Cluster Profiles of Alcohol Use, Expressed Emotion, and Quality of Life Among Persons with Alcohol Dependence and Their Caregivers In Tribal Communities In India

Background: Alcohol dependence is associated with disruptions in emotional functioning and well-being, particularly in tribal communities where socio-economic vulnerabilities and cultural norms around alcohol consumption amplifies caregiving difficulties. Prior research has shown alcohol use, expressed emotion, and quality of life are closely related; however, these factors are often examined independently. Additionally, tribal populations remain underrepresented in research on these psychosocial processes. Given the potential for these factors to co-occur in complex and heterogeneous ways, a person-centered approach is warranted. The present study aimed to identify distinct profiles based on these factors and examine differences across these profiles.

Methods: This exploratory cross-sectional study employed a person-centered analytic approach to identify subgroups of participants with similar psychosocial profiles. Participants included persons with alcohol dependence syndrome (ADS) and their primary caregivers (n=150 dyads) recruited from tribal communities in forest regions of Karnataka, India. Measures included the Alcohol Use Disorders Identification Test (AUDIT), Family Emotional Involvement and Criticism Scale (FEICS), and World Health Organization Quality of Life scale (WHOQOL). Weak correlations indicated the possibility that these variables may interact in more complex, non-linear ways. Accordingly, K-means cluster analysis was used to identify groups of participants with similar patterns across the three variables. Cluster analysis was conducted at the dyadic level, combining patient alcohol severity and caregiver psychosocial variables. The number of clusters was evaluated using the elbow method, which supported a three-cluster solution. Before conducting cluster analysis, scores on the AUDIT, FEICS, and WHOQOL were standardized (z-scores) to ensure that each variable contributed equally to the clustering solution. Three one-way ANOVAs with Tukey post hoc tests were performed to assess differences across clusters.

Results: A three-cluster solution emerged. Cluster 1 (n = 39, 26.4%) was characterized by below-average expressed emotion (z = −0.83), alcohol use (z = −0.92), and quality of life (z = −0.81). Cluster 2 (n = 40, 27.0%) demonstrated higher alcohol use (z = 1.03), moderate expressed emotion (z = −0.24), and below-average quality of life (z = −0.57). Cluster 3 (n = 69, 46.6%) was characterized by above-average expressed emotion (z = 0.61) and quality of life (z = 0.79), with near-average alcohol use (z = −0.08). Significant differences were observed across clusters for expressed emotions (F(2, 145) = 43.67, p < .001, η² = .38), alcohol use (F(2, 145) = 77.36, p < .001, η² = .52), and quality of life (F(2, 145) = 91.77, p < .001, η² = .56).

Conclusions and Implications: The findings show three distinct psychosocial profiles, indicating that alcohol-related risk, family emotional processes, and quality of life cluster differently within tribal communities. These differences suggest that one-size-fits-all approaches for interventions may be insufficient. For social work practice, the findings support culturally responsive, family-centered assessment and intervention strategies that should account for variation in family emotional processes and overall functioning, rather than focusing solely on alcohol use. They also highlight the importance of developing interventions in partnership with caregivers in tribal communities, ensuring that services are grounded in local cultural contexts.