Public knowledge and beliefs about depression among urban and rural Chinese in Malaysia

Mental illness stigmatisation among Malaysian adults: a systematic review

BACKGROUND

Stigmatisation is considered a 'second illness' for people with a mental illness and is highly prevalent in Malaysia. Stigmatisation negatively impacts wellbeing, recovery and productivity. Addressing stigmatisation is integral towards people attaining a higher quality of life.

AIM

To explore mental illness stigmatisation in Malaysian adults.

METHOD

A systematic literature review was conducted using thematic analysis to synthesise and categorise evidence. Five key themes emerged, providing insight into mental health stigmatisation.

FINDINGS

Cultural beliefs, limited knowledge of mental health and lack of education on mental health were factors influencing stigmatisation. Stigmatisation significantly affected the wellbeing and functioning of people with a mental illness. Interventions such as contact-based education effectively reduce stigmatising attitudes manifested by healthcare providers.

CONCLUSION

Establishing mental health literacy, encouraging patient contact, promoting mental health awareness and strengthening mental health policies could reduce mental illness stigmatisation and its impact in Malaysia. Future research is warranted to investigate the impact on physical wellbeing and anti-stigmatising strategies targeting the general public.

Urban-Rural Differences in Depression Literacy Among High School Teachers in the Kingdom of Eswatini

BACKGROUND

Concerns have been raised over teachers' mental health literacy in low-income countries and lower- and middle-income countries wherein pediatric mental health resources are limited. This study aims to investigate adolescent depression literacy among teachers in Eswatini and to explore the role of urbanicity.

METHODS

We conducted a cross-sectional survey in 59 public high schools in Eswatini in 2019-2020. Data were collected by a paper-and-pencil questionnaire; depression literacy was assessed by the 17-item Adolescent Depression Knowledge Questionnaire.

RESULTS

Teachers' adolescent depression literacy item-level correct rates fell between 27 and 80%. Although the multivariate response models indicated that teaching in urban areas was slightly associated with having higher depression literacy in general (adjusted odds ratio [aOR] = 1.46; 95% confidence interval = 1.00-2.12), such urban-rural differences did not manifest homogeneously across all items: urban teaching was significantly linked with reduced correct responses toward certain items concerning depression etiology and treatment, including "depression runs in some families," "major stress as a necessary cause," and "a curable illness" (aOR = 0.57 ∼ 0.68).

CONCLUSION

Urban-rural differences in teachers' depression literacy were manifested at both scale- and item-levels. A critical need exists for urban/rural areas-tailored intervention on teachers' literacy toward mental disorders in the resource-limited regions to better improve health and developmental outcomes of students.

Mental health literacy: A systematic review of knowledge and beliefs about mental disorders in Malaysia

BACKGROUND

Mental health problems in Malaysia are on a rise. This study aimed at performing a systematic review of mental health literacy (MHL) in Malaysia.

METHODS

Medline, Embase, ERIC/Proquest, ScienceDirect, Pubmed, PsycINFO, CINAHL, Scopus, EBM Reviews - Cochrane Central Register of Controlled Trials, Ovid Emcare and reference lists of included studies were searched in February 2020. Studies that evaluated at least one of the main components of MHL, including (1) knowledge related to mental health issues, and (2) stigma, were included irrespective of study design. As secondary findings, the review also synthesized results related to facilitators and barriers to seeking mental health services. Depending on the research design, the quality of each study was assessed through checklists.

RESULTS

Forty six studies published between 1995 to 2019 were included. Most studies used cross-sectional designs to investigate MHL. Findings indicate that most Malaysians have stigmatizing attitudes towards mental health problems. Participants in the included studies endorsed multifactorial explanations of mental health issues with a dominance of supernatural and religious aetiologies. Likewise, the commonest barrier was considering sources other than professional sources of mental-health services. Presence of adequate knowledge and considering providers as competent facilitated help-seeking. Additionally, there was considerable heterogeneity in studies and a lack of standardized measures assessing MHL.

CONCLUSIONS

There is an increase in studies on MHL in Malaysia. A few of these studies, based on experimental design, have shown positive effects. Researchers, practitioners, and policymakers should develop standardized measures and interventional studies based on all the components of MHL.

The effect of a culturally sensitive mental well-being module on Pakistani nursing students' knowledge and beliefs regarding their own mental health and illness

This study examined the effect of a mental well-being module on undergraduate nursing students' knowledge and beliefs regarding causes and treatment of mental health and illness, and explored the relationship between these variables and depression and anxiety. The one group design incorporated pre-intervention, intervention and post-intervention phases, in a consecutive sample of 246 students in a 4-year BScN programme in Pakistan. A culturally sensitive, interactive mental well-being module of four hours length was delivered to three groups of approximately 40 students per group. Repeated measures ANOVA was performed to assess the difference in the mean knowledge scores. Paired t-tests investigated between-group differences on the factor scores. A total of 112 students screened positive for anxiety and depression symptoms. Repeated measures ANOVA showed a significant difference in the mean knowledge scores regarding mental illness (P < 0.001). Factor analysis resulted in four factors for the aetiology items. Paired t-test showed significant differences (P < 0.001) between psycho-social and environmental factors, supernatural and religious beliefs, and neuro-genetics. For treatment, significant differences (P < 0.001) were found between all factors - Professional and Help from others, Religiosity and Socialization, and Alternative and Medical Treatment. There was a significant and positive change in students' mental health knowledge, beliefs and mental health-seeking behaviour and diminished stigmatized beliefs. Based on the findings, it is highly recommended to incorporate the mental well-being program in the curriculum.

Implementation of family-based treatment for Asian adolescents with anorexia nervosa: A consecutive cohort examination of outcomes

OBJECTIVE

This study describes the implementation of family-based treatment (FBT) in an eating disorder program in Asia as well as clinical outcomes of Asian adolescents with anorexia nervosa (AN) treated with FBT.

METHOD

This retrospective consecutive cohort study of 147 Asian adolescents with AN was compared between those in FBT (n = 65) versus treatment as usual (TAU) (n = 82). Variables associated with weight restoration were analyzed between groups.

RESULTS

Participants' mean age was 14.2 (SD = 1.5) years and 93% were female. Mean presenting %mBMI was 74.0 (SD = 7.8) and average illness duration was 7.7 (SD = 6.1) months. The two groups' baseline characteristics were not significantly different. Weight restoration rates in the FBT group were significantly higher than the TAU group at 6-, 12-, and 24-month time points. A linear mixed model showed the mean %mBMI was significantly higher at 0, 6, 12, and 24 months in the FBT group. The median time to weight restoration for patients on FBT was shorter (FBT: 7.0 months, TAU: 19.0 months; 95% CI [14.5, 23.5] χ² = 15.84, p < .001). Within the FBT group, those that completed ≥9 FBT sessions had significantly higher rates of weight restoration at 12 months. Across all participants, those with a lower starting %mBMI were less likely to achieve weight restoration by 12 months.

CONCLUSION

FBT can be effectively implemented in a multidisciplinary eating disorder program managing Asian adolescents with AN with improved rates of weight restoration. Further research is needed to understand the predictors and moderators of remission using FBT in Asian adolescents with AN.

A systematic review of mental health literacy in Pakistan

Individual mental health has become a primary global concern. In Pakistan, the prevalence of mental health issues is still unclear, as not many studies have assessed the level of mental health literacy (MHL) in the country. This systematic review aims to bridge this gap by encouraging the early detection of mental disorders, lessening stigma, and improving help-seeking behavior. Nine electronic databases were searched to identify empirical literature in this area. Only studies that evaluated MHL efficacy and those published in English were selected. Non-peer reviewed articles and gray literature were excluded. From 613 studies retrieved, 59 studies met the inclusion criteria and were reviewed. Forty-three of the included studies mentioned mental health outcome measures (of which only four mentioned reliability indices), 13 discussed stigma, 18 examined help-seeking approaches to mental illness treatments, and 47 discussed mental health knowledge. Additionally, the outcome of the MHL measures had considerable heterogeneity and limited validity. Meta-analysis was not conducted due to a lack of MHL operationalization. Besides, the measurement tools in the studies lacked consistency and standardization. This review compiled the available studies on MHL to assist researchers currently studying the various dimensions of MHL, as well as those designing new studies or investigating effective methods to increase MHL. This review highlights the need for well-designed controlled intervention studies. Further implications for researchers, practitioners, and policymakers are mentioned.

Health literacy in rural and urban populations: A systematic review

OBJECTIVE

This review assessed whether health literacy differences exist between rural and urban populations and whether rurality is a determinant.

METHODS

Eight online databases were searched using the keywords "health literacy", "rural" and "urban", and related terms. Peer-reviewed original research comparing health literacy levels between rural and urban populations were evaluated for strength of evidence. A narrative synthesis summarised the results of included studies.

RESULTS

Nineteen articles met inclusion criteria and were of sufficient methodological quality for data extraction. The majority of studies found that urban populations had higher health literacy than rural populations. Differences were more likely to be found in developing than developed countries. Studies that performed covariate analysis indicated that rurality may not be a significant determinant of health literacy.

CONCLUSION

Evidence suggests that rurality alone does not explain rural-urban health literacy differences and that sociodemographic factors play important roles.

PRACTICE IMPLICATIONS

These findings could be used to help inform the development of evidence-based interventions specifically for rural populations, at both health policy and clinical levels; for example, by tackling healthcare access challenges. The findings also provide a lens through which to consider efforts to reduce rural-urban health outcome disparities.

The Singaporean public beliefs about the causes of mental illness: results from a multi-ethnic population-based study

AIMS

To identify the common causal beliefs of mental illness in a multi-ethnic Southeast Asian community and describe the sociodemographic associations to said beliefs. The factor structure to the causal beliefs scale is explored. The causal beliefs relating to five different mental illnesses (alcohol abuse, depression, obsessive-compulsive disorder (OCD), dementia and schizophrenia) and desire for social distance are also investigated.

METHODS

Data from 3006 participants from a nationwide vignette-based study on mental health literacy were analysed using factor analysis and multiple logistic regression to address the aims. Participants answered questions related to sociodemographic information, causal beliefs of mental illness and their desire for social distance towards those with mental illness.

RESULTS

Physical causes, psychosocial causes and personality causes were endorsed by the sample. Sociodemographic differences including ethnic, gender and age differences in causal beliefs were found in the sample. Differences in causal beliefs were shown across different mental illness vignettes though psychosocial causes was the most highly attributed cause across vignettes (endorsed by 97.9% of respondents), followed by personality causes (83.5%) and last, physical causes (37%). Physical causes were more likely to be endorsed for OCD, depression and schizophrenia. Psychosocial causes were less often endorsed for OCD. Personality causes were less endorsed for dementia but more associated with depression.

CONCLUSIONS

The factor structure of the causal beliefs scale is not entirely the same as that found in previous research. Further research on the causal beliefs endorsed by Southeast Asian communities should be conducted to investigate other potential causes such as biogenetic factors and spiritual/supernatural causes. Mental health awareness campaigns should address causes of mental illness as a topic. Lay beliefs in the different causes must be acknowledged and it would be beneficial for the public to be informed of the causes of some of the most common mental illnesses in order to encourage help-seeking and treatment compliance.

Beliefs about the causes of and treatments for depression and bipolar disorder among South Koreans

Public beliefs about psychiatric disorders are important for understanding help-seeking behaviours. We investigated factors that affect South Koreans' beliefs about the causes and treatment of depression and bipolar disorder. We recruited 654 participants aged 15-54 years using an online panel survey. Participants completed two questionnaires: 34 possible causes of and 33 possible treatments for depression and bipolar disorder. For both disorders, the questionnaires about causes revealed four factors: social-environmental, God/fate, heath/lifestyle, and biological; the questionnaires about treatments revealed five factors: self-help/stress management, physical treatment/health management, seeking mental health services, religious help, and resting. Causes of depression were more recognized as social-environmental, religious, and health/lifestyle compared to bipolar disorder. Participants expressed more beliefs in self-help/stress management, physical treatment/health management, seeking mental health services, and resting for depression, compared to bipolar disorder. Participants' beliefs about the causes of the disorders and their demographic and psychiatric characteristics were closely associated with beliefs about treatment validity. Participants' beliefs about the causes of depression and bipolar disorder significantly affected their beliefs about treatment. Therefore, strategies to improve mental health literacy should provide the aetiology of specific mental disorders. Further research using a representative community sample is needed to generalize our findings.

Mental health literacy in Hong Kong

BACKGROUND AND AIMS

The aim of this study was to investigate Hong Kong nationals' ability to recognize 13 different mental disorders and to examine whether there may be a relationship between their mental health literacy (MHL) and their tendency to describe/explain symptoms of mental disorders in physical terms.

METHODS

A total of 299 participants took part in this study and the vignettes depict post-traumatic stress disorder, depression, obsessive-compulsive disorder (OCD), dependent personality disorder, schizotypal personality disorder, generalized anxiety disorder, agoraphobia, bipolar disorder, social phobia, panic disorder, narcissistic personality disorder, schizophrenia and antisocial personality disorder.

RESULTS

Overall, OCD was the best identified and the personality disorders were the worst. A significant negative correlation was found between participants' MHL and the rate of offering a 'physical' rather than a 'psychological' explanation. Some mental disorders were better recognized than others such as OCD (40.1%) and depression (36.3%). However, the majority of the other disorders were very poorly recognized and labelled with the rest having 'correct response' rates of lower than 15%. Over half of the mental disorders had 'correct' response rates of lower than 5%.

CONCLUSION

In accordance with many other studies in the area, this study found Asian participants poor at recognizing mental disorders. This is probably due to the fact that mental illnesses of all kinds remain a taboo topic.

Beliefs about the causes and cures of depression

BACKGROUND

This study used attitude statement and vignette methodology to examine a mixed British sample's belies about the causes and consequences of depression.

AIMS

To test whether the group would recognise both vignettes with having depression and that the favoured cure would be Psychotherapy/Talking Cure.

METHOD

In all, 320 adults completed a two-part questionnaire. In the first part, they were given two vignettes describing a 30-year-old female and a 45-year-old male both with depression. They were asked what they thought (if anything) was wrong with the person and how they could best be helped. In the second part, they completed two questionnaires, one which lists 47 possible causes and the other 48 possible treatments for depression.

RESULTS

Most participants 'diagnosed' depression for the two vignettes although they chose very different terms and offered a variety of 'cures', including medication and counselling. The questionnaires about cause and cure factored into seven interpretable factors which were logically correlated. A series of regressions showed that sex, age, media interest, political beliefs, experience with depression and other mental illnesses as well as having known of others diagnosed with depression predicted different beliefs about the causes and cures of depression.

CONCLUSION

People have a detailed and multidimensional view of the causes and cures for depression which is systematically related to each other.

Depression literacy of undergraduates in a non-western developing context: the case of Sri Lanka

BACKGROUND

Research examining the depression literacy of undergraduates in non-western developing countries is limited. This study explores this among undergraduates in Sri Lanka.

METHODS

A total of 4671 undergraduates responded to a survey presenting a vignette of a depressed undergraduate. They were asked to identify the problem, describe their intended help-seeking actions if affected by it and rate the helpfulness of a range of help-providers and interventions for dealing with it. Mental health experts also rated these options, providing a benchmark for assessing the undergraduates' responses.

RESULTS

Only 17.4% of undergraduates recognised depression, but this was significantly lower among those responding in Sinhala compared to English (3.5 vs 36.8%). More undergraduates indicated intentions of seeking informal help, such as from friends and parents, than from professionals, such as psychiatrists and counsellors. However, a majority rated all these help-providers as 'helpful', aligning with expert opinion. Other options recommended by experts and rated as 'helpful' by a large proportion of undergraduates included counselling/psychological therapy and self-help strategies such as doing enjoyable activities and meditation/yoga/relaxation exercises. However, a low proportion of undergraduates rated "western medicine to improve mood" as 'helpful', deviating from expert opinion. Although not endorsed by experts, undergraduates indicated intentions of using religious strategies, highly endorsing these as 'helpful'. Labelling the problem as depression and using mental health-related labels were both associated with higher odds of endorsing professional help, with the label 'depression' associated with endorsing a wider range of professional options.

CONCLUSIONS

The recognition rate of depression might be associated with the language used to label it. These undergraduates' knowledge about the use of medication for depression needs improvement. Health promotion interventions for depressed undergraduates must be designed in light of the prevalent socio-cultural backdrop, such as the undergraduates' high endorsement of informal and culturally relevant help-seeking. Improving their ability to recognise the problem as being mental health-related might trigger their use of professional options of help.

Assessment of mental health literacy using a multifaceted measure among a Chinese rural population

OBJECTIVES

The present study aims to assess mental health literacy (MHL) using a standardised multifaceted 20-item instrument called Mental Health Knowledge Questionnaire (MHKQ) developed by the Chinese Ministry of Health, among a rural Chinese population.

SETTING

Four villages in Liuyang county of Hunan province, China.

PARTICIPANTS

This was a cross-sectional study. A multistage cluster-sampling method was adopted, leading to a final sampling frame of 2377 residents aged 18-60 years from four villages of Liuyang county. Included in the study were residents aged 18-60 years living in their village for at least half a year; excluded were those not living in the areas during the research period, those with difficulty in communication due to serious physical or mental illness and those who were cognitively impaired or actively psychotic. Finally, 2052 participants completed the survey.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary outcome was correct response rate of the MHKQ; secondary outcome measures were association between sociodemographics and MHL, and association between MHL and health outcomes.

RESULTS

Correct response rates for the 20 MHKQ items ranged from 19% to 94%, with a mean rate of 58%. Younger age (r=-0.02, p<0.01), higher education (r: 1.38-2.69, p<0.01) and higher income (r=0.41, p<0.01), were independently associated with higher MHL. MHL was independently associated with self-rated general health (r=2.31, p<0.01), depression (r=-0.09, p<0.01) and anxiety (r=-0.07, p<0.05).

CONCLUSIONS

MHL in the rural areas of Liuyang is lower than that reported in urban areas of China. There is much room for improvement with regard to MHL promotion in rural areas of China. Younger age, higher education and higher income are the three robust factors related to higher MHL, so cohort-specific educational intervention efforts may be indicated.