Abstract
PurposeThe aim of this study was to explore how small area deprivation is associated with attitudes towards mental illness in a large sample of individuals living in private households in England.MethodCross-sectional data from Health Survey for England (2014) were analysed using multilevel models. The exposure of interest was the deprivation level of the small area in which an individual resides as measured by Index of Multiple Deprivation (IMD) score. The primary outcome was an individual’s overall attitude towards mental illness, measured using a 12 item version of the Community Attitudes toward the Mentally Ill (CAMI) scale. Further outcomes were the two subscales of the CAMI, reflecting attitudes of (1) prejudice and exclusion and (2) tolerance and support. Individuals were nested within household and small geographical area.Results5820 participants were included. Results from unadjusted models found strong evidence that individuals residing in the most deprived areas of England have worse attitudes towards mental illness compared to individuals living in the least deprived areas (estimated difference = − 3.5 points; 95% CI − 4.8 to − 2.2; P < 0.001). After adjusting for age, sex, education level, ethnicity and weekly income there was no longer evidence for this association (adjusted difference = − 0.1 points, 95% CI − 1.3 to 1.2; P = 0.931). Similar patterns of results were found for the CAMI subscales.ConclusionsThe relationship between small area-level deprivation and attitudes towards mental illness is no longer observed when controlling for certain individual-level characteristics.
Highlights
Each year approximately one in six adults in England experience a common mental disorder (CMD) such as depression or anxiety [1]
This work used nine large regions of England, such as the North West and South East, to define areas. Large areas such as these may contain a range of area types within them that differ markedly in deprivation levels and, in turn, in the attitudes of residents. This present study aims to explore how small area deprivation is associated with individual attitudes towards mental illness in a large sample of individuals living in private households in England
When it became clear that both variables did not change model estimates materially, analyses were repeated in the larger initial interview sample. 1212 participants (15.0% of the initial sample) with incomplete data on other variables of interest were excluded from analyses, leaving a final analytical sample of 5820 participants (72.1% of those interviewed) (Fig. 1) nested within 3741 households and 2422 local areas (LSOAs)
Summary
Each year approximately one in six adults in England experience a common mental disorder (CMD) such as depression or anxiety [1]. Illness, levels of stigma and discrimination remain high [2]. Stigma is one of the biggest factors contributing to reduced help-seeking for mental illnesses [3] and stigma towards CMDs can negatively impact quality of life [2] and is associated with both increased absenteeism and lost productivity in the workplace [4]. In relation to mental illness, stigma can be defined as problems with attitudes (prejudice), knowledge (ignorance) or behaviour (discrimination) towards an individual with a mental health problem [5], where discrimination is the behavioural responses that arise as a result of stigma [6]. Due to its adverse effects, identifying and addressing the causes of stigmatising attitudes towards mental illness are a priority for policy makers, health services and researchers alike
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