Severity of domestic abuse and its relationship with distress tolerance and medication adherence in women with mental illness in South India

Abstract

Domestic abuse is prevalent in all strata of society and has been associated with various mental health problems. However, the severity of abuse in women with mental illness has not been studied much. The amount of distress experienced often depends on the severity of domestic abuse. Ability to tolerate distress may buffer the effect of abuse-this determines the perceived level of abuse. Both the severity of abuse and distress tolerance may in turn determine adherence behaviour towards treatment in mentally ill women. There is a paucity of research examining these variables. Hence this study was undertaken to examine the severity of abuse and distress tolerance and their relationship with medication adherence in women with mental illness. This study took place on an outpatient basis in the department of psychiatry at a tertiary care centre in South India. One hundred women with a mental illness currently in remission for at least two months -living in the community with family members after an episode of mental illness- were consecutively recruited by purposive sampling method after obtaining an informed consent. Due to issues related to reliability, patients with a diagnosis of mental retardation or dementia or psychotic symptoms were not included. All participants were initially assessed using socio-demographic and clinical forms. The severity of abuse was assessed with Composite Abuse Scale (CAS) and the level of distress tolerance was evaluated with Distress Tolerance Scale (DTS). Medication adherence status was assessed with the commonly used Morisky Medication Adherence Scale (MMAS). There was a high level of abuse (mean 20.33, SD=20.55) and distress tolerance (mean 26.80, SD=12.07) in this sample as compared to those in general population. Scores in domestic abuse had a significant positive association with Tolerance (p=0.001) and Absorption (p=0.014) subscales of distress tolerance. Scores in domestic abuse had no statistically significant association with level of medication adherence. With the findings of this study, it can be concluded that women with mental illness face considerable level of domestic abuse and they have a higher capacity to tolerate distress. Severity of domestic abuse is inversely associated with their perceived ability to tolerate emotional distress; and positively associated with the level of attention being absorbed by negative emotions. The study was constrained by its cross-sectional design and small sample size, and further replication of data is needed with bigger sample size and control group.