Stigma Towards Mental Illness Amongst Adults Who Primarily Identify Themselves With Greek Culture
Stigma Towards Mental Illness Amongst Adults Who Primarily Identify Themselves With Greek Culture
AbstractStigma can be defined as a negative attitude towards a certain group of people and is present globally amongst communities. Mental health problems refer to disorders of the human mind that affect behaviour, mood and communication. Stigma towards mental health exists in many cultures, however, in this study; the stigma present in Greek culture will be explored. This will be done using a cross-sectional quantitative method, with a self developed questionnaire containing social demographic articles that will be inspired by the CAMI scale. The target group of this study is people of both genders, with a Greek culture, with ages ranged from 18 to 65. Results may indicate that there is stigma present and may indentify the specific type of stigma that there is towards the mentally ill. The results of this study may be shared with the general population, non-profit organisations and academic centres. In order to reduce stigma, further action may be taken in the form of increased awareness, education and promotion.
Contents
TOC o “1-3” h z u HYPERLINK l “_Toc376853191” Abstract PAGEREF _Toc376853191 h 0
HYPERLINK l “_Toc376853192” 1. Introduction PAGEREF _Toc376853192 h 1
HYPERLINK l “_Toc376853193” 1.1 Mental Health PAGEREF _Toc376853193 h 1
HYPERLINK l “_Toc376853194” 1.2 Stigma Towards Mental Health PAGEREF _Toc376853194 h 2
HYPERLINK l “_Toc376853195” 1.3 Greek Culture PAGEREF _Toc376853195 h 3
HYPERLINK l “_Toc376853196” 2. Rationale PAGEREF _Toc376853196 h 4
HYPERLINK l “_Toc376853197” 3. Aims and Objectives PAGEREF _Toc376853197 h 5
HYPERLINK l “_Toc376853198” 4. Literature review PAGEREF _Toc376853198 h 6
HYPERLINK l “_Toc376853199” 5. Methodology PAGEREF _Toc376853199 h 8
HYPERLINK l “_Toc376853200” 5.1 Approach PAGEREF _Toc376853200 h 8
HYPERLINK l “_Toc376853201” 5.2 Questionnaire PAGEREF _Toc376853201 h 10
HYPERLINK l “_Toc376853202” 5.3 Participants PAGEREF _Toc376853202 h 11
HYPERLINK l “_Toc376853203” 5.4 Data collection and analysis PAGEREF _Toc376853203 h 11
HYPERLINK l “_Toc376853204” 5.5 Ethical issues PAGEREF _Toc376853204 h 11
HYPERLINK l “_Toc376853205” 5.6 Permission PAGEREF _Toc376853205 h 12
HYPERLINK l “_Toc376853206” 6. Discussion of Results PAGEREF _Toc376853206 h 12
HYPERLINK l “_Toc376853207” 7. Dissemination PAGEREF _Toc376853207 h 13
HYPERLINK l “_Toc376853208” 8. Reflection PAGEREF _Toc376853208 h 13
1. Introduction1.1 Mental HealthThe term ‘mental illness’, by its scientific meaning, is used to describe the consequences and the experiences that cause disorders in the human mind, emotions, behaviour, and communication with other people (Xaritsi, 2007). When dealing with mental health, one looks at both the body and mind as two processes that work together (Pritchard, 2006). According to the World Health Organisation (WHO) (2005) the crux of a good quality of life is mental health well being; with this, humans are inspired to experience life better and be creative, proactive citizens: “Mental health is an essential component of social cohesion, productivity and peace and stability in the environment, contributing to social capital and economic development in societies” (WHO, 2005, page 1). However, the majority of those diagnosed as mentally ill tend to reject the diagnosis and reciprocate that they are healthy and do not require treatment. Regarding individuals diagnosed with mental illnesses, it is often the case that their lives include detrimental experiences and this plays a role in their diagnosis (Ryan and Pritchard, 2004). Moreover, mental illnesses are caused by the collaboration of both the environment and genetics, so individuals whom suffer through terrible life experiences may also have a genetic predisposition to a certain disorder and a bad experience may act as a “trigger” event that causes the mental illness to surface (Davison, Neale and Kring, 2004).
Recent studies indicate that a vast number of personal, genetic, physical, behavioural, social, economic, cultural, and environmental determinants contribute to mental health issues and mental well-being (Cattan and Tilford, 2006). In order to fully understand the role of mental well being in the lives of people, it is imperative that factors that negatively impact mental health are thoroughly considered and examined (Cattan and Tilford, 2006).
Patients most commonly consult doctors due to mental health issues; these consultation tests occur in primary healthcare, in the accident and emergency department or in outpatient clinics (Davies and Craig, 2009). At any given time, about one third of the world’s adult population report symptoms of mental distress, such as worry, sleep disturbance and irritability (Davies and Craig, 2009). Mental disorders are responsible for 22% of total disability all over the world and are ranked as the fifth of the top ten causes of life with disability (Davies and Craig, 2009).
The World Health Organisation declared that mental illnesses worldwide account for 11% of the “ill health burden” and was expected to rise to 15% by the year 2020 (Cattan and Tilford, 2006). The WHO (2012) conducted a meta-analysis of community studies in Iceland, Norway and Switzerland. Results showed that 27% of the adult population aged 18-65 had experienced one or more symptoms from at least one mental disorder, such as anxiety, depression, psychosis and eating disorders. Out of this 27%, 35.2% were female and 21.7% were male. Suicide is linked with mental illness and is a cause for great concern in the public health sector. According to the WHO (2012), 123.853 people commit suicide every year and men are nearly five times more inclined to commit suicide than women; an average statistic of EU countries shows that 23.8 of 100 000 men and 5.2 of 100 000 women commit suicide, even though women are shown to harbour more mental illnesses (see above).
It is clear to see how dire the issue of mental health and well being is, regardless of age, sex or geographical location. However, the issues developed from this and how they are dealt with in practice are of greater importance, which is demonstrated by the vast number of local and international strategies (Cattan, 2009).
1.2 Stigma Towards Mental HealthThe term “stigma” hails from Ancient Greek. In Ancient Greece, this term was used to describe a brand, a scar from a burn injury or a cut that was used to indicate that the individual bearing the scar was a slave or a criminal (Arboleda-Florez, 2003 & Leff and Warner, 2006). Subsequently, the term was altered to suit a more positive context (“stigmata”), and was used to refer to marks that resembled the wounds of the crucified body of Christ; these were reported to be present on the bodies of saints and other holy people (Arboleda-Florez, 2003 & Leff and Warner, 2006). Moreover, the word “stigma” is derived from “differences”, which may be present as differences in personality, physical appearance, age, gender, sexual orientation, illness and disability (Mason et al., 2001). Presently, the term “stigma” explicates an attitude that towards a person or a group of people that is discriminatory (Mason et al., 2001).Worldwide, people suffering from mental illnesses are looked at differently than those suffering from physical illnesses and ordinary people. This stigma towards mental health may be due to a perceived connection between those suffering from mental illnesses and violence and crime. It is also due to the fact that the majority of people have trouble to understand how and why individuals with mental illnesses behave and act in the way that they do (Leff and Warner, 2006). Additionally, individuals suffering from mental illnesses have great trouble in sharing their thoughts and experiences and thus understanding them becomes even more difficult. It is common that people possess the desire to distance themselves from individuals suffering from mental illnesses or keep them away from society and urban areas. These factors contribute in the development of stigma towards individuals with mental health issues (Leff and Warner, 2006).Stigma does not only affect the target group of stigmatisation, but also those close to them, such as family members and friends. Professionals in the mental health sector, psychiatric hospitals and inevitably all mental health services are negatively affected by this stigmatisation, which could lead to a detrimental effect to the output of their services. In 1996, the WHO launched a global campaign to fight against stigma towards mental health (Papadopoulos, 2009).
Stigma is a global phenomenon and an inexorable human attribute, although it takes form in different ways according to society and culture. The consequences of stigma are manifested not only on the target group or individual, but on society as a whole and more work should be done to attempt to eliminate or reduce stigma (Cuttcliffe and Hannigan, 2001).
1.3 Greek CultureGreek people have a negative attitude towards the government’s strategy for the deinstitutionalisation of psychiatric patients, although, the Greek state considers the deinstitutionalisation strategy as an important move towards dealing with community stigmas (Papadopoulos, 2009). According to a survey conducted on the public’s opinion on schizophrenia in Greece, it was concluded that social-distance levels were higher in Greece compared to results from Germany and Canada (Papadopoulos, 2009). Moreover, 50% of the Greek participants responded that they would be disturbed if they were asked to work with individuals suffering from schizophrenia. However, most of the participants had a positive attitude towards establishing mental health community homes, as long as such homes were not in their own neighbourhoods. The results showed that the views that were more stigmatising were harboured from the participants who were older (Papadopoulos, 2009).
According to Papadopoulos et al. (2002), people of a Greek culture were stigmatising of individuals suffering from mental health problems. They compared white English and Greek/Greek Cypriot’s attitudes towards mental illness and the results showed that Greek/Greek Cypriots were less open-minded, more restrictive towards mentally ill people and more prone to considering them as less intelligent. However, Greeks seemed to be more sympathetic towards people who suffer from mental health problems, but considered them as inferior and dangerous people to be isolated for the safety of the general public. The results of another study on UK-migrant Greeks recorded that Greek Cypriots are likely to reject the possibility that a family member have mental health problems (Papadopoulos, 2009).
2. Rationale
Mental health and the life of people who are suffering from mental health problems are an aspect of social reality. It is very possible that this reality is kept in silence, due to its stigmatisation, and so the real dimensions of this phenomenon cannot be accurate in the social environment. According to the WHO (2001), the adverse effects that occur due to the stigmatisation of the mentally ill includes, rejection by family, friends, neighbours, employees and can lead to long lasting feelings of isolation, loneliness and depression.
Papadopoulos et al. (2002) state that Greek and Greek-Cypriot UK immigrants hold significantly higher levels of stigmatizing attitudes than white-English UK born people (Papadopoulos, 2009). In order to understand the height of stigma towards mental health problems amongst people with a Greek culture, it is important to carry out this study.
It is important to gain an understanding of the level and type of mental illness stigma within a specific cultural group, in order to target the problem more invasively and thus create policies, programs, strategies and raise awareness amongst those that possess stigma towards mental illness. For example, stigma towards mental illness may worsen the symptoms of individuals suffering from mental disorders, as it has a negative impact and causes social exclusion. Moreover, programs may be developed that provides support to the mentally ill, with the aim to aid them in dealing with stigma towards mental illness.
However, there is a limited amount of up-to-date research on this topic amongst people with a Greek culture and this may be due to the economic crises in Greece and Europe. As a result of this, this study may provide useful information on the topic.
3. Aims and ObjectivesThe aim of this study is to explore the prevalence and type of mental illness stigma that exists amongst adults (aged 18-65), who primarily identify themselves with Greek culture.
The specific objectives of the study are:
To investigate the prevalence of mental illness stigma
To investigate the types of mental illness stigma which may exist
To investigate the knowledge and experience level of mental illness
To investigate which factors (including knowledge and experience level) help to explain mental illness stigma
To use the study findings to:
Develop the evidence-base of stigma reducing programmes and strategies
Raise awareness among the general population and the professional community about the stigma issues in this culture both to
Suggest improvements/amendments to existing mental health policies
4. Literature reviewThere is a limited amount of up-to-date research on stigma towards mental illness among people with a Greek culture. However, it is necessary to understand how stigma affects the lives of people who are suffer from mental problems and the level of stigma towards them amongst people with Greek culture. In order to indentify the level and type of stigma towards the mentally ill, to certify new dimensions on the topic and to provide useful information, studies related to this topic have been looked at and reviewed.
In 2002, Papadopoulos, Leavey and Vincent conducted a study by the name “Factors influencing stigma: a comparison of Greek/Cypriot and English views towards mental illness in north London”. The study took place in north London because a vast amount of Greek/Cypriot people reside there. The researchers compared the attitudes of first- and second generation Greek/Cypriots and those of a white/English ethnicity towards mental illness. The researchers used the snowballing sampling method in order to attain participants and the participants consisted of 91 Greek/Cypriots and 79 white-English individuals. The Community Attitudes Towards the Mentally Ill scale (CAMI) was used to the attitudes towards mental illness and the Wolf et al. questionnaire was utilized in order to measure the participants’ understanding of mental illness and contact with the mentally ill (Papadopoulos et al., 2002). The CAMI scale measures levels of authoritarianism, benevolence, social restrictiveness and community mental health ideology. The researcher choose this scale because previous studies have shown it to be “valid and reliable, relatively brief and has a focus on community rather than professional attitudes toward mentally ill” (page 114 Papadopoulos, 2009). The results of the study showed that Greek/Cypriots hosted more stigmatising views and were more distanced towards the mentally ill and had less knowledge of mental illness as compared to the white-English participants. Moreover, attitudes towards mental illness by the first and second generation of Greek/Cypriots were very similar, although there were no negative views in terms of knowledge on mental illness. In addition, it was found that knowledge of mental illness was linked with positive views towards the mentally ill (Papadopoulos et al., 2002).
Another study, conducted by Papadopoulos (2009), explored whether or not the cross-cultural value paradigm ‘individualism-collectivism’ is an explanatory model for mental health illness stigmatisation. Although previous literature provided information on the importance of this factor, this was the first attempt of investigating this directly.The study, titled ‘Stigma towards people with mental health problems: An individualism-collectivism cross-cultural comparison’, used a combination of quantitative and qualitative data collection and method techniques. The researcher chose a mixed-methods approach, as the combination of techniques and methods would help to facilitate the exploration of the research aims. The data for the quantitative and qualitative survey was collected using a snowballing sampling method. Three-hundred and five individuals (residing in the UK) from four different cultures participated in the study – English, American, Greek/Greek Cypriot and Chinese in U.K. The questionnaire for the quantitative survey included data such as social-demographic data, attitudes towards mental health problems, and individual scores of individualism and collectivism. In order to measure the attitudes and stigma levels towards people with mental health problems, the researcher made use of the CAMI scale. These questions were included, as previous studies have shown that there are associative factors with culture in determining stigma (Papadopoulos, 2009). In addition, other questions such as length of stay in England and first language were included to underline the level of acculturation to the English culture. Moreover, the questions created by Wolf et al. were utilised, as the aim of the study was to explore the participants’ beliefs on aggression and intelligence on people with mental health problems. Finally, the researcher utilised the vertical-horizontal individualism-collectivism method by Triandis in order to explore participant type and level of individualism and collectivism; however there is a question of the internal reliability of this survey, as no research has been done to investigate this (Papadopoulos, 2009).
The results of this study showed that the cross cultural paradigm can be considered as a factor which can explain views towards mental illness. The researcher found that when people have more stigmatising views, it tends to root from collectivism. The participants from America illustrated the least stigma towards mental illness, and the white-English participants also demonstrated this and both groups showed high scores on levels of individualism (Papadopoulos, 2009). In contrast, Greek/Cypriot and Chinese participants showed to have the least positive views towards mental illness and were also found to be more collectivistic. The results did not show that the attitudes of the participants are wholly stigmatising (Papadopoulos, 2009).
In the study conducted by Papadopoulos et al. (2002), the results demonstrate that there are stigmatising views towards the mentally ill present amongst people with a Greek culture; however, the sample size of this study was quite small, so it is difficult to generalise these findings to a larger, general population. In the more recent study, conducted by Papadopoulos (2009), the results further demonstrate this and also indicate that collectivism plays a role in forming stigmatising attitudes, yet in this study, the sample was also quite small and hence the application of the results to a general population is difficult. Additionally, questionnaires may not always reflect the true opinions of individuals, as it was not an open ended questionnaire; participants were forced to choose amongst a set number of predefined answers (McQueen & Knussen, 2006). Moreover, the CAMI scale is quite old (1981) and perhaps a revised version would have more validity and reliability, as human behaviour and cognition alters with time due to environmental and socio-cultural changes (O’Neil, 2006). Moreover, as the head researcher of both of the studies has a Greek background, there may be the possibility of researcher bias.
In conclusion, one can infer that stigma towards mental health exists amongst people with a Greek culture and this may be due to the collectivistic nature of it and so it is important to further study this to gain more insight on the matter by measuring the level and specific type of stigma; this will allow for better prevention methods, anti-stigma campaigns and raise the awareness amongst the general population.
5. Methodology5.1 ApproachIn this study, a cross-sectional survey using quantitative data will be applied. Therefore, this is a primary research study. As the aim of this study is to examine stigma on mental health in Greek culture, a non-randomised convenience sampling method will be used as there is limited funding, resources and time and hence it is not practical to conduct a randomised survey. The study targets people of a specific culture and as it is cross-sectional – people with ages ranged from 18 – 65 will be participating, in order to achieve a wide array of results and also to highlight any potential differences between age and opinions towards mental health. The reason why a survey will be used is due to the fact that it is more convenient, cost effective and allows for a large number of participants and hence, the findings may be applied to a general population (McQueen & Knussen, 2006). Participants may participate via many forms of communication, such as by phone, online, via email or in person, and it does not take much time to fill out a survey. A survey is also advantageous as the participants have a set number of answers that they can provide and so the processing of the results will be more obliging and the need to process individual answers will be absent (McQueen & Knussen, 2006). However, this is also one of the disadvantages, as when there are answers already given to the participants, the participant is not given the freedom to answer according to their individual thoughts, but forced to choose an option that is second best or close to their opinion (McQueen and Knussen, 2006). Moreover, when questionnaires are issued via email or phone, there is a chance that the questionnaires will be not be filled out or be incomplete, as this commonly happens with questionnaires issued through these means of communication; this may be due to laziness, indifference, forgetfulness or an unwillingness to participate (McQueen and Knussen, 2006).
The aim of this study is to identify different forms of stigma towards mental health in Greek culture. The questionnaire will be distributed with the snowball sampling method; participants will be asked to refer the questionnaire to any individuals that they know. The participants will be informed of the aims of the study, what is expected of them and that they have the right to withdraw at any given time. Most of the questionnaires will be distributed face to face, as this will increase chances of a fully completed questionnaire and participants will also be able to ask any questions they have regarding the questionnaire. The questionnaire will be administered via email, in order to reach as many participants as possible and also as it is more economically feasible and saves time. Moreover, the questionnaire will also be made available to members of Greek societies or any organisations involving Greek culture. During the collection and analysis of data, only fully completed questionnaires that meet the inclusion criteria will be utilised for analysis and the discussion of results.
In order to track my progress and determine the amount of time I require, I will make use of a Gantt-chart (see figure 1). A Gantt-chart is a bar chart that was developed by Henry Gantt and is typically used to highlight the schedule of a project (Pinedo, 2009).
Figure 1: Proposed timeline for the study and write up.
5.2 QuestionnaireThe questionnaire will contain socio-demographic articles relating to attitudes towards mental illness, and make use of the Likert-scale with five possible responses; strongly agree, agree, neutral, disagree and strongly disagree. The questionnaire will first contain general demographic questions such as age and sex. Some example statements include: “Individuals whom suffer from mental illnesses should be kept away from urban areas”, “Parents should keep children away from children with mental illnesses” and “The mentally ill should have the same rights as anyone else”. These statements will be used as previous studies show that there are associative factors with these questions in establishing stigma towards mental health (Papadopoulos, 2009).
This study will use the Community Attitudes Towards the Mentally Ill (CAMI) (Taylor and Dear, 1981) to measure the prevalence and type of mental illness stigma. The CAMI was chosen as it has a high validity, is reliable and concentrates on the community attitudes towards the mentally ill (Papadopoulos, 2009), which is what will be examined in this study. The CAMI consists of 40 inventory questions with 5 Likert-scale response options; this is easy for participants to use and also more convenient in terms of measurement (McQueen and Knussen, 2006). The CAMI measures four dimensions of attitudes towards the mentally ill, which are authoritarianism, benevolence, social restrictiveness and community mental health ideology (Taylor and Dear, 1981). Authoritarianism refers to the view that individuals suffering from mental illnesses are of lower social status and require stricter treatment; benevolence explicates a more sympathetic view towards persons suffering from mental illnesses; social restrictiveness explains the view that individuals with mental illnesses are dangerous and should kept away from society; community mental health ideology involves the approval of mental health services and mentally ill patients in the community (Taylor and Dear, 1981). The questionnaire will also collect socio-demographic data and ask questions about the level of knowledge and any previous experience participants’ have in relation to mental illness; these questions will be derived from the Papadopoulos (2009) study.
5.3 ParticipantsThe target group of this study are adults (aged 18 – 65 years) who primarily identify themselves with the Greek culture.
5.4 Data collection and analysisThe data will be inputted and analysed using SPSS (version 19). Analysis will involve a combination of descriptive and inferential statistic tests. Descriptive analysis will involve running frequency and percentage tests of all key variables. Inferential analysis will involve running tests of significant association and correlation (depending on the nature of the independent and dependent variables).
5.5 Ethical issuesAs a questionnaire may be transmitted via various sources, great care must be taken for the safety, security and confidentiality of filling out surveys, especially via email, due to cyber attacks and the general openness of the Internet. Mental health is also a very sensitive topic, and as a large group of people are participating, there may be individuals who have experienced or are experiencing mental health issues, have mental health issues in their family or amongst friends and may therefore be more sensitive towards this topic and so the questions should be formulated objectively and not ask too invasive questions. The participants will be provided with information, either verbally or written, depending on the method of administration, where all information regarding what the questionnaire aims to study and what is expected of them as participants. Informed consent will be acquired from all participants and they will be given the right to withdraw at any given time. The participants will be informed that their participation will not harm their anonymity, no personal data will be stored and the results will remain confidential. They will be debriefed and given the option to discuss their own results, if they wish to do so. All effort will be taken to ensure the confidentiality of results and the anonymity of the participants. This will be done by making sure that the data (including any data on the participants and their results) is not accessible to anyone but the researcher, ensuring that the electronic version of the questionnaire is on a secure server and protected against viruses and cyber attacks, ensuring that participants who fill in the questionnaire face-to-face are separated from the other participants and cannot see other participants’ answers.
5.6 PermissionPrior to undertaking the study, approval will be applied for from the Research Institute Ethics Committee. The study will not take place until approval is granted.
6. Discussion of ResultsThe results of the study may show that stigma towards individuals’ that suffering for mental health problems plays an important and decisive role. In addition, it may indicate that individuals that primarily indentify themselves with Greek culture appear to have higher levels of stigma towards mental illnesses. Moreover, this study may indentify which form of stigma towards mental illnesses in Greek culture seems to have a higher effect. Furthermore, it might underline the impact of stigma towards the life of people with mental health problems which may therefore indicate that the programmes and strategies of the stigma reduction and discrimination are not being effective enough. If this study succeeds in identifying the specific type and level of stigma, mental health facilities may be able to create programs for the mentally ill, relatives and close friends that provide information and this may lead to better treatment of the mentally ill within society and amongst their families. Facilities may design posters or leaflets in order to raise awareness of stigma, where the specific type of stigma is stated, explained and the reason why people should fight this. Mental health professionals may provide support to individuals that feel they are being negatively affected by stigma; this may include those with relatives and friends with mental illnesses. The government and organisations may implement policies in order to raise awareness and attempt to limit the amount of stigma by forbidding too much personal information being shared in office environments, the military and schools. Policies may be implemented in the educational sector, where children and adolescents can be educated on mental health in order to prevent stigma from forming in newer generations.
7. DisseminationOne of the key outcomes of this study is to share the results, in order to help improve beliefs and attitudes by reducing stigmatisation towards people with mental health issues. The study’s results will be disseminated towards:
Ministry of Health
Psychiatric Hospitals
Non-Government Organisations involved in stigma prevention towards mental illnesses
Communities where people with Greek culture are involved
University library
General public through journals and newspapers
8. ReflectionStigma towards mental health it is an important and global issue. During the process of exploring this topic and designing the study, I faced a lot of difficulties and confusion. I tried to include as much literature that was relevant to the topic and select data and information that would help me later on with my dissertation. It is out of doubt that more effort is required and skills should be developed in order to achieve my dissertation’s aims and objectives. There were moments where I was disappointed and confused but I realised that this experience would give me the opportunity to understand and obtain knowledge about how a successful research study should be developed. I hope my research will be an example for newer stud
