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07.05.2024 | Research

Changes in mental health stigma among healthcare professionals and community representatives in Northern Sri Lanka during an mhGAP intervention study

verfasst von: Shannon Doherty, Behzad Kianian, Giselle Dass, Anne Edward, Ahoua Kone, Gergana Manolova, Sambasivamoorthy Sivayokan, Madonna Solomon, Rajendra Surenthirakumaran, Barbara Lopes-Cardozo

Erschienen in: Social Psychiatry and Psychiatric Epidemiology

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Abstract

Purpose

Research indicates that exposure to conflict, natural disasters, and internal displacement can increase mental health conditions. Since the end of the civil conflict within Sri Lanka, the country has worked to increase access to mental health services to meet the needs of conflict-affected populations, however, gaps remain. To address this, integration of mental health services into primary care can reduce the strain on growing specialized care. As part of a larger study primary care practitioners (doctors), public health professionals (nurses, midwives), and community representatives (teachers, social workers) were trained to deliver mental health services in primary care across the heavily impacted Northern Province. The aim was to reduce mental health stigma among enrolled healthcare workers and community representatives by 50%.

Methods

Stigma was measured across all participant groups at six time points: pre- and post- initial training at baseline, pre- and post- refresher training 3-months after initial training, and pre- and post- refresher training 6-months after initial training.

Results

Results indicate a small improvement in average stigma scores at the 6-month refresher point for primary care practitioners, and no meaningful difference in average scores across time points for public health professionals or community representatives.

Conclusion

World Health Organization mhGAP training appears to reduce stigma among primary care practitioners and could be an effective strategy to counteract mental health stigma in low resource settings. Future research should investigate underlying mechanisms of stigma reduction to improve delivery of mental health services in primary care and community settings.
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Literatur
1.
Zurück zum Zitat Doherty S, Hulland E, Lopes-Cardozo B, Sivalingam K, Surenthirakumaran R, Cookson S, Siriwardhana C (2019) Prevalence of mental disorders and epidemiological associations in post-conflict primary care attendees: a cross-sectional study in the Northern Province of Sri Lanka. BMC Psych 19:83CrossRef Doherty S, Hulland E, Lopes-Cardozo B, Sivalingam K, Surenthirakumaran R, Cookson S, Siriwardhana C (2019) Prevalence of mental disorders and epidemiological associations in post-conflict primary care attendees: a cross-sectional study in the Northern Province of Sri Lanka. BMC Psych 19:83CrossRef
3.
Zurück zum Zitat Porter M, Haslam N (2005) Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. JAMA 294:5CrossRef Porter M, Haslam N (2005) Predisplacement and postdisplacement factors associated with mental health of refugees and internally displaced persons: a meta-analysis. JAMA 294:5CrossRef
4.
Zurück zum Zitat Steel Z, Chey T, Silove D, Marnane C, Bryant R, Van Ommeren M (2009) Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA 302(5):537–549CrossRefPubMed Steel Z, Chey T, Silove D, Marnane C, Bryant R, Van Ommeren M (2009) Association of torture and other potentially traumatic events with mental health outcomes among populations exposed to mass conflict and displacement: a systematic review and meta-analysis. JAMA 302(5):537–549CrossRefPubMed
5.
Zurück zum Zitat Kathriarachchi S, Seneviratne L, Amarakoon L (2019) Development of mental health care in Sri Lanka: Lessons learned Taiwanese. J Psych 33(2):55 Kathriarachchi S, Seneviratne L, Amarakoon L (2019) Development of mental health care in Sri Lanka: Lessons learned Taiwanese. J Psych 33(2):55
6.
Zurück zum Zitat Patel V (2012) Global mental health: from science to action. Har Rev Psych 20(1):6–12CrossRef Patel V (2012) Global mental health: from science to action. Har Rev Psych 20(1):6–12CrossRef
7.
Zurück zum Zitat Keynejad R, Spagnolo J, Thornicroft G (2021) WHO mental health gap action programme (mhGAP) intervention guide: updated systematic review on evidence and impact. EBMH 24(3):124–130 Keynejad R, Spagnolo J, Thornicroft G (2021) WHO mental health gap action programme (mhGAP) intervention guide: updated systematic review on evidence and impact. EBMH 24(3):124–130
8.
Zurück zum Zitat Siriwardhana C, Adikari A, Jayaweera K, Abeyrathna B, Sumathipala A (2016) Integrating mental health into primary care for post-conflict populations: a pilot study. Int J Mental Health Sys 10(1):1–12 Siriwardhana C, Adikari A, Jayaweera K, Abeyrathna B, Sumathipala A (2016) Integrating mental health into primary care for post-conflict populations: a pilot study. Int J Mental Health Sys 10(1):1–12
9.
Zurück zum Zitat Doherty S, Kianian B, Couture A, Dass G, Edward A, Hulland E, Manolova G, Sivayokan S, Solomon M, Stewart R, Surenthirakumaran R, Lopes-Cardozo B (2022) Integrating mental health into primary care for conflict-affected populations: Implementing mhGAP in Northern Sri Lanka In progress. Ment Health Fam Med 9(1):15–24 Doherty S, Kianian B, Couture A, Dass G, Edward A, Hulland E, Manolova G, Sivayokan S, Solomon M, Stewart R, Surenthirakumaran R, Lopes-Cardozo B (2022) Integrating mental health into primary care for conflict-affected populations: Implementing mhGAP in Northern Sri Lanka In progress. Ment Health Fam Med 9(1):15–24
10.
Zurück zum Zitat Fernando S, Deane F, McLeod H (2010) Sri Lankan doctors’ and medical undergraduates’ attitudes towards mental illness. Soc Psych and Psych Epi 45(7):733–739CrossRef Fernando S, Deane F, McLeod H (2010) Sri Lankan doctors’ and medical undergraduates’ attitudes towards mental illness. Soc Psych and Psych Epi 45(7):733–739CrossRef
11.
Zurück zum Zitat Henderson C, Noblett J, Parke H, Clement S, Caffrey A, Gale-Grant O, Schulze B, Druss B, Thornicroft G (2014) Mental health-related stigma in health care and mental health-care settings. Lancet Psych 1(6):467–482CrossRef Henderson C, Noblett J, Parke H, Clement S, Caffrey A, Gale-Grant O, Schulze B, Druss B, Thornicroft G (2014) Mental health-related stigma in health care and mental health-care settings. Lancet Psych 1(6):467–482CrossRef
12.
Zurück zum Zitat Sickel A, Seacat J (2014) Nabors N Mental health stigma update: A review of consequences. Adv Mental Health 12(3):202–215CrossRef Sickel A, Seacat J (2014) Nabors N Mental health stigma update: A review of consequences. Adv Mental Health 12(3):202–215CrossRef
13.
Zurück zum Zitat Fernando S, Deane F, McLeod H (2017) The delaying effect of stigma on mental health help-seeking in Sri Lanka. Asia-Pacific Psych 9:1 Fernando S, Deane F, McLeod H (2017) The delaying effect of stigma on mental health help-seeking in Sri Lanka. Asia-Pacific Psych 9:1
14.
Zurück zum Zitat Samarasekara N, Davies M, Siribaddana S (2012) The stigma of mental illness in Sri Lanka: the perspectives of community mental health workers. Stigma Res & Action 2(2):93–99CrossRef Samarasekara N, Davies M, Siribaddana S (2012) The stigma of mental illness in Sri Lanka: the perspectives of community mental health workers. Stigma Res & Action 2(2):93–99CrossRef
16.
Zurück zum Zitat Luty J, Fekadu D, Umoh O, Gallagher J (2006) Validation of a short instrument to measure stigmatised attitudes towards mental illness. Psych Bull 30(7):257–260CrossRef Luty J, Fekadu D, Umoh O, Gallagher J (2006) Validation of a short instrument to measure stigmatised attitudes towards mental illness. Psych Bull 30(7):257–260CrossRef
17.
Zurück zum Zitat Luty J, Rao H, Arokiadass S, Easow J, Sarkhel A (2008) The repentant sinner: methods to reduce stigmatised attitudes towards mental illness. Psych Bull 32(9):327–332CrossRef Luty J, Rao H, Arokiadass S, Easow J, Sarkhel A (2008) The repentant sinner: methods to reduce stigmatised attitudes towards mental illness. Psych Bull 32(9):327–332CrossRef
19.
Zurück zum Zitat Nickless A, Voysey M, Geddes J, Yu L, Fanshawe T (2018) Mixed effects approach to the analysis of the stepped wedge cluster randomised trial—Investigating the confounding effect of time through simulation. PLoS ONE 13(12):e0208876CrossRefPubMedPubMedCentral Nickless A, Voysey M, Geddes J, Yu L, Fanshawe T (2018) Mixed effects approach to the analysis of the stepped wedge cluster randomised trial—Investigating the confounding effect of time through simulation. PLoS ONE 13(12):e0208876CrossRefPubMedPubMedCentral
21.
Zurück zum Zitat Agresti A (2018) An introduction to categorical data analysis. John Wiley & Sons, New York Agresti A (2018) An introduction to categorical data analysis. John Wiley & Sons, New York
24.
Zurück zum Zitat Kuznetsova A, Brockhoff PB, Christensen RHB (2017) lmerTest package: tests in linear mixed effects models. J Stat Soft 82:1–26CrossRef Kuznetsova A, Brockhoff PB, Christensen RHB (2017) lmerTest package: tests in linear mixed effects models. J Stat Soft 82:1–26CrossRef
25.
Zurück zum Zitat Elff M, Heisig J, Schaeffer M, Shikano S (2021) Multilevel analysis with few clusters: Improving likelihood-based methods to provide unbiased estimates and accurate inference. Brit J of Pol Sci 51(1):412–426CrossRef Elff M, Heisig J, Schaeffer M, Shikano S (2021) Multilevel analysis with few clusters: Improving likelihood-based methods to provide unbiased estimates and accurate inference. Brit J of Pol Sci 51(1):412–426CrossRef
26.
Zurück zum Zitat Christensen RHB 2015 Ordinal—regression models for ordinal data R package version 28 Christensen RHB 2015 Ordinal—regression models for ordinal data R package version 28
28.
Zurück zum Zitat Goodrich B, Gabry J, Ali I, Brilleman S (2020) rstanarm: Bayesian applied regression modeling via Stan. R package version 2:1 Goodrich B, Gabry J, Ali I, Brilleman S (2020) rstanarm: Bayesian applied regression modeling via Stan. R package version 2:1
29.
Zurück zum Zitat Bürkner PC (2017) brms: An R package for Bayesian multilevel models using Stan. J of Stat Software 80:1–28CrossRef Bürkner PC (2017) brms: An R package for Bayesian multilevel models using Stan. J of Stat Software 80:1–28CrossRef
30.
Zurück zum Zitat Bürkner PC (2018) Advanced Bayesian multilevel modeling with the R package. The R Journal 1705:11123 Bürkner PC (2018) Advanced Bayesian multilevel modeling with the R package. The R Journal 1705:11123
31.
Zurück zum Zitat Vehtari A, Gelman A, Gabry J (2017) Practical Bayesian model evaluation using leave-one-out cross-validation and WAIC. Stat & Comp 27(5):1413–1432CrossRef Vehtari A, Gelman A, Gabry J (2017) Practical Bayesian model evaluation using leave-one-out cross-validation and WAIC. Stat & Comp 27(5):1413–1432CrossRef
32.
Zurück zum Zitat Thornicroft G, Mehta N, Clement S, Evans-Lacko S, Doherty M, Rose D, Koschorke M, Shidhaye R, O’Reilly C, Henderson C (2016) Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet 387(10023):1123–1132CrossRefPubMed Thornicroft G, Mehta N, Clement S, Evans-Lacko S, Doherty M, Rose D, Koschorke M, Shidhaye R, O’Reilly C, Henderson C (2016) Evidence for effective interventions to reduce mental-health-related stigma and discrimination. Lancet 387(10023):1123–1132CrossRefPubMed
33.
Zurück zum Zitat Simmons L, Jones T, Bradley E (2017) Reducing mental health stigma: the relationship between knowledge and attitude change. Eur J Ment Health 1(12):25–40CrossRef Simmons L, Jones T, Bradley E (2017) Reducing mental health stigma: the relationship between knowledge and attitude change. Eur J Ment Health 1(12):25–40CrossRef
34.
Zurück zum Zitat Koschorke M, Oexle N, Ouali U, Cherian AV, Deepika V, Mendon GB, Gurung D, Kondratova L, Muller M, Lanfredi M, Lasalvia A (2021) Perspectives of healthcare providers, service users, and family members about mental illness stigma in primary care settings: A multi-site qualitative study of seven countries in Africa, Asia, and Europe. PLoS ONE 16(10):e0258729CrossRefPubMedPubMedCentral Koschorke M, Oexle N, Ouali U, Cherian AV, Deepika V, Mendon GB, Gurung D, Kondratova L, Muller M, Lanfredi M, Lasalvia A (2021) Perspectives of healthcare providers, service users, and family members about mental illness stigma in primary care settings: A multi-site qualitative study of seven countries in Africa, Asia, and Europe. PLoS ONE 16(10):e0258729CrossRefPubMedPubMedCentral
35.
Zurück zum Zitat Kaur A, Kallakuri S, Kohrt BA, Heim E, Gronholm PC, Thornicroft G, Maulik PK (2021) Systematic review of interventions to reduce mental health stigma in India. Asian J Psych 55:102466CrossRef Kaur A, Kallakuri S, Kohrt BA, Heim E, Gronholm PC, Thornicroft G, Maulik PK (2021) Systematic review of interventions to reduce mental health stigma in India. Asian J Psych 55:102466CrossRef
36.
Zurück zum Zitat Corrigan PW, Mittal D, Reaves CM, Haynes TF, Han X, Morris S, Sullivan G (2014) Mental health stigma and primary health care decisions. Psych Res 218(1–2):35–38CrossRef Corrigan PW, Mittal D, Reaves CM, Haynes TF, Han X, Morris S, Sullivan G (2014) Mental health stigma and primary health care decisions. Psych Res 218(1–2):35–38CrossRef
37.
Zurück zum Zitat Mutiso VN, Pike K, Musyimi CW, Rebello TJ, Tele A, Gitonga I, Thornicroft G, Ndetei DM (2019) Feasibility of WHO mhGAP-intervention guide in reducing experienced discrimination in people with mental disorders: a pilot study in a rural Kenyan setting. Epi and Psych Sci 28:2 Mutiso VN, Pike K, Musyimi CW, Rebello TJ, Tele A, Gitonga I, Thornicroft G, Ndetei DM (2019) Feasibility of WHO mhGAP-intervention guide in reducing experienced discrimination in people with mental disorders: a pilot study in a rural Kenyan setting. Epi and Psych Sci 28:2
38.
Zurück zum Zitat Kaur A, Kallakuri S, Daniel M, Yatirajula SK, Devarapalli S, Maulik PK (2021) Directly engaging with people with lived experiences of mental illness from the communities in India. SSM-Mental Health 1:100024CrossRef Kaur A, Kallakuri S, Daniel M, Yatirajula SK, Devarapalli S, Maulik PK (2021) Directly engaging with people with lived experiences of mental illness from the communities in India. SSM-Mental Health 1:100024CrossRef
39.
Zurück zum Zitat Thornicroft G, Sunkel C, Aliev AA, Baker S, Brohan E, El Chammay R, Davies K, Demissie M, Duncan J, Fekadu W, Gronholm PC (2022) The Lancet Commission on ending stigma and discrimination in mental health. The Lancet 400:10361CrossRef Thornicroft G, Sunkel C, Aliev AA, Baker S, Brohan E, El Chammay R, Davies K, Demissie M, Duncan J, Fekadu W, Gronholm PC (2022) The Lancet Commission on ending stigma and discrimination in mental health. The Lancet 400:10361CrossRef
Metadaten
Titel
Changes in mental health stigma among healthcare professionals and community representatives in Northern Sri Lanka during an mhGAP intervention study
verfasst von
Shannon Doherty
Behzad Kianian
Giselle Dass
Anne Edward
Ahoua Kone
Gergana Manolova
Sambasivamoorthy Sivayokan
Madonna Solomon
Rajendra Surenthirakumaran
Barbara Lopes-Cardozo
Publikationsdatum
07.05.2024
Verlag
Springer Berlin Heidelberg
Erschienen in
Social Psychiatry and Psychiatric Epidemiology
Print ISSN: 0933-7954
Elektronische ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-024-02684-4

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