European Journal of Cardiovascular Medicine

Alcoholism impacts nearly every body system and is linked to serious health issues, with about 20% of hospital admissions involving alcohol dependence. Men are over twice as likely to be affected as women, and alcohol-dependent smokers face higher health risks. Beyond health, alcoholism often leads to strained relationships, domestic violence, child neglect, employment issues, homelessness, and legal problems.

Initially, research focused on the clinical and behavioural effects on children of alcoholics, later shifting to foetal alcohol syndrome and the genetic transmission of alcoholism. Contributing factors to childhood psychopathology include genetic, medical, social, and psychological influences, such as poor parental involvement, inconsistent discipline, and low supervision.

Families of alcoholics require support alongside the alcoholic. Marriage and family counsellors, school counsellors, therapists, and state programs play key roles. Organizations like Al-Anon and Ala-teen, based on the Twelve Step Recovery Program, help family members understand they are not responsible for the alcoholic's behaviour and support their independent recovery.

This study aims to asses psychopathology in children of patients with alcohol dependence syndrome.

It is a cross-sectional study.

Objectives and Hypothesis:

The goal of the study is to learn more about the men who became alcohol dependant in order to better understand the underlying causes of the disease and to be able to help the offspring of these men. The earlier phase of the study uncovered that half of male alcoholics have alcohol-dependent fathers and grew up with perceived low levels of nurturing. Based on the findings of this research, Schuckit says the next step is to look at the onset and course of problems in the alcoholic male as well as behavioral and psychological problems in the children.

 Participants:

The study included family members of patients diagnosed with alcohol dependence syndrome at government Medical College and Hospital, Anantapur. Eligible participants were married individuals with alcohol dependence who had children and whose spouses were available and willing to participate in the interview, having given their informed consent. Children of Patients with other co-morbid mental disorders likely to interfere with proposed assessment and children with mental retardation were excluded from the study.

Assessments:

·         INTAKE proforma- written consent and socio demographic data

·         ICD 10: Classification of Mental and Behavioral disorders (WHO 2006) Clinical description and diagnostic guidelines

·         AUDIT Questionnaire Alcohol use disorder identity test

·         Childhood psychopathology measurement scheduled (CPMS)

This is an adaptation of CBCL (child behavior check list) standardized on Indian population. It was developed and standardized by Savita Malhotra (1988).

CPMS is a bilingual scale both in Hindi and English comprising 75 items rated as “YES” (Score –1) or “NO” (Score-0) responses. It can be used as an interview schedule. It is applicable from 4-14 years of age and taking a cut off score of 10 or more, CPMS can be used as a screening instrument in epidemiological studies. Total and specific factor scores can be used to quantify or categorize psychopathology. The eight factors of CPMS are low intelligence with behavioral problems, conduct, disorder, anxiety, depression, psychotic symptoms, special symptoms, physical illness with emotional problems and somatization. The correlation values for the test retest reliability with a two week interval were + 0.88 to 0.96 for various items which were highly significant. The informant should be a parent, preferably the mother or a caregiver.

Procedure:

Written consent was taken from the family members   of alcoholics. The data was collected using the semi structured interview schedule. A total of 54 families (fifty-four patients their spouses and children were interviewed for screening of alcohol abuse by using AUDIT questionnaire for the patients.  The mothers of children were interviewed to rate the CPMS (childhood psychopathology measurement schedule), scale for assessing psychopathology in children.

Statistical Analysis:  The data was collected and subjected to statistical analysis using descriptive statistics using mean, standard deviation and median. For discrete variable contingent table depicting number and percentages, bar diagrams were used.

TABLE-1: Age of patient distribution

        The 1 depicts age of Patients. The mean age of patient is 36.40 years with standard deviation of 5.9077.

TABLE-2: Socio economic status of patient according to kuppu swamy classification:

Table 2 depicts Socio Economic Status. 1.85% was from lower group, 22.22% were from upper lower group, 66.6% were from middle group, 7.40% were from upper middle group, 1.85% was from upper group.

TABLE-3: Age of children distribution:

TABLE-4 CPMS distribution of the child’s age

                Children in the age group of less than 10 years (n=18) had less psychopathology when compared to the age group of more than 10 years (n=36)

TABLE-5: AUDIT for the patient

The mean score for AUDIT in the study is 25.2777.

TABLE-6: History of alcohol use in children

The table 6 depicts that the 54(100%) of children have no history of alcohol use

TABLE -7: CPMS factor wise score:-

The factors anxiety (3) and depression (4) scored the highest values

This is a cross sectional conducted to study the psychopathology in children of alcohol dependent persons at Government Medical College and hospital, Anantapur during the period September 2023 to march 2024.  Patients who abuse alcohol, attending the out Patient and in patient clinic were screened by AUDIT, and those fulfilling the criteria for Alcohol dependence syndrome were taken for the study thorough description of the study was done to the patient and his spouse and written consent was taken. Similarly the mothers were interviewed to rate the children for psychopathology on CPMS (Childhood Psychopathology Measurement Schedule).  

The present study shows the mean age of the patients 36.40 years and mean age of the child 9.34 years. Most of patients were from rural back ground about 64.8% belonging to middle socio economic status according to Kuppu Swamy Classification. Family history of alcoholism reported was 81% in patients family members, medical co morbidities with which the patients presented were 78%. About 66% of the sample was constituted by low to middle socio economical status according to Kuppu swamy classification. It has been well documented that alcohol abuse and dependence was one of the most important determinants of the financial status of the family with an alcohol abuse person in the family due to the toll on health expenditures, productive work hours and social support as was reported in WHO Global state report on alcohol 2004.The fact that persons belonging to low socio economic status prefer to consult at Government health facilities in view of lower treatment cost. 

The result of no history of alcoholic abuse in older children of subjects of the present study, this does not correlate with the results of those in the study by Mathew.R.I et. al. (1991)(60) which found older children to abuse alcohol. Present study noticed depression, anxiety symptoms were significant in children of alcohol dependent persons which was seen by Russel (1984): in his community survey. This could be explained by the fact that it is hospital based sample where more severely affected section of population is admitted and hence the children have serious mental health impact as described by Cornelius, (1995)(59), and Greenfield (1998)(60).However the findings were not in line with those by Kelley and Fals Steward (2004), who had found the rate of psychiatric disorders to be as high as 25% in children of alcoholics.

The present study we did not find any case of conduct disorder in children of alcoholics. These results were similar to those studies by Sandrine Ebru (2006):  Probably the results could be lack of sensitivity of parents to identify the conduct disorders in their children. However the findings in the study cannot be generalized. Further the assessment of children without direct interview may give false positive or false negative results or the interviewer may tap only the tip of the ice-berg. In the present study personality characteristics of family members and also the family dynamics, which may contribute to the psychopathology, were not studied. Thus actual psychopathology might have been missed.    

The present study is a cross-sectional study conducted at Government Medical College and Hospital, Anantapur with aim to study the psychopathology in the children of alcohol dependence syndrome patients. The study group consists of children of patients with alcohol-dependence syndrome. The alcohol dependent syndrome patients were taken from fifty four families constituting fifty four spouses and fifty four first children into the study; they accompanied the patient at the time of admission or outpatient clinic. Children in the age group of 4-14 years with no major physical illness were included in the study. The Informants for the children were their mothers. Childhood psychopathology measurement schedule (CPMS) was administered to mothers of children. The data collected using the semi structured interview schedule and was subjected to statistical analysis.

1.       Mean age group of the patients in the study was 36.4 

2.       In the present study it was found that no family members neither the spouses nor their children had alcohol abuse.

3.       No significant difference was observed in psychopathology in various age

4.       Psychopathology was higher in the middle socio economic status group.

5.       The present study found significant psychopathology in depression and anxiety in children of alcohol dependent subjects.  

6.       Mean age group of children in the study was 9.34 years.

7.       Older children above 10 years had more psychopathology in symptoms of anxiety depression when compared to the younger ones.

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