Stigmatization of severe mental illness in India: Against the simple industrialization hypothesis

Abstract

Background:Major international studies on course and outcome of schizophrenia suggest a better prognosis in the rural world and in low-income nations. Industrialization is thought to result in increased stigma for mental illness, which in turn is thought to worsen prognosis. The lack of an ethnographically derived and cross-culturally valid measure of stigma has hampered investigation. The present study deploys such a scale and examines stigmatizing attitudes towards the severely mentally ill among rural and urban community dwellers in India.Aim:To test the hypothesis that there are fewer stigmatizing attitudes towards the mentally ill amongst rural compared to urban community dwellers in India.Materials and Methods:An ethnographically derived and vignette-based stigmatization scale was administered to a general community sample comprising two rural and one urban site in India. Responses were analyzed using univariate and multivariate statistical methods.Result:Rural Indians showed significantly higher stigma scores, especially those with a manual occupation. The overall pattern of differences between rural and urban samples suggests that the former deploy a punitive model towards the severely mentally ill, while the urban group expressed a liberal view of severe mental illness. Urban Indians showed a strong link between stigma and not wishing to work with a mentally ill individual, whereas no such link existed for rural Indians.Conclusion:This is the first study, using an ethnographically derived stigmatization scale, to report increased stigma amongst a rural Indian population. Findings from this study do not fully support the industrialization hypothesis to explain better outcome of severe mental illness in low-income nations. The lack of a link between stigma and work attitudes may partly explain this phenomenon.

Medical and nursing students’ attitudes toward mental illness: An Indian perspective

“…26 These findings were contrary to an Indian study that proved more stigmatizing attitude towards persons with mental illness by the rural participants. 27 In support of earlier research, 28 present study also demonstrated, students those were familiar with people with mental illness hold least restrictive and more benevolent attitudes toward mental illness. Never the less, numerous studies among nursing 29 and medical students 30 revealed that there was a positive change in their attitudes towards persons with mental illness after completion of psychiatry course.…”

“…Ex: "It is not appropriate for a person with mental illness to get married"; (iv) Benevolence (reverse coded): includes eight items (18-23, 25, 26) related to kindness and sympathetic views of the respondents towards people with a mental illness. Ex: "People with mental illness can hold a job"; (v) Pessimistic prediction: composed of four items (27)(28)(29)(30) intended to measure the level of prejudice toward mental illness. Ex: "It is harder for those who have a mental illness to receive the same pay for the same job"; and (vi) Stigmatization: includes four items (31-34) that measure the discriminatory behavior of the students toward mental illness.…”

Culture, Psychiatry and Cultural Competence

“…Negative attitudes and stigma directly affects the clinical practice in psychiatry (Byrne, 1999). Stigmatization of individuals with mental illnesses is widespread (Chowdhury et al, 2001;Jadav et al, 2007) and serves as a major barrier to proper mental health care and the better quality of life (Mann & Himelein, 2004;Charles et al, 2007). Reduction of stigma against persons with mental illness is a serious preventive work (Arboleda & Sartorius, 2008;Crisp et al, 2000) at all levels of mental health work-from clinic, hospitals, institution to community (Penn & Couture, 2002).…”

Undergraduate nursing students’ attitude towards mental illness: a cross sectional study

“…In day to day practice it is seen that undergraduate nursing students show unfavorable attitudes toward psychiatric/mental health nursing as a career. 5 Nursing students are future health manpower of our country. They will be part of societal development.…”