Cross-National Analysis of Beliefs and Attitude Toward Mental Illness Among Medical Professionals From Five Countries

Abstract

This quantitative study sought to compare beliefs about the manifestation, causes and treatment of mental illness and attitudes toward people with mental illness among health professionals from five countries: the United States, Brazil, Ghana, Nigeria, and China. A total of 902 health professionals from the five countries were surveyed using a questionnaire addressing attitudes towards people with mental illness and beliefs about the causes of mental illness. Chi-square and analysis of covariance (ANCOVA) were used to compare age and gender of the samples. Confirmatory factor analysis was employed to confirm the structure and fit of the hypothesized model based on data from a previous study that identified four factors: socializing with people with mental illness (socializing), belief that people with mental illness should have normal roles in society (normalizing), non-belief in supernatural causes (witchcraft or curses), and belief in bio-psycho-social causes of mental illness (bio-psycho-social). Analysis of Covariance was used to compare four factor scores across countries adjusting for differences in age and gender. Scores on all four factors were highest among U.S. professionals. The Chinese sample showed lowest score on socializing and normalizing while the Nigerian and Ghanaian samples were lowest on non-belief in supernatural causes of mental illness. Responses from Brazil fell between those of the U.S. and the other countries. Although based on convenience samples of health professional robust differences in attitudes among health professionals between these five countries appear to reflect underlying socio-cultural differences affecting attitudes of professionals with the greater evidence of stigmatized attitudes in developing countries.

Witchcraft and Biopsychosocial Causes of Mental Illness

“…The structure was confirmed by confirmatory factor analysis (CFA) in the data set used in the present study (Stefanovics et al, 2015). Goodness-of-fit statistics for the CFA were as follows: χ 2 (308) = 865, p < 0.0001, goodness of fit index = 0.90, and rootmean-square error of approximation = 0.05, confirming that the previous factor structure adequately fit to the present data.…”

“…Although the construct validity of the factor structure of the instrument was confirmed in previous studies (Iheanacho et al, 2014) and evaluated through the means of CFA in an earlier study (Stefanovics et al, 2015), more extensive validating evidence would be desirable.…”

“…The established factor structure for this survey (Iheanacho et al, 2014;Stefanovics et al, 2015) includes four factors: 1) interest in or willingness to socialize with people diagnosed with mental illness, 2) favorable attitudes toward normalization of role functioning in the lives of people with mental illness, 3) belief in supernatural causes of mental illness (e.g., witchcraft, curses, God's punishment, possession of evil spirit), and 4) endorsement of aspects of the biopsychosocial model of mental illness (brain disease, physical abuse, biological factors). Individual items and factors and item weights have been previously published (Iheanacho et al, 2014).…”

“…Although studies of the attitudes of mental health professionals are less common than studies of the general population (Hugo, 2001), one recent study examined differences in attitudes toward people with mental illness among health professionals from five countries (Brazil, Nigeria, China, Ghana, and the United States) and found substantial differences, with attitudes favoring the biopsychosocial view of mental illness in the United States and views favoring supernatural explanations in Nigeria and Ghana, with Brazil closer to the United States and the Chinese sample showing more stigmatizing attitude (Stefanovics et al, 2015).…”

“…Whereas the previous study (Stefanovics et al, 2015) demonstrated differences in the attitudes of professionals toward people with mental illness across countries, the current study uses the same data set to explore the interrelation of beliefs about causation of mental illness and attitudes toward people with mental illness both across and within the five countries. In light of the evidence of contrasting values across societies on a continuum from what we have called the traditional to the biopsychosocial perspectives on mental illness, a long tradition has assumed conflict and contradiction between what are roughly termed religious and scientific attitudes (Brooke, 1991).…”