Knowledge, attitude and behaviors towards patients with mental illness: Results from a national Lebanese study

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Abstract

Objectives

Patients with mental health disorders often have to endure the burdens of the condition itself and the stigma that follows. Since no study has been conducted in Lebanon on this topic, our objective was to assess the knowledge, attitude and behaviors towards public stigma of mental health diseases, among a sample of the Lebanese population.

Methods

A cross-sectional study, conducted between November 2017 and May 2018, enrolled 2289 participants. The Mental Health Knowledge Schedule (MAKS), the Community Attitudes toward Mental Illness (CAMI) and the Reported and Intended Behavior Scale (RIBS) were used to assess knowledge, attitude and behaviors toward mental illness respectively. The 25th, 50th and 75th percentile of the MAKS, CAMI and RIBS scales scores were considered as cutoff points for low, medium and high scores respectively.

Results

A high knowledge score was found in 33.0% of the participants, whereas a high attitude score and a higher behavior score were found in 32.2% and 26.9% of the participants respectively. Living in North Lebanon (Beta = 1.331) and being familiar with a non-close person with mental illness (Beta = 0.811) were associated with higher knowledge of mental illness (higher MAKS score), whereas living in Bekaa (Beta = -8.693) and being 70 years old and above (Beta = -5.060) were associated with lower knowledge toward mental illness (lower MAKS score). Higher knowledge of mental illness (higher MAKS score) (Beta = 0.670), having a high level of education (university (Beta = 8.785), secondary (Beta = 6.084) and technical (Beta = 5.677)) were associated with less stigmatizing attitudes (higher CAMI scale). Being familiar with close people with mental illness (Beta = 0.577), less stigmatizing attitudes (higher CAMI scale) (Beta = 0.077) and higher knowledge of mental illness (higher MAKS score) (Beta = 0.115) were associated with higher favorable behaviors (higher RIBS score), whereas knowing a non-close person who have a mental illness (Beta = -0.720) was associated with lower favorable behaviors (lower RIBS score).

Conclusion

A mass media awareness campaigns that could transmit health messages to a wide public audience in the country to fight stigma toward mental illness, seems warranted.

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Most cited references 55

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"A disease like any other"? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence.

Bernice Pescosolido, Jack K Martin, J Scott Long … (2010)

Clinicians, advocates, and policy makers have presented mental illnesses as medical diseases in efforts to overcome low service use, poor adherence rates, and stigma. The authors examined the impact of this approach with a 10-year comparison of public endorsement of treatment and prejudice. The authors analyzed responses to vignettes in the mental health modules of the 1996 and 2006 General Social Survey describing individuals meeting DSM-IV criteria for schizophrenia, major depression, and alcohol dependence to explore whether more of the public 1) embraces neurobiological understandings of mental illness; 2) endorses treatment from providers, including psychiatrists; and 3) reports community acceptance or rejection of people with these disorders. Multivariate analyses examined whether acceptance of neurobiological causes increased treatment support and lessened stigma. In 2006, 67% of the public attributed major depression to neurobiological causes, compared with 54% in 1996. High proportions of respondents endorsed treatment, with general increases in the proportion endorsing treatment from doctors and specific increases in the proportions endorsing psychiatrists for treatment of alcohol dependence (from 61% in 1996 to 79% in 2006) and major depression (from 75% in 1996 to 85% in 2006). Social distance and perceived danger associated with people with these disorders did not decrease significantly. Holding a neurobiological conception of these disorders increased the likelihood of support for treatment but was generally unrelated to stigma. Where associated, the effect was to increase, not decrease, community rejection. More of the public embraces a neurobiological understanding of mental illness. This view translates into support for services but not into a decrease in stigma. Reconfiguring stigma reduction strategies may require providers and advocates to shift to an emphasis on competence and inclusion.

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Evolution of public attitudes about mental illness: a systematic review and meta-analysis.

G Schomerus, C Schwahn, A Holzinger … (2012)

To explore whether the increase in knowledge about the biological correlates of mental disorders over the last decades has translated into improved public understanding of mental illness, increased readiness to seek mental health care and more tolerant attitudes towards mentally ill persons. A systematic review of all studies on mental illness-related beliefs and attitudes in the general population published before 31 March 2011, examining the time trends of attitudes with a follow-up interval of at least 2 years and using national representative population samples. A subsample of methodologically homogeneous studies was further included in a meta-regression analysis of time trends. Thirty-three reports on 16 studies on national time trends met our inclusion criteria, six of which were eligible for a meta-regression analysis. Two major trends emerged: there was a coherent trend to greater mental health literacy, in particular towards a biological model of mental illness, and greater acceptance of professional help for mental health problems. In contrast, however, no changes or even changes to the worse were observed regarding the attitudes towards people with mental illness. Increasing public understanding of the biological correlates of mental illness seems not to result in better social acceptance of persons with mental illness. © 2012 John Wiley & Sons A/S.

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Public conceptions of mental illness: labels, causes, dangerousness, and social distance.

Laura J Phelan, A Stueve, Bernice Pescosolido … (1999)

The authors used nationwide survey data to characterize current public conceptions related to recognition of mental illness and perceived causes, dangerousness, and desired social distance. Data were derived from a vignette experiment included in the 1996 General Social Survey. Respondents (n = 1444) were randomly assigned to 1 of 5 vignette conditions. Four vignettes described psychiatric disorders meeting diagnostic criteria, and the fifth depicted a "troubled person" with subclinical problems and worries. Results indicate that the majority of the public identifies schizophrenia (88%) and major depression (69%) as mental illnesses and that most report multicausal explanations combining stressful circumstances with biologic and genetic factors. Results also show, however, that smaller proportions associate alcohol (49%) or drug (44%) abuse with mental illness and that symptoms of mental illness remain strongly connected with public fears about potential violence and with a desire for limited social interaction. While there is reason for optimism in the public's recognition of mental illness and causal attributions, a strong stereotype of dangerousness and desire for social distance persist. These latter conceptions are likely to negatively affect people with mental illness.

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Author and article information

Contributors

Carla Abi Doumit: Role: Data curationRole: Writing – original draftRole: Writing – review & editing

Chadia Haddad: Role: Formal analysisRole: Writing – original draftRole: Writing – review & editing

Hala Sacre:

ORCID: http://orcid.org/0000-0001-6547-6251

Role: Writing – review & editing

Pascale Salameh: Role: Formal analysisRole: Writing – review & editing

Marwan Akel: Role: Data curationRole: Writing – review & editing

Sahar Obeid: Role: Writing – review & editing

Maria Akiki: Role: Data curationRole: Writing – review & editing

Elie Mattar: Role: Data curationRole: Writing – review & editing

Najla Hilal: Role: Data curationRole: Writing – review & editing

Souheil Hallit:

ORCID: http://orcid.org/0000-0001-6918-5689

Role: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – review & editing

Michel Soufia: Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing

Janhavi Ajit Vaingankar: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 16 September 2019

Publication date Collection: 2019

Volume: 14

Issue: 9

Electronic Location Identifier: e0222172

Affiliations

[1 ] Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon

[2 ] Psychiatric Hospital of the Cross, Jal Eddib, Lebanon

[3 ] Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Lebanon

[4 ] INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon

[5 ] Faculty of Medicine, Lebanese University, Beirut, Lebanon

[6 ] Faculty of Pharmacy, Lebanese University, Beirut, Lebanon

[7 ] School of Pharmacy, Lebanese International University, Beirut, Lebanon

[8 ] Faculty of Philosophy and Human Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon

[9 ] Faculty of Pedagogy, Lebanese University, Beirut, Lebanon

Institute of Mental Health, SINGAPORE

Author notes

Competing Interests: The authors have declared that no competing interests exist.

‡ These authors also contributed equally to this work.

* E-mail: Souheilhallit@ 123456hotmail.com (SH); Michel_soufia@ 123456hotmail.com (MS)

Author information

Hala Sacre http://orcid.org/0000-0001-6547-6251

Souheil Hallit http://orcid.org/0000-0001-6918-5689

Article

Publisher ID: PONE-D-19-08902

DOI: 10.1371/journal.pone.0222172

PMC ID: 6746362

PubMed ID: 31525219

SO-VID: 6a1f7c0a-13e5-42e5-a369-7a2f755e8fad

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 28 March 2019

Date accepted : 22 August 2019

Page count

Figures: 0, Tables: 4, Pages: 16

Funding

The author(s) received no specific funding for this work.

Custom metadata

Data Availability Data cannot be shared publicly due to restrictions imposed by the Psychiatric Hospital of the Cross Ethics Committee to protect patient confidentiality, but is available upon request. Data requests may be sent to Mrs. Rana Nader at rnader@ 123456naderlawoffice.com or the corresponding author.

Knowledge, attitude and behaviors towards patients with mental illness: Results from a national Lebanese study

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Most cited references 55

"A disease like any other"? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence.

Evolution of public attitudes about mental illness: a systematic review and meta-analysis.

Public conceptions of mental illness: labels, causes, dangerousness, and social distance.

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