Table Of ContentHEALTH EFFECTS AND COPING STRATEGIES
AMONG CHILDREN OF ALCOHOL
DEPENDENT PARENTS
A THESIS
Submitted by
P. GENESTA MARY GYSEL
In partial fulfilment of the requirements
for the degree of
DOCTOR OF PHILOSOPHY
DEPARTMENT OF NURSING
FACULTY OF MEDICAL AND HEALTH SCIENCES,
SRM UNIVERSITY, KATTANKULATHUR,
KANCHEEPURAM DISTRICT – 603203
TAMIL NADU, INDIA
JUNE - 2016
DECLARATION
I hereby declare that the dissertation entitled “HEALTH EFFECTS AND
COPING STRATEGIES AMONG CHILDREN OF ALCOHOL DEPENDENT
PARENTS” submitted for the Degree of Doctor of Philosophy is my original work
and the dissertation has not formed the basis for the award of any degree, diploma,
associate ship or fellowship of similar other titles. It has not been submitted to any
other University or Institution for the award of any degree or diploma.
Place:
Date: P.GENESTA MARY GYSEL
ii
SRM UNIVERSITY, KATTANKULATHUR – 603 203
BONAFIDE CERTIFICATE
Certified that the thesis titled “HEALTH EFFECTS AND COPING
STRATEGIES AMONG CHILDREN OF ALCOHOL DEPENDENT
PARENTS” is the bonafide work of Mrs. P.GENESTA MARY GYSEL who
carried out the research under my supervision. Certified further, that to the best of
my knowledge the work reported herein does not form part of any other thesis or
dissertation on the basis of which a degree or award was conferred on an earlier
occasion for this or any other candidate.
Dr. P. Paramanandam, MD, DCH, Ph.D.,
SUPERVISOR
Professor,
Department of Paediatrics,
SRM MCH & RC
SRM University,
SRM Nagar, Kattankulathur,
Kancheepuram District - 603203
Tamil Nadu, India.
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ACKNOWLEDGEMENT
I thank the God Almighty for the opportunity he gave me and grace showered
upon me throughout the course of my study.
I extend my heartfelt thanks to Chancellor, Chairman, President,
Vice-president, Vice Chancellor, Pro Vice Chancellor, Registrar, Controller of
Examinations and all the Officials of SRM University, for granting unlimited
access to utilize the facilities of this respected institution.
I extend my sincere, respectful and wholehearted gratitude to
Dr. N. Chandraprabha, Director, Health Sciences, Dr. D. Narayana Rao, Director
of Research, Dr. S.V. Kasmir Raja, Dean of Research, Dr. D. Balakrishnan, Dean
of Medical Research, SRM University for efficient guidance, encouragement and
valuable suggestions in all my endeavours.
My heartfelt thanks to Dr. Paramanandam, Guide, Department of
Paediatrics, SRM MCH & RC.SRM University, for his essential motivation,
constructive criticisms, inspiration and continuous support throughout my study and
making this piece of research work successful. It’s my great honor and privilege to
have completed this study under his guidance.
I owe my deepest gratitude and series of thanks to doctoral committee
members Prof. Dr. A. Mahali, Professor of Paediatric, Prof. Dr. L. Umadevi,
Professor & Head of Department of Paediatrics, Dr. Thirunavukkarasu, Professor
& Head of Psychiatry and Dr. Subash, Associate Professor of Paediatrics for their
valuable guidance, support, inspiration, analytical approach, untiring outstanding
contribution and spending precious time to make this research project presentable.
I wish to thank Dr. Sumathi. C, Chairman, Institutional Ethical Committee
and other Ethical committee members for ethical approval of this research project.
I am greatly indebted to Dr. A. Judie, Dean, Dr. Jaya Mohanraj, former
Dean and Prof. Selvakani Pandian, former vice principal, SRM College of
Nursing, Prof . Dr. P. Sekar, Professor & HOD of Paediatric and SRM University
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for their incredulous insight and recommendations which lent to the essence of this
project.
I express my sincere thanks to all the Experts who had given the content
validity, ideas and valuable suggestions to shape this study.
I solicit my gratitude to my statistician Dr. Venkatesan Satish, Statistician
for his wisdom, positive outlook, direction and support throughout this endeavour.
It is my privilege to express my sincere gratitude and heartfelt thanks to
A. Lokeshmaran, Assistant Professor, Community Medicine for his patient support
and excellent and positive direction to complete this study successfully.
I sincerely thank Dr. Rajeswari vaidhyanathan, Principal, Sri Ramachandra
college of nursing, Chennai, whose empathy and generosity will never be forgotten.
My heartfelt thanks to the former correspondent of our institution,
Mr. V. Manogaran, Chennai, for giving me an excellent opportunity and constant
support to carry out this study. I express my sincere gratitude to G. Gopinarayanan,
Chairman of our college for his constant motivation for the study.
I acknowledge my sincere thanks to Dr. Sharadha Ramesh, Principal, Indira
College of Nursing whose support and guidance has been of great help in completing
of this study. I am immensely grateful to Dr. A. Mala, Chief Nursing Officer, BGS
Global Hospitals, Bengaluru, for her inspiration and patient motivation which made
this study fruitful.
It is my privilege to express my sincere gratitude and heartfelt thanks to my
friend Prof.(Mrs.) R. Uma, Vice principal, Sabari College of Nursing for her
encouragement, support and constant sharing of my academic responsibility in
college throughout this study period.
It’s my privilege to express my sincere gratitude and heartfelt thanks to my
Friends, Faculty, for their encouragement, support and motivation to pursue this
study.
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I express my sincere thanks to Mrs. N. Vijayalakshmi, Mr. Maharaj Singh
and Faculty of SRM College of Nursing for their timely help and guidance
throughout the course of my study.
I express my heartfelt gratitude to all the study subjects, and parents for
their kind cooperation throughout the study.
I dedicate this work to my Husband and to My Daughters for their relentless
love, care, support, prayers and encouragement to complete this work.
I would like to express my appreciation to the many unnamed people who
gave their opinion in order to help me to shape my study that allowed me to use their
creative suggestions and achieve the goal to complete my study.
My heart filled thanks to One and All who directly and indirectly helped me
in successful completion of this dissertation.
P.GENESTA MARY GYSEL
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ABSTRACT
Alcohol is a universal problem and of a great public health concern. Alcohol
addiction is now the third leading cause of life style choice death. Nearly 2.5
million people worldwide die each year due to the harmful effects caused by alcohol
addiction. According to World Health Organization 2014 report, episodes of heavy
drinking among Indian population was 3.2% in male and less than 0.1% in female
aged 15years and above. The prevalence of alcohol use disorders was found to be
4.5% and 3.8% respectively among males aged 15 years and above and in females it
was 0.6% and 0.4% respectively. Age standardized death rate related to liver
cirrhosis in male was 39.5 and in female was 19.6.
Family of alcohol dependents suffer from deep emotional issues, marital
disruption, poor cohesion, expressiveness and communicational problems and lack of
hierarchical boundaries. Families experiencing problems with alcohol dependence
are fragile. Alcohol addiction usually has strong negative effects on marital
relationship.
There are many significant cost alcoholism exacts upon family, one of its
most detrimental may be its negative effects upon the children who grow up with the
alcohol dependent parents. The family members of the alcohol dependent person also
suffer in the background. The children of alcoholic dependent parents are the
unwilling victims of the problem which generally is the centre of their childhood
existence, and therefore shapes their personality and behaviour as adults. These
victimized children are rarely treated as individuals who need help.
The children’s physical and emotional demands are neglected. They do not
share or talk about their suppressed feelings having no opportunity for freedom of
expression and develop mistrust because of the unpredictable behaviour of parents.
They take roles and responsibilities often inappropriate to their age, witness violence
in different forms at home, feel guilty and responsible for their parent’s behaviour.
Faulty role modelling of both parents furthers damage to the children. Therefore the
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investigator aimed the present study to assess the health effects and coping strategies
among children of alcohol dependent parents residing at Kirumambakkam Primary
Health Centre, Puducherry.
The objectives of the study includes, to assess the health effects, to describe
the coping strategies adopted by the children of alcohol dependent parents, to
correlate between health effects and coping strategies adopted by the children of
alcohol dependent parents and AUDIT scores of parents, to associate the health
effects and coping strategies of the children of alcohol dependent parents with
selected demographic variables of parents, to associate the health effects and coping
strategies of the children of alcoholic dependent parents with their selected
demographic variables and to assess the problems faced by the children of alcohol
dependent parents.
Health effects are the physical, psychological health outcomes experienced
and expressed by the children of alcohol dependent parents in which the physical
effects like height, weight, BMI, Haemoglobin and Clinical symptoms were
assessed. Psychological effects like Stress and Self-esteem were measured using
standardized perceived stress scale developed by Cohen (1965) and standard
Rosenberg (1994) questionnaire respectively. Coping strategies were measured by
standardized adolescent coping scale - II developed by Erica Frydenberg (2011).
Problems of the children were also assessed by the structured check list developed by
the investigator.
Male and female children of alcohol dependents parents between the age 12
and 18 years were included as samples of the study. Parents dependent to alcohol
were identified using standardized Alcohol Use Disorder Identification Test
(AUDIT). A non-experimental, quantitative research approach using a cross sectional
exploratory research design was implied for this study. The research study was
conducted in selected villages of Kirumambakkam Primary Health Centre,
Pondicherry. Using non probability purposive sampling technique, 400 children were
included. The children were taught about effective coping strategies at end of data
collection individually by the investigator. The data was analysed using SPSS
package including descriptive and inferential statistics.
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The BMI calculation showed 83(20.75%) children were found to be
underweight and 9 (2.25%) were obese. 145 (36.25%) children were found with
mild anaemia and 73 (18.25%) were having moderate anaemia. The physical health
assessment revealed 39 (9.75%) had worm infestation, 2(0.5% ) had chicken pox, 17
( 4.25%) had scabies, 166 (41.5%) had head ache , 124 (31%) had stomach ache, 53
(13.25%) had back ache, 63 (15.75%) had sleeplessness. Dental carries was found
among 59 (14.75%)children, menstrual irregularities was reported by 9 (2.25%) girls.
Three of them were taking treatment for iodine deficiency and 10 (2.50%) were
taking treatment for ulcer. There were 45 (11.25%) children abused physically and
3(0.75%) sexually abused by their alcohol dependent parents.
The perceived stress level was high among 176 (44.00%) children and very
high among 137 (34.25%) children. The self-esteem of 153 (38.25%) children was
low and only 15 (3.75%) of them had high self-esteem. The children equally
adopted both, productive (Mean 51.21 at SD 13.24), and non productive coping
Mean 51.93 at SD 10.41) strategies. The correlation was significantly positive
between BMI and haemoglobin (r=.26, P= 0.05), coping and self-esteem (r= .17,
P=0.05) and between problem and stress (r =, P= 0.05). A negative correlation was
found between coping and stress(r= - 0.31, P= 0.05), problem and coping level (r=-
.12, P= 0.01) and between AUDIT score of parents and haemoglobin level (r= -.10,
P= 0.02) of children.
Haemoglobin of children had a significant association with education
(𝑥2=16.87, P=0.01*) and occupation of mother (𝑥2=21.57, P=0.005**).
Haemoglobin also found significantly associated with (𝑥 2=15.7, P<0.01**) duration
of addiction of parents. Perceived stress of children had significant association with
occupation of father (𝑥2=30.39, P=0.001**). There was a significant association
found between self- esteem of the children and age (𝑥 2=8.5, P<0.03*) and income
(𝑥 2=7.84, P<0.04*) of the father.
Coping strategies of children and father’s income (𝑥2=8.24., P=0.05*) as well a
de addiction treatment of their parents (𝑥2=4.76, P<0.05*) were found significantly
associated. A significant association was found between haemoglobin level of
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children and their age (𝑥2=35.5, P<0.001***), sex (𝑥2=8.63 P<0.05*) as well as their
educational status (𝑥 2=28.13 P<0.001***). Stress level of children and their gender
(𝑥2=7.12, p=0.05*) had an association, The association was also found significant
between the stress of children and their educational status (𝑥 2=15.3 P<0.01**) and
also with their birth order (𝑥 2=37.81 P<0.05*). Self-esteem level of children and
their educational status (𝑥2=20.0, P=0.001***) are also found associated
significantly.
The problem level revealed that 334 (83.5%) children perceived low
academic problems while 60 (15.0%), and 6(1.5%) of them had mild and moderate
academic problems respectively. The family problem was found low among 261
(65.3%) children, moderate among 118 (29.5%), and high among 21 (2.5%) children.
The assessment of social problem showed 317 (79.25%) had low, 73 (18.25%) had
mild and 10 (2.5%) had severe problems and had significant association with their
education of mother (𝑥2=11.14, P=0.003**).
The results found that the children of alcohol dependent parents (COAs)
suffer from various physical and psychological health effects and experienced low
self-esteem and higher levels of stress. They equally adopted productive and non-
productive coping strategies towards stress caused by their parental alcoholism. The
children of alcohol dependent parents have moderate level of academic, family and
social problems. With regard to correlation, BMI and Haemoglobin, as well as
coping and self-esteem were positively correlated, whereas, stress and coping as well
as coping and problems are negatively correlated.
Children of alcohol dependent parents experience trauma that is little
understood by those who have not grown up in a home with a parent who has the
untreated disease of alcoholism. Many children have great strength, resilience and
coping skill, which can help them adapt in order to function as normal as possible.
Others do not adapt so readily and face a multitude of problems. The current study
found these children are suffering from various health effects and problems adapt
poor coping strategies. The investigator concludes that the miserable impact of
parental addiction to alcohol on their children can lead them to live in an unsafe,
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Description:suffer from various physical and psychological health effects and experienced low self-esteem and higher levels of stress. They equally adopted productive and non- productive coping strategies towards stress caused by their parental alcoholism. The children of alcohol dependent parents have
