A STUDY TO DETERMINE THE PREVALENCE OF PSYCHOLOGICAL MORBIDITY

1. PREVALENCE OF
PSYCHOLOGICAL
MORBIDITY AMONG
MEDICALLY – ILL PATIENTS
Presented By:
Sathish Rajamani M.Sc (N)
09688115454

2. INTRODUCTION
The theme of World Mental Health Day
2009 is “Mental Health in Primary
Care” and it stresses the importance of
identifying and treating mental illness
in general health care settings. Mental
health disorders continue to be a
serious and expensive global health
issue, affecting people of all ages and
from all cultures and socio – economic
status.

3. SIGNIFICANCE AND NEED FOR
THE STUDY
In a study of a general medical clinic in an
American hospital. It has been found that
one third of psychiatric problems were
undetected in medical patients [Brody et al.,
(1972)]
This is for the first time in the history of
nursing, a research has been carried out in
assessing the prevalence of psychological
morbidity among medically ill patients.

4. STATEMENT OF THE PROBLEM
A study to determine the prevalence of
psychological morbidity among medically – ill
patients admitted to non-psychiatric wards in
Government Rajaji Hospital Madurai.
OBJECTIVES
To determine the prevalence of distress in patients
admitted to non-psychiatric wards.
To determine the prevalence of depression in
patients admitted to non-psychiatric wards.

5. Cont………………….
 To determine the prevalence of anxiety in patients admitted to
non-psychiatric wards.
 To determine the prevalence of Somatization in patients admitted
to non-psychiatric wards.
 To find out the association between psychological morbidity and
selected demographic variables such as age, sex, religion,
education, occupation, income, type of family etc.
 To find out the correlation between psychological morbidities of
medically ill patients.

6. HYPOTHESES
There will be a significant association between
psychological morbidity and selected
demographic variables such as age, sex, religion,
education, occupation, income and type of family
etc.
There will be a significant correlation in the
variables of psychological morbidity.

7. Communication
Interaction Transaction
IDENTIFICATION PHASE
EXPLOITATION PHASE
RESOLUTION PHASE
Nurse researcher and medically ill patient get introduced.
Explanation of the procedure
Identification of mutual goal
Nurse researcher collects data on psychological
morbidity by means of 4DSQ through interview
schedule
Nurse researcher thank the medically ill patient
&
KING'S GOAL ATTAINMENT THEORY &PEPLAU'S THEORY OF INTERPERSONAL RELATIONS

8. METHODOLOGY
RESEARCH
APPROACH Survey Approach
RESEARCH
DESIGN
Descriptive Co relational
Design
SETTING
Government Rajaji Hospital
- Madurai

9. Cont………
STUDY
POPULATION Medically ill patients
SAMPLE
Samples were selected based
on the inclusive criteria.

10. Cont………….
SAMPLING
SIZE
Two Hundred and Ten
Medically ill Patients
SAMPLING
TECHNIQUE
Stratified Random & Simple
Random
{Cardiology, Respiratory,
Gastro-Enterology, Nephrology,
Endocrinology and Infection
Wards}
RESEARCH
TOOL
Part-I
Demographic
Variables
Part-II
Four Dimensional
Symptom
Questionnaire
{4DSQ}

11. Cont………….
Part-II
1. Distress
2. Depression
3. Anxiety
4. Somatization
RELIABILITY
Cronbach’s Alpha scores
{Distress – 0.90. Depression –
0.89. Anxiety – 0.88 &
Somatization – 0.84}
VALIDITY
5 Experts in the field of
Psychiatry, Psychiatric Nursing
and Clinical Psychology

12. Cont…………..
PILOT
STUDY
30 Medically ill patients
DATA
COLLECTION
PROCEDURE
Structured Interview
Schedule by using 4DSQ.
DATA ANALYSIS
Descriptive Statistics
{Percentage,
Frequency, Chi-square
and Correlation}

13. MAJOR FINDINGS OF THE STUDY
Majority of the samples (73%) had low distress
and a little over one fourth (26.5%) had
moderately high level of distress.
(40% of the samples with cardiac disorder and
endocrinology disorder had moderately high
distress)
A little less than one fourth (23%) of the samples
were moderately depressed. And very few (2%)
of them scored very high on the depression
subscale of 4DSQ.

14. Cont…………..
(43.4% of the samples with cardiac disorder
suffered from moderately high level of
depression. 10% of the samples with
endocrinology disorder had very high depression)
In anxiety, an overwhelming majority (97%) of
the samples were under low level of anxiety were
as only a very few (3%) are with moderately high
level of anxiety.
(16.6% of the samples with endocrinology disorder
were under moderately high level of anxiety)

15. Cont………….
 An overwhelming majority of samples (93%)
had low somatization, and very few (3%) of them
had moderately high somatization.
(16.6% of patients with cardiac disorder had
moderately high somatization)
 There was a statistically significant association between
demographic variables like age [χ2 (48.1), (P<0.01***)],
marital status [χ2 (7.6), (P<0.05*)], education [χ2 (62.2),
(P<0.01***)], occupation [χ2 (6.0}, (P<0.05*)], social
support [χ2 (11), (P<0.05*)], physical dependence [χ2
{25.4), (P<0.01***)] and distress of the medically ill
patients.

16. Cont……………..
There was a statistically significant association
between the demographic variables like age [χ2
(66.1), (P<0.01***)], marital status [χ2 (9.5),
(P<0.02**)], education [χ2 (55.3), (P<0.01***)],
monthly income [χ2 (13.7), (P<0.01***)], physical
dependence [χ2 (10.3), (P<0.05*)], diagnosis [χ2
(28.2) (P<0.01***)], and the depression of the
medically ill patients

17. Cont…………….
There was a statistically significant association
between demographic variables like, age [χ2
(7.0), (P<0.01***)] and the anxiety of the
medically ill patients. For other variables the
association was insignificant.
There was a statistically significant association
between demographic variables like age [χ2
(11.9), (P<0.02**)] and education [χ2 (16.9),
(P<0.05*)] and somatization of the medically ill
patient.

18. Cont……………
There was a significant positive correlation
between distress & depression (r = 0.8) distress &
anxiety (r= 0.30) distress & somatization (r= 0.54)
depression & anxiety (r= 0.42) depression &
somatization (r = 0.57) and anxiety &
somatization (r = 0.39)

19. IMPLICATIONS
Implications for Nursing Practice
The study findings revealed the importance of
identifying psychological problems of medically
ill patients in general settings.
The study findings signify the importance of
constructing Self Instruction Module for nurses
working in medical wards in identifying
psychological problems of the medically ill
patients.

20. Cont………….
Mental health aspects of the medically ill patients
must also be considered in daily care planning by
the nurses working in general wards.
Nurses must be trained in identifying
psychological problems of the medically ill
patients.
The study findings stress the importance of
collaborative management of medically ill
patients by various health team personnel’s. And
it also emphasizes the World Mental Health Day
2009 theme “MENTAL HEALTH IN PRIMARY
CARE”.

21. Implications for Nursing Education
Psychosocial care of general medical and surgical
patients must be stressed by nursing educators to
the nursing students.
Nursing students in all levels should be trained in
identifying and managing psychological problems
of the medically ill patients.
Implications for Nursing Research
The implications for the nursing
research are given in the form of
recommendation.

22. Implications for Nursing Administration
Administrators can organize an in-service
education programme for nurses on capacity
building in identifying psychological problems
among medically ill patients.
Administrators can organize a workshop for
nursing students and staff nurses on integrating
mental health services in medical care settings.
Nursing administrators can issue pamphlets on
common psychological problems present during
the time of medical illness.

23. LIMITATIONS
This study was conducted only among general
patients; surgical patients were not included in
the study. So generalization must be done with
caution.
RECOMMENDATION
A similar kind of study can be done among
patients in different settings such as out –
patient department, emergency department and
surgical wards.
Similar study can be conducted among cancer
patients and HIV / AIDS Patients.