PERCEIVED STIGMA TOWARDS MENTAL ILLNESS AMONG COLLEGE STUDENTS OF WESTERN NEPAL

Introduc on S gma of people towards mental illness is s ll prevailing in our country due to lack of awareness. General public's view about mental illness remains largely unfavourable. The topic of mental illness itself evokes a feeling of fear, embarrassment or even disgust fostering nega ve a tudes towards mental illness and mentally ill people. There is paucity of ar cles on this topic from our country. Objec ve To inves gate college students' s gma towards mental illness and factors associated with the s gma. Methodology This prospec ve study was done in College students studying Bachelors of Science. A randomly selected sample of students were explained and asked to fill two forms: First containing socio-demographic data and Second Discrimina on Devalua on scale (D-D scale). Data collected were analyzed with SPSS so ware. Descrip ve analysis and Chi-square tests were done. P value less than 0.05 was considered significant. Results There were 78 students included in the study among which 43.6% (n = 34) had high level of s gma towards mental health. This s gma was not significantly associated with age, gender, year of study among the gradua ng students, rural or urban background, history of mental illness, or knowing someone with mental illness. Conclusion S gma towards mental illness is common even in the educated group of people in the country. With the same level of educa on, s gma to mental health is not significantly associated with other demographic variables.


INTRODUCTION
S gma is any persistent trait of an individual or group which 1,2 evokes nega ve or puni ve responses.It is considered an amalgama on of 3 related problems: a lack of knowledge (ignorance), nega ve a tudes (prejudice), and exclusion 3 or avoidance behaviours (discrimina on).Perceived s gma relates to the extent to which an individual perceives the public to hold s gma sing a tudes towards those with 4,5 mental illnesses.
Mental disorders are widely recognized as a major contributor (14%) to the global burden of disease worldwide and are 3,6,7 among the most s gma zing condi ons worldwide.Although some na ons have been successful in figh ng s gma and increasing acceptance of the mentally ill, lack of awareness is very evident in developing countries including Nepal.General public's view about mental illness remains largely unfavourable.The topic of mental illness itself evokes a feeling of fear, embarrassment or even disgust fostering nega ve a tudes towards mental illness and 8 mentally ill people.S gma of people towards mental illness is s ll prevailing in our country, Nepal.Students are most produc ve and educated popula on of na on.Society is mostly influenced by their a tude and values.So, we intended to find out a tude and s gma of college students.Further, this type of study has not been significantly conducted in our country.In order to contribute to this small body of interna onal literature, the aim of this study was to inves gate college students' s gma towards the mental ill and the factors associated with the s gma.

METHODOLOGY
It was a prospec ve observa onal analy cal study done from June 2017 to August 2017 on students studying Bachelor of Science (B.Sc) in Tribhuvan Mul ple Campus (TMC) of Tansen, Palpa.There were a total of 194 students.

2
Using Slovin formula i.e. n = N/(1+ Ne ), and then applying formula for finite popula on i.e.N Nn/N+n-1, a sample 0 = size of 78 was randomly selected from 194 students.In the formula, n is sample size a er Slovin formula, N is total number of available par cipants, e is margin of error (5%), N is final sample size.A list of all students with serial 0 number from one to 194 was formulated.Then, a list of 78 non-repea ng random numbers between one and 194 were generated.Students corresponding these random numbers were included in the study.scale, the answer choices were on a six point likert scale from one to six as strongly agree, agree, somewhat agree, somewhat disagree, strongly disagree respec vely.Scores of all 12 ques ons were added and then divided by 12 to calculate the final score of each par cipant.Mean of final scores of all par cipants was calculated.Scores below the mean were considered as 'Low s gma' and scores of mean and above were considered as 'High s gma'.
Both the scales were in English and reliability was tested on a separate sample of 10 students.

Data collec on:
Data was collected during the month of July 2017.On the days of data collec on, the researchers went into each classroom and established a rapport and explained the purpose of the study to the par cipants.The par cipants were to fill in the forms themselves without their names.Ques onnaire were distributed to the respondents individually and were collected a er two hours.There were two par cipants with history of mental illness.Both of them had low s gma score.Among those who did not have history of mental illness, 42 (55.3%)had low s gma and 34 (44.7%) had high s gma.Fisher exact test showed the rela onship between history of mental illness and level of s gma as sta s cally non-significant (p = 0.5).
Among the par cipants who had a friend or a family member with mental illness, low s gma was present in 15 (50%) and high s gma was present in another 15 (50%).Among those who did not know anyone with mental illness, 29 (60.4%) had low s gma and 19 (39.6%) had high s gma.

DISCUSSION
This study was aimed to assess perceived s gma towards mental illness among college students of Western Nepal and study its associa on with selected demographic variables.Nearly half of the par cipants had high perceived s gma towards mental illness.
We found that 56.5% (n = 44) of the respondents had low perceived s gma towards mental illness and the rest 43.6% (34) had scores indica ng high s gma.A similar result was 10 found in a study by Alonso J. et al.
Among the par cipants, 61.1% (n = 50) were male.Similar 11 finding (55.9%) was there in a study by Thapa L. et al.This finding may be explained in terms of gender inequality.S ll in many parts of our country, females are deprived of studies or they may have limited access to the studies far away from their home.The campus where we did our study is located in the capital town of Palpa district and most of the students come from various villages and small towns far away.However, among those who were pursuing their higher educa on, there was no difference in the level of s gma among male and female.This fact suggest that educa on may be an important factor in reducing s gma towards mental health.This fact is supported by a study where there no significant rela onship between gender significant rela onship between these variables (p = 0.1).These findings highlight the fact that educa on is important to bridge the gap of mental health related s gma between rural and urban areas.
The majority of respondents had no history of mental illness (76%) but 38.4% knew someone among friends or family members with those illnesses.We did not find significant associa on between history of mental illness and perceived s gma (p = 0.53).These findings were supported by research done by Lally J. et al.where majority of respondents had no history of mental illness (88%) and many knew 4 someone with mental illness (28.6%).They did not find significant associa on between history of mental illness and perceived s gma (p = 0.178).However, few studies found a significant rela onship between those variables 14,15 (p = 0.001 in both studies).Low s gma is expected in one who is familiar with mental illness in self or in a friend or rela ve.However, this study showed that the level of s gma was not associated with familiarity of mental illness in self or a close friend or rela ve.Similar level of educa on among the par cipants might be playing a role in reducing s gma in those who were not familiar with mental illness.

CONCLUSION
Among college students, nearly half (43.6%) had high level of perceived s gma whereas the remaining 56.4% had low level of perceived s gma.None of the factors among gender, urban or rural background, history of mental illness, rela ve or friend with mental illness alone were significantly related to the level of perceived s gma among the college students during their gradua on studies.It may be the similar level of study that bridged the gap of difference in the s gma level in students with different socio-demographic factors.

LIMITATION OF THE STUDY
We did not measure whether s gma for mental illness was present or absent in each par cipant.Moreover, it was a single centric study done in students of one batch of a subject.These are a few weaknesses of our study.
The study was approved by Ins tu onal Review Commi ee (IRC) of Lumbini Medical College and a wri en permission from Chief of the Campus was obtained.Verbal consent from each par cipants was taken.Measurement: a) Structured ques onnaire for socio-demographic data was developed.b) Discrimina on Devalua on scale (D-D scale) was used to measure perceived s gma of the par cipants towards mental illness: D-D scale is a 12-item validated scale used to measure perceived s gma and was 9 developed by Link and Colleagues.As in original