ABSTRACT | PDF
RESEARCH
A descriptive study to assess the level of stress among family members of selected mentally ill clients attending psychiatry OPD of a tertiary care teaching hospital
Nabanita Barman, Pushpita Chakravortty1
M. Sc. in Psychiatric Nursing, Clinical Instructor, Fakhruddin Ali Ahmed Medical College Hospital, Barpeta, Assam, India
1Associate Professor of Psychiatric Nursing, Regional College of Nursing, Guwahati, Assam, India
Abstract
Background: Mental disorders have profound implications on health and well-being not only of individuals with the disorder but also of their families and entire community. Much of the interest in the field of mental health around the families who care for their mentally ill members generated has been due to factors such as deinstitutionalisation of the mentally ill, increasing professional recognition of the family’s burden in caring for the mentally ill members and the growing self-help movement of the families of mentally ill.
Material and Methods: Fifty family members of schizophrenia and mood disorder clients attending Psychiatric OPD, Gauhati Medical College Hospital, Assam are assessed by using a structured interview schedule on stress.
Results: 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. There was no significant association between the stress level of family members and their demographic variables. There was a significant difference in the stress level among the family members of mentally ill clients. There was no significant difference between the stress of family members of schizophrenia clients and that of mood disorder clients.
Conclusion: All the family members of mentally ill clients have certain level of stress and they are in need of support in the reduction of stress. The family members are in great need of financial support since highest number of family members has severe stress regarding finance.
Barman N, Chakravortty P. A descriptive study to assess the level of stress among family members of selected mentally ill clients attending psychiatry OPD of a tertiary care teaching hospital. Dysphrenia. 2012;3(1):65-73. Epub 2011 December 30.
Keywords: Schizophrenia. Mood disorder. Finance. Relations.
Correspondence: nitubarman@yahoo.in
Received on 16 December 2011. Accepted on 30 December 2011.
Introduction
Stress is a normal, universal human experience and a routine part of our lives. An unavoidable effect of living, it is an especially complex phenomenon in modern technological society. As early as in 1956, Hans Selye, a Canadian endocrinologist and renowned stress theorist noted, “No one can live without experiencing some degree of stress all the time”.[1] It is a feature of life which can be both protective and harmful. Unfortunately “stress” is too often viewed in a negative context when, in fact, it enables us to cope with change. Selye defines stress as a non specific response of the body to any demand made upon it.[1] Lazarus and Folkman defined stress as “a relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being.”[2]
According to World Health Report 2001, bipolar affective disorder (manic depressive psychosis) and schizophrenia find a place in the list of most disabling illness for the most productive age group of 15-44. Until 1950s, a large number of these patients used to be confined to the walls of the mental hospitals (asylums).With the advances in the psychopharmacology and growing emphasis on outpatient treatment in psychiatry, most patients with these disorders are being looked after by their families.[3] Thus deinstitutionalisation became possible. However, the frequent relapse and remission directed attention to the psychosocial factors that were postulated as influencing the course of illness.[4] Again the idea that family interaction and communication pattern influence the development of psychopathology of the psychiatric disorder, so families became the primary agents of care with deinstitutionalisation.[5]
Mental disorders have profound implications on health and well-being not only of individuals with the disorder but also of their families and entire community. The impacts of mental disorder are wide ranging, often long lasting and sometimes profound. Their impacts are seen having effect associated with personal income, inability to work and productive contribution to the national economy.[6] The most reported burdens on the family members are on constraints, social activities, financial difficulties, problems in work place.[7,8] The resultant emotional distress affects the ability to cope with stress as well as productivity and thus the impact of the mental illness is enormous. Other negative implications among the family members include alcohol and substance abuse, delinquent behaviour and impaired quality of life. Interest is growing in the field of mental health around the families who care for their mentally ill members. Much of the interest generated has been due to factors such as deinstitutionalisation of the mentally ill, increasing professional recognition of the family’s burden in caring for the mentally ill members and the growing self-help movement of the families of mentally ill.[9]
Although the term stress has been in scientific literature since the 1930s and in the nursing literature since the late 1950s, the word however did not become popular vernacular until the late 1970s and early 1980s. The word “stress” began appearing in nursing journals in 1956. Stress gains recognition as a phenomenon of interest for nursing only when anecdotal data from patients and empirical evidence from researchers suggested that stress and health are inextricably related concept.[10]
Need of the study: Mental and behavioural disorders account for 12% of the global burden of disease. The WHO, in its World Health Report 2001 has drawn attention to the fact that of nearly 45 crore people estimated to be suffering from mental and behavioural disorder globally, ‘only small minority are adequately cared for.’ It is estimated that by 2020, 15% of the disability-adjusted life years (DALYs) lost would be due to mental and behaviour disorders, up from ten percent in 1990 and 12% in 2000.[11] Worldwide about 24 million people suffer from schizophrenia and 121 million from depression.[11]
India with a population of more than one billion is home of one sixth of the world’s mentally ill. Psychiatrists estimate that about two percent of Indians suffers from mental illnesses i.e. a staggering 20 million people out of a population of one billion.[12] In a more recent review of mental disorders in India, Ganguly concluded that the National prevalence rates of mental disorders are 73/1000 populations; with rural and urban rates of 70.5/1000 and 73/1000 respectively.[13] The factors associated with occurence of common mental disorders were female gender, poverty, unemployment and lower level of literacy.[14] From an analysis of ten Indian studies on psychiatric morbidity, Madhav concluded that the prevalence rate of all mental disorders is 65.4/1000 population,[15] against 58.2/1000 population as reported by Reddy et al. following a meta analysis of community based survey of India.[16] Prevalence rate of mental illness was found to be 2.3% in India by Kumar et al.[17] According to WHO estimates, one percent of population suffering from severe incapacitating mental illness, ten percent from mild mental disorder, hence there are nine million of severely ill people and ten times of that number mildly ill patients are in India. It has also been observed that nearly 15-20% of the people who seek help from primary health care facilities, general hospitals or private clinics, actually suffer from mental illness in India.[18] In India, the prevalence rate of schizophrenia is 0.7-5.5/1000 and bipolar affective disorder (manic-depressive psychosis) is 0.7-15.0/1000.[16]
In Assam, disease burden due to mental disorder is 8.5%. The prevalence of schizophrenia is 3/1000 and prevalence of mood disorder is 16/1000 (Source: Burden of Disease in India, National Commission on Macroecomics and Health, MoHFW, Govt of India, 2005).[19] From the above statistical data on mental disorders, it has been revealed that prevalence rate of schizophrenia and mood disorder in Assam is high.
The family plays a central role as caregiver for the seriously mentally ill. It is estimated that 65% of patients discharged from mental hospitals return to live with families.[20] Severe mental illness like schizophrenia, bipolar affective disorder and depression is one of the major causes of concern from many Indian homes. Again, it has been reported that the stress on the caregivers of the patients with severe mental disorders is enormous.[21]
The study is undertaken keeping in view the fact that an increasing number of people are being diagnosed with schizophrenia and mood disorder and their lifetime prevalence rate are also high. Moreover because of deinstitutionalisation of mentally ill patients, more and more families thus have to face the stressors that disability brings along and in consequence, have to be able to mediate the stress and cope up in a better way.
There are very few studies in Assam which examine the level of stress among family members of mentally ill clients. So, it inspires the researchers to take up the present study to find out level of stress among the family members of mentally ill clients so that nursing personnel can help family members in assessing their stress and to cope up with it, thus aiding in the improvement in the course of mental illness.
Statement of the problem: A descriptive study to assess the level of stress among family members of selected mentally ill clients attending Psychiatry outdoor patients’ department (OPD), Gauhati Medical College Hospital, Assam.
Objectives: The objectives of the study were—
1. To assess the level of stress of family members of selected mentally ill clients.
2. To find out the association between the level of stress and selected demographic variables viz. relationship with the client, age, sex, education, family type, locality, income.
3. To find out the difference in the level of stress among family members of selected mentally ill clients viz. spouse, parents, children, siblings.
4. To explore the difference between the stress level of family members of schizophrenia clients and that of mood disorder clients.
Methodology
The research approach was survey and design was descriptive. Setting was psychiatry OPD. Sampling technique was non probability convenience sampling. Study sample consisted of 50 family members of selected mentally ill clients. A non standardised tool, Structured Interview Schedule, was used to assess the stress of family members of mentally ill clients. Dependent variable was stress of family members of mentally ill clients. Independent variables were demographic variables. Analysis was done by descriptive and inferential statistics.
Duration of study: The study was conducted from November 2010 up to March 2011.
Description of tool: The tool used to collect data was comprised of two parts. Part I (demographic proforma) consisted of seven elements about the participants’ demographic background. The elements were relationship with the client, age, sex, education, family type, locality and income. Part II (Structured Interview Schedule on Stress) consisted of 50 items with three options for participants’ response against each item, that were never=0, sometimes=1, always=2 for positive statements and the reverse scaling for negative statements. For each item, score ranged from 0-2. The maximum obtainable score was 100 and the minimum obtainable score was 0. The interview schedule on stress comprised of subcategories (table 1).
Table 1. Subcategories of stress, number of items and range of score
|
SERIAL NO |
SUBCATEGORY |
NO. OF ITEMS |
SCORE |
|
1 |
Finance |
3 |
0-6 |
|
2 |
Family member’s occupation |
5 |
0-10 |
|
3 |
Social relations |
3 |
0-6 |
|
4 |
Family relations |
4 |
0-8 |
|
5 |
Family members health |
11 |
0-22 |
|
6 |
Emotional stress |
17 |
0-34 |
|
7 |
Treatment |
7 |
0-14 |
|
|
TOTAL |
50 |
0-100 |
Analysis and interpretation
Method of data analysis: The data were collected by using the structured tool containing two parts i.e. part I - Demographic proforma and part II - Structured Interview Schedule on Stress. The data collected were first coded in master sheet and then analysed by using both the descriptive and inferential statistics from SPSS (Statistical Package for Social Sciences) version 12.0.
Hypothesis of the study: H1 - There was significant association between the level of stress and the selected demographic variables i.e. relationship with the client, age, sex, education, family type, locality and income. H2 - There was significant difference in the level of stress among family members of mentally ill clients viz. spouse, parents, children and siblings. H3 - There was significant difference between the level of stress of family members of schizophrenia clients and that of mood disorder clients.
Results
The data was presented under the following headings: Sample characteristics, stress of family members of mentally ill clients, association between the level of stress and the selected demographic variables, difference in the level of stress among family members of mentally ill clients, and difference between the level of stress of family members of schizophrenia clients and that of mood disorder clients.
Sample characteristics (table 2): It has been found that the maximum numbers of family members were spouse (26%) and parents (26%). Majority of family members were in the age group of 41-50 years (32%). Majority of family members were female (56%). The maximum numbers of family members were illiterate (30%). Most of the family members were from nuclear family (78%). Majority of family members were from urban locality (52%). The most of the family members’ income was <979 (26%).
Table 2. Sample characteristics, frequency (%)
|
RELATONSHIP WITH THE CLIENT Spouse: 13 (26) Parents: 13 (26) Children: 12 (24) Siblings: 12 (24) |
|
AGE 19-30 years: 10 (20) 31-40: 11 (22) 41-50: 16 (32) 51-60: 8 (16) Above 60 years: 5 (10) |
|
SEX Female: 28 (56) Male: 22 (44) |
|
EDUCATION Illiterate: 15 (30) Primary school or literate: 9 (18) Middle school certificate: 7 (14) High school certificate: 7 (14) Higher secondary level: 8 (16) Graduate: - Post graduate: 2 (4) Profession: 2 (4) |
|
FAMILY TYPE Nuclear family: 39 (78) Joint family: 11 (22) |
|
LOCALITY Urban: 26 (52) Rural: 24 (48) |
|
FAMILY INCOME ≥19575: 1 (2) 9788-19574: 4 (8) 7323-9787: 7 (14) 4894-7322: 9 (18) 2936-4893: 6 (12) 980-2935: 10 (20) <979: 13 (26) |
Stress of family members of mentally ill clients: Majority of the participants (56%) had moderate stress while 22% of the participants had severe stress and the remaining 22% of the participants had mild stress.
Frequency and percentage of level of stress for subcategories of stress (figure 1): The maximum stress score was 79 and the minimum stress score was 16. Mean score of stress was 50.52 with a standard deviation of 15.01. All the family members of the mentally ill clients had certain level of stress. Majority of family members (48%) had severe stress regarding finance. The maximum number of family members (58%) had moderate stress regarding their occupation. Most of the family members (62%) had moderate stress regarding social relation. The maximum number of family members (60%) had moderate stress regarding family relation. Majority of family members (54%) had moderate stress regarding their health. Maximum family members (60%) had moderate emotional stress. Most of the family members (58%) had moderate stress regarding treatment.
Figure 1 Distribution of family members by subcategory of stress and level of stress.
Association between the level of stress and demographic variables (table 3): To find out the association between stress level and demographic variables, chi-square test was used. Values were calculated with the total stress score. The demographic variables selected to check the associations with the stress level were relationship with the client, age, sex, education, family type, locality and income.
Table 3. Chi-square values of association between selected demographic variables and level of stress (N=50)
|
Demographic variables |
Chi-square |
Value |
df |
P value |
|
Relationship with client Age Sex Education Family type Locality Income |
Pearson chi-square Pearson chi-square Pearson chi-square Pearson chi-square Pearson chi-square Pearson chi-square Pearson chi-square |
8.492 12.446 4.764 15.219 1.696 1.403 11.495 |
6 8 2 12 2 2 12 |
0.204 NS 0.132 NS 0.092 NS 0.23 NS 0.428 NS 0.496 NS 0.487 NS |
NS=statistically not significant at 0.05 level
The P value was statistically not significant (P>0.05) for all demographic variables indicating that these demographic variables were independent of total level of stress. However, association between selected demographic variables and stress score on subcategories of stress scale was found to be statistically significant. These were as follows: there was statistically significant association between relationship with the patient and emotional stress, the variable age was significantly associated with family members’ occupation and social relation related stress, there was statistically significant association between sex and social relation related stress, the variable education was significantly associated with finance related stress, family members’ health related stress and treatment related stress, there was statistically significant association between family type and family relation related stress, and there was significant association between locality and emotional stress.
Difference in the stress level among family members: To find out the significant difference in the stress level among the family members, F- test was used (table 4). The difference in the finance related stress among the family members was statistically significant (P=0.031 i.e. <0.05). Again, difference in the family members’ occupation related stress among the family members was statistically significant (P=0.031 i.e. <0.05). It was also seen that difference in the family members’ health related stress (P=0.02 i.e. <0.05) and emotional stress (P=0.02 i.e. <0.05) among family members were statistically significant. But the difference in the stress level among family members in terms of subcategory of stress i. e. social relation, family relation and treatment were not statistically significant (P value> 0.05). There was a significant difference in the total stress level among the family members where F(3)=2.907 (P=0.045 i.e. <0.05).
Table 4. F-test values of difference in stress level among family members of mentally ill clients
ANOVA TABLE: N=50
|
Subcategories of stress |
Sum of square |
df |
Mean square |
F value |
Significance level |
|
Finance Family members’ occupation Social relation Family relation Family members’ health Emotional stress Treatment Total stress |
32.88 57.58 0.50 0.80 225.88 251.26 2.36 1758.39 |
3 3 3 3 3 3 3 3 |
10.96 19.19 0.16 0.26 75.29 83.75 0.78 586.13 |
3.214 3.212 0.04 0.056 3.592 3.50 0.151 2.907 |
0.031* 0.031* 0.989 NS 0.982 NS 0.02* 0.02* 0.928 NS 0.045* |
*Statistically significant at the 0.05 level; NS=statistically not significant at the 0.05 level
Difference between the stress level of family members of schizophrenia clients and that of mood disorder clients: To explore the difference between the stress level of family members of schizophrenia clients and that of mood disorder clients, F-test was used (table 5). There was no statistically significant difference in each subcategory of stress and the total stress level of family members of schizophrenia and mood disorder clients (P>0.05) though there was difference in mean stress score. So it could be interpreted that schizophrenia and mood disorder clients cause almost same level of stress to their family members.
Table 5. F-test values of difference between the stress level of family members caused by schizophrenia and that caused by mood disorder clients.
ANOVA TABLE: N=50
|
Subcategories of stress |
Sum of square |
df |
Mean square |
F value |
Significance level |
|
Finance Family members’ occupation Social relation Family relation Family members’ health Emotional stress Treatment Total stress |
0.78 5.388 0.462 7.262 69.071 34.401 8.468 30.531 |
1 1 1 1 1 1 1 1 |
0.78 5.388 0.462 7.262 69.071 34.401 8.468 30.531 |
0.198 0.791 0.115 1.65 2.958 1.253 1.74 0.133 |
0.658 NS 0.378 NS 0.736 NS 0.205 NS 0.092 NS 0.269 NS 0.193 NS 0.717 NS |
NS=statistically not significant at the 0.05 level
Discussion
The first objective of the study was to assess stress level of family members of mentally ill clients. The findings of the study revealed that 22% of the participants had severe stress, 56% of the participants had moderate stress and 22% of the participants had mild stress. Highest family members (48%) had severe stress in relation to finance.
These findings corroborate with the findings of many scholars. Nautiyal[22] found that 65% of the sample reported mild to moderate degree of objective burden while 60% reported severe degree of subjective distress. Of the different categories of burden, financial difficulty was perceived as most burdensome. Madianos et al.[23] reported that 45% of primary caregivers of schizophrenia patients had high levels of burden which is same with the findings of Yusuf et al.[24] Ogilvia et al.[25] found that caregiver burden is high and largely neglected in bipolar mood disorder. Again, Reinares et al.[26] found that caregivers of bipolar patients showed moderate level of subjective burden. Fadden et al.[27] found that finance was much worse in 41% spouses of persistent depression patient since the patient became ill. Shibre et al.[28] found that family burden is a common problem of relatives of schizophrenia cases. Financial difficulty is the most frequently endorsed problem among the family burden domains which corroborates with the present study finding. In contrast, Rose et al.[29] reported least burden of family caregivers in financial problem.
The second objective for the present study was to find significant association between the stress level of family members and selected demographic variables. The findings of the study showed that there is no statistically significant association between the total stress level and demographic variables, but demographic variables are significantly associated with the subcategories of stress. Relationship with the client is significantly associated with emotional stress (P value=0.035 i.e. <0.05). The variable age showed significant association with family members’ occupation (P value=0.039 i.e. P<0.05) and social relation (P value=0.03 i.e. P<0.05). There is statistically significant association between sex and social relation related stress (P value=0.014 i.e. P<0.05). Again, education is statistically significant with finance related stress (P value=0.037 i.e. P<0.05), family members’ health (P value=0.01 i.e. <0.05) and treatment (P value=0.015 i.e. <0.05).Family type is statistically significant with family relation stress where P value=0.002 i.e. <0.05. There is statistically significant association between locality and emotional stress (P value=0.017 i.e. <0.05).
Joseph[30] reported in her study that age of the caregiver was significantly related to emotional burden, physical and social burden but it is not related to financial burden. Sex was related to physical burden and financial burden. Type of family was significantly related to financial burden, physical and social burden but not related to emotional burden. Winefield & Harvey[31] reported that older and female caregivers had lesser burden and family support was associated with lesser psychological disturbances, negative effect and emotional upset in the caregivers. Martyns-Yellowe[32] found that high burden scores of family of schizophrenia clients were associated with rural setting, poorer economic circumstances of the family.
The third objective of the study was to find out the difference in the stress level among family members of selected mentally ill clients. In the present study, a significant difference in the stress level is found among the family members (P value=0.045 i.e. P<0.05). Among the family members, siblings (mean stress score=55.92) were having highest level of stress. The mean stress score of spouse, parents and children was respectively 55.00, 50.08 and 40.75.
There was no similar study found in the review of literature. But closely related study conducted by Rammohan et al.[33] reported greater emotional burden of spouse than parents which corroborates the present study finding. Cook et al.[34] reported that mothers had significantly higher degree of emotional distress which is similar with the findings by Gutiérrez-Maldonado et al.[35] where they found that average level of burden were very high for mothers. Again, Faison et al.[36] reported that sons had significantly less burden than did daughter or other relatives.
The fourth objective of the study was to explore the difference between the level of stress of family members of schizophrenia clients and that of mood disorder clients. The findings of the study revealed that the stress of family members of schizophrenia clients (mean=51.33; standard deviation=17.42) is more than that of mood disorder clients (mean=49.76; standard deviation=12.68). Though there is a difference in the mean stress score between the stress level of family members of schizophrenia clients and that of mood disorder clients, this difference is not statistically significant (P value=0.717 i.e. P<0.05).
This finding supports with the findings of Gogoi[37] and Roychaudhary et al.[38] where they reported higher burden of caregivers of patient with schizophrenia than that of bipolar mood disorder caregivers. The contradictory finding was reported by Chadda et al.[39] who found similar burden in caregivers of schizophrenia and bipolar disorder.
Conclusion
In the present study, it has been observed that all the family members of mentally ill clients had certain level of stress. Majority of the family members of mentally ill clients had moderate level of stress. Majority of the family members had severe finance related stress. Caring a mentally ill client is acknowledged to be stressful work for the family members and there is a need to understand the nature of that problem and to better manage it. Awareness programme on mental health and mental illness and education package on different techniques of stress management for family members as well as different population groups like community group, school or college students, other professionals are recommended to reduce stress level and a better quality life for the mentally ill as well as for their family and community at large. Again the family members are in great need of financial support.
References
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Appendix
Structured interview schedule for stress rating scale: It consists of 50 items which has the following categories of stress-
1. Finance
2. Family member’s occupation
3. Social relations
4. Family relations
5. Family members’ health
6. Emotional stress
7. Treatment
Instruction: The interview schedule contains a number of statements that might be helpful for you to assess the level of stress. In each case you will be asked to indicate how often you experience the stress as given in the statement. Kindly listen and respond as “Never,” “Sometimes” and “Always” as applicable to you where Never= 0, Sometimes=1, Always=2. Star (*) mark statements have reverse marking i.e. Never=2, Sometimes=1, Always=0.
1. Are you concerned that you are largely responsible to meet the patient’s financial needs?
2. Does the patient’s future financial situation worry you?
3. Do you feel that your family is facing financial problems since the patient’s illness?
4. Does the patient’s illness prevent you from earning your livelihood?
5. Does the patient’s illness affect your efficiency at work (at home/ at work place)?
6. Do you need extra time to carryout activities related to household/ job than usual?
7. Do you feel responsible for the patient’s illness?
8. Do you think that your health has been affected because of the patient’s illness?
9. Do you have experienced decreased appetite due to the patient’s illness?
10. Are you not feeling fresh after getting up in the morning?
11. Do you experience difficulty in breathing due to the patient’s illness?
12. Do you often have indigestion, nausea or diarrhoea?
13. Do you have recurrent headache, neck tension or back pain?
14. Do you feel apprehensive/ insecure due to the patient’s illness?
15. Do you feel difficulty in taking up newer responsibility?
16. Do you feel that routine plan of day to day activities are disturbed due to the patient’s illness?
17. Do you feel depressed and anxious because of the patient’s illness?
18. Do you feel difficulty in arriving at proper decision?
19. Do you feel marked tiredness and low energy even with slight effort?
20. Do you feel easily irritable due to the patient’s illness?
21. Do you feel low tolerance to sound/ noise?
22. Has your sleep been affected since the patient look ill?
23. Do you feel like shouting on someone?
24. Do you experience loss of interest or pleasure in activities that were generally enjoyable?
25. Do you feel overwhelmed because of worry about or concern about the patient’s future in the event of your death?
26. Do you regularly need to drink alcohol, smoke or take drugs at relax?
27. Do you feel you have to take the responsibility of ensuring that the patient has everything he needs?
28. Does the patient cause disturbance in the home?
29. Has your family stability been disrupted by your relatives illness (frequent quarrel/ break up)?
30. Does the patient’s illness prevent you from having a satisfying relationship with the rest of your family?
31. Has your workload increased after the patient’s illness?
32. Do you feel that there is no solution to your problem?
33. Does the patient’s unpredictable behaviour disturb you?
34. Do you feel tensed and embarrassed that other people might ask or talk about the patient’s illness?
35. Does your relative’s illness prevent you from having satisfying relationship with your friends?
36. Do you feel neglected if your friends are not meeting you?
37. Is your mind preoccupied with the feeling concerning to the patient’s illness?
38. Do you administer the medication to your patient?
39. Does regular administration of medication to your patient cause distress to you?
40. Do you often feel frustrated that the improvement of the patient is slow inspite of giving regular medication?
41. Do you become anxious and tensed when medications are not in your hand?
42. Do you feel disturbed as because the medication has some side-effects?
43. Are you satisfied with the way the patient takes care of himself?
44. Do you get any help/ support from your family members in caring the patient?
45. Do you get any help/ support from other than family members in caring the patient?
46. Does sharing your problems with others make you feel better?
47. Do you find time to look after your health?
48. Do you get enough time for relaxation as you used to get earlier before the patient’s illness?
49. Do you feel any difficulty in bringing the patient to the OPD for check up?
50. Are you satisfied with the amount of help you are getting from health professionals regarding your relative’s illness?
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