Back
Year : 2015 | Volume : 3 | Issue : 3 | Page : 185 - 189  


Original Articles
Role of Family problems as risk factor for cardiac problems

AA Kameswar Rao1, VV Sastry2, A SaiRam3, K. Sirisha4, B. Harika5

1& 2Professor of Community Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad

3Assistant Professor, Kamineni Academy of Medical Sciences, Hyderabad

4Resident, Prathima Institute of Medical Sciences, Karimangar

5Resident, Prathima Institute of Medical Sciences, Karimangar

Corresponding Author:

Dr. AA Kameswar Rao

Email: avasarala46@gmail.com

Abstract:

Background: Emphasis will be given usually for personal problems like smoking, unhealthy diet and physical activity as the causes for cardiac morbidity, often ignoring the underlying family problems.

Objectives: 1) to study the family problems causing cardiac problems/diseases and 2) to advise the families regarding the mitigation of the preventable family problems.

Methods: A descriptive study was conducted in both urban and rural communities of two health centres. Statistical techniques used were proportions and X2 test. Two resident doctors enquired 150 patients suffering from cardiac diseases/problems and collected information using a pretested questionnaire regarding the family problems: Family size, financial difficulties, dowry problems, lonely living, kith & kin problems etc.    A group meeting was also conducted with an intention to educate the patients and their family members regarding the mitigation of these family problems and prevention of the cardiac problems.

Results: Cardiac problems, especially, hypertensive heart disease and conduction defects were seen in patients in the age group of 40-60 years,(53%) urban (54%) middle class (56%)patients. The main family problems associated with cardiac problems were:  Large family size (95%), nuclear families (78.6%) and financial problems like loans, property losses (83%) and dowry problem for unmarried daughters (31%).

Conclusions: People belonging to large families with financial stress and other social problems appeared to be the victims for the cardiac problems.

Key words: Family problems, Cardiac problems, Social problems, Karimnagar district

INTRODUCTION:

Are the family problems not important enough to cause the cardiac problems?    More studies were conducted mainly on personal problems like smoking, unhealthy diet and sedentary life. [1] Family problems can also cause the cardiac problems but were often ignored or neglected. The family problems like financial strain and property losses, lonely living, paying dowry for unmarried daughters, sickness in the family, medical and educational expenses can induce substantial mental stress to cause the cardiac problems. The risk caused by these family problems is comparatively equal to that caused by smoking, poor diet and sedentary life. [2]

 

 

 

 

 

 

 

They are responsible for psychological states like anger or emotional outbursts and depression which in turn can cause hypertensive heart failure, acute myocardial infarction and even rupture of the heart. [3, 4, 5, 6]  Actually, these family problems are the root causes (underlying determinants) for  the personal risk factors. They can cause depression which can lead to the development of the personal risk factors like smoking, overeating with obesity, and sedentary life.   [7, 8, 9, 10]  If we can reduce or prevent these root causes, all their ill-consequences will get automatically reduced, so also the cardiac problems.  In the present study, with the same intention, the family problems faced by 150 patients and their families were analyzed with regard to their connection with the cardiac problems. Educational interventions were undertaken at individual and family levels.

METHODS:

The study was conducted among the patients attending an urban teaching hospital and a rural health centre in Karimangar district from April 2006 to September 2008.

Preplanning:  Both the medical officers of urban health centre and Rural health centres attached to the Community medicine department were given five days training by the cardiologist and the general physician of the hospital in screening, identifying and referring the patients with cardiac problems and diseases to the cardiology department of the college teaching hospital. As and when, the patients are attending to these centres, the medical officers referred them to the main hospital. An assistant professor of community medicine interviewed these referred patients using a predesigned and pretested questionnaire continuously for 17 months. Pretesting of the questionnaire was carried out among 10% of the sample

                About 3820 patients attended Urban health centre at Karimnagar city and a rural health centre at Vutoor village during these 17 months. About 150 patients among them with cardiac problems (81 from urban health centre and 69 from rural health centre) were referred for confirmation of cardiac problems by the cardiologist and physician for confirming their cardiac nature.  These patients were diagnosed as suffering from cardiac problems/symptoms/diseases by the cardiologist of the hospital and a physician. 

                Study phase: The assistant professor applied the predesigned questionnaire and the questionnaire was pretested among 10% of the selected sample for their completeness.  It was enquired about the age, sex, occupation, socioeconomic status, family size, family type, family history of cardiac problems, dowry problem (compulsory cash payment to the bridegroom by the bride’s parents at the time of marriage) and delayed marriage of the sons, kith& kin problems, sick family members, financial problems like debts, property losses, medical expenses, educational expenses, job problems etc.

                Lastly, the family doctors, local leaders, the patients, patients’ family members were involved in a group discussion. Health education regarding the importance of family problems causing cardiac problems among them was shown and discussed regarding their mitigation in future. Various activities like literacy campaign to reduce the ill-effects of the dowry system, income generating activities and family planning adoption and financial assistance from commercial banks etc were suggested and their feasibility was discussed. Data was analyzed using proportions and X2 test.

RESULTS:

Commonest cardiac problems observed in this study were Hypertensive heart failure and Conduction defects. (Table.1) Cardiac problems were more seen among the age group of 40-60 years and equal in both sexes (Table.2).  They were more observed among the urban large families, broken families and among unskilled middle class illiterates. (Table.3)

Family problems and cardiac problems:  Large family size, financial debts, educational and medical expenses, unmarried daughters with dowry problem and unmarried sons, living alone while children were abroad, deaths and accidents in the family were the main family problems responsible for the cardiac troubles in this study. (Table.4).

Preventive measures adopted were regular medication 98(65.3%), regular medical check ups 78(52%), Meditation, Yoga exercises (body and mind controlling exercises), Pranayama (a method of breath controlling ®ulating) practice 70(46.6%), maintaining good relations with others 37(24.66%) and LIC Policy 31(20.65%).

DISCUSSION:

The stress due to the family problems can induce adrenergic stimulation and cause hypertensive heart disease and arrhythmias etc. The study population were suffering from hypertensive heart disease and conduction defects like extrasytoles, palpitations etc. Hornstein, Rozanski, Das et al, Hula J found similar situation with their studies. [9, 10, 11, 12] The cardiac problems were found equally in both sexes [1] and more in large middle class urban, illiterate families. This may be due their poverty complex status, a combination of poverty, illiteracy and ignorance which is capable of causing stress. Urban families with inadequate income and unplanned expenditures will experience more financial stress as seen in this study population and as in other studies.[13,14,15,16,17] Most of the patients in the present study had financial problems like debts, property losses, medical and educational expenses as also noticed by others.[13,  14, 15, 16]  Illiterates were more affected similar to other studies. [(14, 15, and 17] The ignorance of knowledge to protect from the cardiac problems was also observed. Dowry problem for unmarried daughters was another stress factor causing cardiac problems among some of the patents. They have to pay a lot of money as dowry, a social evil still present in this country. This dowry problem is seen among patients also in other studies. [18] Large family size, broken family, problems caused by the kith& kin and sickness among family members, all of them, contributed to the cardiac morbidity by inducing stress. De la Revilla et al found similar situation among their study patents. [19]

Strengths and weaknesses:  The study findings are strong enough to say that family  problems  also need our attention in addition to the usually addressed risk factors like smoking, unhealthy diet and sedentary life  and worth preventing to prevent cardiac problems. Secondly, the cardiac problem, which we consider as disease of modern society till now, was observed in rural populations also. Here, there is a further scope for research for stress factors among rural factors.  The weakness of this study is its non-scientific sampling technique. It is most impossible to get all the cardiac cases at the same time and hence purposive sampling has become unavoidable.

Recommendations: At family level, family oriented medical measures are essential to solve these family problems. Revamping of family medicine is the appropriate solution to mitigate these family problems. At community level, social support, altruism, faith and optimism will be helpful in reducing these family stresses. With this intention, various activities like literacy campaign to reduce the ill-effects of the dowry system, income generating activities and family planning adoption and financial assistance from commercial banks etc were suggested to the patients and their family members in this study. Stress releasing relaxation measures like regular exercises, developing sense of humor, pet ownership will help in reducing the stress and protecting the heart. It is very encouraging to find out that about 50% of the patients in this study were practicing meditation and other releasing techniques.

CONCLUSION:

To conclude, the family problems are also very important in causing the cardiac problems and they need special attention as they are worth preventing to prevent and reduce cardiac morbidity and mortality.

REFERENCES:

  1. W.H.O Fact sheet N0 317, February 2007.
  2. Siegrist J. Psychosocial factors influencing development and course of coronary heart disease. Herz. 2001 Aug;26(5):316-25
  3. Ghadonii LB, Donald HE, Cropley M et al, Mental stress induces transient endothelial dysfunction in humans; circulation J:102,2473,2000
  4. R.Wayne Alexander,Hurst’s The Heart, Mc Graw Hill Publcations’9th Edition,VoL1,pp117&1183
  5. Doyii YL, Takata T, Hemashnge N, Yowazowa Y,Odawara H, Ozawa t, Congental coronary artery fistula with dilated cardiomyopathies; Chest,1987-91pp404-466.
  6. Tennant C, McLean L. The impact of emotions on coronary heart disease risk .J Cardiovasc Risk. 2001 Jun;8(3):175-83
  7. Albus C, Jordan J, Herrmann-Lingen C. Screening for psychosocial risk factors in patients with coronary heart disease-recommendations for clinical practice, Eur J Cardiovasc Prev Rehabil. 2004 Feb;11(1):75-9.
  8. Albus C, De Backer G, Bages N, Deter HC, Herrmann-Lingen C, Oldenburg B, Sans S, Schneiderman N, Williams RB, Orth-Gomer K. Psychosocial factors in coronary heart disease -- scientific evidence and recommendations for clinical practice] Gesundheitswesen. 2005 Jan;67(1):1-8
  9. Hornstein C. Stress, anxiety and cardiovascular disease: an interdisciplinary approach. vertex 2004; 15 suppl1;21-31(article in Spanish)
  10. Rozanski A, Bluementhal JA, Kaplan J. Impact of psychological factors on the pathogenesis of cardiovascular disease and implications for therapy. Circulation.1999apr 27;99(16)2192-217.
  11. Das S, O’Keefe JH. Behavioral cardiology: recognizing and addressing the profound impact of psychosocial stress on cardiovascular health. Curr atheroscler Rep. 2006 Mar ;8(20: 111-8
  12. Hula j, Opatrny J, Beran j. Psychological factors and heart disease. Cas Lek Cesk. 1998 Nov 2; 137(21):643-6 ( Article in Jech)
  13. Lee G, Carrington M. Tackling heart disease and poverty. Nurs Health Sci. 2007 Dec; 9(4): 290-4.
  14. Pearson TA. Education and income: double edged swords n the epidemiological transition of cardiovascular disease. Ethn Dis. 2003 Summer; 13(2 suppl2):s158-63
  15. Ishthiani LH, Franco Gda, C,  Perpetuo IH, Franca E. socioeconomic inequalities and premature mortality due to cardiovascular diseases n brazil. Rev Saude Publica. 2006. Aug;40(4): 684-91.
  16. Greenwood DC, Muir KR, Packham CJ, Madeley RJ. Coronary heart disease: a review of the role of psychosocial stress and social support: J Public Health Med. 1996 Jun;18(2):221-31
  17. Skodova Z, Nagyova I, van Dijk JP, Sudzinova A, Vargova H, Studencan M, Reijneveld SA. Socioeconomic differences in psychosocial factors contributing to coronary heart disease: a review. J Clin Psychol Med Settings. 2008 Sep;15(3):204-13. Epub 2008 May 24
  18. Diamond-Smith N, Luke N, McGarvey S. Too many girls, too much dowry son preference and daughter aversion in rural Tamil Nadu, India. Cult Health Sex. 2008 Oct;10(7):697-708
  19. de la Revilla L, de los Ríos Alvarez AM, de Dios Luna del Castillo J. Factors underlying psycho-social problems] Aten Primaria. 2007 Jun;39(6):305-11

 

 

 

 

 Table 1: Age & Sex distribution of the study population

Age in years

Males (%)

Females (%)

Total (%)

20-30

04 (2.6)

25 (16.6)

29 (19.3)

40-60

45 (30)

36 (24)

81 (54)

60-80

28 (18.6)

12 (08)

40 (26.6)

Total

77 (51.3)

73 (48.6)

150 (100)

 

Table 2: Types of cardiac problems among the study population

Cardiac problems

Males (%)

Females (%)

Total (%)

Hypertensive heart failure

43 (28.6)

22 (14.6)

65 (43.3)

Conductive defects (palpitations/extra systoles etc)

16 (10.6)

26 (17.33)

42 (28)

Cardiac neurosis

13 (8.6)

17 (11.3)

30 (20)

Valvular diseases with heart failure

05 (3.3)

17 (11.3)

30 (20)

Total

77 (51.3)

73 (48.6)

150 (100)

 

Table 3: Cardiac problems according to social variables

Family size

Males (%)

Females (%)

Total (%)

Less than 2

3 (2)

4 (2.6)

7 (4.66)

More than 2

74 (49.3)

69 (46)

143 (95.34); X2=6.92, p < 0.05

Total

77 (51.3)

73 (48.6)

150 (100)

Family type

05 (3.3)

17 (11.3)

30 (20)

Nuclear

53 (35.3)

39 (26)

92 (61.3)

Joint

11 (7.3)

21 (14)

32 (21.3)

Broken

13 (8.6)

13(8.6)

26(17.3)

Total

77(51.3)

73(48.6)

150(100)

Residence

 

 

X2df1=22.50;(p<0.05)

Significant  urban

Urban

39(26)

42(28)

81(54)

Rural

38(25.3)

31(20.6)

69(46)

Total

77(51.3)

73(48.6)

150(100)

Occupation

 

 

 

Professional

21(14)

8(5.3)

29(19.3)

Managerial

24(16)

7(4.66)

31(20.6)

Skilled

7(4.66)

8(5.3)

15(10)

Unskilled

25(16.6)

50(33.3)

75(50)

Total

77(51.3)

73(48.60)

150(100)

Socioeconomic status

 

 

 

Poor

16(10.66)

26(17.3)

42(28)

Middle

42(28)

43(28.6)

85(56.6)

High

19(12.66)

4(2.66)

23(15.3)

Total

77(51.3)

73(48.6)

150(100)

 

 

 

X2df1=12.07;(p<0.05) significant

Educational status

 

 

 

Illiterates

13(8.66)

23(15.3)

46(30.6)

Primary

17(11.33)

14(9.3)

31(20.60)

Secondary

25(16.6)

15(10)

40(26.60)

Higher

22(14.6)

11(7.3)

33(22)

Total

77(51.30)

73(48.60)

150(100)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Table 4: Cardiac problems and the Family problems

Family problem

Males (%) N=77

Females (%)N=73

Total (%)N=150

Family history

5(3.33)

2(1.3)

7(4.6)

Financial problems

 

 

 

Loans

42(28.)

36(24)

78(52)  

Property losses

7(4.6)

3(2)

10(6.6)

Medical expenses

8(5.33)

14(9.33)

22(14.66)

Educational expenses

21(14)

20(13.3)

41(27.3)

Children problems

 

 

 

Stress of Unmarried daughters (dowry)

24(16)

23(15.3)

47   (31.3)

((X2df1=1.13;p>0.05) significant

Children abroad and living alone

30(20)

15(10)

45(30)

Adverse events in the family

 

 

 

Deaths/accidents

18(12)

27(18)

45(30)

Kith& kin problems

4(2.66)

11(7.3)

15(10)

Sick family members

10 (6.6)

3 (2)

13 (8.6)

 

 





img

Important links

adv apply rec

Open Access Journal

MRIMS Journal of Health Sciences is an open access journal which means that all content is freely available without charge to the user or his/her institution. Users are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles in this journal without asking prior permission from the publisher of the author. This is in accordance with the BOAI definition of open access.

Visitor Count


407732
© 2019 Chandramma Education society . All Rights Reserved.