Public stigma against family members of people with mental illness: findings from the Gilgel Gibe Field Research Center (GGFRC), Southwest Ethiopia

Background: Public stigma against family members of people with mental illness is a negative attitude by the public which blame family members for the mental illness of their relatives. Family stigma can result in self social restrictions, delay in treatment seeking and poor quality of life. This study aimed at investigating the degree and correlates of family stigma. Methods: A quantitative cross-sectional house to house survey was conducted among 845 randomly selected urban and rural community members in the Gilgel Gibe Field Research Center, Southwest Ethiopia. An interviewer administered and pre-tested questionnaire adapted from other studies was used to measure the degree of family stigma and to determine its correlates. Data entry was done by using EPI-DATA and the analysis was performed using STATA software. Unadjusted and adjusted linear regression analysis was done to identify the correlates of family stigma. Results: Among the total 845 respondents, 81.18% were female. On a range of 1 to 5 score, the mean family stigma score was 2.16 (+/- 0.49). In a multivariate analysis, rural residents had significantly higher stigma scores (std. beta = 0.43, P < 0.001) than urban residents. As the number of perceived signs (std. beta = -0.07, P < 0.05), perceived supernatural (std. beta = -0.12, P < 0.01) and psychosocial and biological (std. beta = -0.11, P < 0.01) explanations of mental illness increased, the stigma scores decreased significantly. High supernatural explanation of mental illness was significantly correlated with lower stigma among individuals with lower level of exposure to people with mental illness (PWMI). On the other hand, high exposure to PWMI was significantly associated with lower stigma among respondents who had high education. Stigma scores increased with increasing income among respondents who had lower educational status. Conclusions: Our findings revealed moderate level of family stigma. Place of residence, perceived signs and explanations of mental illness were independent correlates of public stigma against family members of people with mental illness. Therefore, mental health communication programs to inform explanations and signs of mental illness need to be implemented

Longitudinal sex differences of externalising and internalising depression symptom trajectories

Background: Clinical reports indicate that men tend to engage in a range of externalising behaviours in response to negative emotional states. Such externalising behaviours have been theorised to reflect a male sub-type of depression that is inconsistent with current diagnostic criteria, resulting in impeded detection and treatment rates of depressed men. Aims: In addressing previous study design limitations, this article presents self-report longitudinal data for the multidimensional Male Depression Risk Scale (MDRS-22) against ratings of diagnostic criteria for major depressive disorder as assessed by the Patient Health Questionnaire–Depression Module (PHQ-9). Longitudinal psychometric properties of the MDRS-22 are reported and symptom trajectories described. Method: A sample of 233 adults (males = 125; 54%) completed measures of externalising and prototypic depression symptoms at Time 1, and again at Time 2 (15 weeks later). Psychometric properties were examined and within-subjects analyses undertaken. Results: The MDRS-22 demonstrated stable internal consistency and test–retest correlations equivalent to those observed for the PHQ-9. Both prototypic and externalising depression symptoms increased with experiences of recent negative life events. Marked gender differences were observed. Males experiencing ≥ 2 stressful negative life events reported significantly higher MDRS-22 scores at both Time 1 and Time 2 relative to comparable females. Conclusion: Findings contribute to the validity of the MDRS-22 as a measure of externalising depression symptoms. Results suggest that while both males and females experience externalising depression symptoms, these symptoms may be particularly elevated for men following experiences of negative life events. Findings suggest that externalising symptoms may be a special feature of depression for men. Given the problematic nature of such externalising symptoms (e.g. excessive substance use, aggression, risk-taking), their clinical assessment appears warranted

Confirmatory factor analysis of the Gotland Male Depression Scale in an Australian community sample

The Gotland Male Depression Scale (GMDS) was developed to improve the assessment and identification of depression in men by assessing symptoms that fall outside DSM-V/ICD-10 diagnostic criteria for depression. However, research findings from the GMDS have been markedly discrepant. Attempts to validate the latent GMDS factor structure using exploratory factor analysis (EFA) have yielded inconsistent results, bringing the validity and public health utility of the scale into question. The current study used confirmatory factor analysis to test the construct validity of five competing latent factor models identified from prior research. Data were obtained and analyzed separately from an Australian community sample of adult males (n = 318) and females (n = 345). Fit indices demonstrated the original GMDS two-factor model (distress, depression) to be a poor fit to the data. An alternative mixed three-factor model demonstrated improved model fit, although indices remained marginal. Results question the factor structure validity of the GMDS in the present sample and highlight the need for further psychometric development of the scale

Confirmatory factor analysis of the Gotland Male Depression Scale in an Australian community sample

The Gotland Male Depression Scale (GMDS) was developed to improve the assessment and identification of depression in men by assessing symptoms that fall outside DSM-V/ICD-10 diagnostic criteria for depression. However, research findings from the GMDS have been markedly discrepant. Attempts to validate the latent GMDS factor structure using exploratory factor analysis (EFA) have yielded inconsistent results, bringing the validity and public health utility of the scale into question. The current study used confirmatory factor analysis to test the construct validity of five competing latent factor models identified from prior research. Data were obtained and analyzed separately from an Australian community sample of adult males (n = 318) and females (n = 345). Fit indices demonstrated the original GMDS two-factor model (distress, depression) to be a poor fit to the data. An alternative mixed three-factor model demonstrated improved model fit, although indices remained marginal. Results question the factor structure validity of the GMDS in the present sample and highlight the need for further psychometric development of the scale

Public stigma against people with mental illness in the Gilgel Gibe Field Research Center (GGFRC) in Southwest Ethiopia.

BACKGROUND: Public understanding about mental illnesses and attitudes towards people with mental illness (PWMI) play a paramount role in the prevention and treatment of mental illness and the rehabilitation of PWMI. The aim of this study was to measure public stigma against PWMI and the factors associated with stigma in the Gilgel Gibe Field Research Center (GGFRC) in Southwest Ethiopia. METHODS: This community-based, cross-sectional study was conducted from June to August 2012 among 845 randomly selected respondents by using the Community Attitudes towards the Mentally Ill (CAMI) scale, an interviewer-administered questionnaire. Data was entered with EPI-DATA and then exported to STATA for analysis. Simple descriptive and linear regression analyses were performed to identify predictors of stigma against PWMI. RESULTS: Of the total of 845 respondents, 68.17% were from rural districts. The mean stigma score was 2.62 on a 5-point score. The majority of the respondents (75.27%) believed that mental illness can be cured. Stress, poverty, and rumination were the most often perceived causes of mental illness. Rural residents had significantly higher stigma scores (std. β = 0.61, P<0.001). A statistically significant inverse relationship was found between the level of education and degree of stigma (std. β = -0.14, P<0.01), while higher income was significantly associated with more stigma (std. β = 0.07, P<0.05). Respondents with higher scores for perceived supernatural causes (std. β = -0.09, P<0.01) and perceived psychosocial and biological causes (std. β = -0.14, P<0.001) had significantly lower stigma levels. CONCLUSIONS: The study found a more undermining but less avoidant attitude towards PWMI. Rural residents showed higher levels of stigma. Stigma against PWMI was lower in people with an explanatory concept about the causes of mental illness and a higher level of education. Information, education, and communication about the causes, signs, and nature of mental illnesses would help to reduce stigma

The hypothalamic-pituitary-adrenal axis and serotonin abnormalities: A selective overview for the implications of suicide prevention

Suicidal behavior and mood disorders are one of the world's largest public health problems. The biological vulnerability for these problems includes genetic factors involved in the regulation of the serotonergic system and stress system. The hypothalamic-pituitary-adrenal (HPA) axis is a neuroendocrine system that regulates the body's response to stress and has complex interactions with brain serotonergic, noradrenergic and dopaminergic systems. Corticotropin-releasing hormone and vasopressin act synergistically to stimulate the secretion of ACTH that stimulates the biosynthesis of corticosteroids such as cortisol from cholesterol. Cortisol is a major stress hormone and has effects on many tissues, including on mineralocorticoid receptors and glucocorticoid receptors in the brain. Glucocorticoids produce behavioral changes, and one important target of glucocorticoids is the hypothalamus, which is a major controlling center of the HPA axis. Stress plays a major role in the various pathophysiological processes associated with mood disorders and suicidal behavior. Serotonergic dysfunction is a well-established substrate for mood disorders and suicidal behavior. Corticosteroids may play an important role in the relationship between stress, mood changes and perhaps suicidal behavior by interacting with 5-HT1A receptors. Abnormalities in the HPA axis in response to increased levels of stress are found to be associated with a dysregulation in the serotonergic system, both in subjects with mood disorders and those who engage in suicidal behavior. HPA over-activity may be a good predictor of mood disorders and perhaps suicidal behavior via abnormalities in the serotonergic system. © 2010 Springer-Verlag

Stigma mean scores differences based on socio-demographic backgrounds in the Gilgel Gibe Field Research Center, Southwest Ethiopia, 2012.

1<p>AU = authoritarianism,</p>2<p>BE = benevolence,</p>3<p>SR = social restrictiveness,</p>4<p>CMHI = community mental health ideology.</p