|Year : 2019 | Volume
| Issue : 3 | Page : 193-200
Attitude toward mental illness among adolescents: A hospital-based study
Harleen Kaur1, Sneha Sharma2, Om Sai Ramesh Vallamkonda3
1 Intern, Department of Psychiatry, Drug De-Addiction Centre, Lady Hardinge Medical College, New Delhi, India
2 Senior Resident, Department of Psychiatry, Drug De-Addiction Centre, Lady Hardinge Medical College, New Delhi, India
3 Associate Professor of Psychiatry, Department of Psychiatry, Drug De-Addiction Centre, Lady Hardinge Medical College, New Delhi, India
|Date of Submission||14-Nov-2018|
|Date of Decision||22-Feb-2019|
|Date of Acceptance||26-Apr-2019|
|Date of Web Publication||30-Sep-2019|
Dr. Om Sai Ramesh Vallamkonda
Department of Psychiatry, Drug De-Addiction Centre, Lady Hardinge Medical College, New Delhi
Source of Support: None, Conflict of Interest: None
Introduction: Stigma, prejudice, and discrimination toward mental illness continue to plague the society despite multiple advances in etiology and treatment. It deprives the persons with mental illness the right to a good quality of life, social support, and also has a direct effect on treatment seeking and compliance. Objective: The main objective of this study was to assess the attitude toward mental illness among adolescents, who might be an untapped human resource in care of persons with mental illness. Methodology: A cross-sectional comparative study of 70 adolescents aged 14–18 years was done. Attitude toward mental illness of adolescents having family members with severe mental illness was compared to adolescents having family members with chronic medical illness. Purposive sampling from a tertiary health-care center was done, and the “Attitude Scale for Mental Illness questionnaire” was administered. Sociodemographic data were collected using a standard pro forma. Results: Descriptive analysis showed an overall positive attitude on separatism, benevolence, and stigma subscale and a negative attitude toward stereotyping, restrictiveness, and pessimistic prediction. No significant difference was observed in the attitudes of adolescents from both the categories.
Conclusion: Adolescents can form an important bridge in reducing the stigma surrounding mental illness.
Keywords: Adolescents, attitude, interpersonal stigma, mental illness
|How to cite this article:|
Kaur H, Sharma S, Vallamkonda OR. Attitude toward mental illness among adolescents: A hospital-based study. Indian J Soc Psychiatry 2019;35:193-200
|How to cite this URL:|
Kaur H, Sharma S, Vallamkonda OR. Attitude toward mental illness among adolescents: A hospital-based study. Indian J Soc Psychiatry [serial online] 2019 [cited 2019 Oct 13];35:193-200. Available from: http://www.indjsp.org/text.asp?2019/35/3/193/268336
| Introduction|| |
The prevalence of mental illness in India has been varyingly reported as ranging from 9.54 to 200/1000 population. Much of it goes unaddressed due to underreporting. The reasons range from lack of knowledge, reluctancy on the part of patient or family members to seek treatment due to the associated stigma, and the prevalence of cultural myths in causation and treatment of mental illness., Society has mostly been biased toward people with mental illnesses, and it is evident in the form of stigmatization, discrimination, neglect, avoidance, or violence against them.,
This attitude stems from a multitude of factors. Some common factors include cultural stereotyping, erroneous portraying by mass media (especially televisions), hearsay about institutional practices of bygone eras, past experiences (lack of good opportunities when it comes to job, education, housing, or health services), and limited personal knowledge, familiarity, and interaction with people living with mental illness.,
All these factors create a platform on which the society interacts with those having mental illness. While prejudice has been linked to increased social distance, factors such as knowledge and education about mental illness are linked to positive social treatment., Common stereotypes held by the general population regarding mental illnesses are violence (considering people living with mental illness to be dangerous), blame (considering them to be of weak character – that they themselves are responsible for the onset and continuation of their illness), and incompetence (considering them to be incapable of independent living).
The word “stigma” is derived from the Greek word stigmata, loosely translating to “a mark of shame or discredit; a stain, or an identifying mark or characteristic.” It is a negative state of feelings, attitudes, and behaviors toward mental illnesses and people with mental illnesses. It has been seen that the stigma varies depending on whether people know someone with a mental health problem, have a family member with a mental health problem, or have a good knowledge and experience of mental health problems. Type of mental illnesses leading to violence and odd noticeable behavior was also shown to have a relation to prevailing stigma. Crisp et al. in a study on 1700 adults found that illnesses such as schizophrenia, alcoholism, and drug dependence were most commonly perceived to be dangerous; eating disorders and substance abuse were thought to be self-inflicted, and majority believed that people with mental health problems were generally hard to talk to.
The patients' positive and negative symptoms also seem to affect the coping abilities of the caregivers which influence their interpersonal stigma (especially intrafamilial). Adequate social support and positive attitude toward one's mental illness are associated with greater service use.
Persons with severe mental illness not only have to cope up with the symptoms of their disease but also with social and self-stigma. Societal attitudes toward severe mental illness lead to lost opportunities for education, employment, and housing. Self-stigma occurs when individuals assimilate social stereotypes about themselves as persons with severe mental illness. Self-stigma results in a loss of self-esteem, diminished self-efficacy, and a hesitancy to participate in society at large.
While stigma in the adult population has widely been studied, there is a dearth of data on the attitude of adolescents toward mental illness. It has been seen that their personal experience, parents' attitudes, intellectual process, assimilation of others' attitudes, and traumatic life experiences affect their attitudes. Although most studies have shown adolescents to have negative attitudes, being a vulnerable age group, they still provide a room for change.
A study of 63 students evaluating the effect of the stigma and discrimination reduction program showed favorable results. Social discrimination and the tendency toward social restriction reduced with an increase in social awareness of mental health-related problems in a 6-month follow-up, after program implementation. Another study by Weiss observed that children took an increasingly paternalistic view of the mentally ill. They were less likely to see mental illness as an illness like any other, perceived mental patients as less of a threat to society and needing fewer restrictions. Finally, with increasing age/grade, children perceived mental illness as less likely attributable to inadequate, deprived interpersonal experiences. Stigmatization by adolescents has far-reaching consequences such as impact on the mental health of the adolescents themselves. Thus, it becomes important to study the attitude toward mental illness among adolescents who have exposure to psychiatric patients in their family.
The study was conducted with the objective to find out the attitude toward mental illness among adolescents belonging to two categories – one group having family members with mental illness and the other having family members with chronic medical illness and then comparing the attitudes from the two different groups.
The study was conducted with the hypothesis that:
- The adolescents, in general, will show a negative attitude toward individuals with mental illness
- The adolescents having contact with individuals with mental illness in their families will show a less negative attitude toward mental illness than those not having any such contact.
| Methodology|| |
It was a cross-sectional study of 70 adolescents aged 14–18 years, 35 in each group.
Adolescents whose immediate family members have sought inpatient treatment in the Department of Psychiatry, LHMC, for severe mental disorders including schizophrenia, bipolar disorder, major depressive disorder, and mental and behavioral disorders due to psychoactive substance use and cohabiting >2 years with the patient were taken for the study.
For the second group, adolescents whose immediate family members have sought inpatient treatment for chronic medical illness including cardiovascular disorders, cancer, diabetes mellitus, arthritis, cerebrovascular accidents, chronic obstructive pulmonary disease in the Department of Medicine, LHMC, and are cohabiting >2 years with the patient were recruited.
Adolescents having severe mental illness and/or chronic medical illness and adolescents having more than one family member with severe mental illness were excluded from the study.
The participants fulfilling the selection criteria were taken by purposive sampling and given the questionnaire after obtaining their informed consent. Approval from institute's ethical committee was obtained to undertake this research work. The collected data were analyzed further.
Instrument used: The Attitude Scale for Mental Illness questionnaire containing 34 items and six broad conceptual subscales, rated on a 3-point Likert Scale:
- Separatism (1–9 and 24) or attitude to discrimination
- Stereotyping (10–13) or the degree of social distance maintained from the mentally ill
- Restrictiveness (14–17) or perception of the mentally ill as a threat to the society
- Benevolence (18–23, 25, and 26) or paternalistic and sympathetic views
- Pessimistic prediction (27–30) or level of prejudice toward mental illness
- Stigmatism (31–34) or discriminatory behavior toward those with mental illness.
| Results|| |
A total of 70 adolescents were recruited in the study, comprising almost equal number of boys and girls. Majority of adolescents having family members with mental illness were male (62.9%), the other group comprised more number of females (57.1%).
A relatively larger number of adolescents belonged to Hindu religion (85.7%), being almost comparable in both the groups. The rest belonged to the minority religions being Muslim and Sikh.
While observing the educational status of the adolescents, it was found that almost half of them (47.14%) have attended the high school, indicating a good literacy level. While on comparing the two groups, more of the adolescents having family members with mental illness (54.3%) had attended high school, in contrast to the adolescents having family members with chronic medical illness (40%). [Table 1] shows the socio-demographic details of the group.
Of all the adolescents having family members with mental illness, almost 91.5% of them had their immediate family members suffering from mental illness (parents and siblings) [Table 2]. [Table 3] shows the variable response on various sub-scales of the Attitude Scale of Mental Illness Questionnaire.
|Table 2: Relationship of the adolescents with their family members having mental illness|
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|Table 3: Adolescents' response to Attitude Scale for Mental Illness questionnaire|
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On the separatism subscale, almost 74.3% of all the adolescents believed that “mentally ill have unpredictable behavior,” among which those having contact with mentally ill (n = 30, 8.7%) showed a more negative attitude than those not having contact with mentally ill (n = 22, 62.9%). Nearly half of the adolescents (55.7%) felt that “mental patients and other patients should not be treated in the same hospital,” 35.7% of them consider “mentally ill to be violent,” and 31.4% of them perceive “mentally ill to be dangerous,” without much difference among both the groups. 41.4% of all the adolescents disagreed to the statement that “if people become mentally ill once, they will easily become ill again.” Almost two-thirds of all adolescents (74%) disagreed to the statement that “if mental health facility is set up in their community, they will move out of the community,” whereas 64.3% reported that “they were not afraid of treated mentally ill people.” Only 15.7% of the adolescents considered “mentally ill to be dangerous after treatment” with no significant difference of opinion among the two groups.
Almost half of the adolescents held a stereotyped attitude toward people with mental illness. Nearly 41.4% of the adolescents agreed to the statement that “it is easy to identify those who have mental illness,” whereas those having contact with mentally ill (n = 12, 34.3%) held a less negative attitude when compared to those without contact (n = 17, 48.6%). More than half (55.7%) of them felt that “it is easy to tell who has mental illness by the characteristic of their behavior,” with more of a pessimistic attitude among those having contact (n = 21, 60%) than those without contact (n = 18, 51.4%). Nearly 40% of all the adolescents believed that “people with mental illness have a lower IQ,” among which those having contact with mentally ill (n = 18, 51.4%) were more negative as compared to those without contact (n = 10, 28.6%), and almost 51.4% of them felt that “people with mental illness have some strange behavior,” without much of a difference in opinion among the two groups.
On restrictiveness subscale, only about 51.4% of the adolescents having contact (n = 18) with mental illness disagreed that “mentally ill patients cannot recover fully” responding more negatively when compared to those not having contact (n = 24, 68.6%). Only half of the adolescents disagreed to the statement that “it is inappropriate for the mentally ill to get married” (47.1%) and that “they should not have children” (41.4%). Although about two-third of the adolescents disagreed to the statement that “there is no future for people with mental illness.” Those with contact (n = 25, 71.4%) again held a less positive attitude as compared to those without contact (n = 29, 82.9%).
The adolescents overall showed a very benevolent attitude toward mental illness. 88.6% of all adolescents believed that “care and support of family and friends can help people with mental illness to get rehabilitated.” This was more positively seen among those with contact (n = 32, 91.4%) than those without contact (n = 30, 85.7%). Overall 77% of adolescents agreed with the statement that “after people are treated for mental illness, they can return to their jobs,” of which those with contact (n = 25, 71.4%) felt a little less optimistic than those without contact (n = 29, 82.9%). More than two-thirds (77.1%) of all adolescents believed that “the best way to help the mentally ill to recover is to let them stay in the community and live a normal life,” among those with contact (n = 28, 80%) felt it more positively than those without contact (n = 26, 74.3%). A very positive response was found when 84% of the adolescents disagreed to the statement that “even after mentally ill are treated and rehabilitated, we still should not make friends with them.” Those with contact (n = 31, 88.6%) were more positive than those without contact (n = 28, 80%). Almost 60% of adolescents having contact with mentally ill agreed that “anyone can have mental illness” as compared to those without contact 45.7%. About 94.3% of all the adolescents supported the fact that “one should not laugh at mentally ill” with no significant difference among those with contact or without contact. However, 44.3% of all the adolescents believe that “mentally ill patients can hold a job.”
While finding out the pessimist prediction among adolescents, it was found that overall 44.3% of them felt that “it is harder for the mentally ill to receive the same pay of job,” with contacts (n = 17, 48.6%) holding a more pessimistic view than those without contact (n = 14, 40%). 48.6% of all adolescents felt that “even after treatment, it will be difficult for mentally ill to return to the community,” with contacts (n = 20, 57.1%) having a more negative attitude than those without contact (n = 14, 40%). Almost half of the adolescents having contact with mentally ill (n = 18, 51.4%) agreed with the statement that “people are prejudiced toward those having mental illness,” holding a more negative attitude as compared to those without contact (n = 10, 28.6%). Nearly 41.4% of all the adolescents felt that “it is hard for the mentally ill to have good friends.”
On analyzing the prevalence of stigma among adolescents, it was found that overall 92.9% of them disagreed with the statement that “having mental illness is shameful,” with no significant difference among those having contact (n = 33, 94.3%) or those without contact (n = 32, 91.4%). 80% of all the adolescents disagreed that “mental illness is a punishment for doing bad things,” with no significant difference among those with contact (n = 28, 80%) or without contact (n = 28, 80%). A total of 67.1% adolescents believed that “those who have mental illness can disclose their illness,” with no difference in opinion among those with contacts (n = 23, 65.7%) or without contact (n = 24, 68.6%).
| Discussion|| |
Stigma toward those having mentally ill seems to be omnipresent in all age groups. Mind matters study done in Singapore in the year 2014 showed that stigma for mental illness was widely prevalent in all age groups. However, compared to adults, youth had a lower level of stigma associated with mental illness., While this might seem encouraging, studies have shown that conception of the attitude and stigma toward mental illness starts from a young age. Adolescents frequently show reluctance in interacting with those with mental illness and express a desire for social distance. This has far-reaching consequences, both as it creates barrier for help-seeking among adolescent as well as compromises the social support that this group of the population can provide to those with mental illness.
Most of the studies have tried to study adolescent attitude to mental illness in community settings  or in those suffering from mental illness themselves. Studies have also tried to determine the effect that mental health education/interventions/contact has on adolescent attitude., Knowledge-contact interventions done in adolescent have produced an immediate reduction in mental illness stigma and improvement in mental health literacy.,
These interventions try to address the stigma surrounding mental illnesses by bringing in contact known cases of mental illnesses with the target group, with the aim of increasing knowledge and decreasing existing prejudices.
While we know that interventions based on contact with a person having mental illness have shown to reduce stigma in children and adolescents, it is of interest to find the effect on stigma in this age group when a family member is suffering from mental illness. To reduce the biases associated with any chronic medical illnesses, the control group was chosen as those whose family members suffered from nonpsychiatric, chronic medical illnesses.
The current study has given some interesting insights about stigma regarding mental illness in those with a family member with mental illness. It was noticed that the stigma regarding mental illness was high in adolescents, both in those with a family member suffering from physical illness as well as those with mental illness and was comparable. The differences seen in various domains such as stereotyping, restrictiveness, and stigmatism among the two groups were not found to be significant pointing out that having a family member suffering from mental illness does not alter the perception and stigma about mental illness.
The only significant difference between the two groups was on the question-unpredictable behavior (P < 0.005). This probably stems from living in close quarters with the family members with mental illness and their experiences with them. However, on all other questions, no significant difference in attitude was noticed between the two groups even on the subdomain of separatism.
It is quite surprising and contrary to common findings seen in other studies where contact led to positive changes in belief and reduced stigma., The possible explanation for this is that adolescence is a very impressionable age and attitude of their peer, and other adults tend to influence attitudes and behavior. Since negative attitudes are more prevalent in the Indian society as a whole, this is hardly a surprising finding. This, in turn, implies that there is a definitive scope for attitude improvement in all dimensions among all. However, due the small sample of the study, findings should not be taken to be representative of the population. It just highlights the fact that this is as yet an unexplored field which can be studied in great details to determine factors moderating attitudes and stigma. These studies can then be used for formulating interventions to improve the knowledge and attitudes in the adolescent population.
The study also had some positive findings which are heartening in the light of so much stigma. Majority of the adolescents (41.4%) agreed that people with mental illness can have children and acknowledged their need for job opportunities. Stigma related to mental illness is an international concern, and research is needed to understand its basis, mechanisms, and consequences to formulate means by which stigma and its impact may be ameliorated.
The present study has certain limitations. As the participants were selected through purposive sampling, it is not prudent to extend the findings on the general population. Another factor confounding the results is the lack of homogeneity in the groups in terms of gender differences and education status both of which contribute to differences in perceived stigma. The results are, therefore, not generalizable and are not directly comparable to most other studies. Although data regarding the type, severity, and duration of psychiatry illness in the family member were not correlated to stigma, only patients who were admitted in psychiatry ward were taken for the study. This ensured some homogeneity to the sample as inpatients are usually admitted with severe, acute symptoms leading to behavioral disturbances and oddity in behavior, which are main contributors to stigma. Past researches have not shown any clear evidence that perceived or self-stigma varies across diagnosis or duration of mental illness. Furthermore, given that attitudes toward mental illness are culturally and socially sensitive, caution is required when comparing results across different contexts. The study lacked a qualitative component, which may have provided more personal data regarding students' attitudes and understanding of mental illness. However, despite these limitations, we believe this study contains important findings for researchers as well as practitioners working in the field of mental health.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]