Stigma and mental health problems in an Indian context. Perceptions of people with mental disorders in urban, rural and tribal areas of Kerala

Abstract

Background: The concept of stigma has been widely used to understand patterns of discrimination and negative ideas surrounding people with mental health problems, yet we know little of the specific nuances of how this might operate beyond the ‘Global North’. Aim: This paper aims to explore the notion of stigma in an Indian context by considering the lived experience of patients, carers and community members. Methods: A sample of 204 participants, representing mental health patients, informal carers and community members was recruited from urban and rural areas in Kerala, India. Participants took part in interviews where they were encouraged to talk about their experiences of mental ill health, attitudes towards these problems, barriers encountered and sources of support. Results: Experiences akin to the experience of stigma in Europe and the United States were elicited but there were important local dimensions specific to the Indian context. The difficulties faced by people with diagnoses of mental disorders in finding marriage partners was seen as an important problem, leading to marriage proposals being refused in some cases, and secrecy on the part of those with mental health problems. Rather than the ‘self-stigma’ identified in the US, participants were more likely to see this as a collective problem in that it could reflect badly on the family group as a whole rather than just the sufferer. Conclusions: In the Indian context, the idioms of stigma emphasised impairments in marriage eligibility and the implications for the family group rather than just the self.

Reliability and validity of Malayalam version of 12-item Community Attitude Towards Mental Illness (CAMI-12) questionnaire

“…34 Our study has found that 28% of participants had high levels of stigma towards people with mental illness, and this finding is consistent with other Indian studies as well as studies from Kerala. [18][19][20][21][22][23][24] Our study was conducted in a tertiary care setting and would have resulted in a Berksonian bias as majority of the patients attending our centre are having severe MI. The readministration of CAMI-12 at four weeks may have contributed to a recall bias.…”

“…Further, unlike the 'self-stigma' identified in the US, participants were more likely to see stigma as a collective problem which could reflect badly on the family group as a whole. 22 A cross-sectional exploratory survey among 708 college students from Kerala, using a 16-item checklist with yes or no response options that the authors developed, found that amongst the collegegoing population there is considerable stigma about MI and there are prejudices and misinformation about the treatment of mental health problems. 23 Another cross-sectional study among 200 medical students in Kerala using Attitude towards Mental Illness (AMI) questionnaire found that their attitude towards mental illness was not appropriate.…”

Breaking the barriers: overcoming dementia-related stigma in minority communities

“…Further to this, it is not solely the person living with the condition that is impacted by stigma attached to the condition, often there are significant flow-on effects on families and carers ( 24–27 ). This can include shame of having a relative with a stigmatizing condition, fear that the illness may run in the families impacting social standing and in some cultures impact marriage prospects for other family members ( 27 ).…”