Knowledge on early warning Signs and home care Management of mental Illness among care givers of  People with Mental Illness in A Selected Hospital at Mangalore, Karnataka

 

Ms Manju. T (Sr)¹, Ms Merlin Mary Augustine¹, Ms Mini T. K¹, Ms Preethy Jose (Sr)¹

Ms Princy Mathew (Sr)¹, Prof Chanu Bhattacharya², Mr. Rajeeve Mathew³*

¹Post Basic B.Sc (N) students, Father Muller College of Nursing, Mangaluru, Karnataka 

²Former Professor, Department of Mental Health Nursing, Father Muller College of Nursing, Mangaluru, Karnataka 

³Lecturer, Department of Mental Health Nursing, Father Muller College of Nursing, Mangaluru, Karnataka 

 

ABSTRACT:

Introduction: A mental illness is a disease that causes mild to severe disturbances in thought and/or behavior, resulting in an inability to cope with life’s ordinary demands and routines. There are more than 200 classified forms of mental illness. Some of the more common disorders are depression, bipolar disorder, dementia, schizophrenia and anxiety disorders. Symptoms may include changes in mood, personality, personal habits and/or social withdrawal. Mental health problems may be related to excessive stress due to a particular situation or series of events. At least 60 million Indians—a number more than the population of South Africa—suffer from mental disorders. With appropriate effective medication and a wide range of services tailored to their needs, most people who live with serious mental illnesses can significantly reduce the impact of their illness and find a satisfying measure of achievement and independence. A key concept is to develop expertise in developing strategies to manage the illness process. Early identification and treatment is of vital importance; by ensuring access to the treatment and recovery supports that are proven effective, recovery is accelerated and the further harm related to the course of illness is minimized. Objectives of study: 1.To assess the knowledge level of caregivers about the early warning signs and home care management of mental illness. 2. To determine the association between knowledge level of caregivers with their   selected socio demographic variables. Method: A descriptive survey design was used in this study to assess the knowledge level of caregivers about the early warning signs and home care management of mental illness. The sample consists of 100 caregivers who met the inclusion criteria. The subjects were selected by purposive sampling technique. The data was collected through structured knowledge questionnaire. Results: The finding of the study shows that among the subjects 14% had very good knowledge, 73% had good knowledge, 11% had average knowledge and 2% had poor knowledge on early warning signs and home care management of mental illness. It also shows that there is significant association between knowledge score and selected baseline variable such as caregivers relationship with mentally ill (P= 0.019) at 0.05 level of significance. Interpretation and Conclusion: The findings of the study have shown that the knowledge of caregivers on general information of mental illness and early warning signs mental illness was average. Hence health care professionals must give importance in these areas so as to enable and empower the caregivers of mental illness.

 

 

 

INTRODUCTION:

According to WHO, Mental illnesses are medical conditions that impair a person’s social, emotional and cognitive functions on a daily basis. Depression alone is ranked as the leading cause of disabilities worldwide. Around 20% of the world’s adolescents and adults are estimated to have mental disorders or problems. According to the WHO’s 2001 World Health Report on “Mental Health: New Understanding, New Hope,” during their lifetime, people as a whole have a 25% chance of having a mental illness or behavioral problem. Mental illness has several effects on the person, their family and their community. Mental illnesses put a significant burden on the economy due to its effects on families and caregivers, social and health services, reductions in employment and lower mortality¹.

 

Most families are not prepared to cope with learning their loved ones have mental illness. It can be physically and emotionally trying, and can make us feel vulnerable to the opinions and judgments of others. There are more than 200 classified forms of mental illness. Some of the common disorders are depression, bipolar disorder, dementia, schizophrenia and anxiety disorders.  Symptoms may include changes in mood, personality, personal habits and/or social withdrawal².

 

Major mental illnesses such as schizophrenia or bipolar disorder rarely appear “out of the blue.” Most often family, friends, teachers, or individuals themselves recognize that “something is not quite right” about their thinking, feelings, or behavior before one of these illnesses appears in its full blown form.

 

Being informed about developing symptoms, or early warning signs, can lead to intervention that can help reduce the severity of an illness. It may even be possible to delay or prevent major mental illness altogether.

 

Some of the major early warning signs of mental illness include;

1.     Recent social withdrawal and loss of interest in others

2.     An unusual drop in functioning, especially at school or work, such as quitting sports, failing in school, or difficulty  performing familiar tasks

3.     Problems with concentration, memory, or logical thought and speech that are hard to explain.

4.     Heightened sensitivity to sights, sounds, smells or touch; avoidance of over-stimulating situations

5.     Loss of initiative or desire to participate in any activity; apathy

6.     A vague feeling of being disconnected from oneself or one’s surroundings; a sense of unreality

7.     Unusual or exaggerated beliefs about personal powers to understand meanings or influence events; illogical or  “magical” thinking typical of childhood in an adult

8.     Fear or suspiciousness of others or a strong nervous feeling

9.     Uncharacteristic, peculiar behavior

10. Dramatic sleep and appetite changes or deterioration in personal hygiene

 

Untreated, these early symptoms may progress to a psychotic episode. That is, the individual may develop irrational beliefs (delusions), serious disturbances in perception (hallucinations), and disordered thought and speech, or become otherwise out of touch with reality. A psychotic episode can develop very gradually and may go untreated for extended periods of time³.

 

A descriptive study conducted to investigate the knowledge, attitudes and practices of adult caregivers of schizophrenia patients in Port Moresby, in the year 2011. A semi-structured questionnaire was used to obtain the required data from consented caregivers accompanying the schizophrenia patients attending the consultation clinic at Port Moresby General Hospital. A convenient sample of 79 caregivers with patients was selected for this study. Consents were obtained from 40 caregivers, which give a response rate of 50.6%. The result showed that Most of the caregivers (75.0%) had no prior knowledge about schizophrenia; they became aware about schizophrenia from experience with their patients. The fathers (35.0%) and mothers (22.5%) were the major caregivers for the patients. Most of the caregivers indicated that the health workers did not give them adequate education about schizophrenia. Marijuana (47.5%) and psychosocial problems (45.0%) were the two major causes of schizophrenia indicated by the caregivers⁴.

 

A comparative study was conducted regarding home care management versus hospital out-patient supervision in the management of chronic psychiatric patients in Bangalore, India. Twenty-five patients, with a mean duration of illness of nine years, were started on the home care programme while a matched control group of 25 similar patients continued the regular out-patient contact offered by the hospital. Comparative assessments were carried out on the groups at the time of intake and again after two years. The results indicate that hospital admission was less often needed among the home care group⁵.

 

OBJECTIVES:

1.       To assess the knowledge level of caregivers about the early warning signs and home care management of mental illness.

2.       To determine the association between knowledge level of caregivers with their Selected socio-demographic variables.

 

 

METHODOLOGY:

Research approach:

The research approach used for the study is quantitative approach.

 

Research design:

The study design used for this study was non experimental descriptive  survey design.

Sample:

In this study the sample is the caregivers of mentally ill patients who are attending outpatient departments and family psychiatric unit of selected hospital at Mangalore who fulfilled the inclusion criteria.

 

Sample size:

The sample size for this study is 100.

 

Sampling technique:

Purposive Sampling Techniques.

 

Description of the final tool

The tool consisted in the study were:

 

TOOL 1: Baseline proforma:

It consisted of 18 variables- age, gender, education, family income, occupation, religion, marital status, type of family, age of the patient, education of the patient, occupation of the patient, income of the patient, marital status of the patient, type of family of the patient, duration of mental illness, whether the patient takes alcohol and your relationship to the patient.

 

TOOL 2: Structured knowledge questionnaire:

It consisted of 31 items to assess the knowledge of home care givers of mentally ill patients.

 

Criteria for knowledge score

 

Validity and Reliability of the tool:

Validity of the tool was assessed by obtaining opinion from 9 experts.

The reliability of the tool was established by using split half method and the correlation coefficient value was r=+0.8.

Data collection process:

Formal written permission was obtained from concerned authorities of the selected hospital before data collection. The data collection procedure was carried out in the Psychiatric OPD and Family Psychiatric ward of Father Muller Medical College Hospital, Mangalore. The subjects of the study were home care givers of mentally ill patients. In the present study, during the data collection process, the investigator visited the Psychiatric OPD and Family Psychiatric ward and non-randomly selected the subjects who met the inclusion criteria. The sampling process continued until 100 samples were met.

 

After selecting the sample who met the inclusion criteria of the study, the purpose of the study was explained to the subjects and confidentiality of the data collected was assured. An informed consent was obtained from the subjects. Structured knowledge questionnaire was administered to the participants.

 

The average time taken by the participants to complete the tool was 15-20 minutes. The investigators expressed their gratitude for their cooperation. The collected data was complied for analysis.

 

Plan for analysis

Data obtained would be analyzed on the basis of objectives and hypothesis as follows.

1.       Baseline proforma containing sample characteristics would be analyzed using frequency and percentage.

2.       Knowledge of home care givers of mentally ill patients would be analyzed by mean, standard deviation and mean percentage.

 

RESULTS:

Section A: Distribution of subjects according to baseline proforma.

Table 1: Frequency and percentage distribution of subjects according to baseline proforma                                  N=100

SL. NO	Variables	Frequency	Percentage
		(f)	(%)
1. Age (In Years)
	<19	7	7%
	20-29	18	18%
	30-39	25	25%
	40-49	20	20%
	50-59	16	16%
	≥60	14	14%
2. Gender
	Female	47	47%
	Male	53	53%
3. Educational qualification
	No formal education	7	7%
	Primary school	24	24%
	High school	33	33%
	PUC	25	25%
	Degree and above	11	11%
	Professional	0	0%
4. Occupation
	Unemployed	8 8%
	Student	5	5%
	Homemaker	22	22%
	Farmer	6	6%
	Daily wages	30	30%
	Professional	23	23%
	Retired	6	6%
5. Family monthly income in rupees
	<5000	38	38%
	5001-10000		39
	10001-20000	17	17%
	>20000	6	6%
6. Religion
	Hinduism	70	70%
	Christianity	8	8%
	Islam	21	21%
	Others	1	1%
7. Marital status
	Single	28	28%
	Married	68	68%
	Widow	3	3%
	Separated	0	0%
	Divorced	1	1%
8. Type of family
	Nuclear	66	66%
	Extended	10	10%
	Joint	24	24%
9. Age of the mentally ill relative
	≤19	10	10%
	20-29	17	17%
	30-39	31	31%
	40-49	18	18%
	50-59	14	14%
	≥60	10	10%
10. Gender of the mentally ill patient
	Female	34	34%
	Male	66	66%
11. What is the highest level of education
Your mentally ill relative completed?
	No formal education	8	8%
	Primary school	35	35%
	High school	29	29%
	PUC	15	15%
	Degree and above	12	12%
	Professional	1	1%
12. What is the occupational status of your
Mentally ill relative?
	Unemployed	50 50%
	Employed	50 50%
13. If employed, what is the income per month?
	<5000	74	74%
	5001-10000	15 15%
	10001-20000	7	7%
	>20000	4	4%
14. What is the marital status of your mentally ill relative?
	Single	40	40%
	Married	52	52%
	Widow	5	5%
	Separated	2	2%
	Divorced	1	1%
15. What is the type of family of the mentally ill relative?
	Nuclear	74	74%
	Extended	2	2%
	Joint	24	24%
16. Duration of mental illness of your relative
	<1 year	15	15%
	1-5 years	43	43%
	6-10 years	16	16%
	>10 years	26	26%
17. Does your mentally ill relative take alcohol?
	Yes	36	36%
	No	63	63%
	Do not know	1	1%
18. What is your relationship with your mentally ill relative?
	Mother/father	30	30%
	Daughter/son	14	14%
	Sister/brother	22	22%
	Other family member	16	16%
	Spouse	13	13%
	Friend	1	1%
	Neighbor	4	4%
	Colleague	0	0%
	Other	0	0%

 

SECTION 2:

Knowledge level of care givers of mentally ill patients regarding early warning signs and home care management of mentally ill.

 

Table 2: Distribution of subjects according to the grading of knowledge n=100

Range of Score	Frequency (f)	Percentage (%)	Grading of knowledge
≤8	2	2.0	Poor
>8-16	11	11.0	Average
>16-24	73	73.0	Good
>24-31	14	14	Very good

Maximum score -31

 

 

 

Table 3: Mean, Standard deviation and Mean percentage of knowledge score                N= 100

Variable	Mean ±Standard deviation	Mean percentage (%)
Knowledge of caregivers on early warning signs and home care management of mental illness	20.41+4.13	65.83%

 

 

 

Table 4: Area wise Mean, Standard deviation and Mean percentage of knowledge scores                             N =100

Area	Maximum score	Mean	Standard deviation	Mean%	Level of knowledge
General knowledge about mental illness	9	4.660	1.429	52%	Average
Knowledge about early warning sign of mental illness	14	8.610	3.064	62%	Average
Knowledge about homecare management of mental illness	8	7.140	1.279	89%	Good

 

 

Data in table 4 shows that the subjects had average knowledge in all areas and good knowledge on home care management of mental illness

 

SECTION 3: Association between knowledge score of subjects and selected baseline variables.

H01: There will be no significant association of Knowledge of caregivers on early warning signs and home care management of mental illness with selected socio demographic variables.

 

Table 5: Association between knowledge score of subjects and selected demographic variables

Variables	< median	>/= median	P’ value	Significance
Age ≤19 20-29 30-39 40-49 50-59 ≥60	3 8 11 12 10 4	4 10 14 8 6 10	0.373	Not significant
Gender Female Male	20 28	27 25	0.241	Not significant
Education No formal education Primary school High school P.U.C Degree and above Professional	2 14 16 15 1 0	5 10 17 10 10 0	0.999	Not Significant
Occupation Unemployed Student Homemaker Farmer Daily wages Professional Retired	2 2 9 4 19 10 2	6 3 13 2 11 13 4	0.192	Not significant
Income <5000 5001-10000 10001-20000 >20000	20 17 5 6	18 22 12 0	0.173	Not significant
Religion Hinduism Christianity Islam Others	35 2 11 0	35 6 10 1	0.749	Not Significant
Marital status Single Married Widow Separated Divorced	13 33 1 0 1	15 35 2 0 0	0.309	Not significant
Type of family Nuclear Extended Joint	32 4 12	34 6 12	0.835	Not Significant
Age of mentally ill ≤19 20-29 30-39 40-49 50-59 ≥60	5 8 15 7 6 7	5 9 16 11 8 3	0.278	Not significant
Gender of mentally ill Female Male	10 38	24 28	0.577	Not Significant
Education level of mentally ill No formal education Primary school High school P.U.C Degree and above Professional	5 17 12 6 7 1	3 18 17 9 5 0	0.828	Not Significant
Occupational status of mentally ill Unemployed Employed	23 25	27 25	0.814	Not Significant
Income of mentally ill <5000 5001-10000 10001-20000 >20000	34 7 6 1	40 8 1 3	0.504	Not significant
Marital status of mentally ill Single Married Widow Separated Divorced	17 26 3 1 1	23 26 2 1 0	0.221	Not significant
Type of family of mentally ill Nuclear Extended Joint	35 1 12	39 1 12	0.491	Not significant
Duration of mental illness <1year 1-5 year 6-10 year >10 year	8 23 6 11	7 20 10 15	0.985	Not Significant
Alcohol intake Yes No  Do not know	20 27 1	16 36 0	0.423	Not significant
Caregivers Relationship with mentally ill Mother/father Daughter /son Sister /brother Other family members Spouse Friend Neighbor Colleague others	9 7 10 7   10 1 4 0 0	21 7 12 9   3 0 0 0 0	0.019	Significant

P < 0.05 - Significant.

 

Data in Table 5 reveals that there is association between  Knowledge level of care givers of mentally ill patients regarding early warning signs and home care management of mentally ill and selected baseline variable caregivers relationship with mentally ill.(p=0.019). Hence null hypothesis is rejected and research hypothesis is accepted.

 

DISCUSSION:

Findings of the present study shows that majority 73% of the subject had good knowledge, 14% had very good knowledge, 11% had average knowledge and 2% had poor knowledge.

 

Findings of the present study contradict the study finding which was conducted in Nigeria with a aim to assess Family Caregivers' Knowledge about Their Ill Relatives' Mental Illness and Treatment. Results shows that Majority (62%) were female, and (28%) were parents (66%) has primary level education, (76%) had no knowledge about illness of relatives, (84%) did not know the diagnosis (76%) had poor knowledge of medication, and (84%) could not recognize the side effects of medication.⁶

 

CONCLUSION:

The findings of the study have shown that the knowledge of caregivers on general information of mental illness and early warning signs mental illness was average. Hence health care professionals must give importance in these areas so as to enable and empower the caregivers of mental illness.

 

FINANCIAL SUPPORT AND SPONSORSHIP:

Nil.

 

CONFLICTS OF INTEREST:

There are no conflicts of interest.

 

REFERENCES:

1.        The minds foundation. Alleviating suffering from mental illness through a grassroots approach [serial online]. 2013[cited on 2014 June 3]; Available from: http://www.mindsfoundation.org/what-is-mental-illness/?.

2.        Mental Illness and the Family: Recognizing Warning Signs and How to Cope Mental health America[serial online]2004; [cited on 2014 June 4]. Available from:http://www.mentalhealthamerica.net/recognizing-warning-signs.

3.        Warning signs of mental illness. American psychiatri association [serial online].2014[cited on 2014 June 4];  Available from: http://www.psychiatry.org/mental-health/more-topics/warning-signs-of-mental-illness

4.        Sreevani R .A Guide to Mental Health and Psychiatric Nursing. 3^rded. USA: Jaypee  Brothers  Medical Publishers (p)LTD; P-2

5.        Mental Illness Facts[serial online] 2014.[cited on 2014 June 5];Available from: www.nami.org/template.csm?section=about_mental_illness

6.        Evaluation of a home care service for patients with acute mental illness[serial online].2010[cited on 2014 June 5]; Available from:http://nursing-midwifery.tcd.ie/assets/research/pdf/2010%20Home%20treatment.pdf

 

 

 

 

 

 

 

 

Received on 13.04.2017          Modified on 28.09.2017

Accepted on 01.11.2017      ©A&V Publications All right reserved