Original Article
Stigma of mental illness and substance misuse in sub-Saharan African migrants: A qualitative study
Terence V. McCann RN, MA, PhD.,
Andre Renzaho MPH, PhD.,
Janette Mugavin BSocSci, GradDipSci.,
Dan I. Lubman MB, ChB, PhD.,
Corresponding Author
Terence V. McCann RN, MA, PhD.
Centre for Chronic Disease, Program of Nursing and Midwifery, College of Health and Biomedicine, Victoria University, Melbourne, Victoria, Australia
Correspondence: Terence V. McCann, College of Health and Biomedicine, Victoria University, McKechnie Street, St Albans, Vic. 3021, Australia. Email: [email protected]Search for more papers by this authorAndre Renzaho MPH, PhD.
Humanitarian and Development Studies, Western Sydney University, Sydney, Australia
Search for more papers by this authorJanette Mugavin BSocSci, GradDipSci.
Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia
Turning Point, Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorDan I. Lubman MB, ChB, PhD.
Turning Point, Monash University, Melbourne, Victoria, Australia
Eastern Health Clinical School, Monash University, Melbourne, Australia
Search for more papers by this authorTerence V. McCann RN, MA, PhD.,
Andre Renzaho MPH, PhD.,
Janette Mugavin BSocSci, GradDipSci.,
Dan I. Lubman MB, ChB, PhD.,
Corresponding Author
Terence V. McCann RN, MA, PhD.
Centre for Chronic Disease, Program of Nursing and Midwifery, College of Health and Biomedicine, Victoria University, Melbourne, Victoria, Australia
Correspondence: Terence V. McCann, College of Health and Biomedicine, Victoria University, McKechnie Street, St Albans, Vic. 3021, Australia. Email: [email protected]Search for more papers by this authorAndre Renzaho MPH, PhD.
Humanitarian and Development Studies, Western Sydney University, Sydney, Australia
Search for more papers by this authorJanette Mugavin BSocSci, GradDipSci.
Centre for Alcohol Policy Research, La Trobe University, Melbourne, Victoria, Australia
Turning Point, Monash University, Melbourne, Victoria, Australia
Search for more papers by this authorDan I. Lubman MB, ChB, PhD.
Turning Point, Monash University, Melbourne, Victoria, Australia
Eastern Health Clinical School, Monash University, Melbourne, Australia
Search for more papers by this authorAbstract
Stigma of mental illness and substance misuse can deter help seeking, especially in immigrants who are often reluctant to seek help early for these issues. The aim of the present study was to explore the stigma experience surrounding mental illness and substance misuse, and its implications for improving help seeking, for youths and parents from sub-Saharan African immigrant communities. A qualitative, descriptive design was used. Individual interviews were undertaken with 28 youths, and focus group discussions were held with 41 parents and community leaders in Melbourne, Australia. The findings indicated that public stigma and self-stigma were common and deterred participants’ help seeking within sub-Saharan African communities. There was concern about the consequences of disclosure. Personal shame, fear of community rejection, and being labelled a ‘lunatic’ deterred help seeking. Programmes are needed to address stigma, promote help seeking, and increase mental health knowledge. Mental health nurses and other clinicians in the mental health and alcohol and other drug fields can make an important contribution. Steps are needed to employ more sub-Saharan African immigrant clinicians to help increase help seeking from their communities.
References
- Agic, B., Mann, R. E. & Kobus-Matthews, M. (2011). Alcohol use in seven ethnic communities in Ontario: A qualitative investigation. Drugs: Education, Prevention and Policy, 18, 116–123.
- Amuyunzu-Nyamongo, M. (2013). The social and cultural aspects of mental health in African societies. Commonwealth Health Partnerships, 2013, 59–63.
- de Anstiss, H. & Ziaian, T. (2010). Mental health help-seeking and refugee adolescents: Qualitative findings from a mixed-methods investigation. Australian Psychologist, 45, 29–37.
- Ayazi, T., Lien, L., Eide, A., Shadar, E. J. S. & Hauff, E. (2014). Community attitudes and social distance towards the mentally ill in South Sudan: A survey from a post-conflict setting with no mental health services. Social Psychiatry and Psychiatric Epidemiology, 49, 771–780.
- Bos, A. E., Kanner, D., Muris, P., Janssen, B. & Mayer, B. (2009). Mental illness stigma and disclosure: Consequences of coming out of the closet. Issues in Mental Health Nursing, 30, 509–513.
- Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.
10.1191/1478088706qp063oa Google Scholar
- Corker, E. A., Beldie, A., Brain, C. et al. (2015). Experience of stigma and discrimination reported by people experiencing the first episode of schizophrenia and those with a first episode of depression: The FEDORA project. International Journal of Social Psychiatry, 61, 438–445.
- Corrigan, P. W. & Rao, D. (2012). On the self-stigma of mental illness: Stages, disclosure, and strategies for change. Canadian Journal of Psychiatry, 57, 464–469.
- Corrigan, P. W. & Watson, A. C. (2002). The paradox of self-stigma and mental illness. Clinical Psychology: Science and Practice, 9, 35–53.
- Corrigan, P. W., Watson, A. C. & Barr, L. (2006a). The self-stigma of mental illness: Implications for self-esteem and self-efficacy. Journal of Social and Clinical Psychology, 25, 875–884.
- Corrigan, P. W., Watson, A. C. & Miller, F. E. (2006b). Blame, shame, and contamination: The impact of mental illness and drug dependence stigma on family members. Journal of Family Psychology, 20, 239–246.
- Corrigan, P. W., Morris, S., Larson, J. et al. (2010). Self-stigma and coming out about one's mental illness. Journal of Community Psychology, 38, 259–275.
- Corrigan, P. W., Morris, S. B., Michaels, P. J., Rafacz, J. D. & Rusch, N. (2012). Challenging the public stigma of mental illness: A meta-analysis of outcome studies. Psychiatric Services, 63, 963–973.
- Corrigan, P. W., Druss, B. G. & Perlick, D. A. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15, 37–70.
- Department of Immigration and Border Protection (n.d.). Visa support. [Cited 26 September 2017]. Available from: URL: www.border.gov.au/Trav/Visa
- Dickerson, F. B., Sommerville, J., Origoni, A. E., Ringel, N. B. & Parente, F. (2002). Experiences of stigma among outpatients with schizophrenia. Schizophrenia Bulletin, 28, 143–155.
- Dockery, L., Jeffery, D., Schauman, O. et al. (2015). Stigma- and non-stigma-related treatment barriers to mental healthcare reported by service users and caregivers. Psychiatry Research, 228, 612–619.
- Drummond, P. D., Mizan, A., Brocx, K. & Wright, B. (2011). Barriers to accessing health care services for West African refugee women living in Western Australia. Health Care for Women International, 32, 206–224.
- Foundation House and Centre for Multicultural Youth (2013). Responding to challenges of misuse of alcohol and other drugs by young people of refugee backgrounds: reflections from two projects. Melbourne: Mental Health in Multicultural Australia. [Cited 26 September 2017]. Available from: URL: www.mhima.org.au/pdfs/responding%20to%20challenges%20of%20misuse%20of%20AOD%20young%20refugee.pdf
- Gureje, O., Lasebikan, V. O., Ephraim-Oluwanuga, O., Olley, B. O. & Kola, L. (2005). Community study of knowledge of and attitude to mental illness in Nigeria. British Journal of Psychiatry, 186, 436–441.
- Holloway, I. & Galvin, K. (2017). Qualitative Research in Nursing and Healthcare, 4th edn. Oxford: Wiley-Blackwell.
- Horyniak, D., Higgs, P., Cogger, S., Dietze, P., Bofu, T. & Seid, G. (2014). Experiences of and attitudes toward injecting drug use among marginalized African migrant and refugee youth in Melbourne, Australia. Journal of Ethnicity in Substance Abuse, 13, 405–429.
- Hugo, C. J., Boshoff, D. E., Traut, A., Zungu-Dirwayi, N. & Stein, D. J. (2003). Community attitudes toward and knowledge of mental illness in South Africa. Social Psychiatry and Psychiatric Epidemiology, 38, 715–719.
- Kabir, M., Iliyasu, Z., Abubakar, I. S. & Aliyu, M. H. (2004). Perception and beliefs about mental illness among adults in Karfi village, northern Nigeria. BMC International Health and Human Rights, 4, 3.
- Kakuma, R., Kleintjes, S., Lund, C. et al. (2010). Mental health stigma: What is being done to raise awareness and reduce stigma in South Africa? African Journal of Psychiatry, 13, 116–124.
- Kirmayer, L. J., Narasiah, L., Munoz, M. et al. (2011). Common mental health problems in immigrants and refugees: General approach in primary care. CMAJ. Canadian Medical Association Journal, 183, E959–E967.
- Koschorke, M., Padmavati, R., Kumar, S. et al. (2014). Experiences of stigma and discrimination of people with schizophrenia in India. Social Science and Medicine, 123, 149–159.
- Lubman, D., McCann, T., Renzaho, A., Kyle, A. & Mugavin, J. (2014). Bridging the Gap: Educating Family Members From Migrant Communities About Seeking Help for Depression, Anxiety and Substance Misuse in Young People. Melbourne: Beyondblue. [Cited 26 September 2017]. Available from: URL: www.beyondblue.org.au/docs/default-source/research-project-files/bw0278.pdf?sfvrsn=4
- Luoma, J. B., Twohig, M. P., Waltz, T. et al. (2007). An investigation of stigma in individuals receiving treatment for substance abuse. Addictive Behaviors, 32, 1331–1346.
- Maier, T., Schmidt, M. & Mueller, J. (2010). Mental health and healthcare utilisation in adult asylum seekers. Swiss Medical Weekly, 140, 1–7.
- Makanjuola, V., Esan, Y., Oladeji, B. et al. (2016). Explanatory model of psychosis: Impact on perception of self-stigma by patients in three sub-saharan African cities. Social Psychiatry and Psychiatric Epidemiology, 51, 1645–1654.
- McCann, T. V., Lubman, D. I. & Clark, E. (2011). Responding to stigma: First-time caregivers of young people with first-episode psychosis. Psychiatric Services, 62, 548–550.
- Minas, H., Kakuma, R., Too, L. et al. (2013). Mental Health Research and Evaluation in Multicultural Australia: Developing a Culture of Inclusion. MacGregor, Queensland: Mental Health in Multicultural Australia. [Cited 26 September 2017]. Available from: URL: www.mentalhealthcommission.gov.au/media/80646/2093%20MHiMA%20CALD%20REPORT_06.pdf
- Mishra, S. I., Lucksted, A., Gioia, D., Barnet, B. & Baquet, C. R. (2009). Needs and preferences for receiving mental health information in an African American focus group sample. Community Mental Health Journal, 45, 117–126.
- Morse, J. M. (2010). ‘Cherry picking’: Writing from thin data. Qualitative Health Research, 20, 3.
- National Health and Medical Research Council. (2007). National Statement on Ethical Conduct in Human Research 2007 (Updated May 2015). [Cited 26 September 2017]. Available from: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/e72_national_statement_may_2015_150514_a.pdf
- Newbold, B. (2005). Health status and health care of immigrants in Canada: A longitudinal analysis. Journal of Health Services Research and Policy, 10, 77–83.
- Norman, R. M. G., Windell, D. & Manchanda, R. (2012). Examining differences in the stigma of depression and schizophrenia. International Journal of Social Psychiatry, 58, 69–78.
- Palmer, D. (2007). Caught between inequality and stigma: The impact of psychosocial factors and stigma on the mental health of Somali forced migrants in the London Borough of Camden. Diversity in Health and Social Care, 4, 177–191.
- Parahoo, K. (2014). Nursing Research: Principles, Process and Issues. Basingstoke, Hampshire: Palgrave/Macmillan.
10.1007/978-1-137-28127-2 Google Scholar
- Patton, M. Q. (2002). Qualitative Research and Evaluation Methods. Thousand Oaks, CA: Sage.
- Pavlish, C. L., Noor, S. & Brandt, J. (2010). Somali immigrant women and the American health care system: Discordant beliefs, divergent expectations, and silent worries. Social Science and Medicine, 71, 353–361.
- Posselt, M., Galletly, C., de Crespigny, C. & Procter, N. (2014). Mental health and drug and alcohol comorbidity in young people of refugee background: A review of the literature. Mental Health and Substance Use, 7, 19–30.
10.1080/17523281.2013.772914 Google Scholar
- Priebe, S., Giacco, D. & El-Nagib, R. (2016). Public health aspects of mental health among migrants and refugees: a review of the evidence on mental health care for refugees, asylum seekers and irregular migrants in the WHO European Region. Health Evidence Network (HEN) Synthesis Report 47. Copenhagan: WHO Regional Office for Europe. [Cited 26 September 2017]. Available from: URL: www.euro.who.int/en/publications/abstracts/public-health-aspects-of-mental-health-among-migrants-and-refugees-a-review-of-the-evidence-on-mental-health-care-for-refugees,-asylum-seekers-and-irregular-migrants-in-the-who-european-region-2016
- Rusch, N., Angermeyer, M. C. & Corrigan, P. W. (2005). Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. European Psychiatry, 20, 529–539.
- van der Sanden, R. L. M., Bos, A. E. R., Stutterheim, S. E., Pryor, J. B. & Kok, G. (2015). Stigma by association among family members of people with a mental illness: A qualitative analysis. Journal of Community & Applied Social Psychology, 25, 400–417.
- Schomerus, G., Lucht, M., Holzinger, A., Matschinger, H., Carta, M. G. & Angermeyer, M. C. (2011). The stigma of alcohol dependence compared with other mental disorders: A review of population studies. Alcohol and Alcoholism, 46, 105–112.
- Tawiah, P. E., Adongo, P. B. & Aikins, M. (2015). Mental health-related stigma and discrimination in Ghana: Experience of patients and their caregivers. Ghana Medical Journal, 49, 30–36.
Citing Literature
