INTRODUCTION:

Our attitude towards life determines life’s attitude towards us.

- John N. Mitchell

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. ¹

More and more we are hearing in the news that adolescents are displaying troublesome patterns of antisocial behavior. Such behavior pattern includes 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.²

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.³

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.⁴

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.⁸World Health Organization estimates that 10% of the world's population has some form of mental disability.⁸ The point prevalence of mental illness in the adolescents population at any given time is also 10%.¹⁰The 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.¹²Mental 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.¹¹

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.¹²

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.¹³

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. ¹⁶A 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.¹⁴One third of the mental health beds are in one state (MR) and several states have no mental hospitals.¹⁵

A comparative study conducted to examine stigmatizing attitudes towards the severely mentally ill among rural and urban community dwellers in India. Study revealed that 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.¹⁶

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.¹⁷

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.¹⁸A 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.¹⁹

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.²⁰

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 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.²¹

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. ²²

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. ²³

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 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 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 youth reporting more positive attitudes than their nonwhites counterparts. Perceptions were related to psychological openness and indifference to stigma.²⁴

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.²⁵

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. ²⁶

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 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.²⁷

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.²⁸

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.²⁹

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 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.³⁰

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.³¹

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 school.

MATERIAL AND METHOD:

A non-experimental approach and correlational descriptive research design was used. Study was conducted in Khalsa college public school of Amritsar, Punjab. Target population of the study is students of medical and non-medical stream studying in selected school. Stratified random sampling technique was used. Sample size was 100. Study variable was knowledge and attitude towards mental illness. Socio-demographic variables are gender, stream of education, area of residence. Self structured likert scale on knowledge and attitude among school students towards mental illness. The reliability of the tool was calculated by applying split half technique and computed by spearmen brown prophecy formula. The reliability was r=0.7.

ETHICAL CLEARANCE:

The permission for research was taken from the medical officer of Cheharta. Before collecting data, investigator gave brief introduction about self, purpose of the study and information regarding tools. Informed consent was taken from each study subject.

RESULT:

· Sample characteristics concluded that out of 100 students majority were females, have medical stream and were having rural residence.

· It shows that majority (37%) of students have average knowledge followed by 35 % who were having poor knowledge, 28% were having good knowledge and majority (56%) of students have negative attitude towards mental illnesses followed by 44 % who were having positive attitude.

· Coefficient of correlation was 0.52 concluded that knowledge and attitude towards mental illnesses among school students have positive correlation.

· It was concluded that there was no significant association between gender where as stream of education and area of residence is associated with knowledge and attitude towards mental illnesses of school students.

DISCUSSION:

Discussion is based on statistical analysis of the present study and previous selected research.

Objective 1: to assess knowledge of school student towards mental illnesses.

It shows that majority (37%) of students have average knowledge followed by 35 % who were having poor knowledge, 28% were having good knowledge. Hence it is concluded that majority of school student were having average knowledge about mental illnesses. 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 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

Objective 2: to assess attitude of school students towards mental illness

It shows that majority (56%) of students have negative attitude towards mental illnesses followed by 44 % who were having positive attitude. Hence it is concluded that majority of school student have negative attitude towards mental illnesses. 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 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

Objective 3: to ascertain the correlation between knowledge and attitude score of school student regarding the mental illness.

Knowledge mean score of school students was 10.18 and the attitude mean score was found to be 5.68. The correlation of knowledge and attitude was calculated by using coefficient of correlation formula and was appeared to be 0.52 which is moderately positive correlation. Hence it was concluded that knowledge and attitude towards mental illnesses among school students have positive correlation. Finding was found similar to Singh AJ²² study.

Objective 4: to determine association of knowledge and attitude towards mental illnesses of school students with socio-demographic variables.

It was concluded that there was no significant association between gender whereas stream of education and area of residence was associated with knowledge and attitude towards mental illnesses of school students. Finding was found similar to Loretta Ramella²⁴ study.

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Received on 21.08.2015 Modified on 24.08.2015

Asian J. Nur. Edu. and Research. 2016; 6(3): 301-306

DOI: 10.5958/2349-2996.2016.00056.2