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ORIGINAL ARTICLE
Year : 2016  |  Volume : 21  |  Issue : 1  |  Page : 36-41

Effect of paternal alcohol use on mother, child and adolescent health


Department of Psychiatry, Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Madagadipet, Puducherry, India

Date of Web Publication10-May-2016

Correspondence Address:
Anand Lingeswaran
Department of Psychiatry, Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Madagadipet, Puducherry - 605 009
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-8990.182091

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  Abstract 

Background: Children and spouses of alcohol-dependent parents are at higher risk of developing substance abuse, emotional, behavioral, and mental health disorders at all stages of development leading into adulthood. Studies on the impact of alcohol use in children and spouse have been poorly studied. Aims: The aim of this study is to study the general health of the wife, children and adolescents of a family with paternal alcohol use and to assess the personal, family, social, occupational and educational environment of families with paternal alcohol use. Subjects and Methods: Cross-sectional analytical study in the inpatient unit of the Department of Psychiatry, Indira Gandhi Medical College and Research Institute. Participants were selected using inclusion and exclusion criteria and informed consent was obtained for all participants. International Classification of Diseases (ICD-10) diagnosis was used to diagnose alcohol dependence in the father. Sociodemographic proforma, General Health Questionnaire (GHQ), World Health Organization Quality of Life-Bref (WHOQOL-BREF) version were used to collect clinical data of the children and spouse. SPSS version 13 was used to analyze descriptive statistics and mean scores on the GHQ and WHOQOL-BREF scale. Results: Mean GHQ scores were highest in spouses (32.92), children between 12–15 years (20.34) and 16–20 years (25.01) years age group. QOL scores were low among spouses and children across all age groups. Conclusions: Physical, psychological health, well-being and QOL are significantly impacted in families where the father is alcohol dependent. Spouses were more severely affected than children.

Keywords: Alcohol dependence syndrome, mental disorder, quality of life, informed consent


How to cite this article:
Lingeswaran A. Effect of paternal alcohol use on mother, child and adolescent health. J Mental Health Hum Behav 2016;21:36-41

How to cite this URL:
Lingeswaran A. Effect of paternal alcohol use on mother, child and adolescent health. J Mental Health Hum Behav [serial online] 2016 [cited 2019 Dec 10];21:36-41. Available from: http://www.jmhhb.org/text.asp?2016/21/1/36/182091


  Introduction Top


Worldwide, researchers have been focusing on the effect of alcohol use on the family and children. In India, 60% of women qualify as lifetime abstainers making men, more common users of alcohol and other substance use.[1]

Eighty-five percent of men who were violent toward their wives were frequent or daily users of alcohol. More than half of the abusive incidents were under the influence of alcohol. An assessment showed that domestic violence reduced to one-tenth of previous levels after treatment for alcohol dependence. About 20% of absenteeism and 40% of accidents at the workplace are related to alcohol. About 3–45% of household expenditure is spent on alcohol. Use of alcohol increases indebtedness and reduces the ability to pay for food and education.

Children of alcohol dependent (COA) parents are at higher risk for any substance use and experience emotional and behavioral problems such as learning disability, hyperactivity, conduct problems such as lying, stealing, truancy, psychomotor delays, and somatic symptoms. Divorce, parental anxiety, or affective disorders, or undesirable changes in the family or in life situations can add to the negative effect of parental alcohol use on children's emotional functioning. Studies of hyperactive and conduct disorder children have shown increased prevalence of alcohol dependent and sociopathic fathers. Similarly, 46% of adolescents with alcohol abuse showed a family history of alcohol dependence.[2]

Some problems reported among COA are low levels of cohesion, expressiveness, independence, and intellectual orientation and high levels of conflict compared with nonalcoholic families. Long-term alcohol intake has been reported to be associated with the negative parental behavior. Furthermore, COA tended to carry the problematic effects of their early family environment into their adult relationships.[3]

Most of the studies investigating physical, psychological, social and other related aspects of the family, and COA fathers have used a longitudinal observational research design. A lot of research has been experimental in nature studying the neurophysiology of COAs. Since studies of this kind are time-consuming and are not cost-effective, we decided to resort to a basic cross-sectional observational design of estimating the impact of alcohol use of fathers on their spouses and children.

The vast amount of literature is available to support the problems in physical, mental and social wellbeing of the spouse and COAs.

Evidence on impact of alcohol use on spouses of alcohol dependent husbands

A longitudinal study of the relationships among wives' and husbands' lifetime alcohol use status, marital behaviors, and marital adjustment concluded that marital adjustment in alcohol using couples may be driven more by the wives' than the husbands' alcohol use disorders (AUDs) and marital behavior.[4] Autobiographies that explore and describe life-stories and meanings of life in wives of alcohol dependent men by analyzing their autobiographies have showed that the wives of alcohol dependent men who participated in the logotherapeutic autobiography program found the meaning of life through their suffering.[5]

Another study that examined the association between partner alcohol problems and selected physical and mental health outcomes among married or cohabiting women, before and after adjusting for potential confounders, and comparing these associations with those reflecting the impact of the women's own AUDs concluded that partner alcohol problems pose diverse health threats for women that go beyond their well-documented association with domestic violence. The study also reported that group therapy that provide couples' treatment or counseling to female partners of alcohol dependent men have reported to alleviate the mood, anxiety, stress, general health, and quality-of-life problems.[6]

An exploratory study examined the association between the psychological distress of female spouses and each of the following nine independent variables: Male partner lifetime at-risk drinker, stressful life events, job situation, socioeconomic status, perceived health status, presence of children <15 years, length of the marital relationship, presence of a confidant, and availability of social support. Lifetime at-risk drinking is a risk factor for the spouse's psychological distress.[7]

The following family problems have been frequently associated with families affected by alcohol use: Increased family conflict; emotional or physical violence; decreased family cohesion; decreased family organization; increased family isolation; increased family stress including work problems, illness, marital strain and financial problems; and frequent family moves.[8] Families affected by alcohol dependence report higher levels of conflict than do families with no alcohol dependence. Drinking is the primary factor in family disruption. The environment of COAs has been characterized by a lack of parenting, poor home management, and lack of family communication skills, thereby effectively robbing COA parents of modeling or training on parenting skills or family effectiveness.[9]

Households with alcohol dependent husbands have reported low levels of family cohesion, expressiveness, independence, intellectual orientation and higher levels of conflict among alcohol using families compared to non-alcohol using families. Addicted parents often lack the ability to provide structure or discipline in family life, but simultaneously expect their children to be competent at a wide variety of tasks earlier than do nonsubstance abusing parents.[10]

Drawing conclusions from above studies, it is evident that alcohol use in the fathers is associated with mental health concerns in their family members which are usually neglected. Puducherry has a high prevalence of alcohol, nicotine and other substance use disorder, and very little understanding exists in our setting about the comprehensive psychosocial management that should be offered to families with alcohol dependent fathers. Hence, we planned to study the effect of paternal alcohol use on the health of family members in our setting.


  Subjects and Methods Top


Duration of study

Two months.

Study design

Cross-sectional survey.

Study population

Inpatients admitted into the de-addiction unit of the department of psychiatry of Indira Gandhi Medical College and Research Institute, Puducherry, India, with an established psychiatric diagnosis of alcohol dependence with or without other substance use were identified.

Sample size

Sixty-two alcohol-dependent males, their spouses (62) and children (110).

Selection criteria

Inclusion criteria

  • Patients with alcohol dependence syndrome >5 years from the time of inclusion with or without additional other substance use disorders according to World Health Organization (WHO) International Classification of Diseases (ICD-10) clinical diagnosis criteria
  • Paternal age between the ages of 25 years and 50 years, male sex, any religion, caste, education, and socioeconomic group and living with their children for at least 5 years
  • Wife, COA fathers between the ages of 8 years and 11 years and adolescents between the ages of 12 years and 20 years
  • Informed consent to participate in the study.


Exclusion criteria

  • Refusal of informed consent to participate in the study
  • Co-morbid medical conditions such as diabetes mellitus, systemic hypertension, chronic arthritis, bronchial asthma, pulmonary tuberculosis, heart diseases, epilepsy, mental retardation, childhood developmental disorders, and other neurodegenerative disorders
  • Single or unmarried alcohol dependent patients.


Data collection procedures

Patients who were admitted into the De-Addiction Unit of the Department of Psychiatry with a clinical diagnosis of alcohol dependence syndrome made by the principal investigator were be approached, and informed consent was obtained seeking participation in this study. For young children <12 years of age, consent from parents was obtained and for adolescents, assent was obtained. The informed consent form was translated into Tamil language for the purpose of the study. For men, heavy drinking was typically defined as consuming an average of more than two drinks per day. For women, heavy drinking was typically defined as consuming an average of more than one drink per day. Binge drinking has been defined as a pattern of alcohol consumption that brings the blood alcohol concentration level to 0.08% or more. This pattern of drinking usually corresponds to five or more drinks on a single occasion for men or four or more drinks on a single occasion for women, generally, within about 2 h.[11] Co-morbid mental and medical disorders were identified using ICD 10 and from history, physical, and mental state examination and basic laboratory tests. The flow chart below shows the procedure that was followed for data collection [Figure 1].
Figure 1: Flow chart of study procedure

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Instruments used

Sociodemographic proforma

This semi-structured proforma was self-designed by the principal investigator for the purpose of this study. Personal, family, social, occupational, educational, past medical illnesses' details were collected using this proforma.

General health questionnaire-12

The general health questionnaire (GHQ)[12] designed by Goldberg has 12 Likert-type questions with four answers was used to measure the general physical and mental well-being of an adults, adolescent participants over a time frame of 1-month. For children, their parents were asked to rate this questionnaire. The scoring was 0–3 from left to right. 12 items, 0–3 each item score range 0–36. Scores vary by study population. Scores about 11–12 were considered as typical. Score >15 evidence of distress score >20 suggested severe problems and psychological distress. This scale was read to the participants in the native language to maintain uniformity of measurement and due to a general lack of educational skills. GHQ has been validated in Tamil Language and has good reliability in research.

World Health Organization quality of life-BREF

The WHOQOL-BREF [13] instrument comprising of 26 items was used to measure the following broad domains: Physical health, psychological health, social relationships, and the environment. The WHOQOL-BREF, a shorter version of the original instrument. A time frame of 2 weeks was indicated in the assessment. Furthermore, the perception of time was different within different cultural settings and therefore changing the time scale may be appropriate. The WHOQOL-BREF was applied by the primary investigator using an interview format of questioning. Parents were asked to rate the scale for their children. Standardized instructions, given on the second page of the WHOQOL-BREF assessment was read out to the participants before starting the interview. Higher scores indicated better QOL.

Statistical analysis

Statistical Software for Social Sciences (SPSS Inc. Released 2004. SPSS for Windows, Version 13.0. Chicago, SPSS Inc.) was used with the help of statistician to perform statistical analysis of data. Sociodemographic variables were analyzed using Chi-square for nonparametric variables and Student's t- test for parametric variables. Descriptive statistics were calculated for individual scores.


  Results Top


Sociodemographic and clinical variables

A total of 84 cases were identified using the selection criteria and continuous sample collection method, of which 62 alcohol dependent fathers, 62 spouses of these alcohol dependent men and a total of 110 children of these couples were recruited at the end of 2 months data collection period and all of them consented to participate in the study. The remaining 22 cases refused to provide informed consent.

Alcohol dependent fathers

The following are the findings obtained from 62 alcohol dependent males. The mean age of 62 alcohol dependent males was 32.02 years (SD ± 7.10) and ranged from 21 years to 54 years. Sociodemographic data was calculated according to modified Kuppusamy's criteria. Education wise, primary school (26), illiterate (20), high school certificate (7), middle school certificate (4), intermediate schooling (3), graduate (2) and none had any postgraduate or professional education. Majority was unemployed (26), unskilled labor (14), semi-skilled labor (16), skilled labor (4), self-employed (2) and none were professionals. Income wise, 37 earned ≥1500/month, 22 earned 750–1499 and 3 earned 565–749. Overall, 70% (43) belonged to lower socioeconomic status, 29% (18) were upper lower, and 1% (1) was the lower middle. The mean duration of alcohol use was 14.56 (±7.10). The quantity of alcohol consumed over a week during a daily drinking period showed 24% (39) moderate drinking, 6% (15) binge drinking and 5% (8) unknown pattern. The mean duration of living together in marriage was 14.8 years (±2.28). All 100% (62) had marital disharmony problems and apart from this, 16% (27) had extramarital relationship issues and 30% (48) had periods of separation from a spouse.

Wives of alcohol dependent males

The mean age of the spouses was 26.20 (±5.80) and ranged from 20 years to 31 years. The majority (48) were illiterate, primary school (6), middle school (3), high school (3) and post high school diploma (2).

Children of alcohol dependent fathers

The following are the sociodemographic and clinical variables that were obtained from 110 children from the sample of 62 alcohol dependent fathers and their spouses. The mean age of the group was 13.63 (±3.10). Majority, 59 children were in the 8–11 years age range while 31 were in 12–15 years range and 20 were in 16–20 years range. Sex ratio was male (38):female (72). 69% (43) lived in their own homes, 53% (33) lived in thatched or brick homes, 42% (26) had debts on their property, and 30% (19) lived in rented homes. Children reported that 100% (62) fathers smoked inside their homes, 67% (42) consumed alcohol at home and 82% (51) smoked and drank at home. Education wise, 53% (62) studied in government schools, 50% (56) had done middle school, 5% (6) finished high school, 20% (22) primary school and 19% (21) were illiterates. Only 1% (2) completed post high school diploma, and none had any graduation or more. 19% (21) were school dropouts, 29% (32) had done antisocial activities, and 33% (37) had friends with other children whose fathers were also alcohol abusers.

Psychiatric diagnosis

Based on ICD-10, the distribution of co-morbid psychiatric and behavioral disorders in the entire family was as follows [Table 1].
Table 1: Psychiatric diagnosis among all members of the family

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The following were the results of GHQ [Table 2] and the QOL questionnaires [Table 3] applied on the sample.
Table 2: GHQ scores

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Table 3: WHO-QOL scores

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  Discussion Top


The mean age of the alcohol dependent males shows that as alcohol drinking behavior must have started in the productive years of a person's life between 15 years and 45 years. Since, it is difficult to accurately time the duration of alcohol drinking and the temporal sequence of alcohol dependence, it might be possible that many of the men in our sample may be under-reporting their alcohol use pattern.

The study sample predominantly belonged to a lower socioeconomic status, demonstrating that people dwelling in such impoverished and stressful living conditions were predisposed to develop alcohol and other substance abuse disorders.

The majority of these alcohol dependent males had low education levels, and many were illiterate. Many of these men reported becoming unemployed as a result of their alcohol, nicotine abuse, and dependence. The nature of employment of these fathers was mostly semi-skilled such as masonry, painters and others were doing government jobs. Surprisingly, the monthly income was more than 1000 rupees since the spouse took up jobs to sustain the financial functioning of their families. All the families of the sample had evidence of marital disharmony in the form of strained emotional and physical bonding. Extramarital relationships were seen in some that may indicate the underlying emotional bond that existed in the ongoing marital lives of these alcohol dependent men.

The above findings are similar to studies reported elsewhere in our country which have shown that alcohol dependence and substance-related disorders are common in lower financial, social, economic, educational section of our society, although causality cannot be ascertained using a cross-sectional study design. These factors are also risk factors that predict maintenance of AUDs.

The psychiatric disorders that were identified in the sample of alcohol dependent fathers were identical to the results of many similar published studies. Nicotine was the most commonly abused substance with alcohol. The bipolar affective disorder was more common than schizophrenia and delusional disorder. Not surprisingly, major depression was less common since the self-medication hypothesis does not support the neurobiological association of alcohol and depression. Since many alcohol-dependent persons tend to use alcohol to overcome anxiety problems, anxiety disorders were the more common psychiatric diagnoses in the sample followed by personality disorders such as emotionally unstable, antisocial, anxious, and mixed types.

Our sample showed a 7–20 years history of alcohol use and many reported moderate drinking as their frequency of drinking. Researchers worldwide agree that it is impossible to accurately investigate the use of alcohol use in a person due to the inevitable bias in reporting the same by the users.

The GHQ and QOL scores indicate that these alcoholic fathers had reported physical and psychological distress and a low QOL, health. Most of them were isolated from their healthier counterparts socially, and living in an environment that made alcohol use, a mode of relaxation. Furthermore, alcohol use was rationalized as a need to counter the hardships of the nature of employment that these men were doing.

Wives of alcohol dependent husbands

Major depressive disorder, dysthymia and anxiety disorders were more common among the spouses of alcohol dependent males in addition to sexual dysfunction as reported in most other studies on this topic. It was evident that mental illnesses among spouses developed following their marriage apart from personality traits that were present in a few.

Concurrent presence of marital disharmony, periods of separation from spouse in the family of these alcoholics are well-known contributory factors for the development of mental illnesses. Extramarital relationships in the alcoholic males can affect the mental health status of the spouses and their children and can be maintaining factors for mental ill-health. Younger age (26.20 years) of the spouses when compared to mean age of alcoholic husbands (32.02 years), mean duration of marriage (14.8 years) and duration of alcohol use (14.56 years) demonstrates early marriage of the spouse, early onset of alcohol use and long-term alcohol use in the males before their marriage. In addition, lower socioeconomic status (income, education, occupation) of the families, together form risk factors for mental ill-health and creates a biopsychosocially vulnerable living environment for the children in these families.

The age range of the spouses was slightly lesser than their alcoholic husbands. Almost 80% of them were illiterate showing the less importance given to female education in the underprivileged communities of our society. The GHQ scores in this group were the least compared with their alcoholic husbands and children indicating the high degree of psychological and physical distress. This may be the outcome of these women having to undertake additional responsibilities of becoming the breadwinner of the family, taking care of the children and household and often compromising their own health, happiness and lifestyle in all aspects. The WHOQOL scores also provide additional evidence to support the overall poor life quality, the health of these women. The domain scores further indicate the low quality of social, environmental, physical and psychological status due to the presence of alcohol dependence in their husbands and the long-lasting ill-effects of it.

Children of alcohol dependent

The children of the alcohol dependent fathers in this study were in the age range of 8–20 years with a mean of 13. Sixty-two years. Since the parents were younger too, the majority of these children were in the 8–11 year age group with more girls than boys. In terms of education, 53% were put in government schools due to financial constraints. Most of them received education, but 19% also had dropped out of school due to various reasons, and 29% were indulging in antisocial activities such as stealing, lying, poor educational achievement, early drop out from schools and making friendships with peers who also had alcohol drinking fathers. These findings indicate the socially vulnerable environment in which these children grow and remain susceptible for substance use too.

Ethical issues and limitations

The children and the spouses of the sample were offered complete psychopharmacological treatment for the mental health problems identified during this study absolutely free. Children who had learning difficulties were referred to special educators and clinical psychologists for further assistance. No form of financial assistance to participate in the study was offered since the spouses and children who participated with informed consent visited the patient on weekends during their convenient time.

Our study was conducted not without limitations notably such as duration of the study of 2 months, inpatient hospital setting, predominantly lower social class sample, comorbid mental illnesses, all of which can narrow the broader application of the findings of this study.

Acknowledgment

I wish to thank the participants in this research study. I thank the family members of the children who gave their informed consent for participation in the study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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Skevington SM, Lotfy M, O'Connell KA, WHOQOL Group. The World Health Organization's WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A report from the WHOQOL group. Qual Life Res 2004;13:299-310.  Back to cited text no. 13
    


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    Tables

  [Table 1], [Table 2], [Table 3]



 

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