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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 6  |  Issue : 9  |  Page : 1-5

Assessment of family functionality status among patients with mental illness at a tertiary health facility in rivers state, Nigeria


Departments of Mental Health/Neuropsychiatry, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria

Date of Web Publication2-Aug-2017

Correspondence Address:
Chukwuma Ugochukwu Okeafor
Department of Mental Health/Neuropsychiatry, University of Port Harcourt Teaching Hospital, P. M. B. 6173, Port Harcourt, Rivers State
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/nnjcr.nnjcr_47_16

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  Abstract 


Context: Family functionality is the extent to which the patterns of family are effective and useful in achieving cordial relationship. A functional family relationship is vital for coping with mental stress. Aim: This study aimed to assess the family functionality status of patients with mental illness. Settings and Design: A cross-sectional design was employed in this study. Patients with mental illness were selected through systematic sampling from the mental health outpatient clinic of the University of Port Harcourt Teaching Hospital in Rivers State. Materials and Methods: Family functionality status was assessed using the family adaptation, partnership, growth, affection, and resolve questionnaire, a validated and study instrument. Statistical Analysis Used: Univariate and bivariate analyses were performed using Predictive Analytics Software version 20. A P < 0.05 was considered statistically significant. Results: The study consists of 151 patients, with a male–to-female ratio of 1:1.2. Functional family relationship was reported in 99 (65.6%) patients while severely and moderately dysfunctional relationships were noted in 12 (7.9%) and 40 (26.5%) patients, respectively. The prevalence of dysfunctional family relationship was highest among patients with mental and behavioral disorders due to psychoactive substance use (58.3%). The differences in proportions of family functionality status across the diagnostic categories were not significant. Conclusions: The presence of dysfunctional family status among patients with mental illness in this study highlights the need to implement family therapies to promote functional family relationship in patients with mental illness.

Keywords: Family functionality, mental illness, Rivers State


How to cite this article:
Okeafor CU, Chukwujekwu DC. Assessment of family functionality status among patients with mental illness at a tertiary health facility in rivers state, Nigeria. N Niger J Clin Res 2017;6:1-5

How to cite this URL:
Okeafor CU, Chukwujekwu DC. Assessment of family functionality status among patients with mental illness at a tertiary health facility in rivers state, Nigeria. N Niger J Clin Res [serial online] 2017 [cited 2019 May 23];6:1-5. Available from: http://www.mdcan-uath.org/text.asp?2017/6/9/1/212005




  Introduction Top


The importance of social connections, especially good family relationships, has been demonstrated in the coping mechanisms of life's stressors.[1] Cohen and Wills[2] have postulated ways in which family functionality status could worsen or improve psychological functioning. It has been noted that functional family relationship may have a protective or buffering role in psychological disorders.[3] Studies on family relationship and mental disorders have reported that negative family relationship was significantly related to mental disorders.[4],[5]

Mental health disorders contribute significantly to the global health burden and are associated with profound socioeconomic impacts on individuals.[5],[6] The myriad of social problems sequel to the occurrence of mental illness has been linked to functionality of the patient's family.[7] In most Nigerian and African settings, mental illnesses serve as stressors to the family owing to the high levels of stigma and superstition.[3],[8],[9] The presence of such high levels of stigma and superstition in these settings hampers on the emotional well-being and the stability of sufferers of mental ill health. The World Health Organization (WHO), in response to mental health problems, has identified social support as a vital component in caring for patients with mental illness.[6]

Family functionality is a key aspect of social support. Family functionality is the extent to which patterns of family are effective and useful in achieving cordial relationship.[10],[11] The dynamics of family functionality has been described in five dimensions, namely, adaptation, partnership, growth, affection, and resolve (APGAR).[11] Adaptation addresses the manner in which the resources are utilized for solving problems in the family, while partnership refers to the decision-making and nurturing responsibilities shared by members of the family. The dimension on growth refers to the physical and emotional maturation as well as the self-fulfillment achieved by family members through mutual support. Affection is the presence of loving and caring relationship among family members, while resolve means the commitment by family members to devote time to one another.[7],[11] A functional family relationship is vital for coping with mental stress.[3] On the other hand, a dysfunctional family relationship negatively impacts on mental health.[5]

Therefore, the assessment of family functionality is an important factor when considering the optimal health of patients with mental illness. This study sought to answer the research questions; what is the family functionality status of patients with mental illness and are there differences in family functionality status by types of mental illness? The study aimed to assess the family functionality status among patients with mental illness accessing care at a tertiary health facility in the Niger Delta region of Nigeria.


  Materials and Methods Top


Study design and setting

This study was a cross-sectional study carried out in Port Harcourt, Rivers State. Rivers State is located in the southern part of Nigeria and is also among the states that constitute the oil-producing Niger Delta region, with a population of 5,198,716.[12] The study population comprised adult stable patients attending the psychiatric outpatient clinics at the University of Port Harcourt Teaching Hospital (UPTH), which is a tertiary health facility. Patients with acute and severe psychological disturbance were excluded from the study.

Sample size calculation and selection of respondents

Sample size formula for cross-sectional studies[13] was employed based on the 95% significance level (1.96), reported dysfunctional family prevalence of 65.2% from a similar study involving patients with mental illness[14] and a precision of 8% to give a minimum sample size of 136. After adjustment for 10% nonresponse, a sample size of 151 was reached. Patients were selected from the psychiatric outpatient clinic using the systematic sampling method.

Study instruments

Functionality of family was assessed based on the current family relationship as generally perceived by the patient. The family APGAR questionnaire, a validated and reliable tool,[15],[16] was used to ascertain the family functionality status of the patients. The questionnaire consists of five questions graded as 0-1-2, with minimum score of 0 and maximum score of 10.[11] Scores from 0 to 3 are categorized as severely dysfunctional family, moderately dysfunctional family are based on scores of 4–6, while functional family are based on scores of 7–10.[11] The family functionality categories were also dichotomized as dysfunctional (scores of 0–6) and functional (scores of 7–10).[16] The diagnosis of mental illness made by the specialist mental health physicians were grouped into broad ICD-10 diagnostic categories. The sociodemographic variables of age, sex, marital status, educational level, and type of family setting raised in childhood were also assessed.

Statistical analysis

Data were analyzed using the Predictive Analytics Software version 20 (International Business Machines (IBM, Corporation, United States). The qualitative variables were expressed in frequencies and proportions. Fisher's exact test was used to determine the differences in proportion. Quantitative variables were assessed for normality using Q-Q plots after which they were then summarized using the mean and standard deviation. The independent t-test and analysis of variance (ANOVA) were used to compare the differences in means across two groups and more than two groups, respectively. A P < 0.05 was considered statistically significant.

Ethical consideration

Ethical approval for the procedures of the study was obtained from the Research and Ethical Committee of the UPTH. The principles of ethics were upheld all through the research process. Informed consent was obtained from the patients before their inclusion into the study. Anonymity and confidentiality were maintained through the use of research numbers rather than names. Furthermore, the patients had the right to voluntarily opt out of the study without any form of discrimination or denial of medical services.


  Results Top


The study consists of 151 patients, comprising 67 males (44.4%) and 84 females (55.6%). The mean ages (± standard deviation) of male and female patients were 33.5 ± 8.7 years and 31.1 ± 8.6, respectively. This difference in the mean ages by sex was not statistically significant (t = 1.678; P = 0.095). The sociodemographic characteristics of patients are shown in [Table 1].
Table 1: Distribution of sociodemographic characteristics of patients

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The diagnostic category with the highest frequency was mood and affective disorders (45.7%; n = 69), while mental and behavioral disorders (MBD) due to psychoactive substance use had the lowest frequency of 7.9% (n = 12). The diagnostic categories of the patients are represented in [Table 2].
Table 2: Distribution of diagnostic categories of patients

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The mean family APGAR score of all the patients was 7.2 ± 2.6. Patients with schizophrenia, schizotypal, and delusional disorders had the highest mean family APGAR score (7.7 ± 2.0), while the lowest mean score was reported among patients with MBD due to psychoactive substance use (6.7 ± 3.2). The differences in the mean family APGAR scores across the diagnostic categories were not statistically significant (ANOVA = 0.598; P = 0.618).

[Table 3] shows the comparison of the mean family APGAR scores across the diagnostic categories.
Table 3: Comparison of mean family Adaptation, Partnership, Growth, Affection, and Resolve scores by diagnostic categories

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Functional family relationship was reported in 99 (65.6%) patients. Severely and moderately dysfunctional relationships were noted in 12 (7.9%) and 40 (26.5%) patients, respectively, as shown in [Figure 1].
Figure 1: Distribution of family functionality status among the patients

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Higher frequencies of dysfunctional family were reported among patients aged < 40 years (35.5%, n = 43), males (37.3%, n = 25), currently single (40.8%, n = 42), and those below secondary level of education (37.5%, n = 3), but these were not statistically significant (P > 0.05). A significantly higher proportion of patients who were raised in polygamous family settings (44.7%, n = 34) had dysfunctional family in comparison to those raised in monogamous family setting (28.0%, n = 21) as shown in [Table 4].
Table 4: Distribution of family functionality status by characteristics of patients

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More than half of all patients with MBD due to psychoactive substance use had dysfunctional family relationship (58.3%; n = 7). Patients with neurotic, stress-related, and somatoform disorders had the lowest frequency of dysfunctional family relationship (33.3%; n = 10). The differences in the proportions of family functionality status across the diagnostic categories of mental illness were not statistically significant (P = 0.455). [Table 4] shows the distribution of functional family status by characteristics of the patients.


  Discussion Top


In spite of the well-established importance of family support in care of patients with mental illness, this study appears to be the first in the Niger Delta region of Nigeria to explore this aspect of social support among this group of patients. This present research along with studies by Olanrewaju et al.[14] and Casanova-Rodas et al.[7] expose the necessity of assessing family functionality in the care of patients with mental illness. This is essential in ensuring holistic care of these patients.

The finding of more than half of the patients (65.6%) reporting functional family relationship is quite comparable to a similar study in Mexico,[7] which noted family functionality in 58.3% of the patients with mental illness. Noteworthy, the slightly higher rate of family functionality in the index study in comparison to that of Mexico could be attributed to the communal nature in most Nigerian and African settings, which tends to promote positive family relationship.[17] The finding of 7.9% of patients reporting severely dysfunctional family in the present study is lower than the 19.4% reported in Mexico.[7] Although this difference could be linked to the sociocultural dissimilarities, the need for measures to address dysfunctional family among patients with mental illness is advocated.

Identifying distribution of dysfunctional family status among the mental illness categories may serve as a platform for instituting targeted interventions. This study found that the 58.3% of patients with MBD due to psychoactive substance use had dysfunctional family while another study in Ilesha, Southwest Nigeria,[14] noted dysfunctional family among 65.2% of patients with depression. Notably, the study in Ilesha[14] comprised only patients with depression while the study population for the present study comprised patients with different categories of mental illness. Hence, the findings of the present study could be described as more encompassing. Among the various diagnostic categories, MBD due to psychoactive substance use had the highest frequency of dysfunctional family. This may not be surprising as it has been shown that people with substance abuse problems have been raised in dysfunctional families.[5] In addition, they commonly have challenges with interpersonal relationships within their families as a result of their use of these psychoactive substances.[18] There is need therefore to emphasize on interventional family therapies and social support among this category of patients. However, the absence of no statistically significant differences in family functionality status among the diagnostic categories probably infers that dysfunctional families occur among patients with mental illness, irrespective of any particular category of mental illness. Thus, family functionality should be assessed in all patients with mental illness regardless of their diagnostic category. Adequate interventions which consider the family relationships of mentally ill patients are thus advocated.

The family setting in which the patients were raised was the only significant factor associated with family functionality status in this study. Noteworthy, the negative consequences of polygamous setting which include mistrust within families could affect the perceived family functionality[19] as the present study reported significantly higher prevalence of dysfunctional family among patients who were raised in polygamous settings compared to those raised in monogamous settings. However, further researches are needed to elucidate more on the association between the type of family setting, in which patients were raised in childhood and their perception of the functionality of their families.

The cross-sectional nature of the study does not allow for inference on causality in the findings of the study. The authors recommend that future studies utilizing longitudinal study designs involving family members should be carried out to further elucidate on the temporal relationship of family functionality status and occurrence of mental illness.


  Conclusion Top


The occurrence of dysfunctional family status among patients with mental illness in this study indicates the need for mental health physicians to inculcate assessment of family functionality in patient care to achieve a holistic management. The institution of family counseling and family therapies to promote functional family relationship in patients is encouraged.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Ozbay F, Johnson DC, Dimoulas E, Morgan CA, Charney D, Southwick S. Social support and resilience to stress: From neurobiology to clinical practice. Psychiatry (Edgmont) 2007;4:35-40.  Back to cited text no. 1
    
2.
Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull 1985;98:310-57.  Back to cited text no. 2
    
3.
Chan M. Mental Health and Development: Targeting People with Mental Health Conditions as a Vulnerable Group. Geneva, Switzerland: World Health Organization; 2010. p. 1-6. Available from: http://www.who.int/mental_health/policy/development/mh_devel_targeting_summary_2010_en.pdf. [Last Retrieved on 2016 Oct 07].  Back to cited text no. 3
    
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Tunde-Ayinmode M, Adegunloye O, Ayinmode B, Abiodun O. Psychiatric disorders in children attending a Nigerian primary care unit: Functional impairment and risk factors. Child Adolesc Psychiatry Ment Health 2012;6:28.  Back to cited text no. 4
    
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Oladeji BD, Makanjuola VA, Gureje O. Family-related adverse childhood experiences as risk factors for psychiatric disorders in Nigeria. Br J Psychiatry 2010;196:186-91.  Back to cited text no. 5
    
6.
World Health Organization (WHO). Mental Disorders. WHO Fact Sheet. Geneva, Switzerland: World Health Organization; 2016. Available from: http://www.who.int/mediacentre/factsheets/fs396/en. [Last accessed on 2016 Oct 07].  Back to cited text no. 6
    
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Casanova-Rodas L, Rascón-Gasca ML, Alcántara-Chabelas H, Soriano-Rodríguez A. Social support and family functionality in people with mental disorder. Salud Ment 2014;37:415-20.  Back to cited text no. 7
    
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Adewuya AO, Makanjuola RO. Social distance towards people with mental illness in South-Western Nigeria. Aust N Z J Psychiatry 2008;42:389-95. Available from: http://www.search.ebscohost.com/login.aspx?direct=true&db=cin20& AN=105654495&site=ehost-live&scope=site. [Last accessed on 2016 Oct 07].  Back to cited text no. 8
    
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Barke A, Nyarko S, Klecha D. The stigma of mental illness in Southern Ghana: Attitudes of the urban population and patients' views. Soc Psychiatry Psychiatr Epidemiol 2011;46:1191-202.  Back to cited text no. 9
    
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Ghamari M. Family function and depression, anxiety, and somatization among college students. Int J Acad Res Bus Soc Sci 2012;2:2222-6990.  Back to cited text no. 10
    
11.
Smilkstein G. Family APGAR. United States: Univ North Carolina-Longscan Publication; 2016. p. 1-6. Available from: http://www.unc.edu/depts/sph/longscan/pages/measures/Baseline/Family APGAR.pdf. [Last accessed on 2016 Oct 07].  Back to cited text no. 11
    
12.
Federal Republic of Nigeria. National Bureau of Statistics State Information. Rivers State, Nigeria: Federal Republic of Nigeria; 2013.  Back to cited text no. 12
    
13.
Kirkwood BR, Sterne JA. Calculation of required sample size. Essential Medical Statistics. 2nd ed. UK: Blackwell Science; 2003. p. 420-1.  Back to cited text no. 13
    
14.
Olanrewaju AM, Akintunde AK, Femi F, Ibrahim B, Olugbenga A. Pattern of depression and family support in a Nigerian family practice population. Internet J Fam Pract 2007;6:1-3.  Back to cited text no. 14
    
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Rodríguez-Sánchez E, Pérez-Peñaranda A, Losada-Baltar A, Pérez-Arechaederra D, Gómez-Marcos MÁ, Patino-Alonso MC, et al. Relationships between quality of life and family function in caregiver. BMC Fam Pract 2011;12:19.  Back to cited text no. 15
    
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Muyibi AS, Ajayi IO, Irabor AE, Ladipo M. Relationship between adolescents' family function with socio-demographic characteristics and behaviour risk factors in a primary care facility. Afr J Prim Health Care Fam Med 2010;2:1-10.  Back to cited text no. 16
    
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Columbus O. African cultural values and inter-communal relations: The case with Nigeria. Developing Countries Studies 2014;4:1-11.  Back to cited text no. 17
    
18.
Lander L, Howsare J, Byrne M. The impact of substance use disorders on families and children: From theory to practice. Soc Work Public Health 2013;28:194-205.  Back to cited text no. 18
    
19.
Al-Krenawi A, Graham JR, Al Gharaibeh F. A comparison study of psychological, family function marital and life satisfactions of polygamous and monogamous women in Jordan. Community Ment Health J 2011;47:594-602.  Back to cited text no. 19
    


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    Tables

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



 

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