Rural vs urban residence and experience of discrimination among people with severe mental illnesses in Ethiopia

Abstract

Background Few studies have addressed mental illness-related discrimination in low-income countries, where the mental health treatment gap is highest. We aimed to evaluate the experience of discrimination among persons with severe mental illnesses (SMI) in Ethiopia, a low-income, rapidly urbanizing African country, and hypothesised that experienced discrimination would be higher among those living in a rural compared to an urban setting. Methods The study was a cross-sectional survey of a community-ascertained sample of people with SMI who underwent confirmatory diagnostic interview. Experienced discrimination was measured using the Discrimination and Stigma Scale (DISC-12). Zero-inflated negative binomial regression was used to estimate the effect of place of residence (rural vs. urban) on discrimination, adjusted for potential confounders. Results Of the 300 study participants, 63.3% had experienced discrimination in the previous year, most commonly being avoided or shunned because of mental illness (38.5%). Urban residents were significantly more likely to have experienced unfair treatment from friends (χ2(1)=4.80; p=0.028), the police (χ2(1) =11.97; p=0.001), in keeping a job (χ2(1)=5.43; p=0.020), and in safety (χ2(1)=5.00; p=0.025), and had a significantly higher DISC-12 score than those living in rural areas (adjusted risk ratio: 1.66; 95% CI: 1.18, 2.33). Conclusions Persons with SMI living in urban settings report more experience of discrimination than their rural counterparts, which may reflect a downside of wider social opportunities in urban settings. Initiatives to expand access to mental health care should consider how social exclusion can be overcome in different settings.

Urbanization and emerging mental health issues

“…87 Minorities, including mentally ill persons or sexual minorities, may challenge with violence, more in urban settings than in rural ones, mostly derived by a politically oriented discrimination and leading to more social stress and psychopathology. [87][88][89] Specific mental health services should be developed for mental health issues related to the state of being minority or migrant minority, also specific training on these issues should be introduced in the core curriculum of mental health care professionals. 85…”

Mental Health Stigma and Discrimination in Ethiopia: Evidence Synthesis to Inform Stigma Reduction Interventions

“…According to a qualitative study which involved 26 mental health practitioners or educators, participants perceived community stigma as soon as individuals with severe mental illness were seen outside their homes, regardless of gender [38]. In a population-based study among people with severe mental illness, 63.3% of 300 participants had experienced discrimination in the previous year, mainly by being avoided or shunned because of mental illness [43]. An institution-based study in an urban setting reported similar ndings of perceived stigma (62.6%) among 423 people with schizophrenia [44].…”