A Comparative study to assess the Resilience factors between wives of alcoholics and wives of non alcoholics in a selected hospital, Bangalore

 

Ramya RM¹*, Nisha CK², Johnson P³

¹M.Sc. Nursing, Mental Health Nursing, St. John’s College of Nursing, Bangalore

²Assistant Professor, St. John’s College of Nursing, Bangalore

 

ABSTRACT:

Alcoholism is a progressive disease that impairs the psychological, emotional and physical health of both the alcoholic and his family. Alcoholism has been labeled as a family disease because its effects lead to dysfunctional roles and behaviours of the alcoholics and their family member. An alcoholic husband affects the family in numerous ways and their responsibility has to be taken over by the wife. The wife, in such situations of handling the husband and the family, sometimes falls weak but in some cases stands strong. Mental health and resilience of family members of individuals with alcohol dependence affect their ability to cope with stress, maintain emotional well-being, and to positively adapt to their difficult life circumstances.  Resilience has been described as a measure of stress-coping ability and sustained competence under stress. Higher the resilience, stronger the coping capacity. Objectives: to compare the resilience factors between wives of alcoholics and wives of non alcoholics. Methods: The research design adopted for this study was comparative cross sectional design. The setting was St. John’s Medical College Hospital, Bangalore. A sample of 60 wives of alcoholics and 60 wives of non alcoholics were identified using purposive sampling technique. A modified mini screen scale (MMS) was used to rule out mental illness and the subjects found mentally healthy were taken to collect baseline variables. Resilience scale for adult was used to assess resilience. The collected data was analyzed by using descriptive and inferential statistics. Results: The present study revealed that the wives of alcoholics had a lower resilience than wives of non alcoholics and the difference was statistically significant at p <0.001. Analysis of the subscales also showed significant difference in perception of future and family cohesion at p<0.05. Conclusion: The study showed that there is a significant difference in the resilience factors between wives of alcoholics and non alcoholics. Thereby the knowledge of a patient’s resilience factors is effective in providing a quality care. The findings of the study will serve as a base in teaching the students to plan and give and overall support to both the patient and the caregivers, in preparing prospective nurses to deal with the psychological aspects of the illness.

 

 

 

 

INTRODUCTION:

Alcoholism is a progressive disease that impairs the psychological, emotional and physical health of both the alcoholic and his family. Alcoholism has been labeled as a family disease because its effects lead to dysfunctional roles and behaviors of the alcoholic and their family members¹. Alcohol is the world’s 3rd largest risk factor for disease burden. The harmful use of alcohol is a global problem which comprises both individual and social development². In Bangalore, 30-35% of adult men and 5% of women are regular consumers of alcohol³. Impact of alcohol not only disturbs the physical health of an individual but also the people who are with the individual. Alcoholics were regarded as villains and families as victims⁴. Addiction is a family problem and is a major source of stress for family members. Alcoholism is linked to violence, disrupted family roles, and impaired family communication.

 

Alcoholism is considered as a major health as well as a social problem. Often the family members of alcoholics suffer intense psychological, physical and social trauma due to the core drinking problem of the family member⁵. The wife is the family member who is primarily facing the ill effects of alcohol abuse of her husband. She uses different strategies or coping styles in order to adjust with the husband⁶. When the husband is alcoholic, the wife has to take up the family responsibilities. The wife in such situation of handling the husband and the family sometimes falls weak but in some cases stands strong. The process of adapting well in the face of adversity is called Resilience. It is that ineffable quality that allows some people to be knocked down by life and come back stronger than ever. Being resilient does not mean that a person doesn't experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. In fact, the road to resilience is likely to involve considerable emotional distress. Resilience is not a trait that people either have or do not have. It involves behaviors, thoughts and actions that can be learned and developed by anyone. Thus in such cases of wives of alcoholic husbands they should develop the qualities of resilience and thereby help the husband in de-addiction⁷.

 

Resilience refers to a dynamic process which portrays how well an individual adapts himself/herself when faced with difficulties and without any major change in his/her development process⁸. In the growing field of positive psychology, resilience is highlighted as a strength that can assist people in positive life adaptation. Resilience has been broadly defined as the capacity to positively adapt to, or regain levels of functioning after difficult life experiences. Furthermore, it has been proposed that resilience constitutes not just recovery, but growth and strengthening from adversity. Resilience has also been described as a measure of stress-coping ability, and Werner’s conception of resilience emphasized sustained competence under stress⁹.

 

There have been few studies looking into resilience in wives of alcoholics even though lot of research has targeted children of alcoholics. A wife of an alcoholic who enters into a marital life with a heart full of expectations, becomes disillusioned when she faces tough life situations, she develops feelings of hatred, self pity, avoidance of social contact and even may suffer exhaustion and becomes physically or mentally ill. The wife takes over the husband’s role and performs the roles of both parents for her children¹⁰. In clinical settings, when clients with alcoholic dependent syndrome is admitted, who have their wives with them, the wives are found taking care of their husbands but they are anxious, silent and helpless. The resilient factors of wives need to be assessed to empower them and help them, to face the tough life situations¹¹.

 

OBJECTIVES OF THE STUDY:

·         To compare resilience factors between wives of alcoholics and wives of non alcoholics.

·         To determine the association between resilience factors of wives of alcoholics and non alcoholics with the selected baseline variables.

 

Hypothesis:

H₁: There will be a significant difference in the resilience factors of wives of alcoholics and non alcoholics at 0.05 level of significance.

H₂: There will be a significant association between resilience factors of wives of alcoholics and non alcoholics with selected baseline variables at 0.05 level of significance.

 

MATERIAL AND METHODS:

The research approach adopted was quantitative non experimental approach and the research design was cross sectional design. Sample consisted of 60 wives of alcoholics and 60 wives of non alcoholics selected by purposive sampling method.  Baseline performa was used to collect baseline variables such as age, educational status, duration of marriage, family size, no. of children, standard of living index, loss of parent at an early age, support from family of origin, support from in-laws, support from friends, stressors present, family history of psychiatric illness. Resilience was assessed by Resilience Scale for Adult (RSA) developed by Friborg. It’s a five point semantic differential scale in which each item has a positive and a negative attribute at each end of the scale continuum. It consists of 6 factors: perception of self, perception of future, structured style, social competence, family cohesion and social resources. Permission was obtained from the author to use it in the study. Modified mini screen (MMS) was used to rule out psychiatric illness in wives. It is a 22-item scale developed by OASAS (Office of Alcoholism and Substance Abuse Services), designed to identify persons in need of assessment in the domains of mood disorders, anxiety and  psychotic disorders, whose current mental health status indicates a need for a more thorough assessment by a licensed practitioner. Those who scored ≥6 were excluded from the study.

RESULTS:

Section 1: Description of baseline variables of subjects

Table 1a: Frequency and percentage distribution of subjects according to baseline variables n=120

Sl no	Baseline variables	Wives of alcoholics (n=60)		Wives of non alcoholics (n=60)
		f	%	F	%
1	Age (in years)
	<31	13	21.67	19	31.67
	31-40	24	40.00	26	43.33
	41-50	23	38.33	15	25.00
2	Education
	Primary	07	11.67	05	08.33
	Secondary	25	41.67	14	23.33
	Pre-university	13	21.67	13	21.67
	Graduate/Diploma	13	21.67	17	28.33
	Post graduate	02	03.33	11	18.33
3	Standard of Living
	Middle	09	15.00	11	18.33
	High	51	85.00	49	81.67
4	Duration of Marriage
	<16 yrs	38	63.33	45	75.00
	16-35 yrs	22	36.67	15	25.00
5	Family Size
	<3	22	36.67	33	55.00
	>3	38	63.33	27	45.00
6	No. of Children
	Nil	05	08.33	08	13.33
	≤2	48	80.00	46	76.67
	>2	07	11.67	26	10.00
7	Loss of parent at an early age
	Yes	20	33.33	23	38.33
	No	40	66.67	57	61.67

 

Table 1a depicts that majority of the subjects are in the age group of 31-40years. Most of the wives of alcoholics have secondary education whereas majority of the wives of non alcoholics are graduate/diploma. Both the group has high standard of living. Duration of marriage was < 16 years in most of the subjects. The family size was > 3 in majority of the wives of alcoholics whereas < 3 in wives of non alcoholics. Most of the subjects have 2 or one child.  Only 33.33% and 38.33% of subjects lost their parents at an early age.

Table 1 b shows that most of the subjects have support from family of origin, from in-laws and friends.100% of the wives of alcoholics has current stressor and which is husband’s alcoholism. Only 5% of the subjects have a family history of psychiatric illness.

 

Table 2a reveals that the mean resilience is low in wives of alcoholics than wives of non alcoholics and the difference is statistically significant at p<0.001.

 

 

Table 1b: Frequency and percentage distribution of subjects according to baseline variables n=120

Sl No	Baseline variables	Wives of alcoholics (n=60)		Wives of non alcoholics (n=60)
		f	%	F	%
1	Support from family of origin
	Yes	57	95.00	56	93.33
	No	03	05.00	04	06.67
2	Support from in-laws
	Yes	43	71.67	53	88.33
	No	17	28.33	04	11.67
3	Support from Friends
	Yes	29	48.33	37	61.67
	No	31	51.67	23	38.33
4	Current Stressor
	Present	60	100.00	12	20.00
	Absent	0	0.00	48	80.00
5	Family Psychiatric History
	Present	03	05.00	03	05.00
	Absent	57	95.00	57	95.00

 

 

 

Section 2: Comparison of resilience scores between wives of alcoholics and wives of non alcoholics

Table 2a: Mean, range and standard deviation of resilience scores in wives of alcoholics and wives of non alcoholics.   n= 120

Sl. No.	Subjects	Maximum	Range	Mean	S.D.	t-test	p value
1	Wives of alcoholics	165	81-150	122.57	16.60	3.528	<0.001*
2	Wives of non alcoholics	165	95-161	132.78	15.08

 

Table 2b: Mean, Range and standard deviation of subscales of resilience factors in wives of alcoholics and wives of non alcoholics n=120

Sl. No	Subscales	Wives of Alcoholics			Wives of Non alcoholics			t-test	p value
		Range	Mean	S.D	Range	Mean	S.D
1	Perception of self	14-30	23.47	4.69	18-30	24.82	3.01	1.878	0.063
2	Perception of future	4-20	13.23	4.33	4-20	14.93	3.91	2.255	0.026*
3	Structured Style	8-20	13.90	3.72	4-20	15.00	3.30	1.713	0.089
4	Social Competence	12-30	22.12	4.31	12-30	23.55	3.83	1.926	0.057
5	Family Cohesion	10-30	20.33	4.62	8-30	24.02	4.46	4.444	<0.001*
6	Social Resources	16-35	29.42	4.48	23-35	30.27	3.42	1.167	0.246

 

Table 2b depicts a statistically significant difference between the groups in subscales of perception of future and family cohesion at p< 0.05 level of significance.

 

Section3: Association of resilience factors of wives of alcoholics and wives of non alcoholics with selected baseline variable scores.

 

Table 3a: Association of resilience factors with baseline variables of wives of alcoholics.

Sl No	Baseline variables	Mean	SD	Test of significance	p value
1	Age (in years)#			1.41	0.766
	<31	78.18	8.57
	31-40	73.99	9.89
	41-50	72.38	10.79
2	Education#
	Secondary	71.52	9.27	1.80	0.519
	Pre-university	77.53	10.85
	Graduate/Diploma	77.34	10.43
	Postgraduate	77.58	8.53
3	Standard of Living$
	Middle	67.54	2.89	2.253	0.028*
	High	75.47	1.38
4	Duration of marriage (in years)$				0.117
	<16	75.89	1.51	1.587
	16-35	71.69	2.3
5	Family Size#
	2	79.49	9.57	0.77	2.381
	3	72.19	8.15
	4	74.10	10.07
	5	74.85	12.60
6	No. of children#
	0	82.55	6.17	2.51	4.590
	≤2	71.41	7.24
	>2	74.48	11.03
7	Loss of parent at an early age$
	Yes	74.51	2.67	0.125	0.900
	No	74.17	1.45
8	Support from family of origin$
	Yes	74.31	1.34	0.095	0.924
	No	73.74	6.82
9	Support from in-laws$
	Yes	75.22	1.53	1.152	0.253
	No	71.91	2.42
10	Support from friends$
	Yes	76.41	1.82	1.601	0.114
	No	72.29	1.81
11	Family Psychiatry History$
	Present	83.64	4.89	1.676	0.098
	Absent	73.79	1.32

*significant at p<0.05 # ; ANOVA $ : Independent t test

 

Table 3a shows that standard of living is significantly associated with resilience factors.

Table 3b: association of resilience factors with baseline variables of wives of non alcoholics. N= 60

Sl No	Baseline variables	Mean	SD	Test of significance	p value
1	Age (in years)#			1.29	3.427
	<31	82.61	11.21
	31-40	80.58	8.32
	41-50	77.58	7.20
2	Education#
	Secondary	76.42	9.41	2.02	1.101
	Pre-university	81.21	10.01
	Graduate/Diploma	82.99	8.18
	Postgraduate	82.69	7.61
3	Standard of Living$
	Middle	76.74	2.88	1.511	0.136
	High	81.31	1.28
4	Duration of marriage (in years)$				0.005*
	<16	82.56	1.39	2.871
	16-35	71.69	2.3
5	Family Size#
	2	80.55	1.39	0.32	2.516
	3	81.90	8.55
	4	79.19	8.61
	5	79.39	12.10
6	No. of children#
	0	79.77	8.96	0.27	0.052
	≤2	81.35	9.45
	>2	79.53	0.09
7	Loss of parent at an early age$
	Yes	78.99	1.69
	No	81.39	1.59
8	Support from family of origin$
	Yes	81.02	1.18	1.786	0.079
	No	72.72	5.43
9	Support from in-laws$
	Yes	81.72	1.14	3.128	0.002*
	No	70.99	3.89
10	Support from friends$
	Yes	83.51	1.39	3.565	<0.001*
	No	72.29	1.81
11	Family Psychiatry History$
	Present	80.20	2.28	0.052	0.958
	Absent	80.48	1.24

 

Table 3b reveals significant association between resilience factors and duration of marriage, support from in-laws and support from friends in wives of non alcoholics.

 

DISCUSSION:

The study revealed that majority of the wives of alcoholics and non alcoholics belong to the age group of 30-40 years. Most of wives of alcoholics (41.67%) had secondary education whereas majority of the wives of non alcoholics were graduates (28.33%). The standard of living index was high in both the groups. The duration of marriage was between 5-15years for both the groups. The family size was >3 in wives of alcoholics (63.33%) and <3 in wives of non alcoholics (55%). The no. of children was < 2 in majority of the subjects. Only (33.33) and (38.33) had a history of loss of parents at an early age. Most of the subjects in both the group had support from the family (95%, 93.33%) and in-laws (71.67%, 88.33%). All the wives of alcoholics had stressors in their lives and the major stressor was husband’s alcoholism. Around 95% subjects had no family psychiatric history.

 

The study showed a statistically significant difference in the resilience scores of wives of alcoholics and wives of non alcoholics at p <0.001 level of significance which indicate that the wives of non alcoholics had high resilience than wives of alcoholics. The study finding implies that the resilience in general in wives of alcoholics has been low. This is the first time there is a report of low resilience in wives of alcoholics in India. Also comparing the mean resilience in wives of non alcoholics in the present study to that of Annalakshmi study where the mean resilience scores was 134+ 18.28, there was no significant difference¹². This suggests that the wives of non-alcoholics resilience scores were representative of general population. This strengthens the findings that resilience in wives of alcoholics is lower as compared to wives of non-alcoholics. This finding raises a valid question, despite 10.6 million dependent alcohol users (among 62.5 million alcohol users) in India and with increased estimates of low resilience wives of alcoholics why do the families in India still have low rates of divorce (1.1%) compared to almost 50% in USA ?^13,14 Stanley suggested that divorce in India is viewed as a stigmatized event and traditionally men are the sole bread winners; women are dependent on him and prefer to be in a miserable marriage than remain single due to stigma and attitude of the society towards women who are away from their husbands especially in the middle and lower socioeconomic strata.

Even though this was the condition, currently there are significant changes occurring for women in India in terms of better education, government benefits, change in the attitude of the society towards women an independent income. Another important clinical implication of this finding is that Resilience scales have been found to predict psychiatric disorders later in life¹⁵. Thus, it may be very important to detect low resilience early and intervene to prevent development of psychiatric disorders later in life. It is important to remember that lot of factors may contribute to poor resilience such as personality, support available to her and the resources she is actually using to deal with the situation. This needs to be studied in a greater detail before concluding.

 

Of all the subscales studied perception of future and family cohesion were significantly lower in wives of alcoholics compared to wives of non alcoholics. This suggests that in wives of alcoholics they under estimate how they perceive and plan about the future. Also their understanding about how their family will help her during the times of crisis/stressors and the role of families’ emotional connectedness was also found to be reduced. These aspects are important for a wives of alcoholics because she not only manages the stressors related to husband’s alcoholism but also has to cater to the family members such as children, in-laws and significant others. Even though other subscales did not show any significant difference, the mean scores were low in wives of alcoholics which imply that their resilience is low when compared with that of wives of non-alcoholics.

 

The resilience factors of wives of alcoholics showed a significant association with standard of living. The wives with high standard of living had high resilience. The association of resilience factors of wives of non-alcoholics with duration of marriage, support from in-laws and support from friends were significant at p< 0.05. The resilience was better in those with less duration of marriage. The wives who had support from in-laws and friends had high resilience.

 

CONCLUSION:

The result of the study revealed that there is a difference between the resilience of wives of alcoholics and wives of non alcoholics. Alcoholism being labeled as a family disease, there is a need for assessing the resilience and implementing the correct interventions for the wives of alcoholics as they are affected physically, psychologically and emotionally. Thus this area need to be studied in depth as there are no studies related to resilience in wives of alcoholics. This study adds to the meagre literature on resilience among wives of alcoholics.

 

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Received on 13.07.2019         Modified on 25.07.2019

Accepted on 07.08.2019      ©A&V Publications All right reserved