A STUDY TO ASSES THE KNOWLEDGE AND ATTITUDE

TOWARDS MENTAL ILLNESS AMONG ADOLESCENTS

IN SELEC TEDSCHOOLS AT TUMKUR WITH A VIEW

TO DEVELOP AN INFORMATIONAL PAMPHLET

PROFORMA FOR REGISTRATION OF SUBJECT FOR REGISTRATION

VINDHYA Y .H PSYCHIATRIIC NURSING

ARUNA COLEGE OF NURSINGRING ROAD MARALUR,

TUMKUR-5721052010-2011

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the Candidate : Mrs. VINDHYA Y . H And address M.Sc. Nursing 1st Year

Aruna College of Nursing Ring Road, Maralur. Tumkur.

2. Name of the Institution : Aruna College of Nursing

3. Course of Study and : M.Sc Nursing 1st Year

Subject Psychiatry Nursing

4. Data of Admission : 01:10:2010

5. Title of the Topic : "A Study to asses the knowledge and attitude toward mental illness among adolescent in selected schools at Tumkur with a view to develop an informational pamphlet ".

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6. BRIEF RESUME OF THE INTENDED STUDY

INTRODUCTION

“Acting is the physical representation of a mental picture and the projection of

an emotional concept.”

- Laurete Taylor

“Good attitudes are magnets for good news. Seen it proven a hundred times.” A

mental disorder or mental illness is a psychological or behavioural pattern generally

associated with subjective distress or disability that occurs in an individual, and which is not

a part of normal development or culture.1

Mental illness is an age-old problem of mankind as recorded in the literature of the

oldest civilizations the world over. The public view towards mental illness has been

considered as negative, stigmatized, uninformed and fearful entity right from the ancient time

till date which varies according to age, race, ethnicity, religion, culture, tradition, and

education of the different community. 2

More and more we are hearing in the news that adolescents are displaying

troublesome patterns of antisocial behavior. Such behavior pattern include a chronic

disobedience, aggression towards others , anxiety ,temper tantrums, lying and stealing .The

outcomes of the mental illness are serious and sever, such as physical or emotional injury,

abnormal behavior, disability, finally death and property damage or loss.3

Mental illness was associated with ignorance, superstitions and fears. as a result,

mentally ill patients went through a lot of torture and problems for lack of development in

the field of psychiatry. in other words, lack of knowledge and lack of facilities affected care

of patients. 4

With the introduction of understanding of the human behavior during the later part of

the 19th century, it led to a change towards the mentally ill patients. In the third decade of the

20th century introduction of the physical form of treatment followed. By the fourth decade

pharmacology for the mentally ill was introduced .So the mentally ill started better care.5

Mental health is defined as “... a state of complete physical, mental and social well-

being in which the individual realises his or her own abilities, can cope with the normal

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stresses of life, can work productively and fruitfully, and is able to make a contribution to his

or her community”. In other words, mental health involves finding a balance in all aspects of

life: physically, mentally, emotionally and spiritually. Although mental well-being is believed

to be instrumental to quality living and personal growth, people often take mental health for

granted and may not notice the components of mental well-being until problems and stresses

surface. As a country develops and urbanises, life becomes more complex, and problems

related to social, cultural, and economic changes arise. As per the above discussion we come

to know that there is a difference between mental illness and mental health. Hence we have

taken this topic for study purpose. 6

The term adolescence from word “adolescent.” which means "to grow up" is a

transitional stage of physical and mental human development characterized as beginning and

ending with the teenage stage. Generally occurring between puberty and legal adulthood.

Adolescence is a unique stage of development that occurs between the age of 11-19 years.

It's a time of rapid physical and emotional changes, which can be exciting, developing a

caring attitude, seeking towards the harmonious relationship with significant others. All

above depends upon the sound physical and mental health. The knowledge of normal and

abnormal mental health makes a significant difference in their caring attitude towards the one

with mental illness.7

6.1 NEED FOR THE STUDY

Mental health problems and prejudiced attitudes toward mental illness have common

risk factors. The school is a central place for adolescents’ social interactions and an important

setting for promoting pupils’ health and well-being . The importance associated with the

opportunity to promote mental health through the school. The pervasive negative public

beliefs about mental illness, in turn, create an environment that impedes both treatment

seeking and recovery. For psychiatrically labelled children and adolescents acutely attuned to

the judgments of their peers, misunderstandings and negative attitudes about mental illnesses

among those peers may be particularly painful. Adolescent mental health disorders are

present in around 10% of the population. Research indicates that many young people possess

negative attitudes towards mental health difficulties among peers. 8

World Health Organization estimates that 10% of the world's population has some

form of mental disability.9

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The point prevalence of mental illness in the adolescents population at any given time

is also 10%.10

The consequences of stigma associated with mental illness have attracted the negative

ratings among the public. The public express that the people with mental illness are

Unpredictable and dangerous. Thus the knowledge and attitude among adults towards mental

illness bears profound impact on the person with psychiatric illness.11

In India among the total population, 72.22% of the people live in rural areas and

27.78% in urban area. Among these adults between the age group of 15-59 years form 56.9%

of the total population.12

Mental illness affects the people of all age group It is estimated that 450 million

people are experiencing mental illness at any one time, most of whom live in developing

countries.13

The United States Department of Health and Human Services (USDHHS,1999) stated

that more than 48 million people in the United States (1 in 5, or 20%) have a diagnosable

mental disorder or illness, half of all citizens have a mental illness at sometime in their lives

and most of these people however never seek treatment.14

The National Institute of Mental Health and Neuro-Sciences (NIMHANS) report

shows that in India 70 million people suffer from mental ailments and yet, 50-90 percent of

them are not able to access corrective services due to less awareness and negative attitude or

stigma towards mental illness. 15

In rural India, prevalence rates for all mental illness is 64.4 per 1000 population and

urban part of the country it is 66.4 per 1000 population. 16

A descriptive study conducted on Urban Mental health services in India found that,

the service providers perceived that the important barrier besides the financial problem are

stigma and lack of awareness.17

One third of the mental health beds are in one state (MR) and several states have no

mental hospitals.18

A comparative study conducted to examine stigmatizing attitudes towards the

severely mentally ill among rural and urban community dwellers in India. Study revealed that

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the rural Indians showed higher stigma and view towards the severely mentally ill was

punitive, while the urban group expressed a liberal view of severe mental illness. Urban

Indians rejected to work with existing mental illness among person whereas rural Indians did

not pose such an opinion.19

An epidemiological study on psychiatry morbidity in India showed that the

prevalence rate of all mental disorders was 65.4% per 1000 population. The urban morbidity

rates were 2 per 1000 higher than the rural morbidity rate.20

A community-based cross-sectional study on the prevalence and pattern of mental

disability in 11 villages of Udupi district, Karnataka revealed that prevalence of mental

disability was 2.3% and prevalence of mental disability was more among female compared to

males.21

A study on screening for psychiatric disorders in adult population reported that 39%

of the adult population has mental illness. Proportion of psychiatric morbidity among males

and females were 36.2% and 42.2% respectively.22

Almost every dimensions of life are affected due to the impact of mental illness such

as personal, interpersonal, social, and economic growth. As a result there is destruction in the

whole personality which in turn would cause damage at the outset. Thus the researcher found

the importance of to assess the knowledge and attitude towards mental illness among

adolescents in selected schools.23

6. 2 REVIEW OF LITERATURE:

A study was conducted to assess the attitude towards mental illness found association

of age with the attitude of the people towards mental illness, in that people with age of more

than 14 years favoured social isolation and withdrawal of social responsibility for the people

with mental illness, which throws light on the attitude the urban community holds towards

the person with mental illness.24

A study conducted to assess the attitude of high school students towards mental

disorder. The researchers used exploratory research design on fifty high school students aged

13-15 years. The study revealed that majority of the subjects (68%) feel that mental patient

are always dangerous, and should kept themselves away from the mentally ill person, further

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majority of samples feel that mentally ill person can be managed in PHC and other local

hospitals. Majority of them disagree that the treated mental patients can work with

responsibity.25

A descriptive study was conducted on the knowledge and attitude towards mental

illness in Abuja. Two thousand and forty samples were selected using multistage clustered

sampling technique. The result revealed that 96.5% of subjects perceived that people with

mental illness were dangerous, 82.7% expressed fear to converse with mentally ill persons,

and only 16.9% showed agreement regarding the marriage of mentally ill persons. Therefore,

the study concluded that there was widespread stigmatisation of mental illness persisting. 26

A study conducted on mental health teaching programme on adolescents..Two-group

pre-test-post-test control group study in two English schools. Experimental classes (School E)

received a six-lesson teaching intervention on mental health; control classes (School C) did

mental health difficulties. There was a significant reduction in SDQ scores on conduct

problems and a significant increase on prosocial behaviour among School E pupils compared

with controls. Pupils valued the intervention highly, in particular the lessons on suicide/self-

harm.Teaching 14- and 15-year-olds about mental health difficulties helps to reduce stigma

by increasing knowledge and promoting positive attitudes. The intervention also reduced self-

reported conduct problems and increased prosocial behaviour. Generally, not. Participants

were 14- and 15-year-old pupils. pupils in School E compared with those in School C showed

significantly more sensitivity and empathy towards people with mental health difficulties.

They also used significantly fewer pejorative expressions to describe participating pupils

were positive about the importance of lessons on mental health, and said that they had learnt

much about the lesson topics. 27

An research tested the effectiveness of a widely used mental health education

curriculum in changing knowledge and attitudes about mental illness. High school students

from four schools were provided the Breaking the Silence: Teaching the Next Generation

About Mental Illness mental health instruction while students from other classes at the same

schools received usual class instruction. Students completed questionnaires assessing

knowledge, attitudes, and social distance preferences before, immediately after, and six

weeks after the instruction was given. Result was showed students given the Breaking the

Silence instruction showed improvements in knowledge about mental illness, attitudes toward

mental illness, and willingness to interact with people with mental illnesses. Students in the

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comparison classes showed no changes. Study ended with Breaking the Silence was an

effective and a curriculum, introduced during childhood and adolescence, may help to

prevent the negative attitudes and misunderstanding that characterize adult perceptions of

mental illness.

The present study describes how adolescents perceive their mood disorders (acute vs.

chronic) and their attitudes toward mental health servicesin. The study also explores the

relationships between demographics, clinical characteristics, perceptions of illness and

attitudes among 70 adolescents. Structured interviews were conducted utilizing standardized

instruments. Results show that adolescents with MD have fairly positive attitudes, with youth

reporting more positive attitudes than their nonwhites counterparts. Perceptions were related

to psychological openness and indifference to stigma.28

The present study describes how adolescents perceive their mood disorders (MD; e.g.,

acute vs. chronic) and their attitudes toward mental health services in. The study also

explores the relationships between demographics, clinical characteristics, perceptions of

illness and attitudes among 70 adolescents. Structured interviews were conducted utilizing

standardized instruments. Results show that adolescents with MD have fairly positive

attitudes, with Caucasian youth reporting more positive attitudes than their nonwhites

counterparts. Illness perceptions were related to psychological openness and indifference to

stigma. 29

A descriptive study was conducted to examine the knowledge and attitudes towards

psychiatric diagnoses or illness to prepare exit foster care and services among 268

adolescents with A structured interview assessed knowledge of services with vignette

scenarios and attitudes with a standardized scale. Descriptive statistics described the extent of

knowledge and attitudes among this population and regression analyses examined predictors

of these dimensions of literacy. Most youth suggested a help source, but responses often

lacked specificity. Gender and depression were the strongest predictors of knowledge and

attitudes, respectively. Knowing which aspects of literacy are low, and for whom, can

improve access to care in adolescents. 30

A study descriptive was conducted to examine the prevalence of mental health

difficulties and prejudices attitude toward mental illness among adolescents, and to analyze

possible school and school class effects on these issues. The sample comprised 4,046 pupils

(13–15years) in 257 school classes from 45 Norwegian high schools. The estimated response

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rate among the pupils was about 96%. Self-reported mental health difficulties were measured

with a four-item scale that covered emotional and behavioural difficulties. Prejudiced

attitudes toward mental illness were assessed using a nine-item scale. Multilevel regression

analysis was used to estimate the contribution of factors at the individual level, and at the

school and class levels. The study accounted for by individual level factors (92–94%).

However, there were statistically significant school and class level effects (P\0.01),

confounded by socioeconomic factors. Mental health difficulties were commonly reported,

more often by females than males (P\0.01). Both self-reported mental health difficulties and

prejudiced attitudes were related to educational program, living situation, and parental

education (P\0.01). Concluded that attitude indicate a need for effective mental health

intervention programs. 31

A explorative study was conducted to assess the illness perceptions, attitudes towards

mental health services and adherence behaviours among a group of adolescents in treatment

for mood disorders in an urban city in the United States. Seventy adolescents (70) completed

a battery of questionnaires assessing demographics, perceptions of illness and overall

attitudes towards mental health services. Adolescents and their parents also reported on the

youth's adherence to both psychotropic medication and mental health appointments.

Simultaneous logistic regression analyses revealed that attitudes and family income made a

significant and unique contribution in explaining adolescents' adherence behaviours.

Interventions that help adolescents become aware of their attitudes toward mental health

services and provide information on dimensions of mood disorders, such as the chronic

nature of depression and the effectiveness of treatment, may impact adherence behavior.32

An attitude study was conducted in a total sample of 103 adolescents students at the

junior and senior levels. The study was conducted to ascertain the existence of any evident

special attitudes as a result of minority membership. Although specific group characteristics

were revealed that might be sociocultural, the overall conclusion is that attitudes relating to

the mental health field and its personnel are parallel to the majority population. No evidence

was found to support the contention that members of this population are not good insight

patients, but rather it was found that insight is an individual capacity rather than a culturally

determined one. 33

This exploratory descriptive study examined the attitudes of 89 adolescents toward

mental illness and found significant differences according to gender and education about

mental illness. Responses to social distance items showed that adolescents tended to be less

9

accepting as they were proposed relationships that suggested greater intimacy with the

mentally ill. The mass media, personal experience with someone who had a mental illness,

and parents were perceived by the adolescents as the most important sources of their

attitudes. The major implications for nursing practice with adolescents, and particularly in the

school system, are discussed with suggested interventions.34

A descriptive study conducted on attitude of Indian adololescents towards mental

illnesses. In an area of Jhansi 238 samples were interviewed to assess their views regarding

mental illnesses. Mental illness was not perceived as a serious disease. Cancer was perceived

as the most serious disease. Worries, faulty upbringing, overwork were perceived as a cause

of mental illness by majority. Early identification sings of mental illness described by them

were difficulty in sleeping, changes in facial expression and feeling of impending mental

imbalance. Marital alliance with them was not favoured. However, a sympathetic attitude

towards mental patients was favoured. Avoiding tension, adapting oneself to circumstances,

consulting with elders were considered as preventive measures against mental illness by

majority.35

6. 3 STATEMNT OF THE PROBLEM:

“A Study to asses the knowledge and attitude toward mental illness among adolescent

in selected schools at Tumkur with a view to develop an informational pamphlet “.

6. 4 OBJECTIVES OF THE STUDY

The objectives are to:

1. To assess the pre-existing knowledge regarding the mental illness among the

adolescents.

2. To Identify the attitude towards mental illness among the among the

adolescents.

3. To determine the association between knowledge and attitude scores of

adolescents regarding the mental illness with selected demographic variables

4. To find the correlation between knowledge score and attitude score of

adolescents regarding the mental illness.

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6.5 OPERATIONAL DEFINITIONSThe terms used in this study are defined as follows:

Assess: In this study it refers to the act of determining knowledge and attitude regarding

mental illness as measured by a closed ended knowledge questionnaire and Likert type scale.

Knowledge: In this study it refers to the awareness or familiarity regarding mental illness

expressed by the adolescents as measured by a A closed ended knowledge questionnaire was

prepared to assess the knowledge on mental illness.

Attitude: In this study it refers to the expression of feeling, behaviour or thought exhibited

by the adolescents towards the person with mental illness as measured by a Likert type scale.

Mental Illness: In this study it refers to the clinically significant behaviour or psychological

syndrome or pattern occurs in an individual, which leads to distress or disturbance in the

social, occupational, psychological and physical functioning.

Adolescents: In this study it refers to male and female children who are in the age group of

13 to 15 years and studying in selected schools.

6.6 ASSUMPTION

The study assumes that

Adolescents have some knowledge regarding mental illness.

Adolescents exhibit both positive and negative attitude towards mental illness.

6.7 HYPOTHESIS

Hypotheses will be tested at 0.05 level of statistical significance.

H1: There will be a significant association between knowledge score of the adolescents and

the selected demographic variables.

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H2: There will be a significant association between attitude score of the adolescents and the

selected demographic variables.

H3: There will be a significant correlation between knowledge score and the attitude score of

the adolescents regarding mental health.

7 MATERIALS AND METHODS

7.1 Source of Data

Research approach : Descriptive approach

Research Design : Non –Experimental Descriptive design

Setting of the study : The study will be conducted at the selected

School of Tumkur

Sample Technique : Probability non convenient sampling

Sample size : 100 Adolescents

Selected Variables

Dependent variable : Knowledge and attitude towards mental illness

Among adolescents

Other Variables : Age 13 to 15 years,

Gender – Male, Female

School Medium – English, Kannada, Hindi,

Tamil etc

Population : All the adolescents who full fill the inclusion

Criteria Adolescents Schools at Tumkur.

Sample Criteria

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Inclusion criteria : a) Adolescents who are the age group of 13 to

15 Years

b) Adolescents who are willing to participants

in the study

c) Both male and female adolescents.

Exclusion criteria : a) Adolescents who are suffering with physical

and mental illness

b) Adolescents who are not available at the

time of data collection

c) Adolescent who are no willing to participate

7.1.1 Instrument Intended to be used

A closed ended knowledge questionnaire and Likert type scale will be used

7.2 Methods of data collection

Data collection Technique : Self administrated questionnaire

Tool for data collection : Structured questionnaire

Methods of data Collection

and interpretation : Data will be analysed according to the

objectives of the study using

and inferential statistics and will be

presented in the form of tables, graphs

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and diagrams.

Duration of the study : Six weeks

7.3 Does the study require any investigation / intervention to be conducted?

No

7.4 Has ethical consideration been obtained from your institution?

Yes. Ethical obtained obtained from committee’s reports and concerned authority .

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32. Michelle R. Munson, Jerry E. Floersch, and Lisa Townsend; Attitudes Toward Mental

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9 Signature of the Candidate :

10 Remarks of the Guide :

11 Name and Designation of

11.1 Guide :

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11.2 Signature :

11.3 Co-Guide :

11.4 Signature :

11.5 Head of The Department :

11.6 Signature :

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12.1 Remarks of the Principle :

12.2 Signature of the Principle :

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