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Influence of Family Function and Structure on Depression in Middle Aged Women Attending Federal Medical Centre, Owo

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Influence of Family Function and Structure on Depression in Middle Aged Women Attending Federal Medical Centre, Owo INFLUENCE OF FAMILY FUNCTION AND STRUCTURE ON DEPRESSION IN MIDDLE AGED WOMEN ATTENDING FEDERAL MEDICAL CENTRE, OWO A DISSERTATION SUBMITTED TO THE NATIONAL POST GRADUATE MEDICAL COLLEGE IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF THE FELLOWSHIP OF THE COLLEGE IN FAMILY MEDICINE BY ORJI, ELOHO JOY MB, BS (PORT HARCOURT) 2000 APRIL 2017 DECLARATION I hereby declare that this research work is original except where it is otherwise stated. It has not been presented to any other college for the purpose of award of any degree or fellowship neither has it been previously published. ---------------------------------- ------------------ - DR. ORJI ELOHO JOY DATE 2 CERTIFICATION We certify that this study has been carried out by DR. ORJI ELOHO JOY of The Department of Family Medicine, Federal Medical Centre, Owo, Nigeria. The writing of this dissertation was also duly supervised by us. ------------------------------------------------------- DR. O. O. AKINBOBOYE MB, BS, FWACP, FMCGP(Nig) Consultant family Physician Department of Family Medicine Federal Medical Centre, Owo, Ondo State, Nigeria. ------------------------------------------------------ DR. ADESOKAN AO Consultant Psychiatrist Department of Psychiatry Federal medical Centre Owo, Ondo state, Nigeria. 3 DEDICATION This book is dedicated to the GLORY OF GOD and for the benefit of mankind. 4 ACKNOWLEDGEMENT My special thanks goes first and foremost to my creator, the Lord God Almighty who has been the ever present help for me in my entire life’s endeavours for making the actualization of this work a reality. I sincerely appreciate my wonderful husband, Dr Stanley Orji, who has been of great help and support during this period; also my lovely children Ucheoma, Nkirukamma, Ekele, Otuto and Chimaobiya for their understanding and patience through the period of this training. I also wish to appreciate my parents, Mr. and Mrs. Enaibre, my siblings, my in – laws and my numerous friends for their support and shower of love. I also sincerely appreciate my Head of Department, Dr. Mrs. Adeleke O.E who has been of great assistance all the way, and also my trainer Dr. Akinboboye O.O for his resourcefulness, effort and time in supervising this work. Special thanks to Dr Adesokan AO who co - supervised this work for his profound contributions in proof reading and useful corrections. I must not fail to appreciate all the consultants in the Department of Family Medicine – Dr. Ahmed L.A, Dr. Eneye I, Dr.Olajide O.J, Dr O.B Betiku and Dr Ajuonu J.E for their contributions and constructive criticisms. I am very grateful to Dr. Adeniyi B.O, Dr Adebayo A.M. and Dr. Ilesanmi O.S who assisted me in analyzing and critically scrutinizing this work. 5 TABLE OF CONTENTS Title Page……………………………………………………………………………… I Declaration ………………………………………………………………………II Certification …………………………………………………………………….III Dedication …………………………………………………………………….....IV Acknowledgement………………………………………………………………V Table of Contents……………………………………………………………...VI List of Abbreviations …………………………………………………………..VII Summary ……………………………………………………………………. VIII CHAPTER 1 Introduction……………………………………………………………………….1 Justification for the study…………………………………………………………8 Aim and Objectives of the Study…………………………………………………9 CHAPTER 2 Literature Review ………………………………………………………………...10 CHAPTER 3 Subject and Methods……………………………………………………………...42 CHAPTER 4 Results ……………………………………………………………………………53 CHAPTER 5 Discussion……………………………………………………………………….73 Conclusion……………………………………………………………………….81 Recommendation…………………………………………………………………82 Limitations of Study…………………………………………………………….83 References ……………………………………………………………………….84 Appendices ……………………………………………………………………..100 6 LIST OF ABBREVIATIONS LIST OF ABBREVIATIONS APGAR Adaptability, partnership, growth, resolve and affection. BMI Body Mass Index DSM-1V Diagnogstic and Statistical Manual of Mental Disorder ICD-10 International Classification of Diseases CM Centimetre CNS Central nervous system DM Diabetes Mellitus Ed Edition FDA Federal drug agency FMC Federal Medical Centre Kg/m2 Kilogram per meter squared MDD Major Depressive Disorder MDI Major Depression Inventory SPSS Statistical Package for Social Sciences VMS Vasomotor Symptoms WHO World Health Organization 7 SUMMARY Depression is a significant contributor to the global burden of disease and affects people in all communities across the world. Depression as a common mental disorder, is characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration. It is an illness which contributes to loss in work time, disrupted interpersonal relationships, substance abuse, worsening health status and suicide. Middle age depression has become a serious public health issue as depression in middle aged women is a significant cause of morbidity and disability. The unique manifestations and multi-factorial etiology of middle age depression makes it difficult to recognize and treat. A functioning family is therefore a critical consideration in family - based care of depressed patients thus a strong family support system is crucial for the speedy recovery and return to wellbeing of patients with mental illnesses like depression. The aim of the study was to assess the effect of family function and structure on depression in middle aged women attending Federal Medical Center, Owo. Factors such as family structure, family function, and spousal characteristics were found to be associated with depression. Three hundred and two (302) middle aged women attending out-patient clinic at the center were recruited by simple random sampling method for the study. Relevant data were collected using pretested interviewer administered questionnaire that incorporated Family Structure, Family APGAR and Major Depression Inventory. Descriptive statistics were used to summarize the socio - demographic data. The mean age of participants was 52.08 ± 5.29 with most of the participants in the age range of 45-49 years. More than half (56%) of the participants had a functional family, 66.2% of them were in a monogamous marriage while 64.7% were from a nuclear family. In this study only 5.3% of the participants were found to be depressed. There was a significant association between family functionality, spousal characteristics such as wife beating and spousal alcohol use with depression. Furthermore, the study showed the potential influence of family functionality on patient management. This should therefore be a consideration for the family physicians. 8 9 CHAPTER 1 INTRODUCTION The family is defined as any group of people related either biologically, emotionally, or legally with developed patterns of interaction and relationship.1Murdock defined the family as a social group characterized by a common residence, economic cooperation and reproduction. It includes adults of both sexes, at least two of whom maintain a socially approved sexual relationship and one or more children, own or adopted, of sexually cohabiting adults.2The family remains the most basic relational unit and intimate social environment in our society, as such, the family has a major influence on physical and mental health of its members.3 It is also that group of people that the patient defines as significant for his or her wellbeing.4 Carter and McGoldrick defined family members as people who have a shared history and shared future.5 People are born into a family, live most of their lives within the family, and it is considered to be a high priority in their value systems.4 The family can be viewed as the most basic institution in any society which has been universally agreed to vary from a group of intimate individuals with a shared history and future; to a nuclear family with father, mother and progeny; to people living under the same roof and sharing physical and economic arrangements.6 Minuchin has also defined the family as an invisible set of functional demands that organize ways in which family members interact.7 Family medicine views the family as a mini society based on social, psychological and biological criteria which mediates between the individual and the wider society.8 The World Health Organization (WHO) characterizes the family as “the primary social agent in the promotion of health and well - being”.9 10 The family physician defines a family in the context of an index patient as a group of individuals connected to a patient biologically, legally or by choice from whom the patient reasonably expects a measure of provision in the form of food and shelter as well as financial and emotional support.8 Nigerian families are patriarchal with extended family members having more say thanusual in comparison to family setups in the western world. Although children arevery important to Nigerian families because parents believe that their children will providesupport for them in their old age, family relationships are mostly guided by a strict systemof ‘seniority’ and male tended egoistic values.10The family is therefore a social as well as a biological unit. It also involves individuals not biologically related such as in-laws and those considered honorary uncles, aunts, nieces, cousins and siblings. Overtime, even a family doctor may become an honorary member of the family.8,11 The concept of family has a wide cross - cultural variation on patterns of kinship with many different types of family structure.12,13These include the following: 1. Nuclear family: comprising a couple – including both heterosexual, homosexual or lesbian
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