Attributions and private theories of mental illness among young adults seeking psychiatric treatment in Nairobi: an interpretive phenomenological analysis

Abstract

BackgroundMental illness affects every segment of population including young adults. The beliefs held by young patients regarding the causes of mental illness impact their treatment-seeking behaviour. It is pertinent to know the commonly held attributions around mental illness so as to effectively provide psychological care, especially in a resource constrained context such as Kenya. This helps in targeting services around issues such as stigma and extending youth-friendly services.MethodsGuided by the private theories interview (PTI-P) and attributional framework, individual semi-structured interviews were carried out with ten young adults of ages 18–25 years about their mental health condition for which they were undergoing treatment. Each interview took 30–45 min. We mapped four attributions (locus of control, stability, controllability and stigma) on PTI-P questions. Data was transcribed verbatim to produce transcripts coded using interpretive phenomenological analysis. These codes were then broken down into categories that could be used to understand various attributions.ResultsWe found PTI-P to be a useful tool and it elicited three key themes: (a) psychosocial triggers of distress (with themes of negative thoughts, emotions around mental health stigma and negative childhood experiences, parents’ separation or divorce, death of a loved one etc.), (b) biological conditions and psychopathologies limiting intervention, and (c) preferences and views on treatment. Mapping these themes on our attributional framework, PTI-P themes presented as causal attributions explaining stigma, locus of control dimensions and stability. External factors were mainly ascribed to be the cause of unstable and uncontrollable attributions including persistent negative emotions and thoughts further exacerbating psychological distress. Nine out of the ten participants expressed the need for more intense and supportive therapy.ConclusionOur study has provided some experiential evidence in understanding how stigma, internal vs external locus of control, stability vs instability attributions play a role in shaping attitudes young people have towards their mental health. Our study points to psychosocial challenges such as stigma, poverty and lack of social support that continue to undermine mental well-being of Kenyan youth. These factors need to be considered when addressing mental health needs of young people in Kenya.

What Type of Helping Relationship Do Young People Need? Engaging and Maintaining Young People in Mental Health Care—A Narrative Review

“…There is a possibility that research has been conducted and reported in another language other than English which the authors could not access. Nonetheless, existing research shows that professional mental-health help-seeking rates in these regions are low and this may be due to stigma, low mental health literacy, and differing conceptualizations of mental health (Al-Krenawi et al, 2009; Burlaka et al, 2014; Dogra et al, 2011; Mbuthia et al, 2018; Pheko et al, 2013). A significant factor to consider is that this review explored the type of helping relationship in mental health care that young people want, and this is ultimately based on a Western conceptualization of mental health, which presupposes that young people view mental health problems as issues that require professional intervention (Mbuthia et al, 2018; Pheko et al, 2013).…”

“…Nonetheless, existing research shows that professional mental-health help-seeking rates in these regions are low and this may be due to stigma, low mental health literacy, and differing conceptualizations of mental health (Al-Krenawi et al, 2009; Burlaka et al, 2014; Dogra et al, 2011; Mbuthia et al, 2018; Pheko et al, 2013). A significant factor to consider is that this review explored the type of helping relationship in mental health care that young people want, and this is ultimately based on a Western conceptualization of mental health, which presupposes that young people view mental health problems as issues that require professional intervention (Mbuthia et al, 2018; Pheko et al, 2013). There are differing conceptualizations of mental health throughout the globe; for example, in some countries such as the Ukraine, Nigeria, Kenya, and Botswana, young people use traditional healers or religion for their personal problems (Burlaka et al, 2014; Dogra et al, 2011; Mbuthia et al, 2018; Pheko et al, 2013).…”

“…Apart from one study (Williams, 2012), all the studies in this review were from higher income (95%), Western (100%), and English-speaking countries (90%). This meant that three studies—Burlaka et al (2014) from the Ukraine, Bilican (2013) from Turkey, and Mbuthia et al (2018) from Kenya, which met the study criteria, direct reporting from young people —did not meet academic publishing criteria, the exclusion of university students and age limits . Including these three studies might have provided a deeper dimension of analysis regarding cultural differences and similarities, alternative perspectives, and new insights, to the understanding of trust, confidentiality, support, care, and collaboration.…”

Explanatory Models for Mental Distress Among University Students in Ethiopia: A Qualitative Study

“…56 Being able to give a specific psychiatric term to the complaints may be because of the students' educational status, which may have influenced their mental health literacy; the symptoms of anxiety and stress are very common among university students and considered as normal life challenges. 12 Most students attributed their mental distress to more than one causal factor; similarly, in North Western Ethiopia 57 and Kenya, 58 most participants reported psychosocial explanations as causes for their mental health problem. Of the causal factors, students reported more education-related issues.…”

Improving psychotherapies offered in public hospitals in Nairobi, Kenya: extending practice-based research model for LMICs

“…In this model, akin to dissemination and implementation science approaches and psychotherapy effectiveness models, we use both qualitative and quantitative methods to complement each other. Our qualitative work [36] is helping us understand Kenyan patients’ illness, cure perceptions, and attributions. Our ongoing work with therapists on identifying barriers to providing care that include structural, practical, professional, and personal challenges and difficulties would become basis to understanding the process and outcome data we have collected from therapists and patients in the quantitative work.…”