Quality of Life in Caregivers of Alcohol Use Disorder Patients: Role of Family Functioning and Social Support

Abstract

Background

Caring for alcohol use disorder (AUD) patients poses significant challenges, impacting caregivers’ quality of life (QOL) across all the dimensions. Following Lazarus and Folkman’s Transactional Model of Stress and Coping, family functioning (FF) and social support (SS) are crucial coping resources.

Purpose

This study aims to explore how FF and SS relate to QOL in caregivers of individuals with AUD, recognising their pivotal role in navigating diverse caregiving-related stressors.

Methods

A sample of 128 primary caregivers for AUD patients was collected from two psychiatric hospitals in Amritsar, Punjab. Data were collected using assessment tools, such as the World Health Organization Quality of Life Brief Version (WHOQOL–BREF), Family Assessment Device and PGI Social Support Questionnaire, and were analysed through the Pearson product moment correlation and multiple regression analysis.

Results

FF (r = –0.603) and SS (r = 0.641) exhibited significant correlations with caregivers’ QOL. Multiple regression analysis confirmed that both FF (β = –0.345) and SS (β = 0.436) significantly predicted QOL among caregivers. Approximately 49% of the variance in QOL was explained by the linear combination of SS and FF.

Conclusion

Developing tailored programs is essential to enhance caregivers’ physical, mental, social and environmental well-being. Healthcare professionals should recognise the intricate connections among these dimensions, crafting holistic approaches to nurture a supportive caregiving environment.

Introduction

Globally, caregiver studies have predominantly concentrated on those tending to the elderly with dementia ¹ or persistent physical ailments, ² with subsequent attention extending to caregivers of schizophrenic patients. ³ However, there is a noticeable scarcity of studies involving caregivers of ‘alcohol use disorder’ (AUD) patients. ⁴ AUD is ‘a medical condition characterised by an impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences’. ⁵ The enduring brain alterations arising from alcohol misuse contribute to the persistence of AUD, making individuals prone to relapse. This has a profound negative impact on the quality of life (QOL) of their caregivers, rendering them more susceptible to developing psychiatric disorders. ⁶ In India, 14.6% (16 crore) aged 10-75 years use alcohol, with 2.9 crore being dependent users; Punjab ranks third with a prevalence exceeding 28%, ⁷ while the overall prevalence of AUD in India is 4.7%. ⁸ Research reveals that AUD caregivers, facing heightened stress and reduced well-being, ⁹ report a prevalent 95% caregiver burden. ¹⁰

Lazarus and Folkman’s Transactional Model ¹¹ illuminates how individual perceptions and coping intertwine in caregiving stress. Caregivers’ QOL is intricately linked to associated stressors, with social support (SS) and family functioning (FF) as vital coping resources. The levels of SS and FF significantly influence adaptive strategies, guiding interventions to enhance caregivers’ well-being. This study investigates the QOL of AUD caregivers, emphasising the pivotal roles of SS and FF. This study explores the unique dynamics of AUD caregiving, making a crucial contribution to existing knowledge for developing targeted interventions and support systems.

It was hypothesised that QOL in caregivers of AUD patients would have a significant and negative correlation with perceived family dysfunction and a significant and positive correlation with perceived SS. Additionally, QOL was expected to be significantly and negatively predicted by family dysfunction, and positively predicted by SS, emphasising the impact of both family dynamics and SS on caregivers’ well-being.

Methods

Sample

The study, approved by the Institutional Ethics Committee at the university, was conducted at two psychiatric hospitals in Amritsar, Punjab, North India. Participants, comprising patients and their caregivers, were selected from inpatient/outpatient services after they provided informed written consent. The recruitment period spanned from August 2022 to January 2023. The sample consisted of 128 caregivers, ranging in age from 19 to 76 years, and comprised 18 males and 110 females, with a mean age of 43.05 years. Purposive sampling technique was employed, and consenting patients and their caregivers underwent initial assessments to ensure compliance with pre-established inclusion/exclusion criteria.

Inclusion criteria

• 1.Caregivers and their patients meeting ICD-10 criteria for AUD. ¹²
• 2.Male patients aged between 20 and 65 years.
• 3.Male/female caregivers aged 18 years and older.

Exclusion criteria

• 1.Patients with dependence on substances other than alcohol (excluding nicotine) or any comorbid physical/psychiatric illness.
• 2.Patients having a family member with a diagnosed chronic physical illness/psychiatric disorder, excluding themselves.
• 3.Patients and caregivers who expressed unwillingness to provide consent.

Operational Definition

In this study, a primary caregiver was operationally defined as an individual living with the patient and providing active care for a minimum of one year. If multiple caregivers met the criteria, priority was given to the individual who exhibited greater involvement in the patient’s care.

Measures

• 1.World Health Organization Quality of Life-BREF (2012) ¹³ : A condensed 26-item version of WHOQOL-100 featuring four domains: physical capacity (7 items), psychological well-being (6 items), social relationships (3 items) and environmental health (8 items). The questionnaire employs a five-point rating scale, with higher scores reflecting better QOL.
• 2.PGI Social Support Questionnaire (Nehra et al., 1996) ¹⁴ : A self-report measure employed to evaluate perceived SS. This assessment tool comprises 18 items, each offering four possible responses ranging from fully agreed to not agreed. A high score signifies a greater perceived level of SS.
• 3.Family Assessment Device (Epstein et al., 1983) ¹⁵ : The Family Assessment Device (FAD) is a self-report instrument employed to assess perceived functioning and dysfunctioning within family dynamics. The scale consists of a total of 60 items, each providing four possible responses ranging from strongly agree to strongly disagree. Higher scores on the scale indicate higher levels of perceived dysfunction within the family. The total FAD score was utilised in this study to comprehensively evaluate family dynamics.

Procedure

Clear instructions were provided to the participants before the commencement of data collection. Initial efforts were made to establish rapport, and participants were thoroughly briefed and informed about the details of the study. Participants who comprehended the study were requested to provide written consent willingly, with an assurance of confidentiality. It was completely free for participants to leave the study at any time without repercussions. Subsequently, consenting patients and their caregivers underwent assessments in accordance with pre-established inclusion and exclusion criteria. Precise instructions were given for each test in accordance with the manual. The assessments were conducted individually, with each participant evaluated independently. The analyses of the data were conducted using SPSS-21, the Statistical Package for the Social Sciences, Windows version 21. The data’s distribution was evaluated, with kurtosis deemed within the parametric range if it fell within ±2.

Results

In Table 1, the correlation analysis revealed statistically significant associations between SS and QOL (r = 0.641), indicating a strong positive relationship. Conversely, FF and QOL were negatively correlated (r = –0.603), suggesting a robust negative association.

Table 1. Correlation Results Using PPMCC*.

Variables	QOL	P Value
Social support	.641	.001
Family functioning	–.603	.001

Note: ^*PPMCC refers to the Pearson product moment correlation coefficient.

The positive correlation between SS and QOL suggests that higher levels of SS are linked to improved QOL among AUD caregivers. Conversely, the negative correlation between FF and QOL indicates that increased family dysfunction is associated with lower QOL in this caregiver population. These findings emphasise the critical role of both SS and FF in influencing the QOL of caregivers within the context of AUD.

Moving to Table 2, which presents the results of the multiple regression analysis examining predictors of QOL among AUD caregivers, the overall model is statistically significant (multiple correlation coefficient = 0.698). This suggests a relatively robust relationship among the variables included in the analysis. Approximately 49% of the variance in QOL can be explained by the linear combination of SS and FF. The F-statistic (59.457) testing the overall regression relationship is significant (P = .001), indicating a meaningful association between the set of predictor variables (SS and FF) and the criterion variable (QOL).

Table 2. Summary Table Showing Results of Multiple Regression Analysis.

Criterion	Predictor	t	β	P Value
QOL	Social support	5.487	.436	.001
	Family functioning	–4.337	–.345	.001
R	.698
R square	.488
F = 59.457, p = .001

Examining specific predictors, the β coefficient for SS is 0.436 (P = 0.001), signifying that SS is a noteworthy determinant of QOL among AUD caregivers. Similarly, for FF, the β coefficient is –0.345 (P = .001), indicating that FF is also a significant contributor to QOL.

Assumption checks revealed a Durbin–Watson statistic of 2.132, supporting the assumption of independence in the residuals. Furthermore, the tolerance value is 0.649, and the VIF value is 1.542, suggesting no strong evidence of multicollinearity among the independent variables. These regression results illuminate the critical role of both SS and FF in influencing the QOL of caregivers within the context of AUD.

Overall, the findings of correlation and regression analysis highlight the nuanced interplay between these factors, suggesting potential avenues for targeted interventions to enhance caregiver well-being.

Discussion

Globally, AUD led to over 3 million deaths in 2016, ¹⁶ causing both physical and mental distress for patients and their primary caregivers. In India, around 90% of individuals with chronic mental illnesses reside with their family, where familial norms often designate them as primary caregivers. ¹⁷ Numerous clinical observational studies have definitively shown that caregiving has the potential to evolve into a chronic stress experience for the caregiver.^18–20

As we delve into our study’s focus on the QOL among AUD caregivers, the intricate connection between QOL and key factors such as SS and FF becomes apparent. Our findings, detailed in the correlation analysis, unveil a compelling positive relationship between SS and QOL (r = 0.641), emphasising the pivotal role of supportive networks. Conversely, a noteworthy negative correlation (r = –0.603) between FF and QOL highlights the impact of family dynamics on caregiver well-being.

The subsequent multiple regression analysis reinforced these connections, revealing a statistically significant overall model and suggesting a robust relationship among the analysed variables. Approximately 49% of the variance in QOL was explained by the linear combination of SS and FF. These findings highlight the subtle interplay shaping the QOL of AUD caregivers, providing insights into crucial determinants within this caregiving context.

In elucidating these relationships further, SS functions as a crucial coping asset, providing emotional, practical and informational aid to caregivers as they confront the difficulties of tending to individuals with AUD. In the psychological domain, the delivery of emotional support imparts a feeling of connection and emotional stability to caregivers, mitigating stress and enhancing their psychological well-being. Instrumental support, exemplified by tangible aid in caregiving duties, directly influences physical well-being by alleviating the load of caregiving responsibilities. Moreover, the informational support that caregivers receive bolsters their capacity to navigate the intricate aspects of AUD, exerting an empowering impact on their overall QOL.

Further, the findings of our study indicate a dynamic interplay between family dynamics and caregiver well-being. Efficient problem-solving within the family context equips caregivers with essential tools to tackle the complexities of caring for AUD patients. Open communication enables the expression of emotions and needs, creating a supportive environment. Well-defined roles and balanced affective involvement contribute to a cohesive family structure, positively influencing caregivers’ psychological and social well-being. The family’s capacity for behavioural control empowers caregivers to adopt healthy coping strategies, enabling them to navigate stressors more effectively.

In comparing our study’s outcomes with existing research, we resonate with prior investigations into caregiving dynamics, particularly in the context of chronic mental illnesses.^21–24 In a systematic review encompassing 15 studies, Treanor (2020) concluded that psychosocial interventions have the potential to ease the burden experienced by caregivers of cancer patients. ²⁵ These studies, in conjunction with others, contribute collectively to the comprehension of caregiver experiences across various health conditions.^26–29 Our findings extend this knowledge to the specific domain of AUD caregiving. Furthermore, the conformity of our findings with the extensive literature on caregiving provides intricate insights into the multifaceted character of support systems. Drawing parallels with studies exploring familial support, we emphasise the pivotal role of SS and FF in shaping caregivers’ QOL, contributing to the ongoing discourse on caregiver support.

In essence, our study not only aligns with established findings in caregiving literature but also makes a distinctive contribution to understanding AUD caregiving dynamics. By reinforcing the universal nature of support systems in navigating caregiver challenges within the realm of AUD caregiving, our research adds valuable insights to the existing body of knowledge.

Limitations

The study has a few limitations that warrant consideration when interpreting the findings. First, the sample size is relatively modest, and the study was confined to a specific geographic region, potentially restricting the applicability of results to broader populations. Moreover, the cross-sectional design offers a snapshot of relationships at a specific moment, potentially overlooking long-term dynamics or changes over time. To address these limitations, future research should involve a larger, more diverse sample and employ a longitudinal study design for a comprehensive exploration of the intricate interplay among SS, FF and QOL over an extended period. Furthermore, future studies could consider incorporating more complex analyses, such as mediation analysis, to elucidate the intricate relationships among these variables.

Conclusion

In conclusion, our study emphasises the vital influence of SS and FF on the well-being of AUD caregivers, highlighting the necessity for tailored interventions. Healthcare professionals should prioritise holistic treatment, incorporating targeted social support programs, family counselling and psycho-education, along with community awareness campaigns. These comprehensive strategies address the multifaceted challenges faced by caregivers, contributing to enhanced overall QOL. Within the realm of AUD treatment, the study emphasises the often-overlooked aspect of prioritising caregiver well-being. By enhancing caregivers’ holistic well-being, our research not only correlates with improved patient outcomes but also ensures a stable environment crucial for continuous recovery.

Abbreviations

AUD, alcohol use disorder; QOL, quality of life; SS, social support; FF, family functioning.

Authors’ Contribution

The study’s conception, design, data collection, analysis and duplication checks were collaborative efforts with equal contributions from all authors. The initial draft of the manuscript was prepared by HK, and the final version underwent thorough review and approval by all authors.

ICMJE Statement

The authors of this manuscript adhere to the authorship criteria established by the International Committee of Medical Journal Editors (ICMJE). They take public responsibility for the content, and any discrepancies were resolved in accordance with ICMJE guidelines.

Statement of Ethics

Ethical approval was granted by the Institutional Ethics Committee of Guru Nanak Dev University, Amritsar, Punjab, prior to the commencement of the study. Written informed consent was obtained from all participants before their involvement.