Disturbance of family functioning in depressive disorders of different genesis in the wife

Proper functioning of the family is one of the main conditions of marital adaptation indicators. The aspect of family life in depressive disorders of various genesis in women has great medical and psychological significance. Literature data and our own observations indicate that family functions can be disrupted as a result of psychological trauma, but the family, in turn, can become its source. This is explained by the fact that family relationships play a leading role in the system of personal relationships, as well as the openness of family members to any intra-family factors and their vulnerability, special sensitivity to psychological traumatic effects.

Most often, family psychological traumas are chronic in nature due to the duration of the family relationships themselves. A psychologically traumatic discrepancy between the individual's conscious or unconscious expectations of the family and the actual life of the family can ultimately lead to a state of global family dissatisfaction. Under the influence of family psychological trauma, such family health disorders as family anxiety associated with the individual's uncertainty in some very important aspect of family life can arise.

However, the functioning of the family in depressive disorders of various genesis in women has been very little studied. Only a few works can be named that touch on this topic.

The complex and rather urgent problem of the violation of social, psychological, socio-psychological and biological adaptation of spouses in this pathology and the closely related problem of family dysfunction await their study primarily because the effectiveness of psychotherapeutic correction of family health, an integral indicator of which is the correct performance of its functions, depends on the clarification of the diverse causes, mechanisms of development and polymorphic manifestations of dysfunction.

We observed 399 families in which, during a comprehensive examination, the wives were diagnosed with depressive disorder of various origins. Taking into account the nosological diversity of the patients included in the study, all the examined patients were divided into groups depending on the register of affective pathology, the level of generalization of depressive manifestations and the nosological affiliation of the patients. In the first group of married couples (MP), in which women suffered from affective disorders (172 MP), two subgroups were identified: the first - 129 families in which women suffered from bipolar affective disorder (F31.3); the second - 43 families with recurrent depressive disorder in women (F33.0, F33.1). In the second group of families in which women suffered from neurotic depressions (227 families), three subgroups were identified: 1st - 132 families in which women suffered from neurasthenia (F48.0); 2nd - 73 families with prolonged depressive reaction (F43.21) in women and 3rd - 22 families in which women had a mixed anxious and depressive reaction (F43.22). It was not possible to identify a control group among the families of the first group, since affective disorders in women were always accompanied by health problems in the family. However, among the families of the second group with neurotic depressions in wives, 60 (26.4%) families were identified in which the spouses considered their family healthy. In terms of age and social characteristics, this group did not differ from families with impaired health. This was the basis for considering them as a control group in relation to the main one.

The age of the female patients ranged from 19 to 48 years, with husbands and wives belonging to the same age group. Marital maladjustment in the observed couples was noted from the first weeks or 1-2 years after the beginning of their married life. The duration of marriage in 44% of married couples was from 1 to 5 years, in 35% - from 6 to 10 years, in the rest - from 11 to 15 years and more. More than half (59.2%) of the women were in their first marriage, 30.8% - in their second, 3.1% - in their third, and 10.0% - in a civil marriage. Women of the first group and women of the 3rd subgroup of the second group were most often in their first marriage and in a civil marriage, women of the 1st and 2nd subgroup of the second group were in their second and third marriages. Most married couples (67.8%) had one child, 21.2% had two children, and 5.2% of families were childless. In 5.8% of families, the wives had a child from their first marriage.

The comprehensive examination of women with depressive disorders of various origins and their husbands included clinical, clinical-psychopathological, psychodiagnostic, special sexological examination, and clinical-statistical analysis.

This report presents the results of a psychodiagnostic study using the method of V. V. Krishtal, I. A. Semenkina, which allows calculating the coefficient of family function performance (norm 0.8-1). Family functioning was studied according to the state of 14 family functions identified by I. S. Semenkina.

The following functions were studied: emotional - satisfying the needs of family members for sympathy, respect, recognition, love, emotional support, empathy; spiritual, or the function of cultural communication - satisfying the needs of spouses to spend leisure time together, in mutual spiritual enrichment and spiritual development; sexual-erotic - satisfying the sexual-erotic needs of spouses; reproductive - satisfying the need to have children; economic and everyday; educational - satisfying individual needs for fatherhood, motherhood, in contact with children; the function of socialization (primary, secondary, professional) - development of sociability in family members, assimilation and active reproduction by the individual of social experience realized in communication and activity; the function of social integration - concern for family members to find a place in the community; role function - satisfying the role needs of each family member in the family; protective - satisfying the need for security, psychological, physical and material protection; health maintenance function - ensuring the maintenance of somatic, mental and sexual health of family members and the necessary assistance in case of illness; personalization function - providing psychotherapeutic assistance to family members in difficult situations; rehabilitation function, or primary social control function - ensuring the possibility of family and promoting social rehabilitation, compliance with social norms in case of illness.

The state of family functions in case of bipolar affective disorder in the wife. In women with this disease, the emotional function of the family was highly significant for the spouses. The spiritual and sexual-erotic functions were impaired in all families. The reproductive function of the family suffered the least, being impaired only in isolated cases. The household function was in most cases in women in 2nd place, in men - in 7th place, and sometimes in the last 14th place in importance. The educational function was impaired in all families, men generally assigned it the last place. The functions of socialization and social integration were impaired in all families, except for 1/3 of families with preserved socialization function. The role function was poorly performed in almost all examined families. The protective function was more significant for women than for men. The health maintenance function was weak in more than half of the families. Men and especially women attached little importance to the personalization functions: most often 10th-11th and 10th-12th places, respectively. The same can be said about the psychotherapeutic function, which women mainly placed in 12th-14th places, and men in 10th-12th places. Finally, spouses attached the least importance to the rehabilitation function. It was violated in more than half of the families.

When analyzing the spouses' assessment of the performance of family functions, it turned out that more than 1/3 of the spouses assessed the performance of the emotional function as bad and very bad (-1 and -2, which corresponds to the coefficients of 0.4-0.8 calculated by us), and the spiritual function as bad. All women assessed the performance of the socio-erotic function as bad, all men - as very bad and bad. The performance of the reproductive function was assessed significantly better than the others by both wives and husbands - as satisfactory (+1, coefficient 0.8) in 94.8% of cases. About half of the women also assessed the performance of the health maintenance function as satisfactory, and the performance of the remaining functions as bad and very bad. Some women and several men could not characterize the role function.

The state of family functions in recurrent depressive disorder in the wife. In this disease, in contrast to the previous subgroup, the significance of the emotional function for women was less. The spiritual function was impaired in half of the patients and in 1/3 of their husbands, the sexual-erotic function - in all families, the reproductive function suffered minimally.

The educational function was impaired somewhat less frequently than in bipolar affective disorder. Men valued the socialization function somewhat more than women, the same applies to the social integration function. The role function, as well as the health maintenance function, were poorly performed in all families. The performance of the protective function suffered to the greatest extent. Women valued the personalization function less than men. The psychotherapeutic function was in 13th place for women, most often in 11th place for men, and the rehabilitation function was in 14th and 11-12th places, respectively.

As for the spouses’ assessment of the performance of family functions, all spouses defined the performance of emotional, spiritual and sexual-erotic functions as bad and very bad.

As in the previous subgroup of those surveyed, the performance of the reproductive function was assessed best - all spouses recognized it as satisfactory. The household function, according to the overwhelming majority of both women and men, was poorly performed, as were all other functions, with the exception of psychotherapeutic and rehabilitation, the performance of which was recognized as poor mainly by women. The performance of the social integration function was considered satisfactory only by a portion of men (25.7%).

An analysis of the significance of family functions showed that the most highly valued by all spouses were mainly the psychotherapeutic and rehabilitation functions, and the least valued were the emotional, spiritual and socio-erotic functions. Accordingly, the performance of the most significant family functions was most often assessed poorly and very poorly.

The state of family functions with neurasthenia in the wife. The emotional function of the family for the spouses with neurasthenia in the wife was the most significant for both spouses. The sexual-erotic function was impaired in all families. The reproductive function suffered to the least extent, was impaired only in isolated cases. The household function was preserved in more than half of the families. The educational function suffered to a much lesser extent, and the spiritual function was also impaired less often. The functions of socialization and social integration were impaired in all families. The role function was of great importance only for a few women, while most of them put it in one of the last places, and men - in 9th-11th places. The performance of the protective function suffered to the greatest extent. The spouses rated the function of maintaining health relatively low. The psychotherapeutic and rehabilitation functions were significant for women in most cases, and for men they occupied the last places in importance.

When analyzing the spouses' assessment of the performance of family functions, it was found that the spouses assessed the performance of the reproductive function as satisfactory. More than half of the men also assessed the performance of the psychotherapeutic and rehabilitation functions, while most women assessed their performance as poor. Half of the men and most women assessed the performance of the educational function quite highly. The performance of the protective function and the health maintenance function was often assessed as satisfactory, especially by men. The performance of the emotional function was assessed by most men as bad and very bad, and almost 1/3 of the men could not determine their attitude to it. The performance of the spiritual function was also assessed by most spouses as bad and very bad, although quite a few women considered it satisfactory. All men and women considered the performance of the sexual-erotic function to be bad and very bad. The majority of spouses also assessed the performance of the role function in the same way.

The state of family functions with prolonged depressive reaction in the wife. The emotional function of the family for the spouses with prolonged depressive reaction in the wife was highly significant for all the spouses. The spiritual function was less significant for women than for men. Primary sexual control was preserved in less than 1/3 of the families, and was impaired in all the other families. The sexual-erotic function, as expected, was impaired in all the families. The reproductive function was impaired only in isolated cases. The household function was more important for women than for men. The educational function was of approximately equal importance for women and some men and suffered to a much lesser extent than the spiritual function. The socialization function was impaired for most women, while men attached somewhat greater importance to it. The social integration function was of little significance both for all women and for the overwhelming majority of men. The role function was of great importance only for a few women, while most of them assigned it one of the last places. The performance of the protective function suffered to the greatest extent. The spouses rated the health maintenance function relatively low. The psychotherapeutic function occupied the last places in importance for women, and for men it was highly significant. Women and men more often put the rehabilitation function in the last places.

When analyzing the spouses' assessment of the performance of family functions, it was found that the reproductive function was assessed as satisfactory, while the emotional and spiritual functions were less often impaired. The educational function suffered to a much greater extent. The material function was preserved in more than half of the families. More than 1/3 of women and 1/4 of men assessed the performance of the household function as satisfactory, and more than half of women and 41.5% of men also assessed the performance of the socialization function. Women more often than men assessed the performance of the social integration, protective and psychotherapeutic functions as satisfactory. Most often, spouses, especially women, assessed the performance of the educational, personalistic, role functions and the health maintenance function as poor and very poor.

The state of family functions with a mixed anxious and depressive reaction in the wife. In most spouses, the emotional function was the first in importance, and the spiritual function was the second. The sexual-erotic function was impaired in all families. The reproductive function of the family suffered to the least extent. The household function was preserved in more than half of the families. The educational function was valued more by women than by men. On the contrary, women attached less importance to the functions of socialization and the function of social integration than men. Women did not attach much importance to the role function, while men assigned it a significant place. The protective function, as well as the function of maintaining health, were valued more by women. Women also rated the personalization function higher. Women more often put the psychotherapeutic function in 10th place, and men in 11th and 13th place; the rehabilitation function was somewhat higher valued by men - more often 11th, and by women - 14th place.

The data on the assessment of the performance of family functions showed that half of the women with a mixed anxious and depressive reaction assessed the performance of the emotional function as satisfactory, while most men assessed it as bad and very bad. Women also assessed the performance of the spiritual function as satisfactory quite often, while men in most cases assessed it as bad and very bad. All spouses assessed the sexual function as poorly performed, and almost all assessed the reproductive function as satisfactory. Women more often than men assessed the performance of the educational function, the functions of socialization and social integration, and maintaining health as bad and very bad. Men more often than their wives assessed the performance of the household, psychotherapeutic, and rehabilitation functions in the same way. Spouses assessed the performance of the role function and the personalization function as bad and very bad almost equally often, but a significant number of spouses, especially men, assessed the performance of the personalization function as satisfactory.

When analyzing the performance of family functions, attention is drawn to the frequency of cases when women could not determine the performance of family functions, especially role, emotional, personalization functions, and even household and domestic ones. This circumstance obviously reflects the indecisiveness, anxiety, and lack of independence characteristic of people with a mixed anxious and depressive reaction.

We studied the impact of family dysfunction on the strength of marriage. It turned out that a significant proportion of the wives and husbands of the first group of married couples, in which women suffered from affective disorders, attempted to divorce or thought about divorce (57.8% and 68.7%, respectively), as well as 76.4% of women suffering from neurotic depression (the second group of married couples), tried to divorce or thought about divorce, and among the husbands of patients, more than half wanted to dissolve the marriage - 51.5%. Whereas in the control group of married couples, husbands and wives did not allow themselves to think about divorce, despite the illness of the spouse.

In general, the results of psychological studies confirmed the patterns established during clinical examination of married couples in which the wives suffered from depressive disorders of various genesis. The data obtained showed that both the personal characteristics and personality orientation of patients, the features of gender-role behavior and the combination of these characteristics in a married couple, and the satisfaction with marital relations of both spouses, the importance of family functions and their implementation for each of them play a role in the development of marital maladjustment. The results of the studies allowed us to conclude that the disruption of health and family functioning in depressive disorders of various genesis in women is caused by a complex of factors and, therefore, a systemic and differentiated approach is required for their correction.

Prof. E. V. Kristal, Assoc. Prof. L. V. Zaitsev. Dysfunction of the family in case of depressive disorders of various genesis in the wife // International Medical Journal No. 4 2012