Factors associated with mental health stigma among teachers and caregivers of primary school children in Mbale, Uganda

Abstract

<title>Abstract</title> Background Uganda has one of the youngest populations in the world, with approximately 55% aged below 18 years. Approximately 23% of Ugandan youths are struggling with mental disorders. Despite the high prevalence of mental disorders, the existing stigma surrounding mental health may discourage individuals from seeking help, resulting in untreated conditions that may worsen over time. Examining the factors associated with stigma is crucial for understanding specific target areas to reduce its impact. The current paper examines factors associated with mental health stigma among teachers and caregivers in 18 primary schools in Mbale, Uganda. Methods The current study used baseline data from the TREAT INTERACT stepped-wedge cluster randomized trial among 191 teachers and 732 caregivers. Stigma was measured using the revised Perceived Devaluation-Discrimination scale (PDD). Mental health knowledge was measured with the Mental Health Knowledge Schedule (MAKS), and Psychological aggression was measured with the Dimensions of Discipline Inventory (DDI). Data were analyzed using mixed effects models in R. Mean scores were rescaled to range from 0-100. Results On a range from 0-100, teachers had a mean of 30.7 (SD = 14.0) on the mental health stigma measure, while caregivers scored significantly higher with a mean of 36.9 (SD = 16.9). Lower mental health knowledge (Teachers: -0.36, 95% CI = -0.49; -0.22, Caregivers: -0.24, 95% CI = -0.32; -0.16) and higher prevalence of psychological aggression (Teachers: 0.13, 95% CI = 0.06; 0.21, Caregivers: 0.15, 95% CI = 0.10; 0.20) were significant predictors of higher levels of stigma. Fewer years of education (-4.51, 95% CI= -7.74; -1.29) were additionally significantly associated with higher levels of stigma among caregivers. Factors such as sex, age, school area, years working as a teacher, and caregiver wealth index were not statistically significant factors. Conclusion Higher levels of stigma were associated with lower mental health knowledge and higher frequencies of psychological aggression among teachers and caregivers. Additionally, lower caregiver education was associated with higher levels of stigma. This underscores the importance of targeted interventions to enhance mental health awareness and reduce aggressive disciplinary practices. Additionally, the observed associations with caregiver education emphasize the need for tailored approaches that account for demographic variations in stigma.