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A Study to Assess Care-Giver Burden and Quality of Life amongst Care-Givers of Patients Undergoing Periodic Haemodialysis

Journal of Research in Medical and Dental Science
eISSN No. 2347-2367 pISSN No. 2347-2545

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Research Article - (2022) Volume 10, Issue 10

A Study to Assess Care-Giver Burden and Quality of Life amongst Care-Givers of Patients Undergoing Periodic Haemodialysis

Ankan Paul*, Lakshmi Prabha and Raj Kumar

*Correspondence: Dr. Ankan Paul, Department of Psychiatry, Sree Balaji Medical College and Hospital, Tamil Nadu, Chennai, India, Email:

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Abstract

Introduction: A “care-giver” is a person who caters to the needs of another person with limitations due to illness, injury or disability. Excessive care-giver burden causes deterioration of health of care-giver, which in turn affects the patient. So, it is important to prevent build-up of care-giver burden for which it is necessary to understand factors affecting it.

Materials and methods: It is a cross sectional study done in the nephrology outpatient department. Socio demographic details, ZBI (Zant Burden Interview) and Wl to QOL BREF scale was used to assess the caregiver burden and QOL.

Results: Out of 60, 37% and 67% male and female participants respectively. There is a negative correlation between WHOQOL (BREF) and HADS and HARS score which is significant. ZBI score (care giver burden score) was highest for participants caregiving period of >5-10 years.

Conclusion: This study concludes that the care-giver wishes to be furnished with proper social aid and training concerning coping skills as the duration of caregiving period increases.

Keywords

Anxiety, Depression, Haemodialysis

Introduction

Chronic Kidney Disease (CKD) has emerged as a huge public challenge. It has not stopped at just that, but is slowly assuming catastrophic proportions. According to reliable estimates, the global prevalence of CKD. is about 850 million at this point in time [1]. The international society of nephrology states that the number of people requiring renal-replacement therapies is anywhere between 5.3-10.5 million. The most common renalreplacement therapy is “haemodialysis”, which according to conservative estimates is being offered to 3-4 million people worldwide [2]. About 130000 people undergo periodic haemodialysis in India alone and their number is increasing due to increased longevity and other factors. CKD is a complex condition to manage. It is important to understand that the effect of complexities in management of CKD patients undergoing periodic haemodialysis extend way beyond the patient and are expressed on their care-givers too [3]. “Caregiving” can be simply defined as providing help and support to someone in need of it. Although “health-professionals” are also care-givers in the truest sense, yet in general the term “care-giver” is reserved for non-professional or family care-givers. Here, “care” means spending significant amounts of energy and time to perform tasks that are physically, financially, emotionally and socially demanding. Care-giver burden encompasses the impact on physical, psychological, social, and financial well-being of the care-giver incurred due to caring for the patient [4].

Our study is focused on resolving this issue, by assessing the care-giver burden and quality of life in care-givers of patients undergoing haemodialysis and to bring forth the factors which affect them. We have also tried to find out the factors which lead to psychiatric morbidities in caregivers. We have also analysed the extent of correlation between care-giver burden, quality of life and psychiatric morbidities. We hope that our study would be of help to both health professionals and policy makers for formulating appropriate interventions for care-givers.

Materials and Methods

Study design: The study was designed as a cross-sectional study.

Study population: The study involved care-givers of the patients who were undergoing periodic haemodialysis at “department of nephrology, sree balaji medical college and hospital, Chennai”.

Sample size: Sample size=60.

Sampling criteria

Inclusion criteria

• Family care-givers of patients (close relatives who spend significant amount of time taking care of the patient) who are undergoing periodic haemodialysis.

• Care-givers with age more than 18 years, who willingly gave informed consent, were included in the study.

Exclusion criteria

• Care-givers known to be suffering from major chronic medical conditions like bronchial asthma, arthritis, cancer and cardiac disorders were excluded from the study.

• Care-givers with a previously diagnosed psychiatric disorder were excluded from the study.

Study methodology

The steps involved in conducting the study were as following:

• Approval for the study was obtained from “institutional human ethical committee”.

Age

• A pilot-study was carried out to assess feasibility of the study and to know about the requirements.

• Informed consent was obtained from willing participants.

• Data collection was done using data collection instruments.

• Statistical analysis of the data was performed.

• Results and interpretations are being expressed.

Instruments used

• Socio-demographic clinical preformat

• Zant Burden Interview (ZBI)

• WHO-Quality of Life BREF scale (WHO-QOL-BREF)

• Hamilton Rating Scale for Deprusion (HARF-D)

• Hamilton Anxiety Rating Scale (HARS)

Results

Socio-demographic analysis of study 0079 sample with respect to:

Table 1 shows the age wise description of study sample. 29 participants were in the age group of 45-60 years. 18. participants were aged between 25-<45 years. Minimum age of participants was 19 years and their maximum age was 82 years. Mean age of participants was 45.95 years.

Age group Number of participants Mean age Median age Standard deviation 95% Confidence interval
<25 years 5 45.95 years 46.5 years 13.035 years 45.95 ± 3.298
25-<45 years 18
45-60 years 29
>60 years 8
Total 60

Table 1: Age wise descriptive analysis of study sample.

Table 2 shows the care-giving period wise description of study sample. 31 participants had been care-givers for 0-5 years, whereas 23 participants had been care-givers for >5-10 years. 6 participants had care-giving period of >10 years. Minimum care-giving period among participants was 6 months and maximum care-giving period was 15 years. Mean care-giving period was 5.565 years. 18 participants had physical morbidities. Out of these 18 participants, 11 participants suffered from only diabetes mellitus; 3 participants were diagnosed with only hypertension; and 3 participants were both diabetic and hypertensive. 1 participant among the 18 participants with physical comorbidities was suffering from both diabetes mellitus and hypothyroidism.

Care- giving period Number of participants Mean care- giving period Median care- giving period Standard deviation 95% Confidence interval
0-5 years 31 5.565 years 5 years 3.727 years 5.565 ± 0.943 years
>5-10 years 23
>10 years 6
Total 60

Table 2: Care-giving period wise descriptive analysis of study sample.

Zarit Burden Interview (ZBI) based analysis of study sample with respect to:

Table 3 shows the gender-wise analysis of ZBI scores of study sample. Mean score for male participants was 47.636, whereas mean score for female participants was 46.763.

Gender Mean ZBI score Median ZBI score Standard deviation 95% Confidence interval
Male 47.636 43.5 9.767 47.636 ± 4.082
Female 46.763 43 11.244 46.763 ± 3.575
All 47.083 43 10.735 47.083 ± 2.716

Table 3: Gender-wise analysis of ZBI scores of study sample.

Table 4 shows the gender-wise distribution of ZBI categories in study sample. 25 female participants fell in the category of moderate to severe burden compared to 14 male participants. 9 female participants scored in the category of severe burden compared to 6 male participants.

  Gender  
Burden category Male Female All
Little or no burden 0 2 2
Mild to moderate burden 2 2 4
Moderate to severe burden 14 25 39
Severe burden 6 9 15
Total 22 38 60

Table 4: Gender-wise distribution of ZBI categories in study sample.

No statistically significant association (p-value=0.806) was found between gender of participants and their distribution among ZBI categories.

Table 5 shows the age wise analysis of ZBI scores of study sample. Mean score was highest (50.344) for participants aged between 45-60 years, whereas it was lowest (39.000) for participants aged <25 years.

Age group Mean ZBI score Median ZBI score Standard deviation 95% Confidence interval
<25 years 39 41 5.761 39 ± 5.051
25 = 45 years 45.166 43 8.732 45.166 ± 4.034
45-60 years 50.344 47 11.039 50.344 ± 4.018
>60 years 44.625 45.5 11.682 44.625 ± 8.096
All 47.083 43 10.735 47.083 ± 2.716

Table 5: Age wise analysis of ZBI scores of study sample.

Table 6 shows the age wise distribution of ZBI categories in study sample. 16 participants in age group of 45-60 years fell in the category of moderate to severe burden, whereas 14 participants aged between 25 ≤ 45 years scored in the same category. 12 participants aged between 45-60 years scored in the category of severe burden.

  Age group  
Burden category <25 Years 25 = 45 Years 45-60 Years >60 Years ALL
Little or no burden 0 0 1 1 2
Mild to moderate burden 2 2 0 0 4
Moderate to severe burden 3 14 16 6 39
Severe burden 0 2 12 1 15
Total 5 18 29 8 60

Table 6: Age wise distribution of ZBI categories in study sample.

Statistically significant association (p-value=0.014) was found between age of participants and their distribution among ZBI categories.

Table 7 shows the care-giving period wise analysis of ZBI scores of study sample. Mean score was highest (52.173) for participants with care-giving period of >5-10 years, whereas it was lowest (43.612) for participants with care-giving period of 0-5 years.

Care-giving period Mean ZBI score Median ZBI score Standard deviation 95% Confidence interval
0-5 years 43.612 42 8.146 43.612 ± 2.868
>5-10 years 52.173 61 12.397 52.173 ± 5.067
>10 years 45.5 43.5 7.5 45.500 ± 6.001
All 47.083 43 10.735 47.083 ± 2.716

Table 7: Care-giving period wise analysis of ZBI scores of study sample.

Table 8 shows the care-giving period wise distribution of ZBI categories in study sample. 27 participants with caregiving period of 0-5 years fell in the category of moderate to severe burden, whereas 12 participants with caregiving period of >5-10 years scored in the category of severe burden.

  Care-giving period  
Burden category 0-5 Years >5-10 Years >10 Years ALL
Little or no burden 1 1 0 2
Mild to moderate burden 1 2 1 4
Moderate to severe burden 27 8 4 39
Severe Burden 2 12 1 15
Total 31 23 6 60

Table 8: Care-giving period wise distribution of ZBI categories in study sample.

Statistically significant association (p-value=0.0005) was found between care-giving period of participants and their distribution among ZBI categories.

Table 9 shows the physical morbidities-wise analysis of ZBI scores of study sample. Mean score for participants who had physical morbidities was 48.388, whereas mean score for participants without physical morbidities was 46.523.

Physical morbidities Mean ZBI score Median ZBI score Standard deviation 95% Confidence interval
Present 48.388 46.5 7.265 48.388 ± 3.357
Absent 46.523 42.5 11.872 46.523 ± 3.591
All 47.083 43 10.735 47.083 ± 2.716

Table 9: Physical morbidities-wise analysis of ZBI scores of study sample.

Table 10 shows the physical morbidities wise distribution of ZBI categories in study sample. 15 participants with physical morbidities fell in category of moderate to severe burden, whereas 24 participants12 participants without physical morbidities fell in category of severe burden.

  Physical morbidities  
Burden category Present Absent All
Little or no burden 0 2 2
Mild to moderate burden 0 4 4
Moderate to severe burden 15 24 39
Severe burden 3 12 15
Total 18 42 60

Table 10: Physical morbidities-wise distribution of ZBI categories in study sample.

Gender

without physical morbidities scored in the same category.

World Health Organisation-Quality of Life BREF (W.H.O.-QoL BREF) based analysis of study sample with respect to:

Table 11 shows the gender-wise analysis of W.H.O.-QoL BREF scores of study sample. Mean score for male participants was 63.318, whereas mean score for female participants was 56.473.

Gender Mean W.H.O.-QoL BREF score Median W.H.O.-QoL BREF score Standard deviation 95% Confidence interval
Male 63.318 65.5 16.57 63.318 ± 6.924
Female 56.473 57 14.41 56.473 ± 4.582
All 58.983 58 15.591 58.983 ± 3.945

Table 11: Gender-wise analysis of W.H.O.-QoL BREF scores of study sample.

Table 12 shows the gender-wise distribution of W.H.O.- QoL BREF categories in study sample. 29 female participants scored in the category of ≤ 60/120 compared to 10 male participants. 9 female participants scored in the category of >60/120 compared to 12 male participants.

  Gender  
W.H.O.-QoL BREF category Male Female All
= 60/120 10 29 39
>60/120 12 9 21
Total 22 38 60

Table 12: Gender-wise distribution of W.H.O.-QoL BREF categories in study sample.

Statistically significant association (p-value=0.024) was found between gender of participants and their distribution among W.H.O.-QoL BREF categories.

Table 13 shows the age wise analysis of W.H.O.-QoL BREF scores of study sample. Mean score was highest (80.400) for participants aged <25 years, whereas it was lowest (51.103) for participants aged 45-60 years.

Age group Mean W.H.O.- QoL BREF score Median W.H.O.- QoL BREF score Standard deviation 95% Confidence interval
<25 years 80.4 79 9.35 80.400 ± 8.196
25 = 45 years 63.055 60 12.664 63.055 ± 5.851
45-60 years 51.103 54 12.554 51.103 ± 4.569
>60 years 65 65.5 15.842 65.000 ± 10.979
All 58.983 58 15.591 58.983 ± 3.945

Table 13: Age wise analysis of W.H.O.-QoL BREF scores of study sample.

Table 14 shows the age wise distribution of W.H.O.-QoL BREF categories in study sample. 27 participants in age group of 45-60 years scored in the category of ≤ 60/120, whereas 9 participants aged between 25 ≤ 45 years scored in the same category. 2 participants aged between 45-60 years scored in the category of severe >60/120.

  Age group  
W.H.O.-QoL BREF <25 years 25 = 45 years 45-60 years >60 years All
CATEGORY          
= 60/120 0 9 27 3 39
>60/120 5 9 2 5 21
Total 5 18 29 8 60

Table 14: Age wise distribution of W.H.O.-QoL BREF categories in study sample.

Statistically significant association (p-value=0.000004) was found between age of participants and their distribution among W.H.O.-QoL BREF categories.

Table 15 shows the care-giving period wise analysis of W.H.O.-QoL BREF scores of study sample. Mean score was highest (67.500) for participants with care-giving period of >10 years, whereas it was lowest (51.304) for participants with care-giving period of >5-10 years.

Care- giving period Mean W.H.O.- QoL BREF score Median W.H.O.- QoL BREF score Standard deviation 95% Confidence interval
0-5 years 63.032 58 12.418 63.032 ± 4.372
>5-10 years 51.304 43 16.321 51.304 ± 6.670
>10 years 67.5 71 15.152 67.500 ± 12.124
All 58.983 58 15.591 58.983 ± 3.945

Table 15: Care-giving period wise analysis of W.H.O.-QoL BREF scores of study sample.

Table 16 shows the care-giving period wise distribution of W.H.O.-QoL BREF categories in study sample. 19 participants with care-giving period of >5-10 years scored in the category of ≤ 60/120, whereas 18 participants with care-giving period of 0-5 years scored in the same category. 13 participants with care-giving period of 0-5 years scored in the category of >60/120. Statistically significant association (p-value=0.039) was found between care-giving period of participants and their distribution among W.H.O.-QoL BREF categories.

  Care-giving period  
W.H.O.-QoL BREF 0-5 years >5-10 years >10 years All
Category        
= 60/120 18 19 2 39
>60/120 13 4 4 21
Total 31 23 6 60

Table 16: Care-giving period wise distribution of W.H.O.-QoL BREF categories in study sample.

Physical morbidities

Table 17 shows the physical morbidities-wise analysis of W.H.O.-QoL BREF scores of study sample. Mean score for participants who had physical morbidities was 53.500,whereas mean score for participants without physical morbidities was 61.333.

Physical morbidities Mean W.H.O.-QoL BREF score Median W.H.O.-QoL BREF score Standard deviation 95% Confidence interval
Present 53.5 55.5 9.245 53.500 ± 4.271
Absent 61.333 59 17.094 61.333 ± 5.170
All 58.983 58 15.591 58.983 ± 3.945

Table 17: Physical morbidities-wise analysis of W.H.O.-QoL BREF scores of study sample.

Table 18 shows the physical morbidities-wise distribution of W.H.O.-QoL BREF categories in study sample. 16 participants with physical morbidities scored in category of ≤ 60/120, whereas 23 participants without physical morbidities scored in the same category. 19 participants without physical morbidities scored in category of >60/120.

  Physical morbidities  
W.H.O.-QoL BREF Present Absent All
Category      
= 60/120 16 23 39
>60/120 2 19 21
Total 18 42 60

Table 18: Physical morbidities-wise distribution of W.H.O.-QoL BREF categories in study sample.

Statistically significant association (p-value=0.016) was found between presence or absence of physical morbidities in participants and their distribution among W.H.O.-QoL BREF categories.

Hamilton Depression Rating Scale (HDRS) based analysis of study sample with respect to:

Gender

Table 19 shows the gender-wise analysis of HDRS scores of study sample. Mean score for male participants was 5.954, whereas mean score for female participants was 8.815.

Gender Mean HDRS score Median HDRS  score Standard deviation 95% Confidence interval
Male 5.954 3.5 4.847 5.954 ± 2.026
Female 8.815 8 5.481 8.815 ± 1.743
All 7.766 8 5.435 7.766 ± 1.375

Table 19: Gender-wise analysis of HDRS scores of study sample.

Table 20 shows the gender-wise distribution of HDRS categories in study sample. 18 female participants fell in the category of mild depression compared to 4 male participants. 12 female participants scored in the category of normal compared to 15 male participants.

  Gender  
HDRS category Male Female ALL
Normal 15 12 27
Mild depression 4 18 22
Moderate depression 3 5 8
Severe depression 0 3 3
Total 22 38 60

Table 20: Gender-wise distribution of HDRS categories in study sample.

Statistically significant association (p-value=0.022) was found between gender of participants and their distribution among HDRS categories.

Age

Table 21 shows the age wise analysis of HDRS scores of study sample. Mean score was highest (9.931) for participants aged between 45-60 years, whereas it was lowest (2.400) for participants aged <25 years.

Age group Mean HDRS score Median HDRS score Standard deviation 95% Confidence interval
<25 years 2.4 2 2.059 2.400 ± 1.805
25 = 45 years 6.944 5 5.115 6.944 ± 2.363
45-60 years 9.931 9 5.735 9.931 ± 2.087
>60 years 6.625 6 4.385 6.625 ± 3.039
All 7.766 8 5.435 7.766 ± 1.375

Table 21: Age wise analysis of HDRS scores of study sample.

Table 22 shows the age wise distribution of HDRS categories in study sample. 13 participants in age group of 45-60 years fell in the category of mild depression, whereas 7 participants aged between 25 ≤ 45 years scored in the same category. 3 participants aged between 45-60 years scored in the category of severe depression.

  Age group  
HDRS Category <25 years 25 = 45 years 45-60 years >60 years All
Normal 5 10 7 5 27
Mild depression 0 7 13 2 22
Moderate depression 0 1 6 1 8
Severe depression 0 0 3 0 3
Total 5 18 29 8 60

Table 22: Age wise distribution of HDRS categories in study sample.

No statistically significant association (p-value=0.078) was found between age of participants and their distribution among HDRS categories.

Care-giving period

Table 23 shows the care-giving period wise analysis of HDRS scores of study sample. Mean score was highest (10.478) for participants with care-giving period of >5-10 years, whereas it was lowest (5.333) for participants with care-giving period of >10 years.

Care-giving period Mean HDRS score Median HDRS score Standard deviation 95% Confidence interval
0-5 years 6.225 7 4.148 6.225 ± 1.460
>5-10 years 10.478 11 6.219 10.478 ± 2.542
>10 years 5.333 5 3.448 5.333 ± 2.759
All 7.766 8 5.435 7.766 ± 1.375

Table 23: Care-giving period wise analysis of HDRS scores of study sample.

Table 24 shows the care-giving period wise distribution of HDRS categories in study sample. 13 participants with care-giving period of 0-5 years fell in the category of mild depression, whereas 7 participants with care-giving period of >5-10 years scored in the same category. 6 participants with care-giving period of >5-10 years fell in category of moderate depression. No statistically significant association (p-value=0.078) was found between care-giving period of participants and their distribution among HDRS categories.

  Care-giving period  
HDRS category 0-5 years >5-10 years >10 years All
Normal 16 7 4 27
Mild depression 13 7 2 22
Moderate depression 2 6 0 8
Severe depression 0 3 0 3
Total 31 23 6 60

Table 24: Care-giving period wise distribution of HDRS categories in study sample.

Physical morbidities

Table 25 shows the physical morbidities-wise analysis of HDRS scores of study sample. Mean score for participants who had physical morbidities was 9.277, whereas mean score for participants without physical morbidities was 7.119.

Physical morbidities Mean HDRS score Median HDRS score Standard deviation 95% Confidence interval
Present 9.277 8 3.969 9.277 ± 1.834
Absent 7.119 5.5 5.835 7.119 ± 1.765
All 7.766 8 5.435 7.766 ± 1.375

Table 25: Physical morbidities-wise analysis of HDRS scores of study sample.

Table 26 shows the physical morbidities-wise distribution of HDRS categories in study sample. 12 participants with physical morbidities fell in category of mild depression, whereas 10 participants without physical morbidities scored in the same category. 24 participants without physical morbidities had normal scores.

  Physical morbidities  
HDRS category Present Absent All
Normal 3 24 27
Mild depression 12 10 22
Moderate depression 2 6 8
Severe depression 1 2 3
Total 18 42 60

Table 26: Physical morbidities-wise distribution of HDRS categories in study sample.

Statistically significant association (p-value=0.006) was found between presence or absence of physicalmorbidities in participants and their distribution among HDRS categories

Hamilton Anxiety Rating Scale (HARS) based analysis of study sample with respect to:

Gender

Table 27 shows the gender-wise analysis of HARS scores of study sample. Mean score for male participants was 12.045, whereas mean score for female participants was 19.131.

Gender Mean HARS score Median HARS score Standard deviation 95% Confidence interval
Male 12.045 8 8.126 12.045 ± 3.396
Female 19.131 24 10.374 19.131 ± 3.299
All 16.533 16.5 10.2 16.533 ± 2.581

Table 27: Gender-wise analysis of HARS scores of study sample.

Table 28 shows the gender-wise distribution of HARS categories in study sample. 17 female participants fell in the category of moderate to severe anxiety compared to 2 male participants. 2 female participants scored in the category of severe anxiety.

  Gender  
HARS category Male Female All
No to mild anxiety 16 14 30
Mild to moderate anxiety 4 5 9
Moderate to severe anxiety 2 17 19
Severe anxiety 0 2 2
Total 22 38 60

Table 28: Gender-wise distribution of HARS categories in study sample.

Statistically significant association (p-value=0.006) was found between gender of participants and their distribution among HARS categories.

Age

Table 29 shows the age wise analysis of HARS scores of study sample. Mean score was highest (20.965) for participants aged between 45-60 years, whereas it was lowest (5.800) for participants aged <25 years.

Age group Mean HARS score Median HARS score Standard deviation 95% Confidence interval
<25 years 5.8 5 3.37 5.800 ± 2.954
25 = 45 Years 13.222 8 8.689 13.222 ± 4.014
45-60 years 20.965 25 9.803 20.965 ± 3.568
>60 years 14.625 12 9.136 14.625 ± 6.332
All 16.533 16.5 10.2 16.533 ± 2.581

Table 29: Age wise analysis of HARS scores of study sample.

Table 30 shows the age wise distribution of HARS categories in study sample. 8 participants in age group of 45-60 years fell in the category of mild to moderate anxiety, whereas 12 participants aged between 25 ≤ 45 years scored in the same category. 14 participants aged betssssween 45-60 years scored in the category of moderate to severe anxiety.

  Age group  
HARS CATEGORY <25 years 25 = 45 years 45-60 years >60 years All
No to mild anxiety 5 12 8 5 30
Mild to moderate anxiety 0 3 5 1 9
Moderate to severe anxiety 0 3 14 2 19
Severe anxiety 0 0 2 0 2
Total 5 18 29 8 60

Table 30: Age wise distribution of HARS categories in study sample.

No statistically significant association (p-value=0.067) was found between age of participants and their distribution among HARS categories.

Care-giving period

Table 31 shows the care-giving period wise analysis of HARS scores of study sample. Mean score was highest (21.173) for participants with care-giving period of >5-10 years, whereas it was lowest (12.000) for participants with care-giving period of >10 years.

Care-giving period Mean HARS score Median HARS score Standard deviation 95% Confidence interval
0-5 years 13.967 10 9.092 13.967 ± 3.201
>5-10 years 21.173 26 10.651 21.173 ± 4.353
>10 years 12 10 6.429 12.000 ± 5.144
ALL 16.533 16.5 10.2 16.533 ± 2.581

Table 31: Care-giving period wise analysis of HARS scores of study sample.

Table 32 shows the care-giving period wise distribution of HARS categories in study sample. 8 participants with care-giving period of 0-5 years fell in the category of moderate to severe anxiety, whereas 11 participants with care-giving period of >5-10 years scored in the same category. 2 participants with care-giving period of >5-10 years fell in category of severe anxiety. 19 participants with care-giving period of 0-5 years scored in category of no to mild anxiety.Statistically significant association (pvalue= 0.045) was found between care-giving period of participants and their distribution among HARS categories.

  Care-giving period  
HARS category 0-5 years >5-10 years >10 years All
No to mild anxiety 19 7 4 30
Mild to moderate anxiety 4 3 2 9
Moderate to severe anxiety 8 11 0 19
Severe anxiety 0 2 0 2
Total 31 23 6 60

Table 32: Care-giving period wise distribution of HARS categories in study sample.

Physical morbidities

Table 33 shows the physical morbidities-wise analysis of HARS scores of study sample. Mean score for participants who had physical morbidities was 22.388, whereas mean score for participants without physical morbidities was 14.023.

Physical morbidities Mean HARS score Median HARS score Standard deviation 95% Confidence interval
Present 22.388 25 7.454 22.388 ± 3.444
Absent 14.023 8 10.189 14.023 ± 3.082
All 16.533 16.5 10.2 16.533 ± 2.581

Table 33: Physical morbidities-wise analysis of HARS scores of study sample.

Table 34 shows the physical morbidities-wise distribution of HARS categories in study sample. 10 participants with physical morbidities fell in category of moderate to severe anxiety, whereas 9 participants without physical morbidities scored in the same category. 6 participants without physical morbidities fell in category of mild to moderate anxiety. 26 participants without physical morbidities scored in category of no to mild anxiety.

  Physical morbidities  
HARS category Present Absent All
No to mild anxiety 4 26 30
Mild to moderate anxiety 3 6 9
Moderate to severe anxiety 10 9 19
Severe anxiety 1 1 2
Total 18 42 60

Table 34: Physical morbidities-wise distribution of HARS categories in study sample.

Discussion

Our study sample consisted of 37% male participants and 63% female participants. The study by Nagarathnam,et al. had a sample with 84% of care-givers being females. This observation of majority of care-givers being of female gender was consistent with most other studies In the study by Joy, et al. 30% of participants had been in caregiving role for <1 year, whereas 36.70% of participants had been care-givers for a duration of 1-3 years [5]. 30% of care-givers suffered from one or more physical morbidities, whereas 70% of them had no physical morbidities [6]. In our study which is in accordance with a study done by Hoang, et al. 36.50% of participants had been suffering from chronic health conditions, while the study by Cagan, et al. reported that 45.39% of participants were suffering from at least one chronic health condition. Thus, socio-demographic description of the current study was in tune with previous studies, especially those that had been conducted in India [7].

A statistically significant strong negative correlation was established between W.H.O.-QOL BREF scores and HDRS scores (r=-0.896, p-value ≤ 0.000001). The study by Shukri, et al. reported comparable findings, where an inverse relationship was found between quality of life and presence of depression [8]. Thus, with decline in quality of life the extent of depression increases. This may be a reflection of effect of caregiver burden on quality of life. Mean ZBI scores was highest for participants aged 45-60 years (50.344) than those aged <25 years (39.000) significant association (p=0.014) was found between the age of participants and their distribution among ZBI categories. A statistically significant strong negative correlation was established between W.H.O.-QoL BREF scores and HARS scores (r=-0.852, p-value ≤ 0.000001). The study by Shukri, et al. presented similar findings, where an inverse relationship was observed between quality of life and presence of anxiety. Thus, with decline in quality of life the extent of anxiety increases [9]. This may be a reflection of effect of caregiver burden on quality of life. Thus, status of mental health is deteriorated with decline in quality of life. This could be caused due to the effect of caregiver burden on quality of life

Conclusion

Excess caregiver burden causes deterioration in quality of life of the care-giver, which causes depression and anxiety in them. Hence, the care-giver needs to be provided with proper social support and education regarding coping skills. A multi-faceted approach would be required to improve the quality of life of care-givers, which in turn would improve quality of life of patients.

Reference

Author Info

Ankan Paul*, Lakshmi Prabha and Raj Kumar

Department of Psychiatry, Sree Balaji Medical College and Hospital, Tamil Nadu, Chennai, India
 

Citation: Ankan Paul, Lakshmi Prabha, Raj Kumar, A Study to Assess Care-Giver Burden and Quality of Life amongst Care-Givers of Patients Undergoing Periodic Haemodialysis, J Res Med Dent Sci, 2022, 10 (10): 034-045.

Received: 29-Jul-2022, Manuscript No. JRMDS-22-53398; , Pre QC No. JRMDS-22-53398(PQ); Editor assigned: 01-Aug-2022, Pre QC No. JRMDS-22-53398(PQ); Reviewed: 16-Aug-2022, QC No. JRMDS-22-53398; Revised: 30-Sep-2022, Manuscript No. JRMDS-22-53398(R); Published: 10-Oct-2022

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