Stigma towards mental illness in South Asian communities: A summary of three studies
DOI:
https://doi.org/10.1921/swssr20252616Keywords:
stigma towards mental illness, South Asia, community engagement, attribution questionnaireAbstract
Social workers work with many disadvantaged and stigmatised groups. People with mental health problems have been stigmatised for centuries. In the last few decades attempts have been made to reduce levels of stigma in the general population, such as with the Time to Change program in the United Kingdom. Yet, there is so much about stigma we still do not understand, which has been referred to by Smith as stigma’s ‘dark matter.’ For instance, how do levels of stigma vary among different cultures? In this paper we consider what affects stigma in South Asian populations. After a short review of the literature in Sri Lanka, Pakistan, and India, we describe three studies we have conducted in this area. The first was a quantitative online survey, that used a previously published vignette to assess elements of stigma in 425 participants. The second comprised interviews with 15 people of South Asian heritage. The third was a community engagement event which brought together 99 mental health professionals and community activists for a hybrid educational event. The three studies are presented and discussed. Some tentative conclusions are offered
References
Abdullah, T., and Brown, T. L. (2011) Mental illness stigma and ethnocultural beliefs, values, and norms: An integrative review. Clinical Psychology Review, 31(6), 934-948. https://doi.org/10.1016/j.cpr.2011.05.003
Ali, O. M., Milstein, G., and Marzuk, P. M. (2005) The imam’s role in meeting the counseling needs of Muslim communities in the United States. Psychiatric Services, 56(2), 202-205. https://doi.org/10.1176/appi.ps.56.2.202
Amarasuriya, S. D., Jorm, A. F., Reavley, N. J., and Mackinnon, A. J. (2015) Stigmatising attitudes of undergraduates towards their peers with depression: A cross-sectional study in Sri Lanka. BMC Psychiatry, 15(1). https://doi.org/10.1186/s12888-015-0523-9
Baminiwatta, A., Bandara, W., Athurugiriya, A., Yangdon, T., Cader, G., Bokalamulla, L., Bandara, W., Bandara, W., Chandradasa, K., Athukorala, H., and Dias, G. (2020) A nationwide survey of attitudes towards psychiatry among final-year medical students in Sri Lanka. Asian Journal of Psychiatry, 52, 102101. https://doi.org/10.1016/j.ajp.2020.102101
Bell, J. S., Aaltonen, S. E., Bronstein, E., Desplenter, F. A., Foulon, V., Vitola, A., Muceniece, R., Gharat, M. S., Volmer, D., Airaksinen, M. S., and Chen, T. F. (2008) Attitudes of pharmacy students toward people with mental disorders, a six-country study. Pharmacy World & Science, 30(5), 595-599. https://doi.org/10.1007/s11096-008-9211-x
Böge, K., Zieger, A., Mungee, A., Tandon, A., Fuchs, L., Schomerus, G., Tam Ta, T., Dettling, M., Bajbouj, M., Angermeyer, M., and Hahn, E. (2018) Perceived stigmatization and discrimination of people with mental illness: A survey-based study of the general population in five metropolitan cities in India. Indian Journal of Psychiatry, 60(1), 24.
Castillo, E. G., Ijadi-Maghsoodi, R., Shadravan, S., Moore, E., Mensah, M. O., Docherty, M., Aguilera Nunez, M. G., Barcelo, N., Goodsmith, N., Halpin, L. E., Morton, I., Mango, J., Montero, A. E., Rahmanian Koushkaki, S., Bromley, E., Chung, B., Jones, F., Gabrielian, S., Gelberg, L., Greenberg, J. M., … Wells, K. B. (2019) Community interventions to promote mental health and social equity. Current Psychiatry Reports, 21(5), 35. https://doi.org/10.1007/s11920-019-1017-0
Cinnirella, M., and Loewenthal, K. M. (1999) Religious and ethnic group influences on beliefs about mental illness: A qualitative interview study. British Journal of Medical Psychology, 72(4), 505-524. https://doi.org/10.1348/000711299160202
Corrigan, P. (2004) How stigma interferes with mental health care. American Psychologist, 59(7), 614-625. https://doi.org/10.1037/0003-066x.59.7.614
Corrigan, P. W., Roe, D., and Tsang, H. W. (2011) Understanding and measuring stigma. In, Challenging the stigma of mental illness: Lessons for therapists and advocates (pp. 23-54). John Wiley & Sons.
Corrigan, P. W., and Watson, A. C. (2002) The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice, 9(1), 35-53. https://doi.org/10.1093/clipsy.9.1.35
Corrigan, P. W., Watson, A. C., Gracia, G., Slopen, N., Rasinski, K., and Hall, L. L. (2005) Ng, C. H. (1997). The stigma of mental illness in Asian cultures. Australian & New Zealand Journal of Psychiatry, 31(3), 382-390. https://doi.org/10.3109/00048679709073848
Corrigan, P. W., Watson, A. C., Gracia, G., Slopen, N., Rasinski, K., and Hall, L. L. (2005) Newspaper stories as measures of structural stigma. Psychiatric Services, 56(5), 551-556. https://doi.org/10.1176/appi.ps.56.5.551
Corrigan, P., Markowitz, F. E., Watson, A., Rowan, D., and Kubiak, M. A. (2003) An attribution model of public discrimination towards persons with mental illness. Journal of Health and Social Behavior, 44(2), 162. https://doi.org/10.2307/1519806
Ediriweera, H. W., Fernando, S. M., and Pai, N. B. (2012) Mental health literacy survey among Sri Lankan carers of patients with schizophrenia and depression. Asian Journal of Psychiatry, 5(3), 246-250. https://doi.org/10.1016/j.ajp.2012.02.016
Feeg, V. D., Prager, L. S., Moylan, L. B., Smith, K. M., and Cullinan, M. (2014) Predictors of mental illness stigma and attitudes among college students: Using vignettes from a campus common reading program. Issues in Mental Health Nursing, 35(9), 694-703. https://doi.org/10.3109/01612840.2014.892551
Fernando, S. M., Deane, F. P., & McLeod, H. J. (2010) Sri Lankan doctors’ and medical undergraduates’ attitudes towards mental illness. Social Psychiatry and Psychiatric Epidemiology, 45(7), 733-739. https://doi.org/10.1007/s00127-009-0113-6
Fernando, S. M., Deane, F. P., McLeod, H. J., and Davis, E. L. (2017) A carer burden and stigma in schizophrenia and affective disorders: Experiences from Sri Lanka. Asian Journal of Psychiatry, 26, 77-81. https://doi.org/10.1016/j.ajp.2017.01.023
Fink, P. J., and Tasman, A. (1992) Stigma and Mental Illness. American Psychiatric Association.
Gilbert, P., Gilbert, J., and Sanghera, J. (2004) A focus group exploration of the impact of izzat, shame, subordination and entrapment on mental health and service use in South Asian women living in Derby. Mental Health, Religion & Culture, 7(2), 109-130. https://doi.org/10.1080/13674670310001602418
Guthrie, E., Abraham, S., and Nawaz, S. (2016) Process of determining the value of beliefs about jinn possession and whether or not they are a result of mental illness. BMJ Case Reports, 1-4. https://doi.org/10.1136/bcr-2015-214005
Husain, M. O., Zehra, S. S., Umer, M., Kiran, T., Husain, M., Soomro, M., Dunne, R., Sultan, S., Chaudhry, I. B., Naeem, F., Chaudhry, N., and Husain, N. (2020) Stigma toward mental and physical illness: Attitudes of healthcare professionals, healthcare students and the general public in Pakistan. BJPsych Open, 6(5). https://doi.org/10.1192/bjo.2020.66
Inman, A. G., Yeh, C. J., Madan-Bahel, A., and Nath, S. (2007) Bereavement and coping of South Asian families post 9/11. Journal of Multicultural Counseling and Development, 35(2), 101-115. https://doi.org/10.1002/j.2161-1912.2007.tb00053.x
Institute for Research and Development in Health and Social Care. (2007) Baseline National Surveys; Schools and Community Based, to assess the Prevalence of Mental Illness including Suicidal Ideations and to Study the Attitudes of Professionals and the Public, on Mental Health in Sri Lanka. https://www.ird.lk/wp-content/uploads/2007/03/NMHS-Final-Report-15-10-2008.pdf
Kermode, M., Bowen, K., Arole, S., Pathare, S., and Jorm, A. F. (2009) Attitudes to people with mental disorders: A mental health literacy survey in a rural area of Maharashtra, India. Social Psychiatry and Psychiatric Epidemiology, 44(12), 1087-1096. https://doi.org/10.1007/s00127-009-0031-7
Kishore, J., Jiloha, R., Gupta, A., and Bantman, P. (2011) Myths, beliefs and perceptions about mental disorders and health-seeking behavior in Delhi, India. Indian Journal of Psychiatry, 53(4), 324. https://doi.org/10.4103/0019-5545.91906
Lauber, C., and Rössler, W. (2007) Stigma towards people with mental illness in developing countries in Asia. International Review of Psychiatry, 19(2), 157-178. https://doi.org/10.1080/09540260701278903
Lim, A., Hoek, H. W., and Blom, J. D. (2015) The attribution of psychotic symptoms to jinn in Islamic patients. Transcultural Psychiatry, 52(1), 18-32. https://doi.org/10.1177/1363461514543146
Link, B. G., and Phelan, J. C. (2001) Conceptualizing stigma. Annual Review of Sociology, 27(1), 363-385. https://doi.org/10.1146/annurev.soc.27.1.363
McDowell, C., Randell, A., and Bartholomeusz, C. (2023) Evidence to practice: Universal, community-based approaches to enhance young people’s wellbeing. Part 2: Community engagement. Melbourne: headspace National Youth Mental Health Foundation. https://headspace.org.au/assets/3ef6e60d12/Community-based-approaches-pt-2.pdf
Mungee, A., Zieger, A., Schomerus, G., Ta, T. M., Dettling, M., Angermeyer, M. C., and Hahn, E. (2016) Attitude towards psychiatrists: A comparison between two metropolitan cities in India. Asian Journal of Psychiatry, 22, 140-144. https://doi.org/10.1016/j.ajp.2016.06.014
Musyimi, C. W., Mutiso, V. N., Nandoya, E. S., and Ndetei, D. M. (2016) Forming a joint dialogue among faith healers, traditional healers, and formal health workers in mental health in a Kenyan setting: Towards common grounds. Journal of Ethnobiology and Ethnomedicine, 12(1). https://doi.org/10.1186/s13002-015-0075-6
Naeem, F., Ayub, M., Javed, Z., Irfan, M., Haral, F., and Kingdon, D. (2006) Stigma and psychiatric illness. A survey of attitude of medical students and doctors in Lahore, Pakistan. Journal of Ayub Medical College, Abbottabad: JAMC, 18(3), 46-49. https://pubmed.ncbi.nlm.nih.gov/17348313/
Ng, C. H. (1997) The stigma of mental illness in Asian cultures. Australian & New Zealand Journal of Psychiatry, 31(3), 382-390. https://doi.org/10.3109/00048679709073848
Patel, V., Maj, M., Flisher, A. J., De Silva, M. J., Koschorke, M., Prince, M., and WPA Zonal and Member Society Representatives. (2010) Reducing the treatment gap for mental disorders: A WPA survey. World Psychiatry, 9(3), 169–176.
Randhawa, G., and Stein, S. (2007) An exploratory study examining attitudes toward mental health and mental health services among young South Asians in the United Kingdom. Journal of Muslim Mental Health, 2(1), 21-37. https://doi.org/10.1080/15564900701238518
Rosenberg, M. (1965) Rosenberg self-esteem scale. PsycTESTS
Dataset. https://doi.org/10.1037/t01038-000
Samarasekara, N., Davies, M. L., and Siribaddana, S. (2012) The stigma of mental illness in Sri Lanka: The perspectives of community mental health workers. Stigma Research and Action, 2(2), 93-99. https://doi.org/10.5463/SRA.v1i1.13
Semrau, M., Gronholm, P. C., Eaton, J., Maulik, P. K., Ayele, B., Bakolis, I., Mendon, G. B., Bhattarai, K., Brohan, E., Cherian, A. V., Daniel, M., Girma, E., Gurung, D., Hailemariam, A., Hanlon, C., Healey, A., Kallakuri, S., Li, J., Loganathan, S., … Votruba, N. (2024) Reducing stigma and improving access to care for people with mental health conditions in the community: Protocol for a multi-site feasibility intervention study (indigo-local). International Journal of Mental Health Systems, 18(1). https://doi.org/10.1186/s13033-024-00649-3
Ta, T. M., Zieger, A., Schomerus, G., Cao, T. D., Dettling, M., Do, X. T., Mungee, A., Diefenbacher, A., Angermeyer, M. C., and Hahn, E. (2016) Influence of urbanity on perception of mental illness stigma: A population-based study in urban and rural Hanoi, Vietnam. International Journal of Social Psychiatry, 62(8), 685-695. https://doi.org/10.1177/0020764016670430
Tabassum, R., Macaskill, A., and Ahmad, I. (2000) Attitudes towards mental health in an urban Pakistani community in the United Kingdom. International Journal of Social Psychiatry, 46(3), 170-181. https://doi.org/10.1177/002076400004600303
Thara, R., and Srinivasan, T. (2000). How stigmatising is schizophrenia in India? International Journal of Social Psychiatry, 46(2), 135-141. https://doi.org/10.1177/002076400004600206
Thornicroft, G., Rose, D., Kassam, A., and Sartorius, N. (2007) Stigma: Ignorance, prejudice, or discrimination? British Journal of Psychiatry, 190(3), 192-193. https://doi.org/10.1192/bjp.bp.106.025791
UNICEF SBC Guidance. (n.d.) Community engagement. https://www.sbcguidance.org/understand/community-engagement
Vankar, J. R., Prabhakaran, A., and Sharma, H. (2014) Depression and stigma in medical students at a private medical college. Indian Journal of Psychological Medicine, 36(3), 246-254. https://doi.org/10.4103/0253-7176.135372
Waqas, A., Zubair, M., Ghulam, H., Wajih Ullah, M., and Zubair Tariq, M. (2014). Public stigma associated with mental illnesses in Pakistani university students: A cross-sectional survey. Peer Journal, 2, e698. https://doi.org/10.7717/peerj.698
Warner, R. (1996) The cultural context of mental distress. In, J. Reynolds, R. Gomm, & R. Muston (Eds.), Mental Health Matters: A Reader (pp. 54-63). Macmillan.
World Health Organization (WHO) (2020) Community Engagement: A health promotion guide for universal health coverage in the hands of the people. https://www.who.int/publications/i/item/9789240010529
World Health Organization (WHO) (2024) Deinstitutionalize Mental Health Care, Strengthen Community-based Services: WHO. https://www.who.int/southeastasia/news/detail/12-03-2024-deinstitutionalize-mental-health-care--strengthen-community-based-services--who
Yang, L. H., Kleinman, A., Link, B. G., Phelan, J. C., Lee, S., and Good, B. (2007) Culture and stigma: Adding moral experience to stigma theory. Social Science & Medicine, 64(7), 1524-1535. https://doi.org/10.1016/j.socscimed.2006.11.013
Zieger, A., Mungee, A., Schomerus, G., Ta, T. T., Dettling, M., Angermeyer, M., and Hahn, E. (2016) Perceived stigma of mental illness: A comparison between two metropolitan cities in India. Indian Journal of Psychiatry, 58(4), 432. https://doi.org/10.4103/0019-5545.196706