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Indian Journal of Community Medicine

Epidemiological Study of Psychosocial Profile of Blind People

Author(s): S.V. Chincholikar

Vol. 31, No. 2 (2006-04 - 2006-06)

Abstract:

Objective: To study the risk factors in the psychosocial problems of blind people undertaking vocational training utilizing screening test S.R.Q. Study design: Cross sectional study. Participants: Blind people. Study Variables: Sex, socioeconomic status, literacy, psychiatric morbidity. Results: Recently introduced technique of Self Reporting Questionnaire referred as S.R.Q. was tested for its utility for screening of blind persons to detect possible psychiatric morbidity. It was observed that at cut off point 10, maximum sensitivity and specificity was found in various studies. A score of cut off point equal to or more than 10 was considered as S.R.Q. Positive subjects and less than 10 was considered as S.R.Q. negative subjects. S.R.Q. positive subjects were considered to be having probable psychiatric morbidity. It was observed that there were 14 S.R.Q. positive cases. The overall results of the above detailed tests brought some salient risk factors that can be strongly associated with psychosocial mal adjustments and psychiatric morbidities in the handicapped persons. These risk factors are SRQ positive subjects, Lower socioeconomic class, Rural residence, Illiteracy, Unmarried life and Socially non accepted subjects. These risk factors that emerged out of the statistical analysis of the data can be immensely useful in the planning stages of rehabilitation.

Key Words: S.R.Q., Psychiatric Morbidity, Socioeconomic class, Literacy, Social acceptance.

Introduction:

Application of public health principles to mental disorders was tried relatively recently, with the aim of expanding the mental health research beyond the mental health hospital and the psychiatric clinics. A very substantial lack of manpower trained in psychology, psychiatry, social sciences and related fields has been the real hurdle in this respect.1

In 1976 four studies were undertaken in developing countries by WHO in remote rural areas in India, Colombia, Senegal and Sudan. The main objective of these studies was to evaluate and effectiveness of alternative low-cost methods for providing mental health care in developing countries2. The various performa used in these WHO studies were further modified and designed in a simpler and shorter form by Harding et al in 1980. Which resulted in the currently used form of Self Reporting Questionnaire.2,3 S.R.Q. has been tested in various situations by B.Sen et al. Mari J and Williams P. and D. Chavan and Mohan Agashe and Dr. Chincholikar S.V.4-6,1 in their indigenously conducted studies.

S.R.Q. is commonly used as a tool for screening purpose. It is a self administered questionnaire. It is given to individual who is to be examined and answers are obtained as affirmative or negative. It is relatively inexpensive and requires little time. Therefore the present study was carried out in 2 institutions to study the risk factors in the psychosocial profile of blind people utilizing the above-mentioned psychological screening technique and suggest recommendations if any.

Materials and Methods

The study was conducted in two institutions from Jan '92 to Jan '93. These were Technical Training Institute of Blind Men, Poona Blind Men's Association, situated in Hadpasar, and the Poona School and Home for the blind girls situated near Kothrud. The respective authorities of above institutions admit blind subjects having inability to count fingers at a distance of 6 meters as certified by Civil Surgeon of the concerned district. Permission was obtained form respective authorities of above two institutions far conducting this study.

All the blind enrolled in above two institutions at the time of the study were included. Information was given to all blind included in the study about types of questions and answers were obtained by interview technique. Self Reporting Questionnaire, which was used consisted of 20 questions. Experience for scientific utilization of Self Reporting Questionnaire was obtained by working in the psychiatry department under the guidance of qualified psychiatrist. S.R.Q. has been tested thoroughly in various situations including the indigenous study conducted by Dhananjay Chavan and Mohan Agashe5 and Dr. Chincholikar S.V.1 It was on the basis of these reports, that S.R.Q. was used in the present study for screening of blind subjects to study the risk factors in the psychosocial profile of blind people.

Results and discussion

S.R.Q. score was calculated among blind subjects and subjects were classified as S.R.Q. positive and S.R.Q. negative. It can observed that 6.83% of study subjects were S.R.Q. positive indicating, that approximately 7% of study subjects possibly had psychiatric morbidity. It was observed, that subject having psychiatric morbidity belonged to diagnostic categories of ICD - 10 7classificatian of mental and behavioural disorders with morbidities such as disthymic disorder, mixed anxiety and depressive disorder, anxiety and dependent disorder and adjustment disorder as diagnosed by qualified psychiatrist.

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Bansal et al8 in their study observed, that visually handicapped subjects showed high scores in the areas of depression and tension. Fitzegerald9 in this study found, that blind goes through phases of disbelief, protest, depression and finally recovery. S.R.Q. can be used for screening of probable psychiatric morbidities as this technique is simple, rapid and can be undertaken by non technical lower level functionaries and can give results within short span of time.

It was observed that males were relatively more SRQ positive than females. The observed difference in the psychiatric morbidities in both the sexes could perhaps be due to difference in levels of exposure to socioeconomic stresses and frustrations outside the protection of the home Ray in 196210 and Sethe in 197711 observed higher percentage of male population registered at psychiatric facilities in India. Rudolf Pinter et al12 in their study of deaf observed that men were more neurotic and introverted than women.

None of the 63 urban dwellers showed presence of psychiatric morbidity as indicated by S.R.Q. negative subjects while 9.8% rural subjects showed S.R.Q. positivity. This would mean that blind subjects in rural area need more careful attention especially in the area of psychological counseling, for ensuring better results of rehabilitation process. The mental morbidity in revealed in various rural surveys among general population vary from 18.24 per thousand to 102.8 per thousand. The mental morbidity revealed in various urban surveys among general population vary from 0 per thousand to 38 per thousand.14,15

Table I: S.R.Q. Izesul'i's as Per Sociolconomic Status

Results Socioeconomic Class Total
I II III IV V
S.R.Q + ve 0 0 0 13 1 14
S.R.Q - ve 0 14 46 78 53 191
Total 0 14 46 91 54 205

Table I shows that S.R.Q. results as per socioeconomic status. None of the subjects from class lI and class III showed S.R.Q, positive. Owing to unacceptably small values in some of the cells of the table which would undermine the utility of x2 test the data for class II and class III ( upper and lower middle class) and that for class IV and class V were pooled for statistical analysis. When S.R.Q. results were co-related with socioeconomic status of the subjects there was statistically significant difference (P<0.05).

It appears that occurrence of psychiatric morbidity i.e. S.R.Q. positively, varies according to socio-economic status, as non of the blind subjects in class II and class III were SRQ positive while 14.28% of those in class IV showed presence of psychiatric morbidity.

It would mean, that as socio-economic status become better, SRQ positively decreases i.e. subjects belonging to lower socio-economic classes may have more risk of getting psychiatric maladjustments that those in the higher classes. This confirms, that socio-economic status is one of the important factors in deciding the probable psychiatric morbidity among blind subjects.

It is a known fact, that even in case of persons without any disabilities, the adverse socio-cultural factors present in the lower socio-economic classes make the subjects more vulnerable to psychiatric morbidities. Blindness or other handicaps further complicate the picture.

Several studies made in different parts of world have shown, that lower socio-economic classes have a higher rate of mental disorders. B. Sen. Et a116 in their study observed, that more than half of the families of social class V had psychiatric morbidity.

When SRQ results were correlated with literacy of blind subjects, it was observed that there was statistically significant difference between SRQ results in the 2 groups (P<0.001) (applying fisher's exact test, P=7.258 x 10-9). It appears that SRQ positivity was more in illiterates as compared to literates. As table reveals, that only 1.17% of literates were SRQ positive while 34.3% of illiterates were SRQ positive.

This would mean, that literacy is one of the crucial risk factors that decides the occurrence of psychiatric morbidity. Thus while planning rehabilitation process, more efforts will be needed to provide illiterate blind subjects more facilities for education which will help them to avoid psychological disturbances. Prajakta Tanksale17 in her study observed high association between education of blind subjects and adjustment of blind persons.

Out of 205 subjects included in the study 38 were married . They were interviewed regarding type of relationship with their spouse and degree of contentment in their marital life. It was found that happy marital life contributes immensely to psychological rehabilitation and therefore the success of total rehabilitation process.

Usha Bhalerao18in her study revealed that 94% subjects were contended with their marital life. S.R. Mohasini and P.K. Gandhi19 in their study of physically handicapped observed that 86% subjects were contended with their marital life.

In the present study the subjects were asked whether they were invited to various social functions in the society, whether they accept the invitation and attend it. The answers to the questions were considered to be a fair indication of social acceptance of the subject in the society. Seventy four percent of the educated blind in the study conducted by Usha Bhalerao18 were invited for social functions and were socially accepted. S. R. Mohisini and P. K. Gandhi19 in their study of physically handicapped in India observed, that majority of study subjects were accepted by the society.

The overall results of the above detailed tests brought some salient risk factors that can be strongly associated with psychosocial mal adjustments and psychiatric morbidities in the handicapped persons.

These risk factors are:

  1. SRQ positive subjects,
  2. Lower socioeconomic class,
  3. Rural residence,
  4. Illiteracy,
  5. Unmarried life,
  6. Socially non accepted subjects

These risk factors that emerged out of the study can be immensely useful in the planning of stages of rehabilitation.

Acknowledgement: I am thankful to Dr. A.T. Kulkarni, our respected Principal, Dr. M. V. Talwalkar, Professor Dept. of PSM, for helping me in making corrected proof.

References

  1. Chinholikar SV : Use of S.R.Q. in pshyhiatric epidemiology, Indian Community Medicine. 2004; Vol. XXIX No. 4.
  2. Harding TW, Climent CE, Giel R., lbrahim, Murthy RS, suleman MA, Wig NN. WHO collaborative study on strategies for extending mental health care II. The development of New Research Methods, Amk J Psychiatry. 1983, 140.
  3. Harding TW, de Arango MV, Baltazar J., Climent C,E., Ibrahim H.H.A., Igansio L.L., Murthy RS, Wig NN,: Mental disorders in primary health care. A study of their frequency and diagnosis in four developing countries. Psychological Medicine 1980; 231-241.
  4. Sen B, Williams P. The extent and nature of depressive phenomenon in primary health care: Brit. J psychiatry, 1987; 451:406-449.
  5. Mari JJ, Williams P. A validity study of psychiatric screening questionnaires, (S.R.Q. -20) in, the primary health care in the city of Sao Paula, Brit. J psychiatry. 1986; 148:23-26.
  6. Chavan D, Agashe M. Study of psychological status of patients admitted for a general hospital for attempted suicide. A dissertation submitted for Degree of M.D. - Br. IX, psychiatry. Examination of University of Poona, Dec. 1991, Unpublished personal communication.
  7. ICD 10, WHO Classification of mental, behavioural disorders. 1992.
  8. Bansal RK, Jain IS, Kohli TK, Bansal SL. Psychological factors associated with visual impairment J. of Psychiatry. 1980; 22; 173-175.
  9. Fitzergerald RG Reactions of Blindness: An exploratory study of adults with recent lass of sight. Arch Gen. Psychiatry 1970; 22:370-379.
  10. Ray, Dattas: Social stratification of mental patients Indian J Psychiatry. 1962; 4;3.
  11. Sethi BB, Manchanda R. Social factors and mental illness, an analysis of first admission to a psychiatric hospital. Unpublished, 1977a.
  12. Pinter R, Eisenson R, Stranton M. The psychology of the physically handicapped. New york Appleton Centry Crofts, INC.
  13. Springer NN, Rosler. A comparative study of deaf and hearing children. Jeducatioal psychology. 1938; 29;: 459-466.
  14. Surya. Mental morbidity in Pondicherry. All India Institute of Mental Health. 1964; 9;56.
  15. Nandi DN, Ajmary S, Ganhuli H, Banerjee G, Boral GC, Ghosh A, sarkar S. The incidence of mental disorders in one year in a rural community in west Bengal. Ind j psychiatry. 1976; Vo1.18: p79.
  16. Sen B. Nandi DN, Mukherjee SP, Mishra DC, Banerjee G Sarkar S. psychiatric morbidity in an urban slum- dwelling community. Ind j psychiatry. 1984; Vo1. 28: p185-193.
  17. Tanksale P. The problem of social adjustment and rehabilitation of the blind A dissertation submitted to Nagpur University Nagpur for Degree of Doctor of philosophy, in the faculty of social sciences April 1988, p.22-35.
  18. Bhalerao U. Educated blind of Urban Madhya Pradesh-A sociological study, New Delhi. Sterling Publishes Ltd.1983;p.19-24.
  19. Mohisini SR, Gandhi PK, A study of physically handicapped: The physically handicapped and the government. Page 62-164.

Deptt. of PSM, M.I.M.E.R. Medical College, Talegaon Dabhade,
410507, Dist. Pune, Maharashtra.
Received: 22.1.2005

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