Perceptions of mental illness in south-eastern Nigeria: causal beliefs, attitudes, help-seeking pathways and perceived barriers to help-seeking

Abstract

To provide empirical basis for mental health interventions in the deprived sub-Saharan African region, this study explored the perspectives of the Igbo people of south-eastern Nigeria on four dimensions of mental illness: causal beliefs, attitudes towards sufferers, preferred treatment pathways and perceived barriers to accessing formal psychiatric care. Mixed sampling methods were used to select participants who completed quantitative questionnaires. The number of participants varied between 200 and 706 in the exploratory studies but remained constant (n = 1127) in the confirmatory studies. The study found mixed endorsements of the supernatural, biological and psychosocial causal explanations with supernatural causations being significantly more endorsed. The study also found mixed treatment preferences with formal psychiatric care being significantly more preferred to the spiritual pathway which was in turn significantly more preferred to the traditional pathway. Significant negative attitudes and desire for social distance from persons with mental illness were observed across groups. Barriers to accessing mental healthcare were also significantly perceived with ideological barriers being significantly more perceived than instrumental barriers. Systematic associations were found between causal beliefs and treatment preferences: supernatural causal belief predicted preference for the spiritual and traditional treatment pathways while psychosocial causal belief predicted preference for both formal psychiatric care and the traditional treatment pathway. Mixed causal attributions and treatment preferences reflect holistic view of health and healing and calls for the evolution of complementary model of care that would incorporate people’s spiritual and cultural needs. The prospect is supported in psychosocial causal beliefs being associated with preference for the traditional treatment pathway. Significant negative attitude is a contradiction in the traditionally communitarian and predominantly Christian culture, and is deserving of intervention in the context where the solidarity of the social network should compensate for the inadequate mental healthcare. Significantly more ideological than instrumental barriers have crucial policy implication; improved conceptualizations of mental illness should precede improvement of facilities and services or else these could be underused. Demographic correlates of causal beliefs, negative attitudes, pathway preferences and barriers to accessing formal mental healthcare care were determined for targeted interventions.