Theddeus Iheanacho, Elina Stefanovics, Echezona E Ezeanolue and Robert Rosenheck
Increasingly, mental health services in resource-limited settings are being delivered by lay health workers with limited professional training. This study compared beliefs and attitudes about mental illness among church-based lay health workers in Enugu, Nigeria with no psychiatric training (n=59) and medical trainees with different levels of exposure to psychiatric care from two teaching hospitals in Nigeria; University of Ibadan (n=150) and Imo State University (n=83). A 43-item self-report questionnaire was used to assess their beliefs and attitudes. Exploratory factor analysis using varimax rotation identified four distinct constructs. Analysis of Co-Variance (ANCOVA) was used to compare these constructs across the three groups. Factor analysis identified four domains representing F1) social acceptance F2) normalization of social roles F3) non-superstitious causation of mental illness and F4) stress and trauma as causes of mental disorders. Students at the hospital with a more active, psychiatry training program had significantly higher scores than other groups on three of the four factors (F4=0.91 vs 0.72, 0.32; F1=0.60 vs 0.50, 0.53; F3=0.55 vs 0.40, 0.30), while the church-based lay health workers did not differ from students at the medical school providing minimal psychiatric training on two of the four factors (F1=0.53 vs 0.50; F3=0.30 vs 0.40). Availability of psychiatric education and emphasis on mental health services may have a positive impact on the progressiveness of beliefs and attitudes about mental illness.