Assignment 1: Written Response to Question (15%)
Due date: Week 4
Word Count: 800 – 1000 words
The goal of this assessment is to test your knowledge and comprehension of the fundamental concepts and terms relating to mental health.
Assessment
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Completion of a written assessment
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Format
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Students are required to provide a written response to a guide question(s) based on the unit reading(s).
This assessment must be submitted in Moodle.The submission link (with the guide questions) will open/close in Moodle within a specific timeframe during the week of assessment – timeframe to be provided.
Your assessment must be submitted through Turnitin and must adhere to the College’s academic integrity and authorship requirements.
This is a formative and summative assessment, which serves as a preparatory guide to the learning that students are expected to achieve
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Generic skills assessed
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Information literacy
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Assessment Criteria
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Weighting
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Integration of theory and knowledge
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/4
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Demonstrated understanding of the material presented
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/6
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Cohesive writing
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/5
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TOTAL
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/15
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SPS304 Mental Health in the Community ASSESSMENT 1 Name: Assessment Mark: / 15 Student Number: Date: This assessment will be submitted electronically using Turnitin and submitted like a regular written assessment with a coversheet. Required Reading: M. Subramaniam, E. Abdin, L. Picco, S. Pang, S. Shafie, J. A. Vaingankar , K. W. Kwok, K. Verma and S. A. Chong,. (2017). Stigma towards people with mental disorders and its components – a perspective from multi-ethnic Singapore. Epidemiology and Psychiatric Sciences, 26, 371–382. PLEASE WRITE LEGIBLY. QUESTION 1: From your reading of the journal article: 1. describe the extent of overall stigma as well as the differences in stigma towards people with alcohol abuse, dementia, depression, schizophrenia and obsessive-compulsive disorder. 2. discuss the strengths of the study. 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371..382 Stigma towards people with mental disorders and its components – a perspective from multi-ethnic Singapore M. Subramaniam1*, E. Abdin1, L. Picco1, S. Pang1, S. Shafie1, J. A. Vaingankar1, K. W. Kwok2, K. Verma1 and S. A. Chong1 1 Research Division, Institute of Mental Health, Singapore 2 Sociology Division, Nanyang Technological University, Singapore Aims. The current study aimed to: (i) describe the extent of overall stigma as well as the differences in stigma towards people with alcohol abuse, dementia, depression, schizophrenia and obsessive compulsive disorder, as well as (ii) estab- lish the dimensions of stigma and examine its correlates, in the general population of Singapore, using a vignette approach. Methods. Data for the current study came from a larger nation-wide cross-sectional study of mental health literacy conducted in Singapore. The study population comprised Singapore Residents (Singapore Citizens and Permanent Residents) aged 18–65 years who were living in Singapore at the time of the survey. All respondents were administered the Personal and Perceived scales of the Depression Stigma scale and the Social Distance scale to measure personal stigma and social distance, respectively. Weighted mean and standard error of the mean were calculated for continuous variables, and frequencies and percentages for categorical variables. Exploratory structural equation modelling and confirmatory factor analysis were used to establish the dimensions of stigma. Multivariable linear regressions were conducted to examine factors associated with each of the stigma scale scores. Results. The mean age of the respondents was 40.9 years and gender was equally represented (50.9% were males). The findings from the factor analysis revealed that personal stigma formed two distinct dimensions comprising ‘weak-not- sick’ and ‘dangerous/unpredictable’ while social distance stigma items loaded strongly into a single factor. Those of Malay and Indian ethnicity, lower education, lower income status and those who were administered the depression and alcohol abuse vignette were significantly associated with higher weak-not-sick scores. Those of Indian ethnicity, 6 years of education and below, lower income status and those who were administered the alcohol abuse vignette were significantly associated with higher dangerous/unpredictable scores. Those administered the alcohol abuse vignette were associated with higher social distance scores. Conclusion. This population-wide study found significant stigma towards people with mental illness and identified specific groups who have more stigmatising attitudes. The study also found that having a friend or family member with similar problems was associated with having lower personal as well as social distance stigma. There is a need for well-planned and culturally relevant anti-stigma campaigns in this population that take into consideration the findings of this study. Received 15 September 2015; Accepted 3 March 2016; First published online 28 March 2016 Key words: Alcohol abuse, Dementia, Depression, Mental illness stigma, Obsessive compulsive disorder, Schizophrenia. Introduction Stigma is defined by the World Health Organisation (WHO) as ‘a mark of shame, disgrace or disapproval that results in an individual being rejected, discrimi- nated against and excluded from participating in a number of different areas of society’ (World Health Organization, 2001). Stigma has been linked to adverse outcomes for people with mental illness as it acts as a barrier to help-seeking as well as achievement of age-appropriate functional goals (Corrigan et al. 2009; Clement et al. 2015). In an attempt to circumvent the stigma associated with mental illness there is ‘label avoidance’ i.e. people are reluctant to be diagnosed with or be seen as seeking treatment for mental illness (Corrigan et al. 2014). Public stigma can also lead to ‘self-stigma’ (Link, 1987) among those with mental * Address for correspondence: M. Subramaniam, Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, Singapore 539747. (Email:
[email protected]) Epidemiology and Psychiatric Sciences (2017), 26, 371–382. © Cambridge University Press 2016 doi:10.1017/S2045796016000159 ORIGINAL ARTICLE This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. https://www.cambridge.org/core/terms. https://doi.org/10.1017/S2045796016000159 Downloaded from https://www.cambridge.org/core. IP address: 194.223.45.147, on 30 Jun 2019 at 07:38:26, subject to the Cambridge Core terms of use, available at mailto:
[email protected] http://crossmark.crossref.org/dialog/?doi=10.1017/S2045796016000159&domain=pdf https://www.cambridge.org/core/terms https://doi.org/10.1017/S2045796016000159 https://www.cambridge.org/core illnesses leading to shame, loss of self-esteem, withdra- wal from academic or vocational pursuits (Corrigan & Watson, 2002; Corrigan et al. 2009), poor treatment adherence, increased symptom severity (Mak & Wu, 2006; Livingston & Boyd, 2010) and poor quality of life (Vauth et al. 2007). Given that stigma is a social construct, culture impacts stigma significantly. Culture refers to the behaviours, beliefs, value orientations and symbols that a group of people have in common that influence their customs, norms and practices; and is socially transmitted across generations. These sociocultural norms and practices also determine the meaning, practice and expression of stigma across different populations (Yang et al. 2007; Cheon & Chiao, 2012). For example, cultural beliefs play a significant role in determining the explanatory models of illness (Kleinman, 1980) which in turn gives meaning to stigma. Abdullah & Brown (2011) in their review of the literature suggest that the ‘collectivist’ nature of Asians, leads to the perception that mental illnesses reflect flaws of the family. Supernatural attributions for mental illness are often viewed as a punishment for some individual or familial misdeed (Philips, 1993). Similarly, ‘bad deeds’ and ‘sins’ committed in the present or past lives may be perceived as a cause of the mental illness leading to the stigmatisation of those with these illnesses (Raguram et al. 2004). The inability of a person with mental illness to achieve aca- demic and occupational successes that are highly regarded and valued in many cultures also leads to stigmatisation. While the concept of stigma (and the stigmatisation) of those with mental illnesses has been studied widely in Western countries, relatively few studies have been carried out in Asian countries. The current study aims to bridge this gap by examining stigma among the adult population in an Asian society. Singapore is a multi-ethnic city state country in Southeast Asia, with a resident population of 3.8 million (Statistics Singapore, 2014) of which 74.2% are Chinese, 13.3% are Malays, 9.1% are Indians and 3.3% belong to other ethnic groups. Singapore has a robust developed economy and a highly literate population with English being the language of instruction in schools and gov- ernment. However, culturally rooted traditions and beliefs specific to the various ethnic groups who have largely migrated from China, Malaysia, Indonesia and India are prevalent. An earlier study showed ethnic differences in the perception of mental health problems, with those of Malay ethnicity being the most tolerant of all the ethnic groups (Chong et al. 2007). More than one-third of those surveyed believed that those with mental disorders were dan- gerous and wanted to distance themselves from those with mental disorders. However, no study has since examined the extent or correlates of stigma towards mental illnesses at a population level. The aims of the current study were to: (i) describe the extent of overall stigma as well as the differences in stigma towards people with alcohol abuse, demen- tia, depression, schizophrenia and obsessive compul- sive disorder (OCD), as well as (ii) establish the dimensions of stigma and examine its correlates, in the general population of Singapore among those aged 18–65 years using a vignette approach. Methodology Sample Data for the current study came from a larger nation- wide cross-sectional study of mental health literacy conducted in Singapore from March 2014 to April 2015. Statistical power calculations for binary propor- tions after adjusting for design effect were estimated to determine the sample size for the overall prevalence estimate, as well as for sub-groups by age and ethni- city, with precision of 4% (Kish, 1965). Sample size was derived using 20% as a prevalence estimate for correct recognition of causes of mental disorders in Singapore, as reported in an earlier study (Chong et al. 2007). A sample size of 600 was calculated for each vignette. A total sample size of 3000 (5 vignettes × 600 cases) with the margin of error was then com- puted and estimated to be adequate to provide suffi- cient precision for the study. We recalculated the adequacy of the sample size (i.e. N = 3000) for the stigma study using data from the study by Reavley & Jorm (2011), using prevalence estimate of respon- dents who ‘agree’ (2.5%) or ‘strongly agree’ (72.3%) with statements relating to personal stigma towards mental disorders. The target sample size of 3000 pro- vided sufficient precision with the margin of error for the overall prevalence estimate found to be 0.08– 2.2%, the margin of error for the strata defined by age and ethnicity to be 1.4–2.9% and relative standard error ranging from 1.5 to 26.7%, which was below the acceptable range of 30% (Klein et al. 2002). The study population comprised Singapore Residents (Singapore Citizens and Permanent Residents) aged 18–65 years who were living in Singapore at the time of the survey. The sample was derived using the sampling frame from an administra- tive database in Singapore that maintains data on age, gender, ethnicity and