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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 35  |  Issue : 2  |  Page : 66-70

Impact of mothers with depression, schizophrenia or epilepsy on family functioning


Department of Neuropsychiatry, Faculty of Medicine, Suez Canal University, Ismailia, Egypt

Date of Submission26-Feb-2014
Date of Acceptance06-Mar-2014
Date of Web Publication11-Jun-2014

Correspondence Address:
MD Mona ELsayed
Department of Neuropsychiatry, Faculty of Medicine, Suez Canal University, Ismailia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-1105.134191

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  Abstract 

Objective
To evaluate and compare the impact of mothers with depression, schizophrenia or epilepsy on the family function.
Background
Family is the most important context of an individual. The primary function of a family unit is to provide a setting for the development and maintenance of family members on the social, psychological and biological levels.
Methods
After approval of our ethics committee, this cross-sectional study was conducted among a total of 153 families of mothers with depression, schizophrenia and epilepsy (51 families for each group) who attended the Suez Canal University outpatient clinic. All patients were subjected to clinical interview for the diagnosis of major depressive disorder and schizophrenia according to Diagnostic and Statistical Manual of Mental Disorders, 4th ed. criteria and Family Assessment Device (Arabic version).
Results
There was significant unhealthy family function of mother with depression compared with healthy functioning regarding problem solving (88.2%), communication (84.3%), roles (68.6%), affective responsiveness (62.7%) and behavior control domains (86.3%). There was a significantly higher unhealthy functioning in all domains [problem solving (88.2%), communication (96.1%), roles (76.5%), affective responsiveness (70.6%) and involvement (76.5%), behavior control (94.1%), and general functioning (72.5%)] in mothers with schizophrenia compared with healthy functioning. There was a significantly higher unhealthy functioning in all domains [problem solving (86.3%), communication (86.3%), roles (94.1%), affective responsiveness (72.5%) and involvement (72.5%), behavior control (92.2%), and general functioning (66.7%)] in mothers with epilepsy compared with healthy functioning. There were no statistically significant differences of unhealthy functioning in most of the domains in mothers with depression, schizophrenia, and epilepsy, except in the roles domain.
Conclusion
There was an increased unhealthy functioning in most of the domains in mothers with depression, schizophrenia and epilepsy compared with healthy functioning. There were no differences of unhealthy functioning in most of the domains in the mothers with depression, schizophrenia, and epilepsy, except in the roles domain.

Keywords: depression, epilepsy, family functioning, schizophrenia


How to cite this article:
AbdEl-Moez K, ELsayed M, Fahmy MT, Haggag WE. Impact of mothers with depression, schizophrenia or epilepsy on family functioning. Egypt J Psychiatr 2014;35:66-70

How to cite this URL:
AbdEl-Moez K, ELsayed M, Fahmy MT, Haggag WE. Impact of mothers with depression, schizophrenia or epilepsy on family functioning. Egypt J Psychiatr [serial online] 2014 [cited 2021 Dec 6];35:66-70. Available from: http://new.ejpsy.eg.net/text.asp?2014/35/2/66/134191


  Introduction Top


Family is the most important context of an individual. The primary function of a family unit is to provide a setting for the development and maintenance of family members on the social, psychological, and biological levels (Epstein et al., 1982).

There is one study revealed worse family function in families in which the mothers had chronic mental and physical disorders when compared with the normal controls. However, when dimensions of family function were considered, different cultures had different patterns of dysfunction (Keitner et al., 1986).

Major depression (MD) is the most common of all psychiatric disorders according to the National Comorbidity Survey (Kessler et al., 1994).

Depression is a family issue. It is associated with a host of adverse outcomes for individual family members including very young children as well as problematic functioning for the family as a whole. Depressed mothers often report more dissatisfaction in relationships with their spouses and children (Grace et al., 2003).

Schizophrenia is a chronic mental illness. It begins mainly in adolescence or in young adulthood and disturbs the educational, social, and professional life of the patient significantly. Schizophrenia has a devastating impact on all members of the family (Jalensky, 1996).

There are two types of burden for family caretakers: objective and subjective. Objective burden includes effects on the finances, health, and leisure of the family, and subjective burden deals with feelings, such as depression or anxiety that occur as a result of the patient's illness (Kumar et al., 1992).

Epilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizures. Epilepsy has frequently been found to have a significant negative impact on family, both for adults (i.e. marriage and family life), and for children with epilepsy and their siblings (Fisher et al., 2005).


  Patients and methods Top


Study design

A cross-sectional study.

Study site

The study was carried out in the Suez Canal University psychiatric outpatient clinic.

Study population

  1. Mothers with major depressive disorder and schizophrenia who were following up at the outpatient clinic and were diagnosed by clinical interview according to Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria.
  2. Mothers with intractable epilepsy who had two antiepileptic drug failures, at least one seizure per month for 18 months, and no seizure-free periods longer than 3 months during that time, according to the computerized electroencephalogram (EEG) abnormality and clinical picture.


Inclusion criteria

  1. Mothers who were diagnosed according to DSM-IV criteria as having major depressive disorder or schizophrenia.
  2. Mothers who were diagnosed according to the EEG abnormality and clinical picture as having intractable epilepsy.
  3. Age from 18 to 45 years old.
  4. Family members (husband, children) living with the patient were included in the study.
  5. Duration of the illness in each of the groups was more than 2 years.


Exclusion criteria

  1. Unwilling to participate in the study.
  2. Major depressive disorder with psychotic symptoms.
  3. Comorbidity with general medical condition (chronic illness).
  4. Comorbidity with other psychiatric disorder.
  5. Substance abuse.
  6. Family members having chronic physical illness, past/current psychiatric illness, taking care of more than one chronically ill person in the family.
  7. Mothers or family caregivers who are illiterate.


Sample design

All patients who fulfill the inclusion criteria were included in this study.

Sample size

Survey data from 1999 indicate that ∼69% of depressed individuals reported significant family problems (Friedmann et al., 1997).

Accordingly, the following equation was used (Hedlund and Viewig, 1979):



where n is the sample size; p, the expected prevalence = 69%; z, the critical value that determines the area underlying 95% of the population on a normal distribution curve = 1.96; q = (1-p); and E, desired precision.

Therefore, sample size = 1.96 2 × 0.69 × 0.31/0.135 2 = 45.6-46

The expected drop-out was 10%, and so the total sample size will be: n = 46 × (110/100) = ∼51.

Hence, the calculated sample size was 51 for each of the comparison groups.

Method

  1. All patients were subjected to clinical interview for the diagnosis of major depressive disorder and schizophrenia according to DSM-IV criteria.
  2. All patients and their families were subjected to assessment of sociodemographic data.
  3. A pilot study was conducted on 10 patients and questions were found to be understandable and easy to answer.


All patients and their families were subjected to

  1. Family Assessment Device (FAD; version 3) (Arabic version) (Wilson and Okasha, 2007).
  2. The FAD (Epstein et al., 1983) is designed to assess family functioning on each dimension of the McMaster Model according to individual family members' own perception of their family's functioning. The FAD consists of the six subscales (i.e. Problem Solving, Communication, Roles, Affective Responsiveness, Affective Involvement, and Behavior Control) as well as a General Functioning scale that measures the overall level of the family's functioning.
  3. The FAD is made up of a total of 60 statements, geared to an eighth grade reading level, which describe various aspects of family functioning. Family members rate how well each statement describes their family by selecting among four responses: strongly agree, agree, disagree, and strongly disagree. Also, each of the items on the FAD belongs to only one scale, with some items describing healthy functioning, whereas others describe unhealthy functioning.
  4. Endorsed responses are coded 1-4 with a higher score indicating poorer functioning. In addition, scoring for negatively worded items is transformed. Responses of the items for each subscale are then summed and divided by the number of items answered in that scale. Established cut-off scores indicate healthy and unhealthy functioning.
  5. All family members over the age of 12 complete the questionnaire. The FAD takes ∼20 min to complete.
  6. Each statement should be read carefully before deciding how well it describes the family.


Data analysis

All the data were recorded in investigative report form. These data were transferred to an IBM card, using an IBM-compatible computer with statistical program (statistical package for social sciences): IBM SPSS software unite state version 10:

Descriptive statistics

  1. Frequencies were used to describe both quantitative and qualitative variables.
  2. Mean and SD were used to describe quantitative variables only.


Analytic statistics

  1. The Student t-test was used to compare two means.
  2. The χ2 -test was used to examine the difference among many proportions at the level of 95%.


P-value indicates the level of significance:



P > 0.05 = nonsignificant;
P < 0.05 = significant;
P <0.01 = highly significant;
P < 0.001 = very highly significant.

Ethical consideration

  1. A brief explanation of the aim of the study was given to patients and their families stressing the importance of the data they were going to offer.
  2. Informed consent was obtained before the start of the study from patients and their families.
  3. Individuals were under no obligation to participate.
  4. The confidentiality of the collected data was ensured.
  5. Results of this study were used for the benefit of patients and their families.
  6. There was no harm or complication from this study as the patients and their families were subjected only to a FAD.



  Results Top


[Table 1] shows sociodemographic data of the mothers with depression, schizophrenia, and epilepsy. Most of mothers were more than 30-45 years old, married, with middle level of education, unemployed, from the middle social class, and had a duration of illness of more than 5 years.
Table 1: Sociodemographic data of mothers with depression, schizophrenia, and epilepsy

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There was a significant unhealthy functioning in families of mothers with depression compared with healthy functioning regarding problem solving (88.2%), communication (84.3%), roles (68.6%), affective responsiveness (62.7%), and behavior control domains (86.3%) [Table 2].
Table 2: Family functioning in mothers with depression (n = 51)

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There was a significantly higher unhealthy functioning in all domains [problem solving (88.2%), communication (96.1%), roles (76.5%), affective responsiveness (70.6%) and involvement (76.5%), behavior control (94.1%), and general functioning (72.5%)] in mothers with schizophrenia compared with healthy functioning [Table 3].
Table 3: Family functioning in mothers with schizophrenia (n = 51)

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There was a significantly higher unhealthy functioning in all domains [problem solving (86.3%), communication (86.3%), roles (94.1%), affective responsiveness (72.5%) and involvement (72.5%), behavior control (92.2%), and general functioning (66.7%)] in mothers with epilepsy compared with healthy functioning [Table 4].
Table 4: Family functioning in mothers with epilepsy (n = 51)

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There were no statistically significant difference in unhealthy functioning in most of the domains in mothers with depression, schizophrenia and epilepsy, except in the roles domain. (It was significant in depression.) [Table 5].
Table 5: Comparison between unhealthy family functioning in mothers with depression, schizophrenia, and epilepsy

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  Discussion Top


Depression, schizophrenia, and epilepsy are common health problems. Many studies revealed worse family function in families of mothers with chronic mentaland physical disorders when compared with normalcontrols. Having a family member with psychiatric illness was a risk factor for poor family functioning (Friedmann et al., 1997).

The impact of MD on the wellbeing of family members has been relatively neglected for many years. However, some studies showed that MD influences parenting skills, especially in affected mothers, with a reduction of children's psychological wellbeing (Burke, 2003).

This study showed that families of depressed mothers had significant unhealthy family functioning in most of the domains.

Schizophrenia poses numerous challenges in its management and consequences, which affect family functioning. Schizophrenia is a chronic mental disorder associated with health, social, and financial burden for a long duration, affecting not only the patients but also their families, other caregivers, and the wider society (Figley and McCubbin, 1983).

Schizophrenia has a devastating impact on all members of the family. This study showed that families of schizophrenic mothers had significant unhealthy family functioning in all of the domains. This could be explained by cognitive deficits of psychotic patients, which lead to their negative perception about the problem-solving functioning of their family at the level that maintains effective family functioning (problem solving). Neurocognition is related to functional outcome. It is likely that some cognitive domains have direct, causal relationships, although others may be related to the functional outcome through mediators, such as social cognition or the application of knowledge and reasoning to problem solving (Weickert et al., 2000).

Epilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizures. Epilepsy has frequently been found to have a significant negative impact on family. Higher rates of divorce than the general population have also been found among patients with epilepsy (Fisher et al., 2005).

This study revealed that the numbers of epileptic mothers who had family dysfunction (problem solving, communication, roles, affective responsiveness and involvement, behavior control, and general functioning). This could be because of the general negative attitude toward patients with epilepsy. Epilepsy is considered as a highly contagious and shameful disease in this country. It imposes enormous physical, psychological, social, and economic burdens on individuals, families, and countries, especially because of the misunderstanding, the fear, and the stigma of epilepsy.

This study revealed that the numbers of epileptic mothers who had family dysfunction are higher in schizophrenia and epilepsy than in depression, but there were no statistically significant differences of unhealthy functioning in most of the domains (problem solving, communication, affective responsiveness and involvement, behavior control, and general functioning) in mothers with depression, schizophrenia, and epilepsy, except in the roles domain of family functioning.

Our results are similar to a Turkish study, which found that families of patients with bipolar disorder had healthier functioning than families of patients with schizophrenia and epilepsy. Schizophrenic patients reported problems in communication and behavioral control. Bipolar patients reported problem-solving and general functioning to be problematic, whereas patients with epilepsy perceived behavioral control and roles to be dysfunctional (Unal et al., 2004). [15]


  Acknowledgements Top


Conflicts of interest

None declared.

 
  References Top

1.Burke L (2003). The impact of maternal depression on familial relationships. Int Rev Psychiatry 15:243-255.  Back to cited text no. 1
    
2.Epstein NB, Bishop DS, Baldwin LM. F Walsh, ed. (1982). McMaster model of family functioning: a view of the normal family. Normal family processes. Guilford family therapy series 138-60.  Back to cited text no. 2
    
3.Epstein NB, Bishop DS, Baldwin LM (1983). The Mcmaster family assessment device. J Martial Fam Ther 9:171-180.  Back to cited text no. 3
    
4.Figley CR, McCubbin HI. Catastrophes (1983): an overview of family reactions by Charles Figley. Stress and the family. 2:3-20.  Back to cited text no. 4
    
5.Fisher RS, van Emde Boas W, Blume W, Elger C, Genton P, Lee P, Engel J Jr (2005). Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International Bureau for Epilepsy (IBE). Epilepsia 46:470-472.  Back to cited text no. 5
    
6.Friedmann MS, McDermut WH, Solomon DA, Ryan CE, Keitner GI, Miller IW (1997). Family functioning and mental illness: a comparison of psychiatric and nonclinical families. Fam Process 36:357-367.  Back to cited text no. 6
    
7.Grace SL, Evindar A, Stewart DE (2003). The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Arch Womens Ment Health 6:263-274.  Back to cited text no. 7
    
8.Hedlund JL, Viewig BW (1979). The Hamilton rating scale for depression: a comprehensive review. J Operat Psychiat 10:149-165.  Back to cited text no. 8
    
9.Jablensky A (1986). Epidemiology of schizophrenia: a European perspective. Schizophr Bull 12:52-73.  Back to cited text no. 9
    
10.Keitner GI, Miller IW,Ryan CE, Epstein NB, Bishop DS (1986). The functioning of families of inpatients with major depression. Int J Fam Psychiatry 7:11-15.  Back to cited text no. 10
    
11.Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 51:8-19.  Back to cited text no. 11
    
12.Kumar S, Sameul R, Prabhu R (1992). Schizophrenia and quality of life in relation to health and illness: socio cultural issues at World Ccongress of Social Psychiatry. New Delhi.  Back to cited text no. 12
    
13.Unal S, Kaya B, Cekem B, Oziºik HI, Cakil G, Kaya M (2004). Family functioning in patients with schizophrenia, bipolar affective disorder and epilepsy. Turk Psikiyatri Derg 15:291-299.  Back to cited text no. 13
    
14.Weickert TW, Goldberg TE, Gold JM, Bigelow LB, Egan MF, Weinberger DR (2000). Cognitive impairments in patients with schizophrenia displaying preserved and compromised intellect. Arch Gen Psychiatry; 57:907-913.  Back to cited text no. 14
    
15.Wilson A, Okasha T (2007). Family Assessment Device, version 3 Arabic version.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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Introduction
Patients and methods
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