title: Explanatory model of psychosis: impact on perception of self-stigma by patients in three sub-saharan African cities.
abstract: Most cultures in sub-Saharan Africa subscribe to the belief that the root cause of psychosis is supernatural. Individuals in the community who hold a religiomagical explanatory model of causation have been shown to exhibit more stigmatizing attitudes towards people with psychosis. Self-stigma among individuals with psychosis is less frequently studied.
  
  
  
  We used a mixed-method approach, consisting of key informant's interviews to elicit information on explanatory models of causation of psychosis and questionnaire assessment of internalized stigma with an adapted version of the Scale for Internalized Stigma of Mental Illness. Twenty-four, 31, and 30 subjects with recent experience of utilizing the service of traditional or faith healers for severe mental disorders in Ibadan (Nigeria), Kumasi (Ghana), and Nairobi (Kenya), respectively, were interviewed.
  
  
  
  About 44 % (42.1 %) of the Nigerian respondents had a high (severe) level of self-stigma with the respective proportions among Ghanaian and Kenyan respondents being 20.7 and 37.5 %. Compared with 4 out of a total of 12 respondents (33.3 %) who reported low self-stigma reported supernatural attribution, 14 out of 20 respondents (70 %) with the highest level of self-stigma reported supernatural attribution across the three sites. When low scorers ascribed supernatural causation, it was often with a religious focus.
  
  
  
  There is a greater tendency for persons with high levels of self-stigma than those with low levels to ascribe supernatural attribution to their experience of a severe mental health condition.
authors: Department of Psychiatry, University of Ibadan, Ibadan, Nigeria. vmakanjuola@yahoo.com.
authors: Victor
authors: 0000-0001-7449-0506
authors: V
authors: Makanjuola
authors: Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
authors: Yomi
authors: Y
authors: Esan
authors: Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
authors: Bibilola
authors: B
authors: Oladeji
authors: World Health Organization Country Office, Abuja, Nigeria.
authors: Lola
authors: L
authors: Kola
authors: Kwame Nkuruma University of Science and Technology, Kumasi, Ghana.
authors: John
authors: J
authors: Appiah-Poku
authors: University of Liberia, Monrovia, Liberia.
authors: Benjamin
authors: B
authors: Harris
authors: University of Nairobi, Nairobi, Kenya.
authors: Caleb
authors: C
authors: Othieno
authors: National Institute of Mental Health, Bethesda, USA.
authors: Leshawndra
authors: L
authors: Price
authors: Stellenbosch University, Stellenbosch, South Africa.
authors: Soraya
authors: S
authors: Seedat
authors: Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
authors: Oye
authors: O
authors: Gureje
mesh_terms: D000293:Adolescent; D000328:Adult; D044383:Black People; D005260:Female; D005869:Ghana / Q000208:ethnology; D006801:Humans; D007630:Kenya / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009549:Nigeria / Q000208:ethnology; D011618:Psychotic Disorders / Q000208:ethnology / Q000523:psychology*; D012649:Self Concept; D057545:Social Stigma; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Explanatory model; Psychosis; Religious theme; Self-stigma; Sub-saharan Africa