A cross-cultural examination of knowledge and beliefs about mental disorders

This thesis was submitted for the award of Doctor of Philosophy and was awarded by Brunel University LondonHow and why do the public’s knowledge and beliefs about mental disorders differ across cultures? Research has widely established that knowledge and beliefs about the symptoms, causes, treatments and stigma towards mental illness vary across cultures. However, few studies have examined the factors that may be associated with this variation. The overall purpose of the present dissertation was twofold: first, to cross-culturally validate measures of beliefs about mental disorders, and, second, to examine the influence of cultural variables with the aim of explaining cross-cultural variation. The General Introduction outlines the current research strands of knowledge and beliefs of mental disorders (namely, mental health literacy [MHL] and mental illness stigma), describes the importance of examining culture and introduces its framework, and describes how knowledge and beliefs differ cross-culturally. Further, cultural variables (collectivism and its facets) and their possible role in determining cross-cultural variation in MHL and mental illness stigma are introduced. The present research also examined differences in beliefs between mental disorders (schizophrenia, depression, generalised anxiety disorder [GAD]). Studies 1 and 2 revealed that across cultures MHL was better regarding schizophrenia and depression than GAD. Study 1 further found that recognition of symptoms of mental illness was greater in the Caucasian British sample compared to the South Asian and African-Caribbean samples, which corroborated previous research. Study 2 tested the cross-cultural equivalence of measures of causal and help-seeking beliefs, and cross-culturally validated the MHL model in European Americans and Indians. Confirmatory factor analysis (CFA) eliminated culturally non-equivalent items and therefore established a sound measure of causal and help-seeking beliefs for mental disorders. Furthermore, structural equation modelling (SEM) found good support for the MHL model cross-culturally, with recognition being the best predictor of endorsing causal and help-seeking beliefs across cultures. However, the significant cross-cultural difference in the model was that Indians, but not European Americans, viewed lay help-seeking beliefs as vital in relation to treatment of mental illness. The second part of Study 2 examined the relationship between MHL and mental illness stigma. Associations between the two constructs were non-significant across cultures, however implications are limited as only one aspect of mental illness stigma was measured. Study 3 cross-culturally validated a commonly-used measure of mental illness stigma and tested equivalence of the mental illness stigma model in European Americans and Indians. As in Study 2, CFA indicated which culturally-equivalent items to retain, and SEM of the mental illness stigma model established its applicability in both cultural groups. Finally, the second part of Study 3 examined social and cultural variables in relation to mental illness stigma. The results showed that classic religiosity, conformity to norms, familial support, honour and obligations were significant predictors of stigma. It was particularly noteworthy that conformity to norms significantly predicted lesser discrimination in the Indian sample, while endorsement of familial obligations indirectly predicted greater discrimination through prejudicial beliefs in the European American sample. The General Discussion evaluates the main findings, discusses implications, limitations, and directions for future research