Yue Zhang1, Orvalho Augusto2,3,4, Kristjana Ásbjörnsdóttir2,3,5, Adam Akullian6, Vasco Cumbe7, Deepa Rao2,8, Sarah Gimbel2,3,9, Kenneth Sherr2,3, Bradley H Wagenaar2,3. 1. Department of Global Health, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA. april.zhangyue@outlook.com. 2. Department of Global Health, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA. 3. Health Alliance International, Seattle, WA, USA. 4. Universidade Eduardo Mondlane, Maputo, Mozambique. 5. Department of Epidemiology, University of Washington, Seattle, WA, USA. 6. Institute for Disease Modeling, Bellevue, WA, USA. 7. Mozambique Ministry of Health, Maputo, Sofala, Mozambique. 8. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA. 9. Department of Family and Child Nursing, University of Washington, Seattle, WA, USA.
Abstract
PURPOSE: This study describes patterns of community-level stigmatizing attitudes towards mental illness (MI) in central Mozambique. METHODS: Data for this study come from a representative community household survey of 2933 respondents ≥ 18 years old in Manica and Sofala Provinces, Mozambique. Six MI stigma questions represented primary research outcomes. Bivariate and multivariable analyses examined the relationship between key explanatory factors and each stigma question. Spatial analyses analyzed the smoothed geographic distribution of responses to each question and explored the association between geographic location and MI stigma controlling for individual-level socio-demographic factors. RESULTS: Stigmatizing attitudes towards MI are prevalent in central Mozambique. Analyses showed that males, people who live in urban places, divorced and widowed individuals, people aged 18-24, people with lower education, people endorsing no religion, and people in lower wealth quintiles tended to have significantly higher levels of stigmatizing attitudes towards MI. Individuals reporting depressive symptoms scored significantly higher on stigmatizing questions, potentially indicating internalized stigma. Geographic location is significantly associated with people's response to five of the stigma questions even after adjusting for individual-level factors. CONCLUSION: Stigmatizing attitudes towards MI are common in central Mozambique and concentrated amongst specific socio-demographic groups. However, geographic analyses suggest that structural factors within communities and across regions may bear a greater influence on MI stigma than individual-level factors alone. Further implementation science should consider focusing on identifying the most significant modifiable structural factors associated with MI stigma in LMICs to inform the development, testing, and optimization of multi-level stigma prevention interventions.
PURPOSE: This study describes patterns of community-level stigmatizing attitudes towards mental illness (MI) in central Mozambique. METHODS: Data for this study come from a representative community household survey of 2933 respondents ≥ 18 years old in Manica and Sofala Provinces, Mozambique. Six MI stigma questions represented primary research outcomes. Bivariate and multivariable analyses examined the relationship between key explanatory factors and each stigma question. Spatial analyses analyzed the smoothed geographic distribution of responses to each question and explored the association between geographic location and MI stigma controlling for individual-level socio-demographic factors. RESULTS: Stigmatizing attitudes towards MI are prevalent in central Mozambique. Analyses showed that males, people who live in urban places, divorced and widowed individuals, people aged 18-24, people with lower education, people endorsing no religion, and people in lower wealth quintiles tended to have significantly higher levels of stigmatizing attitudes towards MI. Individuals reporting depressive symptoms scored significantly higher on stigmatizing questions, potentially indicating internalized stigma. Geographic location is significantly associated with people's response to five of the stigma questions even after adjusting for individual-level factors. CONCLUSION: Stigmatizing attitudes towards MI are common in central Mozambique and concentrated amongst specific socio-demographic groups. However, geographic analyses suggest that structural factors within communities and across regions may bear a greater influence on MI stigma than individual-level factors alone. Further implementation science should consider focusing on identifying the most significant modifiable structural factors associated with MI stigma in LMICs to inform the development, testing, and optimization of multi-level stigma prevention interventions.
Entities:
Keywords:
Determinants of stigma; Geographic information systems; MI stigma; Mozambique; Spatial analysis
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