Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Doctor of Philosophy

Program

Nursing

Supervisor

Forchuk Cheryl

Abstract

Background

The psychosocial perspectives of stigma have been explored over the years. However, research that encompasses the study of stigma as a socio-cultural, religious, and moral phenomenon is lacking. This study aimed to develop and test a Dynamic Stigma Model of Mental illness (DYSMO) among a cohort of Outpatients receiving care in Ghana.

Methods

The study examined hypothesized relationships within a newly developed stigma model using structural equation modeling techniques. A non-probabilistic convenience sampling technique was used to recruit 330 participants at the Out-Patient Department of two psychiatric hospitals in Southern Ghana.

Results

Confirmatory factor analysis produced a final model with five latent variables and 17 indicators. Mediation analysis on the full structural model produced standardized fit indices that include the following: (c2/df = 335.403 (105), p£ .000; RMSEA= .08 (90% CI: .072 -.092; CFI = .921; SRMSR=.059; TLI = .90). While some of the standardized regression coefficients of the DYSMO were significant, others were not. The significant regression coefficients of the DYSMO include structural violence (SV) versus religiocultural beliefs (RCB) = .463, p£ .000; stigma perception appraisal (SPA) versus SV = .698, p£ .000; SPA versus RCB = -.185, p£.042; anticipated discrimination (AD) versus SPA = .448, p£.000; and social withdrawal (SW) versus AD = .661, p£.000). The following coefficients were however not significant: AD versus SV = -.147, p = -.147; AD versus RCB = .064, p = .494; SW versus SPA = -.047 p = .710; SW versus SV = .016, p = .904; SW versus RCB = .039, p = .619).

Conclusion

The study results revealed that religious, cultural, and structural violence perspectives can promote and damage mental health perceptions and increase stigma. It is imperative that all stakeholders, gain increased awareness and knowledge of the role religious and cultural beliefs play in the perpetuation and outcomes of mental illness stigma.

Summary for Lay Audience

Since the initial scientific work of Goffman (1963), various people have conducted research and have confirmed the existence of stigma. Not only does stigma affect persons with a mental illness, but also family relatives and all who care for them. Stigma is currently regarded as a multifaceted phenomenon that is characterized by psychological, social, cultural, religious, and moral issues. There have been many studies on stigma over the years. However, researchers have a gap studying the stigma of mental illness as a socio-cultural, religious, and moral phenomenon.

The purpose of this study was to develop and test a model named the ‘Dynamic Stigma Model of Mental illness (DYSMO)’ among a group of outpatients who were receiving care in Ghana. The cross-sectional study examined relationships within the newly developed stigma model using high level statistical analyses techniques. A convenience sampling method was used to recruit 330 of the outpatients coming for treatment in two psychiatric hospitals in Southern Ghana.

The statistical analysis produced a final model with five main components.All five dimensions of the stigma model had significant relationships in influencing how individuals with mental illness perceived stigma from members of their society. For instance, this study found that religious and cultural beliefs positively influenced extreme social injustice otherwise known as structural violence towards people with mental illness. The study also revealed that the extent to which a person appraised stigma as positive or negative was influenced by existing religious and cultural belief systems. The study further found that stigma perceptions of persons with mental illness influenced their anticipation of discrimination and subsequent social withdrawal especially when in public places.

The study results revealed that factors such as religious, cultural, and structural violence perspectives can promote and damage perceptions about individuals with mental health problems. It is necessary that all stakeholders including mental health practitioners, policymakers, and community members gain increased awareness and knowledge of the role religious and cultural beliefs play in the perpetuation and outcomes of mental illness stigma.

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