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NATURE AND MAGNITUDE OF CORPORAL

NATURE AND MAGNITUDE OF CORPORAL ABUSE
OF FEMALE PSYCHIATRIC PATIENTS BY FAMILY MEMBERS

1 K. Rai, 2 S. Mohanty, 3 S. Kumar

Additional Director;1 Research Officer, 2 Director & CEO, 3 Institute of Mental Health and Hospital, Agra

 

Abstract

Background: Psychiatric patients both victimize and become victims of physical attacks by family members. The severity and extent of such physical attacks show large variations.

Aim: In the index study we explored the nature and magnitude of corporal abuse of female psychiatric patients by their family members.

Methodology: The study was conducted at Institute of Mental Health and Hospital, Agra. The female patients admitted to the in-patient unit and Family ward of the Institute from May 2006- April 2007 served the study sample. Informed written consent was obtained from both guardians and patients. The patients were physically examined for any visible physical injury. They were interviewed in detail for the injury.

Results: Among 649 patients 56.95% were psychotic, 18.24% were having bipolar disorder, 19.58% were having depression and 5.23% were mentally retarded. Physical abuse was reported in 59.49%of cases. Visible physical injury was evident in 5.55% cases. The increased number of victimization in schizophrenia and other major psychiatric disorders may be due to increased psychopathology which is not present in case of MR. In majority of cases (41.60%) the physical abuse was done by husbands of the patients followed by in-laws (17.67%), parents (13.25%) and siblings (10.17%).

Conclusion: Significant proportion of female psychiatric patients reported physical abuse. Majority of cases reported mild form of physical abuse such as slapping hair pulling. 1.69% patients reported serious form of physical abuse. Husbands are the victimizer in most of the cases.

Key Words: Physical abuse of psychiatric patients, Families of psychiatric patients, Victims of mentally ill

Introduction


Crime victimization is common among persons with mental disorders who live in the community1, 2, 3,4,5,6 People who are assaulted have an increased risk of psychiatric symptoms and long-term psychiatric disorders7, 8, 9. Studies of clinical populations also indicate high rates of lifetime victimization of psychiatric patients10, 11.

Not only may assault be a risk factor for psychiatric disorders, but mental illness may be a risk factor in victimization12. Once mental illness develops, a symptomatic individual may be subjected to more assault13, 14.

Criminal victimization of those with severe mental illness has been associated with more severe clinical symptoms1,4, substance misuse2,4 transient living conditions (including homelessness)2, lower functioning, lack of social support and a history of previous victimization1.

Since de-institutionalization, much has been written about the risk posed to members of the public by those with severe mental illness8. The overall evidence, however, is that the contribution made by those with psychosis to violent crime in society is small and is accounted for by a small minority of patients15 Conversely, little attention generally is paid to the risk posed to this vulnerable group of people. Cross-sectional surveys have reported the prevalence of criminal victimization to be high among mentally ill people1,2,4 The only case–control study to date has found those with severe mental illness at significantly increased risk of violent victimization compared with neighborhood controls, after controlling for socio-economic disadvantage and the individual’s own violent behavior 5.

It was found that 15.2% of 270 acute psychiatric inpatients had been hit, forced to have sex, or threatened or attacked with a weapon within the preceding 10 weeks5. In another study it was observed that 38% of 172 outpatient clients with schizophrenia had been victimized within the preceding 3 years; 91% of the incidents were violent4. It is reported that 10% of persons with severe mental illness who had been deemed suitable for enforced community treatment post-discharge were victimized in the first year1. Men are less likely than women to be victims of physical, emotional and sexual abuse from their partners16.

It is becoming increasingly clear that there is a need to refocus the issue of community risk away from the danger posed by mentally ill individuals to the danger posed to them from other members of society15. This has been highlighted by an American finding that patients with psychosis living in the community are 14 times more likely to be the victims of a violent crime than to be arrested for such a crime4

Routine psychiatric examination often fails to uncover abuse. However, standardized interviews that inquire directly about exposure to traumatic events tend to find high rates of victimization within families.

Aim The index study explored the extent to which female psychiatric patients are the victims of corporal abuse by family members.

Method

The study was conducted at Institute of Mental Health and Hospital, Agra. The female patients admitted to the in-patient unit and Family ward of the Institute from May 2006- April 2007 served the study sample. Informed written consent was obtained from both guardians and patients. The patients were physically examined for any visible physical injury. They were interviewed in detail for the injury. Patients without any physical injury were also interviewed for any type of physical, sexual and emotional abuse by the family members. Information was also collected from the family members to confirm the statements given by the patients. For excited, mute and uncooperative patients, the researcher had to wait for interview and examination till such patients became ready to respond to the interview. The patients who failed to cooperate, who had to be discharged in a couple of days, did not give consent, and whose family members were not available got excluded from the study.

Results and Discussion

681 female patients were admitted in the in-patient facility of the institute during May 2006-April 2007. 8 patients did not give their consent for participation, 5 patients got discharged early due to unavoidable familial reasons, 4 patients did not cooperate, 9 patients’ family members denied the statements given by the patients and reported other reasons for abuse and 6 patients’ family members were not available during the study. The data were gathered for 649 patients. The demographic and clinical characteristics of the patients are displayed in the following tables.


 

Table-1: Characteristics of the Patients

Age (in years)

36.61±13.52

Duration of illness (in years)

6.20±4.74

Education

Illiterate

53.54%

Upto H.Sc

33.85%

Above H.Sc

12.62%

Marital Status

Married

75.30%

Unmarried

24.70%

Family Type

Nuclear

74.24%

Joint

25.76%

Domicile

Rural

53.93%

Urban

46.06%

Diagnosis

Schizophrenia

56.95%

Mania

18.24%

Depression

19.58%

MR

5.23%

 

Among 649 patients 56.95% were psychotic, 18.24% were having bipolar disorder, 19.58% were having depression and 5.23% were mentally retarded. Physical abuse was reported in 59.49%of cases. Visible physical injury was evident in 5.55% cases. The increased number of victimization in schizophrenia and other major psychiatric disorders may be due to increased psychopathology which is not present in case of MR.

Relationships with the patient who inflicted corporal abuse are depicted in following figure.

In majority of cases (41.60%) the physical abuse was done by husbands of the patients followed by in-laws (17.67%), parents (13.25%) and siblings (10.17%). Similar findings were also reported by Hegarthy19 who reported that in most of the cases women are the victims of physical, emotional and sexual abuse by their partners. Husbands, in-laws and parents are the next immediate persons who are liable to take the overall responsibilities of the patient may be overburden. Due to increased burden they usually develop low tolerance and to control the situation they physically abuse the patient. 

The nature and magnitude of the abuse is depicted in following figure.

 

The most common physical abuse was slapping by family members (52.08%) followed by beating (23.57%), hair pulling (12.48%), tying in rope (10.17%). The more serious abuse that is, attempt to hang was found in 1.69% cases. Slapping and hair pulling are the minor form of physical abuse which family members opt to control the situation. But beating, tying in rope and attempt to hang are the serious forms of physical abuse which may cause damage and sometimes death of the patients.

Conclusion

Significant proportion of female psychiatric patients reported physical abuse. Majority of cases reported mild form of physical abuse such as slapping hair pulling. 1.69% patients reported serious form of physical abuse. Husbands are the victimizer in most of the cases.

Implication

In general crime victimization can cause anxiety, depression and PTSD. In patients with mental disorder victimization can exacerbate existing disorder, increase hospitalization and reduce quality of life. To reduce victimization and its consequences family education is warranted. Education about modifiable risk factors can help the family members to develop skill that enhance personal safety, improve conflict management and decrease their vulnerability.

Limitation

Like most prior studies of persons with severe mental illness, we sampled persons receiving treatment, which limits generalizability.

References

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