Background The evidence base for stigma in mental health largely originates from high-income countries. Aims This study from Pakistan aimed to address the gap in literature on stigma from low- and middle-income countries. Method This cross-sectional study surveyed 1470 adults from Karachi, Pakistan. Participants from three groups (healthcare professionals, healthcare students and the general public) completed the adapted Bogardus Social Distance Scale (SDS) as a measure of stigma. Results All three groups reported higher scores of stigma toward mental disorders compared with physical disorders. SDS scores for mental illness in the general public were significantly higher than in healthcare students (mean difference (MD) 6.93, 95% CI 5.45–8.45, P < 0.001) and healthcare professionals (MD 6.93, 95% CI 5.48–8.38, P < 0.001). However, SDS scores between healthcare students and healthcare professionals were not significantly different (MD 0.003, 95% CI −1.14–1.14, P > 0.99). Being female was associated with lower stigma scores and being over the age of 30 years was associated with higher stigma scores. Conclusions Stigma campaigns in Pakistan need to target the general population. However, evidence of negative attitudes toward mental illness in healthcare students and healthcare professionals supports the need for stronger emphasis on psychiatric education within undergraduate and postgraduate training in Pakistan.

The COVID-19 pandemic has had a profound effect on stress levels around the world. In developing nations such as Pakistan, lack of resources and socioeconomic inequalities have compounded the negative impact of the pandemic, especially for minorities. Religion in the developing, collectivistic, Muslim-majority nation of Pakistan is a powerful identity marker inherited at birth and reflected in all identifying documents. A well-developed conceptual framework for religion is attachment to God, which has demonstrated strong predictive value for perceived stress in Western samples. Given the importance of other attachment relationships as well, this study has examined the predictive value of attachment to parents, attachment to God, and religiosity on perceived stress in Christian minorities within a Pakistani context. The sample consisted of 183 adult Christian Pakistanis. Multiple regression indicated that religiosity, attachment to father, and attachment to God were the strongest predictors of perceived stress, though not in the same pattern as expected in Western contexts. This finding demonstrates the importance of the impact of culture, attachment relationships, and religious context on perceived stress, indicating a need to consider both religion and culture in psychological care, as well as local and international public policy, to mitigate stress along minorities in developing nations in such uncertain times.

Introduction: Research indicates that attachment to God is correlated with parental attachment and perceived stress.  However, these relationships have not been studied outside the Western context.  The present research evaluated the relationship between attachment to God and attachment to parents within different family systems and the impact of these attachments on perceived stress. Methods: A sample of 284 Christian undergraduate students was surveyed.  The data were collected from the participants through convenience sampling.  Relationships between attachment to parents, attachment to God, religiosity, and perceived stress were studied. Results: A significant positive relationship between attachment to parents and to God was found for the nuclear family system on the anxiety subscale.  For the avoidance subscale, both nuclear and joint family systems had significant positive relationships between parental attachment and attachment to God; however, it was stronger for joint family systems.  The multiple regression analysis showed parental avoidance (β = .256, p <.001) and God anxiety (β = .281, p <.001) as the strongest predictors of stress. Discussion: The findings highlight the impact of collectivistic cultural values, particularly the importance of relationships.  The implications include the significance of the impact of culture on attachment relationships and the finding that attachment correlates with lower levels of perceived stress.  The research also shows the difference in attachment styles depending upon the family system the participant belongs to which can again be attributed to cultural norms and values.