Determinants of self and public stigma and discrimination against people with mental illness and their family in Jimma zone, Southwest Ethiopia

Background: Stigma can be detrimental to the quality of life, as
well as the treatment and rehabiltation process of people with
mental illness. The purpose of this study was to measure the extent
and determine correlates of public and self-stigma against people
with mental illness (PWMI) and their families in Jimma Zone,
Southwest Ethiopia. Methods: Community and institution based
quantitative and qualitative cross-sectional studies were conducted
among 845 randomly selected community members at GGFRC, consecutive
422 PWMI and 422 family members of PWMI at Jimma University
Specialized Hospital. Univariate, bivariate and multivariate linear
regression analyses were done. Results: The mean scores of public
stigma against PWMI and their family members were 2.62 (+0.34) and
2.16 (+0.49), respectively, on a range of 1 to 5. The mean
self-stigma score among PWMI, on a range of 1 to 4, was 2.32
(+0.30). Place of residence, belief in the supernatural,
psychosocial and biological explanations of mental illness were
associated with stigma towards PWMI and family members of PWMI.
Level of education and income predicted PWMI public stigma. A
higher number of perceived signs of mental illness was correlated
with lower stigma against family members of PWMI. Females,
individuals with history of traditional treatment, individuals
experiencing higher number of drug side-effects, and individuals
who subscribed to more signs and supernatural explanations had
significantly higher levels of self-stigma. In contrast, patients
with higher education level and higher self esteem showed
significantly lower levels of self-stigma. Supporting supernatural
explanations of mental illness was associated with greater
care-givers’ self-stigmatization. Conclusion: High public stigma
against PWMI and high levels of patients’ self-stigma were found.
Care-givers demonstrated reluctance to be identified with PWMI.
Systematic forms of discrimination against PWMI and their family
members were identified. PWMI and their family members faced
behavioral and structural challenges. Thus, reducing stigma against
patients may help to reduce stigma against family members.
Developing strategies to improve patients’ self esteem, and
developing policies and guidelines about mental illness may be
helpful in reducing stigma. Effective intervention strategies that
target patients, their families, as well as the public need to be
designed to reduce stigma.