Marital Adjustment, Depression, Anxiety and Stress among HIV working and non-working married women.

Marital Adjustment, Depression, Anxiety and Stress among HIV working and non-working married women.

(ii) Introduction :HIV/AIDS affects the economic well-being of families, businesses, and societies in many ways. When people become ill and die, society loses not only those people but also their productive potential. They no longer hold jobs, manufacture goods, provide services, or support their families. Families lose their breadwinners; the nation loses people who contribute to the well-being of society.

As families use their time and money to care for ill members, their energies and diverted from working to provide income or farming to provide food. Not only the present but also the future is affected, as family members discontinue education because of the financial needs of the family. Even burying the dead makes life more difficult for families and society. Funerals are costly, and people miss days from work to attend the rituals. The epidemic’s high death toll is producing cultural changes. In some communities with high rates of HIV infection, cemeteries have become overcrowded, creating pressure to accept practices not previously sanctioned by religious and cultural authorities, such as cremation. Funerals are a visible, potentially numbing reminder to all that a deadly disease threatens their survival.

HIV threatens workplace productivity because of deaths, absenteeism due to illness and funeral attendance, and lower productivity of sick or newly hired replacement workers. Other increased costs to the business sector include expenses for insurance and medical care for sick employees, which must be weighed against the cost of having to train new employees if more experienced employees become sick because of inadequate health care.

At the societal level, economic growth in many nations is lagging because so many skilled and experienced workers have dies of AIDS. High unemployment and high rates of infection to keep social supports intact. Studies of teachers and health care workers, for example, indicate that many in those professions have been infected with HIV. Society faces the challenges of having many of its productive members sick or dying, leaving few people to care for children and the elderly. In many countries, the number of people affected by HIV/AIDS is overburdening health care and social support resources.

The effect of HIV /AIDS on broader indicators for development, such as life expectancy, has been profound. In the 1950s, a child born in southern Africa had a life expectancy  of 44 years. By the early 1990s, that figure has risen to almost 60 years. But life expectancy is expected to drop to 45 years between 2005 and 2010 because of the toll that AIDS has taken. Poor households are being pushed deeper into poverty. The effects of the AIDs epidemic will be felt for generations, because so many children are being deprived of adequate nurturing, nutrition, education, and good role models. 

Psychological Effects of HIV on the Family

HIV affects the whole family, not only the infected individual. When one member of a family has HIV, often there are others who are as yet undiagnosed. When HIV infects one partner in a relationship, both partners are affected. The infection may indicate that sex or other risk behavior has occurred outside the relationship, but even if the infection predated the relationship, both partners will be involved in the emotional trauma of the discovery. Ideally, the couple should openly discuss sensitive matters such as condom use, sexual fidelity, and childbearing. This step does not always happen. Regardless of his or her own risk behavior, the undiagnosed partner may express anger and violence toward the person who has been diagnosed. The diagnosis of HIV infection in a child usually indicates the presence of the virus in the mother. The father and other siblings may carry the infection as well.

Cultural, social, biological, and economic pressures make women more vulnerable to HIV infection than men. In some areas, the high prevalence of rape puts some women at risk of acquiring HIV. In others, older men who may be infected with HIV pressure teenagers into sexual relationships. Women are often economically dependent on men and unable to negotiate safer-sex practices, including condom use. Women are usually the primary caregivers for their families and may have little support from others when they are ill themselves. As more people receive care for HIV/AIDS in their own homes or the homes of others, health care workers must keep in mind that HIV-infected women are likely to care for everyone else in the family, often to the detriment of the women’s own health. Households led by women also face greater economic difficulties and have fewer supports.

Strengthening the family structure is especially important because of the tremendous stress that HIV puts on family systems. Besides caring for ill relatives and for orphans, families are often beset by economic and social problems as well as the grief that accompanies the loss of family and friends. They may benefit from group or family counseling, including counseling about their desire to have a family, perhaps the need to prevent unwanted pregnancies, and negotiation or risk = reduction practices such as condom use. Individuals may need training in assertiveness and how to communicate their needs. Remember also the more basic needs that the family is facing food, shelter, and dwindling finances.

One of the most important relationship between a man and women is marriage. It involves emotional and legal commitment that is quite important in any adult life. Moreover, selecting a partner and entering into a marital contact is considered both maturational milestone and personal achievement. There is no doubt that the choice of marital partner is one of the most important decisions one makes in his/her life time. People marry for many reasons, like; love, happiness, companionship and the desire to have children, physical attraction, or desire to escape from an unhappy situation. Marriage is a commitment with love and responsibility for peace, happiness and development of strong family relationships. Marriage as socially legitimate sexual union, begun with a public announcement and undertaken with some ideas of permanence; it is assumed with more a less explicit marriage contract, which spells out the reciprocal rights and obligations between the spouses and future children. 

Marital adjustment is the state in which there is an overall feeling in husband and wife of happiness and satisfaction with their marriage and with each other. All the marriages are aimed at happiness.  In one or another way most couples marry filled up with expectations. Some of the expectations will be realistic while others unrealistic. This is due to the complex as a universe. Therefore, is marriage two universes close together. Marital adjustment calls for maturity that accepts and understands growth and development in the spouse. If this growth is not experienced and realized fully, death of marital relationship is inevitable. A relationship between couples is not instantaneous rather a slow progress. It is like the undetected cancer that kills silently and softly. 

Husbands and wives have indicated some of the factors that contributed to marital satisfaction. Some of their findings revealed existing social, cultural, educational level as related with greater satisfaction. Occupation and income, which are often thought to be associated with levels of satisfaction, have no relationship with it. The number of children too affects marital satisfaction. There is evidence that the pressure of managing multiple roles in women are the greatest, and the psychological benefits of employment are the least, under conditions of heavy family responsibilities that is, when young children are at home. But beyond specific factors such as these, what is important to martial satisfaction over the course of marriage is the ability of partner to adjust to a variety of changes and to cope with a number of stresses.

HIV infected spouses suffering from severe stress blame the deteriorating relationships on their spouses.  Looking at the growing rate of divorces, court cases for alimony, physical abuses and single parents; it does seem as if handling a relationship can be a tricky and often taxing issue. The possible causes can be endless. More often than not, stress arising from marital relationships is manifested in chronic disorders such as depression, anxiety, insomnia and hypertension. Since a relationship depends on the nature of the persons involved, it helps to seek the middle path when the inherent individual differences surface. It often helps to change one’s attitude go for counseling or talk openly with your spouse’s about problems facing your relationship. 

Depression in a spouse is an issue that most HIV couples will face at some point in their marriage. Depression is a normal & natural response to loss or grief, whether a death, separation from a loved one, job loss, loss of physical health or relocation. Marital distress and relationship conflict also contribute to depression.

Symptoms of depression include feelings of sadness, hopelessness, helplessness, anxiety, irritability, agitation, fatigue, low energy, and reduced activity level are common and there is also withdrawal from social contact and loss of interest in previously enjoyed activities, including sex. There may be changes in appetite, weight or sleep patterns, memory problems or difficulty concentrating often there are feelings of worthlessness or inadequacy and a lowered sense of self-esteem. In more serious cases there may be suicidal thoughts or a feeling that life is not worth living (comer, 1996). Married women have higher rates of depression than unmarried women, but the reverse is true for men. Marriage seems to confer a greater protective advantage on men than women.

• Origin of the research problem:

Psychosocial aspects of HIV patients have been studied extensively throughout the fast few years. Many researches have contributed to increase psychological and social adjustments of HIV patients. Current investigation is based on these researches and the increasing need of methods of psychosocial adjustments of HIV patients.

• Interdisciplinary relevance:

Better psychosocial adjustments of HIV patients will further help Medical Science, Anthropology, Sociology and Biology.

• Review of Research and Development in the Subject :

Happily married people have been found to be healthier than unmarried  people or unhappily married people,  consistently over a number of separate researches (Kiecolt-Glaser and Newton, 2001). Marital functioning is central to mental as well as physical health, including autonomic, endocrine and immune systems (Whisman, 1999). Periodontal disease, rheumatoid arthritis,  cardiovascular function, blood pressure, behavioural symptoms of neurological disorders are examples of biological diseases that are affected by marital relationship. Better sleep, fewer depressive symptoms also characterize satisfied married couples (Prigerson et al.,1999).

However, these benefits are stronger for men and not so for women. In satisfied marital relationships, men and women are equally benefitting in health measures but in dissatisfied marriages the women manifested more physical and mental health problems, including depression (Sullivan et al.,1994). The underlying mechanism contributing to women’s greater responsivity to marital distress may be explained by relational self-representations, communion trait and role differences (Cross and Madson, 1997a). Bird (1999) reports that the role inequalities and family responsibilities faced by working women at home contributes to depression, high blood pressure, higher levels of cortisol and norepinephrine.

Women who are living with HIV are particularly vulnerable since they are faced with specific problems. They often feel lonely and experience shame, stigma, anxiety, depression and feelings of uncertainty and, in addition, are challenged in their roles as caregivers, mothers and wives (Chung and Magraw 1992). Lack of emotional, financial and social support, poverty, low level of education also compounds the problem (Mello et al., 2010). Leserman (2008)found substantial and consistent evidence that chronic depression, stressful events, and trauma may negatively affect HIV disease progression. Jones et al. indicated that family stressors predicted deterioration in health of women with HIV.

Significance of the study:

To improve the quality of life of women living with HIV it is important to understand the depression, anxiety, stress, marital adjustment, and working/non-working status and plan suitable interventions in the light of the findings.

·         (iii) Objectives

1. To study the level of marital adjustment among working and non-working married women with HIV.
2. To study the level of depression anxiety and stress among working and non working married women with HIV.

·         (iv) Methodology & Plan of Work:

Sample : The sample of 150 HIV infected married women (75 working and 75 non-working) will be taken for this study from Karnataka and Punjab. Working women would be counselors, peer educators and Nurses. Convenient random sampling will used for this study.

Tools :

Marital adjustment Inventory (MAI) (1987) by Dr. Harmohan Singh (1987) self-reported inventory of marital adjustment is consisting A-10 & B-10 Items.

The coefficient of reliability for each of the six professions of the inventory and for general population are 94. There were determined for correcting the odd-even terms and applying the spearman Brown-prophecy formula.

Depression Anxiety stress scale by Lovibond (DASS) (1995)

Internal consistency reliability coefficients for DASS-42 items, depression, anxiety stress subscales and full scale were found to be high with cronbach’s alphas of .89,  .85,  .81 and .95 respectively. For DASS-21, these values were .79, .71, .76 and  .89.

Statistical analyses

Appropriate statistical analyses will be done to explain the relationship between the variables under study.