Home | About IPJ | Editorial board | Ahead of print | Current Issue | Archives | Instructions | Contact us |   Login 
Industrial Psychiatry Journal
Search Articles   
    
Advanced search   
 


 
ORIGINAL ARTICLE
Year : 2018  |  Volume : 27  |  Issue : 2  |  Page : 226-230  Table of Contents     

Psychiatric morbidity in children of alcoholic parents


1 Department of Psychiatry, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
2 Department of Psychiatry, D.Y. Patil University, Kolhapur, Maharashtra, India
3 Consultant Psychiatrist, Gokuldas Hospital, Indore, Madhya Pradesh, India

Date of Web Publication14-Jun-2019

Correspondence Address:
Dr. Himanshu Mansharamani
6a/3, New Palasia, Indore - 452 001, Madhya Pradesh
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipj.ipj_57_17

Rights and Permissions
   Abstract 


Context: Children of alcoholics (COAs) are children who have grown up in families in which either one or both parents are alcoholic. The interplay of several factors such as environmental, cognitive, and genetic vulnerability has been linked to the psychopathology among COAs. Aims: To assess psychiatric morbidity in COAs and to compare these children with the children of nonalcoholic parents. Setting and Design: This cross-sectional study was conducted on children of outpatients and inpatients of a tertiary health-care center in Central India, for 18 months. Subjects and Methods: A total of 100 children, fifty children of alcoholic parents and fifty children of nonalcoholic parents between the age groups of 4 and 14 years, were assessed using childhood psychopathology measurement schedule. Statistical Analysis Used: Statistical analysis was done by using descriptive and inferential statistics using Chi-square test and Student's unpaired t-test. SPSS version 22.0, were used for statistical analysis, and P < 0.05 was considered as level of significance. Results: Most of the children were in the age group of 8–11 years. Depression and anxiety were found to be statistically significant (P < 0.05) in COAs than in children of nonalcoholics. Whereas, there was no difference (P > 0.05) for low intelligence and behavioral problems, conduct disorder, psychotic symptoms, special symptoms, physical illness, emotional problems, and somatization. Conclusions: Thus, there is a high need to address the stress to children of persons with substance abuse. Early detection of psychiatric morbidities in such children and appropriate intervention can produce beneficial changes in such children.

Keywords: Alcohol dependence, children, mental disorders


How to cite this article:
Mansharamani H, Patil PS, Behere PB, Mansharamani D, Nagdive A. Psychiatric morbidity in children of alcoholic parents. Ind Psychiatry J 2018;27:226-30

How to cite this URL:
Mansharamani H, Patil PS, Behere PB, Mansharamani D, Nagdive A. Psychiatric morbidity in children of alcoholic parents. Ind Psychiatry J [serial online] 2018 [cited 2019 Nov 12];27:226-30. Available from: http://www.industrialpsychiatry.org/text.asp?2018/27/2/226/260410



Children of alcoholics (COAs) are children who have grown up in families in which either one or both parents are alcoholic. According to the “National Survey on extent, pattern and trends of drugs abuse in India,” the prevalence of alcoholism is 21.4%.[1] In America, approximately one in ten is a drinker, and many of them are married and have families and children. A national survey on Drug Use and Health, which was conducted in the US from 2005 to 2010, concluded that about 7.5 million children in the US have lived with an alcohol-dependent parent, and that almost 1 out of 5 people had grown up in an alcoholic family.[2]

The interplay of several factors such as environmental, cognitive, and genetic vulnerability has been linked to the psychopathology among COAs.[3] Alcohol affects the child from the time the child is in the womb. If the mother of the child abuses alcohol, the child is at the risk of developing fetal alcohol syndrome. It can cause various malformations, functional defects, growth deficiencies, and in some cases death.[4] COAs grow up in an environment where there is a lack of parental care and love, which is essential for the child's development.[5] The characteristics of alcoholic parents are the defective parenting styles. Parenting should ideally be based on discipline and predefined rules, which, in alcoholic parents, are in turn based on parents' drinking status and moods. This results in inconsistent and unpredictable behavior of parents, leaving children to feel insecure and unsafe.[6],[7]

The age of elementary school years, i.e., from 6 or 7–15 years of age, is known as the latency developmental period of children, but this phase of development does not apply to COAs, as they are constantly under stress which hinders their self-development. COAs suffer from direct physical, verbal, emotional, and sexual abuse from their alcoholic parent.[8] Parent–child role reversal has also been seen in COAs, as it has been frequently seen that they have to take responsibilities of the family. These children usually do daily house chores, look after their alcoholic parent(s) and siblings, and even protect other family members when the alcoholic parent becomes intoxicated and abusive.[9] The effects of these stressors are seen in the form of learning difficulties, conduction and behavioral problems, loss of concentration, and poor scholastic performance in COAs.[1]

In COAs, stress sensitivity can be observed through behavioral signs and symptoms. Stress due to external environment not only disrupts the self-regulation of the child, but also interferes with developing a normal coping mechanism, which can be seen in later years, as these children develop more anxiety and depression than the children of nonalcoholic parents.[10] In addition, due to alcoholism, the home environment becomes disharmonious and interaction among family members gets poorer, which in turn affects the psychosocial development of the children.[11]

This study aimed at assessing the psychiatric morbidity in the children of persons with alcohol dependence syndrome. The objectives of the study were (1) To assess the psychiatric morbidity in the children of persons with alcohol dependence syndrome and (2) To compare them with the children of nonalcoholic parents.


   Subjects and Methods Top


It is a cross-sectional study, conducted on children of outpatients and inpatients admitted in the Psychiatry Ward at a tertiary health-care center in Central India. A total of 100 cases, with fifty cases and fifty controls, were included in the study. Institutional ethical clearance was taken before commencing the study, and an informed consent was taken from the parent/caregiver before interviewing. Children between the ages of 4 and 14 years, whose caregivers gave an informed consent, and understood Hindi/English or Marathi were included in the study. Whereas, caregivers who refused to give informed consent were excluded from the study.

Children of persons diagnosed as alcohol dependence syndrome according to the International Classification of Diseases 10th Revision [12] criteria were included in case group. The parents of these children were interviewed by a consultant psychiatrist, and they did not fulfill the criteria for any other major psychiatric illness.

As it was a hospital-based study, children who were admitted in pediatrics ward and having nonalcoholic parents were included in the control group.

The study was conducted over a period of 18 months (January 1, 2015, to June 1, 2016).

Tools used in the study were – (1) A semi-structured sociodemographic pro forma and (2) Childhood Psychopathology Measurement Schedule (CPMS): CPMS was developed and standardized in India according to a study done by Malhotra et al.[13] The CPMS contains 74 questions pertaining to eight factors, i.e., intelligence with behavior problems, conduct disorders, anxiety, depression, psychotic symptoms, special symptoms, physical illness emotional problems, and somatization. These answers are scored on a 2-point scale, i.e., “0” if that particular behavior is not present and “1,” if present. The scale has a total score of 74. A cutoff score of ≥10 is considered to have some psychopathology. Children of ages 4–14 years of both sexes can be assessed. The informant was the parent of the child, preferably mother, or a parent surrogate.

Statistical analysis was done by using descriptive and inferential statistics using Chi-square test and Student's unpaired t-test, and software used in the analysis were Statistical Package of Social Sciences (version 22.0), North Illinois university, USA. P < 0.05 was considered as the level of significance.


   Results Top


A total of 100 children were included in the study, fifty each for case and control groups. It was found that majority of the children included in the study, i.e., 56% for the case group and 62% for the control group, were males [Table 1].
Table 1: Distribution of children according to their gender

Click here to view


Majority of the COAs (44%) and children of nonalcoholics (38%) were in the age group of 8–11 years. The mean age of COAs was 8.69 ± 3.26 and of children of nonalcoholics was 9.46 ± 3.33 [Table 2].
Table 2: Distribution of children according to their age in years

Click here to view


Majority of children were pursuing education in primary school (42% and 40%, respectively, for COAs and children of nonalcoholics) [Table 3].
Table 3: Distribution of children according to their education

Click here to view


Majority of the children were residing in rural areas [Table 4].
Table 4: Distribution of children according to their residence

Click here to view


No significant differences were noted in demographic variables between the children of two groups. Furthermore, there were no differences in demographic variables of the parents of the two groups.

On CPMS, statistically significant difference was found for anxiety (P < 0.05) and depression (P < 0.05) between the COAs and children of nonalcoholics. Whereas, there was no significant difference for low intelligence and behavioral problems, conduct disorder, psychotic symptoms, special symptoms (viz., obsessive-compulsive disorder, pica, and enuresis), physical illness with emotional problems, and somatization. The total score of CPMS was statistically significant between the two groups [Table 5].
Table 5: Co-relation of Factors of Childhood Psychopathology Measurement Schedule between the two groups

Click here to view



   Discussion Top


In this study, the children of age group between 4 and 14 years were included as the children of this age group are vulnerable and the scale measured this age range. The middle childhood is a period of a psychological state as the child is calm, pliable, and educable. Resources of children of this age group are insufficient to effectively cope up with stressful situation, thus they may develop a coping mechanism which is defective.[14] Puberty is another factor for personality change in these children.[1]

In this study, it was found that COAs scored significantly higher for anxiety than children of nonalcoholics. Our study is in concordance with the studies done by Sher et al. and Hill et al.,[15],[16] which also stated that COAs have higher chances of developing general anxiety disorder, agoraphobia, and social phobia. The Epidemiologic Catchment Area Project Data [17] also suggest that COAs have higher 6-month prevalence rates of agoraphobia and simple phobia and also higher lifetime rates of simple phobia, generalized anxiety disorder, panic disorder, and agoraphobia. This can be attributed to the fact that alcoholism in the parent can lead to family disruption and can lead to unpredictable parental behavior and home environments, which can expose the child to anxiety-provoking situations.[6],[18] Abnormal coping mechanism, which the child develops, can again lead to anxiety.[15] Neglect of the child, interparental arguments, economic reversal of family, hospitalization, or accidents of the parent are also other factors.[19]

Another important finding in our study was that depression was found to be significantly higher in COAs than children of nonalcoholics. This finding in our study is in concordance with the study by Chassin et al. and Anda et al.[20],[21] who found that the risk of depression increases as the number of reported adverse experiences increases due to parental alcohol abuse. Hinrichs et al. also found that COAs have a tendency to be passive, avoidant, depressed, and may fear rejection or abandonment.[22] Growing up in an alcohol-abusing home substantially increases the risk for the child to experience adverse situations such as domestic violence, abuse, and family dysfunction. Alcoholism in family also diminishes a mother's capacity to care for child as she is busy with the household problems, and hence the child feels alone, neglected, and lonely.[23]

There was no significant difference for low intelligence and behavioral problems between the two groups. This is corroborated by a study by Narang et al.[19] and Earls et al.[23] who did not find any difference for low intelligence between the COAs and nonalcoholics. Some studies mention that the low intelligence in COAs can be attributed to alcohol's effect on morphogenesis when the child was in its mother's womb.[24],[25] This finding in our study can be due to the fact that all the COAs included in our study had their father as the alcoholic parent and mother as nonalcoholic, as this study was done in a rural setup where the standards of education are not as high as urban areas and hence children with low intelligence may not have been identified by the teachers and parents. However, overall, it has been seen that COAs may have some behavioral problems.[11]

In the study, it was found that there was no significant difference for conduct disorder between COAs and children of nonalcoholics. The finding in our study is in concordance with the study by Schuckit et al.[26] who found that there was no significant relationship between a family history of alcoholism and childhood diagnoses of conduct, oppositional, or attention-deficit disorders. The finding in our study is also in concordance with other studies which did not find any difference in COAs and children of nonalcoholics,[23] though some studies found that conduct disorder is seen more in COAs than in children of nonalcoholics.[27],[28]

Other factors such as emotional problems, somatization, special symptoms (viz., obsessive-compulsive disorder, pica, and enuresis), psychotic symptoms, and physical illness were not significantly different between the two groups in our study. This study is in concordance with other studies by Earls et al. and Goodwin et al.[23],[29] who did not find any significant difference in COAs and children of nonalcoholics. Although some studies have found that COAs have higher admissions in hospitals, spend more days in hospital, and are more susceptible to illnesses than other children.[30]

As observed in the study, anxiety and depression were significantly higher in COAs than in children of nonalcoholics. These children are vulnerable and difficult to identify in our society. They have to suffer a lot due to alcoholism in family, may be directly by physical and emotional abuse of the child, or indirectly by witnessing the marital disharmony among parents and physical and emotional abuse of mother.

Limitations

As this is a hospital-based study, children admitted in pediatrics ward were included in the control group. Due to their physical ailments, the children may have comorbid psychiatric conditions as well, which may have led to bias.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Velleman R. Intergenerational effects – A review of environmentally oriented studies concerning the relationship between parental alcohol problems and family disharmony in the genesis of alcohol and other problems. I: The intergenerational effects of alcohol problems. Int J Addict 1992;27:253-80.  Back to cited text no. 1
    
2.
Substance Abuse & Mental Health Services Administration (SAMHSA). Data Spotlight; 2012. Retrieved from: http://www.samhsa.gov/data/. [Last accessed on 2017 Jul 15].  Back to cited text no. 2
    
3.
Bountress K, Chassin L, Lemery-Chalfant K. Parent and peer influences on emerging adult substance use disorder: A genetically informed study. Dev Psychopathol 2017;29:121-42.  Back to cited text no. 3
    
4.
O'Connor MJ, Sigman M, Brill N. Disorganization of attachment in relation to maternal alcohol consumption. J Consult Clin Psychol 1987;55:831-6.  Back to cited text no. 4
    
5.
Kroll B. Living with an elephant: Growing up with parental substance misuse. Child Fam Soc Work 2014;9:129-40.  Back to cited text no. 5
    
6.
Vaught EL, Wittman PP. A phenomenological study of the occupational choices of individuals who self-identify as adult children of alcoholics. J Occup Sci 2011;18:356-65.  Back to cited text no. 6
    
7.
Jayne M, Valentine G. Alcohol-related violence and disorder: New critical perspectives. Prog Hum Geogr 2016;40:67-87.  Back to cited text no. 7
    
8.
Velleman R, Templeton L, Klein M, Moesgan D. Domestic abuse experienced by young people living in families with alcohol problems: Results from a cross-European study. Child Abuse Rev 2008;17:387-409.  Back to cited text no. 8
    
9.
Kelley ML, French A, Bountress K, Keefe HA, Schroeder V, Steer K, et al. Parentification and family responsibility in the family of origin of adult children of alcoholics. Addict Behav 2007;32:675-85.  Back to cited text no. 9
    
10.
Workman M, Beer J. Depression, suicide ideation, and aggression among high school students whose parents are divorced and use alcohol at home. Psychol Rep 1992;70:503-11.  Back to cited text no. 10
    
11.
Jogdand SS, Naik J. Study of family factors in association with behavior problems amongst children of 6-18 years age group. Int J Appl Basic Med Res 2014;4:86-9.  Back to cited text no. 11
    
12.
World Health Organization. The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization; 1992.  Back to cited text no. 12
    
13.
Malhotra S, Varma VK, Verma SK, Malhotra A. Childhood psychopathology measurement schedule: Development and standardization. Indian J Psychiatry 1988;30:325-31.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Puttler LI, Zucker RA, Fitzgerald HE, Bingham CR. Behavioral outcomes among children of alcoholics during the early and middle childhood years: Familial subtype variations. Alcohol Clin Exp Res 1998;22:1962-72.  Back to cited text no. 14
    
15.
Sher KJ, Walitzer KS, Wood PK, Brent EE. Characteristics of children of alcoholics: Putative risk factors, substance use and abuse, and psychopathology. J Abnorm Psychol 1991;100:427-48.  Back to cited text no. 15
    
16.
Hill SY, Shen S, Lowers L, Locke-Wellman J, Matthews AG, McDermott M. Psychopathology in offspring from multiplex alcohol dependence families with and without parental alcohol dependence: A prospective study during childhood and adolescence. Psychiatry Res 2008;160:155-66.  Back to cited text no. 16
    
17.
Mathew RJ, Wilson WH, Blazer DG, George LK. Psychiatric disorders in adult children of alcoholics: Data from the epidemiologic catchment area project. Am J Psychiatry 1993;150:793-800.  Back to cited text no. 17
    
18.
Sher KJ. Psychological characteristics of children of alcoholics. Res Gate 1997;21:247-54.  Back to cited text no. 18
    
19.
Narang RL, Gupta R, Mishra BP, Mahajan R. Temperamental characteristics and psychopathology among children of alcoholics. Indian J Psychiatry 1997;39:226-31.  Back to cited text no. 19
[PUBMED]  [Full text]  
20.
Chassin L, Pitts SC, DeLucia C, Todd M. A longitudinal study of children of alcoholics: Predicting young adult substance use disorders, anxiety, and depression. J Abnorm Psychol 1999;108:106-19.  Back to cited text no. 20
    
21.
Anda RF, Whitfield CL, Felitti VJ, Chapman D, Edwards VJ, Dube SR, et al. Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression. Psychiatr Serv 2002;53:1001-9.  Back to cited text no. 21
    
22.
Hinrichs J, Defife J, Westen D. Personality subtypes in adolescent and adult children of alcoholics: A two-part study. J Nerv Ment Dis 2011;199:487-98.  Back to cited text no. 22
    
23.
Earls F, Reich W, Jung KG, Cloninger CR. Psychopathology in children of alcoholic and antisocial parents. Alcohol Clin Exp Res 1988;12:481-7.  Back to cited text no. 23
    
24.
Jacobson SW, Jacobson JL, Sokol RJ, Chiodo LM, Corobana R. Maternal age, alcohol abuse history, and quality of parenting as moderators of the effects of prenatal alcohol exposure on 7.5-year intellectual function. Alcohol Clin Exp Res 2004;28:1732-45.  Back to cited text no. 24
    
25.
Gabrielli WF Jr., Mednick SA. Intellectual performance in children of alcoholics. J Nerv Ment Dis 1983;171:444-7.  Back to cited text no. 25
    
26.
Schuckit MA, Smith TL, Radziminski S, Heyneman EK. Behavioral symptoms and psychiatric diagnoses among 162 children in non-alcoholic or alcoholic families. Am J Psychiatry 2000;157:1881-3.  Back to cited text no. 26
    
27.
West MO, Prinz RJ. Parental alcoholism and childhood psychopathology. Psychol Bull 1987;102:204-18.  Back to cited text no. 27
    
28.
Reich W, Earls F, Frankel O, Shayka JJ. Psychopathology in children of alcoholics. J Am Acad Child Adolesc Psychiatry 1993;32:995-1002.  Back to cited text no. 28
    
29.
Goodwin DW, Schulsinger F, Hermansen L, Guze SB, Winokur G. Alcohol problems in adoptees raised apart from alcoholic biological parents. Arch Gen Psychiatry 1973;28:238-43.  Back to cited text no. 29
    
30.
Woodside M, Coughey K, Cohen R. Medical costs of children of alcoholics – Pay now or pay later. J Subst Abuse 1993;5:281-7.  Back to cited text no. 30
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

Top
  
 
  Search
 
  
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    Abstract
   Subjects and Methods
   Results
   Discussion
    References
    Article Tables

 Article Access Statistics
    Viewed434    
    Printed38    
    Emailed0    
    PDF Downloaded23    
    Comments [Add]    

Recommend this journal