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Attitudes to people with mental disorders: a mental health literacy survey in a rural area of Maharashtra, India

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Abstract

Introduction

People with mental disorders experience discrimination as a consequence of stigmatising attitudes that are largely socio-culturally constructed. Thus, there is a need to understand local contexts in order to develop effective programs to change such attitudes. We undertook a mental health literacy survey in rural Maharashtra, India, prior to developing a mental health training program for village health workers (VHWs) in a primary health care setting.

Methods

A cross-sectional mental health literacy survey was undertaken in late 2007, which involved interviewer-administration of a questionnaire to 240 systematically sampled community members, and 60 purposively sampled VHWs. Participants were presented with two vignettes describing people experiencing symptoms of mental disorders (depression, psychosis), and were asked about attitudes towards, and desired social distance from, the people in the vignettes (the latter being a proxy measure for stigma). Linear regression modelling was undertaken to identify predictors of social distance.

Results

Although the community was relatively accepting of people with mental disorders, false beliefs and negative attitudes were still evident. Desired social distance was consistently greater for the person depicted in the psychosis vignette compared to the depression vignette. For both vignettes, the main predictor of greater social distance was perceiving the person as dangerous, and the predictors of reduced social distance were being a VHW, and seeing the problem as a sign of personal weakness. For depression, believing the cause to be family tensions also reduced social distance. For psychosis, labelling the disorder as a mind/brain problem, and believing the cause to be lack of control over life or genetic factors increased social distance. The vast majority did not agree that the problems experienced in the vignettes were ‘a real medical illness’.

Conclusion

Promoting bio-medical explanations for mental disorders in this setting may exacerbate discriminatory attitudes. Provision of contextually relevant mental health training for the VHWs so that they are able to communicate, model and shape more positive attitudes is the next step.

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Acknowledgments

We thank the following people for their contributions to this study: Dr. Raj Arole for having the vision to incorporate mental health into primary health care; Mr. Ravi Arole for data management; Dr. Kaustubh Joag for technical advice; Professor Helen Herrman for support and encouragement; Mrs Ratna Kamble, Ms Shainaj Khudbuddin Sayyad and Ms Shobha Kulkarni for data collection; and Dr. Ramaswamy Premkumar for assistance with sampling. This study was made possible through the award to Michelle Kermode of an Early Career Research grant from the University of Melbourne.

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Authors and Affiliations

  1. Nossal Institute for Global Health, University of Melbourne, Alan Gilbert Building, Level 5, 161 Barry St, Carlton, VIC, 3010, Australia

    Michelle Kermode

  2. National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia

    Kathryn Bowen

  3. Comprehensive Rural Health Project, Jamkhed, Maharashtra, India

    Shoba Arole

  4. Ruby Hall Clinic, Pune, Maharashtra, India

    Soumitra Pathare

  5. ORYGEN Research Centre, University of Melbourne, Melbourne, VIC, Australia

    Anthony F. Jorm

Authors
  1. Michelle Kermode
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  2. Kathryn Bowen
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  3. Shoba Arole
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  4. Soumitra Pathare
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  5. Anthony F. Jorm
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Correspondence to Michelle Kermode.

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Kermode, M., Bowen, K., Arole, S. et al. Attitudes to people with mental disorders: a mental health literacy survey in a rural area of Maharashtra, India. Soc Psychiat Epidemiol 44, 1087–1096 (2009). https://doi.org/10.1007/s00127-009-0031-7

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  • DOI: https://doi.org/10.1007/s00127-009-0031-7

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