Reliability and validity of Malayalam version of 12-item Community Attitude Towards Mental Illness (CAMI-12) questionnaire

Meera Sujathan; Rekha  Mathew; Aravind Karunakaran; Jaimon Plathottathil  Michael; Varghese P Punnoose

doi:10.30834/KJP.36.2.2023.413

Authors

Meera Sujathan Department of Psychiatry, Government Medical College, Kottayam
Rekha Mathew Department of Psychiatry, Government Medical College, Alappuzha
Aravind Karunakaran Department of Psychiatry, Government Medical College, Kottayam
Jaimon Plathottathil Michael Department of Psychiatry, Government Medical College, Ernakulam
Varghese P Punnoose Drepartment of Pscyhiatry, Government Medical College, Kottayam

DOI:

https://doi.org/10.30834/KJP.36.2.2023.413

Keywords:

Stigma, discrimination, caregivers, mental illness

Abstract

Background: Community attitude toward mental illness (CAMI) is an important determinant in the management of people with psychiatric disorders. Stigma interferes with diagnosis, treatment, and rehabilitation of all mental disorders. Even though studies have been done to evaluate knowledge, attitude, and behaviors toward psychiatric patients, no tools are available in the local language, Malayalam, for assessing CAMI. A validated and reliable Malayalam tool is an essential prerequisite for assessing the level of stigma in the local population. The objectives of our study were to assess the reliability and validity of the Malayalam version of the 12-item Community Attitude towards Mental Illness (CAMI-12) Questionnaire and to estimate the proportion of caregivers of patients with MI having a high level of stigma as per CAMI-12. Methods: This observational study was done in Government Medical College, Kottayam, from June 2021 to December 2021, after getting the approval of the Institutional Ethics Committee. Written informed consent was obtained from the participants before recruiting them for the study. One hundred and twenty caregivers of patients with mental illness were recruited by consecutive sampling, and they completed the Malayalam version of CAMI-12 at baseline and after four weeks. Internal consistency was assessed using Cronbach’s alpha. Results: The Malayalam version of CAMI-12 total score and the subscales for Tolerance and Support (TS) and Prejudice and Exclusion (PE) had a high internal consistency with Cronbach’s alpha values of 0.90, 0.89 and 0.90, respectively. Conclusions: Our study demonstrated good reliability and validity for the Malayalam version of CAMI-12. The proportion of caregivers with a high level of stigma was found to be 28.3% (95% Confidence Interval [95% CI] = 20.2-36.4%).

References

GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry 2022;9:137-50.

Drake RE, Bond GR, Essock SM. Implementing evidence-based practices for people with schizophrenia. Schizophrenia Bull 2009;35:704-13.

Wei Y, McGrath PJ, Hayden J, Kutcher S. Mental health literacy measures evaluating knowledge, attitudes and help-seeking: a scoping review. BMC Psychiatry 2015;15: 291. doi: 10.1186/s12888-015-0681-9.

Angermeyer MC, Holzinger A, Carta MG, Schomerus G. Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. Br J Psychiatry 2011;199: 367-72.

Parra F. Social tolerance of the mentally ill in the Mexican American community. Int J Soc Psychiatry 1985;31:37-45.

Brockington IF, Hall P, Levings J, Murphy C. The community's tolerance of the mentally ill. Br J Psychiatry 1993;162: 93-9.

Kobau R, Zack MM. Attitudes toward mental illness in adults by mental illness-related factors and chronic disease status: 2007 and 2009 Behavioral Risk Factor Surveillance System. Am J Public Health 2013;103: 2078-89.

Corrigan PW, Watson AC. Understanding the impact of stigma on people with mental illness. World Psychiatry 2002;1:16-20.

Corrigan PW, Shapiro JR. Measuring the impact of programs that challenge the public stigma of mental illness. Clin Psychol Rev 2010;30:907-22.

Yvon F, Prouteau A. Towards an understanding of stigma: what is the stereotype associated with schizophrenia. Sante Ment Que 2017;42:125-31.

Lyons M, Ziviani J. Stereotypes, stigma, and mental illness: learning from fieldwork experiences. Am J Occup Ther 1995;49:1002-8.

Henderson C, Robinson E, Evans Lacko S, Corker E, Rebollo-Mesa I, Rose D, et al. Public knowledge, attitudes, social distance and reported contact regarding people with mental illness 2009–2015. Acta Psychiatr Scand 2016;134 Suppl 446:23–33.

Hansson L, Stjernsward S, Svensson B. Changes in attitudes, intended behaviour, and mental health literacy in the Swedish population 2009–2014: an evaluation of a national antistigma programme. Acta Psychiatr Scand 2016;134 Suppl 446:71–9.

Vezzoli R, Archiati L, Buizza C, Pasqualetti P, Rossi G, Pioli R. Attitude towards psychiatric patients: a pilot study in a northern Italian town. Eur Psychiatry 2001;16:451–8.

Phelan JC, Link BG. Fear of people with mental illnesses: the role of personal and impersonal contact and exposure to threat or harm. J Health Soc Behav 2004;45:68–80.

Angermeyer MC, Dietrich S. Public beliefs about and attitudes towards people with mental illness: a review of population studies. Acta Psychiatr Scand 2006;113:163–79.

Seeman N, Tang S, Brown AD, Ing A. World survey of mental illness stigma. J Affect Dis 2016;190:115–21.

Salve H, Goswami K, Sagar R, Nongkynrih B, Sreenivas V. Perception and attitude towards mental illness in an urban community in South Delhi - a community based study. Indian J Psychol Med 2013;35:154-8.

Chowdhury A, Gupta K, Patel AK. Attitude, belief and perception toward mental illness among Indian youth. MAMC Journal of Medical Sciences 2019;5:83-8.

Jena S, Zieger A, Boge K, Salunkhe G, Schomerus G, Patel K, et al. Public attitudes toward psychiatric hospitals: a rural-urban comparative public survey in Odisha state, India. Front Psychiatry 2021;12:745604. doi: 10.3389/fpsyt.2021.745604.

Sneha CR, Reddy MM, Nongmeikapam M, Narayana JS. Awareness and attitude toward mental illness among a rural population in Kolar. Indian J Soc Psychiatry 2019;35:69-74.

Raghavan R, Brown B, Horne F, Kumar S, Parameswaran U, Ali AB, et al. Stigma and mental health problems in an Indian context. Perceptions of people with mental disorders in urban, rural and tribal areas of Kerala. Int J Soc Psychiatry 2023;69: 362-9.

Abraham N, Cherkil S, Das N, John TR, Deepak KS. Mental health awareness among young adults in a metro city in Kerala. International Journal of Indian Psychology 2022;10: 894-900.

Soltan MR, Soliman SS, Dawoud ME. A study of anxiety, depression and stress symptoms among Fayoum medical students during COVID-19 lockdown, Egypt. Egypt J Neurol Psychiatr Neurosurg 2021;57:123. doi: 10.1186/s41983-021-00377-2.

Varma NN, Sreekumar S, Varghese PJ. Attitude towards mental illness among doctors working in a tertiary care centre: A cross-sectional Study. Kerala Journal of Psychiatry 2023;36:50-8.

Shaji KS, Raju D, Sathesh V, Krishnakumar P, Punnoose VP, Kiran PS, et al. Psychiatric morbidity in the community: A population based-study from Kerala. Indian J Psychiatry 2017;59:149-56.

Office of the Registrar General & Census Commissioner, India (ORGI). Sample registration system (SRS) – bulletin 2020 volume 55-I. New Delhi: Govt. of India;2022. [cited 2023 May 26]. Available from: https://censusindia.gov.in/nada/index.php/catalog/42687.

Joseph J, Sankar DH, Nambiar D. The burden of mental health illnesses in Kerala: a secondary analysis of reported data from 2002 to 2018. BMC Public Health 2021;21:2264. doi: 10.1186/s12889-021-12289-0.

Taylor SM, Dear MJ. Scaling community attitudes toward the mentally ill. Schizophrenia Bull 1981;7:225-40.

Sampogna G, Bakolis I, Evans-Lacko S, Robinson E, Thornicroft G, Henderson C. The impact of social marketing campaigns on reducing mental health stigma: results from the 2009-2014 Time to Change programme. Eur Psychiatry 2017;40:116-22.

Craig R, Fuller E, Mindell J, editors. Health Survey for England 2014: Health, social care and lifestyles. Leeds: The Health and Social Care Information Centre; 2014.

Evans-Lacko S, Corker E, Williams P, Henderson C, Thornicroft G. Effect of the Time to Change anti-stigma campaign on trends in mental-illness-related public stigma among the English population in 2003-13: an analysis of survey data. Lancet Psychiatry 2014;1:121-8.

Ilic N, Henderson H, Henderson C, Evans-Lacko S, Thornicroft G. Attitudes towards mental illness. Leeds: The Health and Social Care Information Centre; 2014.

Tong Y, Wang Z, Sun Y, Li S. Psychometric properties of the Chinese version of short-form Community Attitudes toward Mentally Illness scale in medical students and primary healthcare workers. Front Psychiatry 2020;11:337. doi: 10.3389/fpsyt.2020.00337.

Tsang S, Royse CF, Terkawi AS. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J Anaesth 2017;11(S1):S80-9.

Nunnally JC. Psychometric theory. 2nd ed. New York: McGraw-Hill;1978.

Marx RG, Menezes A, Horovitz L, Jones EC, Warren RF. A comparison of two time intervals for test-retest reliability of health status instruments. J Clin Epidem 2003;56:730-5.

Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1951;16:297-334.

Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 2007;60:34-42.

Deyo RA, Diehr P, Patrick DL. Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation. Control Clin Trials 1991;12 (Suppl 4):142S-58S.

Kuo YP, Hung JT, Huang TW, Hsu PC, Su HC, Lin CLE. Developing and testing the validity and reliability of the Chinese version attitudes toward mental illness scale in a sample of senior high school students. Hu Li Za Zhi 2014;61:48-56.