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Kidane, Eshetu Girma (2014): Determinants of self and public stigma and discrimination against people with mental illness and their family in Jimma zone, Southwest Ethiopia. Dissertation, LMU München: Medizinische Fakultät



Background: Stigma can be detrimental to the quality of life, as well as the treatment and rehabiltation process of people with mental illness. The purpose of this study was to measure the extent and determine correlates of public and self-stigma against people with mental illness (PWMI) and their families in Jimma Zone, Southwest Ethiopia. Methods: Community and institution based quantitative and qualitative cross-sectional studies were conducted among 845 randomly selected community members at GGFRC, consecutive 422 PWMI and 422 family members of PWMI at Jimma University Specialized Hospital. Univariate, bivariate and multivariate linear regression analyses were done. Results: The mean scores of public stigma against PWMI and their family members were 2.62 (+0.34) and 2.16 (+0.49), respectively, on a range of 1 to 5. The mean self-stigma score among PWMI, on a range of 1 to 4, was 2.32 (+0.30). Place of residence, belief in the supernatural, psychosocial and biological explanations of mental illness were associated with stigma towards PWMI and family members of PWMI. Level of education and income predicted PWMI public stigma. A higher number of perceived signs of mental illness was correlated with lower stigma against family members of PWMI. Females, individuals with history of traditional treatment, individuals experiencing higher number of drug side-effects, and individuals who subscribed to more signs and supernatural explanations had significantly higher levels of self-stigma. In contrast, patients with higher education level and higher self esteem showed significantly lower levels of self-stigma. Supporting supernatural explanations of mental illness was associated with greater care-givers’ self-stigmatization. Conclusion: High public stigma against PWMI and high levels of patients’ self-stigma were found. Care-givers demonstrated reluctance to be identified with PWMI. Systematic forms of discrimination against PWMI and their family members were identified. PWMI and their family members faced behavioral and structural challenges. Thus, reducing stigma against patients may help to reduce stigma against family members. Developing strategies to improve patients’ self esteem, and developing policies and guidelines about mental illness may be helpful in reducing stigma. Effective intervention strategies that target patients, their families, as well as the public need to be designed to reduce stigma.