Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness

1 October, 2019

This paper find that 'Describing mental illness as treatable does not seem to have had any effect on reducing negative attitudes toward mental illness or persons with mental illness in rural southwestern Uganda.' Citation, author summary and a comment from me below.

CITATION: Portrayals of mental illness, treatment, and relapse and their effects on the stigma of mental illness: Population-based, randomized survey experiment in rural Uganda

Justin D. Rasmussen ,Bernard Kakuhikire,Charles Baguma,Scholastic Ashaba,Christine E. Cooper-Vince,Jessica M. Perkins,David R. Bangsberg,Alexander C. Tsai

Published: September 20, 2019 https://doi.org/10.1371/journal.pmed.1002908



Why was this study done?

- Mental illness stigma is a fundamental barrier to improving mental health worldwide.

- While there has been some progress in understanding how to reduce mental illness stigma in high-income countries, it is unclear how this understanding might generalize to low- and middle-income countries.

- The extent to which people perceive that mental illness can be effectively treated may be an important component of changing negative beliefs about mental illness.

What did the researchers do and find?

- We conducted a survey experiment to understand how information about successful treatment of mental illness might affect stigmatizing beliefs in rural southwestern Uganda.

- This experiment involved randomly assigning different people in eight villages to be read a vignette about: a woman who had signs suggestive of one of three different types of mental illness; a woman who had these signs and was treated successfully; or a woman who had these signs and was treated successfully but subsequently relapsed.

- We found that stigma toward mental illness in the community was common and was generally unaffected by descriptions of successful treatment.

What do these findings mean?

- If unaddressed, stigma will continue to pose a major barrier to improving population mental health in Uganda.

- We need to do more research to understand the relationship between perceptions of mental illness treatment and stigmatizing attitudes in Uganda and other countries worldwide.

- Engaging local etiologies, making treatment more accessible, and understanding how mental illness shapes social relationships independent of actual symptoms might be important avenues of research and program implementation to explore.

COMMENT (NPW): I have not had a chance to read this paper in depth and I do not have specialist knowledge, but are the findings surprising? First, the study approach is fairly abstract (people are invited to comment on descriptions of case studies). Second, the focus is on treatability rather than causation. One might expect that the stigma of mental health issues is more related to causation (eg the person is 'cursed' or is being 'punished for wrongdoing') rather than treatability. In Westerns society, part of the reduction in stigma is due to wide recognition that, for example, depression has genetic, experiential and biochemical determinants.

Best wishes, Neil

Coordinator, HIFA Project on Information for Citizens, Parents and Children


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HIFA profile: Neil Pakenham-Walsh is coordinator of the HIFA global health campaign (Healthcare Information For All - www.hifa.org ), a global community with more than 19,000 members in 177 countries, interacting on six global forums in four languages. Twitter: @hifa_org FB: facebook.com/HIFAdotORG neil@hifa.org