Demographic and clinical profile of women receiving inpatient treatment at a deaddiction unit of a psychiatric hospital in India: Five years' observation.

The recent national survey found a varying proportion of women use alcohol, cannabis, opioid, inhalants, and other substances. It has also reported that a small proportion of persons with substance use disorder (SUD) receive inpatient treatment.[1] Studies examining gender differences found that women experience a unique set of barriers to seeking treatment as compared to men, such as more opposition and less support from family and friends,[2]more unemployment, greater economic barriers, family responsibilities, and increased stigma and social disapproval.[34] An earlier review has found women with substance abuse were less likely to enter treatment than males.[5] Research on characteristics and profiles of women with substance use seeking treatment at a psychiatric center in India is limited. To our best of knowledge, only two of these studies included all women seeking treatment at a deaddiction unit.[67] Hence, our study aimed to examine sociodemographic and clinical profiles of women in patients who received inpatient treatment at deaddiction unit of a psychiatric hospital in India during a period of 5 years from July 2015 to June 2020.

The study was conducted at the addiction psychiatry unit of a psychiatric hospital in India. Before collecting data, approval was obtained from the Institute Ethics Committee. Case record files of all women in patients who were admitted at deaddiction unit of our institute during the specified period were accessed. Case record files were reviewed to collect sociodemographic information and clinical details in a predesigned semi-structured pro forma. Data were analyzed using SPSS version 25 (IBM Corp., Armonk, NY, USA) for Windows.

Table 1 shows sociodemographic and clinical profile of female in patients who were admitted during the past 5 years in our institute. A total of 26 women had received inpatient treatment at our deaddiction unit during a specified period of 5 years. The majority (69.20%) of them were Hindu which might be due to the fact that Hinduism is most commonly followed in the general population in India. Near 70% of them were educated only up to or below the 10th class. Lower level of education has been a high-risk factor for substance abuse among women.[48] Lower education has been also found to be a predictor of treatment entry and retention.[3910] Most of them are unemployed (69.20%). This agrees with earlier research where unemployment has been found to be a consequence and risk factor and to predict treatment retention among women.[5911] Around 60% of them hailed from urban areas and 88.5% were living in a nuclear family. Although the location of our hospital in a city might contribute urban predominance among inpatients, few research has discussed urban-rural differences in accessing treatment for SUD and utilization of SUD treatment due to rural specific challenges and barriers.[121314] Majority had a family history of substance abuse (53.80%). Genetic predisposition for SUD among the general population could explain this. Demographic profiles found in our study are consistent with earlier studies.[715] While 58% of them had anxious affect (P < 0.001), around 40% of them had depressive cognitions at the time of admission.

Table 1

Demographic and clinical characteristics of inpatient women with substance use at an addiction psychiatry unit of a psychiatric hospital over five years period (n=26)

Characteristics	Mean (SD)/, n (%)	Characteristics	Mean (SD)/, n (%)
Age (years)	41.73 (9.17)	Family income (INR)	8730.76 (7976.50)
Religion		Family history of psychiatric illness
Hindu	18 (69.20)	Present	3 (11.50)
Muslim	1 (3.80)	Absent	23 (88.50)
Christianity	7 (26.90)
Education		Family history of substance use
Illiterate	8 (30.80)	Present	14 (53.80)
Upto 10thstandard	10 (38.50)	Absent	12 (46.20)
More than 10thstandard	8 (30.80)
Occupation		Premorbid personality
Employed	8 (30.80)	Well-adjusted	24 (92.30)
Unemployed	18 (69.20)	Not well adjusted	2 (7.70)
Marital status		Forensic history
Married	21 (80.80)	Present	0 (0.00)
Unmarried	2 (7.70)	Absent	100 (100.00)
Widowed	3 (11.50)
Address		Treatment received in past
Rural	8 (30.80)	Yes	8 (30.80)
Semi urban	2 (7.70)	No	18 (69.20)
Urban	16 (61.50)
Family type		Abuse of nondependence producing substance
Nuclear	23 (88.50)	Yes	1 (3.80)
Joint	3 (11.50)	No	25 (96.2)
Age of onset (years)	28.73 (6.75)	Substance of dependence
Duration of substance use (years)	10.01 (7.71)	Alcohol	21 (80.76)
		Opioid	3 (11.53)
		Sedative and hypnotic	3 (11.53)
		Tobacco	4 (15.38)
History of psychiatric illness		Comorbid psychiatric disordersa
Present	2 (7.70)	Schizophrenia and other psychotic disorder	1 (3.80)
Absent	24 (92.30)	Mood disorder	7 (30.43)
		Eating disorder	1 (3.80)
		None	18 (69.20)
MSE at the time of latest admission
Speech abnormality		Perceptual abnormality
Present	2 (7.70)	Present	2 (7.70)
Absent	24 (92.30)	Absent	24 (92.30)
Orientation		Stage of motivation
Oriented	26 (100.00)	Precontemplation	14 (53.80)
Disoriented	0	Contemplation	12 (46.20)
Affect		Locus of control
Elated	1 (3.80)	External	13 (50.00)
Irritable	2 (7.70)	Internal	13 (50.00)
Depressed	3 (11.50)
Anxious	15 (57.70)
Cheerful	5 (19.20)
Abnormal thought content		Treatment provideda
Delusions	3 (11.50)	Carbamazepine or sodium valproate or lamotrigine	5 (19.20)
Depressive cognitions	10 (38.50)	Topiramate	6 (23.10)
Overvalued ideas	1 (3.80)	Naltrexone	1 (3.80)
Other	1 (3.80)	Baclofen	5 (19.20)
None	11 (42.30)	Buprenorphine-naloxone	1 (3.80)
		Benzodiazepines	3 (11.50)
		First generation antipsychotics	1 (3.80)
MSE at the time of latest admission
		Second generation antipsychotics	8 (30.80)
		Selective serotonin reuptake inhibitors	5 (19.20)
		Mirtazapine	2 (7.70)
		Bupropion	1 (3.80)
Follow up visit at OPD after discharge		Number of follow up after discharge	1.96 (4.30)
Yes	7 (26.90)
No	19 (73.10)
Total follow up period recorded (months)	12.69 (30.08)	Total number of inpatient admission	1.23 (0.71)

aTotal frequency and percentage exceed n as few patients had more than one substance dependence and comorbid psychiatric disorder. SD – Standard deviation; MSE – Mental status examination; INR – Indian national rupees; OPD – Outpatient department

Alcohol was the most abused substance in our study following a trend found in a recent national survey in India.[1] An earlier hospital-based study among inpatient women attending deaddiction center found opioid to be the most abused substance,[6]whereas a recent study found tobacco to be the most abused one.[7] This reflects the heterogeneous pattern and raises the possibility of changing trends of substance abuse among women across several regions in the country. Which would have a bearing in policymaking on demand reduction. A recent national household survey on the nature and extent of substance use in India,[1]which did not focus on tobacco, found alcohol to be the most commonly (1.7%) used substance among women. Considering the fact that the recent Global Adult Tobacco Survey in India, another recent survey exclusively for tobacco use found 14.2% of women in India use tobacco,[16]it might be concluded that tobacco is the most commonly used substance among women in India. Furthermore, the inpatient population of a hospital-based study does not represent the general population thereby differing from other hospital-based and epidemiological studies. The majority of them did not visit the hospital for follow-up consultation. Research found higher motivation among women,[1718]and comparable motivation with men.[19] While poor motivation might be one reason behind this, other factors should also be examined for poor retention among them. As mentioned earlier several gender-specific barriers exist which play a role for poor retention in SUD treatment among women. A recent qualitative study has reaffirmed a few barriers such as fear of losing custody of a child, social stigma. Lack of childcare facilities in SUD treatment centers is often reported by participants.[20] Although Greenfield et al.[5]found women were less likely to enter treatment, gender was not a significant predictor for treatment retention. Mean follow-up period of about 1 year could not be compared as research on this using standardized constructs of treatment retention is limited.

Although our study had few limitations such as having a small sample size, being retrospective, and our study adds to the sparse literature of inpatient women with substance use at a psychiatric hospital. As India is a large country with diverse demographics with heterogeneous patterns of SUD among women, knowledge on this area would help us to develop more suitable and user-oriented SUD treatment programs which would serve the needs of women with SUD in the future. Future multicentric studies with larger samples with comparison group of men with SUD and prospective design would reduce the knowledge gap in this area.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.