Stigma Causing Delay in Help Seeking Behavior in Patients With Mental Illness

Abstract

Introduction: Stigma is a sign of disgrace or discredit that sets a person apart from others. Stigma has detrimental effect on stigmatized persons’ life which may even hamper or delay the help seeking behavior, which ultimately increases the duration of untreated mental illness.
 Material And Method: A cross sectional survey was conducted among 90 psychiatry outpatients attending Manipal Teaching Hospital, Pokhara, Nepal. Discrimination and disclosure sub-scale of the Stigma scale and ISMI- 10 was administered to measure the extent of stigma. Help seeking delay was assessed using pre- structured questionnaire. Prediction of help seeking delay due to stigma was identified using logistic regression.
 Results: Low mean value on the subscales of the Stigma scale indicated low public stigma in the participants. 34% of the study population exhibited moderate to high self stigma. The full model for initial help seeking delay using logistic regression explained 21.8% (Cox and Snell R square) and 31.5% (Nagelkerke R square) of the variance in initial help seeking delay while the model for the recent help seeking delay explained 13.6% (Cox and Snell R square) and 20.8 % (Nagelkerke R square) of the variance in recent help seeking delay. The strongest predictor of both initial and recent help seeking delay was discrimination subscale (OR= 1.11; 95% CI= 1.033- 1.195).
 Conclusion: Discrimination experienced due to stigmatization leads to delay in help seeking behavior. Public stigma experienced by stigmatized individual acts as a stronger predictor for help seeking delay than self stigma.

Stigma against mental health disorders in Nepal conceptualised with a ‘what matters most’ framework: a scoping review

“…Most of the qualitative studies with stigma as the major theme or domain focused on public stigma of either general community members or healthcare workers. Quantitative or mixed methods studies predominantly focused on self or internalised stigma of people with lived experiences of mental disorders (PWLE) (Adhikari, 2015; Neupane et al ., 2016; Amatya et al ., 2018; Rathod et al ., 2018; Maharjan and Panthee, 2019; Shrestha, 2019), public stigma (family and community members) (Neupane et al ., 2016; Amatya et al ., 2018; Koirala et al ., 2019; Luitel et al ., 2019; Pandey, 2019), health workers’ stigma (Gartoulla et al ., 2015; Pathak and Montgomery, 2015; Kohrt et al ., 2018 b , 2020), medical and pharmacy students’ stigma (Panthee et al ., 2010; Adhikari, 2018; Jalan, 2018; Shakya, 2018), and perceived stigma among PWLE and family members (Adhikari et al ., 2008; Lamichhane, 2019). Four studies exclusively focused on courtesy stigma (Angermeyer et al ., 2003).…”

“…The review identified a number of manifestations of mental disorders. Studies reported the prevalence of self-stigma ranging from 34 to 54% of patients in psychiatric Outpatient Department (OPD) of national hospitals, and 80% of persons screening positive for alcohol use disorder in the community reported internalised stigma (Amatya et al ., 2018; Maharjan and Panthee, 2019; Shrestha, 2019). The patients scored high on components such as stereotype endorsement, discrimination experience and social withdrawal.…”