Geographic distribution and determinants of mental health stigma in central Mozambique

Abstract

Purpose: This study aims to describe community-level patterns of stigma towards MI in Mozambique, which is hypothesized to be one of the main barriers to the provision of effective mental health care. Methods: Data for this study come from a representative community household survey of 2,933 respondents >18 years old in Manica and Sofala Provinces, Mozambique. Six mental health stigma questions represented primary research outcomes. Bivariate and multivariate analyses were done to examine the relationship between key explanatory factors and each stigma question. Spatial and space-time point pattern analyses were done to analyze smoothed geographic distribution of responses to each question and to explore the association between geographic location and mental health stigma controlling for individual-level covariates. Findings: Mental health stigma is prevalent in Central Mozambique. Analyses showed that males, people who live in urban places, divorced and widowed individuals, the youngest age group, those with lower education, those endorsing no religion, and those in lower wealth quintiles tended to have significantly higher levels of stigmatizing attitudes towards MI. Individuals endorsing depressive symptoms scored significantly higher on some key stigmatizing questions potentially indicating internalized stigma. Geographic location is significantly associated with people’s response to five of the stigma questions adjusting/not adjusting for individual level factors. Conclusion: Greater awareness regarding the stigmatization of mental illness is needed. Further investigation on mental health stigma should be done in Mozambique as well as other LMICs. Community-level stigma interventions are urgently needed and could be targeted towards populations that were identified at higher risk.