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| RESEARCH ARTICLE |
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| Year : 2017 | Volume
: 14
| Issue : 1 | Page : 28-31 |
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Development of interventional protocol for reducing perception of burden of caregivers of depressed patients having risk for suicide
Monika Sabharwal1, Sandhya Gupta1, Rajesh Sagar2
1 Faculty, College of Nursing, AIIMS, New Delhi, India
2 Professor, Department of Psychiatry, AIIMS, New Delhi, India
| Date of Web Publication | 9-Jul-2019 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/2231-1505.262418
This experimental study attempted to develop an Interventional Protocol for Managing Suicidality to reduce the perception of burden in the caregivers of patients with depression.
An Interventional Protocol for Reducing Perception of Burden of Caregivers (IPMS) was developed and the programme was conducted for 30 family caregivers of depressed patients having risk for suicide. Results: half of the caregivers reported ‘Very Severe Burden’ before exposure to IPMS whereas there were no caregivers in this category after exposure to IPMS, meaning thereby that IPMS was definitely effective in bringing down the perception of burden among caregivers. There was significant difference in pre and post intervention perception of burden in caregivers of depressed patients having risk for suicide (p = 0.001). Conclusion: There will be decrease in number of admissions as the caregivers would be able to manage the patients having suicidal tendencies at home after undergoing training such as IPMS.
Keywords: Perception of Burden, caregiver burden, Suicidality
How to cite this article:
Sabharwal M, Gupta S, Sagar R. Development of interventional protocol for reducing perception of burden of caregivers of depressed patients having risk for suicide. Indian J Psy Nsg 2017;14:28-31 |
How to cite this URL:
Sabharwal M, Gupta S, Sagar R. Development of interventional protocol for reducing perception of burden of caregivers of depressed patients having risk for suicide. Indian J Psy Nsg [serial online] 2017 [cited 2023 May 28];14:28-31. Available from: https://www.ijpn.in/text.asp?2017/14/1/28/262418 |
| Introduction | |  |
Depression is one of the most debilitating health problems in the world. By the year 2020, depression will rank second among all diseases, accounting for 15% of the disease burden in the world[1]. The demands of being involved in the care of a depressed person with risk of suicide have both an emotional and a practical impact on the caregiver. Perception of burden is high in caregivers of persons with mental illness. It increases further more among caregivers of those persons who are having risk for suicide. Psychosocial interventions targeting the strains of caregiving for a patient with mental disorders and in particular with mood disorder are needed .Decreased caregiver burden will improve patient outcome as the caregiver will be able to care for self and the patient in better way.
| Objectives | | |
The study attempted to: develop Interventional Protocol for Managing Suicidality and to evaluate perception of burden in caregivers of patients having depression and assess effectiveness of IPMS.
| Hypothesis | | |
There will be significant difference in the pre intervention and post intervention burden scores after attending IPMS in caregivers of depressed patients having risk for suicide at 0.05 level of significance.
| Literature Review | | |
Suicidal ideation is prevalent and appears to be a precondition for suicide attempts among patients with major depressive disorder[2]. Lifetime suicidal behaviour is independently and strongly predicted by psychiatric treatment history. The suicidal behaviour within the current episode is predicted most effectively by severity of depression[3]. Appraisal of caregiving burden and psychological distress in relatives of patients in psychiatric units is very high[4]. Caregivers associated with patients with current suicidal ideation or patients with a positive lifetime history of at least one suicide attempt, report lower general health scores than caregivers associated with patients with neither of these indices[5]. Caregiver burden has a significant unique contribution to caregiver’s depressive symptomatology[6]. Psychoeducational intervention for caregivers is successful in reducing caregiver burden over time[7]. Studies suggest that short term family interventions if offered at the time of hospitalization can reduce caregiver burden and increase caregiver reward[8].
| Research Methodology | | |
A quasi experimental longitudinal study was done on a sample of thirty caregivers of depressed patients having risk for suicide in the inpatient unit of Department of Psychiatry, AIIMS. Approval to conduct the study was obtained from the Ethics Committee, AIIMS. Patients having depression were screened for risk for suicide using ‘Suicide Risk Scale’. Caregivers of these depressed patients having risk for suicide, fulfilling the inclusion criteria and willing to participate in the study were explained about the study and provided with the patient information sheet. A written informed consent was taken. Data was collected from the subjects using standardized tools including the structured questionnaire for ‘Demographic and Select Variables’ and ‘Burden Assessment Schedule (modified)'.In the groups of two or three, the subjects were exposed to the IPMS for a period of three days for three hours duration each day.
Perception of caregiver’s burden was assessed four times, first one being before exposure to IPMS, the next one immediately after exposure to IPMS, followed by at the time of discharge and then again on first follow up.
| Research Design | | |
| Results | | |
Caregivers of depressed patients having risk for suicide reported immense burden (high level of burden score; mean score of 128, maximum score was 156). Most (15 out of 30) of the caregivers reported very severe burden.
Interventional Protocol for Reducing Perception of Burden of Caregivers (IPMS)
A blue print for IPMS was developed and given to experts with criterion measures followed by actual conduct of programme which was recorded on audio/ video CD and again given to experts for inter rater reliability. After modifications the inter rater reliability was 100%.
IPMS was designed for nine hours duration and it was conducted in six sessions in three days (for three hours each day). Content covered in IPMS included depression, suicidal behaviour, care of person having risk for suicide, treatment methods for suicidality and depression, community resources available for prevention of suicide, review of roles and responsibilities of caregiver and caregiver’s health. The programme was carried out in Hindi. The methods used during the programme were role plays, storytelling, quiz, question driven discussion and question answer sessions.
| Results | | |
Demographics of Subjects
Mean age of the caregivers was 39.7 years. Most (27 out of 30) of the caregivers were female. Mean duration of caregiving was 5.7 years. Most (8 out of 30) of the caregivers were educated upto higher secondary.
As shown in Fig No.1, caregivers of depressed patients having risk for suicide had significant burden in areas of patient behaviour, physical and mental health of caregiver, family relations, social support and burden related to suicidal ideation in patient.
As shown in [Table 1] half (15 out of 30) of the caregivers reported ‘Very Severe Burden’ before exposure to IPMS whereas there were no caregivers in this category after exposure to IPMS. Most of the caregivers shifted to ‘Moderate level’ from ‘Very severe levels’ of burden score which maintained at lower levels even after going home. Meaning thereby that IPMS was definitely effective in bringing down the perception of burden among caregivers . | Table No.1: Comparison of burden scores of subjects before and after Intervention (n=30)
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As shown in [Table 2], there was significant difference in pre and post intervention perception of burden in caregivers of depressed patients having risk for suicide (p = 0.001). Maximum change in burden scores was observed in the areas of burden related to suicidal ideation in patient, social support, physical and mental health of caregiver and patient behaviour. | Table No. 2: Comparison of the total burden scores of caregivers before and after intervention (n=30)
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| Discussion | | |
Caregivers of depressed patients having risk for suicide reported immense burden(high level of burden score; mean score of 128, maximum score was 156). Most (15 out of 30) of the caregivers reported very severe burden.
In this study, Interventional Protocol for Managing Suicidality was prepared and implemented with caregivers of depressed patients having risk for suicide. There is significant difference in pre and post intervention perception of burden in caregivers of depressed patients having risk for suicide (p = 0.001).There is significant difference in pre and post intervention scores in the perception of burden in the areas of financial burden, patient behaviour, physical and mental health of caregiver, social support and burden related to suicidal ideation in patient. Maximum change was seen in the perception of burden in the area of burden related to suicidal ideation in patient after exposure to IPMS.
Higher levels of patient’s behavioral problems and insufficient support from family members and mental health professionals related to the caregiving role were associated with higher levels of caregiver’s depressive symptomatology and higher level of burden[6].Greater the frequency of client behavioral symptoms and lower the amount of perceived support from family members the higher was the level of overall caregiver’s burden[9].The present study also reported that caregivers had significant amount of burden in the areas of patient behaviour, physical and mental health of caregiver, family relations and social support.
Reducing perception of burden of caregivers and enhancing their awareness of illness and its treatment could lead to adoption of more healthy coping styles by them. The findings of this study are in congruence with the study that suggests that short term family interventions if offered at the time of hospitalization can reduce caregiver burden and increase caregiver reward[8]. The present study reported significant decrease in perception of burden by caregivers of depressed patients having risk for suicide after exposure to the intervention (IPMS).
| Conclusion | | |
After exposure to IPMS, the caregivers felt more confidents to manage their sick relative having risk of suicide. Specialized training in conducting IPMS should be organized for nurses working in all the inpatient services where patients with suicidal risk are kept as it helps to reduce the perception of burden in the caregivers. There will be decrease in number of admissions as the caregivers would be able to manage the patients at home after undergoing training such as IPMS.
| References | | |
| 1. | Global Burden of Disease study, W.H.O, 2005.  |
| 2. | Sokero TP, Melartin TK, Rytsala HG, Leskela US, Lestela Mielonon PS, Isometsa ET. Suicidal ideation and attempts among psychiatric patients with major depressive disorder. J Clin Psychiatry. 2003 Sep;64(9):1094-100. |
| 3. | Vuorilehto MS, Melartin TK, Isometsa ET. Suicidal behaviour among primary-care patients with depressive disorders. Psychol Med 2006 Feb;36(2):203-10. |
| 4. | Ostman M, Hansson L. Appraisal of caregiving, burden and psychological distress in relatives of psychiatric inpatients. EurPsychiatry 2004 Nov19(7):402-7. |
| 5. | Chessick CA, Perlick DA, Milklowitz DJ, Kaczynski R, Allen MH, Morris CD, Marangell LB. Current suicide ideation and prior suicide attempts of bipolar patients as influences on caregiver burden. Suicide Life Threat Behav. 2007 Aug;37(4):482-91. |
| 6. | Song LY, Biegel DE, Milligan SE. Predictors of depressive symptomatology among lower social class caregivers of persons with chronic mental illness. Community Ment Health J. 1997 Aug;33(4):269-86. |
| 7. | Ostwald SK, Hepburn KW, CaronW, Burns T, Mantell R. Reducing caregiver burden: a randomized psychoeducational intervention for caregivers of persons with dementia. Gerontologist. 1999 Jun;39(3):299-309. |
| 8. | Heru AM, Ryan CE. Burden, reward and family functioning of caregivers for relatives with mood disorders: 1-year follow-up. J Affect Disord. 2004 Dec;83(2-3):221-5. |
| 9. | Biegel DE, Milligan SE, Putnam PL, Song LY. Predictors of burden among lower socioeconomic status caregivers of persons with chronic mental illness. Community Ment Health J. 1994 Oct;30(5):473-94. |
[Table 1], [Table 2]
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