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Table of Contents
ORIGINAL ARTICLE
Year : 2017  |  Volume : 13  |  Issue : 1  |  Page : 1-7

Mental health literacy among university students from University Of Delhi


1 Nursing Services, AIIMS, New Delhi, India
2 Faculty College of Nursing, AIIMS, New Delhi, India
3 Faculty Department of Psychiatry & NDDTC, AIIMS, New Delhi, India

Date of Web Publication8-Jul-2019

Correspondence Address:
Sandhya Gupta
Faculty College of Nursing, AIIMS, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-1505.262338

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  Abstract 


Mental health literacy can be defined as knowledge and beliefs about mental disorders which aid their recognition, management or prevention. Young generation and college going students have unique perceptions about mental illness in every section of the society. They are the future adults of this society and windows of modern India, so their opinions are important indicators of mental health literacy. Aim of the study was to assess the mental health literacy among students of university of Delhi. The study was conducted using a descriptive, exploratory, cross sectional survey design on 100 (50 males and 50 females) postgraduate students from the University of Delhi, India. A semi-structured interview, with a standardized tool, Mental Health Literacy (MHL) questionnaire was used to assess the knowledge, awareness, and attitudes of students towards patients with mental disorders like depression and psychosis. Results shows Most of the subjects had well awareness about identification of the patients with mental disorder, whereas as more than half of the subjects had exact awareness to identify depression. Most of the subjects had adequate knowledge and identified poor outcome and prognosis for patients with psychosis as compared to depression if not treated. Stigmatization of subjects towards patient with depression and psychosis was present and was higher for psychosis. Most of the subjects rated psychiatrist and immediate community members as the most reliable help for the patients with depression and psychosis. Conclusions drawn from the study were, overall mental health literacy of the university students in Delhi was found to be adequate, but not satisfactory in the area of risk factors and stigmatization.

Keywords: Mental health literacy, mental disorders


How to cite this article:
Arundev U, Gupta S, Sharma K, Chadda RK. Mental health literacy among university students from University Of Delhi. Indian J Psy Nsg 2017;13:1-7

How to cite this URL:
Arundev U, Gupta S, Sharma K, Chadda RK. Mental health literacy among university students from University Of Delhi. Indian J Psy Nsg [serial online] 2017 [cited 2021 Oct 16];13:1-7. Available from: https://www.ijpn.in/text.asp?2017/13/1/1/262338




  Introduction Top


The term “Mental Health Literacy” was defined by Anthony F Jorm[1]. The concept of mental health literacy implies that it is crucial to increase the knowledge of people about mental health aspects and mental disorders since it is a prerequisite for early recognition and seeking treatment[2]. In spite of significant developments in India's healthcare systems, studies have rarely focused on literacy about mental illness[3].

Every section of society has its unique perceptions about mental illness, particularly the young generation and college going students. Since our modern education system, urbanization and industrialization make a great influence on this generation by a very peculiar and biased way of perceiving situations, so educating this group in realistic method is necessary. They are the future adults of this society and windows of our modern India, so their opinions are important indicators of mental health literacy. Good mental health literacy in young people and their key helpers may lead to better outcomes for those with mental disorders as the attitude and values of college-going students influence society the most. We need a baseline data to improve upon evidence based practice. So the present study has explored the mental health literacy of young people from the selected colleges of University of Delhi.


  Materials and Methods Top


An exploratory, cross sectional survey was conducted in three colleges of University of Delhi the post graduate students were selected using convenient sampling techniques. Total 100 students were selected who were able to read English. Tool no. l: Mental health literacy assessment tool (MHL), contained 105 items, which is adopted with permission from M. Kermode, A.F. Jorm etal.[4] It includes two vignettes (Part -1 and Part -2) as shown in [Figure 1], describing the people experiencing symptoms potentially attributable to a mental disorder (one for depression and one for psychosis). Questions about the vignettes invited a mixture of open and closed responses regarding the name of the problem, its causes and risk factors, discrimination and stigmatization, the helpfulness of possible service providers, treatments, prognosis and experiences. Vignette on depression includes 50 items and Part-2 on psychosis which includes 55 items. Part 1 and Part 2 of the vignettes consist of same number of questions based on the variables to find out the awareness and knowledge of the subjects about mental illness and its treatment. More than one response was possible for each item. Each vignette has 13 items, which are semi structured and contains 50-55 questions about the patients in the case. Test retest reliability, r=0.76. Tools were tried out before use. Approval to conduct the study was obtained from the ethics committee. A pilot study was done to ascertain the feasibility of the study. Informed consent was taken before data collection. The data was analysed by using STATA 11.1 version, descriptive and inferential statistics (MacNemars test) to calculate the difference, frequencies, percentages, of demographic profile and other variables under the study for assessing awareness of mental disorders and its treatment. Level of significance was setup as p≤0.05.
Figure 1: Pie diagram showing the opinion of subjects about discrimination against patients with depression and psychosis by society. (N=100)

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  Result Top


Description of the Subjects

Half (50 %) of the subjects were male, half (50%) were female subjects, and 65 % of the subjects were in the age group of 20-24 years. Most of the subjects (86 %) belonged to Hindu religion. Nearly a quarter (28 %) of the subjects were pursuing post graduation in management, 20% were from life sciences, 18% from literature, 18 % from applied sciences and other 15% were from Information Technology. From the parents of the subjects 28% had education up to graduation and 25 % were post graduates. The family of almost half (49%) of the subjects had monthly income up to Rs 30000 and a quarter (25%) of the subjects reported more than Rs 50000. Most (74 %) of the subjects lived in nuclear family.


  Major Findings Top


More than half (55%) of the subjects reported, internet as a source for getting information about mental illness.

Awareness about identification of mental disorders: Most of the subjects between 70% -80%, had well awareness about identification of the patients with mental disorder, whereas as more than half (54%) of the subjects had exact awareness to identify depression.

Knowledge about outcome and prognosis of mental disorders: Almost half (46%) of the subjects had adequate knowledge and identified more positive outcome for the patients with depression than psychosis if treated [Table 1]. Most (71%) of the subjects had adequate knowledge and identified more negative outcome and prognosis for patients with psychosis than depression if not treated. Knowledge of subjects about problems of patients with depression and psychosis after treatment was not clear as the opinion of subjects were ambiguous.
Table 1: Frequency distribution of subject's knowledge about outcome and prognosis of patient with mental disorders N=100

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Discrimination and stigmatization of mental disorders: Nc conclusion could be drawn for the subject's opinion about discrimination of patients with depression and psychosis by society as subject's responses were ambiguous [Figure 1]. Stigmatization of subjects towards patients with depression and psychosis was present. Discrimination by subjects towards patients with depression and psychosis was reported to be ambiguous, but higher for psychosis. Most of the subjects reported higher problems after treatment, stigma and social distance towards patients with psychosis than depression.

Awareness about causes and risk factors of mental disorders: Most (60%-70%) of the subjects were well aware about possible causes of depression and psychosis, as they identified nearly all of the causative factors. Awareness of subjects about persons who are at risk of developing disorders such as depression was not satisfactory, but more than psychosis where it was apparently low. Most (70%-80%) of the subjects reported no experience with patients having depression and psychosis.

Perception about who will help for patients with mental disorders: Most (84%) of the subjects reported psychiatrist as the most reliable help for the patients with depression and psychosis from the professional groups (ayurvedic doctor, nurse and a local doctor). Most (60%-70%) of the subjects endorsed immediate community members like close friends, neighbors, family and self help group as more helpful for the patients with depression and psychosis than other professional and non-professional persons [Table 2].
Table 2: Frequency distribution of subject's perception about who will help the patients with mental disorders N-100

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Perception about the type of help available for patients with mental disorders

Most (80%) of the subjects endorsed the interpersonal interventions like giving the patient love and affection, listening and trying to understand the problems, and making more active physically as potentially helpful, than pharmacological interventions for patients with depression and psychosis. Non-pharmacological treatments like learn relaxation (80%), psychotherapy (71%), and group therapy (63%) were endorsed by most of the subjects for the patients with depression and psychosis than pharmacological treatments.

Difference in mental health literacy of subjects among various streams: Subjects from management group who had adequate awareness regarding identification of mental disorder and its prognosis, reported more discrimination towards the patients with depression and psychosis by the society [Figure 2].
Figure 2: Bar diagram showing the opinion of subjects from various post graduate courses about discrimination against patients with depression and psychosis by society.

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  Discussion Top


In present study for the depression and psychosis vignette, most (70% - 80%) of the students identified that the case vignettes have some sort of mental or psychological disorder whereas in depression vignette more than half (57%) of the students reported the problem correctly as depression. These results are similar to the research findings from Australia[5],[6],[7],[8],[9],[10],[11],[12],[13],[14] Switzerland[9],[15] and Canada[17] which reports that depression was correctly identified in all groups. This finding of the present study proves adequate mental health literacy was present in university students regarding awareness of warning signs, and ability to identify a mental disorder. Similar findings are reported from Norway[17](2012) that correct naming of psychosis and depression by adolescents from a pretest of an interventional study. Also consistent the findings of another study[18] in 2010 which revealed recognition of depression were equally good in rural and urban young men. Depression was reported as the most common correct answer from a survey of mental health literacy among Portuguese[19] youth (2011) which also have similar findings with present study results.

More than one third of the students reported that the patients with depression will have a better outcome, if treated, whereas only one third of the students believed that patients with psychosis will have good outcome if treated. This finding is convergent with the results by A F Jorm et al.[10],[13] (2011) and Matthias C Angermeyer et. al[20] (2013)who reported that the majority of respondents considered that full recovery followed by problems reoccurring would be the most likely outcome for all case vignettes, other than the psychosis case vignette, for which partial recovery with problems reoccurring was considered to be the most likely outcome. Student's belief about possible outcomes for those with mental disorders reflects a less optimistic view especially for psychosis which may be due to the lack of knowledge of causes and risk factors of mental disorders. Most three fourth of the students in the present study had adequate knowledge that there will be no improvement or the problems may get worse, about the outcome and prognosis of patients with if not treated. Similar results were found by A F Jorm[10], that for all case vignettes, getting worse were considered as the most likely outcome if patients did not receive appropriate treatment. In the present study most of the students identified fewer problems such as violence and suicide for patients after treatment which is consistent with the findings from Nicola J Reavley[10] (2011) that, being violent and attempting suicide was rated as the least likely outcomes for all vignettes.

In the present study nearly half of the students had opinion that patients will be discriminated by the society. This result is consistent with the previous studies of mental health literacy from western literature[16],[21] that also have shown clear discrimination for patients. Surprisingly early detection of disorder results in more stigma and social distancing. The present study showed that stigmatization towards patients with psychosis was more than depression and only one third of the students did not report personal stigma. Studies of, Gulliver et al.[22], Simon etal.(2007)[23], Beverly Bourget[16] (2007), Jorm etal.[10], and R K Mahto etal.(2009)[3] had similar findings that reported ambivalent attitude related to persons with major psychological problems. In present study discrimination by the students is assessed by asking about their level of comfort with various situations of increasing social proximity with patients which revealed that four fifth of the students would be comfortable with patients having depression and psychosis for being neighbors, to socialize, and telling the problem of patients to others. But there was drop in number of students when asked about getting married to a person who had mental illness earlier, voting for a politician, and developing relationships with persons who had mental illness. These findings were consistent with the previous studies[16],[10],[24],[25],[20]. As reported by several studies[16],[10],[20] discrimination or social distancing by the young population was reported to be relatively higher for the psychosis vignette than depression vignette, and most of the students perceived people with psychosis as dangerous, unpredictable and there was a stronger need to separate on-self from them. Most of the students in the present study identified, psychosocial factors as reasons such as day-to-day problems (60-80%), death of someone close (68-70%), financial difficulties (60%-80%), traumatic event (60-70%), and problems from childhood (78%) as likely causative factors for both depression and psychosis.

In present study findings indicate that university students primarily cited psychosocial and environmental causes as the possible reasons for the depression and psychosis. The inheritance or genetic cause was not reported to be a reason for depression, but for psychosis over one third endorsed genetic cause, which is consistent with the findings from Beverley Bourget et al.[16], Matthias C et al.[20] and Jorm etal[10]. This can be explained that depression may be considered by the students as an commonest expected mental disorder which occurs in all communities because of routine life activities. Additionally the present study findings were contradictory to the findings of Yoshibumi Nakane etal.[13] and Harshal Salve et al.[26] that evil spirits, virus or infection and allergy can be the causative factors. The present study shows even though the overall awareness of the students about the risk factors for developing depression and psychosis was low means that understanding of the students about the risk factors for psychosis was apparently poorer than for depression. Similar result was found in the previous study[12]. In the present study four fifth of the students singled out psychiatrist as the most reliable help for the patients from all of the professional groups. Similar findings were found in other studies[16],[27],[17],[18],[12],[28] which revealed that, among the professional helpers most frequently consultation with a psychiatrist was preferred by the majority for depression and depression.

Immediate community members like close friends, neighbors, family and self help group were endorsed to be helpful by most of the previous studies[14],[10],[4],[12] and the same was consistent with the present study findings. More than one third of the students had opinion that dealing with the problem alone could be helpful for depression, which is similar as the results of two mental health literacy studies[29],[17] that approximately half of the sample were of the view that ‘dealing with the problem alone’ is a helpful strategy. In present study a local doctor was reported to be helpful by over one third of the students which is contradictory to other studies[4],[12],[20] which local doctors or general practitioners were judged to be most helpful by majority of participants rather than psychiatrist, one of the reason for this difference can be the disparity of the concept of ‘family doctor’ which is not common in India unlike other countries. In present study most of the students have not identified witch-doctor or a priest to be helpful, which is consistent with previous findings from two studies[30],[31] that turning to a practitioner of complementary medicine, and a priest was less frequently advised instead of informal self help from family and friends was endorsed. Present study has contradictory results from the studies[35],[26] done in Delhi in which some laypeople preferred treatment from Tantric/ Ojha for mental disorders. As reported by most of the previous mental health surveys[15],[12],[4],[13],[20] on young population, interpersonal interventions like giving the patient love and affection, listening and trying to understand the problems and making the patient more active physically were endorsed by the students as potentially helpful (80%), than pharmacological interventions for a patient. Use of sleeping pills, vitamins and appetite stimulants were not endorsed by students in the present study which is inconsistent to the other two studies[4],[12] This finding supports the fact that the university students have become more aware of the type of treatment and the facilities available.

In the present study psychotherapy was reported as a clear favorite treatment identified by three fourth of the students which is consistent with the results of four surveys[28],[3],[20],[31] done on psychiatric treatment approaches. Psychologist (78%) and counselor (70%) were, some of the other professional help considered to be good for the patients in the present study. Similar results were reported in almost all mental health literacy surveys,[16],[19],[12],[13],[28],[3],[20],[31] of young population. Non-pharmacological treatments were supported by the students like learn relaxation (80%), psychotherapy (70%), and group therapy (63%) and reduction in alcohol intake in that order which is in consistent with other eight studies[16],[19],[13],[28],[33],[20],[31],[34] that generally, people prefer self-help, lay support and lifestyle interventions for mental disorders; and people are uncomfortable with medical personnel, and especially psychopharmacological interventions in one study[16]. Hence the findings from the present study highlight the improvement in awareness of young adults towards the medical treatment options available for patients with mental disorders. Possibility of side effects which may occur due to medications and the opinion that, it can cure only the symptoms, not the cause of the mental illness may be the reasons for the emphasis given to non-pharmacological interventions by them.

For identification of problem and outcome in case-vignettes students from management and life science stream were well aware as compared to students from other streams which is in line with findings of previous studies that reported inadequate mental health literacy among students from philosophy, and natural sciences[35]. However regarding discrimination by society towards patients with mental disorders, most of the students were from management stream.


  Conclusion Top


Overall mental health literacy of university students among sample was found to be satisfactory, but not adequate in the areas of identification of risk factors, stigmatization and discrimination. There is a gap of knowledge among university students, especially among those in applied sciences, arts and technology so education regarding mental health should be given as awareness campaigns, educational workshops and training courses for nurses and mental health professionals. Education should emphasize to reduce stigmatization and discrimination of psychosis and depression as a real mental illness. Professionals should work together with the media to disseminate scientific knowledge about symptoms, causes, risk factors and management of mental disorders. Government should improve mental health budgets and identify economic and resource barrier that hinder mental health practice and policy. However the present study have a limitation of small size due to time constraints, similar studies with large sample or qualitative methodology among different student population can be done for the generalizability of findings in future.



 
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