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INTRODUCTION
Depressed individuals in silence, waiting for nearly one year before seeking
professional help:
Health in partnership with Eli Lilly and Company and Boehringer Ingelheim, showed
that people with major depressive disorder, on average, waited more than 11
months to see a doctor and were May 2005 An international survey,
conducted by The World Federation of Mental only diagnosed with
depression after five visits to the doctor, further delaying treatment. The
survey also revealed that nearly 72% of people with major depression did not
believe, prior the diagnosis, that painful physical symptoms such as,
unexplained headache, back ache, gastrointestinal disturbances and vague
aches and pains, when a common symptoms of depression
Health has been defined in the World Health Organization (WHO) Constitution
as a "State of Complete Physical, mental and social well-being". Yet the
provision of an adequate psychiatric care has usually been given a low priority
in developing countries including Nepal. Nepal has largely focused on the
physical aspects of health, hardly, care of physical illness and problems.
.
Depression is an illness, which is for beyond the usual feeling of being sad or
unhappy. This is fact a clinical syndrome, which comprises of various
psychological, biological and behavioral symptoms, which persist of minimum
duration of two weeks. Depression symptoms are feeling persistently low,
decreased interest even to carry out routine activities, easy fatigability,
decreased drive and energy, decreased sense of cocentration, pessimistic ideas
a, heaviness/pain over different body parts, decreased appetite, sleep
disturbances etc. About 6% of general population suffers from it. Females are
more prone to depression as compared to male.
Attitude is the concept or preparation and belief that one has about certain
things, which are not genetically transmitted. Attitude can be learnt socially
transmitted.
The attitude of the person influences various aspects of human life. A person's
attitude also influences people's health and hygiene. However, many people are
not aware that the attitude of a person can affect mental health.
in
male
than
for
female
(http://www.add-adhd-help-
costs
(http://www.add.adhd-help-center.com/Depression/statistics.htm,
21.02.2005).
.
1.2
1.3.
1.4.
Many family members think that mentally ill patents are no longer
productive and they are not equal like human beings are before, so there
is no need to show love, concern and sympathy.
Chapter 2
Review of literature
The group of symptoms which doctors and therapist use to diagnosis
depression (depressive symptoms''), which includes the important proviso that
the symptoms have manifested for more than a few week and that they are
interfering with normal life, normal variation in brain chemistry. This alteration
is similar to temporary, normal variations in brain chemistry which can be
triggered by illness, stress, frustration, or grief, but it differs in that it is self
sustaining and does not resolve itself upon removal of such triggering events 9
if any such trigger can be found at all, which is not always the case.)
Instead, the alteration continues, producing depressive symptoms and through
those symptoms, enormous new stresses on the person:
Unhappiness, sleep disorders, lack of concentration, difficulty in doing one's
job, inability to care for one's physical and emotional needs, strain on existing
relationships with friends and family. These new stresses may be sufficient to
act as triggers for continuing brain chemistry alteration, or they may simply
prevent the resolution of the difficulties, which may have triggered the initial
alteration, or both.
The depressive brain chemistry alteration seems to be self-limiting in most
cases: after one to three years, a more normal chemistry reappears, even
without medical treatment. However, if the alteration is profound enough to
cause suicidal impulses, am majority of untreated depressed people will, in
fact, attempt suicide, and as many as 17% will eventually succeed. Therefore,
depression must be thought of as a potentially fatal illness.
"Mental neurological and psychosocial disorders constitute an enormous public
health burden for both developing and developed nations. A review of the
evidence demonstrates that the implementation of a comprehensive program of
prevention, based on currently available methods, could produce a significant
by
environmental
factors.
http://www.drmarkhillman.com/depressionfactors.html
Chapagai G S (1997) Study of risk factors and precipitating factors for depression.
In this study supported the belief that depressive illness was more common in
female(90% of total cases) than males and the commonest age is 30-45 age
group(44%). More than 55% of the cases had a joint family with the number of family
members more than 8.
Depression illness was found to be more prevalent in case who got married in their
childhood. In this study 55.5% of cases got married before the age of 14 years
WhereasThe cases who got married after 22 years of age were only 11%. In this study
people with depressive illnesses are tended to be highest case. It might be because
depression was more purulent in people of higher cast or people of social spiritual and
household beliefs. According to distribution of cases by cast. Brahmin and newar
were 33.3% each Tamang being 16.6% Chhetri 11.1, and 5.5 untouchables ( Kami,
Damai)
Most of the study cases had good relationship with their family members except
22.2% of cases who had bad relationship. So far as relationship of the patients with
their neighbors was concerned, 39% of them had bad relations. 28% did not care their
relationship and the rest of them had good relationships with their neighbors.
Study shows that around 22% of cases correlated their illness with pre- existing
physical illness. 11.1% become ill after some particular incidents. One of the cases
explained the cause of his illness as somebody rushed into his room, without noticing,
making him wake up and he got bad mood. Since he was frightened at the time. Since
then his mood worsened, and he become severely depressed, people who blamed evil
spirit magic 0r their illness were 5.5% each. Most of cases had been to the
Dhami/Jhankri (55.5) before seeking any medical help and 64% of them did not get
any benefit from the non medical help. 21.4% cases got even worsen of their
illness.16.6% of cases sought health-post service from the beginning of their illness
and 5.5% of cases contacted directly mental hospital in Lagankhel.
Dhami/Jhankri (55.5) before seeking any medical help and 64% of them did not get
any benefit from the non medical help. 21.4% cases got even worsen of their
illness.16.6% of cases sought health-post service from the beginning of their illness
and 5.5% of cases contacted directly mental hospital in Lagankhel.
P.H.C. Services in Nepal' Study revealed that Patient attending two primary
care settings in Nepal (a village health post & districts hospital outpatient
department) were screened for psychiatric morbidity using the self-reporting
questionnaires. Approximately one quarter of all patients screened were found
to have psychiatric morbidity. Women presenting were found to have higher
10
Mahat (2004) Impact study on mental health services in Western region, In his
study also claimed similar reason for having depression and epilepsy were over
all the commonest diagnosis given to mental health patients attending the
health post accounting for (78.3%) of all health diagnosis. The diagnosis
pattern varies considerably from health post to health post. As we know that
approximately 25% of patients presenting to PHC has identifiable
psychological disorder and that majority of these will be suffering from
depression and epilepsy.
Nakarmi. B( 2004) Study reveals ( Qualitative study in Chapagaun)
in
depression health staff were rightly able to identify the common clinical
features of depression. And they can manage to provide treatment in their local
level.
Psychiatric morbidity under community mental health programs in ( 9 health
centers)Bhaktapur district, ( 14 health centers) Makwanpur district,
11
Individual
Age
Sex
Education
Occupation
Ethnicity
Religion
Behavior &
Environment
Care of
Patient
Treatment
Modality
Prognosis
of illness
Family
perception
of marriage
& support
Regularity
of treatment
Work
performance
Independent
Independent variables which is already fixed and (Age, Sex, Education,
Occupation, Ethnicity and Religions) are affected the attitude of family
member's have a direct relationship. Which affects behavior, attitude, early
detection, treatment modality, prognosis of illness, family prognosis of
marriage work performance and regularity services.
12
13
b.
c.
b.
Independent -
Dependent
Sex
Illiterate
Literate
Socidemographic characters
14
CHAPTER -3
Research Methods
3.1.
Research Design
This is a exploratory cross- sectional study. This study will try to focus
on the socio demographic aspect and attitude of the family members
towards depressive patient.
The method will be use for data collection includes an interview schedule
questionnaire based on structured both open and closed ended.
The interview (questionnaires) measurement
a) The socio demographic data of the patient.
b) The socio demographic data of the family.
c) The attitude of the family towards depressive patients.
d) Information related to the reaction of the society towards the depressive
patient
3.2.
3.3
15
Inclusion Criteria
To reduced the bias in the study
Those who were above 16 years of age and able to express feelings
and ideas were included in this study.
Family member or relatives of depressive patients- male and female.
Lagankhel Mental Hospital Chapagaun Health Post and five health
post of Bhaktapur district.
Psychiatric patient who is diagnosed and supervised by psychiatric
will be included in this study.
Exclusion Criteria
To reduce bias in the study
Those who are under 16 years of age are excluded as responded.
Patients who are not seen or diagnose by psychiatrists..
Patient who have not received treatment in mental hospital or health
post are excluded in this study.
Interview schedule:
Interview schedule will be based on structured and unstructured
questionnaires. Structrulal questionnaire will be used to collect the
primary data, which will be filled up by the investigator.
Interview
Investigator will be visited in respective areas to filled up the form with
structured questionnaire.
Informants:
Family member or relatives of depressive patients from the Lagankhel
mental hospital, Chapagaun health post and five health posts of the
Bhaktapur district.
3.4
16
3.5.
3.5
3.7
Data Analysis
All the collected information will be categorized in the relevant groups
and analyzed qualitatively and relevant category will form to relate the
information and present in table. A simple statistical analysis such as
mean and frequency distribution will be computed/ and the result in
graphical form.
3.8
17
b. The age of the respondents are limited in the study. Only above 16
years of age included.
c. The patient sample will be taken only diagnosed or seen by
psychiatrist.
3.9
18
References
1. Adhikari, K. P., Huttunen, J. & Kiljunen, R (2000) A Mental Health in Nepal
2. Adhikari, K.P. (2000 b) Focus group study on Mental Health awareness
Myagdi District Nepal. Mental Health Program, United Mission to Nepal.
3. Adhikari, K.P. & Dennison. D.B. (1999) Mental Health in Nepal: A
Community Survey of a Village Lalitpur, Central Nepal. Mental Health
Program, United Mission to Nepal.
4. Bennett (1983) Dangerous wives and sacred sisters, social and symbolic roles of high
cast women in Nepal. Central Bureau of statistic, Nepal.
5. Chapagai G.S (1997) Study of risk factors and precipitating factors for depression
6. C. Wright, M.K. NepalW.D.A. And Breuce Jones 'Mental Health Patients in P.H.C.
Services in Nepal'
7. H.M.G., Ministry of Health/W.H.O( 1987- 1989), Community Mental Health
Services in Bhaktapur District
8. http://www.drmarkhillman.com/depressionfactors.html
9. Mahat P. (1997) A comparative study in the treatment pattern of mental illness
in trained and untrained jhankris in south Lalitpur.
10. Mahat P (2004). A Impact study of community health program in Western
Region, Nepal.
11. M Haralambos (2000) Sociological Theme and Perspectives: The isolated
nuclear family
12. Nakarmi B.(2004)A study of quality of mental health services provided by the
CDHP supported Health Post.
13. R.Sharma 1889. Principal of sociology: social research and social survey.
14. SOREC.2003 Analysis of society and culture in Nepal: compilation of books
& article review.
15. Wright, M.K. Nepal and W.D.A. Breuce Jones (1990 Jan-Feb-Mar). Mental
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