Background

Causes of mental illness: Beliefs in the general population

Causal beliefs of mental illnesses are a critical aspect of illness perception. Beliefs about the causes of mental illnesses are associated with how individuals suffering from mental illnesses seek treatment for mental health issues, how family members provide support to these individuals, attitudes towards seeking help, and treatment outcomes.

Research literature has consistently shown that the general public attribute more than one cause in the development of mental health issues. The causes can be classified into several categories. For example, Addis, Truax and Jacobson (1995) found that the causes given by adults suffering from depression for their problem can be classified into “childhood trauma”, “life stressors”, “poor coping skills”, “personality”, and “genetic vulnerability”.

Causal beliefs are associated with stigma and acceptance of individuals with mental illnesses. Reavley and Jorm (2014) found that attributing mental illnesses to deficits in one’s personality is linked to higher levels of personal stigma and a desire to keep a distance away from individuals with depression, social anxiety, schizophrenia, and PTSD (post-traumatic stress disorder).

The current research discussed aims to shed light on the beliefs of the general population in Singapore with regard to the cause of mental illnesses (Pang, Subramaniam, Lee, Lau & Abdin, 2017). Apart from the four main ethnic groups in Singapore (Chinese, Malay, Indian, Others), the researchers also explored other sociodemographic differences in causal beliefs of mental illnesses, including income and employment status. The researchers also explored whether causal beliefs of mental health issues in Singapore is related to stigma towards an individual with a mental illness.

Seeking treatment for depression, anxiety and other mental illnesses in Singapore

A large-scale survey of mental health issues in Singapore found that only 31.7% of those affected by mental illnesses sought treatment. Slightly less than half of those who sought treatment for mental health issues (or 15.7% of those affected) approached a mental health professional, such as a psychologist or a psychiatrist, while 8.4% of those affected saw a general practitioner, and 7.6% turning to religious advisors/traditional healers.

It is possible that causal beliefs play a part in the low number of individuals seeking help for mental health issues in Singapore. Causal beliefs may also explain why a significant proportion of those who do seek help turn to traditional healers, instead of a mental health professional to overcome depression, anxiety or other mental health issues.

The Study

Data for this paper was gathered from 3006 participants living in Singapore as part of a larger research project studying mental health literacy on the island. Trained research assistants conducted face-to-face interviews with the participants, selected to match the age groups and ethnicity of the population living in Singapore.

Participants were presented with one out of five scenarios depicting a person with either depression, obsessive compulsive disorder (OCD), schizophrenia, alcohol abuse, or dementia. Participants then answered questions on what they think is the cause of the mental illness of the person in the scenario, as well as how much they would like to be connected with the person (e.g. be neighbours, or have the person marry someone in his/her family).

Results

Factor analysis of the various beliefs on the causes of mental illness indicated that the beliefs can be classified into three difference categories. The first category of beliefs was named “physical causes” (i.e. a virus/infection, or an allergy). The second and third categories were classified as “personality factors” (i.e. possessing a weak character, and highly nervous) and “psychosocial factors” (e.g. a recent traumatic episode, or problems during childhood) respectively.

Psychosocial factors were the most highly attributed beliefs on the causes of mental illnesses in Singapore, with 97.9% of the participants attributing it as a possible cause across the scenarios. Personality causes of mental illnesses were attributed in 83.5% of the participants, while physical causes were the least attributed belief at 37%.

Attribution on causes of mental illnesses in Singapore:

The results also indicated that there was no significant difference in desire for social distance from individuals with mental health issues based on their causal beliefs of mental illnesses.

In terms of sociodemographic differences, there is not much difference in attribution of mental illness across the four races. The only difference found in the study was that Malays were significantly less likely to attribute personality causes for mental health issues compared to the Chinese. Younger adults (aged 18-34 years) were more likely to attribute psychosocial causes of mental illnesses compared to older adults (35-49 years).

Implications

The three categories of causal beliefs found in this study match the findings of previous research. However, the study failed to captured two possible categories of causal beliefs which would be relevant to the Singapore context: spiritual/supernatural causes and genetic causes. Considering almost a quarter of those who sought help for mental illnesses turned to spiritual/religious healers, spiritual or religious beliefs certainly played a part in influencing help-seeking behaviours in Singapore.

The authors of the current research pointed out that it is crucial to engage traditional healers in identifying individuals with mental health issues and encouraging them to seek the services of mental health professionals. The traditional healers can continue to provide moral and spiritual support to those affected, while psychologists and psychiatrists provide psychological therapy and pharmacological treatment respectively.

Mental health professionals in the clinical settings can also explore clients’ and their family members’ beliefs on the cause of their depression, or other mental health issues, at the start of the treatment. The mental health professional should explain to the clients the rationale for their treatment modality if their causal beliefs differ, so as to improve adherence to treatment. For example, if a client with depression believes that his difficulties are due to genetic factors, the clinical psychologist that he is consulting can explain to him how psychological therapy would help him overcome the traumatic events in his past as well as provide him with the necessary coping skills. This would improve treatment adherence.

Finally, the results of the study also point out to the importance of continuing to educate the general population to improve mental health literacy. The relatively high proportion of participants who attribute mental illnesses to personality causes indicates that a large number of people view weaknesses in the person as a cause, even for dementia, which is neurological in nature.

**References. **

Addis, M. E., Truax, P., & Jacobson, N. S. (1995). Why do people think they are depressed? The reasons for depression questionnaire. Psychotherapy, 32(3), 476-483.

Pang, S., Subramaniam, M., Lee, S. P., Lau, Y. W., Abdin, E., Chua, B. Y., ... & Chong, S. A. (2017). The Singaporean public beliefs about the causes of mental illness: results from a multi-ethnic population-based study. Epidemiology and Psychiatric Sciences, 1-10.

Reavley, N. J., & Jorm, A. F. (2014). Associations between beliefs about the causes of mental disorders and stigmatising attitudes: results of a national survey of the Australian public. Australian & New Zealand Journal of Psychiatry, 48(8), 764-771.