|Year : 2008 | Volume
| Issue : 1 | Page : 39-47
A study of stress and psychiatric morbidity in the central industrial security force
G Prasad Rao1, Khaja Moinuddin1, P Geeta Sai2, Eva Sarma3, Angers Sarma3, P Srinivasa Rao1
1 Asha Hospital, Banjara Hills, Hyderabad, India
2 Institute of Mental Health, Hyderabad, India
3 Austin College, Texas, USA
G Prasad Rao
Asha Hospital, Banjara Hills, Hyderabad
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The Central Industrial Security Force (CISF) provides security cover to several of the Nation's vital industrial sectors and the CISF personnel are trained so as to meet expected and unexpected emergencies for varied periods of time.
The present study is undertaken at the National industrial security Academy, NISA, Hyderabad with the objectives of assessing the psychiatric morbidity and the factors contributing to stress among the CISF personnel. A Random stratified sample of 500 subjects stratified to include personnel from all ranks such as SI's, Executive officials and constables are screened using the Goldberg's General Health Questionnaire. A detailed screening Questionnaire adapted from Channabasavanna S.M etal (1996) to assess the stress and coping was used. Those who are screened positive are further evaluated using the Mini International Neuro-psychiatric Interview, M.I.N.I to confirm the psychiatric diagnosis and using detailed personal interviews the factors contributing to stress in the CISF personnel are identified.
The results of the study have shown that personnel posted in stressful areas and of the Rank of constables had perceived stress and more morbidity compared to those posted in nonstressful areas.
|How to cite this article:|
Rao G P, Moinuddin K, Sai P G, Sarma E, Sarma A, Rao P S. A study of stress and psychiatric morbidity in the central industrial security force. Indian J Psychol Med 2008;30:39-47
|How to cite this URL:|
Rao G P, Moinuddin K, Sai P G, Sarma E, Sarma A, Rao P S. A study of stress and psychiatric morbidity in the central industrial security force. Indian J Psychol Med [serial online] 2008 [cited 2017 Sep 22];30:39-47. Available from: http://www.ijpm.info/text.asp?2008/30/1/39/43133
| Introduction|| |
The present Indian society is undergoing rapid changes in several aspects due to rapid urbanization, industrialization, migration and the resultant changing qualities of life have changed the occupational nature and health situation of the people to a large extent. An important occupational group which has evolved as a consequence of these changes is the 'Central Industrial security force' or the 'CISF'. The CISF set up on 10 th March 1969 under an act of the parliament and later made an armed force of the union in 1963 is one of the largest Paramilitary forces of the nation with strength of over 95,779 personnel. The CISF force provides security cover to over 267 units located all over the country comprising vital industrial sectors like Atomic power plants, space installations, defence production units, oil fields and refineries, major ports, steel plants, barrages and fertilizer units etc, most of which are located in difficult terrains of the country with extreme climates. Though created with the purpose of securing the Nation's sensitive undertakings, the CISF now is nowadays increasingly being called upon to perform important duties beyond its charter such as internal security, airport security, security of highways, election duties and of late into attending into naxalite affected areas for security and another disaster management division is being developed to prepare the forces to help people in the Disaster situations like floods, earth quakes etc..
Therefore unlike the other work forces the CISF force does not have a fixed work pattern and they must be geared to meet expected and unexpected emergencies for unspecified periods of time. A culmination of these pressures has resulted in increasing stress on a day to day basis. This subjective stress caused by daily living or working situations may lead to various minor mental health problems leading further to changes in job performance and quality of life. Our present study is an attempt in understanding the work and related problems and the resultant psychiatric problems in a group of CISF personnel.
| Review of Literature|| |
There has been a good deal of research on the psychiatric problems focusing on areas such as stress, personality studies, symptoms of Post traumatic stress disorder involving the Police and the Armed forces personnel.
A survey of stress problems in Indian police personnel by Mathur (1993) reported that certain job related factors acted as specific stressors for the police such as their 1) work conditions 2) work overload 3) lack of recognition 4) fear of severe injury or being killed on duty 5) inadequate equipment 6) shooting someone in line of duty 7) Anti terrorist operations 8) confrontation with public 9) lack of job satisfaction and 10) Police hierarchy.
Bhaskar (1986) has identified several factors intrinsic to the job and closely related to the work as major contributors to stress related problems among police personnel.
The Bureau of Police research and Development (BPR&D) in India has conducted a study in 1993 to identify the various stressful aspects at work, home and community environment to understand their impact on health.
Spragg (1992) identified Post traumatic stress disorder as a major problem among police personnel working in traumatic situations and found that exposure to stressors outside the range of work leading to demoralization and brutalization predisposes them to Post Traumatic stress disorders.
A study by Saathoff and Buckman (1990) evaluated 26 state police officers who were self referred by the department, revealed that the most common primary diagnosis was Adjustment disorders followed by Substance abuse and Personality disorders.
Vena et al (1986) reported that Ischemic heart diseases and Acute Myocardial infarction are very high among police officers subjected to higher degrees of stress.
Mathur (1995) has reported that police personnel were well aware of the stress encountered on a day to day basis in a study involving 71 gazzeted officers and 81 subordinate officers. About 85% of officers from both the groups admitted suffering from stress due to their occupation. The major stressors among the senior officers were neglecting family, inspection tours, frequent transfers, trouble with boss and staying away from family while those in subordinate officers included neglect of family, non grant of leave, doing VIP security duty, performing unofficial work etc.
A study by Prof. S.M.Channa Basavanna et al (1996) obtained data from 2,354 police personnel belonging to various ranks identified the psychiatric morbidity and the various factors contributing to their mental health problems using the 12 item General Health Questionnaire and a six indices semi structure questionnaire developed to measure the factors responsible for work related stress in police personnel. They observed that 28.6% to 48% were screened positive for having a psychiatric disorder and after detailed psychiatric evaluation; psychiatric morbidity is established in 24.4% to 36.8% of the participants. Depressive disorders and Dysthymia are found to be the commonest (10% each) diagnoses followed by Anxiety disorders (in 3.48.7%) and Alcohol related problems (in 2.7%). It was observed that the Police personnel are under continuous and constant stress due to a number of factors operating in work and family and the common reasons for their Job dissatisfaction included extreme work load, extended duty hours, interpersonal relations between police men and lack of time with family etc. It was further recommended that police hospitals need to regularly assess mental health besides the physical health and the police personnel should be educated about coping strategies to deal with job stress.
P.K.Chakraborthy (2002) in a study of Armed forces personnel compared 22 patients who made suicidal acts with 21 randomly selected in-patients and 30 well adjusted controls. He observed that higher incidence of disciplinary problems, poor peer relations and poor authority relations, conflict between patients and their fathers are related more to psychiatric problems in general and specifically to attempted suicides. Persons who make suicidal gestures have difficulty with male authority figures and are impulsive and those who showed clear impulsive behavior, disciplinary problem and poorer peer and authority relations were discharged from service prematurely.
C.R.Samanta (1993) investigated the relationship between distress and job performance in 500 industrial workers in public and private sectors and observed that total, physical and mental distress are significantly and negatively correlated with worker's performance. Distress like mental worries, depression, feeling of insecurity, anxiety, etc. on the mental side and hypertension, indigestion, weak cardiovascular system, weak musculoskeletal systems, high fatigability, high frequency of illness on the physical side are bound to produce an adverse effect on the worker's concentration, devotion and attention to his job.
D.Saldanha (1992) have studied 822 subjects admitted into a Zonal referral hospital of the Armed forces over a period of 2 years and found that Alcohol Dependence Syndrome constituted the third largest group among the psychiatric population in the Armed Forces and Preventive measures such as forced abstinence, change in attitude towards drinking and attempts to induce a global change in the individual's mental make up had a salutary effect only on 1/3r d of the alcoholics who were treated.
The stress faced by the persons in the Central Industrial security force is considered as unique from the other Armed forces as the CISF is being called upon to provide security in more highly stressful and disastrous situations. As there is a dearth of literature focusing on this population in particular, we have undertaken an Epidemiological survey to find the psychiatric morbidity and the levels of stress in the Central Industrial security force.
| Aims|| |
- To assess the psychiatric morbidity in a cross sectional population of CISF of various ranks.
- To assess the perceived stress by various personal (according to ranks)
- to see if the stressful area of posting in the last year will have any impact on either psychiatric morbidity or perceived stress
Few platoons of the Central Industrial Security Force will come for training of various courses at the Head quarters situated at Hakimpet Hyderabad. The selection of subjects is based on stratification. The subjects in the fields were from various postings, some relatively more stressful and some relatively non stressful as determined by officials of the rank of commandant. This is arrived at not only the perception of the stress by filed personal but also by leave seeking pattern, sickness behavior as perceived by visits to hospital.
First level stratification: At the first level stratified sample was divided based on the positions or ranks of the subjects into two strata (i) Constables and Head constables as one group , (ii) Mid rank officers, Sub inspectors and Inspectors and Asst. commandants as another group.
Second level stratification: At the second level these two groups were further stratified based on the relatively stressful and relatively non stressful areas based on the last 2 years of posting place, as determined by the authorities' perception of posting place. These perceptions are based on few objective parameters like sickness absenteeism, leave seeking behavior, complaints records and some subjective perception of officers of Constables and Head constables' behaviors. Proportionate samples from each of these divisions were drawn up and final list was developed.
From the list of the subjects proportionate samples were randomly selected, from each of the divisions (platoons), based on random sampling technique. The areas of functioning for the CISF broadly can be categorized into three groups - the Fire, Executive and Disaster. The Fire groups are concerned with preventive and resuscitative measures during Fire outbreaks. The Executive groups are the 'stressful' postings group. The disaster groups are recently evolved and are concerned with providing security in Naxalite affected areas and during natural disasters like floods, earthquakes, Tsunamis etc.
Sufficient care was taken to include the subjects posted from all over the country with special reference to the stratification. Prior to the study, a coordinator in the Central Institute of Industrial Security Force Academy, Dindigul, an Assistant Commandant rank was selected for the smooth conduction to help the research of the study. This coordinator has coordinated after the subjects were selected to bring them for study. Place and time of interviews were decided and about 15 to 20 subjects were interviewed per day. The interviews were performed at the Academy, at interview rooms. The interviews were performed without any officers or other colleagues around.
All the samples personals medical records were collected to correlate the medical consultations and medical morbidity.
Background of interview format:
In the process of planning of the study and to plan development of the understanding of the working pattern, work load, areas of stress and mental health problems, interviews were performed with Inspector General of C.I.S.F., few commandants, Deputy Commandants, Asst. Commandants, Inspectors, Sub inspectors and Constables. Based on the discussions a semi structured questionnaire was developed on the identified variables.
A questionnaire adopted by Channabasavanna et al (1996), was also selected and used to derive a final questionnaire.
A questionnaire thus developed was initially administered to about 30 subjects of various ranks to check for the comprehensibility, acceptability and relevance and was validated against questionnaire prepared by channabasavanna etal; there were 0.91 concordance between two scales.
| Tools Used in Assessment|| |
1. Socio demographic variables : A semi structured interview schedule focused on personal characteristics, family characteristics, if staying with family and work related factors developed for the study purpose - was used.
2. Screening questionnaire : General health questionnaire (GHQ), 30 item questionnaire - This is a self administered questionnaire for screening of non psychotic mental health instrument. (Hindi version which was earlier used and validated by Chaturvedi et al 1996 was used.)
3. Diagnostic assessment : All the subjects who have scored 55 or above were examined for detailed psychiatric diagnosis using the M.I.N.I Mini International (Version 5) Neuropsychiatric Interview, version 5. Most of the interviews were performed by senior authors (GPR or GS). The diagnosis was based on D.S.M. IV criteria.
4. Stress and coping questionnaire as adapted from (Channabasavanna et al 1996). This is a 67 item questionnaire with one open ended question to tap any other problem not already covered.
This questionnaire aims to assess on 4 point Lickert scale - Poor to Very good. The content mainly includes job tensions, relationship problems at work, and relationship problems with family members.
The total sample consisted of 520 subjects out of whom 120 were posted in more stressed out areas and 400 were posted in less stressed out areas in the past 2 years. Their distribution with respect to the three groups of Fire, Executive and Disaster are as shown in [Table 1].
The socio-demographic characteristics of the sample are shown in [Table 2]. Majority of the subjects in both the areas belonged to the age group of 30-39 years and majority of them are Males. Females constituted only 1.7% of the total sample.
With respect to their education most of the subjects in the rank of Constables are educated up to Intermediate and majority of those in the rank of Officers had at least Graduate level of education.
The monthly income for most of the subjects irrespective of their rank is in the range of 50017000 Rs per month. About one fifths of the subjects in the rank of officers have monthly income exceeding Rs 7000 per month.
When asked if their monthly income is sufficient or not, more than two thirds in the rank of constables expressed that their monthly income is not enough for the maintenance of their families and more than half of the personnel in the rank of officers felt that their income is sufficient [Table 3]. The differences as measured using chi square test did not reach statistical significance.
As shown in [Table 4] more than three fourths of the subjects in all the groups except officers in low stress areas are married. There are no significant differences between the groups with regards to their marital status on chi-square.
About 60% of the subjects in the rank of constables in all the areas are not staying currently with their families and more than half of those in the rank of officers are staying with their families.[Table 5].
During interviews using the stress and coping questionnaire majority of them revealed 'staying away from family' as the major causes of stress. Some of them expressed concerns that even though they are married they have to live 50% of the time as bachelors and for those in the field it may go up to 90%. They expressed concerns regarding their inability to take family responsibilities such as sickness of family members, children's education, and inability to provide emotional support to their kids. For those whose family stayed with the personnel they expressed worry regarding the loss of their local identity for eg, that their children cannot speak or write in their mother tongue.
As shown in [Table 6], about 60% of the subjects in the rank of constables and about one third in the rank of executives irrespective of their areas of work expressed that the time they spent with their families was inadequate.
Using the chi-square test it was observed that significantly greater number of the personnel especially those working in lower ranks of constables and those working in areas of high stress feel that they do not spend adequate time with the family due to their high work load.
[Table 7] shows the comparison of the sample from less stress and more stress areas for those who scored above or below the cut off score of 55 on the 30item General health questionnaire. Out of the 520 subjects screened, 181 (28.8%) have scored above the GHQ cut off score. On comparison using the Chi square test, it was found that significantly greater number of constables working in high stress areas have scored above the GHQ cut off score of 55 and no significant difference was found for higher rank officials.
After detailed evaluation using the Mini international Neuropsychiatric interview, M.I.N.I the presence of psychiatric morbidity and the specific psychiatric diagnoses are confirmed. The [Table 8] represents the diagnostic break up of the sample for diagnoses made using the M.I.N.I. It is obvious that there seems to be a higher psychiatric morbidity among the more stress group and even in this group compared to officers, constables have a high percentage of disorders. Mostly it is major depressive disorder and generalized anxiety disorder. Other common psychiatric diagnoses identified in the sample were Dysthymia, Panic disorder, Bipolar affective disorder and Alcohol dependence syndrome.
Comparing the personnel from High stress and low stress areas with respect to their psychiatric diagnoses using the Chi-square test, the CISF personnel working in high stress areas belonging to lower ranks of constables are found to have significantly greater prevalence of all of the psychiatric disorders except for Dysthymia for which the difference is not significant. Also in the high stress areas the constables are observed to have significantly greater prevalence of Generalized anxiety and Major depressive disorders compared to higher rank personnel.
With regards to their perceived work load, two third of all the CISF personnel posted in high stress areas said that their work load is extremely high. Using Chi-square test it was observed that significantly greater number of Constables working in High stress areas have perceived their work load as 'extremely high' and the difference has not reached statistical significance for those in higher rank officers. More than half to three fourths of the personnel in all areas of stress and from all ranks have felt that their work load is 'High' or 'Extremely high' [Table 9]. Only 10-20% of them have said that their workload is tolerable and is 'OK'.
Considering the main factors which contributed to their high level of work load, the commonest factors for high work stress were identified as 'Absence of regular work timing patterns' and 'Not getting leave' as reported by 87% of the subjects interviewed. About three fourths are concerned about the lack of concern of their seniors and lack of appreciation and encouragement for the work done by them.
Another two-thirds have said that the cause of their work stress is 'lack of well defined roles' as they are being trained for something and are assigned something else, and 'having no recognition of their merit'. Half of the subjects felt that there is no recognition of their personal relations.[Table 10]
An intriguing finding in the study was that about 26% of the CISF personnel expressed dissatisfaction about their financial status as they do not get extra money in the form of 'corruption' like the civil police.
| Discussion|| |
The study aimed at assessing the Prevalence of Psychiatric morbidity and delineating the various factors responsible for causing stress in the Central Industrial Security Force.
Our study population is unique from the earlier studies of Prof.S.M.Channa basavanna (1996) on the Police forces and that of Dr.P.K.Charaborthy (2002) on the Armed force personnel. The Central Industrial Security force as such have a unique and flexible training and work pattern which makes them ready to deal with various kinds of emergencies and disasters. Their Hierarchal pattern is different from the police and Armed forces as is their work environment. We have taken care so that thorough stratification is done to include persons working in all ranks from all areas of posting and have taken considerable size of the sample so as to enhance the statistical power of the observations made.
In the total sample screened, majority were Males in the age group of 30-39 yrs, married and having at least intermediate level of education.
The prevalence of psychiatric morbidity in the sample is found to be about 28.8% and the most common psychiatric diagnoses being Major depressive disorder and Generalized Anxiety disorder which is similar to the observations made by Prof.S.M.Channabasavanna et al (1996).
Quite a few of the subjects have met criteria for Alcohol dependence syndrome, therefore in contrast to the earlier observations in the Armed forces and police personnel, Alcoholism does not seem to be a significant problem in the present study population.
Also during the study we have found that the CISF persons are facing considerable amount of stress and the various factors operating in the family and at work are considered as their causes of stress. Among the other stressors most of them are related to work such as 'having no regular timings of work' and 'having to work excess time in need', 'having no well defined roles' I.e. being trained to do something and made to work in a different field, 'getting no appreciation from seniors' and 'having no close or personal relations'. Most of these are different from the causes of stress as observed in the earlier studies.
Apart from the other factors, 'staying away from their families' is identified an important cause of stress in the CISF personnel and most of the subjects especially from the lower ranks like constables felt that the time they spent with their families was inadequate, and hence they felt that they are unable to take enough responsibility in the families.
And regarding their perceived work load, significantly greater number of personnel from high stress areas, have felt that their work load is extremely high. However one additional cause of concern in our sample was their low financial situation as they do not get 'extra money' and benefits like the civil police.
| Conclusion|| |
In conclusion, this is the first epidemiological survey into the prevalence of psychiatric morbidity and stress in the Central Industrial security force as this particular paramilitary force is considered distinct from other Armed forces with respect to their pattern of work and their levels of stress. The strengths of our study being the huge sample size which is thoroughly stratified and randomly selected at various levels.
| Recommendations|| |
The following recommendations are drawn from the present study:
- There should be regular screening of the mental health of the CISF personnel with the help of psychiatrists, psychologists and counselors apart from their physical health check ups.
- The personnel should be educated about strategies to cope with job related stress on a regular basis.
- Appropriate changes could be made in the organizational system so as to minimize the stressful factors at work by regularizing the times of work, defining their roles, having uniform policies for promotion and obtaining leave etc.
- The work environment could be made more cordial by strengthening the interpersonal relationships between officers and sub-ordinates and by providing encouragement in the form of timely rewards and reinforcements.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10]