|Ahead of print
|A cross-sectional study on domestic violence, marital satisfaction, and quality of life among partners of patients with alcohol use disorder
Divija Bunga1, Rajshekhar Bipeta2, Umashankar Molanguri3
1 Senior Resident, Department of Psychiatry, MGM Hospital, Warangal, Telangana, India
2 Professor and Deputy Superintendent, Department of Psychiatry, Institute of Mental Health, Osmania Medical College, Hyderabad, Telangana, India
3 Professor and Superintendent, Department of Psychiatry, Institute of Mental Health, Osmania Medical College, Hyderabad, Telangana, India
Click here for correspondence address and email
|Date of Submission||10-Jun-2021|
|Date of Acceptance||23-Jul-2021|
|Date of Web Publication||23-Nov-2021|
Introduction: Alcohol use disorders (AUDs) have adverse effects on physical and psychosocial health and results in marital problems with reduced quality of life in partners.
Aims and Objectives: The aims and objectives of the study are to investigate the relationship between domestic violence (DV), marital satisfaction, and well-being in partners of AUD patients.
Materials and Methods: This was a cross-sectional study on patients with AUD and their partners. We administered the Severity of Alcohol Dependence Questionnaire to the participants and DV questionnaire, marital satisfaction scale, coping questionnaire, and the World Health Organization (WHO-5) well-being index scales to the partners.
Statistical Analysis Used: Descriptive statistics were depicted using frequency tables, and linear regression analysis was performed.
Results: DV was reported by 36.98% of the partners, and the marital satisfaction rate was 62.58%. The WHO-5 well-being was 33.88%, engaged coping was 38.60%, tolerant coping was 23.60%, withdrawal coping being 6.18%, and total coping was 72.76%. The severity of alcohol dependence syndrome (ADS) negatively correlated with well-being (r = 0.24) and marital satisfaction (r = 0.17). Furthermore, DV showed a negative correlation with the marital satisfaction (r = 0.32; P = 0.02) and well-being (r = 0.50; P = 0.0001) with statistical significance.
Conclusions: The majority of the partners experienced DV, marital dissatisfaction, and poor well-being.
Keywords: Alcohol use disorder, coping, intimate partner violence, marital satisfaction, partners
|How to cite this URL:|
Bunga D, Bipeta R, Molanguri U. A cross-sectional study on domestic violence, marital satisfaction, and quality of life among partners of patients with alcohol use disorder. Arch Ment Health [Epub ahead of print] [cited 2022 Nov 29]. Available from: https://www.amhonline.org/preprintarticle.asp?id=330927
| Introduction|| |
Alcohol use disorders (AUDs) have a prevalence of 3.6% among adults. In India, alcohol use is higher among men, which is an ongoing stressor for the family. The AUDs account for 1.4% of the global disease burden. Intimate partner violence (IPV) is “as any behavior within an intimate relationship that causes physical, psychological, or sexual harm to those in that relationship.” It includes physical aggression, psychological abuse, forced sexual intercourse, or controlling behavior. 32% of incidents of IPV were committed when the perpetrator was under the influence of alcohol. Alcohol escalates the existing conflict., The higher frequency and quantity of male drinking increases the likelihood of male-to-female partner violence. Alcohol misuse by the male partner is associated with poor mental health and violence among married women., Low marital satisfaction and poor social support are the other significant issues among these spouses. In an Indian study, domestic violence (DV) was reported by 68.3%; at least one psychiatric morbidity was found in 85.0%. Ramadugu et al. found that DV significantly correlates with years of marriage. The husband's alcohol consumption and exposure to physical violence are significantly associated with poor mental health and well-being in wives. Marital satisfaction reflects the perceived benefits of subjective evaluation of positive affect in the marital relationship by partners. The greater the perceived benefits are, the more satisfied one is with the marriage and the partner. Few Indian studies, found high rates of psychological distress and low marital satisfaction among female partners of men with AUDs. Maladaptive coping skills among the partners adversely affect their social and functional roles, significantly impacting family harmony. They undergo tremendous stress and cope in response to the alcohol abusive episode. Discord, avoidance, indulgence, and withdrawal are the common coping behaviors among spouses. In contrast, marital breakdown, taking appropriate action, assertion, and sexual withdrawal were endorsed by them least frequently. Western studies found a positive correlation between the duration of alcohol dependence syndrome (ADS) and marital discord. There is a positive correlation between the duration of ADS in men and distress in spouses. There is a three times higher risk of mood disorders and two times higher risk of anxiety and depressive disorders among female spouses of male alcohol abusers. The prevalence of male-to-female DV is over 50% in AUDs. Impaired attention, concentration and executive functioning, cognitive inflexibility, intensification of negative emotions, inability to exert self-control, inability to constructively process the information lead to misinterpretation of the partner's actions and distorted conclusions. This increases the risk of IPV, exacerbates marital disharmony, neglects family responsibilities, further renders him incapable of providing financial support, assisting in child care, and accusing his spouse of infidelity.,,,,,
In the present study, all the variables mentioned above are investigated in a single research. We hypothesized that AUD causes marital dissatisfaction and a high rate of DV. We aimed to study the association between the severity of ADS, DV, and marital satisfaction rate. In partners of patients with ADS, the objectives were (i) to study the relationship between DV and marital satisfaction, (ii) to study the relationship between marital satisfaction and the severity of ADS, (iii) to study the relationship between DV and the severity of ADS, and (iv) to study the association of coping skills and quality of life with the severity of ADS.
| Materials and Methods|| |
This was a cross-sectional study from a tertiary care psychiatric hospital. By convenience sampling, we included treatment-seeking participants fulfilling the criteria for AUD (DSM-V), and their partners, who provided written informed consent, aged 18 years and above, and of either gender. We excluded those with other substance use disorders (including nicotine), psychiatric disorders, intellectual disability, major uncontrollable physical diseases, and organic brain syndromes. We started the study after obtaining permission to use the following tools and approval from the Institutional Ethics Committee. The Severity of the Alcohol Dependence Questionnaire (SAD-Q) is a 20-item instrument that assesses ADS severity. The DV questionnaire (DVQ) has 20-items that measure psychological and physical aspects of violence. The marital satisfaction scale is a 40-item scale with 12 major variables – communication, spouse support, mutual understanding, husband financial status, understanding, education of partner, sexual satisfaction, gender difference, dual-earning, compromise, self-perception, and in-law's relationship which examines how marital satisfaction affects a couple's well-being. The 5-item World Health Organization well-being index (WHO-5) assesses subjective psychological well-being. The coping questionnaire is a standardized set of 30 questions to evaluate stress, coping, and strain, in family members or relatives with alcohol, drug, and gambling problems to assess stress, coping, and strain in family members with alcohol, drug, and gambling problems. The SAD-Q was administered to the patients, while DVQ, marital satisfaction scale, coping questionnaire, and WHO-5 were administered to spouses.
We analyzed the data using SPSS software-version 24 (IBM Corp., IBM SPSS Statistics for Windows, Armonk, NY, USA). Descriptive statistics were depicted using frequency tables, and linear regression analysis was done.
| Results|| |
[Figure 1] illustrates the selection of participants. The final study sample was 50 patients with AUD and their partners (all these were spouses). The mean age of the partners was 34.7 years (standard deviation [SD] =9.8 years), and the majority (58%) were from urban domiciles with a mean marital life of 19.7 years (SD = 11.1 years). Seventy percent of participants were from lower socioeconomic status, and most (64%) were Hindus and unskilled workers (46%). Thirty-two percent of the participants consumed alcohol for 16–25 years (mean = 22.28 years; SD = 11.5 years). On SAD-Q, around 70% of participants had severe ADS, and 30% had a moderate severity [Table 1] and [Table 2]. [Table 2] depicts the mean values of DV, marital satisfaction scale, coping strategies, and the WHO-5. In the partners, the increased severity of DV (36.9%) was significantly associated with reduced marital satisfaction (marital satisfaction scale; r = −0.326, P = 0.021) and well-being (WHO-5; r = −0.506, P = 0.0001) in the partners. Furthermore, higher marital satisfaction was significantly associated with better well-being [r = 0.508; P = 0.0001, [Table 3]]. Higher DV score was significantly associated with increased tolerant coping (r = 0.376; P = 0.007), withdrawal coping (r = 0.361; P = 0.006), and the total coping score (r = 0.371 P = 0.008). The total coping was low when the marital satisfaction was high, which implies a significant negative association [r = −0.304; P = 0.032, [Table 4]].
|Table 1: Sociodemographic, clinical details, and illness severity scores of subjects with alcohol dependence syndrome (n=50)|
Click here to view
|Table 2: Distribution of the sociodemographic and clinical parameters and rating scale scores in subjects with substance use disorder and their partners (n=50)|
Click here to view
|Table 3: Correlation among alcohol dependence (illness severity in subjects), domestic violence, and marital satisfaction and well-being of partners (n=50)|
Click here to view
|Table 4: Correlation among coping in partners and illness severity (subjects), domestic violence, and marital satisfaction of partners (n=50)|
Click here to view
| Discussion|| |
The current study assessed the DV, marital satisfaction, and well-being among the partners of participants with AUD. The mean DVQ score was 36.98 (SD = 19.6), which is lower compared to another Indian study that showed more than two-thirds of the sample (68.3%) experiencing DV. The association of the severity of ADS as a risk factor for DV and the partner's well-being was positive and significant. The negative association between DV and marital satisfaction implies that participants with ADS may engage in DV directed to their spouse, which may lead to marital disharmony. The partners put efforts to minimize their impact on them and their children using various coping skills, such as denial, avoidance, sexual withdrawal, taking specific action against the partner, marital breakdown, attempt to eliminate the problem, disorganization, and efforts to escape from the issues. In the present study, coping was seen in the three primary forms: engaged coping, tolerant coping, and withdrawal coping. The coping (tolerant, withdrawal, and total) had a significant positive association with DV. In engaged coping, the partners got vigorously engaged through active interaction by using various assertive, controlling, emotional, and supporting behaviors, keeping a watch on every move of the ADS patient to change his drinking pattern. This engaged coping is very tiring and drains the person emotionally; however, this coping serves to maintain the self-esteem and meaning in the life as the partner and employing such actions feel as if they are doing something for the welfare of partner, family, and self. Tolerant coping is like self-sacrifice, like putting yourself out for him or giving money even if you know, it will be spent on alcohol. The withdrawal coping involves avoidance of the patient and active involvement in self-regulating activities. The culture also plays a significant role in the development of the above coping styles. More withdrawal coping is prevalent in Western countries, as women are more autonomous and have enough community resources to engage themselves away from the patient. There is more engaged and tolerant coping in traditional Indian society, where “females are considered a weak, dependent gender.”
Moreover, in Indian culture, where importance is given to relationships, family values and sound external support systems from parents, in-laws, relatives, and friends, marital separation due to alcohol consumption is considered more stigmatizing than a discordant relation. The consequences of marital separation for the children are so overestimated that females do all they can to change their partners' drinking problems for the sake of maintaining the marriage. In the initial few years, they begin with tolerant styles (instrumental support and acceptance). A hope to get things better leads to more engaged coping, which is desirable coping behavior. This could explain significantly less withdrawal coping (avoidance of the partner and active involvement in other self-regulating activities) and high tolerant coping in our study. Earlier studies, found avoidance, discord, and fearful withdrawal the most common coping behavior. Furthermore, not a single case reported or considered divorce procedures. Other behaviors, such as marital breakdown and taking individual action against the partner, were also not found; in contrast, another Indian study found discord, avoidance, indulgence, and fearful withdrawal as the most frequent coping behaviors. This shift from withdrawal coping to engaged coping can be due to transition in the social background from the dependent, submissive stereotype of female to an independent, autonomous female who is capable of doing for self and family, who is aware of the family values and the importance of love and affection of both the parents in raising the children. Our study builds on the existing literature that the partners of participants with AUD are at the receiving end of DV with resultant marital dissatisfaction. It highlights the need to assess the DV, marital dissatisfaction, and poor well-being in partners of patients with AUD that may help to formulate a psychosocial management plan.
Our study has certain limitations. This being a hospital-based study with all the participants being males and all the partners being wives, the findings cannot be generalized. We did not assess psychiatric morbidity in the partners.
| Conclusions|| |
The majority of the wives of males with ADS experienced DV, with significant marital dissatisfaction and poor well-being. Community-based, prospective controlled studies with a larger sample and an interventional design would further establish this link.
The authors thank Dr. Vijay Kumar (Former, Senior Resident of Psychiatry, Institute of Mental Health, Hyderabad) and Dr. Nikhil Ravindranath (Assistant Professor of Psychiatry, ESIC Medical College, Hyderabad, India) for guidance regarding statistical analysis.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Garcia-Moreno C, Jansen HA, Ellsberg M, Heise L, Watts CH; WHO Multi-country Study on Women's Health and Domestic Violence against Women Study Team. Prevalence of intimate partner violence: Findings from the WHO multi-country study on women's health and domestic violence. Lancet 2006;368:1260-9.
Steinglass P. The impact of alcoholism on the family. Relationship between degree of alcoholism and psychiatric symptomatology. J Stud Alcohol 1981;42:288-303.
WHO Expert Committee on Problems Related to Alcohol Consumption. WHO expert committee on problems related to alcohol consumption. Second report. World Health Organ Tech Rep Ser 2007;944:1-53, 55-7.
Zwi AB, Krug EG, Mercy JA, Dahlberg LL. World report on violence and health--exploring Australian responses. Aust N Z J Public Health 2002;26:405-8.
Mirrlees-Black C. Domestic Violence: Findings from a New British Crime Survey Self-Completion Questionnaire. London: Home office; 1999.
Quigley BM, Leonard KE. Alcohol and the continuation of early marital aggression. Alcohol Clin Exp Res 2000;24:1003-10.
White HR, Chen PH. Problem drinking and intimate partner violence. J Stud Alcohol 2002;63:205-14.
Kaufman KG, Straus, MA. The “drunken bum” theory of wife-beating. Soc Probl 1987;34:214-31.
Kumar S, Jeyaseelan L, Suresh S, Ahuja RC. Domestic violence and its mental health correlates in Indian women. Br J Psychiatry 2005;187:62-7.
Varma D, Chandra PS, Thomas T, Carey MP. Intimate partner violence and sexual coercion among pregnant women in India: Relationship with depression and post-traumatic stress disorder. J Affect Disord 2007;102:227-35.
Suman LN, Nagalakshmi SV. Family interaction patterns in alcoholic families. NIMHANS J 1995;13:47-52.
Bhowmick P, Tripathi BM, Jhingan HP, Pandey RM. Social support, coping resources and co-dependence in spouses of individuals with alcohol and drug dependence. Indian J Psychiatry 2001;43:219-24.
] [Full text]
Indu PV, Jinu CR, Pallikkal NR, Sampathkumar R, Joy J. Experience of domestic violence and psychological morbidity in spouses of alcohol-dependent males. Indian J Psychol Med 2018;40:322-7.
] [Full text]
Ramadugu S, Jayaram PV, Srivastava K, Chatterjee K, Madhusudan T. Understanding intimate partner violence and its correlates. Ind Psychiatry J 2015;24:172-8.
] [Full text]
Bradbury TN, Fincham FD, Beach SR. Research on the nature and determinants of marital satisfaction: A decade in review. J Marriage Fam 2000;62:964-80.
Ravindran OS, Joseph SA. Loss of coping resources and psychological distress in spouses of alcohol dependents following partner violence. Indian J Soc Psychiatry 2017;33:202-7. [Full text]
Kishor M, Pandit LV, Raguram R. Psychiatric morbidity and marital satisfaction among spouses of men with alcohol dependence. Indian J Psychiatry 2013;55:360-5.
] [Full text]
Johnson SL, Jacob T. Psychosocial functioning in children of alcoholic fathers. Psychol Addict Behav 1995;9:101-13.
James JE, Goldman M. Behavior trends of wives of alcoholics. Q J Stud Alcohol 1971;32:373-81.
Rao TS, Kuruvilla K. A study on the coping behaviours of wives of alcoholics. Indian J Psychiatry 1992;34:359-65.
] [Full text]
Epstein EE, McCrady BS, Hirsch LS. Marital functioning in early versus late-onset alcoholic couples. Alcohol Clin Exp Res 1997;21:547-56.
Dawson DA, Grant BF, Chou SP, Stinson FS. The impact of partner alcohol problems on women's physical and mental health. J Stud Alcohol Drugs 2007;68:66-75.
Stuart GL, O'Farrell TJ, Temple JR. Review of the association between treatment for substance misuse and reductions in intimate partner violence. Subst Use Misuse 2009;44:1298-317.
Smith CA, Elwyn LJ, Ireland TO, Thornberry TP. Impact of adolescent exposure to intimate partner violence on substance use in early adulthood. J Stud Alcohol Drugs 2010;71:219-30.
Giancola PR. Executive functioning and alcohol-related aggression. J Abnorm Psychol 2004;113:541-55.
Ito TA, Miller N, Pollock VE. Alcohol and aggression: A meta-analysis on the moderating effects of inhibitory cues, triggering events, and self-focused attention. Psychol Bull 1996;120:60-82.
Rubio G, Jiménez M, Rodríguez-Jiménez R, Martínez I, Iribarren MM, Jiménez-Arriero MA, et al.
Varieties of impulsivity in males with alcohol dependence: The role of Cluster-B personality disorder. Alcohol Clin Exp Res 2007;31:1826-32.
Saunders DG, Kindy P
Jr. Predictors of physicians' responses to woman abuse: The role of gender, background, and brief training. J Gen Intern Med 1993;8:606-9.
Shillington AM, Cottler LB, Compton WM, Spitznagel EL. Is there a relationship between “heavy drinking” and HIV high-risk sexual behaviours among general population participants? Int J Addict 1995;30:1453-78.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th
ed. Arlington, VA: American Psychiatric Association; 2013.
Stockwell T, Murphy D, Hodgson R. The severity of alcohol dependence questionnaire: Its use, reliability and validity. Br J Addict 1983;78:145-55.
Indu PV, Remadevi S, Vidhukumar K, Anilkumar TV, Subha N. Development and validation of the Domestic Violence Questionnaire in married women aged 18-55 years. Indian J Psychiatry 2011;53:218-23.
] [Full text]
Ayub N. Development of marital satisfaction scale. Pak J Clin Psychol 2010;9:19-34.
Topp CW, Ostergaard SD, Søndergaard S, Bech P. The WHO-5 well-being index: A systematic review of the literature. Psychother Psychosom 2015;84:167-76.
Orford J, Templeton L, Velleman R, Copello A. Family members of relatives with alcohol, drug and gambling problems: A set of standardized questionnaires for assessing stress, coping and strain. Addiction 2005;100:1611-24.
Orford J, Guthrie S, Nicholls P, Oppenheimer E, Egert S, Hensman C. Self-reported coping behavior of wives of alcoholics and its association with drinking outcome. J Stud Alcohol 1975;36:1254-67.
Orford J, Natera G, Velleman R, Copello A, Bowie N, Bradbury C, et al.
Ways of coping and the health of relatives facing drug and alcohol problems in Mexico and England. Addiction 2001;96:761-74.
Sharma N, Sharma S, Ghai S, Basu D, Kumari D, Singh D, et al.
Living with an alcoholic partner: Problems faced and coping strategies used by wives of alcoholic clients. Ind Psychiatry J 2016;25:65-71.
] [Full text]
Department of Psychiatry, Institute of Mental Health, Osmania Medical College, SR Nagar, Hyderabad - 500 038, Telangana
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]
| Article Access Statistics|
| Viewed||1277 |
| PDF Downloaded||34 |