Doctor of Philosophy
School of Health Sciences
Fernando, Sunera M., Stigma and discrimination toward people with mental illness in Sri Lanka, Doctor of Philosophy thesis, School of Health Sciences, University of Wollongong, 2010. http://ro.uow.edu.au/theses/3569
The number of persons diagnosed with mental illness in Sri Lanka is increasing, but there is no published research on the experience of stigma, or discrimination experienced by patients and their family carers. The aim of the study was to assess the stigma experienced by patients and their carers, and to determine coping strategies and the effects of stigma on help-seeking delay and carer burden. It was hypothesized that higher perceptions of stigma would be associated with higher carer burden and with greater delays in help-seeking. It was expected that coping strategies such as withdrawal and secrecy would be more strongly endorsed than educational and challenge strategies. A cross-sectional sample of 118 patients and their family carers recruited from the outpatient psychiatry clinics of a general hospital and a psychiatry hospital in Sri Lanka were interviewed for this study.
The results revealed that patients experienced both public and self-stigma and that these were present at almost similar levels compared with studies conducted in the U.K. and U.S.A. Employers were the most frequently endorsed sources of discrimination by patients and carers. Disclosure of mental illness was an important issue with over half the patients indicating that they were worried about and avoided telling others about their mental illness. Two thirds of patients reported that their chances of getting married were spoiled due to mental illness. Patients reported levels of public stigma that were significantly higher than those reported by their carers. Withdrawal was the most commonly endorsed stigma coping strategy in patients and carers followed by secrecy, challenge and education. Furthermore, secrecy and withdrawal were more commonly endorsed than education. In both groups, the most frequently (75%) endorsed barrier to seeking healthcare was the concern about being labelled as having a mental illness. Public stigma experienced by carers was significantly related to their ratings of help-seeking delay (r = .22). Regression analysis found that the public stigma experienced by carers accounted for 20% of the variance in help seeking delay, but only reluctance to disclose was a unique predictor of delay. A third of the carers reported high carer burden and both public stigma of patients (rs = .26) and carers (rs = .20) were significantly related to carer burden.
These findings support the theory that stigma contributes to both help seeking delay and carer burden. Therefore, there is a need to institute patient and carer support and advocacy groups to provide a means of helping patients and carers to cope better with the stigma of mental illness. Public education anti-stigma campaigns may also assist to reduce stigma faced by patients and carers.
Medical professionals are gatekeepers to the health care system and have the potential to increase or decrease stigma experienced by patients. Therefore, the second study explored the attitudes toward patients with schizophrenia, depression, alcohol addiction, drug addiction, dementia and panic disorder among 574 medical undergraduates and 72 doctors using self report questionnaires.
Overall, there was higher stigmatisation of the substance use disorders compared to other types of mental disorder. When compared to a UK sample using equivalent methods (Mukherjee et al., 2002), the Sri Lankan doctors and medical students reported more stigmatising attitudes toward patients with depression, alcohol, and drug addiction, but more positive attitudes toward schizophrenia.
The results also indicate the need for reducing stigma during medical education and in particular the need to address blaming attitudes which were relatively high in the Sri Lankan sample. Remedial strategies such as contact with recovered patients in community psychiatry settings may need to be introduced into medical education to improve attitudes. Furthermore, if these attitudes of medical professionals reflect the broader societal attitudes, there is a need to study public attitudes to mental illness in Sri Lanka.