title: Stigmatization of severe mental illness in India: Against the simple industrialization hypothesis.
abstract: BACKGROUND
  Major international studies on course and outcome of schizophrenia suggest a better prognosis in the rural world and in low-income nations. Industrialization is thought to result in increased stigma for mental illness, which in turn is thought to worsen prognosis. The lack of an ethnographically derived and cross-culturally valid measure of stigma has hampered investigation. The present study deploys such a scale and examines stigmatizing attitudes towards the severely mentally ill among rural and urban community dwellers in India.
  
  
  OBJECTIVE
  To test the hypothesis that there are fewer stigmatizing attitudes towards the mentally ill amongst rural compared to urban community dwellers in India.
  
  
  METHODS
  An ethnographically derived and vignette-based stigmatization scale was administered to a general community sample comprising two rural and one urban site in India. Responses were analyzed using univariate and multivariate statistical methods.
  
  
  RESULTS
  Rural Indians showed significantly higher stigma scores, especially those with a manual occupation. The overall pattern of differences between rural and urban samples suggests that the former deploy a punitive model towards the severely mentally ill, while the urban group expressed a liberal view of severe mental illness. Urban Indians showed a strong link between stigma and not wishing to work with a mentally ill individual, whereas no such link existed for rural Indians.
  
  
  CONCLUSIONS
  This is the first study, using an ethnographically derived stigmatization scale, to report increased stigma amongst a rural Indian population. Findings from this study do not fully support the industrialization hypothesis to explain better outcome of severe mental illness in low-income nations. The lack of a link between stigma and work attitudes may partly explain this phenomenon.
authors.affiliation: Centre for Behavioural and Social Sciences in Medicine, London, UK.
authors.forename: Sushrut
authors.initials: S
authors.lastname: Jadhav
authors.forename: Roland
authors.initials: R
authors.lastname: Littlewood
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Ryder
authors.forename: Ajita
authors.initials: A
authors.lastname: Chakraborty
authors.forename: Sumeet
authors.initials: S
authors.lastname: Jain
authors.forename: Maan
authors.initials: M
authors.lastname: Barua