1

Attitude toward mental health and mental illness of

ruler vs urban area in Pakistan

Research Report

Submitted to: Sir Kamran Share

Submitted by: Maryam Firdous and that all

ROLL No : 2231/2221

Course name: Research Methodology ll

Semester: 6th morning

Department: BS APPLIED PSYCHOLO

Submission date:
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Abstract

The purpose of researching mental health and mental illness in rural

versus urban areas of Pakistan is to understand the differences in
prevalence , risk factors , access to mental health services , and cultural
factors that may influence mental health outcomes. By comparing rural
and urban populations, researchers aim to identify disparities and
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develop targeted interventions to improve mental health support and

outcomes in both settings.

Another impsortant issue is to build human rights in rural areas .

They take mental illness as a joke, they want to known about mental
illness . The main objective is to popularize the knowledge of psychological
diseases in these areas.

Purpose of present study is to investigate the attitude of general

public toward mental illness in community setting along with the
factor influencing attitude toward illness.

Keywords; Mental health, MENTAL illness, Ruler area, Urban area ,Community
attitude

Population:
Male in ruler area : 25

Female in ruler area : 25

Male in urban area : 25

Female : 25

Age : Adults
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Variables:
Help seeking scale

Mental health stigma

INTRODUCTION
Mental health and mental illness area critical aspects of overall well-
being , affecting every aspect of a person's life . Mental health
refers to the state of emotional, psychological, and social well-being,
enabling individuals to cope with life's challenges, maintain positive
relationships, and achieve their potential. On the other hand, mental
illness encompasses a wide range of conditions that disrupt a
person's thinking, emotions, mood , and behavior, leading to difficulties
in daily functioning and impairing their quality of life. Understanding
and addressing mental health and mental illness are essential for
promoting a healthier and more compassionate society, where
individuals can seek support and treatment without stigma.

Ruler Area:
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In rural areas of Pakistan, there has been a historical stigma surrounding

mental health and mental illness. People often hesitate to seek professional help
due to cultural beliefs, lack of awareness, and fear of social judgment.
Traditional beliefs and practices may sometimes be preferred over modern
healthcare approaches. In rural areas, attitudes towards mental illness have
historically been influenced by various factors, such as cultural beliefs, lack of
awareness, and limited access to mental health services. Stigma surrounding
mental health issues can prevail, leading to misconceptions and discrimination
against individuals experiencing mental health challenges. The perception of
mental illness in rural communities may differ from urban areas due to traditional
beliefs and values. In some cases, mental health problems might be attributed to
supernatural causes or perceived as a personal weakness rather than a medical
condition. However, efforts have been made to improve mental health awareness
and support in rural areas. Community-based organizations, government
initiatives, and non-profit organizations have sought to educate the public about
mental health, reduce stigma, and provide accessible mental health services.
Despite the challenges, many rural communities are gradually recognizing the
importance of mental health and are working towards fostering a more
understanding and supportive environment for those affected by mental illness.
The concept of mental health and mental illness can vary across different rulers
and societies throughout history. In ancient civilizations, mental health was often
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linked to spiritual or supernatural beliefs, and mental illness was sometimes

attributed to divine punishment or possession. Treatments could involve rituals,
prayers, or even exorcisms. Over time, the understanding of mental health
evolved, and during more recent centuries, medical and scientific approaches
began to shape how mental illness was perceived. In the 19th and 20th
centuries, the field of psychiatry emerged, and mental illnesses were increasingly
studied and categorized. Various theories and treatment methods were developed
to address different conditions. As of my last knowledge update in September
2021, attitudes towards mental health and mental illness might have varied
between rulers and urban areas in Pakistan. Historically, there could have been
stigmatization and lack of awareness regarding mental health issues in both
regions. Rulers, being part of the governing elite, might have had access to
better healthcare resources, including mental health services. However, due to
cultural and societal norms, seeking help for mental health issues might have
been considered a sign of weakness, leading some rulers to avoid openly
addressing mental health concerns. In urban areas, mental health awareness
might have been slightly higher due to increased exposure to modern healthcare
and educational resources. Nevertheless, stigma and cultural factors could still
play a role in preventing people from seeking appropriate treatment for mental
illness. It’s important to note that attitudes towards mental health can evolve over
time, and there might have been changes and developments in this regard since
7

my last update. For the most accurate and up-to-date information, I recommend
consulting recent sources or research on the topic.

Urban area’s attitude:

The concept of mental health and mental illness can vary across different rulers
and societies throughout history. In ancient civilizations, mental health was often
linked to spiritual or supernatural beliefs, and mental illness was sometimes
attributed to divine punishment or possession. Treatments could involve rituals,
prayers, or even exorcisms. Over time, the understanding of mental health
evolved, and during more recent centuries, medical and scientific approaches
began to shape how mental illness was perceived. In the 19th and 20th
centuries, the field of psychiatry emerged, and mental illnesses were increasingly
studied and categorized. Various theories and treatment methods were developed
to address different conditions. It’s important to note that attitudes and
approaches to mental health have significantly changed over time and vary
across cultures and societies. While some rulers and leaders have been
progressive in promoting mental health awareness and care, others may have
perpetuated stigma or neglected the importance of mental well-being. As of my
last update in September 2021, attitudes towards mental health and mental
illness in urban area of Pakistan were gradually improving, but there still existed
significant challenges and stigma surrounding these issues. Historically, mental
8

health has been a topic often overlooked and stigmatized in Pakistan, including
urban areas. Cultural and religious beliefs, lack of awareness, and limited access
to mental health services contributed to this situation. Many individuals with
mental health issues faced discrimination, misunderstanding, and reluctance to
seek professional help. However, in recent years, there has been increased
awareness about mental health and its importance. Mental health professionals,
non-governmental organizations (NGOs), and government initiatives have been
working to reduce the stigma and provide better mental health services. Urban
centers tend to have slightly better access to mental health resources compared
to rural areas due to the concentration of healthcare facilities and professionals.
Nevertheless, disparities still exist, and access to affordable and quality mental
health care remains a challenge for many. It is essential to remember that
societal attitudes and conditions can change over time, and advancements in
mental health awareness and advocacy efforts might have occurred after my last
update. Mental health is state of mental well being that enables people
to cope with the stressor of life realize their ability ,learn well and
well .Because if a person is mentally healthy he will also be physically healthy
Earlier there was no information about mental health in big cities As cities
developed mental health education was started in the cities school colleges and
universities . In the past many people were afraid to go to a psychologist,
Psychiatrist if they had mental illness because they knew that if we went to
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psychologist people would call us mental But now with passage of time Now
information about mental health is being given in the educational institutions of
the cities .Educated people work on mental health and provide easy way out
for people suffering from mental illness .People suffering from illness in cities
go to psychologist because they know that psychologist can treats the disease
(disorder )and they can understand them better. So they turn to them Mental
health awareness in. cities reduce the level of depression anxiety and stress in
people Mental health is state of mental well being that enables people
to cope with the stressor of life realize their ability ,learn well . In the past many
people were afraid to go to a psychologist, Psychiatrist if they had mental
illness because they knew that if we went to psychologist people would call us
mental .But now with passage of time Now, information about mental health is
being given in the educational institutions of the cities .Educated people work
on. mental health and provide easy way out for people suffering from mental
illness .People suffering from illness in cities go to psychologist because they
know that psychologist can treats the disease (disorder )and they can
understand them better. So they turn to. Them Mental health awareness in.
cities reduce the level of depression anxiety and stress .

Combine summery
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As of my knowledge attitudes towards mental health and mental illness might

have varied between rulers and urban areas in Pakistan. Historically, there could
have been stigmatization and lack of awareness regarding mental health issues
in both regions.

Rulers, being part of the governing elite, might have had access to better
healthcare resources, including mental health services. However, due to cultural
and societal norms, seeking help for mental health issues might have been
considered a sign of weakness, leading some rulers to avoid openly addressing
mental health concerns.

In urban areas, mental health awareness might have been slightly higher due to
increased exposure to modern healthcare and educational resources.
Nevertheless, stigma and cultural factors could still play a role in preventing
people from seeking appropriate treatment for mental illnesses.

It's important to note that attitudes towards mental health can evolve over time,
and there might have been changes and developments in this regard since my
last update. For the most accurate and up-to-date information, I recommend
consulting recent sources or research on the topic.

Research question
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1 How do attitude toward mental health and mental illness different

individuals residing in rural area and those living in urban area of
Pakistan?

2 What are the differences in attitudes towards mental and mental illness
between ruler are and urban area of Pakistan?

HYPOTHESIS
There is a Significant difference in attitudes towards mental health and
mental illness between individuals in rural vs urban areas of Pakistan.

There is no a Significant difference in attitudes towards mental

health and mental illness between individuals in rural vs urban areas
of Pakistan.

Literature Reviews
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1:A report by World Health Organization (WHO) (World Health Organization) has
enumerated that mental disorders account for nearly 12% of the global burden
of disease. By 2020, these will account for nearly 15% of disability-adjusted life-
years (DALYs) lost to illness. Incidentally, the burden of mental disorders is
maximal in young adults, which is considered to be the most productive age of
the population. Developing countries are likely to see a disproportionately large
increase in the burden attributable to mental disorders in the coming decades
(WHO Mental Health Context 2003).The range of disorders and deviancies
associated with urbanization is enormous. Some of the disorders are severe
mental disorders, depression, substance abuse, alcoholism, crime, family
disintegration, and alienation. Dementia and major depression are two, dementia
and major depression are the two leading contributors, accounting, respectively,
for one-quarter and one-sixth of all disability adjusted life years (DALYs) in this
group. Most people with dementia live in developing countries: 60% in 2001 is
projected to rise up to 71% by 2040. Rates of increase are not uniform:
numbers are forecast to increase by 100% in developed countries between 2001
and 2040, but by more than 300% in India, China, and their South Asian and
Western Pacific neighbors (Trivedi 2008)

2: Knowledge and Attitude towards Mental Health and Mental Illness: An Issue among
Rural and Urban Community of Japan District of Nepal Babitz
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Introduction: For all individuals, mental, physical and social health is vital strands of life
that are closely interwoven and deeply interdependent. As understanding of this
relationship grows, it becomes ever more apparent that mental health is crucial to the
overall wellbeing of individuals, societies and countries. Unfortunately, in most parts of
the world, mental health and mental disorders are not regarded with anything like the
same importance as physical health. Instead, they have been: largely ignored or
neglected.

Methods: The correlational comparative study was carried out among 75 adults aged
20-60 years each residing in the rural and urban community of Jhapa district in eastern
region of Nepal (i.e.150 in total) by using pre-tested structured interview schedule. Data
were analyzed by using SPSS and MS Excel.

Results: The study concludes that the knowledge of the adults residing in the urban
community regarding mental health and mental illness was higher than that of the adults
residing in the rural community. The attitude of the adults residing in the urban
community towards mental health and mental illness were more favourable as
compared to the adults residing in rural community. There was a positive significant
correlation between the knowledge attitude towards mental health and mental illness
among adults in both the community.

Conclusions: The findings suggest that the information booklet and various mass
media should be developed to enhance their knowledge and change their attitude
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towards mental health and mental illness. Similar study should be replicated on larger
samples.

Key Words: Knowledge, attitude, mental health and illness, adults, rural and urban
community.

3.community attitude toward mental illness in rural and urban population India 2007

Background: Mental illness refers to some alteration in psychological functions

which adversely affects an individual’s life as well as surrounding environment. The
stigmatization and labeling of mental illness is a major problem which affects patients
and their caregivers as well as institutions and health care professionals working with
persons with mental illness. Many individuals with mental problems are discriminated
against because of their mental illness.

Aims: To Assess and Compare the Community attitude towards mental illness in Rural
and Urban Populations.

Method: 60 Samples (30 Urban Populations & 30 Rural Populations) were included,
who qualified the inclusion criteria and samples were selected based on Purposive
Sampling technique. Community attitude towards Mentally Ill Scale was administered on
the samples and data was analyzed using SPSS 20 version.
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Result and Conclusion. Result showed high and positive attitude towards mental
illness in urban population except social restrictiveness.

Keywords: Mental Illness, Community Attitude

4. Awareness and Attitude toward Mental Illness among a Rural Population in Kolar.

Background : There are few studies dealing with the diversity in people's knowledge
and attitude toward mental health problems.

Results: Majority (39%) of the participants agreed that mental illness is caused by
brain disease. On the other hand, one-fifth thought mental illness was God's
punishment. About 22% thought that people with mental health problems are largely to
blame for their own condition and one-third felt that someone with a mental illness was
usually dangerous. The study also identified the magnitude of the stigma attached to
mental illness. Almost half (46%) of the participants said they would not want people to
know about it if they had a mental illness. Less than one-fifth thought someone could
recover from mental illness and only 11% was aware that mental health services were
available in the community.

Conclusion: The present study concludes that the understanding of the nature of
mental illness, its implications for social integration and management remains poor
among the general public. Hence, the need for well-coordinated public education,
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mental health awareness programs and increased accessibility of effective mental

health services.

5:Public Attitudes Toward Psychiatric Hospitals: A Rural-Urban Comparative Public

Survey in Odisha State, India.

Background: Integration of psychiatric care with public health services and offering
mental health care services to patients from lower socioeconomic status remains a
global challenge. Scarcity of funds and professional workforce in psychiatric hospitals
contribute to this situation. However, negative attitudes in the population are also a
known impediment to patients seeking mental health services. This study aimed to
assess the attitudes toward psychiatric hospitals among the urban and rural population
in India.

Subjects and Methods: The study was carried out amongst the general population in
Odisha, India. The total sample (n = 988) includes 496 respondents from an urban-
setting, and 492 respondents from rural parts of the district. Participants were selected
by using simple random-sampling from the Asian Institute of Public Health (AIPH) data
base. A standardized seven-item questionnaire was adopted, with responses indicated
on a 5-point Likert-scale. Interviews were fully structured and conducted face-to-face.
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Results: Level of education (B = −0.192, ß = −0.320, p < 0.000) and urban-rural

comparison (B = −0.272, ß = −0.189, p < 0.000) significantly influenced attitudes toward
psychiatric hospitals. Gender, age, and religious beliefs did not show any significant
effect on attitudes toward psychiatric hospitals. Individuals in rural areas and those with
lower education levels showed more negative attitudes toward psychiatric hospitals.

Conclusion: Negative attitudes toward psychiatric hospitals from those living in rural
areas as well as those with lesser education may be reflective of the lack of availability,
accessibility, affordability, and credibility of such mental health services. The Mental
Health Care Act in India is a progressive legislation which might improve the situation of
the provided services and, consequently, reduce negative attitudes in the years to
come.

Keywords: mental health stigma, psychiatric hospitals, Odisha, India, South Asia

Methodology

Methods; In this research qualitative methods. Quantitative survey are used in this
report The methodology used to study attitudes towards mental health and mental
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illness in rural versus urban areas in Pakistan typically involves a combination of

qualitative and quantitative methods. This may include surveys, interviews, focus
groups, observations to gather data on people's perceptions, beliefs, and behaviors
related to mental health. Researchers often aim to compare responses and experiences
between rural and urban populations to understand the cultural, social, and contextual
factors influencing attitudes towards mental health in different settings.

Research design: its is used correlational design in this research.

Sample: in this research we select 100 total people ,50 rural area’s people ,50 urban
area’s people who gave us their own ideas about mental health.

Procedure: after approval the data collection we start collecting data from rural and
urban areas of Pakistan. After that we used spss scale for data analysis.

Results: we use cooperative study in this report , attitude toward mental health and
illness of rural areas vs urban areas. The people of rural areas often accept of their
family member who are mentally sick but their beliefs about mental heath are so
serotype ,they think that black magic are impact on their mental health , other thing is
superstation’s beliefs , people who are followed mostly Islam they think that distance
from Allah and Islam are served from mental illness .On the other hand people of urban
areas are mor knowledgeable then rural areas if they feel that other people who are
involved mentally ill they seek mental health help. They concern doctors like
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psychologist psychiatrics or counselors. But I note that that people of urban areas not
accept of mental sick people they concerns mental hospitals and clubs that are
affordable for client and family, then rural areas people they suggests that person who
are sick are lived with their family.

Discussion
Research on attitudes towards mental health and illness in Pakistan has indicated that
there are differences between ruler and urban areas. In rural areas, cultural beliefs and
stigmas surrounding mental health can be more entrenched, leading to lower rates of
seeking help and greater reliance on traditional healers. In urban areas, there's often
greater access to mental health services and a more open attitude towards seeking
professional help. However, stigma still exists in both settings, although it may manifest
differently. Given that females, especially those who were older and living in urban
communities held less stigma than their counterparts, this subgroup can be utilized as
champions of care. Education campaigns can utilize these champions within the
community and beyond to create a safe environment for accessing mental health
services and treatment. Similarly, these findings indicate a need to address mental
health literacy among males in rural and urban communities alike. However, campaigns
and mental health promotion must recognize that rural males and urban males will likely
have various perceptions of mental illness and variable stigma. These findings not only
call for a need to address stigma and misperceptions around mental illness but also
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illustrate the need to conduct similar research in each state/community prior to

implementing educational programing or health campaigns. This will allow dollars to be
appropriately allocated and will encourage more effective education. Relationship to
Someone With Mental Illness Direct experience with mental illness had a moderating
(negative) effect for anxiety and hygiene. These findings indicate that those who have a
close relationship with someone who has a mental illness can serve as community
champions. Mental health literacy and stigma mitigation must focus on those who have
less experience interacting with someone with mental illness. Urban residents with such
direct experiences were more optimistic about recovery compared to rural residents with
direct experience which would indicate that there is still a need to address recovery in
rural communities.

Conclusions
Perspective of people should be considered along with their location, gender, and
education when strategizing the psychiatric healthcare system as their
perception/attitude serves as facilitators/barriers for achieving mental healthcare goals
and psychiatric hospital goals. The community has different beliefs and opinions
regarding mental health facilities, which is why increasing awareness among them will
correct negativity. This study suggests that consideration should be given to the
community’s location, gender, and education when planning the awareness or
implementation programs for mental health. Stigma about mental illness can prevent
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treatment and recovery among those with mental illness, poses a barrier for public
health prevention efforts, and can lead to poorer quality of care delivered for those with
mental illness. This study identified subpopulations who hold greater stigma,
subpopulations who can serve as community champions in rural areas, identified
groups in need of mental health education, and also identified specific measures of
stigma requiring focused educational campaigns.

References

1:Chisholm D (2015) Investing in mental health. Eastern Mediterranean Health J

21(7):531–534. https://doi.org/10.1093/heapro/dar059

2: World Health Organization . Mental Health Atlas 2011. World Heal Organ (2011). p.
1–81.Availableonlinat:
http://www.who.int/mental_health/publications/mental_health_atlas_2011/en/ (accessed
September 15, 2021).

3:Sharma S, Varma LP. History of mental hospitals in Indian sub-continent. Indian J

Psychiatry. (1984) 26:295–300. [PMC free article] [PubMed] .

4:ndian Journal of Social Psychiatry | Published by Wolters Kluwer – Medknow.

22

5: Milner J. Mental health in China and India: a growing storm. Lancet Psychiatry.
(2016) 3:793–4. 10.1016/S2215-0366(16)30173-0 [PubMed] [Crossruff] [Google
Scholar]

6:World Health Organization. (2001). The world health report: 2001: Mental health: New
understanding, new hope. www.who.int/whr/2001/en/

7:Da̧ browski, A. (2011). General information. SPA 2011 - Signal Processing:

Algorithms, Architectures, Arrangements, and Applications - Conference Proceedings,
107, 5. https://doi.org/10.1525/california/9780520268807.003.0006.

8:Gaebel W, Ziska H, Zymase J, Cleveland H-R, Siamese K, Stuart H et al (2015)

Stigmatization of psychiatrists and general practitioners: results of an international
survey. Eur. Arch. Psychiatry Clin. Neurosis. 265, 189–197.
https://doi.org/10.1007/s00406-014-0530-8.