Stigma among Singaporean youth: a cross-sectional study on adolescent attitudes towards serious mental illness and social tolerance in a multiethnic population

Abstract

ObjectivesStigma against mental illnesses is one of the significant obstacles faced by mental health service users and providers. It can develop at a young age and is also influenced by culture. Youths in Southeast Asian countries are under-represented in mental health research, thus this study aims to explore the dimensions of stigma and social tolerance and examine its correlates in the younger, multiethnic population of Singapore.DesignAn online survey collected data with sociodemographic questions, the Attitudes Towards Serious Mental Illness (Adolescent version) Scale, Social Tolerance Scale and an open-text question on words or phrases participants associated with the term ‘mental illness’. Principal component analysis and multiple regression models were conducted to investigate the factor structure of the attitudes and social tolerance scales and their sociodemographic correlates.ParticipantsParticipants included 940 youths aged 14–18 years old who were residing in Singapore at the time of the survey and were recruited through local schools.ResultsAbout a quarter of the students (22.6%) reported participating in mental health awareness campaigns while nearly half (44.5%) associated pejorative words and phrases with the term mental illness. The Attitudes Towards Serious Mental Illness (Adolescent version) Scale yielded five factors while the Social Tolerance Scale yielded two. Ethnicity, gender and nationality were significantly correlated with factors of both scales. Chinese youths showed higher sense of ’physical threat' and lower ’social tolerance' than those of other ethnicities. Females showed more ’wishful thinking', ’social concern' and ’social responsibility' towards the mentally ill than males.ConclusionsThe dimensions of stigma and social tolerance are different in Asian cultures compared with Western cultures. Sociodemographic differences in attitudes towards the mentally ill were found among youths living in Singapore. Misconceptions and negative attitudes towards mental illness are common, demonstrating a clear need for effective stigma reduction campaigns.

Mental illness stigma’s reasons and determinants (MISReaD) among Singapore’s lay public – a qualitative inquiry

“…There is a widespread belief denoted by the Chinese culture that mental illness is a result of some form of moral "defect" on the sufferer's part or within their family. This possibly explains why earlier local studies found Chinese to have less social tolerance and more negative attitudes towards PMI as compared to other ethnicities [32,33]. In any case, the implications of such cultural beliefs probably resulted in mental illness being equated to a "loss of face" for the PMI and the family.…”

“…According to Kutcher et al, "Mental health literacy interventions need to be contextually developed and developmentally appropriate", and such interventions have to be framed in appropriate domains and delivered in the context relevant to the target audience [31]. Although there has been earlier work published pertaining to stigma in Singapore, none of those were qualitative in nature [32,33]. Therefore, this study seeks to elucidate the determinants of the stigma towards mental illness in Singapore and to investigate the cultural influences of stigma if any, from the perspective of the general public, by utilizing a qualitative approach.…”

Overview of Stigma against Psychiatric Illnesses and Advancements of Anti-Stigma Activities in Six Asian Societies

“…The Chinese Singaporeans reported the highest social distance scores to people with mental illnesses [98]. Similarly, another study assessing adolescent attitudes suggests that young Chinese Singaporeans display a higher sense of physical threat and lower social tolerance towards people who are mentally ill than youths of other ethnicities [99].…”

Stigma and Life Satisfaction among Out-of-School Korean Youths: The Mediating Roles of Self-Esteem and Depression

“…Youths sometimes are stigmatized and discriminated against by their peers because they are unusual in some way, such as obese, pregnant, HIV positive, sexual minority, mentally ill, or they are early leavers [13][14][15][16][17]. Almost one-half (47%) of out-of-school youths in Korea felt stigmatized in their relationships with peers, family members, and neighbors, which led to the loss of friendships and unwarranted assumptions, distrust, pity, avoidance, and underestimation of their abilities [6].…”