Influence of urbanity on perception of mental illness stigma: a population based study in urban and rural Hanoi, Vietnam

Mental illness through the perspective of undergraduate medical students in Greece: a cross-sectional study at Aristotle University of Thessaloniki

Introduction

Numerous studies reveal that mental health-related stigma, stereotypes, and prejudices negatively affect the patients, jeopardizing their health, prognosis, and social opportunities. Healthcare professionals, who are in the first line of combating mental disease, are expected to play a significant role in drastically changing discriminatory and stigmatizing attitudes toward psychiatric patients and in diminishing the existing healthcare and social disparities. In this study, we aimed to explore and highlight the views of Greek medical students-that is of the future physicians-toward mental illness and people suffering from it.

Materials and methods

It is a cross-sectional, observational study, in which 324 undergraduate students from the most populous Greek medical school of the Aristotle University of Thessaloniki, participated online, during the spring semester of 2022. The tools used were the Opinions about Mental Illness Scale (OMI) that assesses one's viewpoints about mental illness, the Social Distance Scale (SDS) that captures the desired degree of social distancing from patients with mental disorders, and the Level of Contact Report (LCR-12) that estimates the level of familiarity with them.

Results

Participants displayed rather positive attitudes regarding the etiology of mental illness, social integration, and discrimination toward psychiatric patients [as evaluated with the respective OMI subscales; Etiology mean score (μ):8.87 ± 4.68, Social Integration (μ):17.79 ± 5.42, Social Discrimination (μ):13.54 ± 11.17], and more clearly favorable opinions concerning the need for social provision or the enactment of restrictive measures [as expressed with the relative OMI subscales; Social Care (μ):22.74 ± 4.56, Social Restriction (μ):13.27 ± 8.98], while claiming to be quite familiar with mental disorders and individuals experiencing them (as assessed with LCR; μ: 8.71 ± 2.16), and relatively willing to interact with them (as measured with SDS; μ:8.95 ± 4.23). Degree of familiarity with mental illness was directly proportional to the desire for contact with patients living with it, while the higher both were, the more improved most of the aforementioned OMI sectors were found to be. Female sex, clinical medical education, previous clinical psychiatric training, and living with or being a person with a mental disorder were the factors that defined a statistically refined profile in many of the aspects above.

Conclusion

Our findings are in accordance with many prior and recent studies, while showing improved opinions compared to those of previous research in Greek student and healthcare population. They are calling for vigilance, rather than complacency, as well as educational and social interventions, in order to enable current and future healthcare professionals to perform their function to its fullest extent. Implications of our results and further research suggestions are included.

Vietnam's Evolving Healthcare System: Notable Successes and Significant Challenges

From regional and rural grassroots to a nationwide level, Vietnam has established a four-tiered hierarchical healthcare system, comprising national, provincial, district, and commune healthcare centers. Over the last three decades, alongside increasing provision of universal health insurance coverage and cutting healthcare expenditure, the country has demonstrated its dedication to preventative medicine and health promotion. Recent investment in research, development, and production has led to "homegrown" vaccines for SARS-CoV-2 now undergoing clinical trial. Nevertheless, despite substantial progress in improving health outcomes for the entire population, the healthcare sector experiences significant challenges. The current public system is paper-based, requires digitalization, and lacks information technology support. In common with many other countries, there is a vast disparity in the distribution of healthcare professionals between cities and rural areas, as well as between private and public sectors. Consequently, public healthcare in remote locations is particularly underserved. Moreover, ongoing underfunding caused by high out-of-pocket expenses for the average salary, as well as stigmatization of sensitive health issues by a largely conservative populace, demand a well-articulated and culturally sensitive approach. As the level of smartphone ownership and internet coverage are both comparatively high for Southeast Asia, the introduction of telemedicine, mobile health applications, and other digital health solutions may be both practicable and beneficial. Importantly, in order to develop healthcare facilities and reduce patient direct payments, the key issue of funding must be addressed. In order to overcome disease-related stigma, a locally tailored program of community education, awareness, and engagement is required. In summary, in several ways, Vietnam provides a role model for developing healthcare systems in low- and middle-income countries. There are undoubted hurdles to overcome, but the country continues to construct a healthcare system that is accessible and affordable for the majority.

A comparative study of two Mobile Mental Health Units in different catchment rural areas in Greece

BACKGROUND

Mental healthcare service delivery in rural and remote areas in Greece is challenging due to socioeconomic and geographical reasons, and distant facilities. To address the needs of the underserved areas, the Greek state has launched a number of Mobile Mental Health Units (MMHUs).

AIM

The objective of the present study was to explore the differences among two MMHUs, one being run by a university general hospital (MMHU UHA) and the other being run by a nongovernmental organization (MMHU I-T).

METHODS

The two MMHUs deliver services in rural areas of northeast and northwest Greece, respectively. Both MMHUs use the infrastructures of the primary healthcare system and have the potential for domiciliary visits.

RESULTS

Medical and nursing staff is much more in the MMHU UHA, whereas MMHU I-T has more psychologists, social workers and health visitors. Patients attended the MMHU I-T were significantly older than the patients attended the MMHU UHA (mean age 64.5 vs. 55.3 years) and the percentage of the elderly patients in treatment with the MMHU I-T (56.5%) is significantly higher than the corresponding percentage of the MMHU UHA (20%). The proportion of patients that received home-based care by the two MMHUs was almost identical. The percentage of patients with schizophrenia spectrum disorders that attended the MMHU UHA was significantly higher. Patients with affective disorders, anxiety disorders and organic brain disorders that attended the MMHU I-T were significantly more.

CONCLUSIONS

Despite the similarities among the MMHUs in rural Greece, this study recorded some important differences. The differences in staffing may be accounted for by the availability of resources. The differences in the patients' population may be explained by the fact that the MMHU UHA was designed from its beginning to treat patients with severe mental illnesses, mainly psychoses, and it accepts loss of referrals within the general hospital's network of psychiatric services. The MMHU I-T is an independent, locally based service that may be better perceived as an expansion of the primary care system. The results of the study could inform service practice and mental health policy.

Increasing sample diversity in psychiatric genetics - Introducing a new cohort of patients with schizophrenia and controls from Vietnam - Results from a pilot study

OBJECTIVES

Genome-Wide Association Studies (GWAS) of Schizophrenia (SCZ) have provided new biological insights; however, most cohorts are of European ancestry. As a result, derived polygenic risk scores (PRS) show decreased predictive power when applied to populations of different ancestries. We aimed to assess the feasibility of a large-scale data collection in Hanoi, Vietnam, contribute to international efforts to diversify ancestry in SCZ genetic research and examine the transferability of SCZ-PRS to individuals of Vietnamese Kinh ancestry.

METHODS

In a pilot study, 368 individuals (including 190 SCZ cases) were recruited at the Hanoi Medical University's associated psychiatric hospitals and outpatient facilities. Data collection included sociodemographic data, baseline clinical data, clinical interviews assessing symptom severity and genome-wide SNP genotyping. SCZ-PRS were generated using different training data sets: (i) European, (ii) East-Asian and (iii) trans-ancestry GWAS summary statistics from the latest SCZ GWAS meta-analysis.

RESULTS

SCZ-PRS significantly predicted case status in Vietnamese individuals using mixed-ancestry (R² liability = 4.9%, p = 6.83 × 10^-8), East-Asian (R² liability = 4.5%, p = 2.73 × 10^-7) and European (R² liability = 3.8%, p = 1.79 × 10^-6) discovery samples.

DISCUSSION

Our results corroborate previous findings of reduced PRS predictive power across populations, highlighting the importance of ancestral diversity in GWA studies.

Research on psychotic disorders in rural areas: Recent advances and ongoing challenges

BACKGROUND

Research on patients with chronic psychotic disorders in rural areas is scarce. Those patients may not receive adequate mental health care. Mental health disparities among rural and urban areas have been recognized.

AIMS

This review aims to present the most recent research on psychotic disorders in rural areas.

METHOD

We conducted a search in the PubMed and Scopus databases. The search involved articles published over the last decade (2011-2020). All types of research design were included, if studies had used a controlled group of urban patients and reported on the differences among rural/urban residents with psychotic disorders. The focus of the review was on outcome and treatment.

RESULTS

A total of 12 studies were included in this review. Most have been conducted in China or India. Reports from Western countries are rare. Outcome studies showed that employment rates are significantly higher in rural patients, as well as rates of marriage in women. It is not clear what is the impact of those outcomes on patients' lives. The finding of lower cost of psychotic disorders in some rural areas, should be viewed with scepticism. Studies on treatment aspects suggested that rural patients were less likely to receive antipsychotics, antipsychotic combination or clozapine. Those results were attributed to limited access to specialized treatment. When rural patients receive specialized community care they seem to have better outcomes than urban patients.

CONCLUSION

There is an ongoing, but still scarce research on patients with chronic psychotic disorders in rural areas. Researchers pointed out the impact of socioeconomic inequalities on outcome and treatment, and stressed the importance of minimizing mental health disparities. These findings may have potential implications for future research; for the introduction of accessible, locally based mental health services in rural areas; and for political initiatives that would address poverty and social inequalities.

Mental health in HIV prevention and care: A qualitative study of challenges and facilitators to integration in Vietnam

INTRODUCTION

Globally, men who have sex with men (MSM) experience a disproportionate burden of mental health issues. While HIV service providers may possess the skills and relationships to provision mental health and psychosocial support (MHPSS) to this population, task-sharing models that integrate MHPSS into HIV contexts remain limited. The aim of this study was to explore the sociodemographic, psychological, and structural factors operant at the client and HIV service provider levels that shape MHPSS access and burden among MSM and opportunities for integration in Vietnam.

METHODS

Between June and August 2018, semi-structured interviews were conducted with 20 MSM and 13 service providers at out-patient clinics (OPCs) and community-based organizations (CBOs) in Hanoi, Vietnam. Interviews explored participants' understandings of and experiences with the signs, causes, and appropriate treatments for mental health concerns; and perceived barriers to MHPSS integration in HIV contexts. Data were coded thematically and analyzed in MAXQDA.

RESULTS

Most MSM did not view their mental distress as constituting illness or as warranting clinical attention. Specifically, terms like "mental illness" were often associated with being "crazy" or immoral, while symptoms of distress were interpreted as having to do with everyday difficulties associated with being MSM and/or HIV-positive. Due to mental health stigma, MSM were reluctant to access services while service providers were similarly reluctant to query about needs. Few service providers knew where to refer patients for MHPSS, and none had done so previously. Most service providers reported lacking the human capital, expertise, and funding to address MHPSS needs.

CONCLUSIONS

Our findings suggest that aside from mental health stigma, future integration strategies must address competing demands and incentivization structures, limitations in existing mental health infrastructure and funding, misperceptions around MHPSS needs and symptoms, and opportunities to streamline MHPSS with existing CBO activities to strengthen community wellbeing.

The Relationship between Individual-Level and Context-Level Factors and Social Distancing from Patients with Depression in Taiwan: A Multilevel Analysis of National Surveys

Background: Research on social distancing from patients with depression has primarily focused on individual-level factors rather than context-level factors. This study aimed to investigate the relationship between individual-level and context-level factors and social distancing from depressive patients. Methods: Sample data were collected via computer-assisted telephone interviews with 800 Taiwanese adults aged 20 to 65 years in 2016. All effects were tested using multilevel analysis. Results: With regard to individual-level variables, male sex, older age, people with more perceived dangerousness and those with more emotional reaction of fear were associated with greater social distancing from depressive patients. After controlling for individual-level variables, a positive association was found between the degree of urbanization and social distancing. We also found the interaction between the density of psychiatric rehabilitation services and perceived dangerousness to be associated with social distance. This finding revealed that persons with more perceived dangerousness and living in a region with higher density of psychiatric rehabilitation services were associated with greater social distance. Conclusions: We found that social distancing from depressive patients is not only determined by individual-level factors but influenced by the surroundings. This study provides useful directions for the implementation of optimal anti-stigma interventions for patients with depression.

Mental health stigma and mental health knowledge in Chinese population: a cross-sectional study

BACKGROUND

Little is known about the public stigma on mental illness and mental health knowledge (MHK) in China, public stigma and low MHK can negatively affect patients' health and increase the burden of mental disorders on society. This study aimed at investigating the rates of stigma and MHK, the correlates of stigma and MHK, and the association between MHK and stigma among a Chinese population.

METHODS

The data is from the Tianjin Mental Health Survey (TJMHS), which involved a large and a representative sample of adult community residents in the Chinese municipality of Tianjin (n = 11,748). In a 12% random subsample (n = 1775) the Perceived Discrimination and Devaluation scale (PDD) and a Mental Health Knowledge Questionnaire (MHKQ) were administered. First, percentages of the responses to the individual items of the PDD and MHKQ were investigated. Second, sociodemographic correlates of PDD and MHK, and the association between stigma and MHK were investigated.

RESULTS

We found that a sizable proportion of participants responded that others would hold a negative attitude towards (former) mental patients, especially with regard to engaging in closer personal relationships. Most people were not familiar about the causes, treatments and prevention of mental illness. Resident area, age, education level, Per capita family income and employment status were related to devaluation score and MHKQ score. MHK was negatively associated with public stigma.

CONCLUSIONS

There is room for improvement with regard to levels of public stigma and MHK in China. Providing psychoeducation to improve public MHK could also contribute to reduction of public stigma.

Impact and differences of illness course perception on the desire for social distance towards people with symptoms of depression or schizophrenia in Hanoi, Vietnam

OBJECTIVES

Public stigma against psychiatric disorders leads to delayed treatment utilization and worsens treatment outcome. This study analyses the impact of expectations regarding the course of illness and attribution as medical illness on the desire for social distance towards schizophrenia and depression in Vietnam.

METHODS

In 2013, a survey (n = 771) using unlabelled vignettes either depicting a person with symptoms typical for schizophrenia or major depression was carried out in Hanoi. All respondents had to indicate whether the person was suffering from a medical illness or not. As an indicator of public stigma, the desire for social distance was measured. A possible correlation between expectations towards the course of illness and social distance was evaluated using a linear regression model.

RESULTS

85 % of respondents endorsed that the person depicted in the schizophrenia vignette had a mental illness, compared to only 60 %, who were confronted with the depression vignette. This attribution of mental illness was correlated with higher levels of desire for social distance only in the schizophrenia vignette. While in the case of schizophrenia negative prognostic perceptions were associated with more desire for social distance, in the event of depression, it was only the expectation of lifelong dependency. Moreover, only for depression, positive expectations towards the course of illness correlated with less desire for social distance.

CONCLUSION

These results indicate an impact of prognostic expectations on the desire for social distance and support strategies that aim at maintaining social integration and strengthening autonomy.

Very Long-Term Outcome of Community-Dwelling Patients With Schizophrenia Spectrum Disorders in Rural Greece

The objective of the present study was to measure the very long-term outcome in community-dwelling patients with a diagnosis of psychosis and to search for possible correlations of outcome with clinical factors. The sample included 55 psychotic patients with at least 15 years of disease duration (M = 32.1 years). For the estimation of the outcome, the Health of the Nations Outcome Scale and the Clinical Global Impression Scale were used. A total of 34.5% of the patients had a good outcome, whereas 27.3% had poor outcome. Outcome was found to be correlated to symptoms, and it was significantly worse in patients living with other severely mentally ill family members. In our study, outcome was good in more than a third of patients. Both symptoms and social functioning were associated with outcome. This study may have some implications for mental healthcare delivery.

Rural vs urban residence and experience of discrimination among people with severe mental illnesses in Ethiopia

BACKGROUND

Few studies have addressed mental illness-related discrimination in low-income countries, where the mental health treatment gap is highest. We aimed to evaluate the experience of discrimination among persons with severe mental illnesses (SMI) in Ethiopia, a low-income, rapidly urbanizing African country, and hypothesised that experienced discrimination would be higher among those living in a rural compared to an urban setting.

METHODS

The study was a cross-sectional survey of a community-ascertained sample of people with SMI who underwent confirmatory diagnostic interview. Experienced discrimination was measured using the Discrimination and Stigma Scale (DISC-12). Zero-inflated negative binomial regression was used to estimate the effect of place of residence (rural vs. urban) on discrimination, adjusted for potential confounders.

RESULTS

Of the 300 study participants, 63.3% had experienced discrimination in the previous year, most commonly being avoided or shunned because of mental illness (38.5%). Urban residents were significantly more likely to have experienced unfair treatment from friends (χ2(1) = 4.80; p = 0.028), the police (χ2(1) =11.97; p = 0.001), in keeping a job (χ2(1) = 5.43; p = 0.020), and in safety (χ2(1) = 5.00; p = 0.025), and had a significantly higher DISC-12 score than those living in rural areas (adjusted risk ratio: 1.66; 95% CI: 1.18, 2.33).

CONCLUSIONS

Persons with SMI living in urban settings report more experience of discrimination than their rural counterparts, which may reflect a downside of wider social opportunities in urban settings. Initiatives to expand access to mental health care should consider how social exclusion can be overcome in different settings.

Treatment recommendation differences for schizophrenia and major depression: a population-based study in a Vietnamese cohort

Background

In Vietnam, the mental health care infrastructure is on the verge of transformation with an increase in the demand for access to adequate and effective mental health care services. Public attitudes towards mental illness, as well as corresponding treatment options influence help-seeking behaviors of patients and caregivers, affecting the course of their treatment. This study assesses attitudes towards treatment options for depression and schizophrenia, as the two most common psychiatric disorders in Vietnam, accounting for at least 75% of all psychiatric inpatients.

Methods

A general population-based survey was conducted in Hanoi, Vietnam between April and August 2013. Participants received a description of a person with symptoms of either depression (n = 326) or schizophrenia (n = 403) and were asked to give recommendations for adequate sources of mental health support and treatment options. Multiple analyses on a single item level compared the likelihood of recommendation between schizophrenia and depression.

Results

Overall, respondents recommended health care services, ranging from seeking mental health care professionals, psychotherapists, and psychiatrists for both disorders. Psychotherapy was the most favored treatment method, whereas further treatment options, such as concentration and relaxation exercises, meditation or yoga and psychotropic medication were also endorsed as helpful. For the schizophrenia vignette condition, psychotherapy, visiting a psychiatrist or psychotherapist received stronger endorsement rates as compared to the depression vignette. Furthermore, ECT, Feng Shui-based practices, praying and visiting natural healers were recommended less by respondents for the depression vignette in comparison with the schizophrenia vignette.

Conclusions

The Vietnamese public endorsed evidence-based treatment recommendations from a variety of treatments options. Differences in the treatment recommendations between depression and schizophrenia reflected the perceived severity of each disorder. Further developments of the Vietnamese mental health care system concerning mental health care providers, as well as the legal regulations surrounding the provision of psychotherapy are needed.

Perceptions of mental health and mental health services among college students in Vietnam and the United States

The global burden of mental health disorders is a significant public health issue. One population that has a risk for mental health issues is college students. Little is known about perceptions of mental illness and mental health services among college students in Vietnam. The purpose of this study is to describe perceptions of mental illness and mental health services among college students in Vietnam, and to compare them with those in the United States (US). The cross-sectional data were collected using a self-administered survey from January to March in 2018 at a national university in Vietnam, and a state university in the US. The study revealed differences in perceptions of causes of mental health between Vietnamese and US participants. Vietnamese participants tended to believe that individuals with mental illness were dangerous and need to be kept out from the community, while US participants perceived that mental illnesses are the same as other illnesses. An important indicator of Vietnamese perceptions of mental health was the low likelihood of seeking formal help because of preference for seeking help from family or friends for mental illness. Interventions, such as mental health awareness campaigns or training courses should be provided for college students in Vietnam. Some strategies to improve mental health among college students used in the US may help to reduce stigma toward mental illness in Vietnam.

Impact of perceived course of illness on the desire for social distance towards people with symptoms of schizophrenia in Hanoi, Vietnam

In Vietnam, stigmatisation and discrimination of patients with mental illness are highly prevalent. This study explores whether the perception of course of illness of people with symptoms indicating schizophrenia is associated with the desire for social distance in the Vietnamese public. A population-based survey (n = 455) using unlabelled vignettes for schizophrenia was carried out in the Hanoi municipality in 2013. First, a factor analysis was performed to group items indicating perception of prognosis. Second, a linear regression analysis was used to search for correlations between these expectations and desire for social distance. The factor analysis revealed three independent factors of perception of course of illness: (1) loss of social integration and functioning, (2) lifelong dependency on others, and (3) positive expectations towards treatment outcome. Both factors with negative prognostic perceptions (1&2) were associated with more desire for social distance. The results indicate a link between social acceptance and the perceived ability to maintain a social role including a capability of reciprocity within the Vietnamese society. Additionally, these findings highlight the importance of preserving social functioning in any treatment approach for patients with schizophrenia, which includes psychosocial intervention and rehabilitation programs.

Perceived stigma and its correlates among treatment seeking alcohol and opioid users at a tertiary care centre in India

BACKGROUND AND AIMS

Perceived stigma is related to the beliefs that members of stigmatized group have about the stigmatizing attitudes present in society. We present the data on perceived stigma in alcohol and opioid users seeking treatment.

METHODS

This study was conducted at a tertiary care de-addiction facility with recruitment of patients with substance use disorders (alcohol and opioid use). Perceived stigma was assessed using Perceived Stigma of Substance Abuse Scale (PSAS).

RESULTS

The study included 201 participants, majority of whom were males (99.5%), educated up to 10^th std. (65.7%), with mean duration of substance use of 11.4 years. Opiates were the primary substance of abuse in the majority (83.6%) with ever-injecting drug use present in a considerable proportion (29.4%). The mean perceived stigma scale score was 21.23 ± 3.03. The perceived stigma was higher in patients from rural background, but was not associated with age, educational status, current living situation, duration of substance use and injecting drug use.

CONCLUSION

Stigma remains an important issue among patients with alcohol and opioid use disorders. Perceived stigma could affect participation in society and health seeking behavior in substance using population, thus needs further exploration.

Public attitude towards restrictions on persons with mental illness in greater Hanoi area, Vietnam

BACKGROUND AND AIMS

In recent years, there has been a growing awareness of the need to protect human rights in psychiatry. Within the last years, considerable effort has been made to reduce restrictive measures in mental health settings. Reducing restrictive measures within mental health care has also moved increasingly into the focus of public debate. This study aims, for the first time in a Southeast Asian sample, to explore whether socio-demographic factors affect public attitudes toward restrictions on mentally ill people in Hanoi, Vietnam.

METHODS

A general population-based survey (self-report questionnaire) was carried out in 2013 in the greater Hanoi area. The survey sample ( N = 813) was recruited according to the latest published census (2009) and micro-census (2013) in Vietnam and Hanoi with regard to the socio-demographic factors gender, age, urbanity, household size and marital status. Multinomial logistic regressions for odds ratios with 95% confidence intervals were calculated to examine the influence of epidemiological variables, like gender and age, on the public attitude toward restrictions imposed on mentally ill people in Vietnam.

RESULTS

This study found, for the first time in a large Vietnamese sample, that gender and age were associated with public attitudes toward restrictions on mentally ill people. In detail, significantly fewer men endorsed compulsory admission to a hospital and abortion than Vietnamese women. In addition, endorsement of abortion was significantly higher in older people.

CONCLUSION

The results offer some insight into roles of women in the Vietnamese society and might reflect the traditional gender expectations in Vietnamese families. Moreover, the results emphasize the need for supporting female psychiatric patients and their families within their communities and in the Vietnamese society.

Public attitudes towards psychiatrists in the metropolitan area of Hanoi, Vietnam

OBJECTIVES

Mental health associated stigmatization remains problematic in low and middle-income countries, thus preventing patients from adequate access to psychiatric care. Public attitudes towards psychiatrists have not been examined in many countries, especially not in Vietnam where merely one psychiatrist per 300.000 population is available. The study aims to explore attitudes towards psychiatrists in the Hanoi municipality and to identify socio-demographical factors that influence these attitudes.

METHODS

Between April and August 2013, a general population-based survey was carried out in the greater Hanoi area, Vietnam. The sample of 817 participants was stratified according to the latest Vietnamese census (2009) and micro-census (2013) with regards to socio-demographic factors. Multivariate analyses were conducted to determine the influence of these factors on attitudes towards psychiatrists.

RESULTS

Gender and religious beliefs significantly influenced public attitudes towards psychiatrists. Male participants reported significantly more negative perception towards psychiatrists compared to female respondents. Participants following a religion reported significantly more negative attitudes toward psychiatrists than those without self-reported religious attainment.

CONCLUSIONS

Negative attitudes towards psychiatrists are associated with religious beliefs and gender affiliation in the greater Hanoi area. A strategy that involves religious institutions in raising awareness about mental health issues while considering public's socio-cultural attitudes may pave the way for greater potentialities of adequate psychiatric care, destigmatize the mental health system, and care provider.

Perceived stigmatization and discrimination of people with mental illness: A survey-based study of the general population in five metropolitan cities in India

BACKGROUND

India faces a significant gap between the prevalence of mental illness among the population and the availability and effectiveness of mental health care in providing adequate treatment. This discrepancy results in structural stigma toward mental illness which in turn is one of the main reasons for a persistence of the treatment gap, whereas societal factors such as religion, education, and family structures play critical roles. This survey-based study investigates perceived stigma toward mental illness in five metropolitan cities in India and explores the roles of relevant sociodemographic factors.

MATERIALS AND METHODS

Samples were collected in five metropolitan cities in India including Chennai (n = 166), Kolkata (n = 158), Hyderabad (n = 139), Lucknow (n = 183), and Mumbai (n = 278). Stratified quota sampling was used to match the general population concerning age, gender, and religion. Further, sociodemographic variables such as educational attainment and strength of religious beliefs were included in the statistical analysis.

RESULTS

Participants displayed overall high levels of perceived stigma. Multiple linear regression analysis found a significant effect of gender (P < 0.01), with female participants showing higher levels of perceived stigma compared to male counterparts.

CONCLUSION

Gender differences in cultural and societal roles and expectations could account for higher levels of perceived stigma among female participants. A higher level of perceived stigma among female participants is attributed to cultural norms and female roles within a family or broader social system. This study underlines that while India as a country in transition, societal and gender rules still impact perceived stigma and discrimination of people with mental illness.

Acculturation and severity of depression among first-generation Vietnamese outpatients in Germany

BACKGROUND

Challenges of migration, particularly concerning the process of acculturation are associated with an increased risk of mental illness. Vietnamese migrants constitute the largest Southeast Asian migrant group in Germany, yet there is no data on the relationship between the mental health status and acculturation among this population.

AIMS

Therefore, the present study examines the relationship between two well-established dimensions of acculturation, that is, dominant society immersion (DSI) and ethnic society immersion (ESI), the four resulting acculturation strategies (integration, assimilation, separation and marginalization), and severity of depression.

METHODS

A sample of N = 113 first-generation Vietnamese outpatients from a psychiatric outpatient clinic for Vietnamese migrants in Germany was studied regarding their self-reported depressive symptoms (Beck Depression Inventory-II (BDI-II)) and acculturation (Stephenson Multigroup Acculturation Scale (SMAS)).

RESULTS

Consistent with the hypotheses, patients reported less severe depressive symptoms, when they reported higher orientation toward the German and the Vietnamese society. Moreover, the results showed that integrated patients reported a lower severity of depression compared to marginalized patients, who reported the highest severity of depression.

CONCLUSIONS

The findings indicate that among a sample of first-generation Vietnamese patients with depression, an orientation to both, the mainstream society and one's heritage society might serve as a potential resource. The rejection of any orientation to any society is associated with an increased risk for depression.