Continuum beliefs and stigmatising beliefs about mental illness: results from an Asian community survey

OBJECTIVES To establish the prevalence and correlates of continuum beliefs for five mental illnesses in a multiethnic population and to explore its association with stigma. DESIGN A community-based, cross-sectional study. SETTING A national study in a multiethnic Asian country. PARTICIPANTS A comprehensive study of 3006 Singapore residents (Singapore citizens and permanent residents) aged 18-65 years who were living in Singapore at the time of the survey. OUTCOME MEASURES Parameters assessed included belief in a continuum of symptom experience, stigma dimensions and causal beliefs in mental illness. Statistical analyses included descriptive statistics and multiple linear regression (MLR). RESULTS About half of the population indicated agreement with a continuum of symptoms for depression (57.9%) and dementia (46.8%), whereas only about one in three respondents agreed with it for alcohol abuse (35.6%), schizophrenia (32.7%) and obsessive-compulsive disorder (OCD) (36.8%). MLR analyses revealed that students (β=0.28; 95% CI 0.05 to 0.50; p=0.018) and those who were unemployed (β=0.60; 95% CI 0.26 to 0.95; p=0.001) (vs employed) as well as those who had previous contact with people with mental illness (β = 0.31; 95% CI 0.18 to 0.45; p<0.001) and believed stress, family arguments, difficulties at work or financial difficulties to be a cause for mental illness (β=0.43; 95% CI 0.13 to 0.73; p=0.005) were associated with a higher belief in a continuum of symptom experience. Continuum beliefs were related to lower desire for social distance in alcohol abuse, OCD and schizophrenia; however, they were associated with higher scores on 'weak-not-sick' stigma dimension in dementia and schizophrenia. CONCLUSIONS Perceiving that a person with a mental illness is similar to themselves may reduce social distancing by the public. Thus, the approach may lend itself well to public education aimed at reducing stigma.