Profile difference between male and female psychiatric patients seeking certificate of disability

Five-Year Trend in Issuing Disability Certificates from a General Hospital Psychiatric Unit in South India

BACKGROUND

Mental disability is a common condition but is considered as an invisible disability. The disability certificate in psychiatry remains underexplored. Some reasons are issues of confidentiality, stigma, lack of awareness in the public, and the hesitancy in the mental health professionals. We aim to provide a brief profile of patients with mental illness issued disability certificates from a psychiatric unit over a five-year period (2013-2017).

METHODS

Our retrospective study is based on the data available from the copies of the issued disability certificates from a psychiatric unit that functions in a multispecialty tertiary care teaching government hospital in Southern India. Patients undergoing treatment in psychiatry apply for a disability certificate to the medical superintendent of the hospital. Each applicant undergoes a detailed workup to ascertain the diagnosis, and the mental disability is assessed using Indian Disability Evaluation and Assessment Scale (IDEAS). Those with intellectual developmental disorder (IDD) are assessed by a clinical psychologist for quantifying intelligence quotient, based on which the disability certificate is issued. Data were extracted and analyzed using SPSS. Descriptive statistics were used.

RESULTS

Over five years, 258 disability certificates were issued. A total of 218 were for mental illness and 40 were for IDD. Schizophrenia was the commonest primary diagnosis. There was no gender predominance, nor the influence of gender on different domains of IDEAS except on work domain dysfunction due to mental illness. The validity period was not mentioned in 81% of the issued certificates for mental illness.

CONCLUSIONS

This descriptive study found a lower number of certificates issued from the psychiatric unit. Schizophrenia remains the main psychiatric diagnosis for which a disability certificate was issued. We did not assess the utilization pattern of the issued certificates.

Internal consistency & validity of Indian disability evaluation and assessment scale (IDEAS) in patients with schizophrenia

BACKGROUND & OBJECTIVES

The Indian Disability Evaluation and Assessment Scale (IDEAS) has been recommended for assessment and certification of disability by the Government of India (GOI). However, the psychometric properties of IDEAS as adopted by GOI remain understudied. Our aim, thus, was to study the internal consistency and validity of IDEAS in patients with schizophrenia.

METHODS

A total of 103 consenting patients with residual schizophrenia were assessed for disability, quality of life (QOL) and psychopathology using the IDEAS, WHO QOL-100 and Positive and Negative symptom scale (PANSS) respectively. Internal consistency was calculated using Cronbach's alpha. For construct validity, relations between IDEAS, and psychopathology and QOL were studied.

RESULTS

The inter-item correlations for IDEAS were significant with a Cronbach's alpha of 0.721. All item scores other than score on communication and understanding; total and global IDEAS scores correlated significantly with the positive, negative and general sub-scales, and total PANSS scores. Communication and understanding was significantly related to negative sub-scale score only. Total and global disability scores correlated negatively with all the domains of WHOQOL-100 (ρ<0.01). The individual IDEAS item scores correlated negatively with various WHOQOL-100 domains (ρ0< 0.01).

INTERPRETATION & CONCLUSIONS

This study findings showed that the GOI-modified IDEAS had good internal consistency and construct validity as tested in patients with residual schizophrenia. Similar studies need to be done with other groups of patients.

A study of profile of disability certificate seeking patients with schizophrenia over a 5 year period

BACKGROUND

Schizophrenia has been identified as one of the most disabling condition known to mankind. Until recently there was no published literature on disability certification seeking behavior of patients diagnosed with schizophrenia. The current study aimed at understanding the profile of patients diagnosed with schizophrenia seeking disability certification for a tertiary level multispecialty hospital in India.

MATERIALS AND METHODS

The study was carried out at the Psychiatry department for a tertiary care hospital in India. The evaluation of the subjects was carried out in the presence of a primary care giver. First, the diagnosis was established using International Statistical Classification of Diseases and Related Health Conditions (ICD)-10. Subsequently, the disability was assessed using Indian Disability Evaluation Assessment Scale (IDEAS). Data were analyzed using SPSS (Statistical Package for Social Sciences) software version 17.

RESULTS

A total of 169 subjects seeking disability certification over the study period of 5 years were diagnosed with schizophrenia. Out of 169 subjects 132 (78.1%) were male and 37 (21.9%) were female. There was a statistically significant difference in the marital status of the male and female study subjects. Family history of psychiatric illness was positive in 9.8% of male subjects and 10.8% of female subjects. There was no significant difference between male and female subjects for the duration of illness and duration of being on treatment. Male and female subjects did not differ significantly on the IDEAS global score, personal care, interpersonal interaction, and understanding and communication domains of IDEAS. The two groups differed significantly on the work domain.

CONCLUSIONS

Majority of patients with schizophrenia seeking disability certificate continue to be male. However, male and female subjects tend to differ very little on various socio-demographic and illness related variables. The levels of disability are also comparable among males and females. However, the work related disability is relatively higher among males and females continue to be financially dependent on the family members.