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SPS304 Mental Health in the Community

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.

(800 – 1000 words in total)


1. Stigma is defined by the WHO as distinctive attitude or belief establishing a differentiation between the person with mentalhelath condition and the society attributing to the disease characteristics (Shi et al., 2020). Stigma in mental illness is a worldwide phenomenon and is one of the biggest barrier treatments seeking behavior and psychological well-being indiivuduls with mental health conditions (Whittle et al., 2017).

Subramaniam et al. (2017) studied the overall stigma and the differences of experienced stigma among indiivduals with dementia, alcohol abuse, schizophrenia, depression and OCD. The author categorized them into five vignettes with participants of each condition. The authors measures the stigma in terms of the Perceived and Personal scales of the Depression & Social Distance scale to analyse stigma.

The overall stigma is experienced in three forms: public stigma (this is the general public’s attitude towards the individuals with mental illness), self-stigma (which is the sellf- prejudices one holds towards themselves due to their mental illness), and healthcare professionals due to stereotypical beliefs. Stereotypes (negative thoughts about a group), prejudice (negative emotional reaction), and discrimination are the three components of the overall stigma. The stigma associated with issues faced by the friends and family of the person with the mental health illness was consistently associated with all five vignettes. The personal stigma in all three vignettes was also found to be satistical significant. Anticipatory discrimination was also common to all where the awareness of the negative perception due to misconceptions results in lower social interactions, loss of self esteem and confidence (Wakida et al., 2018).

The study found that people with alcohol abuse and schizophrenia faced the maximum stigma with high social distance from society members. Individuals with lower socio-economic status and lower education levels were significantly associated with public and personal stigma. The study observed a significant cultural difference in the stigma pattern. For example, people with the Malay culture had a weak score, which means they do not consider mental illness a real disease; however, for Indian culture, the score was high. The social distance was low, which means they are more open to include them in their society. The participants from the depression vignette have weak stigma experience in comparison to schizophrenia. The author suggested that depression is considered a psychosocial disorder, and schizophrenia is perceived as pathological and dangerous. Participants with dementia, depression, and OCD have lower social distance scores than schizophrenia, where alcoholism has the highest score. Alcohol addiction and schizophrenia were found to be at one end of the spectrum. In contrast anxiety disorders, depression and dementia at the other end were perceived as less dangerous in comparison. The people with alcohol use were considered as the most dangerous, unpredictable, and the one to be avoided

2. The strength of the research study includes the reliability, validity, structure, study design, sample size, data collection, and generalizability.

The strengths of this study conducted by Subramaniam et al., 2017 are as follows:

a) The large sample size: a total sample size of 3000 individuals was taken by the authors, where each vignette had 600 participants. The sample size was thoroughly calculated using the statistical calculation of binary proportion. The participants sizw was the further calculated  using a 20% prevalence rate estimation for correct understanding of mental disorders as reported in previous studies. The sample size is an essential consideration for the research study. A larger sample size provides more accurate mean values and a more significant statistical establishment with a smaller margin of errors (Caetano & Noel, 2018).

b) Good response rate: A total of 3000 respondents were contacted; out of these, 71% of individuals responded to the questionnaire to evaluate the stigma issues. The response rate was high, which increased the reliability of the study and established the result’s generalizability (Caetano & Noel, 2018). Higher response rates ensure the data accuracy and quality with better quantitative analysis. The high response rate also reflected the structured and appropriate design of the study (Ross et al., 2019).

c) Comparison across multiple illnesses using standardized questionnaires: mental literacy was assessed using the  Depression Literacy Questionnaire. The clinical differentiation and definition of each condition of the vignettes were done using the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders. The personal and perceived scales of the stigma for depression were used. The eight subcategories for depression personal scale were used. The social distance scale was used to analyze public stigma, which measures the self-reported willingness to contact the individual with the mental illness present in the vignette.

However, using other specific questionnaires such as behavioral discrimination such as the Reported and Intended Behaviour scale could have further strengthened the study. The use of a standardized questionnaire is significant s it allows better data collection, information synthesis, and answer to the research question in a more accurate form (Caetano & Noel, 2018).


Caetano, R., & Noel, J. (2018). Web-Based Research: Strengths, Weaknesses, and JSAD’s Guidance for Authors. Journal of studies on alcohol and drugs, 79(6), 813–815.

Ross, P. T., & Bibler Zaidi, N. L. (2019). Limited by our limitations. Perspectives on medical education8(4), 261–264.

Shi, W., Shen, Z., Wang, S., & Hall, B. (2020). Barriers to Professional Mental Health Help-Seeking Among Chinese Adults: A Systematic Review. Frontiers In Psychiatry, 11.

Wakida, E., Talib, Z., Akena, D., Okello, E., Kinengyere, A., Mindra, A., & Obua, C. (2018). Barriers and facilitators to the integration of mental health services into primary health care: systematic review. Systematic Reviews7(1).

Whittle, E., Fisher, K., Reppermund, S., Lenroot, R., & Trollor, J. (2017). Barriers and Enablers to Accessing Mental Health Services for People With Intellectual Disability: A Scoping Review. Journal Of Mental Health Research In Intellectual Disabilities, 11(1), 69-102.

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