International Journal of Mental Health & PsychiatryISSN: 2471-4372

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Research Article, Int J Ment Health Psychiatry Vol: 2 Issue: 3

Cross-Sectional Study of Knowledge, Attitude and Practice (KAP) towards Mental Illnesses among University Students in Lebanon

Sara Abou Azar1, Krystelle Hanna1, Riwa Sabbagh1, Karen Sayad1, Rita Tatiana Abi-Younes1, Marie Nader1, Jean Claude El-Aramouni1, Jose Bou Nassif1, Juliana Breidy2 and Hani Tamim2,3*
1American University of Beirut Medical Center, School of Medicine, Beirut, Lebanon
2American University of Beirut Medical Center, Faculty of Medicine, Clinical Research Institute, Beirut, Lebanon
3American University of Beirut Medical Center, Faculty of Medicine, Department of Internal Medicine, Beirut, Lebanon
Corresponding author : Hani Tamim, PhD
Associate professor, Department of Internal Medicine, Director, Biostatistics Unit, Clinical Research Institute, Director, Fellowship and Residency Research Program, American University of Beirut Medical Center, Beirut, Lebanon
Tel: 00961-71-807767
Fax: 000961-1-738025
E-mail: [email protected], [email protected]
Received: April 01, 2016 Accepted: June 06, 2016 Published: June 10, 2016
Citation: Azar SA, Hanna K, Sabbagh R, Sayad K, Abi-Younes RT, et al. (2016) Cross-Sectional Study of Knowledge, Attitude and Practice (KAP) towards Mental Illnesses among University Students in Lebanon. Int J Ment Health Psychiatry 2:3. doi:10.4172/2471-4372.1000125

Abstract

Purpose: Society tends to accord greater importance to biological illnesses, in comparison to mental disorders. In Lebanon, a gap was observed in the knowledge, attitude and practice (KAP) towards mental disorders. We aimed to assess the KAP regarding mental illnesses among university students and to compare their outlook based on socio-demographic characteristics, educational factors and previous exposure to mental disorders.

Methods: A cross-sectional study was conducted among Lebanese university students. A questionnaire was filled by 598 students. KAP were assessed by separate sets of questions for two categories of disorders: anxiety and depression (AD) and schizophrenia and bipolar disorder (SBD). The questionnaire consisted of 4 sections with 5 possible answers to choose from. A mean score was generated for each of the 4 sections.

Results: The mean age of students was 20.9 (±2.1). The mean scores for the “Causes” of AD and SBD were 3.1 (±0.57) and 3.3 (±0.6), respectively. The average scores for the “Knowledge” of AD and SBD were 3.6 (±0.7) and 3.4 (±0.7), respectively. As for the “Attitude”, the average scores were 3.6 (±0.6) for AD and 3.4 (±0.6) for SBD. In relation to “Practice”, the mean scores for AD were 3.2 (±0.5), and 3.2 (±0.4) for SBD. Factors as “Health” field of study, higher educational level, female gender and previous exposure to mentally ill patients were found to be associated with higher scores in KAP.

Conclusion: Better educational plans are needed in Lebanon to further increase society’s general understanding and management of mental disorders.

Keywords: Mental illness; Knowledge; Attitude; Practice; Cause; Students

Keywords

Mental illness; Knowledge; Attitude; Practice; Cause; Students

Introduction

Mental disorders consist of an abnormal development of one’s thoughts, actions, perceptions, and/or feelings. These illnesses mainly result from diseases of the brain that impair cognitive thinking and social relations among other factors. It has been shown that at least 250 million persons are subject to mental disorders worldwide ranging from complex illnesses such as schizophrenia and dementia, to lesser ones that include depression and neurosis [1]. Though bodily and physical illnesses are, without any doubt, important and shouldn’t be taken lightly, mental illnesses tend to be deemed of less attention and consideration.
An anxiety disorder is the constant and persistent state of fear of an incoming threat or danger. This determined condition will affect one’s social behaviour and may even have biological side effects associated with stress [2]. As for depression, it is a manifestation of several of the following feelings: unhappiness, frustration, misery and melancholy. Clinical depression, on the other hand, is a mood disorder in which the above-mentioned feelings affect day-to-day activities [3]. Bipolar disorder, used to define a more serious type of condition, consists of a form of mental illness whereby the affected are prone to severe mood changes. These mood swings fluctuate from feeling “high or elated” to feeling “very low or depressed” with intermittent intervals of normal moods. Another disorder, schizophrenia, is used to describe an even more severe type of mental disorder. It consists of a condition where one feels split from reality. Normal daily activities become trivial compared to the strange thoughts and feelings one may be experiencing.
If left untreated, anxiety disorders can have severe consequences conflicting with job requirements, family obligations or other basic activities of daily living. Research has demonstrated that a form of psychotherapy known as “cognitive-behavioral therapy” can be highly effective in treating anxiety disorders. Behavioral therapy involves using techniques to reduce or stop the undesired behaviors associated with these disorders. Psychologists use this therapy to help people identify and learn to manage the factors that contribute to their anxiety [4]. Study showed that psychological treatment for patients with anxiety disorders can decrease by 37% the cost of general medical treatment [5]. The main medical treatment for depression is anti-depressant medication. Anti-depressant medication may be prescribed, along with psychological cognitive treatments, when a person experiences a moderate to severe episode of depression. Cognitive therapy and anti-depressant medications engage some similar neural mechanisms, as well as mechanisms that are distinctive to each [6]. A systematic review has shown that antipsychotic drugs are effective in the acute treatment of mania episodes related to bipolar disorder; their efficacy in the treatment of depression episodes related to the same disorder is variable [7]. The treatment of schizophrenia has evolved over the past half century primarily in the context of antipsychotic drug development. Three basic classes of medications (conventional (typical), atypical and dopamine partial agonist antipsychotics) all of which, despite working by varying mechanisms of actions, act principally on dopamine systems [8].
KAP views the individual’s personal knowledge, attitude, and practice towards the matter of interest. “KAP” study measures the Knowledge, Attitude and Practices of a community. It serves as an educational diagnosis of the community [9]. Knowledge is the ability to acquire and use information. It is the combination of comprehension, judgment, and experience. Attitude refers to one’s reactions - mostly inclined - towards a subject matter. Finally, practice is the conversion of knowledge and attitude into action. KAP Study tells us what people know about certain things, how they feel and also how they behave. KAP will therefore allow for an efficient assessment of society’s considerations towards mental illnesses.
According to the literature, several studies have assessed KAP with regard to mental illnesses taking into consideration several demographic factors including level of education, exposure to mental illness, and age. It was implicated that KAP differs vastly between educated and less educated subject. The less educated presented a more pejorative attitude and limited comprehension of these diseases as compared to the higher educated class [10]. Moreover, exposure to such diseases has been implicated to impinge on the knowledge and attitude towards mental illness. More specifically, a study comparing KAP between doctors and nurses and regular staff workers in Kenya showed that doctors and nurses were more aware of the disease and exhibited a more positive attitude and better action than staff workers [1]. A study determining the gender difference in KAP in Qatar revealed that men had better knowledge, beliefs and attitudes towards mental illness than women. Most of the women were afraid and not willing to keep friendships with the mentally ill [11]. In another study, age was found to affect KAP in such a way that younger subjectspossess a better understanding and attitude towards mental diseases than the older population [12]. No studies were shown to compare KAP towards mental illnesses in relation, residential area, and field of study.
In Lebanon, according to a survey done between September 2002 and September 2003, the prevalence of any mental disorder in a population aged between 18-29 years is 17.0% [13]. An extensive literature review was conducted to evaluate the KAP of mental illnesses in Lebanon. However, unsatisfactory results were yielded. Despite the great advancements in research, medicine, and technology to date, we can still predict a lack of awareness regarding mental illnesses. Therefore, assessing the KAP towards mental illnesses among various Lebanese University students will provide a clearer image of the information, familiarity and awareness they behold regarding this topic. The objective of this study was to assess the KAP of Lebanese University students towards mental illnesses. Moreover, we assessed the effect of different socio-demographic characteristics on the KAP.

Methods

Study design
The study conducted was a cross-sectional community-based design among Lebanese University students.
Setting
In Lebanon, there is one public university and 28 private universities granted a license from the Ministry of Education. In total, 5 private universities were randomly selected to conduct the survey and 598 students were surveyed during the month of June 2011. The students were randomly approached on University campuses (mainly in cafeterias and outdoors) during their free time.
Study population
Assuming an expected response rate of 75% and 450 needed respondents, a sample size of 600 students were invited to take the survey. One hundred and twenty participants were randomly selected from each of the 5 different universities. Students from all religions, genders, educational levels, and socioeconomic status were eligible to participate in this study, while the exclusion criteria were any student below the age of 17. The actual response rate was 99.7% with only 2 participants that refused to answer.
Data collection
The questionnaire used in this study was previously validated and obtained from a published paper assessing the perception of mental health in Iraq [14]. It was developed in 2010 in English language. The questionnaire distributed in this study was translated, edited, and provided in both English and Arabic to all respondents.
The questionnaire consisted of four major sectionsentitled: “Causes of Mental Illness”, “Knowledge of People with Mental Illness”, “Attitude towards People with Mental Illness”, and “Care and Management of People with Mental Illness”. Each section included relevant questions with 5 possible answers that the respondent could choose from: Agree, Somewhat Agree, Neutral, Somewhat Disagree, and Disagree. “Causes of Mental Illness” and “Knowledge of people with Mental Illness” sections consisted of 6 questions each – referred to as “Causes” and “Knowledge” in our study, “Attitude towards People with Mental Illness” included 12 questions, while “Care and Management of People with Mental Illness” – also referred to as “Practice” – comprised 9 questions. Furthermore, in order to narrow down the generalization of the vast range of mental disorders, KAP was assessed towards four illnesses: anxiety, depression, bipolar disorder, and schizophrenia. To do so, our questionnaire was grouped into two categories. The first one addressed less complex conditions such as anxiety and depression (referred to as “Anxiety / Depression” or “AD”); while the second category regarded more complex illnesses such as schizophrenia and bipolar disorders (“Schizophrenia / Bipolar Disorders” or “SBP”). For all 33 questions asked, the respondents answered separately for each of the two categories to obtain an expected total of 66 answers.
As for the scoring system, in order to obtain a general overview of each student’s responses, all answers from “1 to 5” were ranked – “5” being the most appropriate and “1” being the least appropriate answer. For example in the question “The mentally ill should not get married”, a score of 5 would be given for the answer “Disagree” while a score of 1 is given to “Agree”. By adding the scores of every respondent and computing their average for each of the four categories present in our questionnaire mentioned above, a specific score was generated indicating the individual’s awareness about the separate sections. This would provide an efficient strategy to assess and compare all different students based on several independent variables.
Additionally, the questionnaire outlined several demographic variables including age, gender, marital status, residence, educational level, field of study, and university. Moreover, the questionnaire also included a “yes or no” question for whether an individual has had previous contact with a mentally ill person. For the subsequent analysis of the various KAP sections, age was converted from continuous to categorical data by separating the values into “≤ 21”, “21-23”, and “≥ 24”. Educational level was separated into “Sophomore”, “Junior”, “Senior”, and “Graduates”. As for the field of study, we obtained a very wide database of majors separated into seven principal groups: Medicine, Psychology, Biology, Engineering, “Medical Others” (Nursing, Medical Laboratory, Dentistry, Food Sciences), “Non-Medical Others” (Landscape Design, Interior Design, Physics, Economics, Chemistry, Mathematics, Business, French, English, Philosophy…), and “Other” (major-less, un-defined Master students). The previous seven categories were re-distributed into two main ones: “Health” and “Non-Health” majors. The classification “Other” was kept as separate.
Statistical analysis
Statistical Package for the Social Sciences (SPSS) version 22 was used for data entry and analysis. Questionnaires which were less than 50% filled were disregarded. Descriptive analyses were carried out by calculating the number and percent for categorical variables, whereas the mean and standard deviation (±SD) were calculated for the continuous variables. The bivariate analyses were performed using independent sample t-test or one-way ANOVA test to assess the association between categorical variables and the sections of KAP, as appropriate. Average means and p-values were measured for each of the four categories of the questionnaire (Causes, Knowledge, Attitude, and Practice) and the proposed variables. Moreover, a Pearson correlation test displaying the correlation coefficient “r” was used to determine the association between the scores on each “Causes”, “Knowledge”, “Attitude”, and “Practice” within each of the two categories of mental illnesses. Additionally, chi-square test was used throughout the analysis to associate between two different categorical variables, such as gender and field of study. Multiple linear regression analysis using a backward selection procedure, with significance level for removal from the model set at 0.1, was conducted to examine the relationship between the causes and KAP outcomes of AD and SBD and various potential predictors, mainly age, gender, marital status, residence, field of study, educational level, and exposure to mentally ill individual. All determinants that are statistically and clinically significant were entered into the regression analysis.
Ethical considerations
The Institutional Review Board at the American University of Beirut approved this study approved by the appropriate ethics committee and declare it have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Moreover, approval was obtained from each University’s administration office to hand out questionnaires to students on their corresponding campus. Students were given the choice to participate or not after clear explanation of the study’s objectives. Anonymity was maintained and participants were given their privacy while filling the questionnaires.

Results

Table 1 summarizes the demographic and educational factors among the sampled university students. The mean age of the sample was 20.9 (±2.1) years with more than 90% of students aged 23 years old or less and 53.8% being males. Moreover, the majority of students resided in an urban area (79.4%). As for educational level, most were in their senior year (32.1%) followed by juniors (27.0%) and almost equal percentage of sophomores (21.1%), and graduates (19.8%). It was noted that 20.7% of students were part of the “Health” field of study, while 61% were enrolled in “Non-Health” majors. Finally, it was observed that the majority of students (61.1%) had not been previously exposed to a mentally ill individual.
Table 1: Demographic and Educational Factors among the sampled University students.
Tables 2 and 3 illustrate the average overall scores obtained on the “Causes” and KAP for the two disorders separately. The mean score for the “Causes” of AD was 3.2 (±0.6) (Table 1) and slightly higher with 3.3 (±0.6) for SBD (Table 2). The average score for the “Knowledge” was 3.6 (±0.7) for AD (Table 1) and lower with 3.4 (±0.7) for SBD (Table 2). As for the “Attitude”, the average scores were 3.6 (±0.6) for AD (Table 1) and lower with 3.4 (±0.6) for SBD (Table 2). In relation to “Practice”, the mean score for AD and SBD were somewhat similar with 3.2 (±0.4) (Table 1), and 3.2 (±0.4) (Table 2), respectively. The effect of the various demographic and educational variables in relation to the understanding of the “Causes” and KAP towards the AD and SBD disorders was investigated in the both tables too. In AD disorder (Table 1), Females reporteda higher average than males on all sections, but these was only significantly higher in the “Knowledge” (p-value 0.03) “Attitude” (p-value 0.001) and “Practice” (p-value 0.05) sections. Non single students showed a higher average 3.6 ± 0.5 statistically significant (p=0.004) in the “Practice” score. In relation to the educational level, graduates obtained a significantly higher average and juniors a lower average on the “Causes”, “Knowledge” and “Attitude” scores. The mean score for juniors was 3.4 ± 0.7 on the “Knowledge” score and 3.5 ± 0.7 on the “Attitude” score comparing to 3.6 ± 0.7 and 3.7 ± 0.6 respectively for graduates.. Also, psychology students generated significantly better responses than other majors in all sections except “Practice” (3.7 ± 0.4 on “Causes”, 3.9 ± 0.9 on “Knowledge”, and 4.0 ± 0.5 on “Attitude”). These results are further highlighted by obtaining significantly higher scores by the “Health” students on all four sections as compared to the “Non-Health” and other majors. Finally the students who were exposed to mentally ill patients showed a significantly higher score on both “Knowledge” 3.7 ± 0.7 and “Attitude” 3.7 ± 0.6 scores. In SBD disorder (Table 2) a significantly positive correlation (p-value 0.01) was found between the overall score of the “Practice” section in relation to the student’s age. Students who were above 24 years old reported a higher average 3.3 ± 0.5 in the “Practice” score Gender also seemed to play a role where females obtained significantly higher scores on the four sections as compared to males, Educational level was positively associated with scores obtained on all four sections. As for AD before, Graduates scored significantly higher and juniors lower on the four sections. Knowledge”” As for the field of study, Psychology students obtained significantly higher scores than other students on “Knowledge” (3.7 ± 0.9) and “Attitude” (3.7 ± 0.8). Similarly, “Health” majors scored significantly higher than “Non- Health” majors on both “Knowledge” (3.6 ± 0.7 and 3.4 ± 0.7, respectively) and “Attitude” (3.6 ± 0.6 and 3.4 ± 0.6, respectively); and non-significantly higher scores on “Causes” and “Practice”. Students who were exposed to mentally ill patients had a significantly higher score in “Knowledge” 3.5 ± 0.7 and “Attitude” 3.5 ± 0.6.
Table 2: Average overall scores of causes and KAP of AD and association with the Proposed Variables.
Table 3: Scores of the Causes and KAP of SBD in Relation to the Proposed Variables.
Table 4 summarizes the correlation comprising KAP within the category of AD, than of SBD, and between both AD and SBD. In regards to AD, all correlations were significant with p-values<0.01, with the exception of the association of “Causes” and practice (p-value 0.12). The highest correlation of 0.58 (p-value<0.0001) was noted between knowledge and attitude of AD; while the lowest correlation of 0.06 (p-value 0.12) was observed between “Causes” and practice. As for SBD, significant correlations were found between the sections (p value<0.01). A 0.54 correlation (p-value<0.0001) was notable between knowledge and attitude (the highest), while a 0.16 correlation (p-value<0.0001) was observed between “Causes” and attitude (the lowest). With regards to the correlation test between AD and SBD, a statistically significant correlation was illustrated (p-value<0.01). A 0.82 was the highest correlation (p-value<0.0001) obtained for attitude of AD and SBD, while the lowest association was highlighted for cause of AD and SBD with a value of 0.39 (p-value<0.00001).
Table 4: Correlation between cause, knowledge, attitude and practice within the AD group, within the SBD, and between AD and SBD.
Multilinear regression modelling in Table 5 demonstrated that field of study, educational level, gender, marital status, age and exposure to mentally ill patients were found to be predictors for ”Causes”, ”Knowledge”, “Attitude” and “Practice of AD and SBD. For AD, the only factor positively predicting the “Cause” score is the field of study with both students enrolled in “Health” and “Non Health” major. However being in a “Heath” major increased the “Cause” score significantly (p-value<0.0001) by 0.40. Exposure to mentally ill patients, being enrolled in a “Health” field of study, and female gender are factors that positively predict the “Knowledge” score. Otherwise the junior students are negatively associated (p-value 0.003) to the “Knowledge” score and decreased it by 0.21. Female gender and exposure to mentally ill patients are factors that are positively associated with the “Attitude” score. Being exposed to mentally ill patients increased significantly the “Attitude” score by 0.18. Students coming from “Non-Health” major and junior students contribute significantly in decreasing the score. Marital status and being enrolled in a “Non-Health” field are factors that predict negatively the practice score. Being single decreased significantly the “Practice score” by 0.42. For SBD Factors as gender and graduate students predict positively the “Cause” score. Females increased the score by 0.22. Same factors than AD predict the “Knowledge” score in addition to residence. The highly negative predictor is junior students with a decreasing of 0.24 in the score and the highly positive predictor is the “Health” field of study with an increasing of 0.17. The “Attitude” score is also predicted by the same factors than “AD” Exposure to mentally ill patients positively predict the score by increasing it by 0.12 and junior students negatively predict it by decreasing it by 0.19. The “Practice” score is being positively predicted by age and gender and negatively by marital status. Students aged above 24 increased significantly the score by 0.16. However being single decreased the score significantly by 0.27.
Table 5: Multivariate analysis for the predictors of cause, knowledge, attitude and practice of AD and SBD.

Discussion

The study focused on the assessment of KAP towards mental illnesses among five universities in Lebanon. The following variables: age, gender, residence, educational level, field of study and exposure to mental illness had a noticeable impact on the KAP for the two categories of mental diseases, anxiety/depression disorders (AD) and bipolar disorder/schizophrenia (SBD).
An interesting finding was that participants proved to be better informed about the “Causes” of complex mental illnesses (SBD) compared to milder ones (AD), which was demonstrated through the overall generated scores. Society tends to associate mental illnesses more strongly with schizophrenia and bipolar disorders than with anxiety and depression. In fact, anxiety and depression are thought to be more common states and are not regarded as illnesses per se. However, looking at “Knowledge”, “Attitude” and “Practice”, we observed that our participants had better results concerning the KAP regarding the AD group as compared to the SBD category. KAP defines one’s familiarity to a certain mental illness; for this reason, subjects tend to be more acquainted with anxiety and depression, being more common conditions, than with schizophrenia and bipolar disorders. This, therefore, explains the reason for the higher scores obtained for the KAP of AD in relation to that of SBD. Furthermore, the participants were more sympathetic and understanding of the AD. In fact, they might have personified themselves more with a depressed or anxious person than a schizophrenic one, leading to a more positive attitude towards the AD category.
The major factor affecting and predicting one’s KAP towards mental illnesses was concluded to be the field of study. In all four sections of the questionnaire, it was observed that students in the “Health” fields significantly scored higher than the “Non-Health” majors whether regarding AD, or SDB, or both. More specifically, Psychology majors were the ones who scored the highest amongst all “Health” fields. As expected, engaging in a scientific environment cultivates students about the several illnesses, whether biological or mental, allowing for a better understanding of mental disorders. Furthermore, it was stated by Wang J that “mental health education and promotion clarifies misconceptions about causes, treatments, and risk factors for depression” [15]. We are living in a 21st century Lebanese community somewhat oblivious to the wide spectrum, complications, severity, and management of mental illnesses in all their forms. For instance, when faced with two critical situations: a child’s broken arm or a reserved youngster, most – and a vast majority – would sympathize with and rush to the care of a broken arm. However, what we fail to realize is that a broken arm will heal and wouldn’t lead to any consequences except the mere pain. On the other hand, the curiously silent child might actually be presenting signs of future schizophrenia, a remarkably more devastating condition than a cracked bone. In fact, it is only after having had a specific education that we will realize this discrepancy.
Moreover, there was a significant indication that participants with a higher level of education had better knowledge and a more positive attitude towards mental diseases. In specific, graduate participants were the most knowledgeable since they have the most advanced level of education. The graduates also had the highest KAP scores. However the junior students tend to decrease the causes and KAP scores in both AD and SBD. These results are in accordance with a study by Cook and Wang in 2010 affirming that “participants with higher levels of education reported less stigmatizing attitudes than those with less education” [16].
Exposure to mental illness whether a family member, a friend or a mere acquaintance is also expected to affect the results. The exposed group scored higher for both categories although significance was noted only for knowledge and attitude. Moreover, the exposure increased significantly the scores of knowledge and attitude in both AD and SBD. A person exposed to mental illness has a greater familiarity to the matter. Therefore, the results obtained seem to be rational. Moreover, as referred in the article written by Siu BW, personal and regular contact with ill patients appeared to be the principal factor that improves the knowledge towards mental illnesses [17].
An additional significant finding was the observation that females obtained a higher KAP towards both mild and severe illnesses. Females also predict by increasing the scores of knowledge and attitude in AD and SBD. A paper by Deen TL indicated that “men had lower depression literacy than woman” [18] (35% versus 68%). To justify these results, gender was crossed with the different fields of study and with the exposure variable. More women were found to be in Psychology majors and previously exposed to mental illness as compared to males, proving the obtained finding. Therefore, the better performance of females in the questionnaire was accounted for by the larger number of women studying Psychology and previously exposed to mental illnesses.
Considering age, it was found that the older the respondents, the better their KAP towards AD and SBD. Older students were found to be increasing the practice score of SBD. This was coherent with our expectations since older students tend to be more experienced and exposed to these medical issues. This finding was confirmed by a study conducted by Levav I. that similarly noted that the older participants were better acquainted with mental disorders [12].
Despite the fact that we unexpectedly found better results for “Non-Urban” students in all four sections (however, only statistically significant for the “Knowledge” about SBD and a decreasing in the same knowledge score for “urban” students.), further investigation provided a possible explanation for this outcome. Results showed that a significantly higher percentage of non-urban students were present in the Psychology field in comparison to the urban respondents. Additionally, most non-urban participants were females. Both Psychology majors and the female gender were previously demonstrated to be significantly positively correlated to the different scores obtained yielding to the fact that non-urban students generally contributed to higher scores than urban ones.
Finally, through the correlation test, one’s understanding about mental illnesses was tabulated to be somewhat similarly reflected through all the various sections provided in the questionnaire within both AD and SBD. In other words, a student obtaining a high score on the “Knowledge” will also be expected to obtain a high score on the other sections. However, “Practice” acquired the lowest correlation when associated with the various sections; this implies that one’s practice towards mental illnesses will not significantly reflect his/ her understanding of the additional sections that include “Causes”, “Knowledge”, and “Attitude”. A study conducted in Australia by Rossetto et al., shows that despite being aware of psychiatric disorders, the public’s ability and skills in first aid help remains minimal and that “particular attention should be given to helping people recognize that anxiety disorders such as social phobia require professional help and to improving responses to a suicidal person”[19]. Furthermore, scores obtained for AD and SBD were positively associated such that a high score on “Attitude” in relation to AD will most probably be reflected by a high score on “Attitude” towards SBD as well. These findings appear to be rational since a better knowledge tends to yield a more positive attitude and understanding of mental illnesses in all their forms.
The study should be evaluated in light of its strengths and limitations. Among the strengths of this study is being the first to assess KAP in Lebanon, while including a large sample size, as well as a representative sample from different universities. Another strength was using a validated questionnaire, creating scores (simplifying interpretation), as well as categorizing mental illnesses into mild and severe. As for the limitations, the study was conducted during the final examination period, which could have affected the completeness of the data. We believe this has minor effect on the results, as only 1.58% of the data was missing from the questionnaire. Another limitation was including private universities, while excluding public ones.

Conclusion

Though significant results were obtained in the study and were comparable to conclusions generated in several published papers, a gap in KAP towards mental illness persists in certain parts of the Lebanese society. Throughout the study, it was shown that a positive correlation exists between knowledge and attitude. This highlights the need for better educational plans and awareness programs in order to further increase society’s general understanding of such disorders. Additionally since it was observed that the gap in knowledge was most accentuated regarding the practice towards mental illnesses, more campaigning needs to be geared towards primary health care and the programs they offer in order to provide better familiarity of the care and management available for mental illnesses in Lebanon.

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