Knowledge and Attitude Towards Mental Illness Among Adolescents in Selected Schools of Tumakuru

Introduction

Young people are one of society’s most valuable resources. It plays a vital role in the development of human capital and link within the individuals’ wellbeing and opportunity for better living. Today, 1.2 billion adolescents stand at the crossroads between childhood and the adult world. Around 243 millions of them live in India. Adolescents in the age range of 10 to 19 years constitute one-fifth of the Indian population.¹ India has articulated its commitment to protect and promote the health and rights of adolescents and meet their developmental needs through numerous policies and programs, which are being implementing over the course of this century.²

Mental health problems and prejudiced attitudes towards mental illness have common risk factors. The school is a central place for adolescents’ social interactions and an important setting for promoting pupils’ health and wellbeing. Importance is associated with the opportunity to promote mental health through the school. The pervasive negative public beliefs about mental illness, in turn, creates an environment that impedes both treatment seeking and recovery. For psychiatrically labelled children and adolescents acutely attuned to the judgments of their peers, misunderstandings and negative attitudes about mental illnesses among those peers may be particularly painful. Adolescent mental health disorders are present in around 10% of the population. Research indicates that many young people possess negative attitudes towards mental health difficulties among peers.³

A stigma against mental illnesses is one of the significant obstacles faced by mental health service users and providers and can be described as prejudice and discrimination against individuals with mental illness due to lack of knowledge, ignorance or misinformation. Negative attitudes also give rise to the desire for social distance, a form of behavioural discrimination which involves reluctance to interact with persons with mental illness. Individuals with mental illness often feel a sense of low self-esteem/well-being as they are rejected and discriminated against by others due to stigma.⁴ Accordingly, they are reluctant to be identified as having a mental illness, resulting in high rates of treatment avoidance.⁵ Thus, stigma is one of the greatest barriers to seeking treatment for those with mental illness.⁶

World Health Organization estimates that 10% of the world’s population has some form of mental disability.⁷ The point prevalence of mental illness in the adolescent population at any given time is also 10%.⁸ The consequences of stigma associated with mental illness have attracted the negative ratings among the public. The public express that the people with mental illness are unpredictable and dangerous. Thus, the knowledge and attitude among adults towards mental illness bears profound impact on the person with psychiatric illness.⁹

In India among the total population, 72.22% of the people live in rural areas and 27.78% in urban areas. Among these, adults between the age group of 15-59 years form 56.9% of the total population.¹⁰ Mental illness affects the people of all age groups. It is estimated that 450 million people are experiencing mental illness at any one time, most of whom live in developing countries.¹¹

The United States Department of Health and Human Services (USDHHS, 1999) stated that more than 48 million people in the United States (1 in 5, or 20%) have a diagnosable mental disorder or illness, half of all citizens have a mental illness at some time in their lives and most of these people however never seek treatment.¹² The National Institute of Mental Health and Neuro-Sciences (NIMHANS) report shows that in India 70 million people suffer from mental ailments and yet, 50-90 percent of them are not able to access corrective services due to less awareness and negative attitude or stigma towards mental illness.¹³

In rural India, prevalence rates for all mental illness is 64.4 per 1000 population and in urban part of the country it is 66.4 per 1000 population.¹⁴ A descriptive study conducted on urban mental health services in India found that, the service providers perceived that the important barriers besides the financial problem are stigma and lack of awareness.¹⁵

These consequences may be particularly relevant during adolescence and preadolescence, a period in which onset of a variety of psychiatric disorders peaks and children are acutely attuned to the judgments of their peers. Accordingly, it is important to understand more about the knowledge and attitudes of youth related to mental illnesses and peers who may manifest such illnesses. However, in the India, attitude towards mental illness among youth has not received as much research attention as attitudes among adults. Hence the investigator felt that there is a need to assess knowledge and attitude towards mental illness among adolescents with view to develop information booklet on prevention of mental illness.

Subjects and Methods

A descriptive survey design was used for the study. The samples were selected by using nonprobability convenient sampling technique. The study was conducted at Vidhyavahini high school in Tumkur. The study involved adolescents between 11-19 years and the study excluded adolescents who were sick, adolescents absent at the time of data collection and adolescents unwilling to participate in the study. One hundred adolescents were selected for the study.

Ethical considerations

The study protocol was approved from institutional ethical committee. Formal permission was obtained from the concerned education department (Block Education Officer) and from the school authority. Informed consent was obtained from the subjects. The purpose, nature, duration of the study, the researcher’s contact information, confidentiality, their right not to participate, risks and benefits of the study were explained.

Assessment Children who fulfilled the inclusion criteria were administered the socio-demographic proforma, knowledge questionnaire, and rating scale.

1. Socio-demographic proforma: It includes questions on their age, gender, religion, educational level, parental education (mother), parental education (father), source of information related to mental illness, family history of mental illness and contact with mentally ill people.

2. Knowledge questionnaire: It included 36 questions to assess knowledge regarding mental illness, causes, symptoms, and management of mental illness. Each question had four options, one being the right answer and carried one mark. Respondents were categorized based on the score obtained like score of less than 18 as poor knowledge, score between 18-27 as average knowledge and score above 27 as good knowledge. Correlation of tool was calculated by using Karl persons coefficient correlation.

3. Rating scale: The five-point rating scale was used to assess attitude of respondents towards mental illness. It included 20 items on attitude towards mental illness. The items were answered using a 5-point Likert scale format ranging from strongly agree to strongly disagree. The minimum score was 20 and maximum score was 100. The scores were interpreted as favorable (60-100), unfavorable (20- 40) and neutral (40-60).

Statistical analysis

Data were analyzed using Statistical Package for the Social Sciences software package (Version 23), and results were presented in table form. Descriptive statistics were used to assess the knowledge and attitude. Karl- Pearson’s co-relation coefficient was used to find out co-relation between knowledge and attitude.

Results

Majority (49%) of the subjects were in the age group of 14 years; about 32% were in the age group of 13 years and remaining 19% were in the age group of 15 years. Majority (63%) of the subjects were males and 37% were females. Majority (44%) of the subjects were from 8th standard, about 31% belonged to 9th standard, 25% of the subjects were in 10th standard. Majority (75%) of the subjects belonged to Hindu religion, 22% of the subjects belonged to Muslim religion, and only about 3% belonged to Christian religion. Majority (47%) of the participants’ mothers had completed school education, about 36% were P.U.C, 11% were degree holders, and 6% were post graduates. Majority (38%) of the participants’ fathers were degree holders, about 27% were P.U.C, 21% were school educated, and 14% were post graduates. Most (69%) of the subjects revealed no history of mental illness in their family and 31% of subjects had history of mental illness in their family. Majority (52%) of the rural subjects had not come across a mentally ill person in the community, and about 48% had exposure to mentally ill person in the community.

The findings of the present study revealed that most (60%) of the subjects had average knowledge, 28% of them had poor knowledge and 12% of them had good knowledge regarding mental illness. The findings of the present study revealed that all 100% of the subjects had favorable attitude towards mental illness. The correlation between knowledge and attitude scores was computed by using Karl- Pearson’s co-relation coefficient and the ‘r’ value was (0.736), indicating positive correlation between knowledge and attitude towards mental illness among adolescents.

Discussion

Mental disorders are generally characterized by combination of abnormal thoughts, emotions, behaviors, and relationships with others. Common mental disorder is a term incorporating depression, anxiety, adjustment disorders, and stress-related ill health, all of which have major consequences around the world. Mental disorders can cause suffering, pose a risk of social isolation, and threaten the personal income of individuals. Fortunately, most of these disorders can be successfully treated. Adequate knowledge regarding mental illness will help in overcoming stigma and prevention of mental illness among adolescents.

The present study showed that most (60%) of the subjects had average knowledge, 28% of them had poor knowledge and 12% of them had good knowledge regarding mental illness. The present study findings are supported by Riffel and Chen where students demonstrated that the knowledge of mental health disorders in general is good and behaved most positively. However, some students still had negative perceptions that encourage doubt and fear to approach someone with a mental disorder.¹⁶

The study conducted by Wahl O et al showed that, middle school students’ knowledge of mental illness is inconsistent. They seemed well-informed about some things, such as the unfavorable treatment and depiction of people with mental illnesses. Their knowledge seemed lacking in other areas, and the greatest gaps in knowledge involved the symptoms of specific mental disorders. The common misconception that schizophrenia involves multiple personalities was apparent among student participants, given that only 9% disagreed with that idea.¹⁷

Knowledge pertains in acquiring, retaining, and using information to one’s capacity. The nature of knowledge depends on different modes of idea acquisition, such as perception, imagination, memory, judgment, abstraction, and reasoning. Attitude refers to an individual’s tendency to react to certain situations in a particular way, view and interpret events according to several tendencies, or organize opinions into coherent and interrelated structures. Knowledge, and attitude are important in increasing students’ awareness towards mental health problems. The present study showed that 100% of the subjects had favorable attitude towards mental illness.

A study conducted by Abolfotouh et alin 2019 validated that mental health perceptions in the Saudi Arabian Society are highly diverse and that knowledge is lacking.¹⁸ In 2018, a study by Li et alasserted that negative attitudes towards mental disorders commonly occur among people in China.¹⁹ In addition, in 2016, Aruna et al corroborated that the population of medical undergraduate students also had considerable deficiencies in knowledge and attitudes related to psychiatric disorders, especially in the early years of education.²⁰

The study conducted by Youssef FF et al., 2014 on knowledge and attitudes towards mental illness among college students showed that overall knowledge scores were low. Knowledge was higher among those persons who knew someone with a mental illness. Attitude scores were suggestive of stigmatization, with drug abuse and schizophrenia seen in a particularly poor light.²¹ The limitations of the study were that data were selfreported, under or over reporting of data may have taken place due to the stigma related to mental illness.

Based on the input from the participants, an information booklet was developed and distributed in the community to create awareness towards mental illness.

Conclusion

The study findings showed that adolescents had suboptimal level of knowledge, unfavorable attitude towards mental illness and its prevention. There is a need to conduct awareness programs on prevention of mental illness to increase the level of knowledge and regarding mental illness screening through the medium of health personnel, friends and mass medias like television, radio and newspaper. Further research is needed to identify effective strategies for recognizing, diagnosing, and treating mental illness among adolescents.

Conflict of interest

None.