Personality and marital adjustment among alcoholics

transcript

THESIS PRESENTATION

VINOD. M4TH BATCH MSC NURSING

GOVT. COLLEGE OF NURSING, THRISSUR

KERALA UNIVERSITY OF HEALTH SCIENCESTHRISSUR

In partial fulfillment of degree of Master of Science in Nursing

Under the guidance of MR. THASLEEM SABITH K

Assistant professorDepartment of Psychiatric Nursing

Govt. College of NursingThrissur

TITLE OF THE STUDY

PERSONALITY TRAITS AND MARITAL ADJUSTMENT AMONG PATIENTS WITH

ALCOHOL DEPENDENCE SYNDROME AND THEIR WIVES

INTRODUCTION• Alcohol is the leading substance among abused substances which is

legal to use and causing considerable burden than any other substances.

• Alcohol harms not only the health of the drinker but also the wellbeing and health of the peoples around the drinker including family.

• Intact and harmonious marital relationships are required not only for the overall health of the individual, but also for a healthy society.

• Alcohol use is a global problem which results in 3.3 million deaths in a year.

• Kerala tops the country in alcohol consumption at eight liters per capita, that is much above the national average of two liters.

• Majority of the divorces, suicides, road accidents, crimes in Kerala are related to alcohol.

NEED AND SIGNIFICANCE OF THE STUDY

• Alcohol consumption is the world’s third largest risk factor for disease and disability.

• Kerala has the highest per capita consumption in the country.

• Alcoholism is a major cause of social problems in Kerala.• Family courts in Kerala have witnessed a increase in

number of divorces. • Majority of the clients seeking treatment from department

of psychiatry has the diagnosis of alcohol dependence.• Personality also determine the adjustment of a person in a

committed relationship especially marriage.

STATEMENT OF THE PROBLEM

A descriptive study to determine the relationship between personality traits and marital adjustment of patients with alcohol dependence syndrome and their wives attending a tertiary care centre, Thrissur.

OBJECTIVES OF THE STUDY• Assess the personality traits of patients with alcohol dependence

syndrome.• Assess the personality traits of wives of patients with alcohol

dependence syndrome.• Assess the marital adjustment of patients with alcohol

dependence syndrome.• Identify the relationship between personality traits and marital

adjustment of patients with alcohol dependence syndrome.• Identify the relationship between personality traits and marital

adjustment of wives of patients with alcohol dependence syndrome.

• Find the association between marital adjustment with selected variables among patients with alcohol dependence syndrome.

OPERATIONAL DEFINITIONS

• Personality : Personality is the quality or fact being a particular person or habitual patterns and qualities of behaviour of any individual as expressed by physical and mental activities and attitudes.

• Personality traits : Personality traits are distinguishing qualities and characteristics of a person. Traits are a readiness to think or act in a similar fashion in response to a variety of different stimuli or situation as measured by the Big five inventory.

• Marital adjustment : Marital adjustment is an adoption between husband and wife to the point there is companionship, agreement on basic values of affectional intimacy, accommodation and on certain other unidentified factors as measured by Revised dyadic adjustment scale.

• Alcohol dependence syndrome : Alcohol dependence syndrome is a cluster of behavioural, cognitive and physiological phenomena that develop after repeated alcohol use and that typically include a strong desire to take alcohol, difficulties in controlling its use, persisting in its use despite harmful consequences as diagnosed by treating physician.

ASSUMPTIONS

• Personality can be assessed by self report measures.

• Marital adjustment is dyadic and can be measured from wives self report.

HYPOTHESES

• H1: There is a significant relationship between marital adjustment and personality traits of patients with alcohol dependence syndrome.

• H2: There is a significant relationship between marital adjustment and personality traits of wives of patients with alcohol dependence syndrome.

• H3: There is a significant association between marital adjustment and selected variables of patients with alcohol dependence syndrome.

CONCEPTUAL FRAMEWORK Karney and Bradbury’s vulnerability-stress-adaptation model

CONCEPTUAL FRAMEWORK

• Enduring vulnerabilities : The individual strengths and weaknesses each spouse brings to the relationship. These stable characteristics can include their personality, beliefs and attitudes about marriage, their family of origin and social background.

• Stressful life events : Stressful life events, on the other hand, encompass all the incidents, transitions or circumstances encountered by the couple that can impinge on their relationship and create tension or stress, eg :- death of family member, loss of job etc.

• Adaptive process : The ways in which a couple addresses conflict, how they communicate, how they support each other and the ways in which they think about marriage, their spouse and their spouse’s behaviour.

REVIEW OF LITERATUREAUTHOR STUDY FINDINGS

Chittakkudam R S Prevalence of alcohol and tobacco is high in Kerala. Aditya P S Majority of alcohol dependents were having no formal education, unskilled

laborers and from low socio economic class. Hareesh M, Praveenlal K

Majority of alcohol dependents had a positive family history of alcoholism. Majority of samples had nicotine dependence.

Subir K D, Vasudevan D M

The drinking practices differ considerably among peoples and also differ according to the cast among peoples residing in same area.

Surendra K M Family burden is moderate to severe among care givers with alcohol and opioid dependent.

Naved Iqbal Marital adjustment and mental health were found to be poor among wives of alcoholics than non alcoholics.

Evlilik Uyumunun Negative communication style and negative conflict resolution styles were positively correlated with marital problems among alcohol dependents.

Kenneth E L Alcohol simply disrupts the attempts to conflict resolution equally in both aggressive and non aggressive addicts.

Belanger C High self esteem and marital adjustment are associated with the use of problem solving strategies and less avoidance as a way of coping.

Theodore Jacob Out of home group experienced a marital separation than the in home group.

Kishor M Marital dissatisfaction is high among alcohol dependent spouses and their association was robust particularly when problems in the physical, interpersonal and intrapersonal domains were high.

Faye Primary reason for divorce is interpersonal problems. Christopher M M Aggressive husbands were younger than nonaggressive husbands, had

younger wives, and had been married for a briefer duration. Aswar N R Life time prevalence of domestic violence against married women was 51%

and it was significantly correlated with husband’s alcoholism. Catherine B S Majority of personality disorder characteristics were positively associated

with marital dissatisfaction.

Mahdi shahanzari Marital satisfaction is positively related to agreeableness, conscientiousness, openness and negatively correlated with neuroticism, but the two significant predictors are agreeableness and conscientiousness.

Amy Claxton Conscientiousness trait has a central role in determining marital satisfaction, mean while in younger samples the degree of marital satisfaction is determined by neuroticism.

Sandra E M Being in a intimate relationship prevent relapse and which in turn improve the living status, abstinent were more often married or in a relationship than alone. On the other hand, relapsed were less frequently married and therefore more often single, divorced or separated.

News report April 2nd 2014 onwards Kerala government introduced new policy on alcohol and closed all outlets without five star facilities.

METHODOLOGY

Research approachQuantitative approach

Research designNon experimental descriptive survey design

Setting of the studyDepartment of Psychiatry, Medical college, Thrissur.

PopulationPatients with alcohol dependence syndrome with their wives attending Department of Psychiatry, Medical College Hospital, Thrissur.

VARIABLES OF THE STUDY• Personality, marital adjustment.• Age, education, occupation, religion, family income, type

of family, number of children, place of residence.• Amount and duration of alcohol intake, frequency of

alcohol intake, number of previous hospitalization for de addiction.

• Duration of married life, history of separation in married life.

• Habit of substance abuse other than alcohol, last intake of alcohol of patients with alcohol dependence syndrome.

METHODOLOGY

Sample and sampling techniqueThe sample consisted of 100 patients

with alcohol dependence syndrome along with their wives who met full selection criteria for the study. Non probability purposive sampling was used for the study.

INCLUSION CRITERIA

Patients with alcohol dependence syndrome• and are willing to participate.• and accompanied by wives.• for more than one year.• and are married and living together for

more than 1 year.•who can comprehend malayalam.

EXCLUSION CRITERIA

Patients with alcohol dependence syndrome who• have co morbid psychiatric problems.• have delirium or other organic brain

disorders.• have major physical illness.

TOOLS OF THE STUDY

• Tool 1 : Socio personal data sheet.• Tool 2 : Big Five Inventory.• Tool 3 : Revised Dyadic Adjustment Scale.

SOCIO PERSONAL DATA SHEET

• Self reported questionnaire to determine socio personal data.

• 16 items.• Content validity index : 0.82.• Reliability coefficient : 0.85.

BIG FIVE INVENTORY• Self reported questionnaire to determine the big five

personality traits.• Standardized tool.• 44 item scale.• Coefficient of alpha reliability is 0.83 and the and

validity 0.93.• Extraversion (8 items), Agreeableness (9 items),

conscientiousness (9 items),• Neuroticism (8 items) and Openness to experience (9

items).

REVISED DYADIC ADJUSTMENT SCALE

• Self reported questionnaire to determine marital adjustment.

• Standardized tool.• 14 item scale.• Cronbach’s alpha (reliability) of 0.90 and the

validity is 0.97.• Total score : 69• Maritally distressed : 47 and below.• Maritally non distressed : 48 and above.

PILOT STUDY

SettingDepartment of Psychiatry, Medical college, Thrissur.

SampleThe sample consisted of 10 patients with alcohol dependence syndrome along with their wives who met full selection criteria for the study. Data collection period was from 7-1-15 to 20-1-2015. After obtaining the consent the tool was administered to the samples in the study. Data were collected by questionnaire format. The data were amenable to statistical analysis and the study was found to be feasible.

ANALYSIS AND INTERPRETATION OF THE STUDY

Frequency and percentage distribution of patients with alcohol dependent syndrome and

their wives based on their age

Age in

Patient Wife

f % Mean age (S D) f % Mean age (S D)

Below 30 02 02 18 18

31 – 60 88 88 47.10 (10 ) 77 77 40.69 (10.1)

Above 60 10 10 05 05

Percentage distribution of patients with alcohol dependence syndrome based on their religion

HinduMuslimChristian

Frequency and percentage distribution of patients with alcohol dependence syndrome and their wives based on their education

Education Patient Wife

f % f %

No formal education 07 07 02 02

Primary 33 33 12 12

Secondary 55 55 72 72

Diploma 03 03 04 04

Degree 02 02 10 10

Frequency and percentage distribution of patients with alcohol dependence syndrome based on their occupation

Occupation Frequency ( f ) Percentage ( % )

Manual labourer 56 56

Skilled worker 32 32

Self employed 05 05

Office work 07 07

Frequency and percentage distribution of wives of patients with alcohol dependence syndrome based on their occupation

Occupation Frequency ( f ) Percentage (%)

House wife 59 59

Manual labourer 27 27

Skilled worker 10 10

Self employed 02 02

Office work 01 01

Professional 01 01

Percentage distribution of patients with alcohol dependence syndrome based on their monthly income of the family

≤ 5000 5001 - 15000 15001 - 250000

Frequency and percentage distribution of patients with alcohol dependence syndrome based on their type of family and number

of children

Socio personal variables Frequency ( f ) Percentage (%)

Type of family

Nuclear 40 40

Extended 42 42

Joint 18 18

Number of children

One 16 16

Two 58 58

Three 21 21

More than three 03 03

No children 02 02

Percentage distribution of patients with alcohol dependence syndrome based on their place of residence

RuralUrban

Frequency and percentage distribution of patients with alcohol dependence syndrome based on the amount spent for daily

alcohol intake and frequency of alcohol intake

Socio personal

variables

Frequency ( f )

Percentage (%)

Amount ( Rs )

Below 100 26 26

100 – 300 61 61

301 – 500 12 12

Above 500 01 01

Frequency of alcohol intake

Daily 78 78

>2 days/week 22 22

Frequency and percentage distribution of patients with alcohol dependence syndrome based on their duration of alcohol

intake duration of married life

Duration

Married life Alcohol intake

f % Mean (S D) f % Mean (S D)

Below 10 20 20 12 12

11 – 20 40 40 41 41

21 – 30 27 27 19.93 (11) 31 31 22.64 (10.1)

31 – 40 11 11 12 12

41 – 50 1 1 4 4

51 – 60 1 1

Frequency and percentage distribution of patients with alcohol dependence syndrome based on their previous hospitalization

for de addiction and separation in married life

Socio personal

variables

Previous hospitalization Separation in married life

Frequency ( f ) Percentage (%) Frequency ( f ) Percentage (%)

Never 40 40 81 81

1 – 3 times 50 50 16 16

More than three 10 10 03 03

Percentage distribution of patients with alcohol dependence syndrome based on substance use other than alcohol

Absent Present0

Percentage distribution of patients with alcohol dependence syndrome based on type of substance use other than alcohol

NicotineCannabis

Frequency and percentage distribution of patients with alcohol dependence syndrome based on their last intake of alcohol

Last intake of alcohol Frequency ( f ) Percentage (%)

< 2 wks 62 62

2wks – 6 months 31 31

> 6 months 07 07

Percentage distribution of patients with alcohol dependence syndrome and their wives based on personality traits

Extraversion Agreeableness Conscientiousness Neuroticism0

PatientWife

Percentage distribution of patients with alcohol dependence syndrome based on their marital adjustment

Non distressedDistressed

Association between personality traits and marital adjustment of patients with alcohol dependence syndrome

Marital adjustment

Personality traits Distressed Non distressed df

Extraversion and

Neuroticism

Agreeableness and

Conscientiousness

46 20 1 4.69*

*0.05 level of significance.

Association between personality traits and marital adjustment of wives of patients with alcohol dependence syndrome

Marital adjustment

Personality traits Distressed Non distressed df

Extraversion and

Neuroticism

Agreeableness and

Conscientiousness

51 19 1 1.54ns

ns = not significant at 0.05 level of significance.

Association between marital adjustment and selected socio personal variables of patients with alcohol dependence syndrome

Variable Degree of

freedom

Chi square value Table value

Age of patients 1 0.01 3.84

Age of wives 1 1.67 3.84

Education of patients 1 0.5 3.84

Education of wives 1 3.62 3.84

Occupation of patients 1 0.15 3.84

Occupation of wives 1 2.74 3.84

Religion 1 4.25 3.84

Family type 2 7.32 5.99

Frequency of alcohol intake 1 15.84 3.84

Association between marital adjustment and selected socio personal variables of patients with alcohol dependence

syndrome

Variable Degree of

freedom

Chi square value Table value

Family income of patients 1 1.26 3.84

Number of children 1 0.05 3.84

Place of residence 1 2.73 3.84

Money spent for alcohol 1 2.67 3.84

Duration of alcohol intake 1 1.79 3.84

Previous hospitalization for de addiction 1 1.85 3.84

Duration of married life 1 1.14 3.84

Substance use other than alcohol 1 0.49 3.84

Last intake of alcohol 1 0.02 3.84

DISCUSSION OF THE STUDY

• The study revealed that majority (77%) of patients with alcohol dependence syndrome is having marital problems. The findings match with the results of study conducted by Faye and his colleagues. The finding of the study is also supported by several other studies.

• In the present study the results revealed marital adjustment of patient with alcohol dependence syndrome is associated to personality traits. This finding is supported by a study conducted by Amy Claxton and others. The finding of the study is supported by several other studies.

• The present study showed that most of the patients with alcohol dependence syndrome were lesser educated, unskilled labourers and from poor socio economic background. The findings matched with results of the study conducted by Subir K D and his colleagues. The finding is also supported by several other studies.

• The results of the present study shows that 95% of substance use other than alcohol, among subjects was nicotine. The findings is supported by study conducted by Nishanth J H, Harish M, Praveenlal.

• The study revealed that 77% of patients were martially distressed, even though majority 88% had no history of separation in their married life. This point out the degree of importance they are giving to their family relationship than their personal problems.

CONCLUSION OF THE STUDY

• Marital adjustment of alcohol dependent patient was poor.

• Marital adjustment had a significant association with personality traits among alcohol dependent patients.

• Marital adjustment had a significant association with socio personal variables such as religion, family type, frequency of alcohol intake among alcohol dependent patients.

NURSING IMPLICATIONS OF THE STUDY

• Psychiatric nurse can assess personality and marital adjustment can as a preliminary assessment and can plan care accordingly.

• Psychiatric nurse can identify risk groups and provide counselling service, psycho education based on the study finding.

• The study finding can be used by nurse educator for improving the knowledge, skill, attitude of nursing students in managing patients with alcohol dependence syndrome.

NURSING IMPLICATIONS

• Since alcoholism is a social issue nurse administrator can create a awareness among staff nurse about the relationship between personality and marital adjustment.

• Nurse administrators can plan, organize and conduct in service education and special training for staff nurses based on the study finding.

• Nurse administrator can develop a protocol for counselling alcoholic family based on personality and marital adjustment.

NURSING IMPLICATIONS

• Research conducted in various aspects of nursing field can increase the wealth of knowledge related to nursing profession and at the same time improve quality of care provided by nurses.

• The present study is a descriptive study, findings of the study suggest that more research should be conducted to study the problem in detail

LIMITATIONS OF THE STUDY

• The setting of the study was limited to one tertiary care setting.

• The study was limited as the randomization of the sample was not done.

• Projective techniques was not used to assess the personality.

• Sample size was small.

RECOMMENDATIONS OF THE STUDY

• The study can be replicated on a larger sample and randomization can be done.

• Longitudinal studies can be conducted to find out the severity of marital problems among alcoholics.

• Comparative study can be conducted with alcoholic and non alcoholic family.

• Qualitative studies can be conducted to study the phenomena in detail.

• Intervention studies can be done to assess the effectiveness of family based intervention, counseling, mindfulness among alcoholic family.

REFERENCES

• Amy Claxton, Norm OR, Julianna ZS, Anita DL. Personality traits and marital satisfaction within enduring relationships. Journal of Social and Personal Relationships. 2011; 29(3):375–396.

• Faye, Abhijeet K, Gurvinder, Subramanyam, Alka S, Kamath. Study of marital adjustment, mechanisms of coping and psychopathology in couples seeking divorce in India. Sexual & Relationship Therapy. August 2013; 28(3):257-269.

REFERENCES• Subir KD, Balakrishnan, Vasudevan DM. Alcohol and its

health social impact of India. The National Medical Journal of India [internet]. April 2006 [cited on: April 2014] ; 19(2). Available from : http://www.nmji.in/archives/Volume_19_2_March_April2006/Medicine_and_Society/Alcohol.htm

• Nishanth JH, Harish M, Praveenlal K. Analysis of patients admitted with alcohol dependence syndrome in a tertiary care hospital in a calendar year. An Open Access Peer Reviewed E-Journal Health Sciences [internet]. 2014[cited on : Feb 2015]; 1(3). Available from : http://healthsciences.ac.in/jan-mar-14/downloads/1A.OriginalArticle.pdf

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Personality and marital adjustment among alcoholics

Healthcare