Journal of Psychology & Psychotherapy
Open Access
ISSN: 2161-0487
ISSN: 2161-0487
Research Article - (2025)Volume 15, Issue 1
Aim: The purpose of the study is to evaluate community interest and how it connects to mental health care among eastern Ethiopian citizens.
Methods: A cross-sectional study that was community-based was conducted between July 2020 and February 2021. The Community Attitude to Mental Illness inventory (CAMI) was utilised to ascertain the level of interest among the participants. The data was imported into Epi Data 3.1 and then exported to SPSS version 20. The linearity assumptions were fit when they were confirmed. A simple and multivariate linear regression model was used to confirm the link between the dependent and independent variables. The significance of the predictors' relationship to the outcome variable was determined using the β coefficient, a p value of less than 0.05 and the matching 95% confidence interval.
Findings: Ninety-one percent of the participants completed the interview. More than half or 52% of the responses, were from female respondents. The subscale measuring kindly attitude had the lowest mean score (27.99 ± 5.18) and the subscale measuring community mental health ideology the highest mean score (33.78 ± 4.53). A higher inclination to be compassionate towards those suffering from mental diseases has been associated with increasing knowledge about mental health (1.32 (0.04, 2.61), p-value<0.05). A more degrading perspective has also been shown by community members who have a family member with a mental illness (β=1.47, CI=0.47-2.47). In conclusion, the community's attitudes towards those with mental illnesses have become less supportive, more socially restricting and more demeaning. Knowledge about mental health has been strongly correlated with the community's concern for others.
Community interest; Attitude; Dire Dawa; Ethiopia
A problem that modifies a person's thoughts, feelings and behaviour is called a mental disease. People who suffer from mental illness often have two problems at once. They have to deal first and foremost with the problems that come with the condition and any consequences that may arise. Mental illness has a major impact on the years of life with a disability and the global burden of disease. It made up 13% of the global sickness burden and by 2020, it was expected to rise to 15%. In lowincome and middle-income nations, respectively, alone mental illness accounts for 25.3% of all impairments and 33.5% of all years lived with a handicap. Mental, neurological and substance use disorders accounted for the majority (56.7%) of the disability adjusted life years resulting from global disabilities (10.4%). In Ethiopia, mental illness is the leading non-communicable disease in the aspects of burden including in rural areas that comprised of up to 11%.
Second, the community's stigmatising, thoughtless and avoidant attitudes have a detrimental effect on those with mental illnesses. They are left to live in the absence of a well-defined quality of life, which includes a social life, suitable housing, steady work and access to sufficient healthcare. Several studies have shown that societies all around the world see people with mental problems as violent and dangerous. A Nigerian survey found that 82.9% of people would find it awkward to talk to those who have mental illnesses. A study conducted in Ghana revealed similar results, with people there having more socially conservative views. About 42.1% of the community believe that marrying someone with a mental disease would isolate them from the community and 39.7% of individuals did not want to live next door to someone who had a mental illness [1].
For most Ethiopians, mental illnesses are the consequence of the "punishing hands of god" for defying social norms, beliefs and values. For instance, a study of the semi-nomadic Borana people revealed that the majority of them believe that supernatural forces are the source of mental illness. It was believed that the primary causes of mental illness were demonic possession, witchcraft and bewitchment respectively. Other purported triggers for mental disease include infection, bereavement, demonic attacks, blood contact, trauma and tainted water.
In low- and middle-income countries, between 76% and 85% of individuals did not undergo treatment due to fear of prejudice and stigma. Until the sickness worsens, they would rather remain at home. If mental illness treatment is put off, there could be a lasting disability or even death from the condition. To address the related issues, it is imperative that the community have a positive attitude towards mental illness when it affects a member of the community, a family member or oneself.
Stigma and a negative mindset also impair one's ability to operate in social, intellectual, professional and recreational domains. The disease victim, his family and the community at large all experience this impairment in functioning. But there isn't much research done on this important mental health issue in Ethiopia's east. Therefore, the purpose of this study is to close the knowledge gap about community interest in providing care to individuals with mental illness among Ethiopian residents of Dire Dawa town [2].
Study design and setting
In the city administration of Dire Dawa, a community-based cross-sectional survey was carried out between July 2020 and February 2021. The city of Dire Dawa is situated in the eastern region, bounded by the states of Somalia and Oromia, 515 kilometres from Ethiopia's capital. There are 38 rural peasant groups and 9 urban kebelles in it. The 2018 central statistical agency estimation report estimates the administration's total area at 128,802 hectares and population at 436,266. The estimated number of people living in cities among them is 282,336. Eight health centres and six hospitals total two staterun and four privately owned. There are 70,178 households in the town, averaging 4 people per home.
Population
The survey covered all adult residents of the city who had been living there permanently for at least six months. Excluded from the study were those who were very sick and could not speak Amharic, oromiffa or Af-Somali.
Sampling procedure and sampling technique
For the first objective, we used the standard deviations from community studies in GGFRC and for the second target, we used several literatures. With the second objective, we obtained the greatest sample size of 1174 with design effect 2 and a 10% non-response rate. We took four kebelles or 40% of the nine kebelles in the town. The chosen kebelles received a proportionate distribution of these sample populations. Ultimately, a systematic sampling procedure was used to choose the study participants [3].
Data collection technique and tool
Four clinical nurses used an interviewer-administered questionnaire to gather data. The four sub-scales of the Community Attitude to Mental Illness inventory (CAMI) are social restrictiveness, authoritarianism, generosity and community mental health ideology. For every ten items in each sub-scale, there are five possible answers. The responses span the subscales from 1 (strongly disagree) to 5 (strongly agree), with a minimum of 10 and a maximum of 50 points for each. Ethiopia is among the African nations where the instrument has been utilized. The tool's reliability was tested in alpha cronbatch=0.84 and its overall reliability was determined by AU, α=0.61, BE, α=0.6, SR, α=0.7 and CMHI, α=0.82.
Data quality assurance
The survey was translated from English into the regional tongues of Af-somali, Oromiffa and Amharic. Data collectors received training and a pretest was conducted in the 5% of the sample size population that wasn't made up of the kebelles that were chosen for the study. Every day, the gathered data were examined and verified for accuracy.
Data processing and analysis
Epidata 3.1 was used to enter the acquired data, which were then exported to SPSS version 20 for analysis. The variables were described using descriptive statistics. The tests for the main linear assumptions were examined. After a p-value of p ≤ 0.2 in simple linear regression analysis, factors related to the dependent variable were subjected to multiple linear regression analysis for additional investigation. Variables on multiple linear regression were considered statistically significant if their p-value was less than 0.05 at the 95% confidence interval.
Ethical consideration
The Dire Dawa university institutional review board granted the clearance. The administration of Dire Dawa city provided written consent. Participants in the study gave their informed consent after being fully told about the goal of the investigation.
Names, addresses and other personally identifiable information were not collected. Before beginning data collection, the researchers sought consent and gave an explanation of the study's purpose. The study participants were granted the liberty to enquire about the study and to end the interview at any point in time. The data collected from the participants was kept private [4].
Socio-demographic characteristics of participants
About 1174 participants were proposed to be included in this study and interviewed. 1071 participants were included for analysis making the response rate of 91.23% (Table 1).
| Variables | Categories | Frequency | Percentage |
| Sex | Male | 514 | 48% |
| Female | 557 | 52% | |
| Age | Mean (SD) | 37.16 | |
| Marital status | Single | 315 | 29.4% |
| Married | 542 | 50.6% | |
| Divorced | 112 | 10.5% | |
| Widowed | 102 | 9.5% | |
| Religious affiliation | Orthodox | 484 | 45.2% |
| Muslim | 357 | 33.3% | |
| Protestant | 146 | 13.6% | |
| Catholic and others | 84 | 7.8% | |
| Educational status | Unable to read and write | 43 | 4% |
| Primary school | 159 | 14.8% | |
| Secondary school | 255 | 23.8% | |
| College diploma | 346 | 32.3% | |
| University degree and above | 268 | 25% | |
| Occupational status | Government employee | 243 | 22.7% |
| Housewife | 199 | 18.6% | |
| Merchant | 226 | 21.1% | |
| Student | 202 | 18.9% | |
| NGOs employee | 135 | 12.6% | |
| Other | 66 | 6.2% |
Table 1: Socio-demographic characteristics of the study participants in Dire Dawa City administration, Ethiopia (N=1071).
Mental health information and history of mental illness
About 74.2% of participants have got information about mental health within the last one year (Table 2).
| Variables | Category | Frequency | Precentage |
| Got information about mental disorder | Yes | 795 | 74.2% |
| No | 276 | 25.8% | |
| Source of information about mental illness | Television or radio | 262 | 33% |
| Magazine or book | 127 | 16% | |
| Health institution | 129 | 16.2% | |
| Religious institution | 130 | 16.3% | |
| Other sources | 70 | 8.8% | |
| More than one source | 77 | 9.7% | |
| Suffered from any type of mental disorder | Yes | 82 | 7.7% |
| No | 989 | 92.3% | |
| Know someone who ever suffered from mental illness | Yes | 809 | 75.5% |
| No | 262 | 24.5% | |
| If yes for the above question, What is your relation? | Family member | 137 | 16.9% |
| Neighbor | 152 | 18.8% | |
| Friend | 168 | 20.8% | |
| Just saw on street and hospitals | 309 | 38.2% | |
| More than one of the above | 43 | 5.3% | |
| Involved in the caring of patients with mental disorder | Yes | 484 | 45.2% |
| No | 587 | 54.8% | |
| Have you ever been hurt by patients with mental disorder | Yes | 337 | 31.5% |
| No | 734 | 68.5% | |
| Have you ever witnessed hurt by patients with mental disorder | Yes | 610 | 57% |
| No | 461 | 43% |
Table 2: Mental health and related description of the study participants in Dire Dawa city adminstration, Dire Dawa, Ethiopia (N=1071).
Community interest to care people with mental disorder
During analysis, the subscale items in the CAMI tool were recoded into their corresponding pro values. Each of the ten subscales contains five likert scale items, ranging from strongly disagree to strongly agree, with a minimum value of 10 and a maximum value of 50. Hence, among the subscales, the beneficent (27.99 ± 5.18) and community mental health ideology (33.78 ± 4.53) domains showed the lowest and highest mean scores, respectively. The social restrictiveness and undermining attitude sub-scales had mean scores of 28.82 ± 3.86 and 30.48 ± 4.82, respectively.
Sixty percent of the individuals on the CAMI's benevolent subscale had a greater non-benevolent attitude, indicating a decreased desire in helping people with mental illness. For the statement, "spending on mental health services is a waste of tax dollars," 84% of survey participants responded in the affirmative or strongly agree, while 77% of participants responded in the same way for the statement, "the mentally ill don't deserve our sympathy." The overall percentage of participants who received a subscale score below the mean or median is 55.7%, which is higher than the average. This indicates that over 50% of the community has little interest in helping those who suffer from mental illness (Table 3) [5].
| Item | Mean and St. dev | Strongly disagree/disagree | Neutral | Strongly agree/agree |
| The mentally ill have for too long been the subject of ridicule | 3.3 ± 1.35 | 34.5% | 11.4% | 54.1% |
| More tax money should be spent on the care and treatment of the mentally ill | 2.95 ± 1.55 | 50.6% | 2.2% | 47.2% |
| We need to adopt a far more tolerant attitude toward the mentally ill in our | 3.65 ± 1.40 | 0.28% | 3.3% | 68.8% |
| Our mental hospitals seem more like prisons than like places where the mentally ill can be cared for | 3.12 ± 1.28 | 34.2% | 26.9% | 38.9% |
| We have a responsibility to provide the best possible care for the mentally ill | 4.23 ± 1.06 | 10.6% | 2.2% | 87.2% |
| The mentally ill don't deserve our sympathy | 2.16 ± 1.2 | 19.3% | 3.7% | 77% |
| The mentally ill are a burden on society | 1.92 ± 1.02 | 8.8% | 12.7% | 78.5% |
| Spending on mental health services is a waste of tax dollars | 1.89 ± 0.85 | 5.3% | 10.7% | 84% |
| There are sufficient existing services for the mentally ill | 2.67 ± 1.16 | 24.7% | 27.8% | 47.5% |
| It is best to avoid anyone who has mental problems | 2.11 ± 0.99 | 8.9% | 20.1 | 71% |
Table 3: Residents’ responses to the items on the benevolent subscale of Community Attitudes towards the Mentally Ill (CAMI) in Dire Dawa city adminstration, Dire Dawa, Ethiopia (N=1071).
Factors associated with community interest to care to people with mental disorder
Regression using multiple linear models after testing hypotheses, one-way ANOVA and independent t-test were used to predict characteristics linked to community involvement in providing care to individuals with mental problems for the variables significantly connected in the basic linear regression model [6].
Consequently, the community's interest in providing care for individuals with mental illness has been linked to factors such as marital status, education level, occupation, knowledge of mental health and prior mental disease history (Table 4).
| Variables | Category | Authoritarianism coefficient with 95% CI | Benevolent β coefficient with 95% CI |
Social restrictiveness β coefficient with 95% CI |
Community mental health ideology β coefficient with 95% CI |
| Age | Age | 0.05 (0.02,0.08)** | 0.03 (0.01, 0.05)* | ||
| Marrital status | Widowed | 1.55 (0.4, 2.65)** | -1.2 (-2.24,-0.2)* | ||
| Education level |
Primary school | -1.8 (-2.8, -0.87)** | 1.02 (0.14, 1.91)* | ||
| Secondary school | -1.1 (-1.88,-0.3)** | -0.22 (-0.92, 0.48) | |||
| University degree and above | 1.32 (0.53, 2.1)** | 0.56 (-0.13, 1.25) | |||
| Occupational status | Gov’t employee | ||||
| Merchant | 1.75 (0.75, 2.75)** | 0.11 (-0.64, 0.87) | 1.55 (0.62, 2.47)** | ||
| NGOs employee | 1.05 (-0.04, 2.12) | 1.11 (0.17, 2.04)* | 0.58 (-0.44, 1.59) | ||
| Having information about mental disorder | 2.15 (-2.28, 6.59) | 1.32 (0.04, 2.61)* | 0.28 (-0.81, 1.38) | ||
| Suffered from MD | 0.34 (-0.71, 1.39) | 1.78 (0.64, 2.91)** | |||
| Do not know someone with MD | 3.09 (1.1, 5.08)** | ||||
| Involved caring of PWMD | 0.67 (0.03, 1.3)* | 0.86 (0.34, 1.4)** | |||
| Have you ever been hurt by PWMD | 0.59 (-0.05, 1.25) | -0.11 (-0.77, 0.55) | 0.60 (0.07, 1.14)* | ||
| Have you ever witnessed hurt by patients with mental disorder | -0.72 (-1.3, -0.12) | -0.7 (-1.18 -0.2)** | -1.14 (-1.70, -0.58)** | ||
Table 4: Factors associated with community attitude toward peoples with mental disorder in Dire Dawa, Ethiopia.
The four subscales of the CAMI authoritarianism, benevolence, social restrictiveness and community mental health ideology were used in our study to assess the interest of the community in providing treatment for individuals with mental disorders. The benevolent sub-scale in our study had the lowest mean score, which is much lower than in earlier studies. The majority of participants in our study (55.7%) had a poor (below average) interest in providing care for individuals with mental illness. While 84% of participants agreed or strongly agreed that spending money on mental health services is a waste of government funds, 87.2% of people agreed or strongly agreed that it is our duty to care for the mentally ill. This shows that the community do not want to invest a cost to mental health care, in caring mentally ill. The difference might arise from the population difference.
More than half (52.7%) of participants reported more socially avoidant and discriminating attitude towards people with mental illness with mean value of 28.82 ± 3.86 which is lower than stigma score of a study done Worabe town in Ethiopia and Karnataka city in India. This shows that the eastern Ethiopia community is less likely to prohibit the social interaction of people with mental illness as compared to study participants in other study area [7].
The community mental health ideology sub-scale had the highest mean score, which was greater than the mean of a study done in the Ethiopian town of Worabe. This demonstrates that if any interested party attempts to integrate mental health treatments with primary healthcare facilities, the community will not object. The discrepancy may result from variations in the population.
The Dire Dwa town community's authoritarianism and socially restrictive attitudes were correlated with age. This variable has been linked to a study conducted in Worabe town, which found that older adults are less supportive of the integration of mental health services into their neighborhood. This may indicate that older members of the community have a more negative attitude towards those who suffer from mental illness. This may be a result of the societal perception that those suffering from mental illness are like children, needing to be controlled. However, in a study conducted in Ethiopia at the GGFRC in Worabe town, age was not linked to the community's attitude towards authoritarianism. The sociocultural and communal time differences may be the cause of the discrepancy. Age was also linked to the community's socially conservative mindset. A rise in the socially avoidant attitude towards individuals with mental illness has been correlated with every year of age. The observation of older individuals exhibiting more demeaning and socially stigmatizing attitudes towards others suggests the need for age-based anti-stigma interventions. This may be because more information regarding mental illness is available now than it was in the past.
Widowed marital status has been linked to the community of Dire Dawa town's less socially restricted and more charitable attitudes. This suggests that widows are more tolerant of mentally ill individuals, enabling them to participate in social activities. According to other Ethiopian research, marital status has no bearing on the opinions of the society. The population and likely setting differences could be the cause of the discrepancy. According to our research, bereaved community members have the ability to raise awareness of mental health issues among their fellow members.
A shift in the community's charitable and communal mental health ideological attitude has been linked to changes in educational attainment. Education at the primary and secondary school levels was found to be negatively correlated with the community's altruistic spirit. Primary and secondary school attendees had a less charitable attitude towards individuals with mental illnesses, while higher education, namely a university degree, has been linked to a more charitable attitude within the community towards those with mental illnesses. This appears to be the result of those receiving only elementary or secondary school either receiving incomplete or immature information about mental health issues. A study conducted in GGFRC supports this conclusion, but a study conducted in Worabe town found no correlation between education and altruism. More charitable attitudes were seen in our study when individuals' educational standing increased to a university degree and beyond. Higher levels of education are linked to more compassionate, humanistic and understanding attitudes towards those who suffer from mental illness, according to this study. The GGFRC treated education as a scandalous issue and did not present a category for it. Those who attend higher education institutions may be able to obtain adequate information about mental health. Community mental health ideology is positively impacted by primary school educational status. Being educated has revealed more comfortable attitude for mental health integration with primary healthcare setting which is supported by a research done in Ghana. There was no association in a study done in Worabe town between education and community mental health ideology [8].
In our study, the authoritarian, altruistic and communal mental health ideology subscales of the CAMI have been linked to occupation. Merchants have a reputation for being more authoritarian and for having a negative attitude towards those who suffer from mental illness. Additionally, they are more accepting of the inclusion of mental health treatments in community health programs. Employees of NGOs are also thought to be more kind, compassionate and understanding of those who suffer from mental illness. Here, we can observe that retailers have the ability to become involved in the development of nearby mental health facilities. NGOs are a great place for people to get involved in helping others who suffer from mental illness. Thus, we can make appropriate use of these groups to collaborate on mental health care. However, a study conducted in the GGFRC found no correlation between merchants and NGO employees, while a study conducted in the Ethiopian town of Worabe found that being a farmer and a student was related with a negative change in benevolence. Even while occupation was not related in our study, a study conducted in Worabe town found that being a farmer was associated with a shift in greater social restrictions. The setting and demographic differences could be the cause of the discrepancy.
According to studies, learning about mental health within the recent year has been linked to a decline in social restrictiveness and authoritarianism. In our study, it has been linked to an improvement in showing kindness towards those who suffer from mental illness. However, receiving knowledge on mental disease from places of worship has been linked to a decline in the general public's charitable views towards those who suffer from mental illness. This could be the case because people who obtained their information from places of worship believe that mental illness is the result of an evil spirit possessing a person. Information from health organisations, religious institutions and television and radio has been linked to a shift in the community's mental health beliefs for the better. These people are likely to support the integration of mental health services to the community health facilities. They have good will to people with mental illness.
Positive changes in benevolence towards those who suffer from mental illness have been linked to mental illness, but not to other subscales. It appears that if a person had a history of mental illness, he had benefited from outside assistance, such as from governmental institutions. Someone may become more humanistic, sympathetic and supportive of those who suffer from mental illness as a result of this experience.
Being aware of someone who has experienced mental illness in the family or elsewhere has been linked to a shift in attitudes towards the integration of mental health care that is more supportive of societal restrictions, less charitable and more authoritarian. People with mental illness are more likely to be seen negatively by those who are aware of mental illness in a family member or friend, as opposed to neighbors and friends. They had an oppressive, dehumanising and socially excluding view of those with mental illnesses. However, it is likely that they will back any initiative that facilitates the integration of mental health services in the neighbourhood that is closer to the community's residential area. The belief in the community that people with mental illnesses are violent, aggressive and destructive may be the source of this up-and-down attitude. However, in another study, there was no significant correlation found between having a relationship with someone who has mental illness and a change in attitude. The sample size and population differences could be the cause of the discrepancy. Compared to the referenced study, this one has a sample size that is nearly three times larger. Participating in the care of individuals with mental illness has been linked to a beneficial shift in the community's authoritarian and socially restrictive attitudes towards those who suffer from mental illness. These individuals may think that those suffering from mental illnesses should be kept under control so they don't endanger others or that they should be kept apart from the general public. However, it has no effect on the community and beneficent mental health ideology subscales. This is one of the barriers to providing care for the mentally ill since it prevents them from receiving rehabilitation services and from participating in society obligations. This association indicates that the individuals in question provide care for patients who are critically ill and have no more than two mental health conditions [9].
A positive correlation has been shown between a history of feeling threatened by individuals suffering from mental illness and a shift towards social avoidance. These individuals decline to assign duties or engage in social interactions with individuals who suffer from mental illness. However, seeing harm inflicted has been linked to a negative shift in socially restrictive behaviour and a positive attitude towards the integration of mental health services into community health settings. The sort of relationship where they saw someone with a mental illness may be the cause of the inverse relationship in the second variable and the direct positive relationship in the first variable. These affiliations indicate that the community has a policy of excluding mentally ill people from all social duties and actively supports the development of specialist care facilities [10].
Our findings revealed a less compassionate and more demeaning attitude towards those with mental illness. The community's positive attitude towards the inclusion of mental health services in the primary healthcare system is a positive development. It is highly recommended that family members of individuals with mental illness receive orientation and counselling regarding how to manage mentally ill individuals and the nature of mental illness. Individuals with primary and secondary education, as well as those who obtained information from religious institutions, have demonstrated a less compassionate attitude towards persons who suffer from mental illness. The manner in which religious institutions disseminate information to their adherents and the society about mental health appears to make intervention crucial. People who have relations with someone with mental illness have shown almost four times change in having less benevolent attitude. This shows that people with mental illness will remain stigmatized and maltreated until the attitude of the community is changed including by their friends.
Despite their involvement in providing care for those suffering from mental illness, individuals were shown to have more socially restricting attitudes. Therefore, it is important for physicians and other stakeholders to remind careers of the positive effects of incorporating mentally ill people in social obligations. A shift in the more socially restrictive attitude towards mentally ill persons has been linked to experiences of being threatened by those who suffer from mental illness. Observing the suffering of those suffering from mental illness has been linked to a shift in socially restricting behaviour and a negative attitude towards the inclusion of mental health services into primary healthcare. Therefore, it is beneficial to defend the community from threats posed by mental illness in order to change the perception of inclusion in the community.
This study might have some possible limitations. The term “people with mental illness” may not be easily understandable for all participants and different participant may perceive differently. The term “mentall illness” lacks specifity and again different participant may interpret the term in different way. Some of the variables are susceptible to social desirability bias.
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Citation: Yeshanew B, Getachew Y, Sema A, Tariku M (2025) Community Interest and the Correlates to Care for People with Mental Disorder among Residents of Eastern Ethiopia, Ethiopia: Community based Cross-Sectional Study. J Psychol Psychother. 15:506.
Received: 08-Feb-2024, Manuscript No. JPPT-24-29547; Editor assigned: 13-Feb-2024, Pre QC No. JPPT-24-29547 (PQ); Reviewed: 27-Feb-2024, QC No. JPPT-24-29547; Revised: 03-Feb-2025, Manuscript No. JPPT-24-29547 (R); Published: 10-Feb-2025 , DOI: 10.35841/2161-0487.25.15.506
Copyright: © 2025 Yeshanew B, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.