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Attitude of Nagas towards mental disorders in relationship to age and gender.

INTRODUCTION

Misconceptions about mental disorders have been common everywhere since the ancient times. Many around the world are ignorant about the nature, cause, treatment and prognosis about mental disorders and it is this lack of adequate knowledge that leads to stigmatizing attitudes toward people who are subject to such disorders. While being afflicted with a mental disorder like schizophrenia or depression can be debilitating in itself, the stigma associated with such disorders can make it even worse. In many cases, people with mental disorders and their family members are hesitant to talk about these problems and do not seek appropriate help for fear of being ridiculed and mocked. With the rising cases of mental disorders worldwide, it is imperative that every member of society is informed about the nature of such disorders so as to break down the age old stigma associated with such disorders.

The World Health Organization (WHO) estimates show that 25 percent of all people are affected by mental disorders at some time during their lives and that the proportion contributed by such disorders to the global disease burden will go up from 10.5 percent in 1990 to 15 percent in 2020 (WHO report 2001).WHO estimates also show that globally about 400 million people of all ages suffer from depression, 60 million from bipolar disorder, 21 million from schizophrenia, and 35 million from dementia. Unless people develop positive attitudes toward mental disorders and toward those afflicted with such disorders, stigma will continue and these disorders will continue to remain a global burden and will continue to be the cause of suffering and misery to millions across the world. It is towards this end that the WHO mental health action plan for 2013-2020 calls for changes in attitude that perpetuate stigma and discrimination (WHO report, 2013).

Many existing studies in different parts of the world show ignorance about causation and treatment of mental disorders and persistent negative attitudes towards those with mental disorders (Jorm et al., 2000; Jackowska, 2009; Audu et al., 2013, Venkatesh et al., 2015), while some have reported considerable changes in public attitudes toward mental disorders(Ineland, Jacobson, Renberg & Sjolander, 2008).

Attitudes towards mental disorders or towards people with mental disorders is not yet well explored in Nagaland, a small state in the north eastern part of India, that is inhabited largely by a group of tribal people called the Nagas. In the late nineteenth century, the American Christian missionaries arrived in this tribal area and started spreading Christianity and education, as a result of which many of the tribal customs and beliefs have been gradually replaced by western and Christian customs and beliefs. While the present day Nagas strive to maintain and preserve their tribal culture to some extent there is no denying the fact that many of them are largely influenced and driven by western culture. Their attitudes toward many aspects in life therefore reflect both their tribal origin and the adopted culture(s). In such a context, one often wonders as to what kind of attitudes they may have regarding mental disorders. While there are numerous studies about attitudes toward mental disorders reported from different parts of the world, there are not many reported studies about the attitude of Nagas toward mental disorders. One study by Longkumer and Borooah, 2013, reported misconceptions among a considerable proportion of participants with regard to causation and treatment of mental disorders and highlighted the role of educational level on attitudes toward mental disorders. However, the role of other demographic factors in the attitude of Nagas toward mental disorders is yet to be explored or reported. Studies in other parts of the world show mixed results regarding the influence of demographic variables on attitudes toward mental disorders (De Crane & Spielberg, 1981; Sellick & Goodean, 1985; Komoya, Good & Sherrod, 2000; AI-Adawi et al., 2002; Adewuya & Makanjuolo, 2005; Song et al., 2005; Jorm & Wright, 2007; Mori et al., 2007; Ewalds, Hogberg & Lutzen, 2013; and Venkatesh et al., 2015). An accurate assessment of public attitudes toward mental disorders and its relationship with various demographic variables is important to effectively plan and implement public sensitization programs on mental disorders and mental health issues. This paper is an attempt to highlight the attitude of Nagas toward mental disorders in relationship to two demographic variables--age and gender.

METHOD

Sampling: The study was based on a sample of 500 respondents from the Ao-Naga tribe. Through the use of incidental sampling technique, the research tool was given to 850 individuals of the Ao-Naga tribe in the age groups 21 and 40 years and above 50 years. The sample covered four villages and four towns. The first 500 respondents were taken as the sample for this study. The distribution of the participants in terms of age and gender was as follows: Males = 228 and females = 272. Younger group (21 to 40 years) = 381 and Older group (above 50 years) = 119.

Research Tool: The research tool included a brief instruction, respondent's personal identification chart, a case vignette of schizophrenia and a questionnaire based on the vignette. The case vignette was one adapted from an Australian study (Jorm & Wright, 2008) that had been prepared to meet the DSM-IV criteria for schizophrenia and validated by mental health professionals. Slight modifications were made to the vignette to suit the respondents of the Naga community.

"Sangpang is a 15 year old who lives at home with his parents. He has been attending School irregularly over the past year and has recently stopped attending altogether. Over the past 6 months he has stopped seeing his friends and begun locking himself in his bedroom and refusing to eat with his family or to have a bath. His parents hear him walking about in his bedroom at night while they are in bed. Even though they know he is alone, they have heard him shouting and arguing as if someone is there. He has become unreasonably suspicious and talks incoherently. When they try to encourage him to do more things he whispers that he won't leave home because he is being spied upon by the neighbors. His face is expressionless most of the time and sometimes he giggles at rather inappropriate times."

The questionnaire had items relating to the person in the vignette and was validated by several subject experts and a pilot study on thirty adults belonging to the Ao-Naga tribe. The case vignette as well as the questionnaire was presented in both English and Ao-Naga.

RESULTS AND DISCUSSION

Attitudes indicating understanding and acceptance of the person in the vignette or others with similar problems and attitudes indicating stigma are shown separately for males and females as well as for the younger and older groups.

Attitudes indicating understanding and acceptance--by gender: Majority of both male and female respondents agreed with the views that persons like the one in the vignette deserve attention, that they can get well with treatment, and that they were willing to visit the person's house. A little more than half the respondents in both gender groups expressed comfort in talking to the person but less than half the respondents in both groups agreed on the opinion of giving them jobs with responsibility (Table 1).

Significant gender differences were observed with regard to different levels of acceptance. More percentage of males (92%) compared to females (82%) expressed willingness to visit the person's family ([X.sup.2] = 5.38, P<.05), more percentage of males (71%) compared to females (56%) showed willingness to befriend the person ([X.sup.2] = 12.28, P<.01), and more percentage of males (25%) compared to females (14%) expressed willingness to marry the person ([X.sup.2] = 8.56, P<.01).

Attitudes indicating understanding and acceptance--by age: Majority of both older and younger respondents reported that persons like the one in the vignette deserve attention and that they can get well with proper treatment. A great majority of respondents in both age groups also expressed willingness to visit the person's house and more than half the respondents in both age groups also expressed willingness to befriend people like the one depicted in the vignette (Table 1).

Significant difference was observed between the two age groups with regard to the idea of giving jobs with responsibility ([X.sup.2] = 10.82, P<.01) as 56% of older respondents endorsed the idea while only 39% of younger respondents endorsed it. A significantly higher percentage of older respondents (74%) compared to younger respondents (58%) also reported feeling comfortable talking to persons like the one in the vignette ([X.sup.2] = 9.71, P<.01). While majority of respondents in both age groups reported willingness to visit the person's house, the percentage endorsing this idea was significantly higher ([X.sup.2] = 5.38, P< .05) for the younger group (91%) than the older group (83%). With regard to acceptance in marriage, majority of both older and younger respondents did not agree. However, compared with the percentage of older respondents agreeing (11%), significantly more percentage of younger respondents (22%) endorsed the idea of accepting a person like the one in the vignette in marriage ([X.sup.2] = 7.19, P<.01).

Attitudes indicating stigma--by gender: Only small percentages of both male and female respondents agreed with the views of keeping the person behind locked doors, giving physical punishment, and avoiding the person. Considerably higher proportions of respondents in both gender groups, however, agreed that having a problem like the one depicted in the vignette is shameful and about half the respondents in both groups agreed that persons with such disorders are dangerous and that they are scared of such people (Table 2).

Significant gender difference was observed with regard to fear of persons with mental disorders. Significantly more percentages of females (55%) compared to males (44%) agreed to being scared of persons like the one in the vignette ([X.sup.2]= 9.31; P<.01).

Attitudes indicating stigma--by age: Only small percentages of respondents in both age groups endorsed the ideas of keeping the person behind locked doors, giving physical punishment, and avoiding the person. Considerably higher proportions of respondents in both groups, however, agreed with the ideas of shame, fear and being dangerous (Table 2) and significant differences were also observed between the two age groups in terms of the proportions agreeing with these ideas. Significantly higher percentage of older respondents (66%) compared to younger respondents (50%) agreed with the view that persons like the one in the vignette are more dangerous than others ([X.sup.2]= 8.34, P<.05), higher percentages of older respondents (50%) compared to younger respondents (27%) endorsed the view that being inflicted with such a problem is something to be ashamed of ([X.sup.2] = 22.12, P< .01), and higher percentage of older respondents (61%) compared to younger respondents (47%) also reported being scared of people with such problems ([X.sup.2] = 6.39, P<.05).

Gender differences were observed with regard to different levels of acceptance with significantly more percentages of males expressing willingness to visit the person's family, befriend or marry the person. Gender differences were also observed with regard to stigmatizing attitudes towards persons like the one in the vignette with significantly more percentages of females, as compared to males, attaching the stigma of fearfulness. The findings seem to indicate that when it comes to attitudes toward mental disorders, more females than males are negative and hold reservations with regard to acceptance. This is consistent with findings from a number of similar studies in other parts of the world (Ewalds--Kvist, Hogberg, and Lutzen, 2013; Adewuya and Makanjuolo, 2005) but not consistent with findings from a number of other similar studies (Jorm and Wrigth, 2007; Mori et al., 2007; De Crane and Speilberger, 1981, Johnson, 1988, Komoya, Good and Sherrod, 2000).

One reason why the male respondents in this study showed less negative attitudes may be explained in the light of the Naga context. Traditionally, the Naga men were warriors and even in the present day men are expected to be outwardly brave, to be the protectors of the family and the society at large, and to show less submissiveness. This could be one possible reason for the expression of negativity and fear by relatively lesser number of males in this study. However, more research needs to be done in this area to exclude the role of other possible factors.

The age effect seems complex with more number of older respondents reporting to be comfortable to engage in conversations and also endorsing the idea of giving jobs with responsibility while with regard to the ideas of acceptance in marriage and visiting the person, more number of younger respondents than older ones gave their endorsements. It appears that although they report to be more at ease in conversations with people with mental disorders, older respondents are more accepting of people with such disorders only in general situations that do not call for close interpersonal contact. It is the younger respondents that seem more accepting of the mentally ill when considering closer interpersonal relationships.

Age differences were also observed with regard to stigmatizing attitudes with significantly more number of older respondents attaching the stigma of fear, shame and dangerousness to mental disorders. The findings seem to indicate that older respondents hold more negative attitudes as compared to the younger ones. This is in tune with the finding mentioned above that the older group is less accepting of persons with mental disorders in close relationships. However, these results need to be viewed with caution as the two categories of responses do not correspond perfectly.

Existing evidence for the role of age in attitudes toward mental disorders is mixed with some studies associating increase in age with more negative attitudes, some others associating it with more positive attitudes toward mental disorders and still others showing no relationship between age and attitudes towards mental disorders.

In the Naga context it may be reasoned that because people of the younger generation have more access to the internet media it is possible that they have more exposure to information regarding the nature, causes and treatment of mental disorders as compared to the older ones who are more reserved when it comes to the use of modern technology such as the internet media. Future studies, however, may look into the factors that interact with age in the attitudes of Nagas toward mental disorders.

In general, it may be noted that irrespective of gender or age, respondents showed some form of understanding and tolerant attitudes towards people with mental disorders as is indicated by their endorsements of views such as willingness to visit the person's house, that the mentally ill deserve attention, or the view that the mentally ill can get well with treatment. However, when it comes to acceptance in closer relationships considerable proportions of respondents showed reservations and, age and gender differences were also observed. Prevalence of negative attitudes such as fear of the person, perception of the condition as shameful or the perception of the person as dangerous have also been observed in considerable proportions across both gender and age groups, albeit higher in females and older respondents. Negative attitudes and reservations with regard to acceptance in close relationships are indicative of lack of adequate knowledge about mental disorders and may be corrected through proper advocacy through awareness and educational programs.

Although not without limitations, the present study has highlighted the relationship of age and gender with the attitudes of Nagas toward mental disorders that will have implications in the planning and implementation of mental health programs in the state.

References

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Longkumer, I. and Borooah, I. P. (2013). Knowledge about and attiutdes toward mental disorders among Nagas in North East India. IOSR Journal of Humanities and Social Science, 15(4), 41-47

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Received: June 25, 2016

Revised: July 10 2016

Accepted: July 20, 2016

Imlisongla Longkumer * and Indranee Phookan Borooah **

* Assistant Professor, Department of Psychology, Nagaland University, Kohima Campus, Nagaland and ** Professor, Department of Psychology, Gauhati University, Guwahati, India
Table 1: Attitudes indicating understanding and
acceptance - by gender and age

Items                              Male      Female %   [X.sup.2]
                                 %agreeing   agreeing    Gender
                                   n=228      n=272

Persons like the one in the         84          82        0.77
vignette deserve as much
attention as others with
physical illness.

Most people with problems           89          90        .005
like the one depicted in the
vignette can, with treatment,
get well and return to
productive lives.

Persons like the one in the         40          45        1.71
vignette should be given jobs
with responsibility.

Feel comfortable talking            66          58        3.21
to the person.

Visit the person's family           92          82       5.38 *
knowing that he / she is in
the same house.

Consider friendship with the        71          56      12.28 **
person or with someone having
similar problems.

Willing to marry / allow            25          14       8.56 **
one's children to marry
someone who has, at one time
or the other, suffered from a
problem like the one depicted
in the vignette.

Items                              Older      Younger    [X.sup.2]
                                 %agreeing   %agreeing      Age
                                   n=119       n=381

Persons like the one in the         78          84         1.88
vignette deserve as much
attention as others with
physical illness.

Most people with problems           93          89         2.66
like the one depicted in the
vignette can, with treatment,
get well and return to
productive lives.

Persons like the one in the         56          39       10.82 **
vignette should be given jobs
with responsibility.

Feel comfortable talking            74          58        9 71 **
to the person.

Visit the person's family           83          91        5.38 *
knowing that he / she is in
the same house.

Consider friendship with the        64          63          .02
person or with someone having
similar problems.

Willing to marry / allow            11          22        7 19 **
one's children to marry
someone who has, at one time
or the other, suffered from a
problem like the one depicted
in the vignette.

* P < .05; ** P < .01

Table 2: Attitudes indicating stigma--by gender and age

Items                              Male       Female     [X.sup.2]
                                 %agreeing   %agreeing    Gender
                                   n=228       n=272

Person like the one in the          12           8         1.33
vignette should be locked
indoors.

Physical punishment can              5           4          .43
rectify the person's problem.

Persons like the one in the         53          54          .04
vignette are more dangerous
than other people.

Feel scared to be with people       44          55        9.31 *
like the person in the
vignette.

Having a problem like the one       34          32          .14
depicted in the vignette is
something to be ashamed of.

Best to avoid the person so         13          13          .03
that you don't develop this
problem yourself.

Items                              Older      Younger    [X.sup.2]
                                 %agreeing   %agreeing      Age
                                   n=119       n=381

Person like the one in the          13           8         1.48
vignette should be locked
indoors.

Physical punishment can              8           4         3.10
rectify the person's problem.

Persons like the one in the         66          50        8.34 **
vignette are more dangerous
than other people.

Feel scared to be with people       61          47        6.39 *
like the person in the
vignette.

Having a problem like the one       50          27       22.12 **
depicted in the vignette is
something to be ashamed of.

Best to avoid the person so         16          12         1.29
that you don't develop this
problem yourself.

* P<.05; ** P<.01
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Author:Longkumer, Imlisongla; Borooah, Indranee Phookan
Publication:Indian Journal of Community Psychology
Article Type:Report
Geographic Code:9INDI
Date:Sep 1, 2016
Words:3778
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