Violation of family functioning in depressive disorders of various genesis in the wife

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

Most often, family psychotrauma is chronic because of the length of the family relationship itself. A psychotraumatic discrepancy between a person's perceived or unconscious expectations about the family and the actual life of the family can ultimately lead to a state of global family dissatisfaction. Under the influence of family psychotrauma, such family health disorders as family anxiety associated with a person's insecurity in some aspect of family life that is very important for him can arise.

However, the functioning of the family in depressive disorders of various genesis in women is very little studied. You can only name a few works relating to this topic.

The complex and rather topical problem of disturbing the social, psychological, social, psychological and biological adaptation of the spouses in this pathology and the closely related problem of disrupting the functioning of the family are waiting for their investigation primarily because from the elucidation of the multiple causes, mechanisms of development and polymorphic manifestations of functional disorders, the effectiveness of psychotherapeutic correction of family health, the integral indicator of which is the correct performance of its functions.

Under our supervision, there were 399 families in whom a comprehensive diagnosis of the wives diagnosed a depressive disorder of various genesis. Given the nosological diversity of the patients enrolled in the study, all those examined were divided into groups, depending on the register of affective pathology, the level of generalization of depressive manifestations and nosological affiliation of patients. In the first group of married couples (SP), in which women suffered from affective disorders (172 joint ventures), two subgroups were singled out: the first was 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 joint ventures), three subgroups were identified: 1st -132 families in which women suffered from neurasthenia (F48.0); 2 nd - 73 families with prolonged depressive reaction (F43.21) in women and 3rd-22 families, where the women had mixed anxiety and depressive reaction (F43.22). It was not possible to single out a control group among the families of the first group, because in an affective disorder, women always had family health disorders. However, among the families of the second group with neurotic depressions, 60 (26.4%) families were allocated to wives in which the spouses considered their family healthy. By age and social characteristics, this group did not differ from families with disrupted health. This was the reason to consider them as a control group in relation to the main one.

The age of sick women was between 19 and 48 years, with husbands and wives in the same age group. Adult maladaptation in the observed pairs was observed from the first weeks or 1-2 years after the onset of marital 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 remaining - from 11 to 15 years and more. More than half (59.2%) of women were in the first marriage, 30.8% in the second, 3.1% in the third and 10.0% in the civil marriage. In the first marriage and in a civil marriage, most often were women of the first group and women of the third subgroup of the second group, in the second and third marriage - women of the 1 st and 2 nd subgroup of the second group. Most couples (67.8%) had one child, 21.2% had two children and 5.2% had no children. In 5.8% of families, the wives had a child from the first marriage.

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

This report presents the results of a psychodiagnostic study using the methods of V. V. Krishtal, I. A. Semenkina, which makes it possible to calculate the coefficient of family functions (norm 0.8-1). The functioning of the family was studied according to the status of 14 family functions, singled out by IS Semenkina.

The following functions were studied: emotional - meeting the needs of family members for sympathy, respect, recognition, love, emotional support, empathy; spiritual, or function of cultural communication, - satisfaction of the spouses' need for joint leisure activities, mutual spiritual enrichment and spiritual development; sexual-erotic - satisfaction of sexual-erotic needs of spouses; reproductive - meeting the need to have children; household and household; educational - the satisfaction of individual needs in paternity, motherhood, in contact with children; the function of socialization (primary, secondary, professional) is the development of social cohesion among members of the family, the assimilation and active reproduction by the individual of social experience carried out in communication and activity; function of social integration - care of finding family members a place in the community; role function - satisfaction in the family of the role needs of each member of the family; protective - meeting the need for security, psychological, physical and material protection; the function of maintaining health - ensuring the preservation of the physical, mental and sexual health of family members and the necessary care for the disease; the function of personalization - providing psychotherapeutic assistance to family members in difficult situations; rehabilitation function, or the function of primary social control, - the provision of family opportunities and the promotion of social rehabilitation, the implementation of social norms in the event of a disease.

The state of family functions in bipolar affective disorder in the wife. With this disease in women, the emotional function of the family was highly significant for the spouses. Spiritual and sexual-erotic functions were violated in all families. The least affected was the reproductive function of the family, which was only disrupted in isolated cases. The household function was for women in most cases on the 2nd, for men - on the 7th, and sometimes on the last 14th place in importance. Educational function was violated in all families, men assigned to it basically the last place. The functions of socialization and social integration are violated in all families, except for 1/3 families with a preserved function of socialization. The role function was poorly performed in practically all the families surveyed. The protective function was more significant for women than for men. The function of maintaining health was weak in more than half of the families. The functions of personalization of men and, in particular, women attached little importance: most often, respectively, 10-11th and 10th-12th places. The same can be said about the psychotherapeutic function that women put mainly on the 12-14th, and men - for 10-12th places. Finally, the least meaning was betrayed to the wife of rehabilitation function. It was violated by more than half of the families.

When analyzing the spouses' assessment of family functions, it was found that more than 1/3 of the spouses evaluated the performance of the emotional function as bad and very bad (-1 and -2, which corresponds to the 0.4-0.8 coefficients we calculated), spiritual - as bad. The performance of the social and erotic function was assessed by all women as bad, all men - as very bad and bad. Much better than the rest was estimated by both wives and husbands fulfillment of reproductive function - as satisfactory (+1, coefficient 0.8) in 94.8% of cases. The performance of the health preservation function for about half of the women was also assessed as satisfactory, and the performance of the remaining functions was both bad and very bad. Part of the 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, unlike the previous subgroup, the significance of emotional function for women was less. Spiritual function was disrupted in half of patients and in 1/3 of their husbands, sexually-erotic - in all families, the reproductive function suffered minimally.

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

With regard to the spouses' assessment of the performance of the functions of the family, the performance of emotional, spiritual and sexual-erotic functions was defined by all spouses as bad and very bad.

As in the previous sub-group, the performance of the reproductive function was best evaluated - all spouses recognized it as satisfactory. The household function, in the opinion of the overwhelming majority of both women and men, was poorly performed, as well as all other functions, except for psychotherapeutic and rehabilitation, the implementation of which was recognized as poor mainly by women. Implementation of the function of social integration was considered satisfactory only by a part of men (25.7%).

Analysis of the importance of family functions showed that the most highly valued by all spouses is mainly psychotherapeutic and rehabilitation and least of all - emotional, spiritual and social-erotic functions. Accordingly, the performance of the most significant family functions is often poorly and very poorly evaluated.

The state of family functions in cases of neurasthenia in the wife. The emotional function of the family for spouses in case of neurasthenia in the wife was the most significant for both spouses. Sexually erotic function was violated in all families. The reproductive function suffered the least, was broken only in isolated cases. The household function was kept by more than half of the families. The educational function suffered to a much lesser degree, and the spiritual function was also less often violated. The functions of socialization and social integration were violated in all families. The role function was of great importance only for a few women, most of them put it on one of the last places, and men - on the 9-11th place. The performance of the protective function suffered the most. Relatively low evaluated the spouses function of maintaining health. Psychotherapeutic and rehabilitation functions for women were significant in most cases, and for men, they ranked the last in terms of significance.

When analyzing the spouses' evaluation of family functions, it was found that the spouses satisfactorily evaluated the performance of the reproductive function. More than half of men also evaluated the performance of psychotherapeutic and rehabilitation functions, while the majority of women rated their performance as poor. Quite highly estimated half of men and most women performing educational function. Often evaluated as a satisfactory, especially men, performance of protective function and health preservation function. Performance of emotional function, most men rated as bad and very bad, and almost one-third of men could not determine their attitude towards it. The performance of the spiritual function of most spouses was also assessed as bad and very bad, although quite a few women considered it satisfactory. Performing a sexual-erotic function all men and women considered bad and very bad. The majority of spouses and the performance of the role function were also assessed.

The state of family functions in the prolonged depressive reaction of the wife. The emotional function of the family for the spouses in the prolonged depressive reaction of the wife was highly significant for all spouses. The spiritual function of women occupied a less significant place than that of men. Primary sexual control was preserved in less than 1/3 of the families, it was violated in all other families. Sexually erotic function, as might be expected, was disrupted in all families. The reproductive function was disrupted only in isolated cases. The household function for women was more important than for men. The educational function had for women and part of men about the same value and suffered in a much lesser degree than the spiritual function. The function of socialization was violated in most women, men gave it a little more importance. The function of social integration was of little significance for all women, and for the vast majority of men. The role function was of great importance only for several women, most of them assigned to it one of the last places. The performance of the protective function suffered the most. Relatively low evaluated the spouses function of maintaining health. The last place in terms of importance was occupied by the psychotherapeutic function of women, and for men it was highly significant. The rehabilitation function of women and men was often put on the last places.

When analyzing the assessment of the spouses' performance of family functions, it was found that the performance of the reproductive function was satisfactorily assessed, and emotional and spiritual functions were less often disturbed. The educational function suffered much more. The material function was retained by more than half of the families. The performance of household functions was estimated at more than 1/3 of women and 1/4 of men as satisfactory, more than half of women and 41.5% of men were evaluated as fulfilling the function of socialization. The performance of the function of social integration, protective and psychotherapeutic women was more often than satisfactory for men. Most often, both bad and very bad were assessed by spouses, especially women, performing educational, personalistic, role-playing functions and the function of maintaining health.

The state of family functions in a mixed anxiety and depressive reaction in the wife. In most spouses, the emotional function was the first in importance, and the spiritual function was the second. Sexually erotic function was violated in all families. The least reproductive function of the family. The household function was kept by more than half of the families. Upbringing function was more appreciated by women than men. The functions of socialization and the functions of social integration of women, on the contrary, were given less importance than men. Role role of women did not attach much importance, while men assigned it a significant place. The protective function, as well as the function of maintaining health, was appreciated by women. Also higher is the women's personalization function. Psychotherapeutic function of women was more often put on 10th, and men - on 11th and 13th places; rehabilitation function was rated somewhat higher by men - more often 11th, and women - 14th.

Data on the evaluation of the performance of family functions showed that half of women with mixed anxiety and depressive reactions were assessed as satisfactory performance of emotional function, while most men rated it as poor and very poor. The fulfillment of the spiritual function of women was also often estimated as satisfactory, and in most cases, men are both bad and very bad. Sexual function was assessed by all spouses as being performed poorly, reproductive - almost all as performed satisfactorily. Women more often than men were assessed as poor and very poor performance of educational function, socialization functions and social integration, preservation of health. Men more often than their wives evaluated in the same way the performance of household, psychotherapeutic and rehabilitation functions. The performance of the role function and the personalization function of the spouse was assessed as poor and very poor almost equally, but the performance of the personalization function was appreciated by a significant number of spouses, especially men, 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 and even household functions. This circumstance, obviously, reflects indecisiveness, anxiety, and lack of independence characteristic for persons with mixed anxious and depressive reaction.

We have studied the impact of disruption of the family's functioning on the strength of marriage. It turned out that a significant number of wives and husbands of the first group of married couples in which women suffered from affective disorders made attempts to divorce or thought of divorce (57.8% and 68.7%, respectively), as well as 76.4% of women suffering from neurotic depressions (the second group of married couples), tried to divorce or thought about divorce, and among the husbands of the patients they wanted to terminate the marriage more than half - 51.5%. While in the control group of married couples, husbands and wives did not allow the thought of divorce, despite the illness of the spouse.

In general, the results of psychological research have confirmed the patterns established in the clinical examination of married couples in which the wife suffered from depressive disorders of various genesis. The obtained data showed that in the development of spousal disadaptation, the personal characteristics and orientation of the patients' personality, the characteristics of sex role behavior and the combination of these characteristics in the couple, as well as the satisfaction with the marital relations of both spouses, the significance for each of them of the functions of the family and their fulfillment play a role. The results of the studies made it possible to conclude that the violation of the health and functioning of the family in depressive disorders of various genesis in women is due to a complex of factors and, therefore, a systematic and differentiated approach is required to correct them.

Prof. E. V. Krishtal, Assoc. L. V. Zaitsev. Disturbance of family functioning in depressive disorders of different genesis in the wife // International Medical Journal No. 4 2012