knowledge of and attitude to mental illnesses in nigeria ... · c. knowledge of and attitude to...

Integrative Journal of Global Health 2017

Vol. 1 No. 1: 5iMedPub Journalshttp://www.imedpub.com

Research Article

1© Under License of Creative Commons Attribution 3.0 License | This article is available in: http://www.imedpub.com/integrative-journal-of-global-health/

Udoka Okpalauwaekwe1, Mansfield Mela2 andChioma Oji3

1 DepartmentofAcademicFamilyMedicine,UniversityofSaskatchewan,Saskatoon,SK,Canada

2 DepartmentofPsychiatry,CollegeofMedicine,RoyalUniversityHospital,Saskatoon,SK,Canada

3 DepartmentofPsychiatry,UniversityofNigeriaTeachingHospital,Enugu,Nigeria

Corresponding author: UdokaOkpalauwaekwe

[email protected]

DepartmentofAcademicFamilyMedicine,UniversityofSaskatchewan,Saskatoon,SK,Canada.

Tel: 3063702111

Citation:OkpalauwaekweU,MelaM,OjiC.KnowledgeofandAttitudetoMentalIllnessesinNigeria:AScopingReview.IntegrJGlobHealth.2017,1:1.

shapeattitudesandhavebeenshowntohaveahugeimpactontheacceptanceofthementallyillamongstNigerians[8].

Researchhaslinkednegativesocietalattitudewiththebehaviourofthementallyill,ratherthanthecauseofthesementalillnesses[1,8,9]. Thus,mentally ill persons are frequently referred to asdangerous, suspicious, unstable, unreliable, irresponsible, andhomicidal [1]. These labels on the mental behaviour of thementally ill have aggravated stereotypes and provoked furtherprejudicesonpeoplewithmentalillnesses[9].

The impact of the stigmatizing attitude and poor knowledgeof mental illness among Nigerians have shown to be a majorhurdleto improvingmentalhealth inNigeria.Currentevidence

Knowledge of and Attitude to Mental Illnesses in Nigeria: A Scoping Review

AbstractBackground: ManyNigerianshavemisconceptionsandmisbeliefsaboutmentalillness,hencestigmatizepeoplewithmental illness.This scoping reviewontheknowledgeofandattitudetowardsmentalillnessamongNigeriansaimstoidentifythe extent of literature on the issue, summarize current reports and identifyresearchgapsinhopestoprofferworkablesolutionstothisproblem.

Methods: A scoping review was designed to identify peer-reviewed articlesonly. Key search termswith synonymswerepre-developedandmappedon sixbibliographicdatabases;Medline/Pubmed,Scopus,Webofknowledge,Embase,PsycINFO, and PsychARTICLES. No grey literature searches and no time linerestrictionswereobserved.

Results: Twenty five articles met the eligibility criteria and were selected forscopingoutofatotalof2079identifiedarticles(2063fromthelibrarydatabasesand16 fromhand searchingof article citations).Most studieswerequalitative(23/25;95%)andsomemixed(2/25;8%).Studydesignsobservedinthescopingarticleswerecross-sectionalstudies(24/25;96%)andcommunity-basedresearch(1/25; 4%). Most common knowledge of causes of mental illness observed inscopingarticleswassupernaturalcauses(magic,witchcrafts,sorcery,anddivinepunishments).Socialdistancewasthemostcommonattitudeexpressedinarticlesscoped and traditional (unorthodox) medicine was a treatment preference inreferencetohealthseekingbehaviours.

Conclusion: In a country likeNigeria,wherepoormental health facilities, poorhealth outcomes, health inequalities and disparities exist, the need formentalhealth literacy, and workable health policies are vital. These will significantlyreducestigmaandincreasehealthseekingbehaviorofthementallyill.

Keywords: Knowledge;Attitude;Mentalillnesses;Nigeria

Received: February08,2017; Accepted: February20,2017; Published: March05,2017

Introduction UnderstandingmentalillnessinNigeriaissomethingthathastobetakencontextuallyandhistorically.Thereisalargemisconceptionand misinformation on the context of the subject amongstNigerians.Thegeneralbeliefisthatpreternaturalorsupernaturalforces, witches, evil spirits and even God causemental illness[1-7]. These beliefs have influenced the attitude of Nigerianstowardsthementallyill.Historically,peoplewithmentalillnesseswereburned,hanged,mutilated,abandonedandrestrainedwithchains,allinthebidtosavetheirsouls,orbringredemptiontotheirfamiliesandcurbtheiniquitiescausingmentalillnesswithinthefamilies[1,7].Thesebeliefsontheetiologyofmentalillness

2 This article is available in: http://www.imedpub.com/integrative-journal-of-global-health/

ARCHIVOS DE MEDICINAISSN 1698-9465

2017Vol. 1 No. 1: 5

Integrative Journal of Global Health

points to the paucity of basic knowledge aboutmental illness,its causes and characteristics. This in turn affects the neededprioritiesonwhat servicesor facilities are required tomanagethem.Conversely,thereisagrowingevidencethatchangingtheperceptionofNigerians tomental illnesswill result in a betterandmore improvedmentalhealth carewithin the country [1].Thisscopingreviewwasdesignedinabidtoevaluatethelevelofpeer-reviewed literatureand informationon theknowledgeof,perceptionsandattitudeofNigerianstowardsmentalillness.TheresultssummarizetheviewsofNigeriansonmentalhealthissues,challenges,existinggapsinliteratureandpossibleinterventionsthat could help unravel this issue. It is hoped that this reviewwill instigate feasible and practical interventions, raise policiesandhealtheducationprogramsthatwillimprovementalhealthliteracyamongNigerians.

MethodsScoping reviews are exploratory studies that systematicallymap literature on select topics with the goal of determiningthe feasibility of conducting a systematic review, summarizingand disseminating research findings to knowledge users andidentifying gapswhere further researchmaybe required. As aformofsynthesis,orsystematicreviewing,scopingreviewsarenascent and methodological frameworks being refined [10].This scoping review employed the methodological frameworkandadvancementsputforwardbyseveralauthors[11-13].Theyinvolvesixstages,whichinclude:

1. Identifyingtheresearchquestion2. Identifyingrelevantstudies3. Selectingthestudies4. Chartingthedata5. Collating,summarizingandreportingoftheresults,and6. Conductingconsultationexercises(optional)

Thereviewmethodologyhelpedprovideflexibilityforsynthesisofavarietyofstudydesignsandarticletypes[11,12].Althoughpresentedinsteps,theprocesswasnotlinearassomestepswererepeatedtoensureacomprehensiveassessmentofthestudy.

Stage 1: Identification of the research questionResearch questions used in scoping studies are initially broadasthefocusistosummarizethebreadthofevidencebylinkinga clear purpose to a well-defined set of literature [11]. The

primaryquestionthatguidedthisscopingreviewwas:Whatarethe knowledge of and attitude towardsmental disease amongresidentsinNigeria?

Stage 2: Identification of studies relevant to the research questionThisstage involved identifyingrelevantstudiesbydevelopingasearchstrategy,keywords,searchsources,timespanandlanguagefilters[11,12].WiththeinvolvementoftheSaskatchewanCollegeof Medicine librarian, a broad search strategy was designedusingthe followingkeywordcombinationsandtheirsynonyms:‘Knowledge’,‘Attitude’,‘Mentalillness’and‘Nigeria’(Table 1).Sixelectronicbibliographicdatabases(WebofKnowledge,PUBMED/MEDLINE,EMBASE,Scopus,PsycINFO,andPsychARTICLES)weresearched using a syntax composed of all identified keywordsand their synonyms. Table 1 also provides the search stringsandqueriesused in identifying relevantarticles for the review.TheinitialarticlesearchwascommencedonApril17,2016andcompleted onMay 28, 2016. A second searchwas carried outfrom June 09 to June 10, 2016 using all identified electronicbibliographic.Thirty(30)articleswereretrievedrandomlybasedontitleandabstractscreening,andtheirreferencessearchedtoavoidmissing relevantarticles.Hand searchingofarticles citedin full text articles retrieved, were completed (the snowballphenomenon). To ensure completeness, a third search wascarriedoutfromJuly18toJuly202016usingsamesyntaxandbibliographicdatabases.Nogreyliteraturewasusedorretrievedinthisstudy.

Citation management: Allcitationswere importedormanuallyenteredusingthereferencemanagersEndnoteX7andMendeleyDesktop13.8.Associatedfulltextarticleswerethereafteraddedto citations for further reviewing. Duplicates were removedmanuallyafterassemblingcitations.

Stage 3: Study selectionAtthisstage,thesearchstrategywas

refined based on title and/or abstracts retrieved for the initialsearch results. Thiswas achieved by applying a pre-developedeligibilitycriteriaandselectionprocess.

Eligibility criteria: Owing to the large number of anticipatedarticlesforthistopic,thisstudywaslimitedtothefollowing;

1

Knowledge

PerceptionORknowledgeORawarenessORrecognitionORcomprehensionORimpressionORopinionORconsciousnessORstigmaORbelief

2

Attitude

AttitudeORapproachORbeliefORmindsetORmindsetORnotionORperspectiveORphilosophyORsentimentORinclinationORsocial-distance

3

Mental illness

MentalillnessORmentaldiseaseORmentaldisorderORmentalhealthORpsychopathyORpsychosisORinsanityORpsychiatricdisorderORpsychiatricdiseaseorpsychiatricillnessORpersonalitydisorderORschizophreniaORdepressionORmooddisorder

4 Nigeria5 #1AND#2AND#3AND#4

Table 1Keywords(withsynonyms)andsearchstringsusedforliteraturesearch.


2017Vol. 1 No. 1: 5


3© Under License of Creative Commons Attribution 3.0 License

1. Peer-reviewedjournalarticles,2. ReviewarticleswritteninEnglishorEnglish/French,and3. Review articles that assessed a combination of any of

thekeywords; knowledge (or its synonyms),attitude (orsynonyms),Mentalillness(oritssynonyms)andNigeria.

Notimelinerestrictionswereplaced.Allarticlesthatfailedtofallwithinthesecriteriawereexcluded.

Selection process: A two-stage selection process was usedto assess the relevance of articles identified from the search.After deduplication and application of the inclusion criteria,all identified articlesweremanually screened for relevance bychecking their titles and abstracts for identified keywords. Fulltextarticles(FTAs)wereretrievedatthisstage,iftheyhadatleastoneormoreidentifiedkeywordcombinations.Thesecondlevelscreeningprocessinvolvedreadingthefulltextarticlesretrievedfromthefirststagetoensureselectedarticlesreflectananswertotheresearchquestion[11].Thus,several iterationsofstages1 to 3 occurred. The selectionprocesswas carriedout by tworeviewersandarevieweragreementscorecalculated.Theoverallkappawas0.91,whichrepresentsahighlevelofagreement.

Stage 4: Charting the data within included studiesThisstepinvolvedreadingandre-readingthefulltextarticlesfromthoseselectedtoidentifyandchartkeythemesthatmaysupportorcontradictideasidentifiedfromotherincludedscopingreviewarticlesonastandarddataextractionsheet[11].Forthisscopingstudy,a tabular spreadsheetwascreatedusingMicrosoftExcel2013 for data entry and coding. The followingtitle fieldswereenteredforselectedscopingarticles:

• Author(s):Namesofleadingauthorandco-authors• Year:Yearofpublicationinidentifiedjournal• Title:Titleofpublicationarticleorresearch• Studydesign:Researchdesign(cross-sectional,case-control,

cohort,casestudies,etc.)• Studytype:Quantitative,qualitativeormixedstudytype• Setting:Locationofstudy• Summary/Abstract• Knowledge of mental illness among residents in Nigerian

community• AttitudetowardsmentalillnessamongresidentsinNigerian

community• Comparisonsnoted• Studystrengths• Limitationstostudy(Table 2).

Stage 5: Collating, summarizing and reporting results of the review synthesisThis stage is aimed to provide a coherent structure fromthe scoping review results, so the chart, using descriptivenumerical summaries and thematic analysis [11]. In this study,thedatagatheredwas subsequentlyanalysed thematicallyandquantitatively,usingQSRInternational'sNVivo10qualitativedataanalysisSoftwareandIBMSPSSStatisticsforMacintosh,Version21.0. Results of analysis and frequency tables are displayed inTables 2-5.

ResultsStudy selectionA totalof2079peer-reviewedarticleswere retrieved fromtheoverall search;with2063collected from the sixbibliographicaldatabasesselected,and16fromhand-searchingofreferencesandsnowball phenomenon. Following deduplication and relevancescreening,111articleswerefoundtomeettheeligibilitycriteria(basedontheirtitlesand/orabstracts).All111FullTextArticles(FTAs) were thereafter reviewed for inclusion based on theirrelevance to the research question. Of the 111 FTAs read, 86articles failed to meet these eligibility criteria, leaving a totalof25peer-reviewedarticles for inclusion into thefinal scopingreview(Figure 1).

Descriptive numerical summaryThe overall characteristics for the scoping articles are showninTable 3. Thepeer-reviewedarticles included fourteen (56%)published between the years 2000 and 2010, seven (28%)publishedbeforetheyear2000,andfour(16%)publishedaftertheyear2010.

Wordterminologiesusedtodescribethekeywordsforthesearchstrategy in this scoping reviewwere consistent across selectedarticles. Of the 25 articles, 11 (44%) articles used beliefs todescribe theknowledgeofmental illnesses, six (24%)used thewordperceptionalternatively for knowledgeand8 (32%)used‘knowledge’askeywordterminology.Similarly,17ofthe25(68%)articlesusedattitudeaskeywordterminologydescribingattitudetomental illness,and15(60%)usedthekeywordterminology‘mental illness’ (Table 3). Only one article however, definedbeliefsinthecontextofmentalhealth.Definitionoftermsusedwas rare except where belief was described as an acceptableknowledge and a cognitive information an individual acceptsaboutanobject.Inotherwords,asubsetofknowledge[7].Thetermattitudeswerenotdefinedinanyselectedpublication.

Reported methods from scoping articlesThe methodological characteristics of reviewed articles aresummarized in Table 4. Twenty-four (96%) studies used cross-sectionalresearchdesignwithoneapplyingacommunity-basedparticipatory(CBP)approach.Withregardstostudytype,22(92%)werequantitative studiesand two (8%)mixed studies.Alldataprovidedinthesestudieswereprimarydata (Tables 2 and 4).Thelargestdatasetcontainedinformationon2342respondentsfromthreedifferentcommunitiesparticipatinginthestudy[8,14].

Questionnaires and survey instruments were used as primarysourceofdatacollection forall identifiedarticles including theCBP research. Focus group discussion was used in collectingqualitativedatafromparticipantsinonestudywhichalsoutilizedstandardizedquestionnaires[15].

Methodological strengths and limitations of the scoping articlesThemethodologicalstrengthsandlimitationsofidentifiedscopingstudies are summarized in Table 2. Fourteen (56%) articlesacknowledgedpossiblestrengths,limitationsandbiaswiththeir



2017Vol. 1 No. 1: 5


ID Authors Year (Citation #)

Title Design and methods Setting in Nigeria Summary of findings Study Strengths and Limitations

Abasiubongetal.[1]

AcomparativestudyofattitudetomentalillnessbetweenjournalistsandnursesinUyo,Nigeria.

Cross-sectionalquantitativestudycarriedouttoassesstheattitudeof250randomlyassessedjournalistsintomentalillnessusingtheTaylorandDearInventoryofCommunityAttitudetomentalillness.Resultswerethencomparedwith180nursesfromHealthcentersinthesamecity.Responseratewere84%(210)forjournalistand86%(154)fornurses.Primarydata.

Uyo,Akwa-ibomstateNigeria

(South-easternNigeria)

Responsesweresimilarinthetwogroups,howeverthereshowedtobeawidespreadnegativeattitudetomentalillnessamongjournalist(70%)thannurses(60%).Commonopinionsgivenonknowledgeandcausesofmentalhealthbyjournalists(79.5%)andnurses(59.1%)included;blackmagic,evilpowers,witchcrafts,God’spunishmenttosin.Amajorityofthejournalists(97%)andnurses(89%)believedmentallyillpeopletobedangerous,violentandshouldnotbemarried.

Limitationsofgeneralizationandpoorsamplesize.

Abayomietal.[17]

Changingattitudetomentalillnessamongcommunitymentalhealthvolunteersinsouth-westernNigeria.

Acommunity-basedquantitativeinterventionstudy.60communityvolunteersrecruitedandmadetocompletetheFamiliaritywithMentalIllnessQuestionnaireandamodifiedversionoftheBogardusSocialDistanceScalebeforeandafteraneducationalprogramme.Responseratewas52%(31).Primarydata.

Pakoto,aruralcommunityinIfolocalgovernmentareofOgunstateNigeria

(South-westernNigeria)

Thisstudyaimedtoassesstheeffectofaneducationalprogramontheattitudetowardsmentalillnessamongvolunteersinaruralcommunitysetting.Attheendoftheintervention,perceiveddangerousnesswassignificantlyreducedandsocialdistancetowardspeoplewithmentalhealthshowedsignificantimprovement.

Limitedbythesmall,non-randomizedsampleandlackofacontrolgroup.Natureofinterventionandpositiveoutcomesposesastrengthforthestudy.

Abiodun[31] KnowledgeandattitudeconcerningmentalhealthofprimaryhealthcareworkersinNigeria.

Cross-sectionalprospectivestudy.Recruited240primaryhealthcareworkersfromthecommunity.Responseratewas86%(207).Primarydata.

IrepodunlocalgovernmentareaofKwarastate,Nigeria.

(West-centralNigeria)

Thestudywasdesignedtoexaminetheknowledge,attitudeto,detection,andtreatmentofmentaldisordersbyprimaryhealthworkerswithoutpriorexposuretomentalhealthtraining.72%ofthemexpressedanegativeattitudetowardsmentallyillpatients.

Notmentioned.

Adebiyietal.[15]

Enactedandimpliedstigmafordementiainacommunityinsouth-westNigeria.

Studywasamixedmethodcommunitybasedcross-sectionalstudy.313participantswereselectedusingclustersamplingmethods.Quantitativedatawascollectedusingintervieweradministeredquestionnaires,whilequalitativedatawascollectedthroughfocusgroupdiscussionsacrosssixgroupswitheightparticipantseach.Primarydata.

LaluponinLagelulocalgovernmentareaofOyostate,Nigeria.


Qualitativedatashowedtheexistenceofenactedstigmainthecommunitywiththeterm‘madman’usedtodescribepeoplewithdementia.Quantitativedatashowedonly68%ofrespondentswereawareofthetermdementiawithdescribedaliasessuchas‘memorylossdisease’,‘diseaseofforgetfulness’,‘ageingdisease’,‘diseaseofinsanity’and‘braindisorder’usedtolabelthedisease.Enactedstigmawasmanifestedin36%ofrespondentwhileimpliedstigmawasevidentin33%.

Alikelihoodofsocialdesirabilitybiasandsocialhierarchybias.

Table 2Summaryofarticlesincludedinscopingreview(n=25).


2017Vol. 1 No. 1: 5



AdebowaleandOgulesi[7]

BeliefsandknowledgeaboutaetiologyofmentalillnessamongNigerianpsychiatricpatientsandtheirrelatives.

Aquantitativecross-sectionalstudywhichenrolledatotalof140participants.70wereout-patientswhohadbeendiagnosedwitheither,schizophrenia,mania,odbipolaraffectivedisorder,notacutelyillorhavinganysymptomsofmentaldisorderattheperiodofassessment.Another70wererelativesofpsychiatricpatients.Responseratewas100%.Primarydataused.

AroNeuropsychiatrichospital,Abeokuta,OgunState,Nigeria.


Datawascomparedbetweenbothgroupsbasedonpre-identifiedindicestoassesstheknowledgeandbeliefsofbothgroupsonthecausalfactorsofpsychiatricillness.17%ofpatientsandrelativesrespectivelygavemedicalcausalexplanations;23%ofpatientsand19%ofrelativesgavepsychosocialcausalexplanations.Themostacceptablecausalexplanationforbothpatientsandrelativeswassupernaturalexplanation,whiletheleastwaspsychosocial.

Thestudywaslimitedbythemethodofassessmentofcausalbeliefswhichmayhaveeliciteddelusionalandsociallydesirableresponses.

Adeosunetal.[32]

ExperiencesofdiscriminationbypeoplewithschizophreniainLagos,Nigeria.

Mixedmethodscross-sectionaldescriptivestudy.Recruited150out-patientswithschizophreniawhowereinterviewedwiththeDiscriminationandStigmaScale(DISC12).Responseratewas87%.Primarydataused.

Federalneuro-psychiatrichospital,Yaba,Lagosstate,Nigeria.

(South-westNigeria)

Resultsshowedthat87%ofrespondentshavebeendiscriminatedandavoidedbypeoplewhofoundouttheyhadschizophrenia.71%experiencedunfairtreatmentfromfamilymembers,63%fromfriends,32%fromsociety,29%fromintimaterelationships,and39%inpersonalsafety.

Over-representationofeducatedparticipantsandhospital-basedstudy,limitinggeneralizationoffindings.

AdewuyaandMakanjuola[33]

SocialdistancetowardspeoplewithmentalillnessamongstNigerianuniversitystudents.

Quantitativecross-sectionalstudy.Primarydataproduced.Recruited1,668studentsfromaNigerianfederaluniversityandusedamodifiedversionofBogardusSocialDistanceScaletoassessthedesireforsocialdistancetowardspeoplewithmentalillness.Responseratewas100%.

ObafemiAwolowoUniversity,Ile-ife,Osunstate,Nigeria.


Resultsshowed65%ofstudentshadhighsocialdistancetowardsmentallyillpeople.Resultsalsorevealedthatsocialdistancesincreasedwiththelevelofintimacyrequiredintherelationshipwhichwashigherthanwithstudentsinthewesternuniversities.

Studystrengthsnotedincluded:largesamplesize.


SocialdistancetowardspeoplewithmentalillnessinsouthwesternNigeria.

Quantitativecross-sectionalsurvey.Primarydata.Selected2342respondentsfrom3differentcommunitiesbeingurban,semi-urbanandrural.Responseratewas88%.

Osunstate,Nigeria.


Resultsshowedthatthelevelofdesiredsocialdistancetowardsmentalillpeopleincreasedwiththelevelofintimacyrequiredintherelationship.15%categorizedashavinglowsocialdistance,25%havingmoderate,and61%havinghighsocialdistancetowardsthementallyill.

Culturaldifferencesmayaffectgeneralizationofstudy.Thestrengthsliedinthelargesamplesize,andbeingacommunity-basedstudy,fromaculturenotwellstudied


LaybeliefsregardingcausesofmentalillnessinNigeria:Patternandcorrelates.

Quantitativecross-sectionalstudy.Primarydata.Selected2342respondentsfrom3differentcommunitiesbeingurban,semi-urbanandrural.Responseratewas88%.

Osunstate,Nigeria.


Resultsshowedbeliefsinsupernaturalfactorsandthemisuseofpsychoactivesubstancestobethemostprevalentfactors.Urbansettlement,highereducation,andknowledgeofmentalillnesscorrelatedwithbeliefinbiologicalandpsychosocialcausation.Ruralsettlement,olderageandlackofknowledgeofmentalillnesscorrelatedwithbeliefinsupernaturalcausation.Educationalstatushadnoeffectonbeliefinsupernaturalcausation

Culturaldifferencesmayaffectbeliefs,andstudygeneralization.Thestrengthshoweverliedinthelargesamplesize,studybeingcommunity-basedandfromaculturenotwellstudied.



2017Vol. 1 No. 1: 5


AdewuyaandOguntade[34]

Doctors'attitudetowardspeoplewithmentalillnessinWesternNigeria.

Cross-sectionalstudy,quantitative,primarydata.Randomlyrecruited350medicaldoctorsfromeightselectedhealthinstitutionsinthreestatesinNigeria.Haddoctorscompletedaquestionnaireontheknowledgeandattitudetowardspatientswithmentalillness.Responserate,89%.

Ekiti,OndoandOsunstatesinSouth-westernNigeria.

Resultsreported64%ofmedicaldoctorsshowedhighsocialdistance.Beliefinsupernaturalcausesweremoreprevalentandperceiveddangerousnesswasalsohighamongrespondents

Culturaldifferencesfromsouth-westernethnicitymayaffectgeneralization.Focusonthegeneralterm‘mentalillness’mayhavecreatedbiasedresponses.

Aghukwa[35]

Medicalstudents'beliefsandattitudetowardmentalillness:Effectsofapsychiatriceducation.

Prospectivecross-sectionalstudyinvolving35final-yearmedicalstudentsofaNigerianfederaluniversity.Studentswereinvolvedina4-weekpsychiatryrotation.Primarydatawascollectedpre-andpost-clerkship.Responseratewas100%

DepartmentofPsychiatry,AminoKanoTeachingHospital,BayeroUniversity,Kanostate,Nigeria.

(North-WesternNigeria)

Thestudywasdesignedtoassesstheimpactofa4-weekpsychiatricrotationonthebeliefsandattitudeoffinal-yearmedicalstudentstowardsmedicalillness.Resultsrevealedthatstudentshadlimitedknowledgeofpsychiatricdisorders.Ahighproportionbelievedinsupernaturalfactorsascausesofmentalillnesspre-clerkship.Thereweresignificantchangesintheknowledgeandbeliefsaboutmentalillnesspost-clerkship.

Smallsamplesize,andfromonlyonemedicalschoollimitsgeneralization.

Aghukwa[16]

Secondaryschoolteachers'attitudetomentalillnessinOgunState,Nigeria.

Studywasprospectivecross-sectionalwithatotalsamplesizeof358,randomlyselectedacross20schoolsinthelocalgovernmentarea.Primarydatawascollectedfromtheteacherswhoparticipatedusingself-administeredstructuredquestionnaires.Responseratewas90.8%.

AbeokutaSouthLocalGovernmentArea,OgunState,Nigeria.(South-westernNigeria)

Thestudywasdesignedtodeterminetheattitudeofhighschoolteacherstomentalillness.Resultsshowedthatabout75%expressednegativeattitudetowardsmentallyillpersons.50%expressedperceiveddangerousnesstowardsthementallyill.80%ofrespondentsexpresseddisapprovalformentallyillpersonsholdingsensitivejobpositions

Lacksacontrolgrouptovalidatefindings.Socialdesirabilitybiasmayhaveplayedinbeingthatrespondentswerewellenlightened.

Aghukwa[36]

AttitudetowardspsychiatryofundergraduatemedicalstudentsatBayeroUniversity,Nigeria.

Studywasacomparativeandprospectivecross-sectionalresearchinvolving119fifth(84)andfinalyear(35)medicalstudentsinafederalNigerianuniversity.Primarydatawascollectedusingadaptedself-administeredquestionnairesandtestedforassociationbetweenthefinalyearand5th-yearmedicalstudents’responses.Responseratewas76%.

AminoKanoTeachingHospital,BayeroUniversity,Kanostate,Nigeria.

(North-WesternNigeria)

Thestudyaimedtocompareresponsesof5th-and6th(final)-yearmedicalstudentsonattitudetopsychiatryasaprofessionaswellasevaluatethebeliefsaboutpsychiatryandmentalillpersons.Resultsshowedlessthan2%ofstudentsconsideredpsychiatryasfirstchoice,morethan50%expressedsocialdistancetowardsmentallyillpatients,andpoorremunerationsassociatedwiththeprofession.Attitudebetweenthetwogroupswerenotstatisticallysignificant(p>0.05).

Smallsamplesizeandpoorresponseratemayhavelimitedgeneralization.

Akighir[2] Traditionalandmodernpsychiatry:asurveyofopinionsandbeliefsamongstpeopleinplateaustate,Nigeria

Cross-sectionalquantitativestudy.80respondents(ruralandurban)interviewed.100%responserate

Jos,Plateaustate,Nigeria.

(North-centralNigeria)

Resultssuggestnegativeattitudetowardsmodernpsychiatrywithtraditionalhealersconsideredmorefavorable.Mysticalcausesblamedformentalillnesses.

Notmentionedinarticle.


2017Vol. 1 No. 1: 5



Gurejeetal.[22]

CommunitystudyofknowledgeofandattitudetomentalillnessinNigeria.

Quantitativestudytypewithcross-sectionalsurveydesign.Sampleswereselectedusingamulti-stagedclustersamplingmethod.RespondentswerepickedfromthreestatesinthewesternpartofNigeria(22%oftheNigerianpopulation).Totalsamplesize,2040,responserate74.2%.

Ogun,OyoandOsunstatesinNigeria.(WesternNigeria)

StudytriedtodeterminetheknowledgeandattitudeofclusteredcommunitiesinNigeria.Resultsshowedapoorunderstandingofcausationofmentalillnesswithnegativeviewsaboutthem.Perceiveddangerousnesswasprevalent.Socialdistanceandmarriagestigmawerealsonotedfromthesurveys.

Studydidnotdetermineheattitudetopeoplewithdifferentmentaldisorders.

ThestudywasconductedinonelanguagegroupinNigeria.Socialdisabilityeffectmayhaveplayedaswell

Kabiretal.[4]

PerceptionandbeliefsaboutmentalillnessamongadultsinKarfivillage,northernNigeria

Across-sectionaldescriptivestudyinvolving250adultsrandomlyselectedusingamulti-stagetechnique.Quantitativeprimarydatawascollectedusingapre-tested,semi-structuredquestionnaire.Responseratewas100%

KarfiVillage,Kanostate,Nigeria.

(NorthernNigeria)

Thestudywasdesignedtoassesstheknowledge,attitudeandbeliefsaboutcauses,manifestationsandtreatmentofmentalillness.Resultsrevealed50%hadnegativefeelingstowardsthementallyill.Also,themostcommoncauseofmentalillnesswassubstanceabuseandalcohol,thensupernaturalpowersandmagic.46%preferredorthodoxmethodsoftreatment.


OdejideandOlatawura[3]

AsurveyofcommunityattitudetotheconceptandtreatmentofmentalillnessinIbadan,Nigeria

Across-sectionalstudyexaminingtheattitudestomentalillnessusingfourdifferentcommunitiestotallingabout638subjects.Primarydatawascollected.

a)Akufovillage,Ibadan,OyoState,b)MinistryofAgriculture,Ibadan,Oyostate,NursesandDoctorsinc)AdeoyoGeneralHospital,Ibadan,Oyostateandd)AroNeuropsychiatricHospital,Abeokuta.

Thesubjectswithformaleducationexpressedlessnegativeattitudetomentalillnessthanthepeoplewithnoformaleducation.Psychiatrictrainednursesanddoctorsexpressedmorepositivefeelingstowardsmentalillnessthannon-psychiatrictrainedregisterednurses.


OgunlesiandAdelekan[5]

NigerianPrimaryHealthCareworkers:apilotsurveyonattitudetomentalhealth.

Apilotstudyinvolving31primaryhealthcare(PHC)respondents.Quantitativeprimarydatacollectedusingstructuredquestionnaires

Ogunstate,Nigeria.


ResultsshowedthatthegeneralawarenessaboutmentalhealthprincipleswaslowamongstudiedPHCworkers.9outofevery10believedthatmentalillnesshadpreternaturalbasisandpreferredtraditionaltreatmenttoorthodoxtreatmentformentalhealthissues.


Ogunsemietal.[37]

Stigmatisingattitudeofmedicalstudentstowardsapsychiatrylabel

Comparativecross-sectionaldescriptiveresearch.167final-yearmedicalstudentsfromaNigerianfederaluniversitywererecruited.Randomlydividedintoacontrolandinterventiongroup.Interventiongroupreceivedacasedescriptionwithapsychiatriclabelattachedwhilecontrolgroupwaswithout.Primarydatacollected.Responseratewas86.2%

OlabisiOlabanjoUniversityTeachingHospital,Sagamu,Ogunstate,Nigeria.


Theaimofthestudywastoassesstheeffectofpsychiatriclabelsattachedtoapparentlynormalpersonsontheattitudeofmedicalstudents.Theywerenegativeattitudetothemandescribedwithapsychiatriclabelthanwithout.Studentsexpressedstigmatowardsthementallyillshowingunwillingnesstorenthouses,marryorbemarriedtoandlivenext-doortoapsychiatriclabelperson.Theyalsoexpressperceiveddangerousness(physicallyandemotional)

Notmentionedinarticle



2017Vol. 1 No. 1: 5


Olade[38] Attitudetowardsmentalillness:acomparisonofpost-basicnursingstudentswithsciencestudents.Journalofadvancednursing

Cross-sectionalcomparativestudyusing52students(37registerednursingstudents(interventiongroup)and15sciencestudents(controlgroup)).ResponseswerecollectedusingtheOpiniononMentalIllness(OMI)scaleonattitudetowardsmentalillness.100%responserate.

Departmentofnursing,UniversityofIbadan,OyoState,Nigeria.

(South-westNigeria)

ThenursesshowedfavorableattitudetowardsmentalillnessbyscoringhigherthansciencestudentsinfactorsC(interpersonaletiology)andE(mentalhygieneideology)oftheOMIscale.However,theyscoredlowerinfactorsA(Authoritarianism),B(benevolence)andD(Socialrestrictiveness).PositivecorrelationwasnotedbetweenfactorsAandD,andbetweenfactorsA,DandB.


Olade[39] Attitudetowardsmentalillness:effectofintegrationofmentalhealthconceptsintoapostbasicnursingdegreeprogramme

Aprospectivecross-sectionalstudyinvolving66nursingstudents.Dividedintotwogroupsandfollowedfortwoyears.PrimarydatawascollectedusingtheOMIscaledesignedbyCohenandStruening(40).100%responserate

Departmentofnursing,UniversityofIbadan,OyoState,Nigeria.

(South-westNigeria)

Thisstudyassessedtheeffectofintegratingmentalhealthconceptsintoapost-basicnursingdegreeprogramme.Resultsshowedchangesinbothgroupsintermsoftheirauthoritarianismandsocialrestrictivenessthusvalidatedthestudythatmentalhealthconceptsintegratedhadsomeeffectinreducingthenegativeviewofmentalillnesses,andlookatitmorelikeanyotherillness.


Ronzonietal.[41]

StigmatizationofmentalillnessamongNigerianschoolchildren

Quantitative,cross-sectionaldesign.167studentrespondents(10-18years)fromruralandurbansouthwestNigeriawererecruited.Surveyquestionasked“Whatsortofwordsorphrasesmightyouusetodescribesomeonewhoexperiencesmentalhealthproblems?”Responseratewas80.5%.

Ibadan,OyoState,Nigeria.

(South-westNigeria)

Responsesweretabulatedintothemes.Themostpopulardescriptionwasderogatory.30%describedmentallyillpersonsasabnormalinappearanceandbehaviour.Otherthemeswere;‘physicalillnessanddisability’(14%),‘negativeemotionalstates’(7%)and‘communicationdifficulties’(3.4%)and‘Idon’tknow’answers(14%).

Languagebiasandculturaldifferences

UkpongandAbasiubong[20]

Stigmatisingattitudetowardsthementallyill:AsurveyinaNigerianuniversityteachinghospital

Across-sectionaldescriptivestudyinvolvingconveniencesampleof208hospitalparticipants(38MDs,100medicalstudents,10pharmacists,5physiotherapists,12laboratorytechs,9medicalrecordofficersand34administrativestaff.TheCommunityAttitudetowardsMentalIll(CAMI)scalewasusedtocollectquantitativeprimarydata.Responseratewas100%.

UniversityofUyoTeachingHospital,Uyo,Akwa-Ibomstate,Nigeria(South-easternNigeria)

Thesurveyresultsshowedstrongnegativeviewsaboutthementallyill,beingauthoritarianandrestrictiveintheirattitude.52%ofrespondentsbelievedwitches,while44%blameddemons,30%blameddivinepunishment,ascausesofmentalillnesses.Thiswasdespiteappearingknowledgeableandeducatedontheroleofgeneticsandpsychosocialfactorsinmentalillnesscausation.


Uwakwe[6] TheviewsofsomeselectedNigeriansaboutmentaldisorders

Quantitative.Cross-sectionaldescriptivestudy.Had144respondents(30medicalstudents,20nurses,20medicalrecordofficers,10religiousministers,and64others).Primarydatawascollectedusingself-administeredquestionnairesassessingthecausesofmentaldisorders,theroleofevilspiritsinmentaldisordersandtreatmentoptions

NnamdiAzikiweUniversityTeachingHospital,Nnewi,Anambrastate,Nigeria.

(South-easternNigeria)

28.4%expressedevilspiritsarecausesofmentalillnessesand66%recommendedprayerhousesfortreatmentofmentaldisorders.Therewasnodifferenceinbeliefsandattitudeformedicalstudentsevenafter4-weeksofrotationinmentalhealthclerkship.



2017Vol. 1 No. 1: 5



YusufandBaiyewu[42]

BeliefsandattitudetowardsdementiaamongcommunityleadersinNorthernNigeria

Cross-sectionaldescriptiveresearch.Quantitative.PrimarydatacollectedusingtheCommunityScreeningInterviewforDementiaandBlessedDementiaScale.100northerleaders(57traditionalleaders,43Islamicclerics)wereinterviewed.

Zaria,Kadunastate,Nigeria(North-centralNigeria)

Studydemonstrateddementiatobeanormalagingprocesscommonamongrespondents(82%).Mostoftheparticipantsalsopreferredorthodoxtreatmentforcasesofdementia.Meanageofrespondentswere57.7+/-11.1years.

Smallsamplesize.

Characteristic Number (n=25) Percentage (%) Article ID*

PublicationyearBelow2000 7 28% (C,E,N,Q,R,T,U)2000-2010 14 56% (A,G,H,I,J,K,L,M,O,P,S,V,W,X)

2010-Nov2016 4 16% (B,D,F,Y)Knowledgeterminology

Knowledge 8 32% (C,G,O,Q,R,S,V,W)Perception 6 24% (A,D,F,L,M,P)

Belief 11 44% (B,E,H,I,J,K,N,T,U,X,Y)Attitudeterminology

Attitude 17 68% (A,B,C,E,J,K,L,M,N,O,P,Q,R,T,U,X,Y)Stigma(Stigmatization) 6 24% (D,F,I,S,V,W)

Social-distance 2 8% (G,H)Mentalillnessterminology

Mentalillness 15 60% (A,E,G,H,I,J,K,L,O,P,Q,S,T,U,V,W)Mentalhealth 2 8 (B,R)

Psychiatricdisorder 5 20% (C,M,N,S,X)Dementia 2 8% (D,Y)

Schizophrenia 1 4% (F)

Table 3Generalattributesofpublicationsincludedinthescopingreview(n=25).

respective studies and research designs. Notable limitationsreportedwerepoorsamplesize(A,B,K,M,Y),socialdesirabilitybias (D, E, L, O) and cultural differenceswhichmay influencesbeliefsandchoices(H,I,J,O,V,).Forexample,inacross-sectionalquantitative study set out to determine the attitude of highschoolteacherstomentalillness.Thelackofacomparisongroupwasdullyrecognisedasamajorlimitationtothestudyaswellaspoorvalidityandapossiblesocialdesirabilitybiasgiventhattherespondentswereeducatedandwellenlightened[16].

Authors of selected scoping studies generally attributed theirstudystrengths to the largesamplesizes theygot (G,H, I)andan intervention arm of the study (B). The attitudinal changeascribedtoaneducationalprogramwasnotedtobesignificantinacommunitybasedintervention[17].

Although not all scoping articles reported limitations in theirrespective studies, we inferred further researcher limitationsfromtheresultsandnatureofdataoftheserespectivestudiesas,languagebiases,selectionbiases, reportingbiasesandpossiblyconfoundingespeciallywiththemixedmethodstudies(D,F).

Thematic analysis and study findingsWegroupedthefindingsofthescopingreviewintotwogroups;1)KnowledgeofmentalillnessesamongNigeriansand2)Attitudetowards mental illness among Nigerians. Results for each aresummarizedinTable 5.

Knowledge of mental illnesses among Nigerians: Knowledge,perceptions and beliefs of Nigerians about mental health andillnesswasassessedquantitatively in all of the scopingarticles(92% (23/25) assessed purely quantitatively and 2/25(8%)assessed both qualitatively and quantitatively). StandardizedstructuredquestionnairesliketheFamiliaritywithmentalillnessquestionnaire(B),theOpiniononMentalIllness(OMI)scale(T,U),theTaylorandDearInventoryofCommunityAttitudetoMentalIllness(CAMI) (A,W), the modified version of Bogardus SocialDistance Scale(B,G), the Discrimination and Stigma Scale (DISC12) (F) and the Community Screening Interview for Dementiaand Blessed Dementia Scale(Y) among other tested surveyinstrumentswereusedtoassesstheknowledgeofandattitudetowardsmentalillness.

Afteranalysingresultsofindividualarticlesacrossall25scopingarticles,we categorized the knowledgeof causal attributionofmentalillnessbasedoncommonresponsesto;

a) Medical-which included hereditary, brain dysfunction, andotherbiologicalfactors,

b) Supernatural- witchcraft, ‘juju’ (sorcery), evil spirits, divinepunishment,etc.and

c) Psychosocial-poverty, stress, drugs and alcohol abuse,traumaticevent,shock,etc.

Themostcommoncausalattributiontomentalillnessnotedwas


2017Vol. 1 No. 1: 5



ascribedtosupernaturalcauses.Thiswasreportedasaprimaryoutcomeforknowledgeofcausesofmentalillnessin36%(9/25)(A,C,E,H,K,N,Q,R,X). Six articles (24%) recorded psychosocialcauses(I,J,K,O,P,W)asamajorcauseofmentalillnesswhileonlytwoarticles(8%)reportedmedicalcauses(D,Y).

Several studiesalsoassessed theknowledgeandpreferenceoftreatment options for people with mental illness, in additiontoknowledgeandattitude.Ofthe25articlesscoped,six (24%)expressed a preference for unorthodox (traditional) treatmentoptions (C,N,O,Q,R,X)while20%(5/25)expressedapreferencefor orthodox (western) treatment options (D,L,P,W,Y). Mentalillnesswasgenerallyviewed inabad lightNigerians, inarticlesreviewed.Threescopingarticles(12%)reportedabadprognosisofmental illnessasoneoftheprimaryoutcomesassessingtheknowledgeofprognosisofmentalhealth(H,J,V) (Table 5).

Attitude towards mental illness among Nigerians: ThescopingreviewalsoscopedtheattitudeofNigerianstowardspeoplewithmental illness. After analysing data charts from all 25 scopingarticles, we thematically categorized attitude(s) of Nigerianstowardsmentalillnessintosevencategories(Table 5);

a) Socialdistanceandavoidance:Thisisthedegreetowhichsomeone is willing to accept or associate with peoplehavingdifferentsocialcharacteristics-in thiscasementalillnesses[14,18].

b) Marriagestigma:Thisincludedthewillingnesstomarry,tostayinmarriageorbegiveninmarriagetosomeonewithmentalillness.

c) Jobentrustmentstigma:Thisincludedthefreedomforamentallyillpersontoworkamongorbeemployedamonghealthyornon-mentallyillpersons.

d) Perceiveddangerousness: This is theperception that anindividual with a mental illness is extremely dangerous[18,19].

e) Social acceptance: This included acceptance at work,homeandsocietywheretheylivedin)

f) Sympathy: The awareness of someone’s distress andexpressedcompassionforthem[1]

g) Indifference: A condition in which the person isunconcernedwithsymptomsofothers[20]

The most prevalent attitude expressed as a primary outcomefrom all 25 articles scoped was social distance and avoidance(B,C,F,G,H,I,J,K,L,M,Q,S,W). Social distance was expressed in52% (13/25) of scoping articles. Following that was perceiveddangerousnessdue to fear,angerormistrust towardsmentallyillpersons(A,B,F,H,J,L,O,P,T,U,V,W).Perceiveddangerousnesswasexpressed in twelve (48%) of scoping articles.Marriage stigmawas recorded in 16% (4/25) of scoping articles (C,L,O,S). Jobentrustment stigma (C,L), Social acceptance(O,L) and sympathy(O,D)werenotedasprimaryoutcomesofattitudetowardsmentalillnessin8%(2/25)ofscopingarticlesrespectively.Onlyonearticlerecordedandindifferencetomentalillness(L)(Table 5).

DiscussionThis scoping review applied a systematic approach to assesstheknowledgeandattitudetowardmental illnessbyNigerians.Thefindings showsomecross-cultural variations,however, stillsimilar in outcomes. Evaluating attitude towardsmental illness

throughtheknowledgeofthecausesofmentalillnesswascriticalandimportantforfutureserviceorganization.Suchfindingshavelinked causal attribution and stigmatising attitude to mentalillness[8,21,22].Resultsfromthescopingreviewshowedapoorknowledge and widespread belief that mental illnesses werecausedby supernatural forces including sorcery,witchcraftandpunishment from God for sins. Culturally, Nigerians regardlessof education seem to adhere in varying degrees to a belief insupernatural causation for any illnessoroutcome [20]. Resultsfrom the scoping revieweven showed that this beliefwas notlimitedtothepublicalone,butalsopopularamongtheworkersinhealthcaresectors(A,J,K,M,S,T,U,W,X).Abeliefinsupernaturalcausationproject peoplewithmental illness as dangerous anddistasteful[8].

Psychologicalcausessuchasalcohol,drugsandsubstanceabuse,stress, and traumawere also implicated as common causes ofmental illness.Again, this is a commonbeliefamongNigerianswhotendtoattributementalillnesscausationtopsychologicalorsocialinfluences.

The downside to this view is that it tends to instigate morestigmatization rather than sympathy as the society viewsthe mental illnesses as being self-inflicted or self-deserving[1,4,20,22]. All these objectionable views and beliefs oncauses of mental illness by Nigerians, further complicates thepreferencefortypeofcare.Asupernaturalviewofthecauseofmental illnesswill implythatunorthodox(traditional)meansoftreatment supersedes theorthodoxmeans.Hence, spiritualistsand traditional healers are then patronized. Although resultsfrom our scoping review showed that a few studies reportedpreferenceforacombinationofbothtreatmentoptions(J,Q,R),itislikelythattheelementofculturalmisconception,whichhasbeenshownintheNigeriansocietytoaffecttheirhealthseekingbehaviour,maystillmakethemchoosethetraditionalmeansoftreatment over the western approach. This behaviour doesn’tonly relate in reference to mental illness but in other illnesstypes.TheissueisthatalotofNigerianswhohavelosthopeinthehealth-caresystem,willresorttospiritualanswersbygoingtoprayerhouses,traditionalhealersandspiritualists.Noarticleswere found comparing the treatment approaches. Findings ofsuchstudiespotentiallywillreducestigmaandimpactattitudinalbeliefsaboutmentalillness.

Although studies have claimed that there is less stigmatizingattitude towards mental illness in Nigeria [23], this scopingstudy showed otherwise. Several studies have shown thatstigmatizingattitudetomental illness is significantlyassociatedwith stereotypes and discrimination [1,21]. It was concerningthe report that the Nigerians seem to despise people withmental disorders more than their illnesses (D,F,G,H,I). Overall,negative viewswere expressed in all scoping articles reviewedinthisstudy(A-Y). Insomestudies,negativeattitudeexpressedwere indicativeof age, gender, educationaloreconomic status(A,B,C,F,G,H,I,J,K,L,M,Q,S,W).Anotablearticlewasastudycarriedout in Lagos, Nigeria’s most populous state, supposedly ladenwiththeeducatedandelite(F).Resultsfromthisstudyrevealedawidespreadnegativeattitudetowardsmentalillnessevenafterpreviousstudiesmayhavesaidotherwise[3].Themostcommon



2017Vol. 1 No. 1: 5


Methodological characteristic Number (n=25) Percentage (%) Article ID*

ResearchdesignCross-sectionalstudies 24 96% (A,C-Y)

Communitybasedparticipatoryresearch 1 4% (B)Researchdata

Primarydata 25 100% (A-Y)Secondarydata 0 0 -Notreported 0 0 -

StudyTypeQuantitative 23 92% (A-C,E,G-Y)Qualitative 0 0 -Mixed 2 8% (D,F)

AssessmentofKnowledge,AttitudeandPractice(KAP)Assessedquantitatively 23 92% (A-C,E,G-Y)

Bothqualitativelyandquantitatively 2 8% (D,F)Notassessed 0 0 -

*RefertoTable2forkeytostudytitlesandauthors.

Table 4Methodologicalcharacteristicsofpublicationsincludedinthescopingreview(n=25).

Variables freq (%) Article ID*KnowledgeofcauseofMentalillness

Medicalcauses 2(8%) (D,Y)Supernaturalcauses 9(36%) (A,C,E,H,K,N,Q,R,X)Psychosocialcauses 6(24%) (I,J,K,O,P,W)

Knowledgeofbadprognosisofmentalillness 3(12%) (H,J,V)

Knowledgeandpreferencefororthodoxtreatmentoptions 5(20%) (D,L,P,W,Y)Knowledgeandpreferenceforunorthodoxtreatmentoptions 6(24%) (C,N,O,Q,R,X)

Attitude towards the mentally illSocialdistanceandavoidance 13(52%) (B,C,F,G,H,I,J,K,L,M,Q,S,W)

Marriagestigma(togive,stay,orbegiveninmarriage) 4(16%) (C,L,O,S)Jobentrustmentstigma(allowedoremployedtowork) 2(8%) (C,L)Considereddangerous(duetofear,mistrustoranger) 12(48%) (A,B,F,H,J,L,O,P,T,U,V,W)

Societalacceptance(work,liveandco-habit) 2(8%) (O,L)Sympathy 2(8%) (Q,D)Indifference 1(4%) (L)

*RefertoTable2forkeytostudytitlesandauthors

Table 5 Overviewsummaryofmajorprimaryoutcomesin‘Knowledge’and‘Attitude’towardsthementallyilldescribedinpublicationsincludedinthescopingreview(N=25).

viewsabout thementally ill reported from the scoping review,wasperceiveddangerousness(A,B,F,H,J,L,O,P,T,U,V,W)andsocialdistance (B,C,F,G,H,I,J,K,L,M,Q,S,W). Studies have shown thatthese twonegativeviews stimulate social resentment [21]andfoster social distance [14,15]. Regrettably, there were also nochanges inknowledgeandattitudeviewsovertime,comparingolderarticles(belowtheyear2000)andnewerarticles(abovertheyear2000).

There were a few research gaps observed from this scopingreview.One strikingobservationwasa rarityof studies carriedoutintheeasternpartofNigeria.Nigeriaisaculturallyassortedcountrywith dissimilarities in access tomental health serviceswhichcouldaffectknowledgeandattitudetomentalillness[24].Nevertheless,severalstudiesamongotherethnicgroupsinthisscoping review have suggested a widespread poor knowledge

ofandattitudetowardsmental illnesswhichhavebeenshownto have a strong validity and reliability (A,B,C,E,J,K,L,M,N,O,P,Q,R,T,U,X,Y). Secondly, the focus onmental illness as a generaltermratherthanonspecificmentaldisordermayhavecreateda bias to respondents in individual studies, who have little orno knowledgeabout the termmental illnessormaypossess anarrowviewofwhatthetermmeans.

However, the findings of this scoping review supportobservations from other studies done outside Nigeria eventhoughmethodologicaldifferencesmayprecludecomparability[25-30].This corroborates thenotion that stigma isauniversalphenomenon,butexperiencesarelocal[27].Thus,theneedformentalhealthliteracyisaglobalsubject.TheimpactofeducationontheknowledgeandattitudeofNigerianstomentalillnesswasstudiedinafewofthescopingreviews(B,I,K,M,P,S,U,W,X,Y)and


2017Vol. 1 No. 1: 5



Figure 1 Flowchartshowingselectionofarticlesforscopingreview(n=25).

showed thatmentalhealth literacywas significantlyassociatedwithpositiveattitudetowardsmentalillness.Ithasbeensaidthatanincreaseinliteracyandeducationregardingthementalhealthand illnesses,will result in an improvement in attitude towardpeople with mental illness [8] as mental health illiteracy is arenownedsourceof stigmatizingattitude towards thementallyill [22]. A potential direction this finding leads is the need todemonstrateeffectiveinterventionssoastocurbtheattitudinalexcesses[40].

Conclusion and RecommendationsTheoutcomeof this scopingreview isavalidationofachronicwidespread public stigmatization of the mentally ill. Thisdemonstrates the need for mental health literacy in all levelsof education. A better understanding of mental illness wouldsignificantly improve knowledgeandattitude towardsmentallyillpersons.There isanurgentnecessity, to improve thehealthcare system in Nigeria, by developing strategies that wouldimprovementalhealthliteracy,andchangestigmatizingattitudeatbothinstitutionalandcommunitylevels.Thiswill inthelong

runimprovethequalityofthesocietalattitudetowardsmentalillnessandthesocio-economyofthementallyill.

One practical yet feasible way to improve literacy in mentalhealth,isbyinstitutingage-appropriateschool-basededucationalprogrammes.Althoughcomplexitiesmayariseincreatingtheseeducational programs, reason being that stigmatizing attitudeand beliefs in supernatural causation have been shown to stillexistamongeducatedhealthworkers,however,it’sagoodplacetostart from.Anotherpractical recommendation is to increasepsychiatry clerkship rotations for medical students, beyond 4weeks. This will help familiarize students more with mentalhealth diseases outside their pre-conceivedmisconceptions. Inaddition, it is necessary to encourage health workers (nurses,psychologists,psychiatristsandotherhealthcareprofessionals)toshowpositiveattitudetowardsmentallyillpersonsasthisplayan important role in influencing their response to treatment.Missing in the scoping review was the role of the media inpropagatingattitudinalobservationorchanges.Futurestudiestoexaminehowthemediacanplayaroleineducationorreducingstigma.



2017Vol. 1 No. 1: 5


References1 Abasiubong F, Ekott JU, Bassey EA (2007) A comparative study of

attitude to mental illness between journalists and nurses in Uyo,Nigeria.African journalofmedicineandmedicalsciences36:345-351.

2 Akighir A (1982) Traditional and modern psychiatry: a survey ofopinions and beliefs amongst people in plateau state, Nigeria.InternationalJournalofSocialPsychiatry28:203-209.

3 OdejideAO,OlatawuraMO(1979)Asurveyofcommunityattitudesto theconceptand treatmentofmental illness in Ibadan,Nigeria.Nigerianmedicaljournal:journaloftheNigeriaMedicalAssociation9:343.

4 Kabir M, Iliyasu Z, Abubakar IS, Aliyu MH (2004) Perception andbeliefsaboutmental illnessamongadults inKarfivillage,northernNigeria.BMCInternationalHealthandHumanRights4:3.

5 Ogunlesi AO, Adelekan ML (1988) Nigerian primary health careworkers:apilotsurveyonattitudeto.PsychiatricBulletin12:441-443.

6 UwakweR(2007)TheviewsofsomeselectedNigeriansaboutmentaldisorders.TheNigerianpostgraduatemedicaljournal14:319-324.

7 Adebowale TO, Ogunlesi AO (1998) Beliefs and knowledge aboutaetiologyofmentalillnessamongNigerianpsychiatricpatientsandtheirrelatives.Africanjournalofmedicineandmedicalsciences28:35-41.

8 AdewuyaAO,MakanjuolaRO(2008)Laybeliefsregardingcausesofmental illness in Nigeria: pattern and correlates. Social psychiatryandpsychiatricepidemiology43:336-341.

9 GoveW(1982)Labellingtheory'sexplanationofmental illness:Anupdateofrecentevidence.DeviantBehavior3:307-327.

10 GoughD,ThomasJ,OliverS (2012)Clarifyingdifferencesbetweenreviewdesignsandmethods.Systematicreviews1:28.

11 Arksey H, O'Malley L (2005) Scoping studies: towards amethodologicalframework.International journalofsocialresearchmethodology8:19-32.

12 LevacD,ColquhounH,O'BrienKK(2010)Scopingstudies:advancingthemethodology.ImplementationScience5:69.

13 PhamMT, Rajic A, Greig JD, Sargeant JM, Papadopoulos A (2014)A scoping reviewof scoping reviews: advancing theapproachandenhancingtheconsistency.Researchsynthesismethods5:371-385.

14 AdewuyaAO,MakanjuolaRO(2008)Socialdistancetowardspeoplewith mental illness in southwestern Nigeria. Australian and NewZealandJournalofPsychiatry42:389-395.

15 AdebiyiAO,FagbolaMA,OlakehindeO,OgunniyiA(2015)Enactedand implied stigma for dementia in a community in south-westNigeria.Psychogeriatrics.

16 AghukwaNC(2009)Secondaryschool teachers'attitudetomentalillness in Ogun State, Nigeria: original article. African journal ofpsychiatry12:59-63.

17 AbayomiO,AdelufosiAO,OlajideA(2013)Changingattitudetomentalillness among communitymentalhealth volunteers in south-westernNigeria.InternationalJournalofSocialPsychiatry59:609-612.

18 LinkBG,CullenFT,FrankJ,WozniakJF(1987)Thesocialrejectionofformermentalpatients:Understandingwhylabelsmatter.AmericanjournalofSociology92:1461-500.

19 Steadman HJ (1981) Critically reassessing the accuracy of publicperceptions of the dangerousness of the mentally ill. Journal ofHealthandSocialBehavior,pp:310-36.

20 UkpongDI,AbasiubongF(2010)Stigmatisingattitudestowardsthementallyill:AsurveyinaNigerianuniversityteachinghospital.SouthAfricanJournalofPsychiatry16:56-60.

21 HaywardP,BrightJA(1997)Stigmaandmentalillness:Areviewandcritique.JournalofMentalHealth.1997Aug.

22 Gureje O, Lasebikan VO, Ephraim-Oluwanuga O, Olley BO, Kola L(2005) Community study of knowledge of and attitude tomentalillnessinNigeria.TheBritishJournalofPsychiatry186:436-441.

23 Fabrega H (1991) Psychiatric stigma in non-Western societies.Comprehensivepsychiatry32:534-551.

24 Ayonrinde O, Gureje O, Lawal R (2004) Psychiatric research inNigeria:bridgingtraditionandmodernisation.TheBritishJournalofPsychiatry184:536-538.

25 TharaR,SrinivasanTN(2000)Howstigmatising isschizophrenia inIndia?.InternationalJournalofSocialPsychiatry46:135-141.

26 ShibreT,NegashA,KullgrenG(2006)Perceptionofstigmaamongfamily members of individuals with schizophrenia and majoraffectivedisorderinruralEthiopia.Socialpsychiatryandpsychiatricepidemiology.

27 Murthy RS (2002) Stigma is universal but experiences are local.Worldpsychiatry1:28.

28 NgSL,MartinJL,RomansSE(1995)Acommunity'sattitudestowardsthementallyill.TheNewZealandmedicaljournal108:505-508.

29 Medianos MG (1999) Changes in public attitude towards mentalillnessinAthensarea.ActapsychiatricaScandinavica99:73-78.

30 Thornicroft G, Semrau M, Alem A, Drake RE, Ito H, et al. (2011)Community Mental Health: Putting Policy into Practice Globally:JohnWileyandSons.

31 Abiodun OA (1991) Knowledge and attitude concerning mentalhealthofprimaryhealthcareworkersinNigeria.TheInternationaljournalofsocialpsychiatry37:113-120.

32 AdeosunII,AdegbohunAA,JejeOO,AdewumiTA(2014)Experiencesofdiscriminationbypeoplewith schizophrenia in Lagos,Nigeria. JPublicMentHealth13:189-196.

33 Adewuya AO, Makanjuola ROA (2005) Social distance towardspeople with mental illness amongst Nigerian university students.SocialPsychiatryandPsychiatricEpidemiology40:865-868.

34 Adewuya AO, Oguntade AA (2007) Doctors' attitude towardspeoplewithmentalillnessinWesternNigeria.Socialpsychiatryandpsychiatricepidemiology42:931-936.

35 AghukwaCN(2010)Medicalstudents'beliefsandattitudestowardmentalillness:Effectsofapsychiatriceducation.AcadPsychiatry34:67-70.

36 AghukwaNC(2010)AttitudestowardspsychiatryofundergraduatemedicalstudentsatBayeroUniversity,Nigeria.SouthAfricanJournalofPsychiatry16:147-152.

37 OgunsemiOO,OdusanO,OlatawuraMO(2008)Stigmatisingattitudeofmedical students towards a psychiatry label. Annals ofGeneralPsychiatry7:15.

38 Olade RA (1979) Attitudes towards mental illness: a comparisonof post-basic nursing students with science students. Journal ofadvancednursing4:39-46.


2017Vol. 1 No. 1: 5



39 Olade RA (1983) Attitudes towards mental illness: effect ofintegration of mental health concepts into a postbasic nursingdegreeprogramme.Journalofadvancednursing8:93-97.

40 Cohen J, StrueningEL (1962)OpinionsaboutMental Illness in thepersonnelof two largementalhospitals. JournalofAbnormalandSocialPsychology64:349-360.

41 Ronzoni P, Dogra N, Omigbodun O, Bella T, Atitola O (2010)Stigmatization of mental illness among Nigerian schoolchildren.InternationalJournalofSocialPsychiatry56:507-514.

42 YusufAJ,BaiyewuO(2012)BeliefsandattitudestowardsdementiaamongcommunityleadersinNorthernNigeria.WestAfricanJournalofMedicine31:8-13.

knowledge of and attitude to mental illnesses in nigeria ... · c. knowledge of and attitude to...

Documents