Title : Anxiety Among Primary Care Givers of Patients Admitted in the Acute Care Room in Hospital


Anxiety Among Primary Care Givers of Patients Admitted in the Acute Care Room in Hospital


Family is defined as a group of individuals who live together during important phases of their lifetime and are bound to each other by biological and /or social and psychological relationship (Avasthi, 2010). In particular, caregivers play an im-portant role in supporting people with illness either acute or chronic who can experience anxiety from time to time (National Alliance of Care Giving, 1997). There is an increase in the prevalence of psychiatric morbidity among caregivers of patients with mental disorders, in particular anxiety owing to financial difficulties, disruption of leisure activities and uncertainty of the prognosis. Many caregivers’ variables have been reported as being significantly related to their development of depression and anxiety, including the general stress of coping with psychiatric ill-ness (Magliano, McDaid, Kirkwood & Berzins, 2007). However it is unclear whether family dysfunction leads to the anxiety or vice versa. Paucity of litera-ture in this field in developing countries like India warrants the necessity to explore anxiety among care givers which will help to tailor interventions according to the felt needs of the family.

Literature review

Wellbeing of caregivers is important because the patients depend on them to uphold in the community. Additionally, hospitalisation on an emergency basis places burden on caregivers of patient as well. Caregivers of patients with psychiatric disorders have been found to be at higher risk of social isolation, emotional burden and a reduction in quality of life (Thommessen et al, 2002; Martinez et al, 2005; Bhatia

Gupta, 2003) when the patients are admitted in the emergency psychiatric ward. The caregivers have been found to have an increased rate of affective and anxiety disorders (Lantz, 2004; Ohaeri, 2003; Cochrane, Goering & Rogers 2002). Thus, there is a need to understand the nature, stressfulness, and effectiveness of coping in caregivers providing care to patients at different times during the trajectory of recovery in order to understand the overall impact of illness.

In a study conducted by Das et al (2010) in India among 199 patients who required emergency in-patient admission in a psychiatric hospital, anxiety and depression were found in 70 percent and 76 percent of caregivers, respectively. The caring process can be very taxing and exhausting, especially if the care recipient has a severe mental disorder and it can escalate if the patient is in an acute care room. In spite of mental disorders being one of the most common causes of disability with long course of illness, very few studies have addressed the impact of these conditions on caregivers (Carnwarth & Johnson, 1987). There are limited studies undertaken in this area in India which inspired the current study.


 The objectives of the study were:

  1. To assess the level of anxiety among primary care givers of patients with psychiatric disorders, and
  2. To identify the association between anxiety and selected socio demographic variables of primary care givers and clinical variables of patients.

Operational definitions

Psychiatric Disorders: It includes psychotic disorders (Schizophrenia, Depression, Mania), and others (Obsessive Compulsive Disorder, Phobia, Dissocia-tive disorders, Personality disorders, Substance use disorders).

Anxiety: It is characterised by feelings of apprehension which has physiological, behavioural and cognitive manifestations as measured by Hamilton Anxiety Rating Scale (HAMA).

Primary care giver: Male/ female family member who stays with the patient minimum for a period of 6 months and looks after the needs of the patient.

Acute care room: It is a ward for admitting psychiatric patients on an emergency basis.


Conditions which warrant admission in the ward include deliberate self-harm, violence, drug-induced side effects, substance-induced delirium, psychiatric illness with acute onset and chronic illness with relapse.


Primary care givers of patients with psychiatric disorders will experience significant anxiety.


The research design was descriptive cross-sectional design. The setting was the acute care room at the department of psychiatry, Christian Medical College, Vellore, a 12-bedded ward with bed occupancy at 95 to 100 percent in which patients are admitted on an emergency basis.

Population: Primary care givers of patients admitted in the acute care room at the department of psychia-try, Christian Medical College, Vellore


Sample: 50 consecutive primary care givers of patients with mental illness were recruited for the study. Those who provided informed consent were considered as the sample.

Criteria for sample selection

Inclusion criteria was primary care givers of patients with psychiatric illness admitted on an outpatient basis who were above the age of 18, could understand and/or speak Tamil and English, and were staying with the patient for more than 6 months.


Exclusion Criteria was primary care givers with language, hearing or cognitive impairment, diagnosed as mentally ill and were the primary care givers of inpatients.

Data Collection Instruments and Techniques

Tool 1: Socio demographic data of patient and primary care givers. The demographic data of patient and family member such as age, sex, religion, marital status, education, occupation, monthly income, type of family, duration of illness, diagnosis, relationship and duration of stay with the patient. 

Tool 2: Hamilton Anxiety Rating Scale (HAMA) con-sisting of 14 items, each defined by a series of symptoms, and measures both psychic anxiety (mental agi-tation and psychological distress) and somatic anxiety (physical complaints related to anxiety) (Borkovec

Costello, 1993). The test-retest reliability of the scale was found to be 0.92 and an intraclass correlation of 0.86. Its sensitivity was 74 percent for de-tecting anxiety disorders, and 87 percent for affec-tive disorders in general, whereas specificity was 100 percent. Eight items contributed significantly to dis-tinguishing between anxious and depressed patients in a discriminant analysis. It also exhibited good construct validity, showing statistically significant relationships with independent self-report measures of generalised anxiety and other anxiety variables.

Scoring and interpretation of the scale: Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0–56, <17= mild, 18–24 mild to moderate, 25-30 moderate to severe.

Data collection procedure

The data was collected from 2 June 2016 to 15 July 2016 from the primary care givers of patients with major psychiatric disorders admitted in acute care room at Mental Health Centre, Bagayam using HAMA, after 24 hours of admission. Consecutive sampling was employed for selecting the subjects and those who fulfilled the inclusion criteria were recruited for the study. Subjects and their relatives were briefly explained about the aim of the study and data was collected during a single session lasting for approximately 15-20 minutes from primary care givers after obtaining the informed consent.

Data analysis

Sociodemographic variables was analysed with appropriate descriptive statistics. Chi-square test was used to find out the association between selected variables and anxiety.

Ethical consideration: Permission was obtained from the Head of the department and the Nursing Superintendent. Informed consent was obtained from the subjects prior to the data collection and confidentiality of information was ensured throughout the study.


Findings of the study are discussed under the following sub headings.

Section A: Sociodemographic variables of patients and primary care givers and clinical variables of patients.

Section B: Anxiety among primary care givers of patients with mental disorders.

Section C: Association of anxiety with selected socio demographic and clinical variables.

Table 1 shows that half of the patients were in the age group of 31 to 48 years. The mean age of patients was 40.7 (SD:11.975). Majority of them were males (71%) and 52 percent were married; 30 percent re-ceived primary education, though 18 percent were illiterate; 54 percent were unemployed, however 16 percent were engaged in skilled work. Majority (64%) of the subjects were Hindu by religion.


Table 2 reveals that 54 percent of patients were admitted with the diagnosis of schizophrenia and with illness duration of 6 to 10 years.One fourth (28%) of them were admitted at least once or twice in the past, though18 percent of them were admitted for the first time.

Table 3 reveals that 48 percent of care givers were in the age group of 31 to 48, majority being female (72% ) and were married (60%). Half of them were skilled workers and monthly income was between Rs.1001 to 5000/-. Most of the caregivers were spouse (56%) and majority of them were staying for more than 11 years with the patients (60%).

 Tables 4 & 5 show that there is a significant association between level of anxiety with duration of illness and number of hospitalisations.


Findings of the study were discussed according to the following objectives

The first objective was to assess the anxiety among primary caregivers of patients with mental disorders. Anxiety among primary caregivers was assessed using Hamilton Anxiety Rating Scale (HAMA). The re-searcher found that 32 percent of primary care giv-ers had mild anxiety, 30 percent had moderate anxiety and 38 percent had severe anxiety. Similarly, significant high levels of anxiety in caregivers of patients with psychiatric illnesses were observed by Basheer et.al, 2005, Cochrane et.al, 2002 and Taj, et.al, 2005. That majority of the caregivers are female (60%) supports the study conducted by Magliano et al (2007) who reported that the prevalence of anxiety are 1.8 to 2.5 times higher in female caregivers than male caregivers.

The second objective was to identify the association between anxiety of care givers and selected sociodemographic variables of patients. There was a significant relationship between anxiety and gender of the patients statistically. Care givers of female patients had severe anxiety (p=0.01) and no other reports had identified such relationship. No previ-ous reports have looked at the relationship between anxiety and demographic characteristics of patients and care givers.

The third objective was to identify the association between anxiety and clinical variables. There was a significant association between level of anxiety and duration of illness of the patient (p=0.07). Care givers of patients who had illness duration of less than a year experienced severe anxiety, which was in contrast with reports by Rashda et al (2004) who reported that anxiety is typically associated with chronic illnesses or disabilities. Also, anxiety had an association with number of hospitalisations (p=0.07). Care givers of patients who were admitted to the hospital for the first time had severe anxiety. However, moderate anxiety was experienced by care givers of patients who were hospitalised once in the past which was supported by Thommessen et al (2002). Fig 1 outlines the magnitude of anxiety among pri-mary care givers.

Implications of the study

Nursing practice: Care giving role is defined by the nature of the needs and demands of the family member who receives the care, by the other roles and responsibilities that compete for the caregiver’s time and energy, and by the availability of support to assist the caregiver in negotiating this role. Nurses who are taking care of the patients should address the anxiety experienced by primary caregivers and provide support accordingly.

Nursing education: Nurse managers and charge nurses can motivate staff nurses to provide psycho education to the primary caregivers based on the assessment so that appropriate care can be evident.

Nursing Administration: Administrators can help the staff to assess the anxiety among primary caregivers and can set up policies regarding interventional strategies for them. Charge nurses should motivate the staff to assess the symptoms of anxiety and provide appropriate psycho education to them and to document it. 

Nursing Research: The findings of the present study can be used for future reference by the nurses. More studies can be attempted with the anxiety of the primary caregiver.


The study reports that primary caregivers experience significant level of anxiety and it has a relationship with clinical variables of the patients, requiring therapeutic interventions. Employing psycho educational intervention for the primary caregivers could be effective in reducing anxiety


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Author: Karunakaran KP
Charge Nurse, Dept of Psychiatry-II, Christian Medical College, Vellore (TN)
Sources: TNAI Journal