2. TITLE OF THE THESIS
BURDEN AND QUALITY OF LIFE IN
CAREGIVERS OF PATIENTS WITH
DISSOCIATIVE DISORDER
3. CHIEF GUIDE
DR. SUDHIR KUMAR
(Professor and Principal)
Department of Psychiatry
HIMS, Barabanki
CO-GUIDE
DR. ASTHA SINGH
(Associate Professor)
Department of Psychiatry
HIMS, Barabanki
CO-GUIDE
PROF.(DR.)HASEEB KHAN
(Professor and HOD)
Department of Psychiatry
HIMS, Barabanki
4. INTRODUCTION
• A caregiver has been defined as
“a family member, who has been staying with the patient for
more than a year and has been closely related with the patient’s daily
living activities, discussions, and care of health”.
• The WHO states caregiver burden as
“the emotional, physical, financial demands and responsibilities of
an individual’s illness that are placed on the family members, friends, or
other individuals involved with the individual outside the health-care
system.”
5. “Quality of life is defined as individuals perceptions of their
position in life in the context of the culture and value systems
in which they live and in relation to their goals, expectations,
standards and concerns.”
7. Author Subject Assessment tool Result
Walke et al,
2019
cross-sectional
study (n=320) was
conducted between
January 2016 and
June 2016 in two
private tertiary care
centers and one
public secondary
care center located
in Udupi taluk.
Burden Assessment
Schedule (BAS) and Brief
Cope Scale (BCS)
According to BAS, severe burden
accounted for 40.9% and moderate for
59.1%.
The highest amount of burden was seen in
the areas of physical and mental health,
spouse related, and in areas of external
support.
8. Author Subject Assessment tool Result
Grover and
Dutt, 2009
A cross-sectional
assessment of 50
patients with OCD
and their caregivers
was carried out.
The severity of OCD was
assessed using the Yale–
Brown Obsessive
Compulsive Scale. The
caregivers were assessed
using the Family Burden
Interview Schedule and
the World Health
Organization Quality of
Life BREF version
(WHOQOL-BREF).
Fifty-six percent of caregivers reported a
high objective burden. Severity of illness
correlated with burden and impaired QOL
of caregivers.
9. Author Subject Assessment tool Result
Puzhakkal et al,
2017
A comparative
cross-sectional study
conducted at a tertiary
care center.
A total of eighty CGs of
patients from four
different groups, twenty
participants each from
schizophrenia, bipolar
affective disorder, alcohol
use disorders, and
depressive disorders
were assessed within
1-month period by
consecutive sampling
Burden Assessment
Schedule and World
Health Organization
Quality of Life-BREF scale.
CGs of schizophrenia, depression , BPAD and AUD
were studied. Schizophrenia CGs burden were
found to have highest and depressive disorders
with least burden. CG burden increases with
severity of illness except in depressive disorders.
There was a significant negative correlation
between CG burden and quality of life in all the
four groups.
10. Author Subject Assessment tool Result
KSVR et al,
2019
A cross-sectional
study of caregiver
of 60 patients
diagnosed with
Schizophrenia and
BPAD were taken.
WHO-QOL BREF scale for
quality of life and Burden
Assessment Scale for the
caregiver burden were
used. Correlation
statistical tests were
applied.
A significant negative correlation between
quality of life and the caregiver burden in
both the groups. Caregiver burden is
higher in schizophrenia compared to
bipolar affective disorder.
11. AIM & OBJECTIVES
AIM
To estimate the relationship between caregiver burden and quality of life in
caregivers of patients with dissociative disorder.
OBJECTIVES
PRIMARY
To estimate the burden and quality of life in caregivers of patients with dissociative
disorder.
SECONDARY
To assess association between caregiver burden and quality of life.
12. MATERIAL AND METHOD
1. STUDY AREA - Tertiary care centre, Barabanki
2. STUDY DESIGN- Observational cross-sectional study
3. STUDY PERIOD- 1 year (6 months period of data collection and 6
months period of data analysis)
4. STUDY SUBJECT- Caregivers of in-patients and out-patients
13. INCLUSION CRITERIA
• Caregivers of a patient diagnosed with Dissociative Disorder on ICD 10-DCR
• Age of caregiver between 20-55 years.
• Informed consent was taken.
EXCLUSION CRITERIA
• Caregivers having a significant neurological, psychiatric, and major physical
illness.
• Caregiver who refuse to participate.
14. SAMPLE SIZE
• Adequate sample size was calculated by using the Cochrane’s formula
n = (Zα)2 p ( 1 – p ) / E2
p= Prevalence or Proportion or Incidence
Zα= Critical value of standard normal variate at α level of significance (α= 5%, Zα=
1.96)
E= Margin of error or allowable error
P= 40.9% = 0.409 [According to BAS, severe burden accounted for 40.9%]
E= 12%= 0.12(Absolute margin of error)
n= (1.96)2 × 0.409(1- 0.409) / (0.12)2
n= 64.4≈ 65
15. SAMPLING
Consecutive sampling was done.
Caregivers of all consecutive patients of dissociative disorder
fulfilling the inclusion criteria was taken up for the study.
17. METHOD
17
Diagnosis was made according to ICD 10 DCR criteria
Inclusion and exclusion criteria were applied
Consent was taken and socio-demographic details were
collected
WHO-QOL BREF scale and Burden Assessment Schedule
scale were applied
Data obtained will be analyzed using appropriate statistical
tools
18. Protocol presentation: Nov. 2022
Ethics Approval: July, 2023
Data Collection started: July, 2023
Data in the master chart: Jan, 2024
Statistical analysis : Jan, 2024
Thesis writing will be completed by 2nd week of
Jan, 2024
19. STATISTICS
Data Collection
Socio-demographic data was collected using the semi-structured proforma,
WHO- Quality of Life BREF Scale and Burden Assessment Schedule scale was
used in the caregivers of patients with Dissociative disorder in the specified
time frame.
Data Analysis
Data is being entered in Master chart and will be analysed using SPSS
(Statistical Package for Social Sciences) Software Version-26.
The data will be checked for Normality.
Mean and Standard Deviation will be computed for all continuous
variables.
Pearson’s corelation will be used to see the association between the
caregiver burden and quality of life.
20. 3 were Type-2
Diabetes Mellitus
Data for 5 subjects
missing
93 participants were recruited for
the study
70 subjects taken for processing
11 refused to give
consent
21. Strength of Study
• In India, there is hardly few studies on burden assessment and quality of life
among CGs
22. Limitations
• Present sample was taken from the patients attending the clinical
psychiatry services of a tertiary hospital.
• Sample size is relatively small due to logistical and time constraints
• Care give burden was evaluated in care givers of dissociative disorders only.
• The study was not matched for age and gender and hence may have
confounding factors.
• Information was obtained from a single family caregiver.
• Several mediators of burden such as coping, appraisal, expressed emotions,
and social support were not assessed.
24. Future Directives
Future research should be conducted in a large sample with a
prospective design, to see the effects of duration of illness and other
mediators such as family type, coping, and social support on the family
burden
WHO SCALE- This manual was drafted by Alison Harper on behalf of the WHO-QOL group in 1996. WHOQOL BREF is an abbreviated version of the WHOQOL-100.
has 26 items. Has 4 domains: Physical (7 items), Psychological (6 items), Social Relationships (3 items) and Environment (8 items). There are two global scores: overall QoL (1 item) and overall satisfaction with health (1 item). The responses to items were recorded on a 5-point Likert scale. Domain scores were scaled in a positive direction (higher scores denote better QoL), with a score range of 4-20 that were transformed to 0-100 scale according to the standard procedure defined in WHO QOL user manual(13). The questionnaire is based on the 5-point Likert scale, including very bad to very good, very dissatisfied to very satisfied, not at all to very possible, and never to always. the total score ranging between 26 and 130, a higher score indicating a better QOL.
BAS- bas was developed at the schizophrenia research foundation(SCARF) CHENNAI,measures burden in nine areas: (a) Spouse related (b) Physical and mental health (c) external support (d) caregiver’s routine (e) support of patient (f) taking responsibility (g) other relations (h) patients behavior (i) caregivers’ strategy. There are 40 items rated on a three-point scale. The inter-rater reliability(kappa) is .80 and the criterion validity ranges from .71-.80. Each question has three options “not at all”, “to some extent”, and “very much”. The minimum score of the scale is 40 and the maximum is 120. According to this scale, the burden is classified into mild burden (0-40), moderate burden (41-80), and severe burden (81-120). This scale has been used in various studies conducted in India.(15). BAS is the use of a combination of qualitative and quantitative methods.
