title: Attitudes to people with mental disorders: a mental health literacy survey in a rural area of Maharashtra, India.
abstract: BACKGROUND
  People with mental disorders experience discrimination as a consequence of stigmatising attitudes that are largely socio-culturally constructed. Thus, there is a need to understand local contexts in order to develop effective programs to change such attitudes. We undertook a mental health literacy survey in rural Maharashtra, India, prior to developing a mental health training program for village health workers (VHWs) in a primary health care setting.
  
  
  METHODS
  A cross-sectional mental health literacy survey was undertaken in late 2007, which involved interviewer-administration of a questionnaire to 240 systematically sampled community members, and 60 purposively sampled VHWs. Participants were presented with two vignettes describing people experiencing symptoms of mental disorders (depression, psychosis), and were asked about attitudes towards, and desired social distance from, the people in the vignettes (the latter being a proxy measure for stigma). Linear regression modelling was undertaken to identify predictors of social distance.
  
  
  RESULTS
  Although the community was relatively accepting of people with mental disorders, false beliefs and negative attitudes were still evident. Desired social distance was consistently greater for the person depicted in the psychosis vignette compared to the depression vignette. For both vignettes, the main predictor of greater social distance was perceiving the person as dangerous, and the predictors of reduced social distance were being a VHW, and seeing the problem as a sign of personal weakness. For depression, believing the cause to be family tensions also reduced social distance. For psychosis, labelling the disorder as a mind/brain problem, and believing the cause to be lack of control over life or genetic factors increased social distance. The vast majority did not agree that the problems experienced in the vignettes were 'a real medical illness'.
  
  
  CONCLUSIONS
  Promoting bio-medical explanations for mental disorders in this setting may exacerbate discriminatory attitudes. Provision of contextually relevant mental health training for the VHWs so that they are able to communicate, model and shape more positive attitudes is the next step.
authors.affiliation: Nossal Institute for Global Health, University of Melbourne, Alan Gilbert Building, Carlton, VIC 3010, Australia. mkermode@unimelb.edu.au
authors.forename: Michelle
authors.initials: M
authors.lastname: Kermode
authors.forename: Kathryn
authors.initials: K
authors.lastname: Bowen
authors.forename: Shoba
authors.initials: S
authors.lastname: Arole
authors.forename: Soumitra
authors.initials: S
authors.lastname: Pathare
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Jorm
mesh_terms: D001294:Attitude to Health; D003150:Community Health Workers / Q000193:education / Q000523:psychology; D003430:Cross-Sectional Studies; D003469:Culture; D003625:Data Collection / Q000706:statistics & numerical data*; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D007194:India / Q000453:epidemiology; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology*; D011287:Prejudice; D012929:Psychological Distance; D011639:Public Opinion; D012424:Rural Population / Q000706:statistics & numerical data; D013240:Stereotyping