• Mariana Tumin Department of Medical and Community Health Sciences, Universiti Malaysia Sarawak
  • Md Mizanur Rahman Department of Medical and Community Health Sciences, Universiti Malaysia Sarawak
  • Zulkifli Jantan Department of Medical and Community Health Sciences, Universiti Malaysia Sarawak




Mental illness, Stigma, Discrimination, Education, rural Sarawak


People with mental illness often encounter stigma and discrimination. Mental illness-related stigma and discrimination represent the enormous obstacles that stand in the way of delivering mental health care. Little is known about stigma and discrimination toward mental illness in rural Sarawak. Thus, this study aimed to identify the stigma and discrimination towards mental illness among Sarawak’s rural community and the factors affecting them. A cross-sectional survey was carried out on 840 respondent adults aged 21 and above. A validated Community Attitude towards Mental Illness (CAMI) and Discrimination towards Mental Illness questionnaire was used for data collection. A Two-way Multiple Analysis of Covariance (Two-way MANCOVA) test was carried out to determine how much gender and education level influence stigma and discrimination towards mentally ill patients. Analysis showed that there was a statistically significant difference of standardised stigma and discrimination scores with education level (p<.001), but not with gender (p>.05). Age had a positive linear effect on both stigma and discrimination, whereas experience with mentally ill patients negatively affected both stigma and discrimination. Individuals with a lower level of education, older in age, and lesser experience in dealing with the mentally ill would have a higher level of stigma and discrimination towards mental illness. Thus, targeted and practical strategies need to be organised and implemented to combat mental illness-related stigma and discrimination.


GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Lond Engl. 2017;390(10100):1151-1210. doi:10.1016/S0140-6736(17)32152-9

GBD 2016 Mortality Collaborators. Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Lond Engl. 2017;390(10100):1084-1150. doi:10.1016/S0140-6736(17)31833-0

Rehm J, Shield KD. Global Burden of Disease and the Impact of Mental and Addictive Disorders. Curr Psychiatry Rep. 2019;21(2):10. doi:10.1007/s11920-019-0997-0

Liu Q, He H, Yang J, Feng X, Zhao F, Lyu J. Changes in the global burden of depression from 1990 to 2017: Findings from the Global Burden of Disease study. J Psychiatr Res. 2020;126:134-140. doi:10.1016/j.jpsychires.2019.08.002

Ministry of Health, Malaysia. National Health Morbidity Survey 2015 (NHMS 2015). Vol. II: Non-Communicable Disease, Risk Factors & Other Health Problems. National Institutes of Health; 2016. http://iku.moh.gov.my/images/IKU/Document/REPORT/nhmsreport2015vol2.pdf

Ministry of Health, Malaysia. National Health and Morbidity Survey (NHMS) 2019: Vol. I: NCDs – Non-Communicable Diseases: Risk Factors and Other Health Problems. National Institutes of Health; 2020:392. http://www.iku.gov.my/images/IKU/Document/REPORT/NHMS2019/Report_NHMS2019-NCD_v2.pdf

Ng CG. A Review of Depression Research in Malaysia. Med J Malaysia. 2014;69 Suppl A:42-45.

Schomerus G, Stolzenburg S, Freitag S, et al. Stigma as a barrier to recognizing personal mental illness and seeking help: a prospective study among untreated persons with mental illness. Eur Arch Psychiatry Clin Neurosci.2019; 269(4):469-479.doi:10.1007/s00406-018-0896-0

Seeman N, Tang S, Brown AD, Ing A. World survey of mental illness stigma. J Affect Disord. 2016;190:115-121. doi:10.1016/j.jad.2015.10.011

Fujii T, Hanya M, Kishi M, Kondo Y, Cates ME, Kamei H. An internet-based survey in Japan concerning social distance and stigmatization toward the mentally ill among doctors, nurses, pharmacists, and the general public. Asian J Psychiatry. 2018;36:1-7. doi:10.1016/j.ajp.2018.05.017

Razali SM, Ismail Z. Public stigma towards patients with schizophrenia of ethnic Malay: a comparison between the general public and patients’ relatives. J Ment Health. 2014;23(4):176-180. doi:10.3109/09638237.2014.910644

Bartolomei J, Baeriswyl-Cottin R, Framorando D, et al. What are the barriers to access to mental healthcare and the primary needs of asylum seekers? A survey of mental health caregivers and primary care workers. BMC Psychiatry. 2016;16(1):336. doi:10.1186/s12888-016-1048-6

Chan SKW, Tam WWY, Lee KW, et al. A population study of public stigma about psychosis and its contributing factors among Chinese population in Hong Kong. Int J Soc Psychiatry. 2016;62(3):205-213. doi:10.1177/0020764015621941

Evans-Lacko S, Henderson C, Thornicroft G. Public knowledge, attitudes and behaviour regarding people with mental illness in England 2009-2012. Br J Psychiatry. 2013;202(s55):s51-s57. doi:10.1192/bjp.bp.112.112979

Noh J-W, Woo J-M, Park H, Jung SJ, Lee Y, Kwon YD. Factors Related to the Attitude of North Korean Refugees Towards People with Mental Illness. Iran J Public Health. 2018;47(Suppl 1):39-46.

Siti Zubaidah S, Norfazilah A. Attitudes towards the mentally ill patients among a community in Tampoi, Johor, Malaysia, 2012 to 2013. Malays J Public Health Med. 2014;14(3):1-7.

Reta Y, Tesfaye M, Girma E, Dehning S, Adorjan K. Public Stigma against People with Mental Illness in Jimma Town, Southwest Ethiopia. PLoS ONE. 2016;11(11): e0163103. doi:10.1371/journal.pone.0163103

Taylor SM, Dear MJ. Scaling community attitudes toward the mentally ill. Schizophr Bull. 1981;7(2):225-240.

IBM SPSS. IBM SPSS Statistics Software Version 22. Published online 2014.

Tabachnick B, Fidell L. Using Multivariate Statistics. 6th Edition. Pearson Education, Inc; 2013.

Bedaso A, Yeneabat T, Yohannis Z, Bedasso K, Feyera F. Community Attitude and Associated Factors towards People with Mental Illness among Residents of Worabe Town, Silte Zone, Southern Nation’s Nationalities and People’s Region, Ethiopia. Dalal K, ed. PLOS ONE. 2016;11(3):e0149429. doi:10.1371/journal.pone.0149429

Pascucci M, Montagna ML, Sabatino DD, et al. Stigma and attitudes towards mental illness: Gender differences in a sample of Italian medical students. Eur Psychiatry. 2017;41(S1):S739-S739. doi:10.1016/j.eurpsy.2017.01.1359

Poreddi V, Thimmaiah R, Math SB. Attitudes toward people with mental illness among medical students. J Neurosci Rural Pract. 2015;6(3):349-354. doi:10.4103/0976-3147.154564

Li J, Zhang M, Zhao L, Li W, Mu J, Zhang Z. Evaluation of attitudes and knowledge toward mental disorders in a sample of the Chinese population using a web-based approach. BMC Psychiatry. 2018;18(1):367. doi:10.1186/s12888-018-1949-7

Hsiao C-Y, Lu H-L, Tsai Y-F. Factors influencing mental health nurses’ attitudes towards people with mental illness. Int J Ment Health Nurs. 2015;24(3):272-280. doi:10.1111/inm.12129

Toner S, Fabisch K, Priebe S, Klug G. Attitudes towards severe mental illness and social distance: A survey of volunteer befrienders in Austria. Int J Soc Psychiatry. 2018;64(5):470-475. doi:10.1177/0020764018776346

Abi Doumit C, Haddad C, Sacre H, et al. Knowledge, attitude and behaviors towards patients with mental illness: Results from a national Lebanese study. PLoS ONE. 2019;14(9):e0222172. doi:10.1371/journal.pone.0222172




How to Cite

Tumin, M., Md Mizanur Rahman, & Zulkifli Jantan. (2021). EFFECT OF EDUCATION ON STIGMA AND DISCRIMINATION TOWARDS MENTAL ILLNESS: A MULTIVARIATE ANALYSIS OF COVARIANCE. Malaysian Journal of Public Health Medicine, 21(2), 329–337. https://doi.org/10.37268/mjphm/vol.21/no.2/art.1032