Elsevier

Social Science & Medicine

Volume 47, Issue 10, November 1998, Pages 1463-1472
Social Science & Medicine

Perception of the social support role of the extended family network by some Nigerians with schizophrenia and affective disorders

https://doi.org/10.1016/S0277-9536(98)00111-7Get rights and content

Abstract

Enquiries into patients' perception of psychosocial support from families should help objectively to identify the strengths and needs of families with sick members, in order to enhance management. The aim of this study was to identify the categories of relatives in the extended family whom a sample of Nigerian psychiatric patients perceived as having provided material, social and emotional support, and the factors associated with these perceptions. 123 schizophrenics and 31 patients with major affective disorders attending out-patient clinics were interviewed. Using operational definitions of family member (i.e. tendency to confide in and expect support from a relative), it appears that the size of extended family network that was mostly relied upon for support was five, including parents, full siblings, uncles/aunts, first cousins and in-laws. There were no significant differences in summary scores of family size and social support between the two illness groups. Age and duration of illness were significantly negatively correlated with perception of supports. The size of family network with whom patients interacted was predicted by tendency to confide in members, and emotional support. The findings indicate that the presumed support of the extended family should not negate the need to strengthen the resources of the nuclear family, in order to provide a focus for attraction and deployment of materials needed for the effective care of patients.

Introduction

In Nigeria, as in many developing countries, the lack of organised social welfare services of the type seen in developed countries makes the extended family the only consistent source of social support for the mentally ill (Jegede et al., 1985). In a study of 226 patients in the long-term care unit of the psychiatric hospital at Abeokuta, south-west Nigeria, Odejide (1981)reported that discontinuation of visits by members of the extended family contributed to long or indefinite patient stays. When continued family contact is difficult or impossible, patients discharged from hospital are frequently unable to return to their villages and become homeless. These vagrant psychotics are a frequent tragic sight in West Africa.

In Nigeria, as in many African countries, the social support role of the extended family is taken for granted, so much so that people commonly refer to “the African extended family system” as if it were peculiar to Africa (Radcliffe-Brown and Forde, 1958; Fadipe, 1970).

Fadipe (1970)has described the typical family structure as exemplified by the Yorubas who live in the south-west of Nigeria. The prevalent form of dwelling in rural Yoruba land is a collection of apartments for individual families. Collectively, these apartments are known as the compound or to the Yoruba as “agbo ile” (a flock of houses). They consist of two or more adjoining rooms for each family — polygynous or monogamous. In this patrilineal society, most of the members of a compound, other than women admitted into it by marriage, are related to one another on the father's side. Three generations, from grandfather to grandson, may show the same close blood ties, particularly where the compound has been long established and the members have remained within it; from brothers, uncles and nephews through to second or even further cousins. The head of the compound is usually the eldest male member, who is called “baale” (father of the house). Women who have married into the compound are regarded as members, as are in-laws.

Hence in the traditional culture, which also affects those living in urban areas, the extended family consists of families of “brothers” of several generations who live together in large compounds or otherwise geographically contiguous abodes. A child growing up in such circumstances has a long list of elders: “fathers”, “uncles”, “mothers”, “brothers” and “sisters” in addition to its natural parents; a complex mesh of kinship ties.

In the urban areas, although recent acculturating phenomena (e.g. urbanisation, education, Christianity, unemployment and national severe economic hardship) have considerably destabilised the extended family system, thereby giving way to an increasing sense of nuclearisation among families, it is usual for people to take cognisance of their kinship ties with members of the extended family in their villages of origin, especially in times of need (Jegede, 1981). As a result, urban residents who are vulnerable (e.g. the chronic mentally ill) to social instability from these acculturating phenomena seek to maintain their family relations and livelihoods. In spite of these adverse social influences, the supportive role of the extended family in the care of chronic mentally ill patients has recently been reported in a study in Senegal (Franklin et al., 1996). In their study of 910 patients at the national psychiatric hospital (Thiaroye Mental Hospital) in Dakar, 96.3% of subjects were accompanied for their first visit to hospital by relatives. (Law enforcement agents accompanied patients in only 2.3% of visits.) In the Arab World, the salutary role of the extended family in the care of schizophrenics has been highlighted (El-Islam, 1979).

Disruption of kinship ties by recent social changes is not peculiar to Africa. In developed countries, the possible adverse impact on family ties of welfare policies and the rise of female-headed households is being debated (Folbre, 1986; Wilkie, 1991; Moore, 1994). For instance, in the United States in 1960, 42% of households were supported by a sole male breadwinner but by 1988 the figure was down to 15% (Wilkie, 1991). In contradistinction to the thinking that extended families are peculiar to Africa, it has been noted that in the United Kingdom where the ideology of the nuclear family is powerful, the number of individuals resident in such units is only about a quarter of the population (Moore, 1994). In the United States, less than 25% of American families now conform to the nuclear model (Hill, 1994). In particular, African–American families have historically been characterised as having large, extended networks of social support (Hill, 1972; McAdoo, 1982).

Social support is defined as access to and use of individuals, groups or organisations in dealing with life's vicissitudes (Pearlin, 1989). It has emotional, cognitive/informational and material components (Jacobson, 1986). Although the variables constituting social support are related, the medical–social literature makes it quite clear that the terms material, social and emotional support can be operationally defined as distinct factors (Jacobson, 1986; Ell, 1996). Hence material support concerns the provision of physical necessities (such as food and money), social support deals with companionship (e.g. visiting the patient and recreational opportunities), while emotional support is experienced at the deeper psychological level of feelings of sympathy and acceptance.

A large body of health-related research has convincingly documented the salutary effects of social support on mortality and morbidity, psychosocial adaptation and adherence to treatment (Ell, 1996). The consensus of opinion in the literature appears to be that families are primary sources of patient support and are commonly looked to first when support (whether material or emotional) is needed (Ell, 1996). In other words, families are best perceived as providing social, emotional and material support.

In Nigeria, there has been no systematic research into the levels of support which psychiatric patients receive from members of the extended family network. We need to know patients' perceptions of how much and what type of social support their families are giving, particularly when a severely depressed national economy has seriously eroded the material resources of families. Findings from this type of study should help objectively to identify the strengths and needs of families with sick members in order to enhance their capacity for coping.

The objectives of the study were:

(1) to highlight the categories of extended family relatives whom Nigerian subjects with schizophrenia and major affective disorders would identify as family members, in the sense of confiding in or seeking help from them in solving problems arising from their illnesses;

(2) to highlight the categories of family members from whom the patients would expect help, and who were perceived as having interacted with patients in the past year;

(3) to identify the categories of relatives perceived as having provided actual material, social and emotional support in the past year;

(4) to assess the relationship between perceived size of extended family network and support provided, on the one hand; and socio-demographic characteristics, clinical outcome and duration of illness, on the other hand;

(5) to assess the predictors of perceived social support provided by relatives.

The subjects' perception of the extended family and social support provided are discussed in the light of available knowledge on how the extended family network is ordinarily conceived in Nigeria and the types of support they provide in the general population (Radcliffe-Brown and Forde, 1958; Fadipe, 1970; Jegede, 1981; Fajemilehin et al., 1996).

Section snippets

Subjects

Subjects consisted of 154 (76 males, 78 females) consecutive attendees at the psychiatric out-patient clinic of the University College Hospital, Ibadan, Nigeria, who fulfilled the International Classification of Diseases, tenth edition, (ICD-10) criteria for schizophrenia, mania and severe depression. To be included in the study, subjects had to be in a stable condition of health (i.e. not requiring increased medication or hospitalisation), and be able to participate in a 30-minute interview.

Socio-demographic and clinical characteristics

The 154 patients (76 males, 78 females) were made up of 123 (79.92%) schizophrenics and 31 (20.1%) with major affective disorders (i.e. mania and severe depression), with a higher proportion of females having affective disorders (21 or 26.9% of 78) than males (10 or 13.3% of 76). They were aged between 16 and 76 years; 51 (33.1%) were aged 16–30 years, and the tendency for the females to be older (39.3, SD 12.9 years) than the males (36.1, SD 11.9) was not statistically significant (P=0.1). The

Discussion

Like schizophrenics and severe affective disorder cases in previous Nigerian reports (Makanjuola, 1985; Ohaeri, 1992, Ohaeri, 1993), subjects in this study were predominantly young adults in low employment conditions. Also as in previous studies (Onyeama and Onuora, 1980; Ihezue, 1981, Ihezue and Kumaraswamy, 1984; Johnson, 1983), the male subjects were significantly more likely to be better educated and of single marital status than the females. The seemingly better employment situation of the

Acknowledgements

This study was supported by a grant from Basir-Thomas Foundation, University of Ibadan, Nigeria. Mrs Oyin Awosika and Miss Tosin Cole interviewed the patients. Messers Ogedengbe, Francis Okocha, and Biodun Oyelami played invaluable roles in data collection and analysis. Mr Bunmi Salako, Mrs Adeeko and Dr K. Thein typed the manuscripts. The author is grateful to the patients and relatives who participated in this study.

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