BURDEN OF CARE IN THE CAREGIVERS OF INDIVIDUAL WITH SCHIZOPHRENIA AND BIPOLAR AFFECTIVE DISORDER

Schizophrenia and bipolar affective disorder are severe mental illness, which is stressful not only for the patients, but also for family members (Saunders, 2003). The family is generally perceived by society as the unit responsible for providing children with an environment that serves their physical and emotional needs (Goldstein et al., 1978). It is accepted practice today to view the family as a system organized around the support regulation, nurturance and socialization of its members within this framework, the family also can be viewed broadly as “a small social systems made up of individual who comprise a household or cluster of household that persists over years. Members enter the family through birth, adoption or marriage and leave only by death (Minuchin, 1974). Specific to mental health; family plays a very significant role in development of positive mental health and making a person psychologically resourceful and socially organized (Seligman & Csikszentmihalyi, 2014).

The past few decades especially after 1950 researchers have shown clinical and scientific interest over family and its role as one of the most significant social forces in human development (Bachrach, 1976). Everyone in the family plays a role or takes part in the welfare and difficulties of a person. If a person’s per formance and social functioning is inadequate or affected, it leads to greater distress on the family. A person’s poor performance or inadequate social functioning due to any mental illness leads to dysfunction in psychosocial area. Providing continuous care to the persons with psychiatric disorders especially severe psychiatric disorder e.g., Schizophrenia and Bipolar Affective Disorder (BPAD) is taxing to caregivers. After the era of deinstitutionalization, rehabilitation of the patient in the society has been emphasized and since then the family members are taking care of mentally ill relatives at their home (David, 1978). Due to constant strains of care giving task, caregivers experience diminished adjustment. Burden is common and wellknown concept as consequences of caregiver’s experience. Family burden may be described as some of the difficulties experienced by families who live with mentally ill members (Breakey, 1996).

In last few decades a paradigm shift has been taken place in the field of mental health service delivery system by replacing institutionalized care with community and family based care to the severely ill mental patients. Having once been identified as the source of the illness, blamed and excluded from involvement in care, families are now seen as a principal source of support and an important partner in the rehabilitation of the mentally ill. The changes in the mental health system have led to many consequences. This change has caused sharp increase in the daily responsibilities of family nd sources of stress at a time when they are also dealing with the uncertainty and stigma associated with a chronic psychiatric illness in a close relative. This way family member starts to feel to be stressed out or burdened by their responsibilities to patients.

AIM
The aim of the present study was to examine the socio-demographic characteristic and compare the burden of care of the caregiversof patient with schizophrenia and bipolar affective disorder.

MATERIALS AND METHODS
The present study was conducted at outpatients and inpatients department of Ranchi Institute of Neuro-Psychiatry and Allied Sciences, Kanke, Ranchi, Jharkhand. It is a was cross–sectional hospital based and single contact study. Purposive sampling was used. To sellect 60 caregivers, which include 30 caregivers of patient with schizophrenia and 30 caregivers of patients with bipolar affective disorder. The patients were diagnosed with schizophrenia and bipolar affective disorder as per ICD-10 DCR (Cooper, 1994) and received treatment from this institute. For this study, caregivers were defined as the first degree relatives who spent more than two years of his or her life with the patient and took active part in treatment (e.g., attended physician appointments as a companion and cooperated with the patient to achieve compliance with treatment). The eligible consenting caregivers had to be older than 20 years of age and able to answer the administered tools. Because of the low socioeconomic and educational level of the participants in this study, the questions were read to them, and their oral responses were scored by the interviewer. Caregivers of patients with concomitant co morbidity which is likely to affect the state of their own health were excluded from the study.

Tools
Caregivers were asked to answer a structured questionnaire concerning the following sociodemographic characteristics: age, sex, marital status, educational level, occupation, and relation with patient . Occupation was separated into employed and unemployed, educational level into (primary, high school intermediate, graduation & above and relation with patient into parents spouse, children and sibling. After taking socio-demographic details of caregivers GHQ-12 was used for the assessment of caregiver’s health and Family Burden Interview Schedule (FBIS) (Sánchez & Dresch, 2008 and Pai & Kapur, 1978) was administered to measure the main study outcome. This Schedule has six domains derived from the 24 items, comprising of financial burden, disruption of family activities, disruption of family leisure, disruption of family interaction, effect on physical health of other and effect on mental health of other domain. These six domains were shown to be valid measures of overall family burden.This schedule is cross culturally sensitive and has good, excellent reliability and validity. The higher score meant a higher family burden. In this study the Hindi translation of the schedule as applied by Kumar and Kumari (2002) was used.

Statistical Analysis
The Statistical Package for Social Sciences (SPPS) 20.0 for windows was used for analysis. Both descriptive and inferential statistics were used for analyzing data. Chi square test was used for comparing categorical variables and test was used for comparing continuous variables. In this study, the level of significance was set at P < 0.05 and P < 0.01 for all analysis.