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New Study Highlights Cross-Cultural Differences in Mental Health Stigma

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A recent study by researchers Noah Ramos and Richard J. McNally sheds light on the varying degrees of stigma towards mental health issues between Filipinos and Americans. The study, which involved comprehensive surveys conducted in both countries, reveals significant cultural differences in how mental disorders are perceived and the willingness of individuals to seek treatment. The findings were published in the journal Transcultural Psychiatry.

The study found that Filipinos exhibit significantly more stigma towards mental health issues compared to Americans. This was particularly evident in areas concerning relationship disruption, interpersonal anxiety, and poor hygiene. Filipinos were more likely to believe that mental disorders lead to disrupted relationships, cause anxiety, and are associated with poor hygiene. In contrast, Americans showed higher perceived behavioural control over seeking treatment and stronger subjective norms supporting mental health treatment.

Cultural beliefs play a significant role in shaping attitudes towards mental health in both countries. In the Philippines, collectivist social norms such as “pakikisama” (social harmony) and “kapwa” (shared identity) can contribute to the stigma. Filipinos often fear that mental disorders will lead individuals to act selfishly or fail to reciprocate social norms, which are highly valued in their culture. This contrasts with the more individualistic culture in the US, where seeking mental health treatment is more normalised and supported by societal norms.

Noah explained: “There are a lot of cultural norms, such as social harmony and shared identity, which I explore in the study, which inadvertently lead to negative attitudes against mental health treatment and historically make mental illness something that is rarely considered a possibility for an individual to have.”

Education and urbanisation were found to be important factors influencing stigma. In the US, higher levels of education were associated with lower levels of interpersonal anxiety and greater belief in the recoverability of mental health patients. But this correlation was not observed among Filipinos. Instead, parental education had a significant impact on reducing stigma in the Philippines, with Filipinos who had college-educated parents reporting lower levels of perceived relationship disruption and interpersonal anxiety.

Urbanisation also played a different role in the two countries. For Filipinos, living in an urban environment was associated with greater trust in mental health professionals. This is likely due to the lack of mental health services in rural areas, which limits awareness and trust in psychiatric care. In contrast, the widespread availability of mental health services in the United States means that rural Americans still have access to these services and trust them to a similar extent as their urban counterparts.

The study also examined the impact of personal experience with mental disorders on attitudes towards mental health. Interestingly, having a family member or close friend with a mental disorder led to different outcomes in the two countries. In the US, this experience was associated with a stronger belief in the treatability of mental health conditions. However, in the Philippines, it led to decreased belief in the recoverability of patients. This may be due to the lower availability of treatment options in the Philippines, which can lead to a more pessimistic view of recovery.

Noah said: “A person’s surrounding environment, such as the extent to which they have access to mental health professionals and meaningful interactions with others who disclose their mental illnesses, appears to interact with their stigma. This also suggests that there is hope for future interventions to decrease stigma in individuals through changing these environmental factors.”

The researchers acknowledged several limitations in their study. The use of convenience sampling, particularly through online platforms like MTurk and Reddit, may not provide a fully representative sample of the populations. Additionally, cultural differences in the understanding and interpretation of survey questions may have influenced the results. The Mental Illness Stigma Scale (MISS) and the Theory of Planned Behavior (TPB) questionnaire used in the study were originally designed for American and German populations, respectively, and may not fully capture the nuances of Filipino cultural beliefs. Ramos reflected on this aspect: “An issue with this study that I did not address is the America-centric approach that I took that assumes the perception and treatment of mental illness in the USA is the ‘correct’ way.”

The findings of this study have important implications for designing interventions to reduce stigma and improve mental health treatment-seeking behaviour. In the Philippines, efforts should focus on increasing education about mental health and expanding access to mental health services, particularly in rural areas. Addressing cultural beliefs and promoting understanding and acceptance of mental health issues within the context of Filipino social norms is crucial.

Noah, motivated by his personal experience, said: “I hoped to support dialogue around stigmatising attitudes towards mental illness in Filipinos and potential future interventions to decrease these negative beliefs.”

In the US, continued efforts to integrate mental health education into the school curriculum and promote positive attitudes towards seeking treatment are essential. Enhancing support systems for individuals with personal experience with mental disorders can further reduce stigma and encourage treatment-seeking behaviour.

Looking forward, Noah plans to pursue his doctorate degree at the PGSP-Stanford PsyD Consortium. “Within this programme, I intend to continue researching culturally sensitive mental health interventions. In my future work, I hope to take an approach that properly draws on the strengths of Filipino culture or the values of other non-Eurocentric cultural groups.”

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