Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jul-Sep;40(3):220-227.
doi: 10.4103/ijsp.ijsp_205_22. Epub 2023 Nov 10.

Internalized Mental Illness Stigma is Linked to Suicidality in Rural Indian Adults with Depression or Anxiety and Chronic Physical Illness

Elsa Heylen  1 , Krishnamachari Srinivasan  2   3 , Ruben Johnson-Pradeep  3 , Maria L Ekstrand  1   2
Affiliations

Internalized Mental Illness Stigma is Linked to Suicidality in Rural Indian Adults with Depression or Anxiety and Chronic Physical Illness

Elsa Heylen et al. Indian J Soc Psychiatry. 2024 Jul-Sep.

Abstract

Background: Mental illness (MI) remains stigmatized globally, including in India, where suicide and suicidality have been rising. Internalization of society's negative stereotypes by people with MI is known as internalized MI stigma.

Aims: The present paper examined the prevalence of internalized MI stigma in a large sample of rural Indian participants with comorbid chronic medical conditions and previously undiagnosed, mostly mild-to-moderate depression/anxiety. It further examined correlates of internalized MI stigma and its association with suicidality.

Subjects and methods: Face-to-face interviews were conducted at four-time points with adults with depression/anxiety and chronic physical illness in primary health centers in Ramanagaram, Karnataka. Topics included demographics, social support, depression (9-item Patient Health Questionnaire scale), anxiety (7-item General Anxiety Disorder scale), suicidality (Mini-International Neuropsychiatric Interview), and internalized MI stigma (Internalized Stigma of Mental Illness [ISMI] scale). Data analysis included linear and hierarchical logistic regression.

Results: At baseline, 29.1% of participants showed a high level of internalized stigma, and 10.4% exhibited at least moderate suicidality. Hierarchical logistic regression showed that every 1-point increase on the ISMI scale more than tripled the odds of moderate to high suicidality (adjusted odds ratio [AOR] 3.24). Those being at least moderately depressed/anxious were 2.4 times more likely to be at least moderately suicidal than participants with no-mild depression/anxiety. Social support lowered the odds of suicidality (AOR 0.44).

Conclusions: Internalized MI stigma and suicidality were substantial among these rural adults with mostly mild-to-moderate anxiety/depression. Higher stigma was associated with increased suicidality, independently of depression/anxiety. Therefore, efforts to reduce internalized MI stigma should be included in mental health treatment.

Keywords: Co-morbidity; Karnataka; mental health; mental illness; rural; stigma; suicidality.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest There are no conflicts of interest.

Figures

Figure 1:
Figure 1:
(a) Mean levels of internalized mental illness stigma and social support over time. (b) Probability of at least moderate suicidality and depression or anxiety over time
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Institute for Health Metrics and Evaluation. Global Burden of Disease; 2019. Available from: https://www.healthdata.org/gbd/2019. [Last accessed on 2022 May 23].
    1. Arvind BA, Gururaj G, Loganathan S, Amudhan S, Varghese M, Benegal V. et al. Prevalence and socioeconomic impact of depressive disorders in India: Multisite population-based cross-sectional study. BMJ Open 2019;9:e027250. - PMC - PubMed
    1. Perianayagam A, Prina M, Selvamani Y, Gudekar D, Salvi S, Varghese M, et al. Sub-national patterns and correlates of depression among adults aged 45 years and older: Findings from wave 1 of the Longitudinal Ageing Study in India. Lancet Psychiatry 2022;9:645–59. - PMC - PubMed
    1. Daré LO, Bruand PE, Gérard D, Marin B, Lameyre V, Boumédiène F, et al. Co-morbidities of mental disorders and chronic physical diseases in developing and emerging countries: A meta-analysis. BMC Public Health 2019;19:304. - PMC - PubMed
    1. Coppens E, Van Audenhove C, Scheerder G, Arensman E, Coffey C, Costa S, et al. Public attitudes toward depression and help-seeking in four European countries baseline survey prior to the OSPI-Europe intervention. J Affect Disord 2013;150:320–9. - PubMed