Procena kvaliteta života opijatskih i alkoholnih zavisnika i njihovih staratelja

Abstract

Bolesti zavisnosti predstavljaju medicinske poremećaje iz domena psihijatrije, koji sa sobom nose kompleksnu uzročnost nastanka, mnogobrojna ispoljavanja bolesti, drugačiji klinički tok i ishod. Kao i u većini drugih oboljena, bolest vezujemo i prepisujemo pojedincu, a time zanemarujemo značajni aspekt koji može da se odrazi i na okolinu oko samog bolesnika, prvenstveno misleći na njegovo najbliže okruženje. Poremećaji uzrokovani alkoholnom i opijatskom zavisnošću dovode do fizičkog, mentalnog i socioekonomskog propadanja ne samo pacijenta već i njihovih porodica, odnosno staratelja. Porodični staratelji su osobe koje pružaju neplaćenu negu drugim članovima porodice kojima je potreban nadzor ili pomoć u bolesti, odnosno nesposobnosti, kao i osobama sa specijalnim potrebama. Bolest negativno utiče na pojedinca u vidu fizičke, emocionalne, finansijske i socijalne disfunkcionalnosti. Sve navedeno dovodi do problema, teškoća ili neželjenih događaja koji utiču ne samo na obolelog nego i na njegovu okolinu. Studije su pokazale, da bolest jednog člana porodice utiče na kvalitet života ostalih članova porodice, a pogotovo na staratelja obolelog. Dosadašnje studije ukazuju da je veliki značaj podrške članova familije i uticaja na započinjanje tretmana zavisnosti , komplijansu i učestvovanje u istom , ali i na sam ishod odnosno uspešnost tretmana. Ciljevi: Glavni ciljevi istraživanja obuvatali su analizu kvaliteta života zavisnika od psihoaktivnih supstanci i njhovih staratelja, ispitivanje razlike u kvalitetu života između alkoholnih i opijatskih zavisnika, kao i identifikovanje prediktora koji doprinose boljem kvalitetu života kod zavisnika od psihoaktivnih supstanci, kao i kod njihovih staratelja. Metod: U studiju je uključeno 136 pacijenata koji su se nalazili na lečenju u Specijalnoj bolnici za bolesti zavisnosti u Beogradu, radi lečenja zavisnosti od psihoaktivnih supstanci (opijata i opioida ili alkohola), i 136 njihovih staratelja. Podaci o ispitanicima su prikupljani u periodu od aprila do oktobra 2014. godine. Zavisnost ispitanika je definisana prema Međunarodnoj klasifikaciji bolesti, 10. revizija (MKB-10) i kliničkoj definiciji Svetske zdravstvene organizacije (SZO) kao skup fizioloških, bihejvioralnih i kognitivnih fenomena koji se pojavljuju posle ponavljane upotrebe neke supstance ili grupe supstanci, čije uzimanje postaje od primarnog značaja za osobu u odnosu na ranije važeće prioritete. Tokom ovog istraživanja sprovedena je studija preseka. Kao istrumenti merenja u ovom istraživanju, pored opšteg upitnika korišćeni su i specifični upitnici , i to upitnik za ispitivanje kvaliteta života (36 item Short-Form Health Survey – SF-36), Bekova skala depresivnosti (Beck depression inventory – BDI) i Pitsburgov upitnik (Pittsburgh Sleep Quality Index – PSQI) koji se odnosi na kvalitet sna. Rezultati: Sociodemografske karakteristike ukazuju da su muškarci zavisnici brojniji, kao i žene staratelji (p< 0,001). Zavisnici od psihoaktivnih supstncu pripadaju starosnoj polulaciji ≤39 godina, u odnosu na staratelje koji pripadaju grupi starijoj od 50 godina (p<0,001). Bračni status ispitanika pokazao je da je najveći procenat pacijenata bez partnera, dok je isti broj staratelja u bračnoj zajednici (p<0,001). Socio-ekonomski status ispitanika pokazao je statistički značajnu razliku u odnosu na socioekonomske uslove pacijenata i njihovi staratelja. Skorovi SF-36 domena kod staratelja bili su slični kao i oni kod zavisnika od PAS, uz to da su 2 domena bila značajno niža, a odnose se na fizičko funkcionisanje ( p < 0.001) i telesni bol ( p = 0.003)...

Addictive diseases are medical disorders from the field of psychiatry, which carry with them a complex causality of occurrence, numerous manifestations of the disease, a different clinical course and outcome. As with most other diseases, we attribute the disease to an individual, and thereby neglect the important aspect that can affect the environment around the patient, primarily thinking of his immediate environment. Disorders caused by alcohol and opiate addiction lead to physical, mental and socioeconomic deterioration not only of the patient, but also of their families, i.e. guardians. Family caregivers are persons who provide unpaid care to other family members who need supervision or help in case of illness or disability, as well as to persons with special needs. The disease negatively affects the individual in the form of physical, emotional, financial and social dysfunction. All of the above leads to problems, difficulties or unwanted events that affect not only the patient but also his environment. Studies have shown that the illness of one family member affects the quality of life of other family members, especially the caregiver of the patient. Previous studies indicate that the support of family members is of great importance and influence on the initiation of addiction treatment, compliance and participation in it, but also on the outcome itself, i.e. the success of the treatment. Aims: Primary aims of this study included the analysis of the quality of life of those addicted to psychoactive substances and their caregivers, the examination of the difference in the quality of life between alcohol and opiate addicts, as well as the identification of predictors that contribute to a better quality of life in those addicted to psychoactive substances, as well as in their caregivers. Method: The study included 136 patients who were being treated at the Special Hospital for Addiction Diseases in Belgrade, for the treatment of addiction to psychoactive substances (opiates and opioids or alcohol), and 136 of their caregivers. Data on respondents were collected in the period from April to October 2014. The subject's addiction is defined according to the International Classification of Diseases, 10th revision (ICD-10) and the clinical definition of the World Health Organization (WHO) as a set of physiological, behavioral and cognitive phenomena that appear after repeated use of a substance or group of substances, the use of which becomes of primary importance for a person in relation to previously valid priorities. During this research, a cross-sectional study was conducted. As measuring instruments in this research, in addition to the general questionnaire, specific questionnaires were used, namely the questionnaire for examining the quality of life (36 item Short-Form Health Survey - SF-36), the Beck depression inventory (BDI) and the Pittsburgh questionnaire (Pittsburgh Sleep Quality Index - PSQI) which refers to the quality of sleep. Results: Sociodemographic characteristics indicate that there are more male addicts, as well as female caregivers (p< 0.001). Psychoactive substance addicts belong to the age group ≤39 years, compared to caregivers who belong to the group older than 50 years (p<0.001). The marital status of the respondents showed that the largest percentage of patients were without a partner, while the same number of guardians were married (p<0.001). The socio-economic status of the respondents showed a statistically significant difference in relation to the socioeconomic conditions of the patients and their caregivers. SF-36 domain scores in caregivers were similar to those in PAS addicts, with the exception that 2 domains were significantly lower, related to physical functioning (p < 0.001) and bodily pain (p = 0.003)...