research study on marital adjustment among alcoholics

1. THESIS PRESENTATION
VINOD. M
4TH BATCH MSC NURSING
GOVT. COLLEGE OF NURSING, THRISSUR

2. KERALA UNIVERSITY OF HEALTH SCIENCES
THRISSUR
In partial fulfillment of degree of
Master of Science in Nursing
Under the guidance of
MR. THASLEEM SABITH K
Assistant professor
Department of Psychiatric Nursing
Govt. College of Nursing
Thrissur

3. TITLE OF THE STUDY
PERSONALITY TRAITS AND MARITAL
ADJUSTMENT AMONG PATIENTS WITH
ALCOHOL DEPENDENCE SYNDROME AND
THEIR WIVES

4. INTRODUCTION
• Alcohol is the leading substance among abused substances which is
legal to use and causing considerable burden than any other
substances.
• Alcohol harms not only the health of the drinker but also the
wellbeing and health of the peoples around the drinker including
family.
• Intact and harmonious marital relationships are required not only for
the overall health of the individual, but also for a healthy society.
• Alcohol use is a global problem which results in 3.3 million
deaths in a year.
• Kerala tops the country in alcohol consumption at eight liters
per capita, that is much above the national average of two liters.
• Majority of the divorces, suicides, road accidents, crimes in Kerala
are related to alcohol.

5. NEED AND SIGNIFICANCE OF
THE STUDY
• Alcohol consumption is the world’s third largest risk
factor for disease and disability.
• Kerala has the highest per capita consumption in the
country.
• Alcoholism is a major cause of social problems in Kerala.
• Family courts in Kerala have witnessed a increase in
number of divorces.
• Majority of the clients seeking treatment from department
of psychiatry has the diagnosis of alcohol dependence.
• Personality also determine the adjustment of a person in a
committed relationship especially marriage.

6. STATEMENT OF THE PROBLEM
A descriptive study to determine the
relationship between personality traits and
marital adjustment of patients with alcohol
dependence syndrome and their wives
attending a tertiary care centre, Thrissur.

7. OBJECTIVES OF THE STUDY
• Assess the personality traits of patients with alcohol dependence
syndrome.
• Assess the personality traits of wives of patients with alcohol
dependence syndrome.
• Assess the marital adjustment of patients with alcohol
dependence syndrome.
• Identify the relationship between personality traits and marital
adjustment of patients with alcohol dependence syndrome.
• Identify the relationship between personality traits and marital
adjustment of wives of patients with alcohol dependence
syndrome.
• Find the association between marital adjustment with selected
variables among patients with alcohol dependence syndrome.

8. OPERATIONAL DEFINITIONS
• Personality : Personality is the quality or fact
being a particular person or habitual patterns
and qualities of behaviour of any individual as
expressed by physical and mental activities
and attitudes.

9. OPERATIONAL DEFINITIONS
• Personality traits : Personality traits are
distinguishing qualities and characteristics of a
person. Traits are a readiness to think or act in
a similar fashion in response to a variety of
different stimuli or situation as measured by
the Big five inventory.

10. OPERATIONAL DEFINITIONS
• Marital adjustment : Marital adjustment is an
adoption between husband and wife to the point there
is companionship, agreement on basic values of
affectional intimacy, accommodation and on certain
other unidentified factors as measured by Revised
dyadic adjustment scale.

11. OPERATIONAL DEFINITIONS
• Alcohol dependence syndrome : Alcohol
dependence syndrome is a cluster of behavioural,
cognitive and physiological phenomena that develop
after repeated alcohol use and that typically include a
strong desire to take alcohol, difficulties in
controlling its use, persisting in its use despite
harmful consequences as diagnosed by treating
physician.

12. ASSUMPTIONS
• Personality can be assessed by self report
measures.
• Marital adjustment is dyadic and can be
measured from wives self report.

13. HYPOTHESES
• H1: There is a significant relationship between
marital adjustment and personality traits of
patients with alcohol dependence syndrome.
• H2: There is a significant relationship between
marital adjustment and personality traits of wives
of patients with alcohol dependence syndrome.
• H3: There is a significant association between
marital adjustment and selected variables of
patients with alcohol dependence syndrome.

14. CONCEPTUAL FRAMEWORK
Karney and Bradbury’s vulnerability-stress-adaptation
model

15. CONCEPTUAL FRAMEWORK
• Enduring vulnerabilities : The individual
strengths and weaknesses each spouse brings
to the relationship. These stable characteristics
can include their personality, beliefs and
attitudes about marriage, their family of origin
and social background.

16. CONCEPTUAL FRAMEWORK
• Stressful life events : Stressful life events, on
the other hand, encompass all the incidents,
transitions or circumstances encountered by
the couple that can impinge on their
relationship and create tension or stress, eg :-
death of family member, loss of job etc.

17. CONCEPTUAL FRAMEWORK
• Adaptive process : The ways in which a
couple addresses conflict, how they
communicate, how they support each other and
the ways in which they think about marriage,
their spouse and their spouse’s behaviour.

18. REVIEW OF LITERATURE
AUTHOR STUDY FINDINGS
Chittakkudam R S Prevalence of alcohol and tobacco is high in Kerala.
Aditya P S Majorityof alcohol dependents were havingno formal education, unskilled
laborers and from low socio economic class.
Hareesh M,
Praveenlal K
Majorityof alcohol dependents had a positive familyhistoryof alcoholism.
Majorityof samples had nicotine dependence.
Subir K D,
Vasudevan D M
The drinkingpractices differ considerablyamong peoples and also differ
accordingto the cast amongpeoples residingin same area.
SurendraK M Familyburden is moderate to severe amongcare givers with alcohol and
opioid dependent.

19. REVIEW OF LITERATURE
AUTHOR STUDY FINDINGS
Naved Iqbal Marital adjustment and mental health were found to be poor among wives
of alcoholics than non alcoholics.
Evlilik Uyumunun Negative communication style and negative conflict resolution styles were
positively correlated with marital problems among alcohol dependents.
Kenneth E L Alcohol simply disrupts the attempts to conflict resolution equally in both
aggressive and non aggressive addicts.
Belanger C High self esteem and marital adjustment are associated with the use of
problem solving strategies and less avoidance as a way of coping.
Theodore Jacob Out of home group experienced a marital separation than the in home
group.

20. REVIEW OF LITERATURE
AUTHOR STUDY FINDINGS
Kishor M Marital dissatisfaction is high among alcohol dependent spouses and their
association was robust particularly when problems in the physical,
interpersonal and intrapersonal domains were high.
Faye Primary reason for divorce is interpersonal problems.
Christopher M M Aggressive husbands were younger than nonaggressive husbands, had
younger wives, and had been married for a briefer duration.
Aswar N R Life time prevalence of domestic violence against married women was 51%
and it was significantly correlated with husband’s alcoholism.
Catherine B S Majority of personality disorder characteristics were positively associated
with marital dissatisfaction.

21. REVIEW OF LITERATURE
AUTHOR STUDY FINDINGS
Mahdi shahanzari Marital satisfaction is positively related to agreeableness, conscientiousness,
openness and negatively correlated with neuroticism, but the two
significant predictors are agreeableness and conscientiousness.
Amy Claxton Conscientiousness trait has a central role in determining marital satisfaction,
mean while in younger samples the degree of marital satisfaction is
determined by neuroticism.
Sandra E M Being in a intimate relationship prevent relapse and which in turn improve
the living status, abstinent were more often married or in a relationship than
alone. On the other hand, relapsed were less frequently married and
therefore more often single, divorced or separated.
News report April 2nd
2014 onwards Kerala government introduced new policy on
alcohol and closed all outlets without five star facilities.

22. METHODOLOGY
Research approach
Quantitative approach
Research design
Non experimental descriptive survey design
Setting of the study
Department of Psychiatry, Medical college, Thrissur.
Population
Patients with alcohol dependence syndrome with their
wives attending Department of Psychiatry, Medical
College Hospital, Thrissur.

23. VARIABLES OF THE STUDY
• Personality, marital adjustment.
• Age, education, occupation, religion, family income,
type of family, number of children, place of residence.
• Amount and duration of alcohol intake, frequency of
alcohol intake, number of previous hospitalization for
de addiction.
• Duration of married life, history of separation in
married life.
• Habit of substance abuse other than alcohol, last intake
of alcohol of patients with alcohol dependence
syndrome.

24. METHODOLOGY
Sample and sampling technique
The sample consisted of 100 patients with
alcohol dependence syndrome along with their
wives who met full selection criteria for the
study. Non probability purposive sampling was
used for the study.

25. INCLUSION CRITERIA
Patients with alcohol dependence syndrome
• and are willing to participate.
• and accompanied by wives.
• for more than one year.
• and are married and living together for
more than 1 year.
• who can comprehend malayalam.

26. EXCLUSION CRITERIA
Patients with alcohol dependence syndrome
who
• have co morbid psychiatric problems.
• have delirium or other organic brain
disorders.
• have major physical illness.

27. TOOLS OF THE STUDY
• Tool 1 : Socio personal data sheet.
• Tool 2 : Big Five Inventory.
• Tool 3 : Revised Dyadic Adjustment Scale.

28. SOCIO PERSONAL DATA SHEET
• Self reported questionnaire to determine socio
personal data.
• 16 items.
• Content validity index : 0.82.
• Reliability coefficient : 0.85.

29. BIG FIVE INVENTORY
• Self reported questionnaire to determine the big
five personality traits.
• Standardized tool.
• 44 item scale.
• Coefficient of alpha reliability is 0.83 and the and
validity 0.93.
• Extraversion (8 items), Agreeableness (9 items),
conscientiousness (9 items),
• Neuroticism (8 items) and Openness to
experience (9 items).

30. REVISED DYADIC ADJUSTMENT
SCALE
• Self reported questionnaire to determine marital
adjustment.
• Standardized tool.
• 14 item scale.
• Cronbach’s alpha (reliability) of 0.90 and the
validity is 0.97.
• Total score : 69
• Maritally distressed : 47 and below.
• Maritally non distressed : 48 and above.

31. PILOT STUDY
Setting
Department of Psychiatry, Medical college, Thrissur.
Sample
The sample consisted of 10 patients with alcohol
dependence syndrome along with their wives who met
full selection criteria for the study. Data collection
period was from 7-1-15 to 20-1-2015. After obtaining
the consent the tool was administered to the samples in
the study. Data were collected by questionnaire format.
The data were amenable to statistical analysis and the
study was found to be feasible.

32. ANALYSIS AND INTERPRETATION
OF THE STUDY
Frequency and percentage distribution of patients with alcohol dependent syndrome and
their wives based on their age
Age in
years
Patient Wife
f % Mean age (S D) f % Mean age (S D)
Below 30 02 02 18 18
31 – 60 88 88 47.10 (10 ) 77 77 40.69 (10.1)
Above 60 10 10 05 05

33. Percentage distribution of patients with alcohol dependence
syndrome based on their religion
84 %
12 %
4 %
Hindu
Muslim
Christian

34. Frequency and percentage distribution of patients with alcohol
dependence syndrome and their wives based on their education
Education Patient Wife
f % f %
No formal education 07 07 02 02
Primary 33 33 12 12
Secondary 55 55 72 72
Diploma 03 03 04 04
Degree 02 02 10 10

35. Frequency and percentage distribution of patients with alcohol
dependence syndrome based on their occupation
Occupation Frequency ( f ) Percentage ( % )
Manual labourer 56 56
Skilled worker 32 32
Self employed 05 05
Office work 07 07

36. Frequency and percentage distribution of wives of patients
with alcohol dependence syndrome based on their occupation
Occupation Frequency ( f ) Percentage (%)
House wife 59 59
Manual labourer 27 27
Skilled worker 10 10
Self employed 02 02
Office work 01 01
Professional 01 01

37. Percentage distribution of patients with alcohol dependence
syndrome based on their monthly income of the family
55
42
3
0
10
20
30
40
50
60
≤ 5000 5001 - 15000 15001 - 25000

38. Frequency and percentage distribution of patients with alcohol
dependence syndrome based on their type of family and number of
children
Socio personal variables Frequency ( f ) Percentage (%)
Type of family
Nuclear
40 40
Extended 42 42
Joint 18 18
Number of children
One 16 16
Two 58 58
Three 21 21
More than three 03 03
No children 02 02

39. Percentage distribution of patients with alcohol dependence
syndrome based on their place of residence
88 %
12 %
Rural
Urban

40. Frequency and percentage distribution of patients with alcohol
dependence syndrome based on the amount spent for daily
alcohol intake and frequency of alcohol intake
Socio personal
variables
Frequency ( f ) Percentage (%)
Amount ( Rs )
Below 100 26 26
100 – 300 61 61
301 – 500 12 12
Above 500 01 01
Frequency of alcohol intake
Daily 78 78
>2 days/week 22 22

41. Frequency and percentage distribution of patients with alcohol
dependence syndrome based on their duration of alcohol
intake duration of married life
Duration
(yrs)
Married life Alcohol intake
f % Mean (S D) f % Mean (S D)
Below 10 20 20 12 12
11 – 20 40 40 41 41
21 – 30 27 27 19.93 (11) 31 31 22.64 (10.1)
31 – 40 11 11 12 12
41 – 50 1 1 4 4
51 – 60 1 1

42. Frequency and percentage distribution of patients with alcohol
dependence syndrome based on their previous hospitalization
for de addiction and separation in married life
Socio personal
variables
Previous hospitalization Separation in married life
Frequency ( f ) Percentage (%) Frequency ( f ) Percentage (%)
Never 40 40 81 81
1 – 3 times 50 50 16 16
More than three 10 10 03 03

43. Percentage distribution of patients with alcohol dependence
syndrome based on substance use other than alcohol
15
85
0
10
20
30
40
50
60
70
80
90
Absent Present

44. Percentage distribution of patients with alcohol dependence
syndrome based on type of substance use other than alcohol
95 %
5 %
Nicotine
Cannabis

45. Frequency and percentage distribution of patients with alcohol
dependence syndrome based on their last intake of alcohol
Lastintakeof alcohol Frequency( f) Percentage(%)
<2wks 62 62
2wks–6months 31 31
>6months 07 07

46. Percentage distribution of patients with alcohol dependence
syndrome and their wives based on personality traits
0
5
10
15
20
25
30
35
40
Patient
Wife

47. Percentage distribution of patients with alcohol dependence
syndrome based on their marital adjustment
23 %
77 %
Non distressed
Distressed

48. Association between personality traits and marital adjustment
of patients with alcohol dependence syndrome
Marital adjustment
Personality traits Distressed Non distressed df 
Extraversion and
Neuroticism
31 03
Agreeableness and
Conscientiousness
46 20 1 4.69*
*0.05 level of significance.

49. Association between personality traits and marital adjustment
of wives of patients with alcohol dependence syndrome
Marital adjustment
Personality traits Distressed Non distressed df 
Extraversion and
Neuroticism
26 04
Agreeableness and
Conscientiousness
51 19 1 1.54ns
ns = not significant at 0.05 level of significance.

50. Association between marital adjustment and selected socio personal
variables of patients with alcohol dependence syndrome
Variable Degree of
freedom
Chi square value Table value
Age of patients 1 0.01 3.84
Age of wives 1 1.67 3.84
Education of patients 1 0.5 3.84
Education of wives 1 3.62 3.84
Occupation of patients 1 0.15 3.84
Occupation of wives 1 2.74 3.84
Religion 1 4.25 3.84
Family type 2 7.32 5.99
Frequency of alcohol intake 1 15.84 3.84

51. Association between marital adjustment and selected socio
personal variables of patients with alcohol dependence
syndrome
Variable Degree of
freedom
Chi square value Table value
Family income of patients 1 1.26 3.84
Number of children 1 0.05 3.84
Place of residence 1 2.73 3.84
Money spent for alcohol 1 2.67 3.84
Duration of alcohol intake 1 1.79 3.84
Previous hospitalization for de addiction 1 1.85 3.84
Duration of married life 1 1.14 3.84
Substance use other than alcohol 1 0.49 3.84
Last intake of alcohol 1 0.02 3.84

52. DISCUSSION OF THE STUDY
• The study revealed that majority (77%) of
patients with alcohol dependence syndrome is
having marital problems. The findings match
with the results of study conducted by Faye
and his colleagues. The finding of the study is
also supported by several other studies.

53. DISCUSSION OF THE STUDY
• In the present study the results revealed marital
adjustment of patient with alcohol dependence
syndrome is associated to personality traits.
This finding is supported by a study conducted
by Amy Claxton and others. The finding of the
study is supported by several other studies.

54. DISCUSSION OF THE STUDY
• The present study showed that most of the
patients with alcohol dependence syndrome
were lesser educated, unskilled labourers and
from poor socio economic background. The
findings matched with results of the study
conducted by Subir K D and his colleagues.
The finding is also supported by several other
studies.

55. DISCUSSION OF THE STUDY
• The results of the present study shows that
95% of substance use other than alcohol,
among subjects was nicotine. The findings is
supported by study conducted by Nishanth J H,
Harish M, Praveenlal.

56. DISCUSSION OF THE STUDY
• The study revealed that 77% of patients were
martially distressed, even though majority 88%
had no history of separation in their married
life. This point out the degree of importance
they are giving to their family relationship than
their personal problems.

57. CONCLUSION OF THE STUDY
• Marital adjustment of alcohol dependent
patient was poor.
• Marital adjustment had a significant
association with personality traits among
alcohol dependent patients.
• Marital adjustment had a significant
association with socio personal variables such
as religion, family type, frequency of alcohol
intake among alcohol dependent patients.

58. NURSING IMPLICATIONS OF THE
STUDY
• Psychiatric nurse can assess personality and marital
adjustment can as a preliminary assessment and can
plan care accordingly.
• Psychiatric nurse can identify risk groups and provide
counselling service, psycho education based on the
study finding.
• The study finding can be used by nurse educator for
improving the knowledge, skill, attitude of nursing
students in managing patients with alcohol
dependence syndrome.

59. NURSING IMPLICATIONS
• Since alcoholism is a social issue nurse administrator
can create a awareness among staff nurse about the
relationship between personality and marital
adjustment.
• Nurse administrators can plan, organize and conduct
in service education and special training for staff
nurses based on the study finding.
• Nurse administrator can develop a protocol for
counselling alcoholic family based on personality and
marital adjustment.

60. NURSING IMPLICATIONS
• Research conducted in various aspects of nursing
field can increase the wealth of knowledge related to
nursing profession and at the same time improve
quality of care provided by nurses.
• The present study is a descriptive study, findings of
the study suggest that more research should be
conducted to study the problem in detail

61. LIMITATIONS OF THE STUDY
• The setting of the study was limited to one
tertiary care setting.
• The study was limited as the randomization of
the sample was not done.
• Projective techniques was not used to assess
the personality.
• Sample size was small.

62. RECOMMENDATIONS OF THE
STUDY
• The study can be replicated on a larger sample and
randomization can be done.
• Longitudinal studies can be conducted to find out the
severity of marital problems among alcoholics.
• Comparative study can be conducted with alcoholic and
non alcoholic family.
• Qualitative studies can be conducted to study the
phenomena in detail.
• Intervention studies can be done to assess the
effectiveness of family based intervention, counseling,
mindfulness among alcoholic family.

63. REFERENCES
• Amy Claxton, Norm OR, Julianna ZS, Anita DL.
Personality traits and marital satisfaction within
enduring relationships. Journal of Social and Personal
Relationships. 2011; 29(3):375–396.
• Faye, Abhijeet K, Gurvinder, Subramanyam, Alka S,
Kamath. Study of marital adjustment, mechanisms of
coping and psychopathology in couples seeking
divorce in India. Sexual & Relationship Therapy.
August 2013; 28(3):257-269.

64. REFERENCES
• Subir KD, Balakrishnan, Vasudevan DM. Alcohol and its
health social impact of India. The National Medical Journal of
India [internet]. April 2006 [cited on: April 2014] ; 19(2).
Available from :
http://www.nmji.in/archives/Volume_19_2_March_April2006/
Medicine_and_Society/Alcohol.htm
• Nishanth JH, Harish M, Praveenlal K. Analysis of patients
admitted with alcohol dependence syndrome in a tertiary care
hospital in a calendar year. An Open Access Peer Reviewed E-
Journal Health Sciences [internet]. 2014[cited on : Feb 2015];
1(3). Available from : http://healthsciences.ac.in/jan-mar-
14/downloads/1A.OriginalArticle.pdf

65. THANK YOU