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

Abstract

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. 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. 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. 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). 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.