Perceived stigma and quality of life among people living with mental illness in Ethiopia: An institutional cross-sectional study

Background Globally, mental illness is a significant public health concern that can lead to disability and is marked by a range of physical, psychological, and behavioural symptoms. Negative attitudes toward mental illness can result in perceived stigma, which contributes to social exclusion, poor medication adherence, decreased functioning, and higher dropout rates from treatment services. However, there is limited research on perceived stigma and its related factors among individuals with mental illness in sub-Saharan countries, including Ethiopia. Therefore, this study aimed to examine the prevalence of high perceived stigma and its associated factors among individuals with mental illness in Ethiopia. Methods A facility-based cross-sectional study was conducted in Ethiopia between October 1, 2022, and March 1, 2023. A systematic random sampling technique was used to recruit 638 patients diagnosed with mental illness from the outpatient clinic of the University of Gondar Comprehensive Specialised Hospital. Patients attending the clinic were approached in intervals of three for participation. Psychiatry nurses administered interviews using a questionnaire designed to measure perceived stigma and other relevant factors. The Perceived Devaluation and Discrimination Scale (PDD-12) was employed to assess perceived stigma. The questionnaire also included queries about sociodemographic factors, self-esteem, drug adherence, substance use, and severity of illness. The collected variables were coded and entered into SPSS-28 for analysis, which included descriptive statistics, multivariate logistic regression, and chi-square tests. Adjusted odds ratios (AORs) with a 95% confidence interval (CI) and p-values <0.05 were declared significant. Results Prevalence of high perceived stigma in patients who followed an outpatient clinic in Ethiopia was found to be 40.7%. In the multivariate logistic regression, patients living alone were two times (AOR=2.14, 95% CI:1.31, 3.51) more likely to report high perceived stigma. Compared to their counterparts, patients with a diagnosis of schizophrenia (AOR=1.42, 95 % CI:1.01,2.01), episodic illness ≥ 2/yr. (AOR=1.89, 95 CI:1.29, 2.77) and having a relapse (AOR=1.48, 95%CI:1.05, 2.07) were at higher odds of high perceived stigma. In addition, patients who had a long clinic waiting time of 2-3 hours were 1.64 times (AOR=1.64, 95% CI:1.02,2.62) more likely to report high perceived stigma. Moreover, high perceived stigma was 1.6 times more likely in patients who had moderate and severe objective severity of illness (AOR=1.59, 95 % CI:1.05, 2.38), 1.84 times more likely in patients with a family history of substance use (AOR=1.84, 95 % CI:1.14, 2.96), and 1.84 times in patients who used alcohol (AOR=1.80, 95 % CI:1.16, 2.77). The Chi-square test results (χ² = 5.6, p < 0.017) indicate a statistically significant association between poor Quality of life and perceived stigma. Conclusions High levels of perceived stigma were reported by forty percent of patients receiving outpatient care. Significant factors associated with this high perceived stigma included living alone, having schizophrenia, experiencing episodic illness, suffering with a relapse, facing long waiting time, having severe illness, and having a family history of substance or alcohol use. The study demonstrates that perceived stigma had correlations with the poor quality of life for individuals living with mental illness in Ethiopia, underscoring its critical role in enhancing patients' overall well-being and recovery.