CAREGIVER BURDEN IN TREATMENT SEEKING ...

CAREGIVER BURDEN IN TREATMENT SEEKING INDIVIDUALS

WITH ALCOHOL USE DISORDERS, TAMILNADU

Dissertation submitted in partial fulfillment of the

requirements for the degree of

M.D. (PSYCHIATRY)

BRANCH XVIII DEPARTMENT OF PSYCHIATRY

201728551

KARPAGA VINAYAGA INSTITUTE OF MEDICAL SCIENCES

AND RESEARCH CENTRE, KANCHIPURAM 603308

THE TAMILNADU DR. M.G.R. MEDICAL UNIVERSITY,

CHENNAI, TAMILNADU

MAY 2020

ii

CERTIFICATE

Certified that this dissertation entitled “CAREGIVER BURDEN IN

TREATMENT SEEKING INDIVIDUALS WITH ALCOHOL USE

DISORDERS, TAMILNADU” is a bonafide work done by Dr.

KARPAGALAKSHMI.R, Post graduate student, Karpaga Vinayaga

Institute of Medical Sciences, Madhuranthagam, during the academic year

2017 – 2020.

Signature:

Prof. V. Sethumadhavan, MD, D.P.M.,

Professor & Head,

Department of Psychiatry,

Karpaga Vinayaga Institute of Medical Sciences & Research Centre

Kancheepuram 603308

iii

CERTIFICATE

Certified that this dissertation entitled “CAREGIVER BURDEN IN

TREATMENT SEEKING INDIVIDUALS WITH ALCOHOL USE

DISORDERS, TAMILNADU” is a bona fide work done by

Dr. KARPAGALAKSHMI.R, Post graduate student, Karpaga Vinayaga

Institute of Medical Sciences, Madhuranthagam, during the academic year

2017 – 2020.

Signature:

Dr. Sufala Sunil Viswasrao, MD,

Principal,

Karpaga Vinayaga Institute of Medical Sciences and Research Centre,

Kancheepuram 603308.

iv

CERTIFICATE – II

This is to certify that this dissertation entitled “CAREGIVER

BURDEN IN TREATMENT SEEKING INDIVIDUALS WITH

ALCOHOL USE DISORDERS, TAMILNADU, KANCHEEPURAM,

TAMILNADU” of the candidate Dr. R. Karpagalakshmi, with registration

Number 201728551 for the award of M.D. in the branch Psychiatry. I

personally verified the urkund.com website for the purpose of plagiarism

check. I found that the uploaded thesis file contains from introduction to

conclusion pages and result shows percentage of plagiarism 5% in the

dissertation.

Guide and Supervisor

Sign with Seal

v

DECLARATION BY THE CANDIDATE

I, hereby declare that this dissertation entitled “CAREGIVER

BURDEN IN TREATMENT SEEKING INDIVIDUALS WITH

ALCOHOL USE DISORDERS, TAMILNADU” submitted by me for the

degree of M.D is the record work carried out by me during the period from

July 2017 to May 2020 under the guidance of Prof. V. Sethumadhavan,

Head of the Department of Psychiatry, Karpaga Vinayaga Institute of

Medical Sciences and has not formed the basis of any degree, diploma or

fellowship titles in this or any other university or other similar institution of

higher learning.

Signature:

Dr. R. KARPAGALAKSHMI

Post Graduate Registrar (MD),


Karpaga Vinayaga Institute of Medical Sciences and Research Centre,

Kancheepuram 603308.

vi

ACKNOWLEDGEMENT

I sincerely thank Dr. R. ANNAMALAI RAGHUPATHY, Managing

Director, Karpaga Vinayaga Institute of Medical Sciences for his kindness in

helping us with all available resources.

I wish to thank Dr. SUFALA SUNIL VISWAS RAO, Principal,

Karpaga Vinayaga Institute of Medical Sciences for her support and

guidance.

It is beyond words to express my sincere thanks and gratitude to my

Professor and HOD and my guide Dr. V. SETHUMADHAVAN, Professor,

KIMS who consistently guided me in each and every step of my thesis work.

His kind support and encouraging words are great pillars of my success.

I wish to proudly thank my Associate Professor Dr. T. SIVAILANGO

for his valuable advice and support.

I feel happy to thank Dr.S.ARUMUGANATHAN, Assistant Professor

and my co guide for the encouragement, guidance and support rendered by

him all through my works. His passion for the subject and his zeal to share

his immense knowledge and experience with me will always be a source of

inspiration.

vii

It also gives me immense pleasure in thanking Dr. S.

SUMITHRADEVI, Assistant Professor and Dr. S. USAID, senior resident,

for helping me in overcoming difficult situations during this thesis work and

for their valuable guidance. I am also thankful our Clinical Psychologist

Mr.M.Krishnamoorthy, for his assistance in bringing out this project.

I thank my co-postgraduate, my juniors and CRRIs who has been a

source of constant support and help.

I thank my family and my friends for the limitless love, support and

motivation.

I thank the “Almighty” immeasurably, because without HIS blessings I

wouldn’t have been able to complete this dissertation.

Finally, I am immensely thankful and grateful to all the patients and

their caregivers who had involved themselves and participated in this study,

making it a successful completion.

viii

ix

CONTENTS

S NO TITLE PAGE NO

1 INTRODUCTION 1 – 3

2 REVIEW OF LITERATURE 4 –35

3 AIMS AND OBJECTIVES 36 – 38

4 MATERIAL AND METHODS 39 – 48

5 OBSERVATIONS & RESULTS 49 – 72

6 DISCUSSION 73 – 82

7 CONCLUSION 83 – 85

8 REFERENCES 86 – 98

9

ANNEXURES

i. ABBREVIATIONS

ii. CONSENT FORM

iii. STUDY INSTRUMENTS

iv. ETHICS COMMITTEE

APPROVAL CERTIFICATE

v. MASTER CHART

99 – 137

101

102 – 103

104 – 121

122

123 - 137

1

INTRODUCTION

2

INTRODUCTION

Alcohol use disorders not only affect the individual but also their

family members. In the human history alcohol has played a major role

irrespective of the culture, race, traditional background and religion. Many

societies in the world make use of exhilarating, euphoric substances among

which alcohol was believed to be the most common.

Family plays a vital part in the care of the patient with mental illnesses.

In country like India, family is the most important factor due to various

factors like interdependence, culture and concern for the family members1.

Increased consumption of alcohol has been identified as a major risk

factor for global disease burden. According to global status report, overall

5.1% of global disease burden and injury were attributed to alcohol2

Alcohol use disorders are defined as a cluster of behavioral and

physical symptoms which can include withdrawal, tolerance and craving.

Alcohol withdrawal symptoms develop 4-12 hours after reduction of intake

following prolonged, heavy alcohol ingestion. Craving for alcohol is

indicated by a robust desire to drink that produces it troublesome to think

about the rest which usually leads to the onset of drinking. School and job

performance may also suffer either from the after effects of drinking or from

actual intoxication at workplace; childcare or household responsibilities may

be neglected; and alcohol related absences may occur from school or work.

3

Finally individuals with an alcohol use disorder may continue to consume

alcohol despite the knowledge that continued consumption possess

significant physical (blackouts, liver disease), psychological (depression),

social or interpersonal problems (violent arguments with spouse while

intoxicated, child abuse (DSM 5)3

Alcohol use has become one of the major public health problems and

third largest risk factor for disease and disability globally. Since most studies

focused mainly on individuals who consume alcohol and very few on

caregivers, this study is an attempt to assess the pattern of alcohol use,

correlation between the severity of alcohol use and caregiver burden.

4

REVIEW OF LITERATURE

5

REVIEW OF LITERATURE

Alcoholism:

Alcoholism is a bio psychosocial phenomenon par excellence; it results

from the contribution of multiple individual and environmental risk factors.

Theories have taken many disparate considerations, from the effects of policy

to the influence of familial and sociocultural environments across cultures

and over time. Some ethnic groups have traditionally had low rates of

alcoholism (Asians, Jews, and some North American Aboriginals) and the

prevalence is generally higher in males across both age cohorts and

ethnicities.

Another layer of complexity lies in the fact that alcoholism is a

clinically heterogeneous disorder with variable age of onset, drinking

patterns, severity, and comorbidity with other mental disorders. In general,

alcoholics have one or more clinical diagnoses in addition to alcohol

dependence, including drug abuse, antisocial personality disorder, anxiety,

and depression. The course of the disorder is variable with high rates of

remission and relapse; its manifestation changing in pattern and severity in

response to life events (stressors) and other aspects of the environment.

The availability of alcohol and the social promotion of frequent or

heavy drinking are examples of social risk. But environmental facilitation

6

does not explain the genesis of an alcohol dependence disorder in specific

individuals. This disorder is best understood because the results of social

prompting and individual vulnerabilities. There is a variance in drinking and

heavy drinking patterns, alcohol use disorders and treatment for alcoholism

recorded more in men than in women3

Alcohol Use Disorder

Alcohol Use Disorder is a complex, multifaceted cluster of behavioral,

cognitive, and physiological symptoms. The elements represent biological,

psychological (cognitive), and behavioral processes. This helps to explain the

linkages and interrelationships that account for the coherence of signs and

symptoms. The main feature is co-occurrence of signs and symptoms.

Salience means that drinking is given a higher priority than other activities in

spite of its negative consequences.

This is reflected in the emergence of alcohol use as the preferred

activity from a set of available alternative activities. Once drinking to

intoxication goes against the understood social rules governing the time,

place, or quantity usually expected by the user’s family or friends, this might

indicate hyperbolic salience. Salience is when a person continues to drink or

drug use despite of negative consequences.

7

This implies that substance use has become the preferred activity in the

person’s life. One indication of this is the amount of time or effort devoted to

obtaining or using substances or recovering from substance use.

Chronic drinking interferes with the person’s ability to conform to tacit

social rules governing daily activities, such as keeping appointments, caring

for children, or performing a job properly, that are typically expected by the

person’s reference group. Excessive use also results in mental and medical

consequences. Thus, a key aspect of the dependence syndrome is the

persistence of excessive drinking in spite of social, psychological, or physical

harm, such as loss of employment, marital problems, depressive symptoms,

accidents, and liver disease. This indicates that alcohol use is given a higher

priority than other activities, in spite of its negative consequences.

Impaired control refers to the inability to limit the amount or frequency

of alcohol use. Resumption of heavy drinking after receiving professional

help for a drinking problem is evidence of lack of success. The symptom is

considered present if the drinker has repeatedly failed to abstain or has only

been able to control drinking with the help of treatment, mutual-help groups,

or removal to a controlled environment.

Tolerance is a decrease in response to a standard dose of alcohol that

occurs with continued use. Tolerance may be physical, behavioral, or

psychological. Physical tolerance is a change in cellular functioning. The

8

physiological effects of alcohol diminish over time, even though the cells

normally affected by alcohol are subjected to the same concentration.

Psychological tolerance occurs when the drinker no longer experiences a

“high” after the initial drink. Behavioral tolerance is a change in the effect of

a standard dose of alcohol that occurs when the person has learned to

compensate for the impairment.

A withdrawal state is a group of symptoms that occur after cessation of

drinking, usually after repeated and usually prolonged drinking. Withdrawal

symptoms can appear after several hours of abstinence, which explains why

some alcoholics have a need to drink soon after waking in the morning.

Dick & Kendler, 2012 says Alcohol use disorder has long been

recognized to run in families 4. There is substantial evidence from twin

research and adoption studies that a major genetic component is operative in

its development, which prior to DSM-5 was called alcohol dependence.

Nonetheless, the disorder is etiologically complex, in that it there is a

sevenfold risk for alcohol dependence in first-degree relatives of alcohol-

dependent individuals, with male relatives of male alcohol-dependent

individuals having the greatest risk for the disorder 5. This highlights the fact

that environmental factors play a role in developing alcohol use disorders,

In a review of population-based twin studies of alcohol dependence,

heritability estimates (i.e., the proportion of risk attributable to genetic

9

factors) ranged between 0.52 and 0.64, with no substantial sex difference

(Kendler, 2001).

Kendler et al., 1997 conducted a study in Sweden using data from

temperance board registrations showed that the estimate of the genetic

contribution to risk of stability of disorder across decades, despite of

changing society

McGue, 1994 conducted many adoption studies and majority of the

results have shown an excess of alcohol dependence in adopted-away

offspring of biological parents. Alcohol dependence appears to be a

polygenic disorder with multiple genes acting in either additive or interactive

ways. Two molecular genetic approaches that have been used to identify the

genes that influence risk for alcohol dependence are candidate gene studies

and linkage studies.

Candidate gene studies are population-level investigations in which

genetic loci that code for proteins thought to be important in the etiology of

the disorder are examined in samples of unrelated individuals. Candidate

Gene Studies are the best-known example of genetic variation affecting risk

for alcohol dependence involves genes that are not directly relevant to

alcohol’s neuropharmacological effects. (Gelernter, 1995).

10

Thomasson et al., 1991 found that the mechanism depends upon the

metabolism of alcohol, first to acetaldehyde by ADH and then to acetate by

acetaldehyde dehydrogenase. Acetaldehyde is toxic and produces a flushing

reaction characterized by a set of uncomfortable symptoms including facial

flushing, lightheadedness, palpitations, and nausea. Thus, increased

metabolism of ethanol or decreased metabolism of acetaldehyde, either of

which can result in increased acetaldehyde concentrations, produces an

aversive effect which could decrease the risk for alcohol dependence. There

is, in fact, evidence that a variant that greatly reduces or eliminates ALDH

function (occurring mostly in Asian populations) is protective against alcohol

dependence, and ADH variants that increase function may also be protective.

The mechanism of this effect depends upon the metabolism of alcohol, first

to acetaldehyde by ADH and then to acetate by acetaldehyde dehydrogenase.

Work by Chen et al., 1999 and Bierut et al., 2012 concluded some people

metabolize alcohol quickly but have a problem breaking down the in-between

by-product acetaldehyde; people carrying this gene variant may be less likely

to drink and therefore may have a lower risk for alcoholism.

Hesselbrock et al., 2001 conducted two large linkage studies in an

effort to identify chromosomal regions that contain genes that modify the risk

for alcohol dependence12

. The larger of these two projects, the Collaborative

Study on the Genetics of Alcoholism (COGA), included more than 9000

11

adults and nearly 1500 children and adolescents. A genomic scan of the

COGA samples showed that chromosomes 1 and 7 each have a region

containing one or more genes that increase the risk for alcohol dependence.

Reich et al., 1998 found a “protective factor” on chromosome 4 for

alcohol dependence13.

A linkage study has also been reported for a sample of

152 subjects belonging to extended pedigrees in a southwestern American-

Indian tribe (Long et al., 1998)14

. A genome-wide scan was performed on

172 sibling pairs from this sample. Evidence for linkage to alcohol

dependence was obtained for regions on chromosomes 4 and 11. Three

closely linked loci on chromosome 4 map onto the Type I ADH gene cluster

in proximity to the region on this chromosome that was identified as linked to

a “protective factor” by COGA.

Epidemiology

Alcoholism is one of the major health problems globally. More than 3

million people died as a result of harmful use of alcohol in 2016, according a

report released by the World Health Organization (WHO) on September 21,

2018. This represents 1 in 20 deaths and it’s more common among men.

Overall, the harmful use of alcohol causes more than 5% of the global disease

burden is caused by harmful alcohol use

12

Alcohol consumption occurs along a Continuum and drinking patterns

vary considerably among individuals with no clear demarcation between

“social” or “moderate” drinking and problem or “harmful” drinking.

However, as the average amount of reached drinking and the frequency of

intoxication increases so does the incidence of medical and psychosocial

problems. In DSM- 4 (American psychiatric association 1994), the most

commonly identified group of people are those with alcohol abuse or

dependence. A less prominent, but more numerous groups consist of

individuals referred to as problem drinkers or harmful drinkers who do not

need the criteria for alcohol dependence.

In DSM-5 alcohol dependence and abuse have been replaced with a

single category of alcohol use disorder. This is likely to result in “diagnostic

orphans”. For Example individuals with alcohol related problems, but not

receiving an alcohol use disorder diagnosis in DSM-5 (Peer et al.2012).

In the 2009 survey on Drug use and health (NSDUH; Substance

abuse and mental health services administration 2010) the majority of U.S

Population aged 12 years and older (51.9% or 130.6 million people reported

consuming alcohol during the month before the interview nearly a quarter of

such individuals (23.7% age or 59.6 million people) engaged in binge

drinking (5 or more drinks on the same occasion) at least once during this

time. Heavy drinking (five or more drinks on separate occasions during the

13

month) was repeated by 6.8% of population or 17.1 million people. The

prevalence of current alcohol use increased with age up to age group of 21 to

25 years where it reached a peak of 70.2%. This is also the same age group

for which the rates of both binge drinking that is 46.5 % and heavy drinking

16% peaked. The 2009 the NSDUH (Substance Abuse and Mental Health

Services Administration 2010) also showed that men were more likely than

women to drink (57.6% versus 46.5%).

Drinking behavior also differed by race, ethnicity. 56 % of white

people reported drinking during the past month followed by individuals

reporting two or more races (47.6 %) Afro-American persons (42.8 %),

Hispanic persons (41.7 %), Asian persons (37.6 %) and American Indian

Alaska native persons (37.1 %). Binge drinking was most common among

Hispanic individuals. (25.0 %), followed by white (24.8 %) American Indian/

Alaska native (22.2 %), African-American (19.8 %) and Asian (11 %)

individuals.

For many years there has been studies shows life time and past year

prevalence of alcohol use disorders. For example, the national comorbidity

survey NCS, a representative household survey of more than 8,000

individuals ages 15 to 54 years was conducted to assess lifetime and past year

alcohol use disorders using the DSM-3 R criteria (American Association

Psychiatric association 1987). The NCS estimated the lifetime prevalence of

14

alcohol abuse and alcohol dependence for adults aged 18 to 54 years to be 9.4

% and 14.1 % respectively.

Together, these data indicate that more than one in five young to

middle-aged in United States met the criteria for a lifetime alcohol use

disorder. (Kessler et al. 1997) 17

. The 12-month prevalence rates for alcohol

abuse and dependence where 2.5% and 4.4% respectively. The 1992

(National longitudinal alcohol epidemiological Survey) NLAES based on

interviews with the national probability household sample of more than

43,000 adults aged 18 and older, showed the one near prevalence of alcohol

use disorder to be 7.4 percentage ( 3.0 percentage with alcohol abuse and 4.4

percentage with alcohol dependence)18

(Grant et al., 1991-92, 2001-02). The

national epidemiological survey on alcohol and related conditions

(NESARC), also a community based survey of more than 43,000 individuals

(Grant et al. 2004a)20

, permitted an evaluation of trends in alcohol use

disorder prevalence and characteristics because it is used a methodology very

similar to that of 1992 NLEAES.

The NESARC are showed a 12 month prevalence of alcohol abuse and

dependence of 4.7% and 3.8%, respectively, so that an estimated total of 17.6

million adult Americans had an alcoholic use disorder during 2001- 2002 the

prevalence of alcohol abuse in the NESARC was significantly increased over

that NLEAS. Whereas the prevalence of alcohol dependence decreased

15

significantly over the ten-year period between the two surveys consistent

with drinking behavior.

National prevalence data also shows that rates of alcohol use disorders

vary by age gender race, ethnicity socioeconomic status and geographic

location. The prevalence of alcohol use disorders has consistently been higher

among men than among women by at least two fold Substance Abuse and

Mental Health Services Administration 2010, the highest prevalence rates of

alcohol abuse and dependence occur among young adults with rates declining

gradually with increasing age.

Adverse consequences of drinking include a variety of social, legal,

and medical problems (Babor et al., 1987)20

. Overall, alcohol-related

mortality is 98,000 deaths each year, or about 7.6% of all deaths in the United

States, putting it among the three leading lifestyle-related causes of death

(Centers for Disease Control, 2012)21

. The number of alcohol-induced

deaths excluding accidents and homicides in 2010 was 25,692. Of alcohol-

related deaths, 44% were attributable to alcohol-related traumatic injury

(Centers for Disease Control, 2012). Alcohol related mortality declined

during the last few decades of the twentieth century.

The age-adjusted mortality rate from liver cirrhosis in 2011 (4.8 deaths

per 100,000 persons) was almost half the 1993 rate (7.9 deaths per 100,000)

(US Department of Health and Human Services, 2013), and alcohol-

16

related automobile fatalities fell by 24.5% between 1998 and 2009, from 5.3

to 4.0 deaths per 100,000 (National Institutes of Health, 2010). Nonetheless,

age-adjusted rates of liver cirrhosis in 2007 remained more than twice as high

for males (12.7 deaths per 100,000 population) than females (5.9 deaths per

100,000 population). (National Institutes of Health, 2010).

The most frequent co-occurring diagnoses are for other drug use

disorders, mood, anxiety, and personality disorders (Hasin et al., 2007)22

.

The relative risks for different types of disorder vary somewhat by gender

(Kessler et al., 1994)23

. Among women, anxiety and affective disorders are

the most common co-occurring disorders. Among men with a history of

alcohol abuse or dependence, drug disorders and conduct disorder account for

the largest proportion of comorbid cases.

Substance use disorders ranging from mild to severe are common

among both men and women with an alcohol use disorder. In 2001–2002,

13.1% of those with a 12-month alcohol use disorder also had a 12-month

drug use disorder. Of these, 73.9% were men and 26.1% were women

(Stinson et al., 2005)24

.

Results from NESARC showed that 28.6% of those with a current

alcohol use disorder had at least one personality disorder. Similarly, 16.4% of

people with a personality disorder had an alcohol use disorder (Grant et al.,

2004a).

17

Problem drinkers have a significantly increased risk for antisocial personality

disorder (ASPD) compared with those in the population with no alcohol use

disorder. Evidence from multiple studies indicates that individuals with an

alcohol use disorder experience a two- to threefold increased risk for

depressive disorders (Swendsen et al25

., 1998; Grant et al, 2004b). The

NESARC study showed mood disorders to be present in 18.9% of those with

an alcohol use disorder (Grant et al., 2004b)26

.

Conversely, 17.3% of individuals with a mood disorder also had an

alcohol use disorder (Grant et al, 2004b). Of the mood disorders, bipolar

disorder is particularly common among individuals with an alcohol use

disorder, with 5.1% having a form of bipolar disorder. Dysthymic disorder,

although present in 2.93% of individuals with an alcohol use disorder, has an

OR of only 1.7 (Grant et al., 2004b) While considered to be important in the

development of alcoholism, comorbid psychiatric disorders also have

prognostic significance (Meyer, 1986)27

.

Rounsaville et al. (1987) found that psychiatric diagnosis at the time

of treatment intake predicted a variety of 1-year post-treatment outcomes.

Among males, the presence of a comorbid lifetime diagnosis of ASPD, major

depressive disorder, or drug abuse/dependence was associated with poorer

drinking outcomes28

.

18

Other investigators have found no difference in drinking outcomes on

comparing primary alcoholics (i.e., those for whom alcohol dependence is the

first and predominant disorder) and alcoholics with a comorbid mood

disorder (Schuckit, 198529

; O’Sullivan et al., 198830

; Powell et al., 199231

).

India being second populous country in the world, around 1/3rd

of its

population consumes alcohol. Alcohol misuse represents a public health

problem in India that need to receive adequate attention. According to WHO

World Health Organization statistics the annual rise in consumption of

alcohol has been increasing in rapid manner. “Magnitude of Substance Use in

India” is a report submitted by NDDTC (National Drug Dependence

Treatment Centre) of the All India Institute of Medical Sciences, New Delhi,

sponsored by the Ministry of Social Justice and Empowerment to Union

Minister for Social Justice and Empowerment.

The Ministry of Social Justice and Empowerment has conducted a

“National Survey on Extent and Pattern of Substance Use in India”. The

Survey was conducted by a team of NDDTC of AIIMS, New Delhi during

2018. This study provides data regarding alcohol use at national and state

level

At the national level, as many as 19% of current users of alcohol

consume alcohol in a dependent pattern. The prevalence of dependent pattern

of alcohol use in the general population (10—75 years) is estimated to be

19

2.7%, or 2.9 crore individuals. States with high prevalence (more than 10%)

of alcohol use disorders are: Tripura, Andhra Pradesh, Punjab, Chattisgarh,

and Arunachal Pradesh. An additional 2.5% of people in the country (about

2.7 crore individuals), consume alcohol in a harmful manner. In other words,

about 5.2% of the population (more than 5.7 crore individuals) are affected

by harmful or dependent alcohol use and need help for their alcohol use

problems. Nearly one in five alcohol users suffers from alcohol dependence

and needs urgent treatment

Patterns of Drinking and Burden of Disease

Alcohol in beverage form is among the most widely used psychoactive

substances in the world. Because of its widespread distribution and the

readiness with which it is consumed in a variety of settings, people do not

generally think of beverage alcohol as a drug. Nonetheless, its complex

pharmacological actions, including panoply of psychoactive effects, have led

societies throughout the world to surround alcoholic beverages with a variety

of rules and regulations to prevent behavioral, social, and psychiatric

problems connected with alcohol misuse (Babor et al., 2010)32

.

Despite these efforts at control, excessive drinking, with its adverse

effects, is widespread. Room et al., 2002 Patterns of drinking and the types

of problems associated with alcohol misuse differ markedly throughout the

world33

. Whereas the highest alcohol consumption rates are generally found

20

among the industrialized countries of Europe and the North American

continent, the lowest consumption rates are found in the predominantly

Islamic countries where the use of alcohol is prohibited or discouraged. The

percentage of drinkers in adult populations ranges from a high of 86% in the

North and Central European countries to less than 10% of adults in Islamic

countries such as Pakistan and Iraq (Room et al., 2002)33

.

According to recent estimates from the World Health Organization’s

Expert Committee (WHO, 2007), the evidence of alcohol’s impact on health

through its intoxicating, dependence-producing, and toxic qualities is

extensive. Alcohol is estimated to cause a net harm of 3.7% of all deaths, and

4.4% of the global burden of disease, as measured in disability-adjusted life-

years (DALYs) lost. Neuropsychiatric disorders, mainly made up of alcohol

use disorders, account for the highest proportion of alcohol attributable

DALYs (Babor et al., 2010).

Sarkar et al., studied socio-demographic characteristics of 187 men

who were alcohol dependent at a de addiction center at west Bengal. They

found that most of the patients were male, married and middle aged. The age

at which they first started drinking and quantity of alcohol intake were

associated significantly with positive family history of alcoholism35

. Strong

familial history in children needs to be evaluated and counseled to prevent

development of alcoholism.

21

In a cross sectional study conducted by Gupta et al34

., concluded that

people consume alcohol much more than the recommended levels often gets

higher rates of binge drinking They also often do not seek treatment for their

alcohol use predisposing them to alcohol related conditions34

.

Sampath et al., conducted a study in a 550-bed teaching hospital in

Kolar, a rural district of Southern India and they found that physical health

issues are common among problem drinkers and there is significant

correlation with smoking and they are likely to prefer local made liquor and

become alcohol dependent.36

John et al.,37

conducted a study at The Department of Community

Health, Christian Medical College, Vellore, Tamil Nadu, Kaniyambadi block

and employed ‘AUDIT’, to assess the use of alcohol. Totally 345 men

interviewed in which 343 were refused to give consent and in that population

One-third sample had used alcohol over last year and one fifth are using

alcohol in a regular basis and about one sixth were hazardous alcohol users.

The study says that it is possible that living in a village which brews alcohol

may encourage positive attitudes towards the consumption of alcohol and

also flagging the risks of illicit liquor. At the same time, the preference for

IMFL, whose availability is widespread in the region, may be a greater risk

for hazardous use.

22

PATTERN OF ALCOHOL USE

A cross-sectional study by Gupta et al34

., on 75 participants with

alcohol use disorders More than half of the participants reported use of

alcohol ‘for relaxation’ or to ‘relieve tension’ and around 40% for

recreational purpose and usual timing for drinking is during night. The most

common place of consuming alcohol was home. Most of the participants

prefer country made liquor followed by Indian made foreign liquor. Around

2/3rd

participants consume alcohol alone and 75% participants would have

something to munch along with drinks and would mix alcohol with water or

soda. More than half of the participants get intoxicated ‘some of the time’

after consuming alcohol in the past three months. In ASSIST scoring, more

than three fourth people scored in high to moderate risk range.

Other studies from different regions of India shows that majority of

population preferred drinking alone and the main reason for drinking is to get

intoxicated and they consume different types of beverages in different

occasion. Beverage type, place where alcohol consumed, manner of

consuming alcohol, proximity of food intake and mixing used with liquor

were often associated with alcohol related complications.(Benegal,200538

;

Vilamovska et al., 200939

, Ronksley , Brien et al40

, Mukamal, & Ghali,

201141

; Turner, Ghosh et al., 201242

; Studer et al., 201543

).

23

CAREGIVER

Steinglass44

studied the impact of alcohol dependence syndrome on the

family in terms of association between extent of alcohol dependence and

psychiatric symptomatology. The sample of the study includes families of

alcohol dependent and non-alcohol dependent spouses. The study showed

that the psychopathology in wives is directly proportional to severity of

alcohol dependence leading to social impairment.

A study from Nepal compared IV drug users and alcohol dependent

individuals and they have found increased caregiver burden in both groups.

However, the caregiver burden was significantly high in IV users. IV drug

abusers showed increased tolerance and less perceived burden in comparison

to other family members.45

About 95 to 100% caregivers of alcohol dependent and opioid

dependent patients had severe burden as reported by a study from

Chandigarh.46

Vaishnavi et al., concluded that severity of alcohol dependence

correlated positively with significant burden in caregivers. It is imperative

that during treatment of alcohol disorder patients alleviating burden of

caregivers is very important to improve treatment effectiveness in alcohol,

use disorder patients.47

24

Srinivasagopalan et al (2015) states that the term Caregiver refers to

anyone who assists to someone else who is in some degree Incapacitated and

needs help. The person who provides unpaid care is called as the informal

caregiver. They may be family member, neighbor or friend. The person who

provides care like a volunteer or being paid for his service that is associated

with the service system is called as formal caregivers48

A hospital based interventional study on burden and quality of life

among caregivers of persons with alcohol dependence syndrome by Swapna

et al., Quality of life has given an approach for management and natural

course of relapse and remission for alcohol dependence.49

It is a dimensional

construct that includes the physical, mental, psychological, social and

religious functioning of the individual. It helps to understand the effects of

the disease on the patient and their caregiver. Among various psychiatric

disorders, alcohol- related disorders significantly affect Quality of life and

extensive studies have to be done on this forum.

Shah et al studied about common mental disorders among spouses of

men with alcohol dependence and he found that 36% depression, anxiety

16%, stress 6% and the risk of self-harm is 2%. This study reveals that

psychiatric comorbities were higher in wives of alcohol dependent men when

compared with wives of non-alcohol dependent men50

. Many studies reported

that women who are married to alcohol dependent men have poor mental and

25

physical health and need for intervention like psychological and social

support to improve the quality of life of affected individuals48

.

Shekhawat et al.,51

conducted a cross sectional study on Caregiver

Burden on Wives of Substance‑dependent Husbands and Its Correlates at a

Tertiary Care Centre in Northern India and it was conducted at Government

Medical College, Kota, Rajasthan and Government Medical College,

Haldwani, Uttrakhand by department of psychiatry and department of

community medicine respectively 50

. Inclusion criteria for patients were those

aged between 18 and 65 years, fulfilled alcohol or heroin (opioid)

dependence criteria as per the WHO ICD‑ 10, duration of heroin or alcohol

dependence for more than 1 year, whose primary caregiver was wife, and

who gave informed consent.

The inclusion criteria for wives were those who gave informed

consent, living with the patient for more than 1 year. There is significance

burden noted in wives of alcohol dependence patients. The burden ranging

from moderate to high and affects the lives of caregivers. On comparing the

mean scores of burden assessment schedule and overall burden between AD

and HD group, there was more burden (in all factors as well as in overall

burden) on wives of HD patients than on wives of AD patients.

Also significant difference was found in the factors of “impact on

marital relationship,” “appreciation of caregiving,” and “impact on relation

with others” but no statistical significant difference was found in the factors

26

of “impact on well‑being” and “perceived severity of disease”. Substance

use in adult phase of life results in the loss of productivity and working

capacity of the patients subsequently disturbing the personal, familial, and

social life as a whole. Present and previous Indian study had shown a higher

prevalence of substance addiction in people from lower socio demographic

status and those who live on daily wages and inability to satisfy the emotional

needs of partner.

Due to lack of appreciation of care given higher burden was perceived

by wives of HD patients as compared to wives of patients of alcohol

dependence. The trend toward the nuclear family system in our country

highlights the importance of wives as the primary care providers and thus

bearing significant caregiver burden. Indian study comparing burden on

caregivers of alcohol‑ and opioid‑dependent patients also found moderate to

severe burden in 95%–100% of the caregivers.

Higher burden in primary caretaker of illiterate patients. Hence,

education becomes an integral part and also important contributor in reducing

burden. As the age of the wife increases, she gets more mature and better

understands the need and care of the patient; hence, she perceives less burden

and more satisfaction because of appreciation and acknowledgment of good

caregiving from family and friends of patients.

Swaroopachary et al52

., conducted a cross sectional of inpatients

attending psychiatry department, SVS Medical college in 2017 for alcohol

27

dependence reported higher caregiver burden in young population and

unemployed group. Care giver burden is high in families with domestic

violence. Severe dependence by married men is associated with poor mental

health and abuse in their wives. Female spouses of persons with alcohol use

disorders experience victimization, mood disorders, anxiety disorders,

subjective to injuries and were often in fair to poor health than spouses of

non-alcohol users. More life stressors were experienced by them. They also

had lower psychological quality of life scores. Partner alcohol problems pose

diverse health threats for women that go beyond their well‑ documented

association with domestic violence.

The quality of marital life of 30 wives of alcohol dependent

individuals and wives of non-dependent control by using Dyadic Adjustment

Scale (DAS) and Social Drinking Scale (SDS) studied by George. Study

results revealed that marital dysfunction among individuals with Alcohol

Dependence Syndrome are related to their drinking habit 53

. The quality of

marital life is influenced by the spouse being dependent prior to or after

marriage. The sample size was small. This was one of the earliest

investigations in the area of the quality of marital life of spouses of alcohol

dependent individuals.

28

Nagalakshmi and Suman conducted a study on 40 families with

fathers having Alcohol Dependence Syndrome and family interaction using

the Family Interaction Scale (FIS) was assessed. They concluded that there

were significant differences between families with fathers having Alcohol

Dependence Syndrome than families with non-alcohol dependent fathers54

.

Families of these individuals were often associated with poor interpersonal

communication, deprivation of mutual warmth and support. The spouse of

the men with Alcohol Dependence Syndrome expressed greater

dissatisfaction in all areas of family functioning than the spouses of men

without Alcohol Dependence Syndrome.

Sabhaney studied 80 families’ individuals with Alcohol Dependence

Syndrome and 30 non-alcohol dependent families55

. He used tools like MMPI

and a semi structured interview to assess the psychiatric disorders in the

families. The MMPI revealed that anxiety, depression, mania, schizophrenia,

and psychopathic deviance were more frequent among wives of alcohol

dependent individuals. Since the study sample was small, conclusion could

not be drawn from the study.

Rao TSS and Kuruvilla K. conducted a study on personality of 30

wives of individuals with Alcohol Dependence Syndrome. They included the

women who satisfied Feighner’s Criteria and simultaneously it was compared

with 30 wives of non-alcohol dependent individuals56

. The tools used are

16PF and Eysenck's Personality Inventory. The results revealed there were no

29

statistically significant differences between the two groups on EPI and the

scores were within normal limits. Similar scores on 16 PF observed in both

the profiles in items of being submissive timid, conventional, conservative,

dependent and poised. These findings were not in favour of the concept of

“pathological wives” causing alcoholism in their husbands as advocated by

other investigators. The results were reliable since the scales used were

standardized but not predictive since the sample size was small.

Sisters of individuals with history of alcohol abuse from high density

multigenerational families were studied to determine the characteristics of

personality. Spousal similarity was assessed in proband and in spouse pairs

from the parental generation, permitting for comparisons of selection versus

contagion as descriptions for this resemblance 57

. Sisters were found to differ

from control women with respect to disaffection and Social nearness from the

MDPQ and Scale 6 (Paranoia) from the MMPI. Only spouses from the

parental generation were similar on estrangement, signifying that exposure

over time (contagion) leads to greater resemblance in parents hailing from

high-risk families.

Correlations of a lesser degree occurring in couples from both

generations reveal that assortative mating for Social nearness occurs among

the parents of these persons from high-risk families, and further expose that a

reduced level of Social intimacy for sisters of alcoholics might be mediated

to a certain extent by the additive genetic variance. It was accomplished that

30

assortative mating for particular traits might attribute to increased risk for

alcohol use. In addition, failure to mate assortatively for other traits may as

well contribute to increased rates in high-risk families. The group of wives of

individuals with Alcohol Dependence Syndrome (N=100) was matched up to

a group of wives of non-alcohol dependent men (N=90). The groups were

indistinguishable in view of their age, employment position and wedded

status.

Eysenck Personality Questionnaire was utilized for determining the

main personality proportions. A structured 38 psychiatric interrogation based

on ICD-10 and DSM-III-R, and assessing behavior of oneself before

matrimony (extraverted vs. introverted) were used as well. The wives of

individuals with Alcohol Dependence Syndrome were found to be less

extraverted than the wives of non-alcohol dependent persons. However there

appeared to be no differences in neuroticism and psychoticism. In respect

with the self-assessment of their behavior before marriage, wives of persons

with Alcohol Dependence Syndrome also manifested less extraverted

behavior before marriage.

Lewis explained the etiology of alcohol use and proposed the

Disturbed Personality Model in 1937. He found that a woman who was in

some way psychologically maladjusted, dependent, hostile, domineering,

masochistic, sadistic, married the man with alcohol dependence syndrome to

fulfill her own neurotic needs58

. Being psychologically disturbed herself; she

31

often contributed to the alcohol use of her husband. He concluded that those

women needed therapeutic help as much as their alcohol dependent husbands.

Idstad et al., conducted a cross sectional study on Mental disorder and

caregiver burden in spouses from Nord-Trøndelag, Norway in the year 1995-

1997. Subjective burden in spouses of persons with mental disorder was

compared with subjective burden in spouses of persons without mental

disorder. Totally 9740 couples were included in the study and the reports

shows that the spouses of these persons with mental disorder shows higher

levels of anxiety and depression and lower levels of subjective wellbeing

when compared with spouses of persons without mental disorder59

. This

study concludes that is an association between mental disorder and one

partner and subjective burden in the spouse, but not to the extent that reaches

a symptom level of anxiety and depression which reflects clinical mental

disorder.

Matoo SK et al (2013) defines family caregivers as “the persons who

gives good care to other family member who needs assistance for his regular

works in illness or disability and those who gives unpaid care to the ill

person with special needs”60

.

Fadden et al61

(1987) in an audit of studies on the family burden of

psychiatric patients have watched that the groups of schizophrenic patients

constituted the main gathering which have been reliably examined, despite

the fact that there was proof that the groups of other patient gatherings were

32

likewise truly influenced. They further note that the families regularly endure

extensive burden without grumbling.

Kuruvilla (1993) recognizes family trouble as a critical examination

range for a creating nation like India. From the accessible writing, it shows

up that so far studies on family burden have been more worried with the

appraisal of psychiatric dismalness among the patients' relatives and that no

significant effort has been made to study their subjective well -being in terms

of positive mental health coping resources62

.

Moos et al in a study on the wives of older individuals with late life

Problem drinking pattern. He found that wives of those individuals whose

drinking problems later remitted reported increased alcohol consumption,

poor general health with symptoms of depression and lack of motivation in

domestic chores, social and religious activities63

.

O’Farell, Harrison and Cutter conducted a study on sixty women

who were married to individuals with alcohol dependent syndrome currently

or formerly with a goal to evaluate the stress involved after their marriage,

stress of their children, and their proximity to marital breakup. It was

generally observed as a common prediction done sociologically that more

stressful the marriage was the faster was the wife was to divorce. Differing to

psychoanalytic prediction s, the disturbances in personality, associated with

stress of childhood, did not show a relationship with proximity to marital

breakup. Factor analytically derived subscales of stressors of marital and

33

childhood exhibited a considerable psychosocial interaction; wives were

more disposed than their more outgoing counterparts to undergo their

husbands' verbal abuse of them and their children67

. In addition, sway by

others to break up, optimistic attitudes toward divorce, fear of violence, and

little or no good period early in marriage all linked absolutely with proximity

to marital breakup64

.

Michael Marshal took sixty studies and did a review on the influence

of alcohol use and marital functioning were taken into consideration that

tested the correlation between alcohol use and one of three domains of the

marital functioning ( the satisfaction, the interaction, and the violence).

Results showed that alcohol abuse is associated with marital discord,

miscommunications and increased levels of marital violence65

.

In a study on alcohol’s influence and marital relations as longitudinal

predictors of marital adjustment the relationships among “married couples”

lifetime alcoholism status, behaviors after marriage, and adjustments after

marriage were tested. The results exhibited that the husbands ' life time

alcohol addictive use resulted in lower levels of their wife's helpful marital

adjustments 3 years later but was not associated with their own or their wife's

marital behaviours 9 years from baseline. Findings indicated that in alcoholic

couples the marital adjustment may be driven more by the wives’ than the

husbands' alcohol abuse and marital behavior.

34

Jayaram studied personality profile of 30 wives of individuals with

Alcohol Dependence Syndrome and 30 controls66

. The tools used were 16PF

and GHQ. He found that wives of individuals with Alcohol Dependence

Syndrome differed from the wives on control on the variable personality on

16PF questionnaire. The two groups differed significantly on 8 of the 16

factors. On GHQ the wives of individuals with Alcohol Dependence

Syndrome had shown marked psychological problems like difficulty to

concentrate, sleep disturbance, worry ad constant strain. The sample used was

small. The investigators used an age-matched control group. This was the

first time GHQ was used for the wives of individuals with Alcohol

Dependence Syndrome. The results possibly indicated the severe trend of

psychopathology in spouses of individuals with Alcohol Dependence

Syndrome

Brennan et al investigated 87 spouses of late life problem drinkers and

87 wives of non-problem drinkers. The spouses of problem drinkers reported

poor health related and social functioning. They also reported more stressful,

less supportive family context in problem drinkers67

.

Ino et al studied ‘addiction trends’ seen among wives of alcohol

dependent individuals. The sample consisted of 162 wives of alcohol

dependent men68

. The addiction screening test for wives of alcohol

dependent men (ASTWA) was used to measure addiction trends. The

ASTWA questionnaire consists of 24 questions, which was designed to make

35

clear views about the wives character trends and their addictions. As for the

character traits, the tendency for obsessiveness and tendency for Among 30

families of alcohol dependent individuals, 9 families showed a family history

of alcoholism. As seen on M.P.Q. test the anxiety, depression, mania,

paranoia, schizophrenia and psychopathic deviation were more common

among wives of alcohol dependent individuals than among the wives of non-

alcohol individuals.

36

AIMS & OBJECTIVES

37

AIM & OBJECTIVES

AIM

1. To study the burden in caregivers of Alcohol use disorders.

OBJECTIVES

Primary Objective

1. To assess the caregiver burden in alcohol use disorder.

2. To study the correlation between severity of alcohol use and the

burden.

Secondary objective

1. To study the drinking pattern of patients with alcohol use disorders.

2. To study the association between drinking pattern and caregiver

burden.

38

RATIONALE

The literature presented suggests that alcohol use disorders and the

patient’s pattern of drinking and severity contributes to significant burden in

caregivers physically and psychologically.

Effects upon the family would be expected due to financial and social

consequences of a patient’s loss of income, role reversal and lack of

emotional bonding with family members.

Very few studies in the past have tried to measure care giver burden in

alcohol use disorder but this study aimed to correlate the pattern of drinking

and severity of alcohol use and burden in caregivers.

39

MATERIALS & METHODS

40

MATERIALS & METHODS

Study design: Cross-sectional study

Study setting: Inpatient and Outpatient department of Psychiatry in

Karpaga Vinayaga Institute of Medical Sciences

Study duration: from April 2018 to September 2019

Study population: Patients and caregivers of patients with alcohol use

disorder

Sample size & sampling:

n=4pq/d2

P=48%

q=52%

d=10%

n=100

Sampling method: convenient sampling

INCLUSION CRITERIA:

Male patients who met diagnostic criteria for alcohol use disorders as

per DSM-5

Caregivers (male and female) of alcohol use disorder patients

Age above 18 (both patients and caregivers)

41

EXCLUSION CRITERIA:

Caregivers who has alcohol or any other dependence except nicotine

Patients who has any other substance abuse except nicotine

Patients who are not willing to give consent

Caregivers who are not willing to give consent

Presence of medical / psychiatric illness that prevents patient or

caregiver from participating in the interview

42

STUDY INSTRUMENTS

Semi Structured Questionnaire

This questionnaire is used to find the socio demographic parameters of

the patient along with their clinical details of alcohol use, patient’s quantity

of alcohol use and frequency in last 3 months. It also provides the details

about their drinking patterns. It also measures socio-demographic parameters

of the caregiver including relationship to patient and family income

The Severity of Alcohol Dependence Questionnaire (SADQ):

It is a well validated measure of the severity of dependence and was

developed by the Addiction Research Unit of Maudsley Hospital

The SADQ questions cover the following aspects of dependency

syndrome:

Physical withdrawal symptoms

Affective withdrawal symptoms

Relief drinking

Frequency of alcohol consumption

Speed of onset of withdrawal symptoms

General Health Questionnaire-12

GHQ developed by Goldberg in 1970 .GHQ is used to detect psychiatric

disorder in the general population. GHQ-12 has been used to assess

psychological distress in primary care giver for current situation. GHQ-12

43

well recognize and validate instrument for screening purpose in general

population. The 12 item General Health Questionnaire contains 3

factors:

Anxiety and depression

Social Dysfunction

Loss of Confidence

The validity of the GHQ-12 was compared with the GHQ-28 in a

World Health Organization study of psychological disorders in general

health. This version of the GHQ is very quick to administer and score as it

contains only 12 questions. It has comparable psychometric properties to the

longer versions even though it only takes around two minutes to complete.

Given its speed of administration, it is often used in research studies where it

is impractical to administer a longer form.

The GHQ-12 was prepared by removing the items endorsed by

‘physically ill’ respondents from the GHQ-60. All items have a 4 point

scoring system that ranges from a 'better/healthier than normal' option,

through a 'same as usual' and a 'worse/more than usual' to a 'much

worse/more than usual' option.

Likert scoring (0-1-2-3) from left to right is used for every question.

Score range from 0 to 36. Scores vary by study population.

Scores 0-10- No distress

Scores 11-15 - Typical symptoms of distress.

44

Score 16-20- Evidence of distress

Score above 20 suggests severe problems and psychological distress

Family Burden Interview Schedule

It was developed by Shaila Pai and Kapur. Semi structure family

burden assessment schedule was used for measuring burden on family in

different domains. This instrument is widely accepted and used in various

study for measuring burden on family in different types of illness. Economic

and cultural condition in India being vastly different from those of the

Western world and areas of family burden are entirely different. Family

burden assessment schedule considered standardized method of assessing

the burden on the family particularly in Indian context (Pai & Kapur 1981).

This interview schedule assesses the burden placed on families of

psychiatric patients living in the community69

. It contain 24 items in 6

different categories for objective burden: financial burden (loss of income,

expenditure), disruption of routine family activities, family leisure disruption,

disruption of family interaction, effect on physical health of others (illness,

injury) and effect on mental health. It also assess total subjective burden .It is

a three point scale

Severe burden-2; Moderate burden-1; No burden-0

45

The objective burden total scores ranges from 0 to 48. Out of which 0

to 6 indicates no burden, moderate score is between 6 and 24 and severe

burden being above 24.

Procedure:

After obtaining informed consent from patient and caregivers who are

fulfilling the selection criteria were approached for the study and informed

consent was obtained. Clinical and socio demographic details of patient and

caregivers were obtained using semi structured proforma. SAD-Q was

administered to the patient by the investigator. Caregivers were administered

GHQ-12 and FBIS. Assessment was cross sectional and it was done in single

setting.

46

STATISTICAL ANALYSIS

The data collected is analysed by using Statistical Package for Social

Scientists, version twenty (SPSS -20)

Descriptive analyses of socio-demographic variables and scores in the

questionnaires carried out. For continuous data, mean, standard deviation and

range were calculated and frequency distribution was calculated alcohol-

related clinical details, and drinking contexts. Independent ‘t’ test and Chi-

square test were carried out for continuous and categorical variables.

Pearson’s correlation was done to assess the correlations between alcohol use

characteristics in patients and General health status and Family burden in

caregivers. The level of statistical significance will be accepted at p < 0.05

for all tests.

47

ETHICAL CONSIDERATIONS:

After obtaining informed consent from the study participants they

were requested to be spontaneous and truthful with the choices they chose on

the questionnaires. The participants were assured of confidentiality of the

information provided and had the option of refusal to participate in the study.

48

STROBE chart:

Case registration at


KIMS

Case of alcohol use disorder

diagnosed by SR / Consultant

Approached 146 patients &

their Caregivers

Consent given by 100

participants & caregivers 46 excluded from study

Assessment on

1. Semi structured questionnaire

(10mins).

2. Burden interview Schedule

(10mins).

3. General Health Questionnaire

(5mins).

4. Severity of Alcohol Dependence

Questionnaire (5mins).

Reasons for exclusion:

1. patient did not give consent

(12)

2. Caregivers not willing to

give consent. (26)

3. Patients who had cannabis

use.(1)

4. Not primary caregivers (7)

49

OBSERVATION & RESULTS

50

OBSERVATION & RESULTS

Socio-demographic profile:

The mean age of the patient was 46.13(± 10.95) years and mean age of

the caregiver 42.03(±10.03) years. All the patients participated in this study

were males and 93 caregivers were females whereas 7 caregivers were males.

Educational status of patient and caregiver

Among the participants around 5% of the patients were illiterate and

2% of the patients were just literate, 14 percent of the patients completed

primary education up to four five years of formal education, around 29% of

patients completed high school education, 26% studied till 12 years of formal

education, 16% were graduates, 5% completed post-graduation and 1% being

professional, remaining 2% education was unknown. Among caregivers 1%

was just literate, 24% were educated till 5 years of formal education, majority

40% of the caregivers were completed high school (till 10 years of formal

education), 26% were studied till higher secondary and 9% were graduates.

51

Table 1: Educational status of patient and caregiver

Variables Patient Caregiver

Illiterate 5% 0

Just literate 2% 1%

Primary(up to 5 years of formal education) 14% 24%

High school (up to 10 years of formal education) 29% 40%

Higher secondary (up to 12years of formal education) 26% 26%

Graduate (up to 13 years of formal education) 16% 9%

Post graduate(up to 15 years of formal education) 5% 0

Professional 1% 0

Unknown 2% 0

Occupational status of patient and caregiver

Considering occupation majority of the patients were unskilled

workers 38%, 15% were transport workers, 14% were farmers, 8% were

doing business, 7% were doing clerical jobs, and 3% were professionals.

Majority of caregivers were housewives 62%, followed by skilled and

unskilled workers 15% and 12% respectively

52

Table No 2: Occupational status of patient and caregiver

Religion of patient and caregivers

Majority of patients and their caregivers belonged to Hindu community

90%; Christians amounting to 9% and1% were Muslims.

Table No 3: Religion of patient and caregivers

Occupation Patient Caregiver

Professional 3 0

Administrator/ clerical work 7 2

Business 8 1

Transport worker 15 0

Skilled worker 5 15

Unskilled worker 38 12

Farmer 14 8

Student 8 0

Unclassifiable (beggar, thief) 2 0

Others/ house wife 0 62

Not known 0 0

Religion Patient Caregiver

Hindu 90 90

Muslim 1 1

Christian 9 9

53

Marital Status of patients and caregivers:

Most of the patients were married & living together 80%, widowers

were 8% and 9% for patients and caregivers respectively, 10% of patients and

3% of caregivers were never married.

Table No 4: Marital Status of patients and caregivers

Family Size:

Majority of the participants belong to a nuclear family which consists

of 4 members 46%, 20% of families has 5 members, 17% has 3 members,

13% of participants has 6 members in their family, 4% has 2 members.

Marital status Patient Caregiver

Married & living together 80 87

Never married 10 3

Staying together without

married 0 0

Divorced 0 0

Separated 2 1

Widower 8 9

54

Table No 5: Family Size

Number of family members Percentage

Two 4%

Three 17%

Four 46%

Five 20%

Six 13%

Caregiver’s relation to the patient

Majority of the caregivers were wives 76%, 9% were mothers, 7%

were daughters to the patients, 4% were fathers, 2% were sons, grandmother

and nephew was 1%

Table No: 6 Caregivers relation to the patient

Relation to the patient Percentage

Wife 77

Mother 9

Daughter 6

Father 4

Son 2

Grandmother 1

Nephew 1

55

Alcohol use details of the patient

The mean duration of alcohol use in patients is 22.26 yr. with 82% of

patients reported craving. Withdrawal was observed in 78% of patients. Daily

use and day time use was reported in 69% and 60% of patients with alcohol

use. Patients consumed on an average around 380 ml per day in a span of

around 70 minutes. The average monthly expenditure on alcohol was about

3500 INR

Table 7: Alcohol use details of the patient

S.no Variables N Mean SD RANGE

1 Duration of alcohol use 100 22.66 10.73 5-50

2 Age of initiation 100 23.49 5.77 11-43

3 Age of onset of daily use 69 31.39 7.01 15-50

4 Age of onset of day time drinking 60 37.25 7.15 17-60

5 Age of onset of Withdrawal 78 32.60 7.09 16-57

6 Age of Onset of craving 82 30.06 6.32 15-49

7 Quantity of alcohol consumed in ml 100 385.20 153.55 180-720

8 Time taken to consume daily

quantity( in minutes) 100 70.30 38.28 30-240

9 Monthly expenditure on alcohol in

rupees 100 3573.50 3707.60 500-22000

56

Associated factors in alcohol use:

The major source of finance was from patients earning (79%) followed

by family members (18%). Around 27% of patients spent more than 25% of

family income on alcohol. 42% of patients reported a family history of

substance use. 38% and 6% reported alcohol and nicotine use in family

members respectively. Brandy was the beverage of choice in 78% of patients

followed by beer in 12% of patients.

57

Table No 8: Associated factors in alcohol use:

S.no Variables Frequency in percentage

1 Source of finance for procuring drink

Self 79%

Family members 18%

Both self & family members 1%

Loan / credit 2%

2 Percentage income spend on alcohol

<25% 73%

25-50% 21%

50-75% 6%

>75% -

3 Family history of substance use

Yes 42%

No 58%

Alcohol 38%

Others (Nicotine) 6%

4 Beverages of first choice

Beer 12%

Whiskey 6%

Brandy 78%

Rum 4%

5 Beverages taken in life time

Single beverages 71%

Two beverages 20%

Three beverages 9%

58

79

73

42

12

71

18 21

58

6

20

1 6

78

9

2 0 4

Souce of finance fordrink

Income Spent onalcohol

Family historyofsubstance use

First choice beverage Beverages taken inlife time

Fig 1: Drinking history

Fig 1: Source of income: (a)self, (b) family members, (c) both, (d) loan or credit

Income Spent on alcohol: (a) <25% (b) 25-50%, (c) 50-75%, (d) >75%

Family history of substance use: (a) yes, (b) no

First choice beverage: (a) beer, (b) whiskey, (c) brandy, (d) rum

Beverages taken in lifetime: (a) single beverage, (b) two beverages, (c) three

beverages

59

Context & Situation of Alcohol use:

Among patients the major reason to consume alcohol is for relaxation

(66%) followed by others insistence (25%). Negative emotions (67%) and a

bad day at work (70%) are the major drive for alcohol use. 74% of the

population preferred to drink in the evening time. 45% and 35% reported

Evenings and returning to home from job as the more common context of

drinking. 73% of the participants reported to have consumed alcohol either at

or outside the liquor shop. The preferred companion to consume alcohol was

friends (60%).

60

Table 9: Pattern of alcohol use (context/ situation) over the past 3

months

Variables Categories Frequency

Reason to consume alcohol Social assertiveness 11

Recreation 12

Relaxation 66

On insistence of others 31

Sexual pleasure 0

Increase power / aggression 25

Others 39

Decision to drink in context of Feeling happy 27

Feeling

sad/angry/irritated/frustrated 67

Wanting to relax 39

Feeling very tired 46

Feeling bored 34

Bad day at work 70

Meeting friends 47

No particular reason 35

Having quarrel with

spouse/parents 54

Miscellaneous 0

Usual time of consumption Morning 3

Lunch time 0

Evening 74

Night 20

Throughout the day 5

61

Usual situation/context of

drinking Evening (almost every day) 45

Returning to home 35

Weekends 6

Going out with friends 7

Festivals, marriages 3

Relaxing at home 3

Others 2

Usual place of consumption Pub, bar, or restaurant 6

Just outside liquor shops in

the open 35

Place where liquor sold 38

Lonely place 11

At home 19

At clubs 5

At parties / friend’s house 0

Outside cool drinks shop 1

At Place of work 0

Others 0

Miscellaneous 0

Preferred company while

drinking Friends/other acquaintances 60

Wife/female friends 0

Mostly my own 41

Other situations 5

62

Table 10: Pattern of alcohol use (context/ situation) over the past 3 months

11

27

3

45

6

60

12

67

0

35 35

0

66

39

74

6

38 41

31

46

20

7

11

5

0

34

5 3

19

25

70

3 5

39

47

2 1

35

0

54

0

Reason to consume Decision to drink incontext of

Usual time ofconsumption

Usual situation/contextof drinking

Usual place ofconsumption

Preferred companywhile drinking

Fig 2: Pattern of alcohol use (context/ situation) over the past 3 months

Fig 2: 1. reason to consume (a) social assertiveness, (b) recreation, (c) relaxation, (d) others insistence, (e) sexual pleasure, (f) power/ aggression, (g)

others. 2. Decision to drink: (a) feeling happy, (2) negative emotions, (c) to relax, (d) tired, (e) bored, (f) bad day at work, (g) meet friends, (h) no

reasons, (i) quarrels, (j) others. 3. Time of consumption: (a) morning, (b) lunch, (c) evening, (d) night, (e) all time. 4. Place: (a) pub, (b) outside shop, (c)

place where sold, (d) lonely place, (e) home, (f) clubs (g) outside cool drinks shop 4. Company (a) friends, (b) females, (c) alone, (d) others

63

45 44

35 29

80

14 14

33

100

49

21

54

4

20

86 86

67

5

54

11

47

1 1

20

Drinking withfood

Close peoplewho drink

Intoxication Feel after adrink

RestrictionAgainst Drinking

Style of drinking Diluting More than 1beverage in

single occasion

More than 5standard drink

Fig 3:Pattern of alcohol use (style of drinking, social aspect, intoxication) over the past 3 months

Fig 3: 1. Drinking with food: (a) snacks, (b) drink before eat, (c) drink along with meals, (d) doesn’t matter. 2. Close people who drink (a) neighbor, (b)

coworkers, (c) friends (d) others. 3. Intoxication: (a) always, (b) sometimes, (c) never. 4. Feel after a drink: (a) relaxed, (b) guilt, (c) nothing specific, (d)

others. 5. Restriction against drinking: (a) No, (b) yes. 6. Style of drinking: (a) sip, (b) gulp. 7. Diluting (a) neat, (b) mixed. 8. More than 1 beverage in

single time: (a) yes, (b) No. 9. Occasion consumed more than 5 Standard drinks (a) yes

64

82

69

60

78

20

86 86

33

18

31

40

22

80

14 14

Craving Daily use Daytime use Withdrawalsymptoms

Restriction AgainstDrinking

Diluting Style of Drinking More than 1beverage at a time

Fig 4: Drinking History

Series 1 Series 2yes No

65

SADQ based classification of severity of alcohol dependent patient

The mean score on SADQ was 16.13(±6.67) with scores ranging between 3-

36. In a total of 100 participants around 48 patients scored in below 16, 44

participants scored between 16-30 and 8 participants scored above 30 in SADQ.

Table 11: Severity of Alcohol Dependence

Category Criteria Frequency

Mild or None Below 16 48

Moderate 16-30 44

Severe Above 30 8

66

General Health Questionnaire for Caregivers

The mean total score on GHQ12 administered to caregivers was

18.42(±6.09) with the range of 3 to 32. Caregivers had higher mean score in

questions assessing feeling depressed (1.94), loss of sleep (1.92), constantly

under strain (1.91).

Table 12: General Health Questionnaire results of caregivers

GHQ 12 Questions Minimum Maximum Mean Std.

Deviation

Been able to concentrate on whatever

you’re doing? 0 3 1.32 0.60

Lost much sleep over worry? 0 3 1.92 0.88

Felt that you are playing a useful part

in things? 0 3 1.19 0.68

Felt capable of making decisions

about things? 0 3 1.32 0.74

Felt constantly under strain? 0 3 1.91 0.92

Felt you couldn’t overcome your

difficulties? 0 3 1.46 0.81

Been able to enjoy your normal day-

to-day activities? 0 3 1.57 0.86

Been able to face up to your

problems? 0 3 1.52 0.81

Been feeling unhappy and depressed 0 3 1.94 0.95

Been losing confidence in yourself? 0 3 1.44 0.82

Been thinking of yourself as a

worthless person? 0 3 1.43 0.83

Been feeling reasonably happy all

things considered? 0 3 1.37 0.65

GHQTOTAL 3.0 32.0 18.42 6.09

67

Family burden scores

The mean scores of each questions in Family burden interview

schedule is calculated and the overall mean scores is computed. The mean

scores were observed to be higher in the expenditure incurred due to patients

illness(1.19), loans or savings spent(1.01), putting off planned activity due to

financial pressures(1.01) in the Financial Burden domain. There was higher

mean score in interaction domain mainly in arguments with others (1.09) and

effects on relationship (1.11). Physical health domain showed higher mean

scores on both variables and psychological help seeking in caregivers (1.05)

in the mental health burden domain of FBIS. The total FBIS mean score was

19.93 with the range of 4-44.

68

Table 13: Family Burden scores in caregivers

S.no Family Burden Questionnaire Range Mean SD

1 Loss of patient's income 0 - 2 0.50 0.56

2 Loss of income of any other family member 0 - 2 0.38 0.53

3 Expenditure incurred due to patient's illness and

treatment 0 - 2 1.19 0.65

4 Expenditure incurred due to extra arrangements 0 - 2 0.15 0.39

5 Loans taken or savings spent 0 - 2 1.01 0.63

6 Any other planned activity put off because of the

financial pressure of the patient's illness 0 - 2 1.01 0.69

7 Patient not going to work, school, college, etc.:

How inconvenient is this for the family? 0 - 2 0.94 0.57

8 Patient not helping in the household work: How

much does this affect the family? 0 - 2 0.99 0.46

9 Disruption of activities of other members of the

family 0 - 2 0.77 0.60

10 Patient's behaviour disrupting activities 0 - 2 0.83 0.62

11 Neglect of the rest of the family due to patient's

illness 0 - 2 0.93 0.59

12 Stopping of normal recreational activities 0 - 2 0.85 0.58

13 Patient's illness using up another person's holiday

and leisure time 0 - 2 0.92 0.56

14 Patient's lack of attention to other members of the

family 0 - 2 0.72 0.64

15 Has any other leisure activity had to be abandoned

owing to the patient's illness or incapacity 0 - 2 0.90 0.58

16 Any ill effect on the general atmosphere in the

house 0 - 2 0.35 0.54

17 Do other members get into argument over this 0 - 2 1.09 0.68

18 Have relatives and neighbours stopped visiting the

family 0 - 2 0.42 0.55

19 Has the family become secluded 0 - 2 0.59 0.59

20 Has the patient's illness had any other effect on

relationships within the family or between the

family and neighbours or relative

0 - 2 1.11 0.65

21 Have any other members of the family suffered

physical ill health, injuries, etc. due to the patient's

behaviour

0 - 2 1.11 0.83

22 Has there been any other adverse effect on health 0 - 2 1.13 0.83

23 Has any other family member sought help for-

psychological illness brought on by the patient's

behaviour

0 - 2 1.05 0.61

24 Has any other member of the family lost sleep,

become depressed or weepy, expressed suicidal

wishes, become excessively irritable, etc.

0 - 2 0.99 0.66

69

25 How much would you say you have suffered owing

to the patient's illness ( Subjective Burden) 1 – 2 1.30 0.46

26 FBS total score 4 - 44 19.93 8.40

Severity categorization by individual Questionnaire

Overall summary of the severity of alcohol dependence in patients,

General health status of caregivers and caregivers experienced family burden

due to alcohol use in patients were provided in the below table:

Table 14: Summary of severity categorization by individual questionnaires

Questionnaires Frequency

SADQ category

None/ Mild 48

Moderate 44

Severe 8

GHQ category

No distress 13

Typical symptoms 4

Evidence of distress 35

Psychological distress 48

FBIS category

No Burden 6

Moderate Burden 67

Severe Burden 27

70

Correlations between Alcohol use characteristics in patients and General

health status and Family burden in caregivers:

Age of the patient is positively correlated with SADQ, age of

caregiver, GHQ and FBIS scores and negatively correlated with family

income. Duration of alcohol use is positively correlated with SADQ, GHQ

and FBIS score. There seems to be a positive association between monthly

expenses on alcohol with SADQ, GHQ, FBIS and subjective burden scores.

Quantity of alcohol consumed is positively correlated with SADQ, GHQ, FBIS and

subjective burden. SADQ scores are positively correlated with GHQ, FBIS and

subjective burden scores. GHQ scores are positively correlated with FBIS and

Subjective burden scores.

SADQ Category GHQ Category FBIS Category Subjective Burden

48

13

6 0

44

4

67 70

8

35

27 30

48

Fig 5:Severity categorization on individual Questionnaire

71

Table 15: Correlations between alcohols use characteristics in patients and

General health status and Family burden in caregivers

Correlations

Age of

patient

Durati

on of

alcohol

use

Monthly

expenses

on

alcohol

Quanti

ty of

alcohol

SADQ

score

caregiv

er Age

Family

income

GHQS

core

Family

Burden

score

subject

ive

burden

Age of

patient

Pearson

Correlati

on

1 .841** .176 .297** .320** .296** -.210* .257** .210* .094

Sig. (2-

tailed) .000 .080 .003 .001 .003 .036 .010 .036 .351

Duration

of alcohol

use

Pearson

Correlati

on 1 .190 .351** .348** .324** -.239* .284** .278** .119

Sig. (2-

tailed) .058 .000 .000 .001 .017 .004 .005 .238

Monthly

expenses

on alcohol

Pearson

Correlati

on

1 .383** .609** .026 .112 .464** .596** .354**

Sig. (2-

tailed) .000 .000 .795 .266 .000 .000 .000

Quantity of

alcohol

Pearson

Correlati

on 1 .647** .108 .053 .415** .455** .303**

Sig. (2-

tailed) .000 .284 .601 .000 .000 .002

SADQ

score

Pearson

Correlati

on 1 .242* -.034 .745** .798** .530**

Sig. (2-

tailed) .015 .737 .000 .000 .000

Age of

caregiver

Pearson

Correlati

on 1 -.303** .082 .094 -.019

Sig. (2-

tailed) .002 .418 .354 .848

Family

income

Pearson

Correlati

on 1 -.033 -.111 -.050

Sig. (2-

tailed) .746 .273 .620

GHQ

score

Pearson

Correlati

on 1 .873** .445**

Sig. (2-

tailed) .000 .000

Family

burden

score

Pearson

Correlati

on 1 .596**

Sig. (2-

tailed) .000

Subjective

burden

Pearson

Correlati

on

1

Sig. (2-

tailed)

**. Correlation is significant at the 0.01 level (2-tailed).

*. Correlation is significant at the 0.05 level (2-tailed).

72

Spouse vs. others as caregivers

77 patients had spouse as caregivers and in 23 patients the caregivers were

mother, father, daughter, son, grandmother and nephew. There was no significant

difference observed between the groups in the severity of alcohol use in patients,

GHQ scores and Family burden score

Table: Spouse vs. others as caregivers

S. no Criteria Category Spouse as

caregivers

(n= 77)

Others as

caregivers

(n= 23)

χ2

/ ‘t’

value

“p”

value

1 SAD Q Mild/ none 37 11 3.87 0.14

Moderate 36 8

Severe 4 4

Mean Score(SD) 15.64(5.95) 17.78(8.6) -1.36 0.17

2 GHQ No distress 11 2 2.36 0.50

Typical symptoms 2 2

Evidence of distress 28 7

Psychological

distress 36 12

Mean Score(SD) 18.16(5.93) 19.30(6.64) -0.75 0.46

3 FBIS No Burden 6 0 2.48 0.29

Moderate Burden 52 15

Severe Burden 19 8

Mean Score(SD) 19.22(7.95) 22.30(9.57) -1.41 0.17

Chi square test for categorical variable and independent‘t’ test for continuous

variables

73

DISCUSSION

74

DISCUSSION

Alcohol use disorder not only affects the patients but also the

individuals who are taking care of them. It affects the family in various levels

like social issues, occupational dysfunction physical health problems, mental

stress and financial burden.

This study was conducted to know about the pattern of alcohol use and

its severity and also how it contributes to care giver burden. This study was

carried out in outpatient and inpatient setting in the department of psychiatry

in a tertiary hospital in Maduranthagam Taluk.

A total of 100 participants and their caregivers were included in this

study. The study comprises of socio demographic details such as age,

education, marital status, occupation, monthly income and residing

background.

Duration of alcohol use:

The mean age of onset of alcohol consumption was 23.49 years in our

study, which is similar to the mean age of onset of alcohol use in the study

conducted by Gupta et al34

which was 21.5 years.

In a cross sectional study conducted by Gupta et al34

found the

participants were problem alcohol users and non-treatment seekers. Whereas

75

our study sample includes individuals who were seeking treatment for

alcohol use disorders

Drinking pattern:

In our study 100 adult males with alcohol use disorders were recruited

and interviewed using questionnaire and standard instruments. Drinking

pattern and style of drinking along with its severity was assessed by severity

of alcohol dependence questionnaire and a semi structured questionnaire. In

our study the participants had a long history of alcohol use with the presence

of features of physical dependence such as withdrawals as well as features of

psychological dependence such as craving for more than a decade which is

similar to Gupta et al34

study. Additionally, it took the participants around 70

minutes to consume their quantity of alcohol. Not surprisingly, almost all of

the participants reported drinking more than 5 standard drinks in the past

3months. Most of our participants spent more than 25% amount of money for

alcohol from their family income.

Caregivers

Poor social performance of one member reciprocally affects the

performance of any other member of the family, who has to compensate the

deficiencies, experiencing burden. This led to the differentiation of burden

into subjective and objective (Hoenig et al70

, 1966).

76

Oldridge et al71

(1992) reported that psychological distress (anxiety,

depression, and insomnia) was twice as high in caregivers as in the general

population.

In our study, caregivers experienced burden in financial domain and in

family interaction domain. They also showed significant burden in physical

and mental health. The above findings matched with Vaishnavi et al47

study.

This is probably because in a country like India males are considered to be

the bread winners of the family (Kiran et al72

).

Our study reveals that majority of the caregivers were females. Among

them most of the caregivers were spouses of patients with alcohol use

disorders Majority of caregivers were not employed and it is similar to

Lennox et al73

study.

A study conducted by Devi et al74

in a nursing college with sample of

70 alcoholic’s wives reveals that around 43% had moderate stress levels and

they average coping strategies which is similar to our GHQ scorings and

caregiver burden scores.

When considering caregiver burden in alcohol use disorder individuals

we have not only focused on spouses but also included other caregivers and

assessed the burden as similar to Rospenda et al75

study in a community

sample within the Chicago city.

77

Domestic violence is the major problem in spouses of alcohol

dependent individuals which is found in a study conducted by

Nanjundaswamy et al76

at NIMHANS whereas our study focusing on

different domains of caregiver burden in alcohol use disorders that includes

financial burden, disruption in family routine and family leisure, disruption in

family interaction, effects of physical health and mental health also showed

high mean score on questions pertaining to injuries sustained due to patient’s

behaviour

Similar study on family members with alcohol dependent people

showed an increase in the risk of the emergence of mental disorders in

spouses, and a greater frequency of physical assaults, deaths of family

members and involvement with the police in those homes. This issue affects

their Quality of life, and predisposes them to the emergence of depressive

symptoms

Presence of alcohol dependence in patient is an important factor which

influences caregiver’s psychiatric morbidity and quality of life and severity

of alcohol dependence in patients was positively correlated with psychiatric

morbidity in caregivers. With increasing dose, duration and severity of

alcohol use results in significant increase in psychological morbidity in

caregivers

78

Quality of life of was found to be significantly poor among caregivers

with psychiatric illness than caregivers without psychiatric illness. We found

that there is a positive correlation between the subjective burdens in

caregivers of individuals with alcohol use disorders

Our study shows more burden among caregivers of higher alcohol

dependence scores which is similar to the findings by Swaroopachary et

al52

., which concluded more burden is seen in seen in severe alcohol

dependence patients.

Based on our study there is a positive correlation found between

SADQ, subjective burden and GHQ 12 and thus caregivers of men with

alcohol use disorder have significantly greater chances of developing anxiety,

depression and other psychiatric morbidities when compared with wives of

men who do not consume alcohol. This is a major problem because increased

psychiatric morbidity in women affects not only them but the entire family

unit, with long-standing consequences. The finding is similar to the study

conducted by Gandhi et al77

., but that was a comparative study. They

compared the group of caregivers of men with alcohol use disorder and men

without alcohol use disorders

Alcohol abuse is associated with marital conflicts, violence against

family members, assault and high risk of committing criminal offences. A

person who uses alcohol can disrupt the routine life of caregivers that leads to

79

harmful consequences which affects their physical and mental health that can

last long their lifetime. The finding is similar to Vishal et al50

but in their

study 50 cases (spouses of alcohol dependence patients) versus 50 controls

(spouses of non-alcohol dependence patients but some other illness)

80

STRENGTHS OF THE STUDY:

Though many studies showed correlation between alcohol use and the

burden in care givers, our study measured the positive correlation with

severity of alcohol dependence with general health of the caregivers and their

burden in different aspects

LIMITATIONS:

There were certain limitations in this study.

The causality could not be explained since this is a cross sectional

study.

This study was conducted in a tertiary setting and it cannot be

generalized to community

There is no comparison group in our study

All the patient population were males who are above 18. So, the results

cannot be generalized to adolescent male and female patient

population.

Most of the caregivers were females and there were less male care

givers. And also the study was predominantly populated by spouses as

caregivers but other caregiver population subgroups were less.

81

SUMMARY

In our study the mean age of the patient was 46.13(± 10.95) years and

mean age of the caregiver 42.03(±10.03) years. All the patients

participated in this study were males and 93 caregivers were females

whereas 7 caregivers were males.

Mean duration of alcohol use in patients is 22.26 year with daily use in

69% of patients. 82% of patients reported craving. Withdrawal was

observed in 78% of patients

Average alcohol consumed per day is 380 ml

Average monthly expenditure on alcohol was about 3500 INR

Most of the patients consumed alcohol for relaxation (66%),

preferably in the evening time (74%) and in the company of friends

(60%).

In SAD Q about 48% had mild/ no dependence, 44% had moderate

dependence and 8% had severe dependence

87% of caregivers expressed distress as measured by GHQ 12

In FBIS, All caregivers experienced subjective burden (mild/none-0,

moderate burden- 70% and severe burden- 30%), Whereas 94% of

caregivers experienced objective burden (6%- none, 67% - moderate,

27%- severe burden)

82

Severity of dependence, duration of alcohol use, monthly expenditure

on alcohol, quantity of alcohol use, impacts the general health status

and perceived burden (family as well as subjective burden) of the

caregivers.

83

CONCLUSION

84

CONCLUSION:

The severity of alcohol use measured by SADQ is positively correlated

with impairment in general health status of caregivers as measured in

GHQ-12.

The severity of alcohol use is also positively correlated with subjective

burden as well as objective burden in FBIS scores (all six domains)

The duration of alcohol use is positively correlated with impairment in

general health status and perceived family burden of the caregivers

In addition, monthly expenditure on alcohol and quantity of alcohol

consumed in a day are positively correlated with impairment in general

health status of caregivers, family burden scores and subjective burden.

Overall, severity of dependence, duration of alcohol use, monthly

expenditure on alcohol, quantity of alcohol use, impacts the general

health status and perceived burden (family as well as subjective

burden) of the caregivers

85

FUTURE DIRECTIONS:

Studies focused on community setting with comparison group for

better results. Researchers should consider doing cohort study so that the

causality can be explained clearly. The future studies can consider including

adolescent population and their care giver burden.

86

BIBLIOGRAPHY

87

BIBLIOGRAPHY

1. Avasthi A. Preserve and strengthen family to promote mental health.

Indian journal of psychiatry. 2010; 52 (2):113-126.

2. World Health Organization, Global Status Report on Alcohol, World

Health Organization, Geneva, Switzerland, 2014

3. Diagnostic and Statistical Manual of mental disorders, Substance-

Related and Addictive Disorders, Alcohol-Related disorders

4. Dick DM & Kendler KS (2012) The impact of gene–environment

interaction on alcohol use disorders. Alcohol Research, 34(3), 318–

324.

5. Gelernter J (1995) Genetic factors in alcoholism: evidence and

implications. In Kranzler HR(ed.) The Pharmacology of Alcohol

Abuse. NewYork,NY: Springer, pp. 297–313.

6. Kendler KS (2001) Twin studies of psychiatric illness. Archives of

General Psychiatry, 58, 1005–1014.

7. Kendler KS, Prescott CA, Neale MC, et al. (1997) Temperance board

registration for alcohol abuse in a national sample of Swedish male

twins born 1902–1949. Archives of General Psychiatry, 54, 178–184.

8. McGue M (1994) Genes, environment, and the etiology of alcoholism.

In Zucker R, Boyd G, & Howard J (eds.) The Development of Alcohol

Problems: Exploring the Biopsychosocial Matrix of

Risk.NIAAAResearch Monograph No. 26. Rockville, MD: US

Department of Health and Human Services, pp. 1– 40.

88

9. Thomasson HR, Crabb DW, Edenberg HJ, et al. (1993) Alcohol and

aldehyde dehydrogenase polymorphins and alcoholism. Behavior

Genetics, 23, 131–136.

10. Chen C-C, Lu R-B, Chen Y-C, et al. (1999) Interaction between the

functional polymorphisms of the alcohol-metabolism genes in

protection against alcoholism. American Journal of Human Genetics,

65(3):795–807.

11. Bierut LJ, Goate AM, Breslau N, et al. (2012) ADH1B is associated

with alcohol dependence and alcohol consumption in populations of

European and African ancestry. Molecular Psychiatry, 17(4), 445–450.

12. Hesselbrock VM, Foroud T, Edenberg H, et al. (2001) Genetics and

alcoholism: the COGA Project. In Agarwal DP & Seitz HK (eds.)

Alcohol in Health and Disease. New York, NY: Marcel Dekker, pp.

103–124.

13. Reich T, Edenberg HJ, Goate A, et al. (1998) Genome-wide search for

genes affecting the risk for alcohol dependence. American Journal of

Medical Genetics, 81, 207–215.

14. Long JC, KnowlerWC,Hanson RL, et al. (1998) Evidence for genetic

linkage to alcohol dependence on chromosomes 4 and 11 from an

autosomewide scan in an American Indian population. American

Journal of Medical Genetics, 81, 216–221.

89

15. WHO 2018 report, Global strategy to reduce the Harmful use of

Alcohol, World Health Organization, September 21, 2018, Geneva

16. Peer K, Rennert L, Lynch K, et al; prevalence of DSM- IV alcohol,

cocaine, opioid and cannabis use disorders in a largely substance

dependent sample. Drug Alcohol Depend Aug 9, 2012.

17. Kessler RC, Crum RM, Warner LA, et al. (1997) Lifetime co-

occurrence of DSM-III-R alcohol abuse and dependence with other

psychiatric disorders in the National Comorbidity Survey. Archives of

General Psychiatry, 54, 313–321

18. Grant BF, Dawson DA, Stinson FS, et al. (2006) The 12-month

prevalence and trends in DSM-IV alcohol abuse and dependence:

United States, 1991–1992 and 2001–2002. Alcohol Research and

Health, 29(2), 79–91.

19. Grant BF, Stinson FS, Dawson DA, et al. (2004a). Co-occurrence of

12- month alcohol and drug use disorders and personality disorders in

the United States: results from the National Epidemiologic Survey on

Alcohol and Related Conditions. Archives of General Psychiatry,

61(4), 361–368.

20. Babor TF, Kranzler HR & Lauerman RL (1987) Social drinking as a

health and psychosocial risk factor: Anstie’s limit revisited. In Galanter

M (ed.) Recent Developments in Alcoholism, Vol.5 New York, NY:

Plenum Press, pp. 373–402.

90

21. Centers for Disease Control and Prevention (2012) Alcohol and Public

Health: Alcohol Related Disease Impact (ARDI), http://apps.nccd.cdc.

22. Hasin DS, Stinson FS, Ogburn E, et al. (2007) Prevalence, correlates,

disability, and comorbidity of DSM-IV alcohol abuse and dependence

in the United States: results from the National Epidemiologic Survey

on Alcohol and Related Conditions. Archives of General Psychiatry,

64(7), 830–842.

23. Kessler RC, McGonagle KA, Zhao S, et al. (1994) Lifetime and 12-

month prevalence of DSM-III-R psychiatric disorders in the United

States. Archives of General Psychiatry, 51, 8–19.

24. Stinson FS, Grant BF, Dawson DA, et al. (2005) Comorbidity between

DSM-IV alcohol and specific drug use disorders in the United States:

results from the national epidemiologic survey on alcohol and related

conditions. Drug and Alcohol Dependence, 80(1), 105–116.

25. Swendsen JD, Merikangas KR, Canino GJ, et al. (1998) the

comorbidity of alcoholism with anxiety and depressive disorders in

four geographic communities. Comprehensive Psychiatry, 39, 176–

184.

26. Grant BF, Stinson FS, Dawson DA, et al. (2004b) Prevalence and co-

occurrence of substance use disorders and independent mood and

anxiety disorders. Archives of General Psychiatry, 61(8), 807–816.

http://apps.nccd.cdc/

91

27. MeyerRE(1986) Howto understand the relationship between

psychopathology and addictive disorders: another example of the

chicken and the egg. In Meyer RE (ed.) Psychopathology and

Addictive Disorder. New York, NY: Guilford Press, pp. 3–16.

28. Rounsaville BJ, Dolinsky ZS, Babor TF, et al. (1987) Psychopathology

as a predictor of treatment outcome in alcoholics. Archives of General

Psychiatry, 44, 505–513.

29. SchuckitMA(1983) Alcoholic patients with secondary depression.

American Journal of Psychiatry, 140, 711–714.

30. O’Sullivan K, Rynne C, Miller J, et al. (1988) A follow-up study on

alcoholics with and without co-existing affective disorder. British

Journal of Psychiatry, 152, 813–819.

31. Powell BJ, Penick EC, Nickel EJ, et al. (1992) Outcomes of comorbid

alcoholic men: a 1-year follow-up. Alcoholism, Clinical and

Experimental Research, 16, 131–138

32. Babor T, Caetano R, Casswell S, et al. 2010 alcohol: No ordinary

commodity- Research and public policy. NewYork, Oxford University

Press

33. Room R, Jernigan D & Carline-Marlatt B (2002) Alcohol in

Developing Societies. Helsinki: Finnish Foundation for Alcohol

Studies

92

34. Gupta S, Lal R, Rao R, Mishra AK, Ambekar A. Pattern of alcohol use

among problem alcohol users in a community-based setting in India: A

cross-sectional study. J Substance Use. 2018 Mar 4 [cited 2019 Aug

3];23(2):130–5. https://doi.org/10.1080/14659891.2017.1366557

35. Sarkar AP, Sen S, Mondal S, Singh OP, Chakraborty A, Swaika B. A

study on socio-demographic characteristics of alcoholics attending the

de-addiction center at Burdwan medical college and hospital in West

Bengal. Indian J Public Health 2013;57:33-5.

36. S. K. Sampath, P. K. Chand, and P. Murthy, “Problem drinking among

male inpatients in a rural general hospital,” Indian Journal of

Community Medicine, vol. 32, article 93, 2007.

37. John, A. Barman, D. Bal et al., “Hazardous alcohol use in rural

southern India: nature, prevalence and risk factors,”

38. Benegal, V. (2005). India: Alcohol and public health. Addiction,

100(8), 1051–1056. doi:10.1111/j.1360-0443.2005.01176.x

39. Vilamovska, A.-M., Brown Taylor, D., & Bluthenthal, R. N. (2009).

Adverse drinking-related consequences among lower income, racial,

and ethnic minority drinkers: Cross-sectional results. Alcoholism:

Clinical and Experimental Research, 33(4), 645–653. doi:10.1111/

j.1530-0277.2008.00879.x

93

40. Brien, S. E., Ronksley, P. E., Turner, B. J., Mukamal, K. J., & Ghali,

W. A. (2011). Effect of alcohol consumption on biological markers

associated with risk of coronary heart disease: Systematic review and

meta-analysis of interventional studies. BMJ, 342, d636.

doi:10.1136/bmj.d636

41. Mukamal, K. J., Maclure, M., Muller, J. E., & Mittleman, M. A.

(2005). Binge drinking and mortality after acute myocardial infarction.

Circulation, 112 (25), 3839–3845.

doi:10.1161/CIRCULATIONAHA.105.574749

42. Ghosh, S., Samanta, A., & Mukherjee, S. (2012). Patterns of alcohol

consumption among male adults at a slum in Kolkata, India. Journal of

Health, Population and Nutrition, 30(1), 73.

43. Studer, J., Baggio, S., Deline, S., N’Goran, A. A., Henchoz, Y.,

Mohler- Kuo, M. Gmel, G. (2015). Drinking locations and alcohol-

related harm: Cross-sectional and longitudinal associations in a sample

of young Swiss men. The International Journal on Drug Policy, 26(7),

653–661. doi:10.1016/j.drugpo.2014.11.004

44. Steinglass.P : The impact of alcoholism on the family relationship

between degree of alcoholism and psychiatric symptomatology;

Journal of studies on Alcohol 1981; 42:288-303.

94

45. P. M. Shyangwa, B. M. Tripathi, and R. Lal, “Family burden in opioid

dependence syndrome in tertiary care centre,” Journal of the Nepal

Medical Association, vol. 47, no. 171, pp. 113–119, 2008.

46. K. Chandra, Burden and coping in caregivers of men with alcohol and

opioid dependence [MD dissertation], Postgraduate Institute of

Medical Education & Research, Chandigarh, India, 2004

47. Vaishnavi R, et al Journal of Addiction, vol 2017, Article ID 8934712,

http://doi.org\10.1155\2017\8934712

48. Srinivasagopalan., Nappinai. Solayappan(2015 march) A Comparative

Study of Caregiver Burden in Cancer Cervix and Breast cancer

illnesses., IJPS.

49. Mrs.Sapna Ganesh "Burden and Quality of Life among Care Givers of

Persons with Alcohol Dependence Syndrome - A Hospital based

Interventional Study.” IOSR Journal Of Humanities And Social

Science (IOSR-JHSS). vol. 22 no. 12, 2017, pp. 20-28.

50. Vishal shah, Behere P, Mishra KK, Sharma A, Kumar K. Psychiatriv

Morbidity among Spouses of Men with Alcohol Dependence. Int J

Recent Surg Med Sci 2017;3(1):10-14

51. Shekhawat BS, Jain S, Solanki HK. Caregiver burden on wives of

substance-dependent husbands and its correlates at a Tertiary Care

Centre in Northern India. Indian J Public Health 2017;61:274-7.

http://doi.org/10.1155/2017/8934712

95

52. Swaroopachary RS, Kalasapati LK, Ivaturi SC, Reddy CM. Caregiver

burden in alcohol dependence syndrome in relation to the severity of

dependence. Arch Ment Health 2018;19:19-23.

53. George S: A comparative study of the quality of marital life among

alcohol dependents: unpublished dissertation; Bangalore

university.1986

54. Nagalakshmi S.V., Suman L.N.: Family interaction patterns in

alcoholic families; NIMHANS Journal.1995;13(1);47-52

55. Sabhaney, J: A study of family and social background of alcoholic

addicts, MD thesis, Bangalore University.1974

56. Rao T.S.S. and Kuruvilla K. : A study in the personality characteristics

of wives of alcoholics; Indian Journal of Psychiatry.1991;33(3),359-

365

57. Hill SY : Personality characteristics of sisters and spouses of male

alcoholics; Alcoholism: Clinical and Experimental Research. 1993

Aug;17(4):733-9.

58. Lewis M.G : Alcoholism and family case work: The Family.1937;18,

39-44

59. Idstad et al. BMC Public Health 2010, 10:516

http://www.biomedcentral.com/1471-2458/10/516

60. S. K. Mattoo, N. Nebhinani, B. N. Anil Kumar, D. Basu, and P.

Kulhara, “Family burden with substance dependence: a study from

http://www.biomedcentral.com/1471-2458/10/516

96

India,” Indian Journal of Medical Research, vol. 137, no. 4, pp. 704–

711, 2013.

61. Fadden, G., Bebbington, P.,& Kuipers, L. (1987). Caring and its

burdens. British Journal of Psychiatry, 151, 660–667

62. Kuruvilla, K. (1993) Towards more rational and responsible patient

care. Indian Journal of Psychiatry, 35,71-72.

63. Moos R , Brennan P.L, Schutte K, Moos B.S: Spouses of Older Adults

With Late-Life Drinking Problems: Health, Family, and Social

Functioning; Journal of Studies on Alcohol and Drugs. 2010 July;

71(4): 506–514

64. O'Farrell TJ, Harrison RH, Schulmeister CA, Cutter HS: A Closeness

to Divorce Scale for wives of alcoholics; Drug and Alcohol

Dependence. 1981;7(4):319-24.

65. Marshal P : For better or for worse? The effects of alcohol use on

marital functioning; Clinical Psychology Review. 2003 December;

23(7): 959–997.

66. Jayaram G: 16PF Profile of wives of alcoholics; unpublished

dissertation,Bangalore university.1988

67. Moos R , Brennan P.L, Schutte K, Moos B.S: Spouses of Older Adults

With Late-Life Drinking Problems: Health, Family, and Social

Functioning; Journal of Studies on Alcohol and Drugs. 2010 July;

71(4): 506–514

97

68. Ino, A; Sugino, K. and Shmiura, M. (1994). The "addiction trends"

seen among the wives of alcoholics, Report 2, Arukom Kenkyuto

Yuhbutsu Ison, April, 29 (2), 121-138

69. Pai, S. & Kapur, R.L. (1981) The burden on the family of a psychiatric

patient: development of an interview schedule. British Journal of

Psychiatry, 138, 332-335

70. Hoenig, J. & Hamilton, M.W. (1966) The schizophrenic patient in the

community and his effect on the household. International Journal of

Social Psychiatry, 12,165-176

71. Oldridge, M., & Hughes, I. (1992). Psychological well-being in

families with a member suffering from schizophrenia. British Journal

of Psychiatry, 161, 249–251.

72. M. Kiran and M. Senthil, “Family burden among caregivers of patients

with epilepsy and alcohol dependence,” Global Journal for Research

Analysis, vol. 5, no. 3, pp. 296–300, 2016.

73. R. D. Lennox, J. A. Scott-Lennox, andH. D. Holder, “Substance abuse

and family illness: evidence from health care utilization and cost-offset

research,”The Journal of Mental Health Administration, vol. 19, no. 1,

pp. 83–95, 1992.

74. Devi C. G., Rajasekar, N. Kokilavani (2013). A Study to Assess the

Level of Stress and Coping Strategies among Wives of Alcoholics at

98

Selected Settings, Chennai, Tamil Nadu. International Journal of

Nursing Education and Research. 1(1), Page 12-14.

75. Rospenda R., & Doman, K (2001). Partner enabling of alcoholic:

Critical review and future directions. American Journal of family

Therapy, 29(4) 257 -270.

76. Nanjundaswamy, M,P.A. Sreedevi , H.M. Gangadharaiah. B.

Viswanath, V. Benegal (2016). A study to assess the stress, coping

strategies and domestic violence in wives of alcohol dependent

individuals, NIMHANS, Psychiatry, Bangalore, India. https://doi.org/

10.1016/S0924-9338(13)77350-4.

77. Rakesh R. Gandhi1, Mahesh A. Suthar1, Sutanaya Pal1 Ankit J.

Rathod2: Archives of Psychiatry and Psychotherapy, 2017; 4: 51–56

99

ANNEXURES

100

ANNEXURES

1. LIST OF ABBREVIATIONS

2. CONSENT FORM (ENGLISH)

3. CONSENT FORM (TAMIL)

4. SOCIO DEMOGRAPHIC QUESTIONNAIRE- PATIENT AND

CAREGIVER

5. SEMI STRUCTURED QUESTIONNAIRE– PATIENT AND

CAREGIVER

6. SAD Q ( Severity Of Alcohol Dependence Questionnaire)

7. GHQ-12 (General Health Questionnaire 12)

8. FBIS (Family Burden Interview Schedule)

9. ETHICAL COMMITTEE CLEARANCE CERTIFICATE

10. MASTER CHART

101

ABBREVATIONS

1 ADH Alcohol Dehydrogenase

2 ADS Alcohol Dependence Syndrome

3. ALDH Aldehyde Dehydrogenase

4. ASPD Antisocial Personality Disorder

5. ASSIST Alcohol, smoking and substance Involvement Screening Test.

6. ASTWA Addiction Screening Test for Wives of Alcohol Dependence Men

7. COGA Collaborative Study On The Genetics Of Alcoholism

8. DALY Disability Adjusted Life Years

9. DAS Dyadic Adjustment Scale

10. DSM Diagnostic and Statistical Manual

11. FAD Family Assessment Device

12. FBIS Family Burden Interview Schedule

13. FIS Family Interaction Scale

14. GHQ General Health Questionnaire

15. HED Heavy Episode Drinking

16. ICD10 International statistical Classification of Diseases

17. MDPQ Mobile Device Proficiency Questionnaire

18. MMPI Minnesota Multiphasic Personality Inventory

19. NCS Family Interaction Scale

20. NDDTC National Drug Dependence Treatment Centre

21. NESARC National Epidemiology Survey On Alcohol And Related Conditions

22. NIMHANS National Institute Of Mental Health And Neuro Sciences

23. NLEAS National Longitudinal Alcohol Epidemiology Survey

24. NSDUH National Survey On Drug Use And Health

25. 16 PQ 16 Personality Factor Questionnaire

26. SAD Q Severity Of Alcohol Dependence Questionnaire

27. SDS Social Drinking Scale

28. SPSS Statistical Package For Social Scientist Version

29. WHO World Health Organisation

102

Informed Consent:

Title: STUDY ON CAREGIVER BURDEN IN TREATMENT

SEEKING INVIDUALS WITH ALCOHOL USE DISORDERS

Principal Investigator

Dr. KARPAGALAKSHMI.R

Department of Psychiatry

Karpaga Vinayaga Institute of Medical Sciences & RC,

Madhuranthakam.

A structured questionnaire will be administered to get necessary

information for the study. The participation in the study will require

approximately 30 minutes of your valuable time and it does/ does not include

any invasive procedure. There are no risks involved in the study.

Participation in the study is completely voluntary and confidentiality will be

maintained. Your consent is required before you can participate in this study

and you have the right to refuse / withdraw from this study.

I have read this consent form and I fully understand the content of this

document and voluntarily consent to participate in the study. All of my

questions concerning this study have to be answered. If I have any questions

in the future about this study the investigator listed above will answer them. I

understand that this consent ends at the conclusion of this study. By signing

this form, I agree to participate in this study.

Date: Caregivers Name & Signature Participants Name &

Signature

CERTIFICATION OF INFORMED CONSENT

I certify that I have explained the nature and purpose of this study to the

above named individual and I have discussed the potential benefits of this

study participation. The questions, the individual had about this study have

been answered and we will always be available to address future questions.

Date: Signature of person obtaining consent

103

. . , .

ந

ந ந

ந ந

+91 9600441233

ந CAREGIVER BURDEN IN TREATMENT SEEKING INDIVIDUALS WITH ALCOHOL

USEDISORDERS

ந ந

. ந ந

. .

ந

.

ந

.

ந

ந :

:

104

SOCIO DEMOGRAPHIC QUESTIONNAIRE- PATIENT

Unique ID :

Age:

Sex:

Religion:

Education:

Residence: rural/urban

Family income\month:

No. of family members:

SOCIO DEMOGRAPHIC PROFILE OF CAREGIVERS

Unique ID :

Age:

Sex:

Relation to patient:

Religion:

Education:

Residence: rural/urban

Family income\month:

No. of family members:

105

SEMI STRUCTURED QUESTIONNAIRE FOR ALCOHOL USE

DISORDER PATIENTS

106

107

108

109

110

111

112

113

114

115

SEMISTRUCTURED QUESTIONNAIRE FOR CAREGIVERS

1.AGE (in years): how old are you? Years:

1. MARITALSTATUS: Tell me whether you are

1. Married& staying together

2. Never married

3. Staying together without married

4. Divorced

5. Separated

6. Widower

7. not known

2. OCCUPATION: what kind of work do you do?

1. Professional

2. administrator/ clerical work

3. business/ self employed

4. transport worker

5. skilled worker

6. unskilled worker / labourer

7. farmer

8. student

9. housewife

10. others ( specify)

11. not known

116

GENERAL HEALTH QUESTIONNAIRE

GHQ-12

Please read this carefully:

We should like to know if you have had any medical complaints, and how your

health has been in general over the past few weeks. Please answer all the questions

simply by underlining the answer which you think most nearly applies to you.

Remember that we want to know about present and recent complaints not those you

had in the past. It is important that you try to answer all the questions.

Thank you very much for your co-operation.

HAVE YOU RECENTLY:

1 Been able to concentrate

on whatever you’re

doing?

Better

than

usual

Same as

usual

Less than

usual

Much

less than

usual

2 Lost much sleep over

worry?

Not at all No

more

than

usual

Rather

more than

usual

Much

more

than

usual

3 Felt that you are playing

a useful part in things?

More so

than

usual

Same as

usual

Less use

than usual

Much

less

usual

4 Felt capable of making

decisions about things?

More so

than

usual

Same as

usual

Less use

than usual

Much

less

cecable

5 Felt constantly under

strain?

Not at all No

more

than

usual

Rather

more than

usual

Much

more

than

usual

117

6 Felt you couldn’t

overcome your

difficulties?

Not at all No

more

than

usual

Rather

more than

usual

Much

more

than

usual

7 Been able to enjoy your

normal day-to-day

activities?

More so

than

usual

Same as

usual

Less than

usual

Much

less than

usual

8 Been able to face up to

your problems?

More so

than

usual

Same as

usual

Less able

man usual

Much

less than

usual

9 Been feeling unhappy

and depressed

Not at all No

more

than

usual

Rather

more than

usual

Much

more

than

usual

10 Been losing confidence

in yourself?

Not at all No

more

than

usual

Rather

more than

usual

Much

more

than

usual

11 Been thinking of

yourself as a worthless

person?

Not at all No

more

than

usual

Rather

more than

usual

Much

more

than

usual

12 Been feeling reasonably

happy all things

considered?

More so

than

usual

About

same as

usual

Less so

than usual

Much

less than

usual

118

FAMILY BURDEN INTERVIEW SCHEDULE

Instructions to relative: We are trying to assess the various difficulties felt by

the family of a psychiatric patient, and will ask you a few questions about these.

Please do not hesitate to express your true feelings.

Instructions to raters: Please interview the relative on the following

guidelines. You may probe further in order to assess a particular item if you feel it

necessary. During the interview note your rating for each general category, as well

as for each individual item, on a three-point scale, viz Severe burden -2, Moderate

burden-1, No burden-0

After completing the interview please assess the burden on the family as a

whole, and give the rating on a similar three-point scale.

A. Financial burden

1. Loss of patient's income: (Has he lost his job? Stopped doing the work

which he was doing before? To what extent does it affect the family

income?)

2. Loss of income of any other member of the family due to patient's illness:

(Has anybody stopped working in order to stay at home, lost pay, lost a job?

To what extent are the family finances affected?)

3. Expenditure incurred due to patient's illness and treatment:(Has he spent or

lost money irrationally due to his illness? How much has this affected the

family finances? How much has been spent on treatment, medicines,

transport, accommodation away from home and so on? How much has been

spent on other treatments such as temples and native healers? How has this

affected family finances?)

119

4. Expenditure incurred due to extra arrangements:(For instance, any other

relative coming to stay with the patient; appointing a nurse or servant;

boarding out children. How have these affected the family finances?)

5. Loans taken or savings spent: (How large a loan? How do they plan to pay it

back? How much does it affect the family? Did they spend from savings?

Were these used up? How much is the family affected?)

6. Any other planned activity put off because of the financial pressure of the

patient's illness: (For instance, postponing a marriage, a journey or a

religious rite. How far is the family affected?)

B. Disruption of routine family activities

1. Patient not going to work, school, college, etc: How inconvenient is this for

the family?

2. Patient not helping in the household work: How much does this affect the

family?

3. Disruption of activities of other members of the family: (Has someone to

spend time looking after the patient, thus abandoning another routine

activity? How inconvenient is this?)

4. Patient's behaviour disrupting activities: (Patient insisting on someone being

with him, not allowing that person to go out, etc? Patient becoming violent,

breaking things, not sleeping and not allowing others to sleep? How much

does it affect the family?)

5. Neglect of the rest of the family due to patient's illness: (Is any other

member missing school, meals, etc? How serious is this?)

C. Disruption of family leisure

1. Stopping of normal recreational activities: (Completely, partially, not at all?

How do the family members react?)

120

2. Patient's illness using up another person's holiday and leisure time: (How is

this person affected by it?)

3. Patient's lack of attention to other members of the family, such as children,

and its effect on them.

4. Has any other leisure activity had to be abandoned owing to the patient's

illness or incapacity e.g. a pleasure trip or family gathering? How do the

family members feel about it?

D. Disruption of family interaction

1. Any ill effect on the general atmosphere in the house: (Has it become dull,

quiet? Are there a lot of misunderstandings, etc? How do the family

members view this?)

2. Do other members get into argument over this (for instance over how the

patient should be treated, who should do the work, who is to blame, etc)?

How are they affected?

3. Have relatives and neighbours stopped visiting the family or reduced the

frequency of their visits because of the patient's behaviour or the stigma

attached to his illness? How does the family feel about this?

4. Has the family become secluded? Does it avoid mixing with others because

of shame or fear of being misunderstood? How do the members feel about

this?

5. Has the patient's illness had any other effect on relationships within the

family or between the family and neighbours or relative e.g. separation- of

spouses, quarrels between two families, property feuds, police intervention,

embarrassment for Family members,etc? How does the family feel about it?

121

E. Effect on physical health of others

1. Have any other members of the family suffered physical ill health, injuries,

etc due to the patient's behaviour? How has this affected them?

2. Has there been any other adverse effect on health (e.g. someone losing

weight or an existing illness being exacerbated)? How severe is it?

F. Effect on mental health of others

1. Has any other family member sought help for- psychological illness brought

on by the patient's behaviour (for instance by the patient's suicide bid, or his

disobedience, or worry about his future)? How severe is this?

2. Has any other member of the family lost sleep, become depressed or weepy,

expressed suicidal wishes, become excessively irritable, etc? How severely?

3. Finally, is there any other burden on the family about which we have not

asked you? If so, what is it? How badly does it affect you?

Subjective burden on the family:

This is to be assessed by asking the following standard question and scoring

the relative's answer: How much would you say you have suffered owing to the

patient's illness: severely, a little or not at all?

122

ETHICAL COMMITTEE CLEARANCE CERTIFICATE

123

UID

age

Sex

Duration

ofalcohol

use

Ageofons

et

dailyuse

ageofons

etofdaily

use

daytime

drinking

ageofons

etofdayti

medrinki

ng

experien

cedwithd

rawal

ageofons

etofwith

drawal

craving

ageofons

etofcravi

ng

socialass

ertivenes

s

recreatin

relaxatio

n

sexualpl

easure

increase

powerag

gression

onothers

insistenc

e

other

source

offinan

ceforpr

ocurin

gdrink

monthly

expendit

ureonalc

ohol

familyincomesp

endonalcohol

familyho

substanc

euse

nameofs

ubstance

used

hopsychi

atriccom

plication

specifyth

edisorde

r

homedic

alcompli

cation

specify

otherme

dicalillne

ssunrelat

edtoalco

hol

specify_

A

complica

tionduet

oothersu

bstance

specify_

B

howman

ytimes

beverage

soffirstch

oice

whichall

beverage

staken

howman

ytimes_A

howmuc

hquantit

y

timetake

ntoconsu

me

occasion

consume

d more

than 5

standard

drink

usualdrin

kingsitua

tion

usualpla

cetohave

adrink

socialdri

nkingpre

ferredco

mpany

styleofdr

inkinggul

ping

diluting

ACGB01 42 1 10.0 32.0 1.0 37.0 1.0 38.0 1.0 35.0 1.0 33.0 .0 .0 .0 .0 .0 .0 1.0 1 3000.0 2.0 1.0 1 2.0 0 1.0

S, GASTRI

1.0 GASTRITIS 2.0 .0 2.0 3.0 3 2.0 360.0 60.0 1.0 1 2,6 1 2.0 2.0

ACGB02 39 1 8.0 31.0 1.0 35.0 1.0 37.0 1.0 35.0 1.0 34.0 .0 .0 1.0 .0 1.0 .0 .0 1 2500.0 1.0 1.0 1 2.0 0 .0

0

.0 0 .0 .0 2.0 1.0 3 2.0 360.0 60.0 1.0 2 3 1 1.0 2.0

ACGB03 32 1 8.0 24.0 1.0 27.0 1.0 30.0 1.0 28.0 1.0 27.0 .0 .0 1.0 .0 .0 .0 .0 1 2000.0 1.0 1.0 1 2.0 0 1.0

RITIS, SEIZ .0 GASTRITIS .0 .0 1.0 3.0 3 1.0 360.0 45.0 1.0 2 2,6 1 2.0 2.0

ACGB04 43 1 23.0 20.0 1.0 35.0 1.0 39.0 1.0 37.0 1.0 34.0 .0 .0 1.0 .0 .0 .0 .0 1 4500.0 2.0 1.0 1 2.0 0 1.0

ABD PAIN

.0 ABD PAIN .0 .0 1.0 3.0 3 1.0 360.0 40.0 1.0 1 2,5 3 2.0 2.0

ACGB05 45 1 25.0 20.0 1.0 35.0 1.0 37.0 1.0 35.0 1.0 34.0 .0 .0 1.0 .0 .0 .0 .0 1 2000.0 1.0 1.0 1 2.0 0 1.0

DICE , GAS

.0 0 .0 .0 2.0 3.0 3 2.0 360.0 90.0 1.0 2 2 1 2.0 2.0

ACGB06 57 1 20.0 27.0 1.0 31.0 1.0 33.0 1.0 31.0 1.0 30.0 .0 .0 1.0 .0 .0 .0 .0 1 2000.0 1.0 1.0 1 1.0 0 2.0

.0 0 .0 .0 2.0 3.0 3 3.0 360.0 60.0 1.0 4 3 1 2.0 2.0

ACGB07 50 1 25.0 25.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 1.0 .0 .0 .0 .0 .0 1 1500.0 1.0 1.0 1 2.0 0 2.0

0

.0 0 .0 .0 .0 .0 0 .0 540.0 60.0 1.0 2 3 1 2.0 2.0

ACGB08 38 1 10.0 28.0 1.0 35.0 1.0 37.0 1.0 36.0 1.0 34.0 .0 .0 1.0 .0 .0 .0 .0 1 10000.0 2.0 1.0 1 2.0 0 1.0

GASTRITIS

.0 0 .0 .0 2.0 1.0 3 1.0 360.0 30.0 1.0 3 4 1 2.0 2.0

ACGB09 65 1 40.0 20.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 .0 1.0 .0 .0 .0 .0 1 1000.0 1.0 1.0 1 2.0 0 2.0

0

.0 0 .0 .0 2.0 3.0 3 3.0 360.0 30.0 1.0 1 5 3 2.0 2.0

ACGB10 52 1 30.0 22.0 1.0 30.0 1.0 40.0 1.0 37.0 1.0 29.0 1.0 .0 .0 .0 .0 .0 .0 1 8000.0 3.0 2.0 0 2.0 0 2.0

GASTRITIS

.0 0 .0 .0 1.0 3.0 3 2.0 540.0 60.0 1.0 1 2 3 2.0 2.0

ACGB11 35 1 10.0 25.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 .0 1.0 .0 .0 .0 .0 1 1000.0 1.0 2.0 0 2.0 0 2.0

0

.0 0 .0 .0 3.0 3.0 3 1.0 360.0 45.0 1.0 1 3 1 2.0 2.0

ACGB12 60 1 20.0 40.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 .0 1.0 .0 .0 .0 .0 2 1500.0 1.0 2.0 0 2.0

1.0

GASTRITIS

.0 0 .0 .0 6.0 3.0 3 2.0 540.0 30.0 1.0 5 3 1 2.0 2.0

ACGB13 40 1 10.0 30.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 .0 1.0 .0 .0 .0 .0 1 500.0 1.0 2.0 0 2.0 0 2.0

0

.0 0 .0 .0 2.0 3.0 3 3.0 180.0 60.0 1.0 9 5 3 2.0 2.0

ACGB14 50 1 35.0 15.0 1.0 20.0 1.0 30.0 1.0 28.0 1.0 19.0 .0 .0 .0 .0 1.0 .0 .0 3 5000.0 1.0 2.0 0 2.0 0 1.0

IS , MEMO

.0 0 .0 .0 1.0 3.0 3 1.0 360.0 45.0 1.0 6 5 1 2.0 1.0

ACGB15 43 1 23.0 20.0 1.0 35.0 1.0 40.0 1.0 37.0 1.0 35.0 1.0 .0 .0 .0 .0 .0 .0 2 5000.0 1.0 2.0 0 2.0 0 1.0

GASTRITIS

.0 0

1.0 3.0 3 2.0 180.0 30.0 1.0 2 2 3 2.0 2.0

ACGB16 40 1 10.0 30.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 .0 1.0 .0 .0 .0 .0 1 2000.0 1.0 2.0 0 2.0 0 2.0

0

.0 0 .0 .0 2.0 1.0 3 1.0 360.0 60.0 1.0 1 5 9 2.0 2.0

ACGB17 56 1 30.0 26.0 1.0 30.0 2.0 .0 1.0 42.0 1.0 30.0 .0 1.0 .0 .0 .0 .0 .0 1 2000.0 1.0 2.0 0 2.0 0 2.0

0

.0 0 .0 .0 6.0 2.0 3 1.0 360.0 45.0 1.0 3 2 3 1.0 2.0

ACGB18 30 1 10.0 25.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 .0 1.0 .0 .0 .0 .0 1 500.0 1.0 2.0 0 2.0 0 2.0

0

.0 0 .0 .0 2.0 3.0 3 1.0 360.0 45.0 1.0 1 3 1 1.0 2.0

ACGB19 60 1 40.0 20.0 1.0 30.0 2.0 .0 2.0 .0 1.0 29.0 .0 .0 1.0 .0 .0 .0 .0 1 11000.0 2.0 2.0 0 2.0 0 1.0

VER DISEA

.0 0

1.0 3.0 3 1.0 540.0 60.0 1.0 2 4 3 2.0 1.0

ACGB20 40 1 10.0 30.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 .0 1.0 .0 .0 .0 .0 1 2400.0 1.0 2.0 0 2.0 0 2.0

0

.0 0 .0 .0 6.0 3.0 3 2.0 540.0 60.0 1.0 1 4 9 2.0 2.0

ACGB21 54 1 14.0 40.0 1.0 40.0 1.0 45.0 1.0 40.0 1.0 40.0 .0 .0 .0 .0 .0 1.0 .0 1 7500.0 2.0 1.0 1 2.0 0 1.0

DICE , GAS

.0 0 .0 .0 1.0 3.0 3 2.0 360.0 30.0 1.0 1 3 1 2.0 2.0

ACGB22 50 1 30.0 20.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 .0 .0 .0 .0 .0 .0 1 4000.0 2.0 2.0 0 2.0 0 1.0

ASTRITIS,

.0 SEIZURES

1.0 3.0 3 2.0 720.0 120.0 1.0 1 5 1 2.0 2.0

ACGB23 55 1 15.0 40.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 .0 1.0 .0 .0 .0 .0 1 1000.0 1.0 2.0 0 2.0 0 2.0

0

.0 0 .0 .0 6.0 3.0 3 3.0 360.0 30.0 1.0 1 1 1 2.0 2.0

ACGB24 65 1 40.0 24.0 1.0 50.0 1.0 55.0 1.0 50.0 1.0 45.0 .0 .0 .0 .0 1.0 .0 .0 2 10000.0 3.0 2.0 0 2.0 0 1.0

CIRRHOSI

.0 0 .0 .0 1.0 3.0 3 3.0 360.0 60.0 1.0 2 2 3 1.0 2.0

ACGB25 70 1 50.0 15.0 1.0 50.0 1.0 60.0 1.0 57.0 1.0 20.0 1.0 .0 .0 .0 .0 .0 .0 2 5000.0 2.0 2.0 0 2.0 0 1.0

CHD

.0 0 .0 .0 1.0 3.0 3 2.0 540.0 30.0 1.0 6 3 3 2.0 1.0

ACGB26 64 1 30.0 32.0 1.0 40.0 2.0 .0 1.0 50.0 1.0 40.0 .0 1.0 .0 .0 .0 .0 .0 1 5000.0 1.0 2.0 0 2.0 0 1.0

IPHERAL N

.0 0 .0 .0 1.0 3.0 3 2.0 180.0 45.0 1.0 1 2 1 2.0 2.0

ACGB27 39 1 9.0 30.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 .0 .0 .0 .0 .0 1.0 1 500.0 1.0 2.0 0 2.0 0 2.0

0

.0 0 .0 .0 2.0 3.0 3 1.0 180.0 30.0 1.0 1 3 3 2.0 2.0

ACGB28 37 1 7.0 30.0 2.0 .0 2.0 .0 2.0 .0 1.0 45.0 .0 .0 .0 .0 .0 .0 1.0 1 500.0 1.0 2.0 0 2.0 0 1.0

GASTRITIS

.0 0 .0 .0 2.0 3.0 3 4.0 180.0 30.0 1.0 1 4 3 2.0 2.0

ACGB29 50 1 30.0 20.0 1.0 22.0 2.0 .0 1.0 30.0 1.0 21.0 .0 .0 .0 .0 .0 .0 1.0 1 6000.0 2.0 2.0 0 2.0 0 1.0

CHD

.0 0 .0 .0 3.0 3.0 3 1.0 180.0 60.0 1.0 1 5 9 1.0 2.0

ACGB30 52 1 30.0 22.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 .0 .0 .0 .0 .0 1.0 1 500.0 1.0 2.0 0 2.0 0 1.0

GASTRITIS

.0 0 .0 .0 4.0 1.0 1 4.0 180.0 30.0 1.0 2 2 3 2.0 2.0

ACGB31 48 1 5.0 43.0 1.0 45.0 1.0 47.0 1.0 46.0 1.0 45.0 .0 .0 .0 .0 .0 .0 1.0 1 16000.0 3.0 2.0 0 1.0 EPRESSIO 1.0

RITIS,JAU

.0 0 .0 .0 1.0 3.0 3 1.0 540.0 30.0 1.0 1 3 1 2.0 2.0

ACBG32 53 1 40.0 13.0 1.0 20.0 1.0 30.0 1.0 27.0 1.0 20.0 1.0 .0 .0 .0 .0 .0 .0 3 20000.0 3.0 2.0 0 2.0 0 1.0

CIRRHOSI

.0 0 .0 .0 1.0 3.0 3 1.0 720.0 30.0 1.0 3 4 3 2.0 1.0

ACBG33 38 1 18.0 20.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 1.0 .0 .0 .0 .0 .0 .0 1 1500.0 1.0 2.0 0 2.0 0 2.0

0

.0 0 .0 .0 4.0 3.0 3 4.0 540.0 60.0 1.0 1 8 3 1.0 2.0

ACBG34 43 1 23.0 20.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 .0 1.0 .0 .0 .0 1.0 1 1500.0 1.0 2.0 0 2.0 0 2.0

0

.0 0 .0 .0 3.0 4.0 4 3.0 540.0 30.0 1.0 4 1 3 2.0 2.0

ACBG35 47 1 27.0 20.0 1.0 40.0 1.0 45.0 1.0 42.0 1.0 39.0 .0 .0 .0 .0 .0 .0 .0 1 22000.0 2.0 2.0 0 2.0 0 1.0

ALD

.0 0 .0 .0 2.0 3.0 3 2.0 720.0 60.0 1.0 5 4 1 2.0 2.0

ACBG36 38 1 8.0 30.0 1.0 35.0 1.0 37.0 1.0 36.0 1.0 33.0 .0 .0 .0 .0 1.0 .0 1.0 1 15000.0 2.0 2.0 0 1.0 OCD 1.0

ORY WEIS

.0 0 .0 .0 2.0 3.0 3 1.0 180.0 60.0 1.0 6 5 1 2.0 1.0

ACBG37 30 1 5.0 25.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 .0 1.0 .0 .0 .0 .0 1 1200.0 1.0 2.0 0 2.0 0 2.0

0

.0 0 .0 .0 2.0 2.0 2 2.0 540.0 120.0 1.0 1 2 3 2.0 2.0

ACBG38 60 1 40.0 20.0 1.0 50.0 1.0 55.0 1.0 52.0 1.0 49.0 .0 .0 .0 .0 1.0 .0 1.0 2 8000.0 2.0 2.0 0 1.0 EPRESSIO 1.0

ATTY LIVE

.0 0 .0 .0 1.0 3.0 3 1.0 540.0 120.0 1.0 4 3 1 2.0 1.0

ACBG39 40 1 10.0 30.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 .0 .0 .0 .0 .0 1.0 1 2500.0 1.0 2.0 0 2.0 0 1.0

GASTRITIS

.0 0 .0 .0 2.0 3.0 3 2.0 540.0 60.0 1.0 5 2 1 2.0 2.0

ACBG40 55 1 15.0 30.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 1.0 .0 .0 .0 .0 .0 .0 1 3000.0 1.0 2.0 0 2.0 0 1.0

GASTRITIS

.0 0 .0 .0 2.0 3.0 3 2.0 540.0 60.0 1.0 9 4 3 1.0 2.0

ACBG41 40 1 25.0 15.0 1.0 30.0 1.0 35.0 1.0 34.0 1.0 30.0 1.0 .0 .0 .0 .0 .0 .0 1 5000.0 3.0 2.0 0 1.0 EPRESSIO 1.0

ALD

.0 0 .0 .0 1.0 3.0 3 1.0 360.0 45.0 1.0 1 5 9 2.0 2.0

ACBG42 46 1 23.0 23.0 1.0 35.0 1.0 40.0 1.0 30.0 1.0 34.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 1 5000.0 1.0 2.0 0 1.0 ANXIETY 1.0

PERTENSI .0 0 .0 .0 2.0 3.0 3 2.0 540.0 120.0 1.0 1 1 1 2.0 2.0

ACBG43 53 1 30.0 23.0 1.0 45.0 1.0 50.0 1.0 40.0 1.0 44.0 .0 .0 1.0 .0 .0 .0 1.0 1 6000.0 1.0 2.0 0 2.0 0 1.0

GASTRITIS

.0 0 .0 .0 2.0 3.0 3 2.0 360.0 60.0 1.0 2 5 3 2.0 2.0

ACBG44 39 1 15.0 24.0 1.0 30.0 1.0 35.0 1.0 33.0 1.0 29.0 .0 .0 1.0 .0 .0 .0 1.0 1 5000.0 2.0 2.0 0 1.0 GAD 1.0

2, GASTR

.0 0 .0 .0 2.0 3.0 3 2.0 360.0 60.0 1.0 3 3 3 2.0 2.0

ACBG45 65 1 40.0 25.0 1.0 25.0 1.0 30.0 1.0 28.0 1.0 25.0 1.0 .0 .0 .0 .0 .0 .0 1 3000.0 1.0 2.0 0 2.0 0 1.0 URE,GAST

.0 0 .0 .0 2.0 4.0 3,4 2.0 540.0 60.0 1.0 4 4 1 2.0 2.0

ACBG46 57 1 30.0 27.0 1.0 30.0 1.0 40.0 1.0 30.0 1.0 30.0 .0 .0 1.0 .0 1.0 .0 1.0 2 2000.0 1.0 1.0 1 1.0 0 1.0

DICE , GAS

.0 0 .0 .0 2.0 3.0 3 2.0 360.0 30.0 1.0 2 2 1 2.0 2.0

ACBG47 50 1 25.0 25.0 1.0 30.0 1.0 35.0 1.0 32.0 1.0 30.0 .0 .0 1.0 .0 1.0 .0 1.0 1 2000.0 1.0 2.0 0 1.0 ANXIETY 1.0

DICE , GAS

.0 0 .0 .0 2.0 3.0 3 2.0 540.0 60.0 1.0 1 3 3 2.0 2.0

ACBG48 35 1 15.0 20.0 1.0 25.0 1.0 30.0 1.0 27.0 1.0 24.0 .0 .0 1.0 .0 .0 .0 .0 1 5000.0 1.0 1.0 1 2.0 0 1.0

GASTRITIS

.0 0 .0 .0 2.0 3.0 3 2.0 360.0 120.0 1.0 2 4 3 2.0 2.0

ACBG49 56 1 29.0 27.0 1.0 30.0 1.0 38.0 1.0 35.0 1.0 30.0 .0 .0 1.0 .0 .0 .0 1.0 1 5000.0 2.0 2.0 0 2.0 0 1.0

S, GASTRI

.0 0 .0 .0 2.0 3.0 3 2.0 360.0 120.0 1.0 4 2 3 1.0 2.0

ACBG50 47 1 27.0 20.0 1.0 25.0 1.0 30.0 1.0 28.0 1.0 25.0 .0 .0 2.0 .0 .0 .0 1.0 1 3000.0 2.0 1.0 1,9 2.0 0 2.0

0

.0 0 .0 .0 2.0 3.0 3,2 2.0 360.0 120.0 1.0 2 5 1 2.0 2.0

ACBG51 26 1 6.0 20.0 2.0 .0 2.0 .0 .0 .0 1.0 25.0 .0 .0 1.0 .0 .0 .0 .0 1 2000.0 1.0 2.0 0 2.0 0 2.0

0

.0 0 .0 .0 1.0 3.0 3 1.0 360.0 120.0 1.0 1 1 3 2.0 2.0

ACBG52 65 1 47.0 18.0 1.0 35.0 1.0 40.0 1.0 35.0 1.0 35.0 .0 .0 1.0 .0 1.0 .0 1.0 2 4000.0 2.0 2.0 0 1.0 EPRESSIO 1.0

DICE , GAS

.0 0 .0 .0 1.0 3.0 3 1.0 540.0 120.0 1.0 1 3,5 1 1.0 2.0

ACBG53 36 1 20.0 16.0 1.0 20.0 1.0 30.0 1.0 20.0 1.0 20.0 .0 .0 1.0 .0 1.0 .0 1.0 2 7000.0 2.0 1.0 1 2.0 0 1.0 RIUM, SEIZ .0 0 .0 .0 1.0 3.0 2,3,4 1.0 720.0 240.0 1.0 2 5 1 2.0 2.0

ACBG54 30 1 12.0 18.0 2.0 .0 2.0 .0 1.0 25.0 1.0 25.0 .0 .0 1.0 .0 1.0 1.0 .0 2 2750.0 2.0 1.0 1 2.0 0 2.0

0

.0 0 .0 .0 3.0 3.0 2,3 3.0 180.0 60.0 1.0 2 3 1 1.0 2.0

ACBG55 42 1 27.0 15.0 1.0 25.0 1.0 30.0 1.0 27.0 1.0 25.0 .0 .0 1.0 .0 .0 1.0 1.0 2 7500.0 3.0 1.0 1 1.0 VIORAL IS 1.0

ES, DT, JA

.0 0 .0 .0 1.0 3.0 1,3 1.0 720.0 120.0 1.0 1 2 1,3 2.0 2.0

ACBG56 55 1 30.0 25.0 1.0 30.0 1.0 40.0 1.0 38.0 1.0 30.0 .0 .0 1.0 .0 .0 .0 1.0 1 3000.0 1.0 1.0 1,9 2.0 0 1.0

OUT,GAS

.0 0 .0 .0 1.0 3.0 2,3 1.0 540.0 60.0 1.0 1 3 1 2.0 1.0

ACBG57 40 1 20.0 20.0 1.0 30.0 2.0 .0 1.0 30.0 1.0 29.0 .0 .0 1.0 .0 .0 1.0 1.0 1 2500.0 1.0 1.0 1 2.0 0 2.0

0

.0 0 .0 .0 2.0 3.0 1,3 2.0 360.0 45.0 1.0 1 3 1 2.0 2.0

ACBG58 29 1 10.0 19.0 1.0 24.0 2.0 .0 1.0 24.0 1.0 23.0 .0 .0 1.0 .0 .0 1.0 .0 1 3000.0 1.0 2.0 0 2.0 0 1.0

GASTRITIS

.0 0 .0 .0 2.0 3.0 3 2.0 360.0 120.0 1.0 1 2 1 2.0 2.0

ACBG59 60 1 40.0 20.0 1.0 30.0 1.0 40.0 1.0 39.0 1.0 30.0 .0 .0 1.0 .0 .0 1.0 .0 2 2000.0 1.0 1.0 1 2.0 0 1.0

M, GASTRI .0 0 .0 .0 2.0 3.0 2,3 2.0 540.0 60.0 1.0 1 3 3 2.0 1.0

ACBG60 47 1 29.0 18.0 1.0 35.0 1.0 40.0 1.0 35.0 1.0 34.0 .0 .0 1.0 .0 .0 1.0 .0 1 2000.0 1.0 1.0 1 2.0 0 2.0

0

.0 0 .0 .0 2.0 3.0 2,3,4 2.0 360.0 60.0 1.0 2 3,5 3 2.0 2.0

ACBG61 32 1 12.0 20.0 1.0 25.0 2.0 .0 1.0 25.0 1.0 24.0 .0 .0 .0 .0 1.0 .0 .0 1 2500.0 1.0 2.0 0 2.0 0 1.0

GASTRITIS

.0 0 .0 .0 2.0 1.0 1,2,9 2.0 360.0 60.0 1.0 2 3 3 2.0 2.0

ACBG62 58 1 30.0 28.0 1.0 35.0 2.0 .0 1.0 40.0 1.0 35.0 .0 .0 1.0 .0 .0 .0 1.0 1 3000.0 1.0 2.0 0 1.0 EPRESSIO 1.0

PERTENSI .0 0 .0 .0 2.0 3.0 3 2.0 180.0 60.0 1.0 2 3 1,3 2.0 2.0

ACBG63 61 1 31.0 30.0 1.0 35.0 1.0 40.0 1.0 38.0 1.0 35.0 .0 .0 1.0 .0 .0 .0 1.0 2 3000.0 1.0 1.0 1,9 2.0 0 1.0

M,CIRRHO

.0 0 .0 .0 2.0 3.0 2,3 2.0 180.0 120.0 1.0 1 2 3 2.0 1.0

ACBG64 48 1 23.0 25.0 1.0 33.0 1.0 35.0 1.0 33.0 1.0 33.0 .0 .0 .0 .0 1.0 1.0

1 2500.0 1.0 2.0 0 2.0 0 1.0

M,GASTRI

.0 0 .0 .0 1.0 3.0 1,3 1.0 180.0 60.0 1.0 1 2 1 2.0 2.0

ACBG65 30 1 12.0 28.0 2.0 .0 2.0 .0 1.0 25.0 1.0 28.0 .0 .0 1.0 .0 1.0 .0 .0 1 1000.0 1.0 2.0 0 1.0 ANXIETY 2.0

0

.0 0 .0 .0 3.0 1.0 1,2 3.0 180.0 60.0 1.0 2 3 1 1.0 2.0

ACBG66 52 1 27.0 25.0 1.0 36.0 1.0 38.0 1.0 30.0 1.0 30.0 .0 .0 1.0 .0 1.0 1.0 .0 1 2500.0 1.0 1.0 1,9 1.0 EPRESSIO 1.0

PERTENSI .0 0 .0 .0 2.0 1.0 2,3 2.0 360.0 120.0 1.0 1 2 3 2.0 2.0

ACBG67 44 1 20.0 24.0 1.0 30.0 1.0 40.0 1.0 35.0 1.0 30.0 .0 .0 1.0 .0 1.0 1.0 .0 1 1500.0 1.0 1.0 1 2.0 0 1.0

GASTRITIS

.0 0 .0 .0 2.0 3.0 3 2.0 180.0 60.0 1.0 1 3 1 2.0 2.0

ACBG68 39 1 20.0 19.0 2.0 .0 2.0 .0 .0 .0 1.0 25.0 .0 1.0 1.0 .0 .0 1.0 1.0 1 1500.0 1.0 2.0 0 1.0 ANXIETY 1.0

GASTRITIS

.0 0 .0 .0 3.0 2.0 1,2 3.0 180.0 60.0 1.0 2 3 1 2.0 2.0

ACBG69 55 1 30.0 25.0 1.0 30.0 1.0 35.0 1.0 32.0 1.0 29.0 .0 1.0 .0 .0 .0 1.0 1.0 1 3000.0 1.0 1.0 1 1.0 EPRESSIO 1.0

M,GASTRI

.0 0 .0 .0 2.0 3.0 3 2.0 540.0 120.0 1.0 1 3 1 2.0 1.0

ACBG70 34 1 14.0 20.0 2.0 .0 2.0 .0 1.0 30.0 1.0 30.0 .0 1.0 1.0 .0 .0 1.0 .0 1 500.0 1.0 2.0 0 2.0 0 2.0

0

.0 0 .0 .0 3.0 2.0 2 3.0 180.0 60.0 1.0 3 2 1 2.0 2.0

124

ACBG71 46 1 27.0 19.0 1.0 25.0 1.0 30.0 1.0 27.0 1.0 24.0 .0 .0 1.0 .0 .0 1.0 .0 1 4000.0 1.0 1.0 1 1.0 ANXIETY 1.0 GASTRITIS .0 0 .0 .0 2.0 3.0 3 2.0 360.0 60.0 1.0 1 2 1 2.0 2.0

ACBG72 50 1 30.0 20.0 2.0 .0 2.0 .0 1.0 30.0 1.0 30.0 .0 .0 1.0 .0 .0 .0 .0 1 1000.0 1.0 2.0 1 1.0 EPRESSIO 2.0 0 .0 0 .0 .0 2.0 3.0 3 2.0 360.0 120.0 1.0 1 2 1 2.0 2.0

ACBG73 47 1 29.0 18.0 1.0 35.0 1.0 37.0 1.0 35.0 1.0 34.0 .0 .0 1.0 .0 .0 1.0 .0 1 2000.0 1.0 1.0 1 2.0 0 2.0 0 .0 0 .0 .0 2.0 3.0 2,3,4 2.0 360.0 60.0 1.0 2 3,5 3 2.0 2.0

ACBG74 53 1 32.0 21.0 1.0 25.0 1.0 30.0 1.0 28.0 1.0 25.0 .0 .0 1.0 .0 .0 1.0 1.0 2 6000.0 2.0 1.0 1 1.0 RESSION, 1.0 ON,DM,M .0 0 .0 .0 2.0 3.0 3 2.0 540.0 120.0 1.0 2 2 1 2.0 2.0

ACBG75 60 1 40.0 20.0 1.0 35.0 1.0 40.0 1.0 38.0 1.0 35.0 .0 .0 .0 .0 .0 .0 1.0 2 5000.0 2.0 2.0 0 1.0 EPRESSIO 1.0 ENSION,S 1.0 GASTRITIS .0 .0 1.0 3.0 3 1.0 720.0 180.0 1.0 1 3 1 2.0 2.0

ACBG76 42 1 22.0 20.0 1.0 30.0 1.0 40.0 1.0 30.0 1.0 28.0 .0 1.0 1.0 .0 .0 .0 1.0 1 4000.0 1.0 2.0 0 1.0 T,ANXIET 1.0 URE,GAST .0 0 .0 .0 1.0 3.0 2,3,4 1.0 540.0 180.0 1.0 2 3 3 2.0 1.0

ACBG77 30 1 12.0 28.0 2.0 .0 2.0 .0 1.0 25.0 1.0 29.0 .0 .0 1.0 .0 1.0 .0 .0 1 1000.0 1.0 2.0 0 1.0 ANXIETY 2.0 0 .0 0 .0 .0 3.0 1.0 1,2 3.0 180.0 60.0 1.0 2 3 1 1.0 2.0

ACBG78 52 1 27.0 25.0 1.0 36.0 1.0 38.0 1.0 30.0 1.0 36.0 .0 .0 1.0 .0 1.0 1.0 .0 1 2500.0 1.0 1.0 1 1.0 EPRESSIO 1.0 PERTENSI .0 0 .0 .0 2.0 1.0 2,3 2.0 360.0 120.0 1.0 1 2 3 2.0 2.0

ACBG79 34 1 14.0 20.0 2.0 .0 2.0 .0 1.0 30.0 1.0 30.0 .0 1.0 1.0 .0 .0 1.0 .0 1 2000.0 1.0 2.0 0 2.0 0 2.0 0 .0 0 .0 .0 3.0 2.0 2 3.0 180.0 60.0 1.0 3 2 1 2.0 2.0


ACBG81 20 1 9.0 11.0 1.0 15.0 1.0 17.0 1.0 16.0 1.0 15.0 .0 1.0 1.0 .0 .0 1.0 1.0 2 4000.0 2.0 1.0 1,9 1.0 ANXIETY 1.0 GASTRITIS .0 0 .0 .0 2.0 3.0 2,3 2.0 360.0 60.0 1.0 1,2 2,3,4,5 1,3 2.0 1.0

ACBG82 61 1 31.0 30.0 1.0 35.0 1.0 45.0 1.0 40.0 1.0 34.0 .0 .0 1.0 .0 .0 .0 1.0 2 3000.0 1.0 1.0 1,9 2.0 0 1.0 M,CIRRHO .0 0 .0 .0 2.0 3.0 2,3 2.0 180.0 120.0 1.0 1 2 3 2.0 1.0

ACBG83 55 1 30.0 25.0 1.0 30.0 1.0 35.0 1.0 30.0 1.0 29.0 .0 1.0 .0 .0 .0 1.0 1.0 1 3000.0 1.0 1.0 1 1.0 EPRESSIO 1.0 M,GASTRI .0 0 .0 .0 2.0 3.0 3 2.0 540.0 120.0 1.0 1 3 1 2.0 1.0

ACBG84 50 1 30.0 20.0 2.0 .0 2.0 .0 1.0 30.0 1.0 30.0 .0 .0 1.0 .0 .0 .0 .0 1 2500.0 1.0 2.0 1 1.0 EPRESSIO 2.0 0 .0 0 .0 .0 2.0 3.0 3 2.0 360.0 120.0 1.0 1 2 1 2.0 2.0

ACBG85 32 1 12.0 20.0 1.0 25.0 2.0 .0 1.0 25.0 1.0 24.0 .0 .0 .0 .0 1.0 .0 .0 1 2500.0 1.0 2.0 0 2.0 0 1.0 GASTRITIS .0 0 .0 .0 2.0 1.0 1,2,9 2.0 360.0 60.0 1.0 2 3 3 2.0 2.0

ACBG86 47 1 29.0 18.0 1.0 35.0 1.0 40.0 1.0 35.0 1.0 35.0 .0 .0 1.0 .0 .0 1.0 .0 1 2000.0 1.0 1.0 1 2.0 0 2.0 0 .0 0 .0 .0 2.0 3.0 2,3,4 2.0 360.0 60.0 1.0 2 3,5 3 2.0 2.0


ACBG88 48 1 23.0 25.0 1.0 33.0 1.0 35.0 1.0 33.0 1.0 33.0 .0 .0 .0 .0 1.0 1.0

1 2500.0 1.0 2.0 0 2.0 0 1.0 M,GASTRI .0 0 .0 .0 1.0 3.0 1,3 1.0 180.0 60.0 1.0 1 2 1 2.0 2.0

ACBG89 47 1 29.0 18.0 1.0 35.0 1.0 40.0 1.0 35.0 1.0 35.0 .0 .0 1.0 .0 .0 1.0 .0 1 2000.0 1.0 1.0 1 2.0 0 2.0 0 .0 0 .0 .0 2.0 3.0 2,3,4 2.0 360.0 60.0 1.0 2 3,5 3 2.0 2.0

ACBG90 30 1 12.0 28.0 2.0 .0 2.0 .0 1.0 25.0 1.0 28.0 .0 .0 1.0 .0 1.0 .0 .0 1 1500.0 1.0 2.0 0 1.0 ANXIETY 2.0 0 .0 0 .0 .0 3.0 1.0 1,2 3.0 180.0 60.0 1.0 2 3 1 1.0 2.0

ACBG91 44 1 20.0 24.0 1.0 30.0 1.0 40.0 1.0 35.0 1.0 30.0 .0 .0 1.0 .0 1.0 1.0 .0 1 1500.0 1.0 1.0 1 2.0 0 1.0 GASTRITIS .0 0 .0 .0 2.0 3.0 3 2.0 180.0 60.0 1.0 1 3 1 2.0 2.0

ACBG92 32 1 8.0 24.0 1.0 24.0 1.0 30.0 1.0 28.0 1.0 24.0 .0 .0 1.0 .0 .0 .0 .0 1 2000.0 1.0 1.0 1 2.0 0 1.0 RITIS, SEIZ .0 0 .0 .0 1.0 3.0 3 1.0 360.0 45.0 1.0 2 2,6 1 2.0 2.0

ACBG93 55 1 34.0 21.0 1.0 29.0 1.0 31.0 1.0 28.0 1.0 29.0 .0 .0 .0 .0 .0 1.0 1.0 1,2 3000.0 1.0 2.0 0 2.0 0 1.0 RITIS,JAU 1.0 MI .0 .0 2.0 3.0 3 2.0 540.0 120.0 1.0 2 3 1,3 2.0 2.0

ACBG94 57 1 30.0 27.0 1.0 30.0 1.0 40.0 1.0 30.0 1.0 30.0 .0 .0 1.0 .0 1.0 .0 1.0 2 2000.0 1.0 1.0 1 1.0 ANXIETY 1.0 DICE , GAS .0 0 .0 .0 2.0 3.0 3 2.0 360.0 30.0 1.0 2 2 1 2.0 2.0

ACBG95 65 1 40.0 25.0 1.0 25.0 1.0 30.0 1.0 28.0 1.0 24.0 1.0 .0 .0 .0 .0 .0 .0 1 3000.0 1.0 2.0 0 2.0 0 1.0 URE,GAST .0 0 .0 .0 2.0 4.0 3,4 2.0 540.0 60.0 1.0 4 4 1 2.0 2.0

ACBG96 43 1 23.0 20.0 2.0 .0 2.0 .0 2.0 .0 2.0 .0 .0 .0 1.0 .0 .0 .0 1.0 1 1000.0 1.0 2.0 0 2.0 0 2.0 0 .0 0 .0 .0 3.0 4.0 4 3.0 540.0 30.0 1.0 4 1 3 2.0 2.0

ACBG97 57 1 30.0 27.0 1.0 30.0 1.0 41.0 1.0 30.0 1.0 30.0 .0 .0 1.0 .0 1.0 .0 1.0 1 2000.0 1.0 1.0 1 1.0 EPRESSIO 1.0 DICE , GAS .0 0 .0 .0 2.0 3.0 3 2.0 360.0 30.0 1.0 2 2 1 2.0 2.0

ACBG98 26 1 7.0 19.0 2.0 .0 2.0 .0 1.0 24.0 1.0 24.0 1.0 1.0 1.0 .0 .0 1.0 1.0 1 2000.0 1.0 1.0 1 1.0 PHOBIA 1.0 GASTRITIS .0 0 .0 .0 2.0 2.0 1,2,3 3.0 180.0 60.0 1.0 2 1,6,5 1,3,9 2.0 2.0

ACBG99 30 1 12.0 18.0 2.0 .0 2.0 .0 1.0 25.0 1.0 25.0 .0 .0 1.0 .0 1.0 1.0 .0 2 1500.0 1.0 1.0 1 2.0 0 2.0 0 .0 0 .0 .0 3.0 3.0 2,3 3.0 180.0 60.0 1.0 2 3 1 1.0 2.0

ACBG100 32 1 8.0 24.0 1.0 24.0 1.0 30.0 1.0 28.0 1.0 24.0 .0 .0 1.0 .0 .0 .0 .0 1 3000.0 2.0 1.0 1 2.0 0 1.0 RITIS, SEIZ .0 GASTRITIS .0 .0 1.0 3.0 3 1.0 360.0 45.0 1.0 2 2,6 1 2.0 2.0

125

UID

alongwit

hfood

moretha

n1bevera

geinsingl

eoccasio

n

usualtim

eofdrinki

ng

drinkwh

enhappy

drinkwh

enfrustra

ted

drinkwh

enrelaxe

d

drinkwh

entired

drinkwh

enbored

drinkwh

enmeetfr

iends

drinkona

baddayin

work

quarrelw

ith

nopartic

ularsitua

tion

anyfamil

ymembe

rsconsu

mealcoh

ol

knownpe

oplecons

umealco

hol

restrictio

nsagains

tdrinking

drinkingl

eadingto

intoxicati

on

feelafter

drinking

SADQoveralltotal

nameofc

aregivers

age2

sex_A

relationt

opatient

religion_

A

educatio

n_A

residenc

e_A

familyincome

nooffami

lymembe

rs

maritalst

atus_A

occupati

on_A

GHQ1

GHQ2

GHQ3

GHQ4

GHQ5

GHQ6

GHQ7

GHQ8

GHQ9

GHQ10

GHQ11

GHQ12

GHQTOT

AL

FINANCI

AL1

ACGB01 2.0 2.0 3 .0 1.0 1.0 .0 1.0 1.0 .0 1.0 .0 3.0 2,3 1.0 1.0 1.0 19.0 handraka 32.0 2.0 1 1.0 5.0 1.0 7000.0 5.0 1.0 9.0 1.0 2.0 1.0 2.0 2.0 2.0 2.0 1.0 3.0 1.0 1.0 1.0 19.0 1.0

ACGB02 1.0 2.0 3,4 .0 .0 .0 1.0 .0 1.0 .0 1.0 .0 3.0 3 1.0 3.0 3.0 16.0 MALA 35.0 2.0 1 1.0 5.0 1.0 20000.0 6.0 1.0 9.0 1.0 .0 2.0 1.0 2.0 2.0 1.0 1.0 2.0 2.0 1.0 2.0 17.0 .0

ACGB03 2.0 2.0 3 .0 1.0 .0 1.0 .0 .0 .0 .0 .0 2.0 2 1.0 2.0 1.0 14.0 SAROJA 48.0 2.0 2 1.0 3.0 1.0 10000.0 5.0 6.0 6.0 1.0 2.0 1.0 1.0 2.0 1.0 1.0 2.0 2.0 1.0 2.0 1.0 17.0 .0

ACGB04 1.0 1.0 3 .0 .0 1.0 1.0 .0 .0 .0 .0 .0 2.0 3 1.0 1.0 1.0 16.0 MALATHI 39.0 2.0 1 1.0 3.0 1.0 20000.0 4.0 1.0 6.0 1.0 2.0 1.0 1.0 3.0 1.0 3.0 2.0 2.0 1.0 1.0 1.0 19.0 .0

ACGB05 1.0 2.0 3 1.0 1.0 .0 .0 .0 .0 1.0 1.0 .0 2.0 2 1.0 2.0 3.0 11.0 MANJULA 40.0 2.0 1 1.0 3.0 1.0 15000.0 4.0 1.0 9.0 2.0 2.0 1.0 2.0 2.0 1.0 1.0 1.0 1.0 1.0 2.0 2.0 18.0 .0

ACGB06 1.0 2.0 3 .0 1.0 .0 .0 .0 .0 1.0 1.0 .0 2.0 3 1.0 2.0 2.0 15.0 VALLI 45.0 2.0 1 1.0 3.0 1.0 20000.0 5.0 1.0 6.0 1.0 2.0 1.0 1.0 2.0 1.0 1.0 1.0 3.0 2.0 3.0 2.0 20.0 .0

ACGB07 2.0 2.0 3 .0 1.0 .0 .0 1.0 1.0 1.0 1.0 .0 2.0 1,3 1.0 1.0 4.0 12.0 VIJAYA 46.0 2.0 1 1.0 3.0 1.0 25000.0 6.0 1.0 9.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 .0 .0 .0 .0 .0 6.0 .0

ACGB08 1.0 2.0 4 1.0 1.0 1.0 1.0 .0 1.0 1.0 .0 .0 3.0 1 1.0 2.0 3.0 20.0 SUDHA 34.0 2.0 1 1.0 3.0 1.0 20000.0 5.0 1.0 9.0 1.0 2.0 2.0 2.0 2.0 1.0 1.0 2.0 2.0 1.0 1.0 2.0 19.0 1.0

ACGB09 2.0 1.0 3 .0 1.0 1.0 1.0 .0 1.0 1.0 0 .0 2.0 3 1.0 2.0 3.0 11.0 SASI 60.0 2.0 1 1.0 3.0 1.0 20000.0 5.0 1.0 9.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 12.0 2.0

ACGB10 1.0 2.0 4 .0 1.0 .0 1.0 .0 .0 .0 .0 .0 1.0 1,3 1.0 1.0 3.0 21.0 SUMATHI 49.0 2.0 1 1.0 5.0 2.0 10000.0 4.0 1.0 9.0 2.0 3.0 1.0 2.0 2.0 2.0 2.0 1.0 2.0 1.0 1.0 1.0 20.0 .0

ACGB11 2.0 2.0 3 .0 1.0 .0 .0 .0 1.0 1.0 1.0 1.0 1.0 1 1.0 2.0 3.0 14.0 LALITHA 30.0 2.0 1 1.0 5.0 2.0 50000.0 4.0 1.0 9.0 2.0 1.0 2.0 1.0 1.0 1.0 1.0 2.0 1.0 2.0 1.0 2.0 17.0 1.0

ACGB12 3.0 2.0 3 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1,3 2.0 2.0 4.0 12.0 RATHNA 57.0 2.0 1 4.0 4.0 1.0 8000.0 6.0 1.0 9.0 1.0 1.0 .0 .0 .0 .0 .0 .0 2.0 2.0 1.0 2.0 9.0 1.0

ACGB13 1.0 1.0 3 .0 1.0 .0 .0 .0 .0 1.0 .0 1.0 1.0 1 1.0 1.0 1.0 5.0 AGALAKSH 38.0 2.0 1 1.0 4.0 1.0 40000.0 4.0 1.0 9.0 .0 .0 .0 .0 .0 .0 1.0 1.0 .0 .0 .0 1.0 3.0 .0

ACGB14 2.0 2.0 3 .0 1.0 .0 .0 1.0 .0 1.0 .0 .0 1.0 1,3 1.0 1.0 3.0 20.0 KALYANI 47.0 2.0 1 1.0 4.0 2.0 40000.0 3.0 1.0 9.0 1.0 3.0 1.0 1.0 3.0 1.0 1.0 1.0 3.0 1.0 1.0 1.0 18.0 .0

ACGB15 1.0 2.0 3 .0 1.0 .0 1.0 1.0 .0 1.0 .0 .0 1.0 1 1.0 1.0 1.0 16.0 ABIRAMI 40.0 2.0 1 1.0 4.0 2.0 30000.0 3.0 1.0 9.0 2.0 2.0 1.0 1.0 2.0 2.0 2.0 2.0 2.0 1.0 2.0 2.0 21.0 .0

ACGB16 2.0 2.0 4 1.0 1.0 1.0 .0 1.0 .0 1.0 .0 1.0 1.0 1 1.0 1.0 4.0 13.0 SHANTHI 38.0 2.0 1 1.0 4.0 2.0 10000.0 3.0 1.0 3.0 .0 .0 .0 .0 .0 1.0 1.0 1.0 1.0 1.0 3.0 1.0 9.0 .0

ACGB17 3.0 2.0 3 .0 .0 1.0 .0 1.0 .0 1.0 1.0 .0 1.0 3 1.0 3.0 4.0 21.0 PARVATH 50.0 2.0 1 1.0 4.0 1.0 10000.0 4.0 1.0 6.0 1.0 3.0 2.0 2.0 3.0 2.0 2.0 1.0 2.0 2.0 1.0 1.0 22.0 .0

ACGB18 1.0 1.0 3 .0 1.0 1.0 1.0 1.0 .0 1.0 1.0 .0 1.0 1,3 2.0 1.0 1.0 15.0 ROOPA 27.0 2.0 1 4.0 4.0 2.0 70000.0 4.0 1.0 2.0 2.0 2.0 1.0 1.0 2.0 3.0 1.0 1.0 2.0 1.0 1.0 1.0 18.0 1.0

ACGB19 2.0 2.0 1 .0 .0 1.0 1.0 1.0 .0 1.0 1.0 1.0 1.0 1 1.0 2.0 1.0 17.0 SAVITHRI 54.0 2.0 1 1.0 3.0 1.0 40000.0 4.0 1.0 9.0 2.0 2.0 1.0 2.0 2.0 1.0 2.0 1.0 2.0 1.0 1.0 1.0 18.0 .0

ACGB20 3.0 2.0 3 .0 .0 1.0 .0 .0 1.0 .0 .0 .0 1.0 1 1.0 2.0 1.0 14.0 RANJITHA 46.0 2.0 1 1.0 4.0 1.0 50000.0 3.0 1.0 9.0 1.0 .0 1.0 .0 1.0 .0 1.0 .0 2.0 2.0 1.0 2.0 11.0 .0

ACGB21 1.0 2.0 3 .0 1.0 1.0 1.0 1.0 .0 1.0 1.0 .0 2.0 1 1.0 3.0 1.0 22.0 RANI 49.0 2.0 1 1.0 4.0 1.0 25000.0 4.0 1.0 9.0 2.0 3.0 1.0 1.0 2.0 3.0 1.0 2.0 3.0 1.0 1.0 1.0 21.0 1.0

ACGB22 1.0 2.0 3 .0 1.0 1.0 .0 .0 1.0 1.0 1.0 .0 1.0 1,3 1.0 1.0 3.0 19.0 RAJA 26.0 1.0 5 1.0 6.0 1.0 15000.0 3.0 2.0 5.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 3.0 1.0 14.0 .0

ACGB23 2.0 2.0 3 1.0 .0 .0 .0 .0 1.0 1.0 .0 1.0 1.0 1 1.0 1.0 1.0 17.0 JANAKI 50.0 2.0 1 1.0 3.0 1.0 30000.0 4.0 1.0 6.0 1.0 2.0 1.0 2.0 2.0 1.0 2.0 1.0 2.0 2.0 1.0 2.0 19.0 2.0

ACGB24 2.0 2.0 3 .0 .0 .0 1.0 1.0 1.0 1.0 .0 .0 1.0 1 1.0 1.0 3.0 19.0 PARIMALA 33.0 2.0 3 1.0 5.0 1.0 7000.0 6.0 1.0 9.0 2.0 2.0 1.0 1.0 2.0 1.0 1.0 1.0 2.0 1.0 2.0 2.0 18.0 .0

ACGB25 2.0 2.0 3 .0 1.0 .0 .0 1.0 1.0 1.0 1.0 .0 1.0 1 1.0 2.0 4.0 32.0 PAZHANI 40.0 1.0 5 1.0 5.0 1.0 10000.0 5.0 1.0 5.0 1.0 2.0 1.0 1.0 3.0 2.0 2.0 2.0 3.0 2.0 2.0 3.0 24.0 1.0

ACGB26 4.0 2.0 3 .0 1.0 .0 .0 1.0 .0 1.0 .0 1.0 1.0 1,3 1.0 3.0 1.0 13.0 PONNI 34.0 1.0 3 1.0 5.0 1.0 12000.0 3.0 1.0 9.0 1.0 3.0 .0 1.0 2.0 2.0 2.0 2.0 1.0 3.0 3.0 2.0 22.0 .0

ACGB27 3.0 2.0 3 .0 1.0 1.0 .0 1.0 1.0 1.0 .0 .0 1.0 1 1.0 3.0 1.0 8.0 MYTHILI 31.0 2.0 1 1.0 4.0 1.0 42000.0 3.0 1.0 9.0 .0 .0 .0 .0 .0 .0 .0 .0 .0 1.0 1.0 2.0 4.0 .0

ACGB28 2.0 2.0 3 1.0 1.0 .0 .0 1.0 1.0 1.0 1.0 .0 1.0 1,3 1.0 3.0 1.0 4.0 SARALA 35.0 2.0 1 1.0 5.0 1.0 30000.0 3.0 1.0 9.0 1.0 .0 .0 .0 .0 1.0 .0 .0 1.0 1.0 1.0 2.0 7.0 .0

ACGB29 1.0 2.0 3 .0 1.0 1.0 1.0 .0 1.0 1.0 1.0 .0 1.0 1,3 1.0 2.0 4.0 19.0 GIRIJA 45.0 2.0 1 1.0 4.0 1.0 10000.0 5.0 1.0 9.0 1.0 3.0 2.0 1.0 3.0 2.0 2.0 2.0 3.0 1.0 1.0 2.0 23.0 .0

ACGB30 1.0 2.0 3 1.0 1.0 .0 1.0 .0 .0 .0 .0 .0 1.0 3 2.0 3.0 3.0 8.0 GOWRI 49.0 2.0 1 1.0 5.0 2.0 20000.0 4.0 1.0 9.0 2.0 1.0 .0 1.0 .0 .0 .0 1.0 1.0 .0 1.0 .0 7.0 .0

ACGB31 2.0 2.0 4 .0 .0 .0 .0 1.0 1.0 1.0 1.0 1.0 1.0 2 2.0 1.0 1.0 32.0 LATHA 26.0 2.0 3 1.0 4.0 2.0 30000.0 3.0 1.0 5.0 3.0 3.0 3.0 3.0 3.0 3.0 3.0 2.0 3.0 3.0 2.0 1.0 32.0 1.0

ACBG32 2.0 2.0 5 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2 2.0 1.0 4.0 36.0 PADMA 46.0 2.0 1 1.0 5.0 1.0 10000.0 4.0 1.0 9.0 2.0 2.0 2.0 1.0 3.0 3.0 3.0 3.0 3.0 1.0 1.0 2.0 26.0 1.0

ACBG33 2.0 2.0 3 1.0 1.0 .0 .0 .0 .0 1.0 1.0 .0 1.0 2 2.0 3.0 1.0 14.0 DHANAM 30.0 2.0 1 1.0 4.0 1.0 30000.0 5.0 1.0 9.0 1.0 1.0 1.0 1.0 1.0 2.0 3.0 1.0 1.0 2.0 1.0 2.0 17.0 1.0

ACBG34 2.0 1.0 4 .0 .0 .0 .0 .0 .0 .0 .0 .0 1.0 3 1.0 2.0 3.0 16.0 VAIDEKI 40.0 2.0 1 1.0 5.0 1.0 50000.0 4.0 1.0 5.0 2.0 2.0 2.0 1.0 2.0 2.0 3.0 2.0 1.0 1.0 1.0 2.0 21.0 1.0

ACBG35 2.0 1.0 5 .0 1.0 .0 1.0 .0 .0 1.0 1.0 1.0 1.0 1 1.0 2.0 1.0 32.0 ANALAKS 42.0 2.0 1 1.0 5.0 1.0 75000.0 4.0 1.0 9.0 2.0 3.0 2.0 3.0 3.0 2.0 3.0 3.0 3.0 2.0 1.0 2.0 29.0 1.0

ACBG36 1.0 1.0 5 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2 1.0 1.0 1.0 11.0 NISHA 30.0 2.0 1 1.0 4.0 1.0 45000.0 6.0 1.0 9.0 2.0 2.0 2.0 1.0 2.0 1.0 1.0 2.0 1.0 2.0 2.0 2.0 20.0 1.0

ACBG37 2.0 1.0 3 1.0 1.0 .0 .0 .0 1.0 .0 .0 .0 1.0 3 1.0 1.0 2.0 20.0 SWARNAM 21.0 2.0 1 1.0 5.0 2.0 50000.0 2.0 1.0 5.0 1.0 1.0 1.0 1.0 2.0 2.0 2.0 2.0 2.0 2.0 1.0 2.0 19.0 1.0

ACBG38 2.0 1.0 5 .0 .0 .0 .0 .0 .0 .0 .0 1.0 1.0 9 2.0 2.0 1.0 18.0 CHITRA 35.0 2.0 3 1.0 5.0 1.0 15000.0 6.0 6.0 5.0 1.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 3.0 2.0 1.0 1.0 22.0 1.0

ACBG39 2.0 2.0 3 .0 1.0 .0 .0 .0 .0 .0 1.0 .0 1.0 3 2.0 3.0 2.0 21.0 LAKSHMI 34.0 2.0 1 1.0 4.0 1.0 20000.0 3.0 1.0 5.0 2.0 2.0 2.0 1.0 2.0 2.0 3.0 2.0 1.0 1.0 1.0 2.0 21.0 1.0

ACBG40 2.0 2.0 3 .0 1.0 .0 1.0 .0 .0 1.0 1.0 .0 1.0 2 1.0 3.0 2.0 23.0 VAIJENTH 51.0 2.0 1 1.0 4.0 2.0 40000.0 5.0 1.0 9.0 2.0 2.0 1.0 2.0 2.0 1.0 2.0 3.0 3.0 3.0 2.0 1.0 24.0 2.0

ACBG41 3.0 1.0 5 1.0 1.0 .0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1 2.0 2.0 1.0 24.0 PANDIYAN 68.0 1.0 4 1.0 3.0 1.0 8000.0 3.0 2.0 9.0 1.0 3.0 1.0 1.0 3.0 2.0 1.0 2.0 3.0 1.0 1.0 1.0 20.0 .0

ACBG42 2.0 2.0 3 .0 1.0 .0 .0 .0 1.0 .0 .0 .0 1.0 1,3 1.0 2.0 4.0 32.0 ANURADH 41.0 2.0 1 1.0 4.0 2.0 30000.0 4.0 1.0 5.0 2.0 3.0 2.0 3.0 3.0 2.0 2.0 3.0 3.0 3.0 2.0 1.0 29.0 1.0

ACBG43 1.0 2.0 3 1.0 1.0 1.0 .0 1.0 1.0 .0 .0 .0 1.0 3 2.0 3.0 4.0 16.0 ARAGATH 50.0 2.0 1 4.0 5.0 1.0 52000.0 4.0 1.0 9.0 2.0 3.0 2.0 1.0 3.0 2.0 3.0 2.0 3.0 1.0 1.0 2.0 25.0 1.0

ACBG44 2.0 2.0 4 .0 1.0 .0 .0 1.0 .0 .0 1.0 .0 1.0 2 1.0 2.0 3.0 11.0 ALAVATH 34.0 2.0 1 1.0 5.0 2.0 15000.0 3.0 1.0 9.0 1.0 2.0 1.0 1.0 2.0 1.0 1.0 3.0 3.0 1.0 3.0 1.0 19.0 .0

ACBG45 1.0 2.0 3 .0 1.0 1.0 .0 .0 1.0 1.0 1.0 .0 1.0 3 1.0 1.0 4.0 14.0 JAMUNA 29.0 2.0 3 1.0 4.0 1.0 20000.0 5.0 6.0 9.0 1.0 2.0 .0 1.0 2.0 1.0 2.0 3.0 1.0 3.0 3.0 1.0 20.0 .0

ACBG46 2.0 2.0 4 .0 .0 1.0 1.0 1.0 .0 .0 .0 .0 3.0 1,3 1.0 2.0 3.0 17.0 BALU 31.0 1.0 5 1.0 5.0 1.0 20000.0 6.0 6.0 5.0 2.0 2.0 1.0 2.0 2.0 1.0 2.0 2.0 3.0 1.0 1.0 1.0 20.0 .0

ACBG47 2.0 2.0 3 1.0 .0 .0 1.0 .0 1.0 .0 .0 .0 1.0 1 1.0 1.0 4.0 12.0 VIVEK 28.0 1.0 5 1.0 4.0 1.0 30000.0 2.0 5.0 5.0 1.0 2.0 1.0 2.0 3.0 2.0 3.0 2.0 2.0 1.0 3.0 2.0 24.0 1.0

ACBG48 2.0 2.0 3 .0 1.0 .0 1.0 .0 .0 1.0 .0 .0 3.0 1,3 1.0 3.0 3.0 18.0 ARCHANA 31.0 2.0 1 1.0 4.0 1.0 25000.0 4.0 1.0 5.0 2.0 2.0 1.0 1.0 3.0 2.0 2.0 2.0 3.0 1.0 1.0 1.0 21.0 .0

ACBG49 1.0 2.0 3 1.0 1.0 1.0 .0 .0 1.0 1.0 .0 .0 3.0 1,3 1.0 2.0 4.0 19.0 SEETHA 48.0 2.0 1 1.0 5.0 1.0 15000.0 3.0 1.0 9.0 1.0 3.0 1.0 2.0 3.0 1.0 1.0 2.0 3.0 1.0 1.0 2.0 21.0 .0

ACBG50 2.0 2.0 3 .0 1.0 .0 .0 .0 .0 .0 .0 .0 2.0 3 1.0 2.0 3.0 23.0 JAYASREE 43.0 2.0 1 1.0 4.0 1.0 10000.0 5.0 1.0 9.0 1.0 2.0 1.0 2.0 3.0 1.0 3.0 1.0 2.0 2.0 2.0 1.0 21.0 .0

ACBG51 1.0 2.0 4 1.0 1.0 1.0 .0 .0 .0 .0 .0 .0 1.0 1 1.0 2.0 1.0 12.0 SURESH 54.0 2.0 4 1.0 4.0 1.0 30000.0 4.0 1.0 5.0 .0 .0 .0 .0 1.0 1.0 1.0 1.0 2.0 2.0 2.0 2.0 12.0 1.0

ACBG52 2.0 2.0 4 .0 1.0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 3 1.0 2.0 3.0 32.0 ANNAMM 58.0 2.0 1 1.0 2.0 1.0 10000.0 6.0 1.0 9.0 2.0 3.0 3.0 3.0 2.0 2.0 3.0 3.0 3.0 3.0 2.0 2.0 31.0 1.0

ACBG53 1.0 2.0 3 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 3.0 1,3 1.0 3.0 4.0 36.0 PADMA 65.0 2.0 2 1.0 3.0 2.0 25000.0 3.0 6.0 6.0 2.0 3.0 3.0 3.0 3.0 3.0 2.0 3.0 3.0 2.0 3.0 1.0 31.0 1.0

ACBG54 1.0 1.0 3 .0 1.0 1.0 .0 .0 1.0 1.0 .0 .0 3.0 3 1.0 2.0 3.0 9.0 KOKILA 50.0 2.0 2 1.0 3.0 1.0 9000.0 4.0 1.0 9.0 1.0 .0 .0 1.0 1.0 .0 .0 .0 1.0 .0 .0 .0 4.0 .0

ACBG55 2.0 1.0 3 .0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 3.0 1 2.0 2.0 4.0 34.0 MARIYA 54.0 2.0 2 4.0 4.0 1.0 10000.0 2.0 6.0 6.0 2.0 3.0 2.0 2.0 3.0 3.0 2.0 3.0 3.0 3.0 2.0 2.0 30.0 1.0

ACBG56 2.0 1.0 3 1.0 1.0 1.0 .0 1.0 1.0 1.0 1.0 .0 3.0 1 1.0 1.0 1.0 17.0 RENUGA 47.0 2.0 1 1.0 3.0 1.0 25000.0 5.0 1.0 9.0 1.0 2.0 2.0 1.0 2.0 2.0 1.0 2.0 2.0 1.0 2.0 1.0 19.0 1.0

ACBG57 2.0 1.0 4 1.0 1.0 1.0 .0 .0 1.0 1.0 .0 .0 2.0 1 1.0 1.0 3.0 16.0 BHARATH 33.0 2.0 1 1.0 4.0 2.0 35000.0 4.0 1.0 9.0 2.0 2.0 1.0 2.0 2.0 1.0 3.0 3.0 3.0 1.0 1.0 1.0 22.0 .0

ACBG58 1.0 2.0 3 .0 1.0 .0 .0 .0 .0 1.0 1.0 1.0 1.0 0 2.0 1.0 3.0 11.0 KOMATHI 49.0 2.0 2 1.0 4.0 1.0 15000.0 4.0 1.0 9.0 1.0 3.0 1.0 .0 2.0 1.0 1.0 1.0 3.0 1.0 2.0 .0 16.0 .0

ACBG59 1.0 1.0 3 .0 1.0 1.0 .0 .0 .0 .0 .0 1.0 3.0 3 1.0 2.0 1.0 16.0 KALA 52.0 2.0 1 1.0 3.0 1.0 20000.0 6.0 1.0 9.0 1.0 2.0 1.0 1.0 3.0 2.0 2.0 2.0 2.0 1.0 1.0 1.0 19.0 1.0

ACBG60 2.0 2.0 3 .0 .0 .0 1.0 .0 .0 1.0 1.0 .0 3.0 3 1.0 2.0 3.0 12.0 MALIGA 44.0 2.0 1 1.0 4.0 1.0 16000.0 4.0 1.0 7.0 1.0 3.0 1.0 1.0 2.0 1.0 2.0 2.0 1.0 2.0 1.0 1.0 17.0 1.0

ACBG61 1.0 1.0 4 .0 1.0 .0 1.0 .0 .0 .0 1.0 .0 3.0 3 2.0 2.0 3.0 11.0 MERRY 25.0 2.0 1 4.0 6.0 1.0 25000.0 6.0 1.0 6.0 2.0 2.0 1.0 1.0 3.0 2.0 3.0 2.0 1.0 2.0 3.0 2.0 24.0 1.0

ACBG62 1.0 2.0 3 .0 .0 1.0 .0 .0 1.0 1.0 .0 .0 1.0 3 2.0 2.0 1.0 13.0 DULRAHE 51.0 1.0 7 2.0 5.0 2.0 40000.0 5.0 1.0 9.0 1.0 2.0 1.0 1.0 1.0 2.0 2.0 1.0 3.0 2.0 1.0 1.0 18.0 .0

ACBG63 2.0 1.0 3 .0 .0 1.0 1.0 .0 .0 1.0 .0 .0 2.0 3 1.0 1.0 3.0 15.0 AJESHWA 55.0 2.0 1 1.0 3.0 1.0 13000.0 5.0 1.0 7.0 1.0 2.0 1.0 2.0 2.0 2.0 1.0 1.0 2.0 2.0 2.0 1.0 19.0 .0

ACBG64 2.0 1.0 1 1.0 .0 .0 1.0 .0 1.0 1.0 .0 .0 1.0 3 1.0 2.0 3.0 17.0 AMUDHA 44.0 2.0 1 1.0 5.0 1.0 30000.0 4.0 1.0 9.0 2.0 2.0 1.0 2.0 3.0 2.0 1.0 2.0 2.0 1.0 1.0 1.0 20.0 .0

ACBG65 1.0 2.0 4 1.0 .0 .0 1.0 .0 1.0 .0 1.0 1.0 1.0 3 1.0 2.0 3.0 11.0 PRIYA 25.0 2.0 1 1.0 6.0 2.0 30000.0 4.0 1.0 5.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 .0 .0 8.0 19.0 1.0

ACBG66 2.0 1.0 3 .0 1.0 .0 1.0 .0 .0 1.0 1.0 .0 1.0 0 1.0 1.0 1.0 14.0 ANGAMM 46.0 2.0 1 1.0 3.0 1.0 20000.0 5.0 1.0 9.0 .0 1.0 .0 2.0 2.0 2.0 2.0 3.0 3.0 3.0 2.0 1.0 21.0 .0

ACBG67 1.0 1.0 3 .0 1.0 .0 1.0 .0 .0 1.0 1.0 1.0 1.0 2 1.0 1.0 3.0 13.0 RADHA 40.0 2.0 1 1.0 4.0 1.0 8000.0 4.0 1.0 9.0 2.0 1.0 1.0 3.0 3.0 2.0 2.0 1.0 3.0 3.0 3.0 2.0 26.0 1.0

ACBG68 1.0 1.0 3 1.0 1.0 1.0 1.0 1.0 .0 .0 .0 .0 1.0 1 2.0 1.0 3.0 12.0 MARY 37.0 2.0 1 4.0 5.0 2.0 50000.0 4.0 1.0 9.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 12.0 .0

ACBG69 1.0 2.0 3 .0 .0 .0 .0 1.0 1.0 1.0 .0 1.0 1.0 3 1.0 1.0 3.0 17.0 KAVERY 49.0 2.0 1 1.0 4.0 1.0 15000.0 4.0 1.0 9.0 1.0 2.0 2.0 2.0 3.0 2.0 2.0 1.0 2.0 1.0 1.0 1.0 19.0 1.0

ACBG70 1.0 2.0 3 1.0 1.0 .0 .0 .0 .0 1.0 .0 1.0 1.0 3 1.0 2.0 1.0 7.0 ANANDHI 30.0 2.0 1 1.0 6.0 2.0 25000.0 3.0 1.0 9.0 2.0 2.0 1.0 1.0 1.0 1.0 .0 .0 .0 .0 .0 .0 8.0 .0

126

ACBG71 1.0 2.0 3 .0 .0 .0 .0 .0 .0 1.0 1.0 1.0 1.0 3 1.0 1.0 3.0 18.0 SAROJINI 40.0 2.0 1 1.0 3.0 1.0 30000.0 5.0 1.0 9.0 2.0 2.0 1.0 1.0 2.0 2.0 2.0 1.0 2.0 2.0 1.0 2.0 20.0 1.0

ACBG72 1.0 1.0 3 .0 1.0 .0 .0 .0 .0 1.0 1.0 1.0 1.0 0 2.0 2.0 3.0 11.0 PREETHI 45.0 2.0 1 1.0 4.0 1.0 15000.0 4.0 1.0 7.0 1.0 2.0 1.0 2.0 1.0 .0 .0 1.0 1 2.0 3.0 2.0 16.0 1.0

ACBG73 2.0 2.0 3 .0 .0 .0 .0 .0 .0 1.0 1.0 .0 3.0 3 1.0 2.0 3.0 12.0 MALINI 40.0 2.0 1 1.0 4.0 1.0 16000.0 4.0 1.0 7.0 1.0 3.0 2.0 1.0 2.0 2.0 2.0 2.0 2.0 1.0 1.0 1.0 20.0 1.0

ACBG74 2.0 2.0 3 .0 .0 .0 .0 .0 1.0 1.0 1.0 1.0 2.0 1 1.0 1.0 4.0 19.0 USHA 49.0 2.0 1 1.0 4.0 1.0 20000.0 4.0 1.0 9.0 1.0 2.0 2.0 1.0 2.0 2.0 2.0 2.0 2.0 1.0 2.0 1.0 20.0 .0

ACBG75 2.0 2.0 3 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1 2.0 2.0 4.0 21.0 JANSI 27.0 2.0 3 4.0 6.0 1.0 20000.0 4.0 2.0 2.0 1.0 2.0 1.0 2.0 2.0 1.0 2.0 2.0 3.0 1.0 1.0 1.0 19.0 1.0

ACBG76 2.0 1.0 3 .0 1.0 .0 .0 .0 1.0 1.0 1.0 1.0 2.0 1 1.0 2.0 3.0 18.0 VASANTH 36.0 2.0 1 1.0 5.0 1.0 30000.0 4.0 1.0 9.0 2.0 2.0 1.0 1.0 2.0 1.0 2.0 1.0 2.0 2.0 1.0 2.0 19.0 .0

ACBG77 1.0 2.0 4 1.0 .0 .0 1.0 .0 1.0 .0 1.0 1.0 1.0 3 1.0 2.0 3.0 10.0 SUBHA 25.0 2.0 1 1.0 6.0 2.0 30000.0 4.0 1.0 5.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 12.0 .0

ACBG78 2.0 1.0 3 .0 1.0 .0 1.0 .0 .0 1.0 1.0 .0 1.0 0 1.0 1.0 1.0 14.0 DEVIKA 46.0 2.0 1 1.0 3.0 1.0 20000.0 5.0 1.0 9.0 1.0 2.0 1.0 2.0 2.0 1.0 2.0 3.0 3.0 3.0 2.0 1.0 23.0 .0

ACBG79 1.0 2.0 3 1.0 1.0 .0 .0 .0 .0 1.0 .0 1.0 1.0 3 1.0 1.0 1.0 3.0 NANDHIN 30.0 2.0 1 1.0 6.0 2.0 25000.0 3.0 1.0 9.0 .0 1.0 1.0 1.0 .0 .0 1.0 1.0 .0 .0 .0 1.0 6.0 .0

ACBG80 1.0 2.0 3 .0 .0 .0 .0 .0 .0 1.0 1.0 1.0 1.0 3 1.0 1.0 3.0 18.0 AKILA 40.0 2.0 1 1.0 4.0 1.0 30000.0 5.0 1.0 9.0 2.0 3.0 2.0 2.0 2.0 3.0 2.0 1.0 2.0 1.0 1.0 2.0 23.0 .0

ACBG81 1.0 1.0 3,4 .0 1.0 .0 .0 .0 1.0 1.0 1.0 .0 3.0 3 1.0 1.0 3.0 19.0 ONAMMA 60.0 2.0 6 1.0 3.0 1.0 15000.0 3.0 6.0 6.0 1.0 3.0 1.0 1.0 3.0 2.0 2.0 1.0 3.0 1.0 2.0 1.0 21.0 .0

ACBG82 2.0 1.0 3 .0 .0 1.0 1.0 .0 .0 1.0 .0 .0 2.0 3 1.0 1.0 3.0 15.0 ARASWAT 55.0 2.0 1 1.0 3.0 1.0 13000.0 5.0 1.0 7.0 1.0 2.0 1.0 1.0 2.0 2.0 1.0 1.0 1.0 2.0 2.0 .0 16.0 1.0

ACBG83 1.0 2.0 3 .0 .0 .0 .0 1.0 1.0 1.0 .0 1.0 1.0 3 1.0 1.0 3.0 17.0 AMILARA 49.0 2.0 1 1.0 4.0 1.0 15000.0 4.0 1.0 9.0 1.0 2.0 1.0 1.0 3.0 1.0 2.0 2.0 3.0 2.0 1.0 1.0 20.0 .0

ACBG84 1.0 1.0 3 .0 1.0 .0 .0 .0 .0 1.0 1.0 1.0 1.0 0 2.0 2.0 3.0 9.0 JANAKI 47.0 2.0 1 1.0 4.0 1.0 15000.0 4.0 1.0 7.0 2.0 1.0 1.0 1.0 .0 .0 .0 1.0 1 .0 .0 .0 5.0 1.0

ACBG85 1.0 1.0 4 .0 1.0 .0 1.0 .0 .0 .0 1.0 .0 3.0 3 2.0 2.0 3.0 11.0 SHEEBA 25.0 2.0 1 4.0 6.0 1.0 25000.0 6.0 1.0 6.0 2.0 3.0 1.0 2.0 3.0 1.0 2.0 2.0 1.0 2.0 3.0 2.0 24.0 1.0

ACBG86 2.0 2.0 3 .0 .0 .0 .0 .0 .0 1.0 1.0 .0 3.0 3 1.0 2.0 3.0 12.0 UMA 42.0 2.0 1 1.0 4.0 1.0 16000.0 4.0 1.0 7.0 2.0 3.0 2.0 1.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 24.0 1.0

ACBG87 1.0 2.0 3 .0 .0 .0 .0 .0 .0 1.0 1.0 1.0 1.0 3 2.0 1.0 3.0 18.0 REENI 40.0 2.0 1 4.0 5.0 1.0 30000.0 5.0 1.0 9.0 1.0 2.0 1.0 1.0 2.0 1.0 2.0 1.0 3.0 1.0 2.0 2.0 19.0 .0

ACBG88 2.0 1.0 1 1.0 .0 .0 1.0 .0 1.0 1.0 .0 .0 1.0 3 1.0 2.0 3.0 17.0 KUMUDH 44.0 2.0 1 1.0 5.0 1.0 30000.0 4.0 1.0 9.0 1.0 1.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 3.0 1.0 1.0 21.0 .0

ACBG89 2.0 2.0 3 .0 .0 .0 1.0 .0 .0 1.0 1.0 .0 3.0 3 1.0 2.0 3.0 12.0 SUGANTH 42.0 2.0 1 1.0 4.0 1.0 16000.0 4.0 1.0 7.0 1.0 2.0 1.0 1.0 3.0 1.0 2.0 1.0 2.0 2.0 .0 1.0 17.0 .0

ACBG90 1.0 2.0 4 1.0 .0 .0 1.0 .0 1.0 .0 1.0 1.0 1.0 3 1.0 1.0 3.0 7.0 RILOCHA 27.0 2.0 1 1.0 6.0 2.0 30000.0 4.0 1.0 5.0 1.0 3.0 1.0 1.0 .0 .0 .0 .0 .0 .0 2.0 1.0 9.0 .0

ACBG91 1.0 1.0 3 .0 1.0 .0 1.0 .0 .0 1.0 1.0 1.0 1.0 2 1.0 1.0 3.0 13.0 SUGANYA 41.0 2.0 1 1.0 4.0 1.0 8000.0 4.0 1.0 9.0 2.0 1.0 1.0 3.0 1.0 2.0 2.0 1.0 3.0 3.0 3.0 2.0 24.0 1.0

ACBG92 2.0 2.0 3 .0 1.0 .0 1.0 .0 .0 .0 .0 .0 2.0 2 1.0 2.0 1.0 14.0 MEENAKSH 50.0 2.0 2 1.0 3.0 1.0 10000.0 5.0 6.0 6.0 1.0 3.0 1.0 1.0 2.0 3.0 1.0 1.0 3.0 1.0 2.0 2.0 21.0 .0

ACBG93 1.0 2.0 3 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1 1.0 2.0 4.0 17.0 ANDAL 49.0 2.0 1 1.0 4.0 1.0 15000.0 4.0 1.0 9.0 1.0 3.0 1.0 1.0 3.0 2.0 1.0 2.0 2.0 1.0 1.0 1.0 19.0 1.0

ACBG94 2.0 2.0 4 .0 .0 1.0 1.0 1.0 .0 .0 .0 .0 3.0 2 1.0 2.0 4.0 19.0 KAMALA 51.0 2.0 1 1.0 4.0 1.0 20000.0 6.0 1.0 9.0 2.0 3.0 1.0 2.0 2.0 2.0 2.0 2.0 2.0 1.0 2.0 1.0 22.0 1.0

ACBG95 1.0 2.0 3 .0 1.0 1.0 .0 .0 1.0 1.0 1.0 .0 1.0 1 1.0 2.0 3.0 18.0 THALAKS 59.0 2.0 1 1.0 3.0 1.0 20000.0 5.0 1.0 9.0 1.0 2.0 1.0 1.0 2.0 3.0 1.0 1.0 3.0 1.0 1.0 1.0 18.0 .0

ACBG96 2.0 1.0 4 .0 .0 .0 .0 .0 .0 .0 .0 .0 1.0 3 1.0 2.0 3.0 11.0 REVATHI 37.0 2.0 1 1.0 5.0 1.0 50000.0 4.0 1.0 9.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2.0 1.0 1.0 2.0 14.0 1.0

ACBG97 2.0 2.0 4 .0 .0 1.0 1.0 1.0 .0 .0 .0 .0 3.0 2 1.0 1.0 4.0 17.0 AJALAKSH 50.0 2.0 1 1.0 5.0 1.0 20000.0 5.0 1.0 9.0 1.0 3.0 1.0 1.0 3.0 1.0 2.0 2.0 2.0 2.0 1.0 2.0 21.0 .0

ACBG98 1.0 1.0 3 1.0 1.0 1.0 .0 1.0 1.0 1.0 .0 .0 3.0 2 1.0 1.0 4.0 7.0 ULOCHAN 46.0 2.0 2 1.0 4.0 1.0 15000.0 4.0 1.0 9.0 1.0 2.0 2.0 .0 .0 .0 .0 1.0 1.0 1.0 1.0 1.0 10.0 1.0

ACBG99 1.0 1.0 3 .0 1.0 1.0 .0 .0 1.0 1.0 .0 .0 3.0 3 1.0 2.0 3.0 5.0 THAMARA 50.0 2.0 2 1.0 3.0 1.0 9000.0 4.0 1.0 9.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 11.0 1.0

ACBG100 2.0 2.0 3 .0 1.0 .0 1.0 .0 .0 .0 .0 .0 2.0 2 1.0 2.0 1.0 14.0 SAROJA 48.0 2.0 2 1.0 3.0 1.0 10000.0 5.0 6.0 6.0 2.0 2.0 3.0 2.0 2.0 1.0 2.0 1.0 1.0 1.0 .0 1.0 18.0 .0

127

UID

FINANCI

AL2

FINANCI

AL3

FINANCI

AL4

FINANCI

AL5

FINANCI

AL6

ROUTINE

ACT1

ROUTINE

ACT2

ROUTINE

ACT3

ROUTINE

ACT4

ROUTINE

ACT5

FAMILYL

EISUR1

FAMILYL

EISURE2

FAMILYL

EISURE3

FAMILY

LEISUR 4

FAMILY

INTERAC

FAMILY

INTERAC

T 2

FAMILY

INTERAC

T 3

FAMILY

INTERAC

T 4

FAMILY

INTERAC

T 5

PHYSICA

L

HEALTH

1

PHYSICA

LHEALTH

2

MENTAL

HEALTH1

MENTAL

HEALTH2

FBS total

score

subjectiv

e burden

FBSCAT

FBSDUAL

CAT

ghqcat

GHQDUA

LCAT

SADQ

CAT

Financial

Routine

family

leisure

family

interacti

on

physical

health

mental

health

Financial

avg

routinea

vg

leisure

avg

interacti

onavg

physicala

vg

mental

avg

ACGB01 1.0 2.0 .0 2.0 1.0 1.0 1.0 1.0 2.0 1.0 1.0 1.0 .0 1.0 1.0 .0 1.0 .0 2.0 1.0 .0 2.0 1.0 24.0 2 2 1 3 1 2.0 7.0 6.0 3.0 4.0 1.0 3.0 1.166667 1.2 0.75 0.8 0.5 1.5

ACGB02 .0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 2.0 2.0 23.0 1 1 1 3 1 2.0 3.0 5.0 5.0 5.0 1.0 4.0 0.5 1 1.25 1 0.5 2

ACGB03 .0 1.0 .0 1.0 2.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 .0 1.0 .0 .0 1.0 2.0 1.0 1.0 .0 18.0 1 1 1 3 1 1.0 4.0 5.0 3.0 2.0 3.0 1.0 0.666667 1 0.75 0.4 1.5 0.5

ACGB04 .0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 .0 .0 1.0 2.0 1.0 1.0 .0 18.0 1 1 1 3 1 2.0 3.0 5.0 4.0 2.0 3.0 1.0 0.5 1 1 0.4 1.5 0.5

ACGB05 .0 1.0 .0 1.0 1.0 1.0 .0 .0 1.0 .0 .0 1.0 1.0 1.0 .0 2.0 .0 .0 1.0 2.0 2.0 .0 1.0 16.0 1 1 1 3 1 1.0 3.0 2.0 3.0 3.0 4.0 1.0 0.5 0.4 0.75 0.6 2 0.5

ACGB06 .0 1.0 .0 1.0 1.0 2.0 1.0 .0 1.0 .0 1.0 1.0 1.0 1.0 .0 .0 .0 1.0 1.0 2.0 1.0 1.0 1.0 18.0 1 1 1 4 1 1.0 3.0 4.0 4.0 2.0 3.0 2.0 0.5 0.8 1 0.4 1.5 1

ACGB07 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 1.0 .0 1.0 .0 .0 1.0 1.0 .0 4 1.0 .0 2.0 1 2 1.0 0.0 0.0 0.0 2.0 1.0 1.0 0 0 0 0.4 0.5 0.5

ACGB08 .0 1.0 1.0 1.0 2.0 1.0 1.0 1.0 1.0 2.0 .0 1.0 1.0 1.0 .0 1.0 1.0 .0 1.0 .0 1.0 1.0 2.0 22.0 2 1 1 3 1 2.0 6.0 6.0 3.0 3.0 1.0 3.0 1 1.2 0.75 0.6 0.5 1.5

ACGB09 1.0 1.0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 1.0 1.0 .0 .0 .0 .0 1.0 7 1.0 .0 2.0 3 1 1.0 4.0 0.0 0.0 2.0 0.0 1.0 0.666667 0 0 0.4 0 0.5

ACGB10 .0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 2.0 1.0 1.0 1.0 1.0 1.0 2.0 .0 .0 2.0 2.0 2.0 .0 1.0 23.0 2 1 1 4 1 2.0 3.0 6.0 4.0 5.0 4.0 1.0 0.5 1.2 1 1 2 0.5

ACGB11 .0 1.0 .0 .0 1.0 1.0 1.0 .0 .0 .0 1.0 .0 .0 .0 .0 2.0 .0 1.0 .0 1.0 1.0 2.0 2.0 15 1.0 1.0 1.0 3 1 1.0 3.0 2.0 1.0 3.0 2.0 4.0 0.5 0.4 0.25 0.6 1 2

ACGB12 .0 1.0 .0 .0 .0 2.0 .0 1.0 .0 .0 .0 .0 1.0 .0 .0 .0 .0 1.0 1.0 .0 .0 .0 .0 8 1.0 1.0 1.0 1 2 1.0 2.0 3.0 1.0 2.0 0.0 0.0 0.333333 0.6 0.25 0.4 0 0

ACGB13 .0 1.0 .0 .0 .0 .0 1.0 .0 .0 .0 .0 1.0 1.0 .0 1.0 1.0 .0 .0 .0 .0 .0 .0 .0 6 1.0 .0 2.0 1 2 1.0 1.0 1.0 2.0 2.0 0.0 0.0 0.166667 0.2 0.5 0.4 0 0

ACGB14 .0 1.0 .0 1.0 1.0 .0 1.0 1.0 1.0 1.0 .0 1.0 1.0 .0 .0 1.0 .0 .0 1.0 2.0 1.0 1.0 1.0 16.0 1 1 1 3 1 2.0 3.0 4.0 2.0 2.0 3.0 2.0 0.5 0.8 0.5 0.4 1.5 1

ACGB15 .0 1.0 .0 1.0 1.0 2.0 1.0 1.0 1.0 2.0 1.0 1.0 1.0 1.0 .0 1.0 .0 .0 1.0 2.0 2.0 .0 1.0 21.0 1 1 1 4 1 2.0 3.0 7.0 4.0 2.0 4.0 1.0 0.5 1.4 1 0.4 2 0.5

ACGB16 1.0 1.0 .0 .0 .0 1.0 1.0 .0 .0 .0 .0 .0 1.0 .0 1.0 .0 1.0 .0 1.0 .0 1.0 .0 1.0 10 1.0 1.0 1.0 1 2 1.0 2.0 2.0 1.0 3.0 1.0 1.0 0.333333 0.4 0.25 0.6 0.5 0.5

ACGB17 .0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1.0 .0 2.0 .0 .0 2.0 1.0 2.0 1.0 .0 19.0 1 1 1 4 1 2.0 3.0 5.0 3.0 4.0 3.0 1.0 0.5 1 0.75 0.8 1.5 0.5

ACGB18 1.0 .0 .0 1.0 1.0 1.0 1.0 1.0 1.0 .0 .0 1.0 1.0 .0 1.0 1.0 1.0 1.0 1.0 .0 .0 1.0 2.0 18 1.0 1.0 1.0 3 1 1.0 4.0 4.0 2.0 5.0 0.0 3.0 0.666667 0.8 0.5 1 0 1.5

ACGB19 .0 2.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 .0 .0 1.0 2.0 2.0 1.0 1.0 21.0 1 1 1 3 1 2.0 4.0 5.0 4.0 2.0 4.0 2.0 0.666667 1 1 0.4 2 1

ACGB20 1.0 .0 .0 .0 .0 .0 1.0 .0 .0 1.0 .0 .0 .0 .0 .0 .0 .0 .0 .0 1.0 .0 1.0 .0 5 1.0 .0 2.0 2 1 1.0 1.0 2.0 0.0 0.0 1.0 1.0 0.166667 0.4 0 0 0.5 0.5

ACGB21 1.0 .0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 .0 .0 1.0 2.0 2.0 1.0 .0 20.0 1 1 1 4 1 2.0 4.0 5.0 4.0 2.0 4.0 1.0 0.666667 1 1 0.4 2 0.5

ACGB22 2.0 1.0 .0 1.0 .0 2.0 1.0 .0 1.0 .0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 20 2.0 1.0 1.0 3 1 2.0 4.0 4.0 3.0 5.0 2.0 2.0 0.666667 0.8 0.75 1 1 1

ACGB23 1.0 1.0 .0 1.0 .0 2.0 1.0 .0 1.0 .0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 .0 .0 .0 1.0 17 2.0 1.0 1.0 3 1 2.0 5.0 4.0 3.0 4.0 0.0 1.0 0.833333 0.8 0.75 0.8 0 0.5

ACGB24 .0 2.0 1.0 1.0 2.0 1.0 1.0 1.0 1.0 1.0 2.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1.0 .0 1.0 1.0 2.0 24.0 2 2 1 3 1 2.0 6.0 5.0 5.0 4.0 1.0 3.0 1 1 1.25 0.8 0.5 1.5

ACGB25 1.0 2.0 .0 2.0 2.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2.0 1.0 2.0 .0 .0 2.0 2.0 2.0 1.0 2.0 30.0 2 2 1 4 1 3.0 8.0 5.0 5.0 5.0 4.0 3.0 1.333333 1 1.25 1 2 1.5

ACGB26 .0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2.0 2.0 1.0 1.0 1.0 .0 .0 1.0 2.0 2.0 23.0 1 1 1 4 1 1.0 3.0 5.0 5.0 5.0 1.0 4.0 0.5 1 1.25 1 0.5 2

ACGB27 .0 .0 .0 1.0 .0 .0 .0 .0 1.0 .0 1.0 .0 .0 .0 .0 1.0 .0 1.0 .0 .0 .0 1.0 1.0 7 1.0 1.0 1.0 1 2 1.0 1.0 1.0 1.0 2.0 0.0 2.0 0.166667 0.2 0.25 0.4 0 1

ACGB28 .0 1.0 .0 .0 1.0 .0 1.0 .0 1.0 .0 .0 1.0 .0 1.0 .0 1.0 .0 .0 1.0 1.0 .0 1.0 .0 10 1.0 1.0 1.0 1 2 1.0 2.0 2.0 2.0 2.0 1.0 1.0 0.333333 0.4 0.5 0.4 0.5 0.5

ACGB29 1.0 1.0 .0 2.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 2.0 1.0 2.0 1.0 1.0 24.0 2 2 1 4 1 2.0 5.0 5.0 4.0 5.0 3.0 2.0 0.833333 1 1 1 1.5 1

ACGB30 .0 1.0 .0 .0 1.0 .0 1.0 .0 1.0 .0 .0 1.0 .0 1.0 .0 .0 .0 .0 .0 .0 .0 1.0 .0 7 1.0 1.0 1.0 1 2 1.0 2.0 2.0 2.0 0.0 0.0 1.0 0.333333 0.4 0.5 0 0 0.5

ACGB31 1.0 2.0 1.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 1.0 2.0 1.0 2.0 2.0 1.0 1.0 2.0 2.0 41.0 2 2 1 4 1 3.0 9.0 10.0 8.0 8.0 2.0 4.0 1.5 2 2 1.6 1 2

ACBG32 1.0 2.0 1.0 2.0 2.0 2.0 2.0 2.0 2.0 1.0 2.0 2.0 2.0 1.0 1.0 2.0 1.0 1.0 2.0 2.0 2.0 1.0 1.0 38.0 2 2 1 4 1 3.0 9.0 9.0 7.0 7.0 4.0 2.0 1.5 1.8 1.75 1.4 2 1

ACBG33 1.0 .0 1.0 .0 1.0 1.0 .0 .0 1.0 .0 1.0 1.0 .0 1.0 .0 .0 1.0 1.0 1.0 .0 1.0 1.0 1.0 15 1.0 1.0 1.0 3 1 1.0 4.0 2.0 3.0 3.0 1.0 2.0 0.666667 0.4 0.75 0.6 0.5 1

ACBG34 1.0 .0 .0 .0 1.0 1.0 1.0 .0 1.0 1.0 1.0 1.0 .0 1.0 .0 1.0 .0 1.0 2.0 1.0 .0 2.0 1.0 18 1.0 1.0 1.0 4 1 2.0 3.0 4.0 3.0 4.0 1.0 3.0 0.5 0.8 0.75 0.8 0.5 1.5

ACBG35 1.0 2.0 1.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 1.0 2.0 1.0 1.0 2.0 2.0 2.0 1.0 1.0 40.0 2 2 1 4 1 3.0 9.0 10.0 8.0 7.0 4.0 2.0 1.5 2 2 1.4 2 1

ACBG36 .0 2.0 .0 1.0 1.0 1.0 2.0 1.0 2.0 1.0 1.0 .0 1.0 2.0 .0 2.0 .0 1.0 2.0 1.0 .0 2.0 2.0 26.0 1 2 1 4 1 1.0 5.0 7.0 4.0 5.0 1.0 4.0 0.833333 1.4 1 1 0.5 2

ACBG37 .0 .0 .0 .0 1.0 .0 1.0 .0 .0 1.0 1.0 1.0 .0 1.0 .0 1.0 .0 1.0 1.0 1.0 .0 1.0 1.0 13 1.0 1.0 1.0 3 1 2.0 2.0 2.0 3.0 3.0 1.0 2.0 0.333333 0.4 0.75 0.6 0.5 1

ACBG38 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 1.0 .0 1.0 2.0 2.0 23.0 1 1 1 4 1 2.0 5.0 5.0 4.0 4.0 1.0 4.0 0.833333 1 1 0.8 0.5 2

ACBG39 1.0 .0 .0 1.0 1.0 1.0 .0 .0 1.0 1.0 1.0 1.0 .0 .0 .0 2.0 .0 1.0 .0 2.0 .0 2.0 2.0 18 2.0 1.0 1.0 4 1 2.0 4.0 3.0 2.0 3.0 2.0 4.0 0.666667 0.6 0.5 0.6 1 2

ACBG40 1.0 1.0 .0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 .0 .0 .0 2.0 2.0 2.0 1.0 1.0 1.0 1.0 1.0 23 2.0 1.0 1.0 4 1 2.0 6.0 4.0 2.0 7.0 2.0 2.0 1 0.8 0.5 1.4 1 1

ACBG41 .0 1.0 .0 1.0 2.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 2.0 .0 .0 1.0 2.0 2.0 1.0 1.0 22.0 1 1 1 4 1 2.0 4.0 5.0 4.0 3.0 4.0 2.0 0.666667 1 1 0.6 2 1

ACBG42 1.0 2.0 1.0 2.0 2.0 2.0 1.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 1.0 2.0 1.0 1.0 2.0 2.0 2.0 1.0 1.0 39.0 2 2 1 4 1 3.0 9.0 9.0 8.0 7.0 4.0 2.0 1.5 1.8 2 1.4 2 1

ACBG43 .0 2.0 .0 1.0 1.0 1.0 1.0 1.0 2.0 1.0 1.0 2.0 .0 1.0 .0 1.0 .0 1.0 1.0 2.0 1.0 1.0 .0 22.0 2 1 1 4 1 2.0 5.0 6.0 4.0 3.0 3.0 1.0 0.833333 1.2 1 0.6 1.5 0.5

ACBG44 1.0 1.0 .0 1.0 2.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 .0 1.0 .0 2.0 1.0 .0 1.0 .0 1.0 2.0 2.0 21.0 1 1 1 3 1 1.0 5.0 4.0 3.0 4.0 1.0 4.0 0.833333 0.8 0.75 0.8 0.5 2

ACBG45 .0 1.0 .0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 .0 .0 1.0 .0 1.0 .0 1.0 .0 1.0 2.0 2.0 17.0 1 1 1 4 1 1.0 3.0 4.0 2.0 3.0 1.0 4.0 0.5 0.8 0.5 0.6 0.5 2

ACBG46 .0 2.0 .0 1.0 2.0 1.0 1.0 1.0 1.0 1.0 1.0 2.0 1.0 1.0 .0 1.0 1.0 1.0 1.0 .0 1.0 2.0 2.0 24.0 1 2 1 4 1 2.0 5.0 5.0 5.0 4.0 1.0 4.0 0.833333 1 1.25 0.8 0.5 2

ACBG47 1.0 2.0 .0 2.0 1.0 1.0 1.0 .0 1.0 2.0 1.0 2.0 .0 1.0 1.0 .0 1.0 1.0 1.0 1.0 .0 2.0 1.0 24.0 1 2 1 4 1 1.0 7.0 5.0 4.0 4.0 1.0 3.0 1.166667 1 1 0.8 0.5 1.5

ACBG48 .0 2.0 .0 1.0 2.0 1.0 1.0 1.0 .0 2.0 1.0 1.0 1.0 1.0 .0 1.0 .0 .0 2.0 .0 1.0 2.0 1.0 21.0 1 1 1 4 1 2.0 5.0 5.0 4.0 3.0 1.0 3.0 0.833333 1 1 0.6 0.5 1.5

ACBG49 .0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1.0 .0 1.0 1.0 2.0 1.0 1.0 20.0 1 1 1 4 1 2.0 3.0 5.0 4.0 3.0 3.0 2.0 0.5 1 1 0.6 1.5 1

ACBG50 1.0 2.0 .0 2.0 1.0 1.0 1.0 1.0 1.0 2.0 1.0 1.0 1.0 1.0 1.0 2.0 .0 .0 2.0 2.0 1.0 1.0 1.0 26.0 2 2 1 4 1 2.0 6.0 6.0 4.0 5.0 3.0 2.0 1 1.2 1 1 1.5 1

ACBG51 .0 .0 .0 .0 .0 .0 1.0 .0 .0 1.0 .0 .0 .0 1.0 .0 .0 .0 1.0 1.0 1.0 .0 .0 .0 7 1.0 1.0 1.0 2 1 1.0 1.0 2.0 1.0 2.0 1.0 0.0 0.166667 0.4 0.25 0.4 0.5 0

ACBG52 1.0 2.0 1.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 1.0 2.0 1.0 2.0 2.0 2.0 2.0 1.0 2.0 42.0 2 2 1 4 1 3.0 9.0 10.0 8.0 8.0 4.0 3.0 1.5 2 2 1.6 2 1.5

ACBG53 2.0 2.0 1.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 1.0 2.0 1.0 1.0 2.0 2.0 2.0 2.0 1.0 42.0 2 2 1 4 1 3.0 10.0 10.0 8.0 7.0 4.0 3.0 1.666667 2 2 1.4 2 1.5

ACBG54 .0 1.0 .0 1.0 .0 .0 1.0 .0 .0 1.0 1.0 .0 .0 .0 .0 .0 .0 .0 1.0 .0 .0 1.0 .0 7 1.0 1.0 1.0 1 2 1.0 2.0 2.0 1.0 1.0 0.0 1.0 0.333333 0.4 0.25 0.2 0 0.5

ACBG55 1.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 2.0 1.0 1.0 44.0 2 2 1 4 1 3.0 10.0 10.0 8.0 10.0 4.0 2.0 1.666667 2 2 2 2 1

ACBG56 .0 1.0 .0 2.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 .0 .0 1.0 2.0 2.0 1.0 1.0 22.0 1 1 1 3 1 2.0 5.0 5.0 4.0 2.0 4.0 2.0 0.833333 1 1 0.4 2 1

ACBG57 1.0 1.0 .0 1.0 2.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 .0 .0 .0 .0 1.0 .0 1.0 .0 1.0 2.0 2.0 18.0 1 1 1 4 1 2.0 5.0 4.0 2.0 2.0 1.0 4.0 0.833333 0.8 0.5 0.4 0.5 2

ACBG58 1.0 2.0 .0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 .0 .0 1.0 1.0 2.0 .0 1.0 19.0 1 1 1 3 1 1.0 4.0 5.0 4.0 2.0 3.0 1.0 0.666667 1 1 0.4 1.5 0.5

ACBG59 1.0 2.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 2.0 .0 .0 2.0 2.0 2.0 1.0 1.0 25.0 2 2 1 3 1 2.0 6.0 5.0 4.0 4.0 4.0 2.0 1 1 1 0.8 2 1

ACBG60 .0 1.0 .0 1.0 .0 1.0 1.0 .0 1.0 1.0 1.0 1.0 .0 1.0 .0 1.0 .0 1.0 1.0 2.0 2.0 1.0 1.0 19.0 1 1 1 3 1 1.0 3.0 4.0 3.0 3.0 4.0 2.0 0.5 0.8 0.75 0.6 2 1

ACBG61 .0 2.0 .0 1.0 1.0 1.0 2.0 1.0 2.0 1.0 1.0 .0 1.0 2.0 .0 2.0 .0 1.0 2.0 1.0 .0 2.0 2.0 26.0 2 2 1 4 1 1.0 5.0 7.0 4.0 5.0 1.0 4.0 0.833333 1.4 1 1 0.5 2

ACBG62 .0 1.0 .0 .0 1.0 1.0 1.0 .0 1.0 1.0 1.0 .0 1.0 1.0 .0 .0 1.0 1.0 1.0 2.0 2.0 1.0 1.0 18.0 1 1 1 3 1 1.0 2.0 4.0 3.0 3.0 4.0 2.0 0.333333 0.8 0.75 0.6 2 1

ACBG63 .0 1.0 .0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 .0 1.0 .0 1.0 .0 .0 1.0 2.0 2.0 1.0 1.0 18.0 1 1 1 3 1 1.0 3.0 4.0 3.0 2.0 4.0 2.0 0.5 0.8 0.75 0.4 2 1

ACBG64 .0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 .0 1.0 1.0 2.0 2.0 1.0 1.0 21.0 2 1 1 4 1 2.0 3.0 5.0 4.0 3.0 4.0 2.0 0.5 1 1 0.6 2 1

ACBG65 .0 1.0 .0 2.0 .0 .0 1.0 1.0 .0 .0 .0 2.0 1.0 1.0 2.0 1.0 .0 2.0 .0 1.0 1.0 1.0 2.0 20 2.0 1.0 1.0 3 1 1.0 4.0 2.0 4.0 5.0 2.0 3.0 0.666667 0.4 1 1 1 1.5

ACBG66 1.0 1.0 .0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 .0 .0 .0 .0 1.0 .0 1.0 2.0 1.0 1.0 1.0 17.0 1 1 1 4 1 1.0 4.0 4.0 2.0 2.0 3.0 2.0 0.666667 0.8 0.5 0.4 1.5 1

ACBG67 1.0 .0 .0 1.0 1.0 .0 1.0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 1.0 1.0 19.0 1 1 1 4 1 1.0 4.0 3.0 4.0 4.0 2.0 2.0 0.666667 0.6 1 0.8 1 1

ACBG68 .0 .0 .0 1.0 1.0 .0 1.0 .0 .0 1.0 .0 1.0 .0 .0 .0 .0 1.0 1.0 .0 .0 .0 .0 .0 7 1.0 1.0 1.0 3 1 1.0 2.0 2.0 1.0 2.0 0.0 0.0 0.333333 0.4 0.25 0.4 0 0

ACBG69 .0 1.0 .0 1.0 2.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1.0 .0 1.0 1.0 2.0 1.0 1.0 22.0 1 1 1 3 1 2.0 5.0 5.0 4.0 3.0 3.0 2.0 0.833333 1 1 0.6 1.5 1

ACBG70 .0 1.0 .0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 .0 1.0 .0 1.0 1.0 1.0 .0 .0 .0 1.0 .0 14 1.0 1.0 1.0 1 2 1.0 3.0 4.0 3.0 3.0 0.0 1.0 0.5 0.8 0.75 0.6 0 0.5

128

ACBG71 1.0 2.0 .0 2.0 2.0 2.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2.0 2.0 1.0 28.0 2 2 1 4 1 2.0 8.0 6.0 3.0 5.0 3.0 3.0 1.333333 1.2 0.75 1 1.5 1.5

ACBG72 .0 1.0 .0 1.0 .0 1.0 1.0 .0 1.0 1.0 1.0 1.0 .0 1.0 .0 1.0 .0 1.0 1.0 1.0 .0 1.0 1.0 16 2.0 1.0 1.0 4 1 1.0 3.0 4.0 3.0 3.0 1.0 2.0 0.5 0.8 0.75 0.6 0.5 1

ACBG73 .0 1.0 .0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2.0 1.0 .0 1.0 .0 1.0 1 1.0 2.0 1.0 .0 20.0 1 1 1 4 1 1.0 3.0 5.0 5.0 3.0 3.0 1.0 0.5 1 1.25 0.6 1.5 0.5

ACBG74 .0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 2.0 .0 1.0 2.0 2.0 2.0 1.0 1.0 23.0 1 1 1 4 1 2.0 3.0 5.0 4.0 5.0 4.0 2.0 0.5 1 1 1 2 1

ACBG75 .0 2.0 .0 1.0 1.0 1.0 1.0 1.0 .0 1.0 .0 1.0 .0 1.0 .0 1.0 .0 .0 1.0 .0 1.0 2.0 2.0 18.0 1 1 1 3 1 2.0 5.0 4.0 2.0 2.0 1.0 4.0 0.833333 0.8 0.5 0.4 0.5 2

ACBG76 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 2.0 1.0 1.0 2.0 2.0 2.0 1.0 1.0 25.0 1 2 1 3 1 2.0 4.0 5.0 4.0 6.0 4.0 2.0 0.666667 1 1 1.2 2 1

ACBG77 .0 2.0 .0 1.0 .0 .0 .0 .0 1.0 1.0 .0 .0 .0 1.0 .0 1.0 .0 .0 1.0 .0 1.0 1.0 1.0 11 1.0 1.0 1.0 3 1 1.0 3.0 2.0 1.0 2.0 1.0 2.0 0.5 0.4 0.25 0.4 0.5 1

ACBG78 1.0 1.0 .0 2.0 1.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 1.0 .0 1.0 .0 2.0 .0 1.0 2.0 2.0 .0 1.0 21.0 1 1 1 4 1 1.0 5.0 4.0 3.0 4.0 4.0 1.0 0.833333 0.8 0.75 0.8 2 0.5

ACBG79 .0 1.0 .0 .0 1.0 1.0 .0 1.0 1.0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 .0 1.0 .0 6 1.0 .0 2.0 1 2 1.0 2.0 3.0 0.0 0.0 0.0 1.0 0.333333 0.6 0 0 0 0.5

ACBG80 .0 1.0 .0 2.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2.0 1.0 1.0 2.0 1.0 1.0 2.0 2.0 2.0 1.0 1.0 27.0 2 2 1 4 1 2.0 4.0 5.0 5.0 7.0 4.0 2.0 0.666667 1 1.25 1.4 2 1

ACBG81 1.0 2.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 .0 .0 2.0 2.0 1.0 1.0 1.0 22.0 1 1 1 4 1 2.0 5.0 5.0 4.0 3.0 3.0 2.0 0.833333 1 1 0.6 1.5 1

ACBG82 .0 1.0 .0 .0 1.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 .0 1.0 .0 1.0 .0 .0 1.0 2.0 2.0 1.0 1.0 18.0 1 1 1 3 1 1.0 3.0 4.0 3.0 2.0 4.0 2.0 0.5 0.8 0.75 0.4 2 1

ACBG83 1.0 2.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2.0 2.0 1.0 1.0 24.0 1 2 1 4 1 2.0 5.0 5.0 3.0 5.0 4.0 2.0 0.833333 1 0.75 1 2 1

ACBG84 .0 .0 .0 1.0 .0 .0 .0 .0 .0 1.0 1.0 .0 .0 .0 .0 1.0 .0 1.0 .0 .0 .0 1.0 .0 7 1.0 1.0 1.0 1 2 1.0 2.0 1.0 1.0 2.0 0.0 1.0 0.333333 0.2 0.25 0.4 0 0.5

ACBG85 1.0 2.0 .0 2.0 1.0 1.0 2.0 2.0 1.0 2.0 1.0 2.0 1.0 1.0 .0 2.0 .0 1.0 2.0 1.0 .0 2.0 2.0 30.0 2 2 1 4 1 1.0 7.0 8.0 5.0 5.0 1.0 4.0 1.166667 1.6 1.25 1 0.5 2

ACBG86 .0 1.0 .0 1.0 .0 1.0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 1 1.0 1.0 .0 1.0 18.0 1 1 1 4 1 1.0 3.0 4.0 4.0 4.0 2.0 1.0 0.5 0.8 1 0.8 1 0.5

ACBG87 1.0 2.0 .0 1.0 2.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 2.0 2.0 1.0 1.0 26.0 2 2 1 3 1 2.0 6.0 5.0 4.0 5.0 4.0 2.0 1 1 1 1 2 1

ACBG88 .0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 .0 .0 2.0 1.0 2.0 1.0 .0 19.0 1 1 1 4 1 2.0 3.0 5.0 4.0 3.0 3.0 1.0 0.5 1 1 0.6 1.5 0.5

ACBG89 .0 1.0 .0 1.0 1.0 1.0 1.0 .0 1.0 1.0 1.0 1.0 .0 1.0 .0 1.0 .0 .0 1.0 2.0 2.0 1.0 1.0 18.0 1 1 1 3 1 1.0 3.0 4.0 3.0 2.0 4.0 2.0 0.5 0.8 0.75 0.4 2 1

ACBG90 .0 1.0 .0 1.0 .0 .0 .0 1.0 .0 .0 .0 1.0 .0 .0 .0 .0 .0 1.0 .0 .0 1.0 .0 .0 6 1.0 .0 2.0 1 2 1.0 2.0 1.0 1.0 1.0 1.0 0.0 0.333333 0.2 0.25 0.2 0.5 0

ACBG91 1.0 1.0 .0 1.0 1.0 1.0 2.0 2.0 .0 1.0 2.0 1.0 2.0 1.0 1.0 1.0 .0 1.0 2.0 2.0 2.0 1.0 1.0 28.0 1 2 1 4 1 1.0 5.0 6.0 6.0 5.0 4.0 2.0 0.833333 1.2 1.5 1 2 1

ACBG92 .0 2.0 .0 .0 2.0 1.0 1.0 1.0 .0 .0 .0 1.0 1.0 1.0 1.0 2.0 1.0 .0 2.0 1.0 2.0 .0 .0 19.0 1 1 1 4 1 1.0 4.0 3.0 3.0 6.0 3.0 0.0 0.666667 0.6 0.75 1.2 1.5 0

ACBG93 .0 2.0 .0 2.0 2.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 2.0 .0 .0 1.0 2.0 2.0 .0 1.0 24.0 2 2 1 3 1 2.0 7.0 5.0 4.0 3.0 4.0 1.0 1.166667 1 1 0.6 2 0.5

ACBG94 .0 2.0 .0 1.0 2.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 2.0 .0 .0 1.0 2.0 2.0 1.0 1.0 24.0 1 2 1 4 1 2.0 6.0 5.0 4.0 3.0 4.0 2.0 1 1 1 0.6 2 1

ACBG95 .0 2.0 .0 .0 2.0 1.0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 .0 1.0 .0 .0 1.0 2.0 2.0 2.0 1.0 21.0 1 1 1 3 1 2.0 4.0 5.0 3.0 2.0 4.0 3.0 0.666667 1 0.75 0.4 2 1.5

ACBG96 .0 1.0 .0 1.0 .0 .0 1.0 .0 .0 .0 .0 .0 .0 1.0 .0 1.0 .0 1.0 1.0 1.0 .0 1.0 1.0 11 1.0 1.0 1.0 2 1 1.0 3.0 1.0 1.0 3.0 1.0 2.0 0.5 0.2 0.25 0.6 0.5 1

ACBG97 .0 1.0 .0 1.0 2.0 1.0 1.0 .0 1.0 1.0 1.0 1.0 1.0 1.0 .0 1.0 .0 1.0 1.0 1.0 2.0 1.0 1.0 20.0 1 1 1 4 1 2.0 4.0 4.0 4.0 3.0 3.0 2.0 0.666667 0.8 1 0.6 1.5 1

ACBG98 .0 1.0 .0 1.0 .0 1.0 1.0 .0 1.0 1.0 .0 .0 1.0 1.0 .0 1.0 1.0 1.0 1.0 .0 .0 1.0 .0 14 1.0 1.0 1.0 1 2 1.0 3.0 4.0 2.0 4.0 0.0 1.0 0.5 0.8 0.5 0.8 0 0.5

ACBG99 .0 1.0 .0 1.0 .0 .0 1.0 .0 1.0 .0 .0 .0 .0 1.0 .0 2.0 .0 .0 2.0 .0 .0 1.0 2.0 13 1.0 1.0 1.0 2 1 1.0 3.0 2.0 1.0 4.0 0.0 3.0 0.5 0.4 0.25 0.8 0 1.5

ACBG100 .0 2.0 1.0 2.0 1.0 1.0 1.0 1.0 2.0 2.0 2.0 1.0 .0 2.0 .0 1.0 .0 .0 1.0 1.0 1.0 1.0 1.0 24.0 2 2 1 3 1 2.0 6.0 7.0 5.0 2.0 2.0 2.0 1 1.4 1.25 0.4 1 1

CAREGIVER BURDEN IN TREATMENT SEEKING ...

Documents