015; Volume 4(2): 263-271
Research Article CODEN: IJPRNK ISSN: 2277-8713 Vasanth Kumar Kasturi, IJPRBS, 2015; Volume 4(2): 263-271 IJPRBS
Available Online at www.ijprbs.com 264
INTRODUCTION
Mental illness can be defined as a clinical, significant, behavioral or psychological syndrome
that occurs in a person and this is normally associated with impairment in one or more
important areas in functioning, or an important loss of freedom.1 The society views the mental
illness as something to be ashamed of and usually the members of the society initially recognize
most of the mentally ill patients behavior deviated from the social norms.2
In such a stage the families play an important role in caring of these mentally ill patients even
though the family members of the mentally ill patients are less likely to label the individuals
behavior as mental illness. The core concept of the care giving consists of accepting the patient,
encouraging and supporting the patient and assist in the daily activities of the patient.3
Caregiver is an individual who has the responsibility of meeting the physical and psychological
needs of the dependent patient. Psychiatric patients need assistance or supervision in their
daily activities and this often places a major burden on their caregivers, thereby placing the
caregiver at a great risk of mental and physical health problems. The diagnosis of a person with
a mental illness makes the care givers initially denial, which is sometimes expressed by anger
and they are looking for a lot of coping methods to cope and adjust with these situations.
Coping with stress is one of the biggest health concerns and its effect can be different from one
person to another. Stress is primarily a process of motivation since it requires some sort of
adaptation (coping) to the demand or set of demands. The effect of stress is directly linked to
coping.4
Stress is an organism’s total response to environmental demands or pressure. The cause of
stress can include any event or occurrence that a person considers a threat to his or her coping
strategies or resources and coping is a complex process. It is variously described as a situational
and as a trait-like response to stress and as a disposition to respond to change.5
A study was conducted in religious practices by chronic mentally ill patient and their care givers
they are living in south India. Persons with mental illness and their care givers were interviewed
at religious sites using a guided questionnaire. The result of the study shows that-seeking
religious help for mental illness is often a first and common step in which most of the care
givers are adopting to cope with the burden.6
A study was conducted in USA to find out the associated stages with adaptive use of coping
methods by Primary Care Givers total of 225 Primary care givers of mentally ill patients were
participated in the study. The result of the study highlighted that more extensive adaptive
coping was associated with increased social support (as measured by the density of the social
network) and with a greater sense of self efficiency in dealing with the illness of the patient.7
Research Article CODEN: IJPRNK ISSN: 2277-8713 Vasanth Kumar Kasturi, IJPRBS, 2015; Volume 4(2): 263-271 IJPRBS
Available Online at www.ijprbs.com 265
OBJECTIVES
To assess the level of stress and Coping among caregivers of mentally ill patients
To assess the level of Coping among caregivers of mentally ill patients
To associate the level of stress and coping among caregivers of mentally ill patients with
selected demographic variables.
To correlate the relationship between level of stress and coping among caregivers of
mentally ill patients.
Materials and methods:
Research approach: Quantitative research approach was adopted for the present study.
Research design: cross sectional descriptive research design was adopted for the study.
Variables of the study:
Independent variable: Mentally ill Patients
Dependent variables: Stress and Coping of caregivers
Extraneous Variables: Age, Gender, Occupation, Education, Income, etc.
Setting: The study was conducted at psychiatry ward, SVRRGGH, Tirupati. The reason for
selected this hospital for the study because, this is the only one Government district hospital
though out this Rayalaseema area. Moreover, daily 50 to 60 outpatients come for checkup
daily. The setting was chosen on the basis of investigator feasibility in terms of availability of
required sample and cooperation extended by the management and health personnel.
Population: The population includes caregivers of mentally ill patients
Sample: Caregivers of mentally ill patients
Sample Size: consists of 100 caregivers who fall under inclusion criteria.
Sampling technique: As the selection of samples depends on availability of the sample, a
convenient sampling technique was adopted based on inclusion criteria. Description of the
research tool
Development and description of the tool:
Research Article CODEN: IJPRNK ISSN: 2277-8713 Vasanth Kumar Kasturi, IJPRBS, 2015; Volume 4(2): 263-271 IJPRBS
Available Online at www.ijprbs.com 266
The tool was developed with the help of related literature from various text books, journals,
web sites, discussion and guidance from the experts in the field of nursing and psychiatric
nursing.
The tool consists of 3 sections.
Section-I: consists of questions to collect demographic data.
Section II: Cohen Perceived Stress
Section-III: Brief Coping
Plan for data analysis:
Analysis of data was done by using descriptive and inferential statistics.
Descriptive statistics were used to find out:
Frequency, Percentage, Mean, Standard Deviation
Inferential statistics were used to find out:
Chi-square, Correlation
Results:
Level of Stress among Caregivers of mentally ill patients
The above Fig-1 illustrate that among 100 Caregivers 24% had mild stress, 52% had moderate
stress and 24% had severe stress levels
[VALUE]%
[VALUE]%
[VALUE]%
0 10 20 30 40 50 60
Inadequate Stress
Moderate Stress
Adequate Stress
Stress Levels
Research Article CODEN: IJPRNK ISSN: 2277-8713 Vasanth Kumar Kasturi, IJPRBS, 2015; Volume 4(2): 263-271 IJPRBS
Available Online at www.ijprbs.com 267
Level of Coping among Caregivers of mentally ill patients
The above Fig-2 Depicts that among 100 Caregivers 24% had mild coping, 52% had moderate
coping and 24% had severe stress coping
Table 1. Frequency and percentage distribution of association between the caregiver’s
demographic variables and stress levels of caregivers of mentally ill patients
Areas of Stress (Demographic Variables)
n
Mean
SD
df
X2
p
Education Illiterate Primary Education Secondary Education Intermediate Graduate Post Graduate
35 17 23 09 15 1
58.43 43.24 41.30 36.39 22.83 25.00
25.140 18.849 25.438 27.218 19.818 26.188
10
28.000
0.002**
Occupation Home Maker Unemployee Coolie Private Employee Government Employee Retired Others
10 3 33 14 5 1 34
43.50 20.83 56.29 29.11 29.50 75.00 42.35
26.066 5.774 25.040 26.010 31.245 22.796 26.188
12
24.879
0.015*
Residence Rural Urban
67 33
52.35 27.80
25.428 19.282
2
14.414
0.001**
24%
52%
24%
0
20
40
60
Coping Levels
Inadequate Coping Moderate Coping Adequate Coping
Research Article CODEN: IJPRNK ISSN: 2277-8713 Vasanth Kumar Kasturi, IJPRBS, 2015; Volume 4(2): 263-271 IJPRBS
Available Online at www.ijprbs.com 268
Monthly Income <3000 3001-6000 6001-10000 >10000
22 28 41 9
37.27 57.41 41.40 33.33
22.677 23.079 26.328 30.949
6
15.071
0.020*
Relationship to Patient Spouse Parent Children Sister Brother Others
39 30 10 8 6 7
39.94 54.17 57.25 25.94 24.58 45.00
21.077 25.859 33.280 16.143 27.451 30.788
10
29.566
0.001**
Table 1. Depicts that there was a statistical significant association between some of the
demographic variables and Stress Levels like Education, Residence, and Relationship to patient
at p<0.01, Occupation and Income at p<0.05 Level
Table 2. Shows the association between the demographic variables and coping levels of
caregivers of mentally ill patients
S. No Demographic Variables Chi-Square Test (χ2) df p
1 Age in Years 14.658 6 0.023
2 Marital Status 27.079 4 0.000
3 Education 47.638 10 0.000
4 Occupation 39.499 12 0.000
5 Residence 21.604 2 0.000
6 Monthly Income 19.824 6 0.003
7 Relationship to Patient 21.085 10 0.021
Table 2. Illustrate that there was a statistical significant association between some of the
demographic variables and coping Levels like Marital status, Education, Occupation, Residence,
Monthly and Income at p<0.01, Age in years and Relationship to patient at p<0.05 Level
Table-3: Mean standard deviation and correlation between stress and coping among
caregivers of mentally ill patients
S. No Scale Mean Standard Deviation Correlation p
1 Stress 44.25 26.188 -0.823
0.000 2 Coping 56.30 20.400
Research Article CODEN: IJPRNK ISSN: 2277-8713 Vasanth Kumar Kasturi, IJPRBS, 2015; Volume 4(2): 263-271 IJPRBS
Available Online at www.ijprbs.com 269
Table 3 depicts Stress Mean and Standard Deviation values was, 44.25 and 26.188. Coping
Mean and Standard Deviation values was, 56.30 and 20.400 respectively. There was statistically
High Significant Negative Correlation (r= -0.823), (p<0.01) exists between stress and coping
among caregivers of mentally ill patients.
Graph 1: Shows the correlation between the Stress and Coping of caregivers of mentally ill
patients
From above Graph 1, there is Statistically High Negative Correlation between Stress & Coping
DISCUSSION
The first objective of the study was to assess the Stress and Coping among the caregivers of
mentally ill patients, out of 100 Caregivers 24% had mild stress, 52% had moderate stress and
24% had severe stress levels. The present study finding were supported by the study conducted
by Nabanita Barman, Pushpita Chakravortty, Majority of the family members (56%) had
moderate level of stress while 22% family members had severe stress and the remaining 22%
family members had mild stress, (8)
The second objective of the study was to assess the Coping levels among the caregivers of
mentally ill patients. Out of 100 Caregivers 24% had mild coping, 52% had moderate coping and
24% had severe stress coping. The present study finding were supported by the study
conducted by Binil V (2008) conducted a correlative study to assess burden and coping
strategies among the caregivers of patients with affective disorders in Kasturba Hospital and
A.V Baliga Hospital, Karnataka which contradicts the findings of the present study. Out of 100
caregivers, 32 % of caregivers were found to be using medium coping and 68 % were using high
coping. Mean percentage score was highest ie 86% in the area of planning. Lowest mean
percentage score i.e. 34% was in humor, substance use and behavioral disengagement. (9)
0
20
40
60
80
100
120
0 20 40 60 80 100 120
Stre
ss
Coping
Research Article CODEN: IJPRNK ISSN: 2277-8713 Vasanth Kumar Kasturi, IJPRBS, 2015; Volume 4(2): 263-271 IJPRBS
Available Online at www.ijprbs.com 270
The third objective of the study was to associate the level of stress and coping among
caregivers of mentally ill patients with selected demographic variables. Related to stress, there
was a statistical significant association between some of the demographic variables and Stress
Levels like Education, Residence, and Relationship to patient at p<0.01, Occupation and Income
at p<0.05 Level. For coping, there was a statistical significant association between some of the
demographic variables and coping Levels like Marital status, Education, Occupation, Residence,
Monthly and Income at p<0.01, Age in years and Relationship to patient at p<0.05 Level. The
present study finding were supported by the study conducted by Clare. C. Pratt, et al (1985)
Two hundred forty subjects were surveyed. Differences in burden scores were not significantly
affected by caregivers' age, sex, income, education, or patient residence (i.e., community
dwellings, institutions). However, burden scores were significantly related to caregivers' health
status. Also burden scores were not significantly related to presence of confidant or support
group membership. Three internal coping strategies (confidence in problem-solving, reframing
the problem, and passivity) and two external coping strategies (spiritual support and extended
family) were found to be significantly related to caregiver burden scores. (10)
The fourth objective of the study was to correlate the relationship between level of stress and
coping among caregivers of mentally ill patients. Stress Mean and Standard Deviation values
was, 44.25 and 26.188. Coping Mean and Standard Deviation values was, 56.30 and 20.400
respectively. There was statistically High Significant Negative Correlation (r= -0.823), (p<0.01)
exists between stress and coping among caregivers of mentally ill patients. The present study
was supported by Rammohan A, Rao K, Subbakrishna DK (2002), Mean total burden
experienced by the spouses (70) is more than the parents (65.4). Spouses reported greater
emotional burden (17.88). Parents used more of denial as a coping strategy, while spouses
more of negative distraction strategies. Patient’s age, educational level, caregiver’s use of
denial as a coping strategy emerged as significant predictors of caregiver burden. The study
highlights the fact that family intervention programs need to address the specific concerns of
caregivers. (11)
CONCLUSION
In the present study, it has been observed that all the family members of mentally ill clients had
certain level of stress. It shows that among 100 caregivers 24% were having sever stress and
24% were having inadequate coping skills, even more present study demonstrated that there is
a significant relationship between the caregivers stress and coping levels with caregivers
demographic variable like Education, Residence, Relationship to patient, Occupation and
Income. Moreover the study revealed that there is a high negative correlation between stress
and coping of caregivers of mentally ill patients. Awareness programme on mental health and
mental illness and education package on different techniques of stress management & coping
Research Article CODEN: IJPRNK ISSN: 2277-8713 Vasanth Kumar Kasturi, IJPRBS, 2015; Volume 4(2): 263-271 IJPRBS
Available Online at www.ijprbs.com 271
strategies for caregivers of mentally ill patients, other professionals are recommended to
reduce stress level and a better coping strategies for the caregivers and community at large
REFERENCE
1. Denise.F. Polit and Cheryl Tatano Beck, (2004 ) “Nursing Research” Lippincott Willians and
Wilkins, Philadelphia, 7th edition, P .No.587,661
2. Jugbauer.J (2006) “Stress of family care givers of psychiatric patients” Abstract retrieved
from pub med database on 17.12,10 PMID: 11407252.
3. Kaplan HI and Sedock BJ, (2000), “Comprehensive text book of Psychiatry”, Lippincott
Williams and Wilkins, Philadelphia, 7th edition, P .No.2587-2613.
4. Stress and coping, by Fumi O. Naughton (spring 1997), California State University,
Northridge.
5. Larry E. Beutler, Rudolf H. Moos (2003), ‘Coping and coping styles in personality and
treatment planning: Introduction to the special series’. Journal of Clinical Psychology, 59 (10):
1045-1047.
6. Lefley HP (2007) “Aging parents as caregivers of mentally ill adult children: an emerging
social problem”. Abstract retrieved from pub med database on 17.12,10, PMID: 3666695.
7. www.amazon.com
8. http://dysphrenia.hpage.co.in/a_descriptive_study_to_assess_the_level_of_stress_among_
family_members_of_selected_mentally_ill_clients_attending_psychiatry_opd_of_a_tertiary_ca
re_teaching_hospital_99184934.html
9. Binil V .A correlative study of burden and coping strategies among the caregivers of patients
with affective disorders in selected hospitals of Udupi district, Karnataka. [M.Sc. thesis].August
2008.Manipal: Maniple University
10. Clare. C. Pratt, et al. Burden and coping strategies of caregivers of Alzheimer’s patients, Vol.
34, No. 1, Jan., 1985
11. Rammohan A, Rao K, Subbakrishna DK. Burden and coping in caregivers of person with
schizophrenia. Indian Journal of Psychiatry 2002; 44:220 -27.